[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.

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.

[Anxiety disorders in elderly patients: psychopathological characteristics, diagnosis, similarities and differences with anxious depression].

OBJECTIVE: There are two points of view on the relation between anxiety and depression: they are comorbid diseases or they are symptoms of the same disease. This inconsistency complicates the diagnosis of anxiety and depressive disorders in clinical practice, in particular in elderly patients. We attempted to study the nosological structure of anxiety states in elderly patients and work out recommendations on differential diagnosis of anxiety disorders and depressions. MATERIAL AND METHODS: A main group included 80 elderly patients with anxiety disorders, 80 patients with anxious depression were enrolled in comparison group. These groups were selected on the basis of the primary diagnosis made before enrollment patients into the study. RESULTS: After the detailed examination of patients with anxiety disorders, the diagnosis has been changed in 67.5% of patients. Symptoms of all patients with hypochondriac, somatisized and somatoform pain disorders were corresponded to atypical anxious depression. Duration and severity of psychogenic disorders of adaptation and acute reactions to stress were also corresponded to the diagnosis of depression. All patients with obsessive-compulsive disorders had typical symptoms of neurosis-like schizophrenia, these patients were excluded from the study. After the revision of diagnoses, the group with anxiety disorders comprised 26 patients and the group with depression increased up to 131 patients. A between-group comparison of clinical/anamnesis data showed that mean age of patients with depression (59.7 years) was significantly higher than that of patients with anxiety disorders (56 years). Levels of anxiety measured with the Hamilton scale (HAM-A) were similar in both groups. MADRS scores were significantly higher in the depression group (27.9) compared to patients with anxiety disorders (16.5). CONCLUSION: The most frequent diagnoses that mask depression in elderly people are hypochondriac, somatisized and somatoform pain disorders as well as acute reactions to stress and disorders of adaptation. Somatoform autonomic dysfunction and agoraphobia are less frequent diagnoses. Clinical-psychopathological examination of elderly patients with these disorders requires a careful search for symptoms of a possible atypical depression. Definite diagnosis is necessary for adequate treatment.

[Hypochondriac symptoms in late-onset depression: the relationship between hypochondria and somatic state of patients].

Authors studied 276 women with late-onset depression. Concomitant chronic somatic diseases were identified in 90%. The presence of disease and its nosological definition did not impact on the development of hypochondriac symptoms in patients with late-onset depression. Patients with hypochondriac late-onset depression more often had disability pension due to somatic disease because they more often referred to internists in case of similar objective severity of somatic pathology. It was singled out three variants of the relationship between hypochondria and somatic state: hypernosognostic (a complete coincidence of hypochondria content with actual somatic pathology; anosognostic (a lack of coincidence) and disharmonic (a partial coincidence). The themes of hypochondria in late-nset depressions were correlated with a total number of somatic diseases and their severity. At the same time, there was no correlation between the content of hypochondria and the character of somatic disease.

[Effectiveness of psychopharmacotherapy of late hypochondriac depression].

Hypochondriac depression is typical for elderly people and is difficult to treat. An aim of the study was to estimate the effect of hypochondriac symptoms on the effectiveness of psychopharmacotherapy of late depression. It has been shown that psychopharmacotherapy of late depression with hypochondriac symptoms is significantly less effective than that of depression without such symptoms. Some predictors of psychopharmacotherapy effectiveness were identified. Many prognostically significant factors were consistent with those found earlier for late depression. The nosological attribution of depression without hypochondria to bipolar affective disorder may explain better effectiveness of its psychopharmacotherapy.

[Depression in patients with chronic hepatitis C during the antiviral treatment: a clinical and psychopathological qualification and a nosological interpretation].

Authors studied 160 patients with chronic hepatitis C on antiviral treatment. Depressive disorders developed in 85 patients. Clinical and pharmacotherapeutic features of depression were specified. Predictors for the prevalence, structure and severity of the depressive syndrome were found. The clinical and demographic heterogeneity of depressions was identified. The results of the clinical and statistical analysis allow to specify the nosological qualification of these depressions, to optimize diagnostic and treatment algorithms and to make more effective treatment of the main disease (chronic hepatitis C).

[Late-onset depression and a new psychometric scale for its clinical evaluation].

The most of existed psychometric scales for depression have some shortcomings hampering their use in old patients. The authors worked out the original scale for clinical evaluation of symptoms of late-onset depression. The list of symptoms was made up basing on literature data. The most significant symptoms that characterized the structure and severity of depression in old patients were singled out. According to results of factor analyses they were combined in the groups forming the corresponding items of the scale. In addition, some symptoms with particular clinical significance for late-onset depression (suicidal thoughts, senesto-hypochondriac symptoms, insight) were singled out. The scale comprises 13 items with scores from -6 to +6. It can be implemented for symptom screening, clinical diagnosis and rating, including dynamics of depression in elderly patients.

[Depressive disorders in elderly patients: an attempt of psychometric assessment with the Montgomery-Asberg Depression Rating Scale].

The objectives of this paper were to choose a psychometric scale that meets requirements for "comparison standard" in elaboration of new methods for psychometric assessment of late depression and to evaluate distortion of results for standard scale used in elderly patients. Based on the literature analysis, authors chosed the Montgomery-Asberg Depression Rating Scale (MADRS) as an etalon. The comparative analysis of MADRS scores and results of psychopathological evaluation revealed distortions of MADRS scores related to elder age. Qualitative and quantitative distortions were assessed for every MADRS item and for the total score. The analysis of separate components revealed that 7 out of 10 MADRS items were significantly changed and correlated with the age of patients while the total score did not change. This allows to use MADRS total score in further studies without any corrections. Application of the MADRS as a comparative scale in the symptomatic analysis of late depression needs the use of correction coefficients.

[The cluster analysis of depression symptoms in elderly patients].

The vast number of clinical and psychopathological studies of depression in elderly patients is based on the simple description of symptoms. In the present paper, authors studied clinical and psychopathological symptoms of depression in elderly people using statistical cluster analysis. Four main clusters of psychopathological symptoms were singled out. The further cluster analysis revealed significant between-group differences in clinical and anamnesis information that were not included in the analysis. Based on this finding, we proposed that each cluster reflected a specific clinical type of depression in the old age. The atypical combination within each type did not allow to identify definitely the nosological attribution of depression according to current classifications. In conclusion, the study of the psychopathology of depression in elderly people using methods of multivariate statistics makes it possible to find new clinical variants of these disorders that may improve diagnosis and allow for differentiation of treatment.

[The optimization of the late-life depression assessment scale and recommendations for its practical use].

The authors elaborated earlier the late-life depression assessment scale (version 1.0) which proved to be effective for the diagnosis and description of the structure and severity of depression in elderly patients. In this paper, they have improved this scale by adding corrections in the scale structure and dimensionality of assessment items. The retrospective analysis of primary symptoms assessed by the scale revealed that items with negative scores reflected the signs of the psychorganic syndrome and are not associated with the psychopathology of depression. The exclusion of these symptoms allow to shorten the scale and to use the same dimensionality to make it easier to use the scale in clinical and research practice. A trial of the new version (1.2) of the scale indicated its diagnostic effectiveness and the ability to measure correctly the depression's severity and changes in the status of elderly patients.

[The experience of using the atypical antipsychotic sertindole in psychiatric inpatient clinics in Russia].

One hundred and fifty psychiatrists from 61 clinics of 30 cities located in 8 regions of the Russian Federation took part in the study. The study included 896 patients treated with sertindole. The duration of illness was from 1 month to 50 years (mean 9,55 ± 8,21), a number of previous relapses varied from 0 to 20 and more (mean 5,79 ± 6,68). Each patient was followed up for 6 weeks. Patient's state was assessed clinically and with the CGI. The statistically significant improvement was seen from the first week of treatment and the percentage of patients with marked mental disorders was constantly decreased from the first to the 6th week. It has been concluded that sertindole is an effective drug for stopping psychotic symptoms in the real practice of treatment of schizophrenic patients. It is well-tolerated and allows to reduce a number of concurrent drugs used for treatment.

[Treatment of depression after stopping acute psychosis in patients with schizophrenia].

The aim was to study the efficacy of different groups of neuroleptics and antidepressants in the treatment of depression after stopping acute psychosis in schizophrenic patients. Authors observed 183 patients during the treatment using a psychopathological method and a battery of psychometric scales for assessing patient's state, structure of psychopathological syndrome and side-effects of the drugs. Correlation analysis was applied to compare treatment characteristics with the dynamics of disease course (favorable or less favorable) during 8 years. We used 13 antipsychotic drugs, including depot drugs, and 15 antidepressants. In conclusion, the additional and strictly differentiated prescription of antidepressants in the treatment of schizophrenic patients with depressive symptoms after stopping acute psychosis is effective and safe. It allows to improve quality of life and prognosis of patients.

[Antiviral therapy in a patient with chronic hepatitis C, metabolic syndrome and interferon-induced depression].

A case of metabolic syndrome is reported in which its elimination before the onset of antiviral treatment of chronic hepatitis A and drug therapy of subsequent depression promoted successful outcome with a stable virological response. Modern approaches are discussed to enhancing efficiency of antiviral therapy by active correction of factors responsible for poor results of the treatment and its undesirable consequences.

[Depressions in schizophrenic patients after the management of acute psychosis].

The study of depressions in 183 schizophrenic patients after the management of acute psychosis included evaluation of depressive symptoms, their relation to other psychopathologic syndromes, and the efficiency of drug therapy. The Calgary scale (CDSS) was used to assess severity of depression in schizophrenia along with other standardized psychometric scales to characterize general psychopathologic, positive, and negative symptoms, locomotor disturbances, other concomitant disorders, and general clinical picture. The predominance of depressive conditions with adynamic symptoms was documented. The majority of depressions occurred after the first attack. Those developing in the early post-attack period differed from depressions within a few months after the reduction of psychosis. Syndromic nature of depressions was evident from the number of psychotic episodes experienced by the patients. Depressive symptoms that developed after the management of the acute psychotic state could be efficiently and safely relieved by additional differential treatment with antidepressants. Depressive symptoms in schizophrenia are not predictors of poor prognosis provided the patient receives adequate therapy. More attention is needed to identification and adequate treatment of depression in schizophrenia. Optimized therapy of affective disorders in schizophrenic patients permits to improve prognosis of the disease.

[Depression in schizophrenia].

Investigations with the use of the Calgary Depression scale for schizophrenia and standardized psychometric scales revealed depression in the acute psychotic phase of the disease in 198 patients and depressive syndrome in 148 ones in the postpsychotic phase. The phase of schizophrenia (acute or postpsychotic) influenced the choice of antidepressive therapy. Depressive syndrome during the acute phase of schizophrenia was the integral part of a psychotic episode. Manifestations of depressive symptoms correlated with the severity of positive symptoms. Depression was responsive to antipsychotic monotherapy using conventional and unconventional agents. Depression with adynamic symptoms was especially frequent in the postpsychotic phase of schizophrenia. Depressions usually developed after the first episode of schizophrenia. Those observed immediately after a psychotic episode differed from depressions following prolonged therapy. The structure of depressive syndrome was influenced by the number of previous psychotic episodes The combination of antipsychotics and antidepressants was effective in the treatment of depressive symptoms in schizophrenic patients during the postpsychotic phase. The presence of depression in case of proper therapy is not a predictor of poor prognosis. Recognition and adequate treatment of depression in schizophrenia require greater attention. Optimized control of mood disorders accompanying schizophrenia increases the possibility to improve the clinical outcome.

[Depressive disturbances during antiviral therapy in patients with type C hepatitis].

The article presents the results of a clinico-psychopathological study of depressive disorder (DD) in 91 patients with chronic C hepatitis and no psychiatric background during combined antiviral therapy (AVT) with interferon-alpha (IFN-alpha) and ribavirin. Depression developed in 39 or 43% of the patients. Moderate or severe depressions (46% and 31%, respectively) prevailed. Clinical features that were different in cases of IFNa-induced depression and endogenous DD were revealed. The severity of depression did not correlate with the severity of the underlying disease, the duration of AVT, and the type of used. The antidepressants and remeron proved to be effective in treatment of IFN-alpha-induced depressions. In all cases, treatment with antidepressants made it possible to carry out complete AVT.

[Differentiated approach to the therapy of endogenous anxious depression].

The paper presents a study devoted to endogenous depression with a pronounced element of anxiety. The subjects, 66 patients, received antidepresive therapy with either amitriptyline or remeron. The study lasted 6 months, during which the symptoms were assessed using Hamilton Depression and Anxiety Scales. Three variants of anxious depressive conditions were revealed: anxious melancholic, anxious hypochondriac and anxious adynamic ones. Amitriptyline proved to be more efficient in treatment of patients with anxious melancholic depression. No difference in time to and the degree of symptom reduction was observed between amitriptyline and remeron in patients with anxious adynamic depression. Remeron proved to be more efficient in patients with anxious hypochondriac depression.

[New data on sensibilizing therapy of alcoholic dependence]. / Novye dannye o sensibiliziruiushchei terapii alkogol'noi zavisimosti.

Lidevine was used in the treatment of 29 patients with chronic alcoholism with unsatisfactory results of previous therapy. The drug was included in the complex therapy at the stage of developing therapeutic remission and during a long-term (1 year) antirelapse treatment. Remission of 1-year duration was achieved in 12 (41%) patients. Use of lidevine contributes to remission stabilization and prevents development of alcoholism relapse after a single "break down". The importance of lidevine assignment in combination with psychopharmacological drugs reducing a drive for alcohol (antidepressants, anticonvulsants-normotimics, neuroleptics with sedative action, etc.), and a need of continuous control of the relatives of the patient over the intake of sensibilazing drug are proved. Good tolerance to the medication is shown.