[The risk of developing cardiovascular disease in bipolar disorder. Biological factors and therapy].

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.

[The risk of developing cardiovascular disease in bipolar disorder. Clinical and social factors].

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.

Aggressiveness in depression: a neglected symptom possibly associated with bipolarity and mixed features.

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.

Relationships between mixed features and borderline personality disorder in 2811 patients with major depressive episode.

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.

[Ethical-deontological problems of therapy of mental disorders]. / Etiko-deontologicheskie problemy terapii psikhicheskikh rasstroistv.

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.

[Problems of mental health in the situation of COVID-19 pandemic]. / Problemy psikhicheskogo zdorov'ya v usloviyakh pandemii COVID-19.

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.

Intramuscular olanzapine vs. intramuscular short-acting antipsychotics: safety, tolerability and the switch to oral antipsychotic medication in patients with schizophrenia or acute mania.

BACKGROUND: This study compared the safety, tolerability and switch to oral medication in patients with bipolar disorder or schizophrenia who received intramuscular (IM) olanzapine or other IM antipsychotics for the treatment of acute agitation. METHODS: Patients (N = 2011) from 15 countries participated in this prospective, observational, non-interventional study. Inpatients requiring treatment with at least one IM injection of a short-acting antipsychotic were assessed at baseline and within 7 days after the first IM injection. Treatment groups comprised: (i) patients prescribed IM olanzapine at baseline; and (ii) patients prescribed any other IM antipsychotic medication at baseline. Outcome measures included: treatment-emergent adverse events, concomitant psychotropic medication and the time taken to switch to oral medication. RESULTS: Fewer patients in the IM olanzapine group experienced an adverse event than patients in the other IM antipsychotic group (34.4% vs. 46.2%, p < 0.001). The most frequently reported adverse events in both groups were: sedation, Parkinsonism, disturbance in attention, akathisia, dystonia and orthostatic hypotension. Fewer patients in the IM olanzapine group used anticholinergics (13.9% vs. 42.5%, p < 0.001) or anxiolytics/hypnotics (47.6% vs. 51.6%, p = 0.023). Patients in the IM olanzapine group switched to oral medication earlier than patients in the other IM antipsychotic group (median time = 46.5 vs. 48.0 h, p = 0.009). CONCLUSIONS: These findings suggest that IM olanzapine may have a favourable impact on individual patients. However, the high rate of oral concomitant medication used throughout the study limits these findings from being associated with IM olanzapine alone.

[Effect of Lurasidone on symptoms of schizophrenia in five-factor dimensional model: pooled analysis of two short-term, randomized, double-blind, placebo-controlled studies in patients from Russia and Ukraine]. / Ispol'zovanie piatifaktornoi dimensional'noi shkaly simptomov shizofrenii dlia otsenki terapevticheskogo deistviia Lurazidona: ob''edinennyi analiz dannykh dvukh kratkosrochnykh randomizirovannykh dvoinykh slepykh platsebo-kontroliruemykh issledovanii na populiatsii patsientov Rossii i Ukrainy.

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.

The relationship between attention deficit hyperactivity disorder, bipolarity and mixed features in major depressive patients: Evidence from the BRIDGE-II-Mix Study.

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.

The implications of hypersomnia in the context of major depression: Results from a large, international, observational study.

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.

[Daily dynamics of time perception in bipolar II disorder patients with redarted or anxious depression]. / Dnevnaya dinamika vospriyatiya vremeni pri zatormozhennoi i trevozhnoi depressii u bol'nykh bipolyarnym rasstroistvom II tipa.

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.

[A comparative study of different types of pharmacotherapy in treatment of depressive phase of bipolar II disorder]. / Varianty farmakoterapii depressivnoi fazy bipoliarnogo affektivnogo rasstroistva tipa II.

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.

[EEG spectral characteristics in resistant depression patients on transcranial magnetic stimulation treatment].

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.

[Comparative effectiveness of preventive use of lithium carbonate, carbamazepine and sodium valproate in affective and schizoaffective psychoses]. / Sravnitel'naia éffektivnost' profilakticheskogo primeneniia karbonata litiia, karbamazepina i val'proata natriia pri affektivnykh i shizoaffektivnykh psikhozakh.

To specify differentiated indications for preventive use of normothymic drugs, a prospective study was made of 3 groups of patients with phasic endogenous psychoses, comparable as regards the main ++clinico-anamnestic characteristics. The patients had been administered lithium carbonate (LC, 30 persons), carbamazepine (CRB, 30 patients), and sodium valproate (SV, 28 patients) for no less than one year. It was discovered that all the drugs exhibited marked preventive action to an equal degree. The mean annual magnitude of the total duration of the affective symptomatology reduced by 49.3% in LC administration, by 55.9% in CRB, and by 45.6% in SV administration; the rate of episodes decreased by 53.8, 57.5 and 52.2%, respectively. The anticonvulsants produced a stable preventive effect more rapidly (within the first 2-3 months of the treatment) as compared to LC. CRB had a more pronounced preventive efficacy in atypical affective and schizoaffective psychoses as well as in depressions, particularly in those with predominance of anxiety. As for its activity profile, SV approximated LC and was more effective in psychic endogenomorphous variants of MDP with a typical circadian vital symptom-complex. Unlike LC, the anticonvulsants demonstrated a well-defined capacity to interrupt the continual course of circulatory disorders including the "rapid cyclicity" phenomenon.

[Unfavorable course of recurrent (schizoaffective) schizophrenia]. / Neblagopriiatnoe techenie rekurrentnoi (shizoaffektivnoi) shizofrenii.

Based on clinico-catamnestic studies conducted in 50 patients with recurrent ("schizoaffective") schizophrenia 2 main types of an unfavourable disease course were distinguished: "stationary" (28 patients) and "labile-continual" (22 patients). The first variant was characterized by long and monotonous persistence of uniform affective delirious symptoms. The second variant was characterized by complete lack of any stability of the condition associated with permanent changing of polar affects and respective hallucinative delirious structures. Pronounced and reduced patterns of the disease course were distinguished in both variants. Clinical characteristics of the variants are provided, and ways by which they are formed are depicted. A number of theoretical problems, especially those concerned with the reliability of criteria for interrelations between the status and the disease course in the diagnosis and individual prognosis of the disease development are discussed.

[Complications of combined use of lithium salts and neuroleptics in patients with endogenous psychoses]. / Oslozhneniia pri sochetannom primenenii solei litiia i neiroleptikov u bol'nykh éndogennymi psikhozami.

The present study deals with side effects following combined lithium-neuroleptic treatment in 60 manic and manic-delusional patients with manic-depressive illness, schizoaffective psychoses and shift-like schizophrenia. The author studied 238 independent courses of combined therapy and compared them with 146 courses of treatment with neuroleptics alone and 43 courses of lithium therapy. Pharmacological and clinical studies make it possible to divide all side effects into three groups: typical neuroleptic and lithium side effects and neuroleptic-lithium ones. The latter were observed in 6.3% of all courses of combined therapy. The author describes severe neurotoxic reactions in two patients, mild persistent psychoorganic (encephalopathic) syndrome in seven patients and some other special side effects. Practically all complications were reversible and occurred significantly more frequently in schizoaffective and schizophrenic patients than in manic-depressive ones.

[Comparative effectiveness of detoxification hemosorption and electroconvulsive therapy in patients with endogenous depression resistant to tricyclic antidepressants]. / Sravnitel'naia éffektivnost' detoksikatsionnoi gemosorbtsii i élektrosudorozhnoi terapii u bol'nykh éndogennymi depressiiami, rezistentnykh k tritsiklicheskim antidepressantam.

In 79 patients with endogenous depressions (66 MDP and 13 circular schizophrenic patients) which received high doses of tricyclic antidepressants (amitriptyline in agitated forms and melipramine++ in inhibited ones) that remained ineffective for at least one month, hemosorption (HS; 39 patients) or ECT (40 patients) were randomly applied. The overall efficiency of HS and ECT was 53.8% and 60%, respectively. The efficiency of HS was substantially higher than that of ECT in the cases with dominant obsessive-phobic symptoms in depression. The reverse relation was observed in the cases with dominant anxious-delirious symptoms. In order to determine the predictors of the efficiency of the therapies, the stepwise discriminant analysis was used and the linear discriminant function equations were derived for HS and ECT involving 11 and 8 parameters, respectively. Correlation coefficients between predicted and de-facto therapeutic effects determined in an additional test group of 20 patients were 0.63 for HS and 0.88 for ECT. This is important in terms of directing a practitioner toward one or another technique with due respect for the individual differential therapeutic prediction of its result.

[Use of electroconvulsive therapy for breaking the continual course of drug-resistant affective and schizoaffective psychoses]. / Primenenie élektrosudorozhnoi terapii dlia obryva kontinual'- nogo techeniia terapevticheski rezistentnykh affektivnogo i shizoaffektivnogo psikhozov.

To break continuous psychoses, the ECT (5 to 10 sessions daily or every other day) was given to 20 patients with affective and schizoaffective psychoses, who suffered not less than 3 affective cycles a year and were resistant to the preventive therapy with lithium carbonate or carbamazepine++ on condition they were used continuously for a year. After the ECT was completed the preventive therapy carried out before was resumed. It has been discovered that the mean value of the total duration of the affective symptomatology for a year and the mean number of affective episodes seen during a year dropped considerably. Complete "breaking" of continuous psychosis with formation of a steady remission lasting not less than 5 to 6 months could be attained in 8 patients including 3 out of 8 patients with "rapid cycling" phenomena. The breaking effect of the ECT was more probable in patients with no signs of organic CNS failure, less disease standing and less period of the continuous disease proper as well as in the presence of well-defined remissions between the episodes, predominance and greater intensity of the depressive cycles as compared to the manic ones. The use of the ECT which brought about "breaking" for the time being of the circular symptomatology enabled lithium to exhibit its normothymic stabilizing activity to a greater degree as compared to carbamazepine.

[Significance of the clinical characteristics of manic, manic- paranoid and manic-hebephrenic conditions for differentiated psychopharmacotherapy]. / Znachenie klinicheskikh osobennostei maniaka'lnykh, maniaka'lno-bredovykh i maniaka'lno-gebefrennykh sostoianii dlia differentsirovannoi psikhofarmakoterapii.

In order to improve the treatment of 200 patients with endogenous psychoses, a total of 412 manic, manic paranoid and manic-hebephrenic exacerbations were studied as well as 1130 psychopharmacotherapeutic interventions. Two-factor dispersion analysis has revealed a substantial impact of such major clinical factors as the nature of treatment, nosology and course type, syndrome variant, and their interrelations on the treatment efficiency. The sum of the factors explained about 25% of variance of the therapy efficiency rating. The data provided a basis for a system of differentiated indications to use various treatments and the tables of their comparative efficiency developed which can serve as a practical guide for the practitioner in his choice of an adequate therapy.

[Comparative effectiveness of mianserin and pyrazidol in endogenous depression]. / Sravnitel'naia éffektivnost' miansana i pirazidola pri éndogennykh depressiiakh.

Psychotropic activity of miansan (mianserin, lerivon) and pyrazidol was subjected to a comparative clinico-statistical study in depressions within the framework of phasically going endogenous psychoses. There were 2 clinically comparable groups each made up of 21 patients. Complete and appreciable efficacy was revealed in 16 patients (76.8%) receiving miansan and in 14 patients (67.2%) on pyrazidol. The general antidepressant effect of miansan correlated statistically significantly with sedative (anxiolytic and hypnotic) effect of the drug. As far as pyrazidol is concerned, the intensity of sedative and stimulating components of the antidepressant action did not essentially differ. No marked side effects were recorded even on drug administration in high doses, including persons with the signs of inferiority. The data obtained attest to the fact that miansan should be preferably used in anxious, anesthetic depressions and depressive paranoid conditions including those resistant to the preceding therapy with tricyclic antidepressants.