Consortium PSYCHIATRICUMConsortium PSYCHIATRICUMConsortium PSYCHIATRICUM2712-76722713-2919Eco-Vector1551310.17816/CP15513REVIEWОБЗОРReview ArticleThe modern concept of schizoaffective disorder: a narrative reviewСовременная концепция шизоаффективного расстройства: нарративный обзор литературыhttps://orcid.org/0000-0003-2742-552X8090-5037PavlichenkoAleksey V.ПавличенкоАлексей Викторович
Russian Federation

MD, Cand. Sci. (Med.), Associate Professor, the Department of Mental Health, Faculty of Psychology, Lomonosov Moscow State University; Chief Specialist, International Scientific and Educational Center for Neuropsychiatry, Samara State Medical University under the Ministry of Health of the Russian Federation

apavlichenko76@gmail.comhttps://orcid.org/0000-0003-4096-62083341-2372PetrovaNatalia N.ПетроваНаталия Николаевна
Russian Federation

MD, Dr. Sci. (Med.), Professor, Head of the Department of Psychiatry and Narcology

доктор медицинских наук, профессор, зав. кафедрой психиатрии и наркологии

petrova_nn@mail.ruhttps://orcid.org/0000-0002-2274-07349873-4400StolyarovAndrey R.СтоляровАндрей Романович
Russian Federation

6th year student of Saint Petersburg State University

apavlichenko76@gmail.comLomonosov Moscow State UniversityМосковский государственный университет им. М.В. ЛомоносоваSamara State Medical UniversityСамарский государственный медицинский университетSaint Petersburg State UniversityСанкт-Петербургский государственный университет04102024081020245342551202202403092024Copyright ©; 2024, Pavlichenko A.V., Petrova N.N., Stolyarov A.R.Copyright ©; 2024, Павличенко А.В., Петрова Н.Н., Столяров А.Р.2024Pavlichenko A.V., Petrova N.N., Stolyarov A.R.Павличенко А.В., Петрова Н.Н., Столяров А.Р.https://creativecommons.org/licenses/by-nc-nd/4.0https://consortium-psy.com/jour/article/view/15513

BACKGROUND: Schizoaffective disorder (SAD) is one of the most complex and controversial diagnoses in clinical psychiatry. Despite the significant changes that have occurred in the conceptualization of SAD in modern classifications and the publications of recent years, many unresolved issues remain regarding the disease, from the point of view of clinical psychiatry and basic neuroscience.

AIM: The purpose of this paper is to summarize published data on the concept of SAD, its clinical characteristics, cognitive profile, potential biomarkers, as well as the place of the disease in the following modern international classifications: the International Classification of Diseases (ICD) 9th, 10th and 11th revisions, and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

METHODS: We undertook a review of the scientific studies in the relevant bibliographic systems and databases (eLIBRARY, PubMed) of the past 15 years. The descriptive analysis method was used to summarize the collected information. A total of 70 publications were selected for review, including different versions of international classifications of diseases (ICD and DSM-5).

RESULTS: There has been some improvement in the inter-rater reliability of SAD criteria in modern classifications, but this has not yet led to a clearer understanding among mental health specialists, while the various subtypes of SAD identified so far fail to account for the heterogeneity in the clinical presentation of the disorder. The dimensional approach to diagnosing SAD, according to which the intensity of psychotic and affective symptoms can fluctuate over time and they can influence one another, more accurately reflects the disease’s ability to embody different forms. Basic research does not support the identification of a distinct cognitive, neuroimaging, or immunological SAD endophenotype that differs qualitatively from schizophrenia and affective psychoses.

CONCLUSION: The conceptualization of SAD remains incomplete, and new approaches rooted in neuroscience are needed to better understand the coexistence of affective and psychotic symptoms.

ВВЕДЕНИЕ: Шизоаффективное расстройство (ШАР) — один из самых сложных и дискуссионных диагнозов в клинической психиатрии. Несмотря на значительные изменения в концептуализации ШАР в современных классификациях болезней и публикациях последних лет, в отношении этого заболевания остается множество нерешенных вопросов с точки зрения клинической психиатрии и фундаментальных нейронаук.

ЦЕЛЬ: Целью работы было обобщить опубликованные данные о концепции ШАР, его клинических характеристиках, когнитивном профиле, потенциальных биомаркерах, а также о месте этого заболевания в следующих современных международных классификациях: Международной классификации болезней (МКБ) 9-го, 10-го и 11-го пересмотра и Диагностическом и статистическом руководстве по психическим расстройствам (Diagnostic and Statistical Manual of mental disorders, 5th edition — DSM-5).

МЕТОДЫ: Выполнен обзор научных исследований в релевантных библиографических системах и базах данных (eLIBRARY, PubMed) за последние 15 лет. Для обобщения полученной информации был использован описательный анализ. Всего для обзора отобрано 70 публикаций, включая различные версии международных классификаций болезней (МКБ и DSM-5).

РЕЗУЛЬТАТЫ: Некоторое улучшение межрейтинговой надежности критериев ШАР в современных систематиках пока не привело к лучшему их пониманию специалистами, а различные выделенные подтипы ШАР не могут объяснить гетерогенность клинической картины этого расстройства. Дименсиональный подход к диагностике ШАР лучше соответствует изменчивой природе заболевания. Согласно ему интенсивность психотических и аффективных симптомов может меняться в разные периоды времени и они могут взаимно влиять друг на друга. Фундаментальные исследования не поддерживают выделение особого когнитивного, нейровизуализационного или иммунологического эндофенотипа ШАР, качественно отличного от шизофрении и аффективных расстройств.

ЗАКЛЮЧЕНИЕ: Концептуализация ШАР в настоящее время далека от завершения. Чтобы лучше понять природу одновременного существования аффективных и психотических симптомов, необходимы новые концептуальные подходы, основанные на достижениях нейронаук.

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