Clinical-catamnestic and medical-social characteristics of periodic endogenous psychoses as a result of pathopersonological transformations (a comparative analysis)

Abstract

Differential diagnosis of endogenous psychoses with episodic course is an extremely relevant issue of modern psychiatry due to the pathomorphosis of mental illnesses and subclinical persistence of clinical markers after the first episodes of the disease. Correct and timely diagnosis of these conditions determines the adequacy of therapeutic and socio-rehabilitation influences not only during disease exacerbations, but also in the period between bouts of psychosis in order to preserve the social adaptation of patients. The purpose of this study was to perform a comparative analysis of the clinical-catamnestic and medico-social characteristics of remission in patients with schizophrenia, schizoaffective disorder (SAD) and affective disorders (AD). Contingents and methods. A total of 221 patients were examined on the basis of the Regional Clinical Psychiatric Hospital (Zaporizhzhіa), 49 of whom were with AD (31 patients with a diagnosis of “bipolar affective disorder” and 18 with a diagnosis of “recurrent depressive disorder”), 76 patients were diagnosed with “schizoaffective disorder” and 96 patients were diagnosed with “paranoid schizophrenia, episodic course” having a pronounced affective component in the structure of psychotic episodes. An obligatory criterion for inclusion was the state of clinical remission with psychotic symptoms reduction. The main methods of the study were clinical-catamnestic and clinical-psychopathological as well as medical statistical analysis. Results. In patients with episodic course of endogenous psychosis, there is a persistent decline in the social adaptation level of varying degrees, the severity and manifestations of which differ depending on nosological form. Schizophrenia and SAD are characterized by a more pronounced negative impact on the level of labor adaptation than AR. This is confirmed by a large percentage of unemployed individuals (P < 0.01), a lower percentage of persons working in positions related to skilled and mental work (P < 0.01). SAD patients more often (P < 0.01) receive treatment courses in a hospital than patients with other periodic endogenous psychoses. Social factors are more likely (P < 0.01) cause repeated hospitalizations in SAD than in AD and episodic schizophrenia (26.7 %, 5.8 % and 12.5 %, respectively). Conclusions. A high level of rehospitalization for social reasons in SAD demonstrates persistent pathopersonological transformations and the lack of efficacy of therapeutic and rehabilitation measures used in SAD during a remission period. Persistent pathopersonological transformations, occurring in endogenous psychoses, require a comprehensive study and a system of congruent therapeutic and rehabilitation measures in order to prevent social disadaptation.

Keywords

• schizophrenia
• schizoaffective disorder
• affective disorders
• social characteristics