Treatment Tactics in Remission Stage of Episodic Schizophrenia Taking into Account Immunological Parameters

Background: the study of clinical remission in schizophrenia has a significant place at the current stage of development of psychiatric science. Prevention therapy and personalized prophylactic therapy is important to improve the quality of remission, stabilization of the endogenous process and prevention of exacerbation. The aim was to develop apathogenetically grounded method of treatment of episodic schizophrenia at the remission stage using complex assessment of clinical, psychometric and immunological parameters of patients, which allows to control the quality and stability of remission, as well as prediction of exacerbation of the endogenous process. Patients and methods: 91 patients (24 men and 67 women) aged from 18 to 70 years were examined. They were in remission after suffering attacks of an endogenous disease with episodic course (the duration of remissions ranged from 6 months to 12 years). Clinical-psychopathological, psychometric, immunological, clinical and followup, and statistical methods were used. Results: determination of inflammatory and autoimmune markers of blood plasma in the dynamics of the disease and their comparison with the severity of psychopathological symptomatology of patients with schizophrenia, made it possible to form 2 groups of patients with differently directed correlations between the change in clinical state (according to the PANSS scale) and the level of activation of the immune system, assessed in the aggregate immune markers determined. For patients of group 1 (n = 58; 63.74%) the decrease of the intensity of psychopathological symptoms in remission is associated with a decrease in the level of immune system activation («positive» correlations). For the patients of group 2 (n = 33; 36.26%) the level of immune system activation in remission does not decrease and remains at the level of the acute stage of the disease (“negative” correlations). It is shown that the increase in the level of immune system activation in patients of group 1 is a prognostic immunological criterion of possible exacerbation of psychopathological symptoms in remission. Based on the determination of immunological blood parameters in remission, personalized treatment tactics have been developed for these patients, associated with the transition from maintenance doses of drugs to therapeutic ones or additional use of drugs of another group. In most cases, this tactic contributed to relatively favorable dynamics of the existing clinical remission without significant changes in the condition. For patients of group 2, the personalized therapy tactics involves continuation of longterm active therapy. Conclusions: complex assessment of clinical, psychometric and immunological parameters of patients with episodic schizophrenia, which allows to control the quality and stability of remission, can be used to control the quality and stability of remission, as well as to detect preclinical signs of exacerbation of the endogenous process.