What is the course of schizophrenia in women?

In the prodromal period, some eccentric behavior is usually attributed to character traits and is ignored. And no psychiatrist can declare a person schizophrenic and begin treatment before the main symptoms appear, namely delusional ideas and hallucinations.

The disease can occur in different forms: continuous, when symptoms are observed constantly from the moment of their appearance and the disease progresses slowly and gradually; paroxysmal or recurrent, when distinct attacks are characteristic, accompanied by affective disorders, and between them there are intervals of enlightenment (remission), often quite long with a high level of working capacity and almost complete social adaptation. An intermediate form is paroxysmal-progressive schizophrenia - the appearance of increasingly complex affective attacks against the background of a continuous course.

Schizophrenia in women in the vast majority of cases manifests itself 5-7-10 years later than in men, perhaps this is the reason for its milder course, which is noted by most authors. After 25 years, a woman has usually already received an education, started building a career, and most of them already have a family. In addition, women are more likely to seek help when they feel unwell in a mental sense, are more ready to have a dialogue with a doctor and follow his instructions, because they want to be cured, work, raise children and enjoy life. There is even an opinion that it is possible to help only those who want this help, who have something to return to in the real world. Perhaps it is all of the listed factors that lead to the fact that women are more often ill with low-progressive (sluggish) schizophrenia, characterized by a relatively favorable prognosis, with the gradual formation of shallow personality changes.

The signs of mild schizophrenia in women are the same, since the disease is the same, only milder. The symptoms are not distinguished by distinct psychotic phenomena, but neurosis-like disorders predominate - absurd obsessions, fears, for example, of objects of a certain shape or color, sometimes quite complex rituals; psychopathic-like, for example, hysteria, emotional coldness, deceit, hyperexcitability, vagrancy; other affective disorders.

A woman can become indifferent, uncaring towards her loved ones and her children, slovenly, and her desire to work and actively relax disappears. It is women who are prone to developing hypochondria, more often she begins to listen to herself, to look for non-existent illnesses, however, she can also focus her attention on the health of her loved ones, and especially her children, getting them "to the gills" with her hypertrophied care.

Danger that threatens not only the patient but also her family members is also a fairly common theme of delirium. The patient becomes wary, suspicious, sometimes aggressive towards those she has considered enemies. Persecution mania is one of the characteristic manifestations of schizophrenia in people of any gender.

Women are typically interested in magic and occult sciences; they can become very zealous parishioners of any religious denomination.

The symptoms may vary, their main feature is the obvious improbability of the statements. The patient in any case shows enviable persistence in her convictions, which do not yield to any logical persuasion. She is haunted by obsessive thoughts, insomnia, constant anxiety. She performs certain protective ritual actions that calm her down for a while. Even such a highly developed instinct in women as motherhood weakens.

To diagnose schizotypal disorder (sluggish schizophrenia), a psychiatrist usually pays attention to oddities in behavior, eccentricity and eccentricity, mannerisms, and the patient’s speech, which is characterized by pomposity and meaningfulness with poverty and inadequacy of intonation.

Under the influence of strong and unshared experiences, the patient may develop a craving for alcohol, drugs, or drug addiction.

The course of schizophrenia can be paroxysmal or constant and progressive. The second type of course is more typical for the absence of treatment. With timely treatment, the symptoms often subside, and the woman leads a very normal life.

Exacerbation of schizophrenia in women may occur under various psychotraumatic circumstances, in the presence of somatic diseases, under the influence of changes in hormonal levels. Sometimes, after the onset at a young age, schizophrenia may only worsen in old age due to the development of age-related changes in the brain and/or chronic somatic pathologies and their intensive drug treatment.

Types

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Stages

This disease is characterized by involution of mental functions, disorganization of the mind, lack of logic in behavior, loss of its harmony. Splitting of the mind is manifested in the fact that while the acquired intellectual baggage is preserved, other mental activity is disrupted, and quite severely, - thinking, emotions, feelings, motor skills. As a result of a long paroxysmal or continuous course, personal autistic changes occur, the person increasingly withdraws into himself and his own thoughts and experiences, known only to him. This is a serious disease affecting the structure of the brain and the metabolic processes in its cells.

The development of schizophrenia, like other severe chronic diseases, occurs in stages. Basically, it is a long process. Each stage lasts for years, except for cases of early manifestation, which are characterized by the rapid passage of the first two stages and the appearance of signs of degradation.

In the prodromal period, some non-specific behavioral oddities can be noticed, but schizophrenia can be diagnosed only from the moment obvious symptoms appear. They appear at the first stage of schizophrenia and gradually take over the mind of the sick woman. This stage is called - takeover. Hallucinations and / or delirium appear, that is, the patient enters a new world for her. Since the memory is preserved, she understands that she and everything around her have changed. The first stages of schizophrenia open up a new and, as it seems to her, true meaning of the events that are happening, she sees "through and through" those around her, their intrigues and insidious plans become clear to her, or she feels her power and messianism due to the fact that only she knows how to make humanity or at least her family happy. Unusual conditions for the patient are accompanied by pronounced depersonalization / derealization. The initial stage of schizophrenia in women is often accompanied by pronounced affective symptoms. Depending on the content of delusions and hallucinations, signs of depression or mania appear. At the first stage, the body mobilizes all its resources to fight, so the manifestation usually occurs quite violently. If treatment is started precisely during this period, there is a high probability that it will end in a long-term remission, and the patient will return to normal life.

In the second stage, adaptation to the disease occurs. The novelty is lost, the patient gets used to the voices, knows everything about the intrigues of enemies or her great mission, gets used to dualism - the reality of the environment quite peacefully coexists in the mind with illusions. The second stage is characterized by certain repetitive behavioral stereotypes - ritual actions that help the patient simply live. The result of treatment at this stage, as psychologists believe, depends on what world the patient chooses for herself and whether she wants to return to what awaits her in reality.

The third and final stage marks degradation – emotional and mental. With successful timely treatment or a mild course of the disease, some patients, fortunately, do not manage to reach the advanced third stage. At this stage of the disease, hallucinations fade, delirium fades, the patient withdraws into herself. Exhaustion of brain activity sets in, behavior becomes increasingly stereotypical – the patient can wander around the room all day long or sit, swaying from side to side, or simply lie, looking at the ceiling. Motor dysfunctions may appear. Nevertheless, even at the third stage, a strong shock can temporarily return the patient to reality.

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Forms

Currently, the International Classification of Diseases identifies eight specified types of schizophrenia. They will no longer be included in the next classifier, and they are no longer included in DSM-V, since the type of disease has no value for either treatment or prognosis, and, in addition, multiple studies have not revealed any differences in the characteristics of the course and response to drug treatment with neuroleptics depending on the type of schizophrenia.

However, while the new classifier has not yet been adopted, and different forms of schizophrenia are still being diagnosed, let us briefly familiarize ourselves with them.

Paranoid schizophrenia manifests in women aged 25-35, sometimes later. The most common. It has a continuous course, develops gradually, personality changes occur slowly. The most pronounced symptoms are persistent paranoid delusions of relationships, influence or impact. The patient is sure, for example, that she is being watched everywhere, without taking her eyes off. She “sees” how observers pass her from one to another, talk about her, shine rays on her, cast a spell, “understands” that surveillance was organized by serious organizations - the CIA, aliens, Satanists... begins to suspect the participation of her acquaintances, neighbors, to fear them, to interpret the words they say in her own way. Later, auditory hallucinations join in - the patient hears voices, sometimes more than one, thoughts sound in her head that were completely unusual for her before, as if implanted from the outside. The most unfavorable are imperative voices, on whose orders the patients can commit life-threatening acts. Over time, a syndrome of mental automatism is formed, orders and internal dialogues determine the patient's behavior and acquire the greatest importance for her. The patient may have and usually does have other symptoms, for example, emotional coldness, motor and speech disorders, but they are weakly expressed, and the hallucinatory-paranoid syndrome prevails. Paranoid schizophrenia in women is usually recognized quickly, since in most cases the delirium is unreal and absurd. However, sometimes the nature of the delirium is plausible, for example, delirium of jealousy, and the patients are very convincing. In such cases, for a long time, those around may not suspect the disease, and the patient's condition may worsen.

Chronic schizotypal (schizophreniform) disorder or, as it was previously called, sluggish schizophrenia develops most often in women. The signs of this disease are approximately the same as those of true schizophrenia, however, it does not reach its height. Paranoid symptoms - delusions and hallucinations may be present, but they are unstable and weakly expressed. Obsessions, strange behavior, rituals, excessive thoroughness, egocentrism and detachment, hypochondria, dysmorphophobia are noticed more often. The imaginary complaints of patients are distinguished by their pretentiousness (steam is bubbling in the lungs, water is gurgling in the brain), patients cover their supposedly ugly chin with a scarf, or measure the length of their ears every day, because it seems to them that one of them is growing. However, negative consequences in the form of deep emotional burnout, as well as social and professional maladjustment do not appear with the disorder. This atypical form of the disease is also called latent schizophrenia in women.

The role of the hereditary factor in morbidity is very great, its presence can be traced in almost all cases, with the exception of the onset in old age, when it is sometimes impossible to trace the family history. Hereditary schizophrenia in women, although rarely, can manifest in childhood and adolescence (12-15 years). Such an early onset indicates a severe progressive course and rapid development of negative symptoms. The following are classified as types of juvenile malignant schizophrenia:

Catatonic - characterized by the prevalence of diametrically opposed psychomotor disorders in the symptoms, usually occurring without clouding of consciousness (immobility is replaced by hyperkinesis). Having regained consciousness, the patient remembers and can tell about what was happening around her. Stupor is preceded by periodic episodes of freezing, for example, patients stand or sit, staring at one point. With this type of disease, oneiroid states can develop. This form of schizophrenia is characterized by a rapid course - the third stage occurs within two to three years.

Herbephrenic schizophrenia in women develops extremely rarely, such a diagnosis is made only in adolescence and early youth. It has a rapid development and an unfavorable prognosis due to the development of autistic disorder. The dominant signs are absolutely inappropriate grimacing and silly behavior.

The simple form is also not typical for female patients, since it develops early, the first two stages are asymptomatic in the absence of psychosis. Then, quite unexpectedly, negative symptoms and a gross personality restructuring begin immediately, accompanied by pronounced psychoses. Simple schizophrenia develops without delirium and hallucinations, moreover, such children usually do not cause any complaints from either parents or teachers before the disease. Changes in behavior appear suddenly and are expressed in a rapid increase in symptoms. In three to five years, patients develop a special schizophrenic defect, consisting in complete indifference to everything.

Manic schizophrenia in women is characterized by the presence of an elevated mood background, which does not decrease even when there are real reasons for this; tachypsychia - an acceleration of the pace of thinking (the patient simply becomes a generator of ideas); hyperbulia - increased activity (motor, incentive, especially in terms of receiving pleasure, multifaceted and fruitless activity). This type of schizophrenia is not distinguished in classifiers, mania is an additional symptom, however, characteristic of women. The intensity and severity of each of the symptoms can vary, moreover, schizophrenics usually have complex manic-paranoid disorders in combination, for example, with delusions of persecution or relationships, delusions of one's own exclusivity. Oneiroid mania can develop in combination with vivid hallucinations. Manic states are mood disorders, that is, affect, under the influence of which the patient's need for rest decreases, a lot of unrealistic plans and ideas appear, she can develop vigorous activity in many directions. Mania is not always associated with a joyful mood, often hyperactivity of thinking and motor skills is accompanied by a decrease in mood, increased irritability, aggressiveness and anger. The patient can go to all lengths, having a sexual marathon, become addicted to drugs or alcohol.

Use of psychoactive substances aggravates the picture of the disease. There is no such thing as alcoholic schizophrenia in women. There is a concept of alcoholic psychosis, which can develop with severe alcohol intoxication, or as delirium as a result of alcohol withdrawal. Its symptoms resemble an attack of schizophrenia - delirium, hallucinations, automatic behavior appear, however, these are etiologically different diseases. Schizophrenia can be complicated by alcoholism, but one cannot become a schizophrenic on the basis of alcoholism, at least for now this is believed and schizophrenia-like symptoms that appeared only on the basis of alcoholism are distinguished.

Affective schizophrenia in women is also an incorrect concept, despite the fact that it is women who have additional symptoms of depression and mania. However, patients with extensive symptoms are not diagnosed with schizophrenia until it is found out that its symptoms preceded the appearance of, for example, manic-depressive psychosis or major depression.

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