[Periodic catatonia in schizophrenia spectrum disorders]. / Periodicheskaya katatoniya pri rasstroistvakh shizofrenicheskogo spektra.

OBJECTIVE: Typological differentiation of periodic catatonia in schizophrenia and schizophrenia spectrum disorders (SSD), in particular, schizoaffective disorder. MATERIAL AND METHODS: Seventy-four patients with the verified diagnosis of schizophrenia and SSD (ICD-10 items F20, F21) were studied. The clinical, psychometric (BFCRS, SANS) and statistical methods were used. Clinical and psychometric study of seizures of periodic catatonia was carried out at the following stages: 1) manifestation of a seizure; 2) the maximum severity of psychopathological disorders. Also, at the end of the seizure, an additional assessment of the severity of negative symptoms was carried out using the SANS. RESULTS: Three forms of periodic catatonia have been identified: hypokinetic, parakinetic, multikinetic. Clinical distinguishing indicators of periodic catatonia seizurs have been established (protracted - two-stage - form of seizures; the phenomenon of «secondary catatonia¼). The psychometric study revealed significant differences between the variants of periodic catatonia seizures in terms of the severity of motor phenomena (at both stages of the seizure) and negative disorders. BFCRS scores at the first stage of seizures were as follows: hypokinetic - 9.7±0.4; parakinetic - 12.8±0.9; multikinetic - 32.3±1.6 (the differences were found between 1 and 2 (p<0.05); between 1 and 3, as well as 2 and 3 (p<0.01)). BFCRS scores at the second stage of seizures were 12.1±0.8; 19.9±1.2 and 47.7±1.9, respectively,with the differences between 1 and 2 (p<0.05); between 1 and 3, and also 2 and 3 (p<0.01). The scores on the SANS anhedonia-asociality subscale were 1.9±0.2 for hypokinetic; 2.3±0.3 for parakinetic and 3.2±0.2 for multikinetic with the differences between 1 and 2, 1 and 3, 2 and 3 (p<0.01). CONCLUSION: Periodic catatonia is the clinical entity that includes a complex of progressively worsening seizures, the psychopathological systematics of which takes into account the clinical structure of motor disorders, their affiliations with positive and negative dimensions, and functional activity.

[Bimodal model of delusional psychoses (on the problem of the correlation of paranoid dimensions in the psychopathological space of schizophrenia)]. / Bimodal'naya model' bredovykh psikhozov (k probleme sootnosheniya paranoidnykh dimensii v psikhopatologicheskom prostranstve shizofrenii).

OBJECTIVE: To establish clinico-pathogenetic ratios of delusional psychoses constituting the psychopathological space of paranoid schizophrenia and to determine clinical and pathogenetic validity of concepts of a single delusional psychosis (a model of chronic delusion with a staged course) and two endogenous delusional psychoses. MATERIAL AND METHODS: A sample consisted of 56 patients (19 women, 37 men; the average age 39.7±9.3 years; average duration of the disease 10.6±9.1 years) with a diagnosis of paranoid schizophrenia, continuous type of course (F20.00), developed at the age above 18 years. At the time of examination, the condition of the patients was determined by persistent delusional or hallucinatory delusional disorders. Clinical, pathopsychological, psychometric (SANS, SAPS, PANSS), immunological and statistical methods were used. RESULTS: The study substantiates a bimodal model of a single delusional psychosis with a polar arrangement of interpretive delusions and delusions of influence based on the phenomena of mental automatism, both in terms of the vector of development (toward the poles of negative/positive disorders) and in terms of the rate of progression. Psychopathological manifestations of interpretive delusions correlate with the slow evolving development of psychosis, the dimensional structure of the paranoid is limited to the limits of the delusional register; functional activity is represented by affiliation to negative changes, integration with personality anomalies ends with the transformation of positive disorders into pathocharacterological ones, corresponding to the post-processual development of the personality. Manifestation of delusional impact (syndrome of mental automatism) is manifested by the complication and maximum expansion of the spectrum of positive disorders; the dimensional structure is represented by a wide range of psychopathological disorders and is formed with the participation of processes of mental dissociation, reaching the level of delusional depersonalization; functional activity is high, which creates conditions for the formation of a «new¼ subpsychotic structure, a «psychotic character¼, which is an attenuated duplicate of delusional psychosis. In both groups of patients, a significant increase in the activity of inflammatory markers of leukocyte elastase (249.2 ((231.1-270.0); 272.2 (236.0-292.6) nmol/min∙ml) and alpha - 1 proteinase inhibitor (48.8 (46.0-55.0); 50.4 (42.1-54.8) IU/ml) was shown compared with controls (205.0 (199.8-217.3) nmol/min∙mL and 33.0 (31.0-36.0) IU/mL, p<0.01, respectively). In the group of patients with delusions of influence, an increased level of antibodies to S-100B was also observed (0.88 (0.67-1.0) opt.density units) compared with the control values (0.7 (0.65-0.77) opt.density units, p<0.05). CONCLUSION: The concept of the model is supported by the results of the immunological study, according to which interpretive delusions and delusion based on the mental automatism, indicates the different level of immunity tension, and a qualitative changes in immune reactivity (also due to different genetic burden).

[To the problem of somatic-hypochondriac paranoia]. / K probleme somaticheskoi-ipokhondricheskoi paranoii.

OBJECTIVE: To unite within the framework of a single clinical entity (based on the model of hypochondriacal paranoia) phenomena of the somatopsychotic and hypochondriacal range, which, in accordance with modern systematics, are classified as various categories of psychosomatic, affective disorders and personality disorders. MATERIAL AND METHODS: The sample for analysis consisted of 29 patients (with the diagnosis of delusional disorder (ICD-10; F22.0 in ICD-10), 10 men (34.5%) and 19 women (64.5%), the average age was 42.9±19.9 years; men - 10 nab. (34.5%), women - 19 nab. (64.5%). The average duration of the disease iswas 9.4±8.5 years. The psychopathological method was used as the main one. RESULTS: The article forms an alternative concept of somatic paranoia based on the model of hypochondriacal paranoia. The fundamental difference between the construct of somatic paranoia is an obligate connection between somatopsychic and ideational disorders. Somatopsychic (coenesthesiopathic) symptoms do not exist as an independent (equivalent to the structure of somatic clinical syndromes) dimensions and are formed exclusively with the participation of ideational phenomena. CONCLUSION: In accordance with the presented concept, coenesthesiopathic symptoms within the framework of somatic paranoia act as a somatic equivalent of delusional disorders.

[On the problem of hysterocatonia in the clinical space of schizophrenia and schizophrenic spectrum disorders]. / K probleme isterokatatonii v klinicheskom prostranstve shizofrenii i rasstroistv shizofrenicheskogo spektra.

OBJECTIVE: To determinate the premorbid personality dimensions in patients with hysterocatatonia; to study the psychopathological characteristics, making it possible to distinguish the manifestations of hysterical catatonia among other hysterical and catatonic phenomena; to establish the prognostic value of the hysterocatatonia, occurring in the structure of schizophrenia and schizophrenic spectrum disorders (SSD). MATERIAL AND METHODS: 25 patients with a verified diagnosis of schizophrenia and SSD (according to ICD-10) with a predominance of «mild¼ catatonic phenomena in the clinical picture of the disease (manifestations of hyperkinesia, pseudoepileptic paroxysms, isolated parakinesis, psychomotor agitation, accompanied by local muscle spasm and/or an increase in general muscle tone, etc.). RESULTS: The overall severity of catatonic disorders corresponded to 22.7±8.3 BFCRS scale points. The phenomenon of abulic deficiency prevailed in the structure of negative disorders (SANS avolition-apathy - 3.7±0.6; SANS anhedonia-asociality - 2.8±0.7). The increase in the subscales of delusional (2.1±0.2) and hallucinatory phenomena (mild signs of somatic passivity according to K. Schneider), accompanied by a feeling of uncontrollability and «alienation¼ of motor symptoms, was observed according to the SAPS scale. The correlation between the BFCRS scores and the hallucinations (0.765) and delusions (0.653) subscales of the SAPS scale has been found. The hysterocatatonia phenomenon is an independent psychopathological construct, forming in the space of schizophrenia and SSD and revealing a tropism to the pathocharacterological structure of conversion hysteria. The key characteristic, that distinguishes the manifestations of hysterocatonia - is the formation mechanism of movement disorders, based on the phenomenon of mental automatism by G.G. Clérambault. CONCLUSION: The inclusion of hysterocatatonical symptoms into the clinical picture of schizophrenia and SSD serves as the predictor of adverse course of the disease as long as the condition is accompanied by the "layering" of catatonic-hypochondrical and catatonic-delusional symptoms, and the previously low-progressive course of the disease starts being aggravated by the development of repeated attacks with exacerbation of psychomotor symptoms.

[History and current state of the problem of negative disorders (research of nosological period)]. / Istoriya i sovremennoe sostoyanie problemy negativnykh rasstroistv (issledovaniya nozologicheskogo perioda).

Pioneers of nosology in psychiatry considered mental deficit as a basic disorder obligated to all clinical forms of illness, as did E. Kraepelin in the concept of dementia praecox and E. Bleuler in the concept of schizophrenia. At the present stage of studies, this position is clearly articulated in the «deficit schizophrenia¼ concept of J. Klosterkotter. Negative disorders are considered in categorical approach to interpret psychopathological dimensions of schizophrenia as coordinated, strongly bound with positive syndromes (concept of «dialectical unity¼ of A.V. Snezhnevskiy, 1964) and classified as syndromes according to systematics of positive disorders. However, distinguished types of negative disorders are determined in terms of positive syndromes or characterological changes (asthenic, pseudopsychopathic deficit). Within a new paradigm (dimensional approach to schizophrenia), which differs from the categorical approach, negative disorders are considered as a distinct domain, primary in relation to other psychopathological phenomena of schizophrenia). A concept of primary persistent negative symptoms serves as basis of the current concept of schizophrenic deficit. Factor analysis revealed two domains of negative disorders: 1) emotional blunting: blunted affect, alogia; 2) avolition: apathy, anhedonia, asociality.

[Negative disorders: history of clinical concepts (prenosological studies)]. / Negativnye rasstroistva: istoriya razvitiya klinicheskikh kontseptsii (isledovaniya donozologicheskogo perioda).

In this review, sequential stages of the development of negative disorders doctrine are presented beginning from first description of negative symptoms (Aretaeus of Cappadocia - AD I-II) and the first deficit classification (including two polar types: congenital and acquired dementia by J.-E. Esquirol) to indigenous Russian (I.M. Balinsky, I.P. Merzheevsky, S.S. Korsakov, V.P. Serbsky and others) and foreign (B. Morel, H. Schüle, K. Kahlbaum, E. Hecker) studies of the middle 19th - beginning of 20th century. Special attention in this review of studies in prenosological period is given to the W. Griesinger's development of the main statements of deficit changes' classification and development pathways. Authors' studies created conditions not only for psychopathological construct of negative disorders to be set apart into particular category - «secondary insanity¼ (a group of psychiatric set of symptoms, which accumulate manifestations of mental deficit), but for to be subsequently clinically studied.

[Negative and positive disorders of schizophrenia (issues of co-dependence, psychopathology and pathogenesis)]. / Negativnye i pozitivnye rasstroistva pri shizofrenii (aspekty sozavisimosti, psikhopatologii, patogeneza).

The authors consider current and own conceptions about correlations of the processes underlying the pathogenesis of schizophrenia presented by negative and positive disorders. With growth of academic psychiatry, evaluation of a correlation between positive and negative dimensions has changed dramatically: on the one hand presenting in clinical unity - simultaneous psychopathologic structures, and on the other hand being clinically and pathogenetically heterogenic in dimensional structure. According to our clinical and biological findings and an analysis of fundamental neurobiological studies, positive and negative disorders present in the clinical picture of schizophrenia as two separate psychopathological and pathogenetic structures. A new paradigm of the correlation between positive and negative structures - the interaction between positive and deficit symptoms - reveals psychopathological functions differentiated for each of dimensional structures. Negative disorders act as «transformers¼ modifying characteristics of primary transnosological positive disorders to the level of psychopathological structures preferable for schizophrenia; positive disorders, in their turn, act as «moderators¼ augmenting, amplifying manifestations of negative symptoms. This psychopathological construct of the correlation between dimensional structures paves a way for the development of a new concept of psychopharmacological treatment of schizophrenic deficit: both negative symptoms and amplifying positive symptoms are considered as «target symptoms¼ for pharmacological interventions.

[Age identity disorders (infantilism/ puerilism) in the psychopathological space of endogenous diseases]. / Rasstroistva vozrastnoi identichnosti (infantilizm/puérilizm) v prostranstve psikhicheskikh zabolevanii éndogennogo kruga.

AIM: A comparative psychopathological and psychometric analysis of age identity disorders (AID) - infantilism and puerilism - on the model of schizophrenia proceeding with hysterical symptoms. MATERIAL AND METHODS: Results of the psychopathological study of 42 patients with schizophrenia and schizophrenia spectrum disorders (SSD), with well-marked signs of AID in the course of the disease (22 sub. - infantilism; 20 sub. - puerilism), are summarized. Psychometric evaluation was carried out using a standardized block of pathopsychological methods; scales for assessing negative and positive psychopathological symptoms (SANS, PANSS, MFI-20); personality assessment instruments (SPQ-A; Personality Traits Questionnaire (V. Rusalova); Methods for diagnostics of personal maturity (V. Ruzhenkova)). RESULTS: The differentiation between infantilism and puerilism, forming in the psychopathological space of schizophrenia and SSD, is not limited by differences in the indicators of age-related immaturity. Infantilism shows an affinity to the dimensional structures of the negative symptoms, acting as primary psychopathological formations - apathoabulic disorders. Conversely, puerilism is derived from the positive symptoms - psychopathological formations related to the dissociative disorders. CONCLUSION: From the perspective of the modern concept of schizophrenia, infantilism and puerilism are associated with polar dimensional structures (positive-negative symptoms) and, accordingly, can be regarded as psychopathologically heterogeneous formations.

[Asthenia in the psychopathological space of schizophrenia and schizophrenia spectrum disorders (The concept of asthenic deficit in aspect of the modern model of negative symptoms)]. / Asteniia v psikhopatologicheskom prostranstve shizofrenii i rasstroistv shizofrenicheskogo spektra (kontseptsiia astenicheskogo defekta v aspekte sovremennykh modelei negativnykh rasstroistv).

At the modern level of knowledge, classification of asthenic deficit as an independent psychopathological category and, in general terms, as the classification of asthenic symptomatic complexes of negative symptoms within schizophrenia and schizophrenia spectrum disorders is the subject of discussion. Studies of recent decades have shown that asthenia cannot be considered as a separate deficient monosyndrome, does not fit into the framework of negative disorders and is excluded from the block of scales of negative symptoms (SANS, PANSS, BNSS, CAINS). The authors suggest a working hypothesis that asthenia symptomatic complexes within schizophrenia are not comparable either in nature or in their psychopathological structure with primary deficiency disorders determined by the disease process. However, at the same time schizoasthenia, acting as a manifestation of the coenesthesiopathic hypochondriacal register, i.e. essentially in the space of positive disorders, is formed in close dependence on negative symptoms and is thus one of the markers of the already formed defect.

[Personality disorders and schizophrenic defect (problem of comorbidity)]. / Rasstroistva lichnosti i shizofrenicheskii defekt (problema komorbidnosti).

AIM: To test the main hypothesis that the deficit phenomena in schizophrenia act not in the 'pure' form, but in the form of aggravating personality characteristics, forming so-called 'common' syndromes with personality disorders (PD). MATERIAL AND METHODS: The results of the psychopathological study (with the use of psychometric methods) of deficit disorders in a sample of 170 patients with schizophrenia and schizophrenia spectrum disorders (63 men, 107 women) are presented in relation to the abnormal structure of premorbid personality (PD of clusters A, B, C). An analysis of negative symptoms according to the comparability of defect to the profile of premorbid personality made it possible to distinguish three groups of deficit states associated with PD - 'common syndromes': defensive schizoidy by the type of deficit schizoid and expansive schizoidy by the type of 'verschroben' (cluster A); pathological hysterical infantilism, malignant hysteria and defective erotomania (cluster B); pseudo-psychasthenia and pathological rationalism (cluster C). RESULTS: It has been found that the symptomatology of 'common syndromes' is subject to patterns reflecting the dichotomy of the basic defect. This pattern is valid not only for one single cluster of PD, but extends to all psychopathy-like disorders, regardless of their affiliation with a particular cluster. The pathocharacterological component of the 'common syndromes' coexisting with the deficit symptom complexes is subject to the basic deficit component of the defect and is separated into polar dimensions (defensive-expansive) within specific clusters of PD, and then unified in accordance with the dichotomy of schizophrenic defect in categories with the predominance of emotional or apathoabulic disorders. CONCLUSION: Psychopathy-like symptom complexes in the space of 'common syndromes' can be qualified as a psychopathological construct secondary to basic deficit disorders, and their isolation as an independent entity of negative disorders appears to be unjustified.