Depersonalization in the clinical picture of schizophrenia (literature review)

Background. At the pre-manifest stage of schizophrenia, nonpsychotic disorders are an important object of study in terms of prognosis of the disease course. In this regard, there is a growing interest of domestic and foreign authors in the study of disorders of self-awareness in the clinical picture of schizophrenia, and the results obtained are as-sessed as significant ones for the early diagnosis of the disease. Meanwhile, despite the long history of describing depersonalization in the clinical picture of schizophrenia, in ICD-10, the disorders of self-awareness are not included in the rank of diagnostically and prognostically informative ones for this disease, and in modern guidelines, they are discussed only partially in this context. In the domestic national handbook of psychiatry, depersonalization-derealization syndrome (F48.1) is defined as a rare disorder and is included in the ICD-10 heading “Neurotic, stress-related and somatoform disorders” (F40-F48). The existing contradictions suggest the need for further study of deper-sonalization-derealization as manifestations of schizophrenia. Objective: to systematize literature data on the phenom-enology of self-awareness disorders, prevalence and clinical manifestations of depersonalization-derealization in differ-ent forms of mental pathology, with an emphasis on their significance in the clinical course of schizophrenia. Materials and Methods. A search for domestic and foreign studies using scientometric databases (eLibrary, CyberLeninka, Pub-Med, ResearchGate) was conducted using the keywords: self-awareness disorders, depersonalization, derealization, schizophrenia, pre-manifest stage. Studies containing information on depersonalization symptoms, mainly presented in the structure of schizophrenia spectrum disorders, were selected for analysis. Results. Literature data indicate a lack of unity of views among modern authors regarding the psychopathological and clinical-nosological aspects of depersonali-zation-derealization. In pathogenetic terms, the development of depersonalization is associated with anxiety, depression, and dissociation. In the ICD-10 classification, it is presented as a separate diagnostic rubric, but is widely used in the clinical picture of various mental disorders, including schizophrenia. Follow-up studies confirm the high stability of de-personalization-derealization throughout all stages of schizophrenia, both in the slowly progressive course and in the manifest forms of the disease. In the clinical picture of initial disorders, depersonalization can manifest itself in the form of short episodes, in combination with other disorders. In the manifest of paranoid schizophrenia, it can be associated with the formation of delusional ideas and mental automatisms. In the clinical picture of schizoaffective psychosis, de-personalization-derealization can also be the basis for the development of delusions of staging, metamorphosis, reincar-nation. However, only a few works by modern authors are devoted to the analysis of the clinical typology of depersonal-ization-derealization in schizophrenia. The clinical variability of depersonalization in different types of course and at different stages of the disease requires clarification, since these data can contribute to the improvement of diagnosis, therapy, and prognosis. Conclusion. The analysis of the literature showed that, despite the long period of studying de-personalization-derealization, there remains a need for an in-depth study of this disorder in the clinical picture of schizo-phrenia. This is due to the prevalence of depersonalization in the clinical course of schizophrenia, its presence at all stag-es of the disease regardless of the type of course, its clinical and pathogenetic variability. This suggests the possibility of identifying clinical and prognostic characteristics in order to optimize the diagnosis, therapy, and prognosis of schizo-phrenia.