Clinical and epidemiological aspects of schizotypal disorder in children and adolescents according to the Moscow psychiatric service

Abstract

BACKGROUND: Given the significant increase in the number of children and adolescents diagnosed with schizotypal disorder and the simultaneous decrease in the incidence of schizophrenia in recent years, studying possible causes of the tendency and provision of psychiatric care to these patients is necessary. AIMS: To analyze the frequency of schizotypal disorder (F21) in children and adolescents and study the correspondence of diagnosis with the ICD-10 criteria and changes in accordance with disease dynamics to improve the continuity of psychiatric care. MATERIALS AND METHODS: This retrospective observational study analyzed data of patients who underwent examination and treatment at Sukhareva Scientific and Practical Center for Child and Adolescent Mental Health between 1999 and 2019, and the inpatient and outpatient records of the center and outpatient records of psychoneurological clinics at the place of patients residence were analyzed. RESULTS: The number of patients diagnosed with F21 schizotypal disorder increased along with the general increase in the number of patients (2812 people in 1999 and 5675 in 2019). They account for nearly half (48.3%) of the patients with diagnoses related to the schizophrenia spectrum (F2 schizophrenia and schizotypal and delusional disorders). Moreover, 71.2% of patients with F21 were diagnosed with F21.8 (schizotypal personality disorder). The number of patients diagnosed with schizophrenia decreased threefold, and the number of patients diagnosed with schizotypal disorder increased six-fold. Among those discharged with F21.8 diagnosis excluding rehospitalizations, 527 patients were selected for the clinical and follow-up study. After the exclusion of patients for various reasons, the patient cohort consisted of 139 patients who had been regularly followed up at psychoneurological clinics. The diagnoses with F2 code remained in 96% of 139 patients included in the cohort for the follow-up study, and only five patients had other disease codes. The diagnosis of schizotypal disorder (F21) persisted in 89 patients (64%). CONCLUSION: The decrease in schizophrenia diagnoses and the increase in the diagnosis of schizotypal disorders in children and adolescents, as revealed in the clinical and epidemiological study of ICD-10 use in 20 years, require further in-depth studies of the possible causes of this transformation. In light of the forthcoming adaptation of ICD-11, unified and clear criteria must be developed for schizotypal disorders, and a common understanding of their nosological affiliation is needed to develop more advanced approaches to diagnosis. The organization of psychiatric care provision must be improved to ensure the continuity of inpatient and outpatient care, including non-state institutions.