[Psychotropic drugs used in a psychiatric hospital (pharmaco-epidemiologic aspects)]. / Psikhotrropnye sredstva, primeniaemye v psikhiatricheskom statsionare (farmakoépidemiologicheskie aspekty).

The aim of the study was to optimize psychopharmacotherapy in a big psychiatric hospital. It was conducted in Moscow Alekseev psychiatric hospital No 1, using a method of comparison of standard psychotropic treatment and medication strategy suggested by the expert group. An analysis of the treatment of 966 patients with different mental disorders revealed that 78.3% were in need of neuroleptic assignment that was in line with routine practice. The expert's conclusions were postulated as follows: a need in phenothyazines is significantly lower than that observed in practice. Xantens and tyoxantens (chlorprothixene, flupentixol, zuclopenthixol, zuclopenthixol decanoate, zuclopenthixol acetate), benzamides (sulpiride) and such atypical antipsychotics as risperidone, olanzapine and quentiapine are underused in the treatment. Comparing to usual practice, more patients (35.8%) need antidepressants treatment. Thymoleptics should be assigned in greater daily doses. Selective inhibitors of serotonin reuptake (paroxetine, fluoxetine, citalopram, sertraline), reversible MAO A inhibitors (pyrazidolum), "double-action" drugs (mirtazapine, milnacipran) are recommended for wider usage. Less patients (33.4%) are in need of tranquilizers, though a number of medications used is consistent with a recommended one. Normothymics may be assigned to essentially less part of the patients and 18% of them need nootropics that is consistent with routine practice.

Prospective evaluation of circulatory levels of catecholamines and serotonin in neuroleptic malignant syndrome.

OBJECTIVE: Neuroleptic malignant syndrome (NMS) may be associated with a dysregulation of the catecholaminergic and serotonergic systems. The objective of the present study was to evaluate prospectively the circulatory levels of serotonin (5-HT), epinephrine (E) and dopa in patients suffering from NMS. METHOD: Platelet-poor plasma (PPP) levels of serotonin, epinephrine and dopa in eight NMS patients were measured twice: in the acute state and in the state of remission. RESULTS: PPP dopa concentration was significantly lower in acute NMS state compared to the remission state (P = 0.023). In contrast, PPP E level was significantly higher (P = 0.019) in the acute NMS state and PPP 5-HT concentrations in the acute state tended to be higher than those at remission (P = 0.078). 5-HT/dopa ratio was significantly higher in the acute NMS (P = 0.015). CONCLUSION: These results may reflect reduction in dopaminergic function and increase in adrenergic and serotonergic activity in the acute NMS state.

Frequency of neuroleptic malignant syndrome in a large psychiatric hospital in Moscow.

A ten-year prospective survey of neuroleptic malignant syndrome (NMS) was performed in a major psychiatric hospital (1,510 beds) in Moscow. All inpatients who developed a persistent and severe extrapyramidal rigidity accompanied by fever after exposure to neuroleptic medication were screened for NMS. The diagnosis of NMS was established according to Levenson's criteria and at a later stage all NMS cases were reevaluated using the DSM-IV research criteria. Data on age, gender and psychiatric diagnoses were analyzed. Of the 78,708 inpatients treated with neuroleptic agents, 19 separate patients had an episode of NMS, for a frequency of 0.02%. Mortality rate was 10.5% (2/19 patients). Of the three potential risk factors studied, only young age (

[Psychopharmacotherapy and management of psychiatric care in somatic hospital]. / Psikhofarmakoterapiia i problema organizatsii psikhiatricheskoi pomoshchi v somaticheskom statsionare.

A clinical trial was made of 1994 patients admitted to a large general hospital in Moscow during a day in two seasons (spring, autumn). The aim of the study was to detect patients of a general hospital in need of psychotropic drugs, to assess their psychic condition and to develop recommendations for optimization of psychiatrist's consulting. It was found that 49.3% of the examinees need psychotropic drugs (at least one). 37.5% need tranquilizers, 20.7%--nootropic drugs, 21.2%--antidepressants, 5.9%--neuroleptics.

[Psychosomatic disorders (clinical picture, epidemiology, therapy and models of health services]. / Psikhosomaticheskie rasstroistva (klinika, épidemiologiia, terapiia, modeli meditsinskoi pomoshchi.

53.6% of the patients of general hospital suffer from psychosomatic disorders (PSD). Two-dimensional (psychologic/ clinical) model of psychosomatic interrelations is presented which proposes the estimation of the influence of both somatic and psychological factors within PSD pathogenesis. The clinical classification of PSD includes 4 types: somatization (somatoform disorders)--organ neuroses--27%; psychogenic (nosogenic) reactions--57%; stress-related exacerbation of the medical illness (symptomatic lability)--14%; exogenous (somatogenic) reactions--1%. Except psychotherapy, PSD treatment demands pharmacological intervention (including tranquilizers, antidepressants, cerebroprotectors and neuroleptics). Pharmacotherapy should be proceeded with the account of both its possible somatic effects and its interaction with conventional medical agents. The results of the follow-up study prove superiority of psychopharmacotherapy over psychotherapy in terms of long-term efficacy. The most effective model of the organization of psychiatric care in PSD clinic is liasion psychiatry (psychiatrist consults and general practitioner treats). Inpatient treatment of non-psychotic PSD patients requires an organization of specialized units within a general hospital.

[Experience with the early use of combined intensive drug and occupational (at an industrial enterprise) therapy of schizophrenic patients]. / Opyt rannego primeneniia kombinirovannoi intensivnoi medikamentoznoi i trudovoi (na promyshlennom predpriiatii) terapii bol'nykh shizofreniei.

The report contains some results of a 3 year study of combined intensive psychopharmacological and occupational therapy of 120 patients (on the basis of the Gannushkin City Mental Hospital N4 and 2 industrial plants) during the stage of a subacute development of the schizophrenic process. On the basis of clinical and methodological criteria the authors distinguish 3 groups of patients and 3 types of rehabilitative programmes respectively. The medical and socio-occupational effectiveness of the new modification of combined intensive psychopharmacological industrial therapy of schizophrenic patients has been confirmed.

[Outpatient arrest of recidives and exacerbations in schizophrenia]. / O vnebol'nichnom kupirovanii retsidivov i obostrenii shizofrenii.

The report contains successful results of ambulatory treatment of 54 patients with relapses of attack-like developing forms and exacerbations of continuous forms of schizophrenia. The basic principles in the treatment were intensity and dynamic influence of psychopharmacotherapeutical agents. As a rule under such conditions there were a rapid reduction in the acuity. The authors distinguish clinical, family-environmental and organizational-therapeutic indications, which may lie at the basis of the place of choice for treatment--hospital or dispensary (out patient clinic).