[Prevalence and risk factors of delirium in COVID-19]. / Rasprostranennost' i faktory riska deliriya pri COVID-19.

OBJECTIVE: To assess the frequency and risk factors of delirium in patients hospitalized with COVID-19. MATERIAL AND METHODS: Four hundred and forty patients admitted to the Infectious Diseases Hospital of the University Clinical Hospital No.3 of Sechenov University were included in the study. The Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Screening Questionnaire-7 (GAD-7), the Insomnia Severity Index (ISI), the Delirium severity rating scale (DRS-R-98) were administered. RESULTS: Delirium was detected in 27.8% of patients. Significant risk factors were age (p=0.002), severity of respiratory failure (p=0.005), concomitant somatic disease (p=0.003), and respiratory therapy (p<0.001). There was an association between severe anxiety (p<0.001) and insomnia (p=0.07) observed at admission with the risk of developing delirium during the hospital stay. CONCLUSION: The study reveals a high prevalence of delirium in patients with COVID-19. In order to prevent delirium and/or reduce the risk, early diagnosis and identification of preclinical forms are of particular importance.

[Psychopharmacotherapy of late-stage hypochondriac conditions: frequency of use and effectiveness of drugs]. / Psikhofarmakoterapiya ipokhondricheskikh rasstroistv pozdnego vozrasta: chastota ispol'zovaniya i effektivnost' preparatov.

OBJECTIVE: To conduct a comparative analysis of psychopharmacotherapy effectiveness in hypochondriac disorders of late age and to identify the optimal combinations of drugs depending on the thymopathic (hypothymic and/or anxiety) components accompanying the main hypochondriac manifestation. MATERIAL AND METHODS: One hundred and eight female inpatients, aged from 50 to 88 years, with leading hypochondriac symptoms of non-delusional level were enrolled in the study. All patients were examined clinically and psychopathologically using psychometric scales: the Montgomery-Asberg Depression Rating Scale, the Hamilton Anxiety Rating Scale, the hypochondria rating scale and the UKU side-effect rating scale. RESULTS: Based on the psychometric assessment, the patients were divided into the following groups: group 1 - subjects with hypochondriac symptoms without accented thymopathic component (n=18); group 2 - subjects with a high level of hypothymia (n=49); group 3 - subjects with a high level of anxiety (n=22); group 4 - subjects with a high level of both anxiety and depression (n=19). Hypochondriac disorder without a thymopathic component was treated with monotherapy with antipsychotic drugs in low therapeutic dosages or with a combination of antipsychotic drugs in low therapeutic dosages with tricyclic antidepressants in low and medium dosages. Hypothymic hypochondriac disorders were treated with antidepressants of mainly SSRIs group and of tricyclic structure in combination with typical and atypical antipsychotic drugs in low therapeutic dosages. In these patients monotherapy with antidepressants or a combination of different antidepressants was effective in rare cases only. Hypochondriac disorder with an anxiety component was significantly more often treated by complex therapy with the addition of anxiolytic drugs, as well as a combination of antidepressants with antiptychotic drugs. Mixed hypochondriac states were treated with a combination of antidepressants and antipsychotic drugs or complex therapy with the addition of an anxiolytic drug. CONCLUSION: Hypochondriac disorders of late age in most cases are accompanied by depressive and/or anxiety symptoms, which must be taken into account for improvement of diagnostic effectiveness and relevant selection of therapy.

[Unipolar depression: a gender-based comparative analysis]. / Depressivnye rasstroistva s monopolyarnym techeniem: sravnitel'nyi analiz po gendernomu priznaku.

OBJECTIVE: To compare socio-demographic and clinical characteristics in men and women with depression. MATERIAL AND METHODS: We studied 388 patients with unipolar depression, 74 men and 314 women. The survey was carried out using the clinical-psychopathological method and psychometric scales for depression. RESULTS AND CONCLUSION: Gender differences are identified for several parameters. Women are older, more often had comorbid somatic and organic disorders; men have personality disorders and chronic depression. The severity of depression in women was higher due to symptoms such as reported sadness, anxiety, reduced sleep and appetite, concentration difficulties, and suicidal thoughts. Apparent sadness did not significantly differ in men and women. Anhedonia was more pronounced in men.

[Clinical presentations and therapy of polysubstance dependence in patients with schizophrenia]. / Osobennosti kliniki i terapii sindroma zavisimosti ot neskol'kikh psikhoaktivnykh veshchestv u bol'nykh shizofreniei.

BACKGROUND: The article presents the results of a clinical therapeutic and follow-up study of patients with a 'dual diagnosis' (polysubstance dependence comorbid with schizophrenia: paranoid schizophrenia or schizotypal disorder). OBJECTIVE: To study clinical/dynamic changes of polysubstance dependence in patients with schizophrenia (paranoid schizophrenia, schizotypal disorder) and to evaluate the duration and quality of therapeutic remissions. MATERIAL AND METHODS: Two hundred and sixty-six male patients, including 176 patients with dependence syndrome and 90 patients with both dependence syndrome and schizophrenia, were studied. RESULTS: Patients with the 'dual diagnosis' are characterized by early social maladjustment, earlier social deformation, lack of social skills and preference for a lonely lifestyle. The clinical and dynamic characteristics of dependence syndrome in patients with 'dual diagnosis' include older age of the first use of a psychoactive substance (PS), preference of alcohol as the first PS, experiment as the most frequent motivation for using PS (due to thought disorder), and the treatment of psychopathological disorders (PS like medicine) with a chaotic pattern being the most common in the use, a tendency to hospitalism. CONCLUSION: The success of the treatment of patients with 'dual diagnosis' is possible by combining the therapy of endogenous disease and polysubstance dependence.

[Clinical and sociodemographic characteristics of patients with the first depressive episode and recurrent depression]. / Klinicheskaya i sotsiodemograficheskaya kharakteristika bol'nykh s pervym depressivnym epizodom i rekurrentnoi depressiei.

OBJECTIVE: To comparare socio-demographic and clinical characteristics of patients with the first depressive episode and recurrent depression. MATERIAL AND METHODS: Three hundred and twenty one patients with unipolar depression, including 96 patients with first depressive episode and 225 patients with recurrent depression, were examined using clinical and psychometric methods. RESULTS AND CONCLUSION: There were differences in clinical characteristics between groups but such factors as gender, marital status, level of education, family history of mental disorders and personality were similar. With each new episode of recurrent depression, the next episode tends to be more severe with more intense pessimistic and suicidal thoughts but fewer anxiety and complaints of depressive mood that affects the differences and requires further research, especially considering the effect of therapy.

[Non-delusional hypochondriac disorders in old age]. / Nebredovye ipokhondricheskie rasstroistva v pozdnem vozraste.

This review aims to present main concepts of hypochondria and 'hypochondriac mood' in old age. Attention is paid to historical and modern positions of old age hypochondria as a meta-syndromic pathology and as an independent mental disorder. Relationships of hypochondriac manifestations with affective variations and anxiety disorders, as well as somatic diseases, organic degenerative brain diseases and vascular disorders are discussed.

[Aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction]. / Aripiprazol i kvetiapin v terapii bol'nykh s komorbidnost'iu shizofrenii i boleznei zavisimosti.

AIM: The randomized comparative study of aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction. MATERIAL AND METHODS: Intra-group analysis of dependent variables on the scales PANSS, BPRS, VAS, SACS showed significant differences in the dinamics of the therapy in all groups. A comparative randomized study included 90 men admitted to an inpatient addiction unit. Of these, 54 (60%) had a previously established psychiatric diagnosis and 36 patients (40%) did not have an established psychiatric diagnosis. They were randomized into 3 groups of 30 patients each: group 1 received aripiprazole at a dose of up to 20 mg/day, group 2 received quetiapine at a dose of up to 600 mg/day and group 3 (controls) was treated with haloperidol at a dose of up to 30 mg/day. Treatment duration was 21 days. The efficacy of aripiprazole and quetiapine was evaluated with PANSS, BPRS, VAS and SACS on 10th, 14th and 21st day (visits 2-4). Drug safety was evaluated by recording adverse events or side-effects. RESULTS AND CONCLUSION: An analysis of independent variables showed significant differences between aripiprazole and haloperidol in PANSS and BPRS scores at visit 4, in VAS scores at visit 3, and in SACS scores at visit 2. An intergroup analysis of independent variables showed significant differences between quetiapine and haloperidol in PANSS, VAS and SACS scores at visit 4 and between aripiprazole and quetiapine in VAS and SACS scores. According to the results of the correlation analisys it has been concluded that presenting features of schizophrenia are closely correlated with drug addiction (craving).

[The current state and future prospects of depression research (clinical and classification problems)]. / Sovremennoe sostoianie i perspektivy issledovanii depressii (voprosy kliniki i klassifikatsii).

Despite decades of research, neurobiological studies of depression haven't achieved significant results. Many experts propose that one of the main reasons for this failure is current diagnostic standards not considering the heterogeneity and polymorphism of depression. Research is unable to identify specific neurobiological changes due to formal diagnosis 'major depressive disorder' and new diagnostic criteria are needed. RDoC (Research Domain Criteria) has intensified the confrontation between biological and clinical researchers and changes in approach to depressive psychopathology are discussed. A review presents the recent approaches used in studies of depressive disorders, the methodology they use, the scientific paradigms they rely on.

[Comparative evaluation of depressive disorders in women and men]. / Osobennosti depressivnykh rasstroistv u zhenshchin i muzhchin.

AIM: To study clinical characteristics of depression in women and men. MATERIAL AND METHODS: One hundred and twenty women, aged from 18 to 65 years, and 67 age-matched men with the diagnosis of recurrent depressive disorder (RDD) (ICD-10 F33) were examined using a specially developed survey. RESULTS: Differences in the clinical picture and course of RDD in women and men were found. RDD in women develops at an earlier age, the number of attacks is greater but remissions are longer. However, complete remission is achieved more frequently in men. Most typical effect in the structure of depression in women is anxiety whereas melancholy prevails in men. Daily mood fluctuations and suicidal thoughts are characteristic of women. Motor retardation and decreased motivation are more frequent in men. Ideas of self-blame, avoidance of contacts with other people, adynamia, persistent sense of fatigue are more common in women. Sleep disorders are equally common in men and women but falling asleep disturbance and lack of sleep feeling are more common in women. Somatic symptoms of depression are generally more common in men as well as concomitant diseases of cardiovascular, respiratory and genitourinary systems. Men are more likely to abuse alcohol and other psychoactive substances. CONCLUSION: The identified characteristics of depression in women and men allow more accurate diagnosis and treatment recommendations.

[Psychopathological features of affective disorders in schizotypal disorder]. / Osobennosti klinicheskoi kartiny affektivnykh narushenii v strukture shizotipicheskogo rasstroistva.

AIM: To explore psychopathological features of affective disorders in the structure of schizotypal disorder. MATERIAL AND METHODS: The study included 102 patients with schizotypal disorder, aged from 18 to 60 years. Assessment was done using clinical/ psychopathological method and psychometric scales - Calgary depression scale in patients with schizophrenia (CDSS), General Clinical Impression scale (CGI), Yang's mania scale (YMRS). RESULTS AND CONCLUSION: Affective disorders are noted in the majority of inpatients with schizotypal disorder. They are represented by depressive disorders of variable severity, and mixed depressive states. A group of patients with schizotypal disorder was identified in whom the symptoms of the affective disorder constituted the main clinical picture of the disease, whereas concomitant neurosis-like disorders were formed solely during the exacerbation of depression, correlated with its severity and reduced on antidepressant therapy along with depressive symptoms. Observed reversibility of productive disorders allowed us to consider the dynamic of these states as similar to the atypical affective phase, and the natural course of the disorder as close to the paroxysmal type in the form of distinct depressive phases. In patients with persistent neurosis-like disorders, affective disorders accompanied axial symptoms of the disease and made a large impact on the structure of the exacerbation of the endogenous process. A reduction of depressive symptoms in these patients was accompanied by a decrease in the intensity of axial symptoms of the disease, however the complete reduction of axial symptoms and remission was not observed.

[The features of psychopharmacotherapy of depressive states with panic attacks]. / Osobennosti psikhofarmakoterapii depressivnykh sostoianii s panicheskimi atakami.

AIM: To develop therapeutic programs for treatment of depression with panic attacks on the basis of their clinical and psychopathological features. MATERIAL AND METHODS: A total of 100 in- and outpatients, aged from 18 to 60 years, with depression of mild and moderate severity with panic attacks were studied. The investigation was carried out using clinical, psychopathological and psychometric (the Atypical Depression Diagnostic Scale (ADDS), the Montgomery-Asberg Depression Rating Scales (MADRS), and the Sheehan Anxiety Rating Scale (ShARS)) methods. The patients were assessed on admission, on the 1st, 2nd, 4th and 8th weeks with subsequent processing and defining standard indicators. Three therapeutic groups were formed: the 1st group received therapy combining an antidepressant and a tranquilizer; the 2nd group an antidepressant, a tranquilizer and a mood stabilizer; and the 3rd group an antidepressant, a tranquilizer and an antipsychotic agent. The time course of expression of the signs of depression, anxiety and frequency of panic attacks was analyzed. RESULTS: The highest efficacy in the form of reduced signs of depression and anxiety was observed in the 3rd group on the 1st week of therapy. No significant differences in reduction of depression and anxiety were found between the 1st and 2nd groups. In the 1st therapeutic group, there was an increase in the frequency of panic attacks together with the reduction in their expression and decrease in the severity of depression as compared to the 2nd and 3rd groups. At the same time the 3rd therapeutic group was characterized by a maximally expressed decrease in the frequency of panic attacks already on the 1st week of therapy. CONCLUSION: The study has shown that the use of antipsychotic drugs in addition to therapy with antidepressants and tranquilizers is the most effective way to stop depression.

Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia.

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

[Genetic and clinical predictors of treatment efficacy in depressive disorders]. / Geneticheskie i klinicheskie prediktory éffektivnosti terapii depressivnykh rasstroistv.

AIM: To study clinical and genetic characteristics that impact on the efficacy of pharmacotherapy of depressive disorders. MATERIAL AND METHODS: The study included 188 patients with unipolar depressive disorders of different genesis (psychogenic, endogenous and organic). A clinical-psychopathological method and depression psychometric scales were used. Serotonin transporter 5-HTTLPR and STin2 and dopamine transporter 3',-VNTR polymorphisms were determined. RESULTS AND CONCLUSION: The S-allele of the 5-HTTLPR polymorphism is associated with the low efficacy of treatment with selective serotonin reuptake inhibitors. Tricyclic antidepressants are more effective in treatment of psychogenic depression. The authors determined clinical factors that can predict response to treatment of psychogenic and endogenous depression. No predictors were found for organic depression.

[Treatment of depression complicated by abuse and dependence on alcohol]. / Osobennosti terapii depressivnykh sostoianii, oslozhnennykh zloupotrebleniem i zavisimost'iu ot alkogolia.

AIM: To evaluate the efficacy of different treatment regimens of depression complicated by abuse and dependence on alcohol and to identify the most effective tactics of treatment. MATERIAL AND METHODS: One hundred patients with depression were studied. Examination of patients was conducted using clinical-psychopathological method, the MADRS (at admission, on the 1st, 2nd, 4th and 6th week of treatment) and CGI scale (in the beginning of treatment and on 6th week). Data analysis using standard statistical indicators was performed. In accordance with the therapeutic tactics, patients were stratified into three groups: patients, treated with a combination of antidepressants, antipsychotics and mood stabilizers (group 1); antidepressants and antipsychotics (group 2); antidepressants and mood stabilizers (group 3). RESULTS: In group 1, a reduction in MADRS scores was significantly higher compared to other groups (8.53 points, p≤0.01). On the 6th week, 50% of the patients showed complete or almost complete remission, and the state of 44.7% patients was classified as 'mild disorders'. In group 3, serious condition remained in 16.7% of patients by the end of the 6th week. By the 6th week of treatment, 39.5% of patients of group 1 had 'very significant improvement'. The least treatment efficacy was noted in group 3. CONCLUSION: The use of the combination of antidepressants, antipsychotics and mood stabilizers demonstrates the greatest efficacy in terms of reduction of depressive symptoms.

[Clinical characteristics of depression in patients with episodic consumption of and dependence on alcohol]. / Klinicheskie osobennosti depressivnykh sostoianii u patsientov s zavisimost'iu ot alkogolia i ego épizodicheskim upotrebleniem.

AIM: To study clinical and psychopathological features of depression in patients with consumption of and dependence on alcohol. MATERIAL AND METHODS: Eighty-nine depressed patients were examined. The first group included patients with depressive disorders complicated by alcoholism. The second group included patients, which used alcohol in depressive phase. Control group included patients with endogenous depression without drinking alcohol. Examinations of patients were carried out using clinical-psychopathological method, MADRS and statistical analysis of the data. RESULTS AND CONCLUSION: Depressive disorders complicated by consumption of and dependence on alcohol were comparable for the clinical picture, family history, premorbid features. At the same time, they had a number of differences. In patients with alcohol abuse in depressive syndrome, anxious and melancholic depressions were more frequent. They were complicated with alcohol dependence, were more severe, had less favorite outcomes and a trend toward prolonged course and were more psychopathologically polymorphic. Characteristics of depression in patients with consumption of and dependence on alcohol will allow for a more accurate differential diagnosis and more adequate treatment of affective disorders.

[The possibility of using standardized self-report anxiety and depression scales in elderly patients: Depression scales/questionnaires in elderly]. / Izuchenie vozmozhnostei primeneniya standartizirovannykh shkal samootsenki trevogi i depressii pri obsledovanii bol'nykh pozhilogo vozrasta: shkaly-oprosniki depressii.

AIM: To study possibilities of using depression scales in elderly patients, evaluate the parameters of their reliability and validity and develop practical recommendations on the use of these scales in clinical practice. MATERIAL AND METHODS: The study included 234 patients, aged over 50 years, with anxious depression. The following scales/questionnaires BDI, GDS-15, CES-D-10, CES-D-20, ZDS and HADS-D were used at baseline and 12 weeks after treatment. Data analysis included the calculation of convergent, discriminative and diagnostic validity of depression scales/questionnaires in elderly. RESULTS: All scales are effective for the diagnosis of depression in elderly people. The possibility of using these scales in patients with mild cognitive impairment is shown. An increase of the correlation between the scores on depression and anxiety scales up to the loss of discriminative validity of «double¼ scales/questionnaires by the alternative set of symptoms for the diagnosis of depression and anxiety was confirmed. CONCLUSION: Based on the RESULTS: the authors have developed common and specific for each scale recommendations on the optimal use of depression scales/questionnaires in elderly.

[The possibility of using standardized self-report anxiety and depression scales in elderly patients: anxiety scales/questionnaires]. / Izuchenie vozmozhnosti primeneniya standartizirovannykh shkal samootsenki trevogi i depressii pri obsledovanii bol'nykh pozhilogo vozrasta: shkaly-oprosniki trevogi.

AIM: To describe the specifics of using self-report anxiety scales in elderly patients, determine the parameters of their reliability and validity and develop recommendations on the use of these scales. MATERIAL AND METHODS: The study included 234 patients, aged over 50 years, with non-psychotic anxiety disorders. The following scales/questionnaires BAI, GAI, STAI, ZAS, HADS were used at baseline and 12 weeks after treatment. Conditions of testing, form and content of instructions were similar. Data analysis included the estimation of reliability and validity of these scales. Assessment made by the physician on the Hamilton anxiety scale (HAМ-А) was used as «validity standard¼. RESULTS AND CONCLUSION: All scales (BAI, GAI, STAI, ZAS, HADS-А) can be used for screening diagnosis of anxiety in elderly people. The diagnostic sensitivity and specificity of the scales for subjective assessment of anxiety slightly decrease in advanced age and is sufficient for screening purposes. Based on the analysis, the authors have developed recommendations (common and specific for each scale) on the optimization of using self-report anxiety scales in advanced age.

[The efficacy of psychopharmacotherapy of late onset depression: the optimization of treatment duration].

OBJECTIVE: To analyze possibilities of using different methods to increase the efficacy of psychopharmacotherapy of late onset depression, in particular to increase treatment duration. MATERIAL AND METHODS: The study included 378patients, aged from 50 to 82 years (mean age 60.6±8.4). Patients were stratified into groups with short (4--8 weeks), moderate (12 weeks) and long (20-34 weeks) duration of psychopharmacotherapy. RESULTS AND CONCLUSION: Treatment effect was much lower after <8 weeks of treatment compared with that after 12 weeks (the comparison of these groups was not available because the initial samples were not). To the 24th week, 63.9% of the patients responded to treatment, 43.4% achieved remission. Partial response and stable positive dynamics to the 12th week (about ½ of the patients achieved remission) were predictors of response with treatment duration <24 weeks. Based on the results obtained, the authors developed algorithms for choosing treatment tactics in patients with late onset depression in dependence of the results of the first 12 weeks of psychopharmacotherapy.

[An increase in the efficacy of psychopharmacotherapy of late-onset depressions: combination and substitution of antidepressants].

OBJECTIVE: To comprehensively analyze the possibilities of using the methods of correction of non-effective psychopharmacotherapy of late-onset depressions. MATERIAL AND METHODS: Methods of potentiating, combination and substitution of non-effective psychopharmacotherapy of late-onset depressions were studied. RESULTS AND CONCLUSION: Indications to the use and specific algorithms of substitution and addition of antidepressants in non-effective psychopharmacotherapy of late-onset depressions have been developed. These algorithms of combination therapy suggest the possibilities for choosing the individual combinations of antidepressants.

[The association between the 5-HTTLPR polymorphism of the serotonin transporter gene and the efficacy and tolerability of selective serotonin reuptake inhibitors].

OBJECTIVE: To search for the association between the 5-HTTLPR polymorphism of the serotonin transporter gene and the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs). MATERIAL AND METHODS: The complex clinical/psychopathological and genetic study of 38 patients with depression treated with SSRIs was carried out. RESULTS AND CONCLUSION: The 5-HTTLPR polymorphism was associated with the rate of achievement of remission and tolerability of treatment: carriers of the SS genotype achieved remission less frequently and more frequently experienced side-effects.