[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.

[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.

[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.

Autoantibodies to glutamate receptors and products of nitric oxide metabolism in serum in children in the acute phase of craniocerebral trauma.

Levels of serum autoantibodies (aAb) to glutamate receptors and products of nitric oxide (NO) metabolism, i.e., nitrates and nitrites, were assayed in children with recent craniocerebral trauma (CCT) of different levels of severity. All the children showed increases in serum aAb to both AMPA and NMDA receptor subtypes from day 1 to day 10 after trauma. The highest levels of serum aAb were to the NMDA subtype of glutamate receptor, which was characteristic of children with mild CCT (MCCT), with Glasgow Coma Scale (GCS) scores of 14-15 points. Levels of aAb to NMDA (NR2A) receptors in children with severe CCT (SCCT, GCS < 9 points) were lower than in children with MCCT, the lowest levels being seen in the group of children with lethal CCT (SCCT-2). Serum concentrations of NO metabolites increased by large factors in the group of children with SCCT, indicating marked brain hypoxia.

Glutamate receptor autoantibody concentrations in children with chronic post-traumatic headache.

We report here studies on the levels of autoantibodies (aAb) to AMPA glutamate receptors (GluR1 subunit) and NMDA glutamate receptors (NR2A subunit) in serum from 60 children aged 7-16 years with chronic posttraumatic headache (CPTHA) following mild craniocerebral trauma (CCT). The first group consisted of 48 children who had sustained cerebral concussion (CC), of which 34 had single-episode CC (subgroup 1a) and 14 had repeated CC (subgroup 1). The second group included 12 children with mild cerebral contusions (MCC). Serum glutamate receptor aAb levels were measured six months and one year after trauma. Increased aAb levels were expressed as percentages and were regarded as significant when increases were to 120% of the level seen in healthy children of the same age. The highest levels of aAb to NMDA receptors were seen in children with MCC (165 +/- 34%) and single CC (145 +/- 12.6%). Children with repeated CC had NMDA receptor aAb at normal levels (108 +/- 12.4%). Increases in NMDA receptor aAb were seen during the first year after trauma. Increases in AMPA receptor aAb were seen in children with repeated CC and MCC (150 +/- 16.8% and 167 +/- 31.3%). EEG studies showed that 18% of these children had nonspecific paroxysmal changes and 6% showed epileptiform activity. These results provide evidence that children with post-traumatic headache demonstrated hyperstimulation of glutamate receptors and overdevelopment of the autoimmune process. Increases in serum levels of aAb to NMDA glutamate receptors reflected hypoxic-ischemic brain lesions in children with CPTHA and dictate the need for these children to receive metabolic therapy.

Autoantibodies to nerve growth factor in disorders of mental development in infants.

Studies were performed using 80 children aged 1-3 years with lesions to mental development. Patients were divided into three groups according to the severity and structure of lesions of mental development: those most strongly characterized by delayed speech development (group 1), those with delayed mental development due to organic CNS lesions (group 2), and those with abnormal mental development and high levels of psychopathological symptoms (group 3). There were significant increases (p < 0.001) in blood levels of autoantibodies to nerve growth factor (NGF) in children in each of these groups as compared with a control group (0.75 +/- 0.24 OD units). The levels of anti-NGF autoantibodies increased from group 1 to group 3 (0.95 +/- 0.24 OD units in group 1, 1.13 +/- 0.27 OD units in group 2. and 1.24 +/- 0.4 OD units in group 3). These correlations suggest that the level of anti-NGF autoantibodies can, taken in conjunction with a number of other parameters, be regarded as a potential molecular marker demonstrating abnormal development of the nervous system.