[Mental disorders and personality characteristics of patients with polycystic ovary syndrome]. / Psikhicheskie rasstroistva i lichnostnye osobennosti u patsientok s sindromom polikistoznykh yaichnikov.

OBJECTIVE: To study the frequency and clinical manifestations of mental disorders in women with polycystic ovary syndrome (PCOS), to describe the personality characteristics and basic behavioral styles of these patients. MATERIAL AND METHODS: One hundred and sixteen women with PCOS were examined, the average age was 26.9±4.1 years. The diagnosis of PCOS was verified by a gynecologist based on the ESHRE/ASRM criteria, the qualification of the mental state was carried out by a psychiatrist based on the ICD-10 criteria. MMPI and 16-PF were used to assess personality characteristics. RESULTS: Mental disorders were diagnosed in 76 (65.5%) patients. Generalized anxiety disorder (26.7%), recurrent depression (19.8%) and bipolar affective disorder (14.7%) were prevailed. A psychological study of the PCOS patients identified four main behavioral styles: anxiety-depressive (n=18, 22.5%), masculine (n=18, 22.5%), hyperthymic (n=25, 31.3%) and sensitive (n=19, 23.7%). Anxiety-depressive and sensitive styles were most frequently combined with mental disorders. CONCLUSION: Women with PCOS have an increased risk of developing mental disorders, which indicates the need to connect psychological and psychiatric support to their medical management.

[Mental disorders in type 2 diabetes]. / Psikhicheskie rasstroistva pri sakharnom diabete 2-go tipa.

OBJECTIVE: To assess the prevalence of mental disorders in patients with type 2 diabetes mellitus (DM2) and their relationship with laboratory findings, somatic comorbidities and psychosocial consequences. MATERIAL AND METHODS: In the frames of the INTERPRET-DD multicenter 200 T2DM patients from primary care (47 men and 153 women) from the Russian sample were studied. The psychometric assessment included MINI-6, HAMD-17, PHQ-9, PAID, WHO-5. RESULTS: One hundred and seventeen patients (58.5%) have mental disorders. Current mental disorders were diagnosed in 93 (46.5%) of patients. Depression (depressive episode, recurrent depressive disorder, bipolar affective disorder type II) was identified in 34 (17.0%), dysthymia in 26 (13.0%), and anxiety spectrum disorders in 39 (19.5%). In about half of the cases, anxiety disorders were combined with depression. The most severe problems were observed in the patients with depression and dysthymia. Patients with social phobia had significantly higher levels of glycated hemoglobin compared to patients without mental disorders. The significant decrease of systolic arterial pressure and body mass index was observed in patients with agoraphobia compared to patients without mental disorders. In addition, there was an increased prevalence of chronic ischemic heart disease in recurrent depression, dysthymia and generalized anxiety disorder, higher prevalence of neuropathy in depressive episode and recurrent depression and nephropathy in panic disorder. CONCLUSION: Depressive and anxiety disorders, as well as severe psychosocial problems, are consistently associated with T2DM. At the same time, concomitant somatic disorders and complications of DM2 are not just by chance comorbid to various forms of mental disorders, which allows for a new look at the problem of comorbidity/multimorbidity in T2DM.

Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: results from the INTERPRET-DD prospective study.

AIMS: To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. METHODS: People with type 2 diabetes treated in out-patient settings aged 18-65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of 'upset') between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. RESULTS: In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS. CONCLUSION: This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

[Procognitive effects of fluvoxamine: preliminary data]. / Prokognitivnye éffekty fluvoksamina (predvaritel'nye dannye).

AIM: To identify and investigate procognitive effects of fluvoxamine. MATERIAL AND METHODS: A prospective non-comparative trial of fluvoxamine was carried out in 50 patients in the remission phase of recurrent depressive disorder. To assess the efficacy of therapy, the Stroop color and word test, the Revised version of Addenbrooke's Cognitive Examination, the Frontal Assessment Battery, the Hamilton Depression Scale and the Social Adaptation Self-Evaluation Scale were used. Fluvoxamine was administered at doses of 50-150 mg/day for 24-weeks. RESULTS: There were the improvement of executive functions, including selective attention and inhibitory control, and recovery of verbal fluency. The procognitive effect of fluvoxamine was dose-dependent and was related to the reduction of residual depressive symptoms. CONCLUSION: Fluvoxamine has procognitive effects, stabilizes remission and improves social adaptation of the patients.

Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries.

AIMS: To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries. METHODS: People with diabetes aged 18-65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale. Demographic and medical record data were collected. RESULTS: A total of 2783 people with Type 2 diabetes (45.3% men, mean duration of diabetes 8.8 years) participated. Overall, 10.6% were diagnosed with current major depressive disorder and 17.0% reported moderate to severe levels of depressive symptomatology (Patient Health Questionnaire scores >9). Multivariable analyses showed that, after controlling for country, current major depressive disorder was significantly associated with gender (women) (P<0.0001), a lower level of education (P<0.05), doing less exercise (P<0.01), higher levels of diabetes distress (P<0.0001) and a previous diagnosis of major depressive disorder (P<0.0001). The proportion of those with either current major depressive disorder or moderate to severe levels of depressive symptomatology who had a diagnosis or any treatment for their depression recorded in their medical records was extremely low and non-existent in many countries (0-29.6%). CONCLUSIONS: Our international study, the largest of this type ever undertaken, shows that people with diabetes frequently have depressive disorders and also significant levels of depressive symptoms. Our findings indicate that the identification and appropriate care for psychological and psychiatric problems is not the norm and suggest a lack of the comprehensive approach to diabetes management that is needed to improve clinical outcomes.

[Mental disorders in patients with acromegaly]. / Psikhicheskie rasstroistva u bol'nykh akromegaliei.

AIM: To study mental disorders in acromegaly due to somatotropinoma. MATERIAL AND METHODS: The study included 115 consecutively recruited patients with acromegaly (95 female and 20 male, aged from 21 to 78 years). Acromegaly was diagnosed by endocrinologists according to current guidelines based on clinical, laboratory data and brain MRI. All patients underwent a clinical psychiatric interview based on ICD-10 criteria. The Mini-Mental State Examination scale and Hypomania-Checklist (HCL-32) were used. RESULTS: Mental disorders were diagnosed in 79.1% of patients. Organic spectrum disorders were found in 46.1%, bipolar spectrum disorders in 35.7%, schizophrenia spectrum disorders in 4.3%. The patients with bipolar spectrum disorders had significantly lower serum insulin-like growth factor 1 (IGF-1) levels compared to patients with organic spectrum disorders (p=0.01). The presence of organic spectrum disorders was associated with older age and number of somatic comorbidities (р=0.0001 and 0.001). CONCLUSION: The prevalence of bipolar, organic and schizophrenia spectrum disorders in patients with acromegaly exceeds that in the general population. Significantly lower IGF-1 levels in acromegalic patients with bipolar disorders, compared to those with organic disorders, can have some implications to their pathogenesis.

The INTERPRET-DD study of diabetes and depression: a protocol.

AIM: People with diabetes are at an increased risk of developing depression and other psychological disorders. However, little is known about the prevalence, correlates or care pathways in countries other than the UK and the USA. A new study, the International Prevalence and Treatment of Diabetes and Depression Study (INTERPRET-DD) aims to address this dearth of knowledge and identify optimal pathways to care across the globe. METHOD: INTERPRET-DD is a 2-year longitudinal study, taking place in 16 countries' diabetes outpatients' facilities, investigating the recognition and management of depressive disorders in people with Type 2 diabetes. Clinical interviews are used to diagnose depression, with clinical and other data obtained from medical records and through patient interviews. Pathways to care and the impact of treatment for previously unrecognized (undocumented) depression on clinical outcomes and emotional well-being are being investigated. RESULTS: Initial evidence indicates that a range of pathways to care exist, with few of them based on available recommendations for treatment. Pilot data indicates that the instruments we are using to measure both the symptoms and clinical diagnosis of depression are acceptable in our study population and easy to use. CONCLUSIONS: Our study will increase the understanding of the impact of comorbid diabetes and depression and identify the most appropriate (country-specific) pathways via which patients receive their care. It addresses an important public health problem and leads to recommendations for best practice relevant to the different participating centres with regard to the identification and treatment of people with comorbid diabetes and depression.

[Clinical polymorphism of depression and cognitive deficit].

OBJECTIVE: To study the relation between psychometric assessment of depression and parameters of cognitive functioning. MATERIAL AND METHODS: Authors examined 90 patients (75 women and 15 men), aged from 20 to 75 years, with depression. Twenty-five patients were diagnosed with depressive episode, 40 with recurrent depression, 6 with bipolar depression, 8 with dysthymia and 11 with sub-depression. The diagnosis was made according to ICD-10 criteria. Its were used the following scales: HAMD, BDI, MMPI, ACE-R. RESULTS: The nosographic differentiation of depression only partially reflected the presence of cognitive deficit. An analysis of depressive syndromes identified psychometrically revealed that cognitive deficit on ACE-R was correlated with behavioral stereotypes on MMPI but not with scores on HAM-D and BDI. CONCLUSION: Observational criteria (registration of abnormal behavioral stereotypes) should be used in assessment of cognitive deficit in patients with depression. This fact should be also taken into consideration in the studies of antidepressant effects on cognitive function.

[Features of the mental state of obese patients with concomitant sleep disorders].

OBJECTIVE: To study the frequency of mental disorders with concomitant insomnia in obese patients. MATERIAL AND METHODS: Authors studied 123 patients (51 men and 72 women, mean age 40.0±11.5; body mass 117.6±30.9 kg; waist circumference 118.2±19.8 cm; BMI 39.8±8.7 kg/m2) with obesity. RESULTS: The questionnaire survey revealed subjective disorders of the quality of sleep in 76%, complaints about snoring in 63%, hypersomnia during the day in 55% higher risk of sleep apnea in 50%, insomnia in 45% of patients. According to the results of psychological testing, the obese patients with insomnia had higher levels of health anxiety. CONCLUSION: Insomnia can be considered as a marker of overt psychopathological disturbances in patients with obesity.

[Cognitive impairment in depression and potential applications of antidepressants with procognitive effects]. / Kognitivnye narusheniia pri depressii i perspektivy primeneniia antidepressantov s prokognitivnym éffektom.

The characteristics of cognitive impairment in depression are reviewed. Data of literature indicate that cognitive impairment may serve as a predictor of depression recurrence and poor prognosis of antidepressant therapy. In this view, we consider the importance of assessment of cognitive impairment and differential use of medications with precognitive effect (bupropion, vorteoxetine and some SSRI antidepressants as well as fluvoxamine, which is a potent agonist of the sigma-1-receptor).

[Early outcomes of Asperger's syndrome].

Mental state of adult patients, who since childhood had features of Asperger's syndrome (AS), was studied. We examined 107 patients (89 men and 18 women). At the moment of inclusion in the study, all the patients met criteria of ICD=10 for AS. This was confirmed by the examination of the patients with the help of ASDASQ and ASDI scales. Based on the results of psychopathological and psychological five variants of AS outcomes in the age of early adulthood were identified as follows: integrated, inhibitory, peculiar, border-line and hypernormative. At the moment of examination, psychosocial compensation was observed in 38% of patients, only 28% of patients were on treatment and 20% had a history of transitory psychotic episodes. The authors conclude that the results of the study suggest the relatively favorable prognosis of AS. The differential clinical evaluation of this group as well as implication of adequate psychosocial and psychotherapeutic methods in their treatment is needed.

[Anxiety-depressive disorders and cognitive impairment in patients of the primary level of health care].

An objective of the study was to compare cognitive and anxiety-depressive disorders in patients of the primary level of health care. Authors studied 103 patients, mean age 51.2±15.9 years, of a psychotherapeutic setting in a polyclinic. Patients were stratified into three groups: patients with anxiety-depressive disorders (ADD), with mild organic mental disorders (MOMD) and with the combination of ADD and MOMD. Patients were assessed using a form for assessment of anxiety and depressive symptoms and psychometric scales HADS, MMSE, FAB, ACE-R. High positive correlations between the total score on the subscale "depression" of the HADS and some ACE-R items (total score, orientation/attention, verbal fluency) and total score on the FAB were identified in patients with ADD and MOMD compared to other groups. In patients with ADD, the correlations between some measures of cognitive style and language disturbances measured with the ACE-R were found. The results indicate that it is necessary to evaluate cognitive impairment (deficit symptoms and distortions in cognitive styles) in patients with anxiety-depressive disorders at the primary level of health care and to take it in account in choosing treatment options and predicting outcome.

[Atarax in treatment of anxiety in outpatient clinic]. / Ataraks v ambulatornom lechenii trevozhnykh rasstroistv.

50 patients (10 men, 40 women) with generalized anxiety (29), disorders of adaptation (15), somatoformed disorders (6), diagnosed according to ICD-10, were treated by atarax. Mean age of the patients was 42.4 years, average duration of the disease-1.9 years. Evaluation of efficiency was performed according to "Global Clinic Impression" scale, Hamilton rating scale for anxiety and depression (HAM-A and HAM-D) as well as according to FARD scale for anxiety. The patients were examined both before the treatment and on 14 and 28 days of treatment. According to "Global Clinical Impression" scale excellent and good results were observed in 66% of the patients. Unsatisfactory results were found in 10% of the cases. Reduction of the total HAM-A scores by 50% and more was observed in 48% of the patients. The same decrease was observed in 58% of the patients according to HAM-D scale and in 54% of the patients according to FARD scale. Following side-effects were noted: transitory sleepiness (36% of the cases), weakness (18%), headache (6%), changes of both appetite (6%) and body mass (6%), slight mucosa dryness (2%). In one case skin allergic reaction in form of urticaria bullosa took place and the therapy was interrupted.

[Pharmacodynamic and pharmacokinetic parameters of the effect of the effect of ethyl alcohol at different stages of alcohol dependence]. / Farmakodinamicheskie i farmakokineticheskie parametry éffekta étilovogo spirta na razlichnykh étapakh alkogol'noi zavisimosti.

The pharmacodynamic and pharmacokinetic parameters of the effect of ethyl alcohol were studied and compared in groups of chronic alcoholics (n-44), persons with everyday hard drinking (n-19) and healthy persons (n-15). In order to evaluate objectively the psychotropic effects of alcohol, use was made of the data obtained on computerized analysis of the EEG dynamics. The studies were performed after the administration of placebo and 0.5 g/kg of ethyl alcohol during 6 hours. The data obtained point to a decrease of alcohol bioavailability as chronic alcoholism progresses, which leads to a reduction of the power of the pharmacodynamic effect of ethyl alcohol. At the same time the psychotropic effect of ethanol was found to be different in the test subjects, which may be accounted for by the nonidentity of the appropriate physiological mechanism mediating the action of alcohol, Particularly, the action of alcohol on the healthy test subjects manifests itself by the encephalographic correlates of the sedative effect. The changes in the EEG seen at the initial stages of alcoholism can be regarded as an equivalent of the stimulating effect, whereas in stage II disease as that of the anxogenous and psychotomimetic effect.

[Effectiveness of combined use of monoamine oxidase inhibitors and psychotherapy in the treatment of chronic alcoholism]. / Izuchenie éffektivnosti sochetannogo primeneniia ingibitorov monoaminoksidazy i psikhoterapii pri lechenii khronicheskogo alkogolizma.

The purpose of the study was to examine the efficacy of nuredal to correct cognitive disorders in patients with alcoholism. The drug treatment was combined with psychotherapy. The study was carried out in the main and control groups by the double blind method. The patients' status was assessed by means of the clinical observation as well as with the aid of a number of psychodiagnostic methods. The data obtained point to positive shifts in the mental status of patients treated with nuredal combined with psychotherapy.

[Changes in the spectral power of the EEG in alcoholics during presentation of stimuli of different semantic modality]. / Izmeneniia spektral'noi moshchnosti EEG u bol'nykh alkogolizmom pri pred"iavlenii stimulov razlichnoi semanticheskoi modal'nosti.

Using bipolar registration of the EEG from two symmetrical temporal leads in 50 alcoholic patients and 20 normal subjects, the authors examined changes in the spectral power (SP) of the EEG in a range of 0.5-32 Hz in response to the presentation of 6 series of visual stimuli different by semantic modality. It was found that stimuli of an alcoholic nature induced in the patients the maximum increase in SP parameters and led to a change in the SP-dominant hemisphere. In contrast, the controls showed augmentation of SP in response to stimuli of food and sex modality without changes in lateralization. A conclusion is drawn about the dependence of SP parameters on the hierarchy of the individual requirements. From the standpoint of concepts about the pathological development of the personality, the authors analyze the qualitative features of EEG responses in alcoholics toward specific stimuli.