[Social adaptation of patients with organic mental disorders in childhood: the results of the long-term study]. / Organicheskie psikhicheskie rasstroistva detsko-podrostkovogo vozrasta: rezul'taty dlitel'nogo nabliudeniia.

AIM: To analyze the clinical and social outcomes of organic mental disorders (OMD), diagnosed in children and teens; establish the factors that are relevant for the formation of the clinical picture of OMD in different sexes; the circumstances that determine the dynamics of remote OMD and the level of social adaptation of patients in adulthood. MATERIAL AND METHODS: Four hundred and ninety-eight children with organic mental disorders were followed-up in one of neuropsychiatric outpatient clinics of Moscow, until they reached 23-25 years of age. The total duration of observation was from 7.5 to 22 years (M±σ: 17.3±3.5 years). Clinical-psychopathological and follow-up methods were used. To assess social functioning of patients, a form for recording social skills of adolescents and a questionnaire for assessment of social functioning and quality of life were used. RESULTS AND CONCLUSION: In 82% of patients, OMD reduced by the time of adulthood. Disorders with severe intellectual impairment, paroxysmal disorders, psychopathic syndrome, mixed forms of the disease were the causes of a lifelong disability in 3.6% of cases.

[Uncompleted suicide attempts in adolescents]. / Nezavershennye suitsidal'nye popytki u podrostkov.

AIM: To analyze the characteristics of suicidal behavior, which was the reason of urgent admission to the psychiatric hospital, in adolescents. MATERIAL AND METHODS: Clinical and psychopathological analysis was performed for 143 adolescents, 55 boys and 88 girls, aged 15-17 years, admitted to a Moscow psychiatric hospital due to suicidal behavior. RESULTS AND CONCLUSION: Among all hospitalized on medical emergencies suicidal behavior was identified in 42%, repeated suicidal attempts were in 27% of boys and in 47% of girls. Mental disorders on admission and in the past history were found in 75%; 25% of the patients received psychiatric examination and treatment. Personality disorders and adaptation disorders were most prevalent; schizophrenia spectrum disorders made up 13%. Common features of suicidal behavior in adolescents were: the use of low fatal methods, mild expression of antivital feelings, short duration of pre-suicidal stage, suddenness of commitment of suicidal actions, an additional stressful event (conflict situation) for the development of suicidal behavior. Significant differences in the methods of realization of suicidal intentions, preferable character of suicidal behavior (blackmailing/demonstrative in girls, brutal and compulsive in boys) and typology of psychopathological symptoms were established.

[Adolescent's refusal of school: a psychopathological aspect].

OBJECTIVE: Despite the multiple studies on the school refusal phenomenon, clinical/psychopathological aspects of this problem need further studies. Authors performed a clinical/psychopathological analysis of the school refusal phenomenon in adolescents who are under supervision of a psychiatrist. MATERIAL AND METHODS: It were examined 223 adolescent patients (169 males and 54 females) with different appearances of school refusal. RESULTS: A set of factors predisposing to school refusal (family system dysfunction, heritability, character features, psychological immaturity, demoralization syndrome) was identified. Psychopathological causes of school refusal were divided into school phobia (31.8%), protest reactions in the frames of developing disorders of excitable personality type (4.9%), signs of mood disorders (22.9%), schizophrenic process (14.4%) and symptoms of organic cognitive impairment (26%). The analysis of clinical/dynamic characteristics of school refusal in different clinical variants demonstrated the differences by gender, stereotype of development, cognitive function and the dynamics of the phenomenon per se. CONCLUSION: In accordance to clinical variant of school refusal, we suggest to use differentiated therapeutic and preventive strategies.

[Schizophrenia in adolescence]. / Shizofreniya perioda adolestsentsii.

AIM: Schizophrenia with childhood and adolescent onset is a serious clinical/social problem. It has been attempted to specify main clinical/dynamic sex-related characteristics of early onset schizophrenia, prognostic criteria and parameters of outcome. MATERIAL AND METHODS: The results of a long-term (1995-2014) clinical follow-up study of outpatients of a psychoneurological dispensary and inpatients of a Moscow Psychiatric Hospital №15, aged 15-17 years, were analyzed. RESULTS: There was the predominance of men over women (4:1). The evidence of poor outcome of childhood and adolescent onset schizophrenia was obtained. At the age of 18 years, no one patient had stable remission, more than 40% of the patients were disabled since childhood. Most of adolescents were disabled in one or another activity. At the same time, there was a relative stabilization of the early malignant variants of schizophrenia resulted in oligophrenia-like deficit. The delayed (for several years) and frequently mistaken diagnosis and the absence of adequate treatment are the most robust premises of the development of early disability, along with the severity of destructive potential of the disease. CONCLUSION: The more distinct qualification of early symptoms of schizophrenia with childhood and adolescent onset, search for social/therapeutic approaches directed to the prevention of exacerbations and prophylaxis of social incompetence of adolescents are needed.

[The follow-up study of childhood-onset schizophrenia: clinical and social aspects].

Fifty-eight patients, 13 girls and 45 boys, with early-onset schizophrenia (mean 5.4 years) were followed up for 9.5 years. The men age at end point was 19.7 years. Full remission or recovery was not identified in any of the patients. The partial remission was observed in 14 (24%) patients and 44 (76%) patients had chronic course without remissions. Two thirds of patients were disabled including 9 patients with severe, 25 patients with moderate and 1 patient with mild disability. Most of the patients (62%) became disabled in childhood. Fourteen patients need the constant care and control from caregivers; 24 patients were able to work in special conditions, 20 patients can live independently and support themselves; 57 patients lived with parents and 1 patient was married. It has been concluded that notwithstanding the intensive psychopharmacotherapy and rehabilitative programs, patients with early-onset schizophrenia show poor outcomes. Therefore, new social-therapeutic approaches for providing care to these patients are needed.

[Manifesting schizophrenic attacks in female adolescents].

Authors have analyzed pre-manifesting symptoms as well as initial and manifesting stages of the disease on the basis of examination of 70 patients, aged 15-17 years. Schizoid and psychastenic types dominated in the premorbid structure of personality. The following variants of the initial stage were singled out: affective, psychopathic-like, with overvalued disorders, neurotic-like, with the predomination of simplex-syndrome, clinically polymorphic. Manifesting schizophrenic attacks in female adolescents were determined by affective-delusive, hallucinatory-delusive, oneiroid-catatonic and polymorphic syndromes. The attack-like course was found in most of cases. The typological similarity of psychotic states studied with those of adult schizophrenic patients was noted.

[Phobic syndromes in mentally ill adolescents].

The incidence of phobias in 1731 adolescents with mental disorders was estimated as 15,2%. A clinical follow-up study included 261 patients, aged 15-17 years, with ICD-10 diagnosis of phobic disorders. One third of patients was diagnosed with organic non-psychotic disorder, while one third with a disorder of endogenous cluster, the other nosologic units were represented rarely. The ratio of male to female was 6:1. Frequency allocation in a spectrum of phobic types was as follows: the fear of darkness (23%), social phobia (20,8%), with about a half of the fears being connected with the study process, thanatophobia (15,8%). Other types were found less often. The analysis of nosologic specificity of phobia content demonstrated an unspecific character of the fear of darkness. Mannered, with complicated content, exaggerated "childish" phobias were presented mainly in schizophrenia spectrum disorders.

[The age peculiarities of nonpsychotic forms of psychogenic disorders caused by everyday stressors]. / Vozrastnye osobennosti nepsikhoticheskikh form psikhogenii, vyzvannykh povsednevnymi stressami.

Three groups of patients were examined in the period of 1994-1999: adolescent (aged 15-18 years), middle-aged (25-59 years) and elderly (60 years and older) with non-psychotic mental disorders developing under the influence of everyday stressors. The highest tolerability to stressors was detected in the middle-aged group. The dominating stressors in the groups were: social situations in the adolescences; interfamily conflicts--in the middle-aged patients and a presence of disease--in the elderly. Stressogenic affective disorders occurred most often in all the groups; anxious-phobic states prevailed in adolescents; neurotic pictures with hysteri-form symptoms, converse type--in the middle age and anxious phobic disorders with primary psychoorganic appearances--in the elderly. Risk factors for psychogenic disorders are: male sex, "organic predisposition", accentuation of the personality, "destructive" types of family bringing up in the adolescences; female sex, signs of endogenic diathesis and reactive lability for the middle-aged patients and female sex, aging factor and related changes of personality as well as somatic diseases in the elderly.

[A comparison of some indices of innate and adaptive immunity in different types of schizophrenia]. / Sopostavlenie nekotorykh pokazatelei vrozhdennogo i priobretennogo immuniteta pri raznykh formakh techeniia shizofrenii.

Leukocyte elastase (LE) blood serum activity as an index of innate immunity and autoimmune reactions to brain antigens i.e. a level of autoantiboies to nerve growth factor (NGF) as an index of adaptive immunity were studied in patients with attack-like and slow progressive schizophrenia. Compared to controls, higher LE activity accompanied by a significant increase of autoantibodies to NGF titers was found in patients with attack-like schizophrenia. In slow progressive schizophrenia, only higher LE activity was detected. Correlations between immunological parameters and some clinical appearances (positive and negative disorders) and disease course peculiarities were revealed. The results suggest an involvement of different parts of immune system in pathophysiology of attack-like and slow progressive schizophrenia.

[Juvenile population in psychoneurologic outpatient clinic]. / Podrostkovyi kontingent psikhonevrologicheskogo dispansera.

Adolescents with mental pathology borned in 1977 were followed up in psychoneurological outpatient clinic for a period of 3 years (1994-1997). The problems of primary care and delay of contact of adolescents with psychiatrists were investigated. The most characteristic diagnostic difficulties, cases of change of diagnosis, development of social-occupational adaptation and suitability for military service are analyzed.

[Clinico-dynamic aspects of long-term remissions in schizophrenia]. / Kliniko-dinamicheskie aspekty dlitel'nykh remissii pri shizofrenii.

The authors studied 56 patients with paroxysmal schizophrenia who had remissions lasting over 10 years. Three variants of such long remissions were identified: with a negative time-course characterized by a gradual decrease in their quality and the presence of signs of slow progression of the disease; with a positive time-course characterized by an elevation in their levels, a gradual reduction of positive symptomatology and stabilization of the patient's status; stationary remissions with an unaltered clinical picture throughout their course. The time-course of prolonged remissions correlated with the regularities of the course of the endogenic process on the whole. Sociotherapeutic recommendations are presented for each of the identified variants.

[1 of the variants of the course of paroxysmal schizophrenia with affective disorder during remission]. / Ob odnoi iz raznovidnostei techeniia pristupoobraznoi shizofrenii s affektivnymi rasstroistvami v remissiiakh.

On the basis of clinico-psychopathological examination of 34 patients with paroxysmal forms of schizophrenia and affective pathology prior to acute psychosis the authors have identified major clinical types of affective disorders during remissions. Correlation was ascertained between the rate of progression of the endogenic process in the premanifest period, the degree of its activity in remissions and clinico-dynamic characteristics of affective disorders.

[1 of the variants of stable psychopath-like states in patients with slowly progressing schizophrenia (problem of residual schizophrenia)]. / Ob odnom iz variantov stoikikh psikhopatopodobnykh sostoianii u bol'nykh maloprogredientnoi shizofreniei (k probleme rezidual'noi shizofrenii).

The peculiarities of the clinical course and development of stable psychopathlike states formed during slow-progressive schizophrenia stabilization were studied in 111 patients. Clinically they were attributed to a group of pseudopsychopathy and could be regarded as residual states. Two forming mechanisms of pseudopsychopathy corresponding to the course of endogenic process were singled out: the first one was typified as a characterological shift in paroxysmal course of the disease; the second one as an "amalgamated type" in stagnant course of the disease. Clinical typology of pseudopsychopathies including schizoid, hypochondriac, hyperthymic, hypoparanoic states is presented. Social rehabilitation peculiarities in each case were marked out. The development of endogenic psychoses eventuating in the formation of psychopathlike states is reviewed.

[Clinical features of the initial manifestations of slowly-progressing schizophrenia]. / O klinicheskikh osobennostiakh nachal'nykh proiavlenii maloprogredientnoi shizofrenii.

On examining 200 patients with slowly progressing schizophrenia it was found that the initial psychopathological disturbances appeared in most cases (in 122 patients) at an age under 20 years, while the distinct progress of the disease was noted much later, in the third or the fourth decade of the life. In 31.5% of the observations, the initial disorders were autochthonous, while in 68.5% they were provoked mainly by psychogenic and environmental factors. A comparison of the autochthonous and provoked initial disturbances showed that both types were presented by affective and obsessive-phobic disorders which could be detected long before the appearance of the clinical manifestation of the process. Clinical aspects of the initial disorders, their time course and interconnections with the symptoms of the subsequent, more advanced stages of the disease are analyzed. The author concludes that the disorders discussed belong to the latent stage of slowly progressing schizophrenia.

[Psychogenic onsets of slowly progressive schizophrenia]. / K probleme psikhogennykh debiutov maloprogredientnoi shizofrenii.

The authors studied 26 patients with slowly progressive schizophrenia, where prior to distinct symptoms of a schizophrenic process there was a reactive depression in the framework of the dynamics of psychopathy and in patients with an eventual development of the schizophrenic process. The report contains arguments indicating to the possibility of assessing the period of reactive lability, prior to the manifestation of schizophrenia, as a latent phase in the development of an endogenous process.

[Features of schizoid states, constitutional and acquired]. / O nekotorykh osobennostiakh shizoidnykh sostoianii, konstitutsional'nykh i nazhitykh.

The authors conducted a clinical comparison of schizoid traits of asthenic pole in 2 nozological heterogenic groups of patients. In one group they were of a constitutional character (the group of effusive schizoids), in the other--they were formed following a schizophrenic attack (the group of patients with mildly progressive schizophrenia in the state of remission of asthenic type). It was possible to demonstrate significant differences between the patients of these groups not only in specific schizophrenic traits (autism, the emotional sphere, social adaptation), but in their development. These differences testify to the existence of constitutionally conditioned stable schizoid states and the necessity to distinguish them from acquired psychopathic traits of the schizoid spectrum.

[Differential pharmacotherapy of neurotic conditions (comparative effectiveness of benzodiazepine derivatives)]. / Differentsirovannaia farmakoterapiia nevroticheskikh sostoianii (sravitel'naia éffektivnost' proizvodnykh benzodiazepina)

The effectiveness in treating borderline states to a certain degree depends upon the pole (sthenic or asthenic) of the corresponding disturbance. Tranquilizers are the preparations of choice in the treatment of disorders of an asthenic pole (psychopathy of the asthenic range, neurotic states). In borderline conditions of a sthenic pole the effectiveness of tranquilizers is equal or sometimes is even less than in therapy with small doses of neuroleptics. In treating neurotic conditions tranquilizers of the benzodiazepine group can be ranged in the following succession: nitrazepam, chlordiazepoxide, medazepam, oxazepam, diazepam, lorazepam. This preparation is a continuun of an increasing psychotropic activity.