Schizophrenic Process Research Articles

Structural Brain Characteristics of Chronic Schizophrenia Patients with Different Types of Functional Outcome

Background: studies allowing to explore the neurobiological characteristics of the long-term schizophrenic process are of high significance for both clinical practice and biological psychiatry. Objective: to examine morphometric brain characteristics in chronic schizophrenia patients with different types of functional outcomes. Patients and methods: morphometric MRI characteristics of the cerebral cortex and subcortical structures are analysed in 46 patients with schizophrenia with a long disease durations (20.5 ± 6.7 years), and in 35 mentally healthy subjects matched by sex and age. Results and discussion: the whole group of patients showed decreased gray matter thickness in some cerebral cortex regions. When outcome was assessed using clinical-psychopathologic, clinical-catamnestic, and clinical-epidemiologic methods, bilateral increases in pallidum and putamen volumes were found to be a presumptive marker of worse functional outcome and remission poor quality. At the same time, when outcome was assessed on the basis of the current psychometric measures of social functioning and clinical symptomatology, patients with an unfavorable outcome were characterized by decreased gray matter thickness in the two cingulate cortex regions compared to both healthy controls and patients with a good outcome. However, the absence of correlations with clinical scales and functioning doesn’t allow a conclusion on the specificity of this decrease as a marker of outcome. Conclusion: the results may only presume beforehand the existence of different neuroanatomical subtypes (biotypes) associated with different functional outcomes in patients with chronic schizophrenia.

The role of resilience and coping behavior in schizophrenia in the prevention of psychosis relapse

IntroductionAccording to scientific sources, personal resources in the form of resilience, stress coping skills play an important protective role in the prevention of psychosis recurrence. Weakening the psychological capacity of the patient and increasing stress are risk factors for psychosis.ObjectivesTo study the protective role of such personal resources as resilience and coping with stress in schizophrenia, as well as the influence of negative symptomatology and psychosociorehabilitation intervention on these factors.MethodsClinical-psychopathological, statistical, and psychometric methods were used (Alfimova-Golimbet’s resilience scale, Amirkhan’s coping strategies questionnaire, and PANSS). Patients of two groups participated in the study: 1 - members of a community organization (OO), n=49, who in addition to psychopharmacotherapy were given comprehensive long-term psychosociorehabilitation (3.7±2.5 years), 2 - patients of the medical-rehabilitation department of a psychiatric hospital (MRO), n=48, in whom the psychosociorehabilitation intervention was shorter (40.3±6.5 days).ResultsThe results of the study showed that significant predictors of a favorable course of the schizophrenic process were high indicators of resilience, coping behavior, and a small degree of negative symptomatology. Analysis of the data regarding patients’ coping with stress shows that constructive coping strategies are more frequent in both groups. Thus, “problem solving” (24.3 points in GS and 22.9 points in MPO) and “search for social support” (23.0 points and 22.7 points, respectively), that is patients of both groups are generally oriented to a productive way of coping with difficult situations and are ready to seek help from others in a difficult situation. Notably, the strategy of “problem avoidance” is less pronounced (18.5 points and 19.4 points, respectively). The high resilience scores in the GS group (32.5 points), comparable to the norm in the population (33.1 points), are explained by long-term comprehensive psychosociorehabilitation, while the resilience scores in the MPO group are lower - 28.7 points. Negative symptoms of schizophrenia were equally pronounced in both groups, manifested by difficulties in communication (2.6 points each), passive-apathetic social withdrawal (2.7 points each). Such negative symptoms as blunting of affect and emotional indifference were more pronounced in the MPO group - 3.2 points each vs. 2.8 points in the group from the GS.ConclusionsHigh levels of resilience and ability to cope with stress as a result of psychosociorehabilitation intervention allow patients to overcome difficult life circumstances more flexibly. They are associated with less pronounced negative symptoms, which generally helps prevent psychosis relapses and contribute to a more favorable course and prognosis of schizophrenia.Disclosure of InterestNone Declared

Cognition in Patients with Schizophrenia: Interplay between Working Memory, Disorganized Symptoms, Dissociation, and the Onset and Duration of Psychosis, as Well as Resistance to Treatment.

In total, 105 patients with schizophrenia were observed. Of these, 66 were women and 39 men. Clinical status was assessed using the Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Dimensional Obsessive-Compulsive Symptom Scale (DOCS), scale for dissociative experiences (DES) and Hamilton Depression Rating Scale (HAM-D)-cognitive functions using the Luria 10-word test with fixation assessment, reproduction and attention analysis. The clinical evaluation of resistance to the treatment showed that 45 patients were resistant to the ongoing medical treatment and the remaining 60 had an effect from the therapy. Our study showed that, in most patients, we found disorders of working memory and attention. In 69.82% of the patients, we found problems with fixation; in 38.1%, problems with reproduction; and in 62.86%, attention disorders. Conducting a regression analysis showed that memory and attention disorders were mainly related to the highly disorganized symptoms scale, the duration of the schizophrenic process and the dissociation scale. It was found that there was a weaker but significant association between the age of onset of schizophrenia and negative symptoms. In the patients with resistant schizophrenia, much greater violations of the studied parameters working memory and attention were found compared to the patients with an effect from the treatment. Impairments in working memory and attention are severely affected in the majority of patients with schizophrenia. Their involvement is most significant in patients with resistance to therapy. Factors associated with the highest degree of memory and attention impairment were disorganized symptoms, duration of schizophrenia, dissociative symptoms and, to a lesser extent, onset of illness. This analysis gives us the right to consider that the early and systematic analysis of cognition is a reliable marker for tracking both clinical dynamics and the effect of treatment.

Intérêt du concept d’émergences psychotiques à l’adolescence : autour de deux situations cliniques

ObjectivesPsychotic symptoms are common in the adolescent population and can occur even in those who have no underlying mental health disorders. For the practicing clinician, psychotic symptoms can represent a myriad of underlying pathologies that can be identified within a range of different circumstances. These include both organic (neurocognitive disorders, genetic disorders, brain lesions, etc.) and non-organic disorders (schizophrenia and bipolar). They can also represent non-pathological processes such as sensory deprivation. Regarding mental health, the positive symptoms of psychosis are associated with many disorders none of which are pathognomonic to any particular diagnosis. However, classically they are associated with the beginning of a schizophrenic disorder. Psychotic symptoms presenting during adolescence pose a unique diagnostic challenge. The emotional instability during this period proves to be an unsteady platform and the symptoms of psychosis are associated with a much broader differential diagnosis. Consequently, psychotic symptoms during this period can be misleading. Therefore, it remains very difficult to decide clinically between the onset of psychosis, an affective or thymic reaction, certain autistic spectrum disorders or the expression of neurocognitive particularities such as attention deficit disorder with or without hyperactivity. The objective of this article is to stress the difficulty of making a diagnosis in the adolescent population with regard to psychosis and to explore the concept of emergent psychosis applied to this age group. We have illustrated our propositions with two case reports. PatientsThe first patient is a 13-year-old teenager hospitalized for severe heteroaggresive behavior. We identified school bullying in his past medical history with a positive family history for ADHD. At first, he described having difficulties with his peers, moderate anxiety and a low-level mood. We observed hyperactivity and impulsivity in the service. The initial diagnosis suggested ADHD and social anxiety. Finally, without any clear positive symptomatology, the use of a screening scale (CAARMs) pointed out a disturbance in thought, which could correspond to a high risk of psychotic transition, which would require early treatment. The second patient is a 12-year-old teenager who presented with intense psychotic symptoms, suicidal tendencies and severe anxiety associated with a low-level mood. He described moments of experiencing a disassociation from reality, auditory hallucinations and interpretative delirious ideas. His mood seemed correlated to those psychotic symptoms. Our first hypothesis was a schizophrenic process. However, we found restricted interest and difficulties in social interaction. An ADOS-2 and an ADI suggested a high probability of autistic spectrum disorder. Finally, by effectively treating his anxiety, the patient showed great improvement with a dramatic reduction in the positive symptoms he had previously exhibited. DiscussionIn the first case report, we found no psychotic symptoms. The patient showed discrete symptoms of disorganization and discrete negative symptoms that suggested a very high risk of psychotic transition. In contrast, the second case report showed very severe positive symptoms. However, we did not find any disorganization or negative symptoms in his presentation. Finally, his anxiety seemed to exacerbate the psychotic symptoms in the context of autism. ConclusionsThe early detection of psychotic prodromes represents a major prognostic challenge in the functional disability that a low-grade psychotic process can generate. However, the appearance of the first positive symptoms does not presume an assured outcome. Thus, the notion of emergent psychosis in young adolescents has the advantage of not excluding the risks of future evolution towards a psychotic pathology, while keeping in mind other hypotheses.

ОСОБЕННОСТИ ПСИХОДИНАМИЧЕСКИХ НАРУШЕНИЙ В СТРУКТУРЕ ШИЗОФРЕНИЧЕСКОГО РАССТРОЙСТВА (НЕДОСТАТОЧНОСТЬ ИНТРАПСИХИЧЕСКОЙ ЖИЗНИ, КОММУНИКАТИВНО-ЭМОЦИОНАЛЬНЫХ ОТНОШЕНИЙ)

The article describes certain aspects of negative psychosocial influence as a complex of specific exogenous-endogenous factors involved in the development of the schizophrenic process. For example, this is the lack of communicative-emotional parent-child relationships, in which one's own existential experience is not formed, which is necessary for the formation of value-motivational behavioral potential. As a result, there is an inability to self-reflection and internal self-regulation, which provoke, among other things, the mechanisms of alienation of the inner I. The issues of metacognitive potential deficits in persons suffering from schizophrenia (social cognition) are also touched upon.

Mental Disorders Associated with the Abuse of Synthetic Cannabinoids (Spices)

Introduction: the abuse of synthetic cannabinoids may trigger the development of mental disorders characterized by distortions of disease processes that can cause incorrect diagnosis.Objective: to study the phenomenon of the abuse of synthetic cannabinoids (Spice) as a trigger psychotic episode in psychiatric patients (with schizophrenia and personality disorders) and risk factors for developing paranoid schizophrenia.Patients and research methods: 291 men were examined: 241 with dependence on synthetic cannabinoids — 101 of them were diagnosed with personality and behavior disorders in adulthood, 140 with a diagnosis of paranoid schizophrenia and 50 with a diagnosis of paranoid schizophrenia without drug dependence.Research methods: clinicalpsychopathological, psychometric (SANS, CGI, MMPI), follow-up, statistical R (R version 3.2.4).Results: intoxication conditions caused by synthetic cannabinoids can provoke the development of psychotic episodes and be a trigger for the manifestation of schizophrenia. There are four variants of narcotic intoxication: delirious, schizophrenic, with pseudo-hallucinations, with delirium. The personalities of patients addicted to synthetic cannabinoids are similar in the prevalence of emotionally unstable, rigid, introverted, deviant traits. Patients with personality disorders, dependent on synthetic cannabinoids, differed from typical drug addicts in such patterns of behavior as disorganization, conflict, unpredictability, spontaneity, thoughtlessness of actions, impulsivity, and nonconformity. The stigmatizing signs of the schizophrenic process in patients who are dependent on synthetic cannabinoids are the symptoms of abulia–apathy of mild severity. Patients with schizophrenia, dependent on synthetic cannabinoids, differed from patients without dependence on drugs by the phenomenon of the absence of an emotional defect expressed in the expressiveness of emotions, the desire for communication.Conclusion: the phenomenon of synthetic cannabinoid abuse is a trigger of a psychotic episode in both schizophrenic patients and those with personality disorders in whom antisocial, schizoid and paranoid personality traits prevail. The abuse of synthetic cannabinoids is a risk factor for the development of paranoid schizophrenia, which differs from schizophrenia without drug dependence by a mild degree of stigmatizing symptoms of abulia–apathy and social activity during periods of short-term remissions.

DIFFERENCES IN TRANSSEXUAL AND HOMOSEXUAL TENDENCIES IN SCHIZOPHRENIA AND INTELLECTUAL DISABILITIES

Within the framework of the study of gender-role deviations in mental illness, conducted by the authors, an analysis of differences in sexual behavior and gender identity in such forms of pathology as schizophrenia and intellectual disability (MR - mental retardation) is presented. The article presents the results of the study of gender identity disorders (GID) in men with schizophrenia and men with ID, presents pathopsychological examples of GID. The study is based on the assumption that both in schizophrenia and in mental retardation, the pathogenesis of transsexualism inherent in these mental disorders is due to the violation of semi-dymorphic brain structures, which qualitatively change the nature of sexual behavior and gender identity. However, the phenomenology of these disorders will depend on the nature and specifics of the pathology, which determines its pathopsychological picture. Based on the analysis of the current state of the problem and the data of our own research, it was found that the disorder of sexual behavior and gender identity in schizophrenia has the form of typical schizophrenic patterns that take the form of metaphysical interpretation, pretentiousness, delusional ideas, etc., that do not contain proper sexual erotic component and is not implemented by the behavior inherent in persons of the opposite sex. This does not allow us to speak about the true transsexual tendencies in schizophrenia and true GID. There are grounds to regard the features of GID in schizophrenia as a separate clinical and psychological phenomenon caused by the influence of the general schizophrenic process. With MR, the key factor of which is retardation, there is a psychologically expressed homosexuality and true transsexual tendencies, accompanied by corresponding inner experiences. The article is important for the pathopsychological differential diagnosis of transsexualism from other mental disorders occurring with EPI, and may contribute to expanding views on the origin of transsexualism.

The Clinical Course and Prognostic Problems of Youth Depressions with Attenuated Schizophrenic Symptoms

Objective Clinical and follow-up verification of Attenuated Schizophrenic Symptoms (ASS) in the first youth depressive episode as early markers of the schizophrenic process, establishing further variants of the course of the disorder and its outcomes.Materials and methods. 124 young inpatients (averaged age 19,6±2,3 years) with the first depressive episode with ASS were examined. The control group consisted of 27 patients with youth depression without ASS. All patients have been tracked for at least five years. The average follow-up period was 7,1±1,6 years. The HDRS, SOPS, SANS and PSP scales were used to assess the symptomatic and functional outcomes. Statistical analysis was carried out using STATISTICA 12.Results. The typological classification of youth depressions (ASD) with ASS has been developed with the identification of three main types: (1) with attenuated positive symptoms (APS), (2) with attenuated negative symptoms (ANS), and (3) with attenuated symptoms of disorganization. Youth depression with ASS, compared to the control group, is more likely to move into chronic forms, has reliably worse functional and symptomatic outcomes, and is more associated with the diagnosis of schizophrenic spectrum disorders at five years follow-up.Conclusion. Attenuated schizophrenic symptoms in the structure of youth depressions have high affinity to each other, indicating a common pathogenic mechanism of their formation, and also have predicate value as risk factors for schizophrenia.

The role of inflammation in pathogenesis of juvenile schizophrenia

IntroductionInflammation is now known to be a key factor in the development of schizophrenia. In this regard, the study of the pathogenic role of inflammation in the early stages of schizophrenic process is of particular importance, making it possible to assess its activity and to predict the development of the disease.ObjectivesTo compare the dynamics of inflammatory markers in blood of first-episode psychosis (FEP) patients and people at risk signs for schizophrenia in the course of the treatment. Juvenile depression (JD) with attenuated symptoms of schizophrenic spectrum (ASSS) was investigated as a risk group.MethodsThe patients aged 17-25 years (20 people, of which 10 FEP patients (F20) and 10 JD with ASSS ones (F32.1-2, F32.38, F32.8)) were examined at admission to the hospital and at discharge. The controls consisted of 10 healthy volunteers. Symptom severity was collected using PANSS, SOPS, SANS, HDRS. The inflammation markers (TNF-α, IL-6, IL-10, leukocyte elastase (LE), CRP, α1-proteinase inhibitor (α1-PI), anti-S100-beta antibodies) were determined in blood.ResultsAn increase of inflammatory markers in both groups compared to controls was found (p<0,05). The highest values of IL-6, LE, CRP, α1-PI and anti-S100-beta antibodies in FEP patients were revealed (p=0,03). After the treatment, the positive trend of inflammatory markers in FEP patients (p<0,05), but not in JD with ASSS patients was detected (except LE activity, p<0,05).ConclusionsThe results confirm the pathogenic role of inflammation in the development of endogenous mental disorders. The inflammatory markers studied reflect the activity of the pathological process in the early stages of schizophrenia.DisclosureNo significant relationships.

Assessment of the effectiveness of psychosocial rehabilitation in schizophrenia patients using biological markers

IntroductionAn important aspect of rehabilitation programmes is assessment of their effectiveness, which is carried out mainly through clinical and psycho-pathological examinations, psychometric and psychological scales and questionnaires. The use of biological markers of the schizophrenic process to assess the effectiveness of rehabilitation assistance is of considerable interest.ObjectivesTo compare the clinical and socio-psychological characteristics of schizophrenia patients receiving psychosocial treatment in various forms of psychiatric care with the level of immune system activation reflecting the activity and severity of the pathological process in brain.Methods77 schizophrenia patients in remission of varying quality were examined, of which 52 patients (the 1st group) participated in a long-term comprehensive rehabilitation programme (3.7±2.5 years) in non-profit organization, and 25 patients (the 2nd group) received medical and rehabilitation assistance in the psychiatric day hospital (duration of treatment no more than 60 days). PANSS, HDRS, SAS-SR, SF-36, BRS scales were used. The activity of the pathological process was evaluated by the level of inflammatory markers.ResultsBoth patient groups showed a similar increase in the level of inflammatory and autoimmune markers compared to control (p<0,01). The 1st group compared to the 2nd one had a significantly higher level (p<0,05) of social functioning, stress resistance, awareness of the disease, motivation, comprehensiveness, as well as less the severity of psychopathological symptoms.ConclusionsThe results indicate the effectiveness of a long-term comprehensive rehabilitation programme to stabilize clinical remission, improve social functioning and the quality of life in schizophrenia patients, despite the active pathological process in brain.

T195. PSYCHOTIC DISORDERS IN PATIENTS WHO USE SYNTHETIC CANNABINOIDS: CLINICAL CHARACTERISTICS AND PATIENT PROFILE

BackgroundCannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) are the two principal ingredients of natural cannabis with counteracting functions. Synthetic cannabinoids (SCs) are much more potent than natural cannabis, since they act as a more potent full agonist at the cannabinoid subtype 1 receptor than THC, and they also lack cannabinoids such as CBD that may otherwise counteract psychoactive properties of THC. Therefore, SCs may induce a more severe clinical presentation than natural cannabis does: the use of SCs may be associated with agitation, anxiety, tachycardia, hallucinations, irritability, memory and cognitive impairment, violent behavior, unresponsiveness, and psychosis.Clinical characteristics, specificity of the disease course and patient profile of the SC-induced psychoses are still poorly characterized in the scientific literature. The present study was therefore designed to evaluate the psychotic disorders in patients with synthetic cannabinoid use disorder in terms of patient profile and clinical characteristics with reference to their follow-up.MethodsA total of 60 male patients (n=60; mean (standard deviation [SD]) age: 23.6 (3.5) years) diagnosed with psychotic disorder induced by the SC use who were hospitalized at the intensive care unit or emergency department of the Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare were included in this single-centre, longitudinal, observational cohort study. The catamnestic follow-up period was up to 2 years.ResultsWe evaluated different clinical cases of SC-induced psychoses and identified four clinical types of them on the ground of leading psychopathological syndrome during the patient’s entire length of hospitalization:Psychosis with predominant mental automatism (20 patients, or 33%).Psychosis with predominant delirium symptoms (16 patients, or 27 %).Psychosis with predominant affective-delusional symptoms (12 patients, or 20%).Psychosis with predominant hallucinatory symptoms (12 patients, or 20%).Then we performed a catamnestic follow-up of patients to reveal the possible schizophrenic process manifestation in patients who use SC. Catamnestic follow-up revealed that manifestation of the schizophrenic process was present in 8 patients (13% of cases).DiscussionOur results revealed that SC-induced psychoses affect young adults primarily. Consistent with the statement that the majority of first-time SC users are experienced marijuana smokers, SC was used following other transitional substances rather than as the first substance in the majority of our patients, with cannabis being the most popular antecedent substance. SC was not the first substance used in the majority of our patients, and it had been preceded by use of other transitional substances, such as cannabis in most cases.Despite the exogenous nature, structurally such psychoses are often endoformic. For instance, even the delirium is atypical and includes the elements of Kandinsky-Clerambault’s syndrome. Psychopathologically hallucinations and delusions dominate in the clinical presentation of the psychoses (with predominant hallucinatory symptoms or affective paranoid symptoms). Development of substance-induced psychoses is often associated with the manifestation of the schizophrenic process (in our study it was revealed in 13% of cases). It is extremely difficult to create a differential diagnosis between such psychotic disorders and a primary endogenous psychotic episode. In such cases the appearance of deficit symptoms specific for schizophrenia becomes crucial.

Is there constitutional and morphological predisposition to akathisia in schizophrenic patients receiving antipsychotic therapy?

Objective:to identify constitutional and morphological predisposition to akathisia in schizophrenic patients receiving antipsychotic therapy.Materials and methods. 250 patients with schizophrenia receiving basic antipsychotic therapy were studied, aged 40 [32; 50] years old; disease duration was 13 [7; 22] years. The age when the schizophrenic process manifested itself was 23 [19; 30] years. Clinical evaluation of akathisia was performed using the Barnes Akathisia Scale (BARS, BAS), so akathisia was detected in 92 (36.8%) patients. All persons included in the study underwent an anthropometric survey according to the Bunak’s method. Statistical analysis was performed using Statistica for Windows software (V. 12.0), the odds ratio was estimated using the MedCalc® online calculator.Results. The comparative analysis of the Rees – Eysenk body index and Tanner stages in groups of schizophrenic patients receiving antipsychotic therapy with and without akathisia showed no significant differences between them (p = 0.317 and p = 0.347, respectively). Comparison of groups in the distribution of constitutional and morphological types also revealed no statistical differences (p = 0.189). Patients with the andromorphic type of somatic sexual differentiation increased the risk of antipsychotic-induced akathisia (OR = 1.73; 95% CI: 1.02–2.94; p = 0.039) almost twofold.Conclusion. Attribution of patients to different constitutional and morphological types does not play a role in the development of antipsychotic-induced akathisia, unlike attribution to andromorphic somatic sexual differentiation types, which significantly increases its risk.

Features of the long-term course of young-onset schizophrenia: a clinical and follow-up study

To determine the features of the course of young-onset schizophrenia based on the long-term follow-up results (20-25 years). The results of the long-term follow-up study of 320 patients with young-onset schizophrenia referred for psychiatric care in an outpatient clinic in Moscow from 1990 to 1994 were analyzed. Correlations between typological variants of the patient's condition during the follow-up and features of the dynamics of the schizophrenic process at different stages of the disease were studied. Clinical-psychopathological, clinical follow-up, clinical-epidemiological and a psychometric method were applied. The severity of symptoms at all stages of the disease correlates with typological variants of conditions at the stage of long-term follow-up. In the first type, there is an accumulation of personality desorders and the most prognostically favorable variants of the initial stage, manifestations of psychotic states, the disease often manifests with only one episode and has a regressive character, the disease process fades quite quickly, mainly high-and medium-quality remissions are formed. In the second type, there is an accumulation of less favorable signs - prolonged variants of the initial stage with a predominance of negative disorders, hallucinatory-delusional manifestations of psychoses with exacerbations after 10-12 years, the high frequency of progressive forms of disease course and remissions of moderate to low quality. Type 3 is characterized by the most severe combinations of positive and negative symptoms, paranoid forms of the initial stage, paranoid and catatonic manifestations of psychoses, a high number of relapses at all stages of the course, low-quality remissions and frequent transition of the disease to a continuous form.

Clinical variants of psychoses in patients using synthetic cannabinoids (Spice)

To describe the structure of psychoses developed due to synthetic cannabinoids (Spice). Forty-six men, aged 18-35 years, with psychosis during abstinence were studied and followed up for 2 years. Four clinical variants with predominant delirious symptoms (27%) or hallucinatory symptoms (19%) or affective-delusions (21%) or mental automatisms (33%) were identified. The follow-up revealed the manifestations of schizophrenic process in 17% of the patients. Clinical and differential diagnostic characteristics of these variants in synthetic cannabinoids users are described.

Schizofrenia i pamięć operacyjna

Neurocognitive deficits are the core feature of schizophrenic process. Among those deficits, working memory impairment is considered a fundamental impairment, opening the gate for the breakthrough of schizophrenia. Some brain regions, like prefrontal cortex and hippocampus, both critical for working memory performance, have demonstrated relationship with deficits in the illness.

The notion of psychopathic personalities in Kurt Schneider's concept

The understanding of psychopathic personalities in early works of Kurt Schneider making start from the traditional doctrine of temperament but straying from the degeneration theory and constitutional concepts of E. Kretschmer is analyzed. Under the notion of psychopathic personality K. Schneider means properly the variation of the character that according to his famous definition can cause by its 'deviations from the average' suffering for the society and can also suffers itself due to those deviations. The importance that K. Schneider attached to the differentiation of all personality anomalies from schizophrenic process is emphasized. The basic characteristics of 10 special types of psychopathic personalities according to K. Schneider's systematics are also analyzed. K. Schneider pursued the identification of one prominent psychological trait in the building of his systematics and definition of special psychopathic types. He strived to avoid sociological labels that had been used by his predecessors ('liars and cheaters', 'enemies of society' 'inborn prostitute' and so on). The great influence of E. Kretschmer on K. Schneider's characteristics of 'affective' and 'unsure of himself' psychopaths is noted although K. Schneider did not accepted the constitutional systems of E. Kretschmer and did not highlight 'schizoid' psychopathy. The growth of psychopathic personality groups compared with the last lifetime systematics of E. Kraepelin (from eight to ten) appears by K. Schneider only formal because E. Kraepelin placed some clinically detailed descriptions of personality disorders beyond the main heading.

Disintegration of the Astroglial Domain Organization May Underlie the Loss of Reality Comprehension in Schizophrenia: A Hypothetical Model

A pathophysiological model of the loss of reality comprehension in schizophrenia is proposed. Based on a formalism it is hypothesized that astroglial domains exert an information-categorizing function which becomes progressively lost in the schizophrenic process, caused by functional and structural disintegration of astroglial domains. Unconstrained synaptic neurotransmission functionally disintegrates the astroglial domains. Microdomains located between perisynaptic astroglial processes and the synaptic membrane are interpreted as elementary functional units categorizing synaptic information processing. Unconstrained diffusion of neurotransmitters into the extrasynaptic space leads to the dysfunction of microdomain formation. In parallel, atrophic processes of astroglia progressively break up the connectivity between synaptic and extrasynaptic compartments disrupting astroglial domains. Basically, the organization of astroglia into definite functional and structural units (modules) of astroglial-synaptic information processing may enable the brain to comprehend ontological realms such as subjects and objects in the environment and their distinct qualities. This fundamental capability of cognition is lost in schizophrenia. It is suggested that this ontological confusion of astroglial domain boundaries progressively disorganizes reality comprehension and may represent the basic pathology in schizophrenia underlying the main symptoms of the disorder. Finally, the testing of the model is shortly discussed.

Истерошизофрения (аспекты дефицитарных расстройств и трудовой дезадаптации)

Background information: The first supposition for conducting this study was hypothesis based on the analysis of literature data according to which there is the possibility of «partial» character of apathoabulic disorders («lability of volitional effort» by D.E. Melekhov). The second presumption was the selection of the construct of «selective» (according to Marin, 1990) «job apathy» (Schmidt G. et al., 2015) by the foreign scientists. In the light of reasons supplied, of special interest is apathy to work in patients with schizophrenia, proceeding on the basisof a hysterical constitution — which is associated with obvious difficulties in diagnosing between partial abulia («job apathy») within the hysterical form of schizophrenia and the dynamics of hysterical psychopathy with the phenomenon of «pension neurosis». A current hypothesis was based on the assumption that there is a special type of deficit symptoms in schizophrenic patients with hysterical personality, according to which apathoabulic disorders «invade» into the sphere of constitutional anomalies, act «under the mask» of intensified pathocharacterological disorders and are accompanied by partial misadaption of life and activities. The purpose of this work was to study the negative symptoms in hysterical form of schizophrenia, proceeding with a predominance of partial apathoabulic disorders. Materials and methods: the present study summarizes the results of observations of 10 patients who applied to the FSBSI NHRC due to exacerbation of schizophrenic process. The diagnostics included clinical and psychometric assessment techniques. Results: the data obtained in the course of the study allowed us to figure out a special type of partial schizophrenic defect state, named as «hysteroabulia», according to which the negative symptoms affect voluntary activity (in particular — labour function), while recreational activity, being hysterical involuntary, doesn’t need to be volitional initiated, so may not reveal an apathoabolic disorder.

On the problem of prevalence of psychotic disorders in adolescents

Objective To analyze indicators of the referral rate for highly specialized inpatient psychiatric care in adolescents with psychotic disorders. Material and methods Clinical/dynamic and statistical methods were used to study the data of patients, aged 14-17 years, with psychotic mental disorders according to ICD-10, as well as the indicators of their hospitalization in psychiatric consulting and medical institution during the calendar year. Results and conclusion The analysis of 2017 data shows that 6.3% of hospitalized children and adolescents have a psychotic disorder, the vast majority (82.3%) of whom are adolescents, aged 14-17 years (149 patients, including 79 boys, 70 girls). Of 181 patients referred to the hospital with a diagnosis of a psychotic disorder, the preliminary diagnostic judgment was not confirmed during hospitalization in 30 (16.6%) patients, in the course of therapy in 24 (13.3%) cases. The prevalence of patients with endogenous psychoses (about 80% in the structure of schizophrenic process, schizoaffective, affective pathology), the prevalence of older adolescents, gender relations in psychotic disorders of different nosological nature are revealed.

Clinical characteristics of synthetic cannabinoid-induced psychotic disorders: a single-center analysis of hospitalized patients

This study was designed to evaluate synthetic cannabinoid (SC)-induced psychotic disorders in terms of their structure and clinical characteristics among hospitalized patients in Russia. It was a longitudinal, observational cohort study which included a total of 46 male patients who underwent the inpatient treatment in the intensive care unit or emergency department due to the SC-induced psychoses. Data on sociodemographic and disease-related characteristics, psychometric assessment scales obtained in face-to-face interviews, were recorded in all patients. The duration of catamnestic follow-up period was 2 years, with the major focus on manifestation of the schizophrenic process. Mean (SD) age of the patients with psychotic disorders induced by the SC use was 23.2 (3.5) years. Among 46 patients, 29 (63%) were SC-dependent and 17 (37%) were diagnosed with SC abuse. Average age at onset was 16.4 for psychoactive substances and 19.7 years for SC use. Marijuana was the most common first used substance. Based on our observations, we identified four clinical variants of the SC-induced psychoses. Our findings revealed that psychotic disorders are typical for the SC intoxication and most commonly influence young adults. Based on our observations, we identified four clinical variants of the SC-induced psychoses and revealed the signs which may indicate them. This study emphasizes the role of appropriate psychiatric management of SC-induced psychoses, since often only catamnestic long-term follow-up enables clinicians to determine the correct diagnosis and reveal the manifestation of the schizophrenic process.