The influence of psychogenic factors on the onset, clinical picture and course of schizophrenia and schizoaffective disorders (literature review). 0 illik yubileyinə həsr olunmuş elmi əsərlərin məjmuəsi. Bakı: “Səda” 2007 The influence of psychogenic factors on the onset, clinical picture and course of schizophrenia and schizoaffective disorders (literature review). The issue of the relationship between psychogenic factors and endogenous diseases has been studied throughout the development of psychiatry, but, despite a number of numerous studies, it still remains controversial. Two positions of scientists can be distinguished on the issue of the influence of psychotraumatic factors on endogenous diseases. Kraepelin, Mayer-Gross, Krause, in their works point to the insignificant dependence of procedural diseases on stressful situations. Other authors (K.G. Jung), on the contrary, suggest a significant role of psychogenic factors in the formation of schizophrenia. Research by Russian psychiatrists (Yanushevsky, Rokhlin) over the years The Great Patriotic War showed that, under the influence of the military situation, endogenous patients were willingly involved in work and helped with housework, as a result of which their social readaptation and even cases of clinical recovery were observed. This issue has not yet been fully studied. For example, the influence of a chronic stress factor, calculated over many years, on the clinical picture and dynamics of endogenous diseases that have already begun is poorly covered in the scientific literature. While in the literature there are known cases where, under the influence of psychogenies, some patients experienced an improvement in their condition. This review reflects the views of various researchers on the influence of psychogenic factors on the onset, syndromogenesis and prognosis of schizophrenia and schizoaffective disorders.1. The influence of psychogenic factors on debut and exacerbation At the beginning of the last century, researchers of the problem of the influence of psychogenic factors on schizophrenia assumed the existence of a special reactive lability that develops against the background of a process disease. In 1929, J. Berze [24] proposed using the term “reactive schizophrenia” to refer to numerous syndromes that occur in patients with schizophrenia in a stressful situation. Smulevich A.B. [16, 17], studying the influence of psychogenic factors on the onset of schizophrenia, noted that before contracting schizophrenia, patients experienced repeated reactive states. Thus, some patients experienced phenomena of reactive lability - readiness for the occurrence of psychogenic reactions. Smulevich calls such reactive lability “acquired,” since the cause of increased sensitivity to the effects of psychotraumatic factors is not the constitutional characteristics of the patient, but the properties of the procedural disease. Research conducted by Tsaruk T.P. [22]. E. Bleuler also pointed out [1], noting that under the influence of stressful situations, prison inmates can develop schizophrenia. K. Jung [23] also pointed out the leading role of psychosocial factors in the genesis of schizophrenia. Among the Russian scientists who contributed to the study of this problem are Krasnushkin E.K. [9] argued that an acute psychogenic factor provokes a catatonic form of schizophrenia. Snezhnevsky A.V. [18] pointed out that at the onset of paranoid and catatonic forms of schizophrenia, patients under the influence of a psychotraumatic situation may develop figurative sensory-specific delusions, difficult to distinguish from psychogenic paranoid. In the 60s and 70s, Russian psychiatrists (Felinskaya N.I., Morozov G.V., Gerasimov S.V., Ilyinsky Yu.A., Efremov) studied the features of the formation of schizophrenia underthe influence of a psychotraumatic situation in a forensic psychiatric clinic. Felinskaya N.I. [21] wrote about the possibility of an endogenous disease occurring after a prolonged reactive state. The author concludes that as a result of the reactive state, the “soil” changes and the conditions for the emergence of the schizophrenic process become easier. Gerasimov S.V. [2] studied the clinical features of a manifest attack or onset that developed under the influence of psychogenic factors. The attacks in patients developed either as hallucinatory-paranoid attacks with hysterical inclusions, or as stuporous syndromes. A number of patients at the time of exacerbation had catatonic disorders that had not been observed before. Morozov G.V. [13], studying the impact of a psychogenic factor on the onset of schizophrenia, comes to the conclusion that the psychogenic debuts of schizophrenia differ in their psychopathological structure from the initial period of schizophrenia, which occurred without the influence of exogenous factors. Moreover, the clinical picture of psychogenic debuts depended on the time of exposure to a traumatic situation. If The initial stage of the endogenous process coincided in time with the influence of a psychogenic factor, then the psychopathological picture, changing, creating a kind of “psychogenic facade,” was nevertheless unstable, its dynamics did not correlate with the course of the endogenous disease. Thus, if a psychotraumatic situation was initially reflected in the plot of delusional ideas of relationship, persecution, then later the delusional ideas were polythematic in nature, affective fluctuations were autochthonous and did not depend on the psychogenic situation. If the psychotraumatic situation preceded the beginning of the endogenous process, the clinical picture was formed according to the type of reactive psychosis. Schizophrenic symptoms were fragmentary and unstable. Subsequently, specific procedural symptoms came to the fore in the clinical picture. The initial syndrome turned out to be a certain stage in the course of schizophrenia. Nguyen D.Z. [15] studying the influence of exogenous factors (psychogenies, infections, intoxications) on the debut and exacerbation of recurrent and paroxysmal-progressive schizophrenia, concluded that patients with periodic schizophrenia are more sensitive to exogenies at the beginning of the process. At the same time, the author found that if the first attack was preceded by exogeny, then in the future the frequency of attacks with exogeny was higher. Some researchers (Tsaruk T.P. [22], Smulevich N.A. [16]) pointed to the influence of age-sex factors for psychogenically provoked conditions. Thus, in patients at a later age, the likelihood of developing reactive disorders increases. Tsaruk T.P. It was noticed that the frequency of development of reactive symptoms in women with schizophrenia exceeds that in men. Efremov V.S. [3] it was found that the number of cases of the onset of the schizophrenic process was greater in situations where patients were exposed to stress factors than in control groups. In contrast to the data obtained by V.S. Efremov, according to the results of studies by some American scientists (WPHoran, J. Ventura, KH Nuechterlein, KLSubotnik, SSHwang, J. Mintz, [26]), persons with recent schizophrenia had a lower history of traumatic events than healthy people. MR Castine et al. [25] studied the role of psychogenic factors (stressful life events) in the onset and exacerbations of schizophrenia and schizoaffective disorders. Psychogenies were more often associated with the first, second and third exacerbation of mental illness than with subsequent ones.2. The influence of psychogenic factors on endogenous diseases during the period of remission. The reactions of patients in remission to psychotraumatic situations are of great practical interest. The influence of psychogenic factors on the course of paroxysmal-progressive schizophrenia during the period of remission in a forensic psychiatric clinic was studied by Ilyinsky Yu.A., Gerasimov S.V. and othersresearchers. Ilyinsky Yu.A. [7,8] noted the emergence of affective disorders, which included non-psychotic affective reactions, reactive affective psychoses, exacerbations and attacks of schizophrenia with a predominance of affective disorders in the clinical picture. The author associated the heterogeneity of the structure of psychogenic affective disorders with the form of the course, the degree of progression and the depth of the postprocessual defect. Thus, he came to the conclusion that in patients with a low-progressive form of paroxysmal-progressive schizophrenia with short-term psychotic attacks, psychopath-like symptoms in remission and moderately expressed emotional-volitional defects in a psychotraumatic situation, reactive affective states (mainly of the depressive pole) arise. a progressive form of schizophrenia with delineated attacks with incomplete remissions and impaired social adaptation under the influence of a traumatic situation, exacerbations of schizophrenia or attacks of schizophrenia of the type of phase-affective states occur. At the same time, at the very beginning of the exacerbation of the schizophrenic process, affective disorders, mainly of a depressive nature, arise. Then hallucinatory-paranoid symptoms appear with the inclusion of persons conducting the investigation in the plot. During attacks of schizophrenia, patients experience typical attacks of schizophrenia with pronounced affective disorders of the type of phase-affective states, new, previously unobserved psychotic symptoms appear in the clinical picture. There are no experiences directly related to the offense committed, which indicates the endogenous nature of clinical manifestations. Gerasimov S.V.[2] also studied the influence of psychogenic factors (judicial opinion) on the clinical picture of paranoid schizophrenia during the period of remission. The majority of patients had a psychopathic-like defect. Under the influence of psychogenic factors, patients experienced relapses, occurring with or without psychogenic symptoms or a state of decompensation, also occurring with or without psychogenic symptoms.3. The influence of psychogenic factors on continuously ongoing forms of schizophrenia. The response to psychogenicity is correlated with the type of course, phases of the disease and the depth of the acquired defect. (Tsaruk T.P.[22], Nguyen D.Z. [15], Morozov S.V.[14]). The more intense the process and the expression of the patient’s mental defect, the less reflected the psychogenic factor in the clinical picture and course of the disease. However, other Russian researchers (Maksimov V.I. [12], Ilyina N.A., Ikonnikov D.V. [6]), studying psychogenies in patients with sluggish schizophrenia with a personality defect and a long history of the disease, found that in this case psychogenies develop according to the type of “refusal reactions” - a complex psychopathological structure manifested in depression, motor retardation and other syndromes of the neurotic register and consisting in the desire to “escape reality” under the influence of a psychogenic factor. Syunyakov T.S. [20] studied the occurrence of dual affective phases in patients with low-grade schizophrenia under the influence of a psychogenic factor. The level of social adaptation in patients with low-grade schizophrenia was higher than in patients with post-traumatic stress disorder. In addition, one of the most common clinical manifestations of attacks was psychogenically provoked mania, which also differed from the literature data.4. The influence of psychogenic factors on the prognosis of endogenous diseases. A number of scientists (G.V. Morozov [14], S.V. Gerasimov [2]) are inclined to believe that in the presence of psychogenicity, the course of an endogenous disease is generally more malignant. According to N. Felinskaya. I. [21], schizophrenia, which has developed psychogenically, proceeds according to its own patterns of development. With this course, the disease, bypassing the intermediate stage, reaches final, incurable states (complex catatonic, paraphrenic syndromes). The author is inclined to think that the transferred reactivethe condition led to such disorders of higher nervous activity that led to the occurrence of later stages of the disease. MR Castine [25] writes about a more favorable prognosis for patients with schizophrenia and affective disorders who experienced life events before the disease. He notes that people with schizophrenia, in whose anamnesis there were no significant events one month before the disease, have more cognitive impairment and less pronounced adaptive abilities. The study of the influence of psychogenic factors on the prognosis of endogenous diseases is associated with the problem of the need-motivational orientation of patients schizophrenia. As is known, in these patients there is a decrease in motivation for activity, which is associated with deficit symptoms characteristic of the schizophrenic process (autism, emotional-volitional dulling). There are works [11] that studied the effect of introducing motivating stimuli on the course of the disease. As a result of these studies, an increase in activity, level of regulation and control of activity was noticed in a number of patients. According to the authors of the work (Kritskaya V.P., Meleshko T.K., Polyakov Yu.F.), repetition of private motivations can further lead to their consolidation in character traits: “The problem of such transformation of situational motives into personal ones is one of the most difficult and at the same time the most important in correctional practice”[11]. At the same time, it is known that in extreme situations, in order to solve problems, a person is required to mobilize all his vital forces. In other words, problems arising in a stressful situation are important motivational factors.6. Conclusion. Thus, when analyzing the assessment of the influence of psychogenic factors on endogenous diseases, we did not identify a unified position of the authors on this issue. The inconsistency of the research results can be explained by several factors: Heterogeneity in almost every given study of the psychogenic factors studied: these are either psychogenies in persons who have committed a criminal offense (a judicial-investigative situation or a situation of serving a sentence), or individually significant events, the very presence or absence of which may be a consequence of an endogenous disease; in many studies no further follow-up study was carried out; the study included patients who were affected by a traumatic situation negatively (manifestation or exacerbation); most authors did not use standardized scales during clinical examination. This issue has not yet been fully studied. For example, the influence of a chronic stress factor over many years on the clinical picture and dynamics of endogenous diseases that have already begun is poorly covered in the scientific literature. Our country is of particular interest for this study. Azerbaijan has been in a state of war for more than 17 years. Also Krasnushkin E.K. [9] noted that “the psychogenic factor of war differs from the psychogenic factor of everyday peaceful situations both in the strength of its impact on the individual psyche and in the homogeneous psychogenic effect on many people simultaneously. Often this is not a one-time, but multiple effect on the same persons.” According to statistical data [19], the number of refugees and internally displaced persons in Azerbaijan in 1999 exceeds 900,000 people. According to statistics, 1-2% of the entire population suffers from schizophrenia and schizoaffective disorders. This means that at least about 10,000 refugees are procedural patients. On the other hand, in Azerbaijan, for more than 17 years, a situation has arisen where a psychogenic factor of the same type, strong in its impact - war, deprivation of shelter, resettlement to other places - on the one hand, has lost its severity, on the other hand, remains relevant, since refugees and internally displaced persons are awaiting a favorable resolution of the situation. Undoubtedly, this protracted psychologically traumatic situation cannot butinfluence the course of endogenous diseases in the above-mentioned individuals. In this regard, solving the issue of interaction between two parallel protracted processes - endogenous and psychogenic - is relevant. Literature: E. Bleuler. Manual of Psychiatry. Berlin, publishing house "Doctor", 1920, p.415-417. Gerasimov S.V. The influence of psychogenic factors on the clinical picture of the paranoid form of schizophrenia in various stages of its course. Author's abstract. dis.cand. honey. 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