[Bipolar and monopolar affective disorders of juvenile age].

Results of clinico-psychopathological and clinico-catamnestic studies are presented based on the examination of 174 patients with affective disorders that manifested themselves at the age of 15-25 years. The main psychopathological features of juvenile phase-affective conditions are described (subtle vital manifestations of the thymic component, polymodality of the affect with simultaneous presentation of two varieties of affective disorders, instability of the affect changing within a single phase, high occurrence of overvalued ideas reflecting specific emotions of the juvenile age with concomitant manifestations of pubertal psychological crisis underlain by common pathogenetic mechanisms). High frequency of mixed affective conditions and the predominance of the bipolar type of the disease are emphasized, clinical features of mono- and bipolar pathology are described. It is concluded that a special algorithm of psychopharmacological and psychotherapeutic therapy adapted to the juvenile age is needed for the treatment of the above disorders.

[Clinical-genetic parameters and the nosological evaluation of schizoaffective psychosis in systematics of attack-like endogenous psychoses].

Authors studied 1013 first- and second degree relatives in families of 193 probands. The probands were stratified by clinical diagnosis into 6 groups: 1) nuclear variant of schizoaffective psychosis (SAP); 2) "marginal" (intermediate) variant of SAP; 3) schizoaffective variant of schizophrenia; 4) recurrent schizophrenia; 5) attack-like progressive schizophrenia; 6) bipolar affective disorder or manic-depressive psychosis (MDP). Probands (n=109) and their relatives were studied using the direct clinical examination; the study of 84 probands and their relatives was based on the medical records from the genetic archive of Mental Health Research Center, Russian Academy of Medical Sciences. Mental pathology was found in 72,5% of relatives; 27,5% were healthy. Prevalence of endogenous and non-endogenous psychoses, personality disorders and cases of alcoholism and suicides in the families of probands was studied. A "set" of these psychopathologies was similar in families of all probands and their frequency was higher than that in the general population that confirmed the affiliation of SAP with endogenous diseases by genetic characteristics. In patients with SAP, hereditary characteristics differed by the frequency, correlation and preference of some types of mental pathology compared to families of patients with schizophrenia and MDP, in particular, hereditary characteristics of patients with recurrent schizophrenia and MDP which were identified with SAP by many authors. The clinical-genetic patterns revealed in the study are considered as an argument for nosological independence of SAP.

[Mixed affective states in the juvenile age (historical aspects, current state of the problem, psychopathology)].

The author analyzed the problem in historical, diagnostic and psychopathological aspects and presented the results of his own study. The aim was to study the structure and dynamics of endogenous juvenile mixed states in order to work out the psychopathological typology and to clarify the criteria of diagnosis, differential treatment and clinical-social prognosis. The study included 174 patients, 118 men and 56 women, aged from 17 to 25 years (mean age 20, 4 years). Depressive states were found in 65%, mania in 16% and mixed in 19% of patients. The clinical differentiation of mixed states was carried out basing on the dominating pole of affective disorders and the following types were singled out and described: mania type (dysphoria-like mania)--34%, depressive type (association-driven depression)--38%; alternating type of mixed states--28%. The preference of the formation of alternating and atypical variants of mixed states in the juvenile age demonstrated in the study may reflect the pathogenetic and pathoplastic effect of biological features characteristic of this age--lability and polymorphism of clinical presentations as well as immaturity of emotional and cognitive spheres.

[Contribution of pubertal psychobiological processes to the formation and clinical manifestations of juvenile depressions].

Based on the study of 486 patients, aged from 16 to 25 years, key features of psychopathology of juvenile depressions were specified. They included bluntness and atypism of a depressive triad with insignificant expression and rudimentariness of the thymic component per se, a large proportion of cognitive disorders and psychopathy-like disturbances, a higher frequency of special overvalued syndromes of metaphysical and dysmorphophobic character. Types of juvenile depressions were singled out as follows: depressions with the clinical picture of juvenile asthenic failure, dysmorphophobic, metaphysical, heboid, psychasthenic-like, depersonalization, senestho-hypochondriac depressions as well as depressions with obsessive-phobic disorders and with "psychogenic contents". The efficacy of the combined use of serotoninergic antidepressive drugs (SSRI) and antipsychotics (flupentixol, trifluoperazine, quentiapine, amisulpride ziprasidone) was confirmed and the high selectivity with respect to cognitive and overvalued disorders as well as to the impairment of mental activity was demonstrated. Correlations between therapeutic effectiveness of separate SSRI drugs and types of juvenile depression were found. The importance of complex approach, including not only psychopharmacotherapy but also cognitive-behavioral psychotherapeutic methods, is emphasized. Current concepts of peculiarities of neuroplastic changes in the human brain underlying manifestations of "puberty mentality" and their pathogenetic and pathoplastic contribution to the formation of juvenile depressions are discussed.

[Anti-somatostatin autoantibodies in the blood serum of patients with schizophrenia]. / Uroven' autoantitel k somatostatinu v syvorotke krovi bol'nykh shizofreniei.

Solid-phase IEA was used to measure the level of autoantibodies to somatostatin in the blood serum of 44 schizophrenics and 24 healthy donors. The patients suffering from schizophrenia manifested a higher (p less than 0.01) level of immune responsiveness of the blood serum to somatostatin (0.665 +/- 0.03) as compared to the control group (0.509 +/- 0.05). The main contribution to the differences between the groups as regards the parameter measured is made by patients with malignant (0.810 +/- 0.10) and paranoid (0.773 +/- 0.08) schizophrenia whereas the patients' subgroup with slow-progressive schizophrenia did not differ from normal regarding the level of autoantibodies to somatostatin in the serum (0.504 +/- 0.03). These tentative data agree with a hypothesis of the involvement of autoimmune processes into the development of schizophrenia.

[Clinical and economic approach to evaluation of the effectiveness of moditen-depot and haloperidol decanoate in the maintenance therapy of attack-like schizophrenia]. / Klinicheskii ékonomicheskii podkhod k otsenke sravnitel'noi éffektivnosti moditena-depo i galoperidola dekanoata v podderzhi- vaiushchei terapii u bol'nykh pristupoobraznoi shizofreniei.

The efficacy of the use of moditen-depo and haloperidol decanoate as preventive anti-recurrence+ therapy was studied and compared in 2 groups of patients suffering from attack-like schizophrenia with frequent exacerbations. The cost-use analysis made it possible to establish their higher efficacy as compared to the routine maintenance therapy. Proceeding from the clinical, economic and socioeconomic indicators the use of haloperidol decanoate turned out more effective than the use of moditen-depo.

[Sensory delirium of attitude in adolescence (problems of phenomenology and its dynamics)]. / Sensitivnyi bred otnosheniia v iunosheskom vozraste (voprosy fenomenologii i dinamiki).

On the basis of a clinical follow-up of juvenile schizophrenia first manifested in delirious states with a picture of sensitive delirium of attitude (65 patients) the author has determined the stages of its development in youth and characteristics of the psychopathological structure of delirious disturbances which are poorly systematized and are still to be researched; the condition is characterized by a combination of elements of sensitive and interpretative delirium. The author has established a close correlation between the contents of delirium in these cases and the pubertal age, a peculiar nature of delirious constructions similar to super-worship formations, as well as a distinctive involvement of affective disturbances and catathymic psychic disorders in their formation. It has been shown that the pubertal age is pathogenetically significant with regard to the manifestations, course, and dynamics of the given variant of sensitive delirium of attitude.

[Early diagnosis, variety of outcomes and prognosis of juvenile schizophrenia with over-value disorders of the "metaphysical intoxication" type onset (results of a late follow-up study)]. / Ranniaia diagnostika, raznovidnosti iskhodov i prognoz iunosheskoi shizofrenii, debiutiruiushchei sverkhtsennymi rasstroistvami tipa "metafizicheskoi intoksikatsii" (dannye otdalennogo katamneza).

On the basis of follow-up findings about juvenile schizophrenia first expressed in superworship manifestations according to the type of metaphysical intoxication (98 observations), the authors established that most frequently these cases were characterized by a torpid course of the disease in the framework of slowly progressing juvenile schizophrenia. There was a high rate of favourable outcomes at the level of "clinical recovery" (in 42.5%). Favourable prognostic signs were as follows: the complete nature of the clinical picture of the syndrome, its similarity to pubertal crisis manifestations, the absence in its structure of other positive disturbances and a number of specific features of the premorbid picture. The authors determined the pattern of correlation between the typological characteristics of the state of juvenile metaphysical intoxication and the outcome of the disease, peculiarities of manifestations of this phenomenon at the initial stage of psychotic forms of juvenile schizophrenia, as well as distinctive features of superworship formations according to the type of juvenile metaphysical intoxication observed in the framework of pubertal decompensation in schizoid psychopathies.