[Risk factors for the development of psychotic disorders associated with synthetic cathinones usage]. / Faktory riska razvitiya psikhoticheskikh rasstroistv, svyazannykh s upotrebleniem sinteticheskikh katinonov.

OBJECTIVE: To identify risk factors and predictors of the development of psychotic disorders in patients who used synthetic cathinones (SKat). MATERIAL AND METHODS: The study included 176 patients who used SKat, which was toxicologically confirmed. One hundred and eleven (63.1%) were male and 65 (36.9%) were female. The median age was 27 years (22-32 (Q1-Q3)). Patients were divided into main and control groups depending on the presence of a psychotic disorder. The main group (those who developed psychosis) consisted of 98 patients, the control groupincluded 78 participants. Clinical-psychopathological, parametric and statistical methods were performed to study predictors and risk factors for the development of psychotic disorders associated with the use of SKat. RESULTS: The study established factors influencing the incidence of psychosis. Older patients were more likely to develop psychosis (p=0.002). Patients who used SKat for more than 21 consecutive days developed psychoses more often (p=0.048). The use of α-pvp (α-pyrrolidinovalerophenone, alpha-pvp) more often led to the development of psychosis (p<0.001). Patients undergoing rehabilitation were less likely to experience the development of psychosis (p=0.009). The resulting regression model is statistically significant (p<0.001). Based on the value of the Nigelkirk coefficient of determination, the model explains 30.9% of the observed group variance. It has been established that the combination of the following factors increases the chances of developing psychosis: female gender, age, duration of daily use, the presence of signs of mental infantilism, fear of the dark in childhood. In turn, the experience of undergoing rehabilitation and any pathology of the mother's pregnancy reduces the risk of psychosis. CONCLUSION: The results are consistent with other studies of substance-induced psychoses. The observed patterns demonstrate that this is a special group of disorders that requires the attention of specialists. The results allow us to outline the field for further study, and may also be useful in the development of therapeutic and preventive recommendations.

[Dual diagnosis: depression and alcohol use disorder]. / Dvoinoi diagnoz: «depressiya¼ i «rasstroistvo upotrebleniya alkogolya¼.

A combination of depression and alcohol use disorder (AUD) is a typical and most common example of a dual diagnosis at the intersection of general psychiatry and addiction psychiatry. A comorbidity of depression and AUD is more common than it can be brought about by mere coincidence, which might be explained to some extent by the synergetic effect of both diseases, with each of them complicating the course and worsening the prognosis of the other. Treatment protocols for patients with depression and comorbid AUD include antidepressants, specific medications for alcohol dependence, and psychotherapy. The first-line antidepressants in the treatment of patients with a comorbid combination of depression and alcohol use disorder, as in other clinical situations implying use of antidepressants, are selective serotonin reuptake inhibitors (SSRIs). Fluvoxamine has certain advantages over the other SSRIs in the treatment of patients with a depression and comorbid AUD.

[Clinical presentations and therapy of polysubstance dependence in patients with schizophrenia]. / Osobennosti kliniki i terapii sindroma zavisimosti ot neskol'kikh psikhoaktivnykh veshchestv u bol'nykh shizofreniei.

BACKGROUND: The article presents the results of a clinical therapeutic and follow-up study of patients with a 'dual diagnosis' (polysubstance dependence comorbid with schizophrenia: paranoid schizophrenia or schizotypal disorder). OBJECTIVE: To study clinical/dynamic changes of polysubstance dependence in patients with schizophrenia (paranoid schizophrenia, schizotypal disorder) and to evaluate the duration and quality of therapeutic remissions. MATERIAL AND METHODS: Two hundred and sixty-six male patients, including 176 patients with dependence syndrome and 90 patients with both dependence syndrome and schizophrenia, were studied. RESULTS: Patients with the 'dual diagnosis' are characterized by early social maladjustment, earlier social deformation, lack of social skills and preference for a lonely lifestyle. The clinical and dynamic characteristics of dependence syndrome in patients with 'dual diagnosis' include older age of the first use of a psychoactive substance (PS), preference of alcohol as the first PS, experiment as the most frequent motivation for using PS (due to thought disorder), and the treatment of psychopathological disorders (PS like medicine) with a chaotic pattern being the most common in the use, a tendency to hospitalism. CONCLUSION: The success of the treatment of patients with 'dual diagnosis' is possible by combining the therapy of endogenous disease and polysubstance dependence.

Atypical antipsychotics in the treatment of patients with a dual diagnosis of schizophrenia spectrum disorders and substance use disorders: the results of a randomized comparative study.

The article presents the results of a randomized comparative study of Aripiprazole and Quetiapine in the treatment of patients with a dual diagnosis: schizophrenia and substance use disorders. During the study, 90 of the 266 male patients were screened. Among them, 54 individuals (60%) had a previously established diagnosis of mental disorder and 36 patients (40%) had no established psychiatric diagnosis. They were randomly randomized into three groups of 30 patients, each receiving an antipsychotic: Aripiprazole at a dose of up to 20 mg daily, Quetiapine at a dose of up to 600 mg daily, or Haloperidol at a dose of up to 30 mg daily. The efficacy of Aripiprazole and Quetiapine was evaluated using the following scales: PANSS, BPRS, VAS, and Substance Craving Scale (SCS). Drug safety was assessed by the development of adverse events, serious adverse events, or adverse reactions. Study results demonstrated the efficacy of atypical antipsychotics in the three groups. Analysis of independent variables showed significant differences between Aripiprazole and Haloperidol in PANSS and BPRS scores by Visit 4, in VAS scores by Visit 3, and in SCS scores by Visit 2. Intergroup analysis of independent variables showed significant differences between Quetiapine and Haloperidol in PANSS, VAS, and SCS scores by Visit 4. Intergroup analysis of independent variables showed significant differences between Aripiprazole and Quetiapine in the VAS and SCS scores. The correlation analysis allowed drawing conclusions about the close connection of the symptoms of schizophrenia and substance use disorders in patients with a dual diagnosis.

[Fluvoxamine in the treatment of depressive disorders in alcohol dependence: results of randomized open-label comparative study]. / Fluvoksamin v terapii depressivnykh rasstroistv pri alkogol'noi zavisimosti: rezul'taty randomizirovannogo otkrytogo sravnitel'nogo issledovaniya.

OBJECTIVE: Assess the efficacy and safety of fluvoxamine, sertraline, citalopram, paroxetine, fluoxetine. MATERIAL AND METHODS: The study included 175 patients with alcohol dependence and depressive disorders. 161 had a diagnosis Alcohol Dependence Syndrome (ADS); 14 patients had a «dual diagnosis¼. All patients were randomized into 5 groups according to the drugs received. To assess the therapeutic efficacy of drugs, the following scales were used: visual analogue scale (VAS), Montgomery-Asberg Depression Rating Scale (MADRS), Hospital Anxiety and Depression Scale (HADS). The safety of drugs was assessed by the incidence of adverse events (AEs) or serious adverse events (SAEs). RESULTS: The drugs relieve depressive disorders: fluvoxamine by the 7th day of treatment, sertraline, paroxetine, citalopram by the 14th day, fluoxetine by the 30th day of therapy. A significant decrease in the level of anxiety when taking fluvoxamine and citalopram occurs by the 7th day, when taking sertraline and paroxetine - by the 14th day, and when taking fluoxetine - by the 30th day. The presence of an anticraving effect in SSRIs is confirmed by the obtained strong and average correlation coefficients between affective disorders and craving for alcohol. The correlation analysis allowed drawing the conclusions about the close connection of presenting features of the affective disorders (depression and anxiety) and craving. The anticraving effect is more expressive in fluvoxamine, sertraline, citalopram and paroxetine. The most common adverse reactions (increased insomnia and anxiety) are observed in: fluoxetine, citalopram, sertraline, paroxetine. Fluvoxamine has the most favorable safety profile. CONCLUSION: SSRIs can be effectively used for the treatment of depressive disorders in alcohol dependence.

[Clinical variants of psychoses in patients using synthetic cannabinoids (Spice)]. / Varianty psikhoticheskikh rasstroistv u patsientov, upotreblyayushchikh sinteticheskie kannabinoidy (spais).

OBJECTIVE: To describe the structure of psychoses developed due to synthetic cannabinoids (Spice). MATERIAL AND METHODS: Forty-six men, aged 18-35 years, with psychosis during abstinence were studied and followed up for 2 years. RESULTS AND CONCLUSION: Four clinical variants with predominant delirious symptoms (27%) or hallucinatory symptoms (19%) or affective-delusions (21%) or mental automatisms (33%) were identified. The follow-up revealed the manifestations of schizophrenic process in 17% of the patients. Clinical and differential diagnostic characteristics of these variants in synthetic cannabinoids users are described.

[Aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction]. / Aripiprazol i kvetiapin v terapii bol'nykh s komorbidnost'iu shizofrenii i boleznei zavisimosti.

AIM: The randomized comparative study of aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction. MATERIAL AND METHODS: Intra-group analysis of dependent variables on the scales PANSS, BPRS, VAS, SACS showed significant differences in the dinamics of the therapy in all groups. A comparative randomized study included 90 men admitted to an inpatient addiction unit. Of these, 54 (60%) had a previously established psychiatric diagnosis and 36 patients (40%) did not have an established psychiatric diagnosis. They were randomized into 3 groups of 30 patients each: group 1 received aripiprazole at a dose of up to 20 mg/day, group 2 received quetiapine at a dose of up to 600 mg/day and group 3 (controls) was treated with haloperidol at a dose of up to 30 mg/day. Treatment duration was 21 days. The efficacy of aripiprazole and quetiapine was evaluated with PANSS, BPRS, VAS and SACS on 10th, 14th and 21st day (visits 2-4). Drug safety was evaluated by recording adverse events or side-effects. RESULTS AND CONCLUSION: An analysis of independent variables showed significant differences between aripiprazole and haloperidol in PANSS and BPRS scores at visit 4, in VAS scores at visit 3, and in SACS scores at visit 2. An intergroup analysis of independent variables showed significant differences between quetiapine and haloperidol in PANSS, VAS and SACS scores at visit 4 and between aripiprazole and quetiapine in VAS and SACS scores. According to the results of the correlation analisys it has been concluded that presenting features of schizophrenia are closely correlated with drug addiction (craving).

Clinical characteristics of synthetic cannabinoid-induced psychotic disorders: a single-center analysis of hospitalized patients.

This study was designed to evaluate synthetic cannabinoid (SC)-induced psychotic disorders in terms of their structure and clinical characteristics among hospitalized patients in Russia. It was a longitudinal, observational cohort study which included a total of 46 male patients who underwent the inpatient treatment in the intensive care unit or emergency department due to the SC-induced psychoses. Data on sociodemographic and disease-related characteristics, psychometric assessment scales obtained in face-to-face interviews, were recorded in all patients. The duration of catamnestic follow-up period was 2 years, with the major focus on manifestation of the schizophrenic process. Mean (SD) age of the patients with psychotic disorders induced by the SC use was 23.2 (3.5) years. Among 46 patients, 29 (63%) were SC-dependent and 17 (37%) were diagnosed with SC abuse. Average age at onset was 16.4 for psychoactive substances and 19.7 years for SC use. Marijuana was the most common first used substance. Based on our observations, we identified four clinical variants of the SC-induced psychoses. Our findings revealed that psychotic disorders are typical for the SC intoxication and most commonly influence young adults. Based on our observations, we identified four clinical variants of the SC-induced psychoses and revealed the signs which may indicate them. This study emphasizes the role of appropriate psychiatric management of SC-induced psychoses, since often only catamnestic long-term follow-up enables clinicians to determine the correct diagnosis and reveal the manifestation of the schizophrenic process.

[The efficacy of remaxol addition in the treatment of alcohol withdrawal syndrome].

OBJECTIVE: To study the efficacy of remaxol addition in the treatment scheme of alcohol withdrawal syndrome. MATERIAL AND METHODS: Eighty patients with alcohol dependence and physical symptoms of alcohol withdrawal syndrome were enrolled. All patients received basic therapy in accordance to the applicable standards of treatment. The patients were randomized to remaxol introduced intravenously 2 times a day (morning and afternoon) in dose of 400 ml for 7 days (n=40) and saline with 25%-magnesium sulfate (10 ml) and 4% potassium chloride (10 ml) (n=40). RESULTS: The effectiveness of the inclusion of remaxol was expressed in a more rapid relief of asthenic syndrome, reduction of phenomena such as tension, dysphoria, headache and impaired coordination of samples. Patients treated with remaxol demonstrated a trend towards a more rapid reduction of the affective (p=0.08) and behavioral components (p=0.09) of the syndrome of pathological craving for alcohol. Hepatoprotective and detoxification properties of the drug were confirmed by the significant decline in ALT and AST activity to the 20th day of treatment. Significant positive changes in lipid metabolism (HDL to the 7th day of treatment) and a normalizing effect on the processes of tissue respiration were shown as well. No adverse effects were noted. CONCLUSION: The data obtained allow to recommend the inclusion of remaxol in the complex treatment regimens of alcohol withdrawal syndrome to improve the treatment efficacy.

[Diagnostic criteria of the severity of the pathologic drive to narcotics]. / Diagnosticheskie kriterii tiazhesti patologicheskogo vlecheniia k narkotiku.

The paper presents variation of the clinical scale for determination of the severity of the pathologic drive to narcotics (drug addiction) elaborated by the authors. The "major" (obligatory) and the "minor" (additional) criteria were established. As the "major" criteria there were the presence of thoughts about narcotic drugs, affective and behavioral disorders, disturbances of sleep. The "minor" criteria included somato-autonomic disturbances, the presence of "narcotic" dreams, attitude to treatment, criticism toward the disease. A quantitative (with the scores) evaluation of the pathologic drive to narcotics was elaborated. The method proposed permits to object quite significantly the diagnosis of the pathologic drive to narcotics, to determine both its severity and dynamics during treatment.

[Clinical peculiarities of post-withdrawal disorders in heroin abuse and approaches to their treatment]. / Klinicheskie osobennosti postabstinentnykh narushenii pri geroinovoi narkomanii i nekotorye podkhody k ikh lecheniiu.

On the basis of the observation of 62 patients with heroin addiction there was described the post-withdrawal syndrome. It was characterised by a lability of psychopathologic symptomatology and by undulate course (with exacerbation and desactualization of the drive to narcotic). Clinically there were determined 3 types of post-withdrawal syndrome's course. The 1-st type was characterised by irresistible drive to narcotic, followed by psychopathic-like behaviour. For the 2-nd type a prevalence of the depressive symptomatology with different intensity of the disorders of the affect was more typical. The 3-d type was presented by unclear polymorphic manifestations and rather deep disorders of a sleep. It was established that clinical picture of the syndrome was determined mostly by a degree of a pathological drive to heroin. Differentiated approaches to a treatment of different types of post-withdrawal disorders were described. A duration of a syndrome was 3-4 weeks.