[Experience of clinical use of fluvoxamine for the treatment of comorbid depression in childhood and adolescence]. / Opyt klinicheskogo primeneniya fluvoksamina dlya lecheniya komorbidnoi depressii v detskom i podrostkovom vozraste.

OBJECTIVE: To identify the frequency of administration of fluvoxamine, to determine the main targets of the drug and the expediency of its use in depression of various genesis in children and adolescents. MATERIAL AND METHODS: To assess the frequency of prescribing fluvoxamine, 195 medical histories of patients who were inpatients in the children's department of the Mental Health Research Center in 2023 were analyzed. To assess the dynamics of depression during treatment with fluvoxamine, a clinical group was formed of 12 patients aged 10 to 15 years (age 13.1±3.6 years) who received fluvoxamine for the treatment of depression with comorbid obsessive-compulsive and anxiety-phobic disorders. Clinical and psychopathological, psychometric (Hamilton Depression Rating Scale - HDRS) and statistical research methods were used. RESULTS: In total, in 2023, fluvoxamine was received by 20% (n=37) of all inpatient patients of child age (from 7 to 16 years). All patients received combination therapy. The therapeutic targets were comorbid depressive, obsessive-compulsive and anxiety symptoms developing in the structure of nosologically heterogeneous states, with the dominance of schizophrenic spectrum disorders. Against the background of the use of the drug fluvoxamine for 4 weeks in the clinical group, there was a significant reduction in depressive symptoms on the HDRS. Adverse events during complex therapy were observed in 20% of patients, but were not severe, did not require discontinuation of therapy and were unreliably associated with the use of fluvoxamine. CONCLUSION: The use of the fluvoxamine provides reduction of depressive symptoms within the framework of various nosologies, and is characterized by sufficient safety. The variety of therapeutic targets of the fluvoxamine, including antidepressant, anti-anxiety, cognitive effects, is certainly a significant advantage of the studied fluvoxamine for use in childhood.

[The clinic of autistic disorders at an early age]. / Klinika autisticheskikh rasstroistv v rannem vozraste.

OBJECTIVE: To study disorders of mental development and psychopathological symptoms in young children with autistic disorders of various origins. MATERIAL AND METHODS: Two hundred and sixty-five children, aged 9 months to 4 years, (201 boys, 64 girls) with symptoms of autistic disorder were examined. The patients were divided into two age groups - the 1st group consisted of 36 children, aged 9 months to 2 years, the 2nd group consisted of 229 children from 2 years to 4 years. Psychopathological, neurological and clinical-dynamic methods were used, taking into account the results of consultations with a speech therapist, defectologist, psychologist. RESULTS: The number of visits to a psychiatrist by parents of children older than two years becomes significantly higher - 13.6% (n=36) and 86.4% (n=112), respectively (p≤0.05), as well as the diagnosis of autistic disorder - 8.3% (n=3) and 16.2% (n=37) respectively, p≤0.05). In both age groups, the diagnosis of «Other general developmental disorders¼ (F84.8) was most often established, with a significant predominance in the younger group - 80.5% and 72%, respectively (p≤0.05). Characteristic symptoms-markers of autism for both age groups are highlighted. It is shown that the diagnoses of childhood autism, Kanner syndrome, exposed at the first treatment, were preserved in all patients after three years. By the age of four, it was possible to clarify the diagnosis in 32% of cases. At the same time, 68% of patients, aged 4 years, retained a clinically undifferentiated diagnosis of F84.8. CONCLUSION: The study showed an increase in the diagnosis of autistic disorder during the first years of life. The necessity of increasing the knowledge of early-age psychiatry among specialists and the organization of a system of early detection, timely treatment and rehabilitation of autistic disorders in children of the first years of life in children's polyclinics is noted.

[Teraligen in the complex treatment of anxiety-phobic, behavioral and depressive syndromes in children and adolescents with schizotypal disorder]. / Teralidzhen v kompleksnoi terapii trevozhno-fobicheskikh, povedencheskikh i depressivnykh narushenii u detei i podrostkov s shizotipicheskim rasstroistvom.

OBJECTIVE: To determine the frequency of prescribing and the main therapeutic targets of Teraligen in the treatment of Schizotypal disorder (STD) in childhood and adolescence. MATERIAL AND METHODS: The sample consisted of 151 patients aged 7 to 16 years with a diagnosis of STD (F 21), of which 31.1% (n=47) of female patients and 68.9% (n=104) of male patients who received inpatient or outpatient treatment at the FSBI NCPZ from 2008 to 2020. The study was conducted by clinical-psychopathological, clinical-catamnestic, and statistical methods. RESULTS: Teraligen was prescribed by psychiatrists to patients with STD in 74.2% of cases, of which in 46.4% of cases patients received Teraligen even before the diagnosis of STD in connection with complaints of neurotic disorders (anxiety, fears and sleep disorders) (n=30), as well as in connection with autistic-like behavior (n=22). At the time of follow-up, 55% (n=83) of patients received Teraligen, of which 63.9% (n=53) of patients were prescribed it for the first time. The applied schemes of prescribing Teraligen for the treatment of anxiety-phobic, depressive and behavioral syndromes within the framework of the STD in a relatively age-related aspect are presented. CONCLUSION: The high frequency of prescribing Teraligen by psychiatrists and neurologists to children and adolescents with STD at different stages of observation is shown, which reflects the confidence of specialists in this drug. Teraligen has demonstrated a multidimensional pharmacological effect, including a mild antipsychotic effect, providing reduction of a wide range of psychopathological symptoms, with good tolerability and drug interaction. The study of the possibilities of Teraligen, both for monotherapy and for augmentation of the treatment of mental pathology in childhood, remains relevant.

[Clinical features of schizotypal disorder in childhood and adolescence]. / Klinicheskie osobennosti shizotipicheskogo rasstroistva v detsko-podrostkovom vozraste.

OBJECTIVE: To identify psychopathological features, patterns of formation and course of schizotypal disorder (STD) in childhood and adolescence, to develop criteria for differential diagnosis. MATERIAL AND METHODS: A total of 151 patients, aged 7 to 16 years (mean age 12.3 years), with a diagnosis of schizotypal disorder were included in the study. Of these, 48 (31.8%) were women and 103 (68.2%) were men. Psychopathological, pathopsychological, psychometric and statistical methods were used. The Schizotypal Personality Questionnaire (SPQ) was used as a formalized tool for assessing the clinical symptoms of STD. RESULTS: Based on the prevailing symptoms, the clinical sample of patients was divided into 3 groups. The 1st group consisted of 56 (32.5%) patients with a predominance of neurosis-like disorders, the 2nd group - 50 (37.7%) patients with a predominance of behavioral disorders, the 3rd group included 45 (29.8%) patients with the dominance of stable personality anomalies. Significant differences between the groups were found in the frequency and severity of psychopathological symptoms, the structure of deficient (negative disorders), the age of onset of disorders, the characteristics of social activity and adaptation. According to the SPQ scale, positive disorders prevailed in group 1 compared to group 3: ideas of attitude (3.3 and 2.7 points respectively), unusual sensations and perceptions (3, 1 and 1.7 points respectively). CONCLUSION: STD is a spectrum of disorders, on one end of which there are variants with a predominance of positive disorders, on the other negative ones. The predominance of certain psychopathological symptoms is due to the age of onset of psychopathological disorders, age at the time of the current exacerbation, and the duration of persistence of the disease. The predominance of neurosis-like, psychopathic-like disorders and persistent personality anomalies makes it possible to classify STD as one of the identified types, which allows us to substantiate differentiated therapy and prognosis.

[Clinical and psychological assessment of the variability of schizotypal personality disorder in children and adolescents]. / Kliniko-psikhologicheskaya otsenka variativnosti shizotipicheskogo rasstroistva u detei i podrostkov.

OBJECTIVE: To analyze the variability of violations of cognitive and emotional-personal parameters in schizotypal disorder (STD) in children and adolescents according to the pathopsychological profile. MATERIAL AND METHODS: 47 patients with STD were examined, 21 of them with psychopathic variant (F21.4), 16 with neurotic (F21.3) and 10 with personality schizotypal disorder (F21.8) aged 9 to 16 years (37 boys and 10 girls). All patients were examined in detail by a psychiatrist and clinical psychologists. The method of integrative assessment of the pathopsychological profile was used, including the assessment of the presence and severity of impairments in cognitive functioning, emotional-personal and motivational-volitional spheres (the assessment was carried out according to detailed psychological reports). Mathematical processing of the obtained data was carried out. RESULTS: Cluster analysis of clinical and psychological indicators showed that patients differ in the level of intellectual impairment, as well as in the characteristics of motivational-volitional and personal spheres. Three clusters are described, two of which included patients (10 and 31 patients) with individual variants of STD with a greater severity of various cognitive deficits, and parameters of the emotional and personal sphere, the last cluster included 6 patients with personality variants of STD. A separate largest cluster included all three analyzed variants of STD in approximately equal proportions, with a mildly pronounced intellectual decline and more noticeable changes (deficiency) in the emotional and personal sphere. CONCLUSION: Thus, patients with STD differ in the severity and structure of deficient changes. At the same time, the nature and degree of involvement of a particular area in the overall picture of the pathopsychological profile is of great importance. Patients with STD differ in the severity and structure of deficient changes. The identified clusters differed in age, in the presence of patients of both sexes, and in various indicators of the pathopsychological profile. At the same time, the nature and degree of involvement of a particular area in the overall picture of the pathopsychological profile is important for diagnosis.

[Experience of Teraligen usage in pediatric psychiatry]. / Opyt primeneniya Teralidzhena v psikhiatrii detskogo vozrasta.

The data of studies on the use of Teraligen in various fields of clinical medicine - neurology, dermatology, gastroenterology, anesthesiology and psychiatry are presented. According to studies conducted in psychiatry, Teraligen is a drug for the balanced treatment of anxiety-phobic, behavioral and sleep disorders in children, both within neurotic conditions and in the structure of autistic and schizophrenic spectrum disorders. Based on 100 case histories of children aged 3 to 16 years, the experience of using Teraligen as part of mono- and combination therapy at a dosage of 1.25 mg to 50 mg/day in the treatment of autism spectrum disorders (n=31), psychotic disorders (n=18), schizotypal disorders (n=41), behavioral and emotional disorders on residual organic soil (n=10). A good clinical effect of Teraligen has been shown in anxiety-phobic, affective, somatovegetative disorders and sleep disorders in all identified nosologies. Good tolerability of Teraligen, the possibility of its use as part of complex therapy and the almost complete absence of adverse events, indicating the softness and balance of the drug were noted.

[Assessment of the initial period of schizotypal disorder in childhood]. / Otsenka nachal'nogo perioda shizotipicheskogo rasstroistva v detskom vozraste.

OBJECTIVE: To identify developmental features, the presence of hereditary burden, social adaptation, the structure of early psychopathological disorders in pediatric patients with schizotypal disorder (STD) and their relationship with the age of manifestation and the clinical structure of the disease. MATERIAL AND METHODS: The study included 150 patients aged 7 to 16 years with a diagnosis of SD, of which 48 were female and 102 were male. Based on the age of onset of the first stable psychopathological disorders, at the stage preceding the diagnosis of SD, 5 groups of patients were identified: up to 3 years (n=38), from 4 to 6 years (n=36), from 7 to 10 years (n=15), 11-13 (n=41), 14-16 years old (n=20). The study used clinical-psychopathological, clinical-catamnestic, with a retrospective analysis, neurological, pathopsychological, psychometric and statistical research methods. RESULTS: A high frequency of deviations from normative parameters in early psychomotor development was found in 99 (65%) patients with STD. Mental retardation was observed in 23 (15%) patients, dissociation in mental development was detected in a significant number of patients - 62 (41%). At the same time, the most significantly more frequent and pronounced were violations in the two youngest groups with the onset of psychopathological disorders up to 6 years. In these groups, there was also more often a deficit in three areas at once - emotional, motivational and volitional (38%) compared with the 4th group (13%). In groups 1 and 2, a deficit in intellectual development was also characteristic, which was reflected in academic indicators. High performance in the primary grades was observed in 16% of patients in the 1st group versus 60% in the 5th, and poor performance was found in 37% in the 1st group and only 5% in the 5th. The relationship of clinical variants of STD with the selected groups was revealed. The diagnosis of schizotypal personality disorder was significantly more often (66%) diagnosed in patients from group 1 compared with groups 3 and 5. In group 2, this diagnosis was established in a third of cases. The diagnosis of the psychopathic variant of STD was predominant in patients with the onset of the disorder between 7 and 13 years of age. The neurosis-like variant had a clear tendency to become more frequent with older age, reaching statistically significant differences in group 5 compared to group 1. CONCLUSION: The age of onset and duration of persistence of psychopathological disorders determines the level of negative changes that have formed at the stage of the disease preceding the onset of distinct clinical symptoms of STD. Age at onset determines the predominant positive disorder.

[History of the formation of views on schizotypal disorder in childhood]. / Istoriya formirovaniya vzglyadov na shizotipicheskoe rasstroistvo v detskom vozraste.

The article reflects the stages of development of views on schizotypal disorder (STD) in adults and children from the prenosological period to the present. It is shown how, after the recognition by the majority of psychiatrists of the concept of early dementia proposed by E. Kraepelin, there is a gradual recognition of the single essence of schizophrenia for childhood and adulthood, but with different, specific clinical manifestations at different age periods. The study of variants of schizophrenia without a fatal outcome in dementia, which led to the isolation of sluggish schizophrenia, including in childhood, begins with the works of E. Bleuler. The differences in approaches to the study and interpretation of sluggish schizophrenia in Russian, European and American psychiatry, which led to the isolation of STEs in the framework of personality disorders, are described. Three main concepts that exist at the present stage of research are presented, in which STD is considered as an independent disease in the spectrum of schizophrenic disorders, as one of the types of personality deviations with a high degree of vulnerability for the development of schizophrenia, and as one of the forms of the disease.

[Clinical features of depression in adolescents with schizotypal disorder]. / Depressii pri shizotipicheskom rasstroistve v detsko-podrostkovom vozraste.

OBJECTIVE: To study the clinical features of depressive disorders in adolescents with schizotypal disorder (STD). MATERIAL AND METHODS: Were examined 87 adolescents with STD (F21), taken for outpatient or inpatient observation in 2018-2020. Of these, 26 patients were selected (12 males, 14 females, mean age 12.7±2.9 years) diagnosed with clinically significant depression (F32). To assess the severity of depression, the Hamilton Depression Rating Scales (HDRS) and the Beck Depression Self-Assessment Questionnaire (BDI) were used. The SPQ questionnaire was used to quantify the presence of STD symptoms. RESULTS: Depressive disorders were observed in 28% of all examined patients with STD. Signs of dysontogenesis were observed in 92% of the examined. The duration of depressive episodes before the start of treatment averaged 8.7 months, and until therapeutic remission was achieved, an average of 12.6 years. A mild depressive episode according to the HDRS scale corresponded in 23.1% of patients with a moderate degree in 61.5% and a severe one in 3.8%. At the same time, according to the BDI questionnaire, the results were different: there was no mild degree of depression during treatment, moderate-severe degree was detected in 8 (30.1%) patients, in the remaining 16 (61.5%) - extremely severe degree. Suicidal thoughts were noted in 76.9% of the surveyed, while the parents knew about their presence only in 27.0% of adolescents. A suicidal attempt was made by 3 patients (11.5%), one of them repeatedly. Non-suicidal self-injurious behavior was found in 38.5% of patients. CONCLUSION: Depressive episodes in adolescents with STD are noted chkasto, characterized by the duration and severity of symptoms. Subjective depressive experiences, primarily internal feelings of longing, ideas of failure and guilt, as well as the frequency of anti-vital thoughts and self-injurious behavior, are much more pronounced in adolescents than they demonstrate in everyday life.

[Classification metamorphoses of autism in child psychiatry]. / Klassifikatsionnye metamorfozy autizma v detskoi psikhiatrii.

The article analyzes the evolution of scientific views on autism in children and milestone changes in the international classification. The main issues related to conceptual, terminological and classification aspects are reflected. The reasons for the increase in the prevalence of autism spectrum disorders, terminological inconsistencies, and deviations from etiopathogenetic views on autism are discussed. The question is raised about the need to adapt the introduced ICD-11 practice or working practice for everyday practice and scientific research in Russia.

[Using Lurasidone in the treatment of mental illness in childhood]. / Primenenie Lurazidona pri lechenii psikhicheskikh zabolevanii v detskom vozraste.

Lurasidone is one of the newest antipsychotics approved for use in childhood. The review presents generalized data on the pharmacological profile of Lurasidone, preclinical and clinical studies of the drug with an analysis of the parameters of pharmacodynamics, pharmacokinetics, clinical efficacy, tolerability and safety of therapy for schizophrenia and bipolar disorder in children. It also provides data on the off-lable use of Lurasidone in childhood for autism spectrum disorders, Tourette's syndrome, hypomania in the structure of bipolar affective disorder. The data on the efficacy of Lurasidone in a wide range of psychopathological disorders, including positive, negative, affective and cognitive domains, as well as a favorable tolerability profile of the drug, including long-term therapy, are presented.

[Cogitum in children's neurology and psychiatry (experience in the practical use)]. / Kogitum v detskoi nevrologii i psikhiatrii (opyt prakticheskogo primeneniya).

The authors review current data on the role of the synthetic aspartic acid analogue N-acetyaspartate (NAA) in various biochemical metabolic reactions in the CNS. Its importance as a biomarker for neuropsychiatric disorders identified using magnetic resonance spectroscopy (MRS) is noted. The authors present their own results of the use of cogitum, a synthetic analogue of NAA, in children with the effects of traumatic brain injury, mental retardation, hyperactivity disorder and in the complex therapy of schizotypal disorder. Effects of cogitum on cognitive deficit, asthenia are evaluated. The neurotrophic effect of the drug, which specifically affects cognitive and asthenic disorders in these diseases, is shown.

[Characteristics of neurological status in children with schizophrenia and schizotypal disorder]. / Osobennosti nevrologicheskogo statusa u deteĭ s shizofrenieĭ i shizotipicheskim rasstroĭstvom.

AIM: To study characteristics of neurological status in children with schizophrenia and schizotypal disorder. MATERIAL AND METHODS: A study included 80 children, aged from 5 to 10 years: 38 children were diagnosed with schizophrenia (ICD-10 F20.8хх3) and 42 with schizotypal disorder (F21). RESULTS AND CONCLUSION: Children of both groups had a wide spectrum of neurological symptoms, diffuseness of which indicated the disintegration of the multilevel system of motor analyzer. No topical between-group differences were found whereas their intensity and frequency was not correlated to either the severity or a stage (exacerbation - remission) of disease. The more marked was disease progression and severity of mental disorders, the greater was the amount and clearness of neurological disorders. There was a predominance of disorders of motor regulation and integration, various extrapyramidal disturbances. As a consequence, in absence of paresis and paralyses, there was not merely the alteration of the function per se but rather of its integrity, completeness, consistency with other mental acts that turned to be the neurologic equivalent of discordance and inconsistency of mental functions specific of schizophrenia. These neurological symptoms may be considered as topic markers of the changes in the brain and dynamics of endogenous process. Transitory and instable character of these symptoms, along with the deficits of extrapyramidal and cortical regulation outside of the process exacerbation, indicates the insufficiency of neurotransmitter mechanisms.

[The system of quality control of psychiatric care in the Netherlands].

The article discusses the current quality control system in the psychiatric care in The Netherlands which has become a result of the involvement of various stakeholders, such as the state and the legislation, insurance companies, patients and their representatives, and the professionals. It can be seen that the influence of the psychiatrists has been rather limited, but their role can increase as the newly established Dutch Association of Medical Specialists will be gaining more weight and participate in the major decisions affecting the health care in the Netherlands.