Diferenciace toxické psychózy a schizofrenní poruchy s důrazem na klinicky pozorovatelná specifika

• Název práce v češtině: Diferenciace toxické psychózy a schizofrenní poruchy s důrazem na klinicky pozorovatelná specifika
• Název v anglickém jazyce: Differentiation of Substance-Induced Psychosis and Schizophrenia with Emphasis on Clinically Observable Specifics
• Klíčová slova: reziduální psychotická porucha, psychotická porucha, schizofrenie, toxická psychóza, diferenciální diagnostika
• Klíčová slova anglicky: residual psychotic disorder, psychotic disorder, schizophrenia, substance-induced psychosis, differential diagnosis
• Akademický rok vypsání: 2024/2025
• Typ práce: diplomová práce
• Jazyk práce: čeština
• Ústav: Klinika adiktologie 1. LF UK a VFN (11-00611)
• Vedoucí / školitel: Mgr. Lenka Šťastná, Ph.D.
• Řešitel: skrytý - zadáno vedoucím/školitelem
• Datum přihlášení: 18.10.2024
• Datum zadání: 18.10.2024
• Datum a čas obhajoby: 12.09.2025 09:00
• Datum odevzdání elektronické podoby: 12.07.2025
• Datum proběhlé obhajoby: 12.09.2025
• Předmět: Obhajoba diplomové práce (B02236)
• Oponenti: Mgr. Lenka Varyšová

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Předběžná náplň práce

Východiska: V posledních desetiletích dochází k výraznému nárůstu prevalence toxických psychóz v České republice. U déletrvajících či opakovaných toxických psychóz (SIP) existují nejasnosti, zda tyto poruchy klasifikovat jako chronické toxické psychózy či schizofrenii. Právě etiologie a charakter psychózy jsou důležitými skutečnostmi pro vedení léčby. Z pohledu adiktologie je důraz kladen zejména na klinicky pozorovatelná specifika.
Cíle: Cílem práce je systematické zpracování aktuálních poznatků v oblasti diferenciace toxických psychóz a schizofrenní poruchy. Dále je cílem vytvoření komparativní případové analýzy. Ta má za cíl mapovat klinicky pozorovatelné aspekty SIP v porovnání se schizofrenní poruchou pomocí retrospektivních zkušeností pacientů.
Metody: Pro vytvoření komparativní případové studie byla zvolena metoda Velmi podobných případů (Very Similar Cases). Tyto případy tvoří dva participanti, kteří zažili opakované toxické psychózy, z nichž u jednoho byla potvrzena diagnóza schizofrenie a druhého nikoliv. Metodou sběru dat byl polostrukturovaný rozhovor. Pro analýzu dat byly použity postupy tematické analýzy.
Výsledky: Přes řadu společných aspektů a širokého překryvu symptomatiky bylo identifikováno několik odlišností, které mohou být přínosné v rámci diferenciální diagnostiky. Nejvýraznější odlišnosti byly identifikovány v rámci: (1) Přítomnosti prodromálních symptomů; (2) Spouštěčů užívání návykových látek; (3) Kvality a rozsahu symptomů akontaktu s realitou; (4) Ústupu symptomatiky; (5) Sociability; (6) Globálního fungování a zotavení; (7) Potřeby cílené léčby. Schizofrenie se jeví jako chronické onemocnění s hlubším narušením vnímání reality, absencí náhledu a trvalými funkčními dopady. Naproti tomu SIP se jeví spíše jako reaktivní a epizodická, často s lepší prognózou při abstinenci.
Závěr: Klinická diferenciace mezi SIP a schizofrenní poruchou vyžaduje komplexní posouzení zahrnující nejen časové hledisko, ale také kvalitativní zmapování symptomatiky. Klinicky pozorovatelná specifika představují užitečný diagnostický ukazatel, zejména pokud jsou hodnocena v kontextu dlouhodobého vývoje při souběžném využití psychodiagnostických metod.

Předběžná náplň práce v anglickém jazyce

Background: In recent decades there has been a significant increase in the prevalence of substance-induced psychoses (SIP) in the Czech Republic. In the case of prolonged or recurrent SIP it often remains unclear whether to classify these conditions as chronic substance-induced psychoses or as schizophrenia. The etiology and nature of the psychosis play a crucial role in guiding treatment. From the perspective of addictology, emphasis is placed particularly on clinically observable characteristics.
Objectives: The aim of this thesis is to systematically synthesize current knowledge in the field of differentiating between toxic psychoses and schizophrenia. Additionally, it seeks to develop a comparative case analysis to explore clinically observable aspects of SIP compared to schizophrenia, based on patients' retrospective experiences.
Methods: The comparative case study uses the method of Very Similar Cases. It involves two participants with recurrent substance-induced psychotic episodes, of whom only one has been formally diagnosed with schizophrenia. Data collection was carried out through semi-structured interviews and thematic analysis was applied to process the data.
Results: Despite a number of shared features and a significant symptom overlap, several distinctive differences were identified that may be useful for differential diagnosis. The most pronounced distinctions were found in the following domains: (1) Presence of prodromal symptoms; (2) Triggers for substance use; (3) Quality and extent of symptoms and contact with reality; (4) Symptom remission; (5) Sociability; (6) Global functioning and recovery; (7) Need for targeted treatment. Schizophrenia emerges as a chronic condition marked by deeper disruption of reality perception, lack of insight, and lasting functional impairment. In contrast, SIP appears more reactive and episodic, with a generally better prognosis under abstinence.
Conclusion: Clinical differentiation between SIP and schizophrenia requires a comprehensive evaluation that includes not only temporal criteria, but also qualitative mapping of symptoms. Clinically observable specificities serve as valuable diagnostic indicators, especially when assessed in the context of long-term development and supported by psychological assessment tools.