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1.
Artigo em Russo | MEDLINE | ID: mdl-37796061

RESUMO

In recent decades, psychiatric ethics has been an area of intensive research and reconsideration of established regulations. Basic principles of medical deontology do not cover ethical issues of modern psychiatric science and practice. The fundamental principle of ethical relationship between a physician and a patient in psychiatric practice is a voluntary informed consent that is based on three main criteria: voluntarism, decision-making capacity and information disclosure about proposed medical procedure. The principle of voluntary informed consent implies a dialogue between a psychiatrist and a patient that rely on the principles of patient's autonomy and does not allow the priority of the paternalistic approach. The physician is obliged to provide all available information on the proposed intervention in a comprehensive way and assess the degree of patient's awareness of this information. The main objective is to determine patient's ability to make decisions as accurately as possible. Many mental disorders affect cognitive processes of decision making and may impact patient's autonomy. It is unacceptable to consider psychiatric patients as incapable of making decisions in advance.


Assuntos
Transtornos Mentais , Médicos , Humanos , Transtornos Mentais/terapia
2.
Ter Arkh ; 94(4): 579-583, 2022 May 26.
Artigo em Russo | MEDLINE | ID: mdl-36286811

RESUMO

BACKGROUND: Bipolar disorder (BD) is one of the most common mental disorders characterized by alternating episodes of mania/hypomania and depression, as well as the possibility of developing mixed conditions. Correct and timely diagnosis of BD is important due to the presence of a high suicidal risk and a high predisposition to the development of cardiovascular disease (CVD). The risk of CVD is higher in ВD than in other mental disorders. MATERIALS AND METHODS: A sample assessment was made of current studies focusing on the vascular-bipolar link. The search was carried out in the PubMed and eLIBRARY databases for the following keywords: bipolar disorder, psychopharmacology, cardiovascular disease, biological mediators. RESULTS: There are several biological factors which explain the close association and common pathogenetic mechanisms of BD and CVD. The most interesting of them are inflammation, oxidative stress, and brain-derived neurotrophic factor. Neuroimaging methods have shown similar structural brain changes in people with BD and with CVD. There is some evidence of the efficacy of statins and angiotensin-converting enzyme inhibitors in reducing cardio-vascular risk factors in BD patients. CONCLUSION: The predisposition of patients of BD to CVD is beyond doubt. It is necessary to consider the peculiarities of the course of BD and conduct active monitoring and preventive measures to reduce the risk of developing life-threatening CVDs. Further research focused on the pathogenetic relationship between BD and CVD could provide more insight into this area.


Assuntos
Transtorno Bipolar , Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Humanos , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Fator Neurotrófico Derivado do Encéfalo/uso terapêutico , Fatores Biológicos/uso terapêutico , Fatores de Risco , Inibidores da Enzima Conversora de Angiotensina
3.
Ter Arkh ; 93(12): 1556-1561, 2021 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-36286688

RESUMO

Bipolar disorder (BD) is one of the most common mental disorders in the world with high mortality and a hard economic burden. Although suicide is the leading cause of death in BD, cardiovascular disease (CVD) also contributes significantly to this rate, the risk of which is seriously underestimated in BD. A sample assessment was made of current studies focusing on the link between BD and CVD. The search was carried out in the PubMed and eLIBRARY databases for the following keywords: bipolar disorder, psychopharmacology, cardiovascular disease, metabolic syndrome. The association between BD and vascular disease is large. The analysis of adjusted mortality estimates in patients with bipolar disorder showed a significant contribution of CVD. A detailed study of the mutual influence of bipolar disorder BD and CVD is difficult due to the earlier manifestation of BD in comparison with CVD. Most of the studies have focused on cardiovascular risk factors (CVRFs), which are more common in BD than in the general population. Metabolic syndrome (MS) plays a significant role among CVRFs. The reasons for the development of MS in patients with BD are currently not known for sure, however, the instigated factors are certainly a disturbance of the diet, decreased physical activity, pharmacological therapy, and the lack of early preventive and medical care. Patients with hyperuricemia had a higher risk of developing MS. Lifestyle correction and a reduction of CVFRs, as well as the rational use of certain cardiac drugs can improve the better prognosis of the disease and reduce mortality in patients with BD. The predisposition of patients with BD to CVD is undeniable. It is necessary to consider the high frequency of CVRFs in people with BD, and promptly recommend appropriate treatment and special rehabilitation programs for the prevention of CVD complications, considering the change in affective phases and the applied mood-stabilizing drugs.


Assuntos
Transtorno Bipolar , Doenças Cardiovasculares , Síndrome Metabólica , Humanos , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Fatores Sociais , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/complicações , Estilo de Vida , Fatores de Risco
4.
Artigo em Russo | MEDLINE | ID: mdl-32621462

RESUMO

The WHO declared COVID-19 pandemic, the deterioration of the epidemic situation in Russia, the lockdown and the growing fear in society caused by panic rumors and misinformation spread on social networks and the media pose urgent organizational and medical tasks for our psychiatric service. Based on the experience of other countries that have already encountered the massive spread of COVID-19, the author presents a review of the proposed urgent and preventive organizational and treatment measures and suggests practical recommendations on urgent temporary reorganization of the psychiatric service, and the provision of psychological and psychotherapeutic support to the most vulnerable groups of the population, including medical personnel working with patients with COVID-19, and the management of mentally ill patients with severe acute respiratory syndrome. As the primary goals, it is proposed to separate the flows of people in need of psychological support and psychiatric care, and organize the remote provision of these services (hotline phones and telemedicine consultations). Particular attention is paid to the management of mentally ill patients with coronavirus respiratory syndrome and the characteristics of psychopharmacological therapy with an overview of the potential risks of side-effects and complications related primarily to respiratory function, including those due to adverse drug interactions.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Saúde Mental , Pandemias , Pneumonia Viral , COVID-19 , Humanos , Federação Russa , SARS-CoV-2
5.
Eur Neuropsychopharmacol ; 29(4): 471-481, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30846287

RESUMO

According to the DSM-5, "reduction in the need for sleep" is the only sleep-related criteria for mixed features in depressive episodes. We aimed at studying the prevalence, clinical correlates and the role of hypersomnia in a sample of acutely depressed patients. Secondarily, we factors significantly increasing the odds of hypersomnia were studied. We conducted a post-hoc analysis of the BRIDGE-II-Mix study. Variables were compared between patients with hypersomnia (SLEEP+) and with insomnia (SLEEP-) with standard bivariate tests. A stepwise backward logistic regression model was performed with SLEEP+ as dependent variable. A total of 2514 subjects were dichotomized into SLEEP+ (n = 423, 16.8%) and SLEEP- (n = 2091, 83.2%). SLEEP+ had significant higher rates of obese BMI (p < 0.001), BD diagnosis (p = 0.027), severe BD (p < 0.001), lifetime suicide attempts (p < 0.001), lower age at first depression (p = 0.004) than SLEEP-. Also, SLEEP+ had significantly poorer response to antidepressants (AD) such as (hypo)manic switches, AD resistance, affective lability, or irritability (all 0<0.005). Moreover, SLEEP+ had significantly higher rates of mixed-state specifiers than SLEEP- (all 0 < 0.006). A significant contribution to hypersomnia in our regression model was driven by metabolic-related features, such as "current bulimia" (OR = 4.21) and "overweight/obese BMI (OR = 1.42)". Globally, hypersomnia is associated with poor outcome in acute depression. Hypersomnia is strongly associated with mixed features and bipolarity. Metabolic aspects could influence the expression of hypersomnia, worsening the overall clinical outcome. Along with commonly used screening tools, detection of hypersomnia has potential, costless discriminative validity in the differential diagnosis unipolar and bipolar depression.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Comorbidade , Feminino , Humanos , Internacionalidade , Masculino
6.
J Affect Disord ; 246: 346-354, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30597295

RESUMO

OBJECTIVE: This study primarily focused on the relationship between comorbid attention deficit-hyperactivity disorder (ADHD), mixed features and bipolarity in major depressive patients. METHODS: The sample comprised 2777 patients with Major Depressive Episode (MDE) enrolled in a multicentre, multinational study originally designed to assess different definitions of mixed depression. Socio-demographic, familial and clinical characteristics were compared in patients with (ADHD + ) and without (ADHD-) comorbid ADHD. RESULTS: Sixty-one patients (2.2%) met criteria for ADHD. ADHD was associated with a higher number of (hypo)manic symptoms during depression. Mixed depression was more represented in ADHD + patients than in ADHD- using both DSM-5 and experimental criteria. Differences were maintained after removing overlapping symptoms between (hypo)mania and ADHD. ADHD in MDE was also associated with a variety of clinical and course features such as onset before the age of 20, first-degree family history of (hypo)mania, past history of antidepressant-induced (hypo)manic switches, higher number of depressive and affective episodes, atypical depressive features, higher rates of bipolarity specifier, psychiatric comorbidities with eating, anxiety and borderline personality disorders. LIMITATIONS: The study was primarily designed to address mixed features in ADHD, with slightly reduced sensitivity to the diagnosis of ADHD. Other possible diagnostic biases due to heterogeneity of participating clinicians. CONCLUSIONS: In a sample of major depressive patients, the comorbid diagnosis of current ADHD is associated with bipolar diathesis, mixed features, multiple psychiatric comorbidity and a more unstable course. Further prospective studies are necessary to confirm the possible mediating role of temperamental mood instability and emotional dysregulation in such a complex clinical presentation.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno Depressivo Maior/complicações , Adulto , Sintomas Afetivos , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Transtorno da Personalidade Borderline/complicações , Estudos Transversais , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Características da Família , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Artigo em Russo | MEDLINE | ID: mdl-31994511

RESUMO

AIM: Evaluation of a new five-factor dimensional model of schizophrenia in recent revisions of classifications of mental disorders (DSM-5 and ICD-11) dictates the need to use this approach in conducting a comprehensive assessment of the effectiveness of new antipsychotic agents, including ethnically homogeneous populations of patients. MATERIAL AND METHODS: Post-hoc analysis of pooled data from two randomized, double-blind, placebo-controlled, 6-week clinical studies (RCTs) of lurasidone (fixed doses, 40, 80, 120 or 160 mg/d) in patients experiencing an acute exacerbation of schizophrenia. Changes in PANSS total score, CGI-S score and five established PANSS factors were assessed using mixed-model repeated measures analysis. RESULTS: Lurasidone (n=162, dose groups pooled) compared with placebo (n=68), significantly improved the PANSS total score at Week 6 (-23.0 vs. -10.5; p<0.001; effect size 0.82) as well as all PANSS factor scores: positive symptoms (-8.5 vs. -4.2; p<0.001; effect size 0.88), negative symptoms (-4.4 vs. -2.8; p=0.011, effect size 0.44), disorganized thoughts (-4.4 vs. -2.1; p<0.001; effect size 0.70), hostility/excitement (-2.7 vs. -0.7; p<0.001; effect size 0.66), and depression/anxiety (-3.5 vs. -2.2; p=0.002; effect size 0.53). CONCLUSION: Lurasidone demonstrated significant improvement for both PANSS total score and each of the five PANSS factor scores, indicating effectiveness across the broad spectrum of schizophrenia symptoms. Effect size for both PANSS total score and each of the five PANSS factor scores for the local population was higher than for the wider population, which included patients from various countries.


Assuntos
Antipsicóticos/uso terapêutico , Cloridrato de Lurasidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Método Duplo-Cego , Humanos , Escalas de Graduação Psiquiátrica , Federação Russa , Resultado do Tratamento , Ucrânia
8.
Acta Psychiatr Scand ; 136(4): 362-372, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28741646

RESUMO

OBJECTIVE: To evaluate aggressiveness during a major depressive episode (MDE) and its relationship with bipolar disorder (BD) in a post hoc analysis of the BRIDGE-II-MIX study. METHOD: A total of 2811 individuals were enrolled in this multicenter cross-sectional study. MDE patients with (MDE-A, n = 399) and without aggressiveness (MDE-N, n = 2412) were compared through chi-square test or Student's t-test. A stepwise backward logistic regression model was performed. RESULTS: MDE-A group was more frequently associated with BD (P < 0.001), while aggressiveness was negatively correlated with unipolar depression (P < 0.001). At the logistic regression, aggressiveness was associated with the age at first depressive episode (P < 0.001); the severity of mania (P = 0.03); the diagnosis of BD (P = 0.001); comorbid borderline personality disorder (BPD) (P < 0.001) but not substance abuse (P = 0.63); no current psychiatric treatment (P < 0.001); psychotic symptoms (P = 0.007); the marked social/occupational impairment (P = 0.002). The variable most significantly associated with aggressiveness was the presence of DSM-5 mixed features (P < 0.001, OR = 3.815). After the exclusion of BPD, the variable of lifetime suicide attempts became significant (P = 0.013, OR = 1.405). CONCLUSION: Aggressiveness seems to be significantly associated with bipolar spectrum disorders, independently from BPD and substance abuse. Aggressiveness should be considered as a diagnostic criterion for the mixed features specifier and a target of tailored treatment strategy.


Assuntos
Agressão/fisiologia , Transtorno Bipolar/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Adulto , Transtorno Bipolar/epidemiologia , Transtorno da Personalidade Borderline/epidemiologia , Transtorno da Personalidade Borderline/fisiopatologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Artigo em Russo | MEDLINE | ID: mdl-28139623

RESUMO

AIM: It is known affective disorders are changing the perception of time. The study of time perception in patients with affective disorders enables researchers to make early diagnostic criteria for these conditions, as well as to shed light on possible mechanisms for the development of affective disorders. MATERIAL AND METHODS: 20 patients with bipolar affective disorder type II in accordance with the DSM-5 criteria (10 patients with a predominance of anxiety and 10 patients with a predominance of psychomotor retardation) and 10 healthy subjects were recruited to the study. Test for measuring minute was conducted from 7 hours to 21 hours with an interval of 2 hours. Patients were distributed into two experimental groups in accordance with the severity ratio of psychomotor retardation and anxiety. All patients were on monotherapy with agomelatine in a single dose 25-50 mg/day. RESULTS AND CONCLUSION: Duration of individual minute, was significantly shorter in the experimental groups compared with the control group and did not differ within experimental groups. In the group of healthy volunteers length of individual minutes was close to «AIM: minute, i.e. 60 seconds, in groups of patients with prevalence of anxiety and a predominance of psychomotor retardation length of individual minutes was set to about 40 seconds and did not differ significantly in patients groups. In patients with retarded depression distribution of a minute duration peaks was shifted for 2 hours late (13-17 h) comparing to controls, in anxious depresssion the distribution was bimodal with peaks in 10 and 18 hours. There were no singnificant differences between groups. Shorter duration of individual minute in patients with recurrent depressive episodes, may be an early sign of a new depressive episode.


Assuntos
Ansiedade/complicações , Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Depressão/complicações , Percepção do Tempo , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Adulto Jovem
10.
Acta Psychiatr Scand ; 133(2): 133-143, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26073759

RESUMO

OBJECTIVE: The study focused on the relationship between mixed depression and borderline personality disorder (BPD). METHOD: The sample comprised 2811 patients with a major depressive episode (MDE). Clinical characteristics were compared in patients with (BPD+) and without (BPD-) comorbid BPD and in BPD+ with (MXS+) and without (MXS-) mixed features according to DSM-5 criteria. RESULTS: A total of 187 patients (6.7%) met the criteria for BPD. A DSM-IV-TR diagnosis of bipolar disorder (BD) was significantly more frequent in patients with BPD+ than in patients with BPD. Patients with BPD+ were significantly younger and reported lower age at onset than BPD-. Patients with BPD+ also showed more hypomania/mania in first-degree relatives in comparison with patients with BPD-, as well as more psychiatric comorbidity, mixed features, atypical features, suicide attempts, prior mood episodes and antidepressant-induced hypo/manic switches. Mixed features according to DSM-5 criteria were observed in 52 (27.8%) BPD+. In comparison with MXS-, MXS+ were significantly younger at age of onset and at prior mood episode and had experienced more mood episodes and hypo/manic switches with antidepressant treatments. CONCLUSION: Major depressive episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.

11.
Artigo em Russo | MEDLINE | ID: mdl-26356613

RESUMO

OBJECTIVE: to examine the EEG spectral characteristics during TMS in resistant depression therapy. MATERIAL AND METHODS: The sample consisted of 32 depressive patients diagnosed with recurrent depressive disorder or bipolar affective disorder. TMS, as well as EEG, were conducted during the previous inefficient thymoanaleptic therapy with reduced doses. TMS was performed in the left prefrontal cortex. Treatment course consisted of 15 procedures with 100% threshold intensity. During a single procedure, the patient received 20 cycles of stimulation pulses with the frequency of 15 Hz, duration of 20 seconds and interval of 60 seconds between single cycles. EEG was recorded with the use of the «NEURO-KM¼ apparatus (Russia) with band pass from 0.5 to 45 Hz and time constant of 0.3 sec before and after the course of TMS. Spectroscopic analysis of EEG was conducted using the Fast Furies Transformation analysis with average of no less than 30 periods for 2 seconds with subsequent mapping with the use of the «BRAINSYS¼ system (Russia). RESULTS AND CONCLUSION: After conducting TMS, EEG changes were generalized and included the reconstruction of all frequencies of the electrical brain activity. However, the major changes were seen in alpha-rhythm spectrums: its index increased in all cortical areas, mostly in the occipital cortex, thereby forming the alpha-rhythm focus in these areas.


Assuntos
Ritmo alfa , Transtorno Bipolar/terapia , Transtorno Depressivo/terapia , Estimulação Magnética Transcraniana , Transtorno Bipolar/fisiopatologia , Mapeamento Encefálico , Transtorno Depressivo/fisiopatologia , Humanos , Córtex Pré-Frontal/fisiopatologia
12.
Zh Nevrol Psikhiatr Im S S Korsakova ; 115(1 Pt 2): 23-30, 2015.
Artigo em Russo | MEDLINE | ID: mdl-25909803

RESUMO

OBJECTIVE: A comparative evaluation of the efficacy and safety of different types of pharmacotherapy: antidepressant monotherapy (agomelatine or sertraline), mood stabilizer monotherapy (valproate) and combination therapy (valproate + sertraline) in bipolar II disorder patients with major depressive episode. MATERIAL AND METHODS: A 6-week open randomized study included 89 inpatients and outpatients. Basic criteria of efficacy were ≥50% reduction of HAMD total score and remission (≤7 points) to the end of the study. RESULTS: At the end of the study (day 42), the highest number of patients with 50% reduction of HAMD total score was noted in the sertraline (65%) and combination therapy (60%) groups, in the valproate group it was 57.1%, and the lowest - in agomelatine group (42.9%), but the differences were not statistically significant. Remission was observed in 45% patients in combination therapy group compared with 33.3% in valproate group, 32.1% in agomelatine group and only 20% in group of sertraline, but the differences between the groups also were not significant. CONCLUSION: Antidepressants (agomelatine and sertraline) have demonstrated fast but insufficient influence on the reduction of depression in the patients. Treatment with sertraline rarely led to remission and was frequently associated with high rate of switch into hypomania. Valproate therapy was moderately effective and well-tolerated without risk of switching. Combination of valproic acid with sertraline had the highest efficacy and was fairly well tolerated.

13.
J Affect Disord ; 155: 90-5, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24230917

RESUMO

BACKGROUND: There are no validated screening tools for Bipolar Disorder (BD) in Russia. OBJECTIVE: To validate the Russian version of the HCL-32 for the detection of Bipolar II disorder (BD II) in patients with Recurrent Depressive Disorder (RDD). METHODS: 409 patients with a current diagnosis of RDD were recruited. The diagnosis was confirmed by the validated Russian version of the Mini International Neuropsychiatric Interview (MINI). Another investigator interviewed the patients using the НСL-32 questions. RESULTS: The total HCL-32 score in patients with BD II was significantly higher than in patients with RDD: 18.2 (4.22) versus 10.85 (5.81) (p<0.001, d=1447). At the cut-off 14 points the sensitivity was 83.7%, specificity 71.9% (p<0.001). The Cronbach's alpha was 0.887 that means good internal consistency. The best discrimination was achieved with 8 items: decreased need for sleep, less shyness or inhibition, talkativeness, more jokes and puns, jumping thoughts distractibility, exhausting or irritating others and high and more optimistic mood. We proposed the reduced variant of the scale, that includes only these 8 variables, with sensitivity 90.5%, specificity 69.8% (AUC=0.88). CONCLUSIONS: The Russian version of the HCL-32 displayed a good ratio of sensitivity to specificity and can be recommended as a validated screening instrument. An 8-item version of HCL needs further research. LIMITATIONS: Limitations include the specific nature of the sample, the HCL-32 assessment carried out by a psychiatrist, no comparison with other BD screening scales. The results of the 8-item version may be sample and culture dependent.


Assuntos
Transtorno Bipolar/diagnóstico , Depressão/complicações , Inquéritos e Questionários , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reprodutibilidade dos Testes , Federação Russa
14.
Zh Nevrol Psikhiatr Im S S Korsakova ; 112(11 Pt 2): 29-40, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23257754

RESUMO

A review of the recent data on the biological mechanisms of depression, including the мonoamine hypothesis, the diathesis-stress model and the chronobiological model, is presented. These and other biological hypotheses are viewed in the aspect of the current genetic, neurochemical and neuroimaging studies as well as in relation to different treatment approaches. Depression seems not to be a homogenous disease and may be caused by different factors. Genetic factors and stressful life events play an important role in the young age. Chronic stress, chronobiological disturbances and comorbid somatic disease are relevant to middle-aged and elderly people. Moreover, recurrent and chronic depression are accompanied by cognitive impairment, social dysfunction and neurodegeneration. All these factors should be taken into consideration in the development of personalized complex treatment programs.


Assuntos
Transtorno Depressivo , Monoaminas Biogênicas/metabolismo , Ritmo Circadiano , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/fisiopatologia , Transtorno Depressivo/genética , Transtorno Depressivo/metabolismo , Transtorno Depressivo/fisiopatologia , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipotálamo-Hipofisário/fisiopatologia , Fatores de Crescimento Neural/metabolismo , Sistema Hipófise-Suprarrenal/metabolismo , Sistema Hipófise-Suprarrenal/fisiopatologia , Recidiva , Estresse Psicológico/genética , Estresse Psicológico/metabolismo , Estresse Psicológico/fisiopatologia
15.
Zh Nevrol Psikhiatr Im S S Korsakova ; 112(11 Pt 2): 67-76, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23378998

RESUMO

The analysis of modern Russian and world literature on the diagnosis and treatment of a depressive phase of bipolar affective disorder (BAD) is presented. Studies on the efficacy of different groups of drugs (antidepressants, mood stabilizers, antipsychotics) used in the treatment of bipolar disorders are reviewed. Expert views on the treatment of bipolar disorders are discussed.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Depressão/tratamento farmacológico , Psicotrópicos/uso terapêutico , Transtorno Bipolar/diagnóstico , Depressão/diagnóstico , Humanos
17.
Artigo em Russo | MEDLINE | ID: mdl-20639852

RESUMO

Glutamate neurotransmission has been considered as one of pathogenetic factors of schizophrenia though all antipsychotics widely used in modern psychiatric practice are dopamine antagonists. LY2140023 is a selective agonist for metabotropic glutamate 2/3 (mGlu2/3) receptors with antipsychotic effect. In the present study, we have assessed clinical efficacy of LY2140023 in patients with schizophrenia compared to the control group receiving olanzapine in a randomized double-blind placebo-controlled trial. The statistically significant reduction of positive and negative symptoms measured with the PANSS (p<0.001) was observed for both antipsychotics at week 4 of treatment compared to placebo. The treatment with LY2140023 was safe and well-tolerated; treated patients did not differ from the placebo group by hyperprolactinemia and extrapyramidal symptoms, and weight gain. The results suggest that the agonist for 2/3 (mGlu2/3) receptors has antipsychotic properties and provides a new, alternative to dopamine agonists, method for pharmacotherapy of schizophrenia.


Assuntos
Aminoácidos/uso terapêutico , Antipsicóticos/uso terapêutico , Receptores de Glutamato Metabotrópico/agonistas , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Idoso , Aminoácidos/efeitos adversos , Antipsicóticos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
19.
Artigo em Russo | MEDLINE | ID: mdl-20032954

RESUMO

One hundred and twenty-five patients (49 men and 76 women, mean age 38,0+/-12,5 years) were randomized in two groups. One group (64 patients) was treated with valproate sodium and another group (61 patients) received lithium carbonate. Monotherapy was administered with the mean dose of valproate 20 mg/kg/day (serum valproate concentration between 70 and 125 ?g/ml) and the mean dose of lithium 800 mg/day (between 600 and 900 mg/day; serum lithium concentration 0,8-1,2 mmol/L) during 12 weeks. Clinical effectiveness was assessed using YMRS, CGI-BP and MADRS at 0, 5th, 10th, 21st , 84th days of treatment. The number of responders (50% reduction in YMRS scores) was 51,7% (30 patients) in lithium group and 56,7% (34 patients) in valproate group by the 21st day (p=0,59).The mean reduction in YMRS scores was 11,6 in patients treated with lithium and 12,3 in patients treated with valproate. By the 84th day (LOCF), the number of responders reached 85% (51 patients) in lithium group and 90,3% (56 patients) in valproate group (p=0,37). The mean reduction in YMRS scores was 19,4 in patients treated with lithium and 19,6 in patients treated with valproate. The average reduction in MADRS scores was -1,4 (p=0,08) and -2,2 (p=0,001) in lithium group; -1,6 (p=0,002) and -1,4 (p=0,019) in valproate group on the 21st and 84th days. Adverse effects were observed in 8 (13,1%) patients who received lithium and 3 patients (4,7%) who received valproate (p=0,12). The most common of them were tremor, nausea, dry mouth. There were no clinically significant abnormalities in laboratory values, vital functions and EEG. In conclusion, the results demonstrated equal therapeutic efficacy, tolerability and safety of valproate and lithium in the treatment of manic episodes in patients with bipolar disorder.


Assuntos
Antimaníacos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Carbonato de Lítio/uso terapêutico , Ácido Valproico/uso terapêutico , Adolescente , Adulto , Idoso , Antimaníacos/administração & dosagem , Antimaníacos/farmacocinética , Transtorno Bipolar/sangue , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Carbonato de Lítio/administração & dosagem , Carbonato de Lítio/farmacocinética , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Ácido Valproico/administração & dosagem , Ácido Valproico/farmacocinética , Adulto Jovem
20.
Artigo em Russo | MEDLINE | ID: mdl-20037568

RESUMO

An aim of the study was to adjust the technique of using oxcarbazepine (OCB) and to study its preventive action and tolerability compared to carbamazepine (CBM) in patients with bipolar and schizoaffective disorders. The study included 48 patients (7 male and 41 female), aged from 18 to 70 years, with phasic psychoses (bipolar disorder, type I - 29 patients and schizoaffective disorder - 19 patients). Patients were randomized into 2 treatment groups: 1 - 28 patients who received CBM in doses 300-1600 mg/day (mean 700+/-120 mg/day) during 25,43+/-2,34 months; 2 - 20 patients who received OCB in doses 600-1800 mg/day (mean 900+/-145 mg/day) during 12+/-0,65 months. Duration of affective symptoms during the preventive therapy with CBM was reduced by 50,1% and that for OCB - by 49,1%; a number of episodes decreased by 34,6 and 35,1%, respectively. A significant effect, i.e. complete stopping of phases, was found in 35,7% of patients of the CBM group and in 40% of patients of the OCB group. The drugs had approximately equal preventive efficacy in regard to depressive and mania phases and episodes of schizoaffective disorders as well. Moreover, both drugs were clearly able to stop the rapid cyclic course of bipolar affective disorder. Side-effects were seen in 67,86% of patients treated with CBM and 55% of patients treated with OCB. Preventive features of OCB were comparable to those of CBM for intensity and spectrum of action. The adjustment of doses for OCB therapy does not need any significant correction, the drug causes less side-effects and subjectively is better tolerated by patients.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Carbamazepina/análogos & derivados , Carbamazepina/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Adolescente , Adulto , Idoso , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Antimaníacos/administração & dosagem , Antimaníacos/uso terapêutico , Transtorno Bipolar/fisiopatologia , Carbamazepina/administração & dosagem , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Oxcarbazepina , Transtornos Psicóticos/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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