[Clinical and psychometric characteristics of cognitive and negative disorders in schizophrenia]. / Klinicheskie i psikhometricheskie osobennosti kognitivnykh i negativnykh rasstroistv pri shizofrenii.

OBJECTIVE: To establish the characteristics of clinical manifestations and cognitive tests in patients with schizophrenia, with a predominance of cognitive and negative disorders. MATERIAL AND METHODS: We examined 76 patients, 66 in the main group, 10 in the comparison group, who were treated in Psychiatric Hospital No. 1 and Psychiatric Hospital No. 4 (Moscow). Clinical-psychopathological, psychometric and statistical methods were used. Features of cognitive functioning were studied using the Frontal Assessment Battery (FAB) and the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS). Emotional intelligence scores were assessed using the Ekman Face Emotion Recognition (EFER) test. RESULTS: Patients with schizophrenia showed dominance of one of 3 types of deficit symptoms: cognitive, emotional, and volitional. Cognitive functions were significantly reduced in patients with schizophrenia when compared with the comparison group (mean FAB score (M±SD) 13.44±2.97 in patients with schizophrenia vs. 16.10±1.70 in the comparison group; t=4.10; p<0.001). Cognitive functions were particularly reduced in patients with volitional deficit (mean EFER total score 42.40±9.0 in patients with volitional deficit vs. 47.21±633 in patients with cognitive deficit; t=2.12; p=0.039; mean FAB score 12.83±3.29 in patients with volitional deficit vs. 16.10±1.70 in the comparison group; t=4.24; p<0.001; mean ECAS score specific to ALS 78.80±9.07 in patients with volitional deficit vs. 84.50±6.71 in the comparison group; t=2.18; p=0.034). CONCLUSION: The greatest contribution to the development of cognitive disorders in schizophrenia is made by dysfunction of frontal (especially) and temporal cortex. Executive functions, speech skills and verbal fluency are most severely damaged.

[Primary and secondary negative disorders in schizophrenia as an actual problem of modern clinical psychiatry]. / Pervichnye i vtorichnye negativnye rasstroistva pri shizofrenii ­ aktual'naya problema sovremennoi klinicheskoi psikhiatrii.

Negative symptoms of schizophrenia represent, at the present stage of their study, a certain group of mental pathology. They include motivation disorders or volitional disorders (anhedonia, abulia, asociality) and disorders of reduced expression or emotional disorders (alogia/poverty of speech and emotional decline/flattening). Negative symptoms are key disorders in schizophrenia, often appear at the pre-manifest stage of the disease, and significantly affect the prognosis and response to therapy. From a scientific and practical point of view, it is important to distinguish between primary and secondary negative symptoms, where the primary symptoms are nuclear, inherent in schizophrenia, and the secondary ones are the result of the influence of positive symptoms (delusions, hallucinations), depression, side-effects of medications, social isolation and hospitalism. Changes in the concept of primary and secondary negative disorders as well as a pathophysiological basis of negative symptoms are considered.

[Efficacy and safety studies review of Teraligen usage in psychiatric practice and general medicine]. / Obzor issledovanii effektivnosti i bezopasnosti primeneniya preparata Teralidzhen v psikhiatricheskoi praktike i obshchei meditsine.

OBJECTIVE: Determination of the dose-dependent effect of the Teraligen for various nosological forms of disorders in psychiatric practice and general medicine. MATERIAL AND METHODS: Analysis of 98 publications included in the database of the RISC (2012-2021) with the identification of disorders (according to ICD-10) in which Teraligen is prescribed or can be used (in adults and children from the age of 7). RESULTS: Despite a rather long and successful history use, research work on the study drug Teraligen continues. Currently Teraligen is widely and actively used by doctors of various specialties in the psychiatry, neurology, pediatrics, gerontology, internal medicine, gastroenterology, gynecology, cardiology, endocrinology and other disciplines. The drug is presented in several release forms: Teraligen 5 mg tablets; Teraligen retard 20 mg; Teraligen solution for intravenous injections. Teraligen is characterized by the following psychotropic effects: anxiolytic (++ - a distinct, moderately pronounced effect); sedative (++); hypnotic (++); antidepressant (+ - the effect is distinct, but expressed slightly and does not determine the drug main prescriptions spectrum); antipsychotic (± - the effect is weakly expressed and clinically insignificant when using conventional (5-80 mg/day) drug dosages). CONCLUSION: According to the authors, the main effect of the «small¼ neuroleptic/antipsychotic Alimemazine (Teraligen ) is primarily aimed at pathological anxiety and affective instability. Its use is possible in various age groups, as it has a fairly high safety. In addition, like other «small¼ neuroleptics/antipsychotics with a predominantly sedative effect, the drug can be used to correct neuroleptics-prolongs side effects with dominant manifestations in the form of anxiety, irritability and insomnia.

[Pathological sectiomania in maxillofacial surgery - the phenomenon of fixed obsession with surgical procedures: clinical case series]. / Patologicheskaia sektsiomaniia v cheliustno-litsevoi khirurgii - fenomen sverkhtsennoi oderzhimosti operativnymi vmeshatel'stvami: seriia klinicheskikh sluchaev.

In the article, on the example of two demonstrative clinical cases, the case histories of patients are described, some phenomenon of which at first glance may be perceived as symptoms of a dental and maxillofacial surgical pathology, but in fact are phenomenon of a mental disorder. In the most severe cases, patients, in order to alleviate their condition, stubbornly insist and achieve from the surgeons multiple operative interventions, which should be considered as the formation of a special type of addiction - pathological sectiomania. Summarizing these observations, the authors come to the conclusion about the clinical expediency of isolating this type of addiction and justify the need to refer these patients for a consultation with a psychiatrist.

[Correlations between the level of social functioning and the severity of psychopathology in patients with paranoid schizophrenia in remission]. / Sootnoshenie urovnya sotsial'nogo funktsionirovaniya i vyrazhennosti psikhopatologii u bol'nykh paranoidnoi shizofreniei v remissii.

OBJECTIVE: to determine the variants of correlations between the level of social functioning and the severity of psychopathological signs of disease in patients with paranoid schizophrenia in remission. MATERIAL AND METHODS: Fifty outpatients with paranoid schizophrenia (ICD-10 F20.0) were examined. The sample included 26 (52%) men and 24 (48%) women, aged from 24 to 64 years. Psychopathological, psychometric (PANSS, CDSS and PSP scales) and sociometric methods were used. RESULTS AND CONCLUSION: Correlations between clinical signs of disease and the level of social adaptation were found in 60% of patients, while in 40% of patients the correlations were not established. Based on the correlations between clinical symptoms assessed by the PANSS and the level of social adaptation (PSP), the authors singled out 4 groups: 1) compensated (compensation in clinical and social aspects), 2) decompensated (decompensation in clinical and social aspects), 3) adapted (severe clinical symptoms with satisfactory social compensation, 4) conflict (low level of clinical signs (nonpsychotic disorders) and marked social decompensation). These variants were found in 32%, 38%, 11% and 19% patients, respectively. This classification of psychosocial status may be a base for prospective studies of the efficacy of psychosocial and medical/rehabilitative measures.

[The differences in the estimation of depression severity by psychiatrists and patients during the combined treatment with agomelatine (a multicenter study "EMOTSIA")]. / Razlichiya v otsenke tyazhesti depressii vrachami i patsientami v protsesse kombinirovannoi terapii agomelatinom (mul'titsentrovoe issledovanie «EMOTsIYa¼).

AIM: To compare the prognosis of depression severity estimated by the physician and by the patient based on the treatment outcome. MATERIAL AND METHODS: One hundred and seven patients with depression were examined. Mental status was assessed with HАМ-D, SHAPS, CGI-S, CGI-I, PGI-S, PGI-I and VAS. A data analysis was performed. RESULTS: There were differences in the estimation of depression severity by psychiatrists and patients. Moreover, the scores on HАМ-D and CGI-S were not consistent when assessed by psychiatrists. As the severity of depression decreased and patient's state improved during the treatment with agomelatine (valdoxan), the assessments of the changes by the psychiatrist and the patient became similar. CONCLUSION: Agomelatine (valdoxan) is effective and tolerable in the treatment of depression of any severity. The differences between the psychiatrist's and patient's estimation of the depression severity at baseline using different psychometric scales can level the prognostic value of treatment outcome.

[Characteristics of schizoaffective episodes developed after emotional stress].

It was studied 74 patients who developed schizoaffective disorder in conditions of emotional stress (the basic group) and 51 patients with spontaneous manifestation of schizoaffective disorder (the comparison group). Three types of effect of stressful factors on the development of schizoaffective disorder in respect to its belonging to affective/dominant or schizo/dominant variants were singled out: the provoking effect referred to the provocation of schizoaffective episode; the pathoplastic effect that manifestef itself by the appearance of psychogenic disorders in the clinical picture of psychosis; the pathokinetic effect that strengthened and expanded existing symptoms, stopped psychosis or changed the character of affective disorder.

[Development of schizophrenia-spectrum psychoses caused by psychotraumatic events].

A study included 213 patients diagnosed with schizoaffective disorder (56.3%) or paranoid schizophrenia (43.7%). In all patients, psychotic symptoms developed under the influence of psychogenic factors. The high percentage of pathological personality disorders (50.2%), neurotic disorders (52.1%) and psychogenic depressive disturbances (53.5%) in the premorbid were found that indirectly indicates a liability to psychogenically caused endogenous psychoses. Three stages of development of schizophrenia-spectrum psychosis under the influence of psychogenic factors were singled out: psychogenic, endogenous-reactive (interim states) and endogenous psychotic disorders. Clinically heterogenic interim syndromes were specified as endogenous-reactive dysthymia (51.2%), obsessive-delusional syndrome (7.5%), hysteriform psychosis (20.2%) and endoreactive paranoia (21.2%). Psychotraumatic events caused three variants of schizophrenia-spectrum psychosis: affective, neurosis-like and paranoia. In conclusion, variants of the pathokinesis of psychogenically caused schizophrenia-spectrum psychosis predict the further course of endogenous process.

[Clinical characteristic of schizoaffective disorders developed after psychic trauma].

Seventy-four patients with schizoaffective disorder caused by psychic trauma (a basic group) and 51 patients with spontaneous manifestation of this disorder (a comparison group) have been studied. The prevalence of personality traits of inhibited spectrum with predisposition to affective disorders and psychogenic reactions were observed in the patients of the basic group. Situations of emotional deprivation were the most frequent content of mental stress. The psychic trauma exerts a provoking, pathoplastic and pathokinetic effect in schizoaffective disorder. Three variants of the course of schizoaffective disorder after emotional stress have been singled out: with psychogenic neurotic manifestation, with psychogenic psychotic manifestation (psychogenic reactive depression type) and with endogenous manifestation.

[The clinical peculiarities of psychogenically-induced exacerbations of paranoid schizophrenia].

One hundred and twenty-eight patients diagnosed with paranoid schizophrenia were studied. A main group comprised 84 patients with psychogenically-induced paranoid psychoses. A control group consisted of 44 patients with spontaneous exacerbations of the disease. Psychogenically-induced exacerbations of paranoid schizophrenia differed by the clinical polymorphism, heterogeneity and atypism. Three types of psychogenically-induced relapses of paranoid schizophrenia were singled out: endoreactive, delusional with affective symptoms and delusional. Higher frequencies of suicidal tendencies (32.1%), absolute therapy resistance (25.0%), hospitalism (21.4%), non-compliance (46.4%) were observed in the main group of patients. These features predicted the poor outcome comparing to paranoid psychoses developed spontaneously. In conclusion, treatment of patients with paranoid schizophrenia with psychogenically-induced exacerbations demands the obligatory administration of psychotherapy. A combination of traditional neuroleptics with symptomatic pharmacotherapy of psychopathological presentations is the most efficient.

[Clinical regularities in the relapsing and continuing course of phobic disorders]. / Klinicheskie zakonomernosti retsidiviruiushchego i zatiazhnogo techeniia fobicheskikh rasstroistv.

To evaluate clinical regularities of the development of phobic disorders with continuous and recurring course there were examined 67 patients with phobias. The duration of disease was from 5 to 50 years. There were 3 variants of relapsing and 4 variants of continuous course of phobic disorders taking into consideration either presence or absence of the tendency to their progression. In the group of relapsing patients 3% of the patients showed no tendency to progression. There was also a relapsing variant with a tendency to progression (6.0%). Continuous-undulating without tendency to progression (8.9%), continuous-undulating with a tendency to progression (19.4%), continuous-progressive (25.4%) and stationary (28.4%) variants. The authors emphasize that revealed peculiarities in the dynamics of phobic disorders with either presence or absence of the tendency to progression may help to improve the therapy of such states and to make more precise the prognosis of the disease.