Features of the dynamics of dimensional characteristics in the remission period in patients with paranoid and undifferentiated schizophrenia

Features of the dynamics of dimensional characteristics in the remission period in patients with paranoid and undifferentiated schizophrenia

 

Authors

 

K.A. Lukmanova

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

 

https://doi.org/10.26617/1810-3111-2025-1(126)-21-28

 

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2025; 1 (126):  21-28.

 

Abstract

Background. In modern psychiatry, the dimensional approach, which reflects the indicators of symptomatic improvement based on the assessment of the achievement of psychopathological symptoms of the subthreshold level on a number of psychometric scales, is the main one for determining the criteria for remission. The advantage of the dimensional approach is the use of a differentiated set of dimensional characteristics at different stages of the disease, which suggests the possibility of expanding the set of standards for the remission state, including the proposal to include an affective component in its structure. A comprehensive assessment of the remission state allows for a more targeted development of a personalized rehabilitation program. Objective: to study the dynamics of dimensional characteristics of remission in the post-hospital stage in patients with schizophrenia depending on the clinical and nosological characteristics and types of therapy received. Material and Methods. Based on the Department of Social Neuropsychiatry of the V.M. Sechenov National Medical Research Center for Pedagogical Sciences, the study was carried out. A clinical sample of patients (n=106) was examined at the Bekhterev Russian National Medical Research Center for Disease Control and Prevention (National Center for Disease Control and Prevention), including 61 men (57.5%) and 45 women (42.5%) aged 19-59 years who had no relapses within 12 months after discharge from the hospital. The majority of patients (n=76, 71.7%) were diagnosed with paranoid schizophrenia (F20.0) according to ICD-10, with a lower frequency (n=30, 28.3%) being diagnosed with undifferentiated schizophrenia (F20.3). Two groups of patients were formed from the total clinical sample: Group 1 received atypical antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone) (n=85, 80.2%), Group 2 received typical antipsychotics (haloperidol) (n=21, 19.8%). Patients of the 2nd group had a more pronounced psychopathological burden, a longer duration of the disease and a higher frequency of exacerbations. The following psychometric scales were used: PANSS, CDSS. Results. The results of the study did not reveal any influence of clinical and nosological features of the course of paranoid and undifferentiated schizophrenia on the dimensional characteristics of remission in the post-hospital period. However, under therapy with typical antipsychotics, the reduction occurs faster. A statistically significant, more pronounced reduction in depressive and negative symptoms was revealed among patients receiving atypical antipsychotics compared to patients receiving haloperidol, which is associated with a more specific effect of atypical antipsychotics and lower adaptive-compensatory biological capabilities of patients receiving haloperidol. Any specific effect of the studied atypical antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone) on the reduction of dimensional characteristics was not found.

 

Keywords: remission, schizophrenia, dimensional approach, atypical antipsychotics, rehabilitation, prognosis, post-hospital stage.

 

Article (pdf)

 

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Materials 

 

For citation: Lukmanova K.A. Features of the dynamics of dimensional characteristics in the remission period in patients with paranoid and undifferentiated schizophrenia. Siberian Herald of Psychiatry and Addiction Psychiatry.2025; 1 (126): 21-28. https://doi.org/10.26617/1810-3111-2025-1(126)-21-28

 

REFERENCES

  1. van Os J, Drukker M, à Campo J, Meijer J, Bak M, Delespaul P. Validation of remission criteria for schizophrenia. Am J Psychiatry. 2006 Nov;163(11):2000-2. https://doi.org/10.1176/ajp.2006.163.11.2000. PMID: 17074953.
  2. Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry. 2005 Mar;162(3):441-9. https://doi.org/10.1176/appi.ajp.162.3.441. PMID: 15741458.
  3. Haro JM, Novick D, Suarez D, Alonso J, Lépine JP, Ratcliffe M; SOHO Study Group. Remission and relapse in the outpatient care of schizophrenia: three-year results from the Schizophrenia Outpatient Health Outcomes study. J Clin Psychopharmacol. 2006 Dec;26(6):571-8. https://doi.org/10.1097/01.jcp.0000246215.49271.b8. PMID: 17110813.
  4. Eberhard J, Levander S, Lindström E. Remission in schizophrenia: analysis in a naturalistic setting. Compr Psychiatry. 2009 May-Jun;50(3):200-8. https://doi.org/10.1016/j.comppsych.2008.08.010. Epub 2008 Oct 28. PMID: 19374962.
  5. Leucht S, Beitinger R, Kissling W. On the concept of remission in schizophrenia. Psychopharmacology (Berl). 2007 Nov;194(4):453-61. https://doi.org/10.1007/s00213-007-0857-1. Epub 2007 Jul 6. PMID: 17618422.
  6. Carpiniello B, Pinna F, Manchia M, Tusconi M, Cavallaro R, Bosia M. Sustained symptomatic remission in schizophrenia: Course and predictors from a two-year prospective study. Schizophr Res. 2022 Jan;239:34-41. https://doi.org/10.1016/j.schres.2021.11.023. Epub 2021 Nov 25. PMID: 34839071.
  7. Mortimer AM. Symptom rating scales and outcome in schizophrenia. Br J Psychiatry Suppl. 2007 Aug;50:s7-14. https://doi.org/10.1192/bjp.191.50.s7. PMID: 18019038.
  8. Smulevich AB, Andryushchenko AV, Beskova DA. The problem of remissions in schizophrenia: a clinical and epidemiological study. S.S. Korsakov Journal of Neurology and Psychiatry. 2007;107(5): 4-15 (in Russian).
  9. Petrova NN, Vishnevskaya OA. On the issue of the peculiarities of remission of paranoid schizophrenia occurring with depression. V.M. Bekhterev Review of Psychiatry and Medical Psychology. 2014;2:70-76 (in Russian).
  10. Petrova NN, Lugovskaya LV. Clinical and functional characteristics of remission and rehabilitation of patients with schizophrenia. Neurological Bulletin. 2020;LII(2):33-39. https://doi.org/10.17816/nb34054(in Russian).
  11. Agranovsky ML, Gulomkodirov MM, Dalimova SA, Muminov RK. Analysis of remote follow-up data for schizophrenia with a remitting course type. Economy and Society. 2022;6 (97):285-288 (in Russian).
  12. Lewis S, Lieberman J. CATIE and CUtLASS: can we handle the truth? Br J Psychiatry. 2008 Mar; 192(3): 161-3. https://doi.org/10.1192/bjp.bp.107.037218. PMID: 18310570.
  13. Huhn M, Nikolakopoulou A, Schneider-Thoma J, Krause M, Samara M, Peter N, Arndt T, Bäckers L, Rothe P, Cipriani A, Davis J, Salanti G, Leucht S. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019 Sep 14; 394(10202):939-951. https://doi.org/10.1016/S0140-6736(19)31135-3. Epub 2019 Jul 11. Erratum in: Lancet. 2019 Sep 14;394(10202):918. https://doi.org/10.1016/S0140-6736(19)31677-0.PMID: 31303314; PMCID: PMC6891890.
  14. Ostuzzi G, Bertolini F, Tedeschi F, Vita G, Brambilla P, Del Fabro L, Gastaldon C, Papola D, Purgato M, Nosari G, Del Giovane C, Correll CU, Barbui C. Oral and long-acting antipsychotics for relapse prevention in schizophrenia-spectrum disorders: a network meta-analysis of 92 randomized trials including 22,645 participants. World Psychiatry. 2022 Jun; 21(2):295-307. https://doi.org/10.1002/wps.20972. PMID: 35524620; PMCID: PMC9077618.
  15. Fastovtsov GA., Oskolkova SN. Formation of crite-ria for remission in schizophrenia. Russian Journal of Psychiatry. 2016;5:26-32 (in Russian).
  16. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261-76. https://doi.org/10.1093/schbul/13.2.261. PMID: 3616518.
  17. Addington D, Addington J, Schissel B. A depression rating scale for schizophrenics. Schizophr Res. 1990 Jul-Aug;3(4):247-51. https://doi.org/10.1016/0920-9964(90)90005-r. PMID: 2278986.
  18. Siris SG. Depression in schizophrenia: perspective in the era of “Atypical” antipsychotic agents. Am J Psychiatry. 2000 Sep;157(9):1379-89. https://doi.org/10.1176/appi.ajp.157.9.1379. PMID: 10964850.
  19. Addington DD, Azorin JM, Falloon IR, Gerlach J, Hirsch SR, Siris SG. Clinical issues related to depression in schizophrenia: an international survey of psychiatrists. Acta Psychiatr Scand. 2002 Mar;105(3):189-95. https://doi.org/10.1034/j.1600-0447.2002.1o458.x. PMID: 11939972.
  20. Phahladira L, Asmal L, Lückhoff  HK, du Plessis S, Scheffler F, Kilian S, Smit R, Buckle C, Chiliza B, Emsley R. The course and concomitants of depression in first-episode schizophrenia spectrum disorders: A 24-month longitudinal study. Psychiatry Res. 2021 Apr; 298:113767. https://doi.org/10.1016/j.psychres.2021.113767. Epub 2021 Jan 29. PMID: 33545422.
  21. Dresvyannikov VP, Starichkov DA, Ovchinnikov AA, Drobizhev MYu, Kireeva AI. Affective disorders in remission in schizophrenia (clinical picture, pathogenesis, therapy). Psychiatry and Psychopharmacotherapy. 2007;9(5):8-11 (in Russian).
  22. Vishnevskaya OA. Features of depression during the period of remission of schizophrenia and social functioning of patients: dissertation abstract Cand. Sc. (Medicine).St. Petersburg, 2013:28(in Russian).
  23. Mosolov SN. Diagnosis and treatment of depression in schizophrenia. Consortium Psychiatricum. 2020;1(2):29-42. https://doi.org/10.17650/2712-7672-2020-1-2-29-42 (in Russian).