Schizophrenic Spectrum Research Articles

On the markers for schizophrenia

Summary. The study of various markers indicating an imbalance in both the neurotransmitter and immune systems observed in patients with schizophrenia is currently of great scientific and practical interest. These studies allow us to deepen knowledge about the etiology and pathogenesis of schizophrenic spectrum disorders, to facili-tate the classification and conduct of differential diagnosis in complex diagnostic cases. The article presents the results of laboratory studies of DMT-1, CD4, CD20, CD34 and dopamine in 24 people suffering from paranoid schizophrenia, and 14 healthy individuals. The aim of the study was to determine DMT-1, CD4, CD20, CD34 and dopamine as possible markers for the diagnosis of schizophrenia using the minimally invasive method.Materials and methods: Buccal epithelium was taken in 2 groups of patients suffering from paranoid schizophrenia receiving and not receiving therapy with psychotropic drugs. The third group consisted of healthy volunteers. The samples were studied by the immunocytochemical method followed by visualization using scanning laser confocal microscopy and morphometric analysis.Results and discussion: : It was revealed that the markers studied were found to be associated with the nature of mental disorder, but not with the influence of psychotropic drugs used in it. Conclusion: The results of this study may indicate the possibility of minimally invasive diagnosis of schizophrenia using this method; however, the authors note that the results of the study should be considered preliminary. It is necessary to expand the number of patients and compare them with groups of patients suffering from other mental disorders, which is certainly important for assessing the adequacy of the proposed method and the possibility of its use in differential diagnosis.

Psychopathology structure of affective disturbances in patients with schizotypal disorder

The study of the structural features of the psychopathological symptomatology of schizophrenic spectrum disorders remains one of the most urgent topics in modern psychiatry; schizotypal disorder deserves special attention in this context. In order to identify the structural characteristics of affective disturbances in patients with schizotypal disorder, during 2019-2020, aprospective study of 128 patients with schizotypal disorder who were on outpatient treatment was conducted. By using clinical-anamnestic, clinical-psychopathological, psychodiagnostic and statistical methods it was revealed, that affective pathology has a significant prevalence among patients with schizotypal disorder, in the vast majority of cases it is represented by unipolar depressive symptoms, the intensity of which varies in a continuum from moderate severity of manifestations to their complete absence; in a quarter of cases affective psychopathological symptoms have a wider spectrum and reach hypomanic states; the prevalence of manic symptoms in the clinical picture lids to a partial elimination of the underlying disease symptoms; the psychopathological content of the affective sphere in one third of the examined patients with schizotypal disorder is represented by specific changes in the form of reduced affect display.

Incidence rates and employment trends in schizophrenia spectrum disorders, bipolar affective disorders and recurrent depression in the years 2000–2013: a Danish nationwide register-based study

Aims The study aimed to investigate time trends in incidence rates in schizophrenic spectrum disorders (ICD-10: F20–F29), bipolar affective disorder (ICD-10: F30, F31), and recurrent depression (ICD-10: F33) and to investigate the rates of employment for all incident cases. Method We used nationwide longitudinal data from 2000 to 2013 on all psychiatric inpatients and outpatients contacts in Denmark. Age-adjusted incidence rate ratios were calculated for the three diagnostic groups, and rates of employment, education, and disability pension were measured 1 year before and 2 years after the diagnosis for all the incident cases. Results The incidence rates increased significantly in all diagnostic groups and both sexes. Comparing the incidence rates in 2013 with 2000 yielded an incidence rate ratio of 1.67 (95% CI 1.51–1.84) for schizophrenic spectrum disorders, 3.82 (95% CI 3.23–4.52) for bipolar affective disorder, and 2.80 (95% CI 2.58–3.04) for recurrent depression. During the same observation period, the employment rates decreased, both 1 year before and 2 years after diagnosis in all three subgroups. In the year 2002, employment rates, 2 years after diagnosis, were 24.6% for schizophrenia spectrum disorder, 35.0% for bipolar affective disorder and 47.1% for recurrent depression. These rates had declined to 15.8%, 26.8%, and 34.7%, respectively, in 2013. Conclusion This study of three severe mental illness subgroups shows significant increasing incidence rates and decreasing employment rates both before and after the diagnosis between 2000 and 2013, highlighting the importance of timely and correct volume of the psychiatric treatment and vocational rehabilitation programs.

Features of Inflammatory Response in Juvenile Depression with Attenuated Symptoms of Schizophrenic Spectrum

Background: early nosological qualification of juvenile depression and detection in its structure of specific phenomena of schizophrenic spectrum makes it possible to identify the onset of an endogenous process and to provide timely therapeutic intervention. This becomes possible using an integrated approach based on a psychopathological assessment of patients and the determination of individual immunological indicators of blood. The objective: to determine the inflammation markers in patients with juvenile depression with attenuated symptoms of schizophrenic spectrum (ASSS) in relation to features of their clinical manifestation and response to therapy. Patients and methods: 50 patients aged 16 to 25 years with fi rst depressive episode with ASSS (F32.1, F32.2, F32.28, F32.8), of which 26 patients with attenuated psychotic symptoms (APS) and 24 ones with attenuated negative symptoms (ANS). The control group consisted of 19 mentally healthy volunteers. The leukocyte elastase (LE) and D1-proteinase inhibitor (D1-PI) activity and the level of autoantibodies (AB) to S100E and MBP were measured in blood plasma. The ratio of LE to D1-PI activity was defined as a leukocyte-inhibitory index (LII). Clinical and psychometric assessment (HDRS, SOPS, SANS scales) as well as immunological examination were carried out at admission to the hospital and at discharge. Results: the differences revealed in profiles of immunological parameters in patients with juvenile depression with ASSS reflect the different variants of the inflammatory response to pathological process. Regardless of the identified clinical group, only 24% of patients were characterized by a balanced immune response. The inflammatory response in 76% of cases was accompanied by varying degrees of insufficiency of neutrophils functional activity and an increase in D1-PI activity, i.e. reduced LII. In 44% of cases, a decrease in LII was also accompanied by an increase in the level of AB to S100E. The relationship between immunological profiles and clinical severity of depression with APS and ANS was confirmed. The patients with balanced immune response without an autoimmune component have the best therapeutic response. Conclusions: the results extend the concepts of the pathogenetic mechanisms of juvenile depression with ASSS and indicate various variants of inflammatory response associated with this pathological condition. Immunological analysis complements the clinical examination of patients in terms of assessing the severity of condition, prediction of the disease course and response to therapy.

The comparative analysis of clinical and social characteristics of patients with schizophrenia and organic mental disorders receiving care in partial inpatient units

The article presents the results of a comparative analysis of the clinical and social characteristics of patients with schizophrenic spectrum disorders (SSD) and organic mental disorders (OMD) who received care in day hospitals and intensive psychiatric care units (Moscow). During the study, a random sample of 487 discharge epicrises was studied, of which 392 (80,49%) were patients with SSD and OMD, who were subjected to further analysis. The study revealed gender differences and low rates of labor and family adaptation in both nosological groups of patients. The highest percentage of patients observed on a long-term basis in neuropsychiatric dispensaries and the rate of hospitalization in a round-the-clock inpatient unit were among the patients with diagnoses of schizophrenic spectrum disorders who were treated in intensive psychiatric care units. There were significant differences in the routing of patients depending on the pathology: district psychiatrists more often refer patients with a diagnosis of schizophrenia to the intensive psychiatric care unit in order to prevent hospitalization and patients with organic mental disorders - to day hospitals for therapy selection and medical and social rehabilitation, while doctors of the round-theclock hospital – vice versa (in order to continue treatment or follow up in out-of-hospital conditions). There was also a circulation of patients between the intensive psychiatric care unit and the day hospitals. Isolated episodes of compliance violations were noted. Indicative indicators such as hospitalization in a round-the-clock psychiatric inpatient unit within a year after the discharge from partial inpatient units was low and was usually due to severe continuous forms of the disease and the formation of therapy resistance in patients. Day hospitals and departments (offices) of intensive psychiatric care in general effectively perform the functions of inpatient unit substitution.

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.

Working memory and abstract thinking in patients with schizophrenic spectrum disorders

IntroductionAccording to a selective meta-analytical review, weakness of working memory is considered as one of the fundamental disorders in schizophrenia. Some researchers propose identifying this disorder as an endophenotypic marker of schizophrenia diathesis. Many researchers also emphasize violations of “abstract thinking”, that is, the ability of patients to operate with abstract concepts. Many scientists understand the violation of “abstract thinking” as the difficulty of patient in operating with the dominant signs of the concept. Based on these approaches, we assume a dark relationship between working memory and abstract thinking.ObjectivesThe aim of this study is to investigate the relationship between working memory and abstract thinking defect in patients with schizophrenic spectrum disorders.Methods16 patients with schizophrenic spectrum disorders were studied. To study abstract thinking, the following neuropsychological and psychometric techniques were used: exclusion of objects, D-KEFS understanding of proverbs (latent concepts were recorded). The following techniques were used to study working memory: n-back; Wechsler Test, subtest Digit Repetition.ResultsAs a result of preliminary research, the following data was obtained. We found significant differences between the number of irrelevant features (which corresponds to impaired abstract thinking) and the severity of impaired working memory (p = 0.035). The more the memory was impaired, the more the subjects demonstrated the impairment of abstract thinking.ConclusionsThus, our results justify our assumption. A relationship between working memory and abstract thinking is founded to be possible. Further studies of this issue requires a wider techniques battery as well as a larger sample.Conflict of interestThe reported study was funded by RFBR, project number 20-013-00772

Bleuler’s a or autism spectrum disorder in adults?

IntroductionNowadays we know that autism spectrum disorders (ASD) and Schizophrenic spectrum (SS) are different types of disorders in their etiology, symptoms and prognosis, but the clinical distinction is often difficult to make due to comorbidity and similar symptoms.ObjectivesWith this project, the authors intend to explore the differential diagnosis between ASD and SS specially when we talk about critical ages of onset.MethodsAn analysis of articles searched on Pubmed (articles between 2010-2020) with the key words “adult autism”, “childhood onset schizophrenia”, “childhood psychosis”.ResultsEarly-onset schizophrenia (EOS) is defined as occurring before age 18 years. The condition share key diagnostic symptoms with adult-onset schizophrenia (AOS) but his prognoses and comorbidities differ. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by difficulties since early childhood across reciprocal social communication and restricted interests and behaviors. ASD is a lifelong neurodevelopmental disorder, however there is a lack of answers and research for adults with ASD. There are shared aspects of odd thinking, rigid behaviors and impaired socialization in schizophrenia and ASD and COS seems to have a strong relationship with ASD, being comorbid in up to 50% of cases.ConclusionsUsually the evaluation of the developmental history of the person, prodrome and onset, its course and the presence of positive symptoms of schizophrenia is enough to help us find a diagnosis. Unfortunately, in some ages the conclusion is not so easy to find. However is essential to determine whether the clinical manifestations belong to the autistic spectrum, the schizophrenic or result from comorbidity.

Integrative psychotherapy of patients with schizophrenic spectrum disorders

IntroductionPsychotherapy of patients suffering from schizophrenic disorders remains controversial. There are promising descriptions of psychothereputic interventions in combination with pharmacological treatment. Some empirical studies show that different forms of psychotherapy are effective. However, there are few models to combine different psychotherapeutic strategies in a comprehensive way.ObjectivesWe here propose a model of integrative psychotherapy that is based on the therapeutic alliance and the general principles of understanding and communication. It comprises interpersonal, behavioral, psychodynamic, and existential elements.MethodsTheoretical principles of different psychotherapeutic schools are applied hermeneutically to a case of schizophrenia. Thus, general methods of psychotherapy gain contextual meaning by the analysis of an individual narrative. The patient himself assessed and approved his case report.ResultsAfter remission of the acute symptoms, integrative psychotherapy played the major role in the recovery of a young musician. It is shown how the therapeutic alliance and communication in a general sense interacted with behavioral, cognitive, psychodynamic, and existential techniques. It is demonstrated narratively how recovery was facilitated, adjunct to pharmacological treatment, by method-integrative psychotherapy. Basic cognitive-behavioral techniques ensured at first the stabilization of the patient. Then psychodynamic remembering, repeating, and working through became possible. Finally, existential topics and creative solutions dominated the sessions.ConclusionsPsychotherapeutic method-integration is necessary to treat patients with various mental disorders especially schizophrenia. We propose an ABCDE-Model that comprises the following principles: Therapeutic alliance (A); behavior change (B); cognitive reflection on dysfunctional meanings and beliefs (C); psychodynamic remembering, repeating, and working through (D); and existential understanding and communication (E).

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.

Forensic psychiatric evaluation of 187 homicidal assailants with and without a schizophrenia spectrum disorder: Clinical, criminological and behavioral characteristics.

Intentional homicide, a declining phenomenon in Italy, represents one of the most extreme forms of violence. Aspecific subgroup of homicidal assailants is represented by those affected by mental disorders, where the relationship between psychopathology and characteristics of the homicidal attack is not yet fully understood. We analyzed the case files of 187 homicides or attempted homicides, in which the defendant had undergone a forensic psychiatric evaluation within the previous 10 years from a single forensic psychiatric center. We described and analyzed the perpetrator, victim and criminological characteristics of the study cases. A diagnosis of a schizophrenia spectrum disorder, a victim who was the perpetrator's biological child and absence of a personality disorder diagnosis were associated with an increased probability of having been adjudicated as lacking or having substantially diminished criminal responsibility due to a mental disorder. Homicidal assailants with a schizophrenia spectrum disorder showed some differences in criminological characteristics compared with murderers without a schizophrenic spectrum disorder, including a higher incidence of parricide, interruption of pharmacotherapy before the crime and disorganized post-crime behavior.

Neurocognitive function in patients with negative thought disorders

IntroductionNegative thought disorders are found in various diagnoses in clinical practice. These symptoms may show a possible psychosis continuum and may be taken into account when assessing schizophrenic risk. Neurocognitive functioning of patients with negative thought disorders need to be clarified.ObjectivesAim of the study is to identify and validate the differences of executive functions between patients with negative thought disorders and patients without thought disorders.MethodsUsed a standardized neuropsychological test battery. There were 15 patients with negative thought disorders (affective disorders, personality disorders, schizophrenic spectrum disorders) and 18 patients with depressive episode without thought disorders in the research. Patients aged 17-25 years. The Mann–Whitney U test and ANOVA were used for statistical analysis.ResultsSignificant results were obtained from The Verbal Fluency Test, The Design Fluency Test, The Digit span, The Rey-Osterrieth Complex Figure and Bidstrup’s drawings (All tests have p-values less than 0.05). In the methods listed above, the results in the group of patients with negative thought disorders are significantly lower than in the group of patients without thought disorders.ConclusionsThe data indicate a violation of Executive functions among patients with negative thought disorders: inhibitory control, planning and regulation, working memory, difficulty switching, which related to left frontal lobe dysfunction. A lack of simultaneity and understanding figurative language, which is associated with right hemisphere dysfunction.DisclosureThe reported study was funded by RFBR, project number 20-013-00772

Neurocognitive function in patients at high risk of schizophrenia with positive thought disorders

IntroductionThe course of affective disorders varies significantly in clinical practice. There are many symptoms that are not related to affective disorders that cannot be described in other nosologies. In the present study such pathopsychological phenomena similar to psychotic symptoms and related to symptoms of “schizophrenia risk” were designated as positive thought disorders (PTD). These symptoms are understood as manifestations of delusional and hallucinatory register.ObjectivesAim of the study is to identify and validate the differences of neurocognitive functions among patients with positive thought disorders and at high risk of schizophrenia and patients without thought disorders.MethodsIn the research there were 17 patients with high risk of schizophrenia dominated by PTD (affective disorders, personality disorders, schizophrenic spectrum disorders) and 18 patients without thought disorders (affective disorders, personality disorders) in the research. Patients aged 17-25 years.ResultsAccording to the results of the The Complex Figure test, the group with a high risk of schizophrenia had significantly low results on the “simultaneity” scale and points for copying the figure (p-value 0.04 and p-value 0.03). According to the results of the Verbal fluency test, the main group had significantly lower indices on the “loss of instruction” scale and on the number of repetitions (p-value 0.021 and p-value 0.009).ConclusionsIn the group of patients with a high risk of schizophrenia with positive thought disorders there are neurocognitive features in the form of reduced inhibitory control and a lack of simultaneity. The most sensitive methods are the Complex figure test and Verbal fluency Test.Conflict of interestThe reported study was funded by RFBR, project number 20-013-00772

Youth Chronic Endogenous Depression in Disorders of the Affective and Schizophrenic Spectrum

Background: chronic endogenous depression in youth has a number of features associated with their severe atypia, work and social maladjustment, deterioration in the quality of life, high risk of suicidal and self-injurious behavior, difficulties in choosing therapy, difficulty in diagnosis and nosological evaluation. Until now, no special research has been done on chronic endogenous depression among young people of this age.Purpose of research: to identify psychopathological features and dynamics of endogenous depression developed in youth, to work out a clinical typology. Patients: 62 young patients (16–25 years old) were clinically and psychopathologically examined, who were first admitted to FSBSI MHRC, within the period of 2017 to 2020 suffering from chronic endogenous depression state for more than two years. Clinically significant somatic, neurological, and mental pathology defined the criteria for exclusion.Methods: for the research the clinical-psychopathological and psychometric methods were used. The patients were examined by the psychometric method upon admission to the hospital and at the stage of reduction of psychopathological disorders upon discharge: the HDRS, SANS and SOPS scales included.Results and conclusion: the clinical picture of youth chronic endogenous depression is characterized by pronounced polymorphism, atypia, erosion of the thymic component, and the dominance of negative affectivity. Based on the analysis of psychopathological characteristics of endogenous depression in youth, two typological varieties were identified: unitary depressions (type I) and supplementary depressions (type II). Among the type II depressions, 2 subtypes were distinguished: with neurosis-like disorders and with psychopathic-like disorders.

Clinical Features of Youth Depression with Attenuated Symptoms of the Schizophrenic Spectrum

Objective: establishment of clinical and psychometric features of youth depression with attenuated symptoms of the schizophrenic spectrum (ASSS) for early differential diagnosis and nosological assessment.Patients and methods: clinical and psychometric examination of young 219 inpatients (average age 19.6 ± 2.4 years), first admitted to the clinic “Mental Health Research Centre” from 2011 to 2020 with the first depressive episode with ASSS. Control group of inpatients (52 patients) with “classical” youth depressions without ASSS (average age 19.6 ± 2.4 years). Diagnosis according ICD-10: F32.1, F32.2, F32.28, F32.8.Results: the psychopathological structure of youth depression with ASSS is characterized by the following types: (1) depression with attenuated psychotic symptoms (APS), which were divided into the subtype (1a) depression with APS and (1b) depression with brief limited intermittent psychotic symptoms (BLIPS); (2) depression with attenuated negative symptoms (ANS), comprising two subtypes (2a) with most emotional damage and (2b) with volitional impairment, and type (3) with attenuated symptoms of disorganization (ASD) in the structure of depressive episode. Clinical and reliable psychometric differences have been established between depressions with ASSS and «classical» youth depressions without ASSS. Conclusions: youth depression with ASSS is definitely different from “classical” youth depression without ASSS. Differences have been found in the psychopathological structure of youth depression with ASSS, resulting in a typological differentiation.

Multifactor Regression Models of Adherence to Treatment in Patients with Schizophrenia and Schizophrenic Spectrum Disorders and Their Relatives

Purpose: formation of multifactor regression models of adherence to treatment of patients with schizophrenia and schizophrenic spectrum disorders and their family members to identify the relationship with socio-demographic, clinical, psychological characteristics, family environment factors and the quality of psychiatric care in order to develop measures to improve the compliance of these groups.Patients and methods: the study involved 107 patients (44 men and 63 women), with diagnoses of schizophrenia (F.20), schizoaffective (F.25) and schizotypal disorders (F.21), eligible the ICD-10 criteria, as well as 105 of their relatives (27 men and 78 women). The following methods were used: сlinical and psychopathological, psychometric, psychological, statistical (correlation and regression analysis), methods of system analysis, method of hierarchy analysis.Results: regression models were built and factors positively or negatively influencing adherence to treatment in groups of patients and their relatives, formed depending on gender differences, awareness of the disease or its denial, as well as on the clinical characteristics of patients, were identified. Gender factors affecting adherence to treatment in men include social functioning, education and income; for women — the motivation for treatment and characteristics of family relationships. In the groups of patients and their relatives, selected depending on the awareness of the disease or its denial, the dominant factors influencing compliance were the duration of the disease, the frequency of hospitalizations, patients’ disability, the level of education of relatives, forgetfulness of taking medications, etc. In groups, depending on the clinical characteristics of patients, the compliance of patients and relatives was influenced by the age of the patient, the level of motivation for treatment of patients and their relatives, the employment of patients and the level of their social functioning, conflict, hostile relations in the family and a number of other factors.Conclusion: knowledge of the factors that affect the adherence to treatment of schizophrenia patients and their family members will contribute to the development of practical measures to improve it. Psychosocial interventions have been proposed to increase adherence to treatment in patients with schizophrenia and schizophrenic spectrum disorders and their families.

Escape and absconding among offenders with schizophrenia spectrum disorder \u2013 an explorative analysis of characteristics

BackgroundEscape and absconding, especially in forensic settings, can have serious consequences for patients, staff and institutions. Several characteristics of affected patients could be identified so far, albeit based on heterogeneous patient populations, a limited number of possible factors and basal statistical analyses. The aim of this study was to determine the most important characteristics among a large number of possible variables and to describe the best statistical model using machine learning in a homogeneous group of offender patients with schizophrenia spectrum disorder.MethodsA database of 370 offender patients suffering from schizophrenia spectrum disorder and 507 possible predictor variables was explored by machine learning. To counteract overfitting, the database was divided into training and validation set and a nested validation procedure was used on the training set. The best model was tested on the validation set and the most important variables were extracted.ResultsThe final model resulted in a balanced accuracy of 71.1% (95% CI = [58.5, 83.1]) and an AUC of 0.75 (95% CI = [0.63, 0.87]). The variables identified as relevant and related to absconding/ escape listed from most important to least important were: more frequent forbidden intake of drugs during current hospitalization, more index offences, higher neuroleptic medication, more frequent rule breaking behavior during current hospitalization, higher PANSS Score at discharge, lower age at admission, more frequent dissocial behavior during current hospitalization, shorter time spent in current hospitalization and higher PANSS Score at admission.ConclusionsFor the first time a detailed statistical model could be built for this topic. The results indicate the presence of a particularly problematic subgroup within the group of offenders with schizophrenic spectrum disorder who also tend to escape or abscond. Early identification and tailored treatment of these patients could be of clinical benefit.

Стили психосоматического поведения у пациентов с расстройствами шизофренического спектра

The article is devoted to the study of psychosomatic behavior styles in patients with schizophrenic spectrum disorders. Empirically revealed the relationship between the psychosomatic behavior styles and individual typological characteristics The results of the study showed that people with schizophrenic spectrum disorders have two styles of psychosomatic behavior: cognitive and socio-cultural. It was found that this sample is characterized by such personal characteristics as anxiety, introversion, lability and sensitivity.

Differential diagnosis on the autism spectrum: Theorizing an “Ordinary Autism”

ObjectivesData on the prevalence of Autism Spectrum Disorder (ASD) reveal several clinical evolutions inducing new psychiatric definitions and diagnostic practices. Thus, autism has shifted from being a rare syndrome with severe clinical forms to a new paradigm: the paradigm of “ordinary” or “invisible” autism, in terms of the frequency and the intensity of the disorders. These changes incorporate new populations into our conception of autism, with new phenotypes that pose theoretical and clinical challenges to clinicians. In response, we propose the hypothesis — based on psychoanalytic theories of psychic structures — of an “ordinary autism” as a definition of a non-prototypical autistic psychic functioning that falls outside the DSM diagnostic framework. This idea seems to provide us new theoretical references that nourish our practices as well as fundamental research. MethodFirst, we will review the nosographic mutations of the DSM-5 and their implications for non-prototypical psychic modes of functioning of autistic people that may not be contained within the autism spectrum's blurry boundaries — especially for the adult population without intellectual delay and in the case of complicated differential diagnosis for clinical and societal reasons. Next, we will discuss the definition of “ordinary” or “invisible” autism in a psychoanalytic structural model, as a possible epistemological orientation for identifying and designing practice with the clinical heterogeneity of autism outside the boundaries of psychiatric ASD. ResultsThe autistic population targeted by the DSM-5 criteria is different from that previously defined by DSM-IV. This leads to two consequences: on the one hand, autistic modes of functioning are not limited to individuals who have been diagnosed with Autism Spectrum Disorders as defined by the DSM-5; thus individuals with autism do not have access to the diagnosis of ASD or are given other diagnoses. The alternative diagnoses proposed by the DSM-5 that attempt to correct this diagnostic exclusion — such as Social (Pragmatic) Communication Disorder — are unsatisfactory. Therefore, there is an entire segment of the autistic population that has subclinical, non-prototypic autistic manifestations or more subtle phenomena discernible in the broader autistic phenotype or sub-threshold autism spectrum that does not have access to the ASD diagnosis and raises differential diagnostic issues. On the other hand, it appears that the autism spectrum brings together extremely different entities and false positives such as schizophrenia and schizophrenic spectrum personality disorders under one diagnostic rubric. Then, the differential problem appears central: both at the theoretical level and in diagnostic practices. The recognition of these limits should encourage us to promote research and clinical applications on this subject. One solution that we envisage is to be found in an extension of Maleval's structural psychoanalytical model: we propose the notion of “ordinary autism” — an echo of ordinary psychosis — to define attenuated or compensated non-prototypical autistic phenotypes, increasingly frequent and with fewer “extraordinary” phenomenological expressions than the classic cases of autism which now call into question the relationship between the normal and the pathological. Discussion“Ordinary autism” seems to offer clinicians the opportunity to formalize the new contemporary and extensive clinical reality of autism. This term situates itself within a theoretical model whose current and future developments might help us respond to clinical and diagnostic issues, but also to therapeutic and societal ones. We propose to continue on the path of the operationalization of these theoretical models in order to identify autistic structural constants that could be found throughout the “ordinary” clinic of autism and could serve as differentiating tools for diagnosis as well as a support in developing and refining therapeutic practices. ConclusionWe conclude that there is an urgent need to conceive of “ordinary autism” to provide us with reference points to respond to new clinical issues, but also to reintroduce respect for the autistic person in his or her subjectivity to the center of our therapeutic practices.

Cariprazine: from receptor affinities to therapeutic effects. Review in schizophrenic spectrum disorders and expert opinion

Schizophrenia is a very disabling condition that may result in a significant impairment of individual, professional and social adjustments. Antipsychotics (APs) are the first-line treatment for schizophrenia that may modify the course of the disease in most cases, by decreasing the institutionalization risk, although they may induce severe side effects. It is worth noting that APs may well control positive symptoms, while their efficacy on negative and cognitive symptoms is low. Cariprazine is one of the latest third-generation APs acting as a partial agonist at dopamine receptor of the type 2 and 3 with a broader spectrum of activities, recently approved for the treatment of adult schizophrenia. The aim of this paper was to review and comment on the available literature on the effectiveness and tolerability of cariprazine in schizophrenia, with a main focus on possibly specific symptoms, as well as in those peculiar patients' populations that could mostly benefit from this latest AP, when compared with previous APs. The current literature would indicate that cariprazine is significantly more effective on both acute and maintenance treatment of schizophrenia, and in improving positive, negative and cognitive symptoms, than other APs. In any case, cariprazine has a good safety and tolerability profile, with akathisia being its most common side effect. Although further independent studies are needed to clarify its advantages over other APs, cariprazine appears to represent a promising treatment for schizophrenic spectrum disorders.