Email this article Clinical subtypes of postpsychotic depression in the first episode of schizophrenia: results of a cross-sectional observational study
- Authors: Antokhin E.Y.1, Neznanov N.G.2,3, Vasileva A.V.2,4, Budza V.G.1, Boldireva T.A.5, Kozlov Y.S.6
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Affiliations:
- Orenburg State Medical University
- National Medical Research Center for Psychiatry and Neurology named after. V.M. Bekhterev
- First St. Petersburg State Medical University named after acad. I.P. Pavlov
- North-Western State Medical University named after I.I. Mechnikov
- Orenburg State University
- Orenburg Regional Clinical Psychiatric Hospital No. 1
- Issue: Vol LVI, No 1 (2024)
- Pages: 37-48
- Section: Original study arcticles
- URL: https://journals.eco-vector.com/1027-4898/article/view/626328
- DOI: https://doi.org/10.17816/nb626328
- ID: 626328
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Abstract
BACKGROUND: Clinical diagnosis of depression in schizophrenia is difficult because of the dimensional overlap of a number of affective symptoms with negative manifestations of schizophrenia spectrum disorders. In the very first attack of schizophrenia, when the negative symptom complex is not yet clear enough, the difficulties of differential diagnosis become even more relevant, especially when depression occurs in the post-attack stage during the formation of remission and the manifestation of postpsychotic depression.
AIM: To establish a diagnostic approach based on a combination of clinical-psychopathological and psychometric methods for the assessment of postpsychotic depression in patients with a first episode of schizophrenia.
MATERIAL AND METHODS: We are examined 1112 patients who had suffered a first psychotic episode. Аfter introducing inclusion/exclusion criteria, two groups were formed in the final design: 243 patients with postpsychotic depression (PPD) and 119 patients without depression in partial remission. Clinical-psychopathological, psychometric (PANSS, CDSS, SCL-90-R scales), and statistical (descriptive, non-parametric statistics — significance level p <0.05) methods were used.
RESULTS: Based on the concept of positive-negative affectivity, three types of PPD have been identified: with signs of positive affectivity — anxious, sensitive-psychasthenic, depersonalisation-hypochondriacal and melancholic-anergic subtypes; with signs of negative affectivity anhedonic, dysthymic-apathetic and dysphoric subtypes; formed due to psychopathological manifestations of the non-affective register — obsessive-ruminative, agoraphobic, paranoid-symbolic subtypes. Patients who were diagnosed with PPD with positive affectivity after an attack were predominat (p <0.05): 46.91% of the total number of depressed patients. PPD formed due to non-affective spectrum disorders is accompanied by the strongest subjective severity of suffering in patients, compared to patients diagnosed with PPD with positive affectivity. Subjectively, the easiest for patients is PPD with negative affectivity, which, however, does not mean that it can be considered as favourable from the standpoint of therapy and rehabilitation.
CONCLUSION: PPD is detected in a significant number of patients with a first psychotic episode, even after excluding the group with pharmacogenic depression, both due to subjective complaints, nosogenic depressive experiences, and as a result of a psychometric assessment of the patients’ condition. The concept of “dissociated post-attack depression” is substantiated.
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About the authors
Evgenii Yu. Antokhin
Orenburg State Medical University
Author for correspondence.
Email: antioh73@yandex.ru
ORCID iD: 0000-0001-6835-8613
SPIN-code: 5875-2889
M.D., Cand. Sci. (Med.), Assoc. Prof., Head of Depart.
Russian Federation, OrenburgNikolai G. Neznanov
National Medical Research Center for Psychiatry and Neurology named after. V.M. Bekhterev; First St. Petersburg State Medical University named after acad. I.P. Pavlov
Email: nezn@bekhterev.ru
ORCID iD: 0000-0001-5618-4206
SPIN-code: 9772-0024
M.D., D. Sci. (Med.), Professor, Director, Scientific Director, Depart. of Geriatric Psychiatry; Head of Depart.
Russian Federation, St. Petersburg; St. PetersburgAnna V. Vasileva
National Medical Research Center for Psychiatry and Neurology named after. V.M. Bekhterev; North-Western State Medical University named after I.I. Mechnikov
Email: annavdoc@yahoo.com
ORCID iD: 0000-0002-5116-836X
SPIN-code: 2406-9046
M.D., D. Sci. (Med.), Assoc. Prof., Head, International Department, Chief Researcher, Professor
Russian Federation, St. Petersburg; St. PetersburgVladimir G. Budza
Orenburg State Medical University
Email: k_budda@orgma.ru
ORCID iD: 0000-0002-8766-5245
SPIN-code: 5972-3797
M.D., D. Sci. (Med.), Prof., Head of Depart.
Russian Federation, OrenburgTatyana A. Boldireva
Orenburg State University
Email: ttatianna@yandex.ru
ORCID iD: 0000-0001-7589-0579
SPIN-code: 3255-5955
Cand. Sci. (Psychol.), Assoc. Prof.
Russian Federation, OrenburgYaroslav S. Kozlov
Orenburg Regional Clinical Psychiatric Hospital No. 1
Email: synergist@yandex.ru
ORCID iD: 0009-0000-5440-6338
M.D., Deputy Chief Physician for the Medical Department
Russian Federation, OrenburgReferences
- Abdin E, Chong SA, Vaingankar JA et al. Trajectories of positive, negative and general psychopathology symptoms in first episode psychosis and their relationship with functioning over a 2-year follow-up period. PLoS One. 2017;12(11):e0187141. doi: 10.1371/journal.pone.0187141
- Neznanov NG, Ivanov MV. Negativnie i kognitivnie rasstroistva pri endogennih psihozah. М.: MedPress; 2021. 322 p. (In Russ.)
- Bashir Z, Griffiths SL, Upthegrove R. Recognition and management of depression in early psychosis. BJPsych Bull. 2022;46(2):83–89. doi: 10.1192/bjb.2021.15
- Budza VG, Antokhin EYu. Problema depressii pri schizophrenii (obzor 2): tipologiya i techenie postschizophrenicheskih depresii. Psihiatriya i psyhofarmakoterapiya. 2014;16(2):47–53. (In Russ.)
- Neznanov NG, Martinihin IA, Моsоlоv SN. Diagnostika shizophrenii v Rossii: rezul’tati on-lain oprosa vrachei-psihiatrov. Chast’ 1. Ispol’zovanie MKB-10. Sovremennaya terapiya psihicheskih rasstroistv. 2019;1:2–13. (In Russ.) doi: 10.21265/PSYPH.2019.24.24.001
- Mendelevich VD. Koncepciya “vtorogo mneniya” v psihiatrii. Nevrologiteskii vestnik. 2023;3:12–20. (In Russ.) doi: 10.17816/nb546148
- Antokhin EYu, Budza VG, Erzin AI, Kryukova EM. Postpristupnaya depressiya pri pervom episode shizophrenii (tipologiya i patopsihologiya). Orenburg: izd-vo OrGMU; 2019. 268 p. (In Russ.)
- Antokhin EYu, Vasil’eva AV, Boldireva TA, Antokhina RI. Individual’no-psihologiteskie harakteristiki i osobennosti sovladaniya s zabolevaniem u pacientov s pervim psihoticheskim epizodom i pstpsihoticheskoi depressiei kak misheni dlya psihosocial’nih intervencii. Obozrenie psihiatrii i medicinskoy psihologii im VM Behtereva. 2024;(1). In press. (In Russ.) doi: 10.31363/2313-7053-2024-775
- Gurovich IYa, Shmukler AB, Movinf LG, Dorodnova AS. Kliniko-organizacionnaya model' okazaniya pomosti bol’nim s pervim psihoticheskim epizodom, napravlennaya na predupregdenie neblagopriyatnih ishodov zabolevaniya. In: Pervii psihoticheskii epizod (problem i psihiatricheskaya pomost’). Pod red. IYa Gurovicha, AB Shmuklera. M.: MEDPRAKTIKA-M; 2010. р. 259–305. (In Russ.)
- Моsоlоv SN, Potapov AV, Shafarenko AA et al. Razrabotka i validizaciya standartizirovannih kriteriev terapevticheskoi remissii pri shizophrenii. Sovremennaya terapiya psihicheskih rasstroistv. 2011;3:2–6. (In Russ.)
- Petrova NN, Vishnevskaya OA, Gvozdeckii AN. Prognosticheskie factori depressii v remissii shizophrenii. Psihiatriya i psyhofarmakoterapiya. 2014;16(6):52–56. (In Russ.)
- Nakajima S, Higuchi Y, Tateno T et.al. Duration mismatch negativity predicts remission in first-episode schizophrenia patients. Front Psychiatry. 2021;25(12):777378. doi: 10.3389/fpsyt.2021.777378
- Ivanova Е, Khan А, Liharska L et al. Validation of the Russian Version of the Positive and Negative Syndrome Scale (PANSS-Ru) and normative data. Innov Clin Neurosci. 2018;15(09-10):32–48.
- Smulevich AB. Psihopatologiya i klinika depressii, razvivayustihsya pri shizophrenii. Psihiatriya i psyhofarmakoterapiya. 2003;5(5):184–186. (In Russ.)
- Karvasarskii BD, Babin SM, Bocharov VV et al. Ocherki dinamicheskoi psihiatrii: transkultural’noe issledovanie. Sankt-Peterburg, 2003. 438 p. (In Russ.)
- Neznanov NG, Vasileva AV. Рsychodynamic aspects of self-stigamtization. European Psychiatry. 2012;27(S1):930.
- Lutova NB, Sorokin MYu, Novikova KE, Vid VD. Sub’ektivnoe vospriyatie psihoza u bol’nih shizophreniei: opit transcul’tural’nogo issledovaniya. Obozrenie psihiatrii i medicinskoi psihologii imeni VM Behtereva. 2018;(3):59–64. (In Russ.) doi: 10.31363/2313-7053-2018-3-59-64
- Kogan BM, Semina TE. Problema dissociacii v psihologii i psihiatrii. Sistemnaya psihologiya i sociologiya. 2010;2(1):43–52. (In Russ.)
- Shmukler AB. Strukturno-funkcional’naya rassoglasovannost’ razlichnih otdelov mozga pri shizophrenii: rol’ integrativnoi percepcii. In: Pervii psihoticheskii epizod (problem i psihiatricheskaya pomost’). Pod red IYa Gurovicha, AB Shmuklera. M.: MEDPRAKTIKA-M; 2010. р. 433–457. (In Russ.)
- Vasileva AV, Karavaeva TA, Neznanov NG. Psihoterapiya. Nacional’noe rukovodstvo. M.: GEOTAR-Media; 2023. 992 р. (In Russ.) doi: 10.33029/9704-7567-6-PSY-2023-1-992
- Vasileva AV. Evolucionnaya model depressii v period pandemii. Al’yans psyho- i farmakoterapii. Obozrenie psihiatrii i medicinskoi psihologii im VM Behtereva. 2021;1:91–10. (In Russ.) doi: 10.31363/2313-7053-2021-1-91-101
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).