Шизофрения: нарративный обзор этиологических и диагностических проблем

ВВЕДЕНИЕ: Несмотря на описание шизофрении еще в древней истории, многолетние исследования, данное расстройство во многих аспектах остается неясным и спорным. Это касается этиологии, патогенеза, классификации, диагностики, оптимизации терапии.

МЕТОДЫ: Литература (выборочные релевантные открытые источники — из системы elibrary.ru и РИНЦ, а также базы Российского отделения Кокрановской библиотеки (https://www.cochrane.org/ru/evidence) анализировалась диахроническим методом, что позволило выявить важные переменные в воззрениях на шизофрению на протяжении 100 лет до настоящего времени. Приоритет отдавался обзорам и руководствам, оригинальным исследованиям по проблеме шизофрении последних 10 лет.

РЕЗУЛЬТАТЫ: Согласно литературе, проанализированной по концепционной схеме (основные направления и факты в изучении этиологии, динамики, критериев диагностики шизофрении, спорные аспекты указанных направлений и фактов; основные перспективы в изучении шизофрении), были получены представленные результаты. У психиатров всегда были основания различных воззрений на данное расстройство, варианты его динамики и критерии динамических этапов, включая ремиссию. В разные годы ученые находят аргументы для взгляда на шизофрению и как на одно расстройство, так и на два и даже на группу расстройств, а также как на синдромы. Систематизирована полиморфная симптоматика и наиболее типичная динамика многообразных форм шизофрении, однако ни в России, ни в других странах по-прежнему не доказана этиология и не сформирована концепция патогенеза даже в рамках отдельных типов расстройства. Приведенные в доступной литературе причины гипо- и гипердиагностики шизофрении не могут охватить все вероятные объективные и субъективные трудности, возникающие при диагностическом процессе.

ЗАКЛЮЧЕНИЕ: В целом же, как следует из отечественной и зарубежной литературы, проблему шизофрении еще долго нельзя будет относить к исчерпанным. Во многом это зависит от позиций общества, развития биологических наук и патоморфоза самого расстройства. Многие аспекты шизофрении могут стать более ясными и менее спорными при систематических системных исследованиях, основанных на полученных ранее и дальнейших данных, на новом этапе методических возможностей. Обзор литературных данных по указанным выше аспектам шизофрении может способствовать вниманию ученых к тем или иным результатам исследований, при ином анализе и синтезе информации.

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