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Studies of the clinical picture and pathogenesis of mental disorders.
Studies of mental disorders are based on the clinical and biological approach to the systematization, the clinical picture, and treatment of endogenous disorders, borderline mental disorders, and psychosomatic diseases. An introduction of new high technologies into research proved to be very helpful. High technologies applied in the studies were as follows: computer methods of examination, visualization of brain structures and plastic restructuring at an ultrastructural level, development of molecular and genetic approaches, which made it possible to obtain new scientific data.
The period under review in this area differs from others, such as studies of schizophrenia, which had been conducted before, but were then continued in the direction of clinical-psychopathological and biological investigation of the continuum including schizophrenia - schizoaffective disorder - affective disorders in different age groups.
During the course of biological studies the following data were established:
a few parameters, characterizing structural changes ( some computer and nuclear magnetic resonance indices) and changes in the bioelictric brain activity (according to EEG) may be regarded as markers of proneness to schizophrenia.
Various types of changes in the parameters of serotonine thrombocyte system were revealed in cases of schizophrenia and scizoaffective disorder as well as in patients with endogenous depression who were non-responders during antidepressive psychopharmacotherapy in comparison with patients responding to therapy.
New data on plastic reconstruction of brain structures in case of schizophrenia and endogenous affective disorders were obtained on the basis of the above mentioned methods.
An increase in the degree of DNA heterochromatization in the nuclei of glial cells in case of schizophrenia was established by means of fluorescent method of chromosome hybridization.
A connection was detected between the system of enkephalin-degrading enzymes of plasma and constitutional and personal characteristics and specificities of the clinical picture of anxiety and phobic disorders of neurotic level.
It was revealed that in case of schizophrenia a decrease in the production of interleukin-1 and interleukin-2 is observed. A clinical and nosologic heterogeneity of a schizoaffective disorder was established. A prognostically adequate principle of its differentiation according to the mechanisms of formation of a delusion in its clinical picture was determined as the most clinically informative one. Nosography of a schizoaffective disorder was specified and the regularities of its nosologically independent variants were substantiated.
The obtained results concerning the clinical and nosologic differentiation of schizoaffective disorders were confirmed by clinical-genetic, -biological (neurophysiological, biochemical), -pathopsychological data. These results made it possible to improve diagnostic criteria and prognostic evaluation of schizoaffective disorders and to substantiate the optimum principles of their treatment.
The data on the clinical study of manifestations and the course of affective and schizoaffective disorders in adolescency corroborated the hypothesis suggested before of the pathoplastic and pathogenic role of the age factor in their formation. The data obtained during the conducted studies demonstrated the necessity of further investigation of the age specificity of these diseases at the level of clinical and pathogenic correlations in comparison with clinical-nosographic specificities of other shift-like endogenous mental disorders.
In the area of gerontopsychiatry the studies were carried out in 3 basic directions.
Functional mental disorders, which first appeared in late age, and their development were investigated in a clinical and computer tomography study.
Specificities of the clinical parameters of a major depressive disorder were revealed in their development (almost in half of the patients) most often with residual affective disorders (including dysthymia-like disorders), the development of vascular or Alzheimer type dementia in 3% of the patients.
Specificities of cognitive indices were determined in their development (according to the data of MMSE) in these patients with gradual, but reliable decrease in the clinical state.
Alterations in brain structures were described in their development, which was accompanied with a growing vascular pathology, central, and subcortical atrophy.
Specificities of clinical manifestations and cognitive functioning were studied in their development alongside with alterations of brain structures.
At the same time it was demonstrated that recurrence of depression was associated with a heightened frequency of brain vascular pathology, remissions were connected with a growing central and cortical atrophy, while residual (subaffective) disorders in remission were associated with an increase in cortical atrophy. A low formation and vascular alterations in the brain explain phenomena of cognitive insufficiency, appearing at earlier stages of depressions (and at an earlier age). At later stages (and at a later age) these phenomena are noticed due to a growing cortical atrophy. The obtained data may testify to the influence of factors of brain aging on the clinical specificities of late depressions.
Clinical aspects of a comparative study of the new and traditional (tricyclic) antidepressive drugs were investigated. Frequency, severity, and specificities of the development of various side effects were determined during the treatment of the elderly depressive patients with antidepressive drugs with various mechanisms of effect. Risk factors of the development of various side effects resulting from the use of antidepressive drugs in late age were revealed. The role of the aging factor in the development of various side effects of antidepressive drugs was analysed. Dependence of the expressivity of side effects upon the indices of efficacy of some antidepressive drugs was detected. An interconnection between the duration of a depressive phase and the efficiency of the course of treatment with antidepressive drugs was analysed. The specificities of prescription of various psychotropic drugs were analysed depending on the age, sex, and nosologic nature of the disease.
Late depressions, structural cerebrovascular alterations, comorbid medical disorders, hypertension, direct and remote outcomes of depressions were also studied.
It was established that in late age alterations of syndrome manifestations, parameters of the course of depressions, and formation of the outcomes of depressive disorders with various expressivity of organic disease were definitely connected with the presence of comorbid somatic pathology, the volume and the severity of its manifestations. It was revealed that the presence of structural cerebrovascular alterations in depressive patients of old age influences to a greater degree separate outcomes of depressions and a tolerance to psychotropic treatment and definite nosologic forms of late depressions.
Clinical psychologists studied typological personality specific features in patients with endogenous mental disorders.
The basic result of the conducted study consisted of establishing connections between the stable personality features and clinical variants of endogenous mental disorders (nosology, premorbid type, negative and productive disorders, sex differences). Data on nosologic proximity according to personality special features of manic-depressive disorder and schizoaffective disorder were obtained. Data was also obtained on the prevalence of field-independent cognitive style with a high level of regulation of mental activities and an ability to make generalizations in patients with depressive symptomatology as compared with manic patients. Data on the correlation between the character of delusion formation - interpretative delusion, paraphrenic delusion and introversion and extraversion irrespective of the patients' sex is of a special interest.
At the same time in patients with a delusion of perception sex differences were noticed, which were combined with a predominance of field-dependent cognitive style in women and field-independent style in men. The obtained data may be used both in the differential diagnosis of endogenous mental disorders with a prognostic aim as well. The data of the study may serve as a basis for recommendations concerning the organization of rehabilitative work with patients.
Specificities of conscious support in the system of interpersonal interaction of affective patients were determined in various age categories. The desocialization syndrome in affective patients of young and middle age was described, which helps to evaluate the patients (formalized evaluations of "social life") according to the levels of social dysfunctions. A method of social support was developed and used taking into consideration the specificities of the age factor. The realization of this method (group psychocorrection work in accordance with the method of social support) brought about the qualitative changes in systems of interpersonal interaction of patients with their social surroundings, which made it possible to speak of the improvement of their mental status up to remission.
Age specificities of spatial analysis and synthesis were studied as well as their role in the formation of impairments in the image of the surrounding world. Data on the peculiarity of spatial disorders in case of senile vascular dementia, Alzheimer's disease were obtained. Quasispatial disorders are formed on the basis of disturbances in various components of mental activity. Patients with senile dementia have difficulties in arbitrary regulation while processing characteristics in various actions. In combination with growing memory impairments it impedes goal-directed actualization of various classes of spatial perceptions from long-lasting memory, which was formed in the ontogenesis, including conceptions related to body space. In case of vascular dementia symptoms of left-side spatial ignoring and impairment of integrity of perception appear with a growing frequency. Coordinate, projection, structural-topological, and metric spatial characteristics are distorted in the course of building spatial images. In case of Alzhermer's disease immediate orientation in space and memorizing of new spatial information are impaired, which is accompanied with a disintegration of spatial constructions in speech activity, making calculations, writing letters of the alphabet, etc. In depressive patients disorders of spatial actions are milder than in patients with dementia, and the disturbances are called forth to a greater degree by a decrease in energy provision of mental activities.
The obtained data is important for solving differential and diagnostic tasks and for forming correction programs.
Psychoparmacologists studied somatoform disorders with a predominance of symptomatology in the system of gastro-intestinal tract, performed clinical and biological analysis and substantiated therapeutic approaches.
During the procedures of clinical psychiatric examination somatoform disorders were diagnosed which comorbidly proceeded with marked depressive phenomena. Differences were revealed in the groups of patients both in the clinical picture and in the character of therapeutic response.
Database was created for conducting statistic analysis of the results of the patients' clinical examination and the results of the received treatment.
Interaction of psychotropic drugs in terms of side effects in the model of classical psychotropic treatment in comparison with the model of treatment with atypical antipsychotic drugs was the object of a special study. In the volume of this theme computer database was created containing anamnestic, clinical, and clinical-pharmacological data, formalized for statistic processing. Database includes information on the monotherapy with tricyclic antidepressive drugs, monotherapy with classical neuroleptic drugs, combination of classical neuroleptic drugs and tricyclics, monotherapy with atypical antipsychotic drugs (Olanzapine, Resperidone). The conducted study demonstrated that traditional prescription of the so-called "drug dosage regimens" is not always justified in terms of both the patient's safety and the efficacy of theatment. A high frequency of the development of side effects was revealed after prescription of various traditional neuroleptic drugs (73.7%) and antidepressive drugs (41%). Among the patients undergoing a combined treatment with neuroleptic drugs and tricyclics side effects and complications developed in 53.1% of cases. Sharp differences were noticed in the safety of traditional neuroleptic therapy and the treatment with atypical antipsychotic drugs.