[Mental disorders and cognitive impairment in patients with antiphospholipid syndrome].

Mental disorders (mainly anxiety and depressive disorders) and cognitive impairment are often found in patients with antiphospholipid syndrome (APS), but their prevalence, structure, and mechanisms of occurrence are not well researched. The review provides literature data on the frequency, spectrum and possible causes of mental disorders and cognitive impairment in patients with APS, the pathogenetic mechanisms of these disorders (in particular, the important role of antiphospholipid antibodies, stress factors, chronic inflammation), the relationship between APS, mental disorders and as well as cognitive impairment is examined. Special attention is paid to the influence of mental disorders and cognitive impairment on patients adherence to treatment, their quality of life, as well as the particularities of psychopharmacotherapy of mental disorders in patients with APS. The aim of the review is to actualize the interdisciplinary problem of mental disorders and cognitive impairment in patients with APS and the need to introduce a partnership model of care.

[Chronic pain and depression in patients with rheumatoid arthritis: results of five - year follow - up].

The aim of the study was to analyze the factors affecting chronic pain in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: 128 patients with reliable diagnosis of RA [111 (86.7%) women and 17 (13.3%) men] were examined. The mean age of patients was 47.4±11.3 years, the median duration of the disease was 96 [48; 228] months. When included in the study in most patients, the activity of RA in DAS28 was moderate (n=56; 43.7%) or high (n=48; 37.5%). BPI (Brief Pain Inventory) scale was used to determine the severity of pain and its impact on various aspects of life. The anxiety - depressive spectrum disorders (ADDs) were diagnosed by psychiatrist during a semistructured interview according to ICD-10 criteria in 123 (96.1%) patients. The severity of depression was determined by the Montgomery-Asberg depression rating scale, anxiety - by Hamilton anxiety scale. For the diagnosis of cognitive impairment used clinical and psychological techniques. Psychopharmacotherapy (PPhT) by antidepressants or anxiolytics is offered to all patients with ADDs, 52 of them agreed to treatment, 71 patients refused. The next groups selected depending on the therapy: 1st - with conventional disease - modifying antirheumatic drugs (cDMARDs; n=39), 2nd - with cDMARDs+PPhT (n=43), 3d - with cDMARDs + biologic (b) DMARDs (n=32), 4th - with cDMARD+bDMARDs+PPhT (n=9). The dynamics of ADDs and outcomes of RA in 5 years were evaluated in 83 (67.5%) patients. RESULTS: When included in the study, 94 (75.2%) patients with RA had moderate and severe pain. According to the regression analysis, the maximum intensity pain in BPImax after 5 years of follow - up associated not the only factors connected with RA - high DAS28, the serum level of C-reactive protein, the degree of radiological stage and functional insufficiency, duration of RA and a lesser duration of glucocorticoids intake, but also with continuing depressive episodes in the framework of recurrent depression and the initial presence of cognitive impairment. The severity of pain after 5 years of follow - up was higher in RA patients receiving only сDMARDs, without the use of bDMARDs and in the absence of PPhT associated with ADDs. CONCLUSION: Depressive episode within recurrent major depression is a significant factor in the chronicity of pain in patients with RA. Timely effective PPhT of depression, selected taking into account depression structure and personal characteristics of the patient, leads to a steady decrease in the severity of pain in patients with RA.

Comparative analysis of anxiety-depressive spectrum disorders in patients with rheumatic diseases.

AIM: Research objective - comparative analysis of incidence and structure of anxiety-depressive spectrum disorders (ADD) in patients with various rheumatic diseases (RD). MATERIALS AND METHODS: 613 patients with RD were enrolled in the study: 180 with a reliable diagnosis of systemic lupus erythematosus (SLE), 128 with rheumatoid arthritis (RA), 110 with systemic sclerosis (SSc), 115 with Behcet's disease (BD), 80 with primary Sjögren's syndrome (pSS). Female prevailed in all groups (95% of patients with pSS, 88,2% - SSc, 87,2% - RA, 85,5% of SLE) except BD patients (70% male). The mean age was 42.3±1.54 years and was lower in patients with BD (33.3±0.98 years) and SLE (34.6±0.93 years) compared to patients with SSc (49.9±2.47 years), RA (47.4±0.99 years) and pSS (46.2±2.3 years). The mean RD duration was 130,0±8,65 months and was more at BD - 148,5±10,4 months, pSS - 141,6±8,92 months, RA - 138,4±10,1months, and less at SLE - 134,9±8,8 months and SSc - 87,0±5,04 months. The mean SLE activity index SLEDAI was 9,13±0,63 points (high), RA (DAS28) - 5,26±0,17 points (high), BD (BDCAF) - 3,79±0,2 points (moderate) and SSc by G. Valentini - 1,1±0,20 points (moderate). Glucocorticoids took 100% of patients with pSS, 91,1% - SLE, 90% - SSc, 87% - BD and 67,2% - RA patients; conventional disease modifying anti-rheumatic drugs (cDMARDs) took 90% of patients with SSc, 84% - BD, 79,6% - RA, 68% - pSS, 40,6% - SLE. Biologic DMARDs took 32% of patients with RA, 17,4% - BD, 7,3% - SSc and 7,2% - SLE. Mental disorders were diagnosed by psychiatrist as a result of screening by the hospital anxiety and depression scale (HADS) and in semi-structured interview in accordance with the ICD-10/ DSM-IV. The severity of depression was evaluated by Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety - by Hamilton Anxiety Rating Scale (HAM-A). Projective psychological methods were used for cognitive impairment detection. RESULTS: Screening of depressive disorders (HADS-D≥8) was positive in 180 (29,4%) patients with RD, including 74 (41%) patients with SLE, 38 (35%) - SSc, 29 (23%) - RA, 23 (20%) - BD and 16 (20%) - pSS; anxiety disorders (HADS-A≥8) - in 272 (44,4%) patients, including 66 (52%) patients with RA, 40 (50%) - pSS, 77 (43%) - SLE, 45 (41%) - SSc and 44 (38%) - BD. In accordance with the ICD-10/ DSM-IV depressive disorders have been identified in 389 (63%) patients, including 94 (73%) patients with RA, 71 (64,5%) - SSc, 69 (60%) - BD, 90 (50%) - SLE and 39 (49%) - pSS; anxiety disorders - in 377 (61,5%) patients, including 20 (25%) patients with pSS, 44 (24,5%) - SLE, 29 (23%) - RA, 20 (17%) - BD and 7 (6,4%) - SSc. CONCLUSION: Anxiety-depressive spectrum disorders are typical for most patients with RA, SLE, SSc, pSS and BD. ADDs diagnosis in RD patients with the use of the HADS did not reveal a significant proportion. To obtain objective data on the frequency and structure of ADDs, psychopathological and clinical psychological diagnosis is necessary.

[Clinical and pathogenetic relationships between immuno-inflammatory rheumatic diseases and psychic disorders].

Literature data and original observations have been used to develop the rationale for the necessity of studying psychic disorders (PD) in patients with immuno-inflammatory rheumatic diseases (RD), such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Special attention is given to the high frequency of disturbances of the anxiety and depression profile (DADP) in patients having RA and SLE with reference to the common provoking stress and pathogenic factors, clinical manifestations, and RD. Great importance is attributed to the degree of depression associated with inflammatory activity, pain intensity, fatigue, sleep disorders, severe functional insufficiency and low quality of life in the patients with RA and SLE. Special emphasis is laid on the influence of depression and stress factors on the survival and morality of patients with these pathologies, the necessity of their combined treatment with the participation of rheumatologists, psychiatrists and medical psychologists for the improvement of clinical course and prognosis of RD.

[The magnitude of fatigue and its association with depression, pain, and inflammatory activity in rheumatoid arthritis].

AIM: To analyze the rate of clinically significant fatigue and to search for its predictors in patients with rheumatoid arthritis (RA). SUBJECTS AND METHODS: The investigation included 95 patients with a valid RA diagnosis. The majority of the patients were women (87.4%); mean age was 46.7 +/- 1.2 years; mean disease duration was 135.5 +/- 11.6 months. The authors evaluated RA activity by the Disease Activity Score (DAS28), magnitude of fatigue by the Fatigue Severity Scale (FSS), that of pain by the Brief Pain Inventory, and functional status and quality of life by the Health Assessment Questionnaire and EQ-5D. A psychiatrist diagnosed mental disorders in accordance with ICD-10 and using the psychiatric and psychological scales and procedures. RESULTS: 80% of the patients felt clinically significant fatigue (FSS scores of > or = 4). Multivariate analysis yielded a prognostic model that made it possible to state that clinically significant fatigue was primarily associated with the magnitude of depression by the Hospital Anxiety and Depression Scale, the presence of a depressive episode, the duration of anxiety and depressive spectrum, the magnitude of pain (Ritchie index), DAS28, and the presence of osteoporosis. CONCLUSION: The presence and magnitude of depression along with the magnitude of pain are an important factor that influences the formation of fatigue in RA, which gives rise to evident functional failure and a low quality of life. Combination therapy for RA may be effective when mental disorders, mainly the anxiety and depressive spectrum, are timely diagnosed.

[Psychosocial pathomorphosis of depressions]. / Psikhosotsial'nyi patomorfoz depressii.

OBJECTIVE: The aim is to determine the changes in phenomenology of depressions (mostly of melancholic type with pronounced affect of sadness, chronobiological shift, neurovegetative changes and typical affect-congruent depressive ideas) over the past decades. MATERIAL AND METHODS: We've compared the archival data of one of the authors (V.N.K.) obtained in the study of depression within 1980-1086 years (1st group, 103 patients, 47 with recurrent depression and 56 with bipolar depression) and the data of the study of depression during 2015-2021 years with registration of symptoms with the same psychopathological scale at the same clinic for affective disorders (2nd group, 109 patients, 52 with recurrent depression and 57 with bipolar depression). The groups are age-comparable (21-59 y.o.). The Hamilton Depression Rating Scale (HDRS-17) has been used to assess the severity of depression (score of 21-32 in both groups). Statistics included frequency analysis with use of χ2 criterion. RESULTS: Biologically mediated symptoms (shortened sleep with early awakening, typical diurnal variations with vitalization of depressive affect and loss of energy mostly first half of day, decreased appetite, libido and motivation for any activity) were not statistically different in the study groups. Whereas symptoms associated with emotional reactivity and congruent depressive ideations like worthlessness, guilt, suicidal thoughts, as well as anaesthesia psychica dolorosa - were statistically rare in 2nd group, except anhedonia. The same time the facts which have been obvious amongst patients of 2nd group were the difficulties to verbalize their feelings, shortage of vocabular for reflections about their suffering, especially amongst young patients. CONCLUSION: The results of the study can indicate some changes in the phenomenology of depression over the past decades. Basically, the same underlying disorders can produce different clinical presentation, particularly concerning an awareness and verbalization of moral feelings and other emotions. One of the possible psycholinguistic assumption may be limited vocabulary for feelings because of spreading social networks with very poor and formal language instead of live direct communication.

[Steadfastly increased level of the ciliary neurotrophic factor in the blood serum within the positive therapeutic dynamics of depression as possible prognostic marker of depressive relapse]. / Ustoichivoe povyshenie urovnya tsiliarnogo neirotroficheskogo faktora v syvorotke krovi pri polozhitel'noi terapevticheskoi dinamike depressii kak veroyatnyi prognosticheskii marker retsidiva depressivnogo epizoda.

OBJECTIVE: To study a role of the ciliary neurotrophic factor (CNTF) in the pathogenesis of depression and its prognostic significance in dynamics of the antidepressant therapy. MATERIAL AND METHODS: CNTF level was investigated in the blood serum of patients with melancholic depression (n=32) before the start of therapy and after 30 days, when improvement was achieved by at least 75% of baseline scores on the Hamilton Depression Rating Scale. RESULTS: Steadfastly increased level of CNTF in the blood serum of patients with melancholic depression compared with the control, remaining practically unchanged with an obvious improvement in the condition - 732.2±126.5 and 679.1±63.1 pg/ml of serum, respectively (p>0.05). CONCLUSION: The initially elevated level of CNTP indicates its probable significance in the pathogenesis of depression; persistently high serum CNTP level, despite clinical improvement during therapy, can serve as a predictor of the stability of the biological mechanisms of recurrent depressive disorder with a continuing risk of another relapse of a depressive episode.

[The clinical picture and treatment of depression spectrum disorders in patients with cardiovascular disease].

AIM: To study the impact of depressive and anxious disorders on the course of cardiovascular disease (CVD) and the specific features of clinical changes during combined pharmacotherapy (with cardiovascular agents and antidepressants). SUBJECTS AND METHODS: Seventy-eight patients with arterial hypertension (AH), acute myocardial infarction (AMI), chronic heart failures (CHF), or concomitant affective spectrum disorders were examined. Clinicopsychopathological and clinicofunctional studies were conducted. RESULTS: Statistically significantly higher degrees of anxiety and depression were revealed in patients with AH and in those with CHF than in patients with prior AMI. After AMI, the degree of psychopathological symptomatology reduced during treatment more rapidly than that in patients with AH and in those with CHF. In all three groups, combined therapy using the antidepressant tianeptine (coaxil) improved intracardiac hemodynamics and left ventricular structural and geometric parameters. CONCLUSION: Anxious and depressive disorders substantially affect the formation of a clinical picture in CVD. Inclusion of tianeptine (coaxil), that has antidepressive and anxiolytic activities, into the combined therapy of patients with CVD and depression spectrum disorders leads to a reduction in affective symptomatology, contributing to the positive impact on intracardiac hemodynamic and left ventricular structural and geometric parameters.

[Relationships between psychosomatics and somatopsychiatry in modern medicine].

Progress in many clinical disciplines and neurobiology for the last decades give reason to reconsider some fundamental provisions of psychosomatic medicine and its relationships with somatopsychiatry. The universally accepted biopsychosocial model of the disease as proposed by V.N.Bekhterev implies involvement of psychological and psychosocial factors at early stages of many forms of somatic pathology. Intricate interplay between somatic and psychic components is exemplified by correlation of cardiovascular disorders and depression. Depression is diagnosed in 17-27% of the patients with coronary heart disease undergoing coronary angiography and in 16-45% of the post-infarction cases. Frequency of depression/hypertensive disease comorbidity is estimated at 30%. Similarity of pathogenetic mechanisms of cardiovascular diseases and depressive states is due to stress as their common provoking factor. Another important aspect of the relationship between medicine and psychiatry (disregarded until recently) is high frequency of somatic disorders in psychiatric patients. Cooperation of psychiatrists and representatives of different medical disciplines in such areas as research and practical health care is needed to address this problem.

[Clinical/dynamic and epidemiological aspects of depressive disorders in the protracted emergency situation].

OBJECTIVE: Depressive disorders are one of the most frequent forms of mental pathology developed in protracted emergency situations. Depression develops independently or comorbid to posttraumatic stress disorder (PTSD). MATERIAL AND METHODS: Authors conducted a population study of the dynamics of depressive disorders in people lived in the area of combat actions in the Chechen Republic. The study included 1000 patients. It started in 2002 with a follow up period of 2 years (2004, 2006 and 2008). RESULTS AND CONCLUSION: Affective disorders of different severity were identified in 40% of the sample. The percentage of depressive disorders decreased with time since the acute phase of the emergency situation, though after 6 years remained significantly higher than in the control area without combat exposure. The issues of providing care to patients with affective disorders are considered.

[Publishing activity of Russian research institutes in the field of psychiatry and addictology in 2006-2013].

OBJECTIVE: To compare the publication activity of 6 psychiatric institutes based on the data from the Russian Citation Index (RCI). MATERIAL AND METHODS: Weighted average data of the last five years was selected for analysis: number of publications and citations per author, number of citations per publication, impact factor of journals published the papers. The analysis of the dynamics of publication activity and citations for the period of 2006-2013 for 6 institutes has been performed. RESULTS: The analysis shows that the Research Center of Mental Health of the Russian Academy of Medical Sciences (RAMS) is the leader among in publication activity in the field of "psychiatry and addiction medicine". In second place the Moscow Research Institute of Psychiatry and the National Research Center of Addictology. Then, by a large margin, are the Bechterev St.Peterburg Research Psycho-Neurological Institute, the Serbsky National Research Center of Social and Forensic Psychiatry and the Siberian Research Mental Health Institute of RAMS. CONCLUSION: RCI data is an important source of information regarding scientific activity of research institutes although the data should be interpreted with caution.

[Disturbance of serum albumin conformation in patients with melancholic depression]. / Narushenie konformatsii al'bumina syvorotki u bol'nykh melankholicheskoi depressiei.

OBJECTIVE: Conformational protein changes may be an important component of the disturbance of molecular processes in the development of pathological process in the body. We studied conformations of albumin molecule in the blood of patients with depression using biophysical -nanotechnical approach. MATERIAL AND METHODS: We examined 19 patients with depression and 25 healthy controls. Properties of serum albumin were compared in patients with typical melancholic depression and controls using spectroscopy (subnanosecond range) with K-35 fluorescent probe. RESULTS AND CONCLUSION: The properties of albumin binding sites in patients before and after treatment differed from those in controls. The authors suggest that it points to the changes in albumin molecule conformation that may influence the functional state of the protein. It has been suggested that these changes may be considered as biomarkers of pharmacotherapeutic efficacy.

[Problems of psychosomatics and somatopsychiatrics in internal medicine]. / Problemy psikhosomatiki i somatopsikhiatrii v klinike vnytrennikh boleznei.

The past 2 decades in our country has been marked by the population's poorer health status, the obvious tendency for the incidence of many somatic and mental diseases to increase. The problem of somatogenic mental diseases and disorders diagnosed in the presence of a somatic disease merits particular attention. The paper considers the background of psychosomatics and somatopsychiatrics, presents the authors' own findings of the mental status in patients with chronic lung diseases. Various somatic disease-detected psychopathological syndrome relationships most common in the treatment of visceral diseases are systematized. Emphasis is laid to the fact that the differentiation of proper mental and somatic diseases, the elaboration of the optimal treatment policy is possible only if therapeutists work in close cooperation with psychiatrists. Principles in the complex therapy of psychopathological disorders in patients with somatic diseases are given.

[The temporal correlates of evoked potentials from the visual and motor cortices in affective states]. / Vremennyé sootnosheniia vyzvannykh potentsialov zritel'noi i motornoi kory pri affektivnykh sostoianiiakh.

Peak latencies (PLs) of seven isopolar components of the evoked potentials (EPs) of the occipital and central areas in patients with different extent of depressions with the predominance of alarm or anguish affects were compared with healthy ones. In alarm affect the differences in PLs of EP components dominant in the occipital areas while in anguish affect they prevail in the central cortical zones.

[Interhemispheric asymmetry according to evoked potential parameters in patients with depression]. / Mezhpolusharnaia asimmetriia po parametram vyzvannykh potentsialov u bol'nykh depressiei.

In depressive patients with different degrees of severity of the disorder hemispheric differences of the occipital and central EP peak amplitude and latency were estimated under the conditions of presentation of a neutral light stimulus, structural stimulus, and mental reproducing the structural stimulus during presentation of the neutral one. Affective responses to the stimuli were also taken into account. In non-psychotic depression hemispheric asymmetry was observed in all responses studied being correlated with the dominant affect. In anxiety most of the EP components were higher in the right hemisphere; in sad affect they were higher in the left hemisphere. In psychotic depression, irrespective of the dominant affect, EP characteristics were higher in the right hemisphere.

[Comparative analysis of memory pathologies of various genesis: epileptic patients and Chernobyl nuclear plant accident liquidators]. / Sravnitel'nyi analiz patologii pamiati raznogo geneza na primere liudei, bol'nykh épilepsiei, i likvidatorov avarii na ChAES.

Different types of short-term memory were examined in two groups of people: epileptic patients during remission and participants of cleaning after the incident at Chernobyl nuclear power plant. The control group matched the experimental groups by sex, age, and education. It was found that memory dysfunctions were similar independently of the kind of pathology. The associative memory was most vulnerable. This finding is explained in terms of the role of protein-nucleic synthesis (the molecular-universal aspect) in the formation of human and animal associative memory.

[Morbid psychic anesthesia in the structure of depression]. / Boleznennaia psikhicheskaia anesteziia v strukture depressii.

On the basis of clinico-psychopathological observations in 167 patients, the structural-dynamic traits of morbid psychic anesthesia were studied in different forms of depressive conditions. The study detected some quantificational differences in morbid psychic anesthesia according to its volume (local, diffuse-partial and total), its actiality (unsufficiently actual, actual and acutely actual), structure (thymical, "reasoning", delusionlike), related to the depressive affect (parallelism with affect, relative parallelism, an absence of parallelism). The nozological and syndromological regularities in the appearance and development of this phenomenon are shown and the criteria of prognostical evaluations of depressive and depressively shaded states, including morbid psychic anesthesia, are outlined.

[Dynamics of neuropsychiatric disorders while engaged in occupational activities]. / Dinamika nervno-psikhicheskikh narushenii, razvivaiushchikhsia v usloviiakh professional'noi deiatel'nosti.

The authors performed a comprehensive study of neuropsychic disorders developing under conditions of occupational activity during a long (up to 6 months) voyage (n = 149). The disorders were shown to change with time and get more complicated from asthenic to unmarked affective ones (of hypothymic nature). A number of biochemical, vegetative and psychological parameters were found to change over time. The disturbances showed a rapid reversibility at rest.

[Certain patterns in the formation of optical illusions]. / O nekotorykh zakonomernostiakh formirovaniia obmanov zreniia.

A structural dynamic analysis of productive disorders in visual perception was attempted on the basis of psychological study of 344 patients. These disorders were studied according to the increasing degree of inadequacy (anisomorphia) of pathological images in respect to real stimula. Considering the differences of such phenomena according to the degree of discrepancy of their perceptive characteristics with the traits of real objects, some successively complicated pathological images were examined, including traditional false recognition, illusions and hallucinations, as well as interlapping intermediate structures. Some pathogenetical mechanisms in the formations of visual illusions are suggested. Clinico-psychopathological parallels are made between disorders of visual perception and disease entities.

[Psychopathologic structure of protracted endogenous depressions]. / Psikhopatologicheskaia struktura zatiazhnykh éndogennykh depressii.

The psychopathological structure of protracted endogenous depressions was studied. An attempt was made to eliminate the main components of the depressive syndrome (variants of the depressive affect - anguish, anxiety, apathy, ideator and motor inhibition and "supplementary" symptoms). The results of the study demonstrated some general psychopathological regularities in the interrelationship of components of the depressive triade and some nozological differences. The assumption is made of the heterogenity in the mechanisms of "delayed" depressions. The most significant appeared to be such factors as the character of the main affect, the degree of intensity and concord of the triade elements and the existence of "supplementary" psychopathological phenomens.