RESUMO
An analysis of EEG spectral power values and of quantitative clinical scores of depressive conditions has been carried out in dynamics of treatment in 40 patients with endogenous depression with the main goal to study neurophysiologic correlates and to search possible predictors of therapeutic outcome. The reduction of depressive symptoms by the end of the treatment course was associated with EEG signs of improvement of brain functional state. Significant correlations have been revealed between the EEG narrow-band spectral power values and clinical scores. As well, significant correlations have been revealed between some initial (before beginning of treatment) EEG parameters and quantitative clinical scores at the stage of remission establishing. The values of EEG beta-1 and beta-2 spectral power appeared to be such predictors, while initially larger values of EEG beta activity spectral power were associated with higher pronounce of residual depressive symptoms after the treatment course. The data obtained allow to justify basic views on brain mechanisms of various aspects of depressive disorders, and to reveal possible neurophysiological predictors of efficacy of treatment of endogenous depression.
Assuntos
Ritmo beta , Depressão/fisiopatologia , Depressão/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The latest advances in molecular medicine, medical genetics and neurobiology have provided for a new look at processes occurring in cells of the brain and have allowed to discover previously unknown phenomena associated with mental traits and to propose new biomedical direction which include genomics, psychiatry and neurobiology - brain genomics. The application of modern molecular and cellular technologies of genome analysis in the brain in common psychiatric disorders (autism, schizophrenia and Alzheimer's disease) has shown that genomic instability is a phathogenetic mechanism of central nervous system abnormalities and plays a role in the brain development. Genomic disbalance alters neural homeostasis leads to cell death and is an important biological marker of psychiatric disorders which determine genomic pathways. These alterations lead to synaptic disfunction and neurodegeneration. In the present review, the main advances of brain genomics and potential application in diagnostic, clinical and therapeutic practice.
Assuntos
Encéfalo , Marcadores Genéticos , Variação Genética , Instabilidade Genômica , Envelhecimento/genética , Doença de Alzheimer/genética , Animais , Transtorno Autístico/genética , Encéfalo/crescimento & desenvolvimento , Encéfalo/fisiologia , Endofenótipos , Estudo de Associação Genômica Ampla , Genômica , Humanos , Doenças Neurodegenerativas/genética , Esquizofrenia/genéticaRESUMO
A classification of endogenous affective disorders based on clinical manifestations of a concrete disease is proposed. It reflects one of the stages of investigations into the structure of psychopathological manifestations of depressive and maniacal disorders. Further studies may provide data for the adjustment of the classification to the current diagnostic strategies.
Assuntos
Sintomas Afetivos , Transtornos do Humor , Atividades Cotidianas , Transtorno Bipolar/classificação , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Doença Crônica , Transtorno Depressivo/classificação , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Inteligência Emocional , Humanos , Transtornos do Humor/classificação , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , PsicopatologiaRESUMO
Problems of future development of psychopathology and clinical psychopharmacology are discussed. It is shown that the study of efficacious psychopharmacological agents is closely related to the study of the psychopathological structure of psychic disorders, problems of therapeutic resistance and maintenance treatment.
Assuntos
Transtornos Mentais , Psicofarmacologia/normas , Psicotrópicos/farmacologia , Relação Dose-Resposta a Droga , Resistência a Medicamentos , Drogas em Investigação/normas , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , PsicopatologiaRESUMO
The clinical picture of paroxysm-like progredient schizophrenia in 104 patients was characterized by a combination of schizophrenic symptomatology, paroxismal and paroxysm-like disorders. Investigation of their psychopathological structure showed that they differ from that of epileptic paroxysms. The data obtained provide a basis for distinguishing a special variant of endogenous process and developing criteria for typological classification of paroxismal and paroxysm-like disorders.
Assuntos
Alucinações , Esquizofrenia , Convulsões , Inconsciência , Adulto , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/etiologia , Sintomas Afetivos/psicologia , Despersonalização/etiologia , Despersonalização/psicologia , Feminino , Alucinações/etiologia , Alucinações/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Psicopatologia , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Convulsões/etiologia , Convulsões/fisiopatologia , Convulsões/psicologia , Inconsciência/etiologia , Inconsciência/psicologiaRESUMO
In the International Classification of Diseases, 10th Revision (ICD-10) two opposing principles are combined and mixed: atheoreticity that is necessary for the natural classification and commitment to nosology. Implementation of these principles requires a two-stage qualification. The first stage should be narrative detailed syndromological qualifications with identification of psychotic level of disorders. As for the second stage, the qualification should be nosological, based on complete clinical analysis, which is far from being possible to realize at once. ICD-10, specifically brought to nosological certainty, may remain the natural foundation for nosological qualification. Implementation of the syndromic qualification at the first stage will allow to consider nosological features of each syndrome at the second stage and to expand the list of criteria in different clusters. Such a suggestion opens the prospect for subsequent revisions of the ICD and allows to direct our efforts and those of practitioners to the unified channel, where the statistical goals would not be implemented at the expense of the research ones.
Assuntos
Classificação/métodos , Classificação Internacional de Doenças , Transtornos Mentais , Melhoria de Qualidade , Pesquisa Comportamental/métodos , Pesquisa Comportamental/normas , Humanos , Classificação Internacional de Doenças/normas , Classificação Internacional de Doenças/tendências , Transtornos Mentais/classificação , Transtornos Mentais/diagnóstico , Modelos Psicológicos , Escalas de Graduação Psiquiátrica/normas , Escalas de Graduação Psiquiátrica/estatística & dados numéricosRESUMO
Two recent studies reported evidence for association between genetic variation of the positional candidate gene P2RX7 on chromosome 12q24 and bipolar I disorder (BPI) [Barden et al. (2006); Am J Med Genet Part B 141B:374-382; McQuillin et al. (2008); Mol Psychiatry 13:1-7] and one study found association with unipolar major depression (Mdd-UP) [Lucae et al. (2006); Hum Mol Genet 15:2438-2445]. In the present work, we aimed to replicate the SNP that showed the strongest association in the above-mentioned studies, namely rs2230912 (P2RX7-E13A) resulting in a change of the amino acid glutamine to arginine at position 460 (Gln460Arg), in four European bipolar I disorder samples from Germany, Poland, Romania, and Russia totaling 1,445 patients, in a German sample of recurrent Mdd-UP patients (N = 640), and a control sample of 2,006 subjects. We found no allelic or genotypic association between rs2230912 and BPI or Mdd-UP both in the national samples and in the combined European patient sample. Additional studies are needed to clarify the potential involvement of P2RX7 and of SNP rs2230912 in the etiology of major affective disorders.
Assuntos
Transtorno Bipolar/genética , Transtorno Depressivo/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único/genética , Receptores Purinérgicos P2/genética , População Branca/genética , Adulto , Alelos , Estudos de Casos e Controles , Feminino , Frequência do Gene , Humanos , Masculino , Receptores Purinérgicos P2X7RESUMO
AIM: To assess the efficacy and safety of pantogam active (PA) in prevention and correction of neurological side-effects during the course neuroleptic treatment of acute endogenous psychoses. MATERIAL AND METHODS: Eighty schizophrenic patients (mean age 33 years) with acute psychosis were examined. All patients received 28-day course treatment with typical and atypical neuroleptics. Two equal groups were studied: patients of the first group were treated with trihexyphenidyl (THP) in dose of 0,002-0,012 mg and patients of the second group received in addition PA in dose 0,9 mg/day. Clinical-observation, psychometric scales (PANSS, CGI-S, UKU) were administered at baseline and in 1st,3rd,7th, 14th, 21st, 28st day. RESULTS: PA in the combination with THP improved tolerability to neuroleptic therapy in whole and exerted the better correction effect on neuroleptic extrapyramidal disorders (EPD) compared to THP monotherapy. The number of patients with ERD was reduced by 1.5 times and prevention of EPD was observed 3 times more frequent in the group treated with PA. In the THP group, other adverse effects (AE) were 1,7 times more frequent and the total AE score was 2,5 times greater compared to the PA group (131 vs 50). Correction and preventive effects of the combined treatment on the clinically severe symptoms of EPD (akathisia, muscle dystonia) were more frequent in patients treated with typical neuroleptics. A less amount of THP (by 1,2 times) was used to stop EPD in the PA group. CONCLUSION: PA in the combination with THP has demonstrated the clear neuroprotective effect on the development, frequency and clinical presentations of neurological side-effects. The Ð Ð can be recommended as a drug of choice for correction and prevention of neuroleptic side-effects, it promotes their tolerability and improves quality of life during the course treatment.
Assuntos
Antipsicóticos/efeitos adversos , Doenças dos Gânglios da Base/induzido quimicamente , Doenças dos Gânglios da Base/tratamento farmacológico , Nootrópicos/uso terapêutico , Ácido Pantotênico/análogos & derivados , Esquizofrenia/tratamento farmacológico , Triexifenidil/efeitos adversos , Ácido gama-Aminobutírico/análogos & derivados , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Doenças dos Gânglios da Base/prevenção & controle , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Pantotênico/uso terapêutico , Qualidade de Vida , Resultado do Tratamento , Triexifenidil/uso terapêutico , Adulto Jovem , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
The author considers the problem of pathomorphosis, i.e. the changes in clinical presentation of endogenous mental diseases (schizophrenia, depression), since the time of its classical description. There is a general trend towards the development of forms with more favorable course in schizophrenia and the domination of prolonged and masked variants in depression. These changes are discussed in aspects of true (natural) pathomorphosis and therapeutic (induced) pathomorphosis. The relative character of this stratification and insufficient understanding of the problem in psychiatry in general are emphasized.
RESUMO
OBJECTIVE: To study the possibility of using immunological parameters for the evaluation of the activity of endogenous process in depression and quality of response to psychopharmacotherapy. MATERIAL AND METHODS: Authors examined 42 patients, aged 20-55 years, with the prevalence of anxiety (n = 22) or apathy (n = 20) in the clinical picture of depression. The following immunological parameters were measured in the blood of the patients: degranulation activity of leukocyte elastase (LE), functional activity of alpha-1-proteinase inhibitor (alpha-1-PI); the level of autoantibodies to neuroantigen S-100B and myelin basic protein. RESULTS AND CONCLUSION: The involvement of inflammatory and autoimmune responses in the pathophysiology of endogenous depression was confirmed. Depression associated with increased levels of autoantibodies to brain neuroantigens (an autoimmune component) had a more complicated structure and showed the tendency to prolonged course and resistance to the therapy. The results suggest that some immunological parameters may be used as markers of patient's clinical status and quality and completeness of psychopathological symptom reduction.
Assuntos
Autoanticorpos/sangue , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/imunologia , Adulto , Biomarcadores/sangue , Transtorno Depressivo/sangue , Feminino , Humanos , Elastase de Leucócito/sangue , Masculino , Pessoa de Meia-Idade , Proteína Básica da Mielina/imunologia , Subunidade beta da Proteína Ligante de Cálcio S100/imunologia , Adulto Jovem , alfa 1-Antitripsina/sangueRESUMO
The basic principle of psychopharmacology--is its impact on the psychopathological syndrome, having in view its specificity, expressivity of negative disturbances, nosological entity. One of the approaches to the selection of adequate psychopharmacotherapy may be the concept of comorbidity of disturbances, determining the structure of the syndrome and perspectives of its impact. With this in view, the structure of some syndromes may be considered not as a complex of closely interrelated disturbances, but as states stemming from relatively independent pathological disturbances, connected by probable relations. The problem of differentiated psychopharmacotherapy in line with the phenomenon of comorbidity at the level of symptom-syndrome, psychopathological personality disturbances (including negative ones), may have a practical as well as a theoretical significance. An analysis of comorbid connections determines as well the selection of preventive drugs in the prophylaxis of relapses of psychoses. An eventual study of all sides of this problem has its goal to define the spectre of action of the already known drugs and new psychopharmacological preparations, a deeper understanding of psychopathology and the clinical state being under the impact of psychopharmacological therapy, a transition from an extensive understanding of a wide range of questions of psychopharmacology to an intensive study of separate facets of the problem, which seems to be most perspective.
Assuntos
Transtornos Mentais/tratamento farmacológico , Psicofarmacologia , Adolescente , Adulto , Fatores Etários , Idoso , Doença Crônica , HumanosRESUMO
Approaches to diagnosing schizophrenia are different. There is a distinct tendency either to narrow the limits of the disease or to expand it, which in some cases leads to a disagreement and even a tendency to disputes. The comprehensive studies conducted in the Mental Health Research Center, Russian Academy of Medical Sciences, have provided an overall notion of the disease in terms of its progression and outcome. The clinical picture of schizophrenia is characterized by obligatory specific disorders, such as autism, reduced energy potential, emotional thinking, and behavioral disorders. Personality changes may be seen as the smoothening of specific personality traits and the appearance of the features that are not inherent to the patients in the past. Schizophernia is also characterized by positive psychopathological syndromes: pseudoneurotic, affective, psychopathy-like, hallucinatory-paranoid and catatonic. A study of 7500 patients with schizophrenia demonstrated that there were clear-cut regularities in the development of the disease, which suggest that there are forms and types in its progression. The study identified 3 forms of development: continuous, recurrent, and attack-like progressive with varying degrees and rates of the process (severe, moderate, and mild). Genealogical and clinicogenetic studies demonstrated accumulation of psychoses and abnormal personalities in the families of probands, manifest and slowly progressive forms of schizophrenia and cases of schizoid psychopathy. Among the wide spectrum of pathogenetic concepts, priority should be given to the dopamine hypothesis, whose main point is accumulation of an excessive amount of dopamine in the brain tissue, especially in the nigrostriatal, mesocortical, and mesolimbic systems. This may lead to activation of dopaminergic brain structures with an increase of dopamine receptors. This hypothesis is confirmed by the neuropathological studies demonstrating a significant increase in the numerical density of the dendritic spines and dendritic trunks in the with layer of the prefrontal cortex. The highest index of the numerical density was observed in young patients with prevalent negative disorders. Inasmuch as there is no correlation of this index with the duration of the disease, it can be concluded that the abundance of synaptical connections is a result of disturbed brain development and a factor predisposing to severe progression of schizophrenia. Treatment modalities are determined by the form and rate of progression of and the pattern of the psychopathological syndrome. Of particular importance is the role of age, somatic state, and individual sensitivity to neuroleptic drugs. Another important factor in the treatment of schizophrenia is a simultaneous or consecutive impact on the psychopathological syndrome and the disease as a whole.
Assuntos
Esquizofrenia , Humanos , Incidência , Prevalência , Pesquisa/tendências , Federação Russa/epidemiologia , Esquizofrenia/classificação , Esquizofrenia/epidemiologia , Esquizofrenia/etiologiaRESUMO
The author outlines the major principles and structure of post-graduate training in the USSR. There are 16 special post-graduate institutes for physicians in the USSR, with 14 chairs of psychiatry. For special branches of psychiatry post-graduate training is accomplished in Psychiatric Research Institutes. The training of professionals in institutes for post-graduate training is implemented through training courses oriented in line with the level of professional skills of the trainees (primary courses, for psychiatrists with a background, for professors) One of the forms of post-graduate training are visiting courses of the teacher-body of the Central Institute for Advanced Medical Training to various regions of the country. Teaching is conducted according to detailed elaborated programmes.
Assuntos
Educação Médica Continuada/tendências , Psiquiatria/educação , Humanos , U.R.S.S.RESUMO
Modern classifications of psychic disorders of the exogenous and exogenous-organic origin are reviewed. It is emphasized that the available international classifications including IDC-8 and IDC-9 as well as the classification currently used in the USA cannot be considered as adequate. The present work aims at attempting a uniform classification of psychic disturbances associated with somatic diseases, infections and intoxications which would reflect in the general form the nature and sequence of the development of the major, most common psychotic disturbances in all diseases of the exogenous and exogenous organic character. The classification proposed includes a group of neurosislike states, acute symptomatic psychoses, protracted symptomatic psychoses and various kinds of the psychoorganic syndrome. The conditions and probabilities of the development of different states of the exogenous organic origin are discussed.
Assuntos
Transtornos Neurocognitivos/classificação , Humanos , Métodos , U.R.S.S. , Estados Unidos , Organização Mundial da SaúdeRESUMO
Overall 70 patients suffering from attack-like progressive schizophrenia associated with paroxysmal and paroxysm-like disorders were examined. The clinico-psychopathological aspects of the disease were many and varied. The common signs of the disease included the presence of affective disorders, their considerable portion among other psychopathological manifestations. The dynamics of affective disorders specified in many respects the common character of the disease and the degree of the process progression and, in many cases, it tended to the formation of affective continuity. The common characteristics of the disease also included the presence of early disease signs which occurred long before manifest features, i.e. since the very childhood. The study of the structure of paroxysmal and paroxysm-like conditions revealed their diversity and certain specificities as compared with analogous paroxysms seen in the clinical picture of epilepsy. In addition to the clinical and psychopathological characteristics and the dynamics of personality disorders, this will provide evidence in favour of a special variant of the endogenous process.
Assuntos
Esquizofrenia/diagnóstico , Convulsões/diagnóstico , Adulto , Diagnóstico Diferencial , Epilepsia/classificação , Epilepsia/diagnóstico , Epilepsia/genética , Epilepsia/psicologia , Feminino , Humanos , Masculino , Psicopatologia , Esquizofrenia/classificação , Esquizofrenia/genética , Psicologia do Esquizofrênico , Convulsões/classificação , Convulsões/genética , Convulsões/psicologiaRESUMO
Current existing problems of clinical psychiatry are considered in the aspect of most urgent and unresolved issues in the field of schizophrenia. Special attention is drawn to the differences in existing approaches to the classification of schizophrenia. In this connection, the author emphasizes the importance of the classification developed by A.V. Snezhnevsky and his school for theoretical and practical psychiatry. In view of this classification, the problem of clinical heterogeneity of schizophrenia related with the conception of different disease forms is considered. Difficulties of diagnosis of some forms and psychopathological evaluation of psychotic attacks developed in the continuous course of schizophrenia well as insufficient understanding of the problem of negative (deficit) symptoms and remission classification are discussed.
Assuntos
Psiquiatria/tendências , Esquizofrenia/classificação , Esquizofrenia/diagnóstico , HumanosRESUMO
OBJECTIVE: To determine the types of oneiroid-catatonic states characteristic of corresponding schizophrenia attacks and their treatment-related changes. MATERIAL AND METHODS: We examined 68 outpatients, 25 men and 43 women, aged from 18 to 54 years, using psychopathological and follow-up methods. Results and conclusion. Two groups of oneiroid states were described. Oneiroid-catatonic states with the predominance of visual (optical) component derangement of consciousness were characteristic of the first group and oneiroid states with the prevalence of sensory component of derangement of consciousness were described in the second group. The second group was divided into two subgroups by the severity of the visual component (minimal and mixed). The types of oneiroid-catatonic states determined the dynamics of the attack in whole and were related to treatment (drug-induced pathomorphosis). These results are significant for differential diagnosis, treatment, and prognosis of the disease.
Assuntos
Transtornos da Consciência/diagnóstico , Transtornos da Consciência/psicologia , Sonhos , Fantasia , Esquizofrenia Catatônica/diagnóstico , Esquizofrenia Catatônica/psicologia , Adolescente , Adulto , Transtornos da Consciência/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia Catatônica/classificação , Adulto JovemRESUMO
OBJECTIVE: To investigate a spectrum of disorders preceding the development of manifesting psychosis in the aspect of their topology and possible prognostic value. MATERIAL AND METHODS: Authors examined 60 outpatients, 21 women and 39 men, aged from 22 to 34 years. All patients were diagnosed with attack-like progressive schizophrenia. The retrospective evaluation of disease history and determination of the psychopathological structure and dynamics of manifesting episode and premanifesting symptom clustering were carried out. RESULTS AND CONCLUSION: It was identified 4 variants of premanifesting disorders: affective (n=15), affective with neurotic-like symptoms (n=17), affective with hallucinatory/paranoid symptoms (n=21) and affective with deficit symptoms (n=7). These disorders determine not only the transparent symptomatics but project in the manifesting episode structure and has a prognostic value thus reflecting a trend towards the continuous course of schizophrenia already at the premanifesting stage.
Assuntos
Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Adulto , Diagnóstico Precoce , Feminino , Alucinações/diagnóstico , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos Neuróticos/diagnóstico , Transtornos Paranoides/diagnóstico , Transtornos Psicóticos/classificação , Estudos Retrospectivos , Esquizofrenia/classificação , Adulto JovemRESUMO
The significant variety of psychopathological presentations of depression causes difficulties in its diagnosis. Depression of middle age is subdivided depending on the predomination of one or another disorder in the clinical picture. There are simple depression and complicated depression with additional psychopathological symptoms. The most difficult is to diagnose depression with onset in early childhood, including infant's age, when the psychopathological presentations depend on the consequences of the perinatal CNS lesion, maternal deprivation and other factors. In children, the clinical picture of depression differs by syndromologic incompleteness, peculiarity of phenomenological presentations and polymorphism of disorders. In adolescence, depression is characterized by the predominance of behavioral disorders, marked psychopathic-like disorders, suicidal attempts, higher frequency of bipolar forms. Depression with late age at onset differs by the abundance of somatic and hypochondriac complaints, anxiety and depressive delusion accompanied by the transitory aggravation of cognitive impairment (depressive pseudodementia).