Patients with continuous hypochondriacal schizophrenia can reveal IBS symptoms, like those with neurosises and hypochondriacal development. However in these cases clinical displays of irritable bowel syndrome and accompanying psychopathological semiology gain a number of features that determine diagnostics of endogenous disease.
In the clinical picture abnormal corporal sensations dominate in abdominal area whereas changes of frequency and consistence of stool are distinctly expressed, as a rule, only in the period of disease manifestation, and later only incidentally. Abdominal sensations lose the painful character; they are characterized by patients with uncertainty (they use words such as twisting, flipping, drilling, rolling).
Persistent aspiration to medical inspection in connection with fears of malignant neoplasms is combined with vigilance and mistrust to the opinion of doctors stating doubt about the possibility of oncological disease. The negative results of inspection don’t bring relief (what’s typical of patients with neurotic disorders), and, on the contrary, may lead to more mistrust, and in some cases to the conviction that doctors purposefully hide the fact of heavy somatic disease. Vigilance concerning possible oncological pathology is accompanied with unilateral interpretation of the changes of the health state: constipation are treated as signs of intestinal impassability, insignificant weight loss – as display of cancer cachexia.
One more feature of the clinical picture of schizophrenia patients with irritable bowel syndrome is the absurd of dietary schemes and other means to which patients resort in order to alleviate unpleasant sensations in the large intestine area: strong pressing or knocking on the area of pain projection, long stay in the bath with cool water, etc.
Alongside with hypochondriac fixing on painful sensations and changes of stool pattern the typical schizophrenia symptoms are revealed: autism and asthenic defect. Autisation connected with endogenic process is lead to gradual narrowing of circle of communication, loss of warm feelings towards relatives, refusal from any kinds of activity and interpersonal contacts, etc.
Signs of asthenic defect increasing in course of time determine lasting sensation of weakness in all body, flabbiness of muscles, intolerance of intellectual, emotional and physical loadings: aggravation of painful sensations and change of stool pattern is occur in reply to any strain.
IBS connected with schizophrenia has the least favorable outcome with the expressed decrease of the professional level and social disadaptation even to the extent of complete loss of working capacity and invalidization.