[Insomnia in the context of affective disorders]. / Insomniya v kontekste affektivnykh rasstroistv.

The article analyzes the current literature on the relationship of insomnia with affective disorders, in particular with depression and anxiety. Research shows that there is a strong multi-channel relationship between insomnia, depression, and anxiety, with insomnia being considered a risk factor for mood disorders more often than vice versa. The so-called insomnia paradox of bipolar disorder is described, the essence of which is that in manic episodes the frequency of insomnia is higher than in depressive episodes. The data of a network meta-analysis, which found an evidence base for the use of a variety of drugs used for the pharmacological treatment of insomnia in adults, are presented. Efficiency and convenience in taking the drug Valocordin-Doxylamine are noted.

[Neuropsychiatric presentations of amyotrophic lateral sclerosis]. / Neiropsikhiatricheskie proyavleniya bokovogo amiotroficheskogo skleroza.

Neuropsychiatric presentations are observed in a substantial number of patients with amyotrophic lateral sclerosis (ALS). Severe behavioral disorders develop in ALS combined with frontotemporal dementia, which are considered to be a disease continuum. Psychiatric disorders in ALS with predominantly motor symptoms are less prominent and mostly presented with apathy. Psychiatric disorders in ALS by their origin could be psychogenic, reflecting the patients' reactions on severe disease, and organic, developing as a result of degeneration of central motor neurons and disconnection between fronto-subcortical and frontotemporal loops. An important role in the development of psychiatric disorders in ALS belongs to genetic factors, in particular to hexanucleotide expansion in the C9orf72 gene. During the first months after establishing the diagnosis of ALS, there is the high risk of developing depressive disorders, which in severe cases can lead to suicide. More research is needed in this area.

[Dual diagnosis: depression and alcohol use disorder]. / Dvoinoi diagnoz: «depressiya¼ i «rasstroistvo upotrebleniya alkogolya¼.

A combination of depression and alcohol use disorder (AUD) is a typical and most common example of a dual diagnosis at the intersection of general psychiatry and addiction psychiatry. A comorbidity of depression and AUD is more common than it can be brought about by mere coincidence, which might be explained to some extent by the synergetic effect of both diseases, with each of them complicating the course and worsening the prognosis of the other. Treatment protocols for patients with depression and comorbid AUD include antidepressants, specific medications for alcohol dependence, and psychotherapy. The first-line antidepressants in the treatment of patients with a comorbid combination of depression and alcohol use disorder, as in other clinical situations implying use of antidepressants, are selective serotonin reuptake inhibitors (SSRIs). Fluvoxamine has certain advantages over the other SSRIs in the treatment of patients with a depression and comorbid AUD.

[Disorders of social cognitive functions in patients after stroke]. / Narushenie sotsial'nykh kognitivnykh funktsii u patsientov posle tserebral'nogo insul'ta.

Social cognitive functions used to encode and decode social information, and are critical for people to understand themselves and others, as well as the norms and procedures of the social world. They could be subdivided into theory of mind, social perception, affective empathy and social behavior. From neuroanatomical viewpoint disorders of social cognitive functions are related to the dysfunction of the certain areas of frontal and temporal lobes of the brain and their connections. In contrast to psychiatric disorders social cognitive deficit is heterogeneous in its nature and depends on the lesion location. Disorders of theory of mind, social perception and social behavior significantly more often are seen in patients after stroke than in healthy people. Social cognitive deficit has a negative effect on the outcome of stroke. More research is needed in this area.

[The problem of comorbidity of epilepsy and psychogenic paroxysms]. / Problema komorbidnosti epilepsii i psikhogennykh paroksizmov.

A review of publications over the last two decades is presented. Psychogenic paroxysms develop in approximately 12% of patients with epilepsy. The analysis of social and demographic data, history details, semiological features and results of electrophysiological and neuroimaging studies does not unequivocally support the comorbidity of epilepsy and psychogenic paroxysms. The pathogenetic mechanisms of the development of comorbidity are various and depend on the presence of pharmacoresistance, psychological traumas in the past, intellectual disability etc. Video-EEG-monitoring is the gold standard in the diagnosis of comorbidity of epilepsy and psychogenic paroxysms. Treatment of such cases includes anticonvulsants and cognitive-behavioral therapy.

[Addictophobia in modern psychiatry (benzodiazepines and other psychopharmacological drugs)]. / Problema addiktofobii v sovremenoi psikhiatrii (benzodiazepiny i drugie psikhofarmakologicheskie sredstva).

The paper analyzes clinical, epidemiological and pharmacological aspects of abuse of psychopharmacological medications (anxiolytics, antidepressants, anticonvulsants) and probability of drug dependence. Emphasis is placed on assessment of addictophobia phenomenon, an unreasonable fear of medication dependence, widespread not only among patients and their relatives but also in medical community. The problem of addictive potential of benzodiazepines, in particular, phenazepam, is specially studied. Based on clinical and pharmacological data and taking into account an elimination half-life, the conclusion about safety of phenazepam and low probability of dependence is made. The author notes that addictophobia reduces the compliance (adherence) to treatment. Ignorance of well-known criteria of the diagnosis of dependence is considered as a cause of addictophobia.

[The problem of aggressive behavior in epilepsy: clinical and neurobiological aspects]. / Klinicheskie i neirobiologicheskie aspekty agressivnogo povedeniia pri épilepsii.

Aggressive behavior is observed in a significant number of patients with epilepsy. The aggressive behavior is associated with structural and functional changes in the amygdala, orbitofrontal cortex and striatum. From the clinical point of view, aggressive behavior more often is not related to the seizure, and develops as part of borderline psychiatric disorder. Another potential cause of aggressive behavior is postictal psychotic disorder. Pre- and intraictal aggressive behavior is rarely observed. Anticonvulsants may influence differently on aggression. Antidepressants, neuroleptics, normotimics and psychotherapy are used in correction of aggression.

[Addictions profiles as a tool for comparison of chemical and nonchemical dependencies]. / Profili addiktsii kak instrument dlia sravnitel'noi otsenki khimicheskikh i nekhimicheskikh zavisimostei.

AIM: A clinical and phenomenological comparative evaluation of addictions (alcoholism, drug addiction, sexual and tobacco dependence, pathological gambling) to develop integrative methods for the assessment of comparative performance profiles of addictive disorders. MATERIAL AND METHODS: One hundred and forty-six patients were examined using clinical, psychometric and statistical methods. RESULTS AND CONCLUSION: Addiction profiles were described and addictive potentials were compared. The most pronounced addictive symptoms were found in groups where the participants were addicted to drugs or to pathological gambling. The least pronounced symptoms were found in patients addicted to tobacco. Participants addicted to alcohol were in the middle range.

[The quality of research publications in psychiatry]. / Kachestvo issledovatel'skikh publikatsii v psikhiatrii.

AIM: To evaluate the quality of research articles in psychiatry and addiction medicine published in 2015. MATERIAL AND METHODS: Five experts analyzed 51 research publications from 13 psychiatric and addiction medicine journals using a standardized questionnaire, which contains 4 general questions (type or results of the study) and 21 questions on the quality of the study. RESULTS: Only 2 articles (4%) met all criteria, 64% of the articles refer to the methodologically least demonstrative (uncontrolled/one-time, series of cases, non-randomized). The most vulnerable were the characteristics which were the most important for evidence: a description of the methods, statistical analysis, accounting for systematic errors and/or side effects, the distribution of patients by group. CONCLUSION: Research publications in psychiatry and addiction medicine have a low level of evidence.

[Sleep disorders (insomnia) as a psychoneurological dilemma in the diagnosis and treatment]. / Dissomnicheskie (insomnicheskie) rasstroistva: psikhonevrologicheskaya dilemma v diagnostike i terapii.

Approaches of psychiatrists and neurologists to the diagnosis and therapy of sleep disorders are analyzed. On the basis of studying of 37 patients, the phenomenon of «somnic anhedonia¼ is described. Data on the relationship between insomnia and various mental disorders are presented. Scientifically based schemes of therapy, in particular, with the application of etifoxine (stresam) are described.

[Methodological mistakes and contradictions in the ederal clinical recommendations on addiction medicine]. / Metodologicheskie oshibki i protivorechiya v Federal'nykh klinicheskikh rekomendatsiyakh po narkologii.

Methodological mistakes and contradictions in the Federal clinical recommendations on therapy of addictive disorders are analyzed. It is noted that the recommendations aren't based on the principles of evidence-based medicine; ignore achievements of world addiction medicine and necessity of using drugs with the proved efficacy; are accepted in the conditions of refusal of scientific collegiality; contradict the instructions on the use of medicines and contain a large number of controversial theoretical issues.

Paradoxes of evidence in Russian addiction medicine.

BACKGROUND: For many years, clinical protocols for treatment of drug abuse patients and treatment standards in Russian Federation were not grounded on the principles of evidence-based medicine [1]. Recommendations for use of certain drugs were not accompanied by any indication of the level of credibility of the evidence supporting it. The appearance in 2014 of such indications in clinical recommendations can be considered a significant step forward for the science of addiction medicine [2]. OBJECTIVE: To compare Russian evidence and practice in addiction medicines with international standards. METHODS: Situation and literature analysis. RESULTS: The analysis shows that in the wording of recommendations on the use of medicines, some were subject of serious methodological errors. For some drugs globally there is high quality evidence supporting effects of certain drugs globally, but this is not recognized in Russia. As a result, Russian standards of clinical care for the treatment of dependency syndrome are radically different to the standards of therapy, presented in the WHO recommendations. This is due both to the disregard of the meta-analyses presented in the Cochrane reviews and also to the specific bioethical preferences in drug treatment in Russia.It is known that there is no convincing data on the effectiveness and safety of antipsychotics in the treatment of alcohol dependence syndrome [3]. 13 randomized trials with a double blind placebo-controlled design involving 1593 patients assessing effects of amisulpride, aripiprazole, flupentixolum dekonoat, olanzapine, quetiapine, tiapride showed that antipsychotics do not result in abstinence, do not reduce abuse and do not stop craving in alcoholic patients: "Antipsychotics should not be used in patients with a primary diagnosis of dependence. Appointment of antipsychotics for the treatment of substance abuse disorders are contraindicated, since not only does it not improve the condition of patients, but it can even worsen the course of the disease, leading to a reduction in the duration and quality of the remission, and is fraught with serious side effects that threaten the health of patients."SSRI antidepressants indirectly improve the results of treatment of comorbid alcoholism in depressed patients, without affecting alcohol dependence per se. Also, there is currently no convincing evidence of the efficacy of anticonvulsants in the treatment of dependence syndrome, particularly alcohol.Despite the fact that traditional psychotherapeutic interventions remain widespread in practice, and treatment of alcohol dependence syndrome showed high efficiency, there is no convincing evidence for long-term benefits as opposed to short-term benefits.The Cochrane Review with data based on 146 scientific studies involving 21,404 patients confirmed the effectiveness of opioid receptor agonists in treatment of opioid dependence. This therapy showed a statistically significant reduction in the use of illegal drugs, HIV transmission and risky sexual behavior, and was significantly more effective compared to the conventional maintenance therapy with opioid receptor antagonists. In countries, where law prohibits prescribing and use of opioid agonists for opioid dependence treatment, the drugs of choice are antagonists.A meta-analysis of thirteen randomized placebo-controlled trials of oral form of naltrexone (1158 subjects), did not show any advantages of this type of treatment both for management and prevention of relapse compared with placebo [4]. Special studies also showed no inclination to reduce the use of opiates in patients receiving naltrexone [5]. However, studies carried out in Russia, showed the best results for daily intake of naltrexone after detoxification, which increased the duration of remission [6]. It was noted that the effect is associated with higher levels of adherence and family support in the examined population.An overview based on controlled clinical studies on the use of antipsychotic drugs (neuroleptics) in patients dependent on opioids revealed no evidence of effectiveness of this approach. It was concluded that the use of antipsychotics is justified only in the presence of co-morbid psychiatric problems in patients [7]. In a recent meta-analytic review on the use of atypical antipsychotics for off-label indications (off-label), there was a lack of data to support the effectiveness of their use in substance abuse [8, 9]. The effectiveness of anticonvulsants in the treatment of opioid dependence syndrome has not been proven.In connection with the above puzzling fact, for Russian standards of treatment (clinical guidelines) the level of credibility of the effectiveness of antipsychotics and antidepressants in treatment of substance abuse is assessed as A or B. This paradox raises the question of the methodology for determining the level of credibility of evidence. It should be noted that Russian recommendations for inclusion of certain drugs and therapies are based on sufficient consensus of experts rather than on the results of meta-analyses [2]. CONCLUSIONS: This fact casts doubt on credibility and validity of scientific recommendations. Thus, one may say that Russian addiction medicine is not based on evidence, which is, in our view, erroneous and may impair the quality of care.

[Accuracy of the choice of the dependence syndrome treatment: evidence-based addictology against clinical practice]. / Argumentirovannost' vybora terapii sindroma zavisimosti: dokazatel'naia narkologiia protiv rutinnoi klinicheskoi praktiki.

In article it is analyzed the reasons of discrepancy of arguments at a choice of dependence syndrome treatment in Russian, in particular when forming National clinical protocols. The conclusion that rejection of use principles of evidence-based medicine is based on the objective and subjective reasons is drawn. Lack of available Russian-speaking scientific literature, insufficient level of knowledge of English for acquaintance with bases of Cochrain library and scientific articles concerns to the first. To the second - domination of the concept «a pathological craving¼, considering an criving as a psychotic syndrome (delusion) and use antipsychotics for its treatment.

[On psychologic profile of locomotive crew workers in Russian Railways JSC and its role in accidents prevention].

The article covers personality characters of locomotive crew workers of Russian Railways JSC, and specifying a block of methods for psychologic support of these workers' occupational activities. According to the results obtained, the authors presented a thorough description of characterologic, motivational personality traits characterizing a select of locomotive crew workers, and analyzed a relationship between the traits and levels of accidents in the workers' occupational activity.

[Chemical and nonchemical addictions in the aspect of comparative addictology]. / Khimicheskie i nekhimicheskie addiktsii v aspekte sravnitel'noi addiktologii.

The existence of chemical as well nonchemical addictions is a clinical reality. It makes it necessary to compare these addictions in order to find mechanisms and common basis of their development, to specify their position in modern classifications of mental diseases and behavioural disorders and to develop treatment approaches. The literature data on all of abovementioned directions are reviewed. The authors stipulate the necessity of broadening narcology, as a field of clinical medicine, to addictology and development of a specialized addictologic service.

[The relationship of drug and alcohol addiction in teenagers with the character of their relations with parents].

An experimental-psychological study of 62 male teenagers with drug addiction and alcohol addiction revealed that the character of their relations with parents was dependent on the form of addiction. It has been concluded that these types of addictions have different psychological mechanisms of formation.

[Phenomenology of craving: from differentiation to adequate therapy].

The author analyzes a phenomenon of addiction from the psychological/psychiatric position and differentiates it from psychopathological disorders, including parabulia, hyperbulia, paraphylia, commonly used for the definition of drive disorders. It has been concluded that addition is a specific complex of clinical symptoms which is not similar to other drive disorders. To avoid diagnostic and therapeutic errors, the author suggests to revise definitions by assigning the biological sense to the conception of addiction within psychoactive substance dependence and sexual addiction, some forms of eating dependence and to use the definition of paraaddictive drives in cases of over-valued drives (gambling, Internet dependence, fanaticism etc).

[The epidemiological aspects of combined arterial hypertension and peptic ulcer]. / Epidemiologicheskie aspekty sochetaniia arterial'noi gipertonii i iazvennoi bolezni.

Altogether 598 workers and employees of an industrial enterprise underwent epidemiological examination. The age of the examined ranged within 30 to 49 years. Arterial hypertension was revealed in 14.2% and ulcer disease in 9% of the population. 1.5% of the population presented with associated pathology. Among risk factors of paramount importance was unbalanced nutrition and hypotensive treatment. Impairment of cell membranes also played a certain role in the occurrence of associated pathology.

[A case of schizophrenia-like psychosis in multiple sclerosis or casuistic association of the 2 diseases]. / Sluchai shizofrenopodobnogo psikhoza pri rasseiannom skleroze ili kazuisticheskoe sochetanie dvukh boleznei.

The authors describe a rare case of schizophrenia-like psychosis in a female patient suffering from cerebrospinal multiple sclerosis. Delineate the time-course of changes in psychic disorders, the data of experimental psychologic and electroencephalographic studies. Analyze the case described as compared with the cases reported in literature.

[Sociological evaluation of various aspects of the organization of psychiatric services]. / Sotsiologicheskaia otsenka nekotorykh aspektov organizatsii psikhiatricheskoi sluzhby

The author provides the data obtained as a result of a sociological study of the public opinion of psychiatry. Overall 1000 adult men and women living in the city were interviewed. Analysis is made of the responses of the following population groups: workers, white collars, students, pupils and pensioners. Their responses are compared to those given by experts (n-40). The data of the poll dealing with the problems of psychiatric services organization are presented.