[Actual problems of systematics of depression].

The authors analyzed traditional (categorical) and current (dimensional) approaches to the systematics of depressive disorders. Clinical concepts underlying current classifications of depression, including the positive-negative affect model, a dimensional rhythmological model of depression, are considered in details. Clinical differentiation of "intermediate" forms between categorically defined affective disorders (schizoaffective disorder - psychotic depression); a search for clinical and social predictors for depression adjusted for the affinity to the presentation of positive-negative affectivity; specification of the structure of constitutional abnormalities associated with affective pathology are key areas that demand further study.

[Personality disorders and depression].

Comorbid relations between personality disorders (PD) of affective and non-affective types (anxiety-hypochondriac character) and depression were analyzed in 35 patients including 13 men (37.1%) and 22 women (62.9%), mean age 49.6±12.5 years. The formation of clinical entity - melancholic depression - was postulated in all cases regardless of PD type. The authors suggest a personality complex - a syndrome of depression risk that predicts the development of phasic affective disorders and exerts the effect on their clinical characteristics. This conception designates the complex of abnormal personality traits both obligatory and facultative (or even latent). The introduction of the definition of "the syndrome of depression risk" and its extrapolation on PD of non-affective types allow consideration of abnormalities of affective cluster and anxiety-hypochondriac character in the frames of a spectrum model.

[Affective phases in dynamics of personality disorders (on a model of borderline personality disorder)]. / Affektivnye fazy v dinamike rasstroistv lichnosti (na modeli pogranichnogo rasstroistva lichnosti).

Affective phases developing in personality disorder (index-sample--98 patients) were compared to those in cyclothymia (85 patients--control group). A preference of phase dynamics in the group of abnormalities relating to ICD-10 item "Borderline personality disorder" was confirmed. In line with a concept considering personality disorders as clinical syndromes, patients of the index-group have personality disorders with the signs of psychopathological diathesis determined by vulnerability to affective disorders. Affective phases are interpreted not only as an expression of a specific type of personality disorders dynamics but as an emergence of affective pathology, which is alternative to endogenous one both by modus of constitutional predisposition and clinical parameters (egosyntonic moderating of the phase, domination of negative affectivity in its structure, amphitymic duality of pathologically altered affect).

[The experience of pyrazidol use in the treatment of non-psychotic depression]. / Opyt primeneniia pirazidola pri terapii depressii nepsikhoticheskogo urovnia.

Pirazidolum ("Masterlek", Russia) was used in the treatment of 30 patients with recurrent depression (ICD-10 item F33) and depression episode (F32), mild and moderate types. The initial dose was 50-75 mg daily, mean dose--200-350 mg daily, treatment course--28 days. The efficacy of the treatment was evaluated by Clinical Global Impression (CGI) scale, Hamilton depression (HAM-D) scale and side effects scale (UKU). Significant improvement was revealed in 73% of the patients. A trend to improvement scored on HAM-D was detected by 2 treatment week 2, and pronounced improvement (more than a half-decreased total score)--by week 4. Only 27.6% of the patients had weak side effects (dry mouth, sweatiness, tachycardia etc) that did not demand any changes in the treatment course. The authors believe that pirazidolum may be referred to antidepressants which are effective for depression with a prevalent positive affect.

[Fluvoxamine (fevarin) in psychogenic depression]. / Primenenie fluvoksamina (fevarina) pri psikhogennykh depressiiakh.

30 patients suffered from psychogeneous depressions with anxiety have been treated with the fluvoxamine (100-300 mg/day) by 8 weeks. The disorder have been developed after the severe psychogenic trauma--the death of one of the close relatives. Assessment of the fluvoxamine efficacy and safety have been carried out by means of both the data of the psychopathological investigation and of some rating scales: Clinical Global Impression Scale--CGI, the Hamilton Depression Scale--HAM-D, the Scale of Side Effects, etc.). The pronounced clinical improvement have been achieved in 63.3% of cases beginning from the 2nd week of treatment. HAM-D scores decreased from 27 to 9 (p < 0.01). The reduction of the anxious and depressive symptoms occurred synchronously but reduction of somatic anxiety preceded the psychotic one. The side effects (sleepiness, nausea, etc.) have been noted only in 7 cases (23.3%) during the 1st week of treatment, and then disappeared.

[The psychopathological structure of depressions]. / K psikhopatologicheskoi strukture depressii.

The theoretical model of depression has been developed on the basis of 275 psychopathological observations of the affective disorders. The primary symptom complexes of hypothymia and alienation are considered to be the obligatory components of the syndrome structure. Depressions are ranged into the system with variants according to comorbid correlations between hypothymia and alienation. The anesthetic depression (in which the signs of vital affective suppression and alienation are characterized by total symptomatological comorbidity) considered to form the center of such system. The variations of affective disorders (vital, existential, "self-torture" depressions, "depression without depression") in which the comorbidity phenomenon is just partly realized and in which one of the symptom complex is totally expressed have the marginal position.

[The comorbidity of hyperthymia and hypochondria]. / K probleme komorbidnosti gipertimii i ipokhondrii.

The authors examined 88 patients with hyperthymic-hypochondriac disturbances. Their typological differentiation is presented. Clinical and prognostic heterogeneity of euphoria and dysphoric-maniacal hypochondria is conditioned by relationships between different comorbid elements within complicated affective-hypochondriac syndrome.

[Psychopathological characteristics of the dynamics and outcomes of asthenia]. / Psikhopatologicheskaia kharakteristika dinamiki i iskhodov astenii.

The dynamics of asthenic syndromes was subjected to a psychopathological analysis in 200 patients. It has been established that asthenia may manifest not only as a transitory neurotic disorder (either completely reversible or preceding the formation of steady morbid manifestations of the other structure) but also represent a number of independent psychopathological disorders that determine the clinical picture of the disease at the main stages of its development. The essence of asthenic syndrome transformation may be reduced to polar change of the morbid manifestations: hyperesthesia--hypesthesia, with estrangement of bodily sensations and own activity. The dichotomy indicated may be distinguished as a prognostically informative differentiating sign. In the light of the typology suggested the authors consider not only the place of asthenia in the continuum of pathological disorders but also its correlation with negative alterations.

[Comparative clinico-genealogical analysis of slowly progressive schizophrenia and hysterical-type psychopathy]. / Sravnitel'nyi kliniko-genealogicheskii analiz maloprogredientnoi shizofrenii i psikhopatii istericheskogo tipa.

A genetic correlational analysis of two variants of slowly progressive schizophrenia (SPS) (hysterical schizophrenia--70 families, paranoid schizophrenia--40 families) and hysterical psychopathy (30 families) has demonstrated that there is a definite genetic heterogeneity between nosologically heterogeneous hysterical manifestations in SPS and constitutional psychopathy which reflects the influence of the general constitutional "axis" in systems of genetic determination of these forms. At the same time no significant genetic correlations (according to hysterical predisposition) have been found between the above forms and the paranoid variant of SPS. The results corroborate the hypothesis about a multiaxial structure of hereditary predisposition in SPS.

[Comparative clinico-genetic analysis of slowly progressive and manifest forms of schizophrenia]. / Sravnitel'naia kliniko-geneticheskii analiz maloprogredientnoi i manifestnykh form shizofrenii.

Using modern genetico-mathematical methods (genetico-correlational analysis), the author made a comparative analysis of the findings from a clinico-genealogic study of two groups of probands--with torpid schizophrenia (192 families) and with manifest forms of schizophrenia (365 families). The results obtained confirm the validity of the clinical differentiation of torpid schizophrenia as one of relatively independent forms of schizophrenia.

[Clinico-geneaological study of paranoid schizophrenia]. / Kliniko-genealogicheskie issledovanie paranoiial'noi shizofrenii.

On the basis of a comparative analysis of aggravated familial history in cases of paranoiac and neurosis-like schizophrenia (73 families in the main and control groups), the authors established accumulation of disturbances of "the paranoid spectrum" (delirious, paranoiac psychoses, paranoid anomalies of the personality) predominant in the families of the main group. This fact is interpreted in favour of a considerable role of constitutional and genetic factors in the genesis of paranoiac schizophrenia.

[Intensive psychopharmacologic therapy of slowly-progressive schizophrenia]. / Intensivnaia psikhofarmakologicheskaia terapiia maloprogredientnoi shizofrenii.

The authors analyze the results of psychopharmacotherapy of 120 patients with slowly progressive schizophrenia characterized by a high resistance to the treatment. Two new methods of the intensive therapy of such conditions (discrete and daily intravenous drip of tranquilizers in conjunction with low doses of neuroleptics) are described. The pharmacological and pharmacokinetic substantiation of each of the two techniques is presented. Clinical indications for their use have been elaborated.

[Family background characteristics in slowly-progressive schizophrenia]. / K kharakteristike semeinogo fona pri malo progredientnoi shizofrenii.

The authors studied the family history of 103 patients with slowly progressive schizophrenia (1218 relatives) characterized by the predominance of obsessions and hysterical disturbances. The study disclosed the accumulation of both various forms of schizophrenia and personality anomalies of psychoasthenic and hysterical types among the relatives of the patients. The clinical specific features of "linear" symptomatology in the families studied were considered. The role of one or another type of constitutional predisposition in the development of phenotypical variants of the disease is shown.

[Psychopharmacotherapy of slowly progressive hypochondriacal schizophrenia]. / K problemem psikhofarmakoterapii maloprogredientnoi ipokhondricheskoi shizofrenii.

The efficacy of psychopharmacological treatment modalities and comatose methods was studied in the therapy of patients with slowly progressive schizophrenia, the clinical picture of which was characterized by cenestho-hypochondriacal disturbances (155 cases). The use of high doses of neuroleptics, atropine and insulin comas in these cases were ineffective. A positive compliance to therapy was attained in the treatment by tranquilizers of the benzodiazepine series, especially by a parenteral administration. The best results were demonstrated in the treatment of pseudoneurotic hypochondria. The therapeutic reluctancy increased in the cenestho-algic syndrome and in the syndrome of "rigid" hypochondria. The most effective in these cases was a combined therapy by tranquilizers (parenteral administration) and small doses of neuroleptics.

[Use of phenazepam in the treatment of neurotic conditions]. / Primenenie fenazepama pri terapii nevroticheskikh sostoianii.

The report contains data concerning clinical studies of a new Soviet tranquilizer of benzodiazepine derivative--phenazepam. Treatment of 100 patients gave a good therapeutical effect in 82%. The best results were attained in the treatment of generalized hystero-neurotical states, somewhat less in the group of neurotic states with a prevalence of affective disorders and the less effective in the obsessive-phobic syndrome. On the basis of comparative studies, the conclusion is made that phenazepam is not worse by its psychotropic activity than ativan (lorazepam) and exceeds diazepam (seduxen), most likely because of its myorelaxing action. The drug exerted an expressed hypnotic effect being not less than eunoctin and other eunectics.