[Rationale for the choice of medication based on the conception of the pathogenesis of mental disorder and mechanism of drug action]. / Ratsional'nyi vybor preparata na osnove predstavlenii o patogeneze psikhicheskogo rasstroistva i mekhanizme ego deistviia.

In modern medicine, when prescribing drugs it is customary to take into account the pathogenesis of the disease and the mechanism of action of drugs. On the example of buspirone, authors have shown that in psychiatry recommendations for administration of drugs should also consider the pathogenesis of diseases (disorders) and the mechanism of drug action. These data will contribute to the rapprochement of neurology and psychiatry with other medical specialties.

[Clinical and psychosomatic peculiarities of essential hypertension under the conditions of chronic stress].

The investigation was dedicated to associations between anxious or depressive conditions and clinical features of essential hypertension (EH) on a model of in-patients undergoing treatment in Groznyy Municipal Hospital No 1. The study found a high frequency of depressive and anxious disturbances in this group of patients (36.4% and 41.6%, respectively). Comparison of patients with mental disorders with mentally healthy controls showed that anxious (to a greater degree) and depressive disorders were in a strong association with crises within the course of EH as well as high prevalence of left ventricular hypertrophy and elevated level of blood catecholamines.

[Nonspecific pains and depression in neurology].

Nonspecific pains (NP) are considered as general symptoms in different pathologies. They occurred in most patients with depression. A data analysis using a program "PARUS" allowed to specify clinical characteristics related to depression. It has been found that the clinically significant depressive state amplified the pains characteristic of somatic and neurological pathology. Therefore, treatment of such patients must be complex and include a therapy of somatic disease and antidepressants. A choice of the latter is depended on its thymoanaleptic and, in case of NP, antinociceptive activity.

[First generation antidepressants in the current treatment of depression].

An aim of the present retrospective (based on medical hystories) study, was to specify the choice of different antidepressants of first generations (AFG) by practical physicians for treatment of different types of depressions. Three hundreds and thirty-four cases (201 female, 133 male) have been studied. The sample included the following types of depression: vital (16 patients), anxious (64), hypochondriac (74), apathic (71), asthenic (13), anesthetic (17), anankastic (19), hysteric (51) and with somatic equivalents (9). It has been found that amitryptiline and imipramine are prescribed in the various depressive states, clomipramine is more often used in anankastic depressions and maprotiline - in anesthetic depressions. When choosing an antidepressant, practical physicians follow the current empiric scheme corresponding to general ideas on the correlation between psychopathological presentations and action of psychotropic drugs on the level of cell metabolism (deficit) of monoamines (dopamine, serotonin, noradrenalin). Moreover, physicians consider clomipramine and maprotiline as more selective antidepressants as they really are; the use of maprotiline is not enough. In conclusion, the author emphasizes the necessity of increasing the knowledge of physicians about possibilities of using AFG taking into account mechanisms of their action.

[The clinical features of the course of coronary artery disease in patients with schizophrenia].

Thirty-nine patients suffering from coronary artery disease (CAD) and schizophrenia (main group) and 32 mentally healthy CAD patients (control group) were included in the study. Cardiological examination including complaint and anamnesis analysis, ECG, EchoCG, stress-EchoCG with dobutamine, 24-hour Holter ECG monitoring was performed; coronaroangiography was carried out in 15 patients. Acute circulatory insufficiency, early post-infarction stenocardia, and chronic left ventricular aneurism were found to be more frequent in patients with schizophrenia vs. controls. Certain differences in CAD risk factors between the groups were revealed. Hyperlipidemia and type 2 diabetes were found in 14 (36%) and 1 (3%) patients in the main group vs. 20 (62%) and 6 (19%) patients in the control group (p = 0.03; p = 0.04), respectively. Glucose intolerance was found in no schizophrenia patients, while it was revealed in 5 (16%) controls (p = 0.02). Patients with schizophrenia sought medical aid later than controls. The number of main group patients who sought medical aid during the first hour, the first 4 hours, the first 4 to 12 hours, or the first 12 to 24 hours was 2 (3%), 3 (5%), 16 (27%), and 38 (64%), respectively; in the control groups these numbers were 12 (30%), 21 (54%), 3 (8%), and 3 (8%), respectively (p < 0.001, p < 0.001, p = 0.02, p < 0.001, respectively).

[Ischemic heart disease in patients with schizophrenia (clinico-epidemiological study)].

We carried out a multicenter controlled study of case histories of patients with schizophrenia and acute myocardial infarction (AMI) or postinfarction cardiosclerosis (PIC) from cardiological (n=44), psychosomatic (n=19) and psychiatric (n=23) hospitals was. In hospital mortality, ischemic heart disease (IHD) risk factors, peculiarities of IHD course, antipsychotic therapy were analyzed. Elevation of in hospital mortality related to PIC and its complications was revealed in somatopsychiatric (21% vs 1.26%; p<0.05) and psychiatric (29% vs 1.26%; p<0.05) hospitals. Hypercholesterolemia, excess weight in patients with schizophrenia were met more rarely (36, 32, 9, 21%, 16, 0% vs 61, 45%, respectively; p<0.05) while diabetes mellitus (5, 5, 9% vs 15%, respectively; p>0.05), arterial hypertension (89, 84, 45% vs 77%, respectively; p>0.05) - with same frequency as in comparison group. Patients with schizophrenia do not differ from persons not suffering from this psychiatric disease by proportion of patients with AMI (39, 47, 49% vs 43%; p>0.05) and PIC (73, 74, 61% vs 73%; p>0.05). Probability of effect of inadequate body weight and psychotherapy with phenothiazine derivatives and antiparkinsonian cholinolytic medications on elevation of mortality of patients with IHD and schizophrenia is discussed.

[Characteristics of the pathogenesis, manifestations and clinical course of psychogenically induced myocardial infarctions].

With the purpose of investigating peculiarities of psychogenically induced myocardial infarction (PIMI) 82 patients with primary myocardial infarction (MI) were chosen as the subjects of the given controlled study and divided into two groups. The main group consisted of 33 patients, the rest 49 formed the control group. The study showed that coronary atherosclerosis was more pronounced in the patients of the main group, among whom cases of exertional angina in past history were more frequent, and who had more pronounced coronary calcinosis compared to the patients of the control group. At the same time, the clinical course of MI in such patients is relatively benign, but it is more often complicated by early postinfarction angina. All this suggests that the pathogenesis of PIMI differs from that of "classic" MI. In particular, PIMI may be associated with the involvement of more distant parts of coronary vessels. Patients with PIMI seem to need to be regarded as having high risk of repeated coronary disasters.

[Anginal States provoked by psychogenic stimuli. To the problem of psychosomatic reactions in patients with ischemic heart disease]. / Psikhogenno provotsirovannye anginoznye sostoianiia (k probleme psikhosomaticheskikh reaktsii u bol'nykh ishemicheskoi bolezn'iu serdtsa).

Two types of vulnerability of coronary vessels damaged by atherosclerosis were proposed basing on results of a study of 94 patients with psychosomatic reactions accompanied with ischemia or myocardial infarction. First variant (35 patients) was characterized by stable course of the disease (high effort angina without coronary catastrophes, episodes of unstable angina, etc.) and selective sensitivity to definite key affect of high personal value. Second variant (49 patients) was distinguished by pronounced clinical manifestations (effort angina with progressive lowering of exercise tolerance). Cardiovascular system displays universal susceptibility to negative emotions of various intensity.

[Factors influencing policy of examination of patients with stable angina pectoris]. / Faktory, vliiaiushchie na taktiku obsledovaniia bol'nykh stabil'noi stenokardiei.

The study was made to evaluate the rate of application of different diagnostic methods in patients with stable effort angina (SEA) treated in the cardiological department; influence of various factors (social, demographic, risk factors, clinical course of ischemic heart disease, associated diseases, internal picture of the disease) on choice by the attending physician of the diagnostic policy. The trial included 49 patients (44 male and 5 female aged 42-73 years, median 63 years) without contraindications to stress tests and without mental diseases. Choice of diagnostic tests (bicycle exercise only, Holter ECG monitoring only, bicycle exercise + ECG monitoring, none of the two) was made by attending physicians. Information on social, demographic, risk factors, clinical features of IHD and associated diseases was obtained in the course of semistructured interview 2-5 days before the discharge from the hospital. The internal picture of the disease was studied by psychometric testing using "Reaction to the Disease Questionnaire". The results were the following: only bicycle exercise, only Holter ECG monitoring were performed in 15 (30.6%) and 19 (38.8%) patients, respectively (95% confidence interval was 17.2-44.0% and 24.6-52.9%, respectively). None of the tests was made in 15 (30.6%) patients (95% confidence interval was 17.2-44.0%). The choice of the physician was significantly influenced by two factors: obesity and internal picture of the disease. The physicians preferred to avoid bicycle exercise conduction in obese patients and patients with hypernosognosia who consider ischemic heart disease a catastrophe and suffer of vital fear and helplessness.

[Psychosomatic reactions comorbid with ischemic heart disease: psychogenically provoked infarctions and myocardial ischemia]. / Psikhosomaticheskie reaktsii, komorbidnye ishemicheskoi bolezni serdtsa: psikhogenno provotsirovannye infarkty i ishemii miokarda.

Ischemic heart disease (IHD) with psychogenic provoked myocardial infarctions (MI) and myocardial ischemic disease (MID) is considered as a psychosomatic disorder. Seventy patients, 17 female and 53 male, aged between 39-77 years, mean age 61.2 +/- 9.9 years, were observed. The presence of both somatic (prolonged atherosclerotic lesion of coronary arteries) and mental (personality disorders with symptoms of reactive lability under psychic trauma influence) predisposition is obligate for manifestation or exacerbation of this IHD type. It is suggested that atherosclerotic coronary vessels affection of heterogeneity may exist. Two types of vulnerability are described. In type 1 cardiovascular system exhibits selective sensitivity to the influence of obligate and of great personality significance cathatymic affect. A strict condition of its realization is amplification of negative emotions up to a level of pathological affective outbursts in the spectrum of paranoiac or explosive reactions. In these cases, IHD is characterized by a stable course (angina of high tensions, without instable anginal episodes etc). In type 2 cardiovascular system reveals vulnerability to negative emotions, the continuum of which is ended by polar pathological affects-cathatymic and anxiety. In contrast to cathatymic affect, a common feature of anxiety affect is a fast, like short-term emotional outburst, manifestation of instable, labile, dramatic external appearances (with tears, converse disorders etc). IHD symptom complex is distinguished by pronounced clinical manifestations (stenocardia of tension with progressive impairment of tolerability to loadings).

[Hyperventilation syndrome in bronchial asthma, essential hypertension and organic neurosis. Clinical picture and external respiration function]. / Giperventiliatsionnyi sindrom pri bronkhial'noi astme, gipertonicheskoi bolezni i organnom nevroze. Klinicheskaia kartina i funktsiia vneshnego dykhaniia.

The external respiration function was studied in 100 patients with hyperventilation syndrome (HVS) divided into 3 groups: 40 patients with HVS and bronchial asthma (group 1) consisting of 15 males and 25 females (age median--45 years, 25 percentile--37 years, 75 percentile--53 years); 39 patients with HVS and essential hypertension (group 2) consisting of 8 males and 31 females (age median 49, 25 percentile--40 years, 75 percentile--57 years); 21 patients with HVS without concurrent somatic diseases of group 3 (7 males, 14 females, age median 45 years, 25 percentile--28 years, 75 percentile--45 years). It is shown that different disorders of pulmonary ventilation correspond to different clinical manifestations of HVS. Thus, in bronchial obstruction (group 1) HVS manifests with "weak respiration", in restrictive pulmonary disorders (group 2) HVS manifests as "heavy respiration", in high parameters of bronchial permeability (group 3)--"shallow respiration".

[Pyrazidol in the treatment of depression in patients with ischemic heart disease]. / Pirazidol pri lechenii depressii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

AIM: To study efficacy and safety of pirazidol administration in depressive patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Pirazidol was given in a dose 0.15-0.3 g/day for 4 weeks to 30 IHD patients aged 21-65 years. 21 of them had nosogenic depression, 9 patients had dysthymia. The efficacy of the antidepressive action was assessed by the Hamilton scale. RESULTS: The trend to a decrease in Hamilton scale scores was manifest by the end of the treatment week 2. To the end of the study the overall score median lowered from 17 to 9, most of the patients had the score sum under 11. Side effects were insignificant. In pirazidol combination with beta-blockers, blockers of calcium channels, antiaggregant, diuretic drugs, nitrates and other cardio- and angiotropic drugs unfavorable interactions were not registered. CONCLUSION: Pirazidol can be effectively used in the treatment of psychosomatic disorders in patients with cardiovascular diseases.

[Psychotropic drugs used in a psychiatric hospital (pharmaco-epidemiologic aspects)]. / Psikhotrropnye sredstva, primeniaemye v psikhiatricheskom statsionare (farmakoépidemiologicheskie aspekty).

The aim of the study was to optimize psychopharmacotherapy in a big psychiatric hospital. It was conducted in Moscow Alekseev psychiatric hospital No 1, using a method of comparison of standard psychotropic treatment and medication strategy suggested by the expert group. An analysis of the treatment of 966 patients with different mental disorders revealed that 78.3% were in need of neuroleptic assignment that was in line with routine practice. The expert's conclusions were postulated as follows: a need in phenothyazines is significantly lower than that observed in practice. Xantens and tyoxantens (chlorprothixene, flupentixol, zuclopenthixol, zuclopenthixol decanoate, zuclopenthixol acetate), benzamides (sulpiride) and such atypical antipsychotics as risperidone, olanzapine and quentiapine are underused in the treatment. Comparing to usual practice, more patients (35.8%) need antidepressants treatment. Thymoleptics should be assigned in greater daily doses. Selective inhibitors of serotonin reuptake (paroxetine, fluoxetine, citalopram, sertraline), reversible MAO A inhibitors (pyrazidolum), "double-action" drugs (mirtazapine, milnacipran) are recommended for wider usage. Less patients (33.4%) are in need of tranquilizers, though a number of medications used is consistent with a recommended one. Normothymics may be assigned to essentially less part of the patients and 18% of them need nootropics that is consistent with routine practice.

[A comparative validation of the scale CES-D, BDI, and HADS(d) in diagnosis of depressive disorders in general practice]. / Sravnitel'naia otsenka shkal CES-D, BDI i HADS(d) v diagnostike depressii v obshchemeditsinskoi praktike.

To determine a most precise instrument for diagnostics of depression and a level of its severity, a comparative study of 3 questionnaires: Hospital Anxiety and Depression Scale (d) (HADS(d)), Beck Depression Inventory (BDI) and Center for Epidemiological Studies Depression scale (CED-D) was conducted in 148 patients (91 women, 57 men), aged 46.5 +/- 9.34 years. An analysis of sensitivity, specificity and predictive values of positive and negative results allowed to detect optimal cut off points, distinguishing depressive patients, as follows: = 18 for CES-D, = 12 for BDI, = 0.89 for HADS(d). For all scales, areas under receiver-operator characteristic (ROC) curve (0.97 +/- 0.02, 0.96 +/- 0.02 and 0.94 +/- 0.02, respectively) proved to be comparable. The optimal cut off points for distinct separation between patients with mild and severe depression were detected as = 26 for CES-D, = 20 for BDI, = 10 for HADS(d). The area under ROC curve for CES-D was higher (0.99 +/- 0.01) than those for BDI (0.86 +/- 0.04) and for HADS(d) (0.83 +/- 0.05). The data obtained reveal that the cut off points ascertained in the study reduce a chance of depression under diagnosis. All the scales could be recommended to interns for primary (screening) diagnostics of depression in routine medical care.

[Visceral neuroses: clinical approaches to the problem]. / Organnye nevrozy: klinicheskii podkhod k analizu problemy.

Visceral neuroses are regarded as psychosomatic pathology represented by functional symptom complexes common for both psychic (personality, psychopathologic disorders of anxietyphobic, affective, hypochondriac spectrum) and somatic pathology. Two hundreds fourteen patients: 67 with hyperventilation syndrome (HVS), 77 with Da Costa syndrome (DCS), 70 with irritable bowl syndrome (IBS) have been studied. The study suggest that visceral neuroses represent a group of independent diseases. In contrast to converse neuroses, a topical projection (respiratory, cardiovascular system, gastrointestinal tract, etc.) of visceral neuroses reflects not only a psychosomatic disorder's specificity but also the course and prognosis regularities inherent to them. HVS course is wavy with periodic exacerbations and incomplete remissions, DCS one is phased (remissive), IBS is chronic without distinct phases and intervals. HVS and DCS are comorbid to milder psychic (personality and anxiety phobic disorders) and somatic pathology. IBS is associated with not only more severe mental disorders (overvalued, hypochondriac, affective) but also with chronic somatic diseases (alimentary system).

[Anxious-phobic disorders in patients with dyspnea]. / Trevozhno-fobicheskie rasstroistva u bol'nykh s narusheniiami dykhaniia.

The examination included 35 patients (21 women, 14 men, mean age 47.2 +/- 2.4 years) with anxious-phobic disorders (APD) and dyspnea phenomena combined bronchial asthma (BA) and hyperventilation syndrome (HVS). There was established that APD in these cases develops more frequently similarly to the panic attacks (PA) and HVS was PA component. Three PA types with dyspnea phenomena were recognized: cognitive ones (with prevalence of cognitive anxiety--8 cases); somatized PA (with prevalence of somatized anxiety--18 cases) and PA with both cognitive and somatized anxiety (9 cases). PA of the first type amplifies BA attack (psychopathologic structure of PA was integrated with manifestations of the acute bronchial obstruction). PA of the second type duplicates (because of the pronounced somatized anxiety associated with asphyxia) an acute bronchial obstruction between BA paroxysms. PA of the third type imitates somatic pathology forming without its participation (polymorphic conversion disorders were found first of all). The link of severity of the anxious-phobic and pulmonary pathology can be interpreted in the ranges of psychosomatic conception of the "reciprocal correlations".

[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.

[Obliterating arteriosclerosis of lower limb arteries and ischemic heart disease clinico-pathogenetic correlations]. / Obliteriruiushchii ateroskleroz arterii nizhnikh konechnostei i ishemicheskaia bolezn' serdtsa: kliniko-patogeneticheskie sootnosheniia.

To study clinical and pathogenetic correlations between different stages of arterial deficiency in obliterating atherosclerosis of lower limbs arteries (OALLA) and various clinical forms of ischemic heart disease (IHD) as well as the influence of different risk factors on OALLA clinical course in different arterial territories. The study included 76 OALLA patients (73 men and 3 women, mean age 56 years). The diagnosis was made on the basis of typical complaints, physical and device examinations. IHD was diagnosed on the basis of typical clinical symptoms and/or findings of the device examinations. OALLA and IHD differ by some risk factors. One of them--chronic alcoholism--is responsible for OALLA progression. This was shown by the analysis of chronic alcoholism prevalence in two groups of patients: with OALLA alone and OALLA in combination with IHD. In the former group alcoholics prevailed (61 vs 24.1%). Chronic alcoholism may be considered as an independent risk factor of OALLA development.