[Personality disorders and schizophrenic defect (problem of comorbidity)]

[Attenuated negative symptoms in the structure of youth depression]

OBJECTIVE

To detect negative symptoms in adolescent depression, to determine their psychopathological structure and predictive significance.

MATERIAL AND METHODS

Seventy-one young in-patients (average age 19.5±2.4 years) (main group) and 52 in-patients (average age 19.8±2.7 years) (comparison group) with the diagnosis «Depressive episode» according to ICD-10 F32.1, F32.2 were examined. Inclusion criterion in the main group was attenuated negative symptoms (ANS) in adolescent depression. Clinical-psychopathological and psychometric examination was carried out using HDRS, SOPS, SANS. The statistical analysis was done by Statistica 12.

RESULTS

Adolescent depression with ANS was more persistent than depression in the comparison group (27.5±17.2 month versus 7.0±6.3, p<0.001), there was higher level of positive symptoms and disorganization symptoms on the respective SOPS sub-scales (7 [5; 9] and 4.5 [3; 8.75], p=0.002; 8 [6; 10] and 5.5 [3.25; 7], p<0.001, respectively). According to the psychopathological structure of the negative symptoms, patients in the main group were divided into a subgroup (n=38, 53.5%) with the predominance of emotional spectrum disorders and a subgroup (n=33, 46.5%) with the predominant involvement of the volition spectrum. ANS in the negative SOPS sub-scale were significantly higher (p=0.045) in patients of the subgroup with volitional disorders. Also, a total HDRS score, reflecting the severity of depressive symptoms, was significantly higher compared to a subgroup with the predominance of emotional spectrum disorders (p=0.038).

CONCLUSION

The results show that it is possible to clinically verify negative symptoms in the adolescent depression, which makes it possible to assign such patients to the risk group of manifestation of schizophrenia, and to assign depression with ANS to the model of the initial stage of schizophrenic process.

[Juvenile depression as at-risk state for psychotic disorders]

OBJECTIVE

To establish the risk of psychotic disorders in juvenile depression and to study the role of negative symptoms in its formation.

MATERIAL AND METHODS

Seventy-four in-patients (19.6±2.3 years old), who were hospitalized for the first time in the clinic for a depressive episode, were examined. Psychometric scales HDRS, SOPS, SANS were used. The risk of manifestation of psychotic disorders was established in the presence of attenuated positive symptoms (APS) with values of at least one of the points P1, P2, P3 and P4 of the corresponding SOPS subscale more or equal to 3. The overall risk of schizophrenia spectrum disorders was established in the presence of attenuated negative symptoms (ANS) with values of at least one of the points H1-H6 of the negative SOPS subscale is more than or equal to 5. Statistical analysis was carried out using the Statistica 12 program.

RESULTS

During the psychometric assessment of patients at admission, four groups were identified based on the presence of APS and ANS: group 1 (APS+ANS), group 2 (APS), group 3 (ANS) and a comparison group without APS/ANS. It was found that the presence of APS and ANS in the structure of depression increased its severity (U=109.0; p=0.009). Assessment of the ANS severity on the negative subscale of SOPS and on the SANS demonstrated quantitative differences with the highest representation of negative symptoms in the corresponding groups (APS+ANS and ANS) with significant differences in total scores in the comparison group (U=93.0; p=0.004 and U=85.0; p=0.002). When studying the structure of negative symptoms according to the SANS subscales, patients with APS differed in a lower degree of severity of negative symptoms only according to the «Avolition-Apathy» subscale (U=141.5; p=0.028). Patients from the comparison group, despite significant differences in other psychopathological symptoms, showed lower values only for the SANS subscales «Affective flattening» (U=112.0; p=0.02) and, to a greater extent, «Avolition-Apathy» (U=84.0; p=0.002).

CONCLUSION

Based on the presence of prodromal symptoms in the structure of juvenile depression and their dynamics during therapy, one can assume not only a different degree of risk of endogenous psychoses, but also their nosological affiliation.

Dynamics of views on different aspects of schizophrenia (Narrative Literature Review)

Как известно, шизофрения остается во многом неясным психическим расстройством, являющимся значительным социальным и экономическим бременем. Поэтому обзоры литературы, охватывающие основные аспекты этиологии, диагностики и диагностических ошибок в разные временные периоды, представляются актуальными. В статье приведены данные анализа более 200 отечественных и зарубежных работ по указанным аспектам шизофрении, преимущественно за последние 10 лет, а также имеющих важное историческое значение. Обзор литературы по вопросам этиологии и диагностики шизофрении может способствовать вниманию ученых к тем или иным результатам исследований на новом концептуальном и методическом этапе. При этом качественные изменения в понимании шизофрении и расстройств шизофренического спектра способствуют развитию инновационных технологий в психиатрии, что важно для науки и практики данной дисциплины.

Conceptualization and management of personality disorders in Russian psychiatry

PURPOSE OF REVIEW

This article aims to present the current picture on conceptualization, diagnosis and care provision of personality disorders (PD) in modern Russia. These issues are highly relevant to Russian psychiatry, which has a rich historical tradition of analysing psychopathic constitution, personality types and dynamics.

RECENT FINDINGS

This narrative review covers the main tendencies in the recent Russian academic literature devoted to PD. PD are most frequently investigated in the frames of forensic psychiatry, in which expert conclusions and assessment of the risk factors for socially dangerous behaviour are particularly important. Another area of research concerns comorbidity, since PD often affect other health conditions or are co-occurrent with other mental or behavioural problems. Specialists have also focused on the challenges of therapy in PD.

SUMMARY

Reviewed manuscripts show a pathogenic and pathoplastic role of personality factors in manifestation of other mental, behavioural or somatic disorders. Analysis of pathocharacterological profile and self-regulation processes is a major component in assessing and diagnosing PD. The principal perspectives in this particular area focus on evidence-based research of mechanisms of personality pathology and validation of targeted personalized combined therapeutic approaches.

[Asthenic disorders in schizophrenia (schizoasthenia) on the model of hypochondriac schizophrenia]

OBJECTIVE

To determine the structure and mechanisms of interaction of asthenic disorders with negative and positive psychopathological symptoms in hypochondriac schizophrenia.

MATERIAL AND METHODS

The study included male and female patients, aged 17-69 years, with a diagnosis of hypochondriac schizophrenia (F20.80 according to ICD-10) and asthenia symptoms. The main research method was clinical, which was supplemented by pathopsychological examination and the use of psychometric scales (PANSS, SANS, MFI-20,VAS asthenia).

RESULTS AND CONCLUSION

Asthenia in case of hypochondriac schizophrenia (schizoasthenia) integrates two unrelated phenomena: «weakness» and «exhaustion» (intolerance to stress), and also acts within the framework of three psychopathological syndromes: neurotic, senestopathic/hypochondriac and overvalued hypochondria. Asthenia with hypochondriac schizophrenia is a predictor of an unfavorable social and clinical prognosis. Integrating into the structure of the clinical manifestations of hypochondriac schizophrenia, asthenia forms close relationships with positive and negative disorders of the type of «general syndromes», but remains outside the categories of both positive and negative symptoms of the disease, thus forming a separate «dimension» in the psychopathological space of schizophrenia.

[Asthenia in the psychopathological space of schizophrenia and schizophrenia spectrum disorders (The concept of asthenic deficit in aspect of the modern model of negative symptoms)]

At the modern level of knowledge, classification of asthenic deficit as an independent psychopathological category and, in general terms, as the classification of asthenic symptomatic complexes of negative symptoms within schizophrenia and schizophrenia spectrum disorders is the subject of discussion. Studies of recent decades have shown that asthenia cannot be considered as a separate deficient monosyndrome, does not fit into the framework of negative disorders and is excluded from the block of scales of negative symptoms (SANS, PANSS, BNSS, CAINS). The authors suggest a working hypothesis that asthenia symptomatic complexes within schizophrenia are not comparable either in nature or in their psychopathological structure with primary deficiency disorders determined by the disease process. However, at the same time schizoasthenia, acting as a manifestation of the coenesthesiopathic hypochondriacal register, i.e. essentially in the space of positive disorders, is formed in close dependence on negative symptoms and is thus one of the markers of the already formed defect.