Clinical-psychopathological Methods Research Articles

Syndromokinesis of psychopathological symptoms of schizotypal disorder

In order to determine the patterns of syndrokinesis of psychopathological symptoms of schizotypal disorder, 100 patients, who were at the outpatient stage of treatment, were examined by using clinical-anamnestic and clinical-psychopathological methods. According to the results of the study, it was determined that most often the debut of schizotypal disorder occurred with a predominance of apathoabulic, paranoid, dissociative and psychopathic manifestations; over time, the course of the disease was marked by a predominance of anxious, apathoabulic and psychopathic- like manifestations; the paranoid and dissociative symptoms, that occurred during the onset of the disease, changed over time into anxious manifestations, in the structure of which there were inlays of paranoid components, «magical thinking» and other parapsychotic elements. The prospect of further research is to identify unfavorable vectors for the development of the disease and develop prevention methods Key words: psychiatry, mental disorders, syndromokinesis, schizophrenia, schizotypal disorder

CLINICAL AND SOCIAL CHARACTERISTICS AND FEATURES OF BIOCHEMICAL INDICATORS IN PERSONS WITH MENTAL DISORDERS WHO HAVE COMMITTED VIOLENT CRIMES

The relevance of the study is conditioned by the need to develop effective methods to prevent public danger arising from persons suffering from mental disorders, with identification of factors that influence aggressive behavior formation in order to improve measures to prevent crimes related to violence. the purpose of this work was to study the socio-demographic, clinical and psychopathological features and biochemical parameters in persons with mental disorders who committed violent crimes. the scientific novelty is determined by the importance of establishing the features of the complex influence of clinical, biological and social factors on the tendency to heteroaggression, the lack of scientifically substantiated data on the role of neurotransmitter and hormonal systems in aggressive behavior formation in patients with severe forms of mental pathology. Materials and methods. the research sample consisted of 100 respondents aged 18 to 60 years with a verified diagnosis of a severe mental disorder and the fact of criminal prosecution for violent crimes. the clinical features of the patients were evaluated using a clinical-psychopathological method with identification of the leading characteristics in psychopathological symptoms and syndromes. Standardized assessment of clinical characteristics was provided by the use of the psychometric methodology "Positive and Negative Syndrome Scale" (PANSS), the methodology "Structured Assessment of Unsafe Behavior Risk" (SOROP). for laboratory testing, blood and urine samples were used to determine the levels of serotonin, dopamine, cortisol, testosterone, free T3 (free T3), estradiol. Results. the most common clinical and social characteristics of persons with severe mental disorders and persistent aggressive criminal behavior were identified and described. in the majority of respondents, the indicators of the neurotransmitter system (serotonin, dopamine levels) were found to differ significantly from the reference values. a negative correlation was determined between serotonin excretion and the sum of points according to SOROP technique, as well as the subscale of aggression, which is part of the indicators in PANSS technique. Conclusions. the obtained data contribute to understanding the nature of heteroaggression in persons with mental disorders, indicating the need for further studying the relationship of social, clinical and biological parameters, determining their role in aggressive behavior formation in this contingent of patients.

Personalized approach to early diagnosis of acute schizophrenia: an observational comparative study

BACKGROUND: An acute schizophrenic episode often meets the diagnostic criteria for the ICD-10 category acute and transient psychotic disorders (ATPD, F23), which includes clinically similar conditions of diverse etiologies. The presence of schizophrenic negative symptoms in ATPD signifies their nosological affiliation and determines the therapeutic tactics. Early recognition of the schizophrenic etiology in the first episode of psychosis may contribute to the development of a personalized approach for the management of patients with acute psychotic disorders.
 AIM: To evaluate the relationship between the developmental characteristics of psychosis and identify the negative symptoms after its reduction in patients with ATPD with the symptoms of schizophrenia.
 MATERIALS AND METHODS: This observational single-center selective comparative study was conducted during 20182020. The clinical-psychopathological method was applied to examine patients hospitalized in a psychiatric hospital with ATPD presenting with the symptoms of schizophrenia (F23.1). In order to objectify the results of the study, the positive and negative syndrome scale was used.
 RESULTS: The study involved 60 patients (50 men, 10 women) aged 1846 years (mean age: 21.46.0 years). Depending on the presence of negative symptoms after the psychosis reduction at 4 weeks of therapy, the study sample was divided into two groups: 1) the group with negative symptoms (NS+; n=41); 2) the group without any negative symptoms (NS; n=19). Individuals presenting with negative symptoms were distinguished from those without it based on the more frequent presence of prodromal disorders, subpsychotic, and, particularly, mild negative disorders at the prodromal stage, prolonged development, and long-drawn course of psychosis. The likelihood of negative symptoms detection after the reduction of psychosis was associated with a family history of schizophrenia and other psychiatric disorders, low premorbid social adjustment, prodromal symptoms, and impaired functioning, as well as with a longer duration of psychotic symptoms and its slow development.
 CONCLUSION: The likelihood of negative symptoms after the reduction of ATPD with symptoms of schizophrenia was associated with hereditary and premorbid characteristics of patients, prodromal psychopathological and functional abnormalities, as well as the clinical and dynamic characteristics of psychosis. The data obtained from this study may contribute to the early recognition of schizophrenia-spectrum disorders and to the development of a personalized approach for the management of patients with ATPD.

Депресивні розлади з переважанням апато-адинамічної чи тривожно-фобічної симптоматики: взаємозв’язок клінічних проявів та пошукової активності

Topicality. In today's world, depressive disorders (DD) are one of the most common mental disorders. DD causes disturbances in various areas of human mental activity, significantly affecting the quality of life, as well as impairing the ability to understand and properly assess the future. The need to develop new strategies for diagnosis and therapy. In addition to the main groups of symptoms in DD should pay attention to clinical and psychopathological syndromes: depressive, asthenic, apathetic, anxiety-phobic, somato-vegetative and hypochondriac. at DD and will need further research. The aim of the study. Explore the severity of apathic-adynamic or anxiety-phobic symptoms in DD, their nosological affiliation in relation to the level of MLO. Methods. We examined 66 patients of both sexes (36 women and 30 men) aged 18 to 40 years (24.4 ± 3.8) with different types of DD, diagnosed according to the criteria of the International Classification of 10 revisions. A clinical-psychopathological method (semi-structured clinical-diagnostic interview) was used to determine apatic-adynamic (AA) or anxiety-phobic (AF) variants of DD. According to the clinical picture, patients are divided into 2 groups: the first - patients with apatic-adynamic symptoms, the second - with anxiety-phobic symptoms. The PHQ-9 patient health questionnaire was used to assess the severity of depression. We used the Test of meaningful life orientation, Leontiev), adapted by D. Leontiev version of the test J. Crambo, L. Maholic "Purpose-in-Life Test". The article examines and analyzes the difference between depressive disorders (DD) and the leading anxiety-phobic and apathic-dynamic symptoms. Results. Significantly lower indicators were found in the scales of goal presence, interest in life, life satisfaction (effectiveness, self-realization) and the ability to control one's life in general in the presence of apatic-dynamic symptoms of DD compared to anxiety-phobic symptoms. The presence of a statistically significant difference indicates possible therapeutic targets in patients of these two groups.

Psychopathological features of hysterical disorders arising as part of affective disorders and schizophrenia

IntroductionHysterical disorders were considered separately in the context of the dynamics of the course of either endogenous affective diseases or schizophrenia, without attention to the conjugation and interaction of issues of hysterical symptoms and affective or psychotic syndromes.ObjectivesTo test the psychopathological structure and provide a typology of the conjugation of hysterical symptoms with other psychopathological syndromes.Methods120 patients (82 women and 38 men) with schizophrenic and affective disorders with associated hysterical symptoms were examined by a clinical psychopathological method.ResultsThree variants of conjugation were identified. In the group of hysterical disorders associated with affective diseases (37,1%) the structure and dynamics of hysterical symptoms directly influenced the developing affective phase: the low intensity of hysterical symptoms contributed to the development of an apatho-adynamic type of depression, and bright and spontaneous hysterical manifestations formed an anxious-hypochondriac type of depression. Hysterical disorders formed in the structure of the psychotic state (41,4%) influenced the nature, structure, dynamics and content of delusional, hallucinatory and paranoid disorders. “Caste” hysterical symptoms (21,4%) revealed a lack of connection with affective and psychotic states. Hysterical symptoms were characterized by persistence, stability, invariability of manifestations, long-term psychotherapeutic and psychopharmacological resistance.ConclusionsClinical and psychopathological analysis of endogenous mental diseases of the affective and schizophrenic spectrum, occurring with hysterical symptoms, showed that the parameter of the conjugation of hysterical symptoms with other psychopathological syndromes is prognostically significant.DisclosureNo significant relationships.

Ethological characteristics of the primary depressive episode

Significant polymorphism of the clinical picture of depression and certain contradictions of scientific views on the nosological specificity of these conditions complicate the establishment of specific clinical and psychopathological signs of endogenous and psychogenic depression, their typology, dynamics, prognosis, which makes the study of nonverbal behavior relevant and promising task. The purpose of the study was to establish the psychopathological and clinical-ethological manifestations of the primary depressive episode and to conduct a comparative analysis of endogenous and psychogenic variants of the primary depressive episode. Contingents and methods. Based on the principles of bioethics, 96 patients (49 men and 47 women) with primary depressive episode – main group – who applied for outpatient psychiatric department of Zaporizhzhia regional psychiatry clinic in 2018-2021 were clinically examined. Diagnostic conclusions were made in accordance with the ICD-10 criteria. The control group consisted of 35 mentally healthy individuals, comparable in age and gender composition with the study group. Results. Patients with mild and moderate severity of the primary depressive episode are characterized by sad look, poses of reflection, submission, concentration in combination with facial expressions of suffering, guilt, helplessness, pensiveness, sideways, wrinkles on the forehead, stereotyped hand movements, head, head, reducing the synchronicity of gestural, facial and motor components of motility; avoidance of contacts and a sharp decrease in reactions to external influences. Severe manifestations of depression are characterized by sad and mournful facial expressions, lowered corners of the mouth, quiet voice, motor retardation, facial expressions of suffering, guilt and shame. Conclusion. The ethological component of the clinical-psychopathological method, based on the description of nonverbal behavior, can significantly improve the diagnostic capabilities of early detection of depressive episode, provides additional tools for typological differentiation and severity of patients with primary depressive episode.

Non-Suicidal Self-Injury in the Decompensation of Personality Disorder in Adolescents During the COVID-19 Pandemic in 2020–2021

The aim of the study was to determine the clinical and psychopathological characteristics of non-suicidal self-injury (NSSI) in personality disorder (PD) in the comparative age-related aspect during the coronavirus infection (COVID-19) pandemic. Patients and methods: a total of 230 patients (177 males and 53 females) aged 16–25, diagnosed with PD and NSSI behavior manifestations, were studied retrospectively in mental hospital and outpatintly by using clinical-psychopathological method. All patients were divided into two equal groups of 115 people each. Group I was examined in 2017–2019, Group II — in 2020–2021 during the coronavirus infection (COVID-19) pandemic. Results: common features established in both groups were as follows: affective instability, alexithymia, conflict relations with significant others, and current traumatic experience. For a comparative assessment of NSSI in patients of both groups, we used the NSSI typology in adolescent PD, previously developed by the authors. Impulsive, demonstrative, addictive, depersonalizing and self-destructive types of NSSI were recognized as significant for the diagnostic assessment. In the second group of patients, that is, during the period of the COVID-19 pandemic, a change in the selected variants of NSSI was found, that is, in borderline and narcissistic PD the impulsive type was replaced by a demonstrative type, and in schizoid and anxious PD it turned into an addictive one. For a comparative assessment of NSSI in patients of both groups, we used the NSSI typology in PD in adolescence, previously developed by the authors. When assessing suicidality in group II, it was revealed that in most types of PD, with a decrease in the number of suicidal attempts, there was a noticeable increase in the incidence of NSSI with demonstrative suicidality, which correlated with the trajectories of the identified variants of NSSI. Conclusions: the study underlined the role of personality pathology in in adolescence in the development of psychopathological disorders with NSSI and their high association with suicidal activity. The modification of various NSSI variants in the context of a coronavirus infection (COVID-19) pandemic may be due to the unique characteristics of the psychotraumatic factor. With the same strength of impact, the multidirectional influence on various personality types and comorbid psychopathological disorders in adolescence should be taken into account, when creating new models of therapeutic and socio-rehabilitation interventions for the adolescent contingent of patients.

Clinical features of sleep disturbances in anxiety disorders of neurotic and organic genesis.

There is a bi-directional link between dyssomnia and psychological diseases. Sleep disorders can influence the severity of the underlying disease, complicate the process of treatment, and increase the risk of the recurrence further. Besides, there is an obvious dependence of the sleep disorder severity from the pathological anxiety. The aim of the research: to study clinical features and relationship of sleep disorders and anxiety in patients with anxiety disorders of neurotic and organic genesis. To achieve the objective, 120 patients with anxiety-depressive disorders, who were divided into 2 groups depending on the genesis of the disease were studied. The first group included patients with anxiety-depressive disorders, anxiety phobic disorder and generalized anxiety disorder. The second group included patients with emotionally labile and organic anxiety disorders. The research was done with the help of clinical-psychopathological method added with psychometric scales and with the method of statistical processing. According to the results, it was detected that the level of insomnia was reliably higher in patients with anxiety disorders of organic genesis than in the group of patients with neurotic disorders. After the analysis of the components of the pathological anxiety it was determined that the components of emotional discomfort and the assessment of the prospects of anxiety dominated in the group of neurotic genesis, but the asthenic and phobic components were more expressed in the group of patients with anxiety disorders of organic level. In addition, according to the results of the correlation analyses, it was determined the link of the degree of expression and the severity of insomnia. Understanding of the semantic character of the pathological anxiety and clinical display of sleeping disorders will give the possibility to create the relevant differential rehabilitation programs of the treatment of the patients with anxiety-depressive disorders with sleep disorders.

Unipolar depression: a gender-based comparative analysis

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

A comprehensive approach in the treatment of adaptation disorders

The article represents data of the development and evaluation of the effectiveness of complex therapy of adaptation disorders using the drug Alora. A comprehensive examination of 154 patients with maladaptation disorders (F43.2) was held, both sexes, aged 20—55 years. Basing on the results of the clinical-psychopathological methods, which were based on generally accepted approaches to psychiatric examination through interviews and observations, the high efficacy and good tolerability of Alora (passiflora incarnata extract) in the treatment of adaptation disorders has been proven. Against the background of the use of the drug Alora there is a rapid reduction of anxiety and depressive symptoms, normalization of the sleep-wake cycle, reduction of the level of nervous and mental stress, restoring efficiency and social activity, improvement of the quality of life of the subjects. The data obtained should be taken into account as diagnostic and preventive measures in the care of this category of patients

Gender Identity Disorder Arising as a Part of Nonpsychotic Forms of Endogenous Diseases and Personality Disorders (Clinical and Psychopathological Aspects)

Purpose: psychopathological differentiation of gender identity disorder (GID) that occurs as part of depressive episode; creating a typology for developing diagnostic and prognostic criteria. Material and methods: 63 patients (46 women and 17 men) who applied to the FSBRI MHRC from 2016 to 2019 were examined by a clinical psychopathological method. All patients were diagnosed with a depression being part of schizotypal disorder or histrionic personality disorder or mixed histrionic and schizoid personality disorder. Results: Clinical and psychopathological analysis of gender identity disorder occurring as a part of depressive episode showed its heterogeneity, varying severity, as well as a diverse relationship with other psychopathological disorders, which required an in-depth and detailed study. We have identified the following typological varieties: type 1 — GID as a part of depersonalization disorders, type 2 — GID as a part of dysmorphophobic disorders, type 3 — GID as a part of histrionic disorders. Conclusions: The obtained results give us the opportunity to suggest that the diagnosis of the disease, in which the gender identity disorder is detected, can help predict its further course and possible outcomes.

Relationship between representation and severity of Gilles de la Tourette syndrome and comorbidities

Aim. To study representation and distribution of comorbidities, their relationship with clinical presentation and severity of Gilles de la Tourette syndrome, with age of onset of motor and vocal tics.
 Methods. Were examined 58 children (44 boys, 14 girls) at the age of 11.070.52 years (418 years old) with observation period from 1 to 10 years with diagnosis of Gilles de la Tourette syndrome. All patients were examined by child psychiatrist, neurologist, child psychologist to clarify diagnosis and psychopathological comorbidities. Comorbidities were determined by clinical-psychopathological method and by standardized scales.
 Results. In the course of the research there were identified the main comorbid disorders, their representation, prevalence and relationship with tic disorder. The results of the study allow us to conceptualize separately comorbid disorders and complex tic-like symptoms. According to the study, comorbid disorders tend to develop on their own, while a number of specific features tend to manifest themselves, increasing representation during the course of development of the main tic disorder.
 Conclusion. Such specific features as self-injurious behaviors, non-obscene, socially inappropriate behaviors, coprophenomena, echophenomena; and paliphenomend are proposed to be called complex tic-like symptoms. In our opinion, we should differentiate and separately classify complex tic-like symptoms from mental comorbidities, that have their own development regardless of the course of tics in Gilles de la Tourette syndrome.

Structural and clinical characteristics of neurotic disorders in medical and technical students

The aim is structural-clinical analysis of neurotic disorders in students of medical and technical higher education in comparative aspect. Material and methods. 995 medical and 804 technical university students were surveyed using the original questionnaire developed by the author based on the international classification of mental disorders № 10. Clinical-epidemiological, clinical-psychopathological methods were used; Retrospective analysis method, statistical. Results. New data have been obtained on the prevalence, structure and clinical manifestations of neurotic disorders in students, depending on the training profile. In medical university, neurotic disorders are more common, characterized by a greater variety of clinical forms, greater expression of anxiety and depressive components, compared to similar disorders in technical university students. Conclusion. The reason for the detected differences is due to the specificity of education in medical universities, which requires daily communication with the sick, study of subjects related to severe pathology, is characterized by heavy loads on the memory of students, which leads to psychoemotional overvoltage and is itself a stress.

Mental disorders in the clinical picture of craniopharyngiomas in adults

The clinical picture of craniopharyngiomas (CPs) is diverse and polymorphic in its manifestations, including endocrine, neurological disorders, visual and mental impairment. Mental disorders in the clinical picture of CPs are detected from 6 to 100 %, according to the literature. But more often one can find a description of individual syndromes only — memory impairment, disorders of the emotional sphere and/or behavior. There is not enough information about mental disorders in different topographic and anatomical variants of craniopharyngioma, possible pathognomonic psychopathological symptoms and/or syndromes. Objective of the article is to describe mental disorders in the clinical picture of craniopharyngioma with different topographic and anatomical variants in adults. Materials and methods. The study included 120 adult patients (18–68 years old, mean age 39 ± 2; 59 women and 61 men) who were first admitted for treatment to the National Medical Research Center for Neurosurgery named after academician N. N. Burdenko with the diagnosis of craniopharyngioma (2007–2015). The clinical-psychopathological method was the main in the research. Results. Mental disorders in the clinical picture of CPs were detected in 103 (85.8 %) patients before surgery in the form of the main syndromes: asthenic syndrome was found in 83 (69 %) patients, emotional-volitional disorders in 79 (65,8 %), amnestic disorder in 71 (59,1 %), personality changes in 71 (59,1 %), paroxysmal conditions in 55 (45,8 %), sleep and dream disorders in 54 (45 %), consciousness disorders in 24 (20 %) patients. Mental disorders did not appear separately, but in combination with each other, prevailing in the clinical picture to one degree or another in various topographic and anatomical variants of craniopharyngioma, respectively. Conclusion. Mental disorders in the clinical picture of CPs were detected in 85,8 % of patients before surgery, they were determined by the location of the tumor lesion — topographic and anatomical variant of CP, the spread and influence of the tumor on the structures of the diencephalic region, limbic system, and third ventricle: in 65 % of cases with endosuprasellar craniopharyngioma, in 86 % of cases with stem craniopharyngioma, in 100 % of cases with extra- and intraventricular CPs.

Remission structure in schizoaffective disorder

The article describes the comparative study of clinical and dynamic structure of remission in schizoaffective disorder (SAD), depending on its type. With the help of the clinical-psychopathological method with an analytical study of tavailable medical documentation and the method of follow-up examination, remissions were analyzed in 78 patients with SAD. In parallel, during the year, the severity of clinical manifestations of the disease was determined using psychometric scales (Young Mania Rating Scale – YMRS, Hamilton Depression Rating Scale – HDRS, Positive and Negative Symptoms Scale – PANSS). Several degrees of remission were identified – partial, complete clinical and complete functional remission. By partial remission, we understood a state when there was a pronounced reduction in clinical manifestations, but residual productive symptoms, poor insight and social maladjustment were observed. Complete clinical remission indicated the absence of any clinically significant signs, but social functioning was reduced. Full functional remission was characterized by the absence of any clinical signs and patient’s good social adaptation. All patients went through the stage of partial remission, however, about half of them (40 observations – 51.3%) went into complete clinical remission. Persistent partial remission which later did not transform into clinical remission was observed in 38 patients with SAD (48.7%). It was represented by the following syndromes — asthenic (28.9%), hypersthenic (23.8%), psychopathic (34.2%), residual delusional syndrome (13.1%). Complete functional remission was found in 19 patients (24.4%). The data obtained indicate that the longest and most complete remissions were observed in manic and depressive types of SAD compared with mixed ones. In the manic type of SAD complete functional remission was more common (12 cases – 38.7%), with the depressive type - complete clinical remission (8 patients – 32.0%), with the mixed type - partial remission (10 patients – 38.5%). Depending on the type of SAD remission there is a different risk of disease recurrence, therefore, the treatment and rehabilitation measures, the appointment of maintenance therapy should be differentiated.

RDoC: integration or separation of neuroscience and psychopathology?

The Research Domain Criteria (RDoC) project, the neurobiological research flagship in psychiatry, was originally introduced as an alternative to the traditional DSM and ICD classifications. However, RDoC and ICD / DSM can become complementary, rather than mutually exclusive. The clinical psychopathological method remains valuable because it’s the only source of directly observable data. Computational science is a promising tool for combining psychopathological and neurobiological data in future.

MENTAL DISADAPTATION AMONG TEENAGERS OF THE CHERNIVTSI REGION

Objective. To explore the prevalence of mental disorders among teenagers of theChernivtsi region taking into account the role and value of the age factors and socialdeprivation.Material and methods. To study mental disadaptation among 585 teenagers in the Chernivtsi region as a result of social stress.The means, which were used: screening-test (ST), hospital scale HADS, clinical-psychopathological method of clinical interview (MCI), experimental-psychological, statisticmethods.Results. As we haven`t the true data about the prevalence of mental disorders because ofdeprivation among the teenagers in Ukraine, we conducted the mass and repeated examinations by the method of clinical interview. It has been established that teenagers,without proper care, when the parental care has the particular significance in the formation of personality, are the most emotionally vulnerable.

ПРОДРОМАЛЬНИЙ ПЕРІОД ПСИХОЗУ: КЛІНІКО-ПСИХОПАТОЛОГІЧНІ ТА ПАТОПСИХОЛОГІЧНІ ЗАКОНОМІРНОСТІ ФОРМУВАННЯ, КРИТЕРІЇ ДІАГНОСТИКИ І ПРИНЦИПИ ПРОФІЛАКТИКИ

Зміцнення психічного здоров’я населення є одним із найважливіших завдань громадської охорони здоров’я в усіх країнах світу. В цьому сенсі особливого значення надають ранньому втручанню у продромальну стадію психозу, що дозволяє запобігти розвитку патологічного процесу, зберегти соціальне функціонування і якість життя пацієнтів.Мета дослідження – вивчити клініко-психопатологічні та патопсихологічні закономірності розвитку продромальної стадії психозу для виявлення факторів ризику формування психозу і розробки профілактичних заходів.Матеріали і методи. Для вирішення поставлених завдань у роботі було використано такий комплекс методів дослідження: I – Клініко-психопатологічний метод. II – Психометричні методи: шкала оцінки продуктивної і негативної симптоматики PANSS; шкала суїцидального ризику (Лос-Анджелеського суїцидологічного центру); шкала продромальних симптомів SOPS; шкала визначення клініко-динамічного варіанту перебігу продромального періоду; шкала структурованого інтерв’ю для оцінки преморбідного статусу – PAS -SI. III – Психодіагностичні методики: опитувальник К. Леонгарда–Шмішека для визначення акцентуацій характеру; методика діагностики рівня соціальної фрустрованості Л. І. Вассермана у модифікації В. В. Бойко; методика оцінки інтеграційного показника якості життя. IV – Методи статистичної обробки отриманих даних з визначенням середніх величин, їх помилок, кореляційного аналізу. У процесі виконання роботи було обстежено 137 пацієнтів із вперше виявленим психозом: 65 пацієнтів (друга–третя госпіталізації) – з діагнозом параноїдної шизофренії (ПШ) (F20.0); 72 особи (перша госпіталізація) – з діагнозом гострого поліморфного психотичного розладу (ГППР) (F23.0, F23.1). Усі пацієнти були обстежені як у форматі реального часу, так і ретроспективно. Вивчення клініко-психопатологічних особливостей продромального періоду психозу (ППП) у хворих ПШ та ГППР показало, що у клініці ППП пацієнтів із ПШ переважають: розлади мислення (концептуальна дезорганізація) – в 26,2 % випадків (р<0,01); пасивно-апатична соціальна відстороненість – у 30,8 % випадків (р<0,05); соціальна ізоляція (усамітнення) – в 33,8 % випадків (р<0,01); стереотипне мислення – у 30,8 % випадків, при (р<0,05), зниження вираження емоцій – у 33,8 % випадків (р<0,05); емоційне відчуження – у 40,0 % випадків (р<0,01), підозрілість, страх переслідування (персекуторні ідеї) – у 30,8 % випадків (р<0,05). Необхідно відмітити помірний та середній ступені вираження зазначених ознак в обстежених.Результати досліджень та їх обговорення. У хворих із ГППР у ППП переважали клініко-психопатологічні симптоми: зниження толерантності до стресу – в 43,1 % випадків (р<0,01); галюцинаторна поведінка (порушення перцепції / галюцинації) – у 26,4 % випадків (р<0,01); збудження – в 25,0 % випадків (р<0,05); тривожний стан – у 31,9 % випадків (р<0,01); напруження – в 34,7 % випадків (р<0,01); порушення уваги – у 30,6 % випадків (р<0,05); розлади сну – в 27,8 % випадків (р<0,01); неприродний вміст мислення (вигадливе мислення) – у 27,8 % випадків (р<0,01). Необхідно зазначити помірний ступінь вираження вищеперерахованих ознак. Згідно з результатами дослідження, можна констатувати, що у хворих на ПШ у ППП переважають негативні симптоми – (3,3±1,2) бала (р<0,05), тоді як у пацієнтів із ГППР у ППП частіше спостерігаються симптоми дезорганізації – (2,9±0,7) бала (р<0,05) і загальні симптоми – (2,7±1,3) бала (р<0,05).Висновки. З урахуванням клініко-психопатологічних та патопсихологічних особливостей, виявлених у пацієнтів у ППП при ПШ та ГППР, у даному дослідженні було розроблено програму раннього втручання, що базувалася на застосуванні психофармакотерапії, психотерапії та соціально-середовищних впливів.

Causeless appearance discontentment in patients of plastic surgeons and cosmetologists: Risk factors and patterns of dynamics

IntroductionThough phenomenon of dysmorphic disorder has been studied extensively clinical dynamical characteristics of this disorder are still being investigated.Aim of this study was to evaluate patterns of dynamics and risk factors of body dysmorphic disorder in patients of plastic surgeons and cosmetologists.MethodsWe included adult patients of Maxillofacial Surgery and Cosmetology departments of Moscow State University of Medicine and Dentistry (from January 2010 to May 2016) with unconfirmed “facial deformity” diagnosed with dysmorphic disorder (F45.2 and F22.88 according to ICD-10). The study used clinical psychopathological method with follow-up period 1–3 years. Data from clinical psychopathological assessment were processed using correlation analysis and non-lineal regression analysis by means of logistic regression method.ResultsStudy sample consisted of 103 patients (78.6% female; mean age 33.4 ± 4.7 years). Statistically significant chronobiological (age, hormone fluctuations, genesial cycle) and psychosocial (financial changes, forced separation, bereavement, loss of job, reduction of social activity, conflict situation, sexual dysfunction, violation of law, diagnosing of somatic disease) risk factors for dysmorphia in different life periods have been established. Strong correlations were found between dysmorphic disorder heterogenic clinical picture (overvalued–33%, affective–24.3%, hypochondric–23.3%, obsessive-compulsive–10.7%, delusional–8.7%) and patterns of dynamics (phasic–41.7%, recurrent–33%, chronic–25.3%). Our data suggest that dysmorphia manifests in any age group and in 74.7% cases is not continuous.ConclusionOur findings allow to conduct focused diagnostic search, prophylactic psychotherapeutic interventions and early psychopharmacological treatment in individuals with identified risk factors for dysmorphic disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Genetic and clinical predictors of treatment efficacy in depressive disorders

To study clinical and genetic characteristics that impact on the efficacy of pharmacotherapy of depressive disorders. The study included 188 patients with unipolar depressive disorders of different genesis (psychogenic, endogenous and organic). A clinical-psychopathological method and depression psychometric scales were used. Serotonin transporter 5-HTTLPR and STin2 and dopamine transporter 3',-VNTR polymorphisms were determined. The S-allele of the 5-HTTLPR polymorphism is associated with the low efficacy of treatment with selective serotonin reuptake inhibitors. Tricyclic antidepressants are more effective in treatment of psychogenic depression. The authors determined clinical factors that can predict response to treatment of psychogenic and endogenous depression. No predictors were found for organic depression.