[Prevalence and risk factors of delirium in COVID-19]. / Rasprostranennost' i faktory riska deliriya pri COVID-19.

OBJECTIVE: To assess the frequency and risk factors of delirium in patients hospitalized with COVID-19. MATERIAL AND METHODS: Four hundred and forty patients admitted to the Infectious Diseases Hospital of the University Clinical Hospital No.3 of Sechenov University were included in the study. The Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Screening Questionnaire-7 (GAD-7), the Insomnia Severity Index (ISI), the Delirium severity rating scale (DRS-R-98) were administered. RESULTS: Delirium was detected in 27.8% of patients. Significant risk factors were age (p=0.002), severity of respiratory failure (p=0.005), concomitant somatic disease (p=0.003), and respiratory therapy (p<0.001). There was an association between severe anxiety (p<0.001) and insomnia (p=0.07) observed at admission with the risk of developing delirium during the hospital stay. CONCLUSION: The study reveals a high prevalence of delirium in patients with COVID-19. In order to prevent delirium and/or reduce the risk, early diagnosis and identification of preclinical forms are of particular importance.

[Psychopharmacotherapy of late-stage hypochondriac conditions: frequency of use and effectiveness of drugs]. / Psikhofarmakoterapiya ipokhondricheskikh rasstroistv pozdnego vozrasta: chastota ispol'zovaniya i effektivnost' preparatov.

OBJECTIVE: To conduct a comparative analysis of psychopharmacotherapy effectiveness in hypochondriac disorders of late age and to identify the optimal combinations of drugs depending on the thymopathic (hypothymic and/or anxiety) components accompanying the main hypochondriac manifestation. MATERIAL AND METHODS: One hundred and eight female inpatients, aged from 50 to 88 years, with leading hypochondriac symptoms of non-delusional level were enrolled in the study. All patients were examined clinically and psychopathologically using psychometric scales: the Montgomery-Asberg Depression Rating Scale, the Hamilton Anxiety Rating Scale, the hypochondria rating scale and the UKU side-effect rating scale. RESULTS: Based on the psychometric assessment, the patients were divided into the following groups: group 1 - subjects with hypochondriac symptoms without accented thymopathic component (n=18); group 2 - subjects with a high level of hypothymia (n=49); group 3 - subjects with a high level of anxiety (n=22); group 4 - subjects with a high level of both anxiety and depression (n=19). Hypochondriac disorder without a thymopathic component was treated with monotherapy with antipsychotic drugs in low therapeutic dosages or with a combination of antipsychotic drugs in low therapeutic dosages with tricyclic antidepressants in low and medium dosages. Hypothymic hypochondriac disorders were treated with antidepressants of mainly SSRIs group and of tricyclic structure in combination with typical and atypical antipsychotic drugs in low therapeutic dosages. In these patients monotherapy with antidepressants or a combination of different antidepressants was effective in rare cases only. Hypochondriac disorder with an anxiety component was significantly more often treated by complex therapy with the addition of anxiolytic drugs, as well as a combination of antidepressants with antiptychotic drugs. Mixed hypochondriac states were treated with a combination of antidepressants and antipsychotic drugs or complex therapy with the addition of an anxiolytic drug. CONCLUSION: Hypochondriac disorders of late age in most cases are accompanied by depressive and/or anxiety symptoms, which must be taken into account for improvement of diagnostic effectiveness and relevant selection of therapy.

[The current state and future prospects of depression research (clinical and classification problems)]. / Sovremennoe sostoianie i perspektivy issledovanii depressii (voprosy kliniki i klassifikatsii).

Despite decades of research, neurobiological studies of depression haven't achieved significant results. Many experts propose that one of the main reasons for this failure is current diagnostic standards not considering the heterogeneity and polymorphism of depression. Research is unable to identify specific neurobiological changes due to formal diagnosis 'major depressive disorder' and new diagnostic criteria are needed. RDoC (Research Domain Criteria) has intensified the confrontation between biological and clinical researchers and changes in approach to depressive psychopathology are discussed. A review presents the recent approaches used in studies of depressive disorders, the methodology they use, the scientific paradigms they rely on.

[Genetic and clinical predictors of treatment efficacy in depressive disorders]. / Geneticheskie i klinicheskie prediktory éffektivnosti terapii depressivnykh rasstroistv.

AIM: To study clinical and genetic characteristics that impact on the efficacy of pharmacotherapy of depressive disorders. MATERIAL AND METHODS: The study included 188 patients with unipolar depressive disorders of different genesis (psychogenic, endogenous and organic). A clinical-psychopathological method and depression psychometric scales were used. Serotonin transporter 5-HTTLPR and STin2 and dopamine transporter 3',-VNTR polymorphisms were determined. RESULTS AND CONCLUSION: The S-allele of the 5-HTTLPR polymorphism is associated with the low efficacy of treatment with selective serotonin reuptake inhibitors. Tricyclic antidepressants are more effective in treatment of psychogenic depression. The authors determined clinical factors that can predict response to treatment of psychogenic and endogenous depression. No predictors were found for organic depression.

[The possibility of using standardized self-report anxiety and depression scales in elderly patients: Depression scales/questionnaires in elderly]. / Izuchenie vozmozhnostei primeneniya standartizirovannykh shkal samootsenki trevogi i depressii pri obsledovanii bol'nykh pozhilogo vozrasta: shkaly-oprosniki depressii.

AIM: To study possibilities of using depression scales in elderly patients, evaluate the parameters of their reliability and validity and develop practical recommendations on the use of these scales in clinical practice. MATERIAL AND METHODS: The study included 234 patients, aged over 50 years, with anxious depression. The following scales/questionnaires BDI, GDS-15, CES-D-10, CES-D-20, ZDS and HADS-D were used at baseline and 12 weeks after treatment. Data analysis included the calculation of convergent, discriminative and diagnostic validity of depression scales/questionnaires in elderly. RESULTS: All scales are effective for the diagnosis of depression in elderly people. The possibility of using these scales in patients with mild cognitive impairment is shown. An increase of the correlation between the scores on depression and anxiety scales up to the loss of discriminative validity of «double¼ scales/questionnaires by the alternative set of symptoms for the diagnosis of depression and anxiety was confirmed. CONCLUSION: Based on the RESULTS: the authors have developed common and specific for each scale recommendations on the optimal use of depression scales/questionnaires in elderly.

[The possibility of using standardized self-report anxiety and depression scales in elderly patients: anxiety scales/questionnaires]. / Izuchenie vozmozhnosti primeneniya standartizirovannykh shkal samootsenki trevogi i depressii pri obsledovanii bol'nykh pozhilogo vozrasta: shkaly-oprosniki trevogi.

AIM: To describe the specifics of using self-report anxiety scales in elderly patients, determine the parameters of their reliability and validity and develop recommendations on the use of these scales. MATERIAL AND METHODS: The study included 234 patients, aged over 50 years, with non-psychotic anxiety disorders. The following scales/questionnaires BAI, GAI, STAI, ZAS, HADS were used at baseline and 12 weeks after treatment. Conditions of testing, form and content of instructions were similar. Data analysis included the estimation of reliability and validity of these scales. Assessment made by the physician on the Hamilton anxiety scale (HAМ-А) was used as «validity standard¼. RESULTS AND CONCLUSION: All scales (BAI, GAI, STAI, ZAS, HADS-А) can be used for screening diagnosis of anxiety in elderly people. The diagnostic sensitivity and specificity of the scales for subjective assessment of anxiety slightly decrease in advanced age and is sufficient for screening purposes. Based on the analysis, the authors have developed recommendations (common and specific for each scale) on the optimization of using self-report anxiety scales in advanced age.

[The efficacy of psychopharmacotherapy of late onset depression: the optimization of treatment duration].

OBJECTIVE: To analyze possibilities of using different methods to increase the efficacy of psychopharmacotherapy of late onset depression, in particular to increase treatment duration. MATERIAL AND METHODS: The study included 378patients, aged from 50 to 82 years (mean age 60.6±8.4). Patients were stratified into groups with short (4--8 weeks), moderate (12 weeks) and long (20-34 weeks) duration of psychopharmacotherapy. RESULTS AND CONCLUSION: Treatment effect was much lower after <8 weeks of treatment compared with that after 12 weeks (the comparison of these groups was not available because the initial samples were not). To the 24th week, 63.9% of the patients responded to treatment, 43.4% achieved remission. Partial response and stable positive dynamics to the 12th week (about ½ of the patients achieved remission) were predictors of response with treatment duration <24 weeks. Based on the results obtained, the authors developed algorithms for choosing treatment tactics in patients with late onset depression in dependence of the results of the first 12 weeks of psychopharmacotherapy.

[An increase in the efficacy of psychopharmacotherapy of late-onset depressions: combination and substitution of antidepressants].

OBJECTIVE: To comprehensively analyze the possibilities of using the methods of correction of non-effective psychopharmacotherapy of late-onset depressions. MATERIAL AND METHODS: Methods of potentiating, combination and substitution of non-effective psychopharmacotherapy of late-onset depressions were studied. RESULTS AND CONCLUSION: Indications to the use and specific algorithms of substitution and addition of antidepressants in non-effective psychopharmacotherapy of late-onset depressions have been developed. These algorithms of combination therapy suggest the possibilities for choosing the individual combinations of antidepressants.

[The association between the 5-HTTLPR polymorphism of the serotonin transporter gene and the efficacy and tolerability of selective serotonin reuptake inhibitors].

OBJECTIVE: To search for the association between the 5-HTTLPR polymorphism of the serotonin transporter gene and the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs). MATERIAL AND METHODS: The complex clinical/psychopathological and genetic study of 38 patients with depression treated with SSRIs was carried out. RESULTS AND CONCLUSION: The 5-HTTLPR polymorphism was associated with the rate of achievement of remission and tolerability of treatment: carriers of the SS genotype achieved remission less frequently and more frequently experienced side-effects.

[Remote consequences of the long-term uncontrollable consumption of anxiolytics and hypnotics in elderly: a problem of drug dependence].

AIM: To identify main clinical/psychopathological characteristics of aged psychiatric inpatients who regularly used anxiolytic and hypnotic benzodiazepines without control from the physician. MATERIAL AND METHODS: Authors examined 56 women over 50 years hospitalized due to a psychiatric disorder. Before admission, they regularly used benzodiazepines without a prescription for more than 2 months. The patients were studied during 4 weeks in the hospital. To assess the severity and dynamics of their condition, we administered psychopathological analysis and common psychometric scales as well as our own version of the scale for benzodiazepine dependence. RESULTS AND CONCLUSION: The diagnosis of drug dependence was based on the three criteria: symptoms of pathological dependence of benzodiazepine, benzodiazepine withdrawal syndrome with severe somatic/autonomic symptoms and exacerbation of dependence, increase in tolerability to benzodiazepine anxiolytics and hypnotics; 64.3% of the patients met these criteria. An analysis of risk factors for this disease in elderly demonstrated the higher risk in patients aged ≤ 60 years and in those who used diazepam. The risk was higher in patients who preferred phenazepam.

[Current state and potential of pharmacogenetic studies in the treatment of depression].

In this literature review, we consider pharmacological studies in the aspect of functioning of cerebral neurochemical systems and their role in the development of depression and mechanisms of antidepressant action. The following sections of the review are devoted to the above issues: adrenoreceptors, serotonin transporter protein, dopamine transporter protein, monoamine oxidase A, catechol-O-methyltransferase, brain-derived neurotrophic factor, the hypothalamic-pituitary-adrenal system, G-proteins, the glutamatergic system.

[Remote consequences of the long-term uncontrolled use of anxiolytic and hypnotic drugs by elderly patients: cognitive disorders].

OBJECTIVE: Frequents cases (10-30% of the elderly population) of regular long-term use of anxiolytic and hypnotic drugs, in particular, benzodiazepines, without control of the physician is an urgent problem of medicine worldwide. Severe and irreversible cognitive impairment is a frequent and severe consequence of this use. Authors studied cognitive impairment in these cases. MATERIAL AND METHODS: Patients were enrolled in the study from a psychiatric hospital. The study included 56 women, aged over 50 years, admitted to the hospital with the diagnosis of a mental disorder. Before admission, the patients regularly used benzodiazepines without a prescription for more than 2 months. Later on, anxiolytics were withdrawn during 1-5 days. The patients were studied during 4 weeks in the hospital. To assess the severity and dynamics of their condition, authors used MADRS, HAM-A, MMSE. RESULTS AND CONCLUSION: Severe cognitive impairment, achieving the level of dementia, was found in 57.2% of the patients, mild or moderate of cognitive impairment was in 32.1% and only 10.7% had normal level of cognitive functioning. After 4 weeks of benzodiazepine withdrawal, the percentage of patients with dementia reduced to 21.4%, the severity of cognitive impairment was estimated as mild or moderate. A number of patients without cognitive impairment increased to 37.5%. The old age of patients was a significant negative predictor of the dynamics. An impact of the high anxiolytic dose was shown on trend level. The duration of a mental disorder and duration of uncontrollable consumption of anxiolytics and hypnotics did not exert an effect on the development and reversibility of cognitive impairment. A combination of anxiolytics with alcohol increased the risk of dementia and did not reverse the cognitive pathology.

[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.

[Treatment of depression: the current state and perspectives of the development of pharmacological studies].

A review of literature over the last two decades is presented. It is emphasized that psyachopharmacotherapy currently remains a main method of treatment of severe and moderate depression. Pharmacogenetic studies are directed mainly towards the identification of probable targets based on pharmacokinetcs and pharmacodynamics of andidepressants as well as the aspect of identification of probably predictors for treatment response.

[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.

[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 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.