psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2023-21-6-31-41psychiatry-1066Research ArticleПСИХОПАТОЛОГИЯ, КЛИНИЧЕСКАЯ И БИОЛОГИЧЕСКАЯ ПСИХИАТРИЯPSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRYКлинико-психопатологические особенности шизофрении и шизофреноподобных расстройств, манифестирующих в позднем возрастеClinical and Psychopathological Features of Late-Onset Schizophrenia and Schizophrenia-Like Psychosishttps://orcid.org/0000-0002-9270-2039ПочуеваВ. В.PochuevaV. V.

Валерия Витальевна Почуева, младший научный сотрудник

отдел гериатрической психиатрии

Москва

Valeriya V. Pochueva, MD, Junior Researcher

Department of Geriatric Psychiatry

Moscow

valeriya.pochueva@gmail.comhttps://orcid.org/0000-0002-2358-1579КолыхаловИ. В.KolykhalovI. V.

Игорь Владимирович Колыхалов, доктор медицинских наук, главный научный сотрудник

отдел гериатрической психиатрии

Москва

Igor V. Kolykhalov, Dr. of Sci. (Med.), Chief Researcher

Department of Geriatric Psychiatry

Moscow

ikolychalov@yandex.ruФГБНУ «Научный центр психического здоровья»РоссияFSBSI “Mental Health Research Centre”Russian Federation2023030120242163141Copyright © Почуева В.В., Колыхалов И.В., 20242024Почуева В.В., Колыхалов И.В.Pochueva V.V., Kolykhalov I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/1066   Обоснование

   Обоснование: после деменции и депрессии шизофреноподобный психоз с очень поздним началом является самой большой диагностической группой среди психических заболеваний в позднем возрасте [1]. Многими авторами обсуждается его сходство с нейродегенеративными заболеваниями, а также риск развития деменции в исходе заболевания.

   Цель

   Цель: изучить клинико-психопатологические особенности очень поздно манифестирующей шизофрении и шизофреноподобных психозов и их влияние на течение заболевания.

   Пациенты и методы

   Пациенты и методы: обследованы 45 пациентов (средний возраст 70,6 ± 8,70 года), у которых были диагностированы шизофрения, шизоаффективное расстройство, хроническое бредовое расстройство и органическое шизофреноподобное расстройство. Возраст манифестации заболевания — 60 лет и старше. Оценка состояния пациентов проводилась клинико-психопатологическим и психометрическим методами с использованием шкал (PANSS, CDSS, HAMD, MoCA, MMSE) на 0 и 28-й день от начала терапии.

   Результаты

   Результаты: была установлена клиническая гетерогенность и описаны различные варианты краткосрочного исхода психоза в зависимости от клинической картины и ведущего синдрома. В 15 случаях (33 %) доминировала тяжелая полиморфная психотическая симптоматика с грубой дезорганизацией психической деятельности, отмечалось формирование негативных и когнитивных расстройств по завершении приступа, что приводило к снижению социального и бытового функционирования. В 22 случаях (49 %) превалировала параноидная симптоматика, имевшая характерную «возрастную» окраску, с сохранением резидуальных бредовых идей и формированием негативных расстройств в исходе острого периода. В 8 случаях (18 %) преобладала аффективно-бредовая симптоматика, для данной группы пациентов был характерна полная редукция расстройств и восстановление доболезненного уровня социально-бытового функционирования.

   Выводы

   Выводы: особенности клинической картины, в том числе характер и степень выраженности когнитивных нарушений в острый период заболевания, являются прогностически значимыми. Полученные данные могут послужить основанием для разработки персонализированных терапевтических подходов, учитывающих синдромальные особенности и течение очень поздно манифестирующих психозов.

   Background

   Background: schizophrenia-like psychosis with very late onset is one of the most common diagnostic group in late age mental disorders exclude dementia and depression with psychotic symptoms [1]. Geriatric psychiatrists discuss its similarity to neurodegenerative diseases and risk of dementia development in the outcome of disease.

   The aim was to study the clinical and psychopathological features of very late manifesting schizophrenia and schizophrenia-like psychoses and their impact on the course of the disease.

   Patients and methods

   Patients and methods: 45 patients were observed, the mean age was 70.6 ± 8.70 years. Patients were diagnosed with schizophrenia, schizoaffective disorder, chronic delusional disorder and schizophrenia-like disorder, with onset after 60 years. Psychopathological and psychometric (PANSS, CDSS, HAMD, MoCA, MMSE) methods were used. Assessment was performed at the 0 day and at the 28th day from the beginning of the treatment.

   Results

   Results: heterogeneity and different short-terms outcomes of acute psychosis were described depending on the clinical characteristics and predominant syndrome complex. In 15 cases (33 %) prevailed severe polymorphic psychotic symptoms of mental disorganization with formation of negative symptoms and cognitive impairment with decreasing social and daily activity. In 22 cases (49 %) dominated paranoid symptoms with old age persecutory delusions with formation of residual positive and negative symptoms. In 8 cases (18 %) prevailed affective and delusional symptoms. This group was characterized with high level of reduction of productive symptoms and restoration of premorbid social and daily activity.

   Conclusions

   Conclusions: features of clinical characteristics, including the nature and severity of cognitive impairment at the onset of disease, are significant for prognosis and outcomes of disease. The data obtained could be served for the development of personalized therapeutic approaches that take into account the syndromic features and course of late-onset psychosis.

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The authors declare that there are no conflicts of interest present.