Schizoaffective psychosis

Description:

Schizoaffective psychosis — an endogenous not progreduated mental disease with rather favorable forecast which is characterized by periodically arising attacks with existence of depressions, manias, the mixed disorders of endogenous character and hallucinatory-dilision manifestations which are not brought out of affect.
For the first time schizoaffective psychosis was allocated by Kazanin (J. Kazanin, 1933) on the basis of the analysis of only 7 patients with acute development of psychosis, but similar clinical descriptions were given by K. Kleyst even earlier (To. Kleist, 1921) as regional, or cycloid, psychoses.
Most of domestic psychiatrists, for example A.B. Snezhnevsky. P.A. Nadzharov (1960, 1969), adhered to a binomial systematics of endogenous psychoses of E. Krepelin and considered schizoaffective psychoses within circular (periodic) schizophrenia.
According to T. F. Papadopoulos (1968, 1983) schizoaffective psychoses have still neither no constant place in psychiatric classification, nor the standard designation. In MKB-10 these psychoses are allocated as schizoaffective disorders in a separate heading (F25) in the class "schizophrenia and other crazy and psychotic frustration", representing one of fragments of a schizophrenic range.

Symptoms of Schizoaffective psychosis:

On dominance of affective or schizophrenic frustration in a picture of a schizoaffective attack allocate affektdominantny and shizodominantny forms.
The Affektdominantny form of a disease generally develops at persons with the schizoid lines reaching accentuation degree (less often) of psychopathic level. At early (prodromal) stages in the period of pubertal crisis (12-15 years) manifestations of affective lability with dominance of depressive reactions are noted, depressions of endoreactive structure can sometimes form.
The manifest schizoaffective attack develops after endogenous provocation, more rare autokhtonno more often. Stages of development of psychosis find consecutive change of phases: affective, affective nonsense, affective and crazy, crazy not affective frustration and again affective manifestations at attack involution. The clinical picture of similar attacks can be shown differently — as option with dominance in a picture of psychosis of acute sensual delirium as nonsense of perception as option with evident and figurative nonsense of imagination or to be characterized by dominance of intellectual nonsense of imagination (see hl. 11 "Thinking pathology (frustration of the sphere of associations"). At repetition of schizoaffective attacks it is possible to note that they have character of "cliche". In remissions negative personal changes in a type of emotional deficiency and the decrease in productivity which is not reaching defect degree can be found.
Shizodominantny form. Clinical manifestations at similar patients are defined by features of crazy syndromes in structure of a schizoaffective attack. A characteristic sign usually consider existence of manifestations of acute sensual delirium and a tendency to ideatorny development of crazy constructions. At the status of patients there is an expressed paranoid register with development at height of an attack of a syndrome of Kandinsky — Klerambo. Actually affective frustration at this option of disease are short (two-three weeks), and the period of formation of the expressed crazy frustration is longer here (one-two months). Schizophrenic symptoms are presented in bigger volume, than at an affektdominantny form. The general duration of a similar schizoaffective attack makes not less than half a year. The ratio of affective and schizophrenic (crazy) frustration at this option schizoaffective a state makes about 1,5:1. The point of premorbidal properties at simultaneous existence of affective disturbances with their long current is characteristic of the domanifestny period in the presence of a schizoid warehouse. In one-two years prior to manifestation increase in weight of manifestations of affective frustration is observed. The manifest attack develops autokhtonno more often, less often its manifestations arise against the background of psychogenias or somatogenias. In a clinical picture crazy frustration prevail, and the attack proceeds as paranoid psychosis with acute manifestations of a syndrome of Kandinsky — Klerambo. Due to the dominance of various typological forms of nonsense the option with a picture of the acute paranoid syndrome deciding by nonsense of perception on separate elements of interpretive nonsense, option with development of acute paranoid psychosis in the presence of evident and figurative nonsense with interpretation elements and also an acute paranoid syndrome (Kandinsky-Klerambo) with unsystematized interpretive nonsense and elements of sensual nonsense is allocated (G. P. Panteleeva соавт., 1999).

Reasons of Schizoaffective psychosis:

The etiology of schizoaffective psychosis, as well as all endogenous diseases, is completely not defined so far. The role of genetic factors in connection with burdeness of heredity at similar patients is essential. Some researchers allocate a special premorbidal warehouse which is defined by them as schizoaffective (J.L. Polozker, 1933). In emergence of affektdominantny forms the external factors provoking development of psychosis have special value. The floor factor (dominance of women) admits not all researchers. P.A. Nadzharov and A.B. Smulevich (1983) consider schizoaffective psychosis as recurrent schizophrenia which meets at women more often.

Treatment of Schizoaffective psychosis:

Main type of therapy of schizoaffective psychosis — use of neuroleptics with the expressed antipsychotic effect of action in a combination with antidepressants (at a depression) or lithium salts (at dominance of maniacal affect). The most often used neuroleptics are aminazine (to 300 mg/days), propazine (to 350 mg/days), Tisercinum (to 200-250 mg/days), Triphtazinum or этаперазин (to 25-35 mg/days), a haloperidol (to 15-20 mg/days) at co-administration of proofreaders (Cyclodolum — 12-20 mg/days), leponexum (to 300 mg/days), klopiksol-akufaz (50 mg intramusculary every other day within two-three weeks), klopiksol-depot (100 - 200 mg intramusculary once in three-four weeks). With depressive affect in structure of an attack attach antialarming antidepressants, such as amitriptyline to these drugs (to 200-300 mg/days), anafranit (up to 150-200 mg/days), antidepressants of "the balanced action" — ludiomit (up to 200-300 mg/days), Pyrazidolum (to 250 mg/days), леривон (to 120 mg/days). At development of schizoaffective attacks with maniacal affect treatment by lithium salts joins the specified neuroleptics (to 1600-2000 mg/days) or Finlepsinum in a dosage to 300-400 mg/days is used. At resistance to the combined antipsychotic therapy treatment is shown by insulin. In these cases an insulin therapy is carried out by a course to 10 - 15 comas. After permission of an attack the maintenance therapy is recommended by small doses of antipsychotic drugs and antidepressants (or lithium salts). Are appointed этаперазин (to 10-15 mg/days), a haloperidol (to 5-6 mg/days), Stelazinum (to 10 mg/days), amitriptyline (to 50-75 mg/days), Pyrazidolum (to 50-75 mg/days), леривон (to 30-45 mg/days) with a gradual dose decline at the accounting of a tendency to stabilization of a state and existence of comfortable vital conditions without risk factors of provocation of psychosis. Labor rehabilitation, psychotherapy, periodic observation in out-patient conditions are shown.