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Psychiatry (Moscow) (Psikhiatriya)

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Vol 20, No 4 (2022)
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PSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRY

6-13 3717
Abstract

Background: depressions in elderly and senile patients  often occur against the background of cerebral changes of vascular and atrophic  origin and are combined with impaired cognitive  functions. It is known that a decrease in the production of neurotrophic factors is one of the leading mechanisms in the pathogenesis of depression. Previously, the effectiveness of combined therapy with antidepressants  and drugs with neuroprotective  properties has been shown, but a differentiated  approach to the appointment of neuroprotective adjuvants needs substantiation.  The aim of the study was to carry out comparative evaluation of the effectiveness of two augmentation  methods of antidepressant  therapy with the inclusion of different neuroprotectors (actovegin  or cerebrolysin) in the treatment of depression in the elderly. Patients  and methods: the study included 2 groups of patients  with a depressive episode of mild and moderate  severity, comparable  in terms of basic demographic and clinical parameters. Patients of the 1st group received antidepressants  in combination with actovegin for a month. Patients of the 2nd group received cerebrolysin simultaneously with antidepressants. The effectiveness  of therapy was assessed on the HAMD-17 and HARS scales; the level of cognitive functioning of patients was assessed using the MMSE scale. Results: the effectiveness of both used types of complex antidepressant  therapy was demonstrated: both with the inclusion of actovegin and with the inclusion of cerebrolysin. In patients of both groups, against the background of a reduction in depressive symptoms, a significant (p < 0.01) improvement in cognitive functioning (according to the MMSE scale) was noticed  by the end of therapy (without statistically significant differences between the groups). The inclusion of actovegin in the antidepressant therapy regimen for elderly patients proved to be effective regardless of the type of depression, but especially in the reduction of anxiety symptoms. Administration of cerebrolysin to depressed patients  was more effective in anergic, asthenic, apathetic  and adynamic depressions. Conclusion: augmentation of antidepressant  therapy with actovegin  and cerebrolysin should be considered effective and recommended for use in a psychogeriatric hospital.

14-26 513
Abstract

Background: Comparative studies of monotherapy with second-generation antipsychotics (SGA) or mood stabilizers in the prevention therapy of Bipolar Disorder (BD) relapses, including those with psychotic symptoms, have not been conducted. Objective: a comparative study of the clinical features of risperidone (RIS) and sodium valproate (SV) in the prevention of relapses of BD. Patients and methods: 96 patients with BD-I (F31, ICD-10) were included, the duration of the disease was at least 2 years, the presence of at least two affective episodes (including psychotic symptoms). Design — open comparative randomized study. Study duration was 24 months. Patients were sequentially divided into groups of RIS and SV, comparable in the number of patients, clinical and sociodemographic indicators. The effectiveness of therapy was determined by comparing the indicators of the dynamics of the course of the disease for 2 years preceding the start of therapy (control period) and 2 years after the treatment beginning. Results: 14 patients dropped out in the first month after the start of therapy due to adverse events, 82 completed the study. The total duration of episodes decreased by 40-60%, the frequency — by 37.2% — 43.3% (p ≤ 0.05). The proportion of responders in the RIS group was 78.1%, SV — 68.3%. Complete suppression of phase formation was observed in 43.75% in the RIS group, in 10.7% — in the SV group. In the RIS group, the total duration of depressive episodes decreased by 38.3% (NS), manic by 65.2% (p ≤ 0.001), in the SV group — by 31.9% (NS) and by 52.9% (p ≤ 0.05), respectively. As to BD with psychotic symptoms, 85% of respondents were in the RIS group, and 50% were in the SV group. The average number of adverse events per patient in the group of SV was 0.9, RIS — 2.1. Conclusions: SV and RIS are comparable in effectiveness with better tolerance of SV. In patients with psychotic symptoms, the effectiveness of RIS was higher than that of SV.

27-35 921
Abstract

Background: suicidal behavior, intentional self-harm and non-suicidal self-harm are important precursors of suicide in children and adolescents. The objective: to determine the prevalence and structure of non-suicidal self-harm, as well as the relationship of non-suicidal self-harming behavior with aggression, anxiety and depression in a non-clinical group of young men of military age. Participants and methods: the object of the study was 507 young men (from 18 to 27 years old). The average age of the examined was 19.32 years (± 2.35). Assessment of non-suicidal self-harm was carried out using a clinical interview and the scale of self-harming behavior (Polskaya N.A., 2014). The analysis of patterns of aggressive behavior was carried out with the Buss-Perry Aggression Questionnaire (BPAQ) to identify the propensity to aggression, the assessment of anxiety and depression level was assessed on Beck Anxiety and Depression Scales (BAI; BDI). Results: the study showed a high prevalence of non-suicidal selfharm in the non-clinical population of young people (33.9%). Instrumental self-harm was committed at least once in a lifetime by 14.7% of the surveyed, somatic — 19.2%. The most common acts of instrumental self-harm are blows with a fist, foot, head or body body on hard surfaces and cuts with cutting objects. From somatic — biting nails and lips, biting cheeks and tongue, combing the skin and creating obstacles to wound healing were the most frequent. As a result of the correlation analysis of the links of acts of self-harm with the domains of the scale of propensity to aggression from instrumental self-harm, a significant positive correlation was found in relation to self-burns. Punching your body and pulling out your hair turned out to be associated with all domains of the aggression scale. Self-harming was accompanied by depressive symptoms. Symptoms of anxiety correlate with somatic self-harm — punching your body, scratching your skin and biting your cheeks or tongue. Conclusion: non-suicidal self-harm showed positive correlations with manifestations of aggression, anxiety and depression. Effective and evidence-based prevention programs can be implemented at the population, subpopulation and individual levels to timely identify self-harming behavior. At the stage of psychiatric examination of young people, it is advisable to include in the complex of psychodiagnostic methods scales aimed at identifying self-harm, anxiety, depression and aggressive behavior.

36-43 442
Abstract

Background: the development of programs for the correction of cognitive impairment in elderly patients with various types of mild cognitive decline is an urgent task of geriatric medicine and clinical psychology. The aim of the study was to conduct neuropsychological and psychometric evaluation of the results of a modified neurorehabilitation program (combination of full time and part time studies) in patients of the “Memory Clinic”. Patients and methods: a total of 114 patients (mean age 73 years) with mild cognitive impairment was studied. Neuropsychological and psychometric evaluation of the dynamics of the cognitive sphere in patients with mild cognitive decline (MCI) before and after participation (week 6) in the full-time/part-time neurorehabilitation program at the “Memory Clinic” was carried out. For psychometric assessment, the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were used. The neuropsychological study was carried out using the “Express Method for the Study of Cognitive Functions at a Late Age” (N.K. Korsakova et al.). For psychometric assessment, the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were used. The neuropsychological study was carried out using the “Express Method for the Study of Cognitive Functions at a Late Age” (N.K. Korsakova, E.Yu. Balashova, I.F. Roshchina). Results: using the method of multivariate analysis of variance (MANOVA), a statistically significant effect (p < 0.05) of the neurorehabilitation program on psychometric tests (MMSE, MoCA) and on the total score of the “Express Methods for the Study of Cognitive Functions at a Late Age”, as well as on its subscales —verbal memory, visual memory, semantic memory, dynamic, spatial and regulatory praxis was detected. Conclusions: a psychometric and neuropsychological study showed the effectiveness of a full time/part-time neurocognitive rehabilitation program for patients with mild cognitive decline under conditions of limited visits to the Memory Clinic during the COVID-19 pandemic.

44-53 731
Abstract

Background: COVID-19-associated psychoses are psychotic disorders that have developed during a new coronavirus infection. Criteria of these psychoses are the manifestation of psychosis simultaneously with infection with the SARS-CoV-2 virus and the presence of documented COVID-19 disease. Information about these diseases appears as brief reports of mental services or with rare clusters. The need to study COVID-19-associated psychoses is due to the relatively high risk of their development, reaching 2.8%. The aim of study was to analyse the identified cases of COVID-19-associated psychosis in comparison with the results presented in the scientific literature. Patients and methods: 50 cases of COVID-19-associated psychosis were analyzed using a clinical method, taking into account the results of physical examination from April 2020 to September 2021. Results: 27 women and 23 men aged 20 to 57 were examined. Common symptoms were revealed: simultaneously or immediately after infection and identification of the virus against the background of growing anxiety and dissomnia, delusional ideas were formed, which quickly turned into fantastic delusion with disturbing agitation and hallucinations and subsequent marked disorganization of behavior with possible confusion of consciousness at the peak of psychosis. Perceptual deceptions were the most common, auditory hallucinations were the most prevalent, and catatonia was relatively common. The cupping therapy led to reduction of psychotic symptoms, and returned patients to a pre-morbid level of functioning. In most cases, there was a critical resolution of the attack, which probably indicates a favorable outcome of the disorder. Such dynamics is consistent with scientific literature data. Conclusion: the question of the primary or secondary nature of COVID-19-associated psychoses remains unresolved. It is necessary to continue the study of COVID-19-associated psychosis with the identification of risk factors for the development of psychosis, manifestation features, psychopathological picture, outcome options to determine the optimal rehabilitation program.

54-63 766
Abstract

Use of new synthetic drugs (synthetic cannabinoids — “spices”, synthetic psychostimulants — “salts”, synthetic GABA-agonists — “butyrates”) is associated with a high risk of psychoses. Nowadays there are no evidence-based guidelines for treatment of these psychotic disorders. Objective: to develop effective therapeutic strategies for the treatment of acute substance-induced psychoses associated with modern synthetic drugs. Material and methods: 96 patients with substance-induced psychoses associated with synthetic cannabinoids (n = 32), synthetic psychostimulants (n = 33), and synthetic GABA-agonists (n = 31) were examined. In these groups we estimated effectiveness of different combination therapy: desintoxication and benzodiazepine, desintoxication and benzodiazepine and haloperidol, desintoxication, benzodiazepine and phenibut. The following methods were used: clinical-psychopathological, laboratory, statistics. Results: сomparative efficacy of therapeutic strategies differed in three investigated groups. In psychoses associated with synthetic cannabinoids the most effective strategy was haloperidol add-on. Differences between treatment approaches in group of psychostimulants-induced psychoses were not found. In psychoses associated with synthetic GABA-agonists the most effective strategy was phenibut add-on. Conclusion: the choice of effective therapeutic intervention in drug-induced psychosis should be based on type of synthetic drug.

64-73 301
Abstract

Background: eccording to numerous medical observations, asthenic syndrome (AS) in persons exposed to emergency radiation is one of the early manifestations of disorders of the central nervous system. The combination of standard drug therapy with non-drug therapy in its treatment to increase the effectiveness of therapeutic measures is very relevant. The objective of the research is to study the effectiveness of non-drug therapy (a combination of Beta training and breathing exercises) in the complex treatment of AS in persons exposed to emergency radiation. Patients and methods: а retrospective analysis of the treatment was carried out. The study involved 80 people born from 1950 to 1957, residing in the coastal villages of the Techa River, who were diagnosed with AS. Participants of the study were divided into two groups comparable in different parameters. In the main group, in addition to standard drug treatment, Beta training was conducted in combination with breathing exercises, in the control group (40 people) standard medical treatment was carried out. To assess the effectiveness of intervention the following methods were used: clinical and psychological methods (Asthenic state scale, MFI-20, simple visual and motor reaction) and statistical processing of materials. Results and conclusion: according to the results of repeated diagnostics in the main group, there is a tendency to improve performance indicators, a statistically significant increase of persons with «low asthenia» (p = 0.039), a low overall score (decrease in asthenic manifestations) according to the MFI-20 method (p = 0.036) compared with the control group, whereas there are statistically significantly more subjects with a high overall score according to the MFI-20 method (p = 0.036). According to the results of Beta training in the main group, there is a statistically significant increase in the power index of the user range (UR) of the beta rhythm (16-20 Hz) at the start of the first and last session (p = 0.002) and the finish of the first and last one (p < 0.001). Conclusion: The use of an integrated approach in the treatment of AS in persons exposed to emergency radiation increases the overall effectiveness of therapeutic measures.

74-83 532
Abstract

Background: the heterogeneity of schizophrenia impedes our efforts to provide adequate treatment. One step toward optimizing treatment is to deepen our understanding of cognitive variety in this disorder. Perhaps due to this heterogeneity, although visual impairment is a frequent symptom of schizophrenia, many studies show inconsistent data. The aim of our study was to identify homogeneous groups of patients with schizophrenia based on susceptibility to the Ponzo illusion, cognitive impairment degree (BACS T-score) and severity of mental state during therapy (Total PANSS score) and to examine the relationship between clinical parameters and the value of the illusion. Patients and methods: a prospective six-week observational study included 30 patients with the paranoid form of schizophrenia in the second week of stable antipsychotic monotherapy, 11 of whom dropped out due to exclusion criteria. At the second and eighth weeks of treatment, patients were assessed for susceptibility to the Ponzo illusion, cognitive impairment using a battery of BACS tests, and severity of mental status during a semi-structured interview using the PANSS scale. Results: the cluster analysis identified 2 clusters of patients who differed in their susceptibility to the Ponzo illusion. Patients in the first cluster (n = 9) with a significantly higher score on negative PANSS symptoms and marked cognitive impairment in the second and eighth weeks of therapy were prone to overestimate the Ponzo illusion, while patients in the second cluster (n = 10) were less susceptible to the Ponzo illusion. Conclusions: this study allowed us to identify two clusters of patients differing in the severity of cognitive and visual impairments, the relationship of susceptibility to Ponzo illusion with such clinical indicators as negative and cognitive symptoms was demonstrated, which confirms the informative value of using the visual illusion methodology as a marker of mental state.

84-95 311
Abstract

Background: the authors previously reported the ultrastructural pathology of oligodendrocytes in contacts with microglia in white matter of the prefrontal cortex in attack-like schizophrenia supposedly associated with microglial activation. Aim of the study: to perform morphometry of the ultrastructural parameters of microglia in contact with oligodendrocytes and to analyze correlations between the parameters of microglia and oligodendrocytes previously studied in the schizophrenia group as compared to the control group. Material and methods: a postmortem ultrastructural morphometric study of microglia in contact with oligodendrocytes in white matter of the prefrontal cortex was performed in 8 cases of attack-like schizophrenia and 20 healthy controls. Group comparisons were performed using ANCOVA and Pearson correlation analyses. Results: we found reduced volume fraction (Vv) and the number of mitochondria and increased Vv, area and number of vacuoles of endoplasmic reticulum and area of heterochromatin in microglia in the schizophrenia group as compared to the control group. Area of microglial cytoplasm correlated positively with area and number of vacuoles in microglia, and Vv and the number of mitochondria in microglia correlated positively with Vv and the number of vacuoles in microglia in the schizophrenia but not in the control group. Positive correlations were found between area of lipofuscin granules in oligodendrocytes and areas of microglial cell, nucleus and cytoplasm and the number of mitochondria in microglia only in the schizophrenia group. Also, area of vacuoles in oligodendrocytes correlated positively with the number of mitochondria in microglia in the schizophrenia group. In contrast, in the control group but not in the schizophrenia group the parameters of mitochondria and lipofuscin granules correlated positively with the same parameters in oligodendrocytes. Conclusion: these data suggest that normal relationships between energy and lipid metabolism of microglia and oligodendrocytes are disturbed in schizophrenia. Dystrophic changes of oligodendrocytes in attack-like schizophrenia might be associated with the effects of microglial activation on lipid and protein metabolism.

96-106 318
Abstract

Background: the significance of the asthenic syndrome as one of the most distressing symptoms affecting the clinical outcome of chronic heart failure (CHF), and insufficient understanding of the pathophysiological aspects of asthenia determines the need to study the clinical and biological features of this syndrome in cardiac pathology. Objective: to determine of a number of inflammatory and autoimmune blood parameters in patients with CHF associated with asthenic disorders in comparison with hypertensive disease in relation to clinical and gender-age characteristics of patients. Patients and methods: 62 patients with CHF (study group; 64.4 ± 9.7 years) and 50 patients with hypertensive disease (HD) (comparison group; 55 ± 9.7 years) were examined. Somatic examination included consultation with a cardiologist. Psychometric assessment was performed using the MFI-20 scale and the MLHFQ questionnaire. In patients' blood, leukocyte elastase (LE) activity, α1-proteinase inhibitor (α1-PI), leukocyte inhibitory index (LII), concentration of CRP, IL-6, and levels of antibodies to S-100B and myelin basic protein were determined. Results: patients with CHF characterized by more pronounced manifestations of all dimensional asthenic disorders compared to patients with HD. The deterioration of CHF patients' quality of life was accompanied by the aggravation of asthenic symptoms on all subscales of the MFI-20 scale. In patients with CHF and HD, multidirectional changes in the leukocyte inhibitory index and significant quantitative differences in other immune parameters compared with the normative values were detected. CHF associated with asthenia was characterized by decreased activity of the blood proteolytic system (decrease in LII), a significant increase in the concentration of IL-6, CRP and antibodies to S-100B in the blood of patients compared to comparison group. Negative correlations between LE activity and several dimensions of the MFI-20 scale, and positive correlations between the severity of general asthenia, patient age, and IL-6 and CRP concentrations indicate the involvement of inflammation in the pathophysiology of asthenic disorders in the cardiac pathology discussed. Conclusion: low activity of blood proteolytic system and high level of inflammation are unfavorable factors in the development of asthenia in chronic heart failure. Qualitative and quantitative features of the spectrum of immunological parameters in patients with CHF are correlated with clinical and genderage characteristics and reflect the severity of both cardiological changes and asthenic symptoms.

107-114 1950
Abstract

Background: mental disorders in children, accompanied by a whole range of disorders, are not uncommon in the clinical practice of a child psychiatrist. The aim was to describe the clinical features of mental disorders in early and preschool age that occur against the background of connective tissue diathesis, using a specific clinical example. Patients and methods: clinical observations of children at risk for the development of mental pathology, including autism spectrum disorders, anxiety-depressive disorders, hyperactivity syndrome. Results: the article presents a brief review of literature data on certain differentiated syndromes of connective tissue dysplasia (CTD), in the clinical symptoms in addition to phenotypic signs and minor developmental anomalies, there are mental disorders. A clinical illustration of the combination of CTD syndrome and clinical manifestations of psychopathological disorders in a 5-year-old girl with development of the type of “schizotypal diathesis”, having various connective tissue anomalies, is given. Conclusion: the study of connective tissue diathesis in the structure of premorbid risk factors for mental diseases, including endogenous diseases, will clarify the nature of these conditions, expand our understanding of possible ways of prevention and therapy.

SCIENTIFIC REVIEWS

115-127 461
Abstract

Objective: to analyze available scientific publications on the problem of clinical and genetic aspects of depressive disorders in patients with coronary heart disease (CHD). Material and methods: by keywords “coronary heart disease”, “mental disorders”, “depression”, “genetics”, “genetic markers”, “polymorphism”, “personality” articles in English and Russian were searched in the MEDLINE/PubMed, Scopus, Web of science, eLibrary databases in the period from 2020 to 2021. Conclusion: depression comorbid CHD is considered as a clinical problem due to its high prevalence, as well as its influence on the features of the course and prognosis of CHD, as well as on the compliance of patients. Heterogeneity of the clinical structure of depressive disorders in CHD (nosogenic, endogenomorphic, endogenous, somatogenic depression) causes difficulties in differential diagnosis and complex therapeutic measures. There are several factors contributing to the onset of depression in CHD patients: biological, clinical, personal characteristics. Genetic markers of depression in CHD, which have prognostic value, require further clarification.

128-138 337
Abstract

Background: there is seminal medicine direction in the diagnosis and therapy of mental disorders, namely personalized medicine. Its concept embodies an individual approach to treatment based on the genotype and phenotype of the patient. Objective: the presented paper deal with the main modern approaches to the individualization of psychopharmacotherapy: genotyping, determination of the level of biomarkers and therapeutic drug monitoring (TDM). Methods: databases of medical and biological publications (MEDLINE, PubMed); clinical observations. Results: examples of genetic tests that allow optimizing the therapy of mental illness are presented. The concept of biomarkers as diagnostic and therapeutic indicators in personalized medicine is considered. Other promising areas of scientific research are briefly described: metabolism, transporters, neurotransmitters (mediators), epigenetics. Population modeling of antibiotic pharmacokinetics also deserves attention. Specific examples of TDM content of antipsychotics are given. Conclusion: the reviewed research directions focused on the introduction of the principles of personalized and translational medicine into routine psychiatric practice.

139-143 755
Abstract

The aim was to analyze scientific publications on Charles Bonnet syndrome in patients with visual impairment. Materials and methods: using the keywords “Charles Bonnet syndrome” (CSB), “blindness”, “hallucinations”, articles were searched in the databases MEDLINE/PubMed, sciencedirect.com, Scopus. Conclusion: Charles Bonnet syndrome is characterized by the presence of complex visual hallucinations, triggered by vision deprivation in the absence of neurological, psychiatric, and/or systemic disorders. The patient usually perceives the hallucinations as not real, which reduces anxiety, although the content, duration, and frequency are variable. Charles Bonnet syndrome can be associated with age-related entities such as enucleation, optic neuritis, diabetic retinopathy, macular degeneration, cataracts, and glaucoma, among others. Accordingly, its prevalence is relatively high in geriatric patients. CBS is very common, but the pathophysiology of hallucinations and treatments are currently unknown. Our goal is to inform doctors about this syndrome.

OBITUARY



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ISSN 1683-8319 (Print)
ISSN 2618-6667 (Online)