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No. 3 (2023)

PSYCHOPHARMACOTHERAPY

Therapy of Obsessive-Compulsive Manifestations in Structure of Schizophrenic Spectrum Disorders

https://doi.org/10.21265/PSYPH.2023.24.86.001

Published 2023-09-30

  • V.V. Stanovaya
    • ,
  • M.V. Ivanov

V.V. Stanovaya
FGBU “National Medical Research Center of Psychiatry and Neurology named after V.M. Bekhterev” Ministry Of Health of the Russian Federation

M.V. Ivanov
National Medical Research Center of Psychiatry and Neurology named after V.M. Bekhterev of the Ministry Of Health of the Russian Federation

Abstract

Introduction: Obsessive-compulsive and psychotic symptoms demonstrate high degree of comorbidity in patients with schizophrenia. Obsessive symptoms can occur at any stage of schizophrenia and often have a negative impact on the course and outcome of the disease. Despite currently available literature data on methods of obsessive-compulsive symptoms management in the structure of schizophrenic disorders, most patients do not respond properly to therapy. Therefore, the development of effective treatment strategies is extremely important. In this literature review, both basic and frequently used methods of the management of such conditions, as well as promising ones with established effectiveness, but insufficient knowledge, were discussed.
Materials and methods: Data search was performed using the PubMed database with the following keywords: obsessive-compulsive disorder, schizophrenia, obsessive-compulsive symptoms in schizophrenia, obsessive-compulsive disorder treatment, schizophrenia treatment. Inclusion criteria were: randomized and nonrandomized clinical trials, meta-analyses and systematic reviews, relevant full-text articles on schizophrenia with obsessive-compulsive symptoms. Exclusion criteria were: articles of poor quality. This article also presents the results of our own observational study on the treatment with cariprazine of patients with schizo-obsessions and the presence of primary and secondary treatment resistance.
Results: The analysis of the literature data has convincingly shown the need for the use of antipsychotics in the management of schizo-obsessions. First of all, the effectiveness of prescribing antipsychotics with highly selective effect on D2/D3 receptors was noted. The obtained results of our own observational study using cariprazine confirmed these data. Antipsychotics that affect serotonin receptors, according to the data provided, should be considered as reserve drugs. With insufficient effectiveness of antipsychotic therapy, the use of augmentation with serotonergic antidepressants and normothimics from the group of antiepileptic drugs (lamotrigine) is indicated. The authors also consider the effectiveness of medications from other pharmacological groups, general biological effects, as well as methods of psychocorrection. The previously obtained data on its use indicate the expediency of their subsequent study. The main difficulties for extrapolating the published data, classified as promising in the review, into clinical practice are mainly related to the methodological shortcomings of these studies: small samples, lack of randomization, short follow-up periods.
Conclusions: The main achievements in the field of modern therapy of schizo-obsessions, according to the results of the literature review, are mainly associated with the use of psychotropic medications. The most indicated for therapy are antipsychotics, antidepressants and normothimics. If monotherapy with antipsychotics is ineffective, it is advisable to use augmentation by means of medications from other pharmacological groups. It is necessary to perform further studies on the correction of these disorders using biological methods of psychocorrection within the framework of integrated therapeutic approach.

Keywords

obsessive-compulsive disorder, schizophrenia, obsessive-compulsive symptoms in schizophrenia, obsessive-compulsive disorder treatment, schizophrenia treatment

PDF (Русский)

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