PSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRY
Background: neuroin flammation is an important link in the pathogenesis of pre-dementia cognitive impairment and the development of dementia in Alzheimer’s disease.
The aim of the study was to determine the prognostic value of inflaammatory markers (enzymatic activity of LE and its inhibitor alpha1-PI) at the stage of mild cognitive impairment for subsequent follow-up evaluation.
Patients and methods: a total of 103 patients with an amnesic type of mild cognitive impairment (aMCI) aged 50 to 89 years (mean age 68.1 ± 9.4 years) were examined. Mental status of the patients was assessed clinically and by psychometric scales and tests. After 3 years of observation, the patients were divided into two groups depending on the dynamics of cognitive status: the 1st group consisted of 49 patients with progression of cognitive decline to the degree of dementia; the 2nd group included 54 patients with a stable state of cognitive functions. The control group included 61 subjects of the same age and gender. The enzymatic activity of leukocyte elastase (LE) and the functional activity of the α1-proteinase inhibitor (α1-PI) were determined in blood plasma. Cluster analysis was used to isolate immunotypes.
Results: the functional activity of α1-PI at the starting point of the study in patients of both follow-up groups exceeded the control values (p = 0.000001, p = 0.000006, respectively). Follow-up groups differed in LE activity at the initial stage. In patients of the 1st group (with an increase in cognitive impairment) LE activity did not differ from the control values (p = 0.144651). Group 2 (with stable cognitive functions) was characterized by a significantly higher LE activity compared to the controls (p = 0.000000). Cluster analysis made it possible to identify two immunotypes that differed in LE activity. In the 1st cluster, LE activity was within the control range and below, it mainly included patients of the 1st follow-up group (68.3%). In the 2nd cluster LE activity exceeded the control values, this cluster mainly consisted of patients of the 2nd follow-up group (85.0%) (χ2 = 27.82, p = 0.0000).
Conclusion: the revealed reliable differences in the distribution of follow-up groups for immunological clusters indicate the possibility of using indicators of LE and α1-PI activity for diagnosing and predicting the dynamics of mild cognitive decline.
Background: imbalance in the energy processes, such as oxidative phosphorylation intensity, and antioxidant systems, and impaired glutamate metabolism in the brain are important biochemical pathogenetic links in the development of schizophrenia. Changes in the activity of a number of platelet enzymes involved in these biochemical pathways were found in patients with schizophrenia.
Aim: to assess the relationship between the treatment effciency of acute psychotic episode in patients with paranoid schizophrenia and the activity levels of platelet enzymes involved in energy metabolism (cytochrome c-oxidase, COX), in the antioxidant glutathione system (glutathione reductase, GR), and glutamate metabolism (glutamate dehydrogenase, GDH).
Patients and methods: we examined hospitalized adult patients with a diagnosis of paranoid schizophrenia, episodic course, exacerbation of the disease (F20.01), receiving antipsychotic therapy, and healthy volunteers as a control group for assessment of control ranges for enzymatic activities. Psychometric assessment was carried out using the Positive and Negative Syndrome Scale (PANSS). Treatment response was assessed as good with a reduction in PANSS scores of 20% or more. The evaluation was performed on the first days after hospitalization and immediately before discharge.
Results: 113 subjects were recruited. 50 healthy volunteers formed the control group and 63 patients, including 60 men and 3 women made up the study group. All indicators were obtained in all control group members and in 42 patients. In the group with a good treatment response, the baseline COX, GDH and GR activities proved to be significantly more often met within the control range, and the GR activity in half of the patients increased after the treatment course. In the group with insuffcient response, half of the patients had an increase in GDH activity after treatment. Of all the biochemical indices, the parameter most associated with therapeutic response was GDH activity.
Conclusion: GDH activity can be considered as a possible candidate for predicting the therapeutic response to antipsychotic therapy.
Background: clinical diversity of schizophrenic spectrum disorders determines a variety of long-term management and treatment outcomes of out-patients.
Aim of the study: to analyze the interrelationships of clinical and social characteristics, quality of life and adherence to therapy in patients with schizophrenic spectrum disorders.
Patients and methods: data of 120 patients observed in a neuropsychiatric dispensary with diagnoses of schizophrenic spectrum disorders (F20, F21, F25 according to ICD-10) were studied.
Results: three categories of individuals were identified, taking into account the high degree of intragroup similarity of clinical and social characteristics. Patients of the first group (29%) have a stable-positive characteristics of social adaptation and a high adherence to therapy. They were characterized by a younger age, mainly an attack-like course of the disease with an affective-delusional structure of exacerbations and weakly pronounced personality changes. Significantly more often than patients of other groups, they received therapy with second-generation antipsychotic drugs of prolonged action. Patients of the second group (39%) have the negative dynamic characteristics of social adaptation and a low adherence to therapy. They were characterized by older age, continuous or episodic types of disease course with increasing defect, higher prevalence of moderately and strongly pronounced positive and negative symptoms at the time of remission. Treatment and rehabilitation measures did not give sufficient results, despite the active use of prolonged antipsychotic drugs of the second generation. In this category of patients, there were phenomena of social drift, with the collapse of social ties, loss of work skills. Patients of the third group (32%) were characterized by contradictory characteristics with stable negative characteristics of social adaptation and high adherence to therapy. A significant part of the patients had negative personality changes and often a low-grade course of the disease with a predominance of neurosis-like and depressive symptoms. Receiving for many years mainly therapy with firstgeneration antipsychotics (APP1) and practically not hospitalized in a psychiatric hospital, they found pronounced social isolation, loneliness and feelings of hostility of the surrounding world.
Conclusions: the management of out-patients with schizophrenic spectrum disorders represent clinical problems depending of different forms of social adaptation and adherence to therapy, for the effective solution of which it is necessary to optimize complex social rehabilitation measures.
Background: depressive disorders remain an important medical problem and present significant economic and social burden on the health care system. This sets the task for the scientific community to increase the level of their detection, treatment and prevention. It seems promising to study the role of markers of neuronal disorders, in particular, proteins S-100, MBP, GFAP, in the pathogenesis of primary and recurrent depressive disorders.
Purpose of the study: to determine the relationship between clinical and psychopathological characteristics of depressive disorders (anxiety, depression, aggressiveness) with markers of neuronal damage (S-100, MBP, GFAP) in primary Depressive Episode (DE) and Recurrent Depressive Disorder (RDR).
Patients and methods: the study participants were 43 patients of the Mental Health Research Institute of the Tomsk National Research Medical Center Clinics with diagnoses DE (F32; n = 26) or RDR (F33; n = 17) according ICD-10. Clinical and psychopathological examination of patients with psychometric tools HDRS-17, HARS, BDHI and sampling of biological material for the study of blood serum biological markers were carried out upon admission before the start of active psychopharmacotherapy. Statistical analysis was performed using the IBM SPSS Statistics 25 program.
Results: in the F32 group was found a correlation of all studied biomarkers with the severity of depressive symptoms and the hostility index according to the BDHI questionnaire (p < 0.05, Spearman).
Conclusion: the relationship between markers of neuronal homeostasis disorders and various clinical and psychometric parameters is most pronounced in the case of primary Depressive Episode and is decreasing in the case of Recurrent Depressive Disorder. This may be important for the diagnostics and objectification of the severity, clinical dynamics in depressive disorders.
Background: affective disorders (AD) are often aggregated in families among relatives of several generations. It suggests the presence of genetic risk factors for recurrent depressive disorder (RDD) or bipolar affective (BD) disorders.
The objective: to assess the risks of affective disorders in individuals with a positive family history, as well as to analyze the clinical characteristics of RDD and BD in family cases.
Participants and method: this family cross-sectional study included 36 families with affective disorders (36 probands with AD and 68 relatives), as well as 23 families for the comparison group (23 probands without affective disorders and 53 relatives). The final sample size was 180 people. The study used a case report form developed by the authors, as well as a semi-structured MINI interview (Mini International Neuropsychiatric Interview).
Results: it was revealed that a family history of AD is a significant risk factor for RDD or BD in probands. The risks of AD based on the assessment of familial recurrence risk in probands with a burdened family history were also higher than in the general population. When comparing probands with AD with their relatives who had RDD or BD diagnoses, it was found that the age at onset of the underlying disease was significantly less in patients with BD, and probands with BD had significantly longer hypo-/manic episodes. This fact may indicate an aggravation of the course of these pathologies in persons with a positive family history.
Conclusion: a burdened family history is an important clinical predictor of the development of AD and their subsequent course. Further multicenter family studies on the Russian population are needed to increase the sample size and analyze the features of aggregation in families of RDD and BD separately using modern molecular genetic methods.
SCIENTIFIC REVIEWS
Background: among the psychological and psychiatric consequences of life-threatening situations, the problem of post-traumatic stress disorder (PTSD) is invariably of leading importance. At the same time, diagnostic and therapeutic approaches to solving this problem have undergone significant changes over the past decades.
The aim of review is the analysis of scientific materials on the problems of PTSD with the use search systems, to highlight the evolution of views on the clinic, pathogenesis, approaches to the treatment of this disorder and to formulate promising directions for further research in this area.
Material and methods: a review of more than 60 scientific papers containing scientifically based information on the diagnostic and therapeutic and preventive aspects of PTSD was conducted using the resources of search engines, including PubMed and eLibrary, for the keywords “post-traumatic stress disorder”, “PTSD”. Results: at present, relatively weak progress in the field of clinical diagnostics is being noted, noticeably lagging behind the results of research in the field of neurophysiology of PTSD, primarily the molecular biology of operant conditioning and extinction of fear reactions, as a result of which this disease is still a diagnostic puzzle.
Conclusion: it is expedient to search for clearer, non-overlapping with other taxonomic units, clinical symptoms and signs with “PTSD pathognomonicity” on the basis of phenomenological and network approaches that allow to eliminate the limitations of polythetical categorization, whereas in genetic studies, on the contrary, the rejection of the methodology looks more promising “case/control” and the transition to the “binding” of the detected polymorphisms to the transnosological characteristics. It is necessary to develop effective methods for the prevention of stress-associated disorders in military personnel, in general, including programs to increase stress resistance, as well as domestic multimodal software and hardware complexes to optimize the treatment and prevention of PTSD.
Background: attention deficit hyperactivity disorder (ADHD) is one of the urgent problems of psychoneurology. ADHD has a significant impact on the quality of life of a patient of any age. The variability of clinical manifestations depending on the age of the patient remain the subject of scientific discussion.
The aim of the review: based on the scientific data of recent years, to study achievements in the field of diagnosis and rational choice of drugs used for the purpose of pharmacotherapy of patients of various age categories with ADHD.
Materials and methods: the review is formed on the basis of scientific articles published in international databases (PubMed, Cochrane Library, Cyberleninka). The search was carried out using the following keywords: “attention deficit hyperreactivity syndrome”, “ADHD”, “psychostimulants”, “psychotropic drugs without psychoanaleptic effect”.
Conclusion: the features of the development and evolution of ADHD over time, by the time the patient grows up, determine its clinical manifestations, they become more heterogeneous, which requires additional diagnostic efforts to clarify the diagnosis in order to select effective pharmacotherapy in combination with psychosocial methods of treatment. Currently, drugs with and without psychoanaleptic effect are used as drug therapy for ADHD. The most promising drugs for the treatment of ADHD are monoaminergic reuptake inhibitors, as well as drugs with melatonergic activity. Of considerable interest is the further study of drugs that affect the GABA system, glutamatergic and cannabinoid transmission in the brain. In general, the authors of analysed publications unanimously recognize that the problem of selecting effective therapy of ADHD in childs and adult patients requires further study and the proposal of new means of correction.
Background: currently, the relevance of the formation of drug dependence on barbiturates, despite a significant decrease in the cases of their prescription, remains prevalent. The breadth of the therapeutic effects of barbiturates determines their use in various branches of medicine, despite the risk of developing dependence and withdrawal syndrome, even in the case of taking therapeutic doses. In addition, the non-drug use of barbiturates in order to achieve a narcotic effect remains relevant.
The aim of review: to analyze the data of scientific publications on specific features of the formation of barbituric dependence in various categories of patients, to determine the groups at greatest risk and the possibilities of minimizing the consequences of barbiturate use.
Materials and methods: based on the analysis of databases (PubMed/MEDLINE, RSCI, etc.), the current concepts of mechanism of action of barbiturates and the ways of development of mental and physical dependence were analyzed. The factors provoking the emergence of drug dependence are determined.
Results: the development of drug dependence when taking barbiturates develops rapidly and is dose-dependent. The features of the formation of barbituric dependence and the development of tolerance are characterized. The risk of developing dependence in the therapeutic use of barbiturates is especially high in the elderly.
Conclusions: to prevent and possibly reduce the risk of drug dependence, the main areas of research are proposed, namely, the development of more effective and safe drugs analogs of barbituric acid, as well as the correction of the features of the use of barbituric acid drugs (frequency, dosage, dosage form, etc.).
Background: stereotypical movements and actions are especially frequents in childhood. The interpretation of this phenomena is ambiguous as well as the concept of pathomorphosis and pathoplastic.
Objective: to analyze published studies concerning pathoplasty and pathomorphosis of stereotypes. Materials and methods: according to the keywords “pathoplasty”, “pathomorphosis”, “stereotypes”, “COVID-19 and psychosis risk”, “stereotypic movements”, “pathoplastic factor”, “repetitive actions”, “habitual movements”, “pathomorphosis of mental diseases”, a search for articles in English and Russian was conducted in the MEDLINE/PubMed, Scopus, Web of Science, eLibrary databases for the period from 2005 to 2023.
Results: the analysis of published works has shown the importance of differentiation of pathoplasty and pathomorphosis of stereotypes, including from the point of view of already established factors of influence on the disease, such as drug pathomorphosis, the effects of the COVID-19 pandemic on patients with mental disorders. A generalized review of foreign and domestic research on the topic of the work highlighted the theoretical foundations for understanding stereotypy not only as a predictor, but also as a differentiated symptom of a mental disorder that can change under the influence of pathoplastic factors.
Conclusion: recognition of differences between pathoplasty and pathomorphosis of stereotypes allowed us to highlight the power of pathoplastic influence on mental illness. This impact can also change the purpose of medical practice, modifying the symptoms and manifestation of stereotypes.
Background: the complex process of transition to the new International Classification of Diseases 11th revision and intensive research in the field of clinical, biological and social psychiatry involves the integration of acquired knowledge about the patient on the basis of a holistic approach. The functional diagnosis of mental disorders is becoming more important as well as the possibility of formulating a functional diagnosis as a system of holistic assessment of the patient’s condition.
Objective: to present the overview of domestic and foreign modern research on the evolution of conceptual views on functional diagnosis in psychiatry and the possibility of its practical applying.
Material and method: a search of scientific publications in the databases of MedLine/PubMed, Scopus, Web of Science, eLibrary, Google Scholar was made over the past 20 years using the keywords “mental disorders”, “functional diagnostics”, “biopsychosocial model”. As a result 97 authors in accordance with criteria were selected.
Results: Analysis of literature testifies that systematic approach to solving the problems of people with mental disorders, in despite of declare is not used in practice. A functional diagnosis is a tool that provides an opportunity to synthesize various information about a patient. The evolution of views on functional diagnostics in psychiatry based on the analysis of various diagnostic concepts is considered in a historical perspective. Taking into account new knowledge in the field of psychiatry, clinical psychology and neuroscience, modern methodological approaches to the substantiation of a functional diagnosis are presented. The role of an integrative dynamic biopsychosocial approach in the treatment and psychosocial rehabilitation of people with mental disorders is shown. The expediency of using a functional diagnosis in planning, implementing and evaluating the effectiveness of team methods of work in psychiatric practice is substantiated.
Conclusion: the term “functional diagnosis” is a reliable framework model that allows a holistic and systematic approach to the patient’s problems, setting and solving new scientific and practical problems.
ANNIVERSARIES
ISSN 2618-6667 (Online)