A Simple Type of Schizophrenia

Simple schizophrenia was first described by O. Diem in 1903 under the name dementia simplex (from Latin - “simple dementia”).

Patients are characterized by such premorbid personality traits as shyness , timidity, timidity, infantility ^[4] , as well as pronounced schizoid traits - from excessive sensitivity and vulnerability to apathy , coldness and “affective dullness” ^[5] .

At the beginning of the course of the disease, a mental disorder is expressed in strengthening traits resembling an accentuation of character , and then there is a distortion of the traits ^[5] . The personality of zealous, obedient, polite adolescents suddenly changes: they become rude in communication, lose their feelings for close relatives or even begin to hate and unreasonably cruel to them, stop attending classes, lie on the bed aimlessly and feel indifferent to useful activities, sleep for a long time or wander, neglect the rules of hygiene and do not follow clothes ^[4] . The voice becomes monotonous, and facial expressions and motility are inexpressive.

Instead of productive activity, many patients begin to reflect on abstract topics, for example, on the problems of the universe, the meaning of life and death, plunge into the study of philosophy , linguistics and other theoretical sciences, which are usually not prepared for, which can be considered as a symptom of metaphysical intoxication ^{[4 ]} . The patient can engage in the construction of theories of philosophy divorced from reality, solve complicated mathematical problems, useless invention, collect unnecessary things, etc. ^[5] .

Persistent hallucinations and delusions with a simple form of schizophrenia are usually absent, but over time, such symptoms may appear. Catatonic or affective disorders appear less frequently ^[6] . Productive psychotic symptoms are possible at the onset of the disease, at the onset: unstable delusional ideas of persecution , attitude and special significance can be observed ^[7] , but after a short time it is reduced. Some researchers claim that delirium and hallucinations do not occur at all ^[3] , only rudimentary hallucinatory disorders can manifest themselves (“hail ”) and episodic delusional alertness ^[4] . Adynamic depression is often noted. , senestopathy and dysmorphophobia ^[5] .

Neurocognitive deficiency with simple schizophrenia is manifested in a deterioration of memory , distraction, difficulty in planning any activity and weak judgments ^[5] .

Disorders of thinking (“formal disorders of thinking” ^[8] , “disorders of the associative process” ^[9] , “disorders of the thinking process” ^[10] ) may be present. This is manifested in the impoverishment of speech, interruptions in the associative process (the so-called " sperprung "), inadvertent sliding off the topic. There may be a feeling of open thoughts (when other people supposedly can see or hear the thoughts of patients), delay, disappearance, influx or insubordination of thoughts ^[3] . Stereotypes may also appear: swaying, gestures, coughing, which some researchers refer to erased catatonic symptoms ^[11] . Uncertain hypochondriacal complaints may be present ^[3] .

In the initial period of the disease, the prevalence of psychopathic (36.8%), neurosis-like (29%) and apato-abulic (34.2%) symptoms is predominant ^{[12] [5]} . In the future, there is an increase in apato-abulic syndrome and a decrease in energy potential , an increase in the phenomena of mental automatism , and the formation of a mental defect ^{[6] [3]} .

Close relatives of the patient may not notice the manifestations of the disease and consider them a bad character or laziness ^[13] .

ICD-9

In the international classification of diseases, injuries and causes of death of the 9th revision ( ICD-9 ), a simple type of schizophrenia (code 295.0 ) is described as “psychosis, in which there is a rather rapid development of oddities in behavior, a decrease in the ability to satisfy the requirements of society, and a weakening of general activity " ^[14] . The classification also notes that hallucinations, delusions and other psychotic disorders are not so pronounced compared with paranoid, hebephrenic and catatonic schizophrenia. With increasing social maladaptation, the patient may begin to engage in vagrancy . Inactivity, aimlessness and autism are characteristic.

The need for careful diagnosis of this form of schizophrenia is noted, since its symptoms are not clearly identified.

: sluggish simple schizophrenia (code 295.52 ).

ICD-10

The diagnosis of simple schizophrenia according to the International Classification of Diseases of the 10th revision is made with an increase in negative symptoms of schizophrenia ( flattening of affect , loss of motivation) in a patient, accompanied by an increasing inability to meet the requirements of society, the development of oddities in behavior and a decrease in overall productivity ^[15] . Moreover, delusional disorders and hallucinations should not be noted ^[15] . A simple variant of malignant schizophrenia and simplex schizophrenia is included, schizophrenia “poor in symptoms” is excluded ( F 21. .5) ^[15] .

For the diagnosis of simple schizophrenia according to ICD-10, the following criteria must be met:

• A. Slow progressive development for at least a year of all three signs:

1. a distinct change in premorbid personality, manifested by a loss of drives and interests, inaction and aimless behavior, self-absorption and social autization;
2. the gradual emergence and deepening of “negative” symptoms, such as severe apathy , poor speech, hypoactivity , emotional smoothness, passivity and lack of initiative and poverty of non-verbal communication (determined by facial expression, contact in the look, voice modulation or posture);
3. a clear decline in social, educational, or professional productivity.

• B. The absence at any time of the abnormal subjective experiences referred to in G1 in F20.0-F20.3, as well as hallucinations or sufficiently fully formed delusional ideas of any kind, that is, a clinical case should never meet the criteria of any another type of schizophrenia or any other psychotic disorder.
• C. Lack of data for dementia or other organic mental disorder as presented in section F0.

Original text

• A. Slowly progressive development over a period of at least one year, of all three of the following:

1. A significant and consistent change in the overall quality of some aspects of personal behavior, manifest as loss of drive and interests, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.
2. Gradual appearance and deepening of “negative” symptoms such as marked apathy, paucity of speech, underactivity, blunting of affect, passivity and lack of initiative, and poor non-verbal communication (by facial expression, eye contact, voice modulation and posture).
3. Marked decline in social, scholastic, or occupational performance.

• B. Absence, at any time, of any symptoms referred to in G1 in F20.0 — F20.3, and of hallucinations or wellformed delusions of any kind, ie the subject must never have met the criteria for any other type of schizophrenia, or any other psychotic disorder.
• C. Absence of evidence of dementia or any other organic mental disorder listed in section F0.

- International Classification of Diseases , 10th revision. Research Diagnostic Criteria ^[16]

A. Kalinovsky distinguishes the following diagnostic criteria for a simple type of schizophrenia ^{[17] [3]} :

• a) a decrease in overall activity and initiative;
• b) a gradual loss of interest;
• c) autism ;
• d) violation of contact with others, up to self-isolation;
• e) formal disorders of thinking;
• f) affective disorders (impoverishment and inadequacy of emotions);
• g) ambivalence ;
• h) lack of criticism of painful manifestations.

Variants of the flow

The designation of the types of disease according to ICD-10:

• continuous F20.60
• episodic with increasing defect F20.61
• episodic with stable defect F20.62
• episodic remitting F20.63

Incomplete remission is indicated by the code F20.64, and full F20.65.

Differential Diagnosis

Schizoid personality disorder demyelinating sclerosing leukoencephalitis should be ruled out. Differential diagnosis of simple schizophrenia from accentuations of character and personality disorders can present certain difficulties ^[5] .

DSM

The "simple type of schizophrenia" ( English schizophrenia, simple type , code 295.0) was present in the second edition of the American "Diagnostic and Statistical Manual of Mental Disorders" - DSM-II of 1968 ^[18] . In it, he was described as “a psychosis characterized by a slow and without obvious symptoms decrease in external attachments and interests, apathy and indifference, leading to the impoverishment of interpersonal relationships, intellectual degradation and adaptation to a lower level of functioning” ^[18] . There was also a contrast with schizoid personality disorder , in which the progression of symptoms is small or absent ^[18] .

In DSM-III and DSM-III-R, a simple type of schizophrenia is not mentioned.

In DSM-IV and DSM-IV-TR, a simple type of schizophrenia is not a recognized diagnosis, but Appendix “B” lists “a set of criteria and axes for further study,” which mentions a simple schizophrenia called a “simple progressive disorder”. simple deteriorative disorder (simple schizophrenia) ) ^{[19] [20]} .

The criteria for a simple progressive disorder were as follows ^[19] :

• the progression of the disorder for at least 1 year;
• noticeable decline in professional or academic productivity;
• poor interpersonal relationships and social exclusion ;
• gradual emergence and exacerbation of negative symptoms, namely affective flattening, lack of will and alogy ;
• there is no compliance with the criteria “A” of schizophrenia (the presence of 2 or more of the following symptoms at the same time: delirium , hallucinations , disorganized speech, rude disorganized or catatonic behavior , negative symptoms);
• schizotypal and schizoid personality disorder , psychotic disorder, affective disorder, anxiety disorder , mental retardation and dementia are excluded ;
• the condition is not caused by the direct physiological effects of the substance or the general medical condition.

DSM-5 does not include this disorder. In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, a related (but not identical) criteria disorder is schizotypal personality disorder .

Like hebephrenia , a simple type of schizophrenia usually begins in adolescence and youth. The course is slow, continuously progressive, the onset of remission is almost impossible to establish. Many psychiatrists note that the malignant course of a simple type of schizophrenia is much less common than sluggish ^[5] .

Psychopathic and neurosis-like types of course are also distinguished ^[3] . Some researchers highlight other variants of a simple type of schizophrenia: “psychopathic”, debuting in adolescence and “pseudo-oligophrenic”, developing in childhood ^{[21] [5]} .

Some psychiatrists question the existence of a simple form of schizophrenia. In this case, the "simple type" is considered either as a rapidly forming defect in paranoid schizophrenia, or as a clinical variant of hebephrenic schizophrenia. Karl Jaspers and Karl Leonhard doubted the existence of this form ^[3] . Emil Kraepelin considered the simple form of schizophrenia rare ^[3] .

For a simple type of schizophrenia, small doses of antipsychotics are used , as well as insulinocomatosis therapy ^[13] (although it is sometimes suggested that insulinocomatosis therapy can worsen the condition with simple schizophrenia ^[22] ).

With simple malignant schizophrenia, clozapine can be used ^[23] . Long-term use of clozapine gives a slight smoothing of negative symptoms and slows down the course of the disease ^[23] . 2nd-line drugs in the treatment of simple malignant schizophrenia are atypical antipsychotics of a new generation ^[23] . Atypical antipsychotics of the new generation do not cause a pronounced inhibitory effect and extrapyramidal effects , therefore, their use usually does not cause the development of secondary negative disorders ^[23] . However, the ability of atypical antipsychotics to reduce the severity of primary negative symptoms still does not have reliable evidence ^[23] .

When using quetiapine , an improvement in the condition of patients was most often observed ^[23] . The literature describes cases where the use of quetiapine, risperidone, and amisulpride in patients with a simple type of schizophrenia caused recovery and some activation ^[23] .

Studies have shown the effectiveness of the direct precursor of dopamine - levodopa in the treatment of a simple type of schizophrenia ^[24] . When it was taken in patients, the tendency to isolation, apathy, emotional estrangement, flattened affect decreased, and no additional productive symptoms were caused ^[24] .

It is not recommended to use traditional / typical antipsychotics ( haloperidol , chlorpromazine , etc.) because of the likelihood of increasing the severity of negative symptoms ^[23] .

• Sluggish schizophrenia
• Schizotypic disorder
• Symptomatic Poor Schizophrenia
• Antipsychotic deficiency syndrome
• Hospitalism

• To study the clinic of a simple form of schizophrenia
• Schizophrenia in adolescents. Simple form