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Predicting severity of paranoid schizophrenia
14. Cancer mortality and occupational exposure to aromatic amines and inhalable aerosols in rubber tire manufacturing in Poland/F. de Vocht, W. Sobala, U. Wilczynska [et al.]//Cancer Epidemiol. Biomarkers Prev. - 2009. - Vol. 33, N 2. - P. 94-102.
15. Veys C. A. Bladder tumours in rubber workers: a factory study 1946-1995/C. A. Veys//Occup. Med. -2004. - Vol. 54. - P. 322-329.
16. Terekhov I. A. Hygienic assessment of working conditions and functional resistance in electric power station workers/I. A. Terekhov//Gig. Sanit. - 2007. - N 2. - P. 35-39.
Kolesnichenko Elena Vladimirovna, Saratov State Medical University named after V. I. Razumovsky, associate professor of Chair of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, PhD E-mail: [email protected]
Predicting severity of paranoid schizophrenia
Absrtact: Clinical symptoms, course and outcomes of paranoid schizophrenia are polymorphic. 206 cases of paranoid schizophrenia were investigated. Clinical predictors were collected from hospital records and interviews. Quantitative assessment of the severity of schizophrenia as special indexes was used. Schizoid, epileptoid, psychasthenic and conformal accentuation of personality in the premorbid, early onset of psychosis, paranoid and hallucinatory-paranoid variants of onset predicted more expressed severity of paranoid schizophrenia. These prognostic factors can be taken into account in clinical practice.
Keywords: paranoid schizophrenia, clinical predictors, exacerbations index.
Schizophrenia is one of the most important challenges for modern clinical psychiatry. About 2 million people are diagnosed with schizophrenia each year, worldwide [1, 162]. Paranoid
schizophrenia is the most common clinical form of schizophrenia [2, 407]. Clinical symptoms, course and outcomes of paranoid schizophrenia are polymorphic [3, 122-130]. Paranoid
schizophrenia now changed due to the clinical and therapeutic pathomorphosis, reported in the literature [4, 28-78]. Psychiatrists from many different countries have been researching course and outcome of schizophrenia and continue to search for markers of prognosis in schizophrenia [5, 173-182; 6, 62-68; 7, 263-268]. Adequate and timely of therapeutic and rehabilitation depend on the accuracy prognosis of development options of the schizophrenic process.
Objective: To search for clinical predictors of severity and activity of paranoid schizophrenia.
Materials and methods
The study involved 206 patients with paranoid schizophrenia (97 women, 109 men; age range — from 18 to 60 years inclusive, the average age in years = 31,2 ± 0,71). All patients were Russian by nationality, with different duration of the disease, admitted for treatment in psychiatric hospitals of Saratov region over the exacerbation of the schizophrenic process. The main selection criteria were verified by a hospital examination the diagnosis of paranoid schizophrenia «F20.0» (according to the diagnostic criteria of ICD-10), somatic well-being. The presence of comorbid psychiatric disorders, traumatic brain injury history and the refusal to cooperate in the interview were exclusion criteria of this study.
Medical history and demographic data were collected from hospital records and clinical interviews. The diagnosis of a mental disorder was defined by the diagnostic criteria of
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Section 1. Clinical medicine
the International Classification of Diseases, Tenth Revision (ICD -10). “The evaluation list ofsymptoms and a glossary for mental disorders, ICD-10” was used to identify the psychopathological state and selective psychopathological symptoms [8]. A qualification of premorbid personality of patients was carried out on the basis of personality typology of research by A. E. Licko. Lichko created his own personality typology on the basis of works by Pyotr Gannushkin and Karl Leonhard [9, 3-214].
These quantified parameters were first used for a quantitative estimation of activity and malignancy of the schizophrenic process:
1. Index exacerbation of schizophrenia (I).
L (%) =
duration of all exacerbations (years) x 100
the patient s age (years)
This index measures the degree of manifestation of the clinically obvious schizophrenic process in the phenotype of the subject. Accordingly, the index will be zero in healthy individuals, and index will strive for 100% in schizophrenic patients with early onset type and a continuous type of course of schizophrenia.
2.
duration of hallucinations and delusions (years) x 100
Index of psychotism (I). * 3 4
IP! (%) = -
sy duration of of thedisease(years)
This index measures the severity of symptoms of psychotism in the schizophrenic phenotype. Symptoms of psychotism include hallucinations and delusions.
3. Index of deficiency (I).
I (/ ) duration of thenegativesymptoms (years) x100 dlf duration of of thedisease(years)
The index assesses the degree of a mental deficiency or «reduction of mental capacity» in the schizophrenic patient, including the depletion and blunting of emotion, poverty of content of speech (alogia), avolition, apathy, anhedonia [10, 193-204; 11, 441-449].
4. Index of desocialization (I).
I (o/\ duration of desocialization (years) x100 des duration of of thedisease(years)
This index assesses the degree of social decline due to schizophrenia in the form of lower social and professional productivity.
Psychopathological definitions that were formulated The Remission in Schizophrenia
Working Group were used in the calculations of the above indexes schizophrenia [11, 441-449].
The study was approved by the Ethics Committee of the Saratov State Medical University named after V. I. Razumovsky. All the patients and the healthy study participants gave written informed consent to participate in the study.
Statistical analysis is made in the Center “Biostatistics” (head Leonov V. P.). Procedures of statistical analysis were performed using the statistical package SAS 9.3, STATISTICA 10 and IBM-SPSS-21. The critical level of statistical significance (p) during the test the null hypothesis was assumed to be 0.05. The null hypothesis was accepted in case of exceeding the achieved level of significance statistical test this value. Non-parametric methods such as ANOVA Kruskal-Wallis and Wilcoxon rank marks Van der Waerden test was used to compare the distribution parameters of the central characters in the comparison groups. Evaluation of Arithmetic Meane (M) and Standard Error of the Mean (m) were counted for all the quantitative traits in the compared groups. These descriptive statistics presented as M ± m in the text.
Results
The first step the severity of schizophrenia was to evaluate in patients with absence and presence of family history of schizophrenia. The differences in values of studied indexes between the groups did not reach statistical significance. Accordingly, a family burdened by schizophrenia has no significant effect on the severity of the schizophrenic process and cannot be used as a prognostic marker.
The next step the mean values of the indexes of activity and malignancy of schizophrenia between the groups with different premorbid personality characteristics was compared. The highest values of the index exacerbation were found in patients with epileptoid (32,1 ± 20,1), psychasthenic (31,9 ± 28,3) and schizoid (30,9 ± 23,6) variants of the premorbid personality accentuation. Consequently, the schizophrenic process in patients with these premorbid accentuations begins earlier and has a marked tendency to the continuous course. Intensity and duration of the productive psychotic symptoms
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Predicting severity of paranoid schizophrenia
as delusions and hallucinations was greatest in patients with schizoid (73,6 ± 32,0) premorbid personality accentuation as well as in patients with epileptoid (69,0 ± 37,2) and conformal (63,7 ± 39,8) premorbid personality accentuations. The severity of the negative symptoms and the socio-professional reduction was great in all the examined groups except patients with hyperthymic and hysteroid personality accentuation in premorbid.
Next, the values of indexes of activity and
malignancy of the schizophrenic process were compared in groups of patients with different age at onset of schizophrenia: the group of patients with early-onset of the disease (manifestation of schizophrenia up to 17 years), the group of patients with typical onset (18 to 35 years) and the group
with late onset (after 35 years). The values of indexes of activity and malignancy of schizophrenia were highest in the group of patients with early-onset disease.
The last step the values of indexes of activity and malignancy of the schizophrenic process were compared in groups of patients with different syndromal variants of first episode of schizophrenia. The lowest values of indexes of activity and progression of schizophrenia have been observed in groups of patients with a combination of delirium and catatonia in the first episode of schizophrenia and in the group with acute delirium at the beginning of the disease.
The numerical values of the results of the study are presented in the summary table (Table 1).
Table 1. - Values of indexes of severity and activity of schizophrenia in patients with different clinical characteristics of the disease
Clinical characteristics I (%) ex I (%) psy 4 ' u%) 1—1
Family history on schizophrenia
Absent (n*=140) 22,0±21,9** 57,9±37,7 77,6±32,5 78,7±32,4
Present (n=36) 33,1±25,3 65,6±39,0 89,3±26,2 88,2±26,6
p-value*** 0,74 0,44 0,77 0,74
Premorbid personality accentuation
Indefinite type (n=76) 19,4±23,7 47,9±37,3 72,9±35,5 73,9±34,9
Hyperthymic type (n=4) 5,9±4,5 11,5±9,7 30,4±24,9 23,6±24,5
Labile type (n=6) 12,9±12,9 43,9±36,5 83,2±29,5 81,8±32,9
Asthenoneurotic type (n=7) 16,5±17,4 59,7±42,4 86,8±24,5 83,3±34,4
Sensitive type (n=10) 16,6±21,4 48,3±38,6 75,4±31,7 75,4±31,7
Psychasthenic type (n=3) 31,9±28,3 56,8±44,8 86,9±22,5 86,8±22,5
Schizoid type (n=65) 30,9±23,6 73,6±32,0 92,5±18,9 93,4±16,9
Epileptoid type (n=22) 32,1±20,1 69,0±37,2 88,9±22,8 88,9±22,7
Hysteroid type (n=4) 5,2±2,6 14,1±6,5 16,2±7,8 23,4±21,5
Conformal type (n=9) 18,1±15,5 63,7±39,8 75,6±34,6 76,9±31,7
p-value 0,0001 0,0003 <0,0001 <0,0001
Age at onset of schizophrenia
Early onset (n=139) 29,8±24,4 64,9±37,8 84,4±29,6 84,7±29,1
Typical onset (n=62) 11,5±12,3 45,7±33,9 72,5±32,7 73,2±33,2
Late onset (n=5) 2,3±1,8 17,3±10,4 51,9±30,2 59,4±34,0
p-value <0,0001 0,0011 0,005 0,007
Syndromal variants of first episode
Acute delirium (n=21) 4,14±4,0 27,1±28,4 39,9±25,8 39,0±29,5
Hallucinatory-paranoid (n=122) 29,1±24,6 66,3±36,9 86,6±27,3 87,1±26,6
Paranoid (n=54) 21,0±18,1 56,3±35,6 86,8±24,7 86,9±23,2
Combination of delirium and catatonia (n=9) 10,4±17,2 27,9±28,9 44,8±38,4 52,4±42,1
p-value <0,0001 <0,0001 <0,0001 <0,0001
* — The number of observations in the group; ** — Data are presented as M ± m, where M — the Meane, and m — SEM; *** — P-value (criterion of Van der Waerden
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Conclusions
According to the results of the study, schizoid, epileptoid, conformal and psychasthenic premorbid personality accentuations, the onset of psychosis at the age of 17 years, hallucinatory-paranoid and paranoid clinical variants of first episode can be predictors of poor prognosis of paranoid schizophrenia. The relatively
favorable prognosis in patients with paranoid schizophrenia is marked in the case of the predominance of gipertimic and hysteroid traits in the character before of the disease, manifestations of schizophrenia later in life, acute delusional symptoms in the clinical picture of the first episode of psychosis. These prognostic factors can be taken into account in clinical practice.
References:
1. Sadock B. J., Kaplan V. A. Clinical Psychiatry. - M.: Medicina. - 2002.
2. Tiganov A. S., Snezhnevsky A. V., Orlovskaya D. D. et al. Endogenous mental illness/Guide of Psychiatry. Edited by A. S. Tiganov, V.1, M.: Publishing House “Medicine”, 1999.
3. Petryuk P. T. To the study of clinic paranoid schizophrenia (review)//Journal of Psychiatry and Medical Psychology, 2010, Volume 1-2.
4. Tsygankov B. D., Vilianov V. B. Clinical and therapeutic pathomorphosis of paranoid schizophrenia. -Saratov.: Publishing of Saratov University. - 2005.
5. Lang F.U., Kösters M., Lang S., Becker T., Jäger M. Psychopathological long-term outcome of schizophrenia - a review. Acta Psychiatr Scand. 2013 Mar; 127 (3).
6. Stefanopoulou E., Lafuente A.R., Fonseca A.S., Keegan S., Vishnick C., Huxley A. Global assessment ofpsycho-social functioning and predictors of outcome in schizophrenia. Int J Psychiatry Clin Pract. 2011 Mar; 15 (1).
7. Juola P., Miettunen J., Veijola J., Isohanni M., Jääskeläinen E. Predictors of short- and long-term clinical outcome in schizophrenic psychosis - the Northern Finland 1966 Birth Cohort study. Eur Psychiatry. 2013 Jun; 28 (5).
8. Janca A., Ustun T. B., J. Van Drimmelen, Dittmann V., Isaac M. The evaluation list of symptoms and a glossary for mental disorders, ICD-10. SPb.: Publishing House “Overlayd”, 1994.
9. Licko A. E. Schizophrenia in adolescents. Health Leningrad. Dep., 1989.
10. Buchanan R.W., Carpenter W.T. Jr: Domains of psychopathology and approach to the reduction of heterogeneity in schizophrenia. J Nerv Ment Dis, Vol. 182, 1994.
11. Andreasen N. C., Carpenter W. T., Kane J. M. et al. Remission in schizophrenia: proposed criteria and rational for consensus//Am J Psychiatry, Vol. 162, 2005.
Mamatkhanova Charos, Tashkent Institute of PostgraduateMedical Education PhD student, the Faculty of Neurorehabilitation and Oriental Medicine
Email: [email protected]
Complex rehabilitation of the invalids with lumbar radiculopathies
Abstract: In this article was researched clinical, instrumental and diagnostic criterion of definition of physical disability in the patients with lumbar radiculopathies, caused by osteochondrosis of the spine as well as were developed principles of medico-social and professional rehabilitation of this category of the patients and invalids.
Keywords: lumbar radiculopathy, osteochondrosis, symptom, neurology, physical disability.
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