[Psychosocial pathomorphosis of depressions]. / Psikhosotsial'nyi patomorfoz depressii.

OBJECTIVE: The aim is to determine the changes in phenomenology of depressions (mostly of melancholic type with pronounced affect of sadness, chronobiological shift, neurovegetative changes and typical affect-congruent depressive ideas) over the past decades. MATERIAL AND METHODS: We've compared the archival data of one of the authors (V.N.K.) obtained in the study of depression within 1980-1086 years (1st group, 103 patients, 47 with recurrent depression and 56 with bipolar depression) and the data of the study of depression during 2015-2021 years with registration of symptoms with the same psychopathological scale at the same clinic for affective disorders (2nd group, 109 patients, 52 with recurrent depression and 57 with bipolar depression). The groups are age-comparable (21-59 y.o.). The Hamilton Depression Rating Scale (HDRS-17) has been used to assess the severity of depression (score of 21-32 in both groups). Statistics included frequency analysis with use of χ2 criterion. RESULTS: Biologically mediated symptoms (shortened sleep with early awakening, typical diurnal variations with vitalization of depressive affect and loss of energy mostly first half of day, decreased appetite, libido and motivation for any activity) were not statistically different in the study groups. Whereas symptoms associated with emotional reactivity and congruent depressive ideations like worthlessness, guilt, suicidal thoughts, as well as anaesthesia psychica dolorosa - were statistically rare in 2nd group, except anhedonia. The same time the facts which have been obvious amongst patients of 2nd group were the difficulties to verbalize their feelings, shortage of vocabular for reflections about their suffering, especially amongst young patients. CONCLUSION: The results of the study can indicate some changes in the phenomenology of depression over the past decades. Basically, the same underlying disorders can produce different clinical presentation, particularly concerning an awareness and verbalization of moral feelings and other emotions. One of the possible psycholinguistic assumption may be limited vocabulary for feelings because of spreading social networks with very poor and formal language instead of live direct communication.

[Steadfastly increased level of the ciliary neurotrophic factor in the blood serum within the positive therapeutic dynamics of depression as possible prognostic marker of depressive relapse]. / Ustoichivoe povyshenie urovnya tsiliarnogo neirotroficheskogo faktora v syvorotke krovi pri polozhitel'noi terapevticheskoi dinamike depressii kak veroyatnyi prognosticheskii marker retsidiva depressivnogo epizoda.

OBJECTIVE: To study a role of the ciliary neurotrophic factor (CNTF) in the pathogenesis of depression and its prognostic significance in dynamics of the antidepressant therapy. MATERIAL AND METHODS: CNTF level was investigated in the blood serum of patients with melancholic depression (n=32) before the start of therapy and after 30 days, when improvement was achieved by at least 75% of baseline scores on the Hamilton Depression Rating Scale. RESULTS: Steadfastly increased level of CNTF in the blood serum of patients with melancholic depression compared with the control, remaining practically unchanged with an obvious improvement in the condition - 732.2±126.5 and 679.1±63.1 pg/ml of serum, respectively (p>0.05). CONCLUSION: The initially elevated level of CNTP indicates its probable significance in the pathogenesis of depression; persistently high serum CNTP level, despite clinical improvement during therapy, can serve as a predictor of the stability of the biological mechanisms of recurrent depressive disorder with a continuing risk of another relapse of a depressive episode.

[Mental disorders and cognitive impairment in patients with antiphospholipid syndrome].

Mental disorders (mainly anxiety and depressive disorders) and cognitive impairment are often found in patients with antiphospholipid syndrome (APS), but their prevalence, structure, and mechanisms of occurrence are not well researched. The review provides literature data on the frequency, spectrum and possible causes of mental disorders and cognitive impairment in patients with APS, the pathogenetic mechanisms of these disorders (in particular, the important role of antiphospholipid antibodies, stress factors, chronic inflammation), the relationship between APS, mental disorders and as well as cognitive impairment is examined. Special attention is paid to the influence of mental disorders and cognitive impairment on patients adherence to treatment, their quality of life, as well as the particularities of psychopharmacotherapy of mental disorders in patients with APS. The aim of the review is to actualize the interdisciplinary problem of mental disorders and cognitive impairment in patients with APS and the need to introduce a partnership model of care.

[Chronic pain and depression in patients with rheumatoid arthritis: results of five - year follow - up].

The aim of the study was to analyze the factors affecting chronic pain in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: 128 patients with reliable diagnosis of RA [111 (86.7%) women and 17 (13.3%) men] were examined. The mean age of patients was 47.4±11.3 years, the median duration of the disease was 96 [48; 228] months. When included in the study in most patients, the activity of RA in DAS28 was moderate (n=56; 43.7%) or high (n=48; 37.5%). BPI (Brief Pain Inventory) scale was used to determine the severity of pain and its impact on various aspects of life. The anxiety - depressive spectrum disorders (ADDs) were diagnosed by psychiatrist during a semistructured interview according to ICD-10 criteria in 123 (96.1%) patients. The severity of depression was determined by the Montgomery-Asberg depression rating scale, anxiety - by Hamilton anxiety scale. For the diagnosis of cognitive impairment used clinical and psychological techniques. Psychopharmacotherapy (PPhT) by antidepressants or anxiolytics is offered to all patients with ADDs, 52 of them agreed to treatment, 71 patients refused. The next groups selected depending on the therapy: 1st - with conventional disease - modifying antirheumatic drugs (cDMARDs; n=39), 2nd - with cDMARDs+PPhT (n=43), 3d - with cDMARDs + biologic (b) DMARDs (n=32), 4th - with cDMARD+bDMARDs+PPhT (n=9). The dynamics of ADDs and outcomes of RA in 5 years were evaluated in 83 (67.5%) patients. RESULTS: When included in the study, 94 (75.2%) patients with RA had moderate and severe pain. According to the regression analysis, the maximum intensity pain in BPImax after 5 years of follow - up associated not the only factors connected with RA - high DAS28, the serum level of C-reactive protein, the degree of radiological stage and functional insufficiency, duration of RA and a lesser duration of glucocorticoids intake, but also with continuing depressive episodes in the framework of recurrent depression and the initial presence of cognitive impairment. The severity of pain after 5 years of follow - up was higher in RA patients receiving only сDMARDs, without the use of bDMARDs and in the absence of PPhT associated with ADDs. CONCLUSION: Depressive episode within recurrent major depression is a significant factor in the chronicity of pain in patients with RA. Timely effective PPhT of depression, selected taking into account depression structure and personal characteristics of the patient, leads to a steady decrease in the severity of pain in patients with RA.

Comparative analysis of anxiety-depressive spectrum disorders in patients with rheumatic diseases.

AIM: Research objective - comparative analysis of incidence and structure of anxiety-depressive spectrum disorders (ADD) in patients with various rheumatic diseases (RD). MATERIALS AND METHODS: 613 patients with RD were enrolled in the study: 180 with a reliable diagnosis of systemic lupus erythematosus (SLE), 128 with rheumatoid arthritis (RA), 110 with systemic sclerosis (SSc), 115 with Behcet's disease (BD), 80 with primary Sjögren's syndrome (pSS). Female prevailed in all groups (95% of patients with pSS, 88,2% - SSc, 87,2% - RA, 85,5% of SLE) except BD patients (70% male). The mean age was 42.3±1.54 years and was lower in patients with BD (33.3±0.98 years) and SLE (34.6±0.93 years) compared to patients with SSc (49.9±2.47 years), RA (47.4±0.99 years) and pSS (46.2±2.3 years). The mean RD duration was 130,0±8,65 months and was more at BD - 148,5±10,4 months, pSS - 141,6±8,92 months, RA - 138,4±10,1months, and less at SLE - 134,9±8,8 months and SSc - 87,0±5,04 months. The mean SLE activity index SLEDAI was 9,13±0,63 points (high), RA (DAS28) - 5,26±0,17 points (high), BD (BDCAF) - 3,79±0,2 points (moderate) and SSc by G. Valentini - 1,1±0,20 points (moderate). Glucocorticoids took 100% of patients with pSS, 91,1% - SLE, 90% - SSc, 87% - BD and 67,2% - RA patients; conventional disease modifying anti-rheumatic drugs (cDMARDs) took 90% of patients with SSc, 84% - BD, 79,6% - RA, 68% - pSS, 40,6% - SLE. Biologic DMARDs took 32% of patients with RA, 17,4% - BD, 7,3% - SSc and 7,2% - SLE. Mental disorders were diagnosed by psychiatrist as a result of screening by the hospital anxiety and depression scale (HADS) and in semi-structured interview in accordance with the ICD-10/ DSM-IV. The severity of depression was evaluated by Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety - by Hamilton Anxiety Rating Scale (HAM-A). Projective psychological methods were used for cognitive impairment detection. RESULTS: Screening of depressive disorders (HADS-D≥8) was positive in 180 (29,4%) patients with RD, including 74 (41%) patients with SLE, 38 (35%) - SSc, 29 (23%) - RA, 23 (20%) - BD and 16 (20%) - pSS; anxiety disorders (HADS-A≥8) - in 272 (44,4%) patients, including 66 (52%) patients with RA, 40 (50%) - pSS, 77 (43%) - SLE, 45 (41%) - SSc and 44 (38%) - BD. In accordance with the ICD-10/ DSM-IV depressive disorders have been identified in 389 (63%) patients, including 94 (73%) patients with RA, 71 (64,5%) - SSc, 69 (60%) - BD, 90 (50%) - SLE and 39 (49%) - pSS; anxiety disorders - in 377 (61,5%) patients, including 20 (25%) patients with pSS, 44 (24,5%) - SLE, 29 (23%) - RA, 20 (17%) - BD and 7 (6,4%) - SSc. CONCLUSION: Anxiety-depressive spectrum disorders are typical for most patients with RA, SLE, SSc, pSS and BD. ADDs diagnosis in RD patients with the use of the HADS did not reveal a significant proportion. To obtain objective data on the frequency and structure of ADDs, psychopathological and clinical psychological diagnosis is necessary.

[Clinical/dynamic and epidemiological aspects of depressive disorders in the protracted emergency situation].

OBJECTIVE: Depressive disorders are one of the most frequent forms of mental pathology developed in protracted emergency situations. Depression develops independently or comorbid to posttraumatic stress disorder (PTSD). MATERIAL AND METHODS: Authors conducted a population study of the dynamics of depressive disorders in people lived in the area of combat actions in the Chechen Republic. The study included 1000 patients. It started in 2002 with a follow up period of 2 years (2004, 2006 and 2008). RESULTS AND CONCLUSION: Affective disorders of different severity were identified in 40% of the sample. The percentage of depressive disorders decreased with time since the acute phase of the emergency situation, though after 6 years remained significantly higher than in the control area without combat exposure. The issues of providing care to patients with affective disorders are considered.

[Publishing activity of Russian research institutes in the field of psychiatry and addictology in 2006-2013].

OBJECTIVE: To compare the publication activity of 6 psychiatric institutes based on the data from the Russian Citation Index (RCI). MATERIAL AND METHODS: Weighted average data of the last five years was selected for analysis: number of publications and citations per author, number of citations per publication, impact factor of journals published the papers. The analysis of the dynamics of publication activity and citations for the period of 2006-2013 for 6 institutes has been performed. RESULTS: The analysis shows that the Research Center of Mental Health of the Russian Academy of Medical Sciences (RAMS) is the leader among in publication activity in the field of "psychiatry and addiction medicine". In second place the Moscow Research Institute of Psychiatry and the National Research Center of Addictology. Then, by a large margin, are the Bechterev St.Peterburg Research Psycho-Neurological Institute, the Serbsky National Research Center of Social and Forensic Psychiatry and the Siberian Research Mental Health Institute of RAMS. CONCLUSION: RCI data is an important source of information regarding scientific activity of research institutes although the data should be interpreted with caution.

[Disturbance of serum albumin conformation in patients with melancholic depression]. / Narushenie konformatsii al'bumina syvorotki u bol'nykh melankholicheskoi depressiei.

OBJECTIVE: Conformational protein changes may be an important component of the disturbance of molecular processes in the development of pathological process in the body. We studied conformations of albumin molecule in the blood of patients with depression using biophysical -nanotechnical approach. MATERIAL AND METHODS: We examined 19 patients with depression and 25 healthy controls. Properties of serum albumin were compared in patients with typical melancholic depression and controls using spectroscopy (subnanosecond range) with K-35 fluorescent probe. RESULTS AND CONCLUSION: The properties of albumin binding sites in patients before and after treatment differed from those in controls. The authors suggest that it points to the changes in albumin molecule conformation that may influence the functional state of the protein. It has been suggested that these changes may be considered as biomarkers of pharmacotherapeutic efficacy.

[Clinical and pathogenetic relationships between immuno-inflammatory rheumatic diseases and psychic disorders].

Literature data and original observations have been used to develop the rationale for the necessity of studying psychic disorders (PD) in patients with immuno-inflammatory rheumatic diseases (RD), such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Special attention is given to the high frequency of disturbances of the anxiety and depression profile (DADP) in patients having RA and SLE with reference to the common provoking stress and pathogenic factors, clinical manifestations, and RD. Great importance is attributed to the degree of depression associated with inflammatory activity, pain intensity, fatigue, sleep disorders, severe functional insufficiency and low quality of life in the patients with RA and SLE. Special emphasis is laid on the influence of depression and stress factors on the survival and morality of patients with these pathologies, the necessity of their combined treatment with the participation of rheumatologists, psychiatrists and medical psychologists for the improvement of clinical course and prognosis of RD.

[Psychotraumatic factors and anxiety-depressive spectrum disorders in Behcet's disease: the interdisciplinary study].

OBJECTIVE: To determine the frequency and variants of anxiety-depressive spectrum disorders (ADSD) in Behcet's disease (BD) and the effects of psychotraumatic factors, personality and clinical symptoms of the rheumatic disease. MATERIAL AND METHODS: Authors examined 60 patients with confirmed BD diagnosis made according to ISGBD criteria. The degree of BD activity was assessed using BDCAF index. The disease severity was ranged according to Ch. Zouboulis classification. All patients underwent complex rheumatologic, psychopathologic and psychological examinations. Childhood psychological trauma and stress factors before BD were analyzed. RESULTS: Most of the patients (86.7%) were diagnosed with a wide spectrum of ICD-10 ADSD: dysthymia (33.3%), recurrent depressive disorders (28.3%) mild or moderate depressive episode (11.7%), generalized anxiety disorder (6.7%), adjustment disorder with anxiety-depressive syndrome (6.7%). Mental disorders were not identified only in 13.3% of patients. The frequency of cognitive impairment (CI) was 88.3%, including 42.7% with mild CI. BD activity, ADSD severity and as well as factors not-related to disease contributed to CI development and severity. Psychological trauma during childhood and adolescence were found in 35 (58.3%) of patients. BD with early onset was recorded more often in the group with psychological trauma at the age <7 years compared to the group without psychological trauma. Treatment adherence was noted in most patients (70%) with BD and ADSD. CONCLUSION: The results confirm the need of timely diagnosis and adequate treatment of ADSD in patients with BD to improve treatment adherence and prognosis of disease.

[The magnitude of fatigue and its association with depression, pain, and inflammatory activity in rheumatoid arthritis].

AIM: To analyze the rate of clinically significant fatigue and to search for its predictors in patients with rheumatoid arthritis (RA). SUBJECTS AND METHODS: The investigation included 95 patients with a valid RA diagnosis. The majority of the patients were women (87.4%); mean age was 46.7 +/- 1.2 years; mean disease duration was 135.5 +/- 11.6 months. The authors evaluated RA activity by the Disease Activity Score (DAS28), magnitude of fatigue by the Fatigue Severity Scale (FSS), that of pain by the Brief Pain Inventory, and functional status and quality of life by the Health Assessment Questionnaire and EQ-5D. A psychiatrist diagnosed mental disorders in accordance with ICD-10 and using the psychiatric and psychological scales and procedures. RESULTS: 80% of the patients felt clinically significant fatigue (FSS scores of > or = 4). Multivariate analysis yielded a prognostic model that made it possible to state that clinically significant fatigue was primarily associated with the magnitude of depression by the Hospital Anxiety and Depression Scale, the presence of a depressive episode, the duration of anxiety and depressive spectrum, the magnitude of pain (Ritchie index), DAS28, and the presence of osteoporosis. CONCLUSION: The presence and magnitude of depression along with the magnitude of pain are an important factor that influences the formation of fatigue in RA, which gives rise to evident functional failure and a low quality of life. Combination therapy for RA may be effective when mental disorders, mainly the anxiety and depressive spectrum, are timely diagnosed.

[Diurnal dynamics of the reactivity to stress-test in patients with depression].

The aim of the work was to study the responses to the stress-test (a threat of painful stimulation) in patients with depressive disorders during the day using encephalography with coherence analysis (COH). The difference in averaged records (stress test - background) over all cortical areas had positive values in the morning (from 8 to 10 am) and in the evening (from 4 to 6 pm) that reflected the generalized enhancement of the functional activity of cortical areas of both hemispheres. The highest value of the difference was observed in the left hemisphere in the morning hours, the lowest - in the right hemisphere in the evening records. The response to the stressful situation in the left hemisphere in the morning and in the evening varied. In the morning, the increased functional activity in frontal, middle- and posttemporal temporal EEG was observed while the weaker activity was seen in the central and occipital areas. In the evening, there was the diffuse increase in the functional activity.

[The changes in the autonomic regulation in depressive disorders of moderate severity].

The results of the study of autonomic dysregulation in anxious and anxious-melancholic endogenomorphic depression of moderate severity are presented. It was examined 36 patients with recurrent depression and depression episode (ICD-10). At functional rest, the reduction of total heart rate variability (HRV) with the maintenance of the balance of activity of sympathetic, parasympathetic and suprasegmental ergotropic systems is revealed. These data indicate a decline in adaptive potential of the organism, loss of "autonomic flexibility" and the reduced tolerance to ordinary stressors with an over-reaction to them. The orthostatic test decreases the parasympathetic reactivity, hyperactivates suprasegmental ergotropic systems and reduces the rate of activity of sympathoadrenal baroreflex mechanisms. These changes are exacerbated with patient's age, duration of affective disorder and number of depressive episodes. The changes in the functioning of regulatory systems (in particular, autonomic) in depression are quite stable, but the full recovery are not observed.

[Problems of current diagnosis of depression].

Diagnostic approaches to depression have been changed during last decades. The criteria of a depressive episode have become more formalized but too broad. Instead of a well-structured formulation of a depressive syndrome with universally recognized melancholic symptoms, psychiatrists have deal with the list of different features, sometimes controversial, which meet the formal criteria for "major depressive disorder". It is making possible to reveal a lot of typical and atypical depressive conditions, and to offer an aid for many people with mental health problems. At the same time, the absence of the strict clinical criteria didn't allow to "translate" modern instrumental findings into scientific understanding of depression and, further on, into practice.

[Diagnosis and treatment of anxiety-depressive disorders in patients with myocardial infarction].

The results of the study of psychopathological, somatic and functional characteristics of anxiety-depressive disorders in patients with acute myocardial infarction are presented. The authors confirmed the wide prevalence of these disorders in acute myocardial infarction and described the features of their diagnostics, dynamics and response to complex treatment. The impact of anxiety-depressive disorders on the clinical and functional state of the cardiovascular system and the dynamics of the patient's status due the concomitant anxiety-depressive disorder are considered.

[Cognitive impairment and anxiety-depressive disorders in patients with rheumatoid arthritis].

Data on the prevalence and features of cognitive impairment in patients with rheumatoid arthritis (RA) are presented. Cognitive impairment was noted in 66% of patients, it did not reach the threshold of dementia and met the diagnostic criteria for moderate cognitive impairment. Anxiety-depressive spectrum disorders were found in 94% patients. Cognitive impairment was associated with apathic affect and anxiety-depressive spectrum disorders (depressive episodes, dysthymia, and elevated anxiety). The impairment of thinking was correlated with the high to moderate inflammatory activity including non-joint RA symptoms, higher levels of proinflammatory cytokines and low doses of glucocorticoids. Cognitive impairment was not associated with the duration and character of standard treatment of RA and concomitant cardiovascular diseases.

[Diurnal changes of alpha-rhythm in endogenous depressions].

The aim of the study was to find the diurnal changes in the EEG alpha-activity in patients with endogenous depressions. Both morning and evening EEG records were characterized by the transition of modal value of leading rhythm into the lower frequency band (9-10 Hz versus 10-11 Hz in healthy people). The spectral power of alpha-rhythm was higher, especially in the occipital cortical areas, in the morning hours than in the evening. In the morning, the intrahemispheric differences in the alpha-rhythm power in occipital areas were leveled out while in the evening hours, the normalization of intrahemispheric balance with higher power of alpha-rhythm in the right occipital area was seen. A comparative analysis of mean values of coherence (COH) in cortical areas in patients revealed higher COH values in parietal-central areas of both hemispheres, as well as in frontal- and right middle temporal areas, in the morning compared to those in the evening. COH values were lower in the morning than in the evening in occipital and posterior temporal areas. The mean COH value of alpha-rhythm in the right hemisphere was higher compared to the left hemisphere both in the morning and in the evening.

[Changes of EEG coherence in different stages of the formation of the psychoorganic syndrome].

The group of liquidators of Chernobyl Nuclear Power Plant accident (n=170) with nonpsychotic mental disorders of exogenic-organic origin was studied. Patients were stratified into five groups on the basis of dominating symptoms in different stages of disorders: group 1 included patients with the prevalence of asthenic symptoms (n=104); group 2 - with the prevalence of autonomous disorders (n=37); group 3 - with the marked neurotic-like symptom complex (n=10); group 4 - with depressive symptoms (n=10); group 5 - with disturbances of cognitive function. The control group included 150 healthy people. Recording and mapping of coherence (COH) of the brain electrical activity was conducted using the apparatus-software complex for topographic mapping of brain electrical activity NEURO-CM (Russia) with the bandwidth from 0 to 40 Hz and the time constant of 0.3 sec. The EEG record was carried out monopolar from symmetrical cortical zones (10-20% scheme). Changes of COH were characterized by staging in patients compared to the controls. In the initial stage of disease, the integrative links were decreased in the temporal cortical zones of the left hemisphere. The reduction of functional activity in temporal-central cortical zones was found that might be the consequence of mesodiencephalic dysfunction. In the later stages, temporal zones of the right hemisphere were mostly affected. The parallel reinforcement of functional activity of occipital zones, in particular, the increase of 'long links' with frontal areas, was noted in the overall formation of the psychoorganic syndrome. This phenomenon may be considered as a compensatory mechanism when the phylogenetically older cortical zones, which are more resistant to pathological changes, become leaders in the realization of integrative brain activity during the development of a pathological state.

[Relationships between psychosomatics and somatopsychiatry in modern medicine].

Progress in many clinical disciplines and neurobiology for the last decades give reason to reconsider some fundamental provisions of psychosomatic medicine and its relationships with somatopsychiatry. The universally accepted biopsychosocial model of the disease as proposed by V.N.Bekhterev implies involvement of psychological and psychosocial factors at early stages of many forms of somatic pathology. Intricate interplay between somatic and psychic components is exemplified by correlation of cardiovascular disorders and depression. Depression is diagnosed in 17-27% of the patients with coronary heart disease undergoing coronary angiography and in 16-45% of the post-infarction cases. Frequency of depression/hypertensive disease comorbidity is estimated at 30%. Similarity of pathogenetic mechanisms of cardiovascular diseases and depressive states is due to stress as their common provoking factor. Another important aspect of the relationship between medicine and psychiatry (disregarded until recently) is high frequency of somatic disorders in psychiatric patients. Cooperation of psychiatrists and representatives of different medical disciplines in such areas as research and practical health care is needed to address this problem.