The role of diagnosis in the treatment of schizophrenia
Treating schizophrenia is challenging. At present, it is difficult to imagine the treatment of schizophrenia without qualified clinical diagnostics , taking into account the dynamics of productive symptoms (obsessive states, hallucinations, delusions, depersonalization phenomena , affective disorders, etc.), negative signs (apathy, decreased energy potential, autism, etc.), as well as features of impaired memory, attention, thinking (neurocognitive deficit). In addition, for the effective treatment of schizophrenia, paraclinical diagnostics is also necessary, as a rule, including the study of the bioelectrical activity of the brain (functional capabilities of the brain), complex programs for the study of evoked brain potentials (cognitive potentials or the P300 program, galvanic skin potentials, etc.), carrying out nuclear magnetic resonance, which allows to determine the degree of damage to the structure of the brain (the state of the ventricles of the brain, subarachnoid spaces, features of the hemispheres and deep structures of the brain), study of the peculiarities of the vascular system of the brain (transcranial scanning of cerebral vessels). Paraclinical diagnostics should include pathopsychological and neuropsychological research, as well as a thorough analysis of the patient’s personality characteristics. For the correct treatment of schizophrenia, it is necessary to assess the state of the patient’s endocrine system (pituitary gland, thyroid gland, adrenal glands, sex hormones), conduct a study of the cardiovascular system and other organs and systems.
Modern treatment of schizophrenia involves the use of the so-called biopsychosocial model, as well as a variety of options for team work. The biopsychosocial approach involves not only biological therapy (medicines, insulin therapy, unloading diet therapy, etc.), but also the mandatory inclusion of many methods of psychotherapy in the treatment and rehabilitation process in its various forms (individual, group and family therapy). Trust in the attending physician, cooperation with him (compliance), active social work, taking into account the peculiarities of the patient’s family and his social status, are important .
A schizophrenic patient should not be in the hospital for a long time and be left to himself. It is necessary to quickly relieve the symptoms of psychosis and subsequent comprehensive rehabilitation, which implies not inactivity, but full employment. It is important to use the entire range of rehabilitation tools (landscape therapy, physiotherapy, swimming pool, balneotherapy, creative expression therapy, music therapy, bibliotherapy, various methods of psychological correction and psychological training).
The brigade form of work in the treatment of schizophrenia involves the participation of not only a psychiatrist and clinical psychologist in the process of treating a patient , but also a social worker. In addition, the therapeutic community is essential, patient- centered therapy . The therapeutic community is the inclusion of the work of the patient and staff in a comprehensive rehabilitation process.
Today, effective drug treatment of schizophrenia is most often the use of only one drug, carefully selected in the necessary dosages, excluding the development of side effects, implying a relatively low cost of treatment, and not several drugs that have not only a large number of side effects, but often absolutely not combined combinations.
Preferred are atypical antipsychotics with minimal side effects and affecting virtually all symptoms of schizophrenia (productive, negative and neurocognitive deficits). By atypical antipsychotics in the order of their appearance on the market of schizophrenia include azaleptin (leponeks) respiridon (rispolept) olanzepin (Zyprexa), kventiapin (Seroquel), amisulpiride (Solian). Usually, after the relief of acute manifestations of schizophrenia (2 – 3 weeks), it is desirable to switch to prolonged forms of atypical antipsychotics (rispolept – const). Probably, for effective treatment of schizophrenia, it is necessary to use nootropics that improve the metabolism of brain cells and microcirculation (Mexidol, amyldranate, milgam, emoxepin, etc.), herbal medicine.
One of the diagnostic methods for schizophrenia is a change in the bioelectrical activity of the brain, recorded on the EEG, but they are not pronounced, incomprehensible and weakly related to the intensity of clinical symptoms. Minimal cerebral dysfunction can be observed in the premorbid period and be a marker of the risk of psychosis, its prognosis and course.
No specific EEG changes in schizophrenia have been identified, but the most common are:
· Fast low-amplitude activity;
• disorganized fast activity;
· Lack of alpha rhythm;
· High-amplitude beta-activity;
· Peak-wave complex;
· Generalized slow-wave activity.
Thus, EEG data are rather nonspecific in the diagnosis of schizophrenia; therefore, in the clinic of V.L. For a minute, it is carried out on other more specific tests. And treatment is prescribed when one or another form of the disease is established.