Features of Cognitive Functioning In Patients with Paranoid Schizophrenia and Concomitant Cerebrovascular Pathology

paranoid schizophrenia cerebrovascular cognitive patient

The separation of schizophrenia into forms was initially supported by the idea of determining the prognosis and adaptation possibilities. At the present stage of the development of the research of schizophrenia, many researchers are moving away from this classical division. Firstly, the modern arsenal of drugs and non-drug methods of treatment helps to achieve high-quality remission. Secondly, pathomorphosis, including drug, erases clear frameworks and criteria. More and more scientific studies are aimed at studying the residual (deficient) symptoms of the disease, cognitive decline, and the possibility of active functioning, despite the presence of the pathological process [1,2].

Under the influence of various factors (medicinal and non-medicinal), the classical picture of paranoid schizophrenia is obliterated. Drug therapy has always introduced certain components in the pathomorphism of the disease. With the introduction of atypical antipsychotics into clinical practice, many scientific works devoted to the study of somatic disorders in this category of patients began to appear. Various studies confirm the negative impact of modern antipsychotic drugs on glucose tolerance, weight gain, and the development of dyslipidemia. Prevailing disorders lead to the development of acute and chronic vascular disorders, including cerebrovascular pathology (CVP), which are manifested not only by cerebral but also by focal symptoms. In many cases, according to modern literature, CVP manifests itself slowly, combined with mild cognitive deficit [3-5].

Despite the long-term study of mental activity, cognitive function, due to its versatility, remains poorly understood. In the structure of cognition, perceptual function, memory, thinking, learning ability, and, according to some researchers, attention are distinguished.

Changes that occur in the mental areas responsible for the cognitive component of the personality lead to violation of the adaptation processes associated with self-realization, initiative, dynamism, and creativity [6, 7].

The ability to apprehend, study and memorize information, in addition to the experience gained with time, that is, possessing a certain mental development coefficient (IQ), is inherent in human beings and confirms the continuity of their mental activity. This ability changes while aging, as well as under the influence of various pathological processes. Traditionally, schizophrenia and schizophrenic spectrum disorders have been separated from organically caused (atherosclerosis, brain damage, atrophy) mental disorders. The thesis that patients with schizophrenia formally preserve memory, intelligence, and attention is undergoing considerable changes [8-11].

Memory, as a process of cognition, employing encoding, storage, and retrieval of information has several functions. On the one hand, it is the availability of factual information about the world (declarative memory). On the other hand, it is information that allows people to perform sequential operations (procedural/random access memory). Its belonging to knowledge is generally accepted and non-discriminatory.

Such mental function as attention raises many questions. Attention can be perceived as an independent mental process and as an auxiliary one, as it participates in the functioning of other mental processes. Some researchers consider a separate mental process and associate it to cognition, while other scientists consider attention within the structure of the effector-volitional sphere. Attention is the ability to concentrate and switch focus, the orientation, selectivity as well as safety of the mental activity. It is carried out through the dominance and irradiation of nervous processes in the reticular formation. At the same time, attention is impossible without cortical influence, which ensures focus and orientation. The zone of attention coincides with the so-called zone of clear consciousness [6, 7].

In modern scientific literature, conflicting data are presented, testifying both in favor of reducing memory and attention in patients with schizophrenia, and data that cast doubt on it. Given the foregoing, this study is devoted to the study of cognitive functioning, in particular memory and attention in patients with schizophrenia, given that these mental functions also suffer from other acute and chronic vascular, atrophic and neurodegenerative brain changes [3, 4].

Purpose of the study

Assess qualitatively and quantitatively the changes in cognitive functions, in particular memory and attention, as well as confirm the assumption of pathomorphism of paranoid schizophrenia in women with concomitant cerebrovascular pathology.

Contingent and research methods

The selection of the contingent for the study was carried out in two stages, in compliance with the rules of ethics and bioethics, the law "On Psychiatric Care", and obtaining voluntarily informed consent to participate in the study. At the initial stage, 59 female patients suffering from paranoid schizophrenia and being treated in 1 psychiatric ward of the KNP KHP OKPB No. 3 were selected during 2018-2019.

The inclusion criteria were: female gender, the presence of an established diagnosis of paranoid schizophrenia for at least 5 years, treatment with atypical antipsychotics for at least 2 years, participants aged 30-45 years.

The exclusion criteria were: a history of electroconvulsive therapy, a history of insulin-coma therapy, the presence of premorbid and uncompensated combined somatic and endocrine pathology, the presence in the history of acute cerebrovascular accident or myocardial infarction, premenopause and menopause, and long-term therapy with clozapine.

In the second stage of the study, 2 groups were selected from this cohort: the study group and the control group. The study group consisted of 29 female patients with a diagnosis of paranoid schizophrenia and with concomitant chronic cerebrovascular pathology (CVP). The control group consisted of 30 patients with paranoid schizophrenia who did not have concomitant cerebrovascular pathology.

The present study used clinical-psychopathological, clinical- anamnestic, psychodiagnostic, and statistical methods. When using the clinical-psychopathological method, clinically directed questioning and observation are involved, leading psychopathological phenomena in the examined contingent are evaluated. The clinical-anamnestic method included collecting a subjective and an objective medical history and working with archival documents (medical history, epicrises from the psychoneurological dispensary (KNP KHOR "GPND No. 3")).

The psycho-diagnostic method included the use of the PANSS method, the Proof Test, and the 10-word memory test with an analysis of the results.

The 10-word memorization test proposed by A.R. Luria made it possible to assess the state of memory (auditory, mechanical memorization, and reproduction) and attention (fatigue, exhaustion, voluntary attention). This technique is applicable for the diagnosis of impaired cognitive mental functions, both in organic diseases of the brain and in other mental pathologies, both in adults and children over 5 years old.

For the sake of research, subjects were offered monotonous, simple words, with the same number of syllables, not connected in meaning by associations. The material was provided to the subject until complete memorization or 5-6 times. Every extra word that was mentioned by the patients was recorded separately.

The "Proof test" is used to examine the concentration and stability of the attention of schoolchildren and adults.

The test takes 5 minutes. We used special forms with rows of randomly arranged letters in which patients marked a specific letter ("e"). Every 60 s, a vertical line was displayed showing the number of characters viewed. Using the Proof test, we evaluated such characteristics of attention as concentration and stability.

Results and discussion

Among the studied contingent of patients, there were no differences in the course of paranoid schizophrenia. All patients exhibited a continuous course of the disease (100%). The following differences were revealed in the development of the defective state. The results are presented in Table 1.

While the paranoid type of defective state prevailed in both groups, certain differences were recorded within the groups. In the study group, after the paranoid defect (48.3%) was the psychopathic defect (31.0%) was more often presented, while in the control group, after paranoid (50.0%), the incidence of the apato-abulic defect (40.0%) was higher than in the study group (20.7%).

In the study group, the initial episode of psychosis (debut) began at an earlier age (24.2±0.7) than in the control group (26.7±0.4; p<0.01). There were also significant differences in the number of hospitalizations per year (3.10±0.3 and 1.9±0.4; p<0.05, respectively). This indicator in the study group exceeded that in the control group. It is known from archival documents and complaints from patients of the study group that over the past (3.7±1.8) years, they have recorded an increase in blood pressure to hypertonic numbers, clinical manifestations of cerebral and diffuse focal neurological symptoms have been recorded (27, 93.1%).

Table 1

General characteristics of the research contingent

Table 2

paranoid schizophrenia cerebrovascular cognitive patient

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