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No. 4 (2025)

ORIRGINAL RESEARCH

Multidimensional Predictive Analysis of Rehabilitation Potential in Patients with the First Psychotic Episode: The Role of Therapeutic Strategy, Clinical and Functional Indicators and the Type of Attitude to the Disease

https://doi.org/10.48612/psyph/3ta5-3m92-496d

Published 2025-12-30

  • V.A. Chinarev
    • ,
  • E.V. Malinina

V.A. Chinarev
Regional Clinical Specialized Neuropsychiatric Hospital No. 1; South Ural State Medical University

E.V. Malinina
South Ural State Medical University

Abstract

Relevance. The persistence of functional and social deficits in psychotic disorders, despite symptomatic remission achieved through psychopharmacotherapy, remains a key determinant of unfavorable long-term outcomes. This underscores the urgent need for effective rehabilitation strategies. This study aimed to develop a multidimensional predictive model of rehabilitation potential (RP) in patients with first-episode psychosis (FEP), assessing the comparative contribution of combined therapy (psychopharmacotherapy + psychosocial rehabilitation), dynamic indicators of symptomatology, level of functioning, and type of attitude towards the disease (TOBOL) to personalize early rehabilitation interventions.

Materials and methods. A prospective randomized controlled trial was conducted at the Clinical Department of the Regional Clinical Specialized Neuropsychiatric Hospital No. 1 in Chelyabinsk. The study included 188 patients, divided into two groups: the main group (n = 109) who received combined therapy with psychopharmacotherapy and 12-month structured psychosocial rehabilitation, and the control group (n = 79) who only received psychopharmacotherapy. Assessment was performed using anamnestic, clinical-psychopathological, and dynamic methods, as well as psychometric scales (Positive and Negative Syndrome Scale (PANSS), Brief Negative Symptoms Scale (BNSS), Global Assessment of Functioning Scale (GAF), TOBOL) at 4 time points (baseline, 1, 6, 12 months). Rehabilitation potential (binary dependent variable) was defined at the 12th month as achieving clinical remission (≥ 50 % reduction in total PANSS score from baseline) and functional recovery (GAF ≥ 65). Binary logistic regression was used to identify predictors of RP.

Results. A statistically significant advantage of combined therapy in achieving clinical remission, reducing negative symptoms, and functional recovery was confirmed (p < 0.001). The multivariate model (Nagelkerke R2 = 0.814, area under the curve (AUC) = 0.95 [ 95% confidence interval (95% CI): 0.92–0.98]) revealed dominant influences of: combined therapy (Odds ratio (OR) = 24.1; 95% CI: 8.9–65.2; p < 0.001), level of functioning (GAF at 12 months: OR = 1.20; 95% CI: 1.11–1.30; p < 0.001), and maladaptive TOBOL types, particularly anosognosic (OR = 0.01; 95% CI: 0.002–0.07; p < 0.001) and apathetic (OR = 0.02; 95% CI: 0.004–0.12; p < 0.001). Symptom severity (PANSS, BNSS) reduced the likelihood of success, and nosological affiliation (schizophrenia/schizoaffective disorder) did not determine the outcome.

Conclusion. These findings justify the integration of structured psychosocial rehabilitation into FEP treatment standards as a mandatory component. A personalized approach should include monitoring of negative symptoms and functioning, as well as correction of pathological attitudes towards the disease (especially anosognosic and apathetic) to bridge the gap between symptomatic remission and functional recovery.

Keywords

rehabilitation potential, psychosocial rehabilitation, functioning, first psychotic episode, schizophrenia, attitude towards illness

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