[Psychopathological features of affective disorders in schizotypal disorder]

[Assessment of the initial period of schizotypal disorder in childhood]

OBJECTIVE

To identify developmental features, the presence of hereditary burden, social adaptation, the structure of early psychopathological disorders in pediatric patients with schizotypal disorder (STD) and their relationship with the age of manifestation and the clinical structure of the disease.

MATERIAL AND METHODS

The study included 150 patients aged 7 to 16 years with a diagnosis of SD, of which 48 were female and 102 were male. Based on the age of onset of the first stable psychopathological disorders, at the stage preceding the diagnosis of SD, 5 groups of patients were identified: up to 3 years (n=38), from 4 to 6 years (n=36), from 7 to 10 years (n=15), 11-13 (n=41), 14-16 years old (n=20). The study used clinical-psychopathological, clinical-catamnestic, with a retrospective analysis, neurological, pathopsychological, psychometric and statistical research methods.

RESULTS

A high frequency of deviations from normative parameters in early psychomotor development was found in 99 (65%) patients with STD. Mental retardation was observed in 23 (15%) patients, dissociation in mental development was detected in a significant number of patients - 62 (41%). At the same time, the most significantly more frequent and pronounced were violations in the two youngest groups with the onset of psychopathological disorders up to 6 years. In these groups, there was also more often a deficit in three areas at once - emotional, motivational and volitional (38%) compared with the 4th group (13%). In groups 1 and 2, a deficit in intellectual development was also characteristic, which was reflected in academic indicators. High performance in the primary grades was observed in 16% of patients in the 1st group versus 60% in the 5th, and poor performance was found in 37% in the 1st group and only 5% in the 5th. The relationship of clinical variants of STD with the selected groups was revealed. The diagnosis of schizotypal personality disorder was significantly more often (66%) diagnosed in patients from group 1 compared with groups 3 and 5. In group 2, this diagnosis was established in a third of cases. The diagnosis of the psychopathic variant of STD was predominant in patients with the onset of the disorder between 7 and 13 years of age. The neurosis-like variant had a clear tendency to become more frequent with older age, reaching statistically significant differences in group 5 compared to group 1.

CONCLUSION

The age of onset and duration of persistence of psychopathological disorders determines the level of negative changes that have formed at the stage of the disease preceding the onset of distinct clinical symptoms of STD. Age at onset determines the predominant positive disorder.

[Clinical features of depression in adolescents with schizotypal disorder]

OBJECTIVE

To study the clinical features of depressive disorders in adolescents with schizotypal disorder (STD).

MATERIAL AND METHODS

Were examined 87 adolescents with STD (F21), taken for outpatient or inpatient observation in 2018-2020. Of these, 26 patients were selected (12 males, 14 females, mean age 12.7±2.9 years) diagnosed with clinically significant depression (F32). To assess the severity of depression, the Hamilton Depression Rating Scales (HDRS) and the Beck Depression Self-Assessment Questionnaire (BDI) were used. The SPQ questionnaire was used to quantify the presence of STD symptoms.

RESULTS

Depressive disorders were observed in 28% of all examined patients with STD. Signs of dysontogenesis were observed in 92% of the examined. The duration of depressive episodes before the start of treatment averaged 8.7 months, and until therapeutic remission was achieved, an average of 12.6 years. A mild depressive episode according to the HDRS scale corresponded in 23.1% of patients with a moderate degree in 61.5% and a severe one in 3.8%. At the same time, according to the BDI questionnaire, the results were different: there was no mild degree of depression during treatment, moderate-severe degree was detected in 8 (30.1%) patients, in the remaining 16 (61.5%) - extremely severe degree. Suicidal thoughts were noted in 76.9% of the surveyed, while the parents knew about their presence only in 27.0% of adolescents. A suicidal attempt was made by 3 patients (11.5%), one of them repeatedly. Non-suicidal self-injurious behavior was found in 38.5% of patients.

CONCLUSION

Depressive episodes in adolescents with STD are noted chkasto, characterized by the duration and severity of symptoms. Subjective depressive experiences, primarily internal feelings of longing, ideas of failure and guilt, as well as the frequency of anti-vital thoughts and self-injurious behavior, are much more pronounced in adolescents than they demonstrate in everyday life.