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

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

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.

Full Text

Restricted Access

About the authors

Margarita E. Pugacheva

Evdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: theoreticusempiricus@yandex.ru
ORCID iD: 0000-0001-5956-5768
SPIN-code: 2192-4610
Russian Federation, Moscow

Galina A. Aleshkina

Evdokimov Moscow State University of Medicine and Dentistry

Email: aleshkina-ga@yandex.ru
ORCID iD: 0000-0002-8872-9810
SPIN-code: 7477-8598

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Leonid M. Bardenshteyn

Evdokimov Moscow State University of Medicine and Dentistry

Email: barden@mail.ru
ORCID iD: 0000-0002-1171-5517
SPIN-code: 9289-9177

MD, Dr. Sci. (Med.), Professor, Honoured Doctor of the Russian Federation

Russian Federation, Moscow

Nicolay I. Beglyankin

Evdokimov Moscow State University of Medicine and Dentistry

Email: begnik@yandex.ru
ORCID iD: 0000-0002-4690-3972
SPIN-code: 7740-2176

Cand. Sci. (Med.), Assistant Professor

Russian Federation, Moscow

References

  1. Schürhoff F, Fond G, Berna F, et al. A National network of schizophrenia expert centres: an innovative tool to bridge the research-practice gap. Eur Psychiatry. 2015;30(6):728–735. doi: 10.1016/j.eurpsy.2015.05.004
  2. World Health Organization [Internet]. ICD-10: The International Statistical Classification of Diseases and Related Health Problems (10th rev). Geneva: World Health Organization, 1994 [cited 2022 Jul 14]. Available from: https://apps.who.int/iris/handle/10665/246208?locale-attribute=en&
  3. Castagnini AC, Berrios GE. Conceptual Issues in Acute and Transient Psychotic Disorders. Psychopathology. 2022;55(1):10–15. doi: 10.1159/000520087
  4. Stern S, Linker S, Vadodaria KC, et al. Prediction of response to drug therapy in psychiatric disorders. Open Biol. 2018;8(5):180031. doi: 10.1098/rsob.180031
  5. Maj M, van Os J, De Hert M, et al. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry. 2021;20(1):4–33. doi: 10.1002/wps.20809
  6. Shamabadi A, Hasanzadeh A, Akhondzadeh S. Integrating Psychiatry and Medical Biotechnology as a Way to Achieve Scientific, Precision, and Personalized Psychiatry. Avicenna J Med Biotechnol. 2021;13(4):172–175. doi: 10.18502/ajmb.v13i4.7201
  7. Lisoway AJ, Chen CC, Zai CC, et al. Toward personalized medicine in schizophrenia: Genetics and epigenetics of antipsychotic treatment. Schizophr Res. 2021;232:112–124. doi: 10.1016/j.schres.2021.05.010
  8. Collo G, Mucci A, Giordano GM, et al. Negative symptoms of schizophrenia and dopaminergic transmission: translational models and perspectives opened by iPSC techniques. Front Neurosci. 2020;14:632. doi: 10.3389/fnins.2020.00632
  9. Queirazza FF, Semple DM, Lawrie SM. Transition to schizophrenia in acute and transient psychotic disorders. Br J Psychiatry. 2014;204:299–305. doi: 10.1192/bjp.bp.113.127340
  10. Suda К, Hayashi N, Hiraga М. Predicting features of later development of schizophrenia among patients with acute and transient psychotic disorder. Psychiatry Clin Neurosci. 2005;59(2):146–150. doi: 10.1111/j.1440-1819.2005.01349.x
  11. Sajith SG, Chandrasekaran R, Sadanandan Unni KE, Sahai A. Acute polymorphic psychotic disorder: diagnostic stability over 3 years. Acta Psychiatr Scand. 2002;105(2):104–109. doi: 10.1034/j.1600-0447.2002.01080.x
  12. Castagnini AC, Laursen ТМ, Mortensen РВ, Bertelsen А. Family psychiatric morbidity of acute and transient psychotic disorders and their relationship to schizophrenia and bipolar disorder. Psychol Med. 2013;43(11):2369–2375. doi: 10.1017/S0033291713000044
  13. Aleshkina GA, Bardenshtein LM. Ostrye i prekhodyashchie psikhoticheskie rasstroistva: monografiya. Moscow: «MEDPRAKTIKA-M»; 2017. (In Russ).
  14. Mezquida G, Cabrera B, Bioque M, et al. The course of negative symptoms in first-episode schizophrenia and its predictors: a prospective two-year follow-up. Schizophr Res. 2017;189:84–90. doi: 10.1016/j.schres.2017.01.047
  15. Ventura J, Subotnik KL, Gitlin MJ, et al. Negative symptoms and functioning during the first year after a recent onset of schizophrenia and 8 years later. Schizophr Res. 2015;161(2–3):407–413. doi: 10.1016/j.schres.2014.10.043
  16. Hovington CL, Bodnar M, Joober R, et al. Identifying persistent negative symptoms in first episode psychosis. BMC Psychiatry. 2012;12:224. doi: 10.1186/1471-244X-12-224
  17. Galderisi S, Mucci A, Bitter I, et al. Persistent negative symptoms in first episode patients with schizophrenia: results from the European First Episode Schizophrenia Trial. Eur Neuropsychopharmacol. 2013;23(3):196–204. doi: 10.1016/j.euroneuro.2012.04.019
  18. Bardenshtein L, Aleshkina G, Shcherbakova I, Beglyankin N. Acute and transient psychotic disorders: comparison. Eur Psychiatry. 2013;28(Suppl.1):1. doi: 10.1016/S0924-9338(13)75881-4
  19. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261–276. doi: 10.1093/schbul/13.2.261
  20. MacBeth A, Gumley A. Premorbid adjustment, symptom development and quality of life in first episode psychosis: a systematic review and critical reappraisal. Acta Psychiatr Scand. 2008;117(2):85–99. doi: 10.1111/j.1600-0447.2007.01134.x
  21. Compton MT, Gordon TL, Goulding SM, et al. Patient-level predictors and clinical correlates of duration of untreated psychosis among hospitalized first-episode patients. J Clin Psychiatry. 2011;72(2):225–232. doi: 10.4088/JCP.09m05704yel
  22. Amoretti S, Verdolini N, Mezquida G, et al. Identifying clinical clusters with distinct trajectories in first-episode psychosis through an unsupervised machine learning technique. Eur Neuropsychopharmacol. 2021;47:112–129. doi: 10.1016/j.euroneuro.2021.01.095
  23. Chang WC, Hui CL, Tang JY, et al. Persistent negative symptoms in first-episode schizophrenia: a prospective three-year follow-up study. Schizophr Res. 2011;133(1–3):22–28. doi: 10.1016/j.schres.2011.09.006
  24. Chan SKW, Chan HYV, Pang HH, et al. Ten-year trajectory and outcomes of negative symptoms of patients with first-episode schizophrenia spectrum disorders. Schizophr Res. 2020;220:85–91. doi: 10.1016/j.schres.2020.03.061
  25. Abramov VA, Lykholetova OI, Putyatin GG. Clinical analysis of initial prodrome of schizophrenia in temporal, gender and age aspects. Journal of Psychiatry and Medical Psychology. 2012;2(29):15–29. (In Russ).

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2022 Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия  ПИ № ФС 77 - 86296 от 11.12.2023 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 80632 от 15.03.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies