Schizophrenia in men: causes, types, diagnosis, prognosis

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

A fairly rapid, often within ten to fifteen years, impoverishment of the entire mental life of patients, a "fatal outcome in feeblemindedness" at a fairly young age was considered the main feature of the disease, which at the end of the 19th century as an independent nosological unit was described by E. Kraepelin, who combined what had previously been considered separate mental pathologies: early dementia, catatonia, herbephrenia and paranoia. It was the prototype of schizophrenia. E. Kraepelin retained the name "early dementia", since all these mental disorders manifested in adolescence and youth and quickly progressed with an outcome in dementia. It was this disease that mainly affected young men.

However, literally 15 years later, with the light hand of E. Bleuler, who noted that this pathology is not always early and a quick "fatal outcome into dementia" is also not observed in all patients, a new independent mental illness appeared - schizophrenia. Its main symptom was called the splitting of the integral psyche. [ 1 ]

Mental disorders in men

Maintaining mental health into old age is not easy in the modern world, especially for residents of megacities. According to the World Health Organization, 20-25% of the planet's inhabitants, regardless of gender or age, suffer from mental disorders to varying degrees, temporarily or permanently. Mental disorders can be temporary, that is, caused by severe mental shocks or abuse of psychotropic substances. Such conditions are not long-lasting and most often have a favorable outcome. Chronic or permanent mental disorders, which include schizophrenia, last a long time, with exacerbations and lead to the emergence of a persistent mental defect.

The most common mental health disorders are depression, bipolar disorder, and schizophrenia. While depression is treatable and can go away without a trace, the other two are chronic, relapsing illnesses that are controlled with medication in most cases.

Depression develops in men twice as rarely as in women. Bipolar disorder has also been considered a more “female” mental disorder since the time of E. Kraepelin. Although modern studies contradict this and indicate that men suffer from bipolar disorder more often, while women are more susceptible to monopolar disorder with a predominance of “black streaks” in the psychoemotional 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; schizotypal affective disorder is also somewhat more common in men.

The male population suffers more from addiction diseases. At the beginning of the last century, there was one woman for every 12 regularly drinking men. Alcohol psychoses are still the prerogative of men, although the fair half of humanity is actively catching up with them, and according to statistics from Great Britain, gender equality has already been established among those suffering from alcoholism. Nevertheless, there are still four men for every one binge drinking female among the entire population of the planet (WHO data). There are 1.3-1.5 times more male drug addicts than female ones. But men are not prone to eating disorders - there is only one man for every ten women suffering from anorexia/bulimia.

Young representatives of the stronger sex more often suffer from autism spectrum disorders, speech disorders, hyperactivity syndromes and attention deficit.

Why is schizophrenia dangerous in men?

The disease is primarily dangerous for the patient, regardless of gender, because it progresses without treatment. The impaired integrity of the psyche causes the patient to be unable to control his behavior, change it in accordance with life circumstances, not go beyond the social rules, plan his life and implement his plans. All this makes a person dependent on others, their help and care, depriving him of independence.

If we compare men with women, then, in general, painful symptoms appear earlier, and in adolescence and youth (sometimes in childhood) by no means benign forms of schizophrenia manifest. Men more often have extensive and persistent delusional disorders, and a state of psychomotor agitation develops. Nevertheless, a more violent and dramatic debut, visible abnormal behavior, although usually makes a difficult impression on others, but also allows timely treatment, resulting in less damage to the patient's psyche. Slow development of the disease is fraught with a later start of treatment and greater disturbances of mental status.

In addition, males are characterized by a combination of schizophrenia with antisocial behavior, substance abuse, and alcoholism, which aggravates the course of the disease and has a greater impact on family and professional status.

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

There are not many schizophrenics among people with particularly dangerous criminal behavior, such as serial killers, and there are not many among professional criminals either. People with schizophrenia, in general, do not pose a danger to society. This is explained, first of all, by the fact that the development of the disease leads to dullness, isolation, and separation from the outside world. [ 2 ]

Epidemiology

Morbidity statistics show that the overwhelming majority of young patients are male, with the peak incidence occurring between the ages of 20 and 28. However, a third of schizophrenia debuts occur between the ages of 10 and 19, and it is assumed that not all debuts are recognized. There are 1.5 to 2 times more boys than girls among the youngest patients. The likelihood of developing schizophrenia in adolescence and youth is 3 to 4 times higher than in middle and old age. The malignant continuous form of the disease most often manifests itself at 10 to 14 years of age, while the milder paranoid form manifests itself after 20 to 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 a disorder of neurotransmitter mechanisms due to damage to some cerebral structures, since structural anomalies are already present during the manifestation of schizophrenia. There is evidence of brain damage at the earliest stages of its development. For example, in patients with schizophrenia, an expansion of the cavity of the transparent septum and a violation of the folding of the brain were found. Such structures develop soon after birth and practically do not change subsequently. These facts confirm the neurogenesis theory of the pathogenesis of schizophrenia. Modern research methods have suggested that the development of the disease is based on the degeneration of brain cells, especially gray matter, and / or neurochemical imbalance, which began at the stages of intrauterine development. The causes of pathological transformations are perinatal infections, intoxications, and other harmful effects during pregnancy. However, the findings of neurobiologists are devoid of specificity and are inherent in people with other psychiatric diseases.

Genetic predisposition also takes place, it is confirmed by twin studies and the presence of structural disorders in close relatives of patients, expressed to a lesser degree. Inheritance is quite complex, hypothetically several mutated genes interact, which leads to a critical increase in the risk of developing schizophrenia. Presumably, several functional-metabolic cerebral processes are disrupted at once, which leads to changes in the psyche, which fit into schizophrenia-like symptoms. But heredity is not recognized as a decisive factor, since not all children of schizophrenic parents get sick, mutations specific to schizophrenia have not been found. In addition, in some cases, gene transformations were random and were absent in the patient's parents. [ 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, intoxication, infections, level of physical activity, psychological and social interactions of various kinds in childhood and adulthood only accelerate the appearance of schizophrenia symptoms in men. Among the social conditions that provoke the development of the disease, living in an urban area is singled out. A higher degree of urbanization in genetically predisposed people increases the risk of developing the disease. Psychological risk factors are also varied. Schizophrenics are very sensitive even to minor negative stimuli, they are often worried about things that an ordinary person may simply not notice, any even far-fetched stress factor can serve as an impetus for the development of the disease.

The use of psychedelics of various kinds can in itself cause schizophrenia-like symptoms, and it can manifest itself in acute intoxication as a result of taking a single large dose and chronic - with long-term abuse. In addition, schizophrenic patients often use psychotropic substances (most often - alcohol as the most popular and accessible product) to overcome their characteristic dopamine hunger. In such cases, it is almost impossible to establish what was primary, and if it is known for certain that a schizophrenia-like condition is observed in a chronic alcoholic or drug addict, then he is diagnosed with severe intoxication or withdrawal syndrome, and not schizophrenia.

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

However, schizophrenics do not become schizophrenics as a result of external influences alone. Exogenous risk factors are superimposed on the innate predisposition. In most patient histories, it is impossible to trace a clear connection between a specific external factor and the onset of the disease. [ 7 ]

Risk factors

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

Substance abuse and various stress factors can contribute to the onset of another attack of schizophrenia, however, their impact alone will not be sufficient for the development of the disease.

In predisposed individuals, external factors can trigger the first attack or debut of schizophrenia, although, in general, the manifestation of the disease occurs without any apparent connection with external influences. Most often, the symptoms of schizophrenia precede the appearance of a pronounced craving 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 say is the patient's desire to neutralize the fear of increasing emotional changes. And, in a way, it allows one to forget for a while, reduce emotional stress, anxiety, and drown out melancholy, but at the same time, psychological dependence is formed.

A characteristic symptom of alcoholism in a patient with schizophrenia is the absence of visible reasons for drunkenness and a tendency to consume alcoholic beverages alone. Drunkenness takes on a binge character, and the state of intoxication is accompanied by excitement, hysteria, and malicious behavior.

Signs of schizophrenia in a man due to alcoholism may be noticeable, because these are delusions and hallucinations, as well as negative symptoms (growing indifference, inactivity, apathy). But these signs also appear with long-term chronic alcoholism. The state of psychomotor agitation accompanying withdrawal syndrome or acute alcohol intoxication also resembles the stormy debut of schizophrenia. In this case, it is almost impossible to differentiate what was primary, therefore, patients who have not previously been diagnosed with schizophrenia are given alcohol dependence syndrome.

Sometimes the first signs of schizophrenia in a man can be noticeable due to stress. But a psychotraumatic situation alone is not enough for the disease to develop. There must be a predisposition, perhaps the process developed unnoticed, and stress provoked the rapid development of the disease. I repeat that in most cases, neither patients nor their relatives associate the first symptoms of the disease with a specific stress factor. It is the unexpected manifestation of schizophrenia in the midst of complete well-being that specialists emphasize as one of the signs that allow one to suspect this disease.

Schizophrenia cannot develop on the basis of jealousy in men. The basis for such a misconception is the fact that delusional jealousy is one of the typical themes 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 common symptom of a number of mental disorders. Its development can be aggravated by alcoholism, drug addiction, acquired physical disabilities, and the tendency to isolation characteristic of schizophrenia.

In general, external psychotraumatic factors alone are not enough to develop schizophrenia. In addition, such a 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, kynurenic, GABAergic and others. In patients with schizophrenia, almost all processes of transmission of nerve impulses are affected in one way or another, but so far none of the hypotheses can reliably explain what is happening, or precisely indicate the brain systems whose functions are disrupted. Moreover, the studies involve long-term patients who are on long-term antipsychotic therapy, which, on the one hand, leads to the normalization of individual structures of the brain, for example, the basal ganglia, and at the same time, under the influence of drugs, other structural deformations and areas of cerebral ischemia occur in the brain tissue. 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 the disease process, continuous schizophrenia is distinguished, the manifestations of which are always present, but can be expressed periodically to a greater or lesser degree (flickering character). Recurrent or circular, which manifests periodically and resembles manic-depressive psychosis, is also distinguished, as well as the most common, mixed or paroxysmal-progressive, when attacks of the disease occur rarely, after 3-5 years or more, but from relapse to relapse they become more complicated and each time negative symptoms progress. It is also called fur coat - with each relapse the patient plunges deeper into the disease (schub in German is a step down).

There are also different types of schizophrenia based on their predominant clinical manifestations.

The most malignant form of continuous schizophrenia, which predominantly affects male patients, manifests itself in adolescence (12-15 years). Juvenile schizophrenia is characterized by rapid progression and increasing emotional and intellectual degradation (corresponds to Kraepelin'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: completely normal teenagers unexpectedly become unbearable for those around them - rude and indifferent to their relatives, in educational institutions - truants and lazy, sleep for a long time, become uncommunicative; quickly degrade - become sloppy, gluttonous, sexually liberated, in many cases unmotivated aggression towards others is manifested;
• hebephrenic schizophrenia, the distinctive feature of which is a behavioral disorder with gross grimacing, grimaces, buffoonery absolutely inadequate to age and situation, patients are also characterized by sexual disinhibition (public masturbation, exposure of genitals), gluttony and sloppiness, deliberate emptying of the bowels and bladder in front of everyone in inappropriate places, literally during the first or second year from the onset of the disease with simple and hebephrenic schizophrenia, the final state is formed with the loss of mental activity and dementia, in the first case - this is complete indifference, in the second - the so-called, "mannered" dementia;
• catatonic schizophrenia, the distinctive feature is catatonia, manifested by stupor (stress psychosis) or excitement, described above, in this form the final state ("stupid dementia") is formed in about two to three years.

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

There is delirium - persecution, influence, relationships, messianism. The person interprets all events and the behavior of others from the point of view of delusional ideas, becomes secretive, suspicious, wary. Paranoid delirium develops and becomes more complex, hallucinations appear, more often auditory - voices commanding, discussing, sounding thoughts, against this background, mental 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, delusional ideas become more and more grandiose, delusional depersonalization may be observed. Patients often imagine themselves to be historical figures, viceroys of the gods, which is noticeable by the condescending tone, proud behavior, showing their sense of superiority. At this stage, specific symptoms of schizophrenia appear - schizophasia, mentism, pseudohallucinations, openness, withdrawal or introduction into the brain from thoughts, moods, dreams, imposition from movements, feelings, etc. The more fantastic the plot of the delusion, the greater the personality defect is assumed in the patient. In the end, paranoid dementia is formed. However, it is this form of schizophrenia that in most cases is well controlled by drugs and the third stage of the disease can be delayed for a very long time.

The fur-like (progressive-progressive) type of paranoid schizophrenia develops initially as continuous, but resolves fairly quickly, and the patient can live a normal life for several years. Then, after several years, the disease returns, the attack becomes more complex and lasts longer, but stops again. The patient emerges from each attack with some autistic losses. Previously, before the discovery of neuroleptics, the third or fourth attack with such a course led to the final stage of the disease. Currently, drug therapy can delay and even prevent the onset of a return of the disease. Juvenile schizophrenia (catatonic, hebephrenic) can also occur in this form. It is more favorable, and patients develop a smaller intellectual defect than with the continuous form.

Recurrent schizophrenia is the periodic development of manic or depressive psychoses, developed to a greater or lesser extent, with delusional, hallucinatory, mixed components, pseudo-hallucinations in the clinical picture. Resembles schizoaffective psychosis.

Manic attacks are excited states with specific symptoms of schizophrenia (echoing thoughts, delusions of influence) up to the development of oneiroid catatonia.

Depressive attacks are characterized by a depressed mood, sleep disorders, premonitions of misfortune, anxiety with specific symptoms of schizophrenia (delusions of persecution, poisoning, influence). A stuporous or oneiroid state may develop. Such attacks are well relieved by medications, however, upon their resolution, personal capabilities are somewhat lost.

Sluggish schizophrenia in men can manifest at any age. At the beginning, it has neurosis-like symptoms. Currently, it is classified as schizotypal personality disorder. The mildest and least progressive form of the disease, described above, and often does not lead to intellectual losses.

There is no such variety as latent schizophrenia in men, because as long as the disease is latent and neither the patient nor the environment suspects 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 the development of schizophrenia only on the basis of alcoholism is not considered possible by modern medicine, although the degradation of neurons in the brain in chronic alcoholics and the development of symptoms resembling schizophreniform psychosis does occur.

The most dangerous form of the disease is the hypertoxic or febrile form of schizophrenia. It is characterized by a sharp increase in the patient's body temperature during the first five days, without any connection with the somatic state or antipsychotic therapy, against the background of developing acute psychosis with catatonic symptoms. The patient is hospitalized and provided emergency care, since his condition poses a risk to life. The pre-febrile phase is characterized by pronounced excitement: the speech of patients is high-flown, incoherent, meaningless, movements are impulsive and unnatural. Patients are exalted, do not close their mouths, but are somewhat confused, depersonalization/derealization syndrome is often present. Sometimes symptoms of catatonia are immediately observed. After the temperature rises, catatonic, hebephrenic excitement or catatonic stupor joins in. Patients jump, tumble, grimace, spit, undress, attack others, and later enter into a negativistic stupor with increasing muscle tone and/or oneiroid.

Currently, a treatment regimen for febrile attacks of schizophrenia has been developed that allows achieving significant remission. Previously, standard antipsychotic therapy often led to a lethal outcome. Febrile attacks mainly manifest fur-like schizophrenia, subsequent exacerbations in the patient usually proceed with normal temperature.

Stages

Like any disease, schizophrenia develops in stages. However, the stages in different forms of the disease are expressed to different degrees and their duration does not always allow us to clearly identify each of them. In addition, there is a prodromal period when the patient does not yet feel like one, and those around him consider him strange, capricious, uncontrollable, and if this happens to a teenager, then everything is attributed to "transitional age".

In the pre-illness state, an inexplicable internal discomfort, mental pain are usually felt, the harmony of the external environment and the patient's inner world is disrupted. But such sensations are not specific. They are there and that's it. This is reflected in unnatural behavior, communication with friends, loved ones and relatives becomes difficult. A person feels special, not like others. He "falls out" of society and gradually loses contact with it. Communication with others becomes increasingly stressful for the patient, and he prefers solitude. Sometimes after such a period, a stormy onset occurs in the form of psychosis.

But often the initial stage of schizophrenia in men proceeds precisely in a latent form. This is how the most difficult to treat forms of continuous juvenile schizophrenia or a sluggish process, which also often manifests itself in teenagers, begin in adolescence. A characteristic early symptom can be completely different behavior, for example, at home and in the company of strangers (at school, at work, etc.) - "splitting behavior". Among loved ones, this is an eloquent person, ready to talk for hours on various topics, argue until hoarse, defending his opinion, sometimes aggressively; in the company of strangers, even well-known ones, he tries to "keep a low profile", is silent, you can't get a word out of him, he is timid and shy.

At the initial stage, when the disease takes hold of a person, the perception of the world, self-perception, and the connection between the two are disrupted. In most cases, delirium and hallucinations, obsessive thoughts appear. Such symptoms often occur from time to time, intensifying and disappearing. This affects the character of the patient, it changes - thoughtfulness, unwillingness to communicate, a desire for solitude appear. Questions from loved ones such as "What happened?" cause irritation and even aggression. Nevertheless, the patient often manages to hide the growing mental stress for quite a long time.

One of the most typical symptoms of the onset of schizophrenia is coldness and aggression towards loved ones, especially towards the mother. Sometimes the delusion of "other people's parents" is formed - the patient is sure that he was adopted, replaced, and that his "real" parents are looking for him and waiting for him somewhere, and they usually present themselves as influential and wealthy people.

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

The next stage is adaptation. The patient has become accustomed to the voices, has “accepted” his ideas, is confident in his exceptionalism, “talent,” and so on. He hides from enemies, draws, invents, follows his unfaithful wife, communicates with alien intelligence… Delirium 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 at this stage. During this period, painful symptoms are clearly noticeable, the patient’s behavior already becomes stereotyped – accompanied by the 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 varies depending on the type of schizophrenia and the severity of the course. In some mild cases, serious damage to the intellect does not occur at all; in juvenile malignant schizophrenia, the third stage occurs 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 who become ill with schizophrenia often drop out of school, work, become homeless, fall under the influence of antisocial elements, and are prone to disorders of desire, in particular sexual perversions.

Approximately half of schizophrenics abuse psychoactive substances, which aggravates the course of the disease, contributes to an increase in the frequency of relapses, suicidal and violent actions, brings the development of general mental impoverishment and self-isolation closer. Patients who use toxic substances have increased resistance to treatment, the probability of a favorable outcome decreases several times. In the final stage, alcoholism or drug use may spontaneously cease, however, this indicates an increase in autism.

It is more difficult for schizophrenics to quit smoking; there are three times more smokers among them than among the mentally healthy population. This habit not only has a detrimental effect on the somatic state of the body, but also inhibits the action of antipsychotics, which is why smoking patients need higher therapeutic doses of drugs, which is fraught with the development of side effects.

Schizophrenics are much more likely to become patients of traumatologists than mentally healthy people, their injuries are usually more severe and the mortality rate from them is higher.

People with schizophrenia often commit suicide, partly in the initial stages of the disease, when they feel that they are losing their minds, partly during the period of developed delusional disorder, considering themselves unworthy of life. Sometimes they can, with the "best" intentions, kill their loved ones in order to "save" them from future torments, and then commit suicide, punishing themselves for it.

The social danger of schizophrenics is greatly exaggerated. However, the risk exists. It increases during periods of exacerbation, when there is a high probability of developing psychomotor agitation.

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

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

Schizophrenia is diagnosed based on the presence of certain clinical symptoms corresponding to this disease, based on complaints of the patient himself, his relatives, and observations in the hospital. Additionally, the family history is studied, and 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 must always be a violation of the unity of the thought process, a specific phenomenon of splitting of the mind, which is present in a schizophrenic from the very beginning. There may be no productive symptoms, however, a complete or partial absence of associative links and clarity of thinking, the ability to purposeful thoughts and actions can be traced. One of the central symptoms is alienation and coldness towards the closest and dearest people, a monotonous mood, increasing passivity and gradual withdrawal from all spheres of active life. Painful schizophreniform manifestations must persist for at least six months. There are no tests or instrumental studies that reliably confirm the diagnosis of schizophrenia and are carried out to differentiate schizophrenia from other diseases in which similar symptoms are observed. [ 12 ]

Differential diagnosis

Differential diagnostics are carried out with neuroses and personality disorders (psychopathy), obsessive-compulsive and bipolar disorder, in which the patient emerges from an 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, both psychoses are quickly relieved with medication, however, the exit from the affective stage of bipolar disorder is characterized by a complete restoration of all personal qualities of the patient, while schizophrenics emerge from 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, and intoxication psychoses. Schizophrenia is also differentiated from epilepsy, organic and traumatic brain damage, and chronic consequences of alcoholism and drug addiction.

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

Is schizophrenia curable in men? No. At present, a guaranteed cure is impossible for patients of any gender and age. Refusal to take medications leads to a resumption of attacks of the disease. Therefore, patients receive maintenance therapy throughout their lives. In many cases, this allows them to avoid exacerbations over a long period and lead a fairly high-quality lifestyle. [ 13 ]

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

Prevention

Nowadays, there is no answer to the question of the origin of schizophrenia, so it is impossible to determine preventive measures. We can recommend the above-mentioned diet, physical activity, and rejection of bad habits.

If a person is already ill, then all treatment comes down to preventing exacerbations. Much depends on the patient himself and his environment, their ability to recognize an impending exacerbation in time and take measures, their readiness to support and help. [ 14 ]

Forecast

Modern medicine has an arsenal of psychotropic drugs and other methods that allow maintaining a fairly active social standard of living for most patients. Schizophrenia in men often begins at an early age and is severe, but even in this case, it is difficult to predict the development of events, although in general, a late onset is prognostically more favorable, as is the onset in the form of acute psychosis and obvious symptoms with timely assistance. Aggravating circumstances include alcohol abuse and/or drug addiction.

However, there is an opinion that regardless of the severity of the disease and the type of progression, the result 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, it is not so. 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 effect on the emotional well-being of patients, increases their self-esteem and confidence in the future, takes up time and distracts them from socially useful activities. Often people start working part-time, then move on to full-time employment. Much depends on the patient's condition and their ability to do a certain job, 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.