PRODROMAL PERIOD OF PSYCHOSIS: CLINICAL-PSYCHOPATHOLOGICAL AND PATHOPSYCHOLOGICAL REGULARITIES OF FORMATION, CRITERIA FOR DIAGNOSIS AND PRINCIPLES OF PREVENTION

Abstract

An improvement of mental health of a population is one of the most important tasks of the public health care in all countries worldwide. In this sense, a special significance belongs to an early intervention in the prodromal stage of psychosis, which enables a prevention of development of the pathological process and saving social functioning and life quality of patients.

The aim of the study – to investigate clinical-psychopathological and pathopsychological regularities of formation of the prodromal period of psychosis in order to define risk factors of psychosis formation and to work out preventive measures.

Materials and Methods. To solve these tasks, a complex of methods was used as it stated below: I. Clinical-psychopathological method. II. Psychometric methods: the scale for assessment of productive and negative symptoms PANSS ; the Scale of Suicidal Risk (Los Angeles Suicidology Center); the scale of prodromal symptoms SOPS ; the scale of detection of clinical-dynamic variant of the prodromal period course; the scale of a structured interview to assess a premorbid status PAS -SI. III. Psychodiagnostic methods: K. Leonhard. Schmischek Questionnaire to define character accentuations; L.I. Vasserman’s method for diagnosis of a social frustration level modified by V.V. Boiko; the method for assessment of integrative index of life quality. IV. Methods of mathematical statistics with calculation of means, their deviations, correlation analysis. During the study course, 137 patients with the first diagnosed psychosis: 65 patients (2nd or 3rd hospitalization) with diagnosis of paranoid schizophrenia (PS ch) (F20.0); 72 patients (1st hospitalization) with diagnosis of acute polymorph psychotic disorder (APPD ) (F23.0, F23.1) were examined. All the patients were examined both in real time frameworks and retrospectively. An investigation of clinical-psychopathological PPP peculiarities in patients with PS ch and APPD demonstrated that in patients with PS ch in their PPP clinical picture there were a predominance of: thinking disorders (a conceptual disorganization) (in 26.6 % of cases; p<0.01); a passive-apathic social withdrawal (in 30.8 % of cases; p<0.05); a social isolation (solitude) (in 33.8 % of cases; p<0.01); a stereotypical thinking (in 30.8 % of cases; p<0.05); a decreased emotional expression (in 40.0 % of cases; p<0.01); suspiciousness, fear of persecution (persecutory ideas) (in 30.8 % of cases; p<0.05). Moderate and middle degrees of manifestations of these features in the examined patients should be pointed out.

Results and Discussion. In patients with APPD in their PPP there was a predominance of such clinical-psychopathological symptoms as a decreased stress tolerability (in 43.1 % of cases; p<0.01); a hallucinatory behavior (impairments of perception / hallucinations) (in 26.4 % of cases; p<0.01); excitement (in 25.0 % of cases; p<0.05); anxious conditions (in 39.1 % of cases; p<0.01); tension (in 34.7 % of cases; p<0.01); attention problems (in 30.6 % of cases; p<0.05); sleep disorders (in 27.8 % of cases; p<0.01); unnatural contents of thoughts (odd thinking) (in 27.8 % of cases; p<0.01). A moderate degree of manifestation of abovementioned features should be pointed out. In accordance to results of the investigation, we may state that in patients with PS ch in their PPP there is a predominance of negative symptoms (3.3±1.2 points; p<0.05), whereas in patients with APPD in their PPP there are more often symptoms of disorganization (2.9±0.7 points; p<0.05) and general symptoms (2.7±1.3 points; p<0.05).

Conclusions. Taking into account the clinical-psychopathological and pathopsychological peculiarities, which were found out for patients in PPP in PS ch and APPD , a program of the early intervention was worked out as result of this work. The program is based on usage of psychopharmacotherapy, psychotherapy, and social-environmental influences.