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Introduction
1. Clinical picture of schizophrenia: brief background
1.1.General clinical characteristics
1.2.Etiology and pathogenesis of schizophrenia
2.0. Psychological portrait of a patient with schizophrenia
2.1. Diagnostics
2.2. Psychological characteristics and symptoms of a patient with schizophrenia
2.2.1. Changing Perception
2.2.2. Inability to separate and interpret external sensations
2.2.3. Delusions and hallucinations
2.2.4. Changing the inner self and body diagram
2.2.5. Changes in emotions
2.2.6. Changes in movement
2.2.7. Changes in behavior
conclusions
Literature

Introduction

Schizophrenia– “a mental illness of unknown etiology, prone to a chronic course, manifested by typical changes in the patient’s personality and other mental disorders varying in severity,” leading, as a rule, to persistent impairments in working capacity and social adaptation. Despite the fact that the term “schizophrenia” appeared only in 1911, when the Swiss psychiatrist E. Bleuler proposed a new term for the name of the disease, the very history of the emergence of schizophrenia (as an endogenous and endogenous-organic disease) causes a lot of controversy among specialists. On the one side, "there are scientists who claim that schizophrenia has always existed, and there are indisputable facts that indicate the antiquity of this disease". As evidence, Sanskrit sources are often quoted or references are made to biblical characters, for example, the Babylonian king Nebuchadnezzar (eating grass like cattle in grazing), or the prophet Ezekiel (auditory and visual hallucinations). They also insist that people with schizophrenia should be kept at home, and that their illness is from God, and, as a result, it cannot be considered a disease at all in the usual sense of the word. On the other hand, their opponents believe that in most of the examples given from the Bible and Sanskrit sources it is impossible to reliably establish the clinical picture. Moreover, most opponents are of the opinion that in such examples we were talking, for the most part, about people with various brain injuries (birthday, for example), or diseases (epilepsy, viral encephalitis, syphilis), in which psychotic symptoms may occur. As a rule, opponents are not inclined to consider schizophrenia (and any other organic diseases) a disease "from God". As a rule, also, opponents deny various theories of schizophrenia in the spirit of the English psychoanalyst R. Laing, ECT, or Dianetics, and rely on strictly scientific methods study, diagnosis and treatment of this disease.

In the last decades of our century, the attention of scientists has been especially acutely drawn to the problems of schizophrenia - its etiology, diagnostic methods and treatment methods. No other disease in related fields of knowledge (psychiatry, neuropsychiatry, clinical psychology, pathopsychology and psychopathology, neurosurgery and many others), despite, of course, the importance of a set of similar measures in the fight against them, is so exciting to scientific thought, so debatable. And given that in recent decades, schizophrenia has become such a widespread disease that it has gone beyond just scientific attention, turning into a social disaster, the topic of early diagnosis of schizophrenic symptoms by persons who are not competent in the closed and frightening field of this knowledge has become especially relevant. The efforts made by mental health services and individual scientists to remove the stigma of a “curse” and “plague” from the disease and help people quickly recognize the early symptoms of schizophrenia are the best evidence of this. Today you will not surprise anyone with popular books about psychiatry, and, in particular, about schizophrenia.

The purpose of this work is the study of portrait features of a schizophrenic patient, the main symptoms of schizophrenia in its various forms and severity.

Main task of the work– give a relatively complete picture of the symptoms of the disease, its clinical manifestations; give examples that reveal some of the behavioral features of patients with schizophrenia.

1. Clinical picture of schizophrenia: brief background

“The large clinical polymorphism of schizophrenia in its modern scope has its historical roots. The main clinical variants of this disease were identified back in the pre-nosological period of the development of psychiatry.”

Schizophrenia as a separate disease was first identified by the German psychiatrist E. Kraepelin (1896). He took groups of patients who had previously been described with diagnoses of hebephrenia (E. Hecker), catatonia (K. Kahlbaum) and paranoids (V. Magnan), and found that in the long term they had a kind of dementia. In this regard, Kraepelin combined these three groups of diseases and called them dementia praecox (dementia praecox). Having identified a separate disease based on its outcome in dementia, Kraepelin at the same time admitted that recovery was possible.

It should be noted that before Kraepelin, the famous Russian psychiatrist V. Kandinsky in 1987 described a similar disease called ideophrenia, and S. Korsakov in 1891 - under the name design. Already at that time, famous Russian psychiatrists noted symptoms in patients that were among the main symptoms of schizophrenia - emotional and volitional disorders, incoherent speech."

The name itself "schizophrenia" was given in 1911 by the famous Swiss psychiatrist E. Bleuler, who described a group of psychoses under this name. Unlike Kraepelin, Bleuler believed that schizophrenia does not necessarily arise in youth, but can develop in adulthood. Bleuler also believed that what is most characteristic of schizophrenia is not the outcome of a kind of dementia, but a special dissociation of the mental processes of the individual, its specific change as a result of the disease process. Bleuler noted that in schizophrenia, lasting improvements and a favorable outcome are possible even without treatment.

If Kraepelin narrowed the scope of schizophrenia, describing only its most malignant forms, then E. Bleuler, on the contrary, overly expanded the boundaries of the disease and classified chronic alcoholic hallucinosis, senile delirium of damage, MDP and even neurotic syndromes as schizophrenia. This was pointed out, in particular, by Gannushkin, saying that “in the large gallery of types of various degenerates and psychopaths, it is not difficult to find examples of such eccentrics who, in their makeup and appearance, are quite consistent with schizophrenics.”

All these studies laid the foundation for the doctrine of schizophrenia, and Bleuler's name has survived to this day, and sometimes schizophrenia is called Bleuler's disease.

1.1.General clinical characteristics

Schizophrenia is included in the group of endogenous and endogenous-limiting mental illnesses. This group includes diseases whose cause has not yet been established, although available data indicate pathology of internal processes in the body, leading to mental disorders. It is also known that schizophrenia (and in general all endogenous diseases) is often observed in individuals with a hereditary burden of the disease. The risk of schizophrenia has even been determined depending on the degree of relationship.

When suffering from schizophrenia, patients become withdrawn, lose social contacts, and experience a depletion of emotional reactions. At the same time, disturbances of sensations, thinking, perception and motor-volitional disorders are observed of varying degrees of severity.

The psychopathological manifestations of schizophrenia are very diverse. According to their characteristics, they are divided into negative and productive. Negative ones reflect loss or distortion of functions, productive ones – identification of specific symptoms, namely: hallucinations, delusions, affective tension and others. Their ratio and representation in the patient’s mental state depend on the severity and form of the disease.

Schizophrenia is most characterized by peculiar disorders that characterize changes in the patient’s personality. These changes concern all mental properties of the individual, and the severity of the changes reflects the malignancy of the disease process. The most typical are intellectual and emotional disorders.

Let us briefly consider each of the typical disorders associated with schizophrenia:

Intellectual disorders. They manifest themselves in various types of thinking disorders: patients complain of an uncontrollable flow of thoughts, their blockage, and others. It is difficult for them to comprehend the meaning of the text they read. There is a tendency to capture special meaning in individual sentences and words, and to create new words. Thinking is often vague; statements seem to slip from one topic to another without a visible logical connection. In a number of patients, the logical sequence takes on the character of speech discontinuity (schizophasia).

Emotional disturbances. They begin with the loss of moral and ethical properties, feelings of affection and compassion for loved ones, and sometimes this is accompanied by acute hostility and malice. In some cases, emotional ambivalence is observed, that is, the simultaneous existence of two contradictory feelings. Emotional dissociations occur when, for example, tragic events cause joy. Characterized by emotional dullness - impoverishment of emotional manifestations up to their complete loss.

Behavioral disorders or disorders of volitional activity. Most often they are the result of emotional disorders. Interest in what you love decreases and, over time, disappears altogether. Patients become sloppy and do not observe basic hygienic self-care. The extreme form of such disorders is the so-called abulic-akinetic syndrome, characterized by the absence of any volitional or behavioral impulses and complete immobility.

Perceptual disorders. They manifest themselves predominantly as auditory hallucinations and often various pseudohallucinations of various sense organs: visual, auditory, olfactory.

Highlight three forms of schizophrenia: continuous, periodic and paroxysmal-progressive. Forms of schizophrenia according to Snezhnevsky A.V. - “a taxonomy of forms of schizophrenia, which is based on the fundamentally different nature of their course with the unity of symptomology and trends in the dynamics of the pathological process, the stereotype of the development of the disease. There are continuous, recurrent and paroxysmal-progressive schizophrenia. Each of these forms includes various clinical variants.”

1.2.Etiology and pathogenesis of schizophrenia

“The etiology and pathogenesis of schizophrenia became the subject of special study soon after the disease was identified as a separate nosological unit (nosology is the study of diseases and their classifications - author’s note).”

To date, scientists have obtained a lot of data that allows them to build one or another theory of schizophrenic etiology. Some of these theories have lost their relevance, having failed to withstand empirical testing, or being untenable due to the emergence of new scientific data. Other theories are considered the most promising today. However, as already mentioned, the etiology of schizophrenia is still considered unknown. It is relatively unanimously recognized that the disease belongs to the group of endogenous diseases, that is, those that do not have an exogenous factor that can provoke the development of the disease (trauma, viral infections, etc.). And although there is evidence of the onset of the disease in connection with the influence of some exogenous factor, but, nevertheless, "...after this" does not mean "as a result of this"".

Genetic theory of schizophrenia. According to genetic theory, schizophrenia is a hereditary disease. The most significant evidence in favor of the genetic theory is the numerous facts of schizophrenia in individuals with a genetic burden. "Studies of identical twins indicate that the risk of schizophrenia in the sibling of an already affected twin is approximately 30 percent."

Neurochemical theory of schizophrenia. The neurochemical theory of schizophrenia dates back to the beginning of our century. In the last two decades, much attention has been focused on dopamine, a neurotransmitter of the catecholamine class. It has been observed that large doses of amphetamines cause an increase in dopamine levels, and the resulting symptoms resemble those of schizophrenia. It has also been observed that the condition of schizophrenic patients worsens if they are given a drug containing dopamine. Scientists have also studied many other neurotransmitters, their interactions and properties (histamine, GABA, glutamic acid, and others).

Theory of developmental defects. Relatively new approach in search of the causes of schizophrenia. More advanced methods of studying intrauterine development have made it possible to obtain many facts suggesting that the cause of schizophrenia may be intrauterine brain injury or directly at the time of birth of the child. Proponents of this theory argue that the onset of the disease may be caused by exogenous factors, namely postpartum brain injuries, immune system disorders, poisoning at an early stage of development, primary metabolic disorders and some other factors.

Other theories. There are many other theoretical developments attempting to explain the etiology and pathogenesis of schizophrenia. For example, the assertion that dominated the 19th century that masturbation can lead to insanity is considered untenable. Some theories, such as the endocrine theory of schizophrenia, the nutrition theory, or the family theory, still exist, although they are not popular.

2.0. Psychological portrait of a patient with schizophrenia

2.1. Diagnostics

Schizophrenia has a wide range of clinical manifestations, and in some cases its diagnosis is very difficult. The diagnostic criteria are based on so-called negative disorders or peculiar changes in the patient’s personality. These include impoverishment of emotional manifestations, impaired thinking and interpersonal disorders. Schizophrenia is also characterized by a certain set of syndromes.

In diagnosing schizophrenia, it is important to distinguish the clinical picture of schizophrenia from exogenous psychopathologies, affective psychoses (in particular, from MDP), as well as from neuroses and psychopathy. Exogenous psychoses begin in connection with certain hazards (toxic, infectious, and other exogenous factors). With them, special personality changes are observed (of an organic type), psychopathological manifestations occur with a predominance of hallucinatory and visual disorders. In affective psychoses, personality changes characteristic of schizophrenia are not observed. Psychopathological manifestations are limited mainly to affective disorders. In the dynamics of the disease, there is no complication of syndromes, while in schizophrenia there is a tendency to complicate attacks. And in the case of a sluggish, inactive course of the schizophrenic process, a differential diagnosis of schizophrenia with neuroses and psychopathy is necessary. It should be noted that the dynamics of schizophrenia are always different from the dynamics of other nosological units, although sometimes they may be indistinguishable in cases of dishonest or incompetent attitude towards the diagnostic process. Such cases are not uncommon, which contributed to the emergence in science of a special section (or discipline) that studies errors in diagnostic and general clinical practice.

In the legal field of knowledge, there is a so-called “forensic psychiatric assessment”, the main task of which is to identify an accurate clinical picture of the mental state of persons who have committed crimes in a state of passion or mental illness. It should be noted that “in forensic psychiatric practice, approximately half of the subjects declared insane are patients with schizophrenia.”

In schizophrenia, it is not possible to identify a single symptom that would be specific only to this disease. However, there are several symptoms that are most typical of schizophrenia, and also, as already mentioned, the pathogenesis of the disease in dynamics differs from all other mental illnesses, although not always self-evident, and sometimes difficult to distinguish even with a thorough examination.

For example, Bleuler believed that the loss of associative thinking occupies a central place in the symptomatology of the disease. K. Schneider proposed a list of symptoms he named "symptoms of the first rank". The presence of one or more of them in a patient directly indicates schizophrenia.

This list included the following symptoms:

1. Auditory hallucinations, in which “voices” speak the patient’s thoughts out loud,

2. Auditory hallucinations where two “voices” argue with each other,

3. Auditory hallucinations in which “voices” comment on the patient’s actions,

4. Tactile hallucinations, when the patient feels the touch of something foreign,

5. "Removing" thoughts from the patient's head,

6. "Putting" thoughts into the patient's head, carried out by strangers,

7. The belief that the patient's thoughts are transmitted to others (as on a radio), or received by him from others,

8. “Putting” into the patient’s consciousness the feelings of other people,

9. “Insertion” of irresistible impulses into the patient’s consciousness by strangers,

10. The feeling that all the patient’s actions are carried out under someone’s control, automatically,

11. Normal events are systematically given some special, hidden meaning.

American psychiatry took a significant step forward in 1980, adopting a new, significantly revised scheme for diagnosing and systematizing psychiatric diseases, enshrined in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). In 1994, its fourth edition was published ( DSM-IV). According to it, a diagnosis of schizophrenia can only be made if the following conditions are met:

1. Symptoms of the disease appear for at least six months,

2. Compared to the period preceding the disease, there are changes in the ability to perform certain actions(work, communication, self-care),

3. These symptoms are not associated with organic changes in brain tissue or with mental retardation,

4. These symptoms are not associated with manic-depressive psychosis,

5. The symptoms listed in one of points a, b, or c must be present, namely:

A). Any two of the following symptoms must have been present for at least a month: delirium; hallucinations;

disorders of thinking and speech (incoherence or frequent loss of associative connections); Severely disorganized or catatonic behavior, “negative” symptoms (blunted emotions, apathy); b). Strange nonsense, which members of the same subculture with the patient see as groundless;

V). Obvious auditory hallucinations in the form of one or more “voices” commenting on the patient’s actions or arguing with each other.

"Symptom lists like the one above may give the impression that schizophrenia is easy to diagnose. This is true when dealing with an advanced form of the disease, but in the early stages, diagnosing schizophrenia is difficult. difficult task. Symptoms can appear with varying degrees of frequency, they can be mild, and the patient can skillfully hide some manifestations of his disease. Therefore, it is a widespread practice among specialists when, at the first meetings with a patient, they write down in the medical history: "suspicion of schizophrenia". This means that their diagnosis is in doubt - until the clinical picture becomes clearer."

2.2. Psychological characteristics and symptoms of a patient with schizophrenia

Currently, in psychiatric classifiers (DSM-III, DSM-IV), as well as in the works of individual authors (Sneznensky A.V., Zhablensky A., Sternberg E.Ya. and Molchanova E.K., and many others) there is There are quite a lot of described forms and varieties of schizophrenia. Sometimes these forms are essentially indistinguishable from each other, but have different terminology. For example, asymptomatic schizophrenia (according to V.A. Gilyarovsky) corresponds to Bleuler’s idea of ​​latent schizophrenia.

Many mental illnesses, speaking from the point of view of nosological form, on the contrary, can be nosologically homogeneous, but differ pathogenetically and clinically (for example, alcoholic psychoses, neurosyphilis, and some others). Different countries have national classifications of diseases. All this introduces a certain amount of confusion into research and requires additional and thorough processing and unification of existing data in the field of clinical psychology, psychiatry, neurosurgery, pathopsychology and some other disciplines.

This work will consider all the main symptoms of schizophrenia without taking into account its nosological features. This approach can be useful in pre-medical diagnosis of latent and early forms of schizophrenia by the patient’s relatives and friends. Symptoms of personality disorder will be considered, namely: changes in perception; inability to separate and interpret external sensations; delusions and hallucinations; changes in the inner self and body diagram; changes in emotions; changes in movements and changes in behavior.

2.2.1. Changing Perception

A change in the interpretation of the environment associated with a change in perception is especially noticeable in the initial stages of schizophrenia and, judging by some studies, can be detected in almost two thirds of all patients. These changes can be expressed both in increased perception (which is more common) and in its weakening.

Changes related to visual perception are more common. Colors appear more vibrant and hues appear more saturated. The transformation of familiar objects into something else is also noted:

"Things seem to jump, vibrate, especially everything red; people take on a demonic appearance - with a black silhouette and white shiny eyes; all objects - chairs, houses, fences - live their own own life, make threatening gestures, come to life."

Changes in perception distort the outlines of objects and make them threatening. The color shades and structure of the material can seem to transform into each other.

Changes in auditory perception are common. Noises and background sounds may seem louder than usual, "It's like someone turned the volume knob on the receiver". Simultaneous strengthening of visual and auditory channels of perception often occurs.

The heightened perception is closely related to the overabundance of incoming signals. The point is not that the senses become more receptive, but that the brain, which usually filters out most of the incoming signals, for some reason does not do this. Such a multitude of external signals bombarding the brain makes it difficult for the patient to concentrate and concentrate. According to some reports, more than half of patients with schizophrenia report disturbances in attention and sense of time.

Changes in perception in schizophrenia affect not only vision and hearing. Many patients, describing their experiences during the period of remission, spoke of extremely strong kinesthetic, olfactory and taste sensations.

Often the change in perception is characterized not by sensory sensitivity, but by the so-called “influx of thoughts” (mentism), “nested thoughts”, described by patients as "the feeling that someone is 'putting' thoughts into their head". One can note the difference in the classification of such symptoms: in the Russian classification, mentism refers to thinking disorders, in the American classification, the symptom is often classified as the so-called "internal irritants".

As a consequence, such changes in perception lead to many and varied changes in the patient's behavior. An unexpected influx of sensory sensations and their aggravation in some patients causes feelings of high spirits, excitement, and exaltation. (This very often leads to erroneous conclusions - for example, the patient’s relatives begin to suspect that he is using drugs. Such exaltation is also characteristic of manic-depressive psychosis, which sometimes also leads to clinical errors). Some patients develop increased religiosity because they believe that they have come into contact with God and the divine. It should be noted that unmotivated increased religiosity, which appeared “suddenly” and does not stem from the characteristics of the subculture of the person displaying it, is one of the fairly reliable symptoms of schizophrenia.

With schizophrenia, perception can not only be sharpened, but also dulled. It should be noted that suppression most often occurs in the later stages of the disease, while the early stages of schizophrenia are characterized by an exacerbation of perception. Suppression is described as "a heavy curtain drawn over the brain; it resembles a heavy thundercloud, obstructing the use of the senses". Your own voice can sound muffled and as if from afar, everything blurs and wavers in your eyes.

2.2.2. Inability to separate and interpret external sensations

A significant group of symptoms in the diagnosis of early schizophrenia are disorders associated with difficulty or inability to interpret incoming signals from the outside world. Auditory, visual and kinesthetic contacts with the environment cease to be understandable to the patient, forcing him to adapt to the surrounding reality in a new way. This can be reflected both in his speech and in his actions.

With such violations, the information received by the patient ceases to be integral for him and very often appears in the form of fragmented, separated elements. For example, when watching television, the patient cannot watch and listen at the same time, and vision and hearing appear to him as two separate entities. The vision of everyday objects and concepts - words, objects, semantic features of what is happening - is disrupted.

“I had to kind of put all the things in order in my head. If I looked at the watch, I saw everything as if separately – the dial, hands, numbers, etc., after which I had to put them together...”

“I tried to sit at home and read; all the words seemed very familiar, like old friends whose faces I know very well, but I can’t remember their names; I read the same paragraph dozens of times, but still didn’t understand anything ", what is it about, and closed the book. I tried to listen to the radio, but the sounds just rang in my head."

Difficulty watching television is very common in schizophrenia. Contrary to popular belief, patients with schizophrenia rarely watch television in clinics. Some may sit in front of a screen and look at it, but very few of them can then tell what they saw. This applies to patients of any level of education and intellectual development. It should also be noted that patients interested in television programs prefer visual programs and cartoons, where it is not necessary to combine auditory and visual signals.

The inability of patients with schizophrenia not only to sort and interpret incoming signals, but also to respond appropriately to them, is one of the main symptoms of this disease. Bleuler, studying schizophrenic patients, was struck by the inadequacy of their behavior. Patients, being unable to adequately perceive the world around them and, as a result, respond adequately and timely to external stimuli, actually lose the possibility of normal communicative relations with the world. Avoidance of social contacts and a tendency to solitude are typical behavior for schizophrenic patients for whom these contacts have become difficult and painful.

The perception of the world, scattered into many heterogeneous and unrelated elements, gives rise to thinking problems, such as confusion of thinking, dissociation of thinking (incorrect associations), concreteness (impaired abstract thinking caused by the disintegration of the world into elements), impaired ability to think logically and see causally - investigative connections. In the latter case, the patient easily combines contradictory statements in his reasoning.

The stage of the disease when the patient, due to his difficulties in contacting the outside world, began to avoid communication, means that the disease is intensively developing and progressing. On initial stage however, noticing obvious violations in speech and the content of what was said (nonsense, neologisms, abracadabra, linguistic absurdities) can very reliably mark the onset of a schizophrenic disease and, as a result, speed up its identification, treatment and further prevention.

2.2.3. Delusions and hallucinations

The strongest impression on others and on the entire culture as a whole, which is expressed even in dozens of works on this topic, is made by the delusions and hallucinations of a patient with schizophrenia. Delusions and hallucinations are the most well-known symptoms of mental illness and, in particular, schizophrenia. Of course, it should be remembered that delusions and hallucinations do not necessarily indicate schizophrenia and schizophrenic nosology. In some cases, these symptoms do not even reflect general psychotic nosology, being a consequence, for example, of acute poisoning, severe alcohol intoxication and some other painful conditions. However, the appearance of hallucinations and delusions in a person “out of nowhere” can accurately indicate the onset (or active phase) of a mental illness.

There are quite developed classifications of delusional and hallucinatory states. Delusional ideas are “erroneous conclusions arising on a painful basis, completely taking over the patient’s consciousness and not amenable to correction”. Every person has errors in judgment and conclusions. However, in a healthy person, logical errors can be corrected by additional facts or arguments, that is, they are correctable. When delirious, the patient is not only unable to change the wrong opinion he has formed, to reconsider his views on this or that phenomenon, but also does not accept criticism from the outside. This is manifested both in the patient’s statements and in his behavior - incorrect, since it is dictated by a point of view that does not correspond to the real situation.

With a more or less gradual development of delirium, one can trace the dynamics of the components that make up its structure. First, a delusional judgment appears, constituting the core of the delusional structure, the catalyst of which is a change in the emotional state - internal tension, anxiety, restlessness, the presence of a feeling of inevitable disaster. The development of such a delusional mood is accompanied by a delusional perception, when everything around becomes dangerous, fraught with a threat, full of some implicit and hidden meaning. Delusional perception is directly related to the formation of a delusional idea, when elements of the past and present are reinterpreted from the point of view of current painful sensations and conditions. Finally, a delusional awareness inevitably arises - an insight, a kind of insight with an intuitive comprehension of the essence of what is happening. From this moment, delusional judgments acquire specific content, which is accompanied by subjective feelings of calm and relief - crystallization of delirium.

“One day I realized that I was being filmed in the leading role of some grandiose film. Wherever I went in London, there were hidden cameras, and everything I said and everything I did was filmed and recorded on tape."

There are delusions of wealth, delusions of invention, delusions of jealousy, delusions of persecution, delusions of jealousy, delusions of self-blame and self-abasement, and many others. These are very common forms with similar symptoms and content in each specific delusional continuum.

One should also distinguish between unsystematized and systematized delirium. In the first case we're talking about, as a rule, about such an acute and intense course of the disease that the patient does not even have time to explain to himself what is happening. In the second, it should be remembered that delusion, having the nature of self-evident for the patient, can be disguised for years under some socially controversial theories and communications.

Hallucinations are considered a typical phenomenon in schizophrenia; they complete the spectrum of symptoms based on changes in perception. If illusions are erroneous perceptions of something that really exists, then hallucinations are imaginary perceptions, perceptions without an object. The hallucinating person hears voices that do not exist and sees people (objects, phenomena) that do not exist. At the same time, he has complete confidence in the reality of perception.

In schizophrenia, auditory hallucinations are the most common. They are so characteristic of this disease that, based on the fact of their presence, the patient can be given a primary diagnosis of “suspicion of schizophrenia,” which may or may not be confirmed, remaining within the framework of another nosological form.

Hallucinations of the auditory type are quite diverse in their content. The patient may hear individual sounds, some noise, music, a voice or voices. They may be constant or appear only from time to time. “Voices” in different variations and quantities are the most common symptom of schizophrenia. In the overwhelming majority of cases, the “voices” are unpleasant for the patient, very rarely they are pleasant, and in some individual cases they act as advisors, helping the patient do some work or make a certain decision.

The appearance of hallucinations indicates a significant severity of mental disorders. Hallucinations, which are very common in psychoses, never occur in patients with neuroses. By observing the dynamics of hallucinosis, it is possible to more accurately determine whether it belongs to one or another nosological form. For example, with alcoholic hallucinosis, “voices” talk about the patient in the third person, and in schizophrenic hallucinosis, they more often turn to him, comment on his actions or order him to do something.

Visual hallucinations in schizophrenia are much less common and usually occur together with auditory ones. According to numerous clinical observations of various forms of mental illness, it is noted that with exclusively visual hallucinations, the likelihood of schizophrenia is very low. It is also noted that the appearance of olfactory hallucinations in the clinical picture of schizophrenia may indicate the development of a tendency towards an unfavorable course of the disease with resistance to treatment.

It is especially important to pay attention to the fact that the presence of hallucinations can be learned not only from the patient’s stories, but also from his behavior. This may be necessary in cases where the patient hides hallucinations from others. Objective signs of hallucinations, which most often reveal the plot of the hallucination in sufficient detail, can indicate a progressive disease to any inquisitive mind and observant eye.

2.2.4. Changing the inner self and body diagram

Another group of symptoms characteristic of many patients with schizophrenia is closely related to delusions and hallucinations. If a healthy person clearly perceives his body, knows exactly where it begins and where it ends, and is well aware of his “I”, then the typical symptoms of schizophrenia are distortion and irrationality of ideas. These ideas in a patient can fluctuate over a very wide range - from minor somatopsychic disorders of self-perception to the complete inability to distinguish oneself from another person or from some other object in the outside world.

The self-reports of patients with schizophrenia - both in the form of speaking in the process of communication with the outside world, and on the basis of clinical observations - are indeed very diverse. The patient may describe constitutional and morphological changes in the perception of his own body that have no basis - “shifted” parts of the body (sunken eyes, bending of the limbs, shifted nose), changes in the size of parts of the body (shrunken head, shortened or lengthened limbs), defects skin, hair (dry, whitened, yellowed skin, wounds, holes). Some parts of the body may begin to live a “life of their own,” as if they were separated from the body.

"My knees are shaking, and my chest rises like a mountain in front of me. My whole body behaves differently. My arms and legs are separated and at some distance, moving on their own. This happens when I feel like I am a different person, and I imitate his movements or stop and stand like a statue. I have to stop and check whether it is my hand in my pocket or not. I am afraid to move or turn my head. Sometimes I throw my hands and see where they land."

A typical symptom of schizophrenia is a delusional belief in the patient’s pathological defect in his body. For example, a patient may be convinced that he does not have a liver. Or stomach. A frequent case of delusion is the belief in a fatal disease with a description of the “cause” - from the relatively sane (where the delusional sign is their incorrigibility) to the self-evidently symptomatic (worms ate the brain, a belly full of nails, etc.).

Impaired perception of oneself and one’s “I” can lead to the patient no longer distinguishing himself from another person. He may begin to believe that he is, in fact, the opposite sex. And what is happening in the outside world can rhyme for the patient with his bodily functions (rain is his urine, etc.).

2.2.5. Changes in emotions

Changes in emotions are one of the most typical and characteristic changes in schizophrenia. In the early stages of this disease, emotional changes such as depression, guilt, fear, and frequent mood swings may occur. At later stages, a decrease in the emotional background is characteristic, in which it seems that the patient is not able to experience any emotions at all.

In the early stages of schizophrenia, depression is a common symptom. The picture of depression can be very clear, long-lasting and observable, or it can be disguised, implicit, the signs of which are visible only to the eye of a specialist. According to some data, up to 80% of patients with schizophrenia exhibit certain episodes of depression, and in half of the patients depression precedes the onset of delusions and hallucinations. In such cases, early diagnosis of schizophrenia is very important, since after the crystallization of delusional states and judgments, the disease passes into a different form, which is more difficult to treat.

At the onset of the disease, the patient usually experiences wide range varied and rapidly changing emotions. Weak or strongly expressed experiences associated with changes in the perception of the external world and one’s own sensory and mental sensations only strengthen this picture. Euphoria, for example, as a marker of schizophrenia, occurs as often as depressive states in later stages, but more often it does not fall into the general clinical picture of symptoms, as it quickly disappears under the pressure of changing circumstances of the external world and futile attempts to adapt to changed conditions. In addition, euphoria often accompanies other psychotic conditions, such as bipolar reactions (MDP in the Russian classification) or severe alcohol intoxication, which can lead to errors in diagnosis and erroneous judgments in general.

The patient experiences many unmotivated emotional experiences: guilt, causeless fear, anxiety.

"I sat in my room, gripped by uncontrollable fear. It just consumed me - I was shaking with fear even at the sight of my cat."

It is believed that the most reliable symptom of schizophrenia is a dulling of the emotional state until the complete disappearance of emotions altogether. Moreover, if in the relatively late stages of a mental illness with a diagnosis of schizophrenia, the patient demonstrates strong emotional reactions, as a rule, this allows one to doubt the diagnosis.

As a rule, at the initial stage of the disease, dulling of emotions may not be very noticeable. Moreover, in neurotic and problematic families, as well as in some subcultures, it may be completely invisible. However, it is possible to trace the symptoms of disruption of the patient’s interaction with other people and empathy, starting from the patient’s everyday picture of the world and his usual behavior, which began to deform in communications and feedback.

2.2.6. Changes in movement

A change in the patient’s general mental picture of the world inevitably leads to a change in his motor activity. Even if the patient carefully hides the pathological symptoms (the presence of hallucinations, visions, delusional experiences, etc.), it is nevertheless possible to detect the appearance of the disease by its changes in movements, when walking, when manipulating objects and in many other cases.

The patient's movement may accelerate or slow down without any apparent reason or more or less clear possibilities to explain this. Feelings of clumsiness and confusion in movements are widespread (often unobservable and, therefore, valuable when the patient himself shares such experiences). The patient may drop things or constantly bump into objects. Sometimes there are short "freezes" while walking or other activity.

Spontaneous movements (signaling hands when walking, gesturing) may increase, but more often they acquire a somewhat unnatural character and are restrained, since the patient seems to be very clumsy, and he tries to minimize these manifestations of his awkwardness and clumsiness. Repetitive movements include tremors, sucking movements of the tongue or lips, tics, and ritualistic movement patterns.

An extreme variant of movement disorders is the catatonic state of a patient with schizophrenia (and other mental disorders), when the patient can maintain the same position for hours or even days, being completely immobilized. The catatonic form occurs, as a rule, in those stages of the disease when it was advanced and the patient did not receive any treatment for one reason or another.

Movement disorders are not the most common symptom in the diagnosis of schizophrenia. If a person develops a movement disorder that persists for some time (about a month according to DSM IV), other signs and symptoms should be looked for. It should also be taken into account that many medications(in particular, antipsychotics) can cause movement disorders: from tics to involuntary muscle spasms of the limbs or trunk.

2.2.7. Changes in behavior

Changes in the patient's behavior are usually secondary symptoms of schizophrenia. That is, changes in the behavior of patients with schizophrenia are usually a reaction to other changes associated with changes in perception, impaired ability to interpret incoming information, hallucinations and delusions, and other symptoms described above. The appearance of such symptoms forces the patient to change the usual patterns and methods of communication, activity, and rest.

The most common changes associated with illness behavior are described in sufficient detail in the psychiatric literature. For example, delusions of persecution force the patient to take a number of actions designed to protect or protect him from imaginary danger: he can install additional locks, doors, bars; on the street, he may constantly look around, or use accessories and clothing that supposedly disguise him. When delirium of jealousy begins, the patient may become exaggeratedly interested in the situation and contacts of the object of jealousy, and visit his place of work under various pretexts; he becomes too demanding when it comes to accurately returning from work or shopping; can secretly inspect clothes or other objects (bags, purses, etc.), and so on.

Schizophrenia is characterized by the so-called “ritual behavior”, when the patient develops a certain sequence of actions that satisfies his obsession and an overvalued attitude towards them. A fairly common delusion of poisoning, for example, pushes the patient to extreme forms of behavior, one way or another related to hygiene and cleanliness: plates are washed many times using very strong chemical cleaning agents, there is a constant struggle with dirt and germs, the patient constantly wipes everything handles of doors and cabinets, washes hands several dozen times a day or more, etc.

“As the dough was ready, a change took place. Individual details began to have their own special meaning. The whole process became a kind of ritual. At some point, the mixing rhythm had to be like the ticking of a clock, at another moment it was necessary to beat the dough, facing the east. "The egg whites had to be beaten from left to right. There was a reason for every action."

It should be borne in mind that the patient, as a rule, has absolute confidence in the correctness of his behavior. Absolutely absurd, from the point of view of a healthy person, actions have a logical explanation and conviction that they are right. And since in a patient with schizophrenia, and, in particular, in patients with various forms delusions, this conviction is not correctable, then an outside observer or close people should not try to convince the patient, relying on a system of certain arguments and logical arguments. The patient’s behavior is not a consequence of his incorrect thinking, but a consequence of a mental illness, which today can be quite effectively treated with psychopharmacological drugs and appropriate clinical care.

conclusions

We can say that today the symptoms of schizophrenia have been described quite fully and exist a large number of clinical data that allows a specialist to make a correct diagnosis with a high degree of probability, on which the further effectiveness and outcome of treatment, the duration of remission, or even the absence of relapses at all depend. However, it should be assumed that the objective difficulties facing a specialist in making a correct and timely diagnosis are only half the problem, if not a smaller part of it. The main problem in the early diagnosis of schizophrenia is that the preclinical stage of the development of the disease in the vast majority of cases remains invisible to the majority of people living near the patient due to various reasons, one of which is incompetence and a tendency to a subjective and biased interpretation of the patient’s changed behavior .

Help in the early diagnosis of schizophrenia (and other mental illnesses) by those close to the patient and who can detect the onset of the disease at its earliest stages could play an invaluable role in reducing the overall incidence of morbidity and difficulties associated with the treatment of schizophrenia. It is well known that the earlier a disease is detected, the greater the likelihood of its successful treatment. For this, psychiatric science and clinical medicine in general need to make a lot of effort - to disseminate simple and effective knowledge that can raise the level of psychohygienic culture and knowledge among non-specialists an order of magnitude higher, which would contribute to more effective preventive work on the part of the population in alliance with the doctor. psychiatrist and clinician in the prevention of schizophrenia and other mental illnesses.

Literature

1. “Through the eyes of a psychiatrist”, Yu.A. Aleksandrovsky, / Moscow, “Soviet Russia”, 1985.

2. “History of Psychiatry”, Y. Kannabikh, / Moscow, TsTR IGP VOS, 1994.

3. “Popular foundations of psychiatry”, D. Enikeeva, / Donetsk, “Stalker”, 1997.

4. “Psychiatry: a textbook”, Zharikov N.M., Ursova L.G., Khritinin D.F., / Moscow, “Medicine”, 1989.

5. “Forensic Psychiatry”, Textbook, /Edited by G.V. Morozova, / Moscow, "Legal Literature", 1990.

6. “Explanatory Dictionary of Psychiatric Terms”, Bleicher V.M., Kruk I.V., / Voronezh, NPO “Modek”, 1995.

7. "Schizophrenia. Clinic and pathogenesis" / Under the general. ed. A.V. Snezhnevsky, / Moscow, 1969.

8. “Schizophrenia: a book to help doctors, patients and members of their families”, E. Fuller Torrey, / St. Petersburg, “Peter”, 1996.

Based on the statistics of existing projects, it was possible to calculate the relationship between the total frequency of requests in the family. kernel and the resulting traffic. Here, however, many difficulties arose: how to take into account negative keywords, what queries to use, what calculation formulas to use for projects with search traffic, and which ones for projects with traffic mainly from YAN and Display Network?

I talked about these nuances at the webinar, so now I would like to pay more attention to aspects related to sales.

Step 2: Budget Forecast

It is also quite possible to calculate the relationship between the forecast values ​​given by Yandex and the real figures of expenditure and cost per click. The more projects you have at hand and the more accurately you classify them, the more accurate the calculations will be.

However, even people who have undergone basic training in calculation methodology are able to make forecasts with an acceptable error of 15-25%.

Step 3: Forecast the number and cost of applications

Leadgen forecasting is the biggest challenge. This is due to the fact that the actual conversion value can vary significantly:

• most often, the current conversion is simply unknown: they haven’t calculated it, they’ve never attracted traffic before, there are no goals set up, there is no analytics...
• If the current conversion values ​​are known, then the error is caused by attracting “dirty traffic” for “junk” keywords, as well as the deplorable state of the site itself: no landing pages, low information content of the catalog, usability, no personalization of content, etc.

That is, most often it turns out like this: the conversion is either unknown or known, but not indicative. Without knowing the conversion, in turn, it is impossible to calculate either the quantity or the cost of the application - these are derivatives of traffic and budget.

Therefore, for some time we abandoned calculating the cost of the application and this immediately had a negative impact on sales - people did not want to delve into our difficulties, much less work with categories such as traffic or budget.

Therefore, we have developed two solutions to this problem:

a) When it is possible to predict conversion.

As the number of completed projects increases, the accuracy of forecasts increases, since people are most often engaged in similar businesses. For example, we know in advance that in jewelry we can assume a conversion of about 1% at best, and in microloans - 12-15%, in furniture 1.5-3% is realistic, in auto parts - from 3 to 7%, in consumer goods loans - about 5-7%, in loans for B2B - from 2 to 4%.

Moreover, changes in conversion become predictable after website improvement, be it the introduction of Yagla or clustering.

b) When conversion is impossible to predict.

Sometimes it happens that we are faced with a project for which there are no statistics at all. In this case, you have to take the numbers “by eye”, usually underestimating the real values ​​in order to be on the safe side.

But there are relatively few such topics: 80% of the businesses that the agency has to deal with contextual advertising, fits in 30-40 niches. What doesn’t get there is most often quite specific and therefore converts quite well: “narrow” services and products with a small and motivated audience most often show a conversion of 2 to 4%.

We have long had the idea of ​​a service in which agency representatives could exchange anonymized data on the cost of traffic and applications in various niches and regions, but so far the implementation of this service has resulted in a closed chat in Telegram for participants in my course on contextual advertising.

Pros: Why does forecasting sell?

Free forecasting of traffic, budget and applications has a number of key advantages, which can allow you to increase sales in your digital agency. When we receive an application at MOAB, we send two letters:

• a letter with questions that we need for calculations,
• a letter with calculation, comment, CP and attached semantic core file, compiled on the basis of the client’s responses.

Here is a review from a client who received these emails:

1. Because people want to plan a business

Most often, people are sent either frankly delusional or very approximate numbers. Many people immediately send just a CP. Therefore, when you let a person plan expenses, it sets you apart from other agencies. Especially when you specify a very reasonable tolerance of 15-20%.

2. Because they ask for money to collect the seed kernel, but you collect it for free

This dissonance makes a big impression on many customers - if you did a good job at the presale, it certainly inspires trust.

3. Because people like the convenience of working with semantics

We send semantics in this form: a file with a set of basic queries (masks) and additional information on them. Instead of abstract promises, the customer receives specific numbers and semantics associated with these numbers.

Of course, these requests do not always exactly meet his needs - somewhere they took something extra, forgot some segments - this is normal, because we are not experts in his topic.

But if 70-90% of the semantics are chosen correctly, then the customer’s impression is definitely positive, and he is drawn into the game: let’s remove these bases, add these, and see how the forecast changes?

This is the time to invite him to make an advance payment, after which he can begin making adjustments.

4. You get clients that you can actually make happy.

I won’t be original if I say that there are no ideal agencies and ideal clients, individual compatibility has not been canceled. Forecasting is an excellent tool for increasing LTV, since those who are not satisfied with your forecast do not buy from you.

And if you make realistic forecasts, then who doesn’t buy from you?

• “Poor” companies that “do not meet” the market bid price. Nobody thinks that in the luxury renovation and finishing segment it’s realistic to attract applications in Moscow for 200 rubles per piece by “setting up” Direct? In each niche there is a certain lower limit, after which further optimization brings minimal results.
• People with high expectations (we want to receive 200 applications a day, we sell tombstones in Naryan Mar).
• People who do not want to work with the agency (they simply will not read the “complex” forecast and correct the semantics).

The question arises: do you need such clients? Maybe it's better to do without them?

Mechanics of attracting applications using traffic forecasting

Features of attraction

In RuNet there are a lot of similar mechanics for attracting applications in complex B2B niches: free audits, webinars, manuals, forecasts of something - in general, expertise in front, money in back at the stage of flirting with the client, closer to the wedding contract - the hut unfolds.

In this matter, the most important thing is halftones and accents, although few people understand this.

For example, you attract traffic to a free site or context audit. It is clear that your and the customer’s interests are diametrically opposed: you need a check from those who came for a “free” audit, they need useful information from you “for thank you”, and then we’ll see.

The most reasonable solution in this situation is to cut the funnel.

Work with loyal audiences, i.e. with those who already know you one way or another. For example, on conferences, articles, speeches. Have you performed at Baltic Digital Days? Why not attract some traffic from YAN by [Dmitry Shakhov]? Loyal audiences are not only retargeting, there are many more of them very close to you - but more about this in the course. However, how to find loyal audiences is a separate topic; it is best to do this through context, in particular, Yandex.Audience and social networks.

Some of the most loyal audiences users from a total selection of more than 100 segments

• Filter messages. Even if your audit is free, do not write anything about “free” in the ad. Write in an ad for YAN\KMS: “Find out the problems of your advertising. Correction from XXX piastres! That is, only those who understand well enough that you will ask them for money sooner or later will click on this ad. At the same time, once on a landing page with a free audit, a person will receive something that exceeds his expectations (since instead of a commercial offer, value is offered for free) - and you will receive a good conversion of traffic consisting of people who are psychologically ready to part with money. Once again: in the ad - not a word about “free”, on the landing page - write about it everywhere. This is important both from the point of view of the advertising budget in pay-per-click systems (those who do not have money click less) and from the point of view of the “idle” load on the sales department.
• The more aggressively you “sell” free stuff in creatives, banners, mailings, the “dirtier” the flow of applications will be, the more colleagues in the market will be in the traffic, known beggars, crazy people and those suffering from attention and communication deficits.
• In any case, when you attract leads for some “free” welcome activity, you will be dealing with a funnel - some of the leads are, in principle, impossible to “close”. Therefore, use audience post-filters: for example, we use questions about business, leadgen structure, channel profitability, etc. to “cut off” those very problematic categories of citizens described above. That is, answers to questions first - and only then a forecast or audit. Representatives of agencies, crazy people, beggars and madmen are rarely ready to talk in detail about their business - because they don’t have one: (If they do, it’s immediately clear from the text that a good dose of haloperidol will not hurt. But decision makers and owners, professional investors -house marketers answer questions in great detail about what, in what volume, for how much money and to whom it is necessary to sell - and there you can immediately see how much “pain” this is for a person. And when there is pain, there is something to do with it work also for the sales department.
• A number of indirect questions perfectly demonstrate the client’s solvency. For example, the monthly check for which it is possible to “close” a client is a derivative of the advertising budget, and it can be predicted quite accurately in advance; for the regions the numbers are a little smaller, for Moscow - a little more.

When something went wrong: difficulties and mistakes

Of course, things don't always go according to plan. Sometimes we make mistakes in forecasts - now significantly less than at the beginning of the journey - but nothing in the world is perfect.

What affects the accuracy of forecasts:

• Experience and base of processed clients - after the first ~1000 campaigns, the accuracy of forecasts increases sharply, I have already encountered most of the niches, the time for 1 calculation decreases.
• Access to the Yandex.Metrics database - most of the data, except for search phrases, is open to this day, and you can often find a site similar to the one that takes part in the calculation - you just need to know how to search.
• Knowledge of niche, regional and other nuances. For example, in the regions there is much less traffic, but, oddly enough, the size of the low-frequency tails decreases slightly; and the conversion rate is often higher than in Moscow - people are not spoiled by the offer; even frankly terrible landing pages can generate applications at a cost-effective price - people don’t need content from the site, but a phone number.

Alternative energy: how else can you sell digital?

Recently, this question has been arising in the “agency” community more and more often: so how to sell agency services, be it contextualization, SEO or website creation?

I will try to systematize my views on this issue a little.

The fact is that if you are not the Lebedev or Ashmanov studio, then it will be difficult to sell directly. An online store of exercise equipment can drive traffic to the product page, but in retail the margin is now at best 15-20%. If you are a studio, then you must have a margin of 50% or higher, and you will have to pay for it - you will not sell it outright. “Cold” traffic from SEO or context will convert poorly, or you will need to set prices for your services in the “one-night-stand” format, when the client obviously closes for the first and only payment: 5000 for context, 10000 for site, 5000 rubles per month for SEO.

What to do about it?

There's nothing wrong with that. It just seems that in digital you can’t attract leads from context or “cold” traffic from VK. You can - you just need to close them for some free welcome bonus. Often, lead processing methods are confused with acquisition channels; I would like to separate these entities.

Processing methods:

• free webinar,
• article in the media,
• free audit,
• free forecast,
• test period of a product with full functionality,
• free consulting,
• presentation at the conference,
• free manual,
• own service with a low entry price and high value functionality.

Why do I call these points “methods”?

They are united by one common meaning: they “warm up” leads, to put it bluntly - for your content/expertise, etc. you buy trust in you and your business.

The digital market is inherently gypsy. And it is very important to prove to the client before starting work that you understand not only gold chains, but also advertising.

For each of these methods, there are channels for attracting traffic, and here I’m unlikely to be original:

• context,
• social networks (both targeting and organic traffic),
• YouTube,
• banner,
• mailings,
• Telegram,
• spam (mail, viber, etc.).

You can combine these methods and channels as you wish.

For example, pour traffic from the context to your free webinar on keyword selection. How to make sure that only business representatives and no colleagues are present at the webinar?

Answer: filter the audience so that it mostly includes business representatives.

For example, how to reach all or almost all owners of “living” individual entrepreneurs in Russia through YAN?

• take the top 100 banks of the Russian Federation,
• make a list of the names of their B2B billings,
• select all the synonyms of these names, incorrect spellings, transliterations, etc.,
• run advertising in YAN for these queries,
• Profit!

Remember - surely each of you who is served by Alfa Bank at one time searched in the search engine?

By the way, in the course I show a list of these requests and not only them - pure B2B traffic can be received for 10-15 rubles per click, you just need to know how to work with it.

Thus, if you create a truly valuable “free” and “filter” the traffic so that only businessmen with money are in it, then the task of B2B sales, and especially the context, does not seem so difficult.

Good luck with your sales.

Good evening, my dear readers!

Today I want to talk about this topic - a sales page and contextual advertising as a tool for selling any product on the Internet. What do you need to know first? What mistakes do newbies make? What should you NOT sell this way?

I’m asking this for a reason, because such tools are not suitable for many entrepreneurs on the Internet. They will simply be unprofitable. So, whether they will be unprofitable or not can be said with a 95% probability even before the start of the entire advertising campaign.

How is this assessed by friends? I will not count the costs of the sales page and setting up contextual advertising, because they are one-time and it is approximately 40-50 thousand rubles. I'm talking about a high-quality sales page and a well-tuned advertising campaign.

The most important thing we need to understand is whether constant investments in advertising will be offset by our profits from the sale of services or products. In fact, this is not difficult to understand; you need to know basic mathematics and understand how the whole process occurs.

I won't bother you financial ratios type ROI or CTR, etc. All these bourgeois symbols can be quite clearly and intelligibly explained in Russian, which is what I will try to do for you, and let advertisers and marketers bother themselves with them, an entrepreneur needs to understand the very essence, that’s enough.

So here it is. They created a landing page for you and set up a direct message. Let’s say that the average cost per click in your topic is 35 rubles. It could be 5 rubles, it could be 70 rubles, it all depends on the topic of your business, the main thing for me is that you get the essence.

To analyze and collect statistical data, we need at least 1000 clicks on our advertisements. You will get 35,000 rubles - this is your first, so to speak, test advertising budget. It’s a trial because we will then need to actually look at which ads to leave, which ones to delete, and which ones to adjust. Those. It was in contextual advertising that we invested 35,000 rubles, we remember this figure.

A good sales page has a conversion rate of 5% to 20%. This means that from 100 TARGET (from Direct ONLY targeted clicks should go) clicks on your advertisement you should be left with from 5 to 20 applications, let's take the average - 10. These are exactly the people who are interested in your product or your service, and you must take this into account and understand that here the client is TARGET, the client is EXPENSIVE and you CANNOT afford him let go, he should become your client!

As a rule, a good sales department or a competent entrepreneur who processes orders himself will convert these 10 applications into 2-5 clients. Let's take the average - 3 clients. Then simple mathematics - from 100 clicks we get 3 clients, from 1000 clicks we get 30 clients. I think everything is clear to everyone here.

Now we need to calculate how much profit we have from one unit of goods or services that we sell. For example, we sell fashionable cases for iPhone 6 for 1,600 rubles, of which our profit is 600 rubles from one sale of our case. And what do we have, my friends???

600×30=18000 rubles! Oops!!! And we spent 35,000 rubles on advertising and ended up with a minus of 17,000 rubles! Such results are very often encountered by young entrepreneurs who do not take their business seriously. An inexpensive product can be sold in a similar way, but only if the cost per click is low, no more than 6 rubles per click in this case!

I'LL SLEEP THE CHIP!!! Your profit from one sale should be no less than the price for 100 clicks!!! Remember this, that is, if your topic has a cost per click in Direct of 35 rubles, then your profit from one sale should be at least 3,500 rubles!!! Anything less will make it harder to recoup your investment!

What should you do if the cost per click is high, but the profit from one sale is not as high as needed? You have 3 options, the first is a landing page! We considered above that the average % of capture on a good sales page is from 5 to 20 and took 10 as the average. So, there are cases, i.e. examples when, with 100 visits to the landing page, 30 people leave requests...40 people!!! Can you imagine? This is 4 times more customers and profits, you can survive and high price click, and a small profit from one sale! BUT...

There is one BUT! You must have SUCH a landing page that can collect such a number of applications! What should it be? Perfect, beautiful, interesting design! Competent, clear and understandable selling texts for everyone! High-quality and sought-after product! Special offer! Here you will do it on HIGHEST level, you can count on increasing profits by 3-4 times!

The second option is to increase the qualifications of the sales department or the personal qualifications of a direct salesperson! This will increase profits not by 3-4 times, but by 2 for sure! And we can easily count on 6 clients out of 10 applications instead of the 3 we counted before!

And the third option is to sell only WHOLESALE! Suitable for both expensive and cheap items! You just need to initially evaluate the advertising company from the point of view of demand for this product, specifically for wholesale!

My friends, imagine doing EVERYTHING AT ONCE!!! Excellent landing page, expensive product, competent sales department, wholesale supplies! I think you understand? what kind of income you can have... the kind you want!

How to sell Yandex Direct settings? This question plagues all freelancers, beginners, agency sales managers and other professionals. For many years I have been selling online advertising. I’ve never wondered how to sell a Yandex Direct setup. There was only one question in my head - “where to find a client?” And when I found it, I simply said everything that came to my mind. But, as it turned out in the future, I was in vain in not analyzing my sales and meetings with clients.

I propose to consider the sale of Yandex Direct settings in stages. I say in advance that our sale is divided into 2 blocks. First, we get to know the client and find out what he needs. Then the 2nd stage, when we give the client what he needs, based on the information that the client disclosed to us in the 1st block:

1. First meeting;
2. Second meeting.

The meeting can be either real or a telephone conversation (Skype). And so let's go.

First meeting on selling Yandex Direct advertising settings

Remember the most important thing in the first meeting with a client. This meeting is divided into 4 stages. I'm not talking now about some secret phrases of sellers. This is not the most important thing. The most important thing is to follow the steps. Write it down and tick it off in your notebook as you go. Do not be shy. On the contrary, when you are in front of a client, you need to write down information. This emphasizes its importance.

What are the stages at the first meeting:

1. Establishing contact;
2. Presentation of the company;
3. Clarification of needs;
4. Presentation of services, depending on needs;
5. Summing up, fixing agreements.

All. Ready. Now let's go through each stage. Why is it important to follow this particular communication policy? Because it is logical and safe. If you first start presenting your services, telling how great your Direct is, how great it is to optimize the client’s website, etc., then the client will fall asleep and want to finish this fcap quickly.

Establishing contact when selling advertising

How to establish contact with a client? On the phone, it’s enough to say hello, say that you’re glad that the conversation took place and move on point by point.

If we talk about a meeting, then here it is necessary to go into the client’s office or meeting room, shake his hand, introduce himself, give him a business card, if he has one. Next, it is advisable to make a compliment about what a modern office he has, or what serious security the client has, etc. After this, it is necessary to offer the client the course of the meeting:

Ivan Stepanovich, I propose to conduct our meeting as follows: I’ll tell you briefly about the company, then we’ll talk about your goals and objectives, choose the best services and sum up the results of the meetings

Usually clients agree, there are those who offer to get straight to the point. Not the point. Next comes the next stage.

Presentation of a company or Yandex Direct advertising specialist

Write yourself a presentation for your company. If you work alone, then go wash yourself =). If one, then write about yourself. If you don’t have the text of the presentation, then write it. There is nothing complicated about this. If it’s difficult, then you shouldn’t mind your little business.

And so, you learn the text and tell it to the client. In terms of time, a presentation about the company should not take more than 2 minutes. It often happens that the client interrupts by asking his own questions. At such moments it is necessary to say this:

Ivan Stepanovich, I will definitely answer all your questions, just a little later.

If you do answer his question, it's okay. Just check the box so you don’t forget what you said before the client asked.

Finding out the client’s needs for Yandex Direct advertising

After the presentation, the stage came where you need to ask questions to the client. How to get to it? Very simple. It is necessary to say:

Ivan Stepanovich, now I would like to know your goals and objectives. What is the current situation now?

The client will begin to talk about himself, about his goals and objectives. This usually happens reluctantly. So far, the client has been hostile to us, one way or another. And it is through questions that we must convey to the client that we are great professionals, and we do not simply offer our services to just anyone.

What questions should you ask the client?

So right off the bat I don’t know what exactly I need to ask. I look at the situation. That is why I am giving a list of questions that you yourself must apply as the situation progresses.

Your task is to find out from the client how many sales, calls, applications there are now. Where do these requests come from? How does it track the effectiveness of the advertising campaign, if any. What he expects, how many calls and sales he wants to have. If he says he wants 100 calls a day, ask if he has had this result before? Ask, what was the maximum result? And dig, dig, dig in this direction.

Here is my general list of questions for the first meeting:

1. What exactly do you do in the company?
2. What business challenges are you facing now?
3. What products/services are currently your top priority?
4. What are you doing to achieve these goals? What advertising activities are you conducting?
5. Which advertising do you think is most effective for you?
6. What were your positive and negative experiences with advertising? Or in working with RA?
7. Who is your target audience? What features can you identify in your target audience?
8. Who are your competitors?
9. How do you measure effectiveness? Is there a conversion rate?
10. Which competitive advantages can you highlight?
11. Do you work with an agency or on your own?

List of questions regarding Yandex Direct for the client

Here is a list of questions that can be asked directly about the tool if the client has already set up contextual advertising, but is looking for other contextual specialists:

1. What strategy are you using?
2. Which phrases do you prefer (highs, mids and lows)?
3. Does your contractor provide analytics and recommendations (or simply act as a contractor)?
4. Do you use automated systems (bid) or do you work manually?

There may be even more questions, but these are the most basic ones. It’s not a fact that you will come to these questions. But if there is a need. Be sure to use it!

Presentation of Yandex Direct advertising services

In fact, it is extremely stupid to communicate with a client using only one tool. Even if you work only with Yandex, this does not mean that the client does not need anything else. There are situations when the market in Direct is severely overheated, and it is simply not profitable for the client to advertise there. And in Adwords, for example, it would be ideal.

Or there may be a situation where the client has low competition in SEO. Well, wow, how low. Yes, you can set up an advertising campaign in Direct, but in SEO, you 100% need to optimize the site. And that’s why you are obliged to check with the client what’s going on with his past advertising campaign how well it worked, what the conversion was. What is the conversion rate of the sales department? And also find out the margin in order to understand how profitable it is for the client to advertise in Direct. Maybe it's just SEO and Adwords. Or maybe target FB and VK.

So, after you ask questions, you should present your Yandex Direct advertising services. It's easy enough to do. The main thing is to speak the language of benefit. This means there is no need to talk about technical details. No need! Only if the client himself asks. Otherwise, if you start talking in your own language, the client will feel stupid. Even if the client nods his head in response to your verbal masturbation, this does not mean that he understands you.

What needs to be told about Yandex Direct? Say this:

All. Here is the presentation. Very short. After which the client's objections may follow. Like, what guarantees will you give me that everything will be of high quality? And so on. That's another question. We'll talk about this in the next article.

Remember one thing: when buying contextual advertising that affects the most target audience(after all, the visitor himself is looking for your product), makes it possible to set clear targeting parameters, allows you to predict the result, pay only for the result - the client receives an increase in sales, a greater likelihood of response to advertising, quick effect and quick sales.

Tell him this. This is the language of benefit. Without unnecessary information.

Stage of summing up and agreements

Just ask the client the most important questions. Which? Here they are

1. What are the criteria for choosing a contractor?
2. What do we need to do in order to become your contractor (the question is direct and should be asked according to the situation)
3. Campaign launch timing?
4. How long will it take to make a decision on our issue?
5. Will you consult with someone on our issue?

Next, say what you agreed on. And this is what you will do with Yandex Direct. And you will show how much money the client will need to invest in advertising. And he will already calculate in his mind how much money he can make from this setting.

Don’t forget that you can offer your client not only Yandex Direct. Offer a range of services. Your task is not to sell him Direct, but to help solve the problem of lack of clients. Make his fucking website work and make a profit.

This is an article from the section.

This chapter is for those who want to start their own business and create a successful contextual advertising agency. The features of this business are captivating...

No investment needed, that's it necessary tools free;

Absolute legality and transparency;

Demand for the service provided by clients;

Support and respect of large companies - Yandex, Google, Begun, etc.;

Stability and serious growth prospects. Clients have been working with a good agency for many years.

Where to start, what to do next, what to strive for?..

Summarizing the experience of well-known agencies, we will talk about the main stages of this difficult but interesting path.

CHAPTER 1 THE FIRST DISASTER: HOW WE KILLED THE TRADITIONAL