Efficacy of psychodynamic therapy in the algorithm of comprehensive treatment for paranoid schizophrenia patients

Psychodynamic therapy aims to carry out psychocorrection of early emotional conflicts in order to eliminate their negative impact on later life, reduce manifestations of self-aggression and psychological avoidance, improve patient socialization, and achieve stable remission. Objective: To assess the effectiveness of psychodynamic therapy in the comprehensive treatment of patients with paranoid schizophrenia. Materials and Methods. The study was conducted at the 3rd and 4th therapeutic departments of the Federal State Institution «Novosibirsk Specialized Psychiatric Hospital with Intensive Observation» of the Ministry of Health of Russia and the 3rd male psychiatric department for the first psychotic episode of the State Budgetary Healthcare Institution «Novosibirsk State Clinical Psychiatric Hospital No. 3». The sample included male patients (n=61) with paranoid schizophrenia (F20.0), with mean age of 33±8.89 years. Based on the type of therapy, the sample was divided into the following groups: the study group (n=41) — a combination of psychopharmacotherapy, psychodynamic therapy, and psychosocial support; the comparison group (n=20) — standard antipsychotic therapy for schizophrenia without psychodynamic therapy. The duration of therapy was 1.5–2 months. The severity and dynamics of the schizophrenic process under the influence of antipsychotic therapy were assessed using the CGI Scale. Psychometric tools included an adapted version of the Symptom Checklist-90, the Defense Mechanisms Rating Scale, an adapted version of the Fear of Personal Death Scale (FPDS), and the Death Attitude Profile-Revised (DAP-R). Statistical analysis was performed using the SPSS Statistics software package with standard methods for calculating means, standard deviations, and frequencies. Results. In both groups, the initial CGI-S score (5.4±0.7 and 5.2±0.4 points) showed no statistically significant differences. In the study group, the intermediate score after three weeks and the final score at discharge showed a statistically significant (p<0.05) reduction (2.1±0.2 and 2.9±0.4 points; 1.3±0.1 and 1.8±0.2 points). According to the PANSS, both groups had a score of 110.0 (103.0; 116.0) at the time of inclusion in the study. During therapy, the study group showed a more pronounced statistically significant (p<0.05) alleviation of deficit symptoms (70.8±10.4 and 80.5±8.5 points) and a more pronounced statistically significant (p<0.05) restoration of the previous state (37.7 and 28.5 points). Conclusion. A relationship between the psychopathological symptoms of paranoid schizophrenia, fear of death, and psychological defense mechanisms was found. A more detailed study focusing on psychodynamic characteristics will deepen and expand psychocorrection strategies and psychotherapeutic tactics for working with patients with this nosology.