[Prevalence and risk factors of delirium in COVID-19]

OBJECTIVE

To assess the frequency and risk factors of delirium in patients hospitalized with COVID-19.

MATERIAL AND METHODS

Four hundred and forty patients admitted to the Infectious Diseases Hospital of the University Clinical Hospital No.3 of Sechenov University were included in the study. The Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Screening Questionnaire-7 (GAD-7), the Insomnia Severity Index (ISI), the Delirium severity rating scale (DRS-R-98) were administered.

RESULTS

Delirium was detected in 27.8% of patients. Significant risk factors were age (p=0.002), severity of respiratory failure (p=0.005), concomitant somatic disease (p=0.003), and respiratory therapy (p<0.001). There was an association between severe anxiety (p<0.001) and insomnia (p=0.07) observed at admission with the risk of developing delirium during the hospital stay.

CONCLUSION

The study reveals a high prevalence of delirium in patients with COVID-19. In order to prevent delirium and/or reduce the risk, early diagnosis and identification of preclinical forms are of particular importance.

[Unipolar depression: a gender-based comparative analysis]

OBJECTIVE

To compare socio-demographic and clinical characteristics in men and women with depression.

MATERIAL AND METHODS

We studied 388 patients with unipolar depression, 74 men and 314 women. The survey was carried out using the clinical-psychopathological method and psychometric scales for depression.

RESULTS AND CONCLUSION

Gender differences are identified for several parameters. Women are older, more often had comorbid somatic and organic disorders; men have personality disorders and chronic depression. The severity of depression in women was higher due to symptoms such as reported sadness, anxiety, reduced sleep and appetite, concentration difficulties, and suicidal thoughts. Apparent sadness did not significantly differ in men and women. Anhedonia was more pronounced in men.

[Clinical presentations and therapy of polysubstance dependence in patients with schizophrenia]

BACKGROUND

The article presents the results of a clinical therapeutic and follow-up study of patients with a 'dual diagnosis' (polysubstance dependence comorbid with schizophrenia: paranoid schizophrenia or schizotypal disorder).

OBJECTIVE

To study clinical/dynamic changes of polysubstance dependence in patients with schizophrenia (paranoid schizophrenia, schizotypal disorder) and to evaluate the duration and quality of therapeutic remissions.

MATERIAL AND METHODS

Two hundred and sixty-six male patients, including 176 patients with dependence syndrome and 90 patients with both dependence syndrome and schizophrenia, were studied.

RESULTS

Patients with the 'dual diagnosis' are characterized by early social maladjustment, earlier social deformation, lack of social skills and preference for a lonely lifestyle. The clinical and dynamic characteristics of dependence syndrome in patients with 'dual diagnosis' include older age of the first use of a psychoactive substance (PS), preference of alcohol as the first PS, experiment as the most frequent motivation for using PS (due to thought disorder), and the treatment of psychopathological disorders (PS like medicine) with a chaotic pattern being the most common in the use, a tendency to hospitalism.

CONCLUSION

The success of the treatment of patients with 'dual diagnosis' is possible by combining the therapy of endogenous disease and polysubstance dependence.

[Clinical and sociodemographic characteristics of patients with the first depressive episode and recurrent depression]

OBJECTIVE

To comparare socio-demographic and clinical characteristics of patients with the first depressive episode and recurrent depression.

MATERIAL AND METHODS

Three hundred and twenty one patients with unipolar depression, including 96 patients with first depressive episode and 225 patients with recurrent depression, were examined using clinical and psychometric methods.

RESULTS AND CONCLUSION

There were differences in clinical characteristics between groups but such factors as gender, marital status, level of education, family history of mental disorders and personality were similar. With each new episode of recurrent depression, the next episode tends to be more severe with more intense pessimistic and suicidal thoughts but fewer anxiety and complaints of depressive mood that affects the differences and requires further research, especially considering the effect of therapy.

[Non-delusional hypochondriac disorders in old age]

This review aims to present main concepts of hypochondria and 'hypochondriac mood' in old age. Attention is paid to historical and modern positions of old age hypochondria as a meta-syndromic pathology and as an independent mental disorder. Relationships of hypochondriac manifestations with affective variations and anxiety disorders, as well as somatic diseases, organic degenerative brain diseases and vascular disorders are discussed.

[Aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction]

AIM

The randomized comparative study of aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction.

MATERIAL AND METHODS

Intra-group analysis of dependent variables on the scales PANSS, BPRS, VAS, SACS showed significant differences in the dinamics of the therapy in all groups. A comparative randomized study included 90 men admitted to an inpatient addiction unit. Of these, 54 (60%) had a previously established psychiatric diagnosis and 36 patients (40%) did not have an established psychiatric diagnosis. They were randomized into 3 groups of 30 patients each: group 1 received aripiprazole at a dose of up to 20 mg/day, group 2 received quetiapine at a dose of up to 600 mg/day and group 3 (controls) was treated with haloperidol at a dose of up to 30 mg/day. Treatment duration was 21 days. The efficacy of aripiprazole and quetiapine was evaluated with PANSS, BPRS, VAS and SACS on 10^th, 14^th and 21^st day (visits 2-4). Drug safety was evaluated by recording adverse events or side-effects.

RESULTS AND CONCLUSION

An analysis of independent variables showed significant differences between aripiprazole and haloperidol in PANSS and BPRS scores at visit 4, in VAS scores at visit 3, and in SACS scores at visit 2. An intergroup analysis of independent variables showed significant differences between quetiapine and haloperidol in PANSS, VAS and SACS scores at visit 4 and between aripiprazole and quetiapine in VAS and SACS scores. According to the results of the correlation analisys it has been concluded that presenting features of schizophrenia are closely correlated with drug addiction (craving).

[The current state and future prospects of depression research (clinical and classification problems)]

Despite decades of research, neurobiological studies of depression haven't achieved significant results. Many experts propose that one of the main reasons for this failure is current diagnostic standards not considering the heterogeneity and polymorphism of depression. Research is unable to identify specific neurobiological changes due to formal diagnosis 'major depressive disorder' and new diagnostic criteria are needed. RDoC (Research Domain Criteria) has intensified the confrontation between biological and clinical researchers and changes in approach to depressive psychopathology are discussed. A review presents the recent approaches used in studies of depressive disorders, the methodology they use, the scientific paradigms they rely on.

Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

[Psychopathological features of affective disorders in schizotypal disorder]

AIM

To explore psychopathological features of affective disorders in the structure of schizotypal disorder.

MATERIAL AND METHODS

The study included 102 patients with schizotypal disorder, aged from 18 to 60 years. Assessment was done using clinical/ psychopathological method and psychometric scales - Calgary depression scale in patients with schizophrenia (CDSS), General Clinical Impression scale (CGI), Yang's mania scale (YMRS).

RESULTS AND CONCLUSION

Affective disorders are noted in the majority of inpatients with schizotypal disorder. They are represented by depressive disorders of variable severity, and mixed depressive states. A group of patients with schizotypal disorder was identified in whom the symptoms of the affective disorder constituted the main clinical picture of the disease, whereas concomitant neurosis-like disorders were formed solely during the exacerbation of depression, correlated with its severity and reduced on antidepressant therapy along with depressive symptoms. Observed reversibility of productive disorders allowed us to consider the dynamic of these states as similar to the atypical affective phase, and the natural course of the disorder as close to the paroxysmal type in the form of distinct depressive phases. In patients with persistent neurosis-like disorders, affective disorders accompanied axial symptoms of the disease and made a large impact on the structure of the exacerbation of the endogenous process. A reduction of depressive symptoms in these patients was accompanied by a decrease in the intensity of axial symptoms of the disease, however the complete reduction of axial symptoms and remission was not observed.

[Treatment of depression complicated by abuse and dependence on alcohol]

AIM

To evaluate the efficacy of different treatment regimens of depression complicated by abuse and dependence on alcohol and to identify the most effective tactics of treatment.

MATERIAL AND METHODS

One hundred patients with depression were studied. Examination of patients was conducted using clinical-psychopathological method, the MADRS (at admission, on the 1st, 2nd, 4th and 6th week of treatment) and CGI scale (in the beginning of treatment and on 6th week). Data analysis using standard statistical indicators was performed. In accordance with the therapeutic tactics, patients were stratified into three groups: patients, treated with a combination of antidepressants, antipsychotics and mood stabilizers (group 1); antidepressants and antipsychotics (group 2); antidepressants and mood stabilizers (group 3).

RESULTS

In group 1, a reduction in MADRS scores was significantly higher compared to other groups (8.53 points, p≤0.01). On the 6th week, 50% of the patients showed complete or almost complete remission, and the state of 44.7% patients was classified as 'mild disorders'. In group 3, serious condition remained in 16.7% of patients by the end of the 6th week. By the 6th week of treatment, 39.5% of patients of group 1 had 'very significant improvement'. The least treatment efficacy was noted in group 3.

CONCLUSION

The use of the combination of antidepressants, antipsychotics and mood stabilizers demonstrates the greatest efficacy in terms of reduction of depressive symptoms.

[The possibility of using standardized self-report anxiety and depression scales in elderly patients: Depression scales/questionnaires in elderly]

AIM

To study possibilities of using depression scales in elderly patients, evaluate the parameters of their reliability and validity and develop practical recommendations on the use of these scales in clinical practice.

MATERIAL AND METHODS

The study included 234 patients, aged over 50 years, with anxious depression. The following scales/questionnaires BDI, GDS-15, CES-D-10, CES-D-20, ZDS and HADS-D were used at baseline and 12 weeks after treatment. Data analysis included the calculation of convergent, discriminative and diagnostic validity of depression scales/questionnaires in elderly.

RESULTS

All scales are effective for the diagnosis of depression in elderly people. The possibility of using these scales in patients with mild cognitive impairment is shown. An increase of the correlation between the scores on depression and anxiety scales up to the loss of discriminative validity of «double» scales/questionnaires by the alternative set of symptoms for the diagnosis of depression and anxiety was confirmed.

CONCLUSION

Based on the RESULTS: the authors have developed common and specific for each scale recommendations on the optimal use of depression scales/questionnaires in elderly.

[Remote consequences of the long-term uncontrolled use of anxiolytic and hypnotic drugs by elderly patients: cognitive disorders]

OBJECTIVE

Frequents cases (10-30% of the elderly population) of regular long-term use of anxiolytic and hypnotic drugs, in particular, benzodiazepines, without control of the physician is an urgent problem of medicine worldwide. Severe and irreversible cognitive impairment is a frequent and severe consequence of this use. Authors studied cognitive impairment in these cases.

MATERIAL AND METHODS

Patients were enrolled in the study from a psychiatric hospital. The study included 56 women, aged over 50 years, admitted to the hospital with the diagnosis of a mental disorder. Before admission, the patients regularly used benzodiazepines without a prescription for more than 2 months. Later on, anxiolytics were withdrawn during 1-5 days. The patients were studied during 4 weeks in the hospital. To assess the severity and dynamics of their condition, authors used MADRS, HAM-A, MMSE.

RESULTS AND CONCLUSION

Severe cognitive impairment, achieving the level of dementia, was found in 57.2% of the patients, mild or moderate of cognitive impairment was in 32.1% and only 10.7% had normal level of cognitive functioning. After 4 weeks of benzodiazepine withdrawal, the percentage of patients with dementia reduced to 21.4%, the severity of cognitive impairment was estimated as mild or moderate. A number of patients without cognitive impairment increased to 37.5%. The old age of patients was a significant negative predictor of the dynamics. An impact of the high anxiolytic dose was shown on trend level. The duration of a mental disorder and duration of uncontrollable consumption of anxiolytics and hypnotics did not exert an effect on the development and reversibility of cognitive impairment. A combination of anxiolytics with alcohol increased the risk of dementia and did not reverse the cognitive pathology.

[Anxiety disorders in elderly patients: psychopathological characteristics, diagnosis, similarities and differences with anxious depression]

OBJECTIVE

There are two points of view on the relation between anxiety and depression: they are comorbid diseases or they are symptoms of the same disease. This inconsistency complicates the diagnosis of anxiety and depressive disorders in clinical practice, in particular in elderly patients. We attempted to study the nosological structure of anxiety states in elderly patients and work out recommendations on differential diagnosis of anxiety disorders and depressions.

MATERIAL AND METHODS

A main group included 80 elderly patients with anxiety disorders, 80 patients with anxious depression were enrolled in comparison group. These groups were selected on the basis of the primary diagnosis made before enrollment patients into the study.

RESULTS

After the detailed examination of patients with anxiety disorders, the diagnosis has been changed in 67.5% of patients. Symptoms of all patients with hypochondriac, somatisized and somatoform pain disorders were corresponded to atypical anxious depression. Duration and severity of psychogenic disorders of adaptation and acute reactions to stress were also corresponded to the diagnosis of depression. All patients with obsessive-compulsive disorders had typical symptoms of neurosis-like schizophrenia, these patients were excluded from the study. After the revision of diagnoses, the group with anxiety disorders comprised 26 patients and the group with depression increased up to 131 patients. A between-group comparison of clinical/anamnesis data showed that mean age of patients with depression (59.7 years) was significantly higher than that of patients with anxiety disorders (56 years). Levels of anxiety measured with the Hamilton scale (HAM-A) were similar in both groups. MADRS scores were significantly higher in the depression group (27.9) compared to patients with anxiety disorders (16.5).

CONCLUSION

The most frequent diagnoses that mask depression in elderly people are hypochondriac, somatisized and somatoform pain disorders as well as acute reactions to stress and disorders of adaptation. Somatoform autonomic dysfunction and agoraphobia are less frequent diagnoses. Clinical-psychopathological examination of elderly patients with these disorders requires a careful search for symptoms of a possible atypical depression. Definite diagnosis is necessary for adequate treatment.

[Characteristics of the pharmacological pathomorphosis of remission in schizoaffective disorders]

OBJECTIVE

To study the effects of different types of psychopharmacotherapy on the changes in the duration and clinical symptoms of remissions in patients with schizoaffective disorders (SAD).

MATERIAL AND METHODS

Authors have analyzed the therapeutic pathomorphosis of remissions in patients with SAD examined from 1980 to 2013. One hundred and there patients have been stratified into 3 groups: patients treated from 1980 to 1990 (group 1), from 1991 to 1999 (group 2) and from 2000 to 2013 (group 3).

RESULTS

Main changes in the quality of remission were correlated with the reduction in the patients' commitment to anti-relapse therapy due to the reduction in the control over its timely receipt as well as decreasing of active surveillance of the mental health of patients. Social factors, together with biological factors (pharmacotherapy), are no less important to maintain the quality of remission providing not only the improvement of compliance in patients, but also increasing their social adaptation.

CONCLUSION

Supporting therapy can be recommended for administration within a year after the first onset of SAD and within three years after repeated attacks. Long-term anti-relapse treatment is recommended to patients with residual symptoms or low compliance.

[Effectiveness of psychopharmacotherapy of late hypochondriac depression]

Hypochondriac depression is typical for elderly people and is difficult to treat. An aim of the study was to estimate the effect of hypochondriac symptoms on the effectiveness of psychopharmacotherapy of late depression. It has been shown that psychopharmacotherapy of late depression with hypochondriac symptoms is significantly less effective than that of depression without such symptoms. Some predictors of psychopharmacotherapy effectiveness were identified. Many prognostically significant factors were consistent with those found earlier for late depression. The nosological attribution of depression without hypochondria to bipolar affective disorder may explain better effectiveness of its psychopharmacotherapy.

[Hypochondriac symptoms in late-onset depression: the relationship between hypochondria and somatic state of patients]

Authors studied 276 women with late-onset depression. Concomitant chronic somatic diseases were identified in 90%. The presence of disease and its nosological definition did not impact on the development of hypochondriac symptoms in patients with late-onset depression. Patients with hypochondriac late-onset depression more often had disability pension due to somatic disease because they more often referred to internists in case of similar objective severity of somatic pathology. It was singled out three variants of the relationship between hypochondria and somatic state: hypernosognostic (a complete coincidence of hypochondria content with actual somatic pathology; anosognostic (a lack of coincidence) and disharmonic (a partial coincidence). The themes of hypochondria in late-nset depressions were correlated with a total number of somatic diseases and their severity. At the same time, there was no correlation between the content of hypochondria and the character of somatic disease.

[The cluster analysis of depression symptoms in elderly patients]

The vast number of clinical and psychopathological studies of depression in elderly patients is based on the simple description of symptoms. In the present paper, authors studied clinical and psychopathological symptoms of depression in elderly people using statistical cluster analysis. Four main clusters of psychopathological symptoms were singled out. The further cluster analysis revealed significant between-group differences in clinical and anamnesis information that were not included in the analysis. Based on this finding, we proposed that each cluster reflected a specific clinical type of depression in the old age. The atypical combination within each type did not allow to identify definitely the nosological attribution of depression according to current classifications. In conclusion, the study of the psychopathology of depression in elderly people using methods of multivariate statistics makes it possible to find new clinical variants of these disorders that may improve diagnosis and allow for differentiation of treatment.

[Depression in patients with chronic hepatitis C during the antiviral treatment: a clinical and psychopathological qualification and a nosological interpretation]

Authors studied 160 patients with chronic hepatitis C on antiviral treatment. Depressive disorders developed in 85 patients. Clinical and pharmacotherapeutic features of depression were specified. Predictors for the prevalence, structure and severity of the depressive syndrome were found. The clinical and demographic heterogeneity of depressions was identified. The results of the clinical and statistical analysis allow to specify the nosological qualification of these depressions, to optimize diagnostic and treatment algorithms and to make more effective treatment of the main disease (chronic hepatitis C).

[Late-onset depression and a new psychometric scale for its clinical evaluation]

The most of existed psychometric scales for depression have some shortcomings hampering their use in old patients. The authors worked out the original scale for clinical evaluation of symptoms of late-onset depression. The list of symptoms was made up basing on literature data. The most significant symptoms that characterized the structure and severity of depression in old patients were singled out. According to results of factor analyses they were combined in the groups forming the corresponding items of the scale. In addition, some symptoms with particular clinical significance for late-onset depression (suicidal thoughts, senesto-hypochondriac symptoms, insight) were singled out. The scale comprises 13 items with scores from -6 to +6. It can be implemented for symptom screening, clinical diagnosis and rating, including dynamics of depression in elderly patients.

[Depressive disorders in elderly patients: an attempt of psychometric assessment with the Montgomery-Asberg Depression Rating Scale]

The objectives of this paper were to choose a psychometric scale that meets requirements for "comparison standard" in elaboration of new methods for psychometric assessment of late depression and to evaluate distortion of results for standard scale used in elderly patients. Based on the literature analysis, authors chosed the Montgomery-Asberg Depression Rating Scale (MADRS) as an etalon. The comparative analysis of MADRS scores and results of psychopathological evaluation revealed distortions of MADRS scores related to elder age. Qualitative and quantitative distortions were assessed for every MADRS item and for the total score. The analysis of separate components revealed that 7 out of 10 MADRS items were significantly changed and correlated with the age of patients while the total score did not change. This allows to use MADRS total score in further studies without any corrections. Application of the MADRS as a comparative scale in the symptomatic analysis of late depression needs the use of correction coefficients.

[The optimization of the late-life depression assessment scale and recommendations for its practical use]

The authors elaborated earlier the late-life depression assessment scale (version 1.0) which proved to be effective for the diagnosis and description of the structure and severity of depression in elderly patients. In this paper, they have improved this scale by adding corrections in the scale structure and dimensionality of assessment items. The retrospective analysis of primary symptoms assessed by the scale revealed that items with negative scores reflected the signs of the psychorganic syndrome and are not associated with the psychopathology of depression. The exclusion of these symptoms allow to shorten the scale and to use the same dimensionality to make it easier to use the scale in clinical and research practice. A trial of the new version (1.2) of the scale indicated its diagnostic effectiveness and the ability to measure correctly the depression's severity and changes in the status of elderly patients.

[Clinical characteristics of initial stages of schizotypal disorder]

The study of clinical-psychopathological characteristics of initial stages of schizotypal disorder was carried out on a sample of 54 male inpatients. Based on the results of clinical-psychopathological and follow-up studies, authors found that symptoms of initial stages of schizotypal disorder presented by non-psychotic depressive disorders. Dissociation of depressive symptoms, heterogeneity and unsteadiness of leading affect, marked polymorphism of depressive presentations, presence of concomitant neurotic-like and psychopathic-like disorders are characteristic of these depressive disorders. Five clinical variants of states described in the initial stages of disease are singled out: depression with symptom- complex of asthenic incompetence (25.9%), apathic-adynamic depression (27.7%), anxiety-depressive (16.6%), depersonalization-depressive (20.4%) states, hypochondriac depressions (9.3%).

[The experience of using the atypical antipsychotic sertindole in psychiatric inpatient clinics in Russia]

One hundred and fifty psychiatrists from 61 clinics of 30 cities located in 8 regions of the Russian Federation took part in the study. The study included 896 patients treated with sertindole. The duration of illness was from 1 month to 50 years (mean 9,55 ± 8,21), a number of previous relapses varied from 0 to 20 and more (mean 5,79 ± 6,68). Each patient was followed up for 6 weeks. Patient's state was assessed clinically and with the CGI. The statistically significant improvement was seen from the first week of treatment and the percentage of patients with marked mental disorders was constantly decreased from the first to the 6th week. It has been concluded that sertindole is an effective drug for stopping psychotic symptoms in the real practice of treatment of schizophrenic patients. It is well-tolerated and allows to reduce a number of concurrent drugs used for treatment.

[Treatment of depression after stopping acute psychosis in patients with schizophrenia]

The aim was to study the efficacy of different groups of neuroleptics and antidepressants in the treatment of depression after stopping acute psychosis in schizophrenic patients. Authors observed 183 patients during the treatment using a psychopathological method and a battery of psychometric scales for assessing patient's state, structure of psychopathological syndrome and side-effects of the drugs. Correlation analysis was applied to compare treatment characteristics with the dynamics of disease course (favorable or less favorable) during 8 years. We used 13 antipsychotic drugs, including depot drugs, and 15 antidepressants. In conclusion, the additional and strictly differentiated prescription of antidepressants in the treatment of schizophrenic patients with depressive symptoms after stopping acute psychosis is effective and safe. It allows to improve quality of life and prognosis of patients.

[Depressions in schizophrenic patients after the management of acute psychosis]

The study of depressions in 183 schizophrenic patients after the management of acute psychosis included evaluation of depressive symptoms, their relation to other psychopathologic syndromes, and the efficiency of drug therapy. The Calgary scale (CDSS) was used to assess severity of depression in schizophrenia along with other standardized psychometric scales to characterize general psychopathologic, positive, and negative symptoms, locomotor disturbances, other concomitant disorders, and general clinical picture. The predominance of depressive conditions with adynamic symptoms was documented. The majority of depressions occurred after the first attack. Those developing in the early post-attack period differed from depressions within a few months after the reduction of psychosis. Syndromic nature of depressions was evident from the number of psychotic episodes experienced by the patients. Depressive symptoms that developed after the management of the acute psychotic state could be efficiently and safely relieved by additional differential treatment with antidepressants. Depressive symptoms in schizophrenia are not predictors of poor prognosis provided the patient receives adequate therapy. More attention is needed to identification and adequate treatment of depression in schizophrenia. Optimized therapy of affective disorders in schizophrenic patients permits to improve prognosis of the disease.

[Depression in schizophrenia]

Investigations with the use of the Calgary Depression scale for schizophrenia and standardized psychometric scales revealed depression in the acute psychotic phase of the disease in 198 patients and depressive syndrome in 148 ones in the postpsychotic phase. The phase of schizophrenia (acute or postpsychotic) influenced the choice of antidepressive therapy. Depressive syndrome during the acute phase of schizophrenia was the integral part of a psychotic episode. Manifestations of depressive symptoms correlated with the severity of positive symptoms. Depression was responsive to antipsychotic monotherapy using conventional and unconventional agents. Depression with adynamic symptoms was especially frequent in the postpsychotic phase of schizophrenia. Depressions usually developed after the first episode of schizophrenia. Those observed immediately after a psychotic episode differed from depressions following prolonged therapy. The structure of depressive syndrome was influenced by the number of previous psychotic episodes The combination of antipsychotics and antidepressants was effective in the treatment of depressive symptoms in schizophrenic patients during the postpsychotic phase. The presence of depression in case of proper therapy is not a predictor of poor prognosis. Recognition and adequate treatment of depression in schizophrenia require greater attention. Optimized control of mood disorders accompanying schizophrenia increases the possibility to improve the clinical outcome.

[New data on sensibilizing therapy of alcoholic dependence]

Lidevine was used in the treatment of 29 patients with chronic alcoholism with unsatisfactory results of previous therapy. The drug was included in the complex therapy at the stage of developing therapeutic remission and during a long-term (1 year) antirelapse treatment. Remission of 1-year duration was achieved in 12 (41%) patients. Use of lidevine contributes to remission stabilization and prevents development of alcoholism relapse after a single "break down". The importance of lidevine assignment in combination with psychopharmacological drugs reducing a drive for alcohol (antidepressants, anticonvulsants-normotimics, neuroleptics with sedative action, etc.), and a need of continuous control of the relatives of the patient over the intake of sensibilazing drug are proved. Good tolerance to the medication is shown.

[Diagnostic criteria of the severity of the pathologic drive to narcotics]

The paper presents variation of the clinical scale for determination of the severity of the pathologic drive to narcotics (drug addiction) elaborated by the authors. The "major" (obligatory) and the "minor" (additional) criteria were established. As the "major" criteria there were the presence of thoughts about narcotic drugs, affective and behavioral disorders, disturbances of sleep. The "minor" criteria included somato-autonomic disturbances, the presence of "narcotic" dreams, attitude to treatment, criticism toward the disease. A quantitative (with the scores) evaluation of the pathologic drive to narcotics was elaborated. The method proposed permits to object quite significantly the diagnosis of the pathologic drive to narcotics, to determine both its severity and dynamics during treatment.

[Clinical peculiarities of post-withdrawal disorders in heroin abuse and approaches to their treatment]

On the basis of the observation of 62 patients with heroin addiction there was described the post-withdrawal syndrome. It was characterised by a lability of psychopathologic symptomatology and by undulate course (with exacerbation and desactualization of the drive to narcotic). Clinically there were determined 3 types of post-withdrawal syndrome's course. The 1-st type was characterised by irresistible drive to narcotic, followed by psychopathic-like behaviour. For the 2-nd type a prevalence of the depressive symptomatology with different intensity of the disorders of the affect was more typical. The 3-d type was presented by unclear polymorphic manifestations and rather deep disorders of a sleep. It was established that clinical picture of the syndrome was determined mostly by a degree of a pathological drive to heroin. Differentiated approaches to a treatment of different types of post-withdrawal disorders were described. A duration of a syndrome was 3-4 weeks.

[The current status of the drug abuse problem in Russia]

The statistic data evidence for rapid increase of the number of narcomanias, especially in juveniles and young people nowadays in Russia. The spectrum of psychoactive preparations used became also wider. On the basis of medico-biological studies the conception concerning main pathogenetic mechanisms of the development of psychoactive substances dependence was formulated. Enzyme immuno assays either for diagnosis of long-term opiate administration or for determination of blood serum methadone level were elaborated. Clinical studies demonstrated pathomorphism of the symptoms of dependence upon well-known narcotics. Clinical pattern of dependence upon new psychoactive preparations which cause dependence syndrome was also investigated. New differentiated methods of treatment of various types of narcomanias are proposed. There is underlined that a comprehensive program of narcomanias prophylaxis in Russia is needed.

[The efficacy and mechanisms of action of lerivon in alcoholism]

Clinico-biological examination of 50 alcoholic patients was carried out. 30 patients were treated with lerivon (L) during 1 month. 15 control patients received amitriptylin for 1 month and 15 patients received relanium for 7 days. It was determined that L was quite effective in treatment of depression in alcoholic patients. The main L effects were anxiolytic, antidepressive and hypnotic. The drug also decreased alcohol addiction, had vegetostabilising and sedative effects. The conclusion was made on pathogenetic action of L in alcoholism: It influences upon dopaminergic mediation in catecholamine system. Administration of L permitted to normalize neurochemical processes underlying alcohol addiction and depression. L was well tolerated. Side effects complications, drug addiction were not registered.