The aim of review: analysis of publications devoted to the outcomes of pathological grief reactions in elderly and senile age.Materials and methods. The scientific publications available to the general use of the Internet, websites pubmed.com, crossref.org, psychoreanimatology.org, cyberleninka.ru, elibrary.ru, printing works, presented in the periodic medical journals, abstracts of doctoral and master’s theses, manuals and monographs, conference proceedings. Retrospective review of works and the state of the problem in relation was made concerning the modern ideas about the formation of the various psychogenic disorders.Results. The basic provisions: pathological grief - state initialization whole complex of problems in elderly and senile age. The outcomes of psychogenic disorders are described as severe, protracted affective disorders and neurodegenerative brainlesions. Analysis of scientific papers devoted to the peculiarities of the dynamics, therapy and prognosis of these outcomes provides insight into the current situation of this problem.Conclusion. The study of the problems of outcomes psychogenic disorders, in particular of the pathological grief, in elderly and senile age is of great importance for the prediction and prevention of possible outcomes, and the correct choice of therapy.

The author of the first handbook on psychiatry «Mental diseases» (1834) professor P.A. Butkovsky is the founder of Russian psychiatry. He first introduced psychological, evolutionary and physiological principles in psychiatry. For the description and analysis of psychopathological phenomena he used psychology and physiology. He was the first apportionment psychopathic, catatonia, a simplex form of schizophrenia, involution depression and involution paranoid. In the characteristic of the diseases related to schizophrenia, described a symptom which corresponds to the thought disorder on the structure, mental and sensual delirium, reduction of energy potential, extracampinic hallucinations, disorder of the body schema. For the first time carried out the delimitation of mental retardation from dementia.

The aim is to present the basal trends in health care, which assure taking care of the mental health of children, prevention, and the modern medical and social organizational forms of work.Material and methods. In order to present the realistic picture of these problems, we submit the national statistics data concerning the prevalence and incidence of mental disorders in children and adolescents.Results. The analytical monitoring of a number of other indicators, as well as the legislative and the departmental fundamentals for ensuring the provision of psychiatric care, clinical examination, diagnosis and prophylaxis was made. Certain statistical data, screening information, clinical recommendations, and standards of care are being presented for the first time.Conclusions. The data of prevalence and incidence of mental and behavioral disorders in children and adolescents is a basis for development of National action strategy in the interests of mental health of this population.

Background. Cardiovascular abnormalities in psychiatric disorders in childhood is more common than in the population and play the role of somatic equivalents of mental disorders.The aim was to study the phenomenology of psychosomatic disorders in children with small anomalies of connective tissue dysplasia of heart.Material and methods. The main group consisted of 60 children at preschool and school age with somatoform autonomic dysfunction of cardiovascular system. The control group included 45 children with classic features of autistic spectrum disorders in comparable age. The assessments were conducted by the clinical method, psychological methods, CGI, PANSS, SANS, SAPS scales. Conducted correlation analysis, factor analysis clinical and psychological data were made.Results. Besides the general the cordial symptom by sonography the clinical picture was defined by mental disorders, mainly borderline level. A number of psychological phenomena, features of psychological development of children as look stigmas a schizotypal burdeness in the early anamnesis, deprivation tendencies in family relationship were revealed.Conclusion. The obtained data allow to consider increased risk for the development of different severity of mental deviations children with connective tissue diseases. The data presented are preliminary and the issue needs further study.

Schizophrenia is a chronic disease, where remission is defined not only by complete absence of symptoms but rather by the minimum degree of their intensity and by moderate patient’s maladjustment. After relapse 35% of patients have symptoms resistant to most antipsychotic drugs. Clozapine is one of the most effective antipsychotic drugs and is the drug of choice for treatment-re- sistant patients. At the same time, its application could be limited by poor tolerance in majority of patients, especially in the initial treatment period. There is alarge individual variety in effective doses of clozapine.Objective. Assessment of clinical relevance of clozapine blood plasma concentration in patients with episodic schizophrenia in partial remission of poor quality.Materials and methods. Twenty five patients (7 men, 18 women) average age of patients with diagnosis of episodic schizophre- nia in partial remission of poor quality with persistent severe residual psychotic disorders in the form of both delusional and/orпсихиатрия 4`2015 hallucinatory symptoms (paranoid schizophrenia, incomplete remission - F20.04 in ICD-10), who were prescribed clozapine, were included into the study. The average age of the patients was 41 ± 11 years, disease duration was 13 ± 8,6 years, age of onset was 28 ± 7,4 years. The main inclusion criterion was as follows: at least one of two items of PANSS, «Delusions» and «Hallucinatory be- havior», should be of mild or more severe degree (three points and higher). Blood sampling was carried out in the period between the seventh and tenth day of receiving by a patient a therapeutic dose of clozapine. Measurement of clozapine level was performed with mass spectrometry in the laboratory of pharmacokinetics MHRC, Clinical and psychometric (PANSS, CGI-S) assessment was done on the 7-th to 10-th and 28-th days of medication. Side effects were registered with UKU scale.Results. Average index of PANSS composite score for the moment of blood sampling amounted 94,9 ± 13,9, positive symptoms subscale - 23,2 ± 5. Average index for the item «Delusions» was 4,5 ± 1,04. For the item «Hallucinatory behavior» it was - 3,9 ± 1,15. Negative symptoms subscale was 24,2 ± 4 and general psychopathology subscale - 47,6 ± 8. Average level clinical global impression according to CGI-S was 4 ± 0,7 points. Average dose of clozapine was 245 mg/day (min. 100 mg/day, max. 700 mg/day). Plasma20 level of clozapine «hit» into the therapeutic window in 4 patients (16%), while in 15 patients (60%) it was lower and in 6 (24%) - higher than therapeutic levels. In two patients (8%) the concentration exceeded the toxic level. After 3 weeks of treatment andВопросы клинической и биологической психиатрии in 2 weeks after the blood sampling the patients with normal drug concentration (3 patients), had PANSS scores lower than in the groups with abnormal concentration. The patients with low plasma level of clozapine (13 patients) had lower PANSS scores than the patients with a high concentration (4 patients). Average number of side-effect cases caught by UKU scale per group was 2,35 ± 3,7: for patients with normal concentration it was - 3 ± 3,6, for low concentration - 0,38 ± 1,12, for high concentration - 8,25 ± 3. Significant moderate interrelation between the number of side-effects and both with dose ( r = 0,52) and with concentration in plasma ( r = 0,63) was found. The dose-dependent side effects included sedation, tachycardia, hypotension, dizziness.Conclusion. Optimal dose adjustment of clozapine according to clinical data only is a very difficult task. Optimal clinical efficacy and tolerability especially in the initial period of treatment may be achieved by accurate dose correction under control of plasma level of the drug. Information on clozapine plasma level could be helpful for individualizing of medication starting with the be- ginning of treatment in everyday practice.

The currency of the study is caused by high frequency of emotional disorders after severe traumatic brain injuries and their impact on rehabilitation process and life quality of the patients.The aim of the study was to investigate different variants of affective pathology in the process of rehabilitation of psychic activity after severe traumatic brain injury.Materials and methods. Affective impairments in 153 patients with severe TBI admitted to hospital in comatose state (with the value 3-7 scores on Glasgow come scale in the first day after injury) were assessed in dynamics by using the clinical method. The study included patients, who survived in the first 6 months after the injury and resuscitated.Results. The following set probability of occurrence of different emotional disorders was found in studied group: apathy (46%), euphoria (33%), dysphoria (26%), depression (48%), anxiety (38%), and hyperthymia (6%). Preferred sequence of their onset after coma in the range of apathy-euphoria-dysphoria-depression-anxiety was found. Interconnection of localization of posttraumatic focal brain changes and possibility of appearance of separate variants of emotional impairments were revealed as a trend: apathy in a case of lesion of left frontal lobe, euphoria in a case of lesion of right frontal lobe, depression in a case of lesion of posterior parts of right hemisphere, anxiety in a case of lesion of posterior parts of the left hemisphere. Unfavorable prognostic value was found for clinical outcomes of severe TBI symptoms for apathy and dysphoria and relatively favorable for symptoms of depression and hyperthymia. The necessity of individualization of psychopharmacotherapy was confirmed, as well as the necessity of exclusion of tricyclic antidepressive drugs and benzodiazepines in the treatment of emotional pathology in postcomatose patients.

Objectives. Studying of psychopathological manifestations, tendencies of dynamics of catatonic features in the structure of endogenous depression, and prognostic factors of the disease.Material and methods. 38 patients aged 16-58 years with depression occurring with catatonic disorders were examined by clinical-psychopathological method.Results. Psychopathological heterogeneity of catatonic features in the structure of complex endogenous depressions was revealed. 3 subtypes of catatonic disorders were defined in the structure of depression: 1) exclusively with hypokinetic symptoms of catatonia; 2) with a discreteness of the manifestations of catatonic disorders of polar registers; 3) with partial dyskinetic catatonia. It is shown that between the examined groups there are significant differences not only in the psychopathological manifestations, but in patokinesis of affective and catatonic disorders. It is revealed the importance of particular catatonic signs in the structure of depression for nosological assessment and determination of prognosis of the disease.

Objectives. To identify clinical and psychopathological features of anhedonia and its dynamics depending on a structure of sub- components in the framework of affective disorders or schizophrenia, as well as patterns of a process, development of the criteria of differential diagnosis and prognosis.Material and methods. Using psychopathological method we examined 37 patients (average age was 27,6 ± 1,2 years).Results. We selected 3 main types of anhedonia: 1) an anhedonia in the framework of depression in affective disorders; 2) aloss of ability to feel pleasure in the framework of depression at the prodromal stages of schizophrenia with continuation and further intensification its particular components; 3) an anhedonia without associated mood disorders (or their minimal expression) in the framework of schizophrenia, registered at initial stage and persisted in the future. The phenomenon of anhedonia has found a considerable heterogeneity, either in terms of the dynamics formation, or proper qualitative characteristics regarding to prognostic significance of the phenomenon.Conclusions. The presented differences of the anhedonia structure allow to speak about its correlation with a risk of manifestation of endogenic psychosis, the course of illness and its prognosis.

At the present time information about course and outcomes of psychosis oflate age, are virtually absent.The aim of the study was to establish the laws of the dynamics and prognosis of hallucinatory psychoses oflate age according to clinical follow-up study.Material. The material included 60 patients at the age of 60 and older with hallucinatory psychoses, developed inlate age at first time.Methods. During the study methods were used as follows: clinical follow-up, clinical-psychopathological, neuroimaging (MRI/ CT), psychometric (MMSE, Hachinski ischemic scale, Neuropsychiatric Questionnaire, NPI).Results. Clinical and follow-up examination of a group of patients, manifested in old age at the first time, showed a high incidence of adverse outcome. Prognostically unfavorable were patients with a true visual hallucinosis, hallucinosis with a long history, and patients with moderate or severe dementia on admission to hospital. Psychotic relapse pattern of psychosis with repeated admission generally is matched the characteristics of hallucinosis on admission. Among patients with recurrent hallucinatory psychosis prevailed cases of visual hallucinosis. Half of the patients re-admitted to the hospital for two years, was found the progression of dementia, and as a consequence a significant simplification of the productive psychotic symptoms.Conclusion. Hallucinatory psychoses of late age prognostically unfavorable, have a high frequency of recurrence of the disease, which depends not only on the psychopathological picture of psychosis, but also on the course of the disease and the presence of cognitive impairment.

Background. Previously we performed the ultrastructural morphometric study of lymphocytes in patients with chronic schiz- ophrenia before treatment and normal controls. We aimed to continue this study of the same patients with schizophrenia under olanzapine treatment to detect the effects of gender and treatment efficacy.Material and methods. We studied lymphocytes in 56 patients with schizophrenia treated 8 weeks with olanzapine and 49 patients treated 28 weeks with olanzapine as compared with 59 patients before treatment and 31 normal controls. Electron microscopy and morphometry were applied to estimate frequency and ultrastructural parameters of small, large, large activated lymphocytes (containing 10 and more mitochondria) and of atypical lymphocytes (lymphoblasts) in men and women, in responders and non-responders.Results. No gender or treatment resistance effects were found in the percentage of small, large and large activated lymphocytes and lymphoblasts in schizophrenia patients treated with olanzapine as compared to the patients before treatment. The volume fraction and the number of mitochondria in small lymphocytes and the number of mitochondria in large lymphocytes decreased significantly only in non-responders. The reduction of the number of mitochondria in large activated lymphocytes and in lymphoblasts was found in men but not in women. Gender significant differences were revealed in large activated lymphocytes after 8 weeks treatment.Conclusion. Treatment resistance and gender differences are associated with the deficit of mitochondria in lymphocytes of schiz- ophrenia patients treated with olanzapine.