Сhanges in severity of enduring primary negative symptoms in patients with episodic schizophrenia

The problem of enduring negative disorders in schizophrenia and approaches to their conceptualization and methods of research attracts attention of researches in the field of psychiatry for many years. One of the ways oflooking at the study of primary enduring negative symptoms (PENS) and changes in their severity is presented in this paper.The aim of study was a conceptualization of PENS and their evolution in long-term observation of patients with shift-like schizophrenia.Materials and methods. On basis of criteria of deficit syndrome in schizophrenia five signs of PENS were formed: diminishing of emotional repertoire, poverty of speech, constriction of interests, diminishing of sense of aim and decreasing of social drive. On platform of CGI-S the system of assessment instruments of PENS was developed: CGI-S-emotional deficit, CGI-S-poverty of speech, CGI-S-restricted interests, CGI-S-diminishing of purposefulness, CGI-S-diminishing of social activity and general assessment of severity of PENS as a sum of them. In addition GAF, PSP, CGI-S-compliance and the scale of autonomy were administrated. For study of compensatory recourses the list of coping-activities, activities addressing to satisfaction of patients needs, attempts to cope with the feeling of impoverishment of inner world or/and general discomfort was developed. Sixty six patients of both sex with diagnosis of episodic schizophrenia without signs of treatment resistance were included into the study. The period of observation varied from one year to ten years, 61% of patients were observed for more than 4 years. All patients were assessed twice: at the beginning and at the end of observational period.Results. All patients of the group demonstrated the signs of PENS. Severity of all signs of PENS except «constriction of interest» reduced during the study. The reduction of severity was small but significant. Severity of PENS correlated with functional scales (GAF r = -0,71; PSP r = -0,70, scale of autonomy r = -0,84). Changes of severity of PENS waslinked with changes of functional scales ( r > 0,50). Reduction of severity of PENS accompanied with improvement of functioning and capability for independentliving. 68% patients demonstrated positive changes of PENS and 32%-none or negative. The groups differed at the end of the study ( p < 0,05) but not at the beginning. The difference was seen in the indices of compliance and number of coping-activities.Conclusion. PENS are the important feature of episodic schizophrenia. This psychopathological entity has close connection with functioning of patients. In spite of significant rigidity, there is some space for reduction in certain conditions including activation of compensatory mechanisms.

шизофрения, стойкие первичные негативные расстройства, дефект, динамика, компенсаторные меха- низмы, schizophrenia, enduring primary negative symptoms, deficit, changes, compensatory mechanisms

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