Schizophrenia in patients with hysterical personality disorder (aspects of negative symptoms and labour disadaptation)

Background information: The first supposition for conducting this study was hypothesis based on the analysis of literature data according to which there is the possibility of «partial» character of apathoabulic disorders («lability of volitional effort» by D.E. Melekhov). The second presumption was the selection of the construct of «selective» (according to Marin, 1990) «job apathy» (Schmidt G. et al., 2015) by the foreign scientists.

In the light of reasons supplied, of special interest is apathy to work in patients with schizophrenia, proceeding on the basisof a hysterical constitution — which is associated with obvious difficulties in diagnosing between partial abulia («job apathy») within the hysterical form of schizophrenia and the dynamics of hysterical psychopathy with the phenomenon of «pension neurosis».

A current hypothesis was based on the assumption that there is a special type of deficit symptoms in schizophrenic patients with hysterical personality, according to which apathoabulic disorders «invade» into the sphere of constitutional anomalies, act «under the mask» of intensified pathocharacterological disorders and are accompanied by partial misadaption of life and activities.

The purpose of this work was to study the negative symptoms in hysterical form of schizophrenia, proceeding with a predominance of partial apathoabulic disorders.

Materials and methods: the present study summarizes the results of observations of 10 patients who applied to the FSBSI NHRC due to exacerbation of schizophrenic process. The diagnostics included clinical and psychometric assessment techniques.

Results: the data obtained in the course of the study allowed us to figure out a special type of partial schizophrenic defect state, named as «hysteroabulia», according to which the negative symptoms affect voluntary activity (in particular — labour function), while recreational activity, being hysterical involuntary, doesn’t need to be volitional initiated, so may not reveal an apathoabolic disorder.

1. Kirkpatrick B. Developing concepts in negative symptoms: primary vs secondary and apathy vs expression. J. Clin. Psychiatry. 2014;75(suppl.1):3–7. https://DOI.org/10.4088/JCP.13049su1c.01

2. Marder S., Galderisi S. The current conceptualization of negative symptoms in schizophrenia. World Psychiatry. 2017;16(1):14–24. https://DOI.org/10.1002/wps.20385

3. Galderisi S., Mucci A., Buchanan R., Arango C. Negative symptoms of schizophrenia: new developments and unanswered research questions. The Lancet Psychiatry. 2018;5(8):664–677. https://DOI.org/10.1016/S2215-0366(18)30050-6

4. Strauss G., Horan W., Kirkpatrick B. et al. Deconstructing negative symptoms of schizophrenia: Avolition–apathy and diminished expression clusters predict clinical presentation and functional outcome. J. Psychiatr. Res. 2013;47(6):783–790. https://DOI.org/10.1016/j.jpsychires.2013.01.015

5. Azorin J., Belzeaux R., Adida M. Negative Symptoms in Schizophrenia: Where We have been and Where We are Heading. CNS Neurosci. Ther. 2014;20(9):801–808. https://DOI.org/10.1111/cns.12292

6. Smulevich A.B., Muhorina A.K., Voronova E.I., Romanov D.V. Sovremennye koncepcii negativnyh rasstrojstv pri shizofrenii i zabolevaniyah shizofrenicheskogo spektra. Psihiatriya.2016;(72):5–19. (In Russ.).

7. Foussias G., Remington G. Negative Symptoms in Schizophrenia: Avolition and Occam’s Razor. Schizophr. Bull. 2008;36(2):359–369. https://DOI.org/10.1093/schbul/sbn094

8. Fursov B.B. Problema motivacii i ee narushenij pri shizofrenii. Social’naya i klinicheskaya psihiatriya. 2012;22(4):91–100. (In Russ.).

9. Fervaha G., Foussias G., Agid O., Remington G. Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia.Acta Psychiatr. Scand. 2014;130(4):290–299. https://DOI.org/10.1111/acps.12289

10. Alfimova M.V., Lezhejko T.V., Bolgov M.I., Tihonov D.V., Golimbet V.E. Samoocenka gedonicheskih i aktivacionnyh aspektov motivacii pri shizofrenii i ee svyaz’ s negativnymi simptomami. Social’naya i klinicheskaya psihiatriya. 2017;3:10–18. (In Russ.).

11. Milev P., Ho B., Arndt S., Andreasen N. Predictive Values of Neurocognition and Negative Symptoms on Functional Outcome in Schizophrenia: A Longitudinal First-Episode Study With 7-Year Follow-Up. American Journal of Psychiatry. 2005;162(3):495–506. https://DOI.org/10.1176/appi.ajp.162.3.495

12. Foussias G., Mann S., Zakzanis K., van Reekum R., Remington G. Motivational deficits as the central link to functioning in schizophrenia: A pilot study. Schizophr. Res. 2009;115(2–3):333–337. https://DOI.org/10.1016/j.schres.2009.09.020

13. Galderisi S., Bucci P., Mucci A. et al. Categorical and dimensional approaches to negative symptoms of schizophrenia: Focus on long-term stability and functional outcome. Schizophr. Res. 2013;147(1):157–162. https://DOI.org/10.1016/j.schres.2013.03.020

14. Fervaha G., Foussias G., Agid O., Remington G. Motivational deficits in early schizophrenia: Prevalent, persistent, and key determinants of functional outcome. Schizophr. Res. 2015;166(1–3):9–16. https://DOI.org/10.1016/j.schres.2015.04.040

15. Reddy L., Llerena K., Kern R. Predictors of employment in schizophrenia: The importance of intrinsic and extrinsic motivation. Schizophr. Res. 2016;176(2–3):462–466. https://DOI.org/10.1016/j.schres.2016.08.006

16. Holzakova N.G. Chastichnaya utrata (stojkoe snizhenie) trudosposobnosti pri shizofrenii. V knige: Problemy pogranichnoj psihiatrii. Moskva; 1935:50–53. (In Russ.).

17. Balashova L.N. Nekotorye tipy remissij i defekty psihiki pri shizofrenii s blagopriyatnym techeniem (v svyazi s zadachami trudoustrojstva). V sb.: Voprosy kliniki, patogeneza i lecheniya shizofrenii. М: Medgiz; 1958. (In Russ.).

18. Polyakov Yu.F., Kritskaya V.P., Meleshko T.K. Patologiya psihicheskoj deyatel’nosti pri shizofrenii: motivaciya, obshchenie, poznanie. M.; 1991:168. (In Russ.).

19. Ivanov M.V., Neznanov N.G. Negativnye i kognitivnye rasstrojstva pri ehndogennyh psihozah: Diagnostika, klinika, terapiya. SPb.: Sankt-Peterburgskij nauchno-issledovatel’skij psihonevrologicheskij institut im. V.M. Bekhtereva; 2008:288. (In Russ.).

20. Barch D., Treadway M., Schoen N. Effort, anhedonia, and function in schizophrenia: Reduced effort allocation predicts amotivation and functional impairment. J. Abnorm. Psychol. 2014;123(2):387–397. https://DOI.org/10.1037/a0036299

21. Treadway M., Peterman J., Zald D., Park S. Impaired effort allocation in patients with schizophrenia. Schizophr. Res. 2015;161(2–3):382–385. https://DOI.org/10.1016/j.schres.2014.11.024

22. Melekhov D.E. Klinicheskie osnovy prognoza trudosposobnosti pri shizofrenii. M.; 1963:198. (In Russ.).

23. Mauz F. Die prognostic der endogenen Psychosen. Leipzig: Thieme; 1930.

24. Marin R. Differential diagnosis and classification of apathy. Am. J. Psychiatry. 1990;147(1):22–30. https://DOI.org/10.1176/ajp.147.1.22

25. Schmidt G., Park G., Keeney J., Ghumman S. Job Apathy: Scale Development and Initial Validation. J. Career Assess. 2015;25(3):484–501. https://DOI.org/10.1177/1069072715599536

26. Chase T. Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment. Neurotox Res. 2010;19(2):266–278. https://DOI.org/10.1007/s12640-010-9196-9

27. Radakovic R., Stephenson L., Colville S., Swingler R., Chandran S., Abrahams S. Multidimensional apathy in ALS: validation of the Dimensional Apathy Scale. Journal of Neurology, Neurosurgery & Psychiatry. 2015;87(6):663–669. https://DOI.org/10.1136/jnnp-2015-310772

28. Mündt Ch. Residual Apathiesyndrom der Schizophrenen. Ergebnisse einer psychopathologischen Langzeitstudie. Nervenarzt. 1983;54(3):131–138.

29. Simson T.P. O shizoidnyh isterikah. Kn: I Vseross. s'ezd po psihonevr. M.; 1923:9–15. (In Russ.).

30. Sjöbring H. Personality structure and development: A model and its application. Acta Psychiatrica Scandinavica. 1973;Suppl:204–244.

31. Schneider K. Die psychopatischen Persönlicheiten. Wien; 1940:104.

32. Ernst K. Die Prognose der Neurosen. Monographien aus dem Gesamtge-biete der Neurologie. Berlin; 1959:118.

33. Weitbrecht H.U. Die chronische depression. Wien Z. Nervenheilk. 1967;24:265.

34. Smulevich A.B., Germanova K.N., Chitlova V.V. Psihogennye depressii i ehndogennyi process (k probleme reaktivnoi shizofrenii). Zhurnal nevrologii i psihiatrii im. S.S. Korsakova. 2016;116(5):4–12. https://DOI.org/10.17116/jnevro2016116514-12 (In Russ.).

35. Conrad K. Die Beginnende Schizophrenic: Versuch einer Gestaltanalyse des Wahns. Thieme: Stuttgart; 1958:315.