[Choice of therapeutic tactics in treatment of endogenous depression by means of statusmetric expert system]. / Vybor terapevticheskoi taktiki s ispol'zovaniem statusmetricheskoi ékspertnoi sistemy pri lechenii éndogennykh depressii.

There was elaborated expert models based on computer data base including 42 formalized signs (anamnesis, state of the patients, medical measures and indices of expert estimation of the response to therapy, based on the reduction of scores of Hamilton's scale). The study was carried out in 104 in-patients whose clinical states corresponded according to ICD-10 to category "depressive episode" and "recurrent depressive disorder". The patients were divided into 2 groups: in the first one the treatment was performed by serotoninergic antidepressants (SA)-fluoxetine (20 patients), fluvoxamine (20), sertraline (30). Tricyclic antidepressant (TAD) amitryptiline was administered to 34 patients of the second group. Two data bases were formed: responders to TAD and responders to SA. Natural pair model of classification (error of the model--12.5%) including 9 informative signs, was constructed, that gave chance to define probability sensitivity to TAD and SA. Check-up of computer model revealed that 3 patients of SA group didn't submit to decisive rule, while there were found 2 such patients in TAD application. Application of computer experiment permitted to turn from group prognosis to individual one.

[Stereotaxic cingulotomy in the complex treatment of a schizophrenic patient with obsessive-compulsive disorder, resistant to treatment]. / Stereotaksicheskaia tsingulotomiia v kompleksnom lechenii bol'nogo shizofreniei s terapevticheski rezistentnymi obsessivno-kompul'- sivnymi narusheniiami.

The authors describe a case of continuous conservative treatment of a patient suffering from severe obsessions. At the definite stage of the disease, the patient underwent psychosurgical operation--bilateral anterior stereotaxic cingulotomy . The surgical intervention was necessitated by dramatic and steady deterioration of the patient's condition, loss of work fitness, suggesting official registration of disability; appearance of suicidal intentions. After the operation the patient started his work again in accordance with his specialty; the question about disability registration did not arise any more.

[Correction of apathetic-abulic manifestations of schizophrenia with cholinotropic drugs]. / Korrektsiia apatoabulicheskikh proiavlenii protsessual'nogo defekta kholinotropnymi preparatami.

The authors describe the results of the treatment of 30 patients suffering from schizophrenia with the well-defined apatho-abulic manifestations. The patients received anticholin-esterase agents (galanthamine and deoxypeganin) combined with the M-cholinolytic drug benactyzine. The treatment lasted 3 to 4 weeks. Satisfactory compensation for the deficiency manifestations was attained in 18 patients (60%). The therapeutic dynamics appeared the best in patients with predominant anergic disorders accompanied by well-defined impoverishment of motor functions. The presence of roductive psychotic disorders in the syndromal structure noticeably decreased the treatment efficacy. The deranged capacity for behavioral initiation classified by the authors with the fundamental deficiency manifestations turned out most refractory to the treatment. The polymediator model of the schizophrenic defect is reviewed, according to which the deficiency manifestations represent adaptive stability states with emergence to a lower energy level. In such a case the neuronal populations with different mediator modality become deactivated. On the one hand, this gives rise to a decrease of psychotic productive disorders, on the other one, to the occurrence of the negative manifestations.

[Neuropsychological study of the schizophrenic defect]. / Neiropsikhologicheskoe izuchenie shizofrenicheskogo defekta.

As many as 30 patients (18 men and 12 women) aged 17 to 47 years were examined. Use was made of A. R. Luria's method. Deficiency of both activation components of the activity and higher form of regulation was recorded in all the cases. 3 variants of the neuropsychological syndrome were distinguished. The first variant was characterized by insufficiency of the function of the nonspecific brain systems, primarily of the medial formations of the frontal lobes. The second variant was marked by dyscoordination of the ++fronto-subcortical relations associated with the weakening of the functions of the primarily prefrontal convex formations of the frontal lobes. The third variant was determined by remarkable insufficiency of the convex formations of the frontal lobes and parietotemporal and occipital parts of the brain. A high correlation was discovered (r = +0.75) between the intensity of neuropsychological disorders and the magnitude of anergy. Comparison of the results with the computer-aided tomography (CT) data did not reveal any differences between the groups. However, in the third group patients, grosser changes on the CT were found. The same group manifested significant accumulation of pre-, peri-, and postnatal harm.

[Relation of electrophysiological indices in various degrees of negative disorders in patients with schizophrenia]. / O sootnosheniiakh nekotorykh élektrofiziologicheskikh pokazatelei pri razlichnykh stepeniakh negativnykh narushenii u bol'nykh shizofreniei.

Preliminary results of the investigation of "expectation wave" phenomenon in 25 schizophrenic patients aged 17 to 41 years (20 or less years since the onset of the disease) are presented. The control group consisted of 10 healthy persons. The characters of evoked responses in patients and normals were essentially different. The decrease in the energy of potentials was found in lower frontal brain leads which was most pronounced while fulfilling a "motivational" task, and in patients with the history of the disease over 10 years. The data are consistent with the literature indications on the morphological disorders and metabolism reduction in the frontal lobes of schizophrenic patients.

[Study of the morphological characteristics of the brain in patients with schizophrenia by the method of computerized tomography]. / Izuchenie morfologicheskikh osobennostei golovnogo mozga bo'lnykh shizofreniei metodom kom'piuternoi tomografii.

The article presents the data on 57 schizophrenic and 26 neurotic patients investigated by computerized tomography (CT). Only 4 of the neurosis patients (15.4%) displayed minor CT changes. In 45 schizophrenic patients (78.9%) CT changes were detected varying in their markedness. Most frequent were enlargement of cortical sulci (39 patients). Brain ventricles were dilated in 18 patients, cistern, retropineal and retrosellar spaces dilated in 13. Deficit disorders prevailed clinically in patients whose CT scans showed distinct signs of cortical and subcortical atrophy. These patients also had signs of organic pathology accumulated in the early childhood anamnesis. The authors suggest that this was a factor increasing the brain system' susceptibility to destructive impact of endogenous events.

[Effectiveness of finlepsin in the prophylactic therapy of phasic affective psychoses]. / Effektivnost' finlepsina pri profilakticheskoi terapii fazno protekaiushchikh affektivnykh psikhozov.

The article presents new, specified results of the use of finlepsin (carbamazepine) for the secondary prophylaxis in patients with endogenic affective psychoses. The data have emanated from a 5-year observation of the course of therapy of 73 patients. A positive effect was observed in 83% of cases, including 27.7% of cases with complete disappearance of circulation. No significant differences in the drug efficacy have been found in patients with manic-depressive psychosis versus schizophrenia. Yet, in most of the schizophrenics the phases have disappeared, while patients with manic-depressive psychosis have presented only partial improvement. The authors recommend that doses at the initial stages of treatment be increased in a gradual manner. Variants of a positive therapeutic time-course are described. They have also determined a period of time (3.5-4 months) after which the continuation of the therapy should be considered inadvisable in case of no favourable effect.

[Sleep deprivation as a method of treating endogenous depression]. / Deprivatsiia sna kak metod lecheniia éndogennykh depressii.

Forty-six patients with various forms of endogenous depression were treated by night sleep deprivation (NSD) which was used as the cardinal method of treatment. A single session of NSD induced a considerable clinical improvement lasting 2-3 days in the majority of patients. Repetition of the procedure (3-6 times with a 2-3 day interval) led to a significant and stable clinical improvement in 32 of the 46 patients. The highest effect of treatment was observed in such symptoms as depression and suicidal tendencies, whereas in patients with vital anxiety, the efficacy of NSD was considerably lower. Individuals with the duration of the phase under one month and the greatest reduction of the symptomatology after the recovery night showed the greatest response to the treatment. Favourable prognostic signs included such symptoms as psychomotor inhibition, lassitude and apathy, although the tempo of their reduction in the process of treatment considerably lagged behind improvement in the general mood, sleep and regress of autonomous disorders. Activation of the noradrenergic system is assumed to be one of the main mechanisms of NSD action.

[Clinical effects of neuroleptics]. / O klinicheskikh éffektakh neiroleptikov.

The current classifications of clinical psychotropic effects of neuroleptics are reviewed. On the basis of analyzing the time-course of the therapeutic regression, the author proposes to differentiate them into rapidly- and slowly-acting ones. The former in turn is divided into the immediate (sedative, thymoleptic, stimulating and stabilizing) and mediated ( deactualization , stratification, disintegration of the link with) the personality, correction of the content and the disappearance of symptomatology) effects. The slow action is presented by changes in the course and the structure of the clinical pictures as well as by a latent course. The classification suggested is the most adequate guideline in determining the ratio of biological and psychosocial therapeutic methods in the total system of rehabilitation treatment.

[Preventive treatment of affective psychoses with finlepsin]. / Profilakticheskoe lechenie affektivnykh psikhozov finlepsinom.

The prolonged (up to two years) use of finlepsin in manic-depressive and schizoaffective psychoses in 35 patients has shown this drug to possess a prophylactic effect comparable with the prophylactic action of lithium. In the course of treatment, the average cumulative duration of the morbid state considered in proportion to the observation period reduced from 87% to 37%. The dose of finlepsin reached as high as 1400 mg daily, with the average maintenance dose being 821 mg/day. Both critical and lytic variants of phasic reduction are traced.

[Intensive therapy of endogenous psychoses]. / Ob intensivnoi terapii éndogennykh psikhozakh.

A reduction of hospital stay facilitates the readaptation of mental patients. One of the conditions for implementing short hospitalization is the intensity of biological treatment: intravenous drip administration of drugs with a rapid increase of doses, rapid neuroleptization, and combination of psychotropic drugs with methods of a general biological influence. A study of 100 patients treated by the routine way demonstrated that intensive therapy significantly reduces the time of hospitalization and promotes remissions. The studies showed that intensive therapy is desirable only in acute psychoses and during the early stages of its development.

[Use of sleep deprivation for the purpose of treating protracted depressive states]. / Ispol'zovanie deprivatsii sna v tseliakh terapii zatiazhnykh depressivnykh sostoianii.

Sleep deprivation therapy was used in 30 patients with protracted, resistant depressive phases within the framework of manic-depressive psychosis. All patients demonstrated some improvement, which lasted from several hours up to 3 days. Changes in the state were mainly expressed in mood swings and to a less extent to the sphere of thinking and motor acts. A course of sleep deprivation (6-8 nights without sleep with an interval of 2-7 days) was administered to 19 patients, of them 7 patients demonstrated a stable improvement. Recording depressive symptomatology by the scale of intensity showed significant positive changes according to the following parameters: mood, thinking, motor acts, interests, sociability. The highest effect was seen in patients with melancholic pictures and significantly worse in depressive-anxious and depressive-obsessional syndromes.

[Clinical features of manic-depressive psychosis with organic brain defects]. / Ob osobennostiakh kliniki maniakal'no-depressivnogo psikhoza pri organicheskoi nepolnotsennosti golovnogo mozga.

The authors studied the clinical picture of manic-depressive psychoses in 71 patients who had signs of an organic brain lesion (both anamnestically and clinically), which were confirmed by X-ray and EEG data. It was established that these patients more frequently exhibit atypical forms of affective conditions (anxious--depersonalizational syndromes, angry mania). As a rule, they also have a significant amount of supplementary psychopathological signs in the syndrome structure (dysphorea, obsessions, depersonalization). Such conditions quite often are refractory to therapy and require special therapeutical approaches.

[Effect of moditen-depot therapy on the duration and quality of remissions in schizophrenia patients]. / Vliianie terapii moditenom-depo na dlitel'nost' i kachestvo remissii u bol'nykh schizofreniei.

The authors studied the effectiveness of out-patient treatment by Moditen-Deppt of 128 schizophrenic patients. A comparison of the previous remissions appearing during usual pharmacotherapy and remissions seen during Moditen-Depot treatment depicted statistically significant differences, indicating a distinct prevention of exacerbations due to this preparation, an increase in the duration and improved quality of remissions. Such improved remissions were expressed in lesser severity, in a decrease of psychopathological disturbances, changes qualified as a "mollification of a defect" and an improvement of some socio-clinical indices.

[Therapeutic pathomorphosis of affective psychoses during the process of long-term treatment with lithium salts]. / Terapevticheskii patomorfoz affektivnykh psikhozov v protsesse dlitel'nogo lecheniia soliami litiia.

The authors report of some results in a long-term (not less than 3 years) prophylactical administration of lithium preparations in 123 patients wiht manic-depressive psychosis and with favourable recurrent schizophrenia. The data contain some considerations in relation to variants of fractional, even and a partial reduction of the psychopathological phasic signs. In 28 patients in the interphasic period there was an anesthetic subdepression. The achieved results are analyzed by the authors from the point of view of a positive and negative therapeutical pathomorphosis.

[Depot fluphenazine as a means of stabilizing remission in cases of schizophrenia]. / Depo-fliufenazin kak sredstvo dlia stabilizatsii remissii pri shizofrenii.

(1) The use of compounds with a prolonged effect completely does away with the uncontrolled intake of drugs, which leads to a considerable reduction in the number of relapses and exacerbations. (2) It allows a diminution of the maintenance dosage and thereby reduces the occurrence of side-effects and furthermore the danger of the chemo-toxic damaging of a series of inner organs and systems. (3) It facilitates the organisation of the treatment of patients in the hospital, so that a more frequent daily administration of drugs is unnecessary. (4) On the side of the patients, the feeling that their condition is constantly dependent of the intake of drugs is reduced and the notion that they suffer from a chronic incurable disease is weakened.