[Treatment of asthenic disorders in patients with psychoautonomic syndrome: results of a multicenter study on efficacy and safety of ladasten].

The study was carried out in 28 clinical centers of Russia. The data on 728 patients with psychoautonomic syndrome (91.6% of the total sample) were available for statistical analysis. All patients suffered from asthenic disorders. The duration of treatment with ladasten in daily dose from 50 to 100 mg was 28 days. Patient's state was assessed with psychometric scales at baseline, 3, 7, 14 and 28 days of therapy and one month after the end of treatment. The percentage of responders was 76.0% on the CGI-S and 90.8% on the CGI-I. The antiasthenic effect of ladasten was seen on day 3 and remained during one month after the withdrawal of therapy. We determined clinical efficacy of ladasten in regard to anxiety-depressive spectrum disorders, autonomic dystonia, sleep disorders. Ladasten therapy led to the significant increase of quality of life, which was seen not only after the end of therapy, but after the withdrawal of the drug. These results suggest the stability of the therapeutic effect achieved. Adverse effects were observed only in 3% of patients, the therapy was discontinued in 0.8%. No serious adverse effects were found. In conclusion, the efficacy of ladasten was shown in its antiasthenic, anxyolytic, autonomic nervous system stabilizing properties, the normalization of sleep-awake cycle and the increase of quality of life. Ladasten in daily dose from 50 to 100 mg is a highly effective, well-tolerated and safety drug with a wide spectrum of clinical effects. Therefore, this drug could be recommended for treatment of asthenic disorders in neurological practice.

[Anxiety-depressive disorders in patients with type 2 diabetes mellitus complicated with acute coronary syndrome].

Psychological status of 140 patients with type 2 diabetes mellitus (DM) and acute coronary syndrome (ACS) was studied on the 12-th day after the moment of admission to the cardioreanimation department and in 6 months after discharge from hospital. Spielberger questionnaire was used for assessment of level of personal and reactive anxiety, Beck scale -- for estimation of level of depression, and Holmes - Ray scale -- for calculation of total number of stressful events. Average level of anxiety in acute period of ACS corresponded to high level of anxiety disorders (reactive anxiety score 47.64 +/- 10.49, personal anxiety score 48.7 +/- 8.77). Level of depressive disorders was in the limits of 3-49 points (median score 15.1 [5.1; 32.9]). Clinically evident depression corresponded to moderate and severe degree in 48.6% (68 of 140) patients. Mean total number of stressful events was 154 +/- 9.8 (median 129 [68.8; 317.8] points). After 6 months of follow up levels of personal and reactive anxiety remained high and were approximately equal to initial (45.63 +/- 11.3 and 40.79 +/- 11.6 points, respectively). Depressive disorders persisted in 57.4% of patients and level of depression corresponded to moderate and severe depressive disorders in 37.7% of cases. High prevalence of anxiety-depressive disorders was revealed in patients with type 2 DM complicated with development of ACS. Anxiety-depressive disorders persist minimally for 6 months after ACS.

[Treatment of chronic back pain with antidepressant cymbalta: an experimental study].

Thirty-two patients at the acute stage of chronic back pain have been studied. Cymbalta was used as a monotherapy in dosage 60 mg daily during 6 weeks simultaneously with traditional non-pharmacological therapy. Treatment efficacy was assessed using self-rating methods and quantitative scales measuring pain intensity as well as Spilberger trait/state anxiety inventory, Beck depression scale, Plutchik scale measuring psychological defense mechanisms, quality of sleep, quality of life and evaluation of autonomic dysfunction. The treatment with cymbalta resulted in significant reduction of pain in 90% patients, with full stopping of the syndrome in 10% and marked reduction in 55%. The stopping of pain syndrome was correlated with significant improvement of emotional status and quality of life and sleep normalization of the patients.

[Clinical and psychological analysis of eating disorders in obesity]. / Kliniko-psikhologicheskii analiz narushenii pishchevogo povedeniia pri ozhirenii.

UNLABELLED: Clinical neurological study and psychometric testing of 36 women with primary obesity, body weight index being over 30 kg/m2, have been conducted. The sample was divided into 4 groups: 1st--without emotiogenic eating behavior (EEB); 2d--with permanent EEB; 3d--with compulsive eating disorder; 4s--with night eating syndrome. All patients did not differ by body weight, body weight index, hereditary anamnesis data and neuroendocrinic disorder expression. Patients with EEB shared a lot of common features, which distinguish them from the patients without EEB: the eating behavior development in childhood, higher level of obesity-comorbid syndromes, higher anxiety and depression level, higher intention of such psychological defense mechanisms as regression and displacement. In the patients with permanent EEB, all obesity-comorbid syndromes were represented equally, the hypochondriac features being emerged more frequently. In the patients with compulsive eating disorder, psycho vegetative disturbances prevailed. In these patients, a lower general intention index of psychic defense combines with a highest depression and anxiety level and lower treatment seeking. In the patients with night eating syndrome, insomniac disorders predominated. They revealed the highest regression level with extremely motivation immaturity, when food became all but the only sleeping-wakefulness regulator. CONCLUSION: While behavior correction and psychotherapy being conducted, the above peculiarities of the patients from different groups should be taken into account.

[Treatment of primary obesity by long-term dose fasting combined with psychotherapy]. / Lechenie pervichnogo ozhireniia dlitel'nym dozirovannym golodaniem v sochetanii s psikhoterapiei/

A long-term dosed fasting of inpatients has been conducted during 18 days followed by rehabilitation period and one year examination. Forty patients have been divided into two groups: with- or without hyperphagic reaction to stress. In both groups, beside body weight increase and eating disturbance, psychovegetative, algic and affective emotional syndromes were represented. Psychological study revealed significant differences in psychological defense mechanisms and personality features. The differences detected were taken into account during the treatment process. Psychotherapy was conducted in each treatment stage. Patients with hyperphagic reaction to stress responded more effectively, the clinic symptoms being reduced quicker. It might be explained, partially, by their stronger desire to reduce weight that facilitates psychotherapeutic correction. Psychotherapy combined with long-term dosed fasting enables to develop and maintain a right eating behavior style in the patient. As a result, 80% of the patients have been keeping the treatment results achieved for more than a one-year period.

[Migraine: dynamics of psychophysiologic pattern]. / Migren': dinamika psikhofiziologicheskogo patterna.

85 patients with migraine without aura and 20 healthy individuals were examined between the attacks, before the attack, during and after it (1-2 days). The examination included clinical-neurological analysis; psychological Spilberger's and Beck's tests, scale of alexithymia and complex algesic questionnaire; recording of the conditional negative wave; determination of nociceptive flexor reflex; recording of trigeminal evoked potentials; spectral analysis of the heart's rhythms; polysomnographic study. Psychophysiologic pattern characteristic for all the patients was established. Psychological and neurophysiological parameters changed synchronously in the periods before the attack, during and after it. Before the migraineous attack a specific pathologic integration increased and presented maximally (the activity of antinociceptive system weakens anxiety increased, tension of catecholaminergic systems grew, hyperactivity in trigeninal sphere elevated, tolerance to the pain decreased). A clear tendency to the reversibility of these changes was observed after an attack. A dynamics revealed in the psychophysiological pattern could serve as a predictor of a migraineous attack and open some perspectives for prophylaxis of the algesic attack.

[Disorder of eating behavior and comorbid syndromes in obesity and methods of their correction]. / Narushenie pishchevogo povedeniia i komorbidnye sindromy pri ozhirenii i metody ikh korrektsii.

Eating behavior and comorbid syndromes were investigated in 40 women with obesity. A frequent combination of obesity with disorders of eating behavior, with emotional-personality, psychoautonomic and algesic disorders as well as with appearance of affective disorders during dietetic nutrition ("dietetic depression") required their correction. As a result of insufficiency of serotoninergic system of brain in pathogenesis of such disorders, fluoxetine (prozac)-a selective inhibitor of serotonine reuptake--was used for treatment of eating disorders. Heterogeneity in the structure of the obesity is shown. Disorders of eating behavior were combined with pronounced anxiety, depression, algesic and psychoautonomic syndromes. Therapy with prozac during 3 months in dose of 20 mg daily resulted in decrease of weight. Normalization of eating pattern, decrease of anxiety, depression, reaction to the external stimuli, increase of stress-resistance of patients, alterations in eating liking, decrease of severity of disorders comorbid to obesity were observed. A conclusion is made that prozac is indicated for patients in whom pathology of eating behavior plays a significant role in pathogenesis of obesity.

[Prozac treatment of chronic tension headache]. / Lechenie prozakom khronicheskikh golovnykh bolei napriazheniia.

The paper summarizes the experience of therapy of chronic tension type headache (TTH) with prozac (fluoxetine)--a selective serotonine reuptake inhibitor. The data are presented concerning clinical psychologic examination of 20 outpatients with chronic TTH both before and after therapy with prozac in daily dose of 20 mg during 6 weeks. Background study of the patients revealed severe depression (according to Beck's and SCL-90 scales), anxiety (Spilberger scale) and alexitimia (Toronto scale). Before the treatment, a frequency of TTH attacks was at least four times a week, the intensivity was equal to 8.9 scores according to visual analogous scale. Together with a headache there were psychopathologic and psychoautonomic manifestations. After the course of therapy the headaches disappeared completely in 25%, while considerable improvement was observed in 75% of the patients. The levels of depression, anxiety, somatization have decreased significantly too. Side effects as well as withdrawal syndrome weren't found. The role of depression in formation of chronic TTH, as well as the role of alixetimia in formation of somatizated variation of the depression were considered.

[The adaptive capacities of patients with panic disorders (a psychophysiological study)]. / Adaptivnye sposobnosti bol'nykh panicheskimi rasstroistvami (psikhofiziologicheskoe issledovanie).

Contingent-negative deviation (CND) and orientational reaction (OR) were studied in 9 women suffering from typical (according to DSM-III-R) panic disorders (PD) and 12 healthy females. CND recording was made after giving neutral (70 dB, 1000 Hz) and stress (120 dB, 2000 Hz) pairs of sounds. Patients with PD were divided in two groups depending upon CND amplitudes. The first group (4 patients) was distinguished from healthy individuals by high CND amplitude (which significantly decreased after reaction on stress sound), by delay of extinction of cutaneogalvanic reaction (CGR) and by higher electromyogram amplitude. The second group (5 patients with more severe course of PD) was characterized by low amplitudes of CND and electromyogram, by absence of changes in CND after stress sound, by delay of extinction of CGR and nonspecific response. Above-mentioned data were evidence of psychophysiological heterogeneity of typical PD. The results were interpreted from a position of adaptive abilities of patients with PD, using ineffective and immature psychophysiological strategies of overcoming stress.

[Sulpiride in the prophylactic treatment of migraine]. / Sul'pirid v profilakticheskom lechenii migreni.

The aim of the work was investigation of both efficacy of sulpiride, atypical neuroleptic drug with pronounced antidepressive activity, and its influence on central nervous system. The study was performed in the course of prophylactic treatment of migraine using contingent negative variation (CNV) index. It is demonstrated that sulpiride is effective in prophylactic treatment of migraine complicated with psychologic disorders and autonomic dysfunctions. Such effect may be caused by the drug's influence on depression, anxiety, autonomic symptoms, tension-type headaches. This conclusion was confirmed by CNV data, change of which after sulpiride administration have indicated normalization of mental performance and increase of active adaptive abilities.

[A comparative psychophysiological analysis of anxiety disorders of a permanent and paroxysmal nature]. / Sravnitel'nyi psikhofiziologicheskii analiz trevozhnykh rasstroistv permanentnogo i paroksizmal'nogo kharaktera.

Observation of patients with panic disorders (PD) and generalized anxious disturbances (GAD) by means of contingent negative variation (CNV) revealed that they significantly differ from healthy individuals. Anxiety, depression and autonomic dysfunction were more pronounced in such patients. Both high amplitude of early CNV component and alteration of its habituation were quite typical for patients with PA in contrast to GAD patients and healthy individuals. There were no differences in CNV indices between the healthy group and the patients with GAD. PA patients differed from GAD ones by smaller manifestation of depression, shorter duration of the disease, shorter time of reaction. The data obtained have demonstrated qualitative psychophysiologic differences between PA and GAD groups of patients. They were mostly pronounced in both amplitude of early CNV and alteration of its habituation. PA patients were characterized by an increase of excitability in brain cortex and by surplus orientation activity. The authors suppose that specific CNV pattern reflects neurodynamics of "paroxysmal brain".

[Clinico-neurophysiological correlations in migraine]. / Kliniko-neirofiziologicheskie sootnosheniia pri migreni.

The more accurate definition of the role of cerebral mechanism in migraine development by means of contingent negative deviation (CND) method was the aim of this investigation. The significant alterations of some parameters were revealed in patients with migraine between the fits as compared with controls. The same indices were normal during the very fits. The CND indices were similar in patients with chronic Headache of strain and healthy individuals. The clinical neurophysiological analysis didn't reveal any significant dependence of CND changes clinical peculiarities and anxious and depressive disorders. The significant elevation of CND parameters observed between the attacks suggests presence of superfluous activity in cerebral structures (noradrenergic mainly) in patients with migraine without aura. Such alterations in their action lead, apparently, to headache attack development.

[The psychophysiological aspects of treating obesity with Izolipan]. / Psikhofiziologicheskie aspekty lecheniia ozhireniia izolipanom.

20 patients with obesity were examined. Their weight was increased as compared with ideal values by 30-140%. The patients were characterized by anxious or depressive disturbances (Spilberger's and Beck tests) and alterations of alimentary behaviour in form of prevalence of emotional and external alimentary behaviour (EMAB and EAB, respectively). The study of cognitive negative variations (CNV) revealed the decrease of late wave's area, which correlated reversely with levels of anxiety, depression and EMAB expression. The Isolipan administration (15 mg, 2 times/daily during 3 months) together with hypocaloric diet resulted in average weight loss equal to 12.3 kg in the whole group. These changes correlated well with normalization of both alimentary behaviour (in the form of decrease of EMAB and EAB indices) and emotional state, and increase of decreased late CNV with disappearance of pathological psycho-physiological correlations between CNV and emotional state.

[The clinical picture, diagnosis and therapy of headaches in patients with a hypothalamic syndrome]. / Klinika, diagnostika i terapiia golovnykh bolei u bol'nykh s gipotalamicheskim sindromom.

190 patients with hypothalamic insufficiency were investigated. The character, frequency of various forms of headache as well as its correlation with neuroendocrine emotional motivation and vegetative disorders were analysed. It was found that headache occurred more frequently in patients with hypothalamic insufficiency (66%) than in the whole population (5-20%). This confirms the role of diencephalic disfunction in its genesis. Psychovegetative disturbances were expressed most of all in tension-type headache (TTH). Very likely that some psychoendocrine mechanisms (particularly depression and idiopathic edema) play important role in pathogenesis of TTH. Clinical effect of Lerivon confirms the pathogenetic role of depression in these cases.

[The course of disseminated sclerosis in men and women]. / Techenie rasseiannogo skleroza u muzhchin i zhenshchin.

It is known that a prevalence of multiple sclerosis in women is greater than in men (gender ration 2:1). The aim of the study was the analysis of sex differences in the course of disease. On the basis of clinical and paraclinical data, including data concerning mental state of patients emotional disturbances, intellectual functioning the authors determined that the development of multiple sclerosis in men is atypical as compare as women. In men the disease begins earlier and its course is more malignant, without remissions and efficacy of hormonotherapy. The data were interpreted as indicating the importance of the gender factor in the pathogenesis of disease.

[The effect of aspirin on the contingent negative wave in healthy subjects]. / Vliianie aspirina na uslovnuiu negativnuiu volnu u zdorovykh ispytuemykh.

Alterations in parameters of slow brain potentials (contingent negative variation, CNV) were examined in healthy individuals under influence of aspirin according to double blind method. The early and late waves of CNV were analysed. The significant decrease of early wave of CNV was obtained after aspirin administration. Late wave of CNV increased after aspirin and placebo intake. The alterations described were explained in terms of central mechanisms of aspirin action including noradrenergic and dopaminergic systems involvement.