ASPECT OF THE TREATMENT OF SCHIZOPHRENIA IN GERONTOLOGICAL PATIENTS WITH CONCOMITANT MULTIMORBIDITY

Abstract

Introduction. Schizophrenia is a pathology of the brain caused by a failure of chemical processes. The specificity of the paranoid syndrome is in its complication and progression, and it can be stopped more often with loading doses of antipsychotics, but taking into account the somatic background of the patient. However, age-related metabolism deterioration in gerontological patients with schizophrenia affects the course and treatment of this disease.
Purpose of the study. Study of the condition of gerontological patients diagnosed with schizophrenia and the influence of concomitant somatic pathology on the course and treatment of exacerbations of psychosis.
Material and methods. Clinical observation and treatment of mentally ill patients at the “Demeu” Center for Social Services in Almaty from November 2013 to February 2022.
Research methods. Examination, psychopathological method, general clinical method, analysis of medical records data.
Research results. Two groups were identified: one group (7 people) with concomitant endocrine pathology and the second (25 people) with concomitant somatic diseases other than endocrine pathology.
In patients with concomitant endocrine pathology, the exacerbation of schizophrenia proceeded clearly with pronounced completed affective-hallucinatory-delusional or affective-delusional syndromes, and despite inpatient treatment, the episode of psychosis was protracted; after the reduction of psychotic symptoms, symptoms of an affective level or a paranoid level of low amplitude remained.
Exacerbations of psychosis in the second group of patients with general somatic diseases were insignificant; the syndromes were incomplete, while insomnia with manifestations of hypomania with irritability or moderate depression and affective-delusional syndromes were more common. The delirium concerned everyday issues, and verbal hallucinosis was rare. Taking psychotropic drugs for a week reduced the psychosis.
Some gerontological patients with exacerbation of endogenous psychosis and the prescription of psychotropic drugs for treatment had “swinging” manifestations of psychosis over time. Such manifestations were associated with changes in the structure of symptoms. If, at the beginning of the exacerbation, the symptoms of endogenous psychosis appear, then those symptoms reduced against a continuing course of treatment with psychotropic drugs without adjusting the doses, and the structure of psychosis changed to exogenous toxic symptoms.
The discussion of the results. It would seem a “homogeneous environment” - all patients with a verified diagnosis of schizophrenia, a stable emotional-volitional defect, suffer for many years, the body’s reserve capabilities are significantly reduced /due to illness and age/, are under observation and care, and at the same time The frequency, clinical presentation, and duration of exacerbations of psychosis vary widely. And this is where concomitant pathology matters. Endocrine pathology has a more pronounced negative effect on the course of the disease and the quality of treatment.
Conclusions.
1. In the clinical manifestation of exacerbation of psychosis in gerontological patients diagnosed with schizophrenia with concomitant endocrine pathology, it can be assumed that at the biochemical level, endocrine pathology enhances the manifestations of psychosis. When psychotropic drugs are prescribed, there is competition between drugs and metabolic products for the same receptors, which contributes to the protracted nature of psychosis.
2. In the clinical manifestation of exacerbation of psychosis in gerontological patients diagnosed with schizophrenia with concomitant somatic pathology of non-endocrine origin, the somatic background does not affect the course of psychosis. It does not interfere with the action of psychotropic drugs, which makes it possible to obtain remission when prescribing medium therapeutic doses of psychotropic drugs in a short course.
3. Further in-depth studies of the dynamics of the condition of patients with schizophrenia with underlying diseases at the biochemical level are needed, for example, monitoring the level of albumin, liver enzymes, and the concentration of psychotropic drugs in the blood of patients.