[Functional hypercortisolism in mental disorder - association with psychopathological manifestations and course of the disease]. / Funktsional'nyi giperkortitsizm pri psikhicheskom rasstroistve ­ assotsiatsiya s psikhopatologicheskimi proyavleniyami i techeniem zabolevaniya.

The article presents a case of a long-term mental disorder in a 35-year-old woman with a persistent laboratory-confirmed increase in cortisol levels, without clinical manifestations of hypercortisolism. The first signs of mental illness appeared at the age of 14; over the past 8 years, the disease has been continuous and manifests itself in the form of a predominantly depressive state with increasing severity and complication of symptoms. Throughout all the years of the disease, active psychopharmacotherapy was carried out, combinations of antidepressants with antipsychotics and mood stabilizers were used, but no pronounced effect was achieved. Inpatient treatment in the clinic of the Mental Health Research Center for 5 months using several methods of enhancing antidepressant therapy had a good therapeutic effect and made it possible to achieve complete remission of the disease. There was a normalization of laboratory parameters of cortisol along with a decrease in the severity of pathopsychological symptoms, which indicates the genesis of hypercortisolism secondary to mental illness and its functional nature. It is assumed that hypercortisolism in this patient contributed to the formation of atypical clinical symptoms and resistance to antidepressant therapy. The discussion substantiates the need to consult a psychiatrist in case of persistent hypercortisolism in the absence of clinical manifestations of Cushing's syndrome. The detection of persistent hypercortisolism in patients with depression determines the advisability of active therapy using several tactics to enhance the effect of antidepressants.

[Effectiveness, safety and adherence to therapy with Elicea Q-Tab in real clinical practice]. / Effektivnost', bezopasnost' i priverzhennost' terapii preparatom Elitseya Ku-Tab v real'noi klinicheskoi praktike.

OBJECTIVE: To evaluate the effectiveness and safety of escitalopram in the form of oral dispersible tablets (Elicea Q-Tab) in real-life clinical practice in patients with depressive and anxiety disorders. MATERIAL AND METHODS: The study included 1.892 outpatient patients, 1.860 of whom completed participation in accordance with the protocol and entered the statistical analysis. Most patients were diagnosed with depressive and anxiety disorders of varying severity, as a rule, these diagnoses were established for the first time. The drug was most often prescribed at a dosage of 10 mg/day. The patients were monitored for 90 days and at each of the 3 visits, scales were used to assess the clinical condition (CGI-S and CGI-I), scales «Interaction with people, maintaining relationships (social functioning)¼ and «Availability of work, task completion, school attendance (professional functioning)¼, scales satisfaction with the convenience of admission/appointment and the effectiveness of treatment, various indicators of quality of life (autonomy, social and professional functioning, hobbies and hobbies), as well as the severity of cognitive disorders were measured. RESULTS: Patients treated with escitalopram in the form of oral tablets dispersible in the oral cavity (Elicea Q-Tab) showed an improvement in their clinical condition (a decrease in CGI-S scores from 3.65 at visit 1 to 2.63 by visit 3, by 28%; a decrease in CGI-I scores from 2.39 at visit 1 to 1.57 to visit 3, by 34%), as well as improving the quality of life, social (from 2.74 points on 1 visit to 4.32 on 2 visits, by 58%) and professional functioning (from 2.81 on 1 visit to 4.35 on 2 visits, by 55%), the level of concentration (from 3.28 points on 1 visit up to 4.5 on 3 visits, by 37%). Doctors and patients noted high satisfaction with the effectiveness and convenience of using the drug, the frequency of adverse events was low. CONCLUSION: The study showed that escitalopram in the form of oral tablets dispersible in the oral cavity (Elicea Q-Tab) is an efficient and safe treatment for depressive and anxiety disorders in real-world clinical settings. Patients and physicians have evaluated the drug positively and it can be considered as an effective agent in psychiatric practice.

[Depersonalization depression in young female patients]. / Depersonalizatsionnye depressii u patsientok molodogo vozrasta.

OBJECTIVE: To study psychopathological structure characteristics of depersonalization depression in young women and nonsuicidal autoaggressive and suicidal behavior characteristics in these states. MATERIAL AND METHODS: We studied 36 adolescent female patients (16-25 years) with endogenous depression (F31.3-4; F34.0; F21.3-4+F31.3-4; F60.X+F31.3-4), whose clinical picture was dominated by depersonalization disorders represented by their auto-, allo-, and somatopsychic forms or combinations. RESULTS: Depersonalization depressions in young female patients are characterized by the following features: the dominance of the manifestations of the sensory («hysterical¼) form of depersonalization (83.3%; n=30); the proximity of the phenomenon of somatopsychic depersonalization (77.8%, n=28) to the manifestations of dysmorphic disorders; the specificity of the manifestations of derealization in the form of a feeling of «pretended, staged¼ environment; infrequent manifestations of psychic anesthesia; marked polymorphism of the clinical picture with comorbid obsessive-compulsive, hysteria-conversion, senestopathic, dysmorphic, and attenuated psychotic disorders; high risk of suicide (83.3%; n=30) with the predominance of planned suicide attempts over impulsive ones; significant frequency and variety of nonsuicidal self-harm with the predominance of «depersonalizing¼ motives for its commission. CONCLUSIONS: Depersonalization depression in young female patients is characterized by the clinical specificity manifested both in depersonalization symptomatology and spectrum of comorbid disorders and in the specificity of motives and methods of suicide attempts and nonsuicidal self-harm.

[Evaluation of the levels of proinflammatory activity of monocytes in depressed patients with schizophrenia]. / Provospalitel'naya aktivnost' monotsitov u bol'nykh s depressivnymi sostoyaniyami v ramkakh shizofrenii.

OBJECTIVE: To evaluate the proinflammatory activity of monocytes (PAM) in depressed patients with schizophrenia by counting the proinflammatory monocyte number and to identify possible correlations between PAM and clinical indicators. MATERIAL AND METHODS: Sixty-eight women with depressive states in schizophrenia and 23 mentally and somatically healthy age- and sex-matched people were examined. The clinical condition of the patients was assessed by the total PANSS (PANSS_tot) and HDRS (HDRS_tot) scores. PAM was determined in the peripheral blood of patients and healthy controls by counting the number of large monocytes with a diameter of 12.5 to 15 microns on a cell counter and analyzer using the positive magnetic separation method to isolate a pure population of CD14 monocytes. RESULTS: Before treatment, the level of PAM significantly exceeded the corresponding value in controls (p<0.001) in half of the patients; after treatment, the level of PAM decreased to control values (p<0.001). Linear regression revealed in a subgroup of patients with an initially low PAM level a positive correlation between its value and HDRS tot (r=0.5, p<0.05) before treatment, that is, a low PAM level before treatment was accompanied by low-severity depressive disorders. The analysis of PAM level in the subgroups of patients responding and not responding to treatment revealed a decrease in the PAM value after treatment in the responding patients assessed by PANSS_tot (p<0.05) and in the responding patients assessed by HDRS_tot (p=0.06). Similar patterns were not detected in the subgroups of nonresponders. CONCLUSION: The correlations between the PAM level and the severity of depressive and other psychopathological disorders in patients with depressive states in schizophrenia may indicate the involvement of immune inflammation in the pathogenesis of this disease. The positive relationship between the initially low PAM level and the mild severity of depressive disorders can be used as a prognostic sign of patients' response to treatment.

[Hysteroform depressions in young female patients]. / Isteroformnye depressii u patsientok molodogo vozrasta.

OBJECTIVE: To study the features of the psychopathological structure of depression in young women with hysteroform symptoms, as well as the features of auto-aggressive non-suicidal and suicidal behavior in these conditions. MATERIAL AND METHODS: The results of a clinical/psychopathological examination of 50 female adolescent patients, aged 16 to 25 years, with endogenous depressions with one of the following ICD-10 diagnosis: (F31.3-4, F34.0, F21.3-4 + F31.3-4, F60.X + F31.3-4) and prevail of hysteroform symptoms in the form of conversion/dissociative disorders in their clinical picture were analyzed. RESULTS: Depression was characterized by an acute onset due to a traumatic situation represented by difficulties in personal or family relationships (36%, n=18), bereavement reactions (28%, n=14) and problems in school/work (22%, n=11). The depressive triad had an erased character, the thymic component was represented by a variable character of affect with a predominance of dysphoria (38%, n=19) and anxiety (32%, n=16). The ideational component of the triad was detected in 50% of cases (n=25), while in 38% (n=19) there was ideational acceleration. In 44% of cases (n=22), dissociative disorders were noted in the form of delusional fantasizing, represented by symptoms close to the «multiple personality¼ phenomenon. Often there were obsessional disorders (58%, n=29), anxiety-phobic symptoms in the form of panic attacks (46%, n=23), isolated phobias (28%, n=14), social phobias (30%, n=15). In 40% of cases (n=20) the formation of overvalued hypochondriacal ideas was noted. Non-suicidal self-harm occurred in 41 patients (82%), in 42% of cases (n=21) the patients made suicide attempts that were distinguished by a low danger to life. CONCLUSION: Hysteroform depressions in girls are characterized by polymorphism of the psychopathological structure, erosion of the depressive triad, originality of the clinical picture of dissociative disorders, presence of comorbid disorders, and frequent, but with a low danger to life suicidal attempts.

[Hyperprolactinemia associated with neuroleptic treatment: clinical characteristics and an impact on sexual function]. / Giperprolaktinemiya, assotsiirovannaya s priemom neiroleptikov: osobennosti klinicheskikh proyavlenii i vliyanie na seksual'nye funktsii.

AIM: To study clinical characteristics of antipsychotic-induced hyperprolactinemia (AIH) and an impact of AIH on sexual function in patients with mental disorders treated with neuroleptics for a long time. MATERIAL AND METHODS: A cross-sectional study of 244 consecutive psychiatric in-patients (F/M=140/104) with mental disorders currently taking antipsychotics was carried out. The patients were screened for serum prolactin, sex hormones and gonadotropin levels. The UKU Side effects rating scale (UKU) was used to assess side-effects. For assessment of sexual dysfunction, the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ) was administered. RESULTS AND CONCLUSION: Asymptomatic AIH was found in 16% of females and in 37% of males. AIH caused menstrual disorders (oligomenorrhea and amenorrhea), galactorrhea in females. AIH was associated with libido decrease and life quality impairment due to sexual dysfunctions in patients of both genders. AIH was associated with orgasm delay and vaginal dryness during sexual intercourse in females. In men, AIH was associated with erectile dysfunction. In contrast to pituitary tumor and idiopathic hyperprolactinemia, there was no association between AIH and weight gain and/or obesity, and hypogonadism in patients of both genders.

[Endogenous anesthetic depressions (psychopathology and typology)].

The psychopathological structure of anesthetic depressions was studied in 80 patients with progredient schizophrenia. Three variants of anesthetic depression were distinguished, viz, anxiety anesthesia with agitation, sensorial psychic anesthesia, and multiple depersonalization symptoms; melancholic anesthesia with the depressive triad, self-reproach ideas and sensorial ideatory psychic anesthesia; anesthesia proper with ideatory psychic anesthesia as the main or sole manifestation of depression. The study revealed transitions of these variants in the structure of schizophrenic episodes from anxiety anesthetic to melancholic anesthetic and further on to purely anesthetic ones. The latter type of depression proved refractory to antidepressive therapy and tended to persist for a long time.

[Paroxysmal and paroxysmal-like conditions during schizophrenia].

The clinical picture of paroxysm-like progredient schizophrenia in 104 patients was characterized by a combination of schizophrenic symptomatology, paroxismal and paroxysm-like disorders. Investigation of their psychopathological structure showed that they differ from that of epileptic paroxysms. The data obtained provide a basis for distinguishing a special variant of endogenous process and developing criteria for typological classification of paroxismal and paroxysm-like disorders.

[Effect of mexidol on 6beta/free hydroxycortisol ratio. Possibility of CYP3A4 activation].

The influence of mexidol (2-ethyl-6-methyl-3-oxypyridine) after a single peroral administration on the levels of 6beta-hydroxycortisol (6beta-OHC) and free cortisol (FC) in human urine has been evaluated. The 6beta-OHC/FC ratio is increased (approximately 2.96 +/- 0.76 times) against the basal 6beta-OHC/FC ratio during the first 24 hour after drug administration. Data analysis on the second and third day after mexidol administration did not show evident changes in 6beta-OHC/FC ratios. It is suggested that CYP3A4 activation after mexidol administration occurred only during active drug biotransformation and excretion and ceased after full excretion from the human body.

[HPLC-MS determination of 2-ethyl-6-methyl-3-oxypyridine].

An HPLC-ESI-MS method has been developed for determining 2-ethyl-6-methyl-3-oxypyridine (EMO) in human urine upon peroral administration of this substance in form ofmexidol. Various sample preparation (extraction) procedures were tested and compared for evaluating the recovery and matrix effect. Solid-phase extraction procedure followed by derivation with dansyl chloride is proposed as a method of choice. The recovery of analyte was 48.1 +/- 3.4%, and the matrix effect was 99.4 +/- 4.1%. The MS and MS/MS spectra of EMO and its dansyl derivatives are presented and interpreted. The analyses were performed using a mass spectrometer of the ion trap type with electrospray ionization at atmospheric pressure, operating in the regime of positive ion detection.

Effect of succinic acid and tween-80 on glucuronidation of 2-ethyl-6-methyl-3-hydroxypyridine.

We studied the effect of succinic acid on the process of glucuronidation of 2-ethyl-6-methyl-3-hydroxypyridine after peroral and intraperitoneal administration in the form of succinate or a base. Since the basic form of 2-ethyl-6-methyl-3-hydroxypyridine is insoluble in water, it was administered in 5% Tween-80. It was necessary to evaluate also the effect of Tween-80 on glucuronidation of 2-ethyl-6-methyl-3-hydroxypyridine in different administration routes. Quantitative assay of glucuronidated fractions was performed by the method of reversed-phase HPLC with fluorometrical detection. The detection limit for this method was 10 ng/ml. We confirmed that the major excretion pathway for 2-ethyl-6-methyl-3-hydroxypyridine is conjugation with glucuronic acid. It was found that succinic acid increased excretion of glucuronidated metabolite after both peroral and intraperitoneal administration of 2-ethyl-6-methyl-3-hydroxypyridine in the form of succinate and base in 5% Tween-80. The effect of Tween-80 was detected only after peroral administration, which was probably related to its effect on absorption of this compound. Tween-80 increased excretion of glucuronate after peroral administration of 2-ethyl-6-methyl-3-hydroxypyridine in the form of succinate and in 5% Tween solution.

[The psychopathology and clinical picture of schizophrenia with a course of paroxysmal and paroxysm-like disorders]. / Psikhopatologiia i klinika shizofrenii, protekaiushchei s paroksizmal'nymi i paroksizmal'nopodobnymi rasstroistvami.

Overall 70 patients suffering from attack-like progressive schizophrenia associated with paroxysmal and paroxysm-like disorders were examined. The clinico-psychopathological aspects of the disease were many and varied. The common signs of the disease included the presence of affective disorders, their considerable portion among other psychopathological manifestations. The dynamics of affective disorders specified in many respects the common character of the disease and the degree of the process progression and, in many cases, it tended to the formation of affective continuity. The common characteristics of the disease also included the presence of early disease signs which occurred long before manifest features, i.e. since the very childhood. The study of the structure of paroxysmal and paroxysm-like conditions revealed their diversity and certain specificities as compared with analogous paroxysms seen in the clinical picture of epilepsy. In addition to the clinical and psychopathological characteristics and the dynamics of personality disorders, this will provide evidence in favour of a special variant of the endogenous process.

[Psychopathology of endogenous anesthetic depression]. / Psikhopatologiia éndogennykh anesteticheskikh depressii.

Studies of the psychopathological structure of anesthetic depressions in 60 patients with attack-like progressive schizophrenia made it possible to distinguish three types of depressive conditions: anxious-anesthetic with agitation, melancholic-anesthetic with a characteristic depressive triad, self-accusation ideas and adynamic disorders and pure-anesthetic ones where psychic anesthesia was the most significant manifestation of the depressive condition with immaterial intensity of other symptoms of depression. In anxious-anesthetic depressions, psychic anesthesia was characterized by primarily sensual character (little differentiated sensation of internal emptiness), whereas in pure-anesthetic depressions, it was marked by primarily ideational character (sensation of inferiority of different sides of emotional life); in melancholic-anesthetic depressions, psychic anesthesia was sensual-ideational in nature and was the main plot for self-accusation ideas. A number of regularities were revealed in the dynamics of anesthetic depression attacks to establish that the types of depressive conditions described previously were stages in the development of an attack.

[The clinical course of schizophrenia associated with anesthetic depression]. / Klinika shizofrenii, protekaiushchei s anesteticheskimi depressiiami.

The clinical picture of attack-like progressive schizophrenia associated with anesthetic depressions was explored in 60 patients. This made it possible to distinguish three varieties of the disease that differed in the premorbid condition, the age of manifestation, the rate of attacks, the psychopathological structure and duration of attacks of anesthetic depressions, personality changes and, therefore, by different degree of the disease progress. It has been established that the role of anesthetic depression in the process development (manifest, non-manifest) as well as the characteristics of its psychopathological structure are of definite prognostic importance.