Characteristics of the affective sphere in patients with negative symptoms in schizophrenia

Abstract

Introduction. The prevalence of schizophrenia in the world reaches 1.4 %, and the number of patients with negative disorders in this group is 90.0 %. Negative symptoms (NS) can be considered the main category symptoms of schizophrenia. They are described as a change in the patient’s usual behavior, which is usually caused by a decrease or lack of motivation, interest, and a violation of the emotional component. Currently five signs are considered key manifestations of schizophrenia NS: flattened affect, alogia, anhedonia, asociality and abulia. The leading manifestation of NS is a flattened affect, characteristic with the weakness of emotional reactions, emotional blunting with a decrease in the brightness of feelings, empathy, indifference to others, misunderstanding of the subtleties of human communication, formality, superficiality of interpersonal relations, low expressiveness of gestures and facial expressions, modulation of voice, posture and emotions. All these manifestations have negative social consequences. At the moment, understanding disorders of the affective sphere manifestations in patients with NS in schizophrenia is far from complete; subsequently the development of innovative treatment of this particular condition has been far too slow, being considered an unsolved problem in modern psychiatry. Therefore, the investigation of the features of the affective sphere in patients with NS in schizophrenia is relevant and requires further careful studies. The aim of the study – to determine the peculiarities of the dynamics of the clinical-psychopathological structure and the severity of affective flattening in patients with NS in schizophrenia in order to improve the diagnosis and correction of the affective sphere in schizophrenia. Materials and methods. Clinical-psychopathological, psychometric (SANS scale) and statistical research methods were used to study the dynamics of the characteristics of the affective sphere in patients with negative symptoms in schizophrenia. In total 252 patients with NS of schizophrenia took part in the investigation, including: 83 patients with a first psychotic episode; 88 patients with schizophrenia in a state of exacerbation; and 81 patients with schizophrenia in a state of remission. Results. Verification of negative violations was carried out using the SANS scale. Affective flattening or blunting prevailed in 34.67 % of patients with a first psychotic episode, in 49.18 % of patients with schizophrenia in a state of exacerbation, and in 68.21 % of patients with schizophrenia in a state of remission. The main manifestation included impoverished expressiveness of reactions and emotional sensitivity. Weakening of emotional reactions, mental coldness, indifference, monotony were also observed. On this background, many patients lost all feelings for relatives and loved ones, and showed complete indifference to themselves and their condition. It was found that the most affected components in patients with a first psychotic episode were reduced expressiveness of speech, avoidance of eye contact, subjective feeling of loss of emotions, and inadequacy of affect. In patients with schizophrenia in a state of exacerbation, intensification of affect was added to the listed symptoms, and in patients with schizophrenia in a state of remission, indicators of intensification of affect increased and symptoms of impoverished motor expressiveness, decreased spontaneous mobility, and impoverished facial expressions were added. Conclusions. The peculiarities of the dynamics of the characteristics of the affective sphere in patients with negative symptoms in schizophrenia were established: a) patients with the first psychotic episode (group I) were characterized mainly by minimal disturbances of emotional reactions and minimal manifestations of impoverished facial expressions; lack of reduced mobility; minimum and average levels of motor expression disorders; a slight level of inadequacy of affect, a subjective feeling of loss of emotions and eye contact disorders; mainly a moderate level of speech intonation deficiency; b) patients with negative symptoms of schizophrenia in an acute state (group II) were characterized mainly by mild and minimal levels of facial expression impoverishment; minimal decrease in spontaneous mobility; mainly minimal and average levels of expressive motor disorders; pronounced and severe levels of eye contact avoidance; a slight decrease in emotional reactions; moderate level of inadequacy of affect, lack of language intonations and subjective feeling of loss of emotions; c) patients with negative symptoms of schizophrenia in a remission (III group) were characterized mainly by moderate and pronounced levels of impoverishment of facial expressions, spontaneous mobility, motor expressiveness, avoidance of eye contact, reduction of emotional reactions; moderate inadequacy of affect; lack of language intonations of pronounced and severe levels; expressed subjective feeling of loss of emotions. The obtained data can be used to establish diagnostic criteria among patients with negative symptoms in schizophrenia, depending on the dynamics of the disease.