Categorical options for remission in patients with paranoid and undifferentiated forms of schizophrenia

Mental disorders are represented in the population mainly in the form of dynamic manifestations of various degrees of severity of remission conditions. The meaningful concept of remission in schizophrenia is a widely discussed topic in modern psychiatry, and is considered in the form of two approaches, categorical (clinical) and dimensional (standardized). The advantages of a categorical approach to classifying remissions in patients with schizophrenia, taking into account the qualitative signs of residual positive, negative (deficit) and personality symptoms, is a holistic view of the psychopathological characteristics of patients, indicating the general nature of supportive therapy, and to a certain extent the prognosis of further development of the disease. The categorical approach in the assessment of remission optimizes the development of rehabilitation measures for patients with various forms of schizophrenia, however, has a number of disadvantages in practical use. The aim of the study was to study the characteristics of the categorical characteristics of remission in patients with undifferentiated and paranoid schizophrenia. Materials and methods: On the basis of the Bekhterev National Research Medical Center of the Ministry of Health of the Russian Federation, patients from a clinical sample (n=106) were examined, including 61 men (57.5%) and 45 women (42.5%), aged 19-59 years, who had no relapses within 12 months after hospital discharge. The majority of patients (n=76, 71.7%) were diagnosed with "paranoid schizophrenia" (F20.0) according to ICD-10, and "undifferentiated schizophrenia" (F20.3) was diagnosed with a lower frequency (n=30, 28.3%). Two groups of patients were formed from the general clinical sample: group 1 who received atypical antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone) (n=85, 80.2%), group 2 who received typical antipsychotics (haloperidol)‒ (n=21, 19,8%). Clinical-psychopathological, clinical-anamnestic, clinical-catamnestic research methods, and a coding list were used. Results: in 106 patients with paranoid and undifferentiated syndrome, remissions are formed more often (71;67%) than symptomatic (35;33%). Patients with paranoid schizophrenia were more likely to have a paranoid variant of symptomatic remission: 14 (56%) versus 0 (0%), p=0.008, and patients with undifferentiated schizophrenia had an obsessive one: 7 (70%) versus 1 (4%), p<0.001; the distribution of syndromic remission variants was similar. Patients receiving typical antipsychotics were more likely to develop an apathetic variant of syndromic remission: 13 (86.7%) versus 3 (5.4%), p <0.001, and patients receiving atypical ones were more likely to develop a psychasthenic variant of syndromic remission:16 (28.6%) versus 0 (0%) in patients receiving typical antipsychotics, p=0.016; the frequency of formation of symptomatic remission variants was similar. There were no significant differences in the frequency of the types of syndromic and symptomatic remissions and their variants depending on the atypical antipsychotic used. The advantages of the categorical approach in optimizing preventive, diagnostic, and therapeutic tactics are analyzed, and the disadvantages of the categorical approach to assessing remission for developing a personalized rehabilitation program for patients with schizophrenia are identified. It is concluded that for a clearer definition of the target symptoms, additional consideration of the dynamic characteristics of the remission state is possible: individual dimensional (affective, negative, positive), as well as social and psychological characteristics.

1. Volovik V.M., Vid V.D. Psihofarmakologiya i psihoterapiya. Farmakoterapevticheskie osnovy reabilitacii psihicheski bol'nyh. Pod red. R.Ya. Vovina (SSSR), G.-E. Kyune (GDR). M.: Medicina; 1989. (In Russ.).

2. Gurovich IYa, Shmukler AB. Schizophrenia in the taxonomy of mental disorders. Social`naya i klinicheskaya psixiatriya. 2014;24(2):46–49. (In Russ.).

3. Davydovskij I.V. Problema prichinnosti v medicine (Etiologiya). M.: Medgiz; 1962. (In Russ.).

4. Kotsyubinsky AP, Isaenko YuV, Kuznetsova SL, Butoma BG, Aksenova NO, Razheva MK. Diagnostic problems in using the categorical-dimensional approach in psychiatry. Message 1. General ideas about categorical-dimensional relationships. Social`naya i klinicheskaya psihiatriya. 2022;32(3):5–11. (In Russ.).

5. Kotsyubinsky AP. Remissions in schizophrenia: Categorical and dimensional approaches. Obozrenie psihiatrii i medicinskoj psihologii im. V.M. Behtereva. 2015;3:3–8. (In Russ.).

6. MKB-10. Mezhdunarodnaya klassifikaciya boleznej (10-j peresmotr). Klassifikaciya psihicheskih i povedencheskih rasstrojstv: MKB-10: Klinicheskie opisaniya i ukazaniya po diagnostike. VOZ; Per. na rus. yaz. pod red. Yu.L. Nullera, S.Yu. Cirkina. SPb.: Overlajd; 1994. (In Russ.).

7. Semenov S.F., Mogilina N.P., Kogan R.D. i dr. Processy kompensacii i adaptacii pri narusheniyah nervno-psihicheskoj deyatel'nosti. Klinicheskie, social'nye i biologicheskie aspekty kompensacii i adaptacii pri nervno-psihicheskih zabolevaniyah: sbornik nauchnyh trudov Moskovskogo NII psihiatrii, T. 85. M.: 1979. (In Russ.).

8. Smulevich AB. Acquired, somatogenically conditioned, hypochondriacal psychopathies (towards the taxonomy of personality disorders). Psihiatriya i psihofarmakoterapiya. Zhurnal im. P.B. Gannushkina. 2006;8(1):5–8. (In Russ.).

9. Smulevich AB, Andryushchenko AV, Beskova DA. The problem of remissions in schizophrenia: a clinical and epidemiological study. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova. 2007;107(5):4–15. (In Russ.).

10. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. text revision. DSM. Arlington, VA, American Psychiatric Association; 2013.

11. Andreasen NC, Carpenter WT, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rational for consensus. American Journal of Psychiatry. 2005;162(3):441–449. https://doi.org/10.1176/appi.ajp.162.3.441.

12. Carpiniello B, Pinna F, Manchia M, Tusconi M, Cavallaro R, Bosia M. Sustainted symptomatic remission in schizophrenia: Course and predictors from a two-year prospective study. Schizophrenia Research. 2022;239:34–41. https://doi.org/10.1016/j.schres.2021.11.023.

13. Correia DT. Different perspectives of validity in psychiatry. Journal of Evaluation in Clinical Practice. 2017;23(5):988–993. https://doi.org/10.1111/jep.12766.

14. De Hert M, van Winkel R, Wampers M, Kane J, van Os J, Peuskens J. Remission criteria for schizophrenia: evaluation in a large naturalistic cohort. Schizophrenia Research. 2007;92(1-3):68–73. https://doi.org/10.1016/j.schres.2007.01.010.

15. Heering HD, Janssens M, Boyette L-L, van Haren NEM. Remission criteria and functional outcome in patients with schizophrenia, a longitudinal study. Australian & N.Z. Journal of Psychiatry. 2015;49(3):266–274. https://doi.org/10.1177/0004867414557680.

16. Rekhi G, San Ang M, Chan YH, Fernandez-Egea E, Kirkpatrick B, Lee J. Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale. Revista de Psiquiatría y Salud Mental (Engl. Edition). 2022;15(1):3–13. https://doi.org/10.1016/j.rpsmen.2022.01.007.

17. Sakinyte K, Holmber C. Psychometric and clinical evaluation of schizophrenia remission criteria in outpatients with psychotic disorders. BMC Psychiatry. 2023;23(1):Article number 207. https://doi.org/10.1186/s12888-023-04701-3.

18. Silva MA, Restrepo D. Functional Recovery in Schizophrenia. Revista Colombiana de Psiquiatría (Engl. Edition). 2019;48(4):252–260. https://doi.org/10.1016/j.rcp.2017.08.004.