[Low doses of quetiapine (Seroquel) as an impulsivity corrector in patients with bipolar affective disorder in remission]. / Nizkie dozy kvetiapina (Serokvelya) v kachestve korrektora impul'sivnosti u patsientov s bipolyarnym affektivnym rasstroistvom v remissii.

OBJECTIVE: To evaluate the effectiveness of low doses (25-75 mg/day) of quetiapine (Seroquel) in patients with bipolar affective disorders in a euthymic state with signs of impaired impulse control. MATERIAL AND METHODS: The main criteria for patients' selection were as follows: both sex, diagnoses of bipolar affective disorders, remission (euthymic state), adult age (from 18 to 60 years old), stable basic therapy. The duration of the study was 6 weeks, a dose of quetiapine (Seroquel) varied from 25 to 75 mg. The examinations were carried out with the Barratt scale, computerized Go-No-Go and Balloon tests. RESULTS: The study group included 32 patients (11 men and 21 women), mean age 31.2±9.7 years (minimum 18, maximum 60 years). The changes in Barratt total score (p=0.000014, Wilcoxon test, effect size 0.48) and Balloon total earnings (p=0.03, Wilcoxon test, effect size 0.22) were statistically significant and reflected clinically significant improvement. The changes of the indices of the Go-No-Go test were not significant. The data of fMRI showed an increase in the connectivity of the cortex of the central and parietal tegmentum of the left hemisphere with other areas of the brain, which correlated with the changes in psychometric and test parameters. CONCLUSION: The results of the study showed that add-on of the low doses of quetiapine (Seroquel) significantly decreases impaired impulse control in remitted patients with bipolar affective disorders both in self-evaluation and in risk-taking experimental test. The drop of high level of impulsivity can improve the quality and stability of remission and reduce behavioral risks due to impaired impulse control.

[Cognitive functions in late-onset psychosis]. / Sostoyanie kognitivnykh funktsii pri pozdnikh shizofrenicheskikh psikhozakh.

The review discusses cognitive functions in late-onset schizophrenia and very late-onset schizophrenia-like psychosis compared to cognition in normal aging, early-onset schizophrenia, and neurodegenerative diseases. The problem of the dynamics of the state of the cognitive functions in patients with late-onset schizophrenic psychoses is highlighted, and prospects for further research are discussed. Patients with late-onset schizophrenic psychosis are characterized by more pronounced cognitive deficits compared to normal aging, but less severe than cognitive changes observed in early-onset schizophrenia. Late-onset schizophrenia may be a heterogeneous condition in terms of cognitive dysfunction.

[An effect of cholinesterase blockade on negative symptoms in schizophrenia]. / Vliyanie blokady kholinesterazy na negativnye rasstroistva pri shizofrenii.

Abstruct. OBJECTIVE: To assess the possibilities of influencing the severity of negative disorders in schizophrenic patients with cholinesterase blockade. MATERIAL AND METHODS: The study included stable 26 patients (13 of them women), average age 40.4 (SD 11.7) with paranoid schizophrenia, episodic form according to ICD-10). All patients received antipsychotic therapy, which was not changed at least for 2 months. We used psychometric scales (Positive and Negative Syndrome Assessment Scale (PANSS), Global Functioning Scale (GAF), neurocognitive techniques (Brief Assessment of Cognition in Schizophrenia-BACS), projective psychological techniques (Rorschach test). RESULTS AND CONCLUSION: The results of the study showed that augmentation of maintenance antipsychotic therapy with a cholinesterase blocker (ipidacrine at a dose of 20 mg per day) had positive impact on negative symptoms, decreasing the severity of emotional deficiency. The positive changes of cognitive impairment, measured with BACS, occurred regardless of changes in the severity of negative disorders, measured with PANSS. The Rorschach test showed an improvement in the conventional orientation of the patients' thinking. No exacerbation of psychotic symptoms was registered.

[The features of emotional processing in patients with depressive disorders]. / Osobennosti pererabotki émotsional'noi informatsii u bol'nykh s depressivnymi rasstroistvami.

AIM: To study neurocognitive symptoms in depressive disorders with the designation of their brain and psychological mechanisms. MATERIAL AND METHODS: Thirty-three patients diagnosed with depression and 33 healthy controls were studied using standardized neuropsychological tests and tests comprising emotiogenic stimuli. RESULTS: A neurocognitive deficit in patients with depression manifested as changes in speed of emotional processing and some cognitive functions. These patients demonstrate decreased attention to negative stimuli combined with decreased attention to positive stimuli. CONCLUSION: The abnormal processes of 'hot' cognition in patients with depressive disorders conceptualize such a core symptom of depression as anhedonia, which is a probable endophenotype of depression.

[Latent dysphoria: an instrument of screening and diagnosis (preliminary results)]. / Latentnaia disforiia: instrument dlia skriningovoi diagnostiki (predvaritel'nye dannye).

AIM: Latent dysphoria is a kind of emotional disorder. Its key features are floating feeling of dissatisfaction and irritability accompanied with suppression of expression of these emotions. The article is devoted to the development of a screening diagnostic tool (checklist) to screen and evaluate patients with this emotional problem. MATERIAL AND METHODS: Three hundred and ninety-four neurologists (outpatient segment) were surveyed to assess the prevalence of an emotional disorder that met criteria of latent dysphoria suggested by the authors. To develop a diagnostic tool, expert judgement method, with the involvement of 19 experts in different medical fields (psychiatry, psychology, gastroenterology, neurology), was used. RESULTS AND CONCLUSION: The final checklist contained the most typical signs of this disorder according to the opinion of the experts. The procedure of evaluation of these signs was developed. However, the results should be considered as preliminary and clinical psychiatric validation of the tool is needed.

[Variants of changes in the psychopathological phenomenology of the long-term remission in stable patients with attack-like progressive form of schizophrenia: a longitudinal study].

AIM: An analysis of literature data on schizophrenia shows the change of interest from acute psychosis to phenomenology of remission. The separate objects of research become the impact of symptoms, observed in remission, on everyday life of patients and factors, which influence rapidity and comprehension of reintegration of patients into society. Authors aimed to describe the changes in psychopathological phenomenology and personality functioning during long-term (no less than three years) remission in patients with schizophrenia treated with atypical antipsychotics. MATERIAL AND METHODS: One hundred and thirty stable patients with schizophrenia underwent regular clinical examination during no less than three years. All patients were constantly medicated with atypical antipsychotics. RESULTS: Long-term observation of patients with the similar diagnosis and phase of disease, similar treatment and good treatment response (at least without psychotic exacerbation during the observation period) and tolerability revealed difference in changes of psychopathological phenomenology and personality functioning, which could be grouped into four distinct variants. The description of specificity of each variant is presented. A role of the initial level of personality functioning and its changes during observation period were analyzed. A new concept is introduced in order to name the ability of patients to use rationally recourses, delivered by treatment. The connection of this concept with the level of personality functioning was demonstrated. The hypothesis of mechanisms which underlie the four variants is offered. CONCLUSION: Long-term observation of the changes in the psychopathological phenomenology in the period of disease reveals the variants of the development of remission. The fluctuation of adaptive and regressive phases is registered. More objective factors, which impact on prognosis, are elucidated.

[Description and validation of a new scale for assessment of autonomy in patients with schizophrenia].

OBJECTIVE: During the last years there is a clear shift of interest from acute to non-acute stages of schizophrenia: psychopathology and quality of remission, social functioning, and quality of life of patients. Authors think that in addition to that, a separate object of research should be the ability of patient to independent existence, or phenomenon of autonomy. For systematic research of autonomy in patients with schizophrenia a specialized assessment scale was constructed. MATERIAL AND METHODS: On the basis of preliminary clinical data, we realized that for description of autonomy it is necessary to consider consistency of patients at least in the following areas of life: to possess sufficient level of physical and psychic power; to be able to form specific and realistic goals at least in the nearest future and structure behavior correspondingly to goal achievement; to be able to use support from the social environment in case of deficit of personal resources; to use efficiently and on regular basis contacts with a doctor and other medical resources; to be able to manage everyday needs from hygiene to self-sufficiency, including ability to support compliance. Scale comprises five items. Each of them is assessed on basis of semi-structured interview and other sources of information: medical records, reports from relatives and/or care-givers, medical stuff. In order to study the validity of the scale 40 patients (13 males and 27 females, age 49.8±9, duration of illness 22±8.6), who were diagnosed as schizophrenia according to ICD-10. They were assessed with the help of the scale of autonomy and well-known scales GAF, PSP, PANSS, NSA and CGI-S, cognitive functioning was assessed by BACS. RESULTS: Analysis of internal consistency showed high consistency of items - Cronbach's alfa - 0.83. Analysis of convergent validity demonstrated low or moderate correlations of indices with related scales GAF and PSP. Discriminative validity showed low or moderate correlations only with negative subscale of PANSS, CGI-S score, NSA total score, BACS total score. CONCLUSION: Сompliance of the scale of autonomy to major psychodiagnostic requirements showed that the scale is a new reliable and sensitive psychometric instrument. The study demonstrated that the scale measured specifically ability of patients to be autonomous (self-dependent support of culturally adequate existence in presence of chronic disease) and can't be reduced to existing categories - quality of life, personal or social functioning.

[The use of acatinol in the treatment of stable patients with schizophrenia with predominance of behaviour disorganization and subcatatonic features].

Our study was based on the hypothesis that a non competitive antagonist of NMDA receptors can improve clinical effects of antipsychotic therapy in a subgroup of patients with schizophrenia with clinical signs of glutamatergic hyperfunction such as catatonic symptoms and disorganization. The study design was open and non-comparative. The duration of the study for each patient was 6 months, the target dosage of acatinol was 20 mg. Forty stable patients with schizophrenia with predominance of signs of disorganization and subcatatonic symptoms were included. The following instruments were used: PANSS, NSA, CGI, BACS, UKU. Adding of acatinol to the antipsychotic treatment improved clinical symptoms, cognitive functioning and social functioning and decreased the number of side effects. The drug was well-tolerated.

[Effects of the anticholinesterase drug neuromidin in patients with schizophrenia with marked neurocognitive deficits].

An objective of the study was to investigate the effectiveness of neuromidin in stable schizophrenic patients with predominance of symptoms of pseudoorganic deficits. Fifty-five patients stable after a transition from routine medication to monotherapy with risperidone were randomized into two groups with add-on placebo or neuromidin treatment. Patients were studied during 24 weeks. The PANSS and a battery of neurocognitive tests were used for assessment of treatment. In the end of the trial, positive changes on the following PANSS items - N1, N2, N6, N7, G4, G7 and G13 were observed in the neuromidin group. In the placebo group, the changes were found only on one PANSS item - N2. The decrease of scores on this item (emotional withdrawal) during the study was more significant only in the patients receiving neuromidin (p=0,037). The results of assessment of cognitive functioning showed the positive changes in visual-spatial memory, attention, retention and retrieval of data, planning in the group treated with neuromidin. In the placebo group, the positive changes were observed only in one index - one type of mistakes (omissions) in visual-spatial memory test. In the end of the trial, between-group differences were significant for planning - number of tasks with time-limit violation and rule violations. All differences were beneficial for patients treated with neuromidin. Not all tests were sensitive to changes in cognitive status of patients: indices of working memory, psychomotor speed, flexibility of attention were not changed significantly in both groups, nor they changed between groups. The authors conclude that the problem of rationality of add-on anticholinergic treatment in schizophrenia is not solved yet due to the difficulties in selection of patients and tests for cognitive assessment. The need of further studies is emphasized.

[A historical analysis of "insight" category in psychiatry].

This work presents a historical analysis of the formation and development of "insight" category (awareness of illness) in the process of interdisciplinary collaboration between psychiatry, psychology and social sciences. Different meanings of the term "insight" and their impact on the modern perception of the awareness of illness phenomenon are analyzed. The differences in particular aspects of the clinical reality described by insight and other concepts used in the studies of awareness of illness are highlighted. The need for introduction of a new conventional category "insight" for studying the problem of awareness of a mental illness and perspectives of their empirical investigation.