psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2020-18-2-82-91psychiatry-479Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSКлинические предпосылки высокого риска развития эндогенного психоза: вопросы диагностики и терапииClinical High Risk Psychosis: Issues of Diagnostics and Therapyhttps://orcid.org/0000-0001-8343-168XОмельченкоМ. А.OmelchenkoM. A.

Омельченко Мария Анатольевна, кандидат медицинских наук, ведущий научный сотрудник

Москва

Maria A. Omelchenko, MD, PhD, Cand. of Sci. (Med.), Leading Researcher

Moscow

omelchenko-ma@yandex.ruФГБНУ «Научный центр психического здоровья»РоссияFSBSI “Mental Health Research Centre”Russian Federation2020220720201828291Copyright © Омельченко М.А., 20202020Омельченко М.А.Omelchenko M.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/479

Цель: анализ современной отечественной и зарубежной литературы, посвященной проблеме определения диагностических критериев клинического высокого риска развития эндогенных психозов (КВР-П) и определения возможностей терапевтического вмешательства с учетом патогенетических механизмов их развития. Материал и метод: произведен анализ публикаций, найденных по поисковым запросам по ключевым словам на русском и английском языках в базах данных MEDLINE/ PubMed и eLIBRARY за временной интервал с 2010 по 2020 г. Заключение: представлено современное определение группы КВР-П с уточнением отдельных диагностических критериев отнесения к этой группе, которые включают аттенуированные психотические симптомы (АПС), короткие интермиттирующие психотические симптомы (КИПС), генетический риск с ухудшением уровня преморбидного функционирования, а также базисные симптомы (БС). Проанализированы данные о гетерогенности группы КВР-П с неодинаковым уровнем манифестации и исходов, что свидетельствует о вовлечении разных патогенетических механизмов в их формирование. Это определяет различные подходы к терапии больных с выбором оптимальных тактик ведения, базирующихся на оценке соотношения потенциальной пользы и рисков развития побочных явлений. Полученные данные свидетельствуют, с одной стороны, о перспективности лечения больных с КВР-П с возможностью влияния на течение заболевания, отсрочки его манифестации и улучшения отдаленных исходов, а с другой стороны, об отсутствии в настоящее время универсальных стандартов терапии. Выбор лечебных мероприятий должен определяться на основании индивидуального подхода к пациенту с комплексной психопатологической оценкой жалоб, особенностей клинического состояния, его динамики с течением времени.

The aim of the review: the analysis of modern Russian and foreign literature dedicated to the problem of determining diagnostic criteria for clinical high risk of psychosis (CHR-P) and outlining the therapeutic approaches based on the pathogenic mechanisms of their development. Material and method: the publications found by searching queries for keywords in Russian and English in the MEDLINE/PubMed and eLIBRARY databases for the time period from 2010 to 2020 were then analyzed. Conclusion: the review presents a modern definition of the CHR-P group, along with a clarification of individual diagnostic criteria, which include attenuated psychotic symptoms (APS), brief limited intermittent psychotic symptoms (BLIPS), genetic risk with deterioration of premorbid functioning, as well as basic symptoms (BS). We found heterogeneity of the CHR-P group with different levels of manifestation and outcomes and indicated the involvement of different pathogenic mechanisms in their formation. These findings determine the development of various approaches to treatment, which involve the assessment of the ratio of potential benefits and the risks of side effects. The obtained data, on the one hand, attest to the prospective viability of the therapeutic approach to the patients with CHR-P with the possibility of influencing the course of the disease, delaying its manifestation and improving long-term outcomes, and, on the other hand, the lack of universal standards of therapy at present. Tactics of treatment are determined basing on an individual approach to the patient with a comprehensive psychopathological assessment of complaints, clinical state and its dynamics.

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