[Therapy of mental disorders in patients with hematological malignancies]. / Terapiya nepsikhoticheskikh psikhicheskikh rasstroistv u bol'nykh s zabolevaniyami sistemy krovi.

OBJECTIVE: To assess the possibilities of therapy with minimal effective doses (MED) of psychotropic drugs for mental disorders (MD) that manifest during the treatment of hematological malignancies (HM). MATERIAL AND METHODS: A prospective study was conducted at the National Medical Research Center for Hematology of the Russian Ministry of Health (Moscow), which included 204 (39.4%) men and 314 (60.6%) women (518 patients in total), aged 17 to 83 years (median 45 years), with various HM, in which the manifestation of MD occurred during the treatment of the underlying disease. To minimize the side-effects of psychotropic drugs and given the relatively mild level of MD, psychopharmacotherapy of patients was carried out mainly at MED. The severity of MD, manifested in patients, was assessed by the illness severity scale of the Clinical Global Impression (CGI) scale, and the effectiveness of the treatment was assessed by the improvement scale (CGI-I). RESULTS: Mainly mild (188, 36%) and moderately pronounced (270, 52%) MD were noted in patients with HM during the treatment of the underlying disease. Severe psychopathological disorders (60, 12%) were observed much less often. Because of psychopharmacotherapy with MED, patients experienced a very significant (97, 19%) and significant improvement (354, 68%) of their mental state, less often the improvement was regarded as minimal (67, 13%). Therefore, almost all patients showed a stable relief of MD; in 87% (95% CI 84-90) of patients, this improvement was significant. CONCLUSION: The tactics of treatment MD that manifest in patients with HM with MED of psychotropic drugs turned out to be therapeutically effective according to the results of the assessment on CGI scales.

[Adherence to treatment of hematological malignancies patients with anxiety and depression].

AIM: To establish the features of the influence of anxiety and depressive disorders on treatment adherence, as well as to clarify the factors associated with it in hematologic malignancies patients. MATERIALS AND METHODS: The study included 117 patients: 51 men and 66 women, aged 19 to 67 years, with Hodgkin's lymphoma - 88, acute lymphoblastic leukemia - 16 and aplastic anemia - 13 patients. Patients were examined by psychiatrist using the Brief Psychiatric Rating Scale, as well as some psychometric methods. RESULTS: Anxiety-depressive spectrum disorders were detected in 36 (40.9%) patients with Hodgkin's lymphoma and 8 (50%) with acute lymphoblastic leukemia, in the aplastic anemia group there were three (23.1%) of such patients. It was found that the average adherence to treatment was in 2/3 of patients, low and high - in the remaining 1/3 of patients. With medium and low adherence to treatment, the risk of adverse events increases by an average of 1.7 times. The adherence to treatment it is significantly higher in patients older than 45 years. Signs of depression that negatively correlated with adherence to treatment were pessimism and disruption of social ties. Adherence to treatment significantly positively correlates with the following types of attitudes towards the disease: anosognosic, hypochondriac and egocentric, and significantly negatively correlates with the following types of attitudes towards the disease: anxious, melancholic and dysphoric. CONCLUSION: Anxiety/depressive disorders contribute to reduced adherence of hematologic malignancies patients to treatment. Their correction and increased adherence should be carried out jointly by hematologists and mental health professionals.

[Psychopharmacotherapy of mental disorders in hematological patients: security concerns]. / Psikhofarmakoterapiya psikhicheskikh rasstroistv u gematologicheskikh bol'nykh: problemy bezopasnosti.

OBJECTIVE: Evaluation of the safety of psychopharmacotherapy (PFT) of mental disorders in modern protocols for the treatment of patients with blood disorders. MATERIAL AND METHODS: The data of medical records of 552 patients with blood disorders who received PFT during treatment at the clinic of the National Medical Research Center for Hematology were analyzed. Any adverse events recorded while taking PFT were taken into account. Statistical analysis included descriptive statistics, frequency analysis, and assessment (Student's t-test) of changes in blood parameters (before and after taking psychotropic drugs). RESULTS: Signs of hematotoxicity were found only in 7.1% (n=37) patients, in all cases while taking benzodiazepines (n=12) in combination with hematotoxic drugs for the treatment of blood disorders. Other significant adverse events (which caused premature discontinuation or dose reduction) were detected in 4.8% (n=25) cases, of which 9 were associated with the appointment of anxiolytics (hydroxyzine, zopiclone), 11 with antidepressants (clomipramine, amitriptyline, duloxetine, trazodone, ademethionine) and 5 with antipsychotics (risperidone, alimemazine, haloperidol). CONCLUSION: Most psychotropic drugs are effective in relation to psychopathological disorders that develop in hematological patients and are safe when used at minimum/average therapeutic doses within the daily dosage ranges established by the official instructions for use.

[Predictors of severe lesions of the central nervous system in the treatment of blood system diseases]. / Prediktory tyazhelykh porazhenii tsentral'noi nervnoi sistemy pri lechenii zabolevanii sistemy krovi.

OBJECTIVE: To determine the types, frequency and key symptoms of severe lesions of the central nervous system (SLCNS) that occurred in patients with hematological malignancies (HM). MATERIALS AND METHODS: The authors conducted a retrospective exploratory study by analyzing the data of 3.620 patients with HM during the period from 01.01.18 to 31.12.19. Thirty-four patients (14 men and 20 women, median age 39 years), who developed SLCNS during treatment, were selected. For comparison with the main group of patients and exclusion of predictors associated with the development of SLCNS, a comparison group was added (by Kernel matching method). A comparison group consisted of 137 patients (59 men and 78 women, median age - 36 years) and was similar to the main group by clinical and laboratory characteristics. A neurological complication was marked as SLCNS if it was an indication for transfer to the intensive care unit (ICU). Statistical analysis included multivariate analysis - multiple binary logistic regression with stepwise inclusion of variables (that were found in the preliminary contingency table analysis) in the model, with control false results (by the false discovery rate method) and estimating the odds ratio, OR (95% CI). RESULTS: SLCNS in patients with HM developed in 0.94% of cases. The main SLCNS in patients with HM were: epileptic seizure (50.0%, n=17), ischemic stroke (20.6%, n=7), hemorrhagic stroke (17.6%, n=6) and meningoencephalitis (11.8%, n=4). The following independent significant (Wald test p≤0.05) predictors associated with the development of SLCNS in patients with HM during inpatient treatment were identified: antibiotic therapy (when more than 5 drugs are prescribed), OR=2.9 (1.2-7, four); polychemotherapy (if more than 4 drugs are prescribed), OR=2.9 (1.1-7.8); thrombocytopenia (with a platelet count less than 50·109 g/l), OR=2.3 (1.0-5.2) and delirium, OR=3.7 (1.3-10.8), and also the presence of neurological disorders in the patient's history, OR=2.6 (1.1-6.3). CONCLUSION: The main types of SLCNS in patients with HM were: epileptic seizure, ischemic and hemorrhagic strokes, and meningoencephalitis. Four predictors associated with the development of SLCNS in the course of HM treatment were identified: massive antibacterial (with more than 5 drugs) and chemotherapeutic (with more than 4 drugs) effects, thrombocytopenia and manifestation of delirium, as well as one risk factor: a history of neurological disorder. These factors need to be considered and monitored during treatment, because each of them increases the risk of developing SLCNS.

[Psychopathological features of victimity in hemophiliacs]. / Psikhopatologicheskie osobennosti viktimnosti u bol'nykh, stradaiushchikh gemofiliei.

AIM: To study psychopathological features of victimity in hemophiliacs. MATERIAL AND METHODS: Thirty-one men with hemophilia, aged 17-63 years, mean age 33.43±9.09, illness duration 16-62 years, were included in the study. All patients were admitted to the hospital due to the main disease and its complications. One of the inclusion criteria was a mental disorder with the symptoms of victimity. A clinical/psychopathological method was used in the study. RESULTS AND CONCLUSION: Mental state of the patients depended on the type of personality disorder. Four types of victimity (paranoiac, dissociative, dissocial, dependent) were singled out. Psychopathological features of each type and correlation with the psychiatric diagnosis were described.

[Mental disorders in Hodgkin's Lymphoma]. / Psikhicheskie rasstroistva pri limfome Khodzhkina.

This literature review differentially describes mental disorders in patients with Hodgkin's lymphoma (HL) with an emphasis on psychotic disorders, affective states and adjustment disorders. Psychotic disorders observed in patients with HL include affective, delusional conditions, delirium. There are different psychogenic states among the adjustment disorders. Attention is drawn to the frequency of anxious, depressive or mixed states. Conversion disorders and behavioral disorders that lead to non-compliance in patients with HL are described as well. In nosologic aspect, mental disorders in HL are classified as somatogenic and adjustement disorders.

[Autoimmune hemolytic anemia associated with mesenteric teratoma]. / Autoimmunnaia gemoliticheskaia anemiia, assotsiirovannaia s teratomoi bryzheiki tonkoi kishki.

The paper describes a case of autoimmune hemolytic anemia (AIHA) in a 27-year-old woman whose examination revealed mesenteric teratoma. AIHA was characterized by a hypertensive crisis and a temporary response to corticosteroid therapy that was complicated by the development of somatogenic psychosis and discontinued. A relapse of hemolysis developed 6 months later. The patient underwent laparoscopic splenectomy and removal of mesenteric root teratoma. Immediately after surgery, a hematological response was obtained as relief of hemolysis and restoration of a normal hemoglobin level. There is a sustained remission of AIHA for the next 16 months.

[Somatogenic and somatogenically provoked psychoses in blood diseases].

AIM: To detect risk factors (RF) to develop somatogenic psychoses (SP) in blood diseases. MATERIAL AND METHODS: A total of 107 SP patients were examined with the disease corresponding to diagnostic points F05 or F06 (IDC-10). RESULTS: The following RF were identified: cytostatic drugs with or without glucocorticosteroids, glucocorticosteroids alone, interferon-alpha, viral encephalitis, neuroleukemia. Single obligatory specific factors which bring manifestation of certain psychoses were not identified. SP in each of the considered hematological malignancies are related with various factors. CONCLUSION: The findings suggest polyfactor etiology of SP including some schemes of chemotherapy, some type of blood disease, specific premorbid features and mental disease burden. We suggest that the clinical picture, dynamics and prognosis of SP in blood diseases may be caused by a profile of factors typical for each disease.

[Somatogenic and somatogenically provoked psychoses in hematologic malignancies. Typology and therapy of somatogenic psychoses in hematologic malignancies].

AIM: To specify clinical typology and develop therapeutic approaches to somatogenic psychoses (SP) in hematologic malignancy (HM). MATERIAL AND METHODS: Clinical assessment was made in 118 patients with SP corresponding to diagnostic rubric F05 or F06 in International Disease Classification 10. RESULTS: Three types of SP in HM were identified: delirium (n = 73, 61.9%), aberration and somatogenically provoked attacks of schizophrenia (n = 7, 5.9%). Clinical picture and conditions of the above diseases onset in HM patients are described. Delirium developing in HM is characterized by subclinical psychoses, endogenomorphic psychoses. Endogenomorphic psychoses in the sample were represented by hallucinative-paranoid and depressive- delirious psychoses. CONCLUSION: SP classification proposed directly influences the choice of treatment methods. Psychotropic drugs with known clinical activity with wide-spectrum therapeutic action are effective in the above patients.

[Somatic masks of depressions in leukemia]. / Somaticheskie maski depressii pri leikozakh.

AIM: To specify types of depressive conditions in a sample of leukemia patients. MATERIAL AND METHODS: The study included 71 leukemia patients with depressions in the structure of which somatized disorders are an obligatory component of the depressive syndrome and determine clinical picture of the condition. This is the form of masking affective disorders. RESULTS: The patients had the following types of depression: somatized, hypochondriac, asthenic, depressive-delirium, hysteric depression. How to manage depression in leukemia patients is described.

[Litigious nosogenic reaction]. / Sutiazhnye nozogennye reaktsii.

In general somatic hospital the prevalence of litigious nosogenic reactions (LNR) was 4,3 pro mille. It was examined 52 cases of LNR. Paranoic (overvalued and delirious) disorders were the main ones in clinical picture of LNR. Two forms of motivation were noted: rental disorders (demand of money compensation of the loss resultant from somatic disease) and equitable ones (revelation of the damage due to actions of medical personnel). Among the patients with rental LNR (43 persons) the individuals with hysteric disorders of personality (hysterical psychopathy) were mainly found. Meanwhile among the patients with equitable LNR (9) there were patients with slow-progredient psychopathic-like schizophrenia inclined to the development of paranoic reactions and with litigious-paranoic tendencies. The development of rental LNR was seen in comparatively favourable course of somatic diseases which was not connected with invalidism or considerable loss of ability to work. In somatic diseases, when equitable LNR were formed, it was not possible to reveal a preference in severity of the course of somatic disease.

[Paranoid nosogenic reactions in patients with somatoform disorders]. / Paranoiial'nye nozogennye reaktsii u bol'nykh s somaticheskimi zabolevaniiami.

The authors examined 16 patients with ischemic heart disease who had psychogenic disorders with ideas of rationalization of therapy. Paranoial personality disorders (paranoial psychopathy) was diagnosed in 11 patients, pseudopsychopathy in residual schizophrenia in 5 patients. The patients had either a fanatic idea of creating new methods of self-therapy and an autoaggressive behavior (performing some dangerous manipulations, usage of non-medicamentous substances, etc.). The premorbid state of such patients was characterized by inclination to paranoial reactions and a special predisposition to them combined with an egodystonic attitude to corporal manifestations. Paranoial reactions of such type were reversible and disappeared in the course of somatic state improvement.