RU2706216C1 - Method for prediction of the probability of an unfavorable outcome in relation to the social postpsychotic functioning of the patients with endogenous psychic diseases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to psychiatry, and concerns prediction of an unfavorable outcome in relation to social post-psychotic functioning of patients with endogenous mental diseases. That is ensured by determining the levels of antibodies to myelin basic protein and S100B protein in optical density units at the beginning of the acute period of the patient's blood. If the level of these proteins or one of them increases above 0.9 units of optical density, an unfavorable outcome with respect to the patient's social post-psychotic functioning is predicted.

EFFECT: method provides the possibility of objective prediction of the patient's social functioning taking into account the course of the pathological process in the brain.

1 cl, 3 ex

Description

The invention relates to medicine, namely to psychiatry, and can be used to predict the likelihood of an adverse outcome in relation to the social postpsychotic functioning of patients with endogenous mental diseases.

Endogenous mental disorders, including schizophrenic spectrum disorders, are serious socially significant diseases. They have serious socio-economic consequences in the form of reduced working capacity (up to disability) and a deterioration in the quality of life of patients due to a violation of their educational, social and family adaptation, as well as the need for significant government spending on specialized medical care for such patients.

The high medical and social relevance of the problem of predicting the likelihood of an adverse outcome is determined by the rather wide prevalence of mental disorders, often with a chronic course and repeated relapses, impaired cognitive functions (memory, attention, perception, thinking, decision making) and emotional disorders.

The etiology and pathogenesis of diseases is unknown today. The important role of genetic factors does not exclude, however, the etiopathogenetic effect of other possible cofactors, such as neuro-And / or psychological trauma, immunity disorders, drug use, etc.

Currently, the multidimensional approach to the study of schizophrenia and other endogenous psychotic disorders has received the greatest development. When studying the continuum of endogenous mental diseases, it was shown that schizophrenia, schizoaffective psychosis, and affective diseases share similar biological changes most pronounced in schizophrenia.

It has been reliably shown that the smaller the age of manifestation, the more exacerbations, hospitalizations, the higher the level of negative symptoms and the worse the level of social and labor functioning, and the worse the long-term global outcome of schizophrenia.

The clinical picture of the prodromal period of schizophrenia and the debut of affective disorders is difficult to distinguish until the appearance of positive symptoms.

Obviously, a comprehensive study during the first and main peak of the manifestation of schizophrenia for men and women (18-35 years old) is important due to the high degree of disability of patients at the most working age (Hafher H, Maurer K, an der Heiden W. ABC Schizophrenia study: an overview of results since 1996. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 1021-1031 [PMID: 23644725 DOI: 10.1007 / s00127-013-0700-4]).

At present, the deterioration of social functioning is considered not just a concomitant symptom of schizophrenia, but one of its central characteristics. Disruption of social functioning is often included among the criteria for the diagnosis of schizophrenia. Moreover, if measures aimed at improving social functioning are effective, they can have a positive effect on the long-term outcome of the disease.

Traditional antipsychotics have helped many patients to leave the hospital and live among people, however, in general, they had only a slight positive effect on functional disorders caused by the schizophrenic process. However, the hope remains that the latest atypical antipsychotics, in particular, their injectable forms of prolonged action, will have a more significant effect on functional disorders.

For these reasons, the functioning of the patient in society is increasingly recognized as an important indicator in studies of new forms of pharmacological treatment of schizophrenia.

It is especially important to be able to predict the likelihood of an adverse outcome in relation to the social postpsychotic functioning of patients with endogenous mental illness.

Currently, in order to predict the further social functioning of the patient in routine clinical practice, they mainly use the clinical and psychopathological method based on a conversation with the patient. The disadvantages of this method is the subjectivity of the specialist’s interpretation of the patient’s condition, while predicting the outcome of the disease is based on theoretical knowledge about the typical course of a particular psychopathological condition to which the patient is referred in the diagnostic process.

http: //www.psychiatry. com / cond / 0 / diss / l994 / 97

http://www.dissercat.com/content/depressivno-paranoidnve klinika-psikhopatologicheskaya-different

http: // www. psychiatry. com / cond / Q / diss / l990 / 225http: //medical-diss.com/medicina/prognoz-adaptatsii-bolnyh-s-perwmi-affektivny bredovymipristupami-shizofrenii

http://medical-diss.com/medicina/psihopatologiya-i-klinika-ostryh-parafre sostoyaniy-pri-shizofrenii

In some cases, to predict the patient's further social functioning, individual clinical signs are important, for example, assessing the severity of psychopathological symptoms on psychometric scales, such as PANSS (https://wvvw.ncbi.nlm.nih.gov/pmc/articles/PMC5788247/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258126/,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830865A.

Recently, more and more attention has been paid to assessing a range of cognitive functions for predicting social recovery in schizophrenia.

https://www.ncbi.nlm.nih.gov/pubmed/15168915.

https://www.ncbi.nlm.nih.gov/pubmed/19203437.

https: //www.ncbi.nlm.nih. gov / pmc / articles / PMC4833310 /

However, this assessment does not always reflect the depth of brain damage and the active period of the disease. This means that phenotypically similar clinical conditions may have different outcomes in terms of further social functioning.

Given these circumstances, it became necessary to search for a biological predictor, closely related to the plastic and regenerative abilities of the nervous system, to predict the level of social functioning of a patient with endogenous psychosis in the post-attack period.

There is a method for predicting the effectiveness of therapy in patients with paroxysmal schizophrenia, including conducting an electroencephalographic study (EEG) of the frontal, parietal, occipital and temporal cortical areas of the brain before treatment of patients with paroxysmal schizophrenia with manic delusional disorders, while an additional immunological study of the content of autoantibodies to the general myelin protein (AAT OBM), and quantitative values of absolute spectral power are determined by EEG studies and in the narrow frequency sub-bands of the EEG theta2 (θ2), alpha 1 (α1), alpha2 (α2), alpha3 (α3), beta2 (β2), in specific EEG leads: in the left frontal (F3), mid-temporal (T3, T4 ), left parietal (P3) and occipital (01, 02) leads, the obtained values are calculated by the formulas of the equations of multiple linear regression X ₁ , X ₂ and X ₃ in conv. units: X ₁ = 0.25 * θ2_O2 + 0.35 * α3_O2-0.52 * β2_T4-0.45 * β2_O1 + l1.89

X ₂ = 0.08 * α1_T3-0.79 * β2_T4-0.02 * α2_O1 + 11.29 * AAT_OBM + 10.58

X ₃ = 0.55 * αl_T4-0.72 * α2_F3-2.69 * β2_T4 + 0.48 * α3_P3 + 71.86

and with a value of X ₁ less than 28 srvc. units points and a value of X ₂ less than 28 points and a value of X ₃ less than 120 srvc. units predict satisfactory efficacy of standard syndromic therapy for this patient. (RU 2621266, 2016) This method can be taken as a prototype.

However, this method does not allow predicting the likelihood of an adverse outcome in relation to the social postpsychotic functioning of patients with endogenous mental illness.

Based on the results of numerous studies of the authors, the involvement of innate (inflammatory reactions) and acquired (autoantibodies to neuroantigens) immunity in the pathogenesis of endogenous psychoses was revealed.

In the study of clinical and biological correlations from a wide range of inflammatory mediators, a number of indicators were identified that are closely related to the clinical characteristics of the patient’s mental state and the degree of activity of the pathological process [Kaleda VG, Klyushnik TP, Sarmaiova ZV, Otman I .P., Dupin AM Correlation of clinical and immunological parameters in the first attack of juvenile endogenous psychosis // Journal of Neurology and Psychiatry. S.S. Korsakova. - 2009 .-- T. 109 (1). - S. 16-19; Klyushnik T.P., Siryachenko T.M., Sarmaiova Z.V., Otman I.N., Dupin A.M. Immunological reactions in various forms of mental pathology // Journal of Neurology and Psychiatry. S.S. Korsakova. -2009. -T. 109 (4). - S. 55-58; Shcherbakova I.V. Features of congenital and acquired immunity at high risk of schizophrenia and in the process of its development: Dis ... doctors honey. sciences. - M., 2006].

Data were obtained indicating that the activation of acquired immunity (the appearance in the blood of autoantibodies to proteins of nervous tissue) accompanies the most severe pathological processes in the brain.

The revealed patterns served as the basis for the creation of a new medical technology that objectively complements the clinical examination of the patient. The technology consists in determining indicators of acquired immunity in the patient's blood serum during an endogenous mental illness.

The nature of the change in these indicators compared to control values allows us to determine the activity of the pathological process in the patient's brain, to assess the degree of its severity and severity.

The authors' studies showed for the first time that the determination of the immune parameters of blood serum at the stage of exacerbation of psychotic symptoms (during a psychotic attack) is in a certain way related to the level of the patient's post-attack social functioning.

73 patients were examined who were admitted to the inpatient department of the Clinic of the first episode of GBUZ “PKB No. 1 DZM” in connection with the acute psychotic state of endogenous nature. Patients were not included in the study if they had an inflammatory, infectious, or autoimmune pathology detected within 1-2 months prior to the examination (due to the fact that such a pathology changes the patient’s immune status and may reduce the accuracy of the prognosis of the effectiveness of therapy by quantitative immunological parameters). An immunological study was carried out as follows:

a) taking patient blood samples for immunological analysis (carried out as part of a standard blood test, mandatory upon admission to the hospital),

b) determination of informative immunological parameters in the blood plasma - the content of autoantibodies to neurospecific antigens: the content of autoantibodies to the main myelin protein (AATOBM) and the content of autoantibodies to protein S100 (AAT S100), in units of optical density - units CD) as markers of neuroplastic processes the brain.

Determination of the content of AAT OBM and AAT S100 in OD units in blood plasma samples is carried out by the standard enzyme-linked immunosorbent assay (ELISA), described in detail in the laboratory technology "Neuro-immuno-test" [Klushnik TP, Zozulya S.A., Androsova L.V., Sarmaiova Z.V., Otman I.N., Panteleeva G.P., Oleichik I.V., Kopeiko G.I., Borisova O.A., Abramova L. .I., Bologoe P.V., Stolyarov S.A. Laboratory diagnostics in monitoring patients with endogenous psychoses (“Neuro-immuno-test”) - Moscow: Medical Information Agency LLC, 2014. - 32 p.].

Based on the numerous results of patient analyzes, the authors revealed a pattern: when the AAT OBM and / or AAT S100 level is higher than 0.9 OD units, there is a high probability of an unfavorable outcome in relation to the social postpsychotic functioning of patients after discharge from the clinic.

The level of social adaptation was measured by presenting the PSP scale to patients during the period of remission before discharge from the clinic.

Immunological parameters were determined in peripheral blood serum, the sampling of which was carried out from a finger into a dry Eppendorf type tube. After blood coagulation, the formed elements were precipitated by centrifugation at 750 g for 15 minutes at 22 ° С, then the serum was taken, which was used for analysis either immediately after receipt or stored at +2 - + 8 ° С for no more than a day or in a frozen state at temperature from -18 to -24 ° C for a month before analysis.

Determination of aAT level for S100b and MBP.

Determination of the level of AAT to S100b and MBP in blood serum was performed by standard enzyme-linked immunosorbent assay (ELISA).

To activate the immunological tablet (Costar, USA), S100b protein or MBP (Sigma, USA) was used. For identification of the bound aAT, a conjugate of rabbit antibodies labeled with horseradish peroxidase labeled with human IgG and IgM was used (IMTEK, Russia). The optical density was measured 2–3 min after the reaction was stopped at a wavelength of 492 nm using a Multiskan RC spectrophotometer (Labsystems, Finland). The level of aAT was evaluated in units of optical density (OD), which is directly proportional to the color intensity.

The technical problem of the present invention is the need to predict and quantify the prediction of the likelihood of an adverse outcome in relation to the social postpsychotic functioning of patients with endogenous mental illness.

The technical result of the invention consists in obtaining quantitative information in the form of an estimate of the probability of an adverse outcome.

To solve the above problem and achieve the technical result, a method is proposed for predicting the likelihood of an adverse outcome in relation to the social postpsychotic functioning of patients with endogenous mental diseases, which includes determining at the beginning of an acute attack in the patient's blood the level of autoantibodies (aAT) for neuroantigens - the main myelin protein (MBP) and S100B protein in optical density units - ed-OD, and, with an increase in the level of autoantibodies to the main myelin protein (MBP) and / or protein in S100B above 0.9 OD, the probability of an adverse outcome is predicted for the social postpsychotic functioning of patients.

At the same time, the forecast of the probability of an unfavorable outcome in relation to the social postpsychotic functioning of patients made at the beginning of an acute attack upon admission to the clinic is compared with the assessment of social functioning using the Personal and Social Performance Scale (PSP) performed before discharge from the patient clinics.

The PSP scale was developed as an improved version of the SOFAS (Social and Occupational Functioning Assessment Scale) scale, which, in turn, is based on the DSM-IV criteria for the diagnosis of schizophrenia. The scale was published in 2000 by Professor Morosini.

Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 2000: 101: 323-329.

The method is implemented as follows.

Upon admission to the clinic at the stage of exacerbation of psychopathological symptoms, blood is drawn from a vein for immunological examination, (performed as part of a standard blood test, which is obligatory when a patient is admitted to a medical institution) with determination of two informative immunological parameters in the blood plasma - the content of autoantibodies to neurospecific antigens: level of autoantibodies (aAT) to neuroantigens - the main myelin protein (MBP) and S100B protein. With an increase in the level of autoantibodies to the basic myelin protein (MBP) and / or S100B protein above 0.9 units. opt.pl. predict the likelihood of an adverse outcome in relation to the social postpsychotic functioning of patients.

The level of social adaptation for comparison was measured by presenting the PSP scale to patients during the formation of remission before discharge from the clinic.

Examples of the method.

Example 1

Patient M. born in 1990

Anamnesis. Heredity is not psychopathologically burdened. Pregnancy and childbirth in the mother proceeded without pathology. Grew and developed according to age. He visited the DDU, adapted easily. Loved the game alone. Formed secretive, unsociable, obedient, but easily annoyed by the little things. I went to school on time. He studied satisfactorily, classes are not duplicated. He had no friends, there were friends with whom he maintained formal communication. Until the age of 10, he grew up in a complete family. After the parents divorced, he stayed with his mother. At the age of 14, there was an episode when he was very nervous, and a “breakdown” developed against this background: he screamed loudly, hit his wall with his fist, his mother called an ambulance, and calmed down after the appointments. In the future, this was not repeated. At the end of 11 classes he entered the MIEM at the faculty of materials science, received the specialty of a materials engineer. He did not serve in the army because of severe psoriasis. Over the next 1.5 years, he worked as a specialist in a radiation equipment manufacturing company. Since 2013, he began to experience intense excitement and anxiety at work, if it was necessary to call someone or agree on something. In the same year he was fired. He lived with his mother in a separate apartment, in fact, lived on her dependent. Occasionally worked as a copywriter in a company with friends.

His condition changed dramatically: on April 30, 2 ... years in the evening, while in his room, he was talking to himself. Then he left home without taking any things with him. He returned at 5 am the next day in a good mood, saying: "Mom do not worry, you will see a new son, we will have a new life." After some time, he began again talking to himself "about God, politics, how to accumulate light in yourself, to kill entities." Further, the speech became "inarticulate", became agitated, aggressive towards the mother. The patient’s father arrived and called a private psychiatrist for a consultation. After being examined by a doctor with a private ambulance team, the patient was taken to the Vozrozhdeniye clinic, where he received treatment from May 1 to 3, 2018. He was referred for treatment at the GBUZ PB No. 1 by a psychiatrist of the psychiatric emergency department due to improper behavior and persistent psychotic symptoms during treatment at the private clinic "Renaissance". He was anxious, he said that "it is necessary to develop psychicity and fight with entities." Productive contact was inaccessible, inhibited, thinking was paralogous.

Mental status at admission: admitted to the orderlies. Sluggish, inhibited. The eyes are half closed. Answers the asked questions selectively, in a low unmodulated voice. Facial expression at times gives the impression of a hallucinatory. The very existence of "votes" denies. He says that "he does not remember what happened to him a few days ago." At the same time, he recalls that "the mother is constantly changing, because of which he realized that different entities are instilling in her." He reports that "he does not understand why the relatives were afraid, because the mother remained alive as a result of his manipulations." Thinking is inconsistent. There is no criticism of the condition, refuses to continue treatment. He was hospitalized involuntarily in connection with an acute psychotic state with hallucinatory, delusional ideas and inadequate behavior in the Clinic of the first episode of GBUZ “PKB No. 1 DZM”.

DZ at admission: Acute polymorphic psychotic disorder with symptoms of schizophrenia, without associated stress (F23.10)

On the second day of treatment in the hospital, an analysis was taken on the level of autoantibodies to the main myelin protein (MBP) - 0.66 units. opt.pl., the level of autoantibodies to protein S-100B 0.63 units. opt.pl. that corresponds to normal indicators.

In the hospital, the patient spent 36 days and after stabilization, he was discharged for aftercare in the day hospital of the clinic of the first episode with the diagnosis: Schizophrenia of other established types (disorganized type), episodic type of course with an increasing defect. The state of drug remission (F20.8198) ”, where he continued treatment for 48 days. Before discharge from the day hospital, an assessment of social functioning was carried out on the PSP scale, a total score of 90, which corresponds to a mild difficulty in social functioning.

Example 2

Patient C., born in 1999

Anamnesis. Heredity is psychopathologically burdened. A maternal grandmother is observed in the PND “about anxiety,” taking phenazepam. The patient was born in a complete family, the second child of two children. Big brother is healthy, works as an artist. Mother works as a groom, soft, empathic in character. Father is a laborer, periodically alcoholized, by nature kind, responsive. Pregnancy and childbirth in the mother proceeded without pathology. Grew and developed according to age. By nature, formed a quiet, shy child. DDU visited, adapted with difficulty, supposedly other children teased her because of completeness. Often cried, did not want to leave the house. From 4 years old she was engaged in horse riding. I went to school from 6.5 years old. I also did not like going to school because of the rude attitude of classmates. It was attacked, other children ridiculed her appearance and the difficult financial situation of the family. At the age of 10, she began to carry her father’s camping knife with her to school for self-defense. Several times she fought off her peers with this knife. I did not share my experiences with my parents, I kept everything in myself. She studied satisfactorily. In adolescence, she began to experience conflicts more sharply. From time to time, she noticed the “boring glances of those around her” on herself, she became afraid to walk outside, and spent most of her free time at home. When she went or rode somewhere, she “felt like everyone was looking, condemning her physique, laughing” at her. From that time she began to lose weight. I excluded sweet and starchy foods from the diet and began to engage in physical exercises. Dropped about 20 kilograms in a couple of months. At 14, she made a tattoo on her arm according to her own sketch with the approval of her parents. At the end of grade 9, she reached a weight of 32 kg with a height of 157 cm, but still felt fat. Mother insisted that she seek help from a psychiatrist at the center. Received treatment with olanzapine, fluoxetine with positive dynamics. I entered the Theater and Art College №60. I stopped going to the psychiatrist, because I thought that he was not helping her. I liked to study, some teachers distinguished her as a talented student. Friends appeared. She began to work as an assistant animator at the Soyuz studio, where one of the teachers arranged it. She coped with the work, left when the project ended. She began to work as a model with her friend. In 2016, it became difficult to cope with school and work. For the first time, thoughts appeared that in life there was no sense, she wanted to "commit suicide." I thought through the various scenarios of passing away in my head. I wanted to hang myself on a belt, drown in the bathroom, jump from the roof. However, I did not dare to take such steps. In the spring of 2017, she abandoned her studies. Ceased to leave the house, all day lay in bed. Many thoughts were spinning in my head that she was a failure, a “defective person”, a burden for relatives. She began to apply superficial self-cutters to her forearms and inner thighs. At the insistence of her mother, she was hospitalized at the NCHP in May 2017. A week after the start of treatment, she insisted on discharge. She took the pleasure, felt “bad”, constantly wanted to sleep, was listless. I quit taking drugs. A month after discontinuing treatment, she drank a pack of amitriptyline for suicidal purpose. She was treated in the Department of Toxicology at the Institute. Sklifosovsky, then was transferred to the Korsakov Clinic. Took rispolept and cyclodol. During treatment, the condition stabilized. After discharge, she spent the summer in a camp in the Yaroslavl region with her mother. In early autumn, she again stopped taking drugs. In the winter of 2017-2018, she began to hear a male voice in my head, which was represented by Zagir. A voice commented on what was happening, condemned the patient, called her “fat”, “ugly”, forbade eating. By the spring of 2018, I began to feel that bugs were crawling under my skin. I saw them moving under their skin. There was an irresistible desire to get them out of there. She cut her leg with a knife in the thigh area in search of beetles. At some point, I realized that "it's not real." After that, the parents turned to IPA No. 1. She received treatment at the OIOPP PND (received haloperidol, mirtazpin), without significant dynamics. Subsequently, the first episode of GBUZ “PKB No. 1 DZM” was hospitalized in the Clinic.

Mental status

The patient is undernourished, her hair is braided in dreadlocks hanging with greasy locks. Consciousness is not darkened, oriented correctly. The contact is formal. In the conversation, she is opposed, emphasized indifferent. Facial expression masky, eye contact does not support. The voice is quiet, monotonous. Answers questions briefly, sometimes with a lowing. Annoyed, she says that she “will not be treated”, he and his father “came here only to see what conditions are here”. It does not deny data from medical records. She replies quite freely that she “wants to lose weight”, “feels fat”, “at home and on the street I felt unpleasant smells of pus and garbage from people, here too”, “spiders crawl under her skin, but she already got used to them”. With targeted questioning, he admits that he hears a male “voice” in his head, which prohibits her from eating. He says that "she never felt normal, even in childhood." He does not deny suicidal thoughts, he says that she tried to commit suicide due to the fact that "everything got tired, and the situation at home, and the appearance." Emotionally emasculated. Thinking is inconsistent, paralogous. In judgments ambivalent. There is no criticism of the state.

DZ at admission: Paranoid schizophrenia, episodic type of course. Hallucinatory-delusional syndrome. (F20.014)

On the second day of treatment in the hospital, an analysis was taken on the level of autoantibodies to the main myelin protein (MBP) - 1.02 units. opt.pl., the level of autoantibodies to protein S-100B 0.9 units opt.pl.

The patient spent 35 days in the hospital and was discharged to a day hospital with a diagnosis of “Paranoid schizophrenia, an episodic type of course with an increasing defect, incomplete remission (F20.014)”. In the day hospital, the patient was treated for 19 days. Before discharge from the day hospital, an assessment of social functioning was carried out on the PSP scale, with a total score of 68, which corresponds to low social adaptation.

Example. 3

Patient K., born 1988

Anamnesis. The heredity of psychopathological diseases is not burdened. Early development proceeded without features. I visited a kindergarten, where I adapted without difficulty. She started schooling in a timely manner and studied satisfactorily. She graduated from 11 classes of a secondary school and university, majoring in business management. At that time, she began to periodically use various surfactants - hash, "grass", LSD, ecstasy for relaxation, along with her ex-husband she was fond of meditations, various philosophical directions. Occasionally used psychostimulants before going to a disco. At times alcoholized, intoxicated, behaved strangely. In 2015, she suffered a severe head injury, help was provided at the emergency room - suturing the head wound, for 3 days she felt very ill, had repeated vomiting, did not get out of bed, then her condition improved. In 2016, the marriage was dissolved at the initiative of her husband, who learned that the patient was meeting with another man at the same time. Divorce was difficult - "divided the children, constantly cursed." Currently living with roommate and children. He does not work for a long time, he is engaged in self-education and self-development, attends various courses, trainings, practically does not engage in raising children. For the past 2 years she has been fond of vegetarianism and has given up all animal products. Her condition changed dramatically: she didn’t sleep a week before the actual hospitalization, wrote business plans at night, then stopped eating and drinking, lost weight very much, began to answer incoherent phrases, expressed anxiety and fears, informed her relatives that she “hears voices”, constantly shifting documents from place to place, walked around the apartment with a bag, said strange things. The ex-husband of the patient called the psychiatrist on duty when he came to her to pick up the things of the children, she was hospitalized in the Clinic of the first episode of GBUZ “PKB No. 1 DZM”.

Mental status. Consciousness is not darkened, oriented formally true. The conversation takes place at the invitation of a doctor. Outwardly tense, closed. Mimic reactions are smoothed out. The voice is quiet, poorly modulated. He answers the questions after a pause, choosing words, not always in the plan of the given. In his experiences, it is not fully revealed. He says that before hospitalization she felt only anxiety, fear. After direct questions from the doctor, she admits that she “heard children's voices”, but explains them “with a creative moment when she was writing a book,” he says evasively. "Voices" talked among themselves, gave advice. In conversation, he suddenly looks around the doctors and begins to smile, to listen to something. He does not deny that she had feelings that someone could read her thoughts, also states that "she can also read people's thoughts." The mood background is not sharply reduced. Thinking is inconsistent, paralogous. Denies perceptions, but the behavior gives the impression of a hallucinatory. It is uncritical to its state, believes that it does not need help.

DZ at admission: Acute polymorphic psychotic disorder with symptoms of schizophrenia, without associated stress (F23.10) Hallucinatory delusional syndrome.

On the second day of treatment in the hospital, an analysis was taken on the level of autoantibodies to the main myelin protein (MBP) - 0.66 units. opt.pl., the level of autoantibodies to protein S-100B 1.09 units. opt.pl.

The patient spent 42 days in the hospital and was discharged under the supervision of the intensive psychiatric care unit in the PND at the place of residence with a diagnosis of Paranoid schizophrenia, the observation period is less than a year. Hallucinatory-delusional syndrome. Hallucinatory-delusional syndrome. (F 20.09) The establishment of remission. " Before discharge, an assessment of social functioning was carried out on the PSP scale, with a total score of 68, which corresponds to low social adaptation.

Thus, the proposed method provides the clinician with quantitative information in the form of the probability of an adverse outcome in relation to the social postpsychotic functioning of patients with endogenous mental diseases.

The authors first established a relationship between the level of autoantibodies (aAT) to neuroantigens - the main myelin protein (MBP) and S100B protein in the patient’s blood and the likelihood of an adverse outcome with respect to the social postpsychotic functioning of patients with endogenous mental illnesses.

Claims (2)

1. A method for predicting the likelihood of an unfavorable outcome in relation to the social postpsychotic functioning of patients with endogenous mental illness, which includes determining at the beginning of an acute attack when the patient’s blood levels of autoantibodies (aAT) to the neuroantigens, the main myelin protein (MBP) and S100B protein, in units of optical density - units OD, and with an increase in the level of autoantibodies to the main myelin protein (MBP) and / or S100B protein above 0.9 units OD predict the likelihood of an adverse outcome in relation to the social postpsychotic functioning of patients. 2. The forecasting method according to claim 1, characterized in that the forecast of the probability of an adverse outcome with respect to the social postpsychotic functioning of patients made at the beginning of an acute attack upon admission of the patient to the clinic is compared with the assessment of social functioning on the scale of personal and social functioning of Personal and Social Performance Scale (PSP) performed before the patient is discharged from the clinic.