КЛИНИКО-ПСИХОМЕТРИЧЕСКАЯ МОДЕЛЬ ОЦЕНКИ УСТОЙЧИВОСТИ РЕМИССИЙ ПРИ ЭНДОГЕННЫХ ПСИХИЧЕСКИХ РАССТРОЙСТВАХ
Keywords:
endogenous mental disordersAbstract
Objective. To present a clinical-psychometric model for assessing the stability of remissions in endogenous mental disorders, based on the integration of psychopathological, functional, and typological indicators.
Materials and Methods. The study included 197 patients with endogenous mental disorders (ICD-10: F20–F33) who had been in remission for at least 6 months. PANSS and SOFAS scales were used to assess the condition, along with M. L. Agranovsky’s typology of remissions. A multifactorial risk analysis was performed using logistic regression, ROC analysis, and the calculation of odds ratios (OR, 95% CI).
Results. Independent predictors of remission stability were:
- pronounced clinical response (ΔPANSS ≥ 15; OR = 0.42; p = 0.002),
- high level of social functioning (SOFAS ≥ 45; OR = 0.35; p = 0.001),
- favorable remission types (IiRsLIL, ATR, NTR, TTR; OR = 0.28; p < 0.001),
- high treatment adherence (OR = 0.31; p < 0.001).
The prognostic model demonstrated high accuracy (AUC = 0.83; 95% CI: 0.78–0.88), sensitivity — 91.8%, specificity — 94.7%, and the Hosmer–Lemeshow test confirmed adequate calibration (p > 0.05).
Conclusion. The developed clinical-psychometric model has high predictive value and can be applied in clinical practice to stratify patients by relapse risk and individualize preventive strategies.
References
1. Аграновский, М. Л. (2019). Клинико-психопатологические типы ремиссий при эндогенных психозах. Журнал неврологии и психиатрии им. С. С. Корсакова, 119(6), 25–32.
2. Аграновский, М. Л. (2020). Ремиссии при шизофрении: клинико-прогностическая значимость. Психиатрия и психофармакотерапия, 22(4), 14–21.
3. Andreasen, N. C., Carpenter, W. T., Kane, J. M., Lasser, R. A., Marder, S. R., & Weinberger, D. R. (2005). Remission in schizophrenia: Proposed criteria and rationale for consensus. American Journal of Psychiatry, 162(3), 441–449. https://doi.org/10.1176/appi.ajp.162.3.441
4. Harvey, P. D., & Bellack, A. S. (2007). Functional remission in schizophrenia: The relevance of cognitive and social functioning. Schizophrenia Bulletin, 33(3), 507–514.
https://doi.org/10.1093/schbul/sbm001
5. Lambert, M., Karow, A., Leucht, S., Schimmelmann, B. G., Naber, D., & Schulte-Markwort, M. (2006). Remission in schizophrenia: Validity, frequency, predictors, and patients’ perspective 5 years later. Dialogues in Clinical Neuroscience, 8(1), 29–40.
6. Robinson, D. G., Woerner, M. G., McMeniman, M., Mendelowitz, A., & Bilder, R. M. (2005). Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry, 162(3), 477–479.
7. Lieberman, J. A., Perkins, D., Belger, A., Chakos, M., Jarskog, F., Boteva, K., & Gilmore, J. (2001). The early stages of schizophrenia: Speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biological Psychiatry, 50(11), 884–897. https://doi.org/10.1016/S0006-3223(01)01284-9
8. Leucht, S., Tardy, M., Komossa, K., Heres, S., Kissling, W., & Davis, J. M. (2012). Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: A systematic review and meta-analysis. The Lancet, 379(9831), 2063–2071. https://doi.org/10.1016/S0140-6736(12)60239-6
9. Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261
10. Lambert, M., & Naber, D. (2011). Current issues in remission criteria in schizophrenia. Dialogues in Clinical Neuroscience, 13(2), 167–177.
11. Emsley, R., Chiliza, B., Asmal, L., & Harvey, B. H. (2011). The nature of relapse in schizophrenia. BMC Psychiatry, 11(1), 82. https://doi.org/10.1186/1471-244X-11-82
12. Kane, J. M., Correll, C. U., & Goff, D. C. (2015). A framework for improving the care of individuals with schizophrenia. Journal of Clinical Psychiatry, 76(5), e639–e647. https://doi.org/10.4088/JCP.14com09519
