[Depressive symptoms worsen cardiovascular prognosis and shorten length of life in patients with arterial hypertension and ischemic heart disease].

UNLABELLED: The KOORDINATA study (clinical epidemiological program of investigation of depression in cardiological practice in patients with arterial hypertension and ischemic heart disease) was a prospective 3 year long multicenter study of effects of depressive and anxiety states on the course and prognosis of ischemic heart disease (IHD) and arterial hypertension (AH). MATERIAL AND METHODS: Patients (n=5038, age more or equal 55 years) with verified IHD and/or AH from 37 cities were included into the study. Symptoms of anxiety and depression were assessed by the HADS scale (Hospital Anxiety And Depression Scale) validated in Russia. RESULTS: Clinically significant symptoms of anxiety ( more or equal 11 HADS) were present in 33 and 38%, of depression - in 30 and 38% of patients with IHD and AH, respectively. Presence of clinically manifested depression at initial examination increased 1.59 times combined risk of nonfatal and fatal cases (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.30-1.96, p=0.0001), 1.64 times - risk of cardiovascular death (OR 1.64, 95% CI 1.20-2.24, p=0.0021), and 1.82 times - risk of death from all causes (OR 1.82, 95% CI 1.41-2.34, p=0.0001). It is known that for somatic patients crossover of anxiety and depression symptoms is typical (simultaneous presence of some symptoms of anxiety and depression). Total HADS score equal to 11 or more increased risk of all cause death (OR 1.41, 95% CI 1.08-1.84, p=0.0111), as well as fatal and nonfatal events (OR 1.33, 95% CI 1.08-1.65, p=0.0089). CONCLUSION: Taking into consideration negative effect of depressive symptoms on prognosis it is recommended to screen patients with IHD in the first place those who have had myocardial infarction and brain stroke with the aim of detection of depression and anxiety depressive symptoms and subsequent their adequate correction.

[Disorders of the anxiety-depressive spectrum in inflammatory bowel diseases (psychosomatic correlations)]. / Rasstroistva trevozhno-depressivnogo spektra pri vospalitel'nykh zabolevaniiakh kishechnika (psikhosomaticheskie sootnosheniia).

AIM: To systemize anxiety-depressive disorders in patients with inflammatory bowel diseases (IBD) and to reveal clinically relevant psychosomatic correlations. MATERIAL AND METHODS: Fifty inpatients with IBD, including 32 with ulcerative colitis and 19 with Crohn's disease, were examined using clinical and follow-up methods. RESULTS AND CONCLUSION: Affective mental disorders (depressions of various structures of different genesis) were found in most (72%) of cases. Adaptation disorders in patients with personality pathology, depression in cyclothymia, bipolar disorder and schizophrenia were identified as well. Psychosomatic correlations depended on the stage of IBD and the genesis of affective disorders. Somatogenic asthenic disorders prevailed at the stage of IBD manifestation and depressions of different structure with different course (recurrent, bipolar, attack-like) at the further stages of IBD. The psychosomatic relations at the subsequent stages of IBD were characterized by psychosomatic balancing. There were tendencies of convergence and divergence of mental disorders with the current somatic disease. The most severe variants (chronic continuous course, resistance to therapy) were found in patients with comorbid endogenous mental disorders. This was primarily due to the lack of a rational attitude of patients to the somatic disease and, therefore, the low compliance that must be taken into account in the treatment.

[Depressive symptoms worsen prognosis in patients with arterial hypertension and ischemic heart disease: first results of prospective phase of Russian multicenter study COORDINATA].

COORDINATA - Russian multicenter prospective (3 year long) study having the aim to elucidate influence of symptoms of anxiety and depression on cardiovascular (CV) prognosis in patients with arterial hypertension (AH) and ischemic heart disease (IHD). Results of 1.5 years of prospective phase of the study are presented. Material and methods. Symptoms of depression and anxiety were assessed by Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. By the end of 1.5 years follow up telephonic interview was carried out with 4449 patients or their relatives in the course of which occurrence of soft and hard end points (cardiovascular complications and deaths of IHD, cardiovascular and other causes) were established. There were 142 deaths (60.6% cardiovascular), 85 strokes, and 42 dynamic disturbances of cerebral circulation. Total number of hard and soft end points was 356 (8.0%). Presence of depressive, anxious, and combined anxious-depressive symptoms in patients with AH/IHD at initial examination increased 1.5 - 2 fold risk of development of cardiovascular catastrophes and death (due to IHD, CV and all causes). Besides psychological factors clear-cut influence on prognosis exerted sex, age, level of education and income of patients, smoking (both in the past and at inclusion in the study), low level of daily physical activity, elevated levels of blood pressure and heart rate, as well as a row of social characteristics of patients.

[Clinico-epidemiological program of the study of depression in cardiological practice in patients with arterial hypertension and ischemic heart disease (COORDINATA)].

UNLABELLED: COORDINATA - first Russian multicenter prospective (3 year long) study having the aim to elucidate prevalence of symptoms of anxiety and depression among patients with arterial hypertension (AH) and ischemic heart disease (IHD) and their influence on cardiovascular (CV) prognosis. Results of baseline epidemiological part of the study are presented. Results of prospective phase will be published in 2008. MATERIAL AND METHODS: Symptoms of depression and anxiety were assessed by validated in Russia Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. Prevalence of CV risk factors was also studied and their association with anxiety/depressive symptoms were evaluated in a framework of multivariate regression analysis. RESULTS: Clinically significant symptoms of anxiety (HADS score >or=11) took place in 33 and 38%, symptoms of depression - in 30 and 38% of patients with AH and IHD, respectively. Relationship of symptoms of anxiety and depression was established with a number of psychosocial and biological risk factors of CV diseases (D) specifically low levels of education and income, insufficient level of physical activity, high level of chronic psychoemotional stress, exposition to acute stresses of great power, lack of social support, social isolation, elevated blood pressure level. It was shown that CVD comorbid anxiety and depressive states might cause excessive use of health care resources by patients.

[Depression in cardiological practice: pilot results from a multicenter clinico-epidemiological trial in hypertensive patients with ischemic heart disease (koordinata)].

AIM: To study effects of depression on the course and prognosis of arterial hypertension (AH) and coronary heart disease (CHD), potentialities of the combined treatment in a prospective multicenter trial. MATERIAL AND METHODS: A total of 376 patients with AH and/or CHD having depression (10 scores and higher by HADS scale) were assigned to two groups: 189 (50.3%) patients received somatotropic therapy+coaxil (the study group), 187 (49.7%) patients received somatotropic therapy alone (the comparison group). Coaxil was given for 6 weeks in a dose of 37.5 mg/day, to patients over 70 years--25 mg/day. The effects were assessed by changes in HADS, CGI scale, blood pressure, heart rate; by tolerance and side effects (objective effects); complaints, well- being, stress, tolerance (subjective effects). RESULTS: The addition of coaxil to somatotropic therapy of patients with AH and/or CHD associated with depression led to improvement of the psychological status (a 36% decrease by HADS depression scale from 13.1 +/- 2.75 to 8.43 +/- 3.64, -delta4.76, p < 0.0001; by HADS anxiety scale--by 35.6% from 12.08 +/- 3.90 to 7.78 +/- 3.63, -delta4.31, p < 0.0001; by response to psychoemotional stress--by 23% from 6.65 +/- 1.94 to 4.77 +/- 1.85, -delta1.88, p < 0.05). Control patients also showed a positive trend in the above indices (a decrease in the above indices from 13.15 +/- 2.65 to 11.79 +/- 3.31, from 11.50 +/- 3.66 to 10.12 +/- 3.95, from 6.63 +/- 1.99 to 6.03 +/- 2.07, p < 0.05, respectively) but positive changes were much weaker than in the coaxil group (p < 0.001). To the end of the treatment, patients of the study group had less number of complaints, more patients achieved the target level of arterial pressure under 140/90 mm Hz (43.9 versus 29.9% in the control group; p < 0.005). CONCLUSION: Standard somatotropic treatment of AH patients with CHD and depression is not sufficiently effective. Combination of such treatment with antidepressive therapy (coaxil) significantly improves psychological status, and efficacy of therapy of basic cardiological diseases.

[Clinical picture, differential diagnosis and forensic-psychiatric evaluation of affective reactions in psychopathic patients with hysterical traits]. / Klinika, differentsial'naia diagnostika i sudebno-psikhiatricheskaia otsenka affektivnykh reaktsii u psikhopaticheskikh lichnostei istericheskogo kruga.

Forty women with a psychopathic hysterical structure of personality undergoing forensic-psychiatric examination at the V. P. Serbsky All-Union Research Institute of General and Forensic Psychiatry were examined for affective responses manifested at the time when they broke the law. The results of studies have shown that in a subjectively important psychogenic traumatic situation hysterical psychopaths present affective responses differing in severity, which dictated the differential forensic-psychiatric evaluation of these states. In patients who were considered responsible in relation to the law-breaking act affective responses were personal in nature and were expressed in exacerbation of psychopathic features in the framework of the accustomed pattern of reacting. Some subjects presented a state of psychopathic decompensation of a psychotic level at the moment of the law-breaking act, which accounts for exculpation of this group.

[Characteristics of mental status of patients with neurocirculatory dystonia]. / Osobennosti psikhicheskogo statusa bol'nykh s neirotsirkuliatornoi distoniei.

AIM: To specify forms of severity of mental disorders in neurocirculatory asthenia (NCA) for more precise differentiation between NCA as a nosological entity and syndrome. MATERIAL AND METHODS: The examination including specially-designed interview, ECG, echo-CG, orthostatic and hyperventilation tests, bicycle exercise, consultation of the psychiatrist, psychological tests covered 80 NCA patients (31 men, 49 women, mean age 29.2 +/- 9.08 years). RESULTS: NCA is characterized by the absence of a clear link with psychoemotional stress, seasonal disease aggravations, weakness, dizziness, negative results of orthostatic and hyperventilation tests. Among NCA criteria, dominating are "additional signs". Patients with anxio-fobic, panic, anxio-depressive neurotic disorders are characterized by strong relations between manifestation, subsequent disease exacerbations with psychogenia; attack-like NCA manifestation, prevalence of "basic signs" among diagnostic criteria (cardialgia, pulse and blood pressure lability, nonspecific alterations of T wave, positive orthostatic and hyperventilation tests). CONCLUSION: NCA presents at least with two variants. In the first variant NCA picture is characterized by hereditary or early acquired vegetative stigmation and secondary neurotic disorders; the second variant presents as a clinically formed illness in which NCA symptoms manifest as a syndrome which is a leading component of a mental disease.

[A clinical and dynamic profile of somatoform depressive disorders of the patients in a general hospital].

It was compared clinical characteristics of somatoform depressive disorders in patients of somatic and psychiatric in-patient departments (110 and 50 people, respectively). The somatic patients were divided into three groups: 1-st group - patients with masked depression (43.6%), 2-nd group - patients with somatic depression (30.9%), 3-rd group - patients with comorbid depression with a somatic disease (25.5%). The clinical presentations of the disease in the 1-st group are characterized by frontal somatic and autonomic disorders, with the presentations of depression corresponding to the term "depression without depression". In the clinical presentations of somatic depression (the 2-nd group) in addition to somatic and autonomic disorders, which mimic the therapeutic pathology, the affective disorders are presented by its reduced variants. In the clinical presentations of disease of the 3-rd group of patients, the symptoms of the somatic disorder are "reproduced" at the level of subjective complaints and symptoms of disease ("psychosomatic imitation"). Such distinction optimizes treatment due to the right choice of the priority clinical model within the framework of unitary psychosomatic disorder.

[Clinical characteristics of mental disorders observed in ambulatory-polyclinical gynecological practice]. / Klinicheskaia kharakteristika psikhicheskikh narushenii nabliudaemykh v ambulatorno-poliklinicheskoi ginekologicheskoi praktike.

Concomitant mental disorders were diagnosed in 97 of the 107 gynecologic patients aged 19 to 66. Twenty of these patients were previously consulted by psychiatrists. Five groups of mental conditions were distinguished, most frequently associated, in a certain mode, with gynecologic diseases. The results of our analysis necessitate that gynecologic outpatients be consulted by psychiatrists.