Clinical-catamnestic and medical-social characteristics of periodic endogenous psychoses as a result of pathopersonological transformations (a comparative analysis)
DOI:
https://doi.org/10.14739/2310-1210.2019.3.169195Keywords:
schizophrenia, schizoaffective disorder, affective disorders, social characteristicsAbstract
Differential diagnosis of endogenous psychoses with episodic course is an extremely relevant issue of modern psychiatry due to the pathomorphosis of mental illnesses and subclinical persistence of clinical markers after the first episodes of the disease. Correct and timely diagnosis of these conditions determines the adequacy of therapeutic and socio-rehabilitation influences not only during disease exacerbations, but also in the period between bouts of psychosis in order to preserve the social adaptation of patients.
The purpose of this study was to perform a comparative analysis of the clinical-catamnestic and medico-social characteristics of remission in patients with schizophrenia, schizoaffective disorder (SAD) and affective disorders (AD).
Contingents and methods. A total of 221 patients were examined on the basis of the Regional Clinical Psychiatric Hospital (Zaporizhzhіa), 49 of whom were with AD (31 patients with a diagnosis of “bipolar affective disorder” and 18 with a diagnosis of “recurrent depressive disorder”), 76 patients were diagnosed with “schizoaffective disorder” and 96 patients were diagnosed with “paranoid schizophrenia, episodic course” having a pronounced affective component in the structure of psychotic episodes. An obligatory criterion for inclusion was the state of clinical remission with psychotic symptoms reduction. The main methods of the study were clinical-catamnestic and clinical-psychopathological as well as medical statistical analysis.
Results. In patients with episodic course of endogenous psychosis, there is a persistent decline in the social adaptation level of varying degrees, the severity and manifestations of which differ depending on nosological form. Schizophrenia and SAD are characterized by a more pronounced negative impact on the level of labor adaptation than AR. This is confirmed by a large percentage of unemployed individuals (P < 0.01), a lower percentage of persons working in positions related to skilled and mental work (P < 0.01). SAD patients more often (P < 0.01) receive treatment courses in a hospital than patients with other periodic endogenous psychoses. Social factors are more likely (P < 0.01) cause repeated hospitalizations in SAD than in AD and episodic schizophrenia (26.7 %, 5.8 % and 12.5 %, respectively).
Conclusions. A high level of rehospitalization for social reasons in SAD demonstrates persistent pathopersonological transformations and the lack of efficacy of therapeutic and rehabilitation measures used in SAD during a remission period. Persistent pathopersonological transformations, occurring in endogenous psychoses, require a comprehensive study and a system of congruent therapeutic and rehabilitation measures in order to prevent social disadaptation.
References
Voloshyn, P. V. & Maruta, N. О. (2015) Stratehiia okhorony psykhichnoho zdorov’ia naselennia Ukrainy: suchasni mozhlyvosti ta pereshkody. [The Strategy of Mental Health Care of the population of Ukraine: contemporary opportunities and obstacles]. Ukrainskyi visnyk psykhonevrolohii, 23, 1(82), 5–11. [in Ukrainian].
Maruta, N. O. & Verbenko, H. M. (2017) Kohnityvni porushennіa u khvorykh na bipolіarnyі afektyvnyі rozlad [Cognitive impairments in patients with bipolar affective disorder]. Zdorovіa Ukrainy, 3, 32–34. [in Ukrainian].
Pidkorytov, V. S., Sazonov, S. O. & Baybarak, N. A. (2014) Osoblyvosti diahnostyky shyzoafektyvnoho rozladu sered spektra afektyvno-paranoidnykh staniv [Diagnostic features of schizoaffective disorder in the spectrum of affective-paranoid states]. Medychna psykholohiіa, 9(3), 71–77. [in Ukrainian].
Pidkorytov, V. S., & Serikova, O. S. (2017) Predyktory ta osoblyvosti klinichnoi kartyny povtornykh napadiv shyzoafektyvnoho rozladu [Predictors and peculiarities of the clinical picture of recurrent attacks of schizoaffective disorder]. Ukrayinskyі visnyk psykhonevrolohii, 25(1), 142–143. [in Ukrainian].
Sumarokova, M. A., & Khritinin, D. F. (2014) Osobennosti lekarstvennogo patomorfoza remissij u bol'nykh s shizoaffektivnymi rasstrojstvami [Characteristics of the pharmacological pathomorphosis of remission in schizoaffective disorders]. Chelovek i lekarstv: Proceedings of the XXI congress. (P. 188). Moscow. [in Russian].
Mosolov, S. N., Shafarenko, A. A., Ushkalova, A. V., Alfimov, P. V., & Kostyukova, A. B. (2014) Formalizovannaya diagnostika bipolyarnogo affektivnogo rasstrojstva u bol'nykh s pristupoobraznoj shizofreniej i shizoaffektivnym rasstrojstvom [Misdiagnosis of Bipolar I Disorder among patients with the diagnoses of paranoid schizophrenia and schizoaffective disorder in Russian Federation]. Sovremennaya terapiya psikhicheskikh rasstrojstv, 3, 2–7. [in Russian].
Chugunov, V. V., & Kireeva, E. N. (2014) Mediko-psikhologicheskie prediktory prodromal'nogo perioda povtornogo e'pizoda rekurrentnogo depressivnogo rasstrojstva [Medical and psychological predictors of prodromal period of repeated episode of major depressive disorder]. Zaporozhye medical journal, 3, 71–76. [in Russian]. doi: https://doi.org/10.14739/2310-1210.2014.3.26035
Murru, A., Manchia, M., Tusconi, M., Carpiniello, B., Pacchiarotti, I., Colom. F., & Vieta, E. Diagnostic reliability in schizoaffective disorder. Bipolar Disorder, 18(1), 78–80. doi: 10.1111/bdi.12366
Santelmann, H., Franklin, J., Bußhoff, J. & Baethge, С. (2015) Test-retest reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression – a systematic review and meta-analysis. Bipolar Disorder, 17(7), 753–68. doi: 10.1111/bdi.12340
Wilson, J. E., Nian, H. & Heckers, S. (2014) The schizoaffective disorder diagnosis: a conundrum in the clinical setting. European Archives Psychiatry and Clinical Neuroscience, 264(1), 29–34. doi: 10.1007/s00406-013-0410-7
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