[Psychopharmacotherapy of mixed affective states in bipolar disorder]. / Psikhofarmakoterapiya smeshannykh affektivnykh sostoyanii pri bipolyarnom rasstroistve.

On the example of a patient with a mixed affective episode within the framework of bipolar affective disorder, the clinical features of this psychopathological condition, the difficulties of diagnosis and selection of therapy in mixed states are presented. The use of the modern atypical antipsychotic ziprasidone in this category of patients is argued.

[Evaluation of the efficiency of the method of biological feedback in complex therapy of patients with hypertonus of the chewing muscles]. / Metod biologicheskoi obratnoi svyazi v kompleksnoi terapii patsientov s gipertonusom zhevatel'nykh myshts.

The aim the study. Evaluate the effectiveness of biofeedback therapy in the complex rehabilitation of masticatory muscle hypertonicity in patients with a high level of anxiety. MATERIAL AND METHODS: The study included 40 patients aged 20 to 32 years with complaints of fatigue and discomfort in the area of chewing muscles, teeth compression during the day, nocturnal bruxism, crowding of teeth. Two groups were formed: the study group, whose patients underwent splint therapy in combination with biofeedback therapy trainings; in the control group, patients received treatment with splint therapy without the use of biofeedback therapy. Electromyography of the masticatory muscles at rest and during compression were used to diagnose hypertonicity of the masticatory muscles. To assess the psycho-emotional state, a medical and social questionnaire was conducted using questionnaires: «Health Questionnaire¼, Beck Depression Inventory, Spielberger-Khanin Anxiety Scale, SF-16 Quality of Life Scale. RESULTS: A decrease in the level of depression, anxiety was revealed with the stabilization of emotional sensitivity in relation to other people, emotional involvement in everyday life, and an increase in the quality of life. When comparing electromyographic data at rest and during clenching of teeth in patients of the study group the indicators were lower than in the control group. CONCLUSIONS: The effectiveness of biofeedback therapy at the stages of orthodontic treatment using splint therapy was established in the form of a decrease in the activity of masticatory muscles in patients of the study group. In the control group, the index of masticatory muscle activity decreased to a lesser extent. Biofeedback methods have shown a high level of effectiveness in reducing the symptoms of anxiety and depression, improving the quality of life.

[Recent approaches to the diagnosis and therapy of monopolar depression]. / Sovremennye podkhody k diagnostike i terapii monopolyarnoi depressii.

Unipolar depression is one of the most significant biomedical problems, which is associated with its high prevalence, a pronounced negative impact on the level of work capacity of the population, worsening of the course of most somatic and neurological diseases, and suicide risk. This review presents current data on approaches to the diagnosis of monopolar depression, both classical (clinical and psychometric) and using modern technologies. The existing approaches to the therapy of monopolar depression - psychopharmacologic, psychotherapeutic, and non-drug biological approaches - are discussed. The advantages of the selective serotonin reuptake inhibitor sertraline are presented, and its use as a first-line drug is justified.

[Complex therapy of psychosomatic disorders associated with the female reproductive cycle]. / Kompleksnaya terapiya psikhosomaticheskikh rasstroistv, assotsiirovannykh s reproduktivnym tsiklom zhenshchiny.

Psychosomatic disorders make a great contribution to the structure of reproductive health disorders in women. The purpose of this review was to analyze the available data on effective methods of therapy for psychosomatic disorders associated with the reproductive cycle of women - psychopharmacological, psychotherapeutic, non-drug biological, hormonal. The review summarizes the evidence in relation to the treatment of disorders such as: stress-related menstrual irregularities; premenstrual dysphoric disorder; perinatal affective disorders (especially depression); psychosomatic disorders of the involutionary period. General recommendations on the complex therapy of psychosomatic disorders associated with the menstrual cycle within the framework of an interdisciplinary team have been formed.

[To the problem of somatic-hypochondriac paranoia]. / K probleme somaticheskoi-ipokhondricheskoi paranoii.

OBJECTIVE: To unite within the framework of a single clinical entity (based on the model of hypochondriacal paranoia) phenomena of the somatopsychotic and hypochondriacal range, which, in accordance with modern systematics, are classified as various categories of psychosomatic, affective disorders and personality disorders. MATERIAL AND METHODS: The sample for analysis consisted of 29 patients (with the diagnosis of delusional disorder (ICD-10; F22.0 in ICD-10), 10 men (34.5%) and 19 women (64.5%), the average age was 42.9±19.9 years; men - 10 nab. (34.5%), women - 19 nab. (64.5%). The average duration of the disease iswas 9.4±8.5 years. The psychopathological method was used as the main one. RESULTS: The article forms an alternative concept of somatic paranoia based on the model of hypochondriacal paranoia. The fundamental difference between the construct of somatic paranoia is an obligate connection between somatopsychic and ideational disorders. Somatopsychic (coenesthesiopathic) symptoms do not exist as an independent (equivalent to the structure of somatic clinical syndromes) dimensions and are formed exclusively with the participation of ideational phenomena. CONCLUSION: In accordance with the presented concept, coenesthesiopathic symptoms within the framework of somatic paranoia act as a somatic equivalent of delusional disorders.

[A role of neurosteroids in the pathogenesis of psychiatric disorders]. / Rol' neirosteroidov v patogeneze psikhicheskikh rasstroistv.

Despite the proven importance of neurosteroids in many physiological processes, their role in the pathogenesis of the most of psychiatric disorders remains relatively understudied. This article reviews the current clinical evidence on the effects of neurosteroids on the formation and treatment of anxiety disorder, depression, bipolar disorder, and schizophrenia. In particular, the article points out the ambivalent nature of the effects of neurosteroids on GABAA- and other receptors. We are especially interested in the anxiolytic and anxiogenic effects of some neurosteroids, the antidepressant effect of allopregnanolone in treating postpartum and other forms of depression, and the nature of short- and long-term mechanisms of antidepressant effects of neurosteroids of different types. The currently unproven hypothesis about the effect of changes in the level of neurosteroids on the course of bipolar disorder is also discussed, with an analysis of the scientific evidence on the development of schizophrenic symptomatology in relation to changing neurosteroid levels in the context of positive and cognitive symptoms.

[Clinical features of asthenic disorders in chronic heart failure]. / Klinicheskie osobennosti astenicheskikh rasstroistv pri khronicheskoi serdechnoi nedostatochnosti.

OBJECTIVE: The aim of the study is to study the clinical features of asthenic disorders in chronic heart failure (CHF) considering the reaction to the disease. MATERIAL AND METHODS: 62 inpatients with CHF II-IV functional class (FC) according to NYHA were examined. Research methods included somatic, psychopathological and pathopsychological examination using psychometric scales. RESULTS: According to a pathopsychological study using the Multidimensional Fatigue Inventory (MFI-20), asthenic disorders were discovered in all examined patients, realized mainly by «general fatigue¼ (75.8%) and «physical fatigue¼ (72.6%), more rarely «mental fatigue¼ was observed (32.2%). Correlations of «general fatigue¼ with the age of patients were revealed (p=0.018). There was a relationship between the severity of asthenic disorders and the severity of CHF, as evidenced by the correlation between «general fatigue¼ and reduced ejection fraction (EF) of the left ventricle (p=0.005), as well as «physical fatigue¼ and FC according to NYHA (p=0.022). The negative impact of all components of the dimensions of asthenic disorders on the quality of life was determined (p<0.05). According to the concept of the formation of different perceptions of the manifestations of a somatic disease, two types of reactions to asthenic disorders were identified: 1. Dissociative reactions, manifested by a discrepancy between the severity of CHF and a subjective assessment of the condition with an underestimation of the asthenic symptoms denial of its influence on the usual lifestyle and associated with an unfavorable course of CHF and 2. Adaptive reactions, realized by a harmonious perception of asthenia, awareness of the need to change lifestyle considering the presence of CHF symptoms. CONCLUSION: In accordance with the results, the described clinical features of asthenic disorders allow to distinguish asthenia in CHF and other pathology, and the identified types of reactions can contribute to the timely verification of asthenia, prevention of further progression of CHF, and the development of appropriate treatment approaches.

[Social and psychological risk factors for decreased adherence among patients with atrial fibrillation].

Adherence has a direct impact on reducing the effectiveness of atrial fibrillation therapy and increasing the risk of thromboembolic events. Among the factors involved in the decrease of adherence, the social and psychological characteristics of patients remain insufficiently studied. At the same time, the available publications allow us to conclude that there are markers of the risk of reduced adherence in patients with atrial fibrillation, which include age, cognitive impairment, psychoemotional disorders (including depression and anxiety) and specific behavioral patterns.

[Impact of anxiety disorders on adherence to anticoagulant therapy in patients with atrial fibrillation].

AIM: To evaluate the impact of anxiety disorders on adherence to anticoagulant therapy (ACT) in patients with atrial fibrillation (AF). MATERIALS AND METHODS: 179 outpatients (131 women, 48 men, mean age 69.96.2 years) with AF were examined. The research methods included a physical examination according to the standards of medical care in an outpatient facility, clinical and psychopathological examination using psychometric scales. RESULTS: Based on the assessment of adherence to ACT using the MoriskyGreen test, 2 groups of patients were identified: Group 1 patients with high adherence to ACT, Group 2 patients with partial/low adherence to ACT. In group 1, anxiety disorders were verified in 51.7% of cases, in group 2 54.3%. There were no statistically significant differences in the prevalence and severity of anxiety in the study groups. In accordance with the binary logistic regression model, the probability of high adherence to therapy is determined by higher (compared with the group of patients with partial/low adherence to therapy) scores in terms of mental health (p0.001), vital activity (p=0.02) and the total score of the SF-36 scale (p=0.08), as well as the extraversion parameter (p=0.02) of the NEO-FFI scale. CONCLUSION: In the present study, no significant association was found between anxiety symptoms and a decrease in adherence to ACT in patients with AF. However, the results obtained suggest a contribution to the adherence to therapy of personality characteristics.

[Clinical and psychopathological aspects of nosogenic reactions in chronic heart failure]. / Kliniko-psikhopatologicheskie aspekty nozogennykh reaktsii pri khronicheskoi serdechnoi nedostatochnosti.

OBJECTIVE: To study the typology of nosogenic reactions in chronic heart failure (CHF) with the determination of the contribution of cardiological and personality factors in their formation. MATERIAL AND METHODS: One hundred and twenty-one patients with nosogenic reactions associated with CHF were examined. Somatic, clinical-psychopathological and psychometric examinations were used. RESULTS: Three types of nosogenic reactions in CHF have been identifiedSignificantly more frequent were dissociative reactions (76 (62.8%) patients, 40 men, 36 women, mean age 64.4±12.7) with an underestimation of the severity of the somatic condition, which formed in CHF with a short (3.2±3.8 years, p<0.05), but the most severe course. They were associated with hyperthymic, hysterical and schizoid personality radical. Hypochondriacal reactions (28 (23.1%) patients, 18 men, 20 women, mean age 63.4±15.2), due to anxiety about health and excessive fixation on the functioning of the heart, were characteristic of CHF, regardless of the severity of cardiological conditions, with an average duration of the course (4.1±4.2 years). They were observed in patients with anxious and hysterical radicals. Depressive reactions (17 (14%) patients, 8 men, 9 women, mean age 64.3±13.5), had the most protracted character (6.1±3.2 years), formed in patients with anankastic and schizoid radicals, and were noted in chronic heart failure with a long course and moderate severity. Heterogeneous nosogenic reactions in CHF were associated with low adherence to treatment due to maladaptive behavior of the patient, determined by the characteristics of the psychopathological structure. CONCLUSION: The study demonstrates the influence of the characteristics of a cardiac disease and personality on the clinical and psychopathological features of nosogenic reactions associated with maladaptive behavior of the patient.

[Pain syndromes and insomnia: the role of association with comorbid mental disorders (on the model of glossalgia)]. / Bolevye sindromy i insomniya: rol' assotsiatsii s komorbidnymi psikhicheskimi rasstroistvami (na modeli glossalgii).

OBJECTIVE: To test the association between pain severity and anxiety, depression, and somatoform symptoms in burning sleep syndrome (BMS). MATERIAL AND METHODS: The study included 36 patients (33 women, 3 men), mean age 58.0±14.8 years. Psychopathological, clinical-dermatological, parametric, statistical methods were used. Psychometric examination included the Visual Analogue Scale (VAS) for assessment of pain (severity of glossalgia), PHQ-4 for self-assessment of severity of anxiety (GAD-2) and depression (PHQ-2), the Hospital Anxiety and Depression Scale (HADS), the Screening for Somatoform Symptoms-2 (SOMS-2), the Pittsburgh Sleep Quality Index (PSQI), the EQ-5D-5L quality of life assessment scale. RESULTS AND CONCLUSION: Insomnia in chronic pain is very common. On the one hand, studies show that sleep deprivation can enhance pain perception. On the other hand, chronic pain can trigger a variety of sleep disorders. One of the localizations of chronic pain syndrome is the oral mucosa. Somatoform pain disorder related to oral mucosa called «glossalgia¼ or «burning mouth syndrome¼ (BMS). The prevalence of insomnia in the study sample was 61.1%. The statistically significant positive correlation was found between the severity of insomnia (PSQI) and the severity of anxiety on both GAD-2 and HADS, while insomnia showed no correlation with depression and pain severity. At the same time, the severity of anxiety showed statistically significant positive correlation with the severity of pain assessed by VAS.

[Modern concepts about insomnia in mental disorders: clinical aspects]. / Sovremennye predstavleniia ob insomnii pri psikhicheskikh rasstroistvakh (klinicheskie aspekty).

Insomnia is one of the most common symptoms of mental pathology (affective, anxious, hypochondriac, asthenic, psychotic) and reveals a number of characteristic features depending on the structure of the mental disorder. Psychopharmacotherapy for insomnia in mental disorders is an important aspect of patient supervision. Doxylamine (donormil) is one of the promising drugs for the correction of insomnia, both in combination with other psychotropic drugs and in monotherapy.

[Neurotic depression: approaches to treatment]. / Nevroticheskaia depressiia: podkhody k terapii.

This paper presents a case report of a patient with neurotic depression. The features of personal predisposition and clinical characteristics of the disease are considered. The authors note the advantages of an integrated approach to the treatment of neurotic depression with antidepressants and psychotherapy (cognitive behavioral therapy).

[Stress-induced atrial fibrillation]. / Stress-indutsirovannaia fibrilliatsiia predserdii.

AIM: To study clinical types of psychosomatic reactions with stress-induced atrial fibrillation (AF) and their contribution to personality disorders and characteristics of stressors. MATERIAL AND METHODS: The sample consisted of 34 patients with a stress-induced AF. A clinical/psychopathological method and psychometric scales were used. RESULTS AND CONCLUSION: Two groups of stress-induced psychosomatic reactions were identified. The first group somatic reactions led to a somatic catastrophe and were associated with paranoia and schizotypal personality disorders, constitutional alexithymia, as well as resistance to somatic problems. Second group was characterized by mental reactions leading to AF revealed predominantly in individuals with a histrionic and anxious personality disorders, reactive lability and the high level of neuroticism under the influence of severe stressors. The dynamics of psychopathological symptoms after AF manifestation was associated with different clinical forms of hypochondria.

[Association of inflammatory genes with neuroticism, anxiety and depression in male patients with coronary heart disease]. / Sviaz' genov vospalitel'nykh faktorov s nevrotizmom, trevozhnost'iu i depressiei u muzhchin s ishemicheskoi bolezn'iu serdtsa.

AIM: To explore the relationship of depression and its endophenotypes (neuroticism and trait anxiety) with inflammatory genes in patients with coronary heart disease (CHD). MATERIAL AND METHODS: A sample consisted of 78 male CHD patients with depression, 91 CHD patients without depression and 127 healthy men. Polymorphisms of the genes encoding interleukine-4 (IL-4 -589 C/T), interleukine-6 (IL-6 -174 G/C), tumor-necrosis factor alpha (TNF-α -308 G/A) and C-reactive protein (CRP -717A/G) were studied. RESULTS: There was the association between the IL-6 -174 G/C and depression comorbid to CHD (р=0.01; OR=2.3 CI 95% 1.2-4.3). The frequency of the 'high expression' allele G in this group was higher compared to controls. The association between IL-4 -589 C/T and CHD was found. Compared to the control group, the frequency of the IL-4 -589CC genotype was higher in patients regardless of whether they had symptoms of depression (р=0.007; OR=2.1 CI 95% 1.2-3.4). No association between the TNF-α -308G/A and the CRP -717A/G with depression in CHD was observed. There were no differences between neuroticism and anxiety scores in patients with different IL-4 -589 C/T, IL-6 -174 G/C, TNF-α -308 G/A, CRP -717A/G genotypes. CONCLUSION: The finding of the association between the IL-6 -174G/C and depression, comorbid to CHD, is in line with literature on a role of IL-6 in the development of depression in patients with CHD.

[A personalized approach to the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease]. / Personalizirovannyi podkhod k legochnoi reabilitatsii bol'nykh khronicheskoi obstruktivnoi bolezn'yu legkikh.

AIM: To elaborate and introduce personalized pulmonary rehabilitation (PR) programs adapted in terms of the types of disease response in patients with chronic obstructive pulmonary disease (COPD) and to evaluate the effectiveness of the programs. SUBJECTS AND METHODS: A total of 85 patients with COPD of more than 2 years' duration (the shortest time frame that was valid to assess the type of disease response) were examined. All the patients underwent adequate physical, instrumental, laboratory, and psychiatric examinations, during which the type of COPD response was determined. Before a rehabilitation cycle, after its termination, and 1, 3, and 6 months later, each patient underwent evaluation of the symptoms of COPD, the frequency of its exacerbations, the level of basic knowledge about COPD according to the author's questionnaire, assessment of the quality of life and the symptoms of anxiety and depression, and functional tests. RESULTS: The final sample included 30 patients who met the inclusion criteria and agreed to voluntarily participate in the PR programs. According to the type of a response to the underlying disease, the patients were divided into 2 polar groups: A) those who were anxious about their illness (excessive apprehension, fears that were associated with the perception of lung disease and that led to distress) and depression (despondency, an agonizing understanding of a possible poor outcome and consequences of the impact of COPD on their lives) and B) those who had a newly diagnosed type of COPD response - hyponosognosia (underestimation of disease severity, perception of the symptoms of COPD as age-related changes, and preservation of the old way of life to the detriment of their health). Effective personalized PR programs were elaborated and applied to both groups. CONCLUSION: Group measures focused on learning how to cope with the disease and its symptoms and on the ability to distinguish its manifestations from the signs of psychological distress and to combat them are effective in patients who are anxious about the disease and depressed (Group A). Individual inpatient activities aimed at the formation and maintenance of motivation, the formation of an image of the disease and its manifestations, and early specialized care for smoking cessation are indicated for patients with hyponosognosia (Group B).

[A retrospective historical study evaluating the safe use of current antidepressants in cardiology practice]. / Retrospektivnoe arkhivnoe issledovanie po otsenke bezo-pasnosti primeneniia sovremennykh antidepressantov v kardiologicheskoi praktike.

AIM: To confirm the data available in the literature on the cardiac safety of antidepressants. SUBJECTS AND METHODS: The archival data of 146 case histories were retrospectively analyzed. A study sample consisted of 96 cardiac inpatients regularly taking an antidepressant for more than 3 days during treatment for the underlying cardiovascular disease. The safe use of antidepressants was evaluated in terms of initial electrocardiogram (ECG) QTc interval changes, systolic and diastolic blood pressures (BP) (SBP and DBP), heart rate (HR), and hemorrhagic complications. The data obtained over periods of 3- and 6-8 days were analyzed. RESULTS: The sample showed no clinically significant ECG QTc interval changes when taking regularly antidepressants within 8 days. Analysis of the dynamics of BP and HR in patients receiving antidepressants revealed no statistically significant differences in these indicators before and 3 and 6-8 days after drug administration. No case of hemorrhagic complications was seen in the study group taking antidepressants. CONCLUSION: The investigation generally confirms the high cardiac safety of new-generation antidepressants within at least the first week of therapy. Noteworthy are the low daily drug dosages (relatively specified in the instructions) that are sufficient for most cardiac patients with depressive disorders and an additional factor for minimizing adverse reactions.

[Interaction Between Personality, Pain, and Genes in Ischemic Heart Disease].

Personality traits of the patient with ischemic heart disease (IHD) are thought to determine disease course. Their level depends on clinical presentations of IHD including the presence of cardiac pain. The aim of the study was to identify the modifying effect of genes coding for serotonin transporter (5-HTTLPR), serotonin receptor type 2A (A-1438G) and 2C (Cys23Ser) as well as brain-derived neurotrophic factor (Val66Met) on personality traits in pain and painless forms of IHD. We found interaction between pain and personality factors mediated by genetic variant. Pain syndrome was associated with higher neuroticism scores in carriers of allele S (5-HTTLPR), allele Ser (5-HTR2C), and the genotype ValVal (BDNF) and with higher hostility levels in patients with allele Ser. The results may be used for purposes of personalized examination of IHD patients directed to prevention of unfavorable course of the disease.

[Depression comorbid to ischemic heart disease: a psychometric and molecular-genetic study].

OBJECTIVE: To compare psychometric and molecular-genetic characteristics of depression caused by ischemic heart disease (IHD) and depression in patients with IHD caused by other psychogenic factors. MATERIAL AND METHODS: One hundred and thirty-five patients with depression comorbid to ischemic heart disease (IHD) were examined. Depression was associated with IHD in 71 patients (group 1). In 64 patients, depression was caused by other psychogenic factors (group 2). The HAMD-21 scale was used to measure depressive symptoms. RESULTS AND CONCLUSION: The comparative analysis of the core symptoms of depression demonstrated that group 1 had a peculiar psychometric profile with marked apathy, which was not accompanied by marked hypothymia, guilt feelings or anxiety, compared to group 2. The molecular-genetic correlate of this profile was found. It included a combination of an allele S (5-HTTLPR) of the serotonin transporter gene, an allele G (A-1438G) of the serotonin receptor type 2A gene and the genotype ValVal (Val66Met) of the brain-derived neurotrophic factor gene.

[Anxiety and polymorphism Val66Met of BDNF gene--predictors of depression severity in ischemic heart disease].

In a framework of search for early predictors of depression in patients with ischemic heart disease (IHD) we studied effect of molecular-genetic factors (polymorphism of brain-derived neirotrophic factor--BDNF), personality traits (anxiety, neuroticism), IHD severity, and psychosocial stressors on manifestations of depression in men with verified diagnosis of IHD. Severity of depression was assessed by Hamilton Depression Rating Scale 21-item (HAMD 21), anxiety and neuroticism were evaluated by the Spielberger State-Trait Anxiety Inventory and "Big Five" questionnaire, respectively. It wa shown that personal anxiety and ValVal genotype of BDNF gene appeared to be predictors of moderate and severe depression.