RU2546021C1 - Method for prediction of clinical effectiveness in schizophrenic patients - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: treating schizophrenia is preceded by carrying out the immunological examination and measuring the biochemical values of blood serum. A high efficacy of neuroleptic therapy can be expected if observing a combination of natural killers (CD16⁺) 0.22·10⁹/L and more, lymphocytes with lazy activation markers (HLADR⁺) 0.56·10⁹/L and serum aspartate aminotransferase (AST) 20.76 U/L and less.

EFFECT: using the given method enables predicting the clinical effectiveness prior to the active psychopharmacological treatment with traditional neuroleptics and taking the target rehabilitation psychopharmacological actions.

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Description

The invention relates to medicine, namely to psychiatry, and can be used to predict the effectiveness of treatment of patients with schizophrenia.

In clinical practice, the effectiveness of therapy is based on dynamic observation of the severity of psychopathological symptoms on average 4-6 weeks after the start of therapy, when the action of antipsychotics reaches its plateau [1], and in the absence of a positive therapeutic effect of the drug or a slight improvement in the patient’s condition, the attending physician changes therapeutic tactics. A significant increase in the doses of a psychopharmacological agent or the administration of several drugs at once in such cases by doctors often leads to the rapid development of side effects and complications of pharmacotherapy. This approach leads to an extension of the reduction of psychopathological symptoms and the patient's stay in the hospital.

Given the severity of the schizophrenic process, the need for a long, in most cases lifelong administration of psychotropic drugs, the development of criteria for predicting the effectiveness of therapy, clarifying and individualizing the indications for prescribing existing antipsychotics remains a priority [2, 3].

Successful individualization of treatment of mentally ill patients is possible on the basis of taking into account not only clinical indications for prescribing a psychotropic drug, but also more objective paraclinical biological prognostic criteria, which are closely related to the pathogenetic mechanisms of schizophrenia.

The use of immunobiological indicators to assess the quality of treatment for patients with schizophrenia is reflected in isolated reports and, mainly, in the study of the clinical and immunological effectiveness of various drugs. As a prognostically favorable criterion for the effectiveness of psychotropic therapy for patients with schizophrenia during the manifestation of endogenous paroxysmal psychosis in adolescence, the increased level of IL-10 observed in patients before therapy is considered [4]. Diagnostic markers for early diagnosis and adequate treatment of men with paranoid schizophrenia are whole blood serum phospholipids [5]. It has been established that with an increase in the severity of the disease according to the PANSS scale in patients with the first episode of schizophrenia, an increase in the activity of monoamine oxidase (MAO) and a further decrease in the activity of semicarbazide-sensitive aminoxidase (CAO) in blood serum can be expected [6]. An elevated level of the glutamine synthetase enzyme in chronic schizophrenia patients prior to the use of the atypical antipsychotic olanzapine was determined by a prognostic marker of improvement during treatment [7].

A combination of clinical and biological signs can be predictors of the effectiveness of therapy: elderly and senile age, obvious signs of social maladaptation, generalization of motor-muscle dysfunctions with severe muscle hypertension, indicators of manual tremor, and the level of “medium molecules” above 0.280 units. opt. densities indicate in aggregate the low effectiveness of long-term therapy with typical antipsychotics of such patients [8].

A known method for predicting the effectiveness of the treatment of schizophrenia by the activity of leukocyte elastase (LE) and α ₁ -proteinase inhibitor (α ₁ -PI): the high activity of these enzymes at the time of exacerbation of the process increases the likelihood of a high therapeutic effect, determined by changing the score for the severity of psychopathological manifestations on a scale PANSS [9].

A known method for predicting the effectiveness of therapy with atypical antipsychotic seroquel to reduce the number of neutrophils with morphological signs of apoptosis and normalize levels of cortisol and dehydroepiandrosterone [10].

A known method for predicting the effectiveness of therapy with an atypical antipsychotic seroquel according to indicators of the immune system (natural killer CD16 ⁺ and immunoglobulin A) [11].

This method is the closest to the claimed and selected as a prototype.

The disadvantage of this method is that it makes it possible to predict the effectiveness of treatment of patients with schizophrenia with one of the atypical antipsychotics, while classical antipsychotics remain in the arsenal of psychiatrists and are included in the standard for the treatment of patients with schizophrenia.

The objective of the invention is to develop criteria for predicting the effectiveness of treatment of schizophrenia patients with classical antipsychotics using immunological and biochemical parameters, which allows you to assign a personalized rehabilitation tactics and helps to increase the effectiveness of therapy.

The task is achieved by additionally determining the immunological and biochemical parameters in the blood of the patient upon admission to the hospital before the appointment of active psychopharmacological treatment, and with the simultaneous content of natural killers (CD16 ⁺ ) of 0.22 · 10 ⁹ / L or more, lymphocytes with late activation markers (HLADR ⁺ ) 0.56 · 10 ⁹ / L or more and the concentration of aspartate aminotransferase (ACT) in serum 20.76 U / L predict the high effectiveness of antipsychotic therapy.

The selection of criteria for predicting the effectiveness of treatment of patients with schizophrenia (the content of natural killers, lymphocytes with markers of late activation and ACT level) was carried out on the basis of the analysis of indicators obtained at 2 points of the study - when patients were admitted to the hospital before the appointment of active psychopharmacological treatment and after 4-6 weeks of treatment. 138 patients with schizophrenia diagnosed with F20.00, F20.01, F20.02, F20.6 (ICD-10) who underwent treatment in the Department of Endogenous Disorders of the Clinic of the Federal State Institution "Scientific Research Institute for Nuclear Medicine" of the Russian Academy of Medical Sciences were examined. The analyzed group consisted of 63 women, 75 men, aged 18 to 64 years (average age 34.1 ± 9.6 years); with a disease duration of 1 to 33 years (average disease duration of 9.37 ± 7.4 years). Patients were prescribed treatment with classical antipsychotics adequate to their mental state (haloperidol in doses of 10-30 mg / day, chlorprotixen in doses of 100-200 mg / day, chlorpromazine in doses of 100-200 mg / day, flupentixol 5-40 mg / day, trifluoperazin doses of 20-40 mg / day, clopixol in doses of 40-80 mg / day).

The dynamics of improvement during treatment were evaluated using the CGI “Scale for Evaluating the Effectiveness of Therapy” (CGI-C subscale: “General assessment of the dynamics of the mental state”).

As a result of the study, patients on the "Scale for assessing the effectiveness of therapy" CGI were divided into 2 polar groups. Group 1 (51 patients) - with a significant improvement in the mental state (patients with a significant and significant improvement in the mental state are combined in the group); Group 2 (87 patients) - with a slight improvement in mental state (patients with a slight improvement and lack of effect were combined in the group). An analysis of the distribution of patients examined by age, duration of disease, and age of patients with disease manifestation did not reveal significant differences between groups with different treatment efficiencies: by age (χ ² = 1.07, p = 0.30), disease duration (χ ² = 0, 34, p = 0.56) and the age of the manifestation (χ ² = 3.02, p = 0.058).

The examined patients had delusions of influence, attitude, persecution, putting or taking away and openness of thoughts, hallucinatory voices of an imperative and commenting nature, less often visual or olfactory hallucinations, negative symptoms such as apathy, psychomotor slowdown, emotional smoothness, passivity, lack of initiative, decreased activity, poverty of non-verbal communication, social isolation and a decrease in social productivity. In addition, there were transient psychotic states with delusions, auditory hallucinations, somatosensory or other illusions, hypochondria, depersonalization and derealization, suspicion and inadequate affect, impaired thinking in the form of amorphousness, detail and slippage, coldness, aloofness, eccentricity, oddity, oddity, strangeness, oddity, oddity, oddity, oddity, oddity, and appearance, loss of social communications, fencing. Affective symptoms in the form of hypomanic and depressive manifestations, suicidal thoughts were less frequently noted.

When comparing the psychopathological symptoms (according to the PANSS scale) between groups before the start of therapy, the sums of the points of positive, negative, general psychopathological disorders and the total score were comparable (p = 0.871, p = 0.145, p = 0.248 and p = 0.218). At the second point of the study, after 4-6 weeks of treatment in the 1st group of patients, the total score of positive (p = 0.011), negative p = 0.036), general psychopathological (p = 0.0001) symptoms and overall PANSS score (p = 0,0002). Pseudo-hallucinations, delusional experiences were reduced in patients, criticism was formed for them, suspicion and ideas of persecution became less obvious, patients became more sociable, their emotional reactions less flattened, a desire to be involved in work processes as part of rehabilitation measures appeared, thinking and speech processes were streamlined, and their thoughts improved self-service skills, the level of anxiety and physical tension decreased, the mood was leveled and suicidal thoughts were reduced, the behavior was ordered e, partially formed compliance.

In the 2nd group of examined patients, the total score of positive, negative, general psychopathological symptoms and the overall PANSS score had only a tendency to decrease during therapy, not reaching a confidence level (p = 0.159, p = 0.420, p = 0.077, p = 0.128), the clinical dynamics of this group was less noticeable: the severity of individual symptoms decreased - suspicion, delusional ideas of persecution; demeanor in behavior became less pronounced, there was no criticism of experiences, fragmentary pseudo-hallucinations, affective and hypochondriacal symptoms, neurocognitive disorders persisted.

When determining the immune status, a complex of immunological tests was used [12, 13] to characterize cell (phenotyping of immunocompetent cells by differentiation clusters CD3, CD4, CD8, CD 16, HLADR, CD20, CD95), humoral (determination of the concentration of serum immunoglobulins M, G, A ; the level of circulating immune complexes - CEC) immunity, phagocytic activity of leukocytes. The concentration of aspartic (ACT) and alanine (ALT) aminotransferases was determined using laboratory methods generally accepted in clinical practice.

An analysis of the data of a comprehensive immunological examination showed (Table 1) that the most pronounced features of the immune status in the first group of patients (with a significant improvement in mental state) compared with the second group (slight improvement) before the appointment of active psychopharmacotherapy are higher values of the number of natural killers ( CD16 ⁺ ) and lymphocytes with late activation markers (HLADR ⁺ ), as well as lower serum aspartate aminotransferase (ACT) concentrations (Table 1). The data obtained allow us to consider the above immunobiological indicators as criteria for predicting the effectiveness of treatment of patients with schizophrenia.

New in the present invention is the use of immunobiological criteria for the effective administration of classical antipsychotics, namely natural killers (CD16 ⁺ ) of 0.22 · 10 ⁹ / L and more, lymphocytes with late activation markers (HLADR ⁺ ) of 0.56 · 10 ⁹ / L and more and the concentration of aspartate aminotransferase (ACT) in serum of 20.76 U / L or less.

New significant features showed in the inventive combination of new properties that are not obvious to a specialist and not explicitly derived from the prior art in this field.

An identical set of features was not found in the studied literature.

The method proposed as an invention can be widely used in clinical practice, as it allows one to individually approach the appointment of antipsychotic therapy and increase the effectiveness of treatment of patients with schizophrenia.

Based on the foregoing, the technical solution of the problem proposed as an invention should be considered as meeting the criteria of “Novelty”, “Inventive step” and “Industrial applicability”.

The method is as follows: in patients with schizophrenia, when they are admitted to the hospital before the appointment of active antipsychotic therapy, they take blood, determine the values of CD16 ⁺ , HLADR ⁺ and ACT and when the content of natural killers (CD16 ⁺ ) is 0.22 · 10 ⁹ / L or more, lymphocytes with late activation markers (HLADR ⁺ ) of 0.56 · 10 ⁹ / L or more and serum aspartate aminotransferase (ACT) concentrations of 20.76 U / L or less, treatment with classic antipsychotics is predicted to be effective.

We give clinical examples as an illustration.

Example 1. Patient L., 35 years old. Sick for 14 years. This hospitalization in a psychiatric hospital 14 in a row. Anamnesis: After the previous discharge, I felt satisfactory, took flupentixol 20 mg, PK-merts 100 mg, carbamazepine 300 mg. Considering her condition to be “good,” in November 2012 she independently canceled carbamazepine, deciding that “she had a headache from time to time.” A month after the cessation of treatment, I found out about the death of a close friend who was frozen in a state of intoxication on the street, felt anxiety, gradually there was a fear of "freezing to death", "going crazy." I felt that “it became difficult to think,” I became absent-minded, there was fatigue, increased fatigue, it became difficult to cope with the work. Unpleasant sensations began to arise in the head and body (in the head there was a sensation of a lump of iron wire, in the chest and heart area there was a feeling of heaviness, tightness). Burdened by her condition, she turned to the clinic of the FSBI “NIIPZ” for medical help, was hospitalized in the 2nd department.

Mental state at admission. Suitable for conversation by invitation, slow, shuffling gait. He sits on the proposed chair in a comfortable position, resting his hands on the table. The gaze is directed at the interlocutor. It looks according to the passport age. Generally untidy, although dressed in clean clothes, things are worn and wrinkled. The hair is dirty, disheveled. Does not use decorative cosmetics. He enters the conversation willingly, sets out in detail complaints and anamnestic data. During the conversation, from time to time, a ridiculous smile appears on the face that does not correspond to the topic of the conversation (explains that “I often smile, but it’s hard in my soul”). Gestures are mild, stereotypical; facial expressions are depleted. It is a speech at a usual pace, with unexpected pauses (explains that “the thought was lost”), frequent slippages (thus, talking about relationships with children, turns to the topic of personal, intimate life), neologisms (in the head of the “stickout”), contradictory statements ( “My head hurt a lot, I stopped drinking carbamazepine, maybe my head hurts now, what am I not drinking?”). In place, time and self, she is fully, correctly oriented.

Complains of "porridge", "sticks" in the head; explains that "it became difficult to think," "thoughts run away," "stupid became," "I can’t think correctly." In addition, he notes increased fatigue during the performance of ordinary daily work, has become more irritable, although he tries to control himself, “I can fall for children, scream at them.” Describes various fears and concerns, for example, that he may die by freezing on the street (walking down the street in the cold there is a fear of freezing, in connection with which the patient enters warm rooms (shops), goes crazy and never gets well again; that inanimate objects can turn into animals, so when he sees a rope, he’s afraid that “she will turn into a snake”). Describes in detail the unpleasant sensations that occur in the head and body (there is a coil of iron wire in the head that rolls, rolls over, causing a headache, feelings of constriction, heaviness arise in the chest and heart, in this regard, asks for an additional ECG ( “I want the heart to see if there is anything there.”) He talks about having an intimate relationship with men in order to “pass the pulling sensations in the genital area.” He is actively interested in whether the drugs she takes affect the There were episodes twice when I heard hail by name in a voice similar to the voice of a deceased friend, it is perceived as sounding from the side. It is critical of fears and an audible voice, considers them to be “manifestations of the disease,” says: “it's all in my head, I think this really isn’t. ”He is worried about his condition, asks if he will be cured, asks for additional tests, she is interested in all the prescribed drugs, their names, the effect on the body,“ they can take drugs that I’m told eat ”, when and at what time he will take them, offers his treatment regimens, but quickly agrees with the opinion of the doctor. He asks to show the results of the analyzes: “everything in the analyzes is normal, I’m not sick of anything”, tell about the conclusion of narrow specialists: “what did the doctor who looked at me wrote.” Thinking is average in pace, according to the patient’s speech, one can judge that in thinking there is inconsistency, slippage, clipping of thoughts, neologisms. Attention is distracted, exhausted. Intelligence corresponds to age and education. Denies suicidal attempts and thoughts. The department is disciplined, carefully fulfills the assignment.

Mental status is qualified by senesto-hypochondriacal and phobic symptoms of a pseudo-neurotic nature against the background of emotional-volitional decline and specific disorders in the associative sphere in the form of sperrings, slippage, ambivalence, neologisms.

Diagnosis. Paranoid schizophrenia, an episodic type of course with an increasing defect (F 20.01). According to clinical indications, treatment is prescribed: flupentixol 20 mg per day, carbamazepine up to 400 mg per day.

The dynamics of changes in the severity of psychopathological symptoms (according to the PANSS scale) during therapy is characterized by a decrease in the total score of positive symptoms from 12 to 10, negative ones from 25 to 22, general psychopathological ones from 37 to 27; the total score is reduced from 74 to 59.

According to the CGI scale, the CGI-S subscale: severity of the disease: 5 - pronounced mental disorders, after 6 weeks of treatment according to the CGI-C subscale: “Global assessment of the dynamics of the mental state” - (1) significant improvement, indicator of treatment effectiveness (clinical impression scale ) - (02) marked improvement with side effects that have little effect on the patient's activity.

Immunological examination before treatment: leukocytes 4.9 · 10 ⁹ / L; lymphocytes 2.50 · 10 ⁹ / L (51%); T-lymphocytes: CD2 ⁺ - 1.37 · 10 ⁹ / L; CD3 ⁺ - 0.95 · 10 ⁹ / L; T-helpers / inductors (CD4 ⁺ ) - 0.75 · 10 ⁹ / L; T-killer suppressors (CD8 ⁺ ) - 0.50 · 10 ⁹ / L; lymphocytes with markers of late activation of HLADR ⁺ - 1.02 · 10 ⁹ / L; B-lymphocytes CD20 ⁺ - 0.22 · 10 ⁹ / L; natural killers CD16 ⁺ - 0.22 · 10 ⁹ / L; IgM - 2.22 g / l; IgG - 14.36 g / l; IgA - 1.66 g / l, the level of circulating immune complexes - 148 conv. units, phagocytic activity of leukocytes - 42%. Biochemical parameters: ACT - 17.80 U / L, ALT - 39.8 U / L.

Thus, the immunobiological parameters before the start of therapy corresponded to those declared as predictors of the prognosis of highly effective therapy (CD16 ⁺ - 0.22 · 10 ⁹ / L; HLADR ⁺ - 1.02 · 10 ⁹ / L, ACT - 17.80 U / L) , and further on the CGI scale a significant improvement was recorded, against the background of treatment, the condition improved significantly, behavior and thinking were streamlined, became more active, makes real plans for the future, and criticism was formed of previous experiences and behavior.

Example 2. Patient S., 27 years old. Sick for 7 years. This hospitalization in a psychiatric hospital is the third in a row. Anamnesis: Inheritance for schizophrenia is not burdened. Visited preschool institutions since three years. It was sharply different from peers in its peculiar character. At home with my parents was very moody, touchy. If it seemed that her desires were ignored or not given enough attention to her, then she cried and screamed. Often quarreled with her older sister, could not tolerate her ridicule, refused to eat with her at the same table, was afraid of her. Outside the house was very timid, shy. In kindergarten, she always stayed away from other children. Could play for hours alone or just sit against the wall, sometimes hiding in a closet. Because of her shyness, she could not turn to a teacher, other children. Particularly embarrassing was the need to contact someone by name. She was even afraid of her father and was embarrassed to say “dad”. Until 13 years old she suffered from enuresis. For parents, she was always an unloved daughter, the relationship was somewhat alienated. I went to school on time, studied mediocre, without interest. It was closed, fenced off in the classroom. At 13, she became irritable, rude to parents and teachers, conflicts arose with classmates, and frequent, painful headaches bothered. From the same age, he notes increased sweating, greasy hair, acne, a sharp increase in weight. At the age of 15, she noticed that classmates began to pay less attention to her, were not so willingly accepted into their company. I was very worried about this, I felt inferior, stupid. She believed that she looked ugly, her hands seemed excessively long, her legs “crooked”, constantly looked in the mirror, squeezed blackheads on her face. I lost interest in everything, stopped doing homework, and my academic performance dropped sharply. Against the background of constant, painful reflections on the relationship with classmates, there was a feeling that they could read her thoughts. Once I heard in my head the voice of one of them, who called her by name. There was an idea that her character did not at all resemble the character of her parents, so she thought, "these are not my parents, they adopted me." When my father was drunk, she closed in her room, smoked, sang loudly. There was an awkwardness in the movements, experienced tension, a feeling arose that "the whole world is looking at her." I felt like an "empty place", "unworthy of living." She stopped monitoring her appearance, refused hygiene procedures. I began to skip classes at school, as it became very difficult to absorb material. The dream was broken, it seemed that he was losing his mind, thoughts arose about unwillingness to live. On the initiative of her parents, she was hospitalized in the clinic of the Scientific Research Institute of Mental Health SB RAMS, where she was diagnosed with Simple schizophrenia. Received treatment: trifluperazine 60 mg / day, thioridazine 100 mg / day. Upon discharge transferred to fluorophenazine depot 50 mg / m. She discharged herself with improvement, thinking was somewhat streamlined, she became more active, a desire to learn appeared. Over the next two years, she was systematically observed by a local psychiatrist, and received supportive treatment in the form of prolonged-acting antipsychotics. I could not continue studying at the previous school, I studied individually. A year later, I entered the Lyceum, where from the first days of training I behaved inappropriately, demanded increased attention from teachers, insisted on daily long-term communication on abstract topics, but there was no desire to study directly, I never completed homework. Once, when one of the teachers made a remark about this, she got very angry, ran out into the street, screaming that she did not want to live. She was hospitalized by ambulance in the Tomsk Regional Clinical Psychiatric Hospital. I was treated for about two months. A psychopathological examination revealed gross disorders of thinking in the form of resonance, ambivalence, amorphism against the background of increasing emotional-volitional decline. She took thioridazine 40 mg / day, clozapine 25 mg / day. After discharge, apathetic-abulic disorders persisted. On the initiative of her parents, she got a job as a fitter at the plant, but could not cope with the work, responded to the comments of the master with a cry, obscene abuse. She did nothing at home, spent most of her time lying on the bed or wandered aimlessly around the apartment. After another conflict at work, she was dismissed, after which her parents again insisted on going to the clinics of the NIIPZ SB RAMS for treatment.

Mental state at admission. Dressed untidy, hair disheveled. The movements are constrained, angular, sharp, devoid of smoothness. Pose changes unexpectedly, impetuously. Facial expressions are depleted, inexpressive, with a stereotypically arising expression on the face, vaguely reminiscent of an embarrassed smile. He doesn’t enter into a conversation right away. Speech in the form of a monologue with a uniform intonation color. He lays down complaints repeatedly in repeated phrases. He feels "inferior, stupid, lazy," does not want to do anything, and is waiting for her to be pitied. Contact with the patient is difficult. He attentively listens to questions, then after a pause he formally answers in a monosyllabic manner and begins to state the same complaints with the same words. A few minutes after talking with the doctor, he again enters the office and, without any explanation, reports the previous complaints. The compartment looks fenced off, closed. Most of the time he sits with an indifferent look, looking aloof in front of him, smokes a lot. When parents come on a date, he does not leave the ward, he does not seek contact with them. Annoyed by remarks of her roommates about her untidy appearance, shouting at them, may offend. She is not interested in the terms of treatment and discharge.

Mental status. Defective thinking is defined in the form of reflection, speech stereotype, ideas of attitude, self-failure and change. Against the background of an increase in autistic traits, emotional impoverishment and inadequacy, signs of hypobulia are revealed.

Diagnosis. Simple schizophrenia, continuous course (F20.60). According to clinical indications, haloperidol up to 60 mg, cyclodol up to 8 mg, amitriptyline 150 mg were prescribed, the condition remained practically unchanged during treatment.

The dynamics of the severity of psychopathological symptoms (according to the PANSS scale) during therapy is characterized by a decrease in the total score of positive symptoms from 17 to 13, negative - from 26 to 21, general psychopathological - from 52 to 49; the total score is reduced from 95 to 83.

According to the CGI scale, the CGI-S subscale: the severity of the disease - (5) significantly pronounced mental disorders, after 6 weeks of treatment according to the CGI-C subscale: “Global assessment of the dynamics of the mental state” - (4) no change, the indicator of treatment effectiveness (clinical scale impressions) - (13) lack of improvement.

Immunological examination before prescribing treatment: leukocytes - 5.5 · 10 ⁹ / L; lymphocytes - 1.49 · 10 ⁹ / L; T-lymphocytes (CD2 ⁺ ) - 1.04 · 10 ⁹ / L; mature T-lymphocytes (CD3 ⁺ ) - 0.58 · 10 ⁹ / L; T-helpers / inductors (CD4 ⁺ ) - 0.52 · 10 ⁹ / L; T-killer suppressors (CD8 ⁺ ) - 0.42 · 10 ⁹ / L; natural killers (CD16 ⁺ ) - 0.06 · 10 ⁹ / L; lymphocytes with late activation markers HLADR ⁺ - 0.42 · 10 ⁹ / L, B-lymphocytes CD20 ⁺ - 0.13 · 10 ⁹ / L; IgM - 1.74 g / l; IgG - 15.72 g / l; IgA - 1.94 g / l, the level of circulating immune complexes - 240 srvc. units; leukocyte phagocytic activity - 80%. Biochemical parameters: ACT - 56.32 U / L, ALT - 9.68 U / L.

Thus, the immunobiological parameters before the start of therapy did not correspond to those declared as predictors of the prognosis of highly effective therapy (CD16 ⁺ - 0.06 · 10 ⁹ / L; HLADR ⁺ - 0.42 · 10 ⁹ / L, ACT - 56.32 U / L ), that is, treatment with classical antipsychotics may be ineffective. Subsequently, the CGI scale was unchanged, the lack of improvement, and the clinical condition remained practically unchanged during treatment.

The method is simple to implement, and based on the determination in patients with schizophrenia before prescribing active psychopharmacological treatment of a number of immunobiological indicators (natural killers (CD16 ⁺ ), lymphocytes with late activation markers (HLADR ⁺ ) in the blood and the concentration of ACT aspartate aminotransferase in blood serum) allows patients to predict the effectiveness of treatment with classical antipsychotics. The proposed method allows prior to the appointment of active psychopharmacological treatment with classical antipsychotics to predict the effectiveness of therapy and purposefully conduct rehabilitation psychopharmacological measures.

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Claims (1)

A method for predicting the effectiveness of treatment of patients with schizophrenia by determining general clinical parameters, characterized in that before prescribing an active psychopharmacological treatment with classical antipsychotics, immunological and biochemical parameters are additionally determined in patients and when the content of natural killers (CD16 ⁺ ) is 0.22 · 10 ⁹ / L or more lymphocytes with late activation markers (HLADR ⁺ ) of 0.56 · 10 ⁹ / L or more and serum aspartate aminotransferase (ACT) concentrations of 20.76 U / L or less are predicted to be high the effectiveness of antipsychotic therapy.