Personalized approach to early diagnosis of acute schizophrenia: an observational comparative study

BACKGROUND: An acute schizophrenic episode often meets the diagnostic criteria for the ICD-10 category acute and transient psychotic disorders (ATPD, F23), which includes clinically similar conditions of diverse etiologies. The presence of schizophrenic negative symptoms in ATPD signifies their nosological affiliation and determines the therapeutic tactics. Early recognition of the schizophrenic etiology in the first episode of psychosis may contribute to the development of a personalized approach for the management of patients with acute psychotic disorders.

AIM: To evaluate the relationship between the developmental characteristics of psychosis and identify the negative symptoms after its reduction in patients with ATPD with the symptoms of schizophrenia.

MATERIALS AND METHODS: This observational single-center selective comparative study was conducted during 2018–2020. The clinical-psychopathological method was applied to examine patients hospitalized in a psychiatric hospital with ATPD presenting with the symptoms of schizophrenia (F23.1). In order to objectify the results of the study, the positive and negative syndrome scale was used.

RESULTS: The study involved 60 patients (50 men, 10 women) aged 18–46 years (mean age: 21.4±6.0 years). Depending on the presence of negative symptoms after the psychosis reduction at 4 weeks of therapy, the study sample was divided into two groups: 1) the group with negative symptoms (NS+; n=41); 2) the group without any negative symptoms (NS–; n=19). Individuals presenting with negative symptoms were distinguished from those without it based on the more frequent presence of prodromal disorders, subpsychotic, and, particularly, mild negative disorders at the prodromal stage, prolonged development, and long-drawn course of psychosis. The likelihood of negative symptoms detection after the reduction of psychosis was associated with a family history of schizophrenia and other psychiatric disorders, low premorbid social adjustment, prodromal symptoms, and impaired functioning, as well as with a longer duration of psychotic symptoms and its slow development.

CONCLUSION: The likelihood of negative symptoms after the reduction of ATPD with symptoms of schizophrenia was associated with hereditary and premorbid characteristics of patients, prodromal psychopathological and functional abnormalities, as well as the clinical and dynamic characteristics of psychosis. The data obtained from this study may contribute to the early recognition of schizophrenia-spectrum disorders and to the development of a personalized approach for the management of patients with ATPD.