Search

Background: The neuronal correlates of depression with mixed traits (according to DSM-5) at rest have not been studied. Objective: to determine the indicators of imaginary coherence of EEG-rest, which distinguish patients with depression with mixed features (according to DSM-5) from patients with depression without mixed features and healthy subjects, and also to trace the dependence of the identified neurophysiological characteristics on the diagnostic belonging of the symptom complex to bipolar II type or recurrent depressive disorder. Patients and methods: on a background free from drug therapy, 80 patients with depression with mixed features (XD; n = 40 — with bipolar II disorder (XB) and n = 40 — with recurrent depressive disorder (XR)), 80 patients with depression without mixed traits (TD; n = 40 — for bipolar II type (TB) and n = 40 — for recurrent depressive disorder (TR), as well as 80 healthy subjects (N). The study groups were matched by sex and age. The study used clinical-psychopathological, psychometric, neurophysiological and statistical research methods. According to the Kruskal–Wallis criterion for independent samples the parameters of imaginary coherence (modulo) of standard frequency ranges (delta (δ) — 0.5–4 Hz, theta (θ) — 4–8 Hz, alpha (α) — 8–13 Hz, beta-1 (β1) — 13–20 Hz, beta-2 (β2) — 20–30 Hz, gamma (γ) — 30–45 Hz) between pairs of 14 cutaneous standard EEG derivations (according to the “10–20” system) in three (XD, TD and N), and then in five (XB, XR, TB, TR and N) comparison groups. Post-hoc analysis was performed using the U-test. The significance level was adjusted according to the Bonferroni correction. Results: three indicators were identified: α-ICoh(C3–P4), β1-ICoh(C3–P3) and β2-ICoh(F3–C4). For all three parameters, the H-test values for the “Group” factor (n = 3 and n = 5) were highly significant. In this case, α-ICoh(C3– P4) — XD = TD, XD < N, TD < N; β1-ICoh(C3–P3) — XD < TD, XD < N; TD < N; β2-ICoh(F3–C4) — XD > TD; XD > N, TD > N. The groups of patients with XD within the framework of recurrent depressive and bipolar II disorders significantly differed in terms of β1- ICoh(C3–P3) — XR > XB. At the level of statistical trends, in type II bipolar disorder — XB > TB according to α-ICoh(C3–P4), and in recurrent depressive disorder — XR > TR according to β2-ICoh(F3–C4). Conclusion. Thus, depression with mixed features can be considered in terms of dysfunctional interactions of the left frontal, bilateral central and parietal cortical zones, depending on the diagnostic affiliation of the depressive symptom complex and reflecting violations of automatic and voluntary regulation of affect, cognitive and behavioral changes.

The research substantiates the role of clinical psychologists in the system of comprehensive rehabilitation within the conditions of bio-psychosocial model of rehabilitation. Practical experience and the analysis of scientific literature made it possible to describe peculiarities of modern complex rehabilitation and the problems experienced by clinical psychologists. The authors determined difficulties and characteristics of professional work of rehabilitation psychologist within modern legal terrain. One problem is the lack of professional standard for the profession of clinical psychologist. The other problem is the inconsistency in the use of terms denoting professional specifics. Тhe paper focuses on the specificity of psychodiagnostic and rehabilitative work of a psychologist in the light of changing theoretical basis of rehabilitation and the transition from the International Classification of Disability Disorders and Social Insufficiency to the International Classification of Functioning, Disability, and Health. The authors showed the discrepancy between the theoretical approaches of domestic and foreign psychology to the assessment of mental disorders. New professional tasks of the psychologist are defined taking into account multidisciplinary orientation of rehabilitation process. The paper describes the problems of professional training of clinical psychologists and specifies new educational tasks are specified proceeding from the modern approach to rehabilitation. Positive dynamics in the solution of the declared problem can be found in new legislative initiatives, development of General clinical recommendations for rehabilitation psychologists, scientific publications on psychological rehabilitation, update of educational programs for training clinical psychologists.

To search for electroencephalographic markers of alexithymia in patients with moderate depression.Sixty-four right-handed inpatients (20 men and 44 women, mean age 29.3+10.7 years), were studied. The level of alexithymia was assessed by the Russian version of the Toronto Alexithymia Scale (TAS-20-R). Patients were stratified into 4 groups by TAS-20-R scores. Two main groups of 22 patients each included people with high (60 scores) and low (20-51 scores) levels of alexithymia. Control groups included 10 patients with 60-85 scores and 10 patients with 52-54 scores. Current methods of electroencephalographic analysis were used.Alexithymia in patients with moderate depression is characterized by a restructuring of the integrative activity of the brain detected by electroencephalography at rest. Patients with high alexithymia differ from those with low alexithymia by (1) lower values of the real part of the coherence between the frontal and anterior temporal leads of the left hemisphere in the band 28-30 Hz; (2) lower values of the imaginary part of coherence in the band 11-12 Hz between the posterior temporal and parietal as well as the posterior temporal and occipital cortical zones of the right hemisphere; (3) higher rates of the real part of the coherence between the right frontal and central leads in the frequency ranges 12-14 and 6-7 Hz; (4) large values of the imaginary part of the coherence between the left parietal and right posterior temporal cortex in the band 24-26 Hz; (5) higher values of the square of the coherence modulus between the left frontal and anterior temporal cortical zones in the band 17-18 Hz.Large cortical representations with involvement of theta, alpha, beta-1 and beta-2 rhythms can contribute to the pathogenesis of alexithymia.Поиск возможных электроэнцефалографических маркеров алекситимии (АЛ) у больных с умеренно выраженными депрессиями.Были обследованы 64 стационарных больных (все правши), 20 мужчин и 44 женщины, средний возраст которых 29,3+10,7 года. Уровень АЛ у них оценивался при помощи русскоязычной версии Торонтской алекситимической шкалы — TAS-20-R. В соответствии с ее показателями были сформированы 4 группы обследованных. Две основные (обучающие) группы по 22 человека составили пациенты с высокой (60 баллов по TAS-20-R) и низкой (20—51 балл) АЛ. В две контрольные (экзаменующие) группы по 10 человек вошли пациенты с пограничными высокому (60—58 баллов) и низкому (52—54 балла) уровнями АЛ. Основным методом исследования была электроэнцефалография с применением различных современных методов анализа ЭЭГ.Установлено, что АЛ у больных депрессиями характеризуется перестройкой интегративной деятельности головного мозга, выявляемой электроэнцефалографически в состоянии покоя. Больные с высоким уровнем АЛ отличаются от пациентов с ее низким уровнем: 1) меньшими значениями действительной части когерентности между лобными и передними височными отведениями левого полушария в полосе 28—30 Гц; 2) более низкими значениями мнимой части когерентности в полосе 11—12 Гц между задними височными и теменными, а также задними височными и затылочными корковыми зонами правого полушария; 3) более высокими показателями действительной части когерентности между правыми лобными и центральными отведениями в частотных диапазонах 12—14 и 6—7 Гц; 4) большими значениями мнимой части когерентности между левой теменной и правой задней височной корой в полосе 24—26 Гц; 5) более высокими значениями квадрата модуля когерентности между левыми лобной и передней височной корковыми зонами в полосе 17—18 Гц. Таким образом, было показано участие в патогенезе АЛ многих корковых структур с вовлечением тета, альфа, бета-1 и бета-2-ритмов.

Based on the complex study of 150 patients with different forms of epilepsy in the remission phase, we singled out a group of 68 (45.3%) patients with depressive disorders. Variants of depressive disorders and their EEG-characteristics were described. Depressive disorders were stratified by the causes, course and response to pharmacotherapy into following variants: depressive disorders caused by the epileptic process per se; organic depressive disorder and disorder of adaptation with depression and anxiety-depressive disorders. Functional neuroimaging methods suggest the involvement of both the limbic system and cortical structures, with the elevated activity of the left hemisphere, in the development of depression.

We studied 35 patients with organic brain lesions caused by secondary brain harmful factors (group 1) and 33 patients with organic brain diseases of vascular genesis (group 2). Mean age of patients was 45.5±2.3 years. Asthenic, cerebroasthenic, psychoorganic syndromes in the combination with dissomnic, psychoautonomous, depressive, hypochondriac disorders predominated in the clinical picture of patients. Pantoham was prescribed in dose 1.0 g 3 times daily during 45 days. The effect of the drug on cognitive and mental disorders was found. The drug was most effective in patients of group 1. Pantoham was well-tolerated.

Seventy-four patients with paroxysmal mental disorders in the debut of epilepsy have been examined. To study an age-related aspect of these disorders, all patients have been stratified by age at debut of epilepsy into 3 subgroups (children, adolescence and adult age). Based on a key psychopathological syndrome, three types of simple and complex partial "psychiatric" seizures have been singled out. The higher is the age of debut, the higher are the variability of clinical presentations of psychopathological disorders and more complex clinical presentations of complex partial (psychomotor) attacks in the structure of simple partial seizures. In children aged 7-14 years and people older than 18 years, the simple partial "psychiatric" seizures as well as first manifestations of disease were seen more often than in adolescents. This type of debut was not observed in children younger than 7 years. The age curve of debut of epilepsy with complex partial seizures has two distinct peaks, at the children (up to 7 years) and adult ages. In the group older than 18 years, frequencies of psychomotor seizures and first disease manifestations are inversely correlated with age.

This article outlines the current WHO concepts of the process of rehabilitation with special reference to the consideration and the analysis of the concept of rehabilitation potential, its structure, levels, and functions of each level. The main stages and the aim of the comprehensive medical and psychological rehabilitation of the patients presenting with acute cerebrovascular accidents (ACVA) are discussed. The importance of the recoverable and reusable resources at the biological and psychological levels that may play the role of compensatory functions in the patients suffering from acute cerebral circulation disorders is emphasized. The three main stages of the rehabilitation process for the ACVA patients («diagnostic», «therapeutic», and «verifying») are described. The necessity of the development of the systemic strategy for medical and psychological rehabilitation of the post-stroke patients is substantiated taking into account the criteria for allocating them to the groups of either early or late rehabilitation and the group of patients suffering from the consequences of acute cerebral circulation disorders. It may allow to achieve the optimal level of the patients' well-being, in accordance with the rehabilitation potential currently attainable for the patients undergoing acute cerebrovascular accidents.В статье изложены современные представления Всемирной организации здравоохранения о процессе реабилитации. Раскрыто и проанализировано понятие реабилитационного потенциала, представлена его структура, описаны уровни и их функции. Также приведены основные этапы и задачи комплексной медико-психологической реабилитации пациентов с острыми нарушениями мозгового кровообращения (ОНМК). Показана важность выявления сохранных ресурсов на биологическом и психологическом уровнях, которые могут выступать в роли компенсаторных функций у пациентов с ОНМК. Описаны три основные стадии реабилитации пациентов с ОНМК: диагностическая, терапевтическая и проверочная. Обоснована необходимость разработки системной стратегии комплексной медицинской реабилитации постинсультных больных с учетом критериев включения их в группы раннего и позднего восстановительных периодов, а также периода последствий ОНМК, что позволит достичь оптимального уровня благополучия, соответствующего возможностям реабилитационного потенциала пациентов с данной патологией.В статье изложены современные представления Всемирной организации здравоохранения о процессе реабилитации. Раскрыто и проанализировано понятие реабилитационного потенциала, представлена его структура, описаны уровни и их функции. Также приведены основные этапы и задачи комплексной медико-психологической реабилитации пациентов с острыми нарушениями мозгового кровообращения (ОНМК). Показана важность выявления сохранных ресурсов на биологическом и психологическом уровнях, которые могут выступать в роли компенсаторных функций у пациентов с ОНМК. Описаны три основные стадии реабилитации пациентов с ОНМК: диагностическая, терапевтическая и проверочная. Обоснована необходимость разработки системной стратегии комплексной медицинской реабилитации постинсультных больных с учетом критериев включения их в группы раннего и позднего восстановительных периодов, а также периода последствий ОНМК, что позволит достичь оптимального уровня благополучия, соответствующего возможностям реабилитационного потенциала пациентов с данной патологией.

The results of the analysis of hepatitis A morbidity during the period of 1996 - 2001, are presented. The cyclic character of this morbidity in its dynamics over the period of several years was noted with the maximum morbidity level reached in 2000. The monthly dynamics of hepatitis A morbidity reflected its seasonal character with the maximum increase in autumn and winter. The virological control of drinking water revealed its contamination in spring and summer, with no subsequent rise in morbidity. The control of sewage reflected the emergence of the virus in the city collector in accordance with the increased morbidity.

Magne-B6 was used, together with anticonvulsive therapy, in the treatment of 25 patients with different forms of epilepsy. In all cases, psychiatric status of patients featured by depression, anxiety and some psychotic sighs. The drug was prescribed in the mean therapeutic dose during 28 days. Along with psychopathologic examination, a psychometric method, using self-rating scales for Zung anxiety and depression scale, SCL-90 and Global clinical impression (CGI) scale, was administered. Magne-B6 exerted a positive non-specific influence on patient's mental state, especially with regard to affective disorders. The positive effect of the drug emerged on 14th day of the treatment and achieved a statistically significant level to 28th day. The medication was more effective in asthenic and subdepressive syndromes, in encephalopathic syndrome the efficacy was lower. The drug was well tolerated and did not cause any side effects.

Thirty patients diagnosed with partial epilepsy (PE): 17 cases with cryptogenic PE, 11--with symptomatic PE and 2--with symptomatic generalized PE, have been switched to topamax monotherapy, in dosage 50-200 mg daily, for 3 months. A type of seizures--simple partial, complex partial and secondary generalized, was taken into account, when considering topamax efficacy. A complete elimination of seizures was achieved after 3 months treatment in 80% of the cases, the mostly pronounced effect being demonstrated for secondary generalized seizures. A decrease of seizures frequency was shown for all types, but in simple partial and secondary generalized seizures the effect emerged earlier (after 1 month of the treatment) comparing to complex partial seizures. Good tolerability of topamax was observed.

Twenty-five epileptic patients, mean age 25.7 years, have been studied. Twenty-two of them were diagnosed with symptomatic partial epilepsy, 1--with criptogenic partial epilepsy and 2--with idiopathic partial epilepsy. Illness duration was estimated as follows: above 5 years--5 patients, above 10 years--10, above 20 years--4 and less than 5 years--6. Polymorphic seizures were detected in 56% of the cases and monomorphic ones, resistant to the previous traditional anticonvulsant therapy,--in 44%. Topamax was used as an add-on therapy to the previously prescribed anticonvulsants in initial dose of 25 mg daily, with a following continuous dose increase. The mean therapeutic dosage was 100 mg daily. Therapeutic efficacy was assessed during 3 months. Since 1 month of topamax adjunction to a treatment schedule, a mean frequency of all types of seizures was reduced. The best effect was found in the case of combination of simple partial and secondary generalized seizures. The medication was effective in 60-80% of the patients with strong resistance to traditional anticonvulsants. Topamax is concluded to be a highly effective antiepileptic medication, which gives new possibilities for a treatment of patients with partial epilepsy resistant to traditional drugs.

The antigenic features of neuraminidases of several drift variants of influenza B virus were studied by enzyme immunoassay using antiserum to influenza B/USSR/100/83 virus neuraminidase isolated by pronase. Studies using immunosorption and competitive solid-phase enzyme immunoassay showed the presence in the antineuraminidase serum of at least two antibody subpopulations capable to inhibiting the activity of the enzyme and interacting with neuraminidase antigenic determinants: one detecting the antigenic determinant common for B/100/83 and B/Lee/40 viruses, and the other characterizing the antigenic determinant inherent in neuraminidase of B/100/83 virus and enzymes of drift variants isolated in 1970-1986 and lacking in the enzyme of B/Lee/40 virus.

Specific inhibition of Lassa virus replication in Vero cells was found to be better achieved with immune gamma globulin in combination with complement than with gamma globulin alone. According to the authors, the inhibitory effect of these preparations is due to the cyto-destructive action of antibodies and complement on the infected cells.

The results of a comparative analysis of biological and antigenic properties of reference influenza B virus strains, B/Lee/40, B/Singapore/222/79, and B/USSR/100/83, are presented. The most marked changes were found in the antigenic properties of hemagglutinin and neuraminidase. Hemagglutinins of the strains under study were found to have both common antigens and qualitatively different strain-specific determinants. The degree of intensity of immunity to the challenge B/Singapore/222/79 Pm+ virus corresponded to the intensity of antigenic relationship in the strains under study.

The influenza epidemic occurring in Minsk in the autumn of 1986 was caused by at least two drift variants of influenza A virus (H1N1 subtype) differing in two antigenic determinants of hemagglutinin from the viruses isolated in previous years (A/USSR/90/77, A/Dunedin/6/83). One of the epidemic drift variants was found to be identical in the antigenic properties of hemagglutinin with the reference A/Taiwan/1/86 virus.

On the basis of neurological, encephalographic and clinico-anamnestic examinations of 106 children with a family history of epilepsy the authors have specified a group of children (n = 38) suffering from different neurotic disorders which included neurotic ticks, sleep disturbances, affective-shock reactions and signs of asthenization. The role of familial factors in the formation of neurotic states of children is emphasized. The authors consider the time during which the child was exposed to psychotraumatic circumstances and the relationship between the severity of epileptic process in parents and the development of neurotic disorders in their progeny. A conclusion has been made that the disease of the parents can exert both direct and indirect influence on the nervous system of the child, this leading to the development of different neurotic states. The prophylaxis of neurotic disturbances in children should include the creation of healthy psychic atmosphere in families where one of the parents suffers from epilepsy.

Using clinical electro-encephalic and experimental psychological methods, 75 children born to epileptic parents were examined. The clinical picture of epilepsy in children was found to correlate with the severity and duration of the disease in the parents. In the majority of children the onset of the disease was characterized by non-convulsive paroxysms. The main course of disadaptation of the children to the environment, which hindered their learning in school was mental change expressed in the form of intellectual, emotional and characterological disorders.

Studied were 150 children born to epileptic parents. Clinical investigation and long-lasting follow-up resulted in singling out the groups of children with psychoneurological disorders, normals and a group at risk of epilepsy. The latter was analysed in detail and the neurologist's tactics with respect to every group was elaborated.

Immunological analysis performed by solid-phase enzyme immunoassay and complement fixation test revealed the presence of host cell antigenic components in purified intact influenza virions and isolated hemagglutinins and glycoproteins. Three antigens inherent to chick embryo cells were identified in virus preparations: the species-specific antigen, heterogenetic Forssman antigen, and one similar to human group A antigen. Antisera to purified whole-virion influenza vaccines, to glycoproteins and to hemagglutinin isolated from them were found to contain antibody populations which were conducive to broad cross reactions between them and heterotypic virus antigens. To avoid erroneous results, these antibody populations must be removed from the sera by pre-adsorption with host cell antigens.

In the period of epidemic rise of the morbidity level in 1983-1984, 207 specimens of nasopharyngeal washings from patients with influenza were analysed by solid-phase radioimmunoassay. Test sera containing a wide range of antihemagglutinating antibodies to different drift variants of influenza type A and type B viruses were used as diagnostic ones. The results indicate the predominance of influenza B infection (18.4%). Influenza A accounted for 14.5%, 9.2% of it being subtype H1N1. Noteworthy is a considerable portion (23.2%) of mixed influenza A and B infection. The results of this study are compared with analysis of paired sera from the same patients by the HI test.

Two heterogeneous antigens, Forssman antigen and an antigen similar to human group A antigen, were detected by enzyme-immunoassay in cells of normal chick embryo CAMN and MDCK culture (dog kidney). Both these antigens were associated with purified influenza B virus preparations reproduced in these cultures since the variants under study actively reacted with antibodies both to Forssman antigen and to human A antigen. Serological differences between the variants grown in different cell systems were due to the presence in their composition of the species-specific cell component typical either of chick embryo tissues or MDCK cultures, since the viruses of chicken origin contained the specific cell antigen CAMN, whereas the same viruses grown in MDCK did not contain it but had the specific activity for dog kidney cells. The virus-specific activity of the variants under study showed no significant differences in relation to host cells.

Clinical and biochemical investigation was performed in 49 patients with epilepsy of different etiology and clinical course, 10 patients with nonepileptic forms of neurologic and psychic disorders and 50 normal subjects. An additional blood serum protein fraction was found in epileptic patients as compared with the normals using the electrophoretic investigation on the acetate-cellulose plates and devices produced by Hélène France company. Additional biochemical study is suggested as a diagnostic tool in epilepsy.