Search

Authors studied 198 patients with first-ever cerebral stroke. Affective disorders, including depression, generalized anxiety disorder (GAD) and phobias, were identified in 71.2% of patients. The study demonstrated that the anxiety syndrome developed in the post-stroke period may be regarded as relatively independent. Some post-stroke anxiety disorders had different risk and pathogenetic factors. GAD is associated with young age and phobias are associated with female sex and inherited predisposition. In contrast to post stroke depression, anxiety-phobic disorders develop more frequently in patients with mild stroke.

With the aim of justifying of neurophysiological correlates of depressive disorders spectral parameters of EEG, and peak latencies of the "late" components of auditory cognitive evoked potentials, and latencies of sensorimotor reactions have been analysed in middle age and elderly patients (age 53-72) during the therapy of prolonged psychogenuously provoked depressive reaction (F43.21 by ICD-10). Background depression severity has been associated with the EEG signs of decreased functional state of anterior areas of the left hemisphere, and of increased activation of the right hemisphere (especially, of its temporal regions). Pronounced improvement of clinical condition resulted from psychopharmacotherapy led to acceleration ofsensorimotor reactions, and to decrease of peak latencies of the "late" components (P2, N2 P3) of auditory cognitive evoked potentials, that have been associated with the EEG signs of improvement of functional state of posterior brain areas, of facilitation of inhibitory processes in the right hemisphere (especially, in its frontal, central and temporal regions), and of more pronounced activation of frontal areas of the left hemisphere. The data obtained are in good concordance with the views on systemic character of impairments of brain functioning in depression, as well as on preferential role of the left hemisphere in control of positive emotions, and of the right hemisphere role in control of negative emotions.

The notion of vascular depression (VD) includes depressive disorders resulting from organic cerebral lesions of vascular genesis. Two types of VD are distinguished: post-stroke VD (PSD) and VD proper (SDP). VD develops in case of clinically manifest (neurologic) lesions in cerebral vessels that simultaneously act as psychogenic (nosogenic) factors. SDP is associated with clinically latent vascular disorders ("silent" infarctions and white matter ischemia). VD is characterized by multiple phenomenological convergence of vascular signs and symptoms inherent in both PSD and SDP. Whatever the type of VDs, they are associated with frequent cognitive problems with a variety of dynamic patterns, viz. reversible, relatively stable, and progressing.

Different types of depression in patients who survived cerebral stroke and their influence on the rehabilitation process were studied. One hundred and fifteen patients were examined. The clinical heterogeneity of post-stroke depression was shown. A clinical analysis allowed to find different nosological and psychopathological forms of depressive disorders. Two main nosological forms of depression--reactive and endoreactive--were found. The liability to affective disorders exerts the influence on the development of depression; reactive depression is related with more severe functional damage. Depression, in particular reactive one, has an unfavorable effect on the rehabilitation of neurological deficit and ability to self-service.

Pantogam was used as a corrector of the side-effects of neuroleptic therapy. The adverse effects were assessed psychometrically with several scales. Attention was focused on the unwanted signs (pathological movements of different groups of muscles). Fifty patients were studied, 37 of them completed the treatment course. Pantogam was administered in dosage 750-3000 mg per day along with traditional and atypical neuroleptics. The drug was effective against the most prevalent side-effects. The mild sedative effect of pantogam, absence of negative influence on myocardial vessels and possibility of its combination with most pharmacological drugs make its possible to use the drug in patients of different age groups.

On the base of clinical psychological and electrophysiological studies of 34 patients with primary manifestations of brain circulation insufficiency good tolerance and high efficiency of Tanakan course treatment (3 x 40 mg/day for 3 months) were showen. Tanakan decreased manifestations of clinical syndrome, improved psychological functions and electrophysiological parameters. Prospective study supported the stability of positive changes in the status of patients for 12 months after Tanakan course treatment.

By means of pharmacoepidemiologic method the analysis of therapy in nonselective ambulatory cohort of mentally ill 60-95 year old patients was performed during 5 months. Each patient had an epidemiological record, in which the main demographic, clinical data as well as all the drugs prescribed and the regimen of their administration were registered. All spectrum of psychotropic drugs was used for treatment of aged patients. In 80% of the cases tranquilizers and hypnotic drugs were prescribed, while neuroleptics were prescribed in 64% of the patients, vasotropic and nootropic preparations--in 32%, antidepressants--in 28%, antiparkinsonic drugs--in 17%, normothymics--in 7%, anticonvulsants--in 2% of the cases. Monotherapy was used in 24% of the cases, two psychotropic drugs were prescribed simultaneously in 31% of the patients, 3--in 23% and 4 drugs--in 17% of the patients. Age factor was not significant for the choice of the drug.

Open study was performed concerning the efficiency of cerebrolysin in treatment of tardive dyskinesia and parkinsonism. 30 patients of middle (18-41 years) and old (60-82 years) age were examined by means of Extrapyramidal Symptom Rating Scale and Abnormal Involuntary Movement Scale. Cerebrolysin was administered intravenously by drops every other day in a dose of 5-10 ml during 28 days. Significant decrease of the severity of extrapyramidal symptoms (according to the Scales used) was observed by the end of the course of therapy. The number of the responders was 46.6%, of the partial responders--26.6%. Efficiency of cerebrolysin was the same both in the groups of patients with drug-induced parkinsonism (number of the responders--54.5%) and in patients with tardive dyskinesia (the responders' number--60%). The efficiency of cerebrolysin was lower in patients with combination of symptoms of parkinsonism and tardive dyskinesia as well as in ones with pronounced negative schizophrenic disorders in clinical picture. Efficacy of cerebrolysin was also the same in patients of both middle and old age. Its efficiency was equally high independently on the duration of extrapyramidal disorders' existence.

Evoked cortical activity in response to acoustic stimuli (oddball paradigm) was studied in patients with different paranoid disorders. The analysis covered the N150 negative wave and positive complex P300. In patients with paranoid schizophrenia and paranoid form of involutional psychosis cortical responses to the stimuli and cortex effects were not recorded. Such cognitive deficiency is believed to be typical for schizophrenia.

Computed tomography was used to study the prevalence rates of various types of intracranial pathology, hydrocephalus (HDC) and cortical atrophy (CA) in patients with late dementia (LD) and to comparatively assess the informative value of tomographic methods of cerebral morphometry. Computed tomographic data were obtained from 432 patients with LD. Despite the type of dementia, the authors revealed intracranial abnormalities of various etiology in 24.5%, postischemic foci being prevalent. Tumors, arachnoidal cysts, and chronic subdural hematomas were more infrequently diagnosed (in 2.6% of cases). HDC and CA were detected in 81.5 and 82.2% of patients with LD, respectively.

A comparative age-associated study of the efficacy and side effects of amitriptyline and maprotyline was carried out in a group of 93 patients over 50. The health status of the patients was assessed with the aid of Hamilton's depression scale and the scale of side effects on days 0, 7 and 28 of the therapy. It has been discovered that on day 28 maprotyline caused a more complete reduction of depressive disorders as compared to amitriptyline. Maprotyline produced a more intensive action on the anxious component of depression. There were differences in the intensity and range of side effects evoked by amitriptyline and maprotyline. Unlike maprotyline, the antidepressive effect of amitriptyline developed in a group of patients over 70, at later stages of the therapy. Therefore, it is more advisable that tetracyclic antidepressants be used for the treatment of senile patients.

Analysis of psychopathological traits of the paranoiac syndrome in 60 patients with late schizophrenia permitted to distinguish certan signs which can be allocated to the differentiation of late schizophrenia from other delusional psychoses in the elderly. The following differential signs were underlined: initial symptoms, such as rudimentary cenesthopathia, stable insomnia, etc., preceding the formation of delusions; appearance of episodic exacerbations in the form of short-time acute paranoiac states; a combination of paranoiac delusion with stable phasic affective disorders; unusual possession of delusional patients expressed in bizarre delusional behaviour, etc. Using this example as a model, the necessity of further profound and differentiated psychopathological studies of syndromes distinguished as predilective for old age is indicated.

A total of 552 patients with attack-like schizophrenia, who attained old age were examined clinically. It was established that the development of negative changes in such patients occurs predominantly during the first half of life. Subsequently not all patients demonstrate a progressive development of the disease and even if it does occur it is seen in the form of more frequent or longer attacks and a complication of psychopathological disorders. At the same time there is a certain correlation between the clinical picture of the attacks and the severity of deficitary changes. A reverse development of some personality changes in long-term remissions in old age are described.

On the basis of the results provided by clinical follow-up, clinico-epidemiological and clinico-genealogical studies, the authors have reviewed the systematics of the major forms of schizophrenia developed at the Institute of Psychiatry of the USSR Academy of Medical Sciences and offer a statistical characteristics of these forms. The authors specifically discussed the questions associated with the characteristics of the syndrome formation and course of slowly progressive (torpid) schizophrenia and the place these forms occupy in the modern foreign classifications, including the DCM-III). The paroxysm-like form was established to run predominantly the course with a small rate of attacks or the "one-paroxysm" course. Slowly progressive and psychotic forms of continuous schizophrenia were shown to be relatively continuous, being characterized by not only the signs of tortuosity of the course but also by those of regression and subsidence of the process. Attention is drawn to the necessity of special elaboration of the notion "residual schizophrenia". All these postulates are illustrated by the appropriate statistical population characteristics.

The study involved a clinical examination of 568 patients with continious forms of schizophrenia and different degrees of progression (from mild sluggish to malignant forms). The following stages of the diseases are differentiated: an initial one, a stage of the highest process activity, a stage of stabilization, reduction of the psychosis and formation of the terminal state. A thorough analysis of the cases demonstrated that even in a continuous development of schizophrenia, the progression of the process is limited in time. It was found that the more polymorphic and severe are the signs of the process in active phase, the less is the time taken by this phase. In compliance with varying duration of the active stages of the disease the age periods during which there ensue a stabilization of the malignant, sluggish and paranoid forms of schizophrenia are very diverse.

On the basis of a comparative clinico-catamestic study of 193 patients with attack-like schizophrenia and a different degree of progressiveness the authors describe the most common traits in the development of the attack-like process. The report contains data related to different tendecines in the course of the disease, its age dynamics and some correlations between the degree of progressiveness and separate clinical parameters. It was established that the most expressed negative personality changes are formed in the initial periods of the disease and to a large extent determine the traits in the course of the disease.

The authors studied 62 patients with late schizophrenia with the predominance of elementary misperceptions. The main variants of such psychoses with auditory, olfactory and tactile perceptive disturbances have been identified. The authors also ascertained common typological signs distinguishing these psychoses from the classical paranoids of late age. A possible role of the age and environmental factors in the formation of the above psychoses is considered.

Thirty-eight patients with late mentally deteriorating processes were studied. Using a standardized neuropsychological method, the authors have outlined four major variants of neuropsychological syndromes characteristic of damage to definite zones of the brain. Comparison of these data with the results of clinical and computer-aided tomographic examination showed that the neuropsychological approach is an adequate method in the combined study of senile dementia.