[Psychological aspects of contrast obsessions]. / Psikhologicheskie aspekty kontrastnykh obsessii.

The paper presents a clinical-psychological examination of 40 patients with contrast obsessions of homicidal- and suicidal-phobic contents. The cohort of patients was divided into two groups by the prevalence of the possibility to commit either autodestructive and criminal actions (group 1-24 patients) or violence and murder (group 2-16 patients) in clinical picture of contrast phobias with anxious apprehension. It was found that in patients of group 1 pathology of personality presented with disorders of the hysteric-hyperthymic sphere together with features of overanxiety, while in patients of group 2--with disorders of the anancastic-schizoid sphere. Differences between the groups in terms of the objective direction of anxiety were associated with peculiarities of the structure of the personality: in group 1 the choice of the object of anxiety from the individuals of the nearest surrounding or the very patient himself, was determined by diffusion or widening of Ego boundaries and identification of patients with their microsocial environment; in group 2 the choice of such object of the "accidental other" was determined by the fixing, narrowing of Ego boundaries and by separation from the microsocial environment. Chronological direction of the anxiety in group 1 was conditioned by the peculiarities of the imagination function: hypertrophy of fantasy, abundance of the means of the symbolization of intrapsychic experience and emotional style of thinking determined an anticipatory anxiety; while an insufficiency of fantasy, alexythymia and the operational style of thinking in group 2 determined a retrospective anxiety.

[Clinical course, internal picture of the disease and pathogenic reactions in patients with bronchial asthma]. / Klinicheskoe techenie, vnutrenniaia kartina bolezni i nozogennye reaktsii u bol'nykh bronkhial'noi astmoi.

AIM: To study clinical features of bronchial asthma (BA) associated with internal picture and nosogenic reactions. MATERIAL AND METHODS: Clinical features of BA were studied in 108 patients (38 males and 70 females, mean age 44.7 +/- 1.4 years, mean BA duration 6.6 +/- 0.76 years) treated in the clinic of the I. M. Sechenov Moscow Medical Academy in 1995-1998. RESULTS: Clinical and statistical analysis of BA clinical course allowed to single out three leading variants of BA course: persistently obstructive (stable and definite respiratory disturbances with progressive deterioration of bronchial permeability), moist (associated chronic bronchitis, allergic rhinosinusopathy, chronic maxillary sinusitis, intestinal dysbacteriosis, repulsive symptoms, e.g. discharge of much sputum et cet), paroxysmal (short-term episodes of asphyxia arrested by inhalations of beta 2-agonists, absence of stable respiratory disorders). The above variants of BA course significantly correlated with types of the internal picture (IP) and types of nosogenies. Persistently obstructive, moist and paroxysmal BA variants were characterized with vital, defensive and coping IP, respectively, neurotic reactions with hypochondria, hypochondriac depressions; pathocharacterological sensitive reactions; neurotic and affective reactions with "la belle indifference" and "euphoric pseudodementia", respectively. CONCLUSION: The above correlations can be used for planning and conduction of psychocorrective measures aimed at optimisation of patient-doctor compliance.

[Clinical aspects of somatic disease and internal course of the disease (heart ischemia and bronchial asthma model)]. / Klinicheskie osobennosti somaticheskogo zabolevaniia i vnutrenniaia kartina bolezni (na modeli ishemicheskoi bolezni serdtsa i bronkhial'noi astmy]

Criteria of subjective severity (SS) and subjective control of the condition (SC) associated with establishment of the disease internal picture (DIP) were determined in 67 patients with verified coronary heart disease (CHD) and 68 with verified bronchial asthma (BA). Essential for SS were: severity of the subjective symptoms, features of the somatic condition debut, the speed of the disease progression. Essential for SC were the following components: effectiveness of self-care, severity of noticeable or ugly symptoms, features of the triggers (attack provokers). SS and SC criteria can be used for differentiation of the interventions to change the patient's attitude to their disease and therapy in the direction of more compliance with the doctor.

[Psychosomatic disorders (clinical picture, epidemiology, therapy and models of health services]. / Psikhosomaticheskie rasstroistva (klinika, épidemiologiia, terapiia, modeli meditsinskoi pomoshchi.

53.6% of the patients of general hospital suffer from psychosomatic disorders (PSD). Two-dimensional (psychologic/ clinical) model of psychosomatic interrelations is presented which proposes the estimation of the influence of both somatic and psychological factors within PSD pathogenesis. The clinical classification of PSD includes 4 types: somatization (somatoform disorders)--organ neuroses--27%; psychogenic (nosogenic) reactions--57%; stress-related exacerbation of the medical illness (symptomatic lability)--14%; exogenous (somatogenic) reactions--1%. Except psychotherapy, PSD treatment demands pharmacological intervention (including tranquilizers, antidepressants, cerebroprotectors and neuroleptics). Pharmacotherapy should be proceeded with the account of both its possible somatic effects and its interaction with conventional medical agents. The results of the follow-up study prove superiority of psychopharmacotherapy over psychotherapy in terms of long-term efficacy. The most effective model of the organization of psychiatric care in PSD clinic is liasion psychiatry (psychiatrist consults and general practitioner treats). Inpatient treatment of non-psychotic PSD patients requires an organization of specialized units within a general hospital.