[Current concept of schizophrenia: state of the art]

Approaches to diagnosing schizophrenia are different. There is a distinct tendency either to narrow the limits of the disease or to expand it, which in some cases leads to a disagreement and even a tendency to disputes. The comprehensive studies conducted in the Mental Health Research Center, Russian Academy of Medical Sciences, have provided an overall notion of the disease in terms of its progression and outcome. The clinical picture of schizophrenia is characterized by obligatory specific disorders, such as autism, reduced energy potential, emotional thinking, and behavioral disorders. Personality changes may be seen as the smoothening of specific personality traits and the appearance of the features that are not inherent to the patients in the past. Schizophernia is also characterized by positive psychopathological syndromes: pseudoneurotic, affective, psychopathy-like, hallucinatory-paranoid and catatonic. A study of 7500 patients with schizophrenia demonstrated that there were clear-cut regularities in the development of the disease, which suggest that there are forms and types in its progression. The study identified 3 forms of development: continuous, recurrent, and attack-like progressive with varying degrees and rates of the process (severe, moderate, and mild). Genealogical and clinicogenetic studies demonstrated accumulation of psychoses and abnormal personalities in the families of probands, manifest and slowly progressive forms of schizophrenia and cases of schizoid psychopathy. Among the wide spectrum of pathogenetic concepts, priority should be given to the dopamine hypothesis, whose main point is accumulation of an excessive amount of dopamine in the brain tissue, especially in the nigrostriatal, mesocortical, and mesolimbic systems. This may lead to activation of dopaminergic brain structures with an increase of dopamine receptors. This hypothesis is confirmed by the neuropathological studies demonstrating a significant increase in the numerical density of the dendritic spines and dendritic trunks in the with layer of the prefrontal cortex. The highest index of the numerical density was observed in young patients with prevalent negative disorders. Inasmuch as there is no correlation of this index with the duration of the disease, it can be concluded that the abundance of synaptical connections is a result of disturbed brain development and a factor predisposing to severe progression of schizophrenia. Treatment modalities are determined by the form and rate of progression of and the pattern of the psychopathological syndrome. Of particular importance is the role of age, somatic state, and individual sensitivity to neuroleptic drugs. Another important factor in the treatment of schizophrenia is a simultaneous or consecutive impact on the psychopathological syndrome and the disease as a whole.