[Use of plasmapheresis in the complex treatment of patients with endogenous psychoses]. / Primenenie plazmafereza v kompleksnom lechenii bol'nykh éndogennymi psikhozami.

The results of the use of plasmapheresis in multimodality treatment of patients with endogenous psychoses are provided for the first time. The use of plasmapheresis was shown to be highly effective in overcoming resistance to psychotropic agents as well as in the treatment of lingering and chronic extrapyramidal neuroleptic disorders. The beneficial effect on the mental and neurologic status of the patients is coupled with pronounced immunocorrective action of the procedure.

[Forced insulin coma therapy and its efficacy]. / Forsirovannaia insulinokomatoznaia terapiia i ee éffektivnost'.

The title method was applied to the treatment of schizophrenic patients suffering from schizoaffective, paranoid and hallucinatory paranoid attacks. Definite correlations were established between the development of insulin coma and the type of the reverse development of psychosis. Five variants of schizophrenia reduction due to the treatment method under consideration were distinguished and described: variant 1--harmonic critical, variant 2--harmonic lytic, variant 3--disharmonious deliric, variant 4--disharmonious affective, and variant 5--incomplete reduction. The established correlations between variants of the development of insulin coma and the type of psychosis reduction enable one to predict whether the use of forced insulin coma therapy will be desirable and effective.

[Effect of prior psychopharmacotherapy on the development, clinical course and therapeutic effect of insulin coma in patients with schizophrenia]. / Osobennosti vliianiia predshestvuiushchei psikhofarmakoterapii na formirovanie, klinicheskuiu kartinu i terapevticheskii éffekt insulinovykh kom u bol'nykh shizofreniei.

In 123 patients the peculiarities of formation and effectiveness of insulin coma (IC) were studied under drug therapy as compared with 49 drug-free patients. Pharmacotherapy preceding the ICs produced uneven effect on its course. Artefact course of IC was most frequently observed after mageptil, chlorpromazine melipramine treatment, and to a lesser extent--after haloperidol, triphtazin, amitriptyline. It was virtually absent after benzodiazepines. The autonomic manifestations in IC and the harmony if its development and clinical picture, markedly changing under drug treatment, were exposed as predictors of the efficiency of IC therapy.

[Adaptation to neuroleptic preparations and several ways of combatting it (experimental study)]. / Adaptatsiia k neirolepticheskim preparatam i nekotorye puti ee ustraneniia (éksperimental'noe issledovanie).

To study the possible mechanisms of the formation of secondary therapeutic resistance, the author carried out a chronic experiment on animals which were administered different doses of a neuroleptic (haloperidol) for 20 days. The neuroleptic effect of the drug was shown to significantly decrease following prolonged administration. It was found that upon the first administration of haloperidol mice developed marked catalepsy 2 hours after administration. In conditions of a prolonged administration of the drug its cataleptogenic action was observed to diminish by the 20th day. Diminution of catalepsy was explained by a decrease of the blocking effect of the neuroleptic on the dopamine system. Change in the function of dopamine receptors (zigzag administration of haloperidol or administration of the drug simultaneously with apomorphine) was found to restore the cataleptogenic properties of the neuroleptic. The data obtained were used in the treatment of 47 patients with paranoid schizophrenia who developed resistance to pharmacotherapy.

[Various methods of overcoming secondary resistance to treatment developing in relation to adaptation to psychotropic drugs during long-term treatment (clinico-experimental study)]. / Nekotorye metody preodoleniia vtorichnoi terapevticheskoi rezistentnosti, formiruiushcheisia v sviazi s adaptatsiei k psikhotropnym sredstvam pri dlitel'nom lechenii (kliniko-éksperimental'noe issledovanie).

Clinical and experimental studies into the phenomenon of adaptation to neuroleptic agents and into the methods of its overcoming were carried out. An experimental study of the long-term administrations of haloperidol revealed the formation of adaptation to the drug which can be overcome by a zigzag-like sharp elevation of the dosage followed by rapid reduction to the baseline level. The trial of this method under clinical conditions showed that it was expedient to use on a large scale the experimental findings on the specific features of the formation and prevention of the secondary therapeutic resistance.

[Forced method of insulin-coma therapy (methodology, effects)]. / Forsirovannyi sposob insulinokomatoznoi terapii (metodika, osobennosti deistviia).

A study of a new regimen of insulin comatose therapy by intravenous instillation has shown the feasibility of determining the minimal comatose dose of insulin and achieving the comatose state in the first days of insulin therapy. This method makes it possible to utilize the advantages of insulin comatose treatment (a more marked arresting antipsychotic action and the remission persistence). At the same time insulin comatose therapy by intravenous instillation permits the physicians to overcome one of the major drawbacks of this treatment, namely the time lag of the therapeutic response associated with the period of time needed to select the minimal comatose dose which was characteristic of the old method.

[Typology of status upon discharge from a psychiatric hospital and evaluation of the effectiveness of treating patients with endogenous psychoses]. / O tipologii sostoianii pri vypiske iz psikhiatricheskoi bol'nitsy i ob otsenke éffektivnosti terapii bol'nykh éndogennymi psikhozami.

A new form of evaluating the state (formula) in patients with endogenous psychoses when being discharged from the mental hospital is proposed. This formula contains a differentiated estimation of the clinical and socio-working state, as well as a list of risk factors for relapses, treatment complications, social deadaptation and an assessment of the treatment efficacy. This form is directed towards a perfection of the continuity between inpatient and outpatient mental services in the treatment of patients.

[Outpatient arrest of recidives and exacerbations in schizophrenia]. / O vnebol'nichnom kupirovanii retsidivov i obostrenii shizofrenii.

The report contains successful results of ambulatory treatment of 54 patients with relapses of attack-like developing forms and exacerbations of continuous forms of schizophrenia. The basic principles in the treatment were intensity and dynamic influence of psychopharmacotherapeutical agents. As a rule under such conditions there were a rapid reduction in the acuity. The authors distinguish clinical, family-environmental and organizational-therapeutic indications, which may lie at the basis of the place of choice for treatment--hospital or dispensary (out patient clinic).