psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2022-20-3-112-123psychiatry-865Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSТерапия кататонии в клиническом пространстве шизофрении и расстройств шизофренического спектраTherapy of Catatonia in Schizophrenia and Schizophrenia Spectrum Disordershttps://orcid.org/0000-0001-9532-7150ИвановС. В.IvanovS. V.

Станислав Викторович Иванов, профессор, доктор медицинских наук

Москва

Stanislav V. Ivanov, Professor, Dr. of Sci. (Med.)

Moscow

stanislvi@gmail.comhttps://orcid.org/0000-0003-2737-3432СмулевичА. Б.SmulevichA. B.

Анатолий Болеславович Смулевич, академик РАН, профессор, доктор медицинских наук; заведующий кафедрой, кафедра психиатрии и психосоматики

Москва

Anatoly B. Smulevich, Аcademician of RAS, Professor., Dr. of Sci. (Med.)

Moscow

absmulevich@list.ruhttps://orcid.org/0000-0002-6563-9169БорисоваП. О.BorisovaP. O.

Полина Олеговна Борисова

Москва

Polina О. Borisova

Moscow

bori.pauline@gmail.comhttps://orcid.org/0000-0001-8109-5977ПискарёвМ. В.PiskarevM. V.

Михаил Валерьевич Пискарёв

Москва

Mikhail V. Piskarev

Moscow

piskarev-mv@mail.ruФГБНУ «Научный центр психического здоровья»; ФГАОУ ВО Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский Университет)РоссияFSBSI “Mental Health Research Center”; I.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГБНУ «Научный центр психического здоровья»РоссияFSBSI “Mental Health Research Center”Russian Federation202229092022203112123Copyright © Иванов С.В., Смулевич А.Б., Борисова П.О., Пискарёв М.В., 20222022Иванов С.В., Смулевич А.Б., Борисова П.О., Пискарёв М.В.Ivanov S.V., Smulevich A.B., Borisova P.O., Piskarev M.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/865

Обоснование: аспекты изучения методов лечения кататонии в настоящее время являются одной из наиболее актуальных задач современных исследований, однако единых терапевтических стратегий в отношении купирования кататонических феноменов до настоящего времени не разработано.Цель работы: обзор методов терапевтических интервенций в отношении кататонических расстройств при шизофрении.Материалы и методы: по ключевым словам «лечение кататонии», «терапия кататонии» были отобраны и проанализированы публикации, найденные в базах данных Scopus, PubMed, Cochrane Library, eLibrary.Результаты: историческая справка иллюстрирует развитие методик лечения кататонии. Результаты научных работ последних десятилетий, посвященных терапии кататонических феноменов, дополнены предварительными результатами собственного исследования эффективности применения диазепама и карипразина для купирования проявлений кататонии. Результаты обзора научных публикаций позволяют заключить, что в настоящее время наиболее распространенным методом лечения кататонических расстройств является применение препаратов бензодиазепинового ряда, однако в отдельных случаях признается целесообразным использование антипсихотиков. Важным методом лечения кататонических состояний остается электросудорожная терапия (ЭСТ). Кроме того, в литературе встречаются и единичные клинические случаи успешного испытания как других фармакологических групп (антидепрессантов, дофаминергических и антихолинергических средств, нормотимических препаратов и др.), так и немедикаментозных интервенций (транскраниальная магнитная стимуляция, ТМС).Выводы: эффективность бензодиазепинов для купирования кататонии, возникающей в структуре шизофрении и расстройств шизофренического спектра (РШС), современными авторами признается спорной. В свою очередь, среди антипсихотиков безопасными для лечения психомоторной симптоматики представляются нейролептики второго и третьего поколения. В соответствии с результатами собственного исследования, кататония в структуре шизофрении и РШС неоднородна. В зависимости от психопатологической структуры кататонических расстройств наблюдается различный ответ психомоторных симптомов на терапевтическое вмешательство.

Background: the study of catatonia’s treatment methods is one of the most important researchers’ tasks, nevertheless the common therapeutic strategies of cupping the catatonic phenomena haven’t been created yet. The aim: review to therapeutic interventions for catatonic disorders in schizophrenia.Materials and methods: according to the keywords “catatonia treatment”, “catatonia therapy”, publications found in the Scopus, PubMed, Cochrane Library, eLibrary databases were selected and analyzed.Results: historical background, illustrating the development of catatonia treatment methods, is given; the results of the last decades scientific studies of catatonia’s treatment and preliminary results of own study, devoted to the effectiveness of diazepam and cariprazine in relieving catatonia manifestations are presented. Based on the studies’ results, presented in the review, it can be concluded that the most common modern method of treating catatonic disorders is the use of benzodiazepines, however, in some cases, the use of antipsychotics is also advisable. Electroconvulsive therapy (ECT) remains an important treatment for catatonic phenomena. There are also isolated clinical cases of successful testing of both: other pharmacological groups (antidepressants, dopaminergic and anticholinergic drugs, normothymic drugs, etc.) and non-drug interventions (transcranial magnetic stimulation — TMS) presented in modern research data.Conclusion: the effectiveness of benzodiazepines in catatonia, associated with schizophrenia and schizophrenia spectrum disorders (SSD), remains controversial according to modern authors’ opinion. In turn, among antipsychotics, antipsychotics of the second and third generation seem to be safe for the treatment of psychomotor symptoms. In accordance with the results of our own study, catatonia in the structure of schizophrenia and SSD is heterogeneous and, depending on the psychopathological structure of catatonic disorders, a different reaction of psychomotor symptoms to therapeutic intervention was observed.

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