Mosaic schizophrenia

Mosaic - translated from French means a motley mix, in a broader sense - something consisting of heterogeneous elements. In medicine, this term refers to diseases that have signs of different forms that can not be attributed to any one type of disease. In modern classifiers, such pathological conditions are preferred to be called mixed (the English version is “mixed”), completely eliminating the metaphorical definition.

Mosaic polymorphic psychopathy was still distinguished in the previous version of the disease classifier (ICD-9), and mosaic schizophrenia in authoritative sources has not been mentioned for a long time. This term is found mainly in the articles, one way or another mentioning the biography of Friedrich Nietzsche and the disease, which at the end of the XIX century, apparently, was so called. In modern versions of classifiers, serious books and articles on psychiatry, the definition of "mosaic" in relation to schizophrenia is no longer encountered, although in everyday life such wording can still be encountered.

What it is?

Former psychopathies, and now severe personality disorders, as they often bring a lot of inconvenience and suffering to the subject and his environment, can lead to isolation and social disintegration. But, at the same time, the psychopath cannot be counted among the patients, because its features are not associated with organic brain damage and are not manifestations of diseases. At least at the present level of diagnosis, it is not possible to detect painful changes in the body, although the mentality of the subject is clearly not all right. In ICD-10, dependent, hysterical, anxious, paranoids, schizoids, sociopaths and others are identified, a total of eight main types and six more, ranked among others. So, mosaic psychopathy does not fit the description of any of the types listed in the classifier. Mosaic or confusion is manifested in the fact that one character has symptoms of several disorders at once, sometimes completely polar. They are so mixed that the core syndrome cannot be distinguished. However, despite the possible progressive social isolation of the psychopath due to his inadequate personality traits, the patient’s intelligence (mental abilities) remains intact.

If we are talking about schizophrenia, then in modern interpretation, it is a serious progressive disease, resulting in mental retardation. Mosaic schizophrenia, in relation to Nietzsche's example, is, above all, an obsession with a supervaluable idea. Psychiatrists notice that not only schizophrenics, but also psychopaths, who have a mixture of symptoms of schizoid and psychasthenic type, besides, are prone to radicalism, appear to the emergence of overvalued ideas and their fanatical advancement.

Psychopaths, unlike schizophrenics, are sane and are well aware of their actions, so they share the same criminal liability for committing unlawful acts. However, a whole group of personality disorders are classified among mental illnesses, since their manifestations differ significantly from the generally accepted norms in society and cause significant anxiety to the subject himself and the people around him. Often the behavior of a psychopath is simply socially dangerous.

Epidemiology

Statistics also do not have exact figures. Psychopaths, in the main, come into the view of researchers only after they have committed crimes and sentenced them. The frequency of occurrence of psychopathies of all kinds is estimated as follows - every twentieth inhabitant of the planet can be a psychopath, every tenth - has separate psychopathic character traits, but still is not a psychopath in the full sense of the word. The vast majority of psychopaths belong to a strong half of humanity - their share is estimated at 80%.

Causes of the mosaic schizophrenia

A person acquires the traits of a psychopathic personality under the influence of many factors. It is assumed that the formation of pathological properties of character occurs mainly at a very early age. It is the influence of adverse external stimuli in the first three years, when the formation of complex behavioral skills that contribute to adaptation in society, and even to a child with a hereditary predisposition, is considered the most destructive. In older children, according to experts, the susceptibility to adverse external influences becomes lower, however, if the effect of negative stress factors continues, then the behavioral features increasingly deviate from the norm.

The development of genetics made it possible to detect a specific kind of genes whose carriers are distinguished from nature by cruelty, egoism, lack of empathy for the sufferings of other people, aggressive behavior. The MAO-A gene (warrior gene, aggression gene) encodes monoamine oxidase A in a certain way, influencing biochemical reactions involving neurotransmitters that regulate mood and behavior — dopamine, serotonin, noradrenaline, melatonin, histamine. The carrier of this gene does not necessarily grow into a psychopath, the atmosphere surrounding it from early childhood is of great importance. The friendly and warm atmosphere in the family, combined with the control of the child’s behavior and certain restrictions, contribute to his socialization.

Unfavorable living conditions, violence, cruelty, the child becomes a witness or participant, an early addiction to alcohol and / or drugs activates the gene of aggression.

By origin, psychopathy is divided into congenital and acquired. The nuclear (innate) form is due to heredity, the constitution of man. Manifested from childhood and under adverse external conditions in which the child grows, develops into a stable asocial behavior.

Acquired divide into regional and organic. The latter are considered as behavioral abnormalities within the framework of any damaging action that caused cerebral insufficiency and are not classified as psychopathies.

Regional acquired at a later age and are associated with a very unfavorable environment. They are considered less stable and deep than nuclear ones, and since the formation of pathological personality traits occurs later and only under the influence of a number of unfavorable factors. They also often fail to classify their appearance; therefore, acquired psychopathies are often referred to as mixed (mosaic) personality disorders.

[1], [2], [3]

Risk factors

Risk factors for the formation of psychopathy, including the mosaic form, include:

• inheritance of a tendency to aggression - among psychopaths, researchers have revealed a reduced activity of the temporal frontal lobes of the brain, responsible for the quality of empathy and the formation of high moral standards;
• pathological pregnancy and childbirth of the mother psychopath;
• injuries and diseases at an early age that influenced the formation of the central nervous system;
• family history, burdened by syphilis, alcoholism, drug addiction;
• parents' indifference to their child, including both excessively harsh upbringing and permissiveness;
• bullying, cruelty, violence in the family or among the inner circle;
• substance abuse;
• periods of age crises and hormonal changes.

Modern psychiatry has not come to a consensus today on the mechanism for the development of a mixed personality disorder, as well as its other forms.

[4]

Pathogenesis

The pathogenesis of psychopathy is considered from the point of view of different theories, and none of them yet provides a complete picture of mental disorder. However, researchers are unanimous in the opinion that the basis of psychopathy is laid in the early period of child development, when a negative social factor is superimposed on the hereditary predisposition, and it plays a major role in the development of regional psychopathy.

The psychodynamic concept, built on the teachings of S. Freud, considers personality disorder as a defensive reaction to pathological relationships within the family.

The followers of IPPavlov explain the occurrence of personality disorders to pathological imbalances in the system of excitation and inhibition, the practical absence of the latter, the weakness of higher nervous activity, and the uncoordinated work of the cortex and subcortex of the brain.

American neuroscientists who study psychopaths who are serving sentences in prisons for committing serious crimes have found that the tomogram of their skull has some peculiarities.

However, there is still no unified pathogenetic theory that would provide exhaustive explanations for such a phenomenon as psychopathy, let alone its forms.

Regardless of the type of personality disorder, the psychopathic scenario unfolds as a closed loop. Defects in the personality of the individual lead to the creation of a conflict situation, as a result of which he develops a psychopathic reaction that lasts more or less long time. Russian and Soviet psychiatrist P.B. Gannushkin, who devoted the study of personality disorders a significant part of its activities, notes that a certain dynamics is peculiar to psychopathy. The environment has the greatest influence on dynamic processes, as a result of which the pathological features of the psychopathic personality are weakened or strengthened. After the end of the next period of decompensation disorders observed aggravation of defective features of nature.

[5], [6],

Symptoms of the mosaic schizophrenia

The nature of mosaic psychopaths is accentuated in several directions, it is not possible to choose their belonging to any one type.

Such an individual can combine the features of a suspicious, suspicious and touchy paranoid, always right and possessing high self-esteem, with schizoid fantasies and the impulsiveness of an emotionally unstable type prone to self-destructive behavior.

The combinations can be varied - a combination of two or more types of disorders, lack of persistence of the core psychopathic syndrome, its variability and is the main clinical sign of a mixed personality disorder.

Experts distinguish the main traits of psychopaths, according to which a person can be attributed to this category - the psychopathic triad.

1. Reckless daring, fearlessness, lack of a sense of danger, tremendous self-confidence and the ability to quickly make a decision allows them to become leaders, show themselves in extreme situations and earn the respect of others.
2. Selfishness in combination with the absence of inhibition is an impulsive action aimed at immediately satisfying one's own desires, not taking into account anything and no one, not thinking about the consequences of the actions committed. Psychopaths are always guided, first of all, by their desires.
3. The lack of ability to empathize even with the closest people, emotional dullness, entailing a train of mean, from the point of view of public morality, deeds.

These features are characteristic of all forms of psychopathy, psychopaths always do this - both excitable and asthenic, inhibited, above all, protect their interests. It is precisely ruthlessness and egoism, with the complete absence of repentance, sometimes well disguised, that distinguish the psychopathic personality from the ordinary person, who also sometimes acts selfishly, can deceive and support, and then experiences and tries to justify and smooth his guilt. Psychopaths are brilliant manipulators and ruthless exploiters; they use the empathy of others to achieve their goals, and they can react to insubordination by harsh aggression. Moreover, these people are always self-righteous, satisfied with themselves, show a complete lack of principles and are prone to sadism, physical and moral.

The first signs of nuclear mosaic psychopathy can be seen already in childhood. Basically, parents pay attention to cruelty towards their peers and / or other living beings, the desire to necessarily dominate, to command not only other children, but also adults, to try to use force to dissent, not paying attention even to the physical superiority of the enemy. Aggression is characterized by great rage and perseverance. Anyone can show such inclinations, but ordinary children react to explanations and exhortations, and small psychopaths are not amenable to any persuasion. They are characterized by a visible lack of repentance, a complete misunderstanding of their own guilt (there is always another guilty person) and, most importantly, such children are not afraid of punishment. Obedience can be obtained from them only by promising them their reward.

It is worth considering if small children constantly offend their friends and adults, snarl, not reacting to admonitions and punishments, take other people's things without asking, try to dominate in any environment. Adolescents in general become unmanageable, they cannot be intimidated by any threats or convincing logically. Not wanting to obey, they often run away from home, get into bad companies and commit unlawful acts. The feelings of others, even the closest ones, are not interested in psychopaths at any age.

However, not everything is so gloomy. Upbringing in a benevolent atmosphere smoothes pathological character traits to a certain limit. Socialized psychopaths are perfectly assimilated in society, make a good career, sometimes reach great heights (VI Lenin, IV Stalin, AG Lukashenko are among the mosaic psychopaths). They have families and a circle of friends, assessing them sufficiently positively, although noting recklessness and fearlessness, a tendency to unusual, often outrageous actions, selfishness and the ability to achieve their own, not too reckoning with the interests of others.

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Forms

Mosaic psychopathy is realized in active, passive and mixed forms. To active, in particular, include the already mentioned political leaders, bigwigs of big business. Experts say that there are about 1% of psychopaths in the population, but more than 5% are among managers at various levels. As a favorite job, or rather, the most frequently held position is called "chairmen of the board."

In ICD-10, the following specific disorders of the personality spectrum are distinguished:

• paranoid - these are suspicious, sensitive and highly suspicious people with high self-esteem, distinguished by a stubborn sense of self-righteousness and convinced of the intentions of others to deceive their trust, which in fact is not to anyone (a typical example is jealous);
• schizoid - closed, prone to self-digging, fantasies, anhedonia, not in need of spiritual affection and even a minimal circle of communication;
• dissocial - sociopaths are distinguished by a significant discrepancy of their behavior to the basic norms adopted in society, the psychopathic triad is expressed to the maximum in this case, and the fear of punishment does not stop them, they easily become enraged and can commit any acts of violence;
• emotionally unstable or excitable - easily come to an excited state in which they are not able to control their behavior;
• hysterical - also easily excited, but their excitability is superficial, more like a theatrical performance in order to attract attention;
• anankastnye - uncertain, meticulous and scrupulous, cautious, but very stubborn, overwhelmed by obsessive ideas, actions that, however, do not reach the height of mania;
• anxious - prone to exaggerating the impending dangers, suspecting others that they are underestimated, hypersensitive to criticism and refusal;
• dependent - do not tolerate loneliness, such people need to obey any of their relatives and / or friends, they are not able to make independent decisions even in small things, the behavior is directly dependent on the chosen idol;
• among others, there are more daffodils, eccentrics, disinhibited, infantile, passive-aggressive and psychoneurotic.

Mosaic psychopaths combine in their behavior at least two types, and sometimes more, of the listed disorders, and the manifestations are so unstable that they cannot be attributed to any type. Mixed personality disorder makes it difficult for the subject to adapt to society, it is also not easy for others to adapt to coexistence with such a person. P.B. Gannushkin called mosaic psychopaths constitutionally stupid, but looking back at historical examples, it is difficult to agree with that.

The most dangerous combination is an antisocial personality with hysterical traits and emotional instability. Such people easily fall under the power of various addictions - they become drug addicts, alcoholics, ludomans (pathologically gambling players), sexual perverts and often overstep the line of law.

The presence of polar symptoms in one subject, for example, hyper-excitability in combination with psychasthenia, should alert the physician and carefully examine the patient for the presence of schizophrenia.

Psychopaths with schizoid and psychoasthenic traits most often devote their lives to the realization of supervaluable ideas, some confine themselves to uplifting, while others threaten to reorganize the world.

If you go back to the example of F. Nietzsche, who was diagnosed by his contemporaries - nuclear mosaic schizophrenia, currently interpreted as an obsession, then perhaps now he would be rated as a mosaic psychopath. And significant personal changes would be attributed to syphilis. After all, if a psychopathic person by nature becomes infected with an infectious disease or suffers a head injury, and this leads to the development of an organic cerebral deficiency, the personality structure is transformed very significantly, and mental degradation occurs.

Obsession with any idea can overcome and schizophrenics. This symptom is additional, but if it exists, it appears at the height of hypomania.

Mosaic or confusion is peculiar to different processes - cognition, thinking, feelings. This concept means superficiality, inconsistency, fragmentaryness. For example, mosaic memory (fragmentary memories, lack of consistency, the inability to create a coherent picture) and broken, symbolic thinking are more likely symptoms of schizophrenia. The mosaic of thinking in this case speaks of a far advanced stage of the disease and is manifested by schizophasia - “verbal okroshka”, absolutely meaningless, associatively unrelated speech, when its parts are combined purely mechanically. Patients, nevertheless, remain in a clear consciousness, fully retain all types of orientation, and their speech in most cases is constructed grammatically correctly. Although these symptoms are inherent and schizoid psychopaths in the stage of decompensation.

Psychopaths can be in two states. Socialized or compensated live with us nearby, study, work (often successfully), create families and do not count, because they do not consider that something is wrong with them, they don’t go to doctors and, being law-abiding citizens, do not fall into the field view of researchers. Staying in the world with society is usually achieved through comfortable living conditions for the psychopathic personality.

Decompensated state is a pathological psychogenic reaction that occurs as a result of adverse external factors. In mosaic psychopaths, the reactions can be very different, since the core symptom complex is absent.

[8], [9]

Complications and consequences

Compensated mixed personality disorder does not prevent people from leading a normal life, get a good education and achieve very significant success in life. If you believe that Lenin and Stalin were the mosaic psychopaths, then the consequence of this disorder was the creation of a state with a fundamentally new social system that existed for 75 years, which should not be underestimated.

Decompensated mosaic psychopathy can be dangerous both for society and for the subject himself. Symptoms of decompensation are the aggravation of antisocial personality traits, and in a mixed disorder, the specificity of affective disorders is diverse. It is very difficult for such a person to adapt to coexistence with other people, just as they adequately perceive him.

Under various adverse living conditions, a fully sociopathic personality can form. Such people are badly tolerated by failure, tend to blame others, are easily amenable to aggression and commit illegal actions. Among the contingent serving punishment for serious crimes, more than a third are psychopaths.

The consequence of frequent decompensations can be life in isolation of the subject himself, his suicide or the commission of violent crimes.

[10]

Diagnostics of the mosaic schizophrenia

People who are socially maladapted are turning to psychiatric help; decompensated psychopathy prevents them from assimilating into society. Or in the field of view of research get subjects who have already committed criminal acts.

The main diagnostic tool are various test questionnaires, which allow to detect a stable combination of personality characteristics, positive and negative, characterizing a given individual. According to the results of the survey and the amount of points scored, it can be concluded whether the given personality is psychopathic. Some tests allow you to determine the form of personality disorder. There is no specific test for mosaic psychopathy, since this form of the disorder does not imply a single symptom complex. It is possible to assume the presence of a mixed personality disorder when, as a result of testing, traits of different personality types appear.

A standardized multifactorial personality study (in the original Minnesota multidimensional personality test) reveals the affinity of the person being tested for a particular type of psychopathy (paranoiac, asthenic, schizoid), establish the degree of anxiety and propensity for antisocial actions, the presence or absence of sexual perversions. In the test, there are also additional scales that allow one to assess the degree of sincerity of the subject, as well as to make adjustments to his inaccurate answers. The whole scale (fourth) is devoted to the propensity for antisocial behavior. High scores that assess the responses of this scale, indicate the impossibility of socializing in society.

When a researcher gets high scores for the presence of personal characteristics belonging to different types of psychopathies and it is impossible to isolate any one type, he is diagnosed with a mixed personality disorder. These are the only criteria for the diagnosis of mosaic psychopathy.

The test of R. Heyr is also used, to which the autobiography of the interview is attached. This test was intended for perpetrators of unlawful acts; therefore, the facts from the biography of the subject had to be documented, since the psychopaths do not differ in their sincerity.

There are other evaluation methods for the patient’s self-assessment, or a survey is conducted and points are given by a specialist. Often used an integrated approach. The quality of an individual’s relationships with other people is studied, his abilities to learn new things, the level of perception, attention, and memory are explored.

Various researches are used - the general level of health is estimated with application of the latest laboratory and tool researches. If an individual has any mental illness, organic damage to the brain structures, or somatic pathologies, then the diagnosis is based on the underlying disease.

You can recognize a person as a psychopath according to the following criteria (according to Gannushkin) - psychopathic features are stable, total, always manifest and make social adaptation difficult, and in advanced cases make it impossible at all.

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Differential diagnosis

The mixed personality disorder in the psychiatric hierarchy according to the severity of the disorder follows the extreme standard of the norm - character accentuation corresponding to the forms of psychopathy. Sustained mosaic anomalies of character appear with accentuation, however, the main diagnostic criterion for differences is the severity of these features. With accentuated personalities, their traits are not a barrier to assimilation in society, they do not reach the height of pathology. The differences are clearly quantitative.

The leading pathological features determine the type of personality disorder, and if it is impossible to isolate it, a mosaic is diagnosed.

Mosaic psychopathy is differentiated from psychopathic post-traumatic disorders, the consequences of infectious diseases, poisonings, endocrinopathies and other pathologies accompanied by damage to the central nervous system, establishing the fact of quite normal development before the appearance of psychopathic symptoms.

There are also constitutional (nuclear) psychopathy with acquired, occur at any age under the influence of psychotrauma. They are distinguished from congenital by a clear onset and connection with a stressful event. Signs of nuclear psychopathy are noted already in early childhood.

Nuclear schizophrenia differentiates with mosaic psychopathy. In states, there is much in common. Schizophrenia has already ceased to be classified by American psychiatrists by type, and ICD-11 is also intended not to single out its types, since the disease is distinguished by a variety of symptoms and its type does not matter for treatment. Its nuclear form is manifested early, already in puberty, the formed pathology is observed in early adolescence (by the age of 18–20). Schizophrenic dementia develops fairly quickly, has a continuous malignant course. For psychopathy, the development of dementia is not typical at all.

[12], [13], [14], [15]

Treatment of the mosaic schizophrenia

With psychopathy, people live their whole lives, the compensated state does not require intervention, but the stage of decompensation is always accompanied by difficulties in social and personal terms. During this period, it becomes necessary to assist the patient to compensate for abnormal characterological deviations.

Psychotherapy comes to the fore. It is difficult to work with such patients, since their deceit and ability to manipulate actions can reverse the whole program of classes, especially group ones. Therefore, in the first place, preference is given to individual programs. Personal attitudes of the patient are corrected in terms of forming ideas about the need to comply with moral norms and rules in dealing with other people. The emphasis is placed on the fact that such a position is beneficial, above all, to the patient himself. The awareness of the need for rational attitudes and aspirations for productive activities is intensified. Classes are held in the form of explanations and discussions, if necessary, can connect family members to classes.

Drug treatment is used in case of emergency, when agitation or depression interferes with the patient's rational thinking and acting, with severe and deep decompensated psychopathies, it may be necessary to have a permanent medical correction with psychotropic drugs. There are no specific drugs for mosaic psychopathy. Medicines are selected individually, taking into account the prevailing symptoms of the disorder and their selective action:

• including braking function;
• mostly retarding with a moderate stimulating effect;
• providing a stimulating effect only;
• predominantly stimulants with moderate inhibition effect;
• providing a general or selective antipsychotic effect.

Only if the range of the psychotropic action of the drug is fully consistent with the structure of the psychopathological symptoms, the therapy will be successful. A mosaic psychopathy is characterized by a large variety of manifestations, and this is the difficulty in relieving the decompensated state.

For the treatment of primarily excitable psychopathic manifestations, low doses of neuroleptics are used. Aminazine, the first drug with a powerful antipsychotic effect and equally impressive side effects, is still used. Its strength of action is a reference and is taken as the unit of measure of the antipsychotic effect of the drug. More modern neuroleptics often have a higher aminazin coefficient and fewer side effects in the form of extrapyramidal disorders (stiffness and muscle spasms, tremors in the body, excessive salivation, etc.), which in all such drugs are related to their ability to change the concentration of dopamine in the synaptic cleft.

For example, Sonapaks, which has an antipsychotic effect, is comparable in strength to Aminazine, but has practically no extrapyramidal symptoms and does not cause drowsiness. Its antipsychotic effect is anti-anxiety. The drug copes well with obsessions and moderately activates productive activities.

Teraligene is one of the last drugs of the aliphatic class, it is characterized by the mild effect of sedation and stimulation. It does not stop delusional hallucinatory conditions, however, produces a good anxiolytic effect, helps normalize sleep and eliminates allergic reactions.

Atypical neuroleptic Seroquel manifests affinity for both dopamine and serotonin receptors. Copes with hallucinations, delusions, paranoia. The power of antipsychotic action is comparable with Aminazin. Seroquel has an antidepressant and moderately stimulating effect.

With pronounced affective symptoms, antidepressants are used. Sometimes they are prescribed in combination with antipsychotics, if there are attacks of rage, delusions and hallucinations.

In severe asthenia with depressive moods, Befol may be prescribed. The anti-depressant Humoril is preferred for patients with severe inhibition, in addition, it does not possess cardiotoxic properties and does not block cholinergic receptors. Reversible monoamine oxidase inhibitor Pirlindol is indicated in patients with severe anxiety. It can be used to treat patients with diseases of the heart and blood vessels, glaucoma and inflammation of the prostate gland. With the symptoms of “major” depression and pronounced suicidal intentions, tricyclic antidepressant Melipramine is used, and a serotonin reuptake inhibitor Prozac is prescribed to patients with cardiovascular pathologies. It has a noticeable timonoanleptic effect, eliminates melancholy, lethargy, stops surges of arousal.

Tranquilizers (Lorazepam, Atarax) are also used, relieving fear and tension associated with it. Psychostimulants (Sidnofen, Mesocarb) improve performance, contribute to maintaining control over their behavior. Attacks of mania are stopped by mood stabilizers - lithium salts, Carbamazepine.

When treating neuroleptics to relieve attacks of drowsiness and lethargy, nootropics, stabilizers of brain activity, may be prescribed as additional drugs.

Dispense drugs individually, depending on the identified symptoms and prescribe short courses to avoid addiction. The treatment is mainly outpatient. The indications for emergency hospitalization at a psychiatric hospital (without the patient’s consent) are severe bouts of aggressive behavior, a state of acute psychomotor agitation, which are dangerous to others or the psychopath himself.

Nuclear mosaic psychopathy is incurable, however, long-term compensation for the condition of the individual is quite possible.

Prevention

A childhood spent in a close-knit family, whose members love and protect each other, is a guarantee that even if the child has psychopathic character traits, he will grow up as a socialized individual. It is especially important to pay attention to the adolescent period, when the formation of the personality takes place, and the child already feels himself adult and free. A good effect is given by regular exercise - the child is busy, he has the excitement to become the first.

For both children and adults, alternative medicine can be used to prevent a decompensated condition or consult a homeopath. Herbal remedies and homeopathic remedies, especially those prescribed by specialists, will help correct behavioral abnormalities, allay anxiety and anxiety, normalize the emotional background, and return to work. In addition, these funds are devoid of side effects.

Since decompensation is caused by external factors, it is necessary to strive to avoid them, if possible.

[16], [17]

Forecast

Of course, the mixed personality disorder of all types of psychopathies is the most difficult, however, there are examples, including historical ones, of complete social adaptation and success of mosaic psychopaths. The prognosis completely depends on the conditions in which an individual with psychopathic features of character will grow and develop.

[18], [19]