Serikova O. Clinico-psychopathological features of schizoaffective disorder at the stages of active, stabilizing and prophylactic therapy

The dissertation is devoted to investigation of clinic-psychopatological peculiarities of schizoaffective disorder (SAD) on stages of active, stabilizing and preventive therapy and developing measures for optimizing the treatment of this contingent of patients. In the course of the study, 110 patients with schizoaffective disorder (F25 for ICD-10) who were treated at the 1st psychiatric department of the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine” for the period from 2000 to 2018 were examined (the patients from period 2000-2012 were examined retrospectivey). The first group consisted of 60 patients with schizoaffective disorder, depressive type by ICD-10 (F25.1) and the second group – 50 patients with manic and mixed type of schizoaffective disorder by ICD -10 (F25.0, F25.2). The following research methods were used to solve the task of the work: clinico-psychopathological method, psychometric methods and mathematical-statistical method. Was revealed that the anxiety-depressive variant prevails among the clinical-typological variants in the structure of the psychopathological symptomatology of patients with a depressive type of SAD (31.82% of cases), while euphoric mania prevails among manic types (46.15% of cases). In the dissertation work on the basis of the conducted systematic study was established that in patients with depressive type of schizoaffective disorder (SAD) among the types of delusional disorders at the manifest stage a polymorphic delusion was more common - in 65.00% of cases, in 13.33% - some manifestations of the Kandinsky-Kleambo syndrome occurred; in patients with manifestation of the manic and mixed types of SAD, polymorphic delusions were the most frequent productive symptoms – 64.00%. Three main variants of the course of a schizoaffective disorder were distinguished: continual, sporadic and circular. The continual type is the heaviest type of flow and is characterized by a higher frequency of exacerbations per year - 3 or more and greater duration of exacerbation - 2.35 ± 0.50 months and a shorter remission 2.5 ± 0.95 month, and it is more typical for the depressive type of SAD exacerbations (66.67%). The sporadic flow type was found to be the most common for the manic type of exacerbations of the SAD - 65.38% cases. For a mixed type of SAD, with a nearly almost frequency, a circular type of flow - 50.00% and continual type of flow - 45.83 (р≤0.001) occurred. In the analysis of anamnestic data, the following prognostic criteria of poor quality remissions inherent in both depressive and manic or mixed types of schizoaffective disorder were found: gradual onset of the disorder (DС = 12.36; MI = 0.32); presence of manifestations of Kandinsky-Clerambault’s syndrome - (DС = 11.46; MI = 0.32); anguish-adynamic variant of the depressive syndrome DС = 11.94; MI = 0.12). The following combined psychopharmacotherapy regimens proved to be the most effective: for manic and mixed types, after usage of the antipsychotic + mood stabilizer scheme, 16 of examined (59.26%) reached high quality remission; for the depressive type, high quality remission was observed after usage of antipsychotic + mood stabilizer + antidepressant scheme in 16 (55.17%) patients. Different types of SAD exacerbations have different directions of reduction of psychotic and affective symptoms, and unequal residual psychopathological symptoms, understanding of this fosters to prescribe differentiated therapy in the exacerbation states and supportive treatment in the remission stage. On the asis of the revealed clinico-psychopathological and psychometric features of the SAD symptoms reduction, a differentiated approach for conducting a treatment, depending on the clinical and psychopathological features of the SAD in the dynamics was developed.