ABSTRACT
Based on clinical models of problem situations, for the first time in the form of structured algorithms, the organization of a doctor's work is described - the process of operational activity of a specialist when considering medical, legal, departmental and interdepartmental issues in child psychiatry. The activity of a children's specialist, requiring intensification during outpatient admission, in its content represents a complex of sequential operational actions, built in stages, logical algorithms for making productive professional decisions. The algorithms of activity take into account the legal, diagnostic, clinical, therapeutic, rehabilitation and preventive stages in the organization of providing assistance. The productivity and efficiency of the work of a child psychiatrist, his specialization, experience, competencies, orientation in legislation and modern scientific and practical industry issues of diagnostics and assistance are indispensable components of the optimal process of organizing a doctor's activities. The availability and quality of assistance in modern society are achieved by observing the continuity of the activities of specialists, saving human resources, and developing service units. Of particular importance is the adoption of the right decisions by the health authorities and the achievement of an effective balance between community care, dispensary, hospital replacement technologies and inpatient specialized care.
Subject(s)
Outpatients , Psychiatry , Humans , ChildABSTRACT
OBJECTIVE: Evaluation of the efficacy and safety of the new drug Prospekta in the treatment of attention deficit hyperactivity disorder (ADHD) in patients aged 7-12 years. MATERIAL AND METHODS: A multicenter (35 clinical centres) double-blind, placebo-controlled, randomized, parallel-group clinical trial enrolled 363 patients. The mean age was 9.3±1.7 years. Children of both sexes aged between 7 and 12 years with a diagnosis of ADHD confirmed by DSM-V diagnostic criteria were included in the study. Patients with a total score of 22 or more on the Attention Deficit Hyperactivity Disorder-Rating Scale-V (ADHD-RS-V) were included in the study. After randomisation, patients in group 1 received Prospekta, 1 tablet twice daily; patients in group 2 received placebo according to the study drug regimen. The primary efficacy criterion was the proportion of patients with a 25% or greater reduction in the overall ADHD-RS-V scale score after 8 weeks of treatment. As additional criteria for efficacy assessment were assessed: change of ADHD-RS-V total score from baseline after 8 weeks of treatment; Clinical Global Impression Efficacy Index (CGI-EI) score after 8 weeks of treatment; side effects. RESULTS: The proportion of patients with a 25% or more reduction in the ADHD-RS-V scale score after 8 weeks of treatment was 55.9% in the Prospekta group, and 43.3% in the placebo group (p=0.0199). There was a reduction of ADHD symptoms in the Prospekta group as a mean ADHD-RS-V score decreased by 10.2±7.7 (in the placebo group by 8.1±7.9); the difference between the mean ADHD-RS-V score reduction during Prospekta and placebo treatment was 2.09±7.81 (p=0.0096). Mean CGI-EI scores calculated on the basis of physician scores were different in the Prospekta group compared to the placebo group at 6.9±3.2 versus 8.0±3.1 (p=0.0012), indicating greater clinical efficacy of the study drug. The frequency of adverse events (AEs) did not differ significantly between the groups. There were a total of 66 AEs in 46 patients, including 31 AEs in 23 (13.2%) Prospekta group participants and 35 AEs in 23 (12.2%) placebo group participants (p=0.87). No cases of serious AEs were reported during the study. Prospekta is compatible with drugs used in pediatric practice. Prospekta did not cause an exciting effect and did not adversely affect the sleep of patients. CONCLUSION: The drug Prospekta is an effective and safe treatment for ADHD in patients 7-12 years old.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Male , Female , Humans , Child , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/diagnosis , Double-Blind Method , Treatment Outcome , Tablets/therapeutic useABSTRACT
OBJECTIVE: To develop clinical and social models and management routes for patients with autism spectrum disorders (ASD). MATERIAL AND METHODS: A clinical follow-up study was performed for 254 patients, aged 4-17 years (average age 7.3 years), who represented the main forms of ASD. Psychopathological, clinical-follow-up, psychological and statistical methods were used. RESULTS AND CONCLUSION: Five management models for patients with different forms of ASD are described; differentiation of routes for interagency monitoring of patients is proposed. The effectiveness of the integrated use of drug and non-drug therapeutic approaches for the management of patients with ASD in the clinical-age aspect is shown. Timely diagnosis of ASD makes it possible to develop differentiated routes of patient management within the framework of interdepartmental interaction and achieve positive results in the clinical and age aspect.
Subject(s)
Autism Spectrum Disorder , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/therapy , Child , Follow-Up Studies , HumansABSTRACT
OBJECTIVE: Screening of children 18-48 months of age at risk of mental and developmental disorders in the general population. MATERIAL AND METHODS: The survey was conducted by a continuous epidemiological method in primary health care institutions in the nine largest regions of Russia. For the period 2017-2019, 595 691 parents of children, aged 18-48 months, were surveyed. RESULTS AND CONCLUSION: The prevalence risk rate for mental and developmental disorders was determined as 1.307:10 000. The prevalence rate for mental and behavioural disorders (ICD-10) was 151:10 000. The analysis of the structure of mental and behavioural disorders was carried out. An increase in cases of pervasive developmental disorders (item F84) was detected - autism spectrum disorders (ASD) with an increase in the age of children. The prevalence of ASD under the age of 48 months was found to be 18:10 000, compared with 2015-2016 - 5:10 000 under the age of 24 months.
Subject(s)
Autism Spectrum Disorder , Child Development Disorders, Pervasive , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Child , Child, Preschool , Humans , Infant , Mass Screening , Prevalence , Russia/epidemiologyABSTRACT
OBJECTIVE: To identify age-related psychopathological disorders and psychological characteristics of mental development and mental state of minors who committed suicide. MATERIAL AND METHODS: The study included a continuous sample of 285 reports of post-mortem psychological-psychiatric forensic assessment (CSPE) of juveniles, aged 11 to 17 years (average age 14.92±1.82), who committed suicide, in 7 federal districts of the Russian Federation. Within the total sample, two age groups were compared: adolescents from 11 to 14 years old (1) and 15-17 years old (2). Document analysis, clinical-psychopathological, clinical-psychological, qualitative and statistical methods were used. RESULTS AND CONCLUSION: Within the period from 11 to 17 years, the exponential growth of suicide rate is observed. An increase of family- and school-related psychological problems as well as difficulties in the relationship with the opposite sex are typical for the older group. Simultaneously, the effect of maladaptive individual features increases and psychopathological states and disorders, including, stress and adjustment disorders and depressive disorders, develop.
Subject(s)
Depressive Disorder , Mental Disorders , Suicide, Attempted , Suicide , Adolescent , Child , Humans , Russia , Suicide/psychology , Suicide, Attempted/psychologyABSTRACT
In this review, the authors analyze the causes of the high prevalence of autism spectrum disorders (ASD) in recent decades. It is shown that the expansion of the boundaries of the 'autistic spectrum' concept led to a significant spread of data on its prevalence, depending on the time, diagnostic criteria, country and region. Stability of the diagnosis of ASD is not high and depends on the age of the child. Diagnostic practice in comorbid psychiatric disorders unfairly shifted toward ASD. At the same time, the hypothesis on the uniqueness of autistic manifestations in infancy is not convincingly confirmed. The practical aspect of the problem of the epidemiology of autism does not exclude, but on the contrary, presupposes early detection of nonspecific mental disorders followed by medical-psychological-pedagogical correction.
Subject(s)
Autistic Disorder , Child Development Disorders, Pervasive , Autistic Disorder/epidemiology , Child , Humans , PrevalenceABSTRACT
AIM: To screen infants of the general population for the risk of autism spectrum disorders (ASD). MATERIAL AND METHODS: The survey was conducted by a total epidemiological method in primary health care facilities in the three largest regions in Russia (Volgograd, Novosibirsk, Chelyabinsk regions). For the period 2015-2016, 74191 parents of children aged 16-24 months were questioned. RESULTS AND CONCLUSION: The prevalence of risk of ASD (a condition of a pre-illness) was 103.5 cases per 1000 of children aged 16-24 months. Some of the children at ASD risk had a preventive consultation with a psychiatrist, 36 children (0.5 per 1000 peers) had severe clinical disorders classified as F84 - 'Pervasive developmental disorders' of ICD-10 (F84.0; F84.1; F84.8). From the perspective of predicative and preventive medicine, children at risk require complex measures to prevent the onset of a mental disorder or worsening of the mental state of the child.
Subject(s)
Autism Spectrum Disorder , Autism Spectrum Disorder/epidemiology , Child , Child, Preschool , Epidemiologic Studies , Humans , Infant , Prevalence , Russia/epidemiologyABSTRACT
The success and achievements in the area of neurosciences due to the development of neuroimaging, neurochemical and genome studies provide tasks for psychiatry determined by the necessity to develop new classifications of mental diseases, primarily ICD-11, specify clinical diagnostic criteria and rethink the essence of some mental disorders. In spite of the multiple direction of scientific opinions on the discussed issues, the development of modern psychiatry is characterized by intensive search of biological background of psychiatric disorders and elaboration of effective approaches to the diagnosis and treatment of mental diseases, including medical rehabilitation of patients.
Subject(s)
Diagnostic and Statistical Manual of Mental Disorders , Mental Disorders/classification , Psychiatry/trends , Humans , International Classification of Diseases , Neurosciences/trendsABSTRACT
The review article addresses transnational problems of socially stressful events and their contribution to the mental state of children and adolescents. The authors suggest the concept of distorted socialization in minors, who had experienced adverse events, with the formation of the concept of socially maladaptive distress reactions (SMDR). This typology has not just the age-related dynamics but also the gender specificity. Research methodology and systemic approach to SMDR from the perspective of understanding by specialists of various professions are significant for psychologists, neurologists and children's and adolescents' psychiatrists, including the forensic-psychiatric experts. The combined approach is important for the diagnostic qualification of conditions, development of correctional psychotherapeutic programs and expert approaches with reliance on gender signs, qualitative and quantitative characteristics of personal response in identifying SMDR.
Subject(s)
Socialization , Stress, Psychological , Adolescent , Child , HumansABSTRACT
The article reviews literature on risk assessment, risk forecasting and performance of aggressive acts by patients with mental disorders. Special attention is paid to the determination of risk factors for violence and ways to overcome them. An integrated system of risk assessment of aggressive behavior of patients with mental disorders, based on an analysis of psychopathological,personality and social factors, is needed.
Subject(s)
Dangerous Behavior , Mental Disorders/psychology , Aggression , Humans , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Personality , Risk Assessment , Socioeconomic FactorsABSTRACT
Fifty-eight male adolescents aged 15-17 years have been divided into 3 groups: 31 patients with mental infantilism syndrome were included in the study group, 14 with organic brain disorders--in the comparison group and 13 psychiatrically and neurologically normal subjects--in the control group. EEG was recorded from 12 leads monopolarly at rest, during hemisphere-specific cognitive tasks performance and exposure to aversive sound stimulation. Two-Hz wide EEG spectral ranges--A, theta1, theta2, alpha1 and alpha2--were analyzed. Only in the study group, there were decreased values of alpha2 spectral power (SP) and reduced reactivity to functional tests and insufficient lateral differentiation of the reactions during the cognitive tasks performance. Maximal deviation of the SP reactivity indices as compared to the comparison group was found in alpha2 range. The disturbances obtained indicate the delay of brain maturation and retardation in formation of specific neural networks. The results of the study demonstrate that indices of alpha2 SP may be considered as objective criteria of delayed mental maturation.
Subject(s)
Brain/physiopathology , Developmental Disabilities/diagnosis , Developmental Disabilities/physiopathology , Electroencephalography , Mental Health , Adolescent , Alpha Rhythm , Child , Cognition Disorders/diagnosis , Cognition Disorders/epidemiology , Delta Rhythm , Humans , Neuropsychological Tests , Theta RhythmABSTRACT
Thirty males with prior myocardial infarction concurrent with arterial hypertension (AH) were examined to study the antihypertensive and antiischemic effects of the AT1-receptor blocker irbesartran. Group 1 comprised 12 (40%) patients with mild AH; Group 2 included 18 (60%) with moderate AH. In Group 2, the standard therapy with irbesartan in a single dose of 150 mg in the morning was supplemented by the beta1-adrenoblocker atenolol in the average daily dose of 31.25 mg. In Group 1 patients there were decreases in systolic blood pressure (SBP) by 28% and diastolic blood pressure (DBA) by 19% while in Group 2 receiving combined therapy with atenolol, SBP lowered on the average of 38.3 mm Hg of the baseline values and DBA became normal in 66.7% of the patients (p < 0.00). Thus, irbesartan provides good antihypertensive and antiischemic effects in patients with grade 1 AH; the combined therapy enhances the efficiency of treatment by 92% in patients with moderate AH.
