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Published: 2020-02-17

Modern approaches to the diagnosis and care of patients at the prodromal stage of schizophrenia

Bogomolets National Medical University
P.L. Shupyk National Medical Academy of Postgraduate Education
prodromal stage of the schizophrenia psychosis risk factors attenuated psychotic syndrome brief limited intermittent psychotic syndrome genetic risk of schizophrenia functional deterioration psychoactive substances treatment

Abstract

Background. The prodrome of psychosis is a period of pre-psychotic disorder that represents a deviation from previous human experience and behavior. It`s diagnosed partly retrospectively after the development of definitive symptoms and signs of schizophrenia. A prolonged untreated prodromal period is a precursor to an adverse disease course.

Method. The research material is modern publications devoted to the study of the clinical features of the prodromal stage of schizophrenia and the provision of specialized medical care. The research method is bibliographic and analytical.

Results. Modern diagnostic systems reveal early signs that are often observed in people at high risk of developing a psychotic disorder. Clinical factors of increased risk of transition to psychosis and very high-risk factors of psychosis in youth have been identified. Certain areas of painful change are stratified into neurotic, affective, cognitive, physical, behavioral, as well as subthreshold nonspecific and specific psychotic symptoms. Were selected types of psychosis` prodrome, depending on the severity of subthreshold psychotic symptoms.

The influence of cannabinoids on the central nervous system is carried out through a system of presynaptic endocannabinoid receptors, among which two types are distinguished: cannabinoid receptors of the first type (CB1) and cannabinoid receptors of the second type (CB2). These receptors are physiologically adapted to interact with two endogenous cannabinoids that are produced in the human body - with anandamide and 2-arachidonoylglycerol. Recent studies have shown that the level of anandamide in the cerebrospinal fluid of patients with schizophrenia is significantly increased. Moreover, in those who used cannabis occasionally, the level of this neurotransmitter was significantly higher than in those who used cannabis systematically or did not use it at all. Currently, there are three main scientific models of a possible association of schizophrenia and cannabis use: the “self-medication hypothesis”, the “causal model” and the “general factor hypothesis”. «General factor hypothesis» seems to be the most logical, since, indeed, the increased risk of both dependence on cannabis and the development of schizophrenia and other psychotic disorders of the schizophrenic spectrum can be associated with some common factor. Some genetic or social factors can act as this common factor, and in the group of people who are under the influence of this factor, the predisposition to psychotic disorders and cannabis use can have a synergistic effect on the emerging of clinically defined schizophrenia. International clinical guidelines recommend a few practical steps in monitoring patients in the psychosis` prodrome. But there are cautious about the use of antipsychotics if the patient does not meet the diagnostic criteria for a psychotic disorder. It`s advisable treating the psychosis` prodrome by a combination of antipsychotics and/or antidepressants, psychotherapy for patients and their families, as well as by omega-3 fatty acids. The prodromal phase of schizophrenia is the most optimal target for primary medical intervention, but its diagnostics and therapy require further scientific research and validation in actual clinical practice.

Conclusion. The prodromal stage of schizophrenia is the most optimal target for primary medical intervention; however, its diagnosis and therapy require further scientific research and confirmation in current clinical practice. In addition, a number of legal issues remain unresolved, because the provision of specialized medical care to people who have not been diagnosed with a mental disorder is currently in a certain legal vacuum.

Full-text of the article is available for this locale: Українська.

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