Relationship of clinical presentation and psychopathological mechanisms at the commitment of grave socially dangerous acts by schizophrenic patients

Aim. To study the relationship of clinical presentation and psychopathological mechanisms at the commitment of grave socially dangerous acts by schizophrenic patients.

Methods. The sample consisted of 201 schizophrenic patients who have committed grave socially dangerous acts targeted at the life and health of people. The investigation that included social-demographic, anamnestic and clinical data was performed. The sample was divided into three subgroups according to psychopathological mechanisms of grave socially dangerous acts commitment, determined by authors: unconditional-psychotic mechanism (n=46), conditional-psychotic mechanism (n=76) and negative-personality mechanism (n=79).

Results. In patients with the unconditional-psychotic mechanism, the acute psychopathological symptoms such as catatonic, affective and delusional syndromes, acute delusional conditions were prevalent by the time of commitment of socially dangerous acts. In patients with this mechanism of catatonic schizophrenia, remittent course or intermittent-progressive course with the increased production of negative symptoms in remission were significantly more common. In patients with the conditional-psychotic mechanism, paranoid schizophrenia was prevalent, which was characterized by a continuous course without remissions, delusions without hallucinations, or chronic paranoid states. In patients with the negative-personality mechanism, the major psychopathological syndromes were defect and final states; residual schizophrenia and paranoid form of schizophrenia were common, intermittent-progressive course with stable but not increasing negative symptoms had dominated. The highest average duration of the disease at the time of committing a socially dangerous action was associated with the negative-personality mechanism. It was 13.56±9.00 years, which is considerably higher than at unconditional-psychotic mechanism (7.02±7.40 years) and at conditional-psychotic mechanism (7.38±8.35 years).

Conclusion. When developing treatment and prevention measures, it is necessary to take into account the psychopathological mechanisms of commitment of grave socially dangerous acts combined with data of clinical presentation.