Schizophrenia in men: causes, types, diagnosis, prognosis

More than a century has passed since schizophrenia was recognized as an independent disease, but there are still discussions not only about its nature, but also about its existence as a separate disease. Many psychiatrists, including E. Bleuler, the author of the term "schizophrenia", are inclined to the opinion that this is a group of mental illnesses, united by a common feature - the patient's integrity of the mental process is violated, the unity of perception, thinking and emotions is lost against the background of increasing weakening of mental activity. Be that as it may, the most malignant and rapidly progressive forms of the disease manifest themselves in adolescence and adolescence, and among young patients, the majority are male patients. Therefore, schizophrenia in men, in general, runs more severe and has a less favorable prognosis than in women. Although in some cases the opposite is true.

Rather rapid, often within ten to fifteen years, impairment of the entire mental life of patients, "fatal outcome in dementia" at a fairly young age was considered the main feature of the disease, which at the end of the XIX century as an independent nosological unit described by E. Kraepelin, combining the previously considered separate mental pathologies: early dementia, catatonia, herbephrenia and paranoia. It was the prototype of schizophrenia. E. Kraepelin left the name "early dementia", because all these mental disorders manifested in adolescence and adolescence and rapidly progressed with the outcome in dementia. It was mainly young male people who were affected by this disease.

However, just 15 years later, a new independent mental illness - schizophrenia - appeared with the easy hand of E. Bleuler, who noted that this pathology is not always early and a quick "fatal outcome in dementia" is also not observed in all patients. Schizophrenia was considered to be the main feature of the disintegration of the holistic psyche. [1]

Mental disorders in men

It is not easy to preserve mental health in the modern world, especially for people living in megacities. According to the World Health Organization, 20-25% of the world's inhabitants, without distinction of sex and age, suffer from mental disorders in varying degrees, temporarily and permanently. Mental disorders can be temporary, that is, caused by severe mental shocks or abuse of psychotropic substances. Such conditions do not last long and most often have a favorable outcome. Chronic or permanent mental disorders, which include schizophrenia, are long-lasting, with exacerbations and lead to a permanent mental defect.

The most common mental health disorders are depression, bipolar disorder and schizophrenia. While depression is treatable and can go away, the other two are chronic relapsing disorders that are mostly controlled with medication.

Depression develops in men half as often as in women. Bipolar disorder has also, since the time of E. Kraepelin, been considered a more "female" mental disorder. Although modern research contradicts this and shows that men are more likely to suffer from bipolar disorder, and women are more prone to monopolar disorder with a predominance of "black streaks" in the psycho-emotional state. Perhaps such statistics are affected by the ambiguity of the diagnostic approach.

Among patients diagnosed with schizophrenia, there are three women for every four men, and schizotypal affective disorder is also somewhat more common in men.

The male population accounts for a higher proportion of addiction diseases. At the beginning of the last century, there was one woman for every 12 men who drank regularly. Alcoholic psychosis is still the prerogative of men, although the female representatives of the beautiful half of humanity are actively catching up with them, and according to UK statistics, gender equality has already been established among alcoholics in their country. Nevertheless, there are still four men per one female drunkard among the entire population of the planet (WHO data). Male drug addicts, in general, 1.3-1.5 times more than female. But men are not prone to eating disorders - there is only one man per ten women suffering from anorexia/bulimia.

Young members of the stronger sex are more likely to suffer from autism spectrum disorders, speech disorders, hyperactivity and attention deficit syndromes.

What are the dangers of schizophrenia in men?

The disease, first of all, is dangerous for the patient, regardless of gender, because if untreated, it progresses. Disturbed integrity of the psyche generates the inability of the patient to manage his behavior, to change it in accordance with life circumstances, not to go beyond the social rules, to plan his life activities and implement the planned. All this makes a person dependent on others, their help and care, depriving him/her of independence.

If we compare men with women, in general, their painful symptoms appear earlier, and in adolescence and adolescence (sometimes in childhood), not at all benign forms of schizophrenia manifest. Men more often have advanced and persistent delusional disorders, develop a state of psychomotor agitation. Nevertheless, more turbulent and dramatic debut, visible abnormality of behavior usually though makes a heavy impression on others, but also allows timely treatment, turning out to be less damage to the psyche of the patient. Slow development of the disease is fraught with a later start of treatment and greater disturbance of mental status.

In addition, the male sex is characterized by combinations of schizophrenia with antisocial behavior, substance abuse, alcoholism, which aggravates the course of the disease, and to a greater extent affects the family and professional status.

The way out of the situation is to seek medical help in a timely manner. Schizophrenia in most cases is controlled by active psychotropic therapy, and its combination with socio-rehabilitation practices allows the patient to regain a sufficiently high quality of life. The greatest danger in schizophrenia is a delayed start of treatment.

There are not many schizophrenics among persons with particularly dangerous criminal behavior, such as serial killers, and not many among professional criminals. In general, schizophrenic patients do not pose a danger to society. This is explained, first of all, by the fact that the development of the disease leads to stupor, isolation, isolation from the outside world. [2]

Epidemiology

Incidence statistics show that among young patients, the vast majority of patients are male, with peak incidence occurring between the ages of 20 and 28 years. However, one-third of schizophrenia debuts occur between the ages of 10 and 19 years and, presumably, not all debuts are recognized. Boys are 1.5 to 2 times more likely than girls among the youngest patients. The probability of developing schizophrenia in adolescence and young adulthood is 3-4 times higher than in middle age and old age. The malignant continuous form of the disease manifests most often at 10-14 years of age, the milder paranoid form - after 20-25 years of age. [3], [4], [5]

Causes Schizophrenia in men: causes, types, diagnosis, prognosis

Modern psychiatry, based on the achievements of neurophysiology, considers this disease to be the result of disruption of neurotransmitter mechanisms due to damage to certain cerebral structures, since structural abnormalities are present already during the manifestation of schizophrenia. There is evidence of brain damage at the earliest stages of brain development. For example, in patients with schizophrenia, dilation of the transparent septal cavity and impaired brain folding have been found. Such structures develop shortly after birth and are virtually unchanged thereafter. These facts support the neurogenesis theory of the pathogenesis of schizophrenia. Modern research methods have suggested that the development of the disease is based on degeneration of brain cells, especially the gray matter, and/or neurochemical imbalance, which began at the stages of intrauterine development. The causes of pathological transformations are perinatal infections, intoxications, other harmful effects during childbearing. However, the findings of neurobiologists are not specific and are inherent in persons with other psychiatric diseases as well.

Genetic predisposition also occurs, it is confirmed by twin studies and the presence of structural disorders in close relatives of patients, expressed to a lesser extent. Inheritance is quite complex, hypothetically several mutated genes interact, which leads to a critical increase in the risk of developing schizophrenia. Presumably, several functional and metabolic cerebral processes are violated at once, which leads to mental changes that fit into schizophrenia-like symptomatology. But also heredity is not recognized as a decisive factor, since not all children of schizophrenic parents become ill, and mutations specific for schizophrenia have not been found. In addition, in some cases gene transformations were random in nature and were absent in the parents of the patient. [6]

The influence of various external triggers is recognized. Risk factors - living conditions in early childhood (dysfunctional family, poverty, loneliness, frequent change of residence, emotional and physical abuse), stress, intoxications, infections, level of physical activity, psychological and social interactions of various kinds in childhood and adulthood only accelerate the appearance of symptoms of schizophrenia in men. Among the social conditions that provoke the development of the disease, living in an urban area is highlighted. A higher degree of urbanization in genetically predisposed people increases the risk of developing the disease. Psychological risk factors are also diverse. Schizophrenics are very sensitive to even minor negative stimuli, they are often concerned about things that an ordinary person may simply not notice, any even far-fetched stressor can trigger the development of the disease.

The use of psychedelics of various kinds can itself cause schizophrenia-like symptoms, which can be acutely intoxicated by a single large dose and chronically intoxicated by prolonged abuse. In addition, schizophrenic patients often use psychotropic substances (most often alcohol as the most popular and available product) to overcome their characteristic dopamine hunger. In such cases, it is virtually impossible to establish what the primary cause was, and if it is known that a schizophrenia-like state is observed in a chronic alcoholic or drug addict, he or she is diagnosed with severe intoxication or withdrawal syndrome, not schizophrenia.

Risk periods are crises associated with changes in hormonal and social status. In men, this is the adolescent period, when most of the disease debuts against the background of rapid physical restructuring and social formation. Late schizophrenia manifests in predisposed men during the period of sexual function fading, which also coincides with changes in social status (retirement, loss of former importance).

However, external influences alone do not result in schizophrenia. Exogenous risk factors are superimposed on congenital predisposition. In most patient histories, no clear link between a particular external factor and the onset of the illness can be traced. [7]

Risk factors

Schizophrenia is an endogenous disease, the exact causes of which are still shrouded in mystery. Currently, it is regarded as a consequence of degenerative processes occurring in the neurons of the brain, the beginning of which is laid at the stage of its formation.

Substance abuse and various stressors can contribute to the arrival of another schizophrenia attack, but exposure to them alone will not be enough to develop the illness.

In predisposed individuals, external factors may trigger the first onset or debut of schizophrenia, although, in general, the manifestation of the illness occurs with no apparent connection to external influences. Most often, symptoms of schizophrenia precede the onset of marked cravings for alcohol or other psychedelics. One of the reasons that almost half of schizophrenics use psychoactive substances, and alcohol is the most accessible of them, experts call the patient's desire to neutralize the fear of increasing emotional changes. And, in a way, it allows you to forget for a while, reduce emotional tension, anxiety, drown out sadness, but at the same time, a psychological dependence is formed.

A characteristic symptom of alcoholism in a schizophrenic patient is the absence of visible reasons for drinking and the tendency to drink alcoholic beverages alone. Drunkenness takes on a binge character, and the state of intoxication is accompanied by agitation, hysteria, and angry outbursts.

There may be noticeable signs of schizophrenia in a man on the basis of alcoholism, because they are delusions and hallucinations, as well as - negative symptoms (increasing indifference, inactivity, apathy). But these signs also appear with prolonged chronic alcoholization. The state of psychomotor agitation accompanying withdrawal syndrome or acute alcohol intoxication, also resembles the rapid debut of schizophrenia. In this case, it is almost impossible to differentiate what was primary, so patients who have not been previously diagnosed with schizophrenia are diagnosed with alcohol dependence syndrome.

Sometimes the first signs of schizophrenia in a man on the basis of stress may be noticeable. But only a psychotraumatic situation for the development of the disease is also not enough. There must be a predisposition, perhaps the process developed imperceptibly, and stress provoked a rapid development of the disease. Again, in most cases, the first symptoms of the disease neither patients nor their relatives do not associate with a particular stressor. It is precisely the sudden manifestation of schizophrenia in the midst of complete well-being that experts emphasize as one of the signs that make it possible to suspect this disease.

It is not possible for schizophrenia to develop from jealousy in men. The ground for this misconception is the fact that delusions of jealousy are one of the typical topics of delusional disorder in schizophrenics. Pathological jealousy is not characteristic of the initial stage of the disease. The so-called Othello syndrome usually manifests itself in representatives of the stronger sex by the age of 40 and, unlike women, it is accompanied by aggressive manifestations.

Morbid jealousy is a frequent symptom of a number of mental disorders. It can be aggravated by alcoholism, drug addiction, acquired physical disabilities, and isolation tendencies characteristic of schizophrenia.

In general, external psychologically traumatic factors alone are not sufficient for the development of schizophrenia. In addition, this diagnosis is usually made not by relatives, but by psychiatrists after a comprehensive examination and observation of the patient, often in a hospital. [8]

Pathogenesis

Many theories try to explain the pathogenesis of schizophrenia from the point of view of neurobiology - dopamine, kynurenine, GABA-ergic and others. In patients with schizophrenia in one way or another affected almost all processes of transmission of nerve impulses, but so far none of the hypotheses can not reliably explain what is happening, to accurately indicate the brain systems, the functions of which are disrupted. Especially since the studies involve patients who have been ill for a long time, being on long-term therapy with antipsychotics, which, on the one hand, leads to normalization of certain brain structures, such as the basal ganglia, and at the same time under the influence of drugs in the brain substance there are other structural deformations and areas of cerebral ischemia. At present, it has not been possible to completely separate the contribution of antipsychotic treatment from structural abnormalities caused directly by the disease. [9], [10]

Symptoms Schizophrenia in men: causes, types, diagnosis, prognosis

According to the type of course of the disease process, there is continuous schizophrenia, the manifestations of which are always present, but may be periodically expressed to a greater or lesser degree (flicker character). There is also recurrent or circular, manifested periodically and resembling manic-depressive psychosis, as well as - the most common, mixed or attack-like-progredient, when the attacks of the disease occur rarely, after 3-5 or more years, but from relapse to relapse is their complication and each time progressing negative symptoms. It is also called schub-like - with each relapse the patient sinks deeper into the disease (schub in German means a step down).

They also distinguish varieties of schizophrenia according to the predominant clinical manifestations.

The most malignant form of continuous schizophrenia, which affects predominantly male patients, manifests in adolescence (12-15 years of age). Juvenile schizophrenia is characterized by rapid progression and increasing emotional and intellectual degradation (corresponding to Krepelin's early dementia). According to its characteristic manifestations, it is divided into three main types:

• Simple schizophrenia - characterized by the predominance of negative symptoms and the practical absence of productive manifestations: quite normal adolescents suddenly for others become unbearable - rude and indifferent to relatives, in educational institutions - truant and lazy, long sleep, become unsociable, quickly degenerate - become slovenly, gluttonous, sexually liberated, in many cases shows unmotivated aggression to others;
• Hebephrenic schizophrenia, which is characterized by a behavioral disorder with rude wiggling, grimaces, joking absolutely inadequate to the age and situation, patients are also characterized by sexual disinhibition (public masturbation, exposure of genitals), gluttony and slovenliness, Intentional emptying of bowels and bladder in front of everyone in inappropriate places, literally within the first or second year from the onset of the disease in simple and hebephrenic schizophrenia forms the final state with loss of mental activity and dementia, in the first case - it is complete indifference, in the second - the so-called "mannered" dementia;
• Catatonic schizophrenia, the distinguishing feature is catatonia manifested by stupor (tension psychosis) or agitation as described above; in this form, the final state ("blunt dementia") forms in about two to three years.

Paranoid schizophrenia in men begins much later after 20 and even 25 years of age, the development of the disease is slow, through all stages and the personality structure of the patient changes gradually. It occurs in both continuous and attack-progressive form.

Delusions of persecution, influence, relationships, messianism are present. The person interprets all events and the behavior of others in terms of delusional ideas, becomes secretive, suspicious, wary. Paranoid delusions develop and become more complex, hallucinations appear, more often auditory - voices, ordering, discussing, sounding thoughts, on this background psychic automatisms are formed and the patient's behavior becomes psychotic. This stage of the disease is called paranoid or hallucinatory-paranoid.

Patients may develop secondary catatonia, delusions become increasingly grandiose, and delusional depersonalization may be observed. Patients often think of themselves as historical figures, viceroys of the gods, which is noticeable by the condescending tone, proud behavior, showing their sense of self superiority. At this stage the specific symptoms of schizophrenia appear - schizophasia, mentism, pseudohallucinations, openness, taking away or introducing into the brain by thoughts, moods, dreams, imposition by movements, feelings and so on. The more fantastic the delirium, the greater the personality defect assumed in the patient. Eventually paranoid dementia is formed. However, this form of schizophrenia is in most cases well controlled by drugs and the third stage of the disease can be delayed for a very long time.

The shub-like (progressive-progressive) type of course of paranoid schizophrenia develops initially as a continuous course, but it resolves quickly enough, and the patient can live a normal life for several years. Then after a few years the disease returns, the attack becomes more complicated and lengthens in time, but again it stops. The patient comes out of each attack with some autistic loss. Formerly, before the discovery of neuroleptics, the third or fourth attack in this course led to the terminal stage of the disease. Nowadays drug therapy can delay and even prevent the onset of the return of the disease. Juvenile schizophrenia (catatonic, hebephrenic) may also occur in this form. It is more favorable, and patients form a smaller intellectual defect than in the continuous form.

Recurrent schizophrenia - periodic development of manic or depressive psychoses, developed to a greater or lesser degree, with delusional, hallucinatory, mixed components, pseudohallucinations in the clinical picture. Reminiscent of schizoaffective psychosis.

Manic seizures are agitated states with specific symptoms of schizophrenia (echoing thoughts, delusions of affect) up to the development of oneiroid catatonia.

Depressive attacks are characterized by low mood, sleep disturbances, premonitions of misfortune, anxiety with specific symptoms of schizophrenia (delusions of persecution, poisoning, exposure). A stupor-like or oneiric state may develop. Such attacks are well controlled by drugs, however, upon their resolution, personality capabilities are somewhat lost.

Flaccid schizophrenia in men can manifest at any age. In the beginning, it has neurosis-like symptomatology. It is currently qualified as schizotypal personality disorder. The most mild and low-progressive form of the disease described above, and often does not lead to intellectual loss.

There is no such thing as latent schizophrenia in men, because as long as the disease is latent and neither the patient nor his surroundings are aware of it, it does not exist. It is impossible to diagnose a mental illness that is asymptomatic.

Alcoholic schizophrenia in men is also not a correct definition. As mentioned earlier, schizophrenics are prone to drinking alcohol, but modern medicine does not consider the development of schizophrenia solely on the basis of alcoholism possible, although degradation of brain neurons in chronic alcoholics and the development of symptoms resembling schizophreniform psychosis do occur.

The most dangerous form of the disease is the hypertoxic or febrile form of schizophrenia. It is characterized by a sharp, within the first five days, increase in the patient's body temperature, unrelated to somatic condition or antipsychotic therapy, against the background of developing acute psychosis with catatonic symptoms. The patient is hospitalized and treated as an emergency because his condition is life-threatening. The pre-febrile phase is characterized by marked agitation: the patients' speech is high-pitched, incoherent, devoid of meaning, movements are impulsive and unnatural. Patients are exalted, keep their mouths open, but are somewhat confused, and there is often a depersonalization/derealization syndrome. Sometimes symptoms of catatonia are present immediately. After fever, catatonic, hebephrenic agitation or catatonic stupor sets in. Patients jump, tumble, wriggle, spit, undress, attack others, and later develop negativistic stupor with increasing muscle tone and/or oneiroids.

Currently, a treatment regimen for febrile seizures in schizophrenia has been developed that allows achieving a pronounced remission. Previously, standard antipsychotic therapy was often fatal. Febrile seizures mainly manifest in schizophrenia, and subsequent exacerbations usually occur with normal temperature.

Stages

Like any disease, schizophrenia develops in stages. However, the stages in different forms of the disease are expressed in different degrees and their duration does not always allow to clearly distinguish each of them. In addition, there is a prodromal period, when the patient does not yet feel as such, and others consider him strange, capricious, uncontrollable, and if this happens to a teenager, they write it all off as "transitional age".

In the pre-disease state, one usually feels unexplained inner discomfort, mental pain, and the harmony of the external environment and the inner world of the patient is disturbed. But such feelings are unspecific. They are there and that's all. This is affected by unnatural behavior, communication with friends, with close and dear people becomes difficult. A person feels special, not like others. He "falls out" of society and gradually loses touch with it. Communication with others increasingly strains the patient, and he prefers solitude. Sometimes after such a period there is a violent beginning in the form of psychosis.

But often the initial stage of schizophrenia in males is hidden. This is how the most difficult-to-treat forms of continuous juvenile schizophrenia or the sluggish process, which also often manifests itself in adolescents, begin in adolescence. A characteristic early symptom may be completely different behavior, for example, at home and in the company of strangers (at school, at work, etc.) - "split behavior". In the company of loved ones, the person is eloquent, ready to argue for hours on a variety of topics, to argue to the hoarse, defending his opinion, sometimes aggressively; in the company of strangers, even well acquainted, he tries to "keep a low profile", is silent, you can not get a word out of him, he is timid and shy.

In the initial stage, when the disease takes hold of a person, the worldview, self-perception, the connection between the two is disturbed. In most cases, delusions and hallucinations, intrusive thoughts appear. Such symptoms often occur from time to time, intensifying and disappearing. This affects the character of the patient, he changes - there is thoughtfulness, reluctance to communicate, desire for solitude. Inquiries from loved ones such as "What happened?" cause irritation and even aggression. Nevertheless, the patient often manages to hide the growing mental tension for quite a long time.

One of the most typical symptoms of the onset of schizophrenia is coldness and aggression towards close people, especially towards the mother. Sometimes delusions of "alien parents" are formed - the patient is sure that he or she has been adopted, substituted and somewhere "real" parents are looking for and waiting for him or her, and they are usually presented as influential and wealthy people.

The prodrome and mastery stage are characterized by disorder of urges. Pyromania, kleptomania, addiction to vagrancy, tendency to asocial lifestyle, sexual perversions are more noticeable. But disorders of attraction can be more refined, for example, the syndrome of "drunken reading", the study of the city, public transportation routes and the like. For the sake of such hobbies are thrown all the necessary things, and read all the books in a row without system and adherence to genres, or the teenager all day long walks around the city / rides on public transportation, making plans and drawings of the "ideal" settlement, almost identical. Moreover, usually patients cannot clearly explain either the nature of their activities or the meaning of plans and schemes.

The next stage is adaptation. The patient is accustomed to the voices, has "accepted" his ideas, is sure of his exclusivity, "talent" and so on. He hides from enemies, draws, invents, follows his unfaithful wife, communicates with an alien mind... Delusions and hallucinations become commonplace, two realities, real and illusory, often peacefully coexist in the patient's consciousness. In many cases, the disease, which develops smoothly and without acute psychosis, becomes clearly noticeable only in this stage. During this period, the painful symptoms are clearly visible, the patient's behavior already becomes stereotyped - accompanied by repetition of the same movements, grimaces, gestures, words or phrases (automatisms).

The last stage is degradation (emotional burnout and mental retardation). The duration of the period preceding it differs depending on the type of schizophrenia and the severity of the course. In some mild cases, there is no serious damage to the intellect at all; in juvenile malignant schizophrenia, the third stage comes quickly. [11]

Complications and consequences

Schizophrenia is a progressive mental illness. Without treatment, it leads to the loss of the ability to exist independently. The patient gradually loses the ability to study, work and earn money, and the ability to exist in society is impaired.

Men with schizophrenia often drop out of school, work, start vagrancy, fall under the influence of antisocial elements, they are prone to disorders of desire, in particular - sexual perversions.

Approximately half of schizophrenics abuse psychoactive substances, which aggravates the course of the disease, increases the frequency of relapses, suicidal and violent acts, and brings closer the development of general mental impairment and self-isolation. In patients who use toxic substances, resistance to treatment increases, the probability of a favorable outcome is reduced many times. In the final stage, alcohol or drug use may spontaneously cease, but this indicates an increase in autization.

Schizophrenics have more difficulty quitting smoking, with three times as many smokers as the mentally healthy population. This habit not only has a detrimental effect on the somatic state of the body, but also inhibits the effect of antipsychotics, so that smoking patients need higher therapeutic doses of drugs, which is fraught with the development of side effects.

Schizophrenics are much more likely to become trauma patients than mentally healthy people, their injuries tend to be more severe and their mortality rates are higher.

Patients with schizophrenia often commit suicide, partly in the initial stage of the disease, when they feel they are losing their minds, partly in the period of developed delusional disorder, considering themselves unworthy to live. Sometimes they may kill their loved ones out of "good" motives, to "save" them from future torment, and then commit suicide, punishing themselves for it.

The social danger of schizophrenics has been greatly exaggerated. Nevertheless, the risk is present. It increases during periods of exacerbation, when there is a high probability of psychomotor agitation.

The consequences of the disease are reduced at a later onset. A stable position in the community, high professional skills and social activity increase the likelihood of a favorable outcome of treatment and preservation of self-sufficiency.

Diagnostics Schizophrenia in men: causes, types, diagnosis, prognosis

Schizophrenia is diagnosed by the presence of certain clinical symptoms corresponding to the disease, based on the patient's complaints, relatives, and observations in the hospital. Additionally, family history is studied, test studies are conducted to assess the level of mental perception in the patient. The clinical picture of the disease is quite individual and complex, but there should always be in the presence of a violation of the unity of the thought process, a specific phenomenon of splitting the mind, which is present in a schizophrenic from the very beginning. There may be no productive symptoms, but there is a complete or partial absence of associative connections and clarity of thought, of the capacity for purposeful thought and action. One of the central symptoms is alienation and coldness to the nearest and dearest people, monotonous mood, increasing passivity and gradual self-dismissal from all spheres of active life. Painful schizophreniform manifestations should persist for at least six months. Analyses and instrumental studies that reliably confirm the diagnosis of schizophrenia are not available and are performed to distinguish schizophrenia from other diseases with similar symptomatology. [12]

Differential diagnosis

Differential diagnosis is performed with neuroses and personality disorders (psychopathies), obsessive-compulsive and bipolar disorder, in which the patient comes out of the attack without personality changes, i.e., there is no progression inherent in true schizophrenia.

For example, bipolar disorder with an atypical course strongly resembles recurrent schizophrenia, and both psychosis is quickly enough bought medically, however, the exit from the affective stage of bipolar disorder is characterized by a full recovery of all personal qualities of the patient, while schizophrenics come out of a manic-depressive attack with losses in the emotional-volitional sphere and reveal some changes - sociability decreases, the circle of acquaintances narrows, the person becomes more withdrawn, reserved.

Acute polymorphic attacks of schizophrenia are differentiated from infectious, traumatic, post-stroke, intoxication psychosis. Schizophrenia is also differentiated from epilepsy, organic and traumatic brain damage, chronic consequences of alcoholism and drug addiction.

Treatment Schizophrenia in men: causes, types, diagnosis, prognosis

Is schizophrenia curable in men? No. Currently, a guaranteed cure is not possible in patients of any gender or age. Refusal to take medication leads to the resumption of attacks of the disease. Therefore, patients receive supportive therapy for life. This in many cases allows you to avoid exacerbations for a long period of time and lead a quite quality lifestyle. [13]

For more information on the treatment of schizophrenia in men, see this article.

Prevention

Nowadays there is still no answer to the question of the origin of schizophrenia, so preventive measures cannot be defined. We can recommend the above-mentioned eating style, motor activity, rejection of bad habits.

If a person is already ill, then all treatment is reduced to the prevention of exacerbations. Much depends on the patient and his or her surroundings, their ability to recognize an impending exacerbation in time and take action, readiness to support and help. [14]

Forecast

Modern medicine possesses an arsenal of psychotropic drugs and other techniques that allow maintaining a fairly active social level of life for most patients. Schizophrenia in men often begins at an early age and proceeds severely, but even in this case, the development of events is difficult to predict, although in general, the late onset is more favorable prognostically, as well as the debut in the form of acute psychosis and obvious symptoms with timely assistance. Aggravating circumstances are alcohol abuse and/or drug dependence.

However, there is an opinion that regardless of the severity of the disease and the type of course, the outcome of treatment is largely determined by the choice of the patient himself - whether he prefers the real world or the illusory one. If he has something to return to in the real world, he will return.

Employment for people with schizophrenia seems to be a very difficult, almost impossible task, however, this is not the case. We are not talking about people who already had a high social status, a job and a certain authority. They usually return to their interrupted activities. [15]

In general, having a job has a positive impact on the emotional well-being of patients, increases their self-esteem and confidence in the future, takes time and distracts them from socially useful activities. Often people start working part-time, then move to full-time work. Much depends on the patient's condition and his ability to perform certain work, resume education. In most cases, people with schizophrenia, while on maintenance antipsychotic therapy, live a full life and realize their potential. The support of relatives in this case is also invaluable.