[Prognosis of late-life depression: clinical and immunological features]. / Prognoz pozdnevozrastnykh depressii: kliniko-immunologicheskie osobennosti.

OBJECTIVE: To study the outcomes of depression at a late age during a 3-year prospective follow-up in patients with various immunophenotypes. MATERIAL AND METHODS: A cohort of patients with depressive disorders who were treated in a gerontopsychiatric hospital and re-examined after 1 and 3 years. The group with immunophenotype A (with increased activity of leukocyte elastase (LE) and complex depressions, comorbid with anxiety and senesto-hypochondriac disorders) included 20 people: 6 men (30%) and 14 women (70%), median age was 68 years. A depressive episode (DE) was diagnosed in 13 patients (65%) with recurrent depressive disorder (RDD) and in 7 patients (35%) with bipolar affective disorder (BAD). The group with immunophenotype B (with reduced activity of LE and prolonged apathetic-adynamic depression) included 31 people: 10 men (32.3%) and 21 women (67.7%), the median age was 68 years. DE was diagnosed in 20 patients (64.5%) with RDD, 9 patients (29%) with BAD, and in 2 patients (6.5%) with a single DE. The patients were examined using clinical, psychometric, immunological and clinical- follow-up methods (after 1 and 3 years). RESULTS: More favorable course of the disease with the formation of high-quality remission was observed in patients with immunophenotype A (95% of cases after 1 and 3 years; χ2=10.44; p=0.001 and χ2=11.97; p=0.001, respectively). In patients with immunophenotype B, an unfavorable course of the disease prevailed (83.9 and 87.1% of cases after 1 and 3 years) with the formation of low-quality remissions (with residual depressive disorders, the development of repeated depressive phases and chronification of depression). CONCLUSION: The study revealed the relationship between clinical and biological features and the course of late-life depression.

[An impact of the COVID-19 pandemia on the onset and course of mental disorders in elderly]. / Vliyanie pandemii COVID-19 na vozniknovenie i techenie psikhicheskikh zabolevanii u lits pozhilogo vozrasta.

OBJECTIVE: To study the impact of COVID-19 on the onset and course of mental disorders in hospitalized elderly patients. MATERIAL AND METHODS: We studied 67 inpatients, aged 50 to 95 years, with various mental illnesses in accordance with the ICD-10 criteria, who underwent COVID-19 from February 2020 to December 2021. Forty-six people were previously mentally ill, in 21 cases the disease developed for the first time. RESULTS: The group of primary diseased patients was dominated by depressive episodes (F32, (42.9%), including psychotic episodes (9.5%). In 28.6% of cases, organic disorders were diagnosed in the form of emotional lability (F06.6), organic depression (F06.3), mild cognitive impairment (F06.7) and delirium (F05.86). In 23.8% of patients, neurotic disorders were observed in the form of depressive reactions (F43), panic (F41.0) and generalized anxiety disorder (F41.1). In one case (4.8%), acute polymorphic psychosis with symptoms of schizophrenia (F23.1) was diagnosed. The diagnoses of the previously mentally ill group were: affective disorders (F31, F32, F33 - 45.7%); organic disorders, including dementia (F06.3, F06.7, F00.1, F00.2 - 26.1%); schizophrenia spectrum disorders (F25, F21, F22, F20.01 - 19.6%), and neurotic somatoform disorders (F45 - 8.7%). In the acute and subacute periods of COVID-19 (≤3 months), acute psychotic states (APS) developed in both groups of patients (in 23.3% and 30.4%, respectively) in the form of delirium, psychotic depression, or polymorphic psychosis. APS were more common in mentally ill patients with organic (50%) and schizophrenia spectrum (33.3%) disorders with a predominance of delirium. In the long-term period of COVID-19, mentally ill patients more often than primary diseased patients (60.9% and 38.1%) developed cognitive impairment (CI), especially in schizophrenic (77.8%) and organic (83.3%) disorders. CI developed twice as often after APS (89.5% and 39.6%, p<0.001), reaching the degree of dementia in 15.8% of cases. APS were significantly associated (p<0.05) with the development of CI (0.567733), the age of patients (0.410696) and the presence of previous cerebrovascular insufficiency (0.404916). CONCLUSION: The age-related features of the mental consequences of COVID-19 are the occurrence of APS in the acute period of infection and the deterioration of cognitive activity at a remote stage. The mentally ill, especially those of the organic and schizophrenia spectrum, were found to be more vulnerable to the effects of COVID-19. In them, the occurrence of APS was a risk factor for the development of dementia, while in primary diseased, affective and neurotic patients, CI was reversible or had the character of a mild cognitive disorder.

[New approaches to the typology and prediction of the effectiveness of therapy for late-life depression]. / Novye podkhody k tipologii i prediktsii effektivnosti terapii depressii pozdnego vozrasta.

OBJECTIVE: To analyze clinical parameters and effectiveness of therapy in depressed patients of late age with different activity of enzymes of energy, glutamate metabolism and antioxidant glutathione system in platelets and red blood cells. MATERIAL AND METHODS: The study included 53 hospitalized patients (41 women and 12 men), aged 60 to 86 years (median - 66 years), with a depressive episode of mild to marked severity within the framework of recurrent depressive disorder, bipolar affective disorder or a single depressive episode according to ICD-10. The patients were examined using clinical, psychometric, biochemical and statistical methods. Psychometric assessment of patients' condition was performed before the start of therapy and on the 28th day of treatment using HAMD-17 and HARS. Blood sampling was carried out to determine the activity of cytochrome c-oxidase (COX), glutathione reductase (GR), glutathione S-transferase (GST) and glutamate dehydrogenase (GDH). RESULTS: Cluster analysis revealed 3 clusters (Cl.1, Cl.2, Cl.3), which differed in biochemical indicators. In Cl.1 (n=24, 45.2%), there was a decrease in the activity of COX (p<0.05) and a decrease of GR activity in red blood cells and GST activity in platelets (p<0.001). Patients of Cl.2 (n=11, 20.8%) had increased COX activity (p<0.001) and decreased GDH activity (p<0.001). In patients of Cl.3 (n=18, 34%) the enzyme activity was similar to that in the controls. Later age at disease onset was observed in Cl.1 compared to Cl.2 (51 years [40; 60.5] and 32 years [19; 59], p=0.052). Compared with Cl.2 and Cl.3, patients of Cl.1 significantly more often (p<0.05) had apathetic depressions (41.7%), while complex depressions were observed almost 2 times less often than in Cl.2 (50% and 91.9%, p<0.05). The effectiveness and tolerability of psychopharmacotherapy was higher in Cl.3. CONCLUSION: There is a relationship between the nature of changes in metabolic parameters and differences in the phenomenology and course of late-age depression. The results of the study open up new directions in the field of predicting the effectiveness of therapy and the development of personalized therapeutic approaches to improve the effectiveness and safety of treatment of depressed elderly patients.

[Platelet glutathione reductase and glutathione-S-transferase in elderly patients with depression]. / Trombotsitarnye glutationreduktaza i glutation-S-transferaza u bol'nykh s depressiyami v pozhilom vozraste.

OBJECTIVE: To compare the activity of platelet glutathione reductase (GR) and glutathione-S-transferase (GST) in elderly patients with depression and in the control group, and to identify a possible relationship between the activity of these enzymes and clinical parameters of the disease. MATERIAL AND METHODS: We examined 42 elderly patients (60-86 years old) with depressive episodes of various nosological categories according to ICD-10: a single depressive episode (F32.0, F32.1), a depressive episode in recurrent depressive disorder (RDR - F33.0, F33.1), and a depressive episode in bipolar disorder (BD - F31.3). The GR, GST activity and the severity of depression were assessed twice: before the beginning of the course of 28-day antidepressant therapy (day 0) and on the 28th day of the course of therapy, using the Hamilton Depressive Scale (HAMD-17) and the Hamilton Anxiety Scale (HARS). RESULTS: As compared with the control group, a significant decrease in GST activity was found in patients before and after the course of therapy (p<0.0001 and p<0.0003, respectively), no significant difference in GR activity was found. Significant correlations of the platelet GR activity in patients before thetreatment course with the age of disease manifestation (R= -0.44; p=0.004, inverse correlation) and with its duration (R=0.43, p=0.004, direct correlation), estimated after a 28-day course of therapy. A significant inverse correlation of the baseline (before treatment) GR activity with the HAMD score estimated after the course of therapy (R=-0.440; p=0.009) was found only in women subgroup (n=33). CONCLUSION: A pilot study has revealed a decrease in platelet GST activity, and a link between platelet GR activity and the severity of depression after a course of therapy. The results obtained indicate the promise of further study of glutathione metabolism enzymes as a biomarker for assessing the state.

[The status of leukocyte-inhibitory system of inflammation in different age groups of patients with endogenous depression]. / Status leikotsitarno-ingibitornoi sistemy vospaleniya pri endogennykh depressiyakh u patsientov raznykh vozrastnykh grupp.

OBJECTIVE: The comparison of inflammatory markers in different age groups of patients with endogenous depression and correlation of immunological parameters with the clinical features of depression. MATERIAL AND METHODS: The study included 140 patients with endogenous depression (ED) (F21, F31-F34, ICD-10) aged 15 to 82 years (39.8±23 years), including 55 patients of adolescent age (18.9±2.8 years), 30 middle-aged patients (38.7±10.3 years) and 55 elderly patients (69.1±7.1 years). The total duration of the disease differed from 5 months to 45 years. Psychometric assessment of patients was carried out using HDRS. The control groups consisted of 143 healthy people aged 16 to 75 years. The activity of inflammatory markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI), their ratio (leukocyte-inhibitory index, LII), the levels of antibodies to S100B and myelin basic protein (MBP) were determined in blood. RESULTS: Three immunological clusters were identified that correspond to different clinical variants of ED. A pro-inflammatory status with an activation of the leukocyte-inhibitory system is characteristic of 52.9% of patients (cluster 1). The clinical feature of this status is predominantly «classic¼ ED in the form of anxious, anxious-melancholic or anxious-apathetic depression without pronounced negative symptoms. Two other clusters are characterized by the imbalance of leukocyte-inhibitory system associated with insufficient a1-PI activity (cluster 2) and with insufficient LE activity (cluster 3). A common clinical feature of such ED is an atypical course with the predominance of apathetic-adynamic and dysphoric depression, the presence of negative disorders and a poor prognosis. The imbalance of leukocyte-inhibitory system associated with insufficient LE activity is typical mainly for elderly patients and is characterized by a longer duration of disease. CONCLUSIONS: The status of leukocyte-inhibitory system of inflammation is correlated with the clinical features of ED in different age groups of patients. LII can be considered as an additional paraclinical criterion for differential diagnosis and prognosis of ED.

[The link of platelet cytochrome C-oxidase activity with some clinical parameters of depression in elderly patients]. / Svyaz' aktivnosti trombotsitarnoi tsitokhrom s s-oksidazy s otdel'nymi klinicheskimi parametrami depressii u bol'nykh pozhilogo vozrasta.

OBJECTIVE: To search for correlations between platelet cytochrome c-oxidase (COX) activity and the quality of therapeutic outcomes and other clinical parameters of depression in elderly patients. MATERIAL AND METHODS: Twenty elderly women, aged 55-78 years, with depressive episodes in recurrent depressive disorder (RDD) or bipolar affective disorder (BD) were studied. COX activity and severity of depression were evaluated twice: before the beginning of antidepressant treatment and at the 28-th day of the therapy, using the Hamilton Depression Rating Scale (HAMD-17) and the Hamilton Anxiety Rating Scale (HAM-A). RESULTS: Significant correlations were revealed between platelet COX activity and some clinical parameters of the disease and the severity of depression in patients after treatment. The baseline level of the platelet COX activity was correlated with the age of disease onset (R= -0.63, p=0.003) and its duration (R=0.55, p=0.010). Significant negative correlations were also found between the baseline level of COX activity and depression severity (HAMD-17 total score) (R= -0.48, p=0.032) and the severity of anxiety (HARSHAM-A total score) (R= -0.54, p=0.010) after 28-day treatment. CONCLUSION: This pilot study has revealed a link between platelet COX activity and the severity of depression and anxiety after a 28-day antidepressant therapy. The results indicate the prospects for further study of COX as a biomarker of therapeutic outcomes in elderly patients with depression.

[The use of neuroprotectors in the treatment of late depression]. / Primenenie neiroprotektorov v terapii depressii pozdnego vozrasta.

OBJECTIVE: Comparative evaluation of the effectiveness and safety of antidepressant monotherapy and combined antidepressant therapy with the inclusion of neuroprotectors in the treatment of depression in old and very old patients in a psychiatric hospital. MATERIALS AND METHODS: The study included 2 groups of patients from the cohort of patients hospitalized in the gerontopsychiatric unit with mild and moderate depression (according to the ICD-10 classification) aged 60 years and older. The groups are comparable in their main demographic and clinical characteristics. Both groups received antidepressant monotherapy with venlafaxine (21 people) or combined therapy with the same antidepressant, but in combination with cerebrolysin or carnicetine (40 people) for 8 weeks. The efficacy of antidepressant therapy was evaluated with HAMD-17 and HARS; the effect of treatment on the level of cognitive activity of patients with MMSE and the 10-word memory test. RESULTS: In the group of patients receiving combined antidepressant therapy, a significantly faster and more pronounced therapeutic response was observed compared to the group of patients treated with antidepressant monotherapy. In the group of combined therapy, an earlier (by 4 weeks) and significant (p<0.001) reduction of depressive and anxiety symptoms was established by the end of treatment, this group had a significantly higher number of respondents, as well as a better quality of therapeutic remission and a significant improvement in the cognitive functioning of patients compared to the monotherapy group. When comparing the effectiveness of different neuroprotectors (cerebrolysin or carnicetine), significant differences in the reduction of depressive and anxiety disorders in favor of carnicetine were established only at the end of the therapeutic course. CONCLUSION: Combined antidepressant therapy with a combination of treatment with an antidepressant and a drug with neuroprotective properties can increase the effectiveness of antidepressant therapy in old and very old patients. Both cerebrolysin and carnicetine can be recommended for use in a psychiatric hospital to improve the quality of the therapeutic response and reduce the time of hospitalization.

[Some inflammation factors and immunophenotypes of depression in elderly patients]. / Nekotorye faktory vospaleniia i immunofenotipy pri depressii u pozhilykh bol'nykh.

AIM: To search for the immunological features of depressions in elderly patients, select certain immunophenotypes and analyze their possible connection with clinical and psychopathological features of depression of old age. MATERIAL AND METHODS: The study included 55 inpatients of old age (median 68 years) with a depressive episode of mild or moderate severity. The control group consisted of 41 elderly people (median 67 years) without depressive disorders. Clinical, psychometric, immunological and statistical methods were used. The rating scales were HAMD-17 and MMSE. The activity of inflammatory and autoimmune markers, including enzymatic activity of leukocyte elastase (LE), α1-proteinase inhibitor (α1-PI), level of autoantibodies to neurospecific antigens S-100B and myelin basic protein, in the serum of patients and control subjects was determined. RESULTS AND CONCLUSION: The scatter in the immunological parameters both in the direction of exceeding the average values and their decrease was shown in the group of depressed elderly patients compared to the controls. Cluster analysis revealed two immunophenotypes of elderly patients with depression. Immunophenotype A is a group of patients with increased PE activity and immunophenotype B is a group of patients with decreased LE activity (p<0.0000). Immunophenotype A includes patients with complex depressions, comorbid with anxiety and senesto-hypochondriac disorders. In immunophenotype B, patients with prolonged apatic/adynamic depressions (p<0.05), with an earlier onset and longer duration of the disease, with incomplete remissions and more burdened with cardiovascular diseases were more common (p<0.05).

[Personalized approach to the treatment of depression in the elderly]. / Personalizirovannyi podkhod k lecheniiu depressii u patsientov pozhilogo vozrasta.

AIM: To develop a personalized approach to the appointment of a complex antidepressant therapy in combination with drugs of neuroprotective and neurotrophic action in depressed elderly patients based on the selection of predictors of low therapeutic response (LTR). MATERIAL AND METHODS: The study included 152 hospitalized patients, aged 60 years and older, with moderate and mild depression (ICD-10) who received monotherapy (44 people) with antidepressants of the new generation and complex therapy (108 people) with the same antidepressants in combination with neuroprotective drugs. In the monotherapy group, correlations between treatment efficacy (change in average total HAMD-17 scores) and a set of parameters, including socio-demographic data, results of psychopathological, somatic, standardized assessment and neuroimaging (CT) of the brain were analyzed. The validity of the established correlations as predictors of LTR was estimated based on a comparison of their frequency among the responders (≥50% reduction) and non-responders (<50% reduction). Comparison of the efficacy of therapy in groups of patients with mono - and complex therapy was carried out depending on the presence or absence of predictors of LTR. RESULTS: LTR predictors are living alone, complaints about memory loss and signs of pronounced diffuse lesions of the subcortical white matter of the brain, which are significantly more frequently observed in non-responders (p<0.05). The increase in the number of predictors (2 and more) correlates with a significant decrease in therapeutic efficacy (p<0.001). Patients with complex in structure and protracted depressions tend to decrease in efficiency, and in most of them (more than 87% of cases) LTR predictors are detected. In patients with LTR predictors, the complex therapy is significantly more effective than monotherapy, allowing in all cases to achieve 50% reduction of depressive symptoms by the 4th week of treatment. CONCLUSION: Personalized indications for the appointment of complex antidepressant therapy in combination with neuroprotective drugs in depressed elderly patients are formulated.

[Augmentation with carnicetine for late depression]. / Augmentatsiia karnitsetinom terapii pozdnikh depressii.

AIM: Comparative evaluation of the efficacy and safety of antidepressant monotherapy and complex antidepressant therapy in combination with carnicetine in the treatment of depression in elderly patients in a psychiatric hospital. MATERIAL AND METHODS: Two groups of hospitalized patients, aged from 60 to 79 years, with mild or moderate depression (according to ICD-10), comparable in basic demographic and clinical characteristics, received mono- or complex (in combination with carnicetine) antidepressant therapy for 8 weeks. Treatment efficacy was assessed with HAM-D, HARS, CGI-S and CGI-I; the level of cognitive activity was assessed with MMSE, the 10-word memory test and clock drawing test. RESULTS: It has been established that the use of complex antidepressants therapy with the inclusion of carnicetine allows to achieve a more rapid and pronounced therapeutic response compared to antidepressant monotherapy. This is confirmed by the earlier (by the 4th week) and significant reduction of depressive and anxiety symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes to the end of treatment and a more rapid improvement in cognitive functioning. CONCLUSION: The results allow us to recommend the inclusion of carnicetine for the augmentation of antidepressant therapy in elderly patients of the psychiatric hospital to achieve a more rapid and complete therapeutic response and reduce the duration of hospitalization.

[The content of N-acetylaspartate in depressed elderly patients during therapy with antidepressants and actovegin]. / Soderzhanie N-atsetilaspartata u pozhilykh patsientov s depressiei v protsesse terapii antidepressantami i aktoveginom.

AIM: To assess the plasma level of N-acetylaspartate (NAA) before and after combined therapy with antidepressants and actovegin in a group of elderly patients diagnosed with depression. MATERIAL AND METHODS: Nineteen patients, 7 men and 12 women, mean age 70.5±5.8 years, were studied using clinical examination and psychometric scales as well as computed tomography (CT). NAA plasma levels were determined. The duration of treatment with antidepressants (venlafaxine, fluvoxamine) and actovegin was 28 days, patients were examined at baseline and on the 28th day of treatment. RESULTS AND CONCLUSION: The NAA plasma level was reduced in patients compared to healthy volunteers. The increase of this indicator after treatment reflected a significant improvement on clinical and psychometric measures. The dynamics of NAA changes (increase or decrease) showed heterogeneity in the group of patients, which was not related to the efficacy of treatment but was correlated with comorbid diseases, in particular vascular diseases, and CT changes (leukoaraiosis). The authors consider the results of this study as preliminary.

[Methods of augmentation of antidepressant therapy (on the model of complex therapy with the inclusion of actovegin) in gerontopsychiatric hospital]. / Metody augmentatsii antidepressivnoi terapii v gerontopsikhiatricheskoi praktike (na modeli kompleksnoi terapii s vkliucheniem aktovegina).

AIM: Increasing the effectiveness of treatment of elderly depressed patients in the conditions of the gerontopsychiatric hospital by augmentation of actovegin to antidepressants of new generations (fluvoxamine, venlafaxine or agomelatine). MATERIAL AND METHODS: The efficacy of the therapy was compared in two groups of 21 patients aged 60 to 79 years with mild to moderate depression in ICD-10 receiving 8-week antidepressant mono- or combined therapy with actovegin. The effectiveness criteria were changes in the mean total scores on the HAMD-17, HARS, CGI scales, as well as the proportion of respondents and the quality of getting out of depression. Cognitive activity was assessed using MMSE, 10 word memory tests and drawing of clock. RESULTS: It has been established that the use of complex antidepressants therapy with the inclusion of actovegin allows for a more rapid and pronounced therapeutic effect compared to monotherapy with antidepressants. This is confirmed earlier (by the 4th week) and significant reduction of depressive and anxious symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes by the end of treatment. In patients with complex therapy, there was also a faster improvement in cognitive functioning. CONCLUSION: Obtained results allow us to recommend the inclusion of actovegin in the antidepressant therapy regimen of elderly in-patients with the aim of achieving a faster and fuller therapeutic response and shortening hospitalization.

[Comparative dynamics of EEG parameters in elderly depressive patients during monotherapy and combined therapy].

OBJECTIVE: To compare the changes in brain functional state in combined antidepressive treatment (venlafaxine plus cerebrolysin) vs. monotherapy with the same antidepressant in elderly depressive patients using quantitative EEG methods. MATERIAL AND METHODS: Forty patients, aged 60-79 years, mean 67.1±5.7) were randomized to two groups. Patients of group 1 were treated with venlafaxine (4 weeks, in dose of 75-150 mg/day). Patients of group 2 were additionally treated with cerebrolysin (totally 20 i/v infusions during 4 weeks, 20.0 ml in 100 ml isotonic NaCl solution). RESULTS AND CONCLUSION: The significant improvement of clinical conditions was shown by the end of the treatment course using both clinical assessments and HAMD-17, CGI-S, CGI-I and MMSE scores in both groups. The combined treatment with venlafaxine and cerebrolysin in patients of group 2 led to more pronounced improvement of their brain functional state (seen as an increase of spectral power and normalization of frequency alpha band of parietal-occipital EEG) in comparison with patients of group 2 treated by the same antidepressant alone.

[Optimization of the efficacy and safety of antidepressant therapy in patients of a geriatric psychiatric unit].

AIM: A comparative evaluation of the efficacy and safety of monotherapy with one of the modern antidepressants (venlafaxine, agomelatine, or fluvoxamine) and combination treatment of one of the above mentioned antidepressants with acetyl-L-carnitine (ALС, carnicetine) in the geriatric psychiatric unit. MATERIAL AND METHODS: Two groups of elderly patients (aged 60-79 years) with mild or moderate depression, randomized according to a number of demographic and clinical characteristics, were treated with antidepressants in monotherapy or combined therapy (antidepressant/carnicetine) within 8 weeks. RESULTS: Combination therapy with the neurotrophic agent carnicetine proved to be more effective compared to monotherapy. At the end of treatment, the more rapid clinical response has been shown for depression, anxiety, apathy, and cognitive dysfunction. Furthermore, combination therapy provides less adverse effects. CONCLUSION: Antidepressant/carnicetine combination therapy may be recommended for treatment of depression in elderly patients.

[Experience of the antidepressive therapy with valdoxan (agomelatine) in a psychogeriatric unit of the psychiatric hospital].

OBJECTIVE: To assess therapeutic efficacy, tolerability and safety of valdoxan (agomelatine) in the treatment of depression in elderly inpatients of the psychiatric hospital. MATERIAL AND METHODS: The study included 20 patients, aged 60 years and older, with depression of varying severity. Patients received valdoxan in standard doses 25-50 mg/day during 42 days. RESULTS: Valdoxan showed a good balanced profile (in terms of indicators of depression, anxiety and anhedonia) of therapeutic response and tolerability in inpatients with mild to moderate depression. The use of valdoxan led to a significant reduction of depressive disorders and anxiety already in the early period of treatment. The severity of anhedonia decreased to the 14th day of treatment. A significant improvement in cognitive functioning of patients was noted to the end of treatment. CONCLUSION: Valdoxan can be recommended for treatment of mild and moderate depression in inpatients of psychiatric hospitals.

[The therapeutic efficacy and the effect of gidazepam and fenazepam on the psychophysiological status and on the performance of operators with mental disorders at a neurotic level]. / Terapevticheskaia éffektivnost' i vliianie gidazepama i fenazepama na psikhofiziologicheskoe sostoianie i rezul'tativnost' deiatel'nosti operatorov s psikhicheskimi narusheniiami nevroticheskogo urovnia.

The effect of placebo and gidazepam on the state, psychophysiological predictors of the quality of the operator's performance and its results in individuals with neurotic reactions was studied (test dose 20 mg 7-day course, 40 mg daily, 24 individuals), as well as the effect of gidazepam and phenazepam (42 individuals with neurotic and neurosis-like states; gidazepam test doses 20 and 50 mg, 14-day course, 40 and 100 mg daily; phenazepam test doses 0.5 and 1 mg, 14-day course, daily dose 2 mg). The generally accepted methods of clinical and psychophysiological examination were applied. Gidazepam in the doses under study did not yield to phenazepam in therapeutic activity. A single and a course administration of gidazepam improved the parameters of the psychophysiological state and the efficacy of the operator performance in patients with neurotic reactions and in those with neurotic and neurosis-like states. This makes it possible, whenever necessary, to recommend this drug for the treatment of the indicated disorders in the working operators.

[Determination of homocysteine by tandem mass spectrometry with chemical ionization].

Homocysteine (Hcy) is an intermediate of methionine metabolism. High plasma Hcy concentrations are an independent risk factor for stroke, peripheral vascular disease, deep venous thrombosis, coronary disease, and cognitive deficiency. Apparently, it is a great importance to measure Hcy levels in human blood. A new method for the quantification of Hcy by means of reversed-phase LC/atmospheric pressure chemical ionization mass spectrometry has been developed. The MRM ion transition, m/z 136.0 ® 90.0 was used for Hcy quantification. The limit of detection was 0.4 mM, quantification was performed from 1 mM to 40 mM with coefficient of determination of R2=0,997. The method was applied successfully to Hcy determination in human blood.

[Comparative efficacy and safety of antidepressant mono- and multimodal therapy in elderly patients with depression (a clinical experience in a psychogeriatric hospital)]. / Sravnitel'naia éffektivnost' i bezopasnost' antidepressivnoi mono- i mul'timodal'noi terapii u pozhilykh bol'nykh depressiei (opyt klinicheskogo primeneniia v gerontopsikhiat-richeskom statsionare).

Objective. A comparative evaluation of the efficacy and safety of a multimodal antidepressant therapy with venlafaxine plus cerebrolysin and monotherapy with the same antidepressant for the treatment of depression in elderly patients in a psychiatric hospital. Material and methods. Two groups of patients (20 patients in each group), aged 60 years and older (60 to 79 years), were studied. The groups were matched for demographic and clinical (severity of depressive episode) characteristics. Patients of the first group were treated with venlafaxine in dose 75-150 mg twice a day. Patients of the second group received additionally 20 intravenous infusions of cerebrolysin (20.0 ml in 100 ml isotonic sodium chloride solution). Results. Therapeutic effect of antidepressant therapy (56 days) was characterized by a good balanced profile in relation to symptoms of depression, anxiety and apathy in both groups. However, the use of multimodal therapy allowed to get the more rapid response and more pronounced therapeutic effect compared to monotherapy with the same antidepressant, as well as to reduce adverse events. Conclusion. The results obtained allow to recommend multimodal antidepressant therapy with venlafaxine and cerebrolysin for using in hospital practice to achieve a more rapid therapeutic response, reduce the risk of adverse effects of antidepressants and shorten a period of hospitalization.

[Neurophysiological characteristics of treatment efficacy in late onset depression].

To reveal neurophysiological correlates of treatment efficacy of late onset depression, EEG spectral power, peak latencies of the "late" components of auditory cognitive evoked potentials, and sensorimotor reaction time have been analyzed in two groups of elderly patients, aged 53-72 years, with prolonged psychogenic depressive reaction (F43.21 by ICD-10) and with endogenous depression (F33.1 and F31.3 by ICD-10) during the treatment with antidepressants. Baseline depression severity has been associated with the EEG signs of the decreased functional state of anterior areas of the left hemisphere, and of the increased activation of the right hemisphere (especially, of its temporal regions). The pronounced improvement of clinical condition of patients after psychopharmacotherapy with antidepressants led to the decrease of peak latencies of the "late" components (Р2, N2 и Р3) of auditory cognitive evoked potentials, and to the acceleration of sensorimotor reaction time that have been associated with the EEG signs of the improvement of the functional state of posterior brain areas, and of the facilitation of inhibitory processes in the right hemisphere (especially, in its frontal, central and temporal regions), and of the more pronounced activation of frontal areas of the left hemisphere. The results are in line with the views on systemic character of brain functioning impairment in depression, as well as on the preferential role of the left hemisphere in the control of positive emotions, and of the right hemisphere role in the control of negative emotions as well as in the pathogenesis of depression.

[Psychopharmacotherapy of out-patient with dementia]. / Ambulatornaia psikhofarmakoterapiia bol'nykh, stradaiushchikh dementsiei.

A treatment of 285 out-patients with different types of dementia and concomitant behavioral and psychiatric disorders has been conducted in gerontopsychiatric unit of Moscow mental out-patient clinic No. 10. The sample analyzed consisted of 88 (31%) men and 197 (69%) women, aged from 60 to 98 (mean 74.5 +/- 6.4) years. Each patient had an epidemiological record registering demographical and clinical details as well as information on the drugs and doses prescribed, etc. Tranquillizers and hypnotics used separately or in combination with other drugs were prescribed to 60% of the patients, neuroleptics--to 37%, vasotropics and nootropics--to 35%, antidepressants--to 16%, antiparkinsonic drugs--to 8%, anticolvunsants--3%. Most frequently different drugs have been used in combination (58% of the cases) and in 33% cases--as monotherapy. Only in 9% of the patients psychotropics have not been prescribed. The choice of psychotropics was dependent on the patient age and disease severity. At older age and severe dementia neuroleptics were prescribed to the patients more frequently.