[Bipolar affective disorder occurring with psychopharmacotherapy-induced manic phases]. / Bipolyarnoe affektivnoe rasstroistvo s indutsirovannymi psikhofarmakoterapiei maniakal'nymi fazami.

To analyze the stages of development of the problem, identify the evolution of views and the main directions of current research in the field of bipolar affective disorder, which occurs with psychopharmacotherapy-induced manic phases, the search for publications by keywords «pharmaco-induced mania¼", «bipolar affective disorder¼ was carried out in the PubMed/MEDLINE, Russian Citation index and other sources from the mid-19th century to the present. The issue of adequate treatment of bipolar depression became relevant back in the 20th century; numerous observations indicated the presence of associated risks when using antidepressants in patients with bipolar affective disorder, namely, the likelihood of affect inversion and aggravation of the course of the disease (accelerated cyclicity, continuum). In recent years, due to the expansion of research capabilities and the introduction of biological psychiatry, works have appeared that consider this problem from both clinical and pharmacodynamic, genetic and neurophysiological aspects, which opens up the prospect of developing advanced methods of personalized medicine for the diagnosis and treatment of bipolar disorder, taking into account the need to minimize iatrogenic effects.

[Peculiarities of the dynamics of eating disorders in the structure of depressive states]. / Osobennosti dinamiki narushenii pishchevogo povedeniya v strukture depressivnykh sostoyanii.

OBJECTIVE: To determine the main trajectories of the association between eating disorders (ED) and depressive symptoms and their impact on the quality of the prognosis of the disease as a whole. MATERIAL AND METHODS: A total sample included 59 female patients, aged 15 to 25 years (average age 16.2+0.9), who were under outpatient and inpatient observation in the department for the study of endogenous mental disorders and affective states in the clinic at the Mental Health Research Center. RESULTS: The authors identified variants of the main trajectories of the association between ED and depression, taking into account the role and place of ED and interdependence with depressive symptoms. The following variants have been established: with a stable (44.0%, n=26), labile type of dynamics (25.0%, n=19) and dynamics according to the type of selective dissociation (22.4%, n=14). CONCLUSION: The study allows us to assume the development of fundamentally different trajectories of the conjugation of eating behavior and depression, showing prognostic capacity and different tropism for therapeutic interventions.

[The impact of depression symptoms on postmorbid adaptation of patients who have undergone SARS-CoV-2 infection (assessment from the position of the multimorbidity model)]. / Vliyanie simptomov depressii na postmorbidnuyu adaptatsiyu patsientov, perenesshikh SARS-CoV-2-infektsiyu (otsenka s pozitsii modeli mul'timorbidnosti).

OBJECTIVE: To evaluate the impact of psychosomatic and anxiety symptoms of depression on the formation of postmorbid adaptation in patients who have undergone SARS-CoV-2 infection. MATERIAL AND METHODS: The data of 54 patients, aged 18-55 years, with a current depressive episode who had outpatient SARS-CoV-2 infection were analyzed. The Hamilton depression rating scale (HDRS) was used and somatic condition was assessed using a general assessment of the patient's function limitation at the stage of reconvalescence. A linear regression analysis was performed to assess the association of psychosomatic and anxiety symptoms with somatic condition in SARS-CoV-2 infection, regardless of other factors. RESULTS: The multimorbidity model took into account, in addition to SARS-CoV-2 caused by organic somatic disorders, psychosomatic manifestations (B=-1.9, p=0.004) and anxiety (B=-3.7, p=0.04) symptoms of depression. Somatic anxiety was significantly correlated with a pronounced impairment of postmorbid readaptation (p<0.05), while mental anxiety did not demonstrate such a relationship (p=0.46). The observed trend seems to be due to the overlap of manifestations of somatic anxiety with the construct of residual somatic symptoms, even though there is no multicollinearity between them. CONCLUSION: Identification of clusters of symptoms associated with reduced opportunities for full recovery in the SARS-CoV-2-postmorbid period can significantly help in providing a high-quality and targeted psychopharmacological care.

[Clinical and therapeutic perspectives of agomelatine (valdoxan) in the treatment of anhedonia in patients with endogenous depressions].

OBJECTIVE: To analyze the therapeutic effect of valdoxan on symptoms of anhedonia in patients with endogenous depressions and to develop indications for its use. MATERIAL AND METHODS: Authors examined 30 women, mean age 35,9 years with anhedonic depression (ICD-10 items F31.3-4, F33.1-2, F20.4). Valdoxan was administered in average daily dose from 25.8 to 45.8 mg during 30 days. Patient's status was assessed on 0, 7, 14 and 30th days, using clinical and psychometric (HAMD-21, HADS, SHAPS and UKU scales) methods. The reduction of scores was used as a measure of therapeutic effect designated as «mild¼, «moderate¼, «good¼ and «marked¼. RESULTS: Antianhedonic effect of valdoxan on 30th day was superior to thymoleptic and anxiolytic effects of this drug (91.5 versus 82.2 and 76.9%). The marked effect was identified already on 14th day and enhanced to 30th day. The best effect was seen in depression of moderate severity. Single autonomic side-effects of the treatment were observed. CONCLUSION: The course treatment of anhedonic depressions with valdoxan should be considered as preferable and highly effective method that provides a dominative antianhedonic effect in the spectrum of antidepressive properties of the drug. Good and marked effects have been achieved in 96.7% of patients. The intensity and rate of its formation, good tolerability allow to tailor indications of valdoxan basing on the psychopathological characteristics of gedonic disorders.

[Psychopathological features of chronic apathetic depressions in schizophrenia]. / Psikhopatologicheskie osobennosti khronicheskikh apaticheskikh depressii pri shizofrenii.

OBJECTIVE: To study the features of apathetic phenomena developed in chronic depressions in patients with attack-like schizophrenia. MATERIAL AND METHODS: Psychopathological features of chronic apathetic depressions in schizophrenia (19 patients) were compared to attack-like depressions in affective disorders (n=25) and schizophrenia with distinct apathetic depressions (n=17). RESULTS AND CONCLUSION: Clinical features of the main cases and their differences from comparison groups have been identified. The influence of endogenous progressive disease on clinical and dynamic features of chronic apathetic depressions is discussed.

[The changes of EEG correlation synchrony at depressive disorder of psychogenic type].

In this work we use the alternative method of assessing the EEG-synchrony which previously has proved its high sensitivity to the differentiation of psychopathological and functional states. The original recording of EEG had been performed in the state of quiet wakefulness with eyes closed for two groups of examinees/patients at the age of 49-82 years: a group of normal subjects (n = 29) and the group of subjects with depressive deviations of F43.21 category according to ICD-10 (n = 51). As a result of research it is received the comprehensive picture of significant topographical, interhemispheric and regional differences between groups of norm and depression. One of basic features of the obtained integrated picture is existence at a depression of the extended zones of reduced EEG-synchrony covering the entire premedial region in the frontal-occiptal direction, including intrahemispheric connections as well as lateral frontal-temporal connections in both hemispheres. It testifies to the deep deprivation with depression frontal-occipital and interhemispheric interaction. As a compensatory reaction during depression the increase of synchrony in axial aimed intrahemispheric pairs of derivations. It is noted the similarity of changes in EEG-synchrony topography of depression to those observed in schizophrenia. The used method has provided close to 100% reliability of the classification of the EEG norms and depressive deviations, which makes possible and promising its use as an auxiliary quantitative differential indicator.

[EEG-correlates of frontal dysfunction as predictors of relative pharmacoresistance in treatment of endogenous affective disorders].

OBJECTIVE: To analyze background EEG parameters correlated with frontal lobe dysfunction, that might be considered, prospectively, as individual predictors of relative pharmacoresistance (or relatively lower treatment efficacy) in different forms of endogenous affective disorders. MATERIAL AND METHODS: An analysis of a set of several EEG parameters and quantitative clinical assessments has been carried out during the treatment in patients with endogenous depression (group 1), depressive-delusional conditions in the frames of attack-like schizophrenia (group 2), and manic-delusional conditions in the frames of attack-like schizophrenia (group 3). RESULTS AND CONCLUSION: Statistically significant correlations have been revealed between initial (before treatment course) values of narrow-band EEG spectral power (mainly of beta activity reflected the frontal lobe dysfunction and hyper-activation of brain stem structures) and quantitative clinical assessments of patient's conditions at remission stage. The data obtained allow to justify the basic considerations on the brain mechanisms of different affective disorders, and to reveal possible neurophysiologic predictors of relative pharmacoresistance (or relatively lower treatment efficacy) in patients with endogenous affective disorders.

[EEG-correlates and possible predictors of efficacy of treatment of endogenous depression].

An analysis of EEG spectral power values and of quantitative clinical scores of depressive conditions has been carried out in dynamics of treatment in 40 patients with endogenous depression with the main goal to study neurophysiologic correlates and to search possible predictors of therapeutic outcome. The reduction of depressive symptoms by the end of the treatment course was associated with EEG signs of improvement of brain functional state. Significant correlations have been revealed between the EEG narrow-band spectral power values and clinical scores. As well, significant correlations have been revealed between some initial (before beginning of treatment) EEG parameters and quantitative clinical scores at the stage of remission establishing. The values of EEG beta-1 and beta-2 spectral power appeared to be such predictors, while initially larger values of EEG beta activity spectral power were associated with higher pronounce of residual depressive symptoms after the treatment course. The data obtained allow to justify basic views on brain mechanisms of various aspects of depressive disorders, and to reveal possible neurophysiological predictors of efficacy of treatment of endogenous depression.

[Dynamics and relationships of parameters of cognitive evoked potentials and sensorimotor reactions in the treatment of apathic depression].

The aim of the study was to investigate the neurophysiologic bases of impairments of motor and some cognitive functions in apathic depression using neurophysiologic and psychophysiologic methods together with clinical assessment of patient's conditions in the dynamics of treatment. Latencies of main components of auditory cognitive evoked potentials (EP) as well as latencies of simple sensorimotor reaction and of two-alternative choice reaction to auditory stimuli have been analyzed. The significant decrease of mean values of the P3 component of auditory cognitive EP in comparison with baseline (before beginning of treatment) level has been noted in patients at the stage of pronounced clinical improvement while latencies of N1, P2 and N2 components have not changed significantly. The mean values of latencies of both simple sensorimotor reaction and of two-alternative choice reaction have been decreased as well. The peculiarities of correlations between clinical indices of depression severity and values of latencies of components of cognitive EP in left and right hemispheric leads in patients with apathic depression indicate the relationship of depression severity with impairment of functional state of the left hemisphere and with activation of the right hemisphere that is in good concordance with contemporary views on the dominant role of the right brain hemisphere in the pathogenesis of depression.

[Changes in EEG and reaction time in the treatment of apathic depression].

The aim of the study was to reveal changes in the brain's functional state of patients with apathic depression, aged 20-51 years, during the treatment. Spectral parameters of background EEG as well as latencies of simple sensorimotor reaction and of two-alternative choice reaction to auditory stimuli have been analyzed. The complex reorganization of EEG spatial-frequency structure at the stage of pronounced clinical improvement was noticed. It included the EEG signs of the facilitation of inhibitory processes (seen as the increase of slow wave delta, theta-1 and theta-2 spectral power) mainly in frontal, central and temporal areas of the right hemisphere; the EEG signs of decreased activation of temporal areas (seen as the decrease of beta spectral power mainly in the right hemisphere), as well as the EEG signs of increased activation of anterior cortical areas by excitatory brain stem reticular structures (seen as the increase of beta spectral power in left frontal and central zones). The mean values of latencies of both simple sensorimotor reaction and of two-alternative choice reaction have been decreased as well. The data obtained are in line with contemporary views on the predominant role of the right hemisphere in the regulation of negative emotions and in the pathogenesis of depression.

[Clinical and psychopathological aspects of endogenous apathetic depressions].

The study included 45 patients with endogenous apathetic depressions differing in clinical picture and psychopathological structure. Typological classification of these depressions into 3 variants dominated by decreased interests, initiative or will is proposed. The problem of nosological identification of apathetic depressions is discussed. Dynamics of these conditions in the structure of endogenous affective diseases and paroxysmal progredient schizophrenia is described.

Double shell liners as an active medium for x-ray lasers.

The operation of x-ray lasers has been successfully demonstrated in laser-produced plasmas. Pulsed-power-driven plasmas of imploding liners offer potentially higher overall efficiencies and less expensive drivers as compared with laser-produced plasmas. Stabilization of a liner implosion is the main problem to be solved to achieve x-ray lasing in liners. Stable liner implosions can be obtained using some methods of liner stabilization. A helical driving magnetic field, a double shell liner structure, and initial axial magnetic field were used to stabilize liner implosions on the SNOP-3 generator (Imax ≃ 1.1 MA, τ ≃ 100 ns). Using a capillary discharge in Fe2O3 to form the inner shell, a stable pinch of iron-bearing plasma with a diameter 150-200 µm and an ion density of (2-4) × 1020 cm-3 was observed. Comparison with theoretical calculations shows that it is possible to create conditions conducive to lasing in neon-like iron using double shell liner implosions On the SNOP-3 generator.

[Surgical treatment of total forms of chronic osteomyelitis of the femur in children]. / Khirurgicheskoe lechenie total'nykh form khronicheskogo osteomielita bedrennoi kosti u detei.

In the article is described a new method of treatment of chronic hematogenic osteomyelitis of femur in children in case of its total affection. The essence of the method consists in making a longitudinal groove along the whole length of a bone by means of chisels and milling cutters till the medullar canal is reached and removal of pus, sequesters, pathologic granulations and zones of excessive osteosclerosis. The cavity after bathing is subjected to ultrasound cavitation; fibrinous film and gauze plastrons, impregnated with hemostatic sponge, are placed in it with the proximal and distal ends connection to the tubular drainage in order to ensure permanent lavage of cavity with antiseptic solution and active vacuum aspiration of its content with the subsequent application of sutures on the wound, tight bandaging of a limb and its immobilization. 6 patients have been subjected to treatment by this method with good outcomes in all cases. The results have been followed through 2.5-8 years.