Background: as a result of global population aging the amount of aged patients with bipolar disorder (BD) is gradually growing both with the disease onset in the first half of life and with disease onset after 60 years.

Aim of the study was to observe clinical features and course of BD in elderly.

Material and methods: continuous sample of bipolar in-patients of geriatric clinical units of MHRC aged 60 and older (n = 146) in 2014–2017 were included to comparative study. According to the aim and tasks of the study the patients were divided into 3 groups depending on the age of BD onset: with early-onset BD (0–49 years), new onset in the involution period (50–59 years) and with late-onset BD (60 years and older). All of the patients were examined by psychopathological, clinical and psychometrical method (Hamilton Depression Rating Scale — HAM-D, Hamilton Anxiety Rating Scale — HARS, Young Mania Rating Scale — YMRS, Mini-Mental State Examination — MMSE and Montreal Cognitive Assessment — MoCA).

Results: early-onset BD (0–49 years) occurred in 92 patients (63%), new-onset BD in involution period (50–59 years) — in 35 cases (24%), late-onset BD (60 years and older) — in 19 patients included to the study (13%). Early-onset BD was more common in men, while new onset in the involution period — in women. Late-onset BD occurred in men and women with equal frequency. In the majority of patients BD started with depressive episode. Mixed affective episodes showed to be more common as a first BD episode with the increase of disease onset age. Age features of clinical course of affective episodes, cognitive functioningand premorbid characteristics of enrolled patients were viewed and discussed in the study. Early-onset BD leads to more frequent affective episode formation in elderly up to rapid cycling forms, while late-onset BD leads to more prolonged clinical course of affective episodes in comparison with early-onset BD. Premorbid features occur more often in patients with disease onset in thefirst half of life than in patients with late-onset BD. Cognitive functioning of all observed patients stay under age norm during intermission.

Conclusion: BD can have its onset at every age, even after 60 years, though in the majority of patients BD onsets before 50 years. Due to ageing, regardless to the age of disease onset depressions and manias in all elderly patients get age-related patterns, mixed affective states become more common.

The relevance of this study is defined by the absence of clear differential and diagnostic criteria of endogenous asthenia in modern systematics and classifications of mental illnesses which significantly complicates appropriate qualification, diagnostic understanding, preliminary assessment and therapy of these conditions.

The purpose of the study: the research of psychopathological characteristics of asthenic disorders in patients with attack — like progressive schizophrenia in remission.

Material and methods: 63 male patients aged 23–58 with attack — like progressive schizophrenia in remission (at least 6 months), with asthenic disorders prevailing in clinical picture, were examined. During the examination, the following methods were used: clinico-psychopathological, psychometric (with the use of scales PANSS, SANS, CDSS, VAS-A, MFI-20), statistical.

Results: based on the detailed analysis of asthenic symptomatology, its clinical heterogeneity in asthenic symptoms was revealed. It allowed to allocate two types of endogenous asthenia: affective-asthenic type (n = 22; 34,9%) and negative-asthenic type (n = 41;65,1%), which included two subtypes: the 1st subtype — negative-asthenic classical (n = 35; 55,6%), the 2nd subtype — negative-asthenic with overvalued hypochondriac ideas (n = 6; 9,5%).

Conclusions: The allocation of several types of asthenic disorders in remission in the course of endogenous process is significant in respect of syndrome-based diagnostic assessment and could serve as a factor enabling to specify the disease prognosis.

The purpose of the study: was to conduct therapeutic drug monitoring in two groups of patients with different nosology (schizophrenia and alcoholic psychosis) taking haloperidol (HAL) in different drug forms, evaluate the distribution of HAL concentrations relative to the therapeutic range, compare the concentration-dose ratio data and make recommendations for personalized pharmacotherapy patients of these groups.

Material and methods: Dur ing this study, clinical , pathological and psychometr ic approaches were used. The concentration of haloperidol was determined by high-performance liquid chromatography in combination with mass-spectrometry. Group A — male patients whose age were 30,02 ± 6,9 years; group B also included male patients whose age were 40,54 ± 9,34 years. Group B was divided into subgroups, where some patients took tablet form of GAL, whereas others received therapy in the form of infusions. The exclusion criterion was overweight and the presence of infectious diseases (HIV, hepatitis, liver disease). Inclusion criteria were a signed voluntary informed consent, clinical diagnosis and the absence of somatic diseases. Concomitant therapy in groupsA and B was different.

Results: In group A, indicators of measured concentrations were in the subtherapeutic range — 18,2%, therapeutic — 54,5%, conditionally toxic range — 27,3%. In group B — for the infusion form of HAL in the subtherapeutic range were 51,6% of the measured concentrations, in the therapeutic range — 48,4%, in the conditionally toxic — 0,0%; for the tablet form, the distri-bution was as follows — 69,2% in the subtherapeutic range, 30,8% in the therapeutic range, in the conditionally toxic range no concentration indicators were recorded.

Conclusion: This study has shown a significant difference between normalized concentrations when comparing indicators from the group of patients with schizophrenia to the patients from the group B, who took the tablet form. That observation allows usto conclude that significant effect on the biotransformation of GAL can have a comedic effect from inducer of the C3A4 isoform of the cytochrome R450 — carbamazepine, while the concomitant therapy in the group A included atypical antipsychotics that did not affect this enzyme.

Background: follow-up of Child autistic spectrum disorders in adults is unknown.

The objective: to study follow-up and functional state of adults diagnosed as Autistic spectrum disorders in childhood.

Material and methods: parents of 70 adults with child diagnoses of autism spectrum disorders were interviewed on follow-up their adult children diagnosed as Autistic spectrum disorders in childhood. Kind of employement and social status were defined. Level of daily-life functioning was assessed as high, medium and low. The link between psychopathology appearing and levels of functioning was analyzed. High functioning correlated with adults' proneness to depression and low functioning was found in catatonia. Tendency to anxiety, dysphoria and aggression was common.

Conclusion: follow-up study of autism spectrum disorders in childhood showed different psychopathological and functional outcomes in adults.

Background: the study of psychopathological and neurobiological features of psychotic states, in particular, manic-delusional and manic-paraphrenic ones, in the framework of paroxysmal endogenous psychoses, is relevant to clarify the diagnosis and individual prognosis of the disease. Quantitative EEG parameters allow objective assessment of the brain functional state in these patients, and clarify the neurophysiological mechanisms underlying the features of the syndromal structure of psychotic states.

Objective: to evaluate the amplitude-frequency and spatial characteristics of the EEG in patients with paroxysmal endogenous psychosis with manic-paraphrenic and manic-delusional conditions.

Patients and methods: 73 inpatient women aged from 18 to 55 years with manifest manic-paraphrenic and manic-delusional conditions in the structure of paroxysmal endogenous psychoses (F20.01, F20.02, F25.0, F30.2, F31.2 according to ICD-10) participated in a multidisciplinary study, Three groups were formed taking into account the peculiarities of the affective component of the syndrome and the mechanism of delusions: the 1st group (28 patients) with affective dominance of acute sensory delusion, the 2nd group (31 patients) with non-systematiting interpretative delusion, the 3rd group (14 patients) with manic delusion states with a dominance of visual-figurative delusions of imagination. Clinical psychopathological, psychometric, and neurophysiological methods were used. Evaluation of the mental state of patients was carried out using the YMRS and PANSS scales, and the brain functional state — using multi-channel recording and spectral analysis of the resting EEG. The correlation analysis method determined the relationships between clinical evaluations and EEG parameters.

Results: the features of the EEG spectral power parameters and topography were revealed. Their correlations with clinical evaluations by the YMRS and PANSS scales significantly differed in the three groups of patients. It has been stated that they are caused by the different degree of hypofrontality and of the level of the brain stem structures activation. Perhaps these factors determine the characteristics of the psychopathic structure of manic-paraphrenic and manic-delusional conditions.

Conclusions: the EEG quantitative characteristics and the structure of their relationshipswith clinical parameters differ in three clinically separated groups of patients with manic-paraphrenic and manic-delusional conditions indicate differences in the functional organization of the brain, mediating the clinical and psychopathological structure of syndromes, and confirm thevalidity of their typological division.

The aim: to identify a number of markers of inflammation in the blood of patients with frontotemporal dementia (FTD).

Material and methods: 34 patients with FTD were examined. The diagnosis of FTD was established according to the diag-nostic criteria of the International consortium 2011. The control group consisted of 35 people, comparable in age and sex with patients with FTD. Blood plasma was used for immunological studies. The enzymatic activity of leukocyte elastase (LE) and the functional activity of D1-proteinase inhibitor (D1-PI) were determined by spectrophotometric method, the concentration of interleukin-6 (IL-6), C-reactive protein (CRP) and the level of autoantibodies to S100b and myelin basic protein (MBP) were determined by enzyme immunoassay.

Results: patients with FTD showed a significant increase in the activity of D1-PI compared with the control (p < 0,001). Other indicators did not differ from the control ones. However, a significant variation of all studied parameters was revealed,both the excess of values and their decrease relative to the control. For example, the scatter of LE activity was from 127 to 276,5 nmol/min u ml. According to the level of LE activity, two immunophenotypes were identified: 47% of patients with FTD are characterized by a proinflammatory immunophenotype with an increase in inflammatory marker values, and 53% of patients with FTD are characterized by a proinflammatory immunophenotype with insufficient neutrophil activity, similar to Alzheimer's disease.

Conclusion: the findings indicate the involvement of inflammatory reactions in the development of FTD and the heterogeneity of this dementia in terms of immunological parameters.

The aim of the review: to generalize the data of the studies on mortality rates and terms of survival of patients with late age dementias, and to present the changes in notions of lifetime and the end of life in patients with late age dementias in accordance with the results of current studies.

Material and methods: for making a review of the literature according to the key words «late age», «dementia», «mortality», and «survival», papers were selected and analyzed from 1990 till 2019 in databases of MEDLINE/PubMed, as well as relevant references in the literature of the analyzed papers.

The results and discussion: according to the results of the analysis of scientific publications, the differences between the mortality rates and the terms of survival were presented in comparison to their values in the case of dementia’s absence. The differences between the mortality rates and the terms of survival, depending on neurodegenerative and vascular genesis of dementia, were shown.

A tendency towards the increase of duration of illness was noticed in dementias of late age, first of all of neurodegenerative type, in comparison to the previous notions. Among the factors of influence on mortality rates and terms of survival, gender and age characteristics of dementia patients, and the presence of multiple medical pathologies, are considered the most significant.

Among the factors of influence on the values of mortality rates and survival, gender and age-related characteristics of patients with dementia, the presence of multiple medical pathologies, are considered the most significant. The current possibilities of dementia diagnostics at the earlieststages of the disease, were considered as to the change of concepts of an increase in the duration of the illness. The effect of therapeutic inter vention is evaluated ambiguously, as well as the living conditions of patients with dementia and the organization of care for them.

Conclusion: the notion of the expected duration of life of the patients with dementia is necessar y for individual medical work with the patients and the members of their families, as well as for state planning of the volume of medical and social assistance to the patients of old age.

The aim: the systematic of complex types of psychopathies according to E. Kahn’s concept of personality stratums with differentiation to drive’ s stratum that is the most contiguous to somatic-biological, temperament’s stratum and relatively more independent from the underlying layers character’s stratum is analyzed.

The results and discussion: E. Kahn dismisses one complex group of psychopathy that was delineated by E. Kraepelin: unstable psychopathy and introduces a group of hypochonrical psychopathies that was rarely included in systematics of psychopathies by the other contemporate to E. Kahn German-speaking authors. E. Kahn’s subdivision to active and passive types of eccentric (twisted) psychopathies is comparable to K. Schneider’s expansive and sluggish fanatics, although in general description E. Kahn’s «twisted» personalities are closer to eccentric (twisted) group of psychopathies presented by E. Kraepelin. The tendency to overvalued formations is not the basic uniting criterion for E. Kahn’s eccentric personalities group in contrast from K. Schneider’s group of fanatics. E. Kahn unlike K. Schneider accepted E. Kretschmer’s group of schizoid psychopathies, however E. Kahn’s active and passive autists can be referred to schizoids only under condition of proven genetical bond with schizophrenia. The aspects of psychopathies dynamics including formulated by E. Kahn episodic, periodic and persistent psychopathies are discussed in comparison to the clinical signs of «degenerative madness».

Vasily Alekseevich Gilyarovsky as a Founder of Institute of Psychiatry of USSR Academy of Medical Sciences.

Scientific Conference of Young Scientists in Memory of Academician A.V. Sneznevsky.

International Conference «Centenary of Community-Based Psychiatry: Landmarks and Perspectives», 16–18 May 2019, Moscow.

Anniversary Celebrations Dedicated to the 75th Anniversary of the Mental Health Research Centre «Psychiatric Science: History and Perspective», 7 June, 2019, Moscow.