[Late-onset schizophrenia]. / Pozdnyaya shizofreniya (kliniko-epidemiologicheskoe issledovanie).

OBJECTIVE: To verify clinical observations by the epidemiological method. MATERIAL AND METHODS: The data of the full investigation of 1781 schizophrenia cases, including 403 patients in the age of 60 and older were used. RESULTS AND CONCLUSION: A number of characteristics inherent for this group were fully consistent with clinical observations. These characteristics were connected with a few factors: probability to reach the old age for patients with young onset schizophrenia; probability to stay under psychiatric care for patients with long disease duration; characteristics of certain forms of schizophrenia and probability of the onset of some symptoms in elderly patients. A combined effect of these factors resulted in the development of some common features of schizophrenia with late-onset, i.e. the rarity of malignant schizophrenia and high frequency of depressive disorders. The author underlines the vagueness of the notion «late schizophrenia¼.

[Schizophrenia: age at disease onset].

OBJECTIVE: Until now the problem of the typical age of schizophrenia onset has been actively discussing in the world literature. Though there are more and more publications, which mention the growth in the number of cases with late-onset and very-late-onset of the disease, a conviction that schizophrenia is the illness of teenagers or young people is still exists. Author aimed to determine a preferable age of the onset of schizophrenia. MATERIAL AND METHODS: Data obtained in multi-year epidemiological research in Mental Health Research Center (Moscow) were analized. The total number of patients with schizophrenia and spectrum disorders was 5486. A subgroup of the patients with the diagnosis that met the current diagnostic criteria of schizophrenia included 1108 people. The study was based on clinical-epidemiological and statistical methods. RESULTS: Most of patients had early onset schizophrenia (16-20 years old maximum). However, it mostly depended on demographic factors, because more than half of patients were young or middle aged at the moment of the examination. The examination of the group aged over 60 years and those who conditionally belonged to this generation (if 100% would have lived to that age) showed that the maximum number of patients had onset between 30-40 years old. CONCLUSION: This research demonstrates the essential predominance of cases with onset of the disease in adolescent and young age that may be rather related with demographic characteristics than pathogenetic mechanisms of schizophrenia. The latter determine predominantly middle age of disease onset (30-40 years). Cases both with early and late onset of the disease are not rare and are random deviations from the mean valuation.

[Pantogam in daily psychiatric practice].

Pantogam was used as a corrector of the side-effects of neuroleptic therapy. The adverse effects were assessed psychometrically with several scales. Attention was focused on the unwanted signs (pathological movements of different groups of muscles). Fifty patients were studied, 37 of them completed the treatment course. Pantogam was administered in dosage 750-3000 mg per day along with traditional and atypical neuroleptics. The drug was effective against the most prevalent side-effects. The mild sedative effect of pantogam, absence of negative influence on myocardial vessels and possibility of its combination with most pharmacological drugs make its possible to use the drug in patients of different age groups.

[The results of questionnaire survey in the patients with affective disorders (European study)]. / Rezul'taty oprosa bol'nykh, stradaiushchikh affektivnymi rasstroistvami (evropeiskoe issledovanie).

The project "Bipolar Educative Awareness Material (BEAM) included a questioning of 1732 patients with affective disorders from 11 European countries. In the present study, the results obtained in Russia are compared to total ones. Russian patients are featured by higher percentage of women and elderly as well as higher education level. The late age at disease onset and earlier diagnostics also were found. There was a significant difference in depression therapy: in most European countries antidepressant of last generation are used most frequently, however in Russia, standard neuroleptics and amitriptilin appear to be standard medications. This difference did not influence on a number of hospitalisations, which was the same both in Russian and BEAM groups. But significantly fewer patients questioned in Russia were satisfied with therapeutic efficacy. Besides, an extent of patient's involvement in public movements and educational programs in Russia was essentially lower, comparing to the total BEAM group, and the patients questioned were less aware of their disease.

[Contemporary system of mental health care: epidemiologic aspects]. / Sovremennaia sistema psikhiatricheskoi pomoshchi: épdemiologicheskii aspekt.

The authors suppose that adequate mental health care management should be based on the knowledge about the number of its potential patients. In order to determine this number the authors formulated a hypothesis that the necessary period of the observation of patients depends on the course of the disease and on the risk of the relapse. From the authors' point of view all mental disorders comprise 3 groups. Patients who belong to the 1-st group need observation during all their life; patients from the 2-nd group need observation during an active period of the illness; patients from the 3-d group need observation during the acute period only. On the basis of estimation of the full number of mentally ill people in Russia the authors calculate a size of each group and the total number of the potential patients--about 21 million of people (14% of the Russian population). This rate has been defined as "the actual number of mental patients".

[Main trends in the demographic development in Russia and dynamics of the rate of patients with schizophrenia]. / Osnovnye tendentsii demograficheskogo razvitiia Rossii i dinamika chislennosti bol'nykh shizofreniei.

The authors analyze both the demographic situation in Russia during the past years and its perspective. A number of patients with paranoid schizophrenia and with schizophrenia on the whole (all forms of disease) was estimated for the period of the coming 15 years (till 2011 yr.). The level of the patients' detection in some Russian regions was estimated by means of comparison of the calculated number of the patients (according to tables of incidence) and actually known during the same period. The proportion of registered schizophrenic patients was up to 95.7% from calculated data in Moscow, while in other regions this index was not more than 50%. A low detection of the schizophrenic patients was explained by both specificity of the organization of psychiatric care in the regions, a shortage of psychiatrists as well as by other factors.

[The patients of the psychiatric office of a polyclinic: patients undetected by the clinic or a new contingent?]. / Patsienty psikhiatricheskogo kabineta polikliniki: nedovyiavlennye dispanserom bol'nye ili novyi kontingent?

Epidemiology study of patients in primary care settings has shown prevalence of borderline mental disorders (41.58 per 1000 population) in comparison with patients of psychiatric outpatient clinic (11.4 per 1000). The question arises were those undetected by psychiatric out-patient clinics (those who didn't visit psychiatrist for individual reasons) or they represented another contingent. Comparative analysis of groups standardized on nosological, syndromal and educational levels revealed that there were various contingents of patients. The main difference was determined by different duration of disease before the first visit to psychiatrist, that reflected various severity of the disease (less severity of the disease was observed in patients of primary care institutions).

[The economic aspects of the activities of a mental health service]. / Ekonomicheskie aspekty deiatel'nosti sluzhby psikhicheskogo zdorov'ia.

Integral economic loss of the society, connected with mental disease, were calculated by the author and presented. The author determined "direct" and "connected" state costs for psychiatric patients, and the volume of non produced national income (indirect costs) because psychiatric patients with temporal or constant disability are excluded from producing process. Financial state of psychiatric hospitals in Moscow was analysed and reserves for improvement of money spending were found out. Calculations of expenses of admission of patients with different diseases to Psychiatric Hospital N 1 by P.P. Kashenko in 1988 were performed. Principles of financing of psychiatric hospitals on the basis of clinical-statistic groups are discussed. The method of determination of prices for medical and diagnostic services to patients is presented.

[The socioeconomic problems of a mental health service]. / Sotsial'no-ékonomicheskie problemy sluzhby psikhicheskogo zdorov'ia.

The state and prospects of the development of mental health service are discussed. Special attention is drawn to the economic aspects of mental health service and financial problems, in particular. The principles of creation and utilization of financial resources for psychiatric facilities in conditions of medical insurance are given. Social and economic aspects of mental diseases and their cost for the society are considered. The conclusion is made on the priority of psychiatric care programmes among other programmes of health care, that must be solved on the state level.

[The problem of representiveness in epidemiological research in psychiatry]. / Problema reprezentativnosti pri épidemiologicheskikh isslevovaniiakh v psikhiatrii.

A group of schizophrenic patients registered by the city psychoneurological center (Petrozavodsk) is compared to a standard sample. It is shown that there is a possibility of defining to what extent the test group differs from the representative one and by what the differences are determined. In accordance with this, the limits of the use of the research data are outlined.

[Favorable outcome of recurrent schizophrenia]. / O blagopriiatnykh iskhodakh pri pristupoobraznoi shizofrenii.

The work was performed on a material of a non-randomized group of patients with attack-like schizophrenia registered (January 1976) at the psychoneurological dispensary of one of the districts of Moscow. Using the method of a clinico-epidemiological catamnesis as well as a definite method of determining the arrest of the process of attack formation in a group of patients, 641 patients could be distinguished. The condition of those patients was qualified as "outcome", "++post-morbid". The rate of such cases in the whole patients' group amounted to 62.5%. The data on the clinical structure of the outcomes, including productive psychopathological and negative symptomatology as well as the level of social and work adaptation of the patients enabled one to distinguish groups with a favourable outcome (471 cases) and unfavourable outcome (170 cases), which accounted for 46.0 and 16.6% of the entire non-randomized group of patients. Therefore, based on the populational regularities of the course of attack-like schizophrenia the authors succeeded in demonstrating a possibility of arresting the process of attack formation at any disease stage, to determine the rate of such cases in the patients' population as well as to objectively prove the domination of a favourable variant of outcome of the morbid process.

[Prospects of elaborating the scientific basis for organizing the psychiatric services]. / Perspektivy razrabotki nauchnykh osnov organizatsii psikhiatri- cheskoi pomoshchi.

It is evident that the setting up of efficient psychiatric services today is not feasible without elaborating serious theoretical concepts. In the authors' opinion, the method which would make it possible to rapidly design the system of psychiatric services for any region on the basis of the data on its geography, population and resources rather than concrete universal services is to be the final product of the theory of psychiatric services. To design such a method, it is necessary to explore a number of important problems of the epidemiological and ++medico-demographic character. The authors provide a list of the studies to be carried out according to the indicated directions as well as of the problems to be solved within the framework of the investigations of the models proper of psychiatric services.

[Dynamics of the epidemiological characteristics of registered contingents of schizophrenia patients]. / Dinamika épidemiologicheskikh kharakteristik uchtennykh kontigentov bol'nykh shizofreniei.

Different populations of schizophrenic patients under this study were registered by three of the Moscow city outpatient psychiatric departments in 1967, 1975 and 1981. These populations' epidemiologic characteristics compared, the following could be concluded: (1) the specific quantity of patients with psychotic disorders diminished, (2) the percentage of aged patients diminished, (3) the mean observation term reduced. Some other characteristics of the tendency to worsen the medical assistance to psychiatric patients were demonstrated. Factors causing such a trend are discussed and the ways to overcome these difficulties outlined.

[Epidemiologic aspect of the problem of the disability of schizophrenic patients (incidence, chronogenic dynamics, risk factors)]. / Epidemiologicheskii aspekt problemy invalidnosti u bol'nykh shizofreniei (chastota, khronogennaia dinamika, faktory riska).

Epidemiological aspects of disability have been studied in a random sample of schizophrenics living in three Moscow districts. It has been found that 39.4% of schizophrenic patients (44.2% of the patients in the productive age) are disabled due to the underlying disease. The past 20 years have seen a trend toward a decrease in the disability rate; the difference between the number of the disabled reported 20 years ago and today is 5.5%, being fully accounted for by paroxysmal forms of schizophrenia. It has been ascertained that the decision as to the patient's disability following medical examination of his or her working ability depends not only on the severity of the patient's clinical status, but also on the patient's sex. Thus, if patients with an equally grave disease are considered, women are more frequently given the status of disability which is explained by the fact that their involvement in household chores is much greater than that of males.

[Population patterns in the development and course of endogenous psychoses as a reflection of their pathogenesis]. / Populiatsionnye zakonomernosti vozniknoveniia i techeniia éndogennykh psikhozov kak otrazhenie ikh patogeneza.

An analysis of a representative epidemiological sample of patients with endogenic psychoses (schizophrenia and MDP) revealed statistical distribution of some parameters of the disease (risk of the development of the disease in relation to age, a number of previous attacks, as well as distribution of patients by the duration of paroxysms and remissions). The authors believe that a collation of the tabulated data with the known mathematical models makes it possible to come to understanding some aspects of the pathogenesis of endogenic psychoses.

[Various statistical patterns in the course of malignant schizophrenia]. / Nekotorye statisticheskie zakonomernosti techeniia zlokachestvennoi shizofrenii.

A statistical study of process schizophrenia (101 cases with the completed process selected from 1198 observations in six psychiatric institutions) has made it possible to establish that the process has the constant rate of progression throughout the active course of the disease up to the development of the residual state without productive disorders. The quantitative expression of the rate of progression is reflected in the fact that the proportion of patients in whom the given clinical stage of the disease course comes to the end constitutes some 30% annually.