Clinical systematics of chronic delusional psychoses in schizophrenia and schizophrenia-spectrum pathology

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OBJECTIVE

To develop a systematics of chronic delusional psychoses in schizophrenia and pathology of the schizophrenic spectrum that takes into account psychopathological structure (the mechanism of delusional formation) and the trajectories of the disease course (the ratio of negative/positive dimensions).

MATERIAL AND METHODS

The study sample was recruited from the large Moscow psychiatric hospital in 2019—2024 and included 126 patients (94 male, 32 female, mean age 36.5±12.1 years) hospitalized with ICD-10 diagnosis of paranoid schizophrenia (F20.00) or delusional disorder (F22). A clinical-psychopathological method was used.

RESULTS

The study identifies three variants of paranoid domains, the typology of which takes into account both the psychopathological structure and the trajectories of their development, which determine the dominance of predominantly negative or positive symptoms throughout the disease: 1) psychosis with delusional interpretations and predominant orientation of symptoms towards the negative pole of the schizophrenia psychopathology (n=37, 29.4%); 2) psychosis with hallucinatory delusions and predominant direction of symptoms towards the positive pole of the schizophrenia psychopathology (n=50, 39.7%); and 3) «combined» hallucinatory-delusional psychosis with a simultaneous orientation of symptoms to the negative/positive poles of the schizophrenia psychopathology (n=39, 30.9%). Detailed phenomenological characteristics of each of the three presented variants are given.

CONCLUSION

The developed three-component taxonomy confirms, on the model of chronic delusional psychoses appearing in schizophrenia and the pathology of the schizophrenia spectrum, the concept of simultaneous representation of two relatively independent domains determined by neurobiological processes in the schizophrenia psychopathology positive and negative disorders.

Keywords:

schizophrenia

delusional disorder

interpretive delusions

hallucinatory delusional syndrome

systematics

classification

Authors:

Smulevich A.B.

Sechenov First Moscow State Medical University (Sechenov University);
Mental Health Research Centre

ORCID: 0000-0003-2737-3432

Kostyuk G.P.

Sechenov First Moscow State Medical University (Sechenov University);
Alexeev Mental Health Clinic No. 1

SPIN RSCI: 3424-4544
Scopus AuthorID: 57200081884
ORCID: 0000-0002-3073-6305

Dorozhenok I.Y.

Sechenov First Moscow State Medical University (Sechenov University);
Mental Health Research Centre

ORCID: 0000-0003-1613-2510

Romanov D.V.

Sechenov First Moscow State Medical University (Sechenov University);
Mental Health Research Centre

ORCID: 0000-0002-1822-8973

Received:

18.04.2024

Accepted:

23.04.2024

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