[Transfer from paliperidone of one-month action to paliperidone of three-month action in schizophrenia spectrum disorders: clinical aspects, pharmacological strategies, therapeutic prediction]. / Perevod s paliperidona odnomesyachnogo deistviya na paliperidon trekhmesyachnogo deistviya pri rasstroistvakh shizofrenicheskogo spektra: klinicheskie aspekty, farmakologicheskie strategii, terapevticheskaya prediktsiya.

OBJECTIVE: To analyze clinical and therapeutic features of the transfer of patients with schizophrenia spectrum disorders from paliperidone palmitate of one-month action (PP-1M) to paliperidone of three-month action (PP-3M). MATERIAL AND METHODS: Data on the psychopharmacological therapy regimens of 677 patients with verified diagnoses of schizophrenia spectrum disorders (F20, F21, F25) treated with PP-3M drugs after PP-1M therapy were studied. RESULTS: The study showed the high efficacy of ultra-long-acting paliperidone therapy in 82.2% of patients with schizophrenia spectrum disorders. The unfavorable dynamics of the mental state in patients when transferring from the drug PP-1M to PP-3M was 14.0%, the return to therapy with PP-1M or tablet forms was 3.8%. Successful management of patients on PP-3M was not associated with sex and age, but was correlated with some clinical and therapeutic indicators. The most successful therapy with PP-3M was noted with the earlier appointment of PP-3M mainly as monotherapy, provided the previous stable condition on shorter-acting paliperidone preparations (including tablet forms). Predictors of a favorable prognosis of PP-3M therapy are also diagnostic categories such as paranoid schizophrenia, episodic type of course with increasing or stable personality changes and pronounced affective disorders in the structure of the clinical picture of the disease. CONCLUSION: The results demonstrate the high efficacy of PP-3M and its significant rehabilitation potential, which allows improving the quality of life and social functioning of patients, as well as optimizing the provision of psychiatric care to this contingent of patients, which is of particular importance in the conditions of the COVID-19 pandemic.

[Questions of primary diagnosis of schizophrenia in middle-aged and older patients]. / Voprosy pervichnoi diagnostiki shizofrenii u patsientov srednego i starshego vozrasta.

OBJECTIVE: An analysis of clinical and social characteristics of patients aged 40 years and older with primary diagnosis of schizophrenia (F 20-21) in a psychiatric hospital. MATERIAL AND METHODS: We studied 114 medical records of patients aged 40 and over who were admitted to a psychiatric hospital for a two-year period (2018-2019) with a first-time diagnosis of schizophrenia (F 20-21) based on the results of inpatient examination and treatment. RESULTS: The analysis shows that 90% of patients were aged 40-59 years, 59.6% of them were women. In every third patient (33.3%), clinical signs of psychosis were observed for five or more years before hospitalization and diagnosis, and in 14.9% for more than 10 years, the average duration of psychosis before diagnosis was 5.1 years. Markers of psychosis were non-specific factors of family adaptation, working capacity, and substance use, which revealed relationships with gender characteristics and age of diagnosis of psychosis. Better adaptation parameters correlated with the female sex and later diagnosis of schizophrenia, lower indicators were more typical for the male sex and earlier diagnosis. CONCLUSION: Signs of increasing social maladjustment should be alarming to the patient's relatives, as well as social and medical services. In addition, the timely diagnosis of psychosis requires psychoeducation of the population, training of social workers and primary health care professionals.

[Some current trends in the use of prolonged injectable antipsychotics in the conditions of modernization of the psychiatric service]. / Nekotorye sovremennye tendentsii primeneniya prolongirovannykh in"ektsionnykh antipsikhotikov v usloviyakh modernizatsii psikhiatricheskoi sluzhby.

OBJECTIVE: A pharmacoeconomical analysis of the use of prolonged injectable antipsychotics in the treatment of patients with schizophrenia in Moscow over 2015-2019 in the context of the reform of the psychiatric service. MATERIAL AND METHODS: The authors studied the economic costs of treatment of psychiatric patients with prolonged injectable antipsychotics on the pharmaceutical market in Moscow for five years on the example of patients diagnosed with paranoid schizophrenia (ICD-10 F20.0) based on the dynamics of the registered contingent of patients with schizophrenic spectrum disorders over the past fifteen years including the period of active modernization of the psychiatric service. RESULTS AND CONCLUSION: A constant increase in public spending on treatment, including therapy with prolonged injectable neuroleptics (both first-generation drugs and atypical antipsychotics), was shown. At the same time, the increase in the use of atypical antipsychotics is ahead of schedule. The number of patients receiving treatment with prolonged injectable haloperidol and zupentixol increased approximately twice during this period, the number of patients receiving treatment with injectable risperidone and paliperidone palmitate increased by more than 3 and 13 times, respectively. There is a significant increase in public spending on the purchase and use of these drugs for the treatment of privileged categories of patients, most of this applies to injectable forms of paliperidone, the cost of using these drugs has increased more than 20 times over a five-year period. These trends indicate a shift in emphasis towards outpatient psychiatric care and improvement of approaches to treatment of patients with schizophrenia, which indicate a new stage in the development of out-of-hospital treatment and rehabilitation systems based on the latest achievements of psychopharmacology and the development of social support systems for patients with schizophrenia spectrum disorders.