[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.

[Antipsychotic selection strategies: the need for a holistic approach]. / Strategii vybora antipsikhoticheskoi terapii: neobkhodimost' kompleksnogo podkhoda.

OBJECTIVE: To describe the connections between strategies for antipsychotic prescribing and clinical, socio-psychological factors of treatment adherence in patients with psychotic disorders. MATERIAL AND METHODS: The study included 83 inpatients with schizophrenic spectrum disorders (F2x) - 67%, affective disorders (F3x) - 15%, neurotic and personality (F4x + F6x) - 9%, organic diseases of the central nervous system (F0x) - 9%. We used a visual analog scale for patients' subjective severity of their condition, locus control test, Internalized stigma of mental disorder scale (ISMI), Treatment motivation assessment questionnaire (TMAQ), and Medication Compliance Scale (MCS), which also includes BPRS, SANS, GAF scales. Dispersion analysis (p≤0.05), effect sizes calculation (Cohen's d/Cramer's V) were performed (ES). RESULTS: The options for prescribed antipsychotics did not depend on positive and negative symptoms, social maladjustment, suicidality, disease recurrence. The outpatient use of more than one antipsychotic was associated with socio-demographic differences in patients, high internality in life failures (ES=0.98), self-stigmatization (ES=0.94) due to the psychiatric stereotypes endorsement (ES=1.03), and social self-isolation (ES=1.08). Prescription of atypical antipsychotics during hospitalization was associated with subjectively less severe condition in patients (ES=0.7), their position of active cooperation with a doctor (ES=1.08), high internality of achievements (ES=0.99), lower psychiatric stereotypes endorsement (ES=1.19), social self-isolation (ES=1.58). Depot antipsychotic was predominantly an option for patients with secondary education (ES=0.34). CONCLUSION: Types and forms of antipsychotic treatment were associated not with clinical but with social and psychological patients' characteristics. The prescription of atypical antipsychotics, including depot forms, is specifically associated with not only treatment adherence, but with a favorable profile of patients' motivation for treatment.

[A role of motivation for treatment in the structure of compliance in psychopharmacologically treated patients].

OBJECTIVE: To reveal an impact of specific motivation structures on the compliance in psychiatric inpatients. MATERIAL AND METHODS: The Treatment Motivation Questionnaire and the Medication Compliance Scale have been administered to 104 patients, including 67 patients with schizophrenia and schizophrenia-spectrum disorders, 15 with affective disorders, 13 with personality and neurotic disorders and 9 with organic disorders, of the department of integrative pharmaco- and psychotherapy. RESULTS: A motivational mechanism based on the subjective suffering from disease plays a key role in the formation of overall score of compliance. Amotivation syndrome has a negative impact on the compliance. "Passive agreement" attitude to treatment corresponds to a deficiency in both patient and physician compliance subsystems along with a reduction in insight and cognitive functions in the patient's subsystem. Extreme external motivation for treatment correlates with insufficiently constructive support on the part of significant others in patient's environment subsystem resulting in the delay of internal motivation development. Extremely low scores based on understanding of disease character leads to the deficiency of medication compliance subsystem.