[Pathological fear of weight gain is a necessary criterion of anorexia nervosa].

OBJECTIVE: To analyze the diagnostic value of fear of weight gain (obesity) criterion in anorexia nervosa (AN). MATERIAL AND METHODS: Authors examined 30 patients with significant weight loss due to self-restriction of food intake. The patients were stratified into the group (n = 15) that met ICD-10 criteria of AN (restrictive variant) and the group with somatoform dysfunction of the autonomic nervous system of the gastrointestinal tract. Authors compared these groups and presented a description of two cases. RESULTS: The patients of the second group met 3 of 4 AN criteria and would be formally diagnosed with atypical AN but they had not the fear of weight gain. Moreover, the patients of this group significantly differed by several clinical parameters and responses to treatment. In diagnostic view, the most important is the presence of the dysmorphophobia/dysmorphomania syndrome in patients with AN and hypochondriac syndrome in the patients with somatoform dysfunction. CONCLUSION: The diagnostic criteria of eating disorders should be revised. However, "fear of weight gain", to our opinion, should be considered as a necessary criterion of AN.

[Anxiety-depressive disorders and paroxysmal atrial fibrillation: the psychosomatic aspects].

One hundred and forty-five patients with paroxysmal atrial fibrillation were examined to evaluate the effectiveness of the correction of physical state in the course of complex (somatotropic and psychotropic) therapy. Personality characteristics of patients with arrhythmias, the structure and severity of stress and anxiety-depressive disorders preceding the manifestation of paroxysmal atrial fibrillation were studied. Patients were examined at baseline and at the 21st day of therapy using clinical and instrumental methods (Holter ECG monitoring) and psychometric scales (the Beck Depression Inventory, the Zung Self-Rating Anxiety Scale, the Hamilton Depression Rating scale, the Hamilton Anxiety Rating scale). The complex treatment of patients with paroxysmal atrial fibrillation with SSRI antidepressants (paroxetine, fluvoxamine, sertraline) allowed to rapidly reduce neurotic anxiety depressive disorders. There was a significant positive trend in the course and frequency of paroxysms of atrial fibrillation on 21st day of treatment. These remedies help to reduce the duration of arrhythmia's attack which has already begun facilitating its relief. After 3-5 months of such regular complex pharmacotherapy, paroxysms of atrial fibrillation were completely stopped in 10.3% of patients. The follow-up investigation 18 months later showed that patients with certain personality traits and the positive dynamics of paroxysmal atrial fibrillation under a complex (somatotropic and psychotropic) treatment can develop cardiophobia' attacks in recurrent significant stress situations. Side-effects of the drugs were not significant and did not require discontinuation of the treatment.

[Sexual problems in patients with prostate cancer and those with benign prostatic hypertrophy]. / Troubles sexuelS chez des patients atteints de cancer ou d'hyperplasie bénigne de la prostate.

We use the word "tumour" both for a benign prostatic hypertrophy and for a prostatic cancer. The psycho-emotional reactions from a man suffering from these illnesses could be different depending on the kind of tumour, but could be similar especially concerning sexual problems connected with the specific affliction. Hence the necessity also to consider beneficial a psychotherapeutic and sexotherapeutic intervention.

[Comparative effectiveness of mood stabilizers in the complex therapy of bulimia nervosa].

Forty-five patients with bulimia nervosa were treated with the antidepressant fluoxetine and additionally with mood-stabilizers: 25 patients received carbamazepine and 20 patients - lamotrigine. A clinical follow-up and experimental-psychological study was conducted before the therapy, after 30 days and after 1 year. The use of fluoxetine in the combination with mood-stabilizers allowed to achieve the marked and stable improvement of the patient's state. Lamotrigine compared to carbamazepine reduced the depression level and improved cognitive functions. After one year, the better social rehabilitation was seen in the group treated with lamotrigine (64,7%) compared to carbamazepine (34,8%). The preventive therapy with lamotrigine was more effective than that with carbamazepine: 35,2% and 46,1%, of patients respectively, relapsed after the withdrawal of fluoxetine.

[Mental disorders in patients admitted for cataract surgery].

An aim of the present study was to clinically evaluate mental changes in patients admitted for extracapsular cataract extraction. Eighty patients (27 male and 53 female), mean age 72,2+/-7,2 years, were studied. A clinical-psychopathological examination was conducted. Type of disease attitude, Eysenck neuroticism and psychoticism scores, Taylor anxiety and Beck depression levels mere studied before and after the surgery. Most of patients - 56 (70%) had mental disorders in the pre-surgery period. They were stratified into 3 groups by syndromes. Twenty-seven patients (33,7%) had asthenic-depressive disorders, 16 (20%) - anxiety-phobic disorders and 13 (16,2%) - anxiety-depressive disorders. These disorders disappeared after the surgery in most patients. The greater stability of psychopathological appearances was characteristic of patients with anxiety-depressive symptoms. These patients also demonstrated personality changes (the higher level of neuroticism).

[Dynamics of bulimia disorders in anorexia nervosa and bulimia nervosa].

Thirty-three female patients with anorexia nervosa (AN) with bulimia disorders and 54 with bulimia nervosa (BN) were studied. The analysis of clinical presentations and dynamics of bulimia disorders in these groups revealed the similarity of types of <> behavior. At the same time, NA differs by the absence of genuine binge attacks characteristic of the patients with BN. Psychopathological basis of the <> behavior in AN seems to be dysmorphophobic, anxiety, hypochondriac disorders as well as insufficient criticism of a patient's state in the absence of pronounced affective disorders and reduced self-esteem and that in BN - cyclothymic, bipolar affective disorders and disorders of drive, dysmorphophobic concerns related to the changes of self-esteem. Also, patients with BN have criticism towards their behavior. These differences should be taken into account in the choice of therapeutic tactics and methods as well as in rehabilitation of patients with eating disorders.

[Peculiarities of psychoactive drug addiction in psychopathic patients at the age of conscription].

Male adolescents (n=193) at the age of conscription (from 17 to 27 years) underwent a military medical examination due to pathological behavior complicated with psychoactive drug addiction. A diagnosis of psychopathy (personal disorders) was confirmed in all cases. Statistically significant correlations were found between different types of psychopathy (excitable, hysteric, hyperthymic, unstable, schizoid) and peculiarities of the development of alcohol and drug addiction. It has been shown that the beginning of psychoactive drug addiction suggests the psychopathy decompensation.

[Clinical features and diagnostic criteria of bulimia nervosa].

Based on the results of the clinical follow-up study of 41 female patients, diagnostic criteria of bulimia nervosa that should be used in clinical studies are suggested as follows: (1) presence of anorexia nervosa or transitory amenorrhea in the premorbid period; (2) eating attacks with losing of the control over food consumption not less than twice a week during 3 months; (3) compensatory behavior in the form of spontaneous vomiting, abuse of purgative and diuretic medications etc; (4) fear of obesity; (5) cycloid affective changes with higher impulsivity, reduction of the control over primitive drives and/or expressed anxiety disorders; inclination to alcohol and drug abuse and nicotine dependence; (6) changes of the body mass index; (7) absence of amenorrhea. The disease dynamics is characterized by formation of the pathological cycle "diet--overeating--compensatory behavior" on the background of cyclothymic affective disorders. Two types of bulimia nervosa--with and without other drive disorders--have been singled out.

[A transition of a functional disease to an organic psychosomatic disorder].

Twenty patients with ulcer (83 female and 117 male) have been studied. It was found out that many patients had functional disorders of the gastrointestinal tract in the form of gastralgia or neurogenic vomiting ("organic neurosis of stomach") long before the disease manifestation. At that time the patients underwent gastroscopy and X-ray examination of the stomach and the duodenum but no pathological organic changes were revealed. The study showed that 13% of men and 28% of women with "organic neurosis of the stomach" had signs of ulcer disease 12-13 years later. Therefore, a transition of functional to organic within unified psychosomatic process is in principle possible.

[Premorbid period of anorexia nervosa]. / Domanifestnyi period nervnoi anoreksii.

Premorbid period of anorexia nervosa was studied in 96 female patients. In 64 cases (group 1) anorexia nervosa was as a separate disease and in 32 cases (group 2)--as a syndrome of endogenous mental disorder. In group 1 premorbid period was characterized by the features of neuropathy and residual organic disorders in combination with accumulation of subjects with personality disorders in the patient's family that promoted development of prolonged neurotic disorders. In group 2 there was hereditary psychosis load, high frequency of obstetrical and other perinatal complications, overvalued ideas and predisposition to autistic games and fantasying. In both groups, psychopathological peculiarities included typical affective, obsessive-phobic, hypochondriac, cenesthopathic and behavioral disorders, of a stable character often provoked by psychotraumatic events.

[Borderline mental disorders in patients with prostate cancer]. / Pogranichnye psikhicheskie rasstroistva u bol'hykh rakom predstatel'noi zhelezy.

Sixty five patients, aged 48-87, with prostate cancer at different stages were studied. Borderline mental disorders were found in all the patients. In the majority of them, affective disorders in the form of anxiety-depressive (52.3%) and astheno-depressive (24.6%) syndromes were observed. Astheno-hypochondriacal and dysphoric syndromes were detected less frequently (in 15.4% and 7.7% of the cases, respectively).