Authors
Burygina L. A.
MD, PhD, Head Physician1
Berezantsev A. Yu.
Doctor of Medicine, Professor, Psychiatrist1,2,5
Golubev S. A.
Doctor of Medicine, Deputy Head Physician1,3,4
Shumakova E. A.
Psychiatrist, PhD Student1,5
1 - Mental-health clinic No.4 named after P.B. Gannushkin, Moscow, Russian Federation
2 - Mental Health clinic named after F.A. Usol'tsev, Moscow, Russian Federation
3 - Mental Health Research Center, Moscow, Russian Federation
4 - Central State Medical Academy of the Office of the President of Russian Federation, Moscow, Russian Federation
5 - Mental-health clinic No. 1 named after N.A. Alexeev, Moscow, Russian Federation
Corresponding Author
Berezantsev Andrey; e-mail: berintend@yandex.ru
Conflict of interest
None declared.
Funding
The study had no sponsorship.
Abstract
Data on 7,236 patients with schizophrenic spectrum disorders (SSD) treated with long-acting injectable antipsychotics were studied, most of whom had paranoid schizophrenia diagnosis (F20.0 – 91.6%), the rest with SSD (F20.1-25.9) observed in 9.4% of patients. In the studied sample, the majority were men (53.9%). Cluster analysis allowed the formation of three cluster groups (CG) of patients, depending on the severity of psychopathological symptoms – positive and negative at the time of remission. The first group (n=4717) included patients with residual productive symptoms and pronounced negative symptoms (CG1); the second (n=1185) – patients with moderately pronounced positive and negative symptoms (CG2); the third (n=1334) – patients with mild positive and negative symptoms (CG3). The largest cohort (CG1) consisted of patients with the most severe register of mental disorders and the lowest social and labor indicators. Patients with CG3 had a mild register of psychopathological disorders and the highest rehabilitation level. Clinically and socially ŃG2 patients occupied an intermediate position. Thus, a large cohort of seriously ill patients with a predominance of pronounced negative symptoms (ŃG1) and patients with more favorable clinical and social characteristics and preserved rehabilitation potential (ŃG3) was identified. A clinical and statistical study has shown that the clinical and nosological heterogeneity of the isolated patients with SSD is dissonant with the approximate homogeneity of the therapy. Regardless of the clinical characteristics of the patients, about a third of them received therapy with prolonged preparations of haloperidol, a third – zuclopentixol, the proportion of long-acting injectable antipsychotics in the groups was also approximately the same and did not exceed 27.4%. It has been established that the subjective perception of psychopharmacotherapy, its direct and side effects is a significant factor influencing the characteristics of long-term antipsychotic therapy. The severity of the clinical course of SSD revealed a relationship with lower compliance, a relatively higher prevalence of episodic therapy intake disorders. It is concluded that pharmacotherapy with prolonged antipsychotics by itself does not determine pronounced shifts in the dynamics of psychopathological disorders and is not determined by clinical and social parameters, which determines the relevance of further catamnestic research of patients of the selected groups after optimizing pharmacotherapy and conducting psychorehabilitation measures taking into account their identified individual characteristics.
Key words
schizophrenic spectrum disorders, long-acting injectable antipsychotics, clinical and social factors, compliance, cluster of seriously ill patients, uniformity of therapy
DOI
References
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