Starostina E A, Yagubov M I
Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(3):18-23. doi: 10.17116/jnevro202112103118.
To study the features of the formation of gender reassignment`s ideas in schizophrenia spectrum disorders and to differentiate diagnosis of these psychopathological formations with transsexualism.
The study was carried out in the Department of Sexology and Therapy of Sexual Dysfunctions of the Moscow Research Institute of Psychiatry - a branch of the Serbsky National Medical Research Center for Psychiatry and Narcology in the period from October 2018 to May 2020. The study included 100 outpatients referred for gender reassignment. The subjects were divided into two groups. The first group consisted of 58 patients with schizophrenia spectrum disorders (Paranoid schizophrenia, F20.0; Schizotypal disorder, F21; Chronic delusional disorders, F22) with ideas of sex change. The second group included 42 patients with a diagnosis of «Transsexualism» (F64.0). Clinical-psychopathological, pathopsychological and statistical methods were used.
Patients with transsexualism are statistically significantly more often adapted in terms of work and family, have experience of life in the desired gender, use hormone therapy and gender-affirmative interventions before undergoing a medical commission on gender reassignment and less often hospitalized in psychiatric hospitals, compared to patients with schizophrenia spectrum disorders (<0.05). Patients with schizophrenia are more likely to experience delays and disharmony in psychosexual development. Sex reassignment ideas are more common in schizotypal disorder than in other types of schizophrenia.
Ideas of gender reassignment in schizophrenia spectrum disorders, as a rule, are formed on the basis of existing deviations in the early stages of the formation of gender identity. The central place in the psychopathology of schizophrenia spectrum disorders with ideas of gender reassignment is occupied by depersonalization-dysmorphophobic experiences with the following formation of overvalued, delusional or paranoid ideas of sex reassignment.
研究精神分裂症谱系障碍中性别重新认定观念的形成特征，并将这些精神病理表现与易性癖进行鉴别诊断。
该研究于2018年10月至2020年5月在莫斯科精神病学研究所性学与性功能障碍治疗科开展，该科室是塞尔维亚国家精神病学与麻醉学医学研究中心的分支机构。研究纳入了100名寻求性别重新认定的门诊患者。受试者被分为两组。第一组由58例患有精神分裂症谱系障碍（偏执型精神分裂症，F20.0；分裂型障碍，F21；慢性妄想障碍，F22）且有性别改变观念的患者组成。第二组包括42例诊断为“易性癖”（F64.0）的患者。采用了临床精神病理学、病理心理学和统计学方法。
与精神分裂症谱系障碍患者相比，易性癖患者在工作和家庭方面的适应情况在统计学上显著更优，有在期望性别中的生活经历，在接受性别重新认定医学委员会评估前使用激素治疗和性别肯定干预，且较少入住精神病院（<0.05）。精神分裂症患者更易出现性心理发展的延迟和不协调。性别重新认定观念在分裂型障碍中比在其他类型的精神分裂症中更常见。
精神分裂症谱系障碍中的性别重新认定观念通常是在性别认同形成早期阶段已存在的偏差基础上形成的。在有性别重新认定观念的精神分裂症谱系障碍的精神病理学中，人格解体 - 畸形恐惧症体验占据核心地位，随后会形成超价、妄想或偏执的性别重新认定观念。
