Schizophrenia in men: symptoms, characteristic signs of behavior

The first signs of schizophrenia are usually perceived by the close circle as eccentricities - a bad mood, a lack of emotions, isolation are not specific signs of schizophrenia alone, or any mental illness in general. Moreover, the disease can develop in different forms and at different speeds. If the disease manifests itself violently and manifests itself as acute psychosis, then relatives have no doubt that the mental state requires correction. The patient quickly receives help, and such a development of events is often more favorable than a prolonged gradual increase in the manifestations of negative symptoms - increasing passivity, emotional and energy deficiency. [ 1 ]

The main symptoms of psychosis in schizophrenics and other mental illnesses are deceptions of perception or hallucinations; persistent ideas and views that have no relation to reality – delusions; manic and/or depressive affective disorders; movement disorders (catatonia).

Often the first sign of the disease in men is psychomotor agitation, which manifests itself in various forms. The following are characteristic of schizophrenia and schizophreniform syndromes:

• catatonic psychomotor agitation is manifested by constant movements, rhythmic, monotonous, coordination may be impaired, in addition, the patient speaks incessantly - affected, grimaces, mimics others, actions are characterized by impulsiveness, meaninglessness, repetitiveness, speech is incoherent, contains rhymes, repetitions of the same words or phrases, the condition is accompanied by violent emotions - the patient can be angry, aggressive, pathetic, fall into ecstasy, at times outbursts of emotions are replaced by indifference;
• hebephrenic psychomotor agitation is manifested by silly behavior and senseless impulsive actions, which in many cases are of an aggressive nature;
• manic form - characterized by activity and an irresistible desire for activity, the mood is elevated, actions and ideas are characterized by absurdity, inconsistency, associative thinking, there may be delirium and hallucinations;
• with psychomotor agitation against the background of hallucinations, the patient is usually focused and tense, makes abrupt impulsive movements, often of an aggressive or defensive nature, speech is incoherent with threatening intonations;
• During delirium, patients are irritated and angry, are distrustful, and may suddenly attack or injure themselves.

But such a bright debut does not always occur. Sometimes one of the earliest manifestations of schizophrenia is a change in the patient's character, especially noticeable if he has previously absent traits. For example, a noticeable decrease in work capacity, activity, decreased interest in previously favorite activities; a sociable man can become a homebody, stop meeting with friends, his girlfriend; his attitude towards loved ones - wife, children, mother - can change, he will become indifferent or even rude and irritable. At the same time, in his free time, he will "get stuck" in one place for a long time with an absent look, just lie or sit on the couch, clearly doing nothing, preferring solitude to any activity. Such inactivity can concern different areas: home activities and so-called "outings - to theaters, guests, exhibitions", study or work. The periods of isolation increase, the man stops caring for his appearance - changing clothes, taking a shower, brushing his teeth and clearly prefers his own company.

Disturbances in the thinking process in schizophrenia and schizophrenia spectrum disorders are expressed in the loss of consistency in thought activity, its purposefulness and logic. The logical connection between thoughts disappears, they often break off (sperrung), as the disease progresses, the patient is often no longer able to express his thoughts coherently, which is manifested in the fact that the patient's speech turns into a chaotic set of fragments of phrases that are not connected to each other.

In milder cases, the patient's speech is dominated by a tendency toward abstraction and symbolism, unusual and absurd associations appear. Thoughts "slip"; the patient, without noticing it, switches from one topic to another. The schizophrenic's thinking disorders manifest themselves in word creation, "neologisms" are distinguished by their pretentiousness and are understandable only to the patient himself, in fruitless reasoning on abstract topics and in the loss of the ability to generalize the information received. Mentism is characteristic - an uncontrollable flow of thoughts. Nevertheless, a certain logic in statements and actions, known only to the patient, is observed, and often it is precisely the peculiar comprehension and integration of facts that gives away the schizophrenic.

Formally, the level of intelligence in patients acquired before the disease and in the initial stages remains intact for a long time, however, over time, cognitive functions are damaged, the ability to compare and analyze facts, plan actions, communicate in society is impaired, so it becomes increasingly problematic for the patient to use the accumulated knowledge. Almost always, difficulties arise in patients when it is necessary to achieve goals and solve issues related to the need to attract new knowledge and skills.

In some cases, thinking disorders only accompany periods of relapses, and disappear when the condition stabilizes. Some persistent disorders of the thinking process persist even in the latent period, constituting a growing cognitive deficit.

The symptoms of schizophrenia and schizophreniform disorders are quite varied and can be identified to varying degrees depending on the form and severity of the disease.

In order for the question of a diagnosis of schizophrenia to arise, according to the International Classification of Diseases, Tenth Revision, the patient must have at least one so-called “major” symptom or two “minor” ones.

One of the following manifestations is sufficient:

• the patient’s confidence that his thoughts are completely open to reading, that they can be stolen, erased, or, conversely, “put” into the head from the outside (echo of thoughts);
• the patient's confidence that he is being controlled from the outside, clearly related to actions, movements, thoughts and sensations (delusion of influence and delusional perception);
• auditory hallucinations – one or more voices, coming from different parts of the body, comment on the patient’s actions, give instructions or simply communicate;
• the presence of delusional ideas that run counter to the generally accepted beliefs and rules of behavior of a given society.

Or at least two "minor" symptoms must be present in any combination:

• constant overvalued ideas or any hallucinations - visual images and entire plots, touches, smells, in combination with the regular appearance of often incompletely formed delusional ideas, without a pronounced affective component;
• sperrung and mentism, confusion and impoverishment of speech and/or neologisms;
• catatonia, its individual manifestations and other motor disorders;
• thinking disorders – inability to make logical conclusions, generalize, or focus on one thought;
• apathoabulic syndrome, depletion of emotions, their inadequacy;
• gradual loss of interest in the outside world and social connections, increasing passivity and isolation.

Psychotic schizophreniform symptoms must be observed for at least a month in the presence of a long-term (at least six months) decline in basic human functions related to work, family relationships, and friendly communication.

New disorders acquired during the illness (delusions, hallucinations, overvalued ideas) are called productive or positive, emphasizing their addition to the pre-morbid mental state. Autism spectrum disorders, depletion of emotions and energy tone are considered losses or negative symptoms.

Behavior of a man with schizophrenia

Before the onset of obvious symptoms of schizophreniform disorder, some oddities may be observed in a man's behavior - a commitment to solitude, isolation, excessive passion for a certain activity that seems useless to others, long fruitless discussions on selected topics, neglect of appearance, work, and study. However, while these manifestations do not have the severity of a schizophrenia spectrum disorder, no one will be able to predict its development based on their presence alone, and even more so - prescribe preventive treatment. Some oddities are inherent in many people who will never develop schizophrenia. Such a diagnosis is made according to fairly specific criteria.

However, the success of treatment largely depends on its timely initiation. The behavior of a man with schizophrenia differs from generally accepted norms even outside of psychosis. Productive symptoms have a great impact on the patient's perception of the world and, accordingly, behavioral deviations become noticeable. [ 2 ]

In the presence of hallucinations, usually auditory, you may notice that your relative often has a dialogue with an invisible interlocutor, as if answering questions or commenting on something, often suddenly falling silent and listening. Sometimes you can hear laughter, crying or angry shouts. A patient suffering from hallucinations usually has a worried or anxious expression on his face, which does not correspond to the current situation. It is difficult for him to concentrate on doing some specific work or topic of conversation, as if something is distracting him. In short, it seems that the patient hears (sees, feels) something that is inaccessible to others. Experts advise not to laugh at the patient under any circumstances and not to be clearly frightened by what is happening. It is also not recommended to dissuade the patient from the illusory nature of his sensations and ask in detail about their content. However, you can let him speak out if he wants to himself, and try to convince him to see a doctor. But you need to act as delicately as possible, trying not to hurt the patient's feelings. Many of them at the initial stage understand the unreality of what is happening, and timely support can help begin treatment.

Aggression in schizophrenia in men is most often a manifestation of delusional disorder. In delirium, the patient becomes suspicious, his distrustful attitude is clearly traced, most often, to the closest people. Sometimes, delusion of influence concerns the life or health of loved ones, then the patient surrounds them with prohibitions and hypertrophied care. Unwillingness to comply with demands causes aggression in a schizophrenic, in general, any opposition to the patient can cause inadequate anger. The appearance of delirium can be indicated by a sudden unfounded suspicion or hostility, often towards loved ones or good acquaintances, sometimes towards complete strangers, visible manifestations of fear - carefully locking windows and doors, drawing curtains on windows, cutting additional locks, checking food for poisoning and other protective actions. The patient may claim that he is being persecuted, threatened with kidnapping himself or loved ones, his thoughts are read or irradiated with invisible rays. The pursuers may be from the realm of fantasy – aliens or foreign intelligence agents. He may develop convictions in his own great mission. But sometimes the fictional stories are quite realistic – adultery, the machinations of competitors, complaints about noisy neighbors, their children who cause harm, damage property, negligent employees who interfere with the implementation of some project, etc.

Often, the man begins to show carelessness in clothing, neglect hygiene. The emotional component is lost, the patient usually cannot empathize with real suffering, however, he does not stop expressing emotions, he can laugh and cry, completely inappropriately, inconsistent with the situation, and with some of his thoughts and experiences. The look of the patients becomes inexpressive, turned inward, they are characterized by strange, in the opinion of others, statements, inadequate reactions. Schizophrenics absolutely do not tolerate criticism of their views, behavior, overvalued ideas and beliefs. No logical conclusions can convince the patient of his morbid fantasies.

A sudden manic fascination with the occult sciences, religion, and esotericism, accompanied by an ever-increasing detachment from reality, is also characteristic of schizophreniform disorders.

Motor functions change. Some patients in the prodromal stage suddenly become slow, everything is done with arrangement, emphasis, for example, things are laid out in a certain order in the apartment or on the table. Hands or feet may start shaking from tension. Unusual motor activity - suddenly appearing fussiness, more intense facial expressions can also precede the onset of the disease. Schizophrenics are characterized by strange, pretentious speech, inconsistent, with repetitions, emphasis, word creation.

The behavior of a man with schizophrenia does not correspond to the current situation, nor to his life experience, and often to the standards of behavior accepted in society. He lives in his own illusory world. For the most part, actions that are absolutely meaningless from the position of a normal person are considered by the schizophrenic to be the only correct ones, and there is no point in trying to convince him otherwise. Also, many patients do not recognize themselves as such and do not want to seek help, seeing intrigues of ill-wishers in persuasion. Schizophrenics, despite their apparent amorphousness, are extremely sensitive even to minor events, comments, and various trifles related to their fantasies and beliefs. In general, people with a sick psyche are usually selfish, they are only concerned with their own problems that appear in an imaginary world. Relatives are advised to act carefully, not to pressure the patient, not to argue with him, since coercion can cause aggression.

After the start of treatment, most patients quickly become sane. And without treatment, the so-called negative symptoms begin. Growing isolation in one's experiences, anxiety, and dissociation from the outside world dull emotions, since there is not enough external information to produce them. This is accompanied by abulia - the loss of volitional impulses and motivation for the most basic actions, and apathy. [ 3 ]

Signs of mild schizophrenia in men

As noted above, when the disease manifests itself in the form of vivid psychosis, there is no doubt that the patient needs the help of a psychiatrist. It is much more difficult to recognize the gradual development of the disease or its mild forms. Slow-moving schizophrenia often manifests itself at a young age, and its first signs coincide with the pubertal crisis. At this time, all young people are characterized by the search for the meaning of life, the desire for independence and the associated rejection of authorities, fascination with various philosophical teachings. Teenagers are rude and irritable, often try to express themselves, dressing extravagantly or deliberately sloppily, shirk household chores and "neglect" their studies, so even the closest people may not notice the initial stage of the disease. [ 4 ]

But if you try, you can pay attention to some signs. In schizophrenia, mutual connections between individual personality characteristics are lost, while intellect, memory and skills are completely preserved, especially in mild cases of the disease. It can be noted that the patient's feelings and emotions, from the point of view of a healthy person, do not correspond to external stimuli, the current situation or subjective interests, the same thing happens with thinking and other types of brain activity. All functions are preserved - a person thinks, speaks, listens, gets angry, laughs or cries at something, however, the mutual correspondence of these actions is difficult to grasp from the outside.

In mild cases, the patient is diagnosed with schizotypal disorder (previously called sluggish schizophrenia). The patient has odd behavior, eccentricity and oddity, pretentiousness of speech, pomposity and meaningfulness with poverty and inadequacy of intonation, mannered behavior. In general, the same schizophreniform symptoms described above are observed, only in more subtle forms.

For the early stages, neurosis symptoms prevail. The patient often complains of sleep disturbances, obsessive thoughts, philosophizing, "mental chewing gum", distorted perception of reality, abstract obsessions. Even not every experienced psychiatrist will recognize the specifics of obsessive components at the beginning. With schizotypal disorder, they are poorly understood, are characterized by a spontaneous nature and the rapid development of persistent, extremely bizarre rituals. Phobias in patients with schizotypal disorder also quickly become habitual. When talking about them, patients do not express any emotions. Fears are absurd - patients are afraid to see, for example, objects of a certain shape or color, to hear certain words uttered by a child, and so on. Sometimes at the beginning it is possible to establish a connection between a phobia and a psychotraumatic event, but over time its plot becomes more complicated and the origin of the fear is erased.

The patient “acquires” absurd rituals; they interfere with normal life and sometimes take a leading role in behavior.

Schizotypal disorder is characterized by depersonalization/derealization, in particular, dysmorphophobia, and patients are embarrassed by completely normal body parts, hide them, are embarrassed to show them. If there are real deformities, then patients ignore them. Hypochondriacal complaints are distinguished by bizarreness and unreality, abstruse diets are followed, the goal of which is also formulated in a not entirely typical way, for example, so that the face is not round, but oval.

The disease can manifest itself in different ways. Patients "engage in scientific work", doing it all day long, copying from various literature, useless and incoherent quotes that are difficult to even unite under a common theme; draw diagrams and drawings of unclear purpose; develop projects; discuss global, but very abstract topics, expressing their thoughts incomprehensibly and incoherently, deliver long monologues, not allowing you to insert a word or ask a question. Some patients conduct scientific experiments on themselves - try various toxic substances, lie in a cold bath, and so on. Such "experiments" can end in disability and even death.

In sluggish schizophrenia, both sexes experience frequent hysterical attacks that are quite strong and not associated with visible stressors. Hysterical attacks are characterized by deliberate caricature and demonstrativeness, increasing negativity, and unmotivated hyper-excitability. Affectation, affectation, inadequate grimaces, and grimacing gradually take on a monotonous form, become formulaic and uniform, emotional inadequacy, coldness, and callousness towards loved ones, especially parents, appear. Negative symptoms develop.

Age-related features

The age at which schizophrenia debuts is associated with some, although not at all obligatory, features of its course and prognosis for treatment - the later, the easier the disease progresses and the less destructive its consequences. The most unfavorable prognosis is characterized by hereditary congenital schizophrenia, although such a diagnosis can be made in a child from the age of seven. It is believed that at this age it is already possible to establish the presence of delirium and hallucinations. Specialists are trying to find criteria by which it is possible to diagnose schizophrenia in the very young. It is assumed that even infants have hallucinations and delirium. [ 5 ]

A child with schizophrenia behaves differently from his healthy peers. The presence of the disease in the youngest can be suspected by the manifestation of irrational fear - fear of toys and/or other objects of a certain color, shape, depicting some animal or cartoon character. Children with schizophrenia are indifferent, and sometimes even wary of their own mother, who is the most important key figure for a healthy young child. The behavior of a sick child is often inexplicable - he cries, gets angry, is capricious for no apparent reason, and reacts inadequately to attempts to attract his attention.

At a later age, when the child begins to enter into social contacts with other children and adults, manifestations of obsession, unfounded aggression, lack of desire to play with peers, indifference to walks, swings and other favorite children's entertainment attract attention.

A child who has mastered speech can tell his parents or older children about the voices he hears, you can notice that he responds to them, listens to something. Frequent, unreasonable mood swings, indifference to normal activities for children of the corresponding age, chaotic speech, inadequate reactions, endless whims and fears can indicate the development of schizophrenia in a child. Parents who have noticed these behavioral features are recommended to record their observations in a diary, then a psychiatric consultation will be more effective.

Schizophrenia most often manifests itself in adolescence, especially its severe forms - simple, catatonic, hebephrenic, both with a continuous and paroxysmal course. In addition, adolescence is often the debut of a low-progressive form of the disease - schizotypal disorder. Adolescence is quite difficult in itself and is characterized by high emotional stress, perhaps this is why the disease most often manifests itself during this period. Moreover, often before the onset of the disease, the teenager does not cause much trouble to parents - he studies diligently, is characterized as serious and responsible, his behavior does not cause complaints. Suddenly, the young man becomes difficult to manage, rude, indifferent to the closest people. He has difficulties with studies, loses interest in previously favorite activities, but new ones may appear, to which he devotes all his free time. Previously sociable teenagers withdraw into isolation, show a tendency to run away from home, use psychoactive substances, become sloppy, suspicious and aggressive.

Signs of schizophrenia in men aged 25, 30, 40, 50 years have virtually no age differences. In adults, the paranoid form most often develops. The development of the disease is gradual, personality changes increase over the years. Characteristic is the progression of alienation, secrecy, mistrust, caused by the appearance of delirium and hallucinations. When the disease manifests itself at a later age in a person who has managed to establish himself professionally, acquire a family and a certain social status, the prognosis in this case is most favorable.

In old age, schizophrenia rarely develops in men, progressing slowly. Such cases are much more common in women. Sometimes, elderly men experience an exacerbation of schizophreniform psychosis, which manifested in their youth and, as a result of successful treatment, did not manifest itself for a long time. It is not easy to recognize that a mental illness is precisely senile schizophrenia; it can be confused with dementia, neurotic disorders, and Alzheimer's disease.