Clinical and Dynamic Characteristics оf Therapeutic Remissions after Acute Paranoid Psychoses in Schizophrenic Patients Treated with Antipsychotics of Various Generations

Abstract

Background: the comparative aspect of the clinical-diagnostic and prognostic evaluation of long-term remissions treated with antipsychotics of various generations in patients with shift-like schizophrenia remains poorly studied and retains scientific and practical actuality. The purpose of the study: a comparative study of the therapeutic effect of antipsychotics of different generations on clinical-psychopathological peculiarities and the dynamics of 2-year remissions after acute paranoid states in patients with shift-like schizophrenia. Patients and methods: 34 female patients (average age made up 26.9 years old) were diagnosed in shift-like schizophrenia with a clinical picture of the attack as acute paranoid syndrome (F20.02 according to ICD-10). 16 patients received treatment with typical neuroleptics (TN), other 18 patients received atypical neuroleptics (ATN). The study was conducted as an open prospective, using clinical-psychopathological, clinical-catamnestic and clinical-psychometric methods. The mental state of patients was assessed four times: upon admission to the hospital in acute psychosis (1 point), when entering remission (2 points), after 1 and 2 years of remission (3 and 4 points). In psychometric assessment was used calculated for 1 patient indices of the main total score of all signs (MTS) and main score of 1 sign (MS) of the PANSS scale and its subscales of positive (P), negative (N) and general psychopathological (G) syndromes. Results: at the end of the active treatment with both types of antipsychotics at the 2 point of assessment, was reduced MS of positive symptoms P+G subscales from 3.3 to 1.7 scores on TN and from 3.8 to 2.2 scores on ATN, with a remission and stabilization of the achieved improvement with reduction of MS at 4 points up to 1.5. MS of negative symptoms by the 2 nd year of remission on ATN decreased from 2.7 to 2.0 in parallel with the reduction of positive signs by P + G; on TN there was an increase in MS indices of subscale N from 2.3 to 2.7 scores. The assessment of negative disorders is discussed as “secondary” negative due to the phenomenologically is assumed with the symptoms of the positive syndrome and the effects of neurolepsy. Conclusion: TN and ATN exhibit a similar “antipsychotic” effect in the treatment of acute paranoid psychoses in shift-like schizophrenia patients with the formation of long-term high quality remissions, stabilization of degrees of reducted productive psychopathological symptoms and with the absence of the progredience disease. To optimize the therapeutic effect of both types of antipsychotics, it is recommended correction of the regime and the term in transition from active to maintenance therapy and prescription of neurolepsy correctors to reduce severity in the picture of “secondary” negative symptoms.