[Avoidant/restrictive food intake disorder in adolescent girls]. / Izbegayushchee/ogranichitel'noe rasstroistvo priema pishchi u devushek podrostkovogo vozrasta.

OBJECTIVE: To analyze the premorbid features, clinical manifestations, dynamics and outcomes of ARFID in adolescent girls, as well as to clarify the relationship of ARFID with other eating disorders (EDs) and comorbid mental pathology. MATERIAL AND METHODS: The study included 52 female adolescents, aged 10.2-16.7 years (mean age 13.1±1.9 years) who, at the time of admission, met the DSM-5 ARFID criteria. The average follow-up period was 5.6±1.6 years, the average age at the time of the last follow-up examination was 19.1±2.7 years. RESULTS: Patients with ARFID accounted for 8.4% of the sample of female adolescents with EDs. The stability of the clinical manifestations of ARFID indicates the validity of considering ARFID as an independent diagnostic category. The clinical picture of ARFID is determined by specific symptom complexes amalgamated with constitutional features. The latter are manifested from early childhood by neuroticism, anxiety, a weakened and somewhat perverted food instinct, metabolic features, partly determining the low need for food, immaturity and weakness of autonomic regulation that may form a predisposition for the development of psychosomatic/somatopsychic disorders. CONCLUSION: The study allows us to talk about a special predisposition, in the form of psychosomatic diathesis, which predisposes to ARFID and is a significant component of the response to psychogenic factors. It is assumed that diathesis as an abnormal constitution that determines the regulation of mental, autonomic and metabolic processes is a significant pathogenetic mechanism for other EDs. A certain commonality of the etiology and pathogenesis of ARFID and the entire group of EDs is confirmed by the high burden of family history of patients with various forms of EDs (13.5%) and a significant frequency of transformation of ARFID into other EDs.

[A phenomenological analysis of non-suicidal self-injuries in adolescents]. / Fenomenologicheskii analiz nesuitsidal'nykh samopovrezhdenii u podrostkov.

AIM: To perform a phenomenological/clinical/psychopathological analysis of non-suicidal self-injury behavior (NSSI) in adolescents. MATERIAL AND METHODS: The authors studied 155 adolescents, 140 girls and 15 boys, aged 12-17 years, including 111 with self-cutting, 5 with self-burning, 4 with self-beating. Other cases included combined, multiple and other variants of NSSI. RESULTS AND CONCLUSION: NSSI develop more often in female teenagers. NSSI may be a component of suicidal behavior or represent a relatively independent behavioral model existing out of a suicidal context. NSSI behavior can be considered as psychological defense as well as a coping strategy in response to nonspecific stress.

[The affective pathology in patients with adolescent bulimia nervosa]. / Affektivnaia patologiia u bol'nykh nervnoi bulimiei podrostkovogo vozrasta.

AIM: To investigate affective pathology in patients with adolescent bulimia nervosa (BN) and to analyze comorbid mutual influences of these clinical entities. MATERIAL AND METHODS: A sample consisted of 52 young female patients, aged from 13.9 to 17.4 years, who simultaneously meet ICD-10 criteria of F50.2 - typical BN and F30-F39 - mood disorders. The Eating Attitudes Test (EAT-26) and the Beck Depression Inventory were used for psychometric assessment. Duration of follow-up ranged from 1 to 7 years. RESULTS AND CONCLUSION: The common forms of affective disorders comorbid with adolescent BN were dysthymia and bipolar affective disorder (BAD) type II. Less often BN manifested in association with psychogenic endoform depressions. And the less typical was comorbidity of BN with endogenous recurrent unipolar depression. The normalization of mood and transition depression to hypomania contributed to the remission of eating disorders. Worst clinical and social outcome was detected in patients with long-term persistent hypothymia caused by dysthymia or protracted depressive episodes of recurrent depressive disorder. A more favorable outcome was seen in patients with alternation of depression and hypomania in the structure of the BAD type II and the best outcome in patients with single episode of psychogenic endoform depression.

[Depressive states at the stage of broad clinical presentations of anorexia nervosa in adolescents].

OBJECTIVE: To specify psychopathological features and dynamics of depression developed at the stage of broad clinical presentations of anorexia nervosa (AN) in adolescent patients. MATERIALS AND METHODS: Authors studied 61 young women, aged from 14 to 18 years, mean age 16.6 ± .9 years. Depressive states manifested during the first year of AN in all patients. RESULTS: Two variants of depressive episodes were described. The first variant was characterized by asthenic/depressive, somatic and autonomic presentations, with the leading role of exogenous/organic and somatogenic factors. In the second variant, affective disorders were characterized by the anxiety affect concomitant with adynamia, dysphoria and melancholia that most probably may be caused by endogenous constitutional/biological factors. The follow-up data (0,5-6 years) indicated that most of the patients with the second variant of depressive episodes had recurrent depressive states. During the course of disease, eating disorders acquired an atypical character and gradually decreased while the affective pathology became dominating. CONCLUSION: Depressive symptomatology in AN patients of pubertal age corresponded to main mechanisms of development of the clinical picture and dynamics of adolescent depression as atypical depressive triad, predominance of anxiety and asthenic/adynamic affect, a trend towards protracted course and substantial frequency of dysmorphophobic symptoms and over-valued ideas.

[Affective pathology in the premanifesting period of anorexia nervosa in adolescents].

Objective of the study were: to specify the features of clinical presentations and dynamics of anorexia nervosa (AN) developed in adolescence during the current depression; to study affective disorders preceding the onset of AN and to analyze comorbidity of these two pathologies. We examined 21 female patients, aged from 15 to 17 years old (mean age 16.7 ± 0.8 years). It was shown that depressive symptoms developed 4-11 months (mean 7.9 ± 2.5 months) before the onset of AN. The development of AN was associated with depression and might be considered as one of mechanisms of formation of eating disorders that might be termed as affective mechanism. Thus, we can specify a variant of adolescent/juvenile depression, or depression with eating disorders. The variant represents a protracted depressive state with overvalued ideas to improve body image and to restrict calories which is combined with adynamic affect associated with anxiety, melancholy and dysphoria.

[Phase-locked alpha oscillations evoked by illusory contour perception in normal and autistic preschool boys].

We examined temporal dynamics of EEG phase-locked alpha oscillations during perception of illusory (Kanizsa square) and non-illusory images in boys with autism and age-matched typically developing boys. In typically developing boys the illusory contour (IC) as compared to the control stimulus provoked an increased alpha response at the parietal scalp areas. This IC effect demonstrated continuity within the time window of 133-267 ms after the stimulus onset. Although boys with autism did not display this effect at the group level, part of the sample showed an atypical two-stage pattern of illusory contour effect. The first early stage of IC effect (50-133 ms) was pronounced at the midline occipital electrode localized in the vicinity of the primary visual cortex. The localization and the early onset time suggest that this early IC effect is related to abnormally enhanced "low-level" locally-oriented processes of contour completion in autism. The second stage of IC effect (267-400 ms) was observed at the left parietal region only, and was delayed comparatively to that in healthy boys, suggesting the deficit of "intermediate" processes of perceptual grouping linked to the higher-order visual areas.

[Peculiarities of organic psychic infantilism in adolescents].

An aim of the study was to specify peculiarities of the clinical dynamics of organic psychic infantilism and psychopathological presentations of this disorder in adolescence. A significant prevalence of psychic infantilism caused by organic CNS damage in patients seeking psychiatric help in adolescence and a negative effect of this disorder on social adaptation in this period of life were found. Sixty-seven patients, aged 15-18 years, (ICD-10 diagnosis F06) with signs of psychic infantilism were studied. In these cases, psychic infantilism encompassed all aspects of mental activity and manifested itself as a constant personality trait that caused the infantile type of reaction to the most of life situations. The clinical heterogeneity of organic infantilism determined by the different degree of psychic immaturity in some areas of psychic activity and concomitant encephalopathy symptoms was noted. This allowed to single out 3 groups of patients: with domination of psychic infantilism in volition (28 patients), in emotional sphere (21 patients) and immaturity of cognitive functions (20 patients). The clinical heterogeneity of psychic infantilism likely reflects the character of CNS damage (localization and time of the damage) and specifics of related organic dysontogenesis.

Speech and motor disturbances in Rett syndrome.

Rett syndrome is a severe, genetically determined disease of early childhood which produces a defined clinical phenotype in girls. The main clinical manifestations include lesions affecting speech functions, involving both expressive and receptive speech, as well as motor functions, producing apraxia of the arms and profound abnormalities of gait in the form of ataxia-apraxia. Most investigators note that patients have variability in the severity of derangement to large motor acts and in the damage to fine hand movements and speech functions. The aims of the present work were to study disturbances of speech and motor functions over 2-5 years in 50 girls aged 12 months to 14 years with Rett syndrome and to analyze the correlations between these disturbances. The results of comparing clinical data and EEG traces supported the stepwise involvement of frontal and parietal-temporal cortical structures in the pathological process. The ability to organize speech and motor activity is affected first, with subsequent development of lesions to gnostic functions, which are in turn followed by derangement of subcortical structures and the cerebellum and later by damage to structures in the spinal cord. A clear correlation was found between the severity of lesions to motor and speech functions and neurophysiological data: the higher the level of preservation of elements of speech and motor functions, the smaller were the contributions of theta activity and the greater the contributions of alpha and beta activities to the EEG. The possible pathogenetic mechanisms underlying the motor and speech disturbances in Rett syndrome are discussed.

[Speech and motor disorders in Rett syndrome]. / Rechevye i motornye rasstroistva pri sindrome Retta.

Rett syndrome (RS) is a severe genetically conditioned disorder of an early childhood with an definite clinical phenotype in girls. Motor and speech disturbances are noted as the essential part of RS clinical picture. The variability of motor dysfunction and degree of speech deterioration were noted at different stages of the illness. The aim of the present investigation was to study dynamics of both speech and motor disturbances during 2-5 years of the course of the illness and to analyze a correlation of motor and speech functions' disorders. The study was performed in 50 girls with classical RS aged from 12 months to 14 years. The data obtained show a gradual involvement of different brain cortex structures in pathological process during the course of RS (especially of frontal and temporal-parietal regions) at the early stage of the illness and subsequent spread of the pathological process with successive involvement of subcortical structures, cerebellum, brain stem and eventually spinal cord. The neurophysiological investigation showed a strong correlation of speech and motor disturbances' degree with the EEG parameters. The level of theta-activity was significantly lower and the level of alpha- and beta-activity was significantly higher in EEGs of RS patients with more preserved speech and motor functions. In discussion mechanisms of motor and speech disturbances in RS were considered.

[Quantitative EEG correlates of the human frontal lobe dysfunction]. / Kolichestvennye EEG-korreliaty disfunktsii lobnykh dolei kory golovnogo mozga cheloveka.

Increased central-parietal EEG theta-2 activity (about 6.5 per sec) was found in children with cognitive disorders (in Rett's syndrome, fragile X-syndrome, infantile autism) and in elderly patients with Alzheimer-type dementia (with prevalence of neuropsychological "frontal" disorders) in the presence of suppressed alpha rhythm. This theta-activity was closely associated with cognitive deficits and possessed a specific functional topography, namely it focused in the parietal region and suppressed by both visual stimulation and motor tests. The similar EEG pattern was observed in some patients treated with neuroleptics and/or during hyperventilation. By taking into account the data available in the literature on motor, oculomotor, regional cerebral blood flow and the probability prediction in frontal lobar dysfunction, it is suggested that the theta-activity described appears in the visuomanual coordination system and is a physiological correlate of decreased functional status of frontal lobes.

[Rett's syndrome: diagnostic issues]. / Sindrom Retta: voprosy diagnostiki.

Rett's syndrome (RS) is a severe disease of an early childhood, affecting girls mainly and manifesting in autistic symptoms, severe mental regression and motor dysfunction. The aim of the study was to analyze both early stages of clinical symptomatology and EEG correlates of RS. 65 patients aged 2.5-13 years with classic RS were examined. It was found that affective and autistic manifestations were the main symptoms during the 1-st stage of RS in approximately 50% of the cases. Two variants of classic RS were described according to the degree of motor dysfunction and behavioral disturbances: RS with motor disorders; RS with schizophrenoform disorders. Analysis of 145 EEG of 62 patients with the III-d PS stage revealed a presence of some correlations between location of the focus of the rhythmic theta-activity and clinical manifestations as well as their prognostic value. Thus, the decrease of the index of the rhythmic theta-activity in the patients on the III-d stage of RS correlated significantly with the improvement of the attention, behavioral and social activity, while its increase correlated with both the change for the worse of the higher cortex functions and advance of the motor disorders.

[Autoantibodies to nerve growth factor and astroglial protein S-100 in Rett's syndrome]. / Autoantitela k faktoru rosta nervov i astrotsitarnomu belku S-100 pri sindrome Retta.

The levels of autoantibodies (AAB) to nerve growth factor (NGF) and to S-100 protein were examined in blood of both mentally normal girls and girls with Rett's syndrome (RS). The elevated titer of anti-NGF AAB, but not of anti-S-100 AAB was determined in the blood of patients with RS. There was relative individual stability of anti-NGF AAB level which didn't depend on the stage of the disease. At the same time, a reverse correlation was found between the level of these antibodies and severity of the disease: the mild form of the disease (with relative preservation of the speech elements and locomotor functions as well as with the later age of the onset of the disease and the later development of the regressive symptoms) is characterized by the higher AAB level. Autoimmune processes role (anti-NGF AAB) in formation of RS clinical features is discussed.

[An elevation in the level of autoantibodies to nerve-growth factor in the blood serum of schizophrenic children]. / Povyshenie urovnia autoantitel k faktoru rosta nervov v syvorotke krovi detei, bol'nykh shizofreniei.

The level of autoantibodies (AAB) to nerve growth factor (NGF) was examined in blood of mentally healthy children, children with early children schizophrenia as well as with Kanner's and Asperger's syndromes too. The elevated titer of AAB to NGF was determined in blood of children with acute, active state of disease; meanwhile the same titer wasn't changed in the state of stable remission or steady defective state as compared with control group. The correlation was found between the level of AAB to NGF and the degree of disease progression. The correlations which were revealed between AAB to NGF level and peculiarities of the clinical state of patients permitted to use this index as the objective marker of both the acuteness and the severity of the patient's state.