Scientific Justification of Measures to Improve Psychosocial Treatment and Rehabilitation Interventions for Patients with Paranoid Schizophrenia
Authors:   N.I. Pirogov Russian National Research Medical University, Goncharenko S.N. ,   Moscow, Russian Federation, Shmilovich А.А. ,   N.I. Pirogov Russian National Research Medical University; Moscow, Russian Federation
Published: November 2024

Aim. To substantiate the implementation effectiveness differential programs medical and social rehabilitation voluntarily hospitalized patients with paranoid schizophrenia to reduce the hospitalizations number. Design. Comparative prospective study. Materials and methods. The study included 100 patients with paranoid schizophrenia, the retrograde duration and anterograde observation was ≥ 3 years. Based on the clinical study clinical and social determinants, three patient’s groups were identified depending on the identified motives for self-seeking psychiatric care: a paranoid motive group (PM) associated with delusional behavior (35%); nonrare psychopathological motives group (NPM) associated with other mental disorders not associated with delusional symptoms (38%); non-psychopathological motives group (NM) not associated with psychopathological symptoms (27%). Further, based on the clinical indicators compliance assessment according to the Positive and Negative Syndrome Scale (PANSS) with the social adaptation level according to the Personal and Social Performance Scale (PSP), patients groups were identified based on the disease clinical picture, cognitive, negative and positive symptoms, as well as adaptation potential, social functioning level and life indicators quality: compensated group (compensation in clinical and social aspects — 15%); decompensated group (clinical and social decompensation — 53%); adapted group (severe clinical disorders with satisfactory social compensation — 20%); conflict group (mild clinical manifestations (the non-psychotic register disorders) and severe social decompensation — 12%). Results. Based on the clinical indicators compliance assessment with the social functioning level for various groups of patient’s social adaptation, differential programs have been developed aimed at reducing the hospitalizations number, including various psychosocial interventions kinds. The psychotic attacks frequency in the PM group did not change significantly with a sufficiently significant decrease in the independent requests number for psychiatric care from 1.6 ± 0.2 to 1.4 ± 0.3 (t > 2, p > 0.95). In the NPM group, both the psychotic attacks frequency and the number of independent visits decreased (in both cases, t > 2, p > 0.95). In the NM group, it was not possible to achieve a statistically significant decrease in the independent requests number for psychiatric care with an observed significant decrease in the psychotic attacks frequency (t > 2, p > 0.95). The hospitalizations duration in the NPM and NM groups was significantly reduced (72 ± 9 to 67 ± 6 and 38 ± 4 to 34 ± 6 bed days (t > 2, p > 0.95), respectively) while simultaneously increasing the outpatient treatment days’ number from 53 ± 4 to 59 ± 9 and from 42 ± 8 to 48 ± 6 (t > 2, p > 0.95), respectively. At the same time, the remission increased duration only in the NPM group from 0.62 ± 0.25 to 0.73 ± 0.19 year (t > 2, p > 0.95). Clinically, the affective (depressive) symptoms severity according to the Calgary Depression Scale for Schizophrenia decreased in the NPM and NM groups (10.2 ± 1.4 to 9.0 ± 1.6 score and 7.3 ± 0.8 to 6.6 ± 0.9 score (t > 2, p > 0.95), respectively), and the psychopathological symptoms severity according to the PANSS scale significantly decreased only in the NM group from 91 ± 4 to 87 ± 6 scores (t > 2, p > 0.95). Conclusion. Basically, the clinical and social medical care for patients with paranoid schizophrenia are the synergistic complementarity psychiatric care and social rehabilitation, mandatory psychotherapeutic and psychoeducational support for medicines prescriptions. Keywords: voluntary hospitalization, paranoid schizophrenia, medical and social rehabilitation, psychosocial interventions, number of hospitalizations, social adaptation.