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Schizoaffective disorder - endogenous neprogredientnoe mental illness with a relatively favorable prognosis, which is characterized by recurrent attacks occurring with the presence of depression, mania, mixed disorders of endogenous nature and hallucinatory-delusional manifestations, not derivable from passion.

Schizoaffective disorder was first identified Kazanin (J. Kazanin, 1933) based on an analysis of 7 patients with acute psychosis, but similar clinical descriptions were given earlier K. Kleist (K. Kleist, 1921) as the boundary, or cycloid psychoses.

Most local psychiatrists, for example AB Snezhnevsky. P.A. Nadzharov (1960, 1969), held a two-term taxonomy of endogenous psychoses E. Kraepelin and schizoaffective psychosis treated within the circular (periodic) schizophrenia.

According to TF Papadopoulos (1968, 1983), schizoaffective psychosis have still no permanent place in psychiatric classification, no conventional notation. In ICD-10, these stand out as psychosis schizoaffective disorder in a separate category (F25) in the class of "schizophrenia and other psychotic disorders, and delusional", representing one of the fragments of the schizophrenia spectrum.

PREVALENCE

The prevalence of schizoaffective psychosis due to the uncertainty of clinical criteria for this group can not be regarded as finally established. A. Marneros (A. Marneros, 1989), focusing on the criteria DSM-III-R, determined by the prevalence of this group of diseases in all endogenous 15-30%. In our country, EV Panicheva (1975, 1982) and L. M. Shmaonova et al. (1 985) found that the prevalence of schizoaffective psychosis is 1.13 or 0, 85 (L. M. Shmaonova) per 1000 under the identification schizoaffective psychosis with recurrent (periodic) forms of schizophrenia.

CLINICAL PRESENTATION

On the prevalence of affective disorders in schizophrenic or schizoaffective picture and attack isolated affektdominantnuyu shizodominantnuyu form.

Affektdominantnaya form of the disease mainly occurs in people with schizoid traits, reaching the degree of accentuation and (rarely) a psychopathic level. In the early (prodromal) stages in the period of puberty crisis (12-15 years) marked affective lability manifestations with a predominance of depressive reactions, sometimes depression can be formed endoreaktivnoy structure.

Schizoaffective symptomatic attack usually develops after endogenous provocation less autochthonous. Stages of development of psychosis show a succession of phases: affective, affective delusions affective-delusional, delusional disorders and nonaffective again affective manifestations in reversal of attack. The clinical picture of seizures can manifest itself in different ways - as an alternative to the predominance of acute psychosis picture sensual delirium delirium type of perception as an option with visual-shaped delusions of imagination or intellectual delirium characterized by a predominance of imagination (see Chap. 11 "Pathology thinking (disorder sphere of associations "). Repeating schizoaffective attacks can be noted that they have the character of" cliche. "in remission may show negative personality changes as a deficiency of emotional and loss of productivity fails to reach the defect.

Shizodominantnaya form. Clinical manifestations in these patients are defined by features of delusional syndromes in the structure of schizoaffective attack. Characteristic feature is usually considered manifestations of the presence of acute sensory delusions and a tendency to develop ideatornoy delusional constructions. In the present status of the patients expressed paranoid register with the development at the height of attack syndrome Kandinsky - Clérambault. Actually affective disorders in this variant of the disease of short duration (two to three weeks), and during the formation of delusional disorders expressed here is longer (one to two months). Schizophrenic symptoms presented in greater volume than affektdominantnoy form. The total duration of this attack schizoaffective is not less than six months. Value for affective and schizophrenic (delusional) disorders in this embodiment schizoaffective state is about 1.5:1. Domanifestnogo period for the presence of schizoid premorbid sharpening typical warehouse properties in the simultaneous presence of affective disorders with long over them. For one or two years before the manifestation of an increase in the severity of symptoms of affective disorders. Overt attack usually develops autochthonous, less its manifestations arise against psychogenic or somatogenically. The clinical picture is dominated by delusional disorder and attack proceeds as paranoid psychosis with acute manifestations of the syndrome Kandinsky - Clérambault. Due to the prevalence of different typologies of delusion released version with picture of acute paranoid syndrome, delirium perception defines certain elements of interpretive delirium option with the development of acute paranoid psychosis in the presence of visual-figurative delirium with elements of interpretation, as well as acute paranoid syndrome (Kandinsky Clérambault ) with systematized delusions and interpretive elements of sensual delirium (GP Panteleeva et al., 1999).

Etiology and Pathogenesis

Etiology schizoaffective psychosis, as well as all endogenous diseases hitherto not fully defined. Essential role of genetic factors in relation to family history in these patients. Some researchers have identified premorbid custom warehouse, which is defined by them as schizoaffective (JL Polozker, 1933). In the advent of affektdominantnyh forms are particularly important external factors that trigger the development of psychosis. A gender (female predominance) is not universally accepted by researchers. P.A. Nadzharov and A.B. Smulevich (1983) considered as recurrent schizoaffective disorder schizophrenia, which is more common in women.

DIFFERENTIAL DIAGNOSIS

Necessary to carry out differential diagnosis of affective disorders (TIR by E.

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