Some Aspects of Psychopathology of Residual States in Schizophrenia (A “New Life” Type Remissions — Modern Models)

Background: Evidence from available literature suggests that the problem of postpsychotic conditions qualifi ed as part of “new life” type remissions requires revision.

The aim: to study the structure of postpsychotic residual disorders that determine the clinical picture of late remissions, which form the type of “new life”.

Patients and method: case reports analysis, clinical interpretation and classifi cation of remission type.

Results and conclusion: a characteristic of residual states is presented — remissions according to the type of “new life” lasting from 10 to 40 years. A medical model of this group of post-procedural states has been developed. The main — “nuclear” group (remissions limited by the level of in-hospital adaptation) — hypoparanoial with residual delirium of persecution (ideas of attitude, damage, persecution by family members). The formation of residual paranoia as the psychosis progresses backwards is accompanied by alienation of all past life realities (rejection of kinship responsibilities and previous productive activities) and the formation of new autistic occupations. The clinical picture of residual states — remissions on the type of “new life” of the spectrum group is also dominated by ideas of alienation of realities of the past — and the beginning of a “new life” with functioning at the level of new super-valuable hobbies. These residual states show essential differences from the basic “nuclear” group. In the social aspect we are talking about more limited changes of a life stereotype — adaptation in the out-of-hospital space, inthgegration into the structure of closely related interpersonal contacts, implementation of labor activity outside the specialized stationary conditions. Psychopathological characteristics of the phenomenon of “new life” appearing in the clinical space of remissions of the “nuclear” group and the “spectrum” group are heterogeneous and differ rentiated both on the basis of severity level and typological heterogeneity of deficit changes, and different structure of positive (hypoparanoial) disorders. The formation of the phenomenon of “new life” in remissions of the “nuclear” group is associated with negative — predominantly emotional changes. The parameters of the complicity of procedural dimensional disorders (negative — positive disorders), which determine the formation of the “new life” phenomenon in remissions of the spectrum group, shift towards delusional rather than negative symptomatology. The change of work orientation by supercreative hobbies is induced by catathymic ideas of delusions of pretension formed as part of post-procedural paranoia development (delusional symptom complexes and delusional fantasies of the desire paranoia circle, Wunschparanoja E. Kretschmer).

1. Sabler VF. Uber die Bedeutung des Wahnsinns und eines darauf zu griindenen Behandlungsprincips desselben, Mitt. Geb. d. Heilkunde, S. 12, Lpz., 1845.

2. Griesinger W. Pathologie und Therapie der Psychischen Krankheiten. 1845:558 s.

3. Mayer-Gross W. Über die Stellungnehme zur abgelaufenen akuten Psychose. Eine Studie über verständliche Zugammenhänge in der Schizophrenie Z. ges. Neurol. Psychiatr. 1920;60:160–213.

4. Vie J. Quelques terminaisons des délires chroniques Ann. méd.-psychol. 1939;2:97–103.

5. Yastrebova MV, Yastrebov VS. On some versions of late remissions in bout-progressive (fur-shaped) schizophrenia. Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova. 1973;73(1):66–70. (In Russ.).

6. Smulevich АВ, Volel BA, Romanov DV. Hypochondria as a personality pathology (to a problem of post-addictive hypochondriasis). Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2008;108(10):4–12. (In Russ.).

7. Smulevich AB, Nefed’ev OP, Orlova VA, Mazaeva NA. On one of the variants of persistent psychopathic similar conditions in patients with low-progressive schizophrenia. Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova. 1983;83(3):419–426. (In Russ.).

8. Smulevich AB, Vorob’yov VY. Psychopathology of schizophrenic defect (to the construction of an integrative model). Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova. 1988;88(9):100–105. (In Russ.).

9. Smulevich AB, Romanov DV, Mukhorina AK, Atadzhikova JA. “Verschroben”-phenomenon in schizophrenia and schizophrenia spectrum disorders: aspects of systematics. S.S. Korsakov Journal of Neurology and Psychiatry/Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2017;117(1):5–16. (In Russ.) DOI: 10.17116/jnevro2017117115-16

10. Smulevich AB, Romanov DV, Voronova EI, Mukhorina AK, Chitlova VV, Sorokina OYu. Evolution of the schizophrenic deficit concept. S.S. Korsakov Journal of Neurology and Psychiatry/Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2017;117(9):4–14. (In Russ.).

11. Smulevich A, Romanov D. Long-term course of negative symptoms in schizophrenia. In I. Bitter (Ed.), Managing Negative Symptoms of Schizophrenia. Oxford: Oxford University Press. 2020:39–50. DOI: 10.1093/med/9780198840121.001.0001

12. Maksimov VI., Zverkova IV. To the typology of defect in patients with nonmaniphestral schizophrenia (clinical and psychological study). S.S. Korsakov Journal of Neurology and Psychiatry/Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 1986;86(5):726–731 (In Russ.).

13. Gurovich IYa, Lyubov EB, Storozhakova YaA. The concept of recovery in schizophrenia. Social’naya i klinicheskaya psihiatriya. 2008;18(2):7–14. (In Russ.).

14. Gurovich IYa, Shashkova NG, Visnevskaya LYa, Storozhakova YaA. The recovery model of psychiatric care users with schizophrenia (personal and social empowerment): discussion of the concept and its perspectives. Social’naya i klinicheskaya psihiatriya. 2013;23(2):89–95. (In Russ.).

15. Zinchuk MS., Semke AV. Infi uence of negative symptoms on dynamic of social status of patients with paranoid schizophrenia. Siberian gerald of psychiatry and addiction psychiatry. 2013;79(4):34–40. (In Russ.).

16. Bellack AS. Scientifi c and Consumer Models of Recovery in Schizophrenia: Concordance, Contrasts, and Implications. Schizophr Bull. 2006;(32):432–442. DOI: 10.1093/schbul/sbj044

17. Warner R. Recovery from schizophrenia and the recovery model. Curr Opin Psychiatry. 2009;22(4):374– 380. DOI: 10.1097/YCO.0b013e32832c920b PMID: 19417668

18. Berry K, Ford S, Jellicoe-Jones L, Haddock G. PTSD symptoms associated with the experience of psychosis and hospitalization. Review of literature. Clin Psychol Rev. 2013;33:526–538. DOI: 10.1016/j.cpr201301.011

19. Jordan G, Pope M, Lambrou A, Malla A, Iyer S. Post-traumatic growth following a first episode of psychosis: a scoping review. Early Interv Psychiatry. 2017;11(3):187–199. DOI: 10.1111/eip.12349 Epub 2016 May 18. PMID: 27189806

20. Nyiro J, Kö S. Uber paranoja postschizophrenia. Psychiat neurol Wschr. 1940:131.

21. Anufriev AK. To the concept of “latent” and “residual” in schizophrenia. In: Sixth All-Union Congress of Neuropathologists and Psychiatrists. 1975;III:19– 23. (In Russ.).

22. Kraepelin E. Erscheinungsformen des Irreseins. Zeitschrift für die gesamte Neurologie und Psychiatrie. 1920;62:1–29.

23. Kloos G. Zum Problem der Wunschparanoia Archiv für Psychiatrie und Nervenkrankheiten. 1933;98:162–222.

24. Kretschmer E. Der Sensitive Beziehungswahn: Ein Beitrag zur Paranoiafrage und zur Psychiatrischen Charakterlehre. Berlin, 1918:397 p.

25. Snezhnevsky AV. General Psychopathology: A Course of Lectures. Moscow: Medpress-Inform, 2001:208 p. (In Russ.).

26. Westertep M. Prozess und Enwicklung bei verschiedenen Paranoiatypen. Z Neurol Psychiat. 1924;91:259.

27. Yudin TI. Psychopathic Constitutions. Highlighting character types (types of complex mental reactions) on the basis of hereditary-biological and clinical analysis of psychoses. М., 1926. (In Russ.).

28. Tsygankov BD, Ovsyannikov SA. Psychiatry. Guidelines for physicians. Moscow, GEOTAR-Media, 2011:496 p. (In Russ.).

29. Freud S. Paranoia (Draft H). 1895.

30. Zhmurov VA. General psychopathology. Irkutsk: Irkutsk University Publisher, 1986:280 p. (In Russ.).

31. McGlashan TH, Fenton WS. The positive-negative distinction in schizophrenia. Review of natural history validators. Arch Gen Psychiatry. 1992;49(1):63–72. DOI: 10.1001/archpsyc.1992.01820010063008

32. Ben-Zeev D, McHugo GJ, Xie H, Dobbins K, Young MA. Comparing retrospective reports to real-time/ real-place mobile assessments in individuals with schizophrenia and a nonclinical comparison group. Schizophr Bull. 2012;38(3):396–404. https// DOI: 10.1093/schbul/sbr171

33. Blum LH, Vakhrusheva J, Saperstein A, Khan S, Chang RW, Hansen MC, Zemon V, Kimhy D. Depressed mood in individuals with schizophrenia: A comparison of retrospective and real-time measures. Psychiatry Res. 2015;227(2–3):318–323. DOI: 10.1016/j.psychres.2015.03.008

34. Mazor Y, Gelkopf M, Mueser KT, Roe D. Posttraumatic Growth in Psychosis. Front Psychiatry. 2016;7:202. DOI: 10.3389/fpsyt.2016.00202 PMID: 28066275; PMCID: PMC5165025

35. Smulevich AB, Shchirina MG. The problem of paranoia (paranoia in endogenous and organic diseases). M.: Medicine, 1972:182 p. (In Russ.).

36. Birnbaum K. Zur Paranoiafrage. Z ges Neurol. Psychiat. 1915;29:305.

37. Buisson J.F. Psychoses passionneles. Éncéphale. 1959;48:79.

38. Smulevich AB, Ivanov SV, Samushya MA. Pathocharacterological predisposition and formation of nosogenic (provoked by somatic disease) mental disorders. Mental disorders in general medicine. 2014;2:7–13. (In Russ.).