[Peculiarities of the psychic state and quality of life in patients with duodenal ulcer in the context of chronomedicine].

Most clinicians consider duodenum ulcer as a psychosomatic disease. Objective: To show the interdependence of this condition and mental disorders and their relation to disturbances of melatonin production . Materials and Methods: 15 patients with seasonal DU and 15 healthy subjects of the control group were examined during 3 years using laboratory, endoscopic, and standard psychodiagnostic methods. Results. It was found that all patients with exacerbation of DU experienced enhanced anxiety, reduced background mood, and impaired quality of life based on general health and mental health scoring scales. The circadian rhythm of melatonin production was markedly distorted throughout the observation period but especially during exacerbations of the disease. Conclusions. The results indicate a high degree of correlation between DU and mental disorders caused by impaired production of melatonin. It suggests common etiological mechanisms of DU and psychosomatic symptom complex.

[Current views of psychosomatic diseases].

This review is designed to analyse current views of physicians representing different fields of medicine (psychoanalysis, pathological anatomy, psychiatry, etc.) on the problem of psychosomatic diseases with reference to its history, past and present concepts, etiopathogenetic mechanisms of these conditions. The authors propose to use the results of analysis as a basis for considering psychosomatic diseases as a singular etiopathogenetic entity resulting from dysregulation of rhythm-organizing structures.

[The psychic state of women suffering infertility in the old reproductive age].

A total 60 infertile women aged 36-42 years treated by ART were examined to evaluate their psychic condition using CES-D and Spielberg-Khanin scales, SF-36 questionnaire. 15 (25%) patients were found (CES-D) to have mild depressive disorder; it was more pronounced in one woman. More than half of the patients exhibited enhanced anxiety, with 32 (53.3%) and 19 (31.6%) having generalized and strong anxiety respectively. Estimation of the quality of life revealed difficulties in maintaining social contacts up to complete isolation, low self-assessment of psychic health and prospects for recovery. It is concluded that comprehensive diagnostics and combined treatment are needed to manage infertile women of old reproductive age with the use of both traditional and psychocorrective methods.

[Functional disorders from the perspective of V.KH.Vasilenko's theory].

The authors turn down the concept of functional disease alluding to the experience of brilliant Russian clinicians and morphologies. Their reasoning is that the adoption of this concept interferes with the correct understanding of the nature and management of a given disease.

[Antidepressants in cardiology].

Amitriptyline was for a long time the sole medication for the management of depression in cardiological patients despite a large number of side effects. It was substituted by the safe and cardiologically neutral sertraline, a selective serotonin re-uptake inhibitor. Presently the results of agomnelatine therapy of cardiovascular diseases and accompanying depressions arise great interest.

[The role of melatonin in the development of psychosomatic diseases].

Relationship between psychic and somatic disorders is currently a most widely discussed problem. The published results of relevant research reflect controversial views of internists and psychiatrists. The aim of this paper is to elucidate common mechanisms underlying some psychosomatic diseases based on the chronobiological approach with special reference to abnormal production of melatonin (main rhythm-controlling hormone) resulting in the disturbance of biological rhythms (desynchronosis). Different scenarios of development of psychosomatic disorders are considered using models of irritated bowel syndrome and ulcer disease.

[Psychic disorders and gastrointestinal pathology. Part 2].

The problem of nosological forms of somatic diseases associated with psychic disorders is discussed as exemplified by gastrointestinal pathology (duodenal ulcer, ulcerative colitis, irritated bowl syndrome). Implication of such diseases provides a basis for regarding certain pathological conditions as specific clinical variants in which somatic and psychic constituents are integrated into a single morbid complex.

[Metabolic syndrome: more questions than answers].

Metabolic syndrome has a close association with "diseases of civilization" and widespread in economically developed countries. By the end of XX century, unification in clusters of cardiovascular diseases risk factors showed, that simultaneous presence of obesity, type 2 diabetes mellitus, arterial hypertension, insulin resistance, hyperinsulinemia and hyperlipidemia contributed to significant increase in mortality.

[Metabolic syndrome--psychosomatic associations].

According to epidemiological investigations data, 10 to 35% of all population suffers from metabolic syndrome. However, until now, in spite of researches, metabolic syndrome remains little-studied complex problem. The aim of the review is summarized analysis of the researches results, going out the limits of internal diseases clinics and reflecting more complicated, psychosomatic mechanisms of the syndrome development. The data of literature indicate the row of patterns in development of psyche and metabolic processes disturbances. Analysis of various directions in study of metabolic syndrome with concomitant mental disturbances is represented in the article. The authors propose to perform further investigation subject to "multisectorality" of the disease, marking out prevailing mechanisms of development of metabolic syndrome subject to somatic and mental factors.

[Sulpiride treatment of irritable colon syndrome]. / Lechenie sul'piridom bol'nykh s sindromom razdrazhennoi tolstoi kishki.

A blind placebo-controlled randomized trial was made of efficiency and safety of sulpirid compared to basic treatment in irritable colon syndrome (ICS). 40 patients over 18 years with ICS were randomized into two groups. Group 1 patients received sulpirid monotherapy (200-450 mg/day). Group 2 received basic therapy (combined treatment with spasmolytic, bacterial and cholagogic drugs). The treatment took 6 weeks. It was proved that sulpirid is more effective in ICS as it reduced the syndrome by 85% (basic therapy by 10%), relieved abdominalgia, anxiety, depression, corrected stool. As to disbacteriosis, sulpirid effect was weak. Tolerance of treatment in both groups was good. Side effects developed in 15% of group 1 patients and were easily corrected by lowering of the daily dose.

[Organic neuroses as psychosomatic problem]. / Organnye nevrozy kak psikhosomaticheskaia problema.

To study a role of psychogenic and somatogenic factors in the development of organic neuroses, 302 patients were examined: 199 with cardioneurosis and 103 with irritable-bowel syndrome (IBS) with mental and subclinical somatic pathology or without it. Two types of organic neuroses were distinguished: a conversive one--somatized hysteria (psychogenically determined subsyndromal hysterohypochondriac phobic or affective reactions with clear difference of algesic and autonomic disorders from symptoms of the somatic pathology, with polymorphism of the involved organic systems); and autonomic neurosis that is a central link in the structure of psychosomatic correlations, which, on the one hand, was overdone by clinical manifestations of the somatic pathology (mitral prolapse--35%, ventricular extrasystoles--12%, etc. in cardioneurosis, lymphoid hyperplasia of colonic mucosa--100%, dysbiopsis--10%, etc. in IBS); on the other hand, autonomic neurosis is a somatopsychic component of psychopathologic disorders of anxious-phobic, affective and hypochondriac sphere (panic disorder--59%, generalized anxiety--15%, anxious depression--18% in cardioneurosis, melancholic or hypochondriac cyclothymic depressions--76%, hypochondriac development--24% in IBS). Psychosomatic correlations were considered in autonomic neurosis in the context of some continuum, where somatic disorders amplified by functional disorders are on the one pole and true mental pathology including somatoautonomic disorders--on the other pole. Recommendations have been formulated on therapy of organic neuroses with anxiolytics, antidepressants and atypical neuroleptics in combination with somatotropic drugs.

[The irritable bowel syndrome in mental patients]. / Sindrom razdrazhennoi tolstoi kishki u psikhicheski bol'nykh.

140 patients with the irritable bowel syndrome were examined. According to the results of clinical analysis of the manifestations, symptomatology and structure of comorbidity, two syndrome types were identified. These included those: with the phenomena of autonomic or conversive neurosis (89.3 and 10.7% respectively). The syndrome with signs autonomic neurosis were characterized by: 1) spontaneous or somatogenic manifestation; 2) homomorphism and stability of both abdominalgias and defecation disorders; 3) limitation of functional disorders in gastrointestinal organs; 4) syndromal and temporary (parallelism of formation and dynamics) comorbidity with endogenous diseases (66%) (cyclothymia, slowly progressive schizophrenia), hypochondriac development (16%) and anxious-phobic disorders (18%); 5) correlation with subclinic somatic pathology of gastrointestinal tract. Syndrome with the phenomena of conversive neurosis was characterized by: 1) psychogenically induced manifestation; 2) polymorphism and instability of abdomnalgias and stool disorders; 3) polymorphism of functional disorders of different organ systems; 4) syndromic and temporary (parallelism of formation and dynamics) comorbidity with subsyndromic psychic disorders: transitent hysterohypochondriac phobias (cardiophobia, tanatophobia)--60%, transitent (less than 2-3 months) hysteroaffective reactions caused by situations--40%; 5) none or minimal concomitant subclinical gastrointestinal pathology.

[Effectiveness of moclobemide in therapy-resistant depression]. / Effektivnost' moklobemida pri rezistentnykh k terapii depressiiakh.

The efficiency of moclobemide (selective reversible inhibitor of monoamine oxidase) in therapy of "hyperestetic" depressions and the relation of the drug's efficiency with both psychopathologic structure and severity of the disease were assessed. 20 patients with prolonged (more than 2 years duration) anxious-somatisized depressions resistant to the treatment with tricyclic antidepressants were treated. Moclobemide was quite effective in 14 (70%) patients. Psychopathologic structure of depression in the group of the responders was characterized by hypothymia, somatopsychic catesthesia and vitalized anxiety. There was a correlation between the therapeutic response, and the severity of depression. It is possible to use positive changes in HAM-D, HAM-A and SCL-90 rating scales as the predictors of the efficiency. It is necessary to use high daily doses (450-750 mg) to overcome resistance. Any side effects are practically absent.