Plenary lectures

WPA Regional Meeting Traditions and Innovations in Psychiatry __________________________________________________________________________________________________________________

World Psychiatric Association Russian Society of Psychiatrists

Traditions and Innovations in Psychiatry WPA Regional Meeting Materials June 10–12, 2010, St Petersburg, Russia

Saint Petersburg 2010


УДК: 616.89(021)

Traditions and Innovations in Psychiatry: WPA Regional Meeting Materials, 10–12 June, 2010, St Petersburg, Russia. — St. Pbg.: The V.M Bekhterev Inst., 2010. — 564 p.

An event on so large international scale is taking place for the first time in Russia. Discussions of the problems related to the development of scientific and practical psychiatry are being held taking into account traditional and modern approaches, findings of the evidence-based medicine, principles of reformation of the assistance-rendering system, interdisciplinary cooperation in the domain of the mental health protection. An extended scientific and educational program for the young specialists is being carried out. This publication is intended for research workers and practitioners in the fields of psychiatry, narcology, psychotherapy, clinical psychology, epileptology.

The texts are published in authors’ wording. The opinion of the Organizing Committee may not coincide with those of the authors.

ISBN: 978-5-94651-054-7 © World Psychiatric Association, 2010 © Russian Society of Psychiatrists, 2010 © St Petersburg V.M. Bekhterev Psychoneurological Research Institute, 2010


Contents Plenary lectures .......................................................................................................................... 33 M. Maj. When does depression become a mental disorder? ................................................ 33 V.N. Krasnov. Russian psychiatry: traditions and current trends ...................................... 34 J. Angst. The mood spectrum: from depression via bipolar disorders to mania ........ 35 N. Sartorius. Co-morbidity of mental disorders and physical illness: the chief challenge for medicine and psychiatry today ............................................................................ 36 H.J. Moeller. Current hypotheses on the course and neurobiology of schizophrenia ...................................................................................................................................... 36 N.G. Neznanov. A biopsychosocial paradigm in psychiatry: its problems and prospects of development in Russia ............................................................................................... 37 Symposium 1. Epistemology and methodology of psychiatry .................................... 39 General abstract ....................................................................................................................................... 39 G.E. Berrios. The history of the “philosophies of psychiatry” .............................................. 39 L. Gurova. Categorization and causal reasoning in psychiatry: what a study of “understanding it makes it normal” alleged fallacy reveals ........................................... 41 R. Smith. Reflexivity in the history of psychiatric knowledge: some reflections ........ 42 M. Aragona. The DSM system I to V: historical and epistemological shifts ................... 43 D.S. Stoyanov, P.K. Machamer, K.F. Schaffner. In quest for scientific status of psychiatry: towards bridging the explanatory gap ................................................................ 44 G. Popov. Study of time and opposites in phenomenological psychopathology ......... 45 S.A. Ovsyannikov, P.V. Morozov. Borderline psychiatry ideas formed in ancient psychiatry (historical and epistemological aspects) ............................................................. 47 I.S. Markova. Reification in psychiatry ........................................................................................... 48 Symposium 2. Understanding the pathogenetic mechanisms of mental disorders .................................................................................................................... 50 N.A. Uranova, V.M. Vostrikov, N.S. Kolomeets, O.V. Vichreva, I.S. Zimina, D.D. Orlovskaya. Abnormalities of glial cells in schizophrenia: findings from postmortem studies ............................................................................................................................... 50 3

June 10–12, 2010, St Petersburg, Russia ____________________________________________________________________________________________________________

S.A. Ivanova, A.F.Y. Al Hadithy, P. Pechlivanoglou, A. Semke, O. Fedorenko, E. Kornetova, L. Ryadovaya, J.R.B.J. Brouwers, B. Wilffert, R. Bruggeman, A.J.M. Loonen. Tardive dyskinesia and polymorphisms of dopamine D3, serotonin 2A and 2C receptors in Russian schizophrenic inpatients............................. 51 M. Uzbekov, T. Syrejshchikova, Yu. Gryzunov, G. Dobretsov, N. Smolina, N. Maximova, A. Komar, I. Gurovich, A. Shmukler, V. Tokarev, E. Misionzhnik, O. Vertogradova. What can we learn from albumin subnanosecond spectroscopy research to understanding of pathophysiology of mental disorders? ..................................................... 53 Y. Dwivedi. Differential regulation of neurotrophins and their cognate receptors in suicide brain: implication for suicide predisposition ........................................................ 55 V.P. Chekhonin, O.I. Gurina, S.N. Oskolkova, G.A. Fastovzev, I.A. Ryabukchin, O.M. Antonova, A.V. Semenova. Cytokine profile of patients with paranoid schizophrenia ............................................................................................................................................ 56 J.M. Canive, J.C. Edgar, A.K. Smith, M.X. Huang, G.A. Miller. Neural mechanisms of sensory gating: novel findings with magnetoencephalography (MEG) ........................ 57 Symposium 3. The protection of the rights of persons with mental illness who are legally incapable ........................................................................................................ 59 D. Bartenev, Y. Marchenko. Implementation of the international legal capacity standards in Central and Eastern Europe ................................................................................... 59 E. Pilt. Changes in guardianship law and its’ implementation in Estonia 2002–2009 ........................................................................................................................... 60 Y. Argunova. Analysis of Russian legislation on incapability ............................................... 60 L. Vinogradova, Y. Savenko. Problems of forensic-psychiatric evaluation of incapability ................................................................................................................................................ 61 A. Bogdanov. Guarantees of civil rights at rendering psychiatric assistance: involuntary measures ........................................................................................................................... 62 Symposium 4. New achievements in old age psychiatry ............................................... 63 General abstract ....................................................................................................................................... 63 4


J.-C. Monfort, A.-M. Lezy-Mathieu, L. Hugonot-Diener. A rating scale for the assessment of the difficult elderly – Second version (EPAD V2) ..................................... 63 S.I. Gavrilova. Neurotrophic approach in preventive therapy of Аlzheimer’s disease .......................................................................................................................................................... 64 S.F. Sluchevskaya, N.V. Semenova. Quality management of the gerontopsychiatric service .......................................................................................................................................................... 65 L.S. Kruglov, I.A. Meshandin. Comorbidity of the advanced age depression and psychoorganic disturbances of vascular genesis: clinico-therapeutic aspects ........... 67 N.M. Mikhaylova. Mixed dementia ................................................................................................... 69 N.V. Semenova, N.Yu. Safonova. Clinical features of depression in patients with lacunar strokes .............................................................................................................................. 71 Symposium 5. Schizophrenia: evolution of the concept and of treatment approaches ................................................................................................................................... 73 General abstract ....................................................................................................................................... 73 W. Gaebel. The developing concept of schizophrenia and related psychoses: a modular approach to diagnosis and treatment ......................................................................... 74 S. Tsirkin. Schizophrenia as a nosological entity ....................................................................... 74 A.P. Kotsubinskyi, N.S. Sheinina, B.G. Butoma, T.A. Aristova, G.V. Burkovskyi, N.A. Penchul. A functional diagnosis in psychiatry ................................................................... 75 Y. Zaytseva, I.Ya. Gurovich. Differentiation of neurocognitive functioning in patients with various courses of schizophrenia after first psychotic episode: 5-year follow-up ...................................................................................................................................... 77 I.Ya. Gurovich, Y. Zaytseva, A.B. Shmukler. Effectiveness of the integrated long-term program of management of patients after first psychotic episode in 5-year follow-up................................................................................................................ 78 A.V. Semke, L.D. Rakhmazova. Adaptation aspects of schizophrenia patients in Siberia........................................................................................................................................................... 80 Symposium 6. Depression in children and adolescents ................................................ 82 S. Tyano. Depression in children and adolescents.................................................................... 82 5


C.W. Hoven. Epidemiology of childhood depression: reducing the burden of disease..................................................................................................................................................... 82 D. Wasserman. New trends in depression/suicide in adolescents.................................... 83 I.V. Makarov, R.F. Gasanov. Affective psychoses and depression in children ............... 84 E. Koren. Depressive disorders in children from perspective of current and future classifications ............................................................................................................................................ 85 V. Carli, D. Wasserman. Saving and empowering young lives in Europe (SEYLE) ..... 86 Symposium 7. Evidence-based approaches to treatment of addictions ................. 88 E. Krupitsky, E. Zvartau. Naltrexone for opiate dependence in Russia: oral, implantable and injectable ................................................................................................................. 88 G. Woody, C. O’Brien. Data points the way: medication assisted therapy for reducing drug use, HIV risk and managing infection in opioid addicted patients ........................ 89 T.R. Kosten. Pharmacogenetics of addictions: alcohol and stimulants ............................ 90 K. Kuoppasalmi, J. Tiihonen. Methylphenidate and placebo in the treatment of amphetamine dependence.................................................................................................................. 91 M.A. Vinnikova, S.O. Mokhnachev. Psychopharmacological strategy in drug addiction treatment .................................................................................................................................................... 92 Symposium 8. Genetics of suicide ........................................................................................ 94 Ya. Ben-Efraim, D. Wasserman, J. Wasserman, M. Sokolowski. Gene-environment interactions of Corticotropin-releasing hormone receptor 1 (CRHR1) and stressful life events in suicide attempts ........................................................................................ 94 J.M. Mann. Childhood adversity, epigenetics and suicidal behavior in major depression .................................................................................................................................................. 95 M. Sarchiapone, V. Carli, S. Keller, A. Videtic, A. Marusic, G. Castaldo, L. Chiariotti. BDNF gene methylation in suicide completers.......................................................................... 95 A. Roy. Interaction between childhood trauma and serotonin transporter gene variation in suicide ................................................................................................................................. 96

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Symposium 9. WPA’s recommendations on working together with service users and carers .......................................................................................................................... 98 General abstract ....................................................................................................................................... 98 H. Herrman. The WPA project on partnerships with service users and carers........... 98 J. Wallcraft. What has been learned from working between mental health professionals, patients and users of psychiatric services, their families and friends? ............................................................................................................................................ 100 S. Steffen. Making a difference with trialogue – speaking together in partnership ........................................................................................................................................ 101 A. Javed1, S. Tyano. Working with patients, users and carers: ethical considerations ....................................................................................................................................... 102 Symposium 10. Mental health care for old people living at residential facilities....................................................................................................................................... 104 I. Icelli. Geriatric psychiatric care in nursing homes in Turkey ....................................... 104 N. Tataru, E. David. QoL and residential care for elderly with mental disorders in Romania .............................................................................................................................................. 105 J. Snowdon. Detecting and treating depression in Australian nursing homes .......... 106 C. Dobbelsteyn, L. Furminger, H. Genereux, M. Tusi, T. Crowell, N. Kang, M. Agbayewa. Knowledge transfer model for psychiatric care in long term care facilities ............. 106 C. Au. de Mendonssa Lima. Residential care as a component of primary care for old persons with mental disorders ...................................................................................................... 108 Symposium 11. New trends and findings in suicide prevention ............................. 109 A. Varnik, M. Sisask, P. Varnik. Preliminary results of SEYLE in Estonia ...................... 109 N.A. Maruta. Suicidal risk in neurotic disorders..................................................................... 110 J.P. Soubrier. Postvention suicide = the ultimate prevention? ......................................... 112 W. Rutz. Suicide and psychosis – an example of person centred suicide prevention ............................................................................................................................................... 112 J.P. Kahn. Suicide in french prisons: some data and some questions............................ 113 N. Kornetov. Conduction of suicide decreasing program in Tomsk region ................ 114 7


Symposium 12. A step forward for improving mental health services in low income countries ..................................................................................................................... 116 A. Javed. WPA Section on Psychiatry in Developing Countries: a step forward for improving mental health services in low income countries ..................................... 116 E. Avdibegovic. Mental health care in Bosnia and Herzegovina – challenges, strengths and weaknesses ............................................................................................................... 117 I. Kosza, J. Harangozo. Psychosocial rehabilitation model, Hungary............................. 118 A.F. Soghoyan, Kh.V. Gasparyan. “Developing countries” – is it stigma for Eastern Europe .............................................................................................................................. 118 H. Wahlberg, J. Hanson, S. Ekblad. Global cooperation for global mental health ..... 119 T. Kadyrova. Mental health condition of population in the Kyrgyz Republic ............ 121

Symposium 13. Stigma and how to fight it ...................................................................... 122 M. Jorge. Stigma and mental disorders: some historical and conceptual issues ...... 122 V.S. Yastrebov. The Rusian experience in stigma fighting .................................................. 122 A. Tasman. Stigma and the media ................................................................................................. 123 N. Sartorius. WPA’s programme against stigma of mental illness: lessons learnt .. 124 W. Gaebel. Stigmatization of psychiatry and psychiatrists: evidence and experience ............................................................................................................................................... 125

Symposium 14. Managing mental health consequences of disasters ................... 127 V.N. Krasnov. Psychiatry of disasters: Russian experience ................................................ 127 G. Christodoulou. Disasters and their psychosocial consequences ................................ 128 K. Idrisov. Traumatic events and posttraumatic stress disorder of the adult population in the longterm emergency situation in the Chechen Republic .............. 128 D.L. Tosevski, B. Pejuskovic. Years of stress – psychiatric consequences and challenges ................................................................................................................................................ 129

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Symposium 15. Community based interventions targeting depression and suicidality ................................................................................................................................... 131 U. Hegerl & the EAAD Consortium. An evidence based 4-level community based intervention to improve the care of depressed patients and prevent suicidality cost effectively ....................................................................................................................................... 131 G. Scheerder, C. Van Audenhove & the EAAD Consortium. Community facilitators’ attitude toward depression: a pilot study in 9 EAAD countries .................................... 132 A. Varnik, M. Sisask, P. Varnik. Evaluation of interventions targeting suicidality .... 133 E. Nikolaev, A. Kozlov, A. Golenkov. Regional aspects of suicide behaviour: experience from Chuvashia ............................................................................................................. 134 Symposium 16. The WPA curriculum project: competency based education and training in psychiatry for residents and medical students ........ 136 A. Lindhardt. Teaching general psychiatry residents for secondary and tertiary health care .............................................................................................................................. 136 J. Kay. Teaching psychiatry to medical students .................................................................... 136 R. Jenkins. Competency based education in mental health for students and residents in low and middle income countries.............................................................. 137 R.D. Alarcon. Core cultural competencies in psychiatric education for medical students and residents ...................................................................................................................... 137 A. Tasman. Competency based evaluation ................................................................................ 138 P. Udomratn Assessment of competencies for medical students in psychiatry ....... 139 Symposium 17. Dynamic psychiatry: an integrative approach ............................... 140 General abstract .................................................................................................................................... 140 V.D. Wied. The integrative pharmaco-psychotherapy of depressions.......................... 140 S. Tyano. Relations between parents’ interactive style in dyadic and triadic play and toddlers’ symbolic capacity .......................................................................................... 142 M. Ammon. Dynamic psychiatry – an integrative psychiatric-psychotherapeutic concept ...................................................................................................................................................... 142 9


I. Burbiel. The relevance of group dynamics for treatment of severe psychiatric disorders .................................................................................................................................................. 143 N.B. Lutova. Medication compliance: psychotherapeutic targets ................................... 143 Symposium 18. Psychosomatic diseases in general medicine and in psychiatry .............................................................................................................................. 145 M. Riba. Distress assessment and management in cancer care ....................................... 145 A.B. Smulevich, S.V. Ivanov. Clinical systematic and pharmacotherapy of psychosomatic disorders .................................................................................................................. 145 D.Yu. Veltishchev, T.A. Lisitsyna, O.B. Kovalevskaya, A.S. Marchenko, O.F. Seravina, A.E. Zeltyn, E.N. Drojdina, J.S. Fofanova, V.N. Krasnov, E.L. Nasonov. Affectivitystress model of depression: implementation in rheumatology practice ................... 146 T. Okasha. Somatoform disorders and medically unexplained physical symptoms: an Arab perspective .................................................................................................... 147 H. Millar. Physical health considerations in the mentally ill: adopting an integrated approach to patient care ...................................................................................... 148 Symposium 19. Spirituality and mental heath global perspective ........................ 150 General abstract .................................................................................................................................... 150 R. D’Souza. The Science of well-being – Spiritual values and well-being: a need in mental health care ............................................................................................................................... 151 P. Ruiz. Religion & mental health: a Latin American perspective ................................... 152 D. Bhugra. Hinduism and mental illness perspectives ........................................................ 152 E.H. Pi The role of spirituality in psychiatric care ................................................................. 153 Symposium 20. Mental health problems in primary care: diagnosis and prevention.................................................................................................................................. 154 L. Kuey. Special issues of diagnosis, prevention and management of mental health problems in primary care ................................................................................................................. 154 M. Kulygina. Student mental health in primary care: early diagnosis and prevention ............................................................................................................................................... 155 10


R.A. Evsegneev. Why the process of psychiaric expansion in general medical practice is so delayed? Case of Belarus .................................................................................... 156 A. Bobrov. Communication style of the primary care physicians ................................... 156 T. Akiyama, K. Sugiura. Need of guidance: practical collaboration between psychiatrists and other physicians ............................................................................................. 158 Symposium 21. Gender aspects in psychiatry ............................................................... 160 A.M. Moeller-Leimkuehler. Gender differences in suicide and depression from a stress perspective ............................................................................................................................. 160 W. Rutz. Male suicidality in changing societies – “from Gotland to Europe”. A public health issue in need of person centred primary prevention and health promotion ................................................................................................................................. 160 M. Kachaeva, V. Rusina. Mental health of women who are victims of domestic violence ..................................................................................................................................................... 162 E. Dozortseva, K. Syrokvashina. Violence and psychic trauma symptoms in delinquent girls ..................................................................................................................................... 162 M. Kulygina. Age-related stress and women mental health in menopause................ 164 V.A. Agarkov, E.V. Uvarova, S.A. Bronfman, K.V. Samokhvalova, T.I. Ponomarjova. Study of gender identity among women with functional hypothalamic amenorrhea ............................................................................................................................................ 164 Symposium 22. Current clinical problems in the therapeutic approach to schizophrenia ...................................................................................................................... 166 H.J. Moeller. Background facts for a chronic course of schizophrenia .......................... 166 A.V. Potapov, S.N. Mosolov. Achieving remission in population of schizophrenic outpatients: validation of international remission criteria ............................................. 167 M. Ivanov, M. Shipilin, M. Yanushko, D. Kosterin. Atypical versus conventional antipsychotics in treatment of acute schizophrenia ........................................................... 169 N. Neznanov, I. Martynikhin. Risk factors for metabolic disorders in patients with schizophrenia .............................................................................................................................. 170 11


E.V. Snedkov, K. Badry, S.F. Sluchevskaya. Different strategies of antipsychotic treatment in patient with schizophrenia ................................................................................. 171 I. Reznik, A. Weizman. Schizophrenia with obsessive-compulsive symptoms: diagnostic approaches and treatment considerations ........................................................ 173 Symposium 23. Towards a new classification ............................................................... 175 V.N. Krasnov. Problems of classification in Russian psychiatry: focus on affective spectrum disorders .......................................................................................................... 175 N. Sartorius. The effects of classifying mental disorders .................................................... 176 A. Okasha. The Emergence of sub-threshold psychiatry .................................................... 176 G. Mellsop, A. Bower, S. Baxendine. Analysis of a patient database to examine the “Goodness of fit” to an externalising/emotional categorical classification ...... 177 W. Gaebel. Psychotic disorders in DSM-V and ICD-11 ......................................................... 178 N. Andersch. The “Matrix of Mental Formation”: A concept on the symbolic character of consciousness and a diagnostic tool alongside the use of descriptive approaches (ICD/DSM) in psychopathology ................................................... 179 Symposium 24. Psychiatry and clinical psychology: common issues and tasks ..................................................................................................... 181 M. Perrez. Common issues and different tasks? The contribution of psychology to the development of modern classification and assessment of mental disorders ... 181 A. Kholmogorova, N. Garanian, T. Dovzhenko, O. Pugovkina, S. Volikova, I. Nikitina, G. Petrova, T. Judeeva. Factors of integrative psychotherapy for affective spectrum disorders effectiveness ..................................................................... 182 M. Hautzinger. Psychotherapy for patients suffering of affective disorder: a common issue and a different task for clinical psychology and psychiatry ........... 183 V. Ababkov. Taxonomy of psychotherapists’ errors ............................................................. 184 Symposium 25. Psychiatric aspects of epileptology .................................................... 186 B.A. Kazakovtsev, V.G. Bulygina. Clinico-epidemiological substantiation of disease prognosis in patients with epilepsy-related mental disorders ................ 186 12


M.V. Olina, I.M. Paschkova, M.Ya. Kissin, E.V. Borisova. Clinical and psychological features of affective disorders and suicidal behavior in patients with epilepsy .... 187 V.V. Kalinin. Motor lateralization, focus laterality, and alexithymia as risk factors for co-morbid affective and anxiety disorders in patients with epilepsy ................... 188 V.A. Mikhailov, L.I. Wasserman. A study of social stigmatization in patients with epilepsy in Russia ...................................................................................................................... 190 A.E. Dubenko, T.A. Litovchenko Iatrogenic causes of inadequate therapeutic efficacy in patients with epilepsy.................................................................................................. 191 Symposium 26. Concepts and progress on person-centered psychiatry and medicine ............................................................................................................................. 194 General abstract .................................................................................................................................... 194 Workshop 1. Humanistic aspects in psychiatric practice .......................................... 195 General abstract .................................................................................................................................... 195 Workshop 2. .............................................................................................................................. 200 Part I. Modernizing disaster mental health .............................................................................. 200 Part II. Acute disaster response: providing psychological first aid ............................... 200 Part III. Resilience and recovery: applying skills for psychological recovery .......... 201 Workshop 3. Basic course in disaster management.................................................... 202 General abstract .................................................................................................................................... 202 Workshop 4. Psychodrama in psychotherapy ............................................................... 204 General abstract .................................................................................................................................... 204 Focus-group. Stakeholders collaboration for person-centered healthcare ....... 204 General abstract .................................................................................................................................... 204 Panel discussion 1. Ethical and legal aspects of mental health care at different times ..................................................................................................................... 205 13


General abstract .................................................................................................................................... 205 M. von Cranach. Ethics in psychiatry: the lessons we learn from nazi-psychiatry . 205 D. Bartenev, Yu. Savenko. Law and ethics in Russian psychiatry during the past 20 years .................................................................................................................................................... 206 A. Lindhardt. The road to compulsary treatment for out patients in Denmark ....... 207 G. Christodoulou Ethical challenges in medicine and psychiatry .................................... 208 J. Hanson. Efficient mental health care, patient security and patient integrety – ethical dilemmas? ................................................................................................................................ 208 W. Rutz. Ethical problems in Psychiatry – an international perspective .................... 209 Panel discussion 2. Person-centered clinical communication: the ways to advance mental health care ......................................................................... 211 General abstract .................................................................................................................................... 211 Panel discussion 3. Integrative correction of mental and behavioral disorders in children and adolescents ................................................................................................. 212 N. Alexandrova, M. Gorodnova. The supervision in psychotherapy and psychiatry ....................................................................................................................................... 212 I. Dobryakov, I. Nikolskaya. Clinical, psychological features of posttraumatic stress disorder, and rehabilitation model in children – victims of act of terrorism in Beslan ........................................................................................................................ 213 E.G. Eidеmiller, S.E. Medvedev. Analytical-systemic family psychotherapy at neuropsychic disorders in children, adolescents and adults .......................................... 214 S. Igumnov, A. Gelda, T. Gelda, S. Davidovski. Suicidal behaviour of adolescents and young people in modern megapolises: diagnosis, prophylaxis, correction ..... 215 A. Severnyi. Complex correction of psychosomatic disorders in pediatric clinic .... 216 Y. Shevchenko, V. Korneeva. Multilevel correction of forming psychopathies........... 218 N. Sukhotina. Prevention of borderline psychic disorders in children ........................ 219 К. Umalas. Application of neuropsychological correction for overcoming disturbances of psychic development ........................................................................................ 220 14


N. Zvereva, A. Khromov, A. Koval-Zaytsev. Age-specific and therapeutic dynamics of cognitive deficit in children suffering from endogenous mental illnesses ........... 223 V. Malygin, E. Smirnova. Features of family education in families of adolescents suffering from computer addiction .............................................................................................. 224 Panel discussion 4. Early career psychiatrists in Northern Europe – advantages and drawbacks – what can the psychiatric associations do? ........... 227 General abstract .................................................................................................................................... 227 Panel discussion 5. Psychotherapeutic training in Europe: the present-day and perspectives ...................................................................................................................... 228 N. Christodoulou. Psychotherapy training in the United Kingdom ................................ 228 A. Delic, E. Avdibegovic, I. Pajevic, M. Burgic-Radmanovic, D. Babic. Psychotherapy training in Europe: the present-day and perspectives in Bosnia and Herzegovina .............................................................................................................. 228 Y. Kochetkov. Psychotherapy training in Europe: the present-day and perspectives in Russia........................................................................................................................ 229 Oral presentations 1 ............................................................................................................... 230 O.B. Blagovidova, A.A. Churkin, Z.S. Charkimova. Issues of doctor’s primary training in mental health skills: a comparative study in two federal districts of Russia ..... 230 R. Tukaev, O. Korabel’nikova, A. Kuznetsov, V. Kuznetsov, K. Sryvkova. Complex cognitively-guided psychotherapy for anxious disorders with panic attacks .......... 231 E.B. Gayvoronskaya, O.V. Gurko. Sensory correction of psychosomatic desadaptation in the age-related aspect................................................................................... 232 A.Yu. Berezantsev, L.I. Monasipova, S.V. Strajev. Mental health and quality of life: possibility of psychotherapy in rehabilitation of women with cancer of reproductive system ........................................................................................................................... 233 M. Rusaka, E. Rancans. Acute transient psychosis – focus on stressful life events before the first episode...................................................................................................... 234 E. Molchanova. Kyrgyz traditional culture and psychopathology .................................. 236 15


Oral presentations 2 ............................................................................................................... 238 I.S. Lebedeva, V.E. Golimbet, V.G. Kaleda, A.V. Petriakin, A.N. Barkhatova, N.A. Semenova, T.A. Akhadov. Toward integration of neurophysiological and molecular-genetic, and fMRI analysis in schizophrenia .................................................... 238 T.V. Shushpanova, A.V. Solonsky, V.Ya. Semke. Peculiarities of structure of synapses and properties of synaptosomal benzodiazepine receptors in the ontogenesis of human brain in norm and during alcoholization of the mother ................................ 239 M. Abou-Saleh. The role of folate in the pathogenesis of depression and its treatment ................................................................................................................................................. 241 I.P. Lapin. Still fresh and inspiriting – kynurenines as common neurochemical links in stress, anxiety, depression, alcoholism, epilepsy .................................................. 242 Poster presentations .............................................................................................................. 244 W.M. Bahk, Y.S. Woo, H.J. Moon, Y.-E. Jung. Diagnostic stability in childhood schizophrenia vs. childhood bipolar disorder ........................................................................ 244 W.M. Bahk, C.U. Pae, D.I. Jon, Y.C. Shin, B.H. Yoon, K.J. Min. The broad effectiveness and tolerability of Bupropion XR in patients with depressive disorders: a multi-centre, 3 months, non-interventional, observational study ............................ 245 N.G. Christodoulou, S. Johnson, P. Bebbington, V.P. Kontaxakis. A cross-cultural comparative study of prevalence and predictive models of depression in schizophrenia ......................................................................................................................................... 246 N.G. Christodoulou, M. Mitkovic, O. Karpenko, B. Dunjic Kostic. Results and suggestions from the pilot phase of the trainees’ questionnaire of the psychiatric association of Eastern Europe and the Balkans (PAEEB) .................. 247 B. Ferreira, N. Borja-Santos, C. Vieira, S. Xavier, B. Trancas, A. Luengo, A. Neto, C. Klut, J. Grasa, J. Tavares, G. Cardoso. Schizoaffective disorder in a patient with Klinefelter syndrome ............................................................................................................... 248 A. Gigantesco, I. Lega. The Italian National integrated epidemiological surveillance in mental health ........................................................................................................ 249

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W. Kim, D.I. Jon, J.M. Woo. Association study of A2a adenosine receptor gene polymorphism in panic disorder ................................................................................................. 250 V.V. Kuznetsov, O.S. Antipova, O.S. Glazachev, O.S. Trofimova. Application of multifactor physiotherapy effects in complex therapy of depression ........................ 251 R. Freire Lucas, P. Carrisso. Conversion disorder: review .................................................. 252 R. Freire Lucas, J.L. Pio Abreu. Delusional state ....................................................................... 253 J.L. Pio Abreu, E. Fradique, R. Freire Lucas. Psychiatry is a branch of medicine, not a specialty ........................................................................................................................................ 254 A.E. Melik-Pashayan. Some data on psychiatric disorders in called up youth .......... 255 E. Nikolaev. Cultural foundations for three-dimensional approach in psychotherapy .................................................................................................................................. 255 T. Savina, O. Gerasimova, N. Tscherbakova. Memory abnormality in schizophrenia ................................................................................................................................... 257 O.S. Trofimova, O.S. Antipova. Character of autonomic regulation at the different stages of depression during active antideperssant treatment ............ 258 Y.S. Woo, D.I. Jon, K.J. Min, W. Kim, B.H. Yoon, W.M. Bahk. The prescription of Lamotrigine: results from a survey of psychiatrists in Korea ........................................ 259 P.Y. Xiu, T.A. Ariyanayagam, S. Masand, A. D. Patil, M. Agius, R. Zaman. Thermoregulation in schizophrenia: a hot topic ................................................................... 261 B.H. Yoon, W.M. Bahk, D.I. Jon, K.J. Min, H.B. Lee, W. Kim. Effect of Ziprasidone after switching from Olanzapine on the subjective estimates of sleep in the 8 weeks treatment of mania............................................................................................... 262 B.H. Yoon, W.B. Bahk, H.B. Lee, Y.J. Kwon, Y. Woo, M.D. Kim. Switching from Olanzapine to Ziprasidone in patients with bipolar disorder: an 8-weeks, multi-center open-label trial ........................................................................................................... 263 Collection of abstracts............................................................................................................ 265 V. Ababkov, M. Perrez, D. Schoebi. A transcultural study of parental influences on the preschool children’s behavior and health ................................................................. 265

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A.F. Abolonin, A.I. Mandel. Formation of pro-social orientation in adolescents with deviant behavior ........................................................................................................................ 266 E.Y. Abritalin, A.V. Korzenev, V.A. Fokin, D.A. Tarumov, A.V. Lebedev, A.V. Sokolov, A.V. Vorobyov. Neuroimaging in diagnosis of depressive disorders ............................. 267 E.G. Agasaryan, B.D. Tsygankov, T.V. Lebedeva. Ericksonian and cognitive-behavioral approaches to treatment of panic disorder ................................ 269 E. Aghekian. Affective disorders in primary care in general practice........................... 270 V.G. Agishev, I.A. Monakhovа, N.I. Kulikova. Experience of the use of drugs in antyhomotoxic gerontological practice ..................................................................................... 271 B.Ye. Alekseyev. The sex role conflict ........................................................................................... 272 E.Yu. Antokhin, V.G. Budza, E.M. Kryukova, V.A. Bardyurkina, O.N. Baldina. Bipolar depression of the II type: psychopathology, therapy .......................................... 274 E.Yu. Antokhin, E.T. Baydavletova, V.G. Budza, V.F. Druz, E.B. Chalaja, P.O. Bomov. Coping behavior in nursing psychiatric and somatic clinics ............................................ 275 L.N. Avdeyenok, M.M. Aksenov. Psychology of development of personality and behavior of children in families of divorcing parents ........................................................ 276 A. Avedisova, L. Kanaeva, K. Zakharova, R. Akhapkin. Symptomatic and functional remission of depression: dimensional and categorical approaches ............................ 277 S.M. Babin, A.M. Shlafer. Сompliance therapy and optimization of psychopharmtherapy of schizophrenics ................................................................................... 279 I.N. Baburin, E.V. Schultz, V.B. Slezin. Spectral characteristics EEG in patients with various clinical types of neurotic disorders .................................................................. 280 V.I. Bagaev, M.V. Zlokazova. Interdisciplinary approach to health services for children with border-line psychic disorders in educational environment ................ 281 O.A. Balunov, N.Y. Safonova. Cognitive impairment in patients with single lacunar cerebral infarction .............................................................................................................. 282 O.A. Balunov, N.Y. Safonova. Cognitive disorders in patients with multiple brain lacunar infarctions............................................................................................................................... 283 А.В. Baranov. Victims of aggression, criminals ill with an alcoholism ......................... 284

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A.Yu. Berezantsev, I.V. Belous. Clinical and pharmacoeconomical aspects of outpatient treatment of schizophrenia ...................................................................................... 285 A.Yu. Berezantsev, L.I. Monasipova, S.V. Strajev. Mental Health and Quality of life: possibility of psychotherapy in rehabilitation of women with cancer of reproductive system ........................................................................................................................... 287 V.P. Bersnev, T.S. Stepanova, R.D. Kasumov, V.R. Kasumov, S.V. Kravtsova. Neurosurgical aspects of epileptogenesis and surgical treatment of temporal epilepsy patients with personality changes ............................................................................. 288 A.V. Bessmertniy. A clinico-psycological study of memory in patients with paranoiac schizophrenia in hospital settings ............................................................... 290 A.S. Bobrov, E. G. Magonova. Depression related with a stress in outpatient psychiatric practice ............................................................................................................................. 291 A.S. Bobrov, O.V. Petrunko, O.V. Hamarhanova, A.V. Shvetsova. Clinical predicts of the speed of therapeutical response to monotherapy by Valdoxan ....................... 292 A.S. Bobrov, O.V. Petrunko, L.A. Ivanova, I.M. Mihalevich. Depression with pathological body sensations ......................................................................................................... 294 N.A. Bokhan, D.M. Kurgak. Ethnocultural problems of dependence in aborigines of Kamchatka.......................................................................................................................................... 295 I. Boukhovets. Clinical presentation and course of bipolar disorder type I with the analysis of differences in psychopharmacotherapy .......................................... 297 S.A. Bronfman, E.V. Uvarova, V.A. Agarkov, K.V. Samokhvalova, E.D. Nagorova. Latent depression in patients with secondary normogonadotropic amenorrhea ............... 298 T. Bryabrina. The problem compliance behaviour of the young persons with vegetative somatoform dysfunction ................................................................................. 300 O.V. Bukhtoyarov, O.N. Chumakova. Multicenter anamnestic study of psychogenesis of cancer .............................................................................................................. 302 O.V. Bukhtoyarov, D.M. Samarin. Mind and cancer: hypothesis of psychogenic carcinogenesis ....................................................................................................................................... 302

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B.G. Butoma, V.B. Slezin, A.P. Kotsubinskyi, E.A. Korsakova, T.A. Arystova, E.V. Schultz, I. D. Stolyarov, A.M. Petrov. Biological and psychological aspects of multidisciplinary approach to the diagnostics of different forms of schizophrenia ................................. 304 N.E. Butorina, G.G. Butorin, L.A. Benko. Comorbid variants of depressive disorders at the residual-organic psychosyndrome at initial pupils ............................ 305 S.O. Byshok. The susceptibility to visual illusions in schizophrenia: Impairments, determinants and functional importance .................................................... 307 E.I. Chekhlaty, V.V. Lukjanov The structure of a burnout syndrome at psychiatrists-experts in narcology with the various work experience ...................... 308 A. Chomsky. Depressive symptoms associated with neuroendocrinological side effects of antipsychotics of second generation ....................................................................... 310 O.N. Chumakova, O.V. Bukhtoyarov, D.M. Samarin. Correlation of mental disorders and immunity in cancer ............................................................................................... 311 O.N. Chumakova, O.V. Bukhtoyarov. Psycho-organic syndrome: effects of cancer chemotherapy ........................................................................................................................................ 312 M. Dalsaev, R. Dalsaeva, A. Aytuganova. Changes in the alcohol addiction level among people during months of Ramadan in dynamics from 2003 to 2009 in conditions of prolonged emergency situation in the Chechen Republic ............... 313 L.J. Danilova. Suicidal behaviour of depressive teenagers ................................................. 314 M. Detke, J.B.W. Williams, D. Osman, S. De Santi, P. Komissarov. Remote assessment in psychiatric clinical trials: patient acceptance and validity ................ 316 N.P. Dguga, V.L. Kozlovsky. A differentiated approach to using adjuvant antipsychotic therapy in schizophrenic patients (a trial of treatment with glycine and hopantenic acid) .............................................................................................. 317 Т. Dokukina, N. Misyuk, V. Dоkukina, M. Minzer. Middle EEG coherence disturbances in patients with organic pseudoneurotic disorders ................................. 318 A. Dolnykova, I. Tarusina, A. Titarenko. The structure of familiees with a patient with schizophrenia or with shcizoaffective psychosis ................................... 320

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O.A. Dorofeyeva, S.A. Syunyakov, G.G. Neznamov. Comparative analysis of different phenazepam formulations efficacy in patients with anxiety disorders of various structure ....................................................................................................... 321 I.U. Dorozhenok, A.N. Lvov, D.V. Romanov. Psychiatric disorders in dermatological practice ............................................................................................................... 322 I.V. Dоrovskikh. To the question of diagnostic criterions of global amnesia.............. 323 D.I. Jon, E. Lee, K.R. Kim, J.H. Seok, H.S. Cho. Clinical characteristics and outcomes of patients with bipolar disorder after first hospitalization: a two-year follow-up ... 324 N.G. Ermakova. Experience in applying personality-oriented psychotherapy i n the rehabilitation of patients with stroke ............................................................................. 325 E. Ershov, O. Limankin Treatment and social rehabilitation issues of mental patients with lung tuberculosis ..................................................................................................... 327 Ju. Fedotova, N. Ordayn. Anxiolytic-like effect of quinpirole in combination with a sub-active dose of 17β-estradiol in ovariectomized rats..................................... 328 P.A. Filippov, N.N. Polosaeva, E.O. Voronina. Productivity of psychosocial actions for patients with vascular disease of a brain .......................................................... 330 D. Foutsitzis, F. Papouli, G. Markou, C. Istikoglou, N. Polonifis, P. Kanellos. Urinary retention following treatment with duloxetine .................................................... 331 D. Foutsitzis, F. Papouli, G. Markou, C. Istikoglou, N. Polonifis, P. Kanellos, A. Vlavianou. Inhalation of volatile substance and the appearance of psychotic symptoms ................................................................................................................................................ 332 N.P. Garganeyeva, A.I. Rozin, D.S. Kaskayeva, A.A. Evsyukov, A.V. Donov. Psychosocial risk factors in assessment of prognosis of cardiovascular diseases ............................ 334 T.V. Glushko, E.O. Vershinina, A.N. Repin, I.E. Kupriyanova, K.V. Galeyeva. Mental disorders in patients of a cardiologic institution................................................................... 335 T. Gogberashvili, Y. Mikadze. Neuropsychological evaluation of cognitive disoders in pediatric focal epilepsy ............................................................................................ 336 E.A. Grigorieva, A.L. Dyakonov. “Psychosis hypersensitivity” in combination with convulsive syndrome – complication of the treatment with classical neuroleptics ............................................................................................................................................ 338 21


I.Ya. Gurovich, Y. Zaytseva, A.B. Shmukler. Effectiveness of the integrated long-term program of management of patients after first psychotic episode in 5-year follow-up .............................................................................................................................. 339 O.V. Guseva. Hospital psychotherapy in the psychiatric practice ................................... 340 Ye.G. Ichitovkina, M.V. Zlokazova. Dynamics of the personality profile of combatants, associates of the Ministry of Internal Affairs .......................................... 342 K. Idrisov. Traumatic events and posttraumatic stress disorder of the adult population in a longterm emergency situation in the Chechen Republic................... 343 S.A. Igumnov, E.P. Stanko, T.V. Dokukina. Medico-social aspects of injecting drug use by patients with HIV infection .................................................................................... 344 S. Igumnov, V. Zhebentyaev. Differentiated short-term psychotherapy in a complex treatment of non-psychotic depressive spectrum disorders.................... 346 B. Ishkhanyan, A. Azizian, M. Yeghiyan. Delayed memory deficits in schizophrenia is linked with severity of negative symptoms .................................... 348 N.R. Israelyan, M.G. Yeghiyan. Compulsive behaviour in patients with anorexia nervosa (comparative pilot study among 15 adolescents) .............................................. 349 M.V. Ivanov. Spatial ideas in the network of schizotypal disorders ............................... 350 L.A. Ivanova, A.S. Bobrov, A.V. Shvetsova. Ladasten in therapy of somathogenic asthenia and adjustment disorders ............................................................................................. 351 T. Ivanova. Clinical types of depression in children aged 6–14 years .......................... 352 D.M. Ivashinenko, J.S. Klueva, O.A. Burmikina. An integrative approach in the therapy of the depressive disorders among patients with ischemic heart disease ............... 354 A.F. Iznak, E.V. Iznak, V.V. Kornilov, V.A. Kontzevoy. Dynamics of EEG and evoked potentials in the course of treatment of prolonged depressive reaction .................. 356 Y.T. Janguildin, B.D. Tsygankov, O.A. Markina. Cliniconosological schizophrenia spectrum disorder differentiation of patients with prolonged use of hallucinogens .................................................................................................................................... 357 B. Jarbussynova. Some aspects of correlation of mental and psychologic health of population of Kazakhstan ............................................................................................. 358

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M. Javanbakht, S.J. Teymori. Correlation between the medical students’ psychological health and their disfunctional attitudes ...................................................... 359 J.S. Cheon, B.H. Oh. Factors influencing on the suicide-related behavior in community dwelling Korean elders............................................................................................. 360 М.А. Kalinina, G.V. Kozlovskaya, V.L. Коtlayrov, G.N. Schimonova, T.P. Klushnik, L.G. Кusmenko. Psychosomathic and autistic disorders in early childhood .............. 362 S.E. Karaoulanis, A.A. Rizoulis, O.D. Mouzas, N.V. Angelopoulos. Is premenstrual syndrome associated with obsessiveness-compulsiveness? ........................................... 363 S.E. Karaoulanis, A.A. Rizoulis, G.A. Lialios, E. Damani, K.A. Rizouli, N. Liakos, N.V. Angelopoulos. Thyroid function in perimenopausal women with anxiety ........ 364 S.E. Karaoulanis, A.A. Rizoulis, O.D. Mouzas, N.V. Angelopoulos. Psychopathology of women with premenstrual dysphoric disorder ........................... 365 I.S. Karaush, I.E. Kupriyanova, A.V. Malanina. Problems of social adaptation of children with hearing disorder ................................................................................................. 366 T.A. Karavaeva. Problems of the ethical-legal regulation of psychotherapy ............. 367 I.G. Kartashova, N.P. Garganeyeva, V.Ya. Semke. Anxiety and depressive disorders inpatients with gastrointestinal diseases ............................................................ 369 B.D. Karvassarsky. Evolution of psychotherapy in Russia in the period of changes (medical and psychosocial consequencies) ..................................................... 370 A.L. Katkov. Methodology of definition of efficiency of psychotherapy dependent on PAS ................................................................................................................................ 372 A.L. Katkov. Psychotherapy dependent from psychoactive substances in Republic of Kazakhstan ................................................................................................................ 373 A.L. Katkov, N.B. Eregepov, E.V. Eregepov, K.O. Imanbekov. Quality management in system of narcological help in Republic of Kazakhstan ............................................... 375 S. Kharitonov. Relational-dynamic psychotherapy ............................................................... 376 A. Kholmogorova, V. Krasnova. Social anxiety as a factor of emotional dysadaptation among students...................................................................................................... 378 E.A. Kolotilshchikova. About the psychological mechanisms of the neurotic disorders .................................................................................................................................................. 379 23


S.A. Kolov. Levels of plasma serum dehydroepiandrosterone-sulfate and cortisol in combat veterans ............................................................................................................. 380 T.A. Korman, V.V. Bocharov. The attitude of relatives to mental disease of a member of family.............................................................................................................................. 381 A. Korzenev, E. Abritalin, V. Shamrey, A. Lebedev, D. Tarumov, V. Fokin, A. Efimcev. Differences and similarities between reactive, endogenous and organic depressions: a neuroimaging study ............................................................................................. 383 Y.V. Kotsubinskaya, N.Y. Safonova, T.A. Lopushanskaya, I.V. Voityatskaya. Dental prothesis and psychoneurological consultation ..................................................... 384 A.I. Kovalyov. Biological predisposition in transsexual patients ..................................... 385 O. Krahmaleva, T. Ivanova. Pharmacoeconomical efficiency of the use Amitriptyline and Stimuloton in the treatment of children’s depressive disorders.......................... 386 О.V. Kremleva. The adult attachment styles influences on the self-reported health-related measures in rheumatoid arthritis.................................................................. 388 E.N. Krivulin, A.S. Beckov, E.V. Ohtyarkin, S.V. Golodnyi. Suicidal behavior in adolescents convicted with mild mental retardation .......................................................... 389 E.M. Kryukova, E.Yu. Antokhin, V.G. Budza, N.E. Lazareva. The structure of the psychological adaptation in patients with schizophrenia depending on duration of a disease ........................................................................................................................... 391 O.I. Kudinova. Somatoform disorders and health care system ........................................ 392 I.E. Kupriyanova. Preventive programs for various groups of the population ......... 392 O. Kushnir. Diagnostic problems and changing of immunological response in patients with general paresis .................................................................................................... 393 A. Lakic, A. Jovanovic. Infantile autism concepts: between old and new ..................... 395 A. Lakic, A. Jovanovic. Quality of life. New concept in research and practice in childhood and adolescence ........................................................................................................ 396 N.D. Lakosina, A.V. Pavlichenko. Pathomorphosis of neurotic phobias ........................ 397 O. Limankin. A systems-oriented model for the development of psychiatric services ..................................................................................................................................................... 398 O. Limankin. Ethical and legal issues of art therapy ............................................................. 400 24


L.V. Lipatova, B.G. Butoma. Neuroimmune disturbances in patients with endogenous psychiatric disorders and epilepsy.................................................................... 401 I.V. Lobanova. Application experience Zoloft (sertralin) at therapy of depressions at patients with MDD .......................................................................................... 403 E. Lyubov. A multicenter pharmacoepidemiological and cost-effectiveness study of 2-year outpatient treatment with atypical antipsychotics for schizophrenia ... 403 E. Lyubov, N. Levin. Supported employment for people with psychiatric disabilities ............................................................................................................................................... 404 V. Malygin, E. Smirnova. Features of family education in families of adolescents suffering from computer addiction .............................................................................................. 405 V. Malygin, B. Tsygankov. Socio-psychological characteristics of pathological gamblers ................................................................................................................................................... 407 D.A. Maryasova, D.B. Tsygankov. Predictors of panic attacks in alcohol-dependent patients ..................................................................................................................................................... 408 S.Yu. Maslovsky, V.L. Kozlovsky. Measurement of quality of life of out-patients with schizophrenia .............................................................................................................................. 409 A. Maximov, A. Kholmogorova. Borderline personality disorder and trauma n homosexual male sex workers in Russia ............................................................................... 411 G. Mazo, A. Chomsky. Depression during an acute episode of schizophrenia and its impact on treatment response ........................................................................................ 412 G. Mazo, T. Shmaneva. Risk factors of pharmacogenic weight gain in patients with a depressive disorder .............................................................................................................. 414 Z.A. Melikyan, Y.V. Mikadze, O.S. Zaitsev. A neuropsychological perspective in pharmacotherapy of cognitive disorders after traumatic brain injury (a literature reivew) ........................................................................................................................... 415 V. Mendelevich. Contemporary problems of biomedical ethics in narcology ............ 416 V.A. Mikhailov, S.A. Gromov, L.I. Wasserman, N.G. Neznanov, S.D. Tabulina, E.S. Eroshina, S.A. Korovina, E.N. Mironova, A.V. Sinyakova. Clinical, individual-personality and socio-enironmental determinants of the quality of life in patients with epilepsy ...................................................................................................... 418 25


R. Milev, L. Lazowski, L. Gedge, D. Murray, D. Summers, R. Jokic. Effects of a switch from bupropion SR to bupropion XL on sleep architecture in patients with unipolar or bipolar depression ........................................................................................... 420 E. Miroshnik. Complex psychological and psychophysiological support of persons with adaptation disorders ......................................................................................... 421 E.B. Mizinova. The psychological pathomorthosis of the neurotic disorders ........... 422 E. Molchanova, T. Galako, M. Zubareva, A. Mukambetov. ICD-10 and “domestic” classification systems in Kyrgyzstan: why are mental health specialists not happy with ICD-10?..................................................................................................................... 424 I.A. Monakhova, V.S. Soultanov, V.G. Agishev. Study of the therapeutic properties of Ropren® in the treatment of Alzheimer’s type dementia ............................................ 425 D. Mrakovic, N. Buder, S. Kulishic. The first forensic psychiatry expert’s report in Serbia ..................................................................................................................................... 426 V. Mrykhin, I. Shurkova, V. Yemtsev. Our experience of using Valdoxan in the treatment of atypical endogenous depressions ............................................................ 427 E. Mukhametshina, K. Yakhin. Depressive disorders at patients with cholelithic illness ......................................................................................................................................................... 429 E. Mukhametshina, K. Yakhin. Experience with Cipralex in the treatment of depressive disorders in cancer patients............................................................................... 429 B.V. Mykhaylov. Psychotherapeutic care in Ukraine, problems and prospects ........ 430 A.G. Naryshkin, I.V. Galanin, A.L. Gorelik, M.N. Abramovskaja. Vestibular dereception as a method of amnesia treatment (preliminary results) ...................... 431 R.F. Nasyrova. Mental health of women at reproductive age with dysmenorrhea . 433 R.K. Nazirov, V.V. Holyavko, S.V. Lyashkovskaya, V.Ya. Sazonov. The development of clinical psychotherapy .................................................................................................................. 434 R.K. Nazirov, S.V. Lyashkovskaya, M.B. Remeslo, V.V. Holyavko, V.Ya. Sazonov. The development of outpatient psychotherapy ..................................................................... 436 G. Nyukhalov. Existential-oriented group therapy for the patients with schizophrenia ......................................................................................................................................... 437 S.S. Odarchenko. Specialized psychiatric care at the end of lipe ..................................... 439 26


N. Yu. Oganesian. Dance psychotherapy in rehabilitation of patients with paranoid schizophrenia with dificiency disorders ..................................................... 441 B. A. Ola. Incidence and correlates of delirium in a West African mental health clinic ............................................................................................................................................. 442 Ye.S. Orudzhev, Ye.A. Kozlenko, Ye.Yu. Zubova. In-patient factors affecting empathy and affiliation of personnel .......................................................................................... 443 A.V. Ostapenko, S.A. Kolov. The influence of stigma on results of treatment and rehabilitation of combatants .................................................................................................. 445 S.A. Ovsiannikov, T.Ju. Balanina. Using typical and atypical neuroleptics in therapy of patients with paranoid shift-like schizophrenia with organic stigmatization ........................................................................................................................................ 446 T. Pavlova, A. Kholmogorova. Psychological factors of social anxiety ........................... 447 A.Y. Perekhov, V.A. Soldatkin. Gerontosexology today .......................................................... 448 A.Y. Perekhov, V.A. Soldatkin. The violation of ethical norms of veracity in modern Russian psychiatry........................................................................................................ 449 N. Petrova1, A. Kutuzova. Psychic disorders and rehabilitation in heart failure patients ..................................................................................................................................................... 450 N. Petrova. Psychotic episode in schizophrenic patients ................................................... 452 N. Petrova. Quality of life and psychosocial adjustment to aging ................................... 453 B.N. Piven. Classification of mental diseases the author’s vision .................................... 454 S.V. Platov. Disturbances of the chronophysiological mechanisms in maniacal states ................................................................................................................................. 455 A.V. Plotnikov. Exogenous organic brain diseases of people with pulmonary tuberculosis ............................................................................................................................................ 457 D. Plounipidis. From indoor to outdoor care. Review of the reform process of psychiatry in Greece (1985–2009) ......................................................................................... 458 M.Yu. Popov. Calcium channel blockers: an alternative to anticholinergics in the treatment of extrapyramidal symptoms in schizophrenic patients? .............. 459 Yu.V. Popov, A.A. Pichikov. Multiple adolescent suicides ..................................................... 461 V.A. Potapova. Psychotherapeutic work with adolescents ................................................ 462 27


Ye. Prytova, S. Trushchelev. Basic information sources in disease reversal ............... 463 O.D. Pugovkina, A.B. Kholmogorova, E.E. Tsucarzi. Effects of rTMS and ECT on memory of depressive patients ............................................................................................... 465 S. Rataemane. Cognitive behavior therapy to improve skills of counselor in South Africa ....................................................................................................................................... 466 M.B. Remeslo, A.S. Yakovis. The system of training physicians psychotherapists and clinical psychologists in clinical psychotherapy ........................................................... 466 L. Renemane, I. Gzibovska. Visual plastic arts therapy efficacy in the treatment of burnout syndrome in nurses who work in mental hospital ........................................ 468 A.S. Ritskov. Efficiency of anti-relapse olanzapine therapy vs. amytriptyline, haloperidol at treatment depressive-delusional disorders ................................................ 469 N. Rivkina. Multi-family group intervention in the first episode clinic........................ 470 D.V. Romanov. Borderline and narcissistic personality disorders: necessity of inclusion for the qualifier of mental disorders .................................................................. 472 I.F. Roschina, B.B. Velichkovsky, N.D. Selezneva, S.I. Gavrilova, Yu.A. Chudina, Z.A. Melikyan. Cognitive control and memory in healthy APOE-e4 carriers with a family history of Alzheimer’s disease ........................................................................... 473 M. Roy, A. Roy. Suicide attempts and ideation in type 1 diabetic patients .................. 474 A. I. Rozin, N. P. Garganeyeva, E. D. Schastnyi. Structure of anxiety-depressive disorders and level of social adaptation in patients of a cardiological institution ................................................................................................................................................ 475 E.V. Ruzhenskaya. Safety of emotionality of the medical personnel of psychiatry ........................................................................................................................................... 477 E.V. Ruzhenskaya. The motivation of the medical personnel of psychiatric service to the actions for increasing vocational training .................................................. 478 I.D. Sanasheva, I.I. Sheremeteva. Mental disorders of Republic Altai inhabitants ... 480 A.P. Savelyev, A.A. Spikina, A.G. Sofronov. Neurocognitive deficits in patients with schizophrenia: the relevance of the study on the clinical models ...................... 481

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T. Savina, V. Orlova, N. Efanova, L. Gubsky, D. Kupriyanov, N. Anisimov. Correlations between morphological (MRI) characteristics of subcortico-limbic structures and brain function peculiarities in patients with schizophrenia ............ 482 M. Semiglazova, T. Dovzhenko, V. Krasnov. Affective disorders in patients with various cardiovascular diseases ......................................................................................... 483 V. Semke. Classification of personality disorders ................................................................... 484 N.V. Semenova, A.S. Kisselev. Psychiatric morbidity in the Leningrad Region in 2000 – 2009....................................................................................................................................... 485 N.V. Semenova, A.S. Kisselev. The incidence of mental disorders in the Leningrad Region, 2000 to 2009 ......................................................................................................................... 487 N.V. Semenova, I.V. Lupinov, Yu.N. Botsmanovskiy. The analysis of the indices of prevalence and incidence of mental disturbances in the Leningrad Region, 2008–2009 .............................................................................................................................................. 488 I.V. Shadrina. About the role of postburn cosmetic defects in survivors’ adaptation................................................................................................................................................ 490 L.K. Shaidoukova, D.N. Usmanov. Psychopathia-like disorders in patients with opiate addiction.......................................................................................................................... 491 E. Shakhbazova, Y. Mikadze. Neuropsychological assessment as a prognostic index in systemic and progressive diseases (the example of approach on patients with multiple sclerosis) ............................................................................................ 492 I.V. Shcherbakova. Inflammatory markers in the schizophrenic patients .................. 493 K.M. Shipkova. The perspective of music therapy in psychological treatment of patients with language disorders ............................................................................................ 495 E. Shmunk. Social adaptation of the patients with depressive disorders for the first time admitted to the psychiatric hospital ............................................................... 496 V. Shprakh, I. Suvorova. Clinical efficacy of neuroprotective therapy in patients with poststroke vascular dementia ...................................................................... 497 V. Shprakh, I. Suvorova. Vascular сognitive impairment and risk factors for vascular dementia ........................................................................................................................ 498

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I.N Shurkova, А.O. Bukhanovsky, V.V. Mrykhin. The cerebral MRI findings in patients suffering from atypical endogenous depression ........................................... 499 I.N. Shurkova, А.O. Bukhanovsky, V.V. Mrykhin. Тhe clinical features, dynamics and treatment of atypical endogenous depressions ........................................................... 500 T.V. Shushpanova, V.Ya. Semke, T.P. Novozheyeva, N.A. Bokhan. Rehabilitation of patients with alcoholism with the use of original anticonvulsant and peculiarities of pharmacokinetics of the preparation in these patients .................... 501 V.Y. Slabinsky, S.A. Podsadnyi. To the question of the role of disorder of circadian rhythm disturbance in the pathogenesis of PTSD ....................................... 503 P.G. Smetannikov. Structural versions of the delirious forms of the functional psychoses of the reverse splitting ................................................................................................ 504 D.A. Smirnova. About the preferable psychotherapeutic approach in the treatment of different clinical types of depressions (methodological aspects of psychotherapy) ............................................................................ 506 D.A. Smirnova. Features of thinking in mildly depressed patients depending on the type of leading hypothymic affect (clinical psychopathology through the prism of psycholinguistic research) .................................................................................... 507 A.B. Smulevich, A.S. Tiganov. Use of paliperidone during long-term remission in attack-like schizophrenia ............................................................................................................ 508 E. Sorel. Russian-American psychiatric collaboration 1986–2010 ................................ 509 A.A. Spikina, A.P. Savelyev, A.G. Sofronov. The influence of inclusion of neurocognitive training in the complex therapy of patients with schizophrenia . 510 E.A. Stepanova, A.V. Andryuschenko, K.A. Albantova. Psychosomatic (rythmological) model of depression in cardiology ............................................................. 512 A. Stroganov. The psychotherapeutic montage: the systems of Meyerhold and Gurdzhiev in psychotherapy .................................................................................................. 513 N.K. Sukhotina. Prevention of borderline psychic disorders in children .................... 515 S.G. Sukiasyan, M.J. Tadevosyan. Dynamic aspects of PTSD psychiatric trauma and clinical picture of Karabagh war Armenian volunteers ............................................ 516

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S.G. Sukiasyan, S.P. Margaryan, N.G. Manasyan, A.A. Babakhanyan-Ghambaryan, A.N. Pogosyan, A.L. Kirakosyan, M.M. Ordyan. Psychiatric aspects of general condition of the patients of diagnostic centre: somatic psychic disorders ............... 517 S.G. Sukiasyan, S.P. Margaryan, N.G. Manasyan, A.A. Babakhanyan-Ghambaryan, A.L. Kirakosyan, A.N. Pogosyan, M.M. Ordyan. The structure of initial of “syndrome of indisposition” in the patients of the “STRESS” diagnostic ............. 518 V.S. Soultanov, V.I. Roschin, I.A. Monakhova, V.G. Agishev. Results of use of Ropren® in treatment of chronic alcoholism ..................................................................... 520 V. Starcevic, G. Porter, D. Berle, P. Fenech. Assessment of problem video game use and its relationship with psychopathology ........................................................ 521 T.S. Syunyakov, E.S. Teleshova, S.A. Syunyakov, G.G. Neznamov. The effect of novel anxiolytic drug Selank on the psychophysiological parameters of patients with generalized anxiety disorder ........................................................................ 522 K. Tataryan. The clinical and epidemiologocal aspects of gerontopsychiatric disorders in Armenia .......................................................................................................................... 523 L.A. Temmoeva. Psychosomatic peculiarities of asthmatic children ............................. 525 A.F. Terentyeva. Depressive and anxiety disorders in patients with rheumatic diseases..................................................................................................................................................... 526 V.A. Tochilov, O.N. Kushnir. Closapine in acute psychosis ................................................... 527 S. Trushchelev. Psychoeducation and insight in schizophrenia ....................................... 528 V. Tsuprun. Suicide and aggression in out-patient contingent of psychiatric patients ..................................................................................................................................................... 529 N. Ustinova. Clinical characteristic of depression in women having children with infantile cerebral paralysis ................................................................................................... 530 E.B. Varshalovskaya, T.V. Sokolovskaya. Psychogenesis and psychotherapy of panic disorders ................................................................................................................................ 531 A.V. Vasilyeva. Diagnosis and treatment of lingering forms of neurotic disorders in dynamic psychiatry paradigm ............................................................................ 532 S.V. Vaulin, M.V. Alexeeva. Predictors of the thymoanalytical therapy efficacy in patients suffering from psychiatric disorders ................................................................... 534 31


E.V. Veshenvetskaya, S.V. Lyashkovskaya, N.S. Medvedeva, A.R. Nazirova. Art-therapy, social rehabilitation, psychotherapy of mental disorders ...................... 535 I.V. Voevodin. Psychosocial prevention of psychoactive substances use among university students .............................................................................................................................. 536 S.V. Volikova, O.G. Kalina, A.B. Kholmogorova. Validation of the children’s depression inventory (CDI, M. Kovacs) ...................................................................................... 537 T. Von, S. Trushchelev. Problems of patients with epilepsy and ways to overcome them ................................................................................................................................ 538 E.O. Voronina, V.G. Budza. Clinical features of an initial stage mixed vascular – Аlzcheimer’s dementia ...................................................................................................................... 540 V.B. Voronkova. The program of psychosocial rehabilitation of adolescents suffering from a schizotypal personality disorder ................................................................ 540 K.K. Yakhin, T.R. Gazizullin. Clinical prediction Aripiprazole efficacy in treatment of schizophrenia ........................................................................................................ 542 O.N. Yakunina. Psychological diagnosis and psychocorrection as components of the treatment-and-rehabilitation process in epilepsy ................................................... 543 N.V. Yalceva, D.A. Yalceva. Association of depression and anxiety alone and in combination with chronic low back pain in primary care pations.......................... 544 V. Zaitsev, Е. Kutsaja, T. Кhmilova. Art-analysis – new method psychotherapy of borderline patients ........................................................................................................................ 545 D.V. Zakharov, O.A. Balunov. Markers of psychosocial acclimatisation of patients with cerebrovascular encephalopathy in the course of rehabilitation ........................ 547 N.V. Zakharova, N.A. Il’ina. The dynamics of paroxysmal schizophrenia with long-term remissions............................................................................................................... 548 N.M. Zalutskaya. Analysis of the general psychological characteristics of successfulness of coping with the family stress in patients with endogenous psychoses ................................................................................................................................................. 549 N. Zaviazkina. Influence of some groups of antiepileptic drugs on the cognitive functions of patients with epilepsy .............................................................................................. 550 Index ............................................................................................................................................ 552 32


Plenary lectures When does depression become a mental disorder? M. Maj Department of Psychiatry, University of Naples, Italy Major depressive disorder is reported to be the most common mental disorder, with lifetime prevalence in the community ranging from 10 to 25% in women and from 5 to 12% in men. These figures are frequently quoted in the psychiatric literature, but are viewed by many, both outside and within the psychiatric field, with a substantial degree of skepticism. From outside the psychiatric field, it has been pointed out that “determining when relatively common experiences such as sadness should be considered evidence of some disorder requires the setting of boundaries that are largely arbitrary, not scientific, unlike setting the boundaries for what constitutes cancer or pneumonia”. From within the psychiatric field, it has been stated that “based on the high prevalence rates identified in both the ECA and the NCS, it is reasonable to hypothesize that some syndromes in the community represent transient homeostatic responses to internal or internal stimuli that do not represent true psychopathologic disorders”. It is likely that these arguments will be increasingly endorsed by the public opinion in the years to come, and it is therefore crucial for our profession to articulate a convincing response to the question “When does depression become a mental disorder?” In this presentation, I will summarize three approaches to this issue, pointing out their weaknesses and the lessons we may take from each of them. The first approach is the one proposed by Wakefield, emphasizing the context in which depressive symptoms occur. The second approach is the one endorsed by several European psychopathologists, according to whom there is a qualitative difference between true depression and normal sadness, a difference which has been lost in the recent process of oversimplification of psychopathology. The third approach is the one according to which, since there is continuity between “normal” sadness and clinical depression, the boundary has to be decided arbitrarily on pragmatic grounds. This is what the DSM-IV actually tries to achieve, regarding depression as a “disorder” 33


when it reaches a given threshold in terms of severity, duration and degree of suffering or functional impairment, thus deserving clinical attention. The problem is, however, that the threshold fixed by the DSM-IV for the diagnosis of major depression is not only arbitrary, but also not based on reasonably solid pragmatic grounds.

Russian psychiatry: traditions and current trends V.N. Krasnov Moscow Research Institute of Psychiatry, Russia In the 19th and 20th century, Russian psychiatry has predominantly followed the clinical tradition established by German, French and Russian psychopathlogical schools. Nosological classification of Kraepelin and psychopathological categories of Jasperes as well as dynamic clinical analysis of the whole individual condition (tradition from Korsakov and Bekhterev) remained the basis of diagnosis and treatment. However, developments of psychiatry in the country have been significantly influenced by psysiological discoveries of Pavlov, psychological concept of personality development by Vygotsky, Leontyev and Myasishchev, and neuropsychological approaches of Luria. As a result systematic approaches were formed that considered the disease as a multifactorial and multidimensional condition. Terrotorial principles of care ensured feasible and free of charge aid for everyone. Unfortunately strict legal regulations came to dominate in psychiatric clinical practice only at the end of the 20th century. Mental health care is gradually overcomig certain drawbacks of the old psychiatric system, partly connected with neglections or violations of patients rights in the late Soviet time. New psychiatric Law (1992) does provide patients rights. At the same time there are a lot of practical difficulties. But step by step the reforms in psychiatry especially in sphere of psychosocial therapy and rehabilitation are developing due to professional initiatives, in some aspects with federal or municipal support.

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The mood spectrum: from depression via bipolar disorders to mania J. Angst Zurich University Psychiatric Hospital, Switzerland The modern concept of bipolar disorder was first formulated in 1851 by Falret as “folie circulaire” and Baillarger 1854 as “folie { double forme”. In 1899 Kraepelin unified depression, mania and circular insanity in a new, broad concept of manicdepressive insanity, but kept involutional melancholia separate. Kleist 1937 introduced the terms “unipolar” (depression [D] / mania [M]) vs. “bipolar” (MD); he considered bipolar to be a form of comorbidity between D and M. In 1966 Angst and Perris provided evidence based on genetics and course for the unipolar-bipolar distinction, and Angst showed that involutional melancholia was merely a late-onset form of unipolar disorder. In 1976 Dunner refined the spectrum with the introduction of bipolar-II disorder (Dm). Mania with minor depressive disorders (Md) and pure mania (M) were subsequently added. The resulting five subtypes of major mood disorders (D-Dm-MD-Md-M) form a continuum defined by varying proportions of the two dimensions, depression and mania. Since 2003 evidence has been growing that major depressive disorders (D) are heavily overdiagnosed and include about 40% of hidden bipolar-II subjects. This was shown by three epidemiological studies: the Zurich Study and the re-analysis of the EDSP study and of the NCS-R study; it was recently also confirmed by a large international patient sample (Bridge Study). The impact of a broader concept of bipolar-II disorder is potentially enormous: it allows much earlier diagnosis and appropriate long-term treatment of BP; it moves the burden of mood disorders, currently dominated by major depressive disorders, to bipolar disorders; it entails a major shift of the burden of comorbidity from the unipolar depressive to the bipolar-II group. Much less is known about the manic wing of mood disorders, because the prevalence rates of Md and M are relatively low and pure hypomanics (m) seldom seek treatment. They both seem to differ strongly from the nuclear MD group in terms of a lower family risk for depression, fewer episodes, lower suicidality and apparent 35


protection against anxiety disorders. On the other hand, they are at risk for substance use disorders, trouble with the law, and perhaps also for cerebro-vascular deaths. More can be learnt by investigating these conditions as medical disorders, measuring the depressive and manic components quantitatively on the basis of longterm prospective studies including data on somatic disorders and biological indicators of CNS changes. The international diagnostic manuals DSM-V and ICD-11 will certainly include more dimensional perspectives in their classification.

Co-morbidity of mental disorders and physical illness: the chief challenge for medicine and psychiatry today N. Sartorius University of Geneva, Switzerland The co-morbidity of mental and physical illness is far more frequent than psycvhiatrists and other medical specialists realize. Nearly one third of long-lasting and/or severe physical illnesses – such as diabetes, cancer and cardiovascular illness will be co-morbid with depression. People with schizophrenia will suffer from all types of physical illness – with the exception of tumors and rheumatoid arthritis – much more frequently than the rest of the population. In addition to the problems arising because of the simultaneous presence of well defined mental illness in people with physical illness major difficulties also arise because of the presence of sub-threshold mental illnesses and isolated psychiatric symptoms in physically ill people. The reasons for this will be discussed in the presentation as well as some of the interventions that could be introduced to prevent or diminish co-morbidity and its severe negative consequences.

Current hypotheses on the course and neurobiology of schizophrenia H.J. Moeller University of Munich, Germany A better understanding of the neurobiology of schizophrenia has implications for treatment and outcome. The neurodevelopmental hypothesis of schizophrenia is of greatest 36


importance in the neurobiological understanding of the aetiopathogenesis of schizophrenia. This hypothesis focuses on insults to prenatal brain development, which lead to brain alterations. Premorbid cognitive disturbances as well as behavioural abnormalities are interpreted as vulnerability markers in the context of this neurodevelopmental theory and are seen as a consequence of the premorbid brain alterations. In the past years, in addition to the neurodevelopmental disorder a neuroprogressive brain disorder has been under discussion to explain the decline especially in the poor outcome subgroup of schizophrenic patients. In recent years, longitudinal brain imaging studies of populations with schizophrenia indicate that progressive brain changes are taking olace during the course of schizophrenia. In schizophrenia, grey matter decreases have been detected in temporal lobes, hippocampus, frontal lobes, thalamus, amygdala and cingulate, and abnormalities in prefrontal white matter, corpus callosum and the posterior superior temporal gyrus. It is of special interest that schizophrenia susceptibility genes and chromosomal abnormalities are associated with premorbid neurodevelopmental abnormalities. Postmortem human brain and developmental animal studies document multiple and diverse effects of developmental genes (including schizophrenia susceptibility genes) at sequential stages of brain development. Increased specificity for the most relevant environmental risk factors such as exposure to prenatal infection, and their interaction with susceptibility genes and/or action through phase-specific altered gene expression, now both strengthen and modify the neurodevelopmental theory of schizophrenia.

A biopsychosocial paradigm in psychiatry: its problems and prospects of development in Russia N.G. Neznanov St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia In modern medicine, there is a distinct tendency to a paradigm change: a nosocentric approach gives way to an antropocentric, holistic, approach. This process is most evident in psychiatry. The understanding of the fact that biological and 37


psychological reductionism cannot cover the human behaviour phenomenon or the problem of psychiatric disorders finds more and more adherents. The interest in the biopsychosocial approach is caused by a number of factors. The World Health Organization studies have shown that in many countries, a change has occurred in the structure of morbidity, mortality, and disability in population. More significant has become the role of chronic noninfectious diseases and of “way-of-livingrelated” diseases that develop owing to such factors as dynamical changes in the environment and the deformation of the way of life (a high level of psychoemotional strain at low physical activity; inefficient nutrition; ecological and humanitarian catastrophes). The developing stereotypes of the modern way of living effect negatively population’s mental health and increase the burden of public health expenditure. Along with cardiovascular diseases, anxiety and depressive disorders are becoming the foremost causes of invalidization and premature deaths. Psychiatric disorders make up 5 out of 10 major causes of disability, which were measured using lifespan indices. The data presented reveal the vulnerability of the existing approach to the study of mental disorders and the consequent errors in the organization and forms of rendering care to the mentally ill. It becomes evident that the medical paradigm whose fundamentals were developed by E. Kraepelin is not effective: the “multicausality” concept has its advantages in theoretical and practical aspects. The principle tendency in the change of the organizational foundations of psychiatric care is deinstitutionalization and decentralization, integration of psychiatry with other fields of medicine, and expansion of psychiatry into various spheres of vital activity of healthy persons. It becomes quite obvious that there is a necessity of a polyprofessional approach, primarily, to task-solving in psychosocial therapy and rehabilitation, as well as in increasing the role of microsocial environment in this process. However, investments in mental health will become effective in terms of decreasing the burden of public health expenditure only in case if the strategic approach of the state policy to health care issues overcomes the barrier of treatmentand-prevention services and provides for measures intended for the entire population. 38


Symposium 1. Epistemology and methodology of psychiatry Organized by WPA Section on Philosophy and History Chairs: German Berrios (UK), Drozdstoy Stoyanov (Bulgaria)

General abstract This joint symposium will be co-sponsored by the “Philosophy and Humanities” and “History of Psychiatry” Sections of the WPA. The main objective is to gain comprehensive understanding of aspects in the epistemology of psychiatry. The contributions come from diverse Eastern and Western cultural and historical backgrounds: Russia, Bulgaria, United Kingdom, Italy, and USA. In this context there will be papers on such critical topics as history of the “philosophies of psychiatry” (Berrios), borderline psychiatry as defined in ancient philosophy and medicine (Ovsyannikov and Morozov), scientific neuropsychiatry and bridging of the explanatory gap with the vehicles of convergent cross-validation (Stoyanov, Machamer, Schaffner), categorization and causal reasoning in psychiatry (Gurova), time and polarities in phenomenological psychopathology (Popov); historical and epistemological shifts in DSM (Aragona), the concepts of reification (Markova) and reflexivity (Smith) as applied in psychiatry. The proceedings of the joint meeting might be published as a special issue of the Journal “History of Psychiatry”.

The history of the “philosophies of psychiatry” G.E. Berrios University of Cambridge, UK The history of the “philosophies of psychiatry” can be defined as the contextualized analysis of the origins and vicissitudes of views developed in the Western world to make sense of the diverse phenomena of “mental disorder” (sensu lato). Such an analysis focuses on the conceptual structure, social appurtenances and aesthetic and moral warrants of such views. 39


The philosophy of psychiatry can be undertaken in a centripetal or centrifugal fashion. Those practising the centripetal style will make use of off-the-shelf philosophies to identify, configure, classify and resolve the problems of psychiatry. Throughout the years, animism, vitalism, phenomenology, logical empiricism, analytical philosophy, etc., have all been resorted to. With varied degree of success, the centripetal way has been tried by both professional philosophers and clinical psychiatrists. Although technically impeccable, the offerings of the former are often off the mark simply because they lack the knowledge by acquaintance with the phenomena of madness, and often enough their contribution is reduced to generalities concerning the philosophy of mind. The latter, on the other hand, rarely offer more than syncretistic solutions (currently re-branded as “pluralism”!), that is, mixtures of fragments taken from different philosophical systems. On the other hand, the centrifugal way proposes that the philosophical analysis starts in the very centre of psychiatry and works out her problems from the inside out. This method requires that a metalanguage be constructed to name, organize and interpret the findings. The centrifugal philosopher will need a first-hand familiarity with the subject-matter of psychiatry because he/she will have to confront issues concerning the understanding of the concept of mental symptom; the internal structure of “mental disorders”; the analysis of the grammar of psychiatric practice; the roles of reflexivity, intersubjectivity and reification in the constitution of the psychiatrist-patient relationship, the epistemological capacity of neuroimaging to capture mental symptoms etc. Solutions to these problems do not exist ready-made nor can they be imported from the philosophy of mind or from general causality theory or from any other external source. They must be original, fresh, and intelligible to psychiatric practitioners. Whether centripetal or centrifugal, the philosophy of psychiatry can be undertaken ante rem, i.e., early in the process of becoming acquainted with the phenomena of madness, or post rem, i.e., as an exercise in justification of whatever object has been created by empirical research. Those who practise the latter approach seem to assume, for example, that biological psychiatry (one of the current sources of such 40


empirical findings) is a non-ideological activity whose “discoveries” are an exact picture of the world. This assumption is unwarranted given that in psychiatry all “empirical” findings are epistemologically dependent upon an object of inquiry which has been primarily and originally constructed in terms of social, moral and aesthetic criteria.

Categorization and causal reasoning in psychiatry: what a study of “understanding it makes it normal” alleged fallacy reveals L. Gurova Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria The instability of psychiatric diagnoses has been broadly recognized as a serious problem for both theoretical psychiatry and clinical practice. Much hope for solution of this problem is set on the efforts to improve the categorical structure and definitions of current nosological systems as well as on revealing the biological etiology and pathophysiological mechanisms of mental disorders. The aim of this paper is to draw the attention to another source of instability/divergency of psychiatric diagnoses: the dependence of symptom-identification process on the causal context of the assessed symptomatic behavior. It will be shown that the causal context effect: – is confirmed by experimental studies of clinician’s decision making in presence/absence of a plausible causal story explaining the assessed behavior as well as by meta-studies of clinical documentation of real case-studies; – is transparent for the current nosological systems DSM-4 and ICD-10 (in the sense that they cannot cope with it); – cannot be eliminated neither by improving the categorical structure of current nosological systems, nor by obtaining more detailed knowledge about the genetic or neural basis of the estimated behavior. All this is presented as a rationale for a plea for a more focused research on the epistemology of symptom recognition processes.

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Reflexivity in the history of psychiatric knowledge: some reflections R. Smith Institute of Psychology, Russian Academy of Sciences, UK A number of philosophers (e.g., R.G. Collingwood, Stuart Hampshire) have held that what divides the natural and human sciences is the reflexivity of knowledge in the latter – knowledge of the object, where it is a person, changes that object. Ian Hacking called this phenomenon “looping”: “People tend to conform or to grow into the ways that they are described”. The illnesses which fall within psychiatry’s remit offer exemplary borderline material for examining this further, as in Hacking’s studies of multiple personality disorder, abuse and autism, and in Allan Young’s historical ethnography of PTSD. If reflexivity is taken seriously, I would argue, it is not possible to use it as a criterion for separating the natural and human sciences and, a fortiori, for separating certain illnesses (like MPD and PTSD) from others in which there is believed to be knowledge of a “real” biological base. Such a separation would revert to an untenable dualism, with all the old problems of saying how mental events could influence physical ones, and vice versa. This leaves a number of options. The first, the reductionist predilection of biological psychiatry, is to demonstrate the organic basis of disorders and to deny the status of illness to those cases which do not show such a basis. But both the recurrence of functional disorders (from melancholia to attention deficit disorder) and the phenomenon of “looping” question the adequacy of this route. The second, often conceived as the opposite of the first, is a strong programme of epistemological relativism – a demonstration of the social and historical construction of all categories of disorder, along with argument that reflexivity is a general feature of epistemology, not special to knowledge of certain subjects. The third option is to recognise our “chronic uncertainty” in relation to these philosophical, ultimately metaphysical, matters. Following Michael Lynch’s response to the so-called “science wars”, we may say that the first two options “fail to acknowledge the long history of debate, the extensive background of scholarship, and the chronic uncertainty associated with these questions”. 42


The third option leads in a number of directions. Inter-disciplinary work may be what we need, work which holds “fundamental” questions, which centuries of wrangling have not settled, in abeyance, while drawing existing intellectual resources into dialogue. For example, there is a literature, based on considerable historical research, about the historicity of psychological categories (such as intelligence, memory and emotion). This clearly parallels studies in the epistemology of psychiatric knowledge. As a second example, there is work on narrativity (as used by Peter Barham on psychiatric material) which promotes discussion of all human states in terms of their place in our meaning establishing symbol systems. And so on. The question then is what form of institutional support, what constructive pluralism, will make progress in the midst of epistemological uncertainty?

The DSM system I to V: historical and epistemological shifts M. Aragona La Sapienza University Rome, Italy The claim that the DSM-III was atheoretical powerfully conveyed the idea that it is possible to simply describe psychopathological symptoms, intended as mere natural facts to be ordered in diagnostic categories. However, there are hidden philosophical/theoretical commitments at the base of the DSM-III, and it was suggested that they are in crisis. Accordingly, the debate on DSM-V should consider the possibility of a yet unclear paradigm shift. In order to understand what is basically wrong with the current diagnostic system, the history of its fundamental theoretical assumptions is needed. Here the historical reconstruction of the road from DSM-I to DSM-V will follow three line of reasoning. The first will focus on the language. For example, the deletion of terms such as reaction and neurosis from the DSM-III is a clear indication of the theoretical reaction against psychodynamic theories. The second will consider the psychopathological theory underlying the DSM-III (neokraepelinianism). The core assumption was that validity would have followed reliability. DSM-III diagnoses were implicitly considered as natural entities (by means 43


of reliable descriptions the nature could be “carved at its joints”), of which later research would have discovered the underlying aetiology. The third level will focus on the neopositivist theory of scientific meanings underlying the DSM-III. The neopositivist debate on classification specifically studied the first edition of the DSM as an example to be discussed. The specific way mental disorders were organized in the DSM-III was based on this critique. Conclusions will focus on the following points: a) The concept of mental disorder in the DSM-III and later editions is technically specific. Its concrete application is responsible of current anomalies that the DSM-V will be probably unable to solve. b) Of the two major theories underlying the “atheoretical” DSM, namely the neopositivist-derived view on how to operationalize scientific concepts and the neoKraepelinian view on objects and purpose of a psychiatric classification, the former is responsible of the emergence of anomalies, whereas the latter seems to be the one that enters in a state of crisis because these anomalies conflict with its basic tenets. c) All this calls for a radical rethinking of the psychiatric nosology that should include a new approach to descriptive psychopathology (aware of the constructive nature of mental symptoms) and the appraisal of the self-implosion of neopositivist theories of scientific meanings (thus needing a study of alternative models).

In quest for scientific status of psychiatry: towards bridging the explanatory gap D.S. Stoyanov1, P.K. Machamer2, K.F. Schaffner2, 3 1 Department of

Health Care Management, University of Medicine, Plovdiv, Bulgaria

2 Department of

History and Philosophy of Science, University of Pittsburgh, USA

3 Department of

Psychiatry, University of Pittsburgh, USA

The contemporary epistemic status of mental health disciplines does not allow the cross validation of mental disorders among various genetic markers, biochemical pathway or mechanisms, and clinical assessments in neuroscience explanations. We attempt to provide a meta-empirical analysis of the contemporary status of the cross44


disciplinary issues existing between neurobiology and psychopathology. Our case studies take as an established medical mode an example cross validation between biological sciences and clinical cardiology in the case of myocardial infarction. This is then contrasted with the incoherence between neuroscience and psychiatry in the case of bipolar disorders. We examine some methodological problems arising from the neuro-imaging studies, specifically the experimental paradigm introduced by the team of Wayne Drevets. Several theoretical objections are raised: temporal discordance, state independence, and queries about the reliability and specificity, and failure of convergent validity of the inter-disciplinary attempt. Insofar both modern neuroscience and clinical psychology taken as separate fields have failed to reveal the explanatory mechanisms underlying mental disorders. The data acquired inside the mono-disciplinary matrices of neurobiology and psychopathology are deeply insufficient concerning their validity, reliability, and utility. Further, there haven’t been developed any effective transdisciplinary connections between them. It raises the requirement for development of explanatory significant multi-disciplinary “meta-language” in psychiatry. We attempt to provide a novel conceptual model for an integrative dialogue between psychiatry and neuroscience that actually includes criteria for cross-validation of the common used psychiatric categories and the different assessment methods. The major goal of our proactive program is the foundation of complementary “bridging” connections of neuroscience and psychopathology which may stabilize the cognitive meta-structure of the mental health knowledge. This entails bringing into synergy the disparate discourses of clinical psychology and neuroscience. One possible model accomplishment of this goal would be the synergistic (or at least compatible) integration of the knowledge under transdisciplinary convergent cross-validation of the commonly used methods and notions.

Study of time and opposites in phenomenological psychopathology G. Popov Medical University of Varna, Bulgaria The target of this study were different aspects of personality polarity and opposites of mental life as well as aspects of time experience in psychopathology in 45


relation with cognitive processes on a macro- and a micro brain level. They were examined through clinical-phenomenological, psychological and social-psychological approaches. On this basis theoretic models of mental functioning in norm and pathology had been created. The study was multidisciplinary and complex. Clinical-phenomenological, psychological

and

social-psychological

methods

had

been

used

and

a

phenomenological approach together with neuronal-cognitive points of view had been applied in the analysis of dates. Nine investigation modules fell in the range of this study. Each module focused specific problems while there was thematic and methodological relation between the modules to ensure continuity in solving the investigation tasks. The first module described the formation and the integration of personality structure of polarity signs, included signs that reflected the temporal structure of personality as well. Individual differences existed in the correlation balanced-nonbalanced polarity sign couples. The non-linear character of personality structure was discussed. The second and the third modules presented the assessments of time intervals, of “quick-slow” time lapse, of intention to past, presence and future and their segmentation investigated in five psychiatric diagnoses as well as in diabetic patients. Time passed considerably more slowly in depressive patients predominantly directed to past. Applying the model of presence, proposed by E. Husserl, the fourth module studied time experience as presence. The used investigation method achieved well defined outlines of the eventful specificity of the center of presence (now) and of its periphery in patients with neurosis and anxiety disorders. The fifth module investigated autobiographic memory and time experience in schizophrenia in the context of eventful past. Statistically considerable disturbances related also to space presentation of events from the past had been discovered. Data revealed disturbances in the structure of event and from this point of view relations between sign and symbol and particularities of the so called symbolic thinking in schizophrenia were analyzed. 46


From a clinical-phenomenological point of view the sixth module referred to the time experience and its relationship with space experience in patients with schizophrenia and depression. The seventh module was dedicated on the presentation of the social (interpersonal) time particularities in three diagnosed groups of patients. The schizophrenic group showed the greatest difficulties given in imprecise assessment of past and even more discriminating inaccuracy regarding the future. The eighth module analyzed the experience and the assessment of age in alcohol addicted patients. It found desynchronization between chronological, biological, psychological and social age. The last ninth module presented the development of theoretic models related to non-linear character of psychological time and personality structure as well as to revalidation of conceptions on causality in psychiatry and on balance in mental activity on the basis of the theory of brain as a complex, nonlinear and dynamic system. A well grounded definition of a fundamental principle in the functioning of mental life termed by “dozed instability” was given as well.

Borderline psychiatry ideas formed in ancient psychiatry (historical and epistemological aspects) S.A. Ovsyannikov1, P.V. Morozov2 1 Moscow

State University of Medicine and Dentistry, Russia

2 Russian State Medical University, Moscow,

Russia

Ancient medicine and philosophy (especially ethics) were inseparably connected. Many ancient philosophers were physicians at the same time (Pythagoras, Empedocles, Aristotle, Zeno, Galen and others). This made possible the introduction of such terms as “morality”, “harmony of soul”, “euthymia”, “temperament”, “character” to indicate the conditions mental health and compare these conditions with the slight deviations of mental and behavioral disorder. It has facilitated the determination of a prototype for the future doctrine of neuroses and personality disorders. 47


Reification in psychiatry I.S. Markova Hull University, UK This paper will be about the relevance of the concept of reification to psychiatry in general and to the concept of mental symptoms in particular. In very general terms, “reification” has been defined as “the mental conversion of a person or abstract concept into a thing…” (OED, 2nd edition). The term has been used in English at least since the 1840s, although the concept (navigating under different words) has been around for longer. The concept of “reification” gained international currency in the work of Karl Marx where together with the broader notions of alienation, commodity, commodification and fetishism became part of his complex analysis of the social ills as caused by the capitalist economy. In 1923, the Hungarian philosopher George Luk|cs extricated the concept of reification (Verdinglichung) from the Marxian model and proposed it as a privileged platform for the development of a form of Marxism that, by preserving notions such as consciousness and intersubjectivity, was more palatable to the West. Adorno and Horkheimer retook the concept in an important work first published in 1944 and suggested that reification was one of the consequences of the ineluctable advance of the process of rationalization in the West. Habermas tried to rescue “reification” from this conceptual morass by reconceptualizing it in terms of his theory of “communicative action”. It remains to be seen whether this move has been successful. What is clear is that he did not reconnect reification with its economic origins. Honneth, the current representative of the Frankfurt School, has focused more on the psychological mechanisms that might be underlying the process rather than on possible causative factors. It will be the aim of this paper to explore how these concepts of reification apply to aspects of psychiatry such as mental symptom, the doctor-patient relationship, the language of description of psychiatric practice, etc. and how reification has also 48


become the prime mover in the process whereby mental disorders are being reduced without residuum to brain dysfunctions. Given the limitations of time, this paper will focus on some examples only, particularly the way in which mental symptoms – known to result from a delicate intersubjective negotiation between the clinician and his/her patient – are reified into “objects”, “items”, “natural kinds” or “phenotypes”, that is, into little more than stereotyped forms of reflex action. In practice, this means that the meaning of mental symptoms can now be fully explained in terms of putative correlations with brain sites/functions. Some may want to justify this reductionism of mental symptoms in a number of ways; for example, it can be claimed that it is due: 1) to the progress of neuroscience or of the philosophy of mind, or 2) to the abandonment of naïve and old-fashioned Cartesian dualism; or indeed combinations thereof. The hypothesis proposed in this paper is that such reductionism is an expression of the broader process of reification of human relationships and subjectivity that started to occur in the Western world during the early 19 th century, and that this process relates, inter alia, to the processes of rationalization of the Western world (in Adorno’s sense) and to the consumerist needs of the ongoing economic system whose survival depends upon the commodification of all forms of social life (including health, art, education, entertainment).

49


Symposium 2. Understanding the pathogenetic mechanisms of mental disorders Chairs: Vladimir Chekhonin (Russia), Marat Uzbekov (Russia), Yogesh Dwivedi (USA) Abnormalities of glial cells in schizophrenia: findings from postmortem studies N.A. Uranova, V.M. Vostrikov, N.S. Kolomeets, O.V. Vichreva, I.S. Zimina, D.D. Orlovskaya Mental Health Research Center, Moscow, Russia Introduction: Neuroimaging and postmortem studies provide evidence for abnormalities of glial cells in schizophrenia (SZ) and mood disorders. Both neuroimaging and microarray studies detected myelin and oligodendrocyte abnormalities in gray and white matters in SZ. Methods: Electron microscopy, Nissl staining and morphometry were applied to study glial cells. Results

and

Discussion:

Dystrophic

changes

and

degeneration

of

oligodendrocytes, the most severely affected cells, were detected in the PFC, caudate nucleus (CN) and hippocampus in SZ. Prominent deficit of oligodendrocytes in gray and white matters of the PFC were found in SZ as compared to normal controls, including lowered number of oligodendroglial satellites of pyramidal neurons and of pericapillary oligodendrocytes. Oligodendroglial deficit was shown in gray matter only in SZ subgroup with predominantly negative symptoms. The proportion of myelinated fibers with atrophy of axon and swelling of periaxonal oligodendrocyte process increased significantly in PFC, CN and hippocampus in SZ as compared to controls. Region-specific deficit and decreased size of nucleus of microglial cells were revealed in CN in SZ subgroup with predominantly negative symptoms and in the subgroup of familial SZ. Microglial reactivity was found to be involved in the pathology of 50


myelinated fibers in SZ: volume fraction (Vv) of microglia correlated significantly negatively with the proportion of pathological of myelinated fibers in CN in SZ group but not in controls. Reduced number of mitochondria in astrocytes in CN and in oligodendrocytes in CN and in PFC was found in SZ. Vv of mitochondria in astrocytes in the hippocampus correlated significantly negatively with duration of SZ. Since alterations of myelinated fibers in SZ are associated with atrophy of axons and of presynaptic axon terminals, they might contribute to altered neuronal connectivity and atrophy of neurons in SZ. Conclusion: A key role of glial abnormalities in the pathophysiology of SZ is proposed. Supported by the Stanley Medical Research Institute.

Tardive dyskinesia and polymorphisms of dopamine D3, serotonin 2A and 2C receptors in Russian schizophrenic inpatients S.A. Ivanova1, A.F.Y. Al Hadithy2, P. Pechlivanoglou3, A. Semke1, O. Fedorenko1, E. Kornetova1, L. Ryadovaya1, J.R.B.J. Brouwers3, B. Wilffert3, R. Bruggeman3, A.J.M. Loonen3 1 Mental Health Research Institute SB RAMSci, 2 Erasmus MC,

Hospital Pharmacy, Rotterdam, the Netherlands

3 University of

Background:

Tomsk, Russia

Tardive

Groningen, Groningen, the Netherlands dyskinesia

(TD)

is

a

potentially

irreversible

antipsychotic-induced movement disorder with a prevalence of about 20–30% in psychiatric patients chronically exposed to antipsychotics. Dopamine D 3, serotonine 2A, and 2C receptors (DRD3, HTR2A, and HTR2C genes, respectively) are involved, at least partially, in the therapeutic and adverse effects of antipsychotics. Genetic variations in these receptors may therefore affect the individual sensitivity to TD. Tardive dyskinesia may be dissected in two phenotypically distinct subsyndromes, orofaciolingual dyskinesia (TDof) and limb-truncal dyskinesia (TDlt). Polymorphisms of dopamine D3 (DRD3), serotonin 2A (HTR2A) and 2C (HTR2C) receptors have been studied in relation with TD in various ethnic groups, but not in Russian. 51


Purpose: To investigate the association between TDof and TDlt and known polymorphisms of DRD3, HTR2A, and HTR2C (Ser9Gly, -1438G>A, and Cys23Ser, respectively) in Russian psychiatric inpatients from Siberia. Methods: After approval of the study protocol by the institutional bioethics committee, subjects were included. DNA extraction and TaqMan genotyping were conducted according to standard protocols. Subjects were characterized either as carriers or non-carriers of an allele. The sum of the first 7 items of the Abnormal Involuntary Movement Scale was utilized as a proxy for the severity of TD (TDsum). Multivariate parametric regression and two-part models were performed to identify the effect of different variables (allele-carriership status, age, gender, type of psychiatric department, use of anticholinergic and antipsychotic medication) on TD. Results: In total 146 Russian Caucasians patients (91 males, 55 females) with an age of 46.8 ± 17.6 years (sample mean ± SD) met the inclusion criteria. Seventy-nine (54%) subjects were included from a psychiatric department for permanently hospitalized, severely ill patients. The remaining 46% were less-severely ill inpatients from a psychiatric department for temporal hospitalization. About 95% of the patients had clinically-established schizophrenia (n = 138) and only 5% had schizotypical disorder (n = 8). The genotype distributions of Ser9Gly (69 Ser9/Ser9, 67 Ser9/Gly9, and 9 Gly9/Gly9) and -1438G>A (62 GG, 68 GA, and 14 AA) were in agreement with Hardy–Weinberg

Equilibrium.

The

genotype

distribution

for

Cys23Ser

(X-

chromosomal) was: 116 Cys23/Cys23, 14 Cys23/Ser23 and 13 Ser23/Ser23. Parametric regression showed that carriership of Gly9 (DRD3) and Ser23-alleles (HTR2C) offer the highest explanatory power among all of the variables studied. These 2 polymorphisms may however act in opposite directions. Whereas carriers of Gly9allele may have 36% higher TDsum values (p = 0.022), carriers of Cys23-allele exhibited 30% lower TDsum values (p = 0.035). Furthermore, two-part model analyses showed that carriership of Gly9 or -1438A-alleles may be associated with 2,5–2,8 folds higher risk of having a TDsum > 0 (p = 0.048 and p = 0.026, respectively). Conclusions: None of the polymorphisms studied predict clinically present TDof or TDlt. Ser9Gly and Cys23Ser polymorphisms may however affect the 52


phenotypic variability of TDlt, but not that of TDof. Our findings reproduce and extend previously published pharmacogenetic data on TD.

What can we learn from albumin subnanosecond spectroscopy research to understanding of pathophysiology of mental disorders? M. Uzbekov1, T. Syrejshchikova3, Yu. Gryzunov2, G. Dobretsov2, N. Smolina1,2, N. Maximova1, A. Komar3, I. Gurovich1, A. Shmukler1, V. Tokarev4, E. Misionzhnik1, O. Vertogradova1 1 Research Institute of 2 Research Institute of

Physical-chemical Medicine,

3 Lebedev Physical Institute of 4 Moscow

Psychiatry,

Russian Academy of Sciences ,

and Russian Federal Nuclear Center – All-Russian Research Institute of Experimental Physics, Sarov, Russia

Objective: Human serum albumin (HSA) is the main extracellular transport protein of the body. Conformational changes of SA binding sites in pathology can disturb its main functions. Detection of these changes can be useful for the assessment of patient’s state and for elucidation of some pathogenetic mechanisms of mental disorders. Aim: In this work the possibility of the use of a time-resolved fluorescence technique as a molecular tool for detection of HSA conformational changes in mental disorders has been studied. Methods: Serum of 22 first-episode drug-naïve of schizophrenic (FES) patients and 10 patients with anxious depression (AD) as well as 7 healthy volunteers were examined. The basic method of research was subnanosecond laser fluorescent spectroscopy. That is a technique in which single emitted photons are detected after excitation of protein-bound fluorophore with shot laser pulse of 10-10 sec. Properties of albumin binding sites were examined with albumin – specific probe K-35 (Ncarboxyphenylimide of dimethylaminonaphthalic acid, CAPIDAN) at different ionic composition of medium. CAPIDAN selectively binds with and fluoresces from albumin. 53


Fluorescence decay technique with resolution of 2 × 10-10 sec (subnanosecond range) and special method of decay amplitude analysis were used. Results: It has been found that CAPIDAN was bound by several sites on albumin globule. From three of them fluorescence decay time of CAPIDAN was 9, 3 and 1 nanoseconds (sites named as A9, A3 and A1, respectively). Changes of media (ionic strength, ionic composition) influenced differently on these centers. There were no differences in values of fluorescence of CAPIDAN from albumin between FES patients and controls using steady-state fluorescence spectroscopy. Using the technique of time resolution in accordance with changing ionic strength of media there were found significant differences between amplitudes of the probe bound with albumin A3 sites of FES patients and controls. Serum of 10 AD patients was investigated before and after the pharmacotherapy using the same technique: analysis of the data has revealed the differences between amplitudes of fluorescence decay values of CAPIDAN bound with A9 and A3 sites at the level of significance of p < 0.01 and p < 0.05, respectively. Analysis of the data has pointed out that on the albumin molecule exist sites the 4 th type with fluorescence decay time in the range of 0.1–0.2 nanoseconds or less and that this sites can be responsible for binding of about 25–40% of the probe. Sites of the 4th type can be assumed as a new potential source of useful information on albumin conformational changes in mental disorders: to solve this problem time resolution of the technique should be developed to 10-11 sec. Conclusion: Changes in albumin conformation influence significantly on CAPIDAN probe fluorescence decay kinetics in subnanosecond time range. Subnanosecond fluorescence technique in combination with albumin – specific fluorescent probe and variations of ionic composition of the medium can be assumed as a perspective molecular tool for investigation of pathophysiological mechanisms of mental disorders and for prognosis and evaluation of efficacy of pharmacotherapy. Study was supported by International Science and Technology Center (ISTC), grant № 3156, and by the grant of Presidium of Russian Academy of Sciences – Fundamental sciences to medicine.

54


Differential regulation of neurotrophins and their cognate receptors in suicide brain: implication for suicide predisposition Y. Dwivedi University of Illinois at Chicago, USA Background: Neurotrophins mediate diverse biological responses, including synaptic and structural plasticity. Recent studies suggest that neurotrophins may play an important role in pathophysiology of depression and suicide. Neurotrophins are unique in using two different classes of cell surface receptors to exert their neuronal functions: 1) Trk receptors (A, B, C), and 2) p75NTR. Trk activity is essential for the majority of the responses to neurotrophins, however, p75NTR, which lacks intrinsic activity, can transmit both positive and negative signals depending upon activation/expression of Trk receptors, such that p75 NTR can mediate neuronal apoptosis when Trk receptor is less expressed/activate. Thus, the expression ratio of p75NTR/Trk receptors is critical in neurotrophin-elicited functions. Methods: We examined expression of neurotrophins BDNF, NGF, NT-3, and NT4/5 as well as expression and activation of their cognate receptors Trks and p75NTR in prefrontal cortex and hippocampus of suicide and non-psychiatric normal control subjects. Results: We observed lower expression of BDNF, NGF, NT-3, and NT4/5 in suicide subjects in a brain region-specific manner. We also observed that expression of TrkA, B and TrkC were lower, whereas, expression of p75NTR was higher in both PFC and hippocampus of suicide subjects. In addition, phosphorylation and therefore activation of all Trk receptors was decreased in these brain areas of suicide subjects. Importantly, we observed increased expression ratios of p75NTR vs. Trks. Conclusions: Reduced expression of neurotrophins and reduced expression and activation of Trk receptors indicate aberrant neurotrophin-mediated response in suicide brain. Additionally, increased expression ratios of p75 NTR/Trks suggest hyperactivation of apoptotic regulatory pathways. Given the role of neurotrophins in neural plasticity phenomenon, these findings are crucial and suggest their possible involvement in pathogenic mechanism of suicide. 55


Supported by ROMH168777, R21MH81099, R01082802, American Foundation for Suicide Prevention, and NARSAD.

Cytokine profile of patients with paranoid schizophrenia V.P. Chekhonin, O.I. Gurina, S.N. Oskolkova, G.A. Fastovzev, I.A. Ryabukchin, O.M. Antonova, A.V. Semenova V.P. Serbsky National Research Centre for Social and Forensic psychiatry, Moscow, Russia In an attempt to define potential immunological dysfunctions in paranoid schizophrenia, we determined the production of inflammatory and anti- inflammatory cytokines (IL-1β, IL-2, IL-4, IL-6, IL-10, γ IFN and αTNF) in supernatants of peripheral mononuclear cell cultures of patients by quantitative immune enzyme analysis. Methods: Peripheral blood mononuclear cells (PBMC) were isolated from 35 patients with exacerbation of paranoid schizophrenia and 25 control subjects (somatic healthy and mentally sane people) using the Ficoll-Hypaque method. PBMC cultures were

stimulated

with

phytohemagglutinin

(PHA;

10

microg/ml)

and

lipopolysaccharide (LPS; 10 microg/ml) during 6 hours. All cytokines were analyzed in the cell culture supernatants by solid phase immune enzyme method with comercial test-systems (Bender-Med-Systems GmBH, Austria). Results: Significant increase of the αTNF and decrease of the IL-4 levels in supernatants of patients with acute exacerbation of paranoid schizophrenia were detected. At the same time quantitative variations of the IL-1β, IL-2, IL-6, IL-10 and γ IFN in this patients weren’t significant. The obtained results allow recommending the quantitative immune enzyme analysis (ELISA) of the αTNF and IL-4, as well as their ratio (αTNF/IL-4) as an early diagnostic criteria of the paranoid schizophrenia exacerbation.

56


Neural mechanisms of sensory gating: novel findings with magnetoencephalography (MEG) J.M. Canive1, 2, J.C. Edgar3, A.K. Smith1, M.X. Huang4, G.A. Miller5 1 Center for Functional Brain Imaging, New

Mexico VA Healthcare System,

Albuquerque, NM, USA 2 Department of

Psychiatry, University of New Mexico, Albuquerque, NM, USA

3 Department of Radiology,

Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, PA, USA

4 Department of

Radiology, San Diego VA Health Care System and University of California, San Diego, California

5 Departments of

Psychology and Psychiatry and Beckman Institute Biomedical Imaging

Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA Introduction: The auditory paired-click paradigm has been used to study auditory processes in schizophrenia. An increased ratio score (second click [S2]/first click [S1]) is frequently observed in schizophrenia, and the finding has been widely replicated. However, fundamental questions remain: (1) Do control and patient ratio score differences reflect encoding (S1) or gating (S2) abnormalities of the 50 and 100 ms event-related potential (ERP) components? (2) What are the neural sources of these ERPs? (3) Do the sources differ across diagnostic groups? (4) Since equivalent current dipole (ECD) has been the most common source localization method, what do novel source localization algorithms, such as Vector Based Spatial Temporal Algorithm (VESTAL), contribute to understand the neural processing deficits in schizophrenia? The present study examined 50 and 100 ms amplitude and ratio scores in electroencephalographic (EEG) and magnetoencephalographic (MEG) recordings to better understand the abnormal paired-click activity in schizophrenia. Methods: EEG Cz and whole-cortex MEG data were acquired during the standard paired-click paradigm in 73 controls and 79 patients with schizophrenia. Paired-click amplitude and ratio scores were obtained at 50 ms (P50 at Cz, sourcelocalized M50 at left and right STG) and 100 ms (N100 at Cz, source-localized M100 at left and right STG). Additional pilot work from three controls and five patients with 57


schizophrenia analyzed via VESTAL illustrates the advantages and contributions of this new method. Results: Cz P50 ratio scores were larger in patients, with no group differences in either P50 S1 or S2 amplitude. There was a Group by Hemisphere interaction, where the M50 gating ratio was larger (worse) in the left than in the right in the schizophrenia group. S1–S2 group differences were observed. Cz N100 ratio scores were larger in patients, with a smaller N100 S1 response in patients than controls. For STG M100, ratio score group differences were observed bilaterally, due to a smaller S1 response in patients. Whereas STG areas were consistently and intensely activated from approximately 30 to 70 ms in controls, STG activity was more weakly and more sporadically active during the same period in patients. Discussion: P50 and M50 ratio score group differences were not explained solely by either a pure encoding deficit (driven by S1) or a pure gating deficit (driven by S2). Interpretation of the 50 ms ratio score group differences across hemispheres remains unclear and requires further study. N100 and M100 ratio score group differences were accounted for primarily by S1, suggesting an encoding deficit. These results suggest the need to examine both ratio and component scores. VESTAL data suggest that prefrontal activation serves as a compensatory mechanism for gating, such that in patients with SZ PFC areas work to overcome processing failures in primary auditory cortex. However, the data also indicate complex interactions between PFC activity and failures in primary auditory areas to properly filter redundant information. The use of MEG alongside EEG provides greater specificity of findings.

58


Symposium 3. The protection of the rights of persons with mental illness who are legally incapable Organized by Independent Psychiatric Association of Russia Chairs: Yury Savenko (Russia), Yury Marchenko (Hungary), Dmitry Bartenev (Russia) Implementation of the international legal capacity standards in Central and Eastern Europe D. Bartenev1, Y. Marchenko2 1 Mental Disability Advocacy Center,

St. Petersburg State University, Russia

2 Mental Disability Advocacy Center,

Hungary

Guardianship system in many post-soviet countries is based on plenary (all encompassing) approach to restriction of the rights of individuals subject to deprivation of their legal capacity. The 2006 United Nations Convention on the Rights of People with Disabilities (CRPD) provided a paradigm shift in defining legal capacity of people with disabilities, including those with mental health or intellectual problems, by requiring the states to take appropriate measures to provide access by persons with disabilities to the support they may need in exercising their legal capacity. Recent legislative and policy developments in the Central and Eastern European countries have demonstrated various approaches to the implementation of the CRPD standards aimed at ensuring that the least restrictive alternatives to legal incapacity are put in place and supportive mechanisms are tailored to the person’s circumstances. Thus, the presentation considers different models of limited capacity for people with mental disabilities and mechanisms for preventing conflict of interests between persons subject to limitation of their capacity and their guardians. The presentation argues that similar legislative approaches can be adopted within the existing framework of the Russian civil and mental health legislation. Recommendations are presented in the conclusion to guide

59


the lawmakers and mental health professionals on how to bring the measures of protection for incapable adults in Russia in conformity with the CRPD standards.

Changes in guardianship law and its’ implementation in Estonia 2002–2009 E. Pilt Estonian Patients’ Advocacy Association, Estonia Estonia inherited the soviet system of psychaitric care as well as the system of guardianship and custopdy under people with mental disorders. In 2002 subjected persons lacked totally their procedural rights: they did not receive any information about court procedures; they had no oportunity to be personally heard by the court; they were not present at the court hearing and had no legal representation; they did not receive their court judgments and had no possibility to file appeal; guardianship was usually plenary and appointed for lifetime; in many cases psychiatrists appointed by the court did not meet subjected persons in person; in many cases psychiatric assessments were based solely on medical diagnosis. The Estonian Patients’ Advocacy Association (EPAA) has made a lot for changing this practice and for improving protection of mentally desabled persons’ rights. The analysis of the results of its activities starting from 2002 and of major changes in guardiansip law shows that the great step forward has been done, but it’s nesessary to continue working.

Analysis of Russian legislation on incapability Y. Argunova Independent Psychiatric Association of Russia Monitoring analysis of Russian laws and regulations, that regulate rights of people with mental disorders, shows that they have some very important defects concerning institute of legal incapability. The principles of the institution of legal incapacity in the Russian Civil legislation do not recognize, so far as this is possible, an 60


existence of different degrees of legal incapacity as well as probable variation of legal incapacity within time. Measures of protection are automatically related with total civic incapacitation without any time limits. Accordingly, the Russian legislation does not provide a proper regulation of legal status of disabled person fully dependable upon the guardian (or upon the facility vested with tutorial functions) and being essentially in his power. And besides there is an unjustifiable restriction of the possibility to protect the rights of legally incapable in the Law, there is no procedure of citizen’s acknowledgement legally capable in Civil Code; consideration of the case on acknowledgment of citizen sui juris can be in absentia. It is evident that Russian laws in this sphere don’t correspond to the Convention on Protection of Human Rights and Fundamental Freedoms, as well as to the Recommendations of the Ministerial Committee of Council of Europe “On principles of legal protection of legally incapable adults” and other generally accepted principles and norm of international laws and they urgently need substantial reforms.

Problems of forensic-psychiatric evaluation of incapability L. Vinogradova, Y. Savenko Independent Psychiatric Association of Russia Medical evaluation on citizen’s mental health is an important factor in the procedure of recognizing a person legally incapable. In Russia at the present time it is the main and crucial argument, because Russian courts don’t agree with the doctors’ opinion and make their decision on the basis of analysis on additional factors in 4% only. In this connection conclusions of forensic psychiatric evaluation on cases of incapability become critically important. Meanwhile Russian forensic experts similarly to hyper diagnostics of schizophrenia in 1960–1980-ies are distinct in hyper diagnostics of incapability, accounted it as a mean of protection. The typical errors in this sphere are the followings: conducting medical evaluation in the absence of detailed information about people social functioning, recognizing incapable for social goals, making decision while a person is in acute condition, neglect of age factor, conditions of life and development, etc. The most vulnerable groups in this regards 61


become young people who were raised in close children facilities and old people living in families with conflict relations. With a goal of establishment a balance between observance of human rights and introduction of necessary restrictions the possibility of “partial incapability” is considered and recommendations for revising of criteria for incapability are proposed.

Guarantees of civil rights at rendering psychiatric assistance: involuntary measures A. Bogdanov Independent Psychiatric Association of Russia, Arkhangelsk, Russia The Law on psychiatric assistance in the Russian Federation prescribes the use of involuntary measures in the case of necessity. Certain compulsory measures (psychiatric examination, hospitalization and extending of hospitalization in mental hospital) are taken according to court ruling and, consequently, they have a judicial level of control. Application of involuntary psychiatric treatment and measures of physical restraint at compulsory hospitalization can be made by the individual decision of doctor-psychiatrist. In such a case level of control over guaranteed observance of patient’s rights has a medical (departmental) nature. In rare cases of patients’ complaints – this is a level of prosecutor’s control. The rights of mental hospital patients to carry on correspondence accept visitors in the hospital and carry on telephone conversations are restricted by the division manager or head doctor as functionaries. The level of control over guaranteed observance of such rights of patients has a medical (departmental) nature as well. There are other compulsory measures (for example, medicinal restraint) which are not reflected in the existing Law or are stipulated by the conditions of stay in mental hospital. There is the problem of control over guaranteed observance of patient’s rights at rendering of psychiatric assistance. Most optimal seems to be a system of judicial control and control by independent service on protection of the rights of mental hospital patients, which is envisaged by the Law and inoperative in actual practice. 62


Symposium 4. New achievements in old age psychiatry Chairs: Nikolay Neznanov (Russia), Svetlana Gavrilova (Russia), Jean-Claude Monfort (France), Lev Kruglov (Russia) General abstract The symposium is dedicated to the topical issues in the field of study of etiopathogenesis and clinical manifestations of the old age mental disorders as well as perfection of the approaches to their treatment. Main subjects for discussion will include the problems of epidemiology, early diagnosis and prevention of mental disorders in the elderly, research in the area of their social functioning and the quality of life. It is envisaged to give especial attention to the current models of rendering medico-social assistance to the population of the senior age groups, innovatory methods and technologies in the diagnosing and therapy of gerontopsychiatric pathology.

A rating scale for the assessment of the difficult elderly – Second version (EPAD V2) J.-C. Monfort, A.-M. Lezy-Mathieu, L. Hugonot-Diener Sainte Anne Hospital Center, Paris, France Summary: We propose a tool in order to assess the severity of three types of behaviors which are able to lead to an emotional burn-out of the difficult elderly’s carers: violence, opposition and relentless need of carer’s company. The rating scale consists of nine items. Assessment’s duration is short and enables meetings of the staff focused on the difficult situation. Validation studies are in progress. The category of the persons: Professionals who practice in psychogeriatry are called to the “difficult persons” who exhaust their helpers and carers. The existing scales for evaluation of the difficult elderly persons: The instruments like NPI and its 163 items or CMAI and its 29 items require time of 63


apprenticeship and time of habituation whose durations are too long in the actual context of the lack of carers. EPAD: We have developed this scale for measuring the behaviors that are likely to exhaust the carers emotionally without prejudgement as to what underlies it. The first version of EPAD was presented at the Congress of SPLF in September, 2005. The second version was presented in September, 2009. It comprises three subscales with three items in each. EPAD can be completed in 27 seconds provided the time of reflection of three seconds per item. The team evaluation permits to arrive at common conclusions with the prospect of adaptation of attitudes of each rater. EPAD is a bearer of perception: its utilization facilitates the description of the situation and leaves a descriptive and quantitative trace in the patient’s file. EPAD has demonstrated that it is usable. The structure with its three scales of violence, refusal and search of contact contributes to its being immediately comprised and adopted by professionals who recognize its necessity. The stages of protocol validation (validity, interrater fidelity and sensitivity) are in progress. The teams which desire to join this validation are welcomed.

Neurotrophic approach in preventive therapy of Аlzheimer’s disease S.I. Gavrilova Mental Health Research Centre of Russian Academy of Medical Science, Моsсоw, Russia The problem of preventive therapy of AD, i.e. medical and preventive measures for the elderlies with high risk of clinical manifestation of AD in the last decades has acquired extreme actuality due to continued growth of population of AD patients and expenses for their care and treatment. During the last years a great number of new facts of involving nerve growth factors

(NGF)

in

pathogenesis

of

Аlzheimer’s

disease

(AD)

and

other

neurodegenerative diseases have been received. It has been also established that the introduction of soluble NGF-protein directly to the brain (intraventricularly) is capable to prevent the degeneration of cholinergic 64


neurons caused by exogenous factors, i.e. ischemia, hypoxia, oxidative stress, etc. Basing on these data the introduction of NGF was admitted as significant neuroprotective strategy of AD therapy which is able to keep alive cholinergic neurons undergoing degeneration and to strengthen the functions of kept neurons. However the delivery to the neuronal brain structures of large protein molecules of neurotrophic factors is still a formidable barrier from therapeutic point of view. In this connection discovery of neurotrophic effects of Cerebrolysin attracted new attention to it. Cerebrolysin is a complex of aminoacids and peptide brain factors, containing only low-molecular oligopeptides it capable to penetrate quite well through a blood-brain barrier in case of parenteral (intravenous or intramuscular) introduction. It has been established that Cerebrolysin renders multimodal, organospecific action on brain. It regulates brain metabolism, has neuroprotective properties and unique neuron-specific activity, similar to NGF activity. The clinical efficacy and safety of Cerebrolysin in AD patients with mild – moderate dementia has been proved in the number of randomized clinical studies. The clinical study of long-term effects of Cerebrolysin has proved that Cerebrolysin is not only an effective agent of symptomatic treatment, but also it has multimodal neuroprotective effect and well-marked positive modifying action on the progression of dementia. Basing on the obtained data there has been made the assumption that the administration of course therapy with Cerebrolysin may promote the prevention or slowing down of clinical manifestation of AD in patients with high risk of AD, i.e. in elderly patients with mild cognitive impairment (MCI) of amnestic type. The aim of the present study was to investigate in an open comparative prospective clinical trial Cerebrolysin ability to slow down or prevent transition of MCI syndrome into the clinically evident AD in the 2 groups of patients repeatedly treated with courses of Cerebrolysin (1st group) or Cavinton (2nd group) during period of 3 years. The study was conducted in 3 Russian centers (Moscow, St. Petersburg and Nizhniy Novgorod). The total sample included 110 patients whose mental state met 65


the diagnostic criteria of MCI. Before and during the clinical trial patient’s status was assessed with a set of clinical scales (MMSE, GDS, CDR etc.) and a battery of neuropsychological cognitive tests. Genotyping for the APOE polymorphism was performed as well. To the beginning of the study the groups did not have the statistically reliable difference by the number of patients, by average age of patients and their sex distribution in the groups and by as well as by ApoE4 (+/–) genotype distribution. The groups turned out to be practically identical by the severity of cognitive disorders. Results: the superiority of Cerebrolysin over Cavinton in slowing down of the cognitive deficit progression and delaying the time or transition of MCI patients to the diagnostic category of Аlzheimer’s disease was demonstrated. Cerebrolysin was particularly effective in MCI patients with the ApoE4 (+) genotype, i.e. in those with higher risk for Alzheimer’s disease. Adverse events during the treatment were light and rare in both groups.

Quality management of the gerontopsychiatric service S.F. Sluchevskaya1, N.V. Semenova2 1 St. 2 St.

Petersburg I.I. Mechnikov State Medical Academy, Russia

Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia

Gerontopsychiatry is special branch of medicine, which more than other type of medical services requires biopsychosocial approach. The mission of the care system is ideologically different from general psychiatry. The main principles were declared in 1997

on

the

gerontopsychiatric

section

of

WHO

by

the

International

Gerontopsychiatric Association: complexity, accessibility, flexible, systematic and accountable. The principals of the quality management system are the same: care is customized according to patient needs and values, the patient is the source of control, knowledge is shared and information flows freely, decision making is evidence-based, safety is a system property, transparency is necessary, needs are anticipated, waste is continuously decreased, cooperation among clinicians is a priority. These principles provide a background for the quality management of gerontopsychiatric services. In 66


St. Petersburg the elderly population is over than 20%. More than 60% (600 thousand people need psychiatric care). Every day there are more than 500 patients older than 65 are stayed in psychiatric clinics. The care conditions are the same as for younger patients. The management and the organization geriatric service should be totally reconstructed. The system should include medical, social and psychological care of elderly people. The management system should be based on documentation, which provides increasing patient satisfaction and participation and ensuring adherence to professional standards. The quality assurance is a process of preparation for the quality improvement and planning the standardization of gerontopsychiatric care, whereas a quality improvement is a process of ensuring adherence to the standards. According to the USAID QA project the quality management starts with planning for the quality, then standards are set and communicated, after which monitoring starts with identification of the opportunities for improvement (QI), then QI are defined, key agents are identified the solution is chosen and designed and then solution implemented. The forth going outcomes are: management on the basis of the balanced system of indicators (Balanced Scorecard) Norton-Kaplan. 1) Financial efficiency; 2) External efficiency (acquisition of competitive advantages, loyalty of clients, ability to keep patients), an internal efficiency (Quality of medical service); 3) Potential of growth of establishment and qualification of the personnel (ability to perception of new ideas, orientation to constant improvements).

Comorbidity of the advanced age depression and psychoorganic disturbances of vascular genesis: clinico-therapeutic aspects L.S. Kruglov, I.A. Meshandin St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia With a high enough prevalence of depressive disorder in the population as a whole (10 – 15%) its frequency during aging exceeds almost twofold the respective figures at the young and middle age. Somatic diseases, in particular cerebrovascular pathology leading to psychoorganic changes quite often are co-morbid to the mentioned disorders especially in the aged persons. On the one side, this comorbidity 67


is predetermined by a high prevalence of both variants of the disorders in the population and an inevitable probability of their finding in one and the same patient. Furthermore, pathogenetic interrelatedness of the advanced age depression and vascular disorders of the brain are also noted.

The aim of the present study was to identify the peculiarities of clinical manifestations of depressive disorder in the patients with comorbid psychoorganic disturbances of vascular genesis as well as to evaluate the effectiveness of therapy of these patients with a combination of antidepressive and neurometabolic therapy. As a variant of the latter in the present case we chose the use of cerebrolysin, since literary data indicate a substantial importance of the neurotrophic factor for the dynamics of depressive states (Post R.M., 2008). The more it concerns the combination of depression and organic changes of the brain in advanced age. Materials and methods: We have examined 46 patients at the age of 50 to 89 years. The criteria of inclusion of patients in this main group consisted in the presence in them of the signs of a depressive episode of moderate intensity in the structure of recurrent depressive disorder as well as manifestations of psychoorganic disturbances of vascular genesis comorbid to it, which did not reach the degree of dementia. The comparison group comprised 29 patients with the signs of a depressive episode in the structure of recurrent depressive disorder without the above-mentioned comorbid pathology. In the course of the work along with the clinico-psychopathological method we used the Hamilton Depression Scale and Cognitive Functioning Scale MMSE, findings of the neurological

and

laboratory-instrumental

examination

including

neurovisualization. Results: Main group: In 50, 5% we identified anergic depression, in 39, 1% – anxious depression, in 10, 4% – melancholic depression. Control group: 69, 6% – anxious depression, 17, 5% – melancholic depression, 12, 9% – anergic 68


depression. On the whole the frequency of anergic depression was statistically significantly higher in depression with comorbid psychoorganic disturbances (p < 0, 01) and anxious depression – without those (p < 0, 05). When comparing such indices as dejectedness, hopelessness, helplessness, sense of one’s own inferiority, psychic anxiety and hypochondria their values in the main group were significantly smaller (p < 0, 05). At the same time inhibitedness and reduced capacity for work in the main group were more marked than in the control group (p < 0, 01 and p < 0, 05 respectively). When comparing the Hamilton Scale indices at the stage of termination of the course of treatment a deeper reduction of the symptomatology was established over the parameters of mood, performance efficiency, inhibitedness and circadian affect oscillations (p < 0, 05) among the patients who received combined therapy with antidepressants and cerebrolysin. Conclusions: The symptomatology of depression in patients with comorbid psychoorganic syndrome of vascular genesis is characterized by the predominance of inhibitedness and reduced performance efficiency, lesser markedness of anxiety, hypochondria as well as certain components in the structure of the reduced frame of mind. Combining the antidepressants and neurometabolic stimulants in particular cerebrolysin optimizes the therapeutic approach in the event of comorbidity of depressive disorder and psychoorganic disturbances of vascular genesis in advanced age. Mixed dementia N.M. Mikhaylova Mental Health Research Center of Russian Academy of Medical Sciences, Moscow, Russia A significant degree of overlap between vascular and Alzheimer-type dementia was demonstrated in terms of clinical symptoms, risk factors and post-mortem brain

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autopsy. Alzheimer’s disease associated with cerebrovascular disease is now considered as the most frequent type of dementia. The aim was to study some clinical characteristics of mixed dementia (Alzheimer-type dementia associated with cerebral atherosclerosis) comparatively with Alzheimer’s disease (AD) and vascular dementia (VaD). A sample made up all patients diagnosed as mild/moderate dementia admitted for the first time to the psychogeriatric unit of one of Moscow psychiatric hospital in a period from 2004 to 2009 year. A total 283 patients with dementia were evaluated. The main group made up 94 patients with diagnosis of mixed dementia. The first control group included 75 patients with diagnosis of VaD. The second compared group was of 114 patients with AD without clinical and MRI signs of cerebral atherosclerosis. M/f ratio was 1:3.9 in mixed dementia since 1:1.3 in VaD and 1:2.8 in AD. Mixed dementia had more frequent late onset (90.4%) than VaD and AD (resp. 85.3 and 64.9%). Mean duration of dementia didn’t differ significantly in all cases of dementia. Mild and moderate dementia was almost equal in frequency in mixed dementia at the moment of the first admission while moderate dementia was more frequent (61.4%) in AD patients. The most patients (81.3%) with vascular dementia had mild degree of dementia severity. Non-cognitive neuropsychiatric disorders were common for all three groups. Behavioral disorders were more common for AD and mixed dementia but much less frequent in cases of VaD. Depressive disorders were more frequent in mixed cases (68.0%) and cases of VaD (61.7%) than in AD. Delusional disorders were 59.6% in mixed dementia compared 46.5% in AD and 26.7 in VaD. A delirium-like confusion was common for mixed dementia (35.1%) and vascular dementia (37.3%) while an amnestic confusion occurred more frequently in AD. Strokes and TIA occurred before dementia as well as in the course of dementia in cases of mixed dementia (35.1%). Heredity of old age dementia in mixed dementia was likely to cases of AD, but the family history of stroke and others vascular risk factors in mixed dementia was the same that in VaD. A high frequency of focal vascular changes in mixed dementia didn’t differ from MRI picture in cases of VD and shows a history of “silent” ischemic brain attacks. ApoE genotyping showed the most frequent presence of ApoE ε3/ε4 in mixed dementia (50.0%). ApoE ε3/ε3 was the most 70


common in VaD (68.5%). ApoE ε 4/ε4 was three times more frequent in AD than in mixed cases (21.6% versus 7.7%) and was absent in VaD. Conclusions: the present study confirms the findings of previous studies of mixed dementia; mixed dementia is more frequent in females; late onset is more common for mixed dementia; there is a high risk of confusion state with delirium-like picture in patients with mixed dementia closed to its frequency in vascular dementia; prevalence of vascular risk factors in mixed dementia is closed to its frequency in VaD; APO E isomorphism in mixed dementia showed an intermediate position compared with AD and VaD, but more closed to AD.

Clinical features of depression in patients with lacunar strokes N.V. Semenova, N.Yu. Safonova St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Purpose: to clarify the manifestations of depression in patients with chronic insufficiency of cerebral circulation. Materials and Methods: There were included 179 people (78 men and 101 women), aged from 38 to 90 years (average age 64.7 ± 11.1) with identified at MRI of brain lacunar strokes. There were conducted general clinical evaluations, ECG, ultrasound transcranial Doppler, assessment of neurological status, psychiatrist consultation. Results: All patients were divided into 3 comparison groups. The first included 27 patients with isolated lacunar stroke. The second group included 123 people with multiple lacunar lesions, and the third group had united 29 patients with large (more than 15 mm) and the lacunar strokes. Among these patients there were acute cerebrovascular accidents of various dates. 92 patients transferred acute strokes, and 63 people had a history of 1 this episode, 23 patients – 2, in three patients three, and 2 people – 4, and one – 5 episodes of disorders of cerebral circulation. Acute stroke predominated in patients with combination of large lesions and lacunar strokes. Neurologic symptoms were represented by different focal disorders. 5% patients had not any neurological changes. 6 patients (22.2%) with a single lacuna had a depressive 71


syndrome (in particular, in 18.5% it was submitted astheno-depressive variant and 1 patient anxiety-depressive). In 27 patients (22%) with multiple lacunar lesions there were astheno-depressive or anxiety-depression. Depressive disorders were diagnosed only in 5 patients (17.1%) with combination of lacunar and non-lacunar lesions. Detection anxious – depressive disorder was an average of 1 month after an acute vascular episodes, and astheno-depressive – in an average of 30.9 months after. Patients of all groups were registered light or moderately depressive syndromes. The average age of anxiety-depressive disorders patients was 56.8 years, asthenodepressive – 63.7, and depression – 72.6 years. According to the MRI did not reveal the relationship between location of lesions and the development of depressive states. Also found no relationship between the severity of motor or speech defect and the development of depression. Patients with motor disorders had slightly more anxiety. Draws attention that patients with a brain lesion combination had depressive disorders which were less manifested compare with other groups, despite greater severity of neurological disturbances. In addition, the depressions of moderate severity were found in 3 patients with multiple lacunar cerebral lesions without neurological manifestations.

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Symposium 5. Schizophrenia: evolution of the concept and of treatment approaches Chairs: Wolfgang Gaebel (Germany), Alexander Kotsyubinsky (Russia), Alexander Shmukler (Russia)

General abstract 100 years after the introduction of the term “schizophrenia”, the evolution of the concept of the group of schizophrenia and related psychoses has still not come to an end. The current revision of the international classification systems DSM-V and ICD-10 has revitalized the discussion. Especially the revision of DSM has questionned the nosological concept of schizophrenia and has even defined whether the term should be abandoned, not the least because of its stigmatizing connotations. Although much research has been done on the nosological formalization of this group of disorders, none of the recent findings has made its way into modern classification systems. The planned symposium will shed light on this development with respect to the concept and therapeutic approaches. W. Gaebel will describe how new concepts employing basic neurocircuits and their disturbances in mental disorders bear on the classification of psychotic disorders. S. Tsirkin will describe how a psychotic diathesis may play a role in nosological conceptualizations of psychotic disorders. A. Kotsyubinsky will discuss the importance of functional approaches to psychiatric classification and nosology. Y. Zaytseva and I.Ya. Gurovich will report on a study on course-specific neurocognitive impairment patterns in first-episode patients with schizophrenia. I.Ya. Gurovich and coworkers will present their data on the effectiveness of an integrated long-term management program in patients with first-episode schizophrenia. Taken together, this symposium will highlight both conceptual issues and novel empirical research of importance to the future classification and treatment of psychotic disorders.

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The developing concept of schizophrenia and related psychoses: a modular approach to diagnosis and treatment W. Gaebel University of Dusseldorf, Germany The pathophysiological foundations of schizophrenia and related psychotic disorders encompass biological, psychological and social factors. A central question of psychiatric nosology in general and not only schizophrenia research is how to unify such seemingly divergent approaches. One possible solution is an approach in which basic neurocircuits of defined functional specificity are considered the basic elements onto which pathogenic factors exert their influences in the pathogenesis of mental disorders. Such basic neurocircuits are today again termed “modules”, an expression which is reemerging after long years of negative stigmatization in the neuroscientific community. However, both basic research studies in health probands and studies in patients with such diverse brain disorders as schizophrenia, Alzheimer’s disease, epilepsy and multiple sclerosis have shown that a “modular” approach can result in novel insights into the pathophysiology of complex brain disorders. This report will summarize the main evidence in these fields of investigation, and how these findings bear on the conceptualization of psychotic disorders in the framework of a “modular psychiatry”.

Schizophrenia as a nosological entity S. Tsirkin Mental Health Research Centre of Russian Academy of medical science, Моsсоw, Russia The mental diathesis concept and analytical psychopathology make nosological status of schizophrenia disputable. The idea of schizophrenia as a severe non-organic disorder contradicts the general medical knowledge: there is a large variation in the severity of each nosological entity. Symptomatological criteria of schizophrenia are arbitrary, and their correlation with the development of schizophrenia defect is not proven. So the latter remains the only conceptually acceptable diagnostic criterion of schizophrenia. This criterion is difficult to use because in cases of mental diathesis there 74


are psychopathologically identical inborn deficit signs, and clinical data are often insufficient to decide whether deficit symptoms become more prominent (schizophrenia) or not (mental diathesis). Theoretical justification of schizophrenia defect criterion is also not evident. Emotional bluntness means decreased capacities for enjoyment and grievance, and those are the negative components of depressive and manic affects. The affective nature of schizophrenia defect is especially plausible as in many cases of schizophrenia remissions different depressive signs are discernible such as typical diurnal and seasonal fluctuations of mood and physical activity. Partial intellect deficit is characteristic for mental diathesis, and it is more prominent during even mild depressive episodes. So it is also diagnostically not valid. The long-term development of mental diathesis closely resembles the schizophrenia course: there are mild episodes before overt manifestation and more severe episodes of deterioration with or without subsequent residual positive symptoms against a background of deficit signs (inborn or not). The most active period in the course lasts about 10–15 years, and the role of stressful events in the exacerbation of clinical state during this period gradually subsides. The question is whether only one and dubious diagnostic criterion of schizophrenia substantiates its nosological validity.

A functional diagnosis in psychiatry A.P. Kotsubinskyi, N.S. Sheinina, B.G. Butoma, T.A. Aristova, G.V. Burkovskyi, N.A. Penchul St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The system of functional diagnostics proposed by the authors is a tool of complex evaluation of a patients’ state, based on unified theoretical positions. Adaptative and compensatory ability of a patient is considered a backbone factor in functional diagnosis. This makes a significant difference between functional and polydimensional diagnosis. The task of a functional diagnosis is identification of incompetence: of the level of “social competence” in main fields of activity, adaptability type of a patient and level of his satisfaction with various life aspects. The functional diagnosis is aimed at identification of factors, setting conditions for incompetence. 75


Three sets of features are reviewed in this setting: disease (biological set of a functional diagnosis), personality (psychological set), social status and patient’s environment (social set). The biological set reflects features of the disease of the specific patient: disease activity, behavior, nature and intensity of basic disintegration, presence of dysontogenesis symptoms as somatic and biological background of compensatory and adaptative processes. Features of the biological set allow to state a detailed clinical diagnosis, thus determining the strategy of psychorharmacological action. Psychological aspect of a functional diagnosis identifies abnormality of cognitive and emotional and volitional processes, caused by a disease, and characterizes a patient’s personality: personality traits, value systems, system of human needs, methods of resolution of conflicts and difficult situations and preferable forms of psychological compensation. Parameters of this set determine a psychological profile of a patient and specify factors that were lost and retained by the personality in the course of a disease that is achieved by the functional diagnosis. Awareness of functioning features of psychodynamic personal mechanisms and his intrapersonal conflicts determine a psychotherapeutic diagnosis and direction of psychocorrectional action. The social aspect of a functional diagnosis identifies features of a social status of a patient and external adaptation factors, caused by the influence of significative environment (family, professional environment, micro-social groups and social institutions). Identification of psycho-social problems of a patient, on the one side, and emotional and instrumental recourses of his social support are summarized in the social diagnosis and determine an extent and characteristics of required sociotherapeutic measures. Analyzing features of 3 sets of a functional diagnosis enables to develop individual up-to-date rehabilitation programs and programs of resocialization of mentally ill patients. This achieves much importance in case of applying up-to-date team-based approach of patients’ management and integration of various approaches,

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when only complex evaluation of a patient’s state allows specialists in different fields to state goals and objectives, set for every team member.

Differentiation of neurocognitive functioning in patients with various courses of schizophrenia after first psychotic episode: 5-year follow-up Y. Zaytseva, I.Ya. Gurovich Moscow Research Institute of Psychiatry, Russia Background: Cognitive deficit is a core feature of schizophrenia. However, there are inconsistencies in the evidence of the cognitive decline over time and these suggest the possibility of different patterns of deficit according to heterogeneity of the illness. Methods: 67 patients with first episode of schizophrenia and schizophrenia spectrum disorders performed neuropsychological testing based on A.R. Luria’s methodology during the 5 year follow-up. Assessment was carried out twice in acute state and in remission on the first and second years of observation and then annually in remission. Patients were assigned to subgroups according to the progression of negative symptoms during the follow-up period. Patients with low rate of negative symptoms (group 1, n = 25) had experienced 1–2 psychotic episodes followed by 1.5–4 years of stable remission close to recovery and rather high social adjustment. Patients with moderate progressing of negative symptoms (group 2, n = 33) revealed continuous or intermittent course of the illness with residual positive and prominent negative symptoms in remission and poor social adjustment. Patients with the early age of onset (group 3, n = 9) presented marked negative symptoms at the onset with their progressive increase in the follow-up. Clinical rating was obtained using Positive and Negative Syndrome Scale (PANSS). Control group consisted of 25 healthy comparisons matched by age, sex and education level to the group 1. Results: Compared with healthy subjects, the overall patients group had a significantly worse qualitative characteristics of neurocognitive functions with relatively similar cognitive profile at the onset. Neurocognitive deterioration in patients of the 1st group fluctuated being worse during onset and relapse and 77


improved in remission. Parameters of praxis, gnosis, visual-spatial recognition, verbal thinking and non-verbal thinking were changeable depending on the phase of the disease, while verbal and visual memory, neurodynamics and executive functioning, remained impaired even in five years, though insignificantly improving in remission. Patients of the 2nd group presented deficit of the main cognitive functions (verbal and visual memory, gnosis, spatial motor skills, verbal and non-verbal thinking, attention, neurodynamics and executive functioning) during the first 2 years which corresponded to the worsening of clinical state over time. Later on these variables remained stable with further decline of visual memory and visual gnosis by the end of 5 year follow-up. Neurocognitive parameters of the 3d group such as praxis, gnosis, visual-spatial recognition, verbal thinking and non-verbal thinking, verbal and visual memory, neurodynamics and executive functioning were considerably poor at the onset in comparison to other groups. The most evident decrease appeared to be in executive functioning and visual-spatial recognition. Moreover, no dynamics has been revealed during follow-up period except overpatching of non-verbal thinking, the parameter which has significantly improved in five-year outcome (p ≤ 0.05). Correlative analysis demonstrated interconnections of cognitive functioning with PANSS rates as the significant positive correlations between the parameters of cognitive functions and negative symptoms were obtained at the 5th year of follow-up (r = 0.25–0.54). Conclusions: The following results indicate different courses of cognitive deterioration in the follow-up period in patients with various courses of progressing after first psychotic episode and during 5-year follow-up.

Effectiveness of the integrated long-term program of management of patients after first psychotic episode in 5-year follow-up I.Ya. Gurovich, Y. Zaytseva, A.B. Shmukler Moscow Research Institute of Psychiatry, Russia Background: Programs focused on multi-disciplinary management of patients with first psychotic episodes within Early Intervention Centers proved to be effective 78


in the improvement of clinical and social outcomes mostly related to 2–3 years of follow-up. However, there is a lack of evidence for the effectiveness of such interventions during the prolonged period of 5 years. Objective: To evaluate the effectiveness of the integrated treatment of patients with early psychosis in comparison with care provision in traditional mental health system in 5-year naturalistic setting. Methods: The integrated program in Early Intervention Service (First Episode Clinic [FEC]), established in Moscow Research Institute of Psychiatry in 2000 is based on the following principles: subsequent management of illness after treatment in FPEC is the same as initial treatment with the focus on the continuity of care, utilization of services within the least restrictive approach, primary use of atypical antipsychotics in combination with psychosocial interventions; long-term follow up with individualized case management; family involvement in treatment and rehabilitation process. The study was carried out as prospective, longitudinal investigation of first episode patients within integrated program in FEC (1st group, n = 114) and in routine care (2nd group, n = 119) during 5-year follow-up. The effectiveness was evaluated in comparison of clinical (rates of relapses and complete remissions, adherence to therapy, setting of the relapse treatment) and social parameters (alterations in social status, social functioning) and in both groups as well as comparative pairwise analysis (33 pairs matched by age, gender, level of education, and type of the onset patients) was performed in order to confirm the overall results. Results: Comparing to the routine care in 5-year follow-up, patients who have been treated in FEC were more compliant with therapy regimen: 48% in the 1st group vs. 12% in the 2nd group. More patients of the 1st group maintained the condition of complete remission (46.5% vs. 36.7%, p ≥ 0.05). Moreover, during the follow-up period they were more likely to show help-seeking behavior and referred to services during the earlier stages of the exacerbation, therefore the relapse rates were decreased (mean = 0.18, SD = 0.45 and mean = 0.59, SD = 0.82, respectively, p ≤ 0.001) and 70.4% of patients were treated in outpatient settings. Symptomatic control of the illness contributed to social recovery in patients within integrated care. By the 5 th year, 79


only 19.3% of the cases of the 1st group were formally recognized as unemployable due to psychiatric disability compared to 41.3% in the 2nd group (p ≤ 0.001). The results of pairwise analysis reaffirmed the following findings. Moreover, the psychotic symptoms of the first group were controlled within shorter time than in patients treated within routine care (38.96 ± 24.16 days vs. 96.5 ± 62.8 days, p ≤ 0.001). Conclusions: Long-term treatment of patients with first psychotic episodes in FEC and routine care showed discordant dynamics of clinical and social parameters in 5-year follow-up with their gradual deterioration in traditional care system. This suggests that management of patients after first episode of psychosis via integrated long-term program could have a greater positive impact on the unfavourable course of schizophrenia.

Adaptation aspects of schizophrenia patients in Siberia A.V. Semke, L.D. Rakhmazova Mental Health Research Institute SB RAMSci, Tomsk, Russia We have distinguished 4 types of adaptation: integrative, with relatively high level of clinical and social adaptation; destructive, with opposite according to sign combination, as well as types of adaptation with dissonance between these indices – extravert, with relatively high clinical and low social adaptation and introvert – in patients preserving social functioning in the worst clinical parameters. Adaptive value of negative disorders is associated with rank, area of impairment, correlation of quantitative-qualitative structure what may be called as endogenous transformation of the personality on which peculiarities of positive disorders in exacerbations and remissions, adaptive reactions and types of individual compensatory-adaptive defense depend. Combination of different in character, depth and area of impairment of negative disorders creates a new personality structure and is a ground determining: content, degree of severity and periodicity of positive psychopathological disorders in remissions; degree of disposition to decompensating influences with possible clinical consequences; character of secondary compensatory 80


formations (short-term adaptive reactions and more constant formations – basic types of compensatory-adaptive defense). This new life stereotype of the patient and finely quality and level of social adjustment take shape depending on individual adaptive possibilities and totality of social conditions, i.e. internal and external preconditions. The external take shape from basic kinds of attitude toward the patient of his/her nearest (loyal, passive-expectative, extremist) with which participation over time adaptively significant totalities of social-environmental influences take shape: hyperprotection, deprivation, formal of differentiated support. Provoking, accelerating and complicating factors can exert influence on the character of positive and negative disorders, increase progression of the process and prevent the therapy, i.e. worsen clinical preconditions, exogenous adversities, somatic and neurological diseases, factors evoking decrease of immune reactivity or preventing effective biological therapy of schizophrenia with traditional methods. Questions of prevalence of schizophrenia, factors determining structure and formation of this pathology, its course and outcomes continue to remain leading in epidemiology mental diseases. Knowledge of basic trends and regularities of change of this situation will promote resolution of issues of program-target development of medico-sanitary services of specialized character. Climatic-geographic, social-demographic peculiarities of districts of Siberian region exerting influence on mental health of the population and reflecting on indices of prevalence of psychiatric pathology in population determine relevance of investigations devoted to study of mental diseases including schizophrenia in “space and time” on some administrative territories of Russia and Siberia.

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Symposium 6. Depression in children and adolescents Chairs: Sam Tyano (Israel), Danuta Wasserman (Sweden), Igor Makarov (Russia)

Depression in children and adolescents S. Tyano Tel Aviv University School of Medicine, Israel Depression Disorders are some of the most ancient disorders known in history of Psychiatry. Nevertheless, only 40 years ago Child Psychiatrists have started to study and describe the clinical course of child depression. Later on we started to understand and study the clinical manifestations of adolescent depression. Only recently, reports on depression in infants, have appeared. In our lecture, we will describe the specificity of the clinical manifestations of pediatric depression, discuss its etiology and report on the pathways of depression from infancy to adulthood, as dependent on the interplay between risk and protective factors. Finally, we will bring the last published guidelines for pharmacological and psychotherapeutic treatments in pediatric depression.

Epidemiology of childhood depression: reducing the burden of disease C.W. Hoven Columbia University, College of Physicians & Surgeons, and Mailman School of Public Health, New York, USA Depression (MDD) currently affects some 150 million persons worldwide. The World Health Organization’s (WHO) “burden of disease” lists depression as the fourth highest factor that may shorten an individual’s life, and projects that this disorder will be the second leading factor in two decades, 2030. Moreover, MDD is often co-morbid with a wide range of psychological conditions, including posttraumatic stress disorder 82


(PTSD), suicidal ideation and behavior, and substance use. Exposure to stressful events, such as violence, war and natural disasters often result in psychopathology. Individuals exposed to traumatic events are more likely to develop depression and PTSD, rather than either one separately. Depression associated with completed suicide, especially in specific populations, e.g., military personnel, is often also comorbid with PTSD. Unfortunately, depression frequently remains untreated even in countries with well-financed psychological services, where as many as 50% of depressed individuals are never diagnosed. Most mental disorders, including some forms of depression, have their onset in childhood or adolescence and persist into adulthood. Consequently, children constitute a critical entry point for achieving an overall reduction in rates of psychopathology, including depression, and therefore warrant particular attention. Yet, psychological disturbances in children and adolescents are even more likely than in adults to be ignored. This is especially true in some areas of high conflict and/or disaster, where the need for intervention may be greatest.

Regional and country-specific,

epidemiologic-based profiles will be presented with the projected “burden of disease”, demonstrating that achieving a positive impact requires that depression in youth be specifically targeted.

New trends in depression/suicide in adolescents D. Wasserman Chair of WPA Section on Suicidology, Sweden Suicide, in general but especially in young people, is a global public health problem and an issue of major concern both in developing countries and in the wellstudied, developed parts of the world. Of the 132,423 deaths occurring in 15–19 yearolds between the years 1965 and 1999 in 90 countries, for which data from the WHO mortality database was available, suicide accounted for 9.1%. The mean suicide rate for young people was 7.4/100,000 (10.5 for males and 4.1 for females). During the same period a rising trend of suicide in young males was observed. It is clear that in many developing countries on all continents, suicide rates are high by international 83


standards. In the past two decades there has also been an increasing trend in mental health problems among the youth in European countries. This increase has been highly associated to decreasing rates of employment, as well as to increasing alcohol consumption, both of which have been shown to lead to impaired social functioning, depression, poor quality of life and anxiety. Unemployment is problematic for young people, who often lack work experience. This is especially true for those who graduate from school with low grades. Preventive activities to counteract risk factors leading to the deterioration of mental health and suicide in young people are necessary to tackle these increasingly problematic issues.

Affective psychoses and depression in children I.V. Makarov, R.F. Gasanov St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Affective psychosis among children and adolescents contingent is very few. According to the records of recent years of other foreign authors, the prevalence of depression in children and adolescents ranging from 2 to 6% and increases with age, with boys and girls in prepubertal age suffer from the same frequency, but adolescents’ depressions are more common in girls. Schizoaffective and atypical affective psychosis. Occur in children under 15 years is relatively rare. Patients with schizoaffective psychosis are not more than 0.3%, while patients with atypical affective psychosis are not more than 0.2% of all hospital patients. Separation of children and adolescents under these diseases in schizoaffective and atypical affective psychoses is practically impossible. In all cases a child with psychotic episode was hospitalized for the first time, and the diagnosis of atypical affective or schizoaffective psychosis in the general similarity of the clinical picture depended primarily on the views and preferences of doctors. According to ICD10, to speak of affective disorder (F30–39) we need even if there is a history of rare schizoaffective episodes, no less developed as a whole fairly typical picture of affective episodes (phases) to give preference to a diagnosis of schizoaffective psychosis (F25) is proposed if along with affective symptoms, hallucinatory and delusional violation of 84


clearly articulated and long-term, and subsequent episodes will also schizoaffective. But when it comes to childhood, we are confronted with the fact that the child is a first psychotic episode in his life, and are observed as expressed by the affective and relatively specific to schizophrenia, hallucinatory, delusional disorder or other. In this case it is better to dwell on the diagnosis of schizoaffective psychosis in children population. Manic-depressive psychosis. It occurs in children under 15 years is rare: between 1992 and 2001 in a children's psychiatric ward of St. Petersburg were only seven patients with this diagnosis (in two cases of manic, five – depressive phase). ICD-10 diagnosis code consistents rubrics F30.1, F32.11 and F32.2. Talk about bipolar disorder (F31) did not have to, because it was the first phase in life. The average age of onset was 14.0 ± 0.9. The patients with manic-depressive psychosis are, to our knowledge, no more than 0.2% of the total contingent of child psychiatric hospital. The rarity of manic-depressive psychosis in patients under 15 years has been mainly associated with the later start of the disease. In addition, such a diagnosis to children exhibited only at a relatively strong belief by the psychiatrist in the correct diagnosis and relatively common clinical variants of both manic and depressive states. In the case of a manic or depressive syndrome in apathetic, dysphoric (for depression), or angry, foolish manifestations (in the case of mania) patients was frequently exhibited a diagnosis of atypical affective psychosis, rather than the TIR.

Depressive disorders in children from perspective of current and future classifications E. Koren Moscow Research Institute of Psychiatry, Russia Depression is a particularly heterogeneous diagnostic category with changing boundaries and methods of classification. However, the introduction of operational diagnostic criteria as described and defined in ICD-10 has at least improved the reliability of diagnosis, although there has been no parallel improvement in diagnostic validity. 85


Although diagnostic criteria for depression in children and adolescents are essentially the same as those for adults, there are atypical traits and important developmental differences in each of these three clustered around core alterations in experience: changes in mood, in thinking and in activity. Thus, the clinical picture varies in ways that are poorly understood, with levels of severity, personal impairment and developmental age and many young people and children in the community who are depressed remain undetected. Even in child mental health clinics depressive signs and symptoms may be missed through cursory inquiry or greater attention being paid to other concurrent difficulties. Also it is clear that depression in children and young people usually occurs in the context of other detectable problems or comorbidity that requires clinical skills to avoid underdiagnosis and undertreatment and clinical status can be examined as an evolving rather than static process. The evidence is that such young people are adding to the general burden of affective morbidity in the community at large, and may continue to do so over time. Equally it would be sensible to exert a level of clinical concern in those with high levels of depressive signs and symptoms that are just below threshold for diagnosis, but with overt psychosocial impairment that may warrant treatment. What little has been done to date suggests that, from the public health perspective, it would be unwise to ignore sub-threshold depressions if they present with psychosocial impairment and category of “minor depression” not formally classified in ICD-10 will be discussed.

Saving and empowering young lives in Europe (SEYLE) V. Carli, D. Wasserman National Prevention of Suicide and Mental Ill-Health (NASP), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden SEYLE is a health promoting programme for adolescents in European schools. Its main objectives are to lead adolescents to better health through decreased risk taking and suicidal behaviours, to evaluate outcomes of different preventive programmes and to recommend effective culturally adjusted models for promoting 86


health of adolescents in different European countries. It will be developed by a consortium of 12 countries: Austria; Estonia; France; Germany; Ireland; Hungary; Italy; Israel; Romania; Slovenia; Spain and Sweden. SEYLE coordinator is Prof. Danuta Wasserman at NASP (National Prevention of Suicide and Mental Ill-Health), Karolinska Institutet, and Stockholm. The project manager of SEYLE is Dr. Vladimir Carli, NASP at Karolinska Insitutet, Stockholm. In this health promotion programme, a pilot intervention study will be implemented to assess the effects of three different health promoting/suicide preventing programmes in 11,000 students across 12 European countries (identified above). The key risks identified in adolescents include mental-ill health, self-harm behaviours, motor vehicle accidents, violence, substance or alcohol abuse, promiscuous sexual behaviours, poor diet, lack of exercise and smoking. The three interventions are: 1) a gatekeeper’s program, training all adult staff at schools (teachers, counselors, nurses etc.) on how to recognize and refer a student with risktaking behaviours or those suffering from mental illness to mental-health help resources; 2) an awareness increasing health promotion program targeting students awareness on healthy/unhealthy behaviors and students self-efficacy in diminishing unhealthy behaviors; 3) screening by professionals of at-risk students through a questionnaire. For adolescents identified as high risk, the program includes referral to mental health treatment and measures ensuring compliance; Each program has a different active component, respectively: empowering teachers and school staff; increasing self-efficacy in students; empowering mental health professionals. Key objectives of the study are to gather information on health and well-being in European adolescents, to perform interventions on adolescents leading to better health through decreased risk taking and suicidal behaviours by comparing the three intervention strategies; to recommend effective culturally adjusted models for promoting the health of adolescents.

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Symposium 7. Evidence-based approaches to treatment of addictions Chairs: Evgeny Krupitsky (Russia), George Woody (USA) Naltrexone for opiate dependence in Russia: oral, implantable and injectable E. Krupitsky1, E. Zvartau2 1 St.

Petersburg V.M. Bekhterev Research Psychoneurological Institute, Russia 2 St.

Petersburg State I.P. Pavlov Medical University, Russia

Opioid dependence is one of the most severe drug dependencies. Naltrexone is a medication that completely blocks all subjective effects of opioids. Being administered to detoxified opioid addicts it prevents a relapse to opioids and helps to maintain abstinence. The major problem with naltrexone is a poor compliance which is particularly the case in the countries where there is a treatment alternative to naltrexone based on the substitution of illicit opioids (first of all, heroin) with orally administered

opioid

agonists

(methadone)

or

partial

agonists-antagonist

(buprenorphine) prescribed by physician. In Russia substitution therapy is forbidden by the law and naltrexone is the only available pharmacotherapy for heroin dependence. As it was demonstrated in our double blind placebo controlled randomized clinical trials with naltrexone we have been doing for more than a decade, due to lack of alternative to naltrexone and also stronger family control of compliance naltrexone in Russia is more effective for relapse prevention and abstinence stabilization than in the Western countries. Combination of naltrexone with antidepressants or alfa-adrenergic ligands does not improve treatment outcome significantly. Our studies also demonstrated that long acting sustained release formulations of naltrexone (injecatble and implantable) are particularly effective compared to the oral ones as they make control of compliance easier.

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Data points the way: medication assisted therapy for reducing drug use, HIV risk and managing infection in opioid addicted patients G. Woody, C. O’Brien University of Pennsylvania; Philadelphia, PA, USA This presentation will begin with a review of research designs that provide data on treatment outcome, with comments on their strengths and weaknesses. Prospective, randomized, placebo controlled trials will be highlighted as the way to obtain the most accurate data, and this type design will be discussed as the one that is preferred by journal editors in making decisions about what papers to publish. The possibility that randomized trials can result in unexpected findings that are contrary to firmly held beliefs will be discussed, and two examples of this phenomenon will be described: 1) a study that led to stopping the routine use of hormone replacement therapy by post-menopausal women, and 2) studies showing that naltrexone can prevent relapse to alcohol dependence, particularly in patients with a specific genetic alteration. Next will be a presentation of data showing high relapse rates following detoxification from opioid addiction and how this finding applies regardless of the patient’s age or years of addiction. These findings will be discussed in the context of our inability to “cure” addiction, and why many countries have chosen to use methadone and buprenorphine maintenance as a way to control addiction over an extended time, much like insulin is used to control diabetes or antihypertensives are used to reduce high blood pressure. Findings from selected studies will be presented to illustrate the benefits of these types of maintenance treatment, with a focus on their value in preventing the spread of HIV and improving adherence to antiretroviral medication. The last part of the presentation will refer to the naltrexone data presented by Dr. Krupitsky, which shows that a few patients stop using heroin with detoxification and counseling alone, but that naltrexone maintenance markedly increases the proportion that stop, while also reducing HIV risk behavior and improving overall adjustment. Taken collectively, these findings show that many treatment approaches 89


can be associated with a reduction or cessation of heroin use and HIV risk behavior, but that maintenance on an effective medication, whether it is naltrexone, methadone or buprenorphine, markedly increases the proportion of patients that stop using and reduce HIV risk behavior, as compared to detoxification and counseling alone. As shown by Drs. Krupitsky, Zvartau and colleagues, extended duration naltrexone has much better results than tablets. The presentation will end with comments on how this finding will be explored in a new randomized trial to see if extended duration naltrexone improves adherence to antiretroviral therapy in AIDS Centers by preventing addiction relapse.

Pharmacogenetics of addictions: alcohol and stimulants T.R. Kosten Baylor College of Medicine, Department of Psychiatry, Houston, TX, USA Pharmacogenetics has become useful for treatment of alcoholism and cocaine using naltrexone and disulfiram, respectively. Both of these medications are effective in placebo controlled studies of unselected patients, but their efficacies are enhanced by pharmacogenetic matching of patient to medication. Alcoholism pharmacotherapy with Naltrexone has been much improved based on selecting patients who have a functional polymorphism in the OPRM1 gene that codes for the mu opiate receptor. Cocaine pharmacotherapy with Disulfiram has been improved based on selecting patients who have a regulatory polymorphism in the DBH gene that codes for the enzyme dopamine beta hydroxylase (DBH). The mechanism for naltrexone and the OPRM1 polymorphism is related to a three-fold increase in activity of the mu opiate receptor. This polymorphism is associated with 2–3 fold lower baseline beta endorphin (BE) levels and marked stimulation of BE release when these individuals drink alcohol. Without this abnormal mu receptor, baseline BE levels are higher and alcohol minimally stimulates BE release. Naltrexone blocks presynaptic mu opiate receptors and stops feedback inhibition of BE release. Thus, BE levels rise, and those patients with the abnormal opiate receptors feel better and more importantly do not get a rise in BE when they drink alcohol. Clinically, these patients lose the “priming 90


effect” of alcohol and can more readily stop drinking and not relapse into dependence. The mechanism for disulfiram and the DBH gene is related to a 10 to 1000 fold lower level of the enzyme DBH with this polymorphism. DBH converts dopamine (DA) to norepinephrine (NE). Those patients who have this genetically low DBH level develop alternative biochemical pathways to make NE while in utero. Disulfiram inhibits DBH and in those 60% of patients who have normal DBH levels, the levels of DA are increased and of NE are decreased. The net effect is to reverse the DA deficiency associated with cocaine (and most other addictions) and produce improved mood and reward sensitivity, as well as a reduction in the “priming effect” of cocaine due to the higher baseline level of DA. The decrease in NE appears to reduce the withdrawal anxiety and over-activity associated with stopping cocaine. Similar effects are expected with alcohol, opiates and other abused drugs. In summary, this presentation with include human laboratory studies of alcohol and cocaine administration in the presence of these medications and outpatient randomized, placebo controlled, clinical trials showing the efficacy of these medications for reducing alcohol and cocaine abuse.

Methylphenidate and placebo in the treatment of amphetamine dependence K. Kuoppasalmi1, J. Tiihonen2 1 National Institute for Health and Welfare, 2 University of

Helsinki, Finland

Kuopio, Niuvanniemi Hospital, Kuopio, Finland

Problems related to illegal amphetamine use have become a major public health issue in many developed countries. To date, evidence on the effectiveness of psychosocial treatments has remained modest, and no pharmacotherapy has proven effective for amphetamine dependence. 210 individuals meeting DSM-IV criteria for intravenous (i.v.) amphetamine dependence were scheduled to be randomized and receive aripiprazole (15 mg/d), slow release methylphenidate (54 mg/d) or placebo for 20 weeks, but the enrollment was discontinued due to unexpected results of interim-analysis on the first 53 patients (one active medication arm being significantly 91


worse than placebo arm). Patients allocated to aripiprazole had more amphetaminepositive urine samples (ITT) than patients in the placebo group (OR = 3.77, 95% CI 1.55–9.18, p = 0.003), whereas patients who received methylphenidate had fewer amphetamine-positive urine samples than patients who had received placebo (OR = 0.46, 95% CI 0.26–0.81, p = 0.008). No severe treatment-related adverse events were observed. In the second 2-arm (methylphenidate vs placebo) phase of the study, 38 new patients have been recruited this far. The results of all recruited patients to the second 2-arm phase will be presented.

Psychopharmacological strategy in drug addiction treatment M.A. Vinnikova, S.O. Mokhnachev National Research Center of Addictions, Moscow, Russia Inpatient and outpatient network of Alcohol and Drug Treatment Service (ADTS) in Russia is a unique national system for treatment and prophylaxis of alcohol and drug addictions. During 2008 358,120 drug addicts were seeking ADTS help and more 70% of all of them are IDUs. Treatment of drug addiction in Russian Federation is regulated and based on “Standards of Diagnostics and Treatment of Drug Addiction Patients”. Main principles of treatment are: voluntariness, multiple treatment approaches, individual approach, drug-free state during treatment and remission – total refusal from any kind of narcotic drugs at all stages of the treatment and rehabilitation process. Treatment types, methods and remedies depend on: clinical features of addiction, personality and microsocial environment. The main goals of treatment are remission stabilization, relapse and recidivism prevention. Treatment targets are withdrawal, craving for drugs and toxic consequences on clinical level, methabolic and neuromediator failure on biological level and co-dependence on social level. Detoxification includes total and immediate deprivation from narcotics, pathogenetic approach. Detoxification if not followed-up, results in low effectiveness. Individual approach means duration of drug abuse, consumed dosage, related psychopathologic disorders, personal symptomatic corrections. Craving for drugs is the most 92


fundamental syndrome and success of treatment depends on craving relief. Psychopharmacological

treatment

includes

neuroleptics,

antidepressants,

neuropeptides, anticonvulsants, tranquillizers, nootropic drugs, opiate antagonists. Psychotherapy and social rehabilitation are also necessary. On the further stages analysis and elimination of basic factors of craving exacerbation allow to reveal the main psychic dependence symptom complex (i.e. psychopathological expression) and to administrate goal-directed therapy. The above-mentioned needs to predict duration and quality of remission. Remission maintenance and anti-relapsing treatment include all forms of opiate antagonists, mild neuroleptics and antidepressants. The results of inpatient drug addiction treatment are assessed by compliance and retention in treatment program, relief of craving for drugs, mood stabilization, reduction of behavioral disorders, absence of relapses, remission duration and quality of life during remission. Remissions from 6 to 12 months – about 30–40% of all opiate addicts hospital admissions (NRCA).

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Symposium 8. Genetics of suicide Organized by WPA Section on Suicidology Chairs: Danuta Wasserman (Sweden), Alec Roy (USA) Gene-environment interactions of Corticotropin-releasing hormone receptor 1 (CRHR1) and stressful life events in suicide attempts Ya. Ben-Efraim, D. Wasserman, J. Wasserman, M. Sokolowski Sweden Background: Risk factors for suicidal behaviors and endophenotypes are partly heritable, and include genetic variants that associate with outcomes related to stress diathesis. Some genetic variants interact with exposure to stressful life events (SLEs) to moderate risk of having stress-related outcomes in synergistic and/or antagonistic ways. Variants of CRHR1, a gene expressed in the hypothalamic-pituitary-adrenal (HPA) axis and other brain regions that are often coupled to HPA axis functioning, interact with childhood abuse and are associated with a dysregulated cortisol response, alcohol misuse, and variation in adult depressive symptoms. Further, CRHR1 x SLE interactions are associated with severe depressive symptoms in suicidal males. Objectives: To explore the role of CRHR1 x SLE interactions in the phenotypic heterogeneity of suicide attempts, suicidal personality endophenotypes, mood and alcohol/substance use disorders. Methods: Family-based association tests were used on a sample of 660 complete trios, probands who made a suicide attempt and both their parents. Single nucleotide polymorphisms (SNPs) and/or haplotypes in CRHR1 were assessed for interaction with SLEs on all outcomes using Fbat-i, and the magnitude of significant associations was estimated with conditional logistic regression using pseudosibs. Gender-specific interactions were studied for age of exposure to rape and/or physical assault and/or lifetime exposure to multiple SLE types using a constructed SLE score. Results: Preliminary results show interactions of CRHR1 SNPs and haplotypes with rape, physical assault, and a high SLE score associated with suicide attempts, as 94


well as with severe depressive symptoms, and alcohol/substance use disorders. Furthermore,

specificity

to

gender

and

age

of

exposure

(both

in

childhood/adolescence and adulthood) was observed. Possible associations of interactions with personality traits are under investigation. Conclusions: Interactions of CRHR1 variants and SLEs were consistent with a stress diathesis model of susceptibility to suicidality, and seemed to be related to phenotypic heterogeneity of suicidal behaviors.

Childhood adversity, epigenetics and suicidal behavior in major depression J.M. Mann New York State Psychiatric Institut, USA Childhood adversity increases the risk of major depression and suicidal behavior. Genes also contribute to the risk of major depression and the risk for suicidal behavior. The effect of childhood adversity may involve epigenetic effects and geneenvironment interactions. We will present data from postmortem studies of suicide and in vivo imaging in suicide attempters of effects of genes and childhood adversity on transmitter systems involved in major depression and suicidal behavior. Will then present data showing how childhood adversity epigenetic effects can depend on genotype and potentially explain some apparent gene-environment interactions.

BDNF gene methylation in suicide completers M. Sarchiapone, V. Carli, S. Keller, A. Videtic, A. Marusic, G. Castaldo, L. Chiariotti University of Molise, Campobasso, Italy Context: Brain-derived neurotrophic factor (BDNF) plays a pivotal role in the pathophysiology of suicidal behaviour and BDNF levels are decreased in brain and plasma of suicide subjects. So far, the mechanisms leading to down-regulation of BDNF expression are poorly understood. 95


Objectives: In this work we tested the hypothesis that alterations of DNA methylation could be involved in the disregulation of BDNF gene expression in the brain of suicide subjects. Design and setting: We determined, by three independent quantitative methylation techniques, the DNA methylation degree at BDNF promoter IV and the genome-wide DNA methylation levels in the brain’s Wernicke’s area of 44 suicide completers and 33 non-suicide control subjects of Caucasian ethnicity. BDNF mRNA levels were determined by quantitative real-time PCR. Results: Post-mortem brain samples from suicide subjects showed a statistically significant increase of DNA methylation at specific CpG sites in the BDNF promoter/exon IV compared to non-suicide control subjects (p < 0.001). Most of CpG sites lying in the –300/+500 region, on both strands, were low or no methylated with exception of few sites located in proximity of transcriptional start site that were differentially methylated while genome-wide methylation levels were comparable among the subjects. The mean methylation degree at the 4 CpG sites analyzed by pyrosequencing was always below 12.9% in the 33 non-suicide control subjects, while in 13/44 cases (30%) among the suicide victims the mean methylation degree ranged between 13.1 and 34.2%. Higher methylation degree corresponded to lower BDNF mRNA levels. Conclusions: BDNF promoter/exon IV is frequently hypermethylated in postmortem brain Wernicke’s area of suicide subjects irrespective of genome-wide methylation levels, indicating that a gene-specific increase in DNA methylation could cause or contribute to down-regulation of BDNF expression in suicide subjects. The reported data reveal a novel link between epigenetic alteration in brain and suicidal behaviour.

Interaction between childhood trauma and serotonin transporter gene variation in suicide A. Roy Co-chair of WPA Section on Suicidology, USA Although the serotonin transporter promoter polymorphism (5-HTTLPR) contributes to depression and suicidality in a fashion modulated by environmental 96


stress, 5-HTTLPR has been little examined in relation to suicidal behavior in substance dependence. Recently, a third functional allele of 5-HTTLPR was discovered enabling more of the interindividual variation in serotonin transporter expression to be predicted by genotype. We examined whether the 5-HTTLPR gene alone, or interacting with childhood trauma, was predictive of suicidal behavior in substance-dependent patients, a clinical population that is at high risk of suicide, as well as childhood trauma and other stress. We interviewed 306 abstinent male African-American substancedependent patients about whether they had ever attempted suicide and administered the 34-item Childhood Trauma Questionnaire (CTQ). Patients and 132 male AfricanAmerican controls were genotyped to determine the S, L(G), and L(A) 5-HTTLPR alleles; some analyses grouped the S and L(G) alleles on the basis of equivalent function. The distribution of 5-HTTLPR genotypes did not differ between patients and controls, nor between suicide attempters and non-attempters. However, patients with low expression 5-HTTLPR genotypes and above-median CTQ scores were more likely to have attempted suicide. Logistic regression showed increasing risk of a suicide attempt with increasing reports of childhood trauma scores; in addition, this increase was exaggerated among those with low expression forms of the 5-HTTLPR genotype. Childhood trauma interacts with low expressing 5-HTTLPR genotypes to increase the risk of suicidal behavior among patients with substance dependence.

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Symposium 9. WPA’s recommendations on working together with service users and carers Chairs: Helen Herrman (Australia), Sam Tyano (Israel) Discussant: Solomon Rataemane (South Africa) General abstract The WPA has invited service users and family carers to join in its work as members of a taskforce, recognizing their essential contribution to improving mental health in any country. The taskforce is preparing recommendations for the international mental health community on best practices in working with service users and carers. It is also working with the WPA Standing Committee on Ethics to review the ethical considerations of this relationship. The symposium will describe the goals and progress of the project. The project was established by WPA President Prof. Mario Maj to support the WPA Action Plan for the years 2008 to 2011 and one of its goals: “Support international and national programmes aiming to protect the human rights of persons with mental disorders; to promote the meaningful involvement of these persons in the planning and implementation of mental health services; to encourage the development of a person-centered practice in psychiatry and medicine; and to promote equity in the access to mental health services for persons of different age, gender, race/ethnicity, religion and socioeconomic status”. The taskforce has three members with a background as service user (Bhargavi Davar, India; Sylvester Katontoka, Zambia; and Jan Wallcraft, UK), three with a background as family carer (Diane Froggatt, Canada; Hussain Jafri, Pakistan; and Sigrid Steffen, Austria) and six psychiatrists associated with the WPA (Michaela Amering, Austria; Julian Freidin, Australia; Helen Herrman, Australia – Chair; Solomon Rataemane, South Africa; Henrik Wahlberg, Sweden; and Richard Warner, USA). The members were appointed as individuals, although several also hold leadership positions in relevant organizations. Chris Underhill, founder and director of Basic 98


Needs, is special adviser, as are two members of the WPA Committee on Ethics, its Chair Sam Tyano and Afzal Javed. The World Health Organization Department of Mental Health and Substance Abuse is helping by offering its experience and advice. The WPA hopes, through the work of the taskforce, to support partnership and participatory developments worldwide, and improve learning from these experiences.

The WPA project on partnerships with service users and carers H. Herrman WPA Secretary for Publications, Australia The project taskforce has first of all defined the need to develop a unified approach to advocacy for mental health and human rights at country and international levels. Adequate support for mental health services and improvement of mental health in any population require a united voice. Achieving this will need support for the capacity of each group to work effectively in partnership. As service users and family carers typically lack the power to interact equally with professionals and government decision makers, assistance in developing this power is mutually important for them and the wider international mental health community. This presentation will describe the background and work of the taskforce and the series of ten recommendations about the changes required that it drafted recently. The draft recommendations begin with the declaration that respecting human rights is the basis of successful partnerships for mental health. The second recommendation is that legislation, policy and clinical practice relevant to the lives and care of people with mental disorders need to be developed in collaboration with users and carers. The series continues with a recommendation that the best clinical care of any person in acute or rehabilitation situations is done in collaboration between the user, the carers and the clinicians. Education, research and quality improvement in mental health care also require this collaboration. Other recommendations include enhancing user and carer empowerment through the development of self-help groups; participation in service planning and management boards and the activities of professional societies; employment of people with mental health disabilities in mental health service 99


provision, user-run community centres and psychosocial clubhouses; and the creation of inclusive local anti-stigma programs. Each country will need specific guidelines to apply these recommendations. The next step is a wide consultation and developing an advisory network to include people and organizations with needed expertise. Consultation will take place in the next few months with Member Societies and other components of the WPA, with other international organizations and through a series of contacts and group discussions with grassroots people and groups.

What has been learned from working between mental health professionals, patients and users of psychiatric services, their families and friends? J. Wallcraft Visiting Fellow of University of Hertfordshire, and Honorary Fellow of University of Birmingham, UK Dr. Wallcraft is a researcher with personal experience of psychiatry and membership of service user organisations for many years. She has worked as a consultant on service user and family/carer issues to the UK Government and a number of national NGOs. What has been learned from the past 20 years of consultation, involvement and partnership working between mental health professionals, patients and users of psychiatric services, their families and friends? What works and how does it benefit mental health services and psychiatry? Partnership working between psychiatry, other professions and consumer and family organisations is now a priority issue given current human rights legislation and changing values in the 21st century. This presentation will give evidence from a literature review of international sevidence about the outcomes of involving a range of consumer and family stakeholders. Studies reviewed include a range of involvement methods, from the more conventional forms, such as inviting representatives from families and service user organisations to sit on committees, to more innovative 100


methods such as training service users as consumer consultants, open discussion forums on a basis of equal status, such as trialogue, inviting service users and family members to act as teachers and trainers for professionals, and funding research to be led and carried out by service users and family members. The presentation will summarise the main outcomes of studies on involvement and partnership working, and show how it can lead to improved services, better outcomes, and more job satisfaction. Also the limitations of some existing methods will be described, and some of the obstacles which hinder progress will be discussed, such as entrenched assumptions and attitudes, low priority and lack of funds available for this work. Finally the presentation will present an argument based on values and human rights for an increased prioritisation of partnership working in psychiatry and mental health.

Making a difference with trialogue – speaking together in partnership S. Steffen President of EUFAMI (European Federation of Associations of Families of people with a mental Illness), Germany After one of her two sons fell ill, Sigrid Steffen started working on a voluntary basis in the mental health field. She is leading a family member organisation and a day centre for people with a severe mental illness in her home country Austria. One of her key interests is to promote the idea of trialogue between professionals, service users and carers. The objective of trialogue is to facilitate communication about the personal experience of dealing with a severe mental illness and its consequences. All participants achieve positive results from the trialogue discussions, requiring them to have a close look at their own roles, limitations as well as opportunities in order to form good relationships and mutual understanding. Therefore one of the key issues of the WPA project on partnership for best practices in working with service users and carers is to enhance the Trialogue. 101


Trialogue participants – users, their families and friends, mental health professionals – strive to give up their isolation and lack of common language. Trialogue will lead to more confidence, self assurance among service users and carers and will reduce prejudice and ignorance – and – this should not go unmentioned – will as a result lead towards recovery. Communicating about and sharing the complex and very heterogeneous subjective experiences and consequences of mental health problems and ways of dealing with them – on equal footing – as experts by experience and experts by training or both, will bring a tremendous improvement in mental health care. Building a culture of discussion based on shared experience enables all participants to work together effectively. Shared experience leads to an open mind for all participants. WPA and its president Mario Maj are very much aware that the active involvement of carers and service users not only in mental health care but also in research is essential for the development of the mental health field.

Working with patients, users and carers: ethical considerations A. Javed1, S. Tyano2 WPA Standing Committee on Ethics, 1 Pakistan, 2 Israel WPA being the representative body of psychiatrists working in more than 135 countries is committed to work for programmes looking at the development of mental health across the globe. In addition to a number of initiatives in different areas of mental health, the WPA Action Plan 2008–2011 also emphasizes supporting international and national programmes aiming to protect the human rights of persons with mental disorders & promoting the meaningful involvement of these persons in the planning and implementation of mental health services. This clearly suggests that a partnership approach between mental health experts and users of mental health services and their families and friends is encouraged & strengthened by WPA & has been given a priority in its current working plan. 102


The establishment of a Task force for looking at this partnership & developing guidelines in this area is a step forward in the WPA’s functioning structure. It is also important that this task force is exploring different aspects of this relationship & exploring further collaboration with other components of WPA especially with the standing committee on Ethics. A joint meeting of these two groups has looked at the ethical considerations of this relationship with a view to suggest ethical guidelines in meeting these targets in clinical practices. This presentation will give an outline of the historical development of Ethical Standards for Psychiatric Practice as prepared & approved by WPA in its Declarations approved in meetings held at Hawaii, Vienna, Madrid, Spain, Hamburg, Yokohama & Cairo and will discuss the recommendations that may be submitted to the next WPA general assembly for consideration of approval. This paper will also raise some issues that need further discussions by the member societies looking at the future directions in ethical aspects of this growing relationship of patients, users & carer’s interaction in areas like confidentiality, involvement of patients in treatment selections, relationship with pharma industry, training of psychiatrists, participation of patients in research, fighting stigma and discrimination, lobbying for support for programmes for mental health education, care, rehabilitation & social inclusion and service provision issues.

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Symposium 10. Mental health care for old people living at residential facilities Organized by WPA Section on Old Age Psychiatry Chairs: Carlos Augusto de Mendonssa Lima (Portugal), John Snowdon (Australia) Geriatric psychiatric care in nursing homes in Turkey I. Icelli Medical Faculty of Celal Bayar University, Turkey Almost in all countries of the world, older people are particularly a vulnerable group with their specific health problems. They become ill more easily and more frequently. According to the 2005 census, elderly population in Turkey constitutes 6% of overall population. This percentage is going to reach the double in the year 2020. With this expectation geriatric psychiatry is developing rapidly in Turkey; but the institutional care system is not well developed. 0.21% of the elderly population takes care in nursing homes. There are 173 nursing homes in 56 cities; 23 cities have no similar institutions. These homes accept healthy elderlies. Before to apply to these institutions, the elderly has to prove that he is mentally and physically healthy with a hospital certification. The treatment and the care of the mental/physical illnesses occured after the acceptance are under rhe responsability of the nursing home. Actually in major cities exist well equiped nursing homes and their caring team is also well trained. The presenc of social worker, geriatric nurse, occupational therapist, physiotherapist, psychogeriatrist and geriatrist are obligatory in these institutions. To stay in those institution require a high amount of money. Severe mental illnesses are treated in general psychiatry hospitals. On the other hand, Turkish people, because of his belief do not want to put his elderly parent in nursing homes. They prefere to keep and treat them in their homes. Lately, the Ministry of Social Security prepared a program which called “Taking care of the elderly in their homes” in order to give 104


financial support to the families who want to care their elderlies in their homes. With this program the elderly will be kept and cared in his nest and the nursing homes will probably reduce their prices and enhance their quality of ther service and care in order to attract more elderly people.

QoL and residential care for elderly with mental disorders in Romania N. Tataru, E. David Forensic Psychiatry Hospital Stei, Bihor, Romania The special needs of mentally ill elderly were not always recognized and respected by the generic services. The number of professionals working in the field is still very low to satisfy the needs of care of elderly with mental disorders and to improve their quality of life. The Mental Health Law appeared in Romania in August 2002, being the first step towards the reform of mental health services and care system of mentally ill patients. In Romania only recently we tried to add to the traditional system of active psychiatric hospital care, the community mental health care services. This started by radically reducing the number of beds. Many long-stay psychiatric wards were transferred to the social services. So far traditionally, the elderly mentally ill were treated for financial reasons in general or geriatric hospitals as there were insufficient psychiatric hospitals. Most Romanians with dementia who have a family are treated at home. Older people with dementia and no behavioural disorders or significant physical disabilities are also admitted to nursing homes and other social services long-stay units organized by the state, non-governmental organizations (NGOs) or churches. In Romania there are also some out-patients services, but only in few districts because there is still a severe lack of resources. The extension of outreach services of nursing homes and residential homes in conjunction with day-care centres, day hospitals and residence care could be a valuable alternative to the high degree of institutionalization of Romanian elderly people with or without mental disorders. The quality standards must be improved, especially those concerning elementary care needs and quality of life. 105


Detecting and treating depression in Australian nursing homes J. Snowdon University of Sydney, Concord Hospital, Sydney, Australia Depression in nursing homes is under-recognised. Since March 2008, the Cornell Scale for Depression in Dementia (CSDD) has been included as an assessment component of Australia’s Aged Care Funding Instrument (ACFI). Scores on the CSDD contribute to a calculation of supplementary funding provided to nursing homes in recognition of added workloads attributable to residents’ mental and physical disorders. The ACFI is under review. Its use in 3 Sydney nursing homes was studied. Of 223 residents, 51 (23%) scored 13 or more on the CSDD. Twenty-one (41%) of these and 25% of those scoring 0 to 12 were taking antidepressants. Whether the CSDD is sufficiently accurate in detecting depression in nursing homes is debatable, but its use at least prompts discussion among staff about depressive symptoms. However, in cases where the CSDD is found to be high, it is uncommon for doctors or staff to arrange repeated testing to examine whether interventions (if any) have led to reductions in CSDD scores. Accreditation of nursing homes should be determined partly by whether staff search for and respond appropriately to evidence of depression among their residents.

Knowledge transfer model for psychiatric care in long term care facilities C. Dobbelsteyn, L. Furminger, H. Genereux, M. Tusi, T. Crowell, N. Kang, M. Agbayewa Geriatric Mental Health Team, Burnaby Mental Health and Addiction Services, Canada University of British Columbia, Vancouver, Canada It is suggested that Long Term Care Facilities (LTCFs) are the new psychiatric institutions. Aging patients of the old institutions are now residents of LTCFs; acute care beds have not increased to compensate for population aging nor are there adequate alternatives for the mentally ill elderly; the tertiary functions of psychiatric units have been lost in most parts and LTCFs do not have comparable quantity and 106


quality of staffing; but are expected to manage very difficult behaviours and other manifestations of psychiatric conditions. Different approaches have been developed to cope with these shortfalls. The approach used in Burnaby is the monthly mental health (MH) knowledge transfer round, the purposes of which are to discuss residents who are not currently receiving our services; determine those who need formal MH assessment and intervention; review those who are on our caseload; and to influence the care process through team discussions that focus on problem solving through knowledge transfer, staff empowerment by increasing their knowledge base in geriatric mental health and thus enhanced resident care. We piloted the model in 2 LTCFs with a combined resident population of 244 and a team of case manager/geriatric psychiatrist assigned to each facility. At the end of the pilot, the team coordinator held a feedback session with the staff and management of each facility to answer our predefined questions on the perceived usefulness of the rounds. This was supplemented with an anonymously completed questionnaire. We also obtained data on referral rates, care related aggressive episodes and injuries pre and post intervention. Results: Combined data from both LTCFs showed a 30% decrease in falls with injuries, more than 75% decrease in resident to resident aggression, 30% decrease in Resident to Staff Aggression and 30% decrease in the use of behaviour related PRNs; more than 50% reduction in active cases; at least 2/3 of staff experienced improvement in work-related quality of life, and they also rated improvement in their knowledge and comfort level which are reflected in reduced need for urgent mental health referrals. Over all, staff and management report the mental health knowledge transfer rounds as helpful and an efficient way of caring for residents in their LTCFs. Conclusion: While this model maybe helpful to LTCFs and provides the team an efficient way to serve more people – resident and staff, it doesn’t replace adequate staffing. There is no attempt to compare this model to others and the perceived positive responses could be a case of “anything is better than nothing”.

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Residential care as a component of primary care for old persons with mental disorders C. Au. de Mendonssa Lima Department of Psychiatry and Mental Health of Alto Ave Hospital Center, Guimaraes, Portugal According to WHO-WPA, though care should be provided in patients' homes for as long as possible, it must be recognised that care in an alternative residential setting may be the only way of meeting patients’ needs effectively or avoiding intolerable carer burden. Such care will always be necessary, particularly for people who have no relatives available or willing to look after them. This means that the provision of residential care is culturally sensitive; it depends on local family structure, financial resources and on the existence of other components of services in the community. The residential care may be useful for respite care which includes a range of short term time limited services to support the carers. But most often residential care should be available for those patients whose physical, psychological, and/or social dependencies make living at home no longer possible. This provision includes a range from supported accommodations with low level supervision, medium level care facilities, to full nursing facilities. These should be organised to achieve the best possible quality of life. Consultation liaison services should be provided for old people with mental disorders living at residential facilities as well to support with education and advice to the staff working with these patients. There are considerable differences in long-term residential care for old people around the world. There is a high prevalence of mental disorders in nursing homes and very often the staff is not adequately educated, trained and supported to care for these individuals. There is a high prevalence of behavioural problems including verbal and physical aggression and the potential for inappropriate use of medications. This communication is the presentation of a systematic review of studies published in selected journals from 2005–2009. The main authors’ goals are identified as well the fields where further studies are necessary to create a based evidence knowledge in this matter. 108


Symposium 11. New trends and findings in suicide prevention Organized by WPA Section on Suicidology Chairs: Jean Pierre Soubrier (France), Vladimir Carli (Sweden) Preliminary results of SEYLE in Estonia A. Varnik1, 2, M. Sisask1, 2, P. Varnik1, 2 1 Estonian-Swedish Mental Health and

Suicidology Institute, Tallinn, Estonia

2 Tallinn University,

Estonia

The overall aim of the European Commission 7th Framework Programme project SEYLE (Saving and Empowering Young Lives in Europe) is to lead adolescents to better mental health through promoting healthy behaviours and preventing risk taking and suicidal behaviours. The baseline evaluation data was collected among 14–15year-old adolescents in 11 European countries; Estonia (Tallinn) was one of participating sites. Preliminary results of the SEYLE project in Estonia will be presented here. Sample of adolescents was selected from randomised schools in a defined catchment area. In total 19 schools participated in the study. Adolescents and one of their parents gave a written informed consent for participation. Eventually 73% of students agreed to participate. The total number of enrolled students was 1038 (46% boys and 54% girls). Mean age of students was 14.2 (SD = 0.5). Structured questionnaire, completed within the confines of the classroom, was utilized for collecting the baseline data. The data include demographic information, information about mental health, well-being, lifestyles, values, risk behaviours and other psychosocial information. A specific procedure to evaluate and immediately assist emergency cases (acutely suicidal adolescents) was compulsory for all pupils participating in the SEYLE project. In total 23 pupils (2.2%) were emergency cases according to the baseline questionnaire results. Face-to-face screening interviews selected out 9 false-positives. The final number of emergency cases referred to healthcare services for treatment was 14 (1.4%). 109


Variables chosen to characterise mental health status of students were subjective psychological well-being (WHO-5), depressiveness (BDI), anxiety (Zung Anxiety) and hopelessness (Aisch-Wasserman one-item-scale). Well-being was poor for 11% of pupils (score < 13), 15% were depressive (score ≥ 14), 9% expressed hopelessness (“My future seems dark to me”) and 23% anxiety (score ≥ 36). Girls reported slightly worse mental health than boys. Alcohol consumption among pupils was high: 32% drink at least twice a weak and 30% drink never. Approximately 1/3 of pupils drink more than 3 dosages (i.e. a bottle of beer, a glass of wine etc) per on time and approximately 1/3 of pupils have been really drunk at least 3 times during their life-time. Probability to consume alcohol frequently was higher among pupils who had seen their family member being drunk (OR = 2.6; CI = 1.3–5.1). A typical complaint among pupils was fatigue. Adolescents reported being every morning sleepy and tired in 38% of cases, often 27%, sometimes 25%, and seldom or never 10%. Pupils sleep on average 7.4 hours per night (school-days) and pupils who complained fatigue reported on average significantly less sleeping hours per night. Tiredness was positively associated with several other mental health and lifestyle variables. Consequently, some measures for mental health promotion can be simple and easily feasible.

Suicidal risk in neurotic disorders N.A. Maruta Institute of Neurology, Psychiatry and Narcology of the AMS, Kharkiv, Ukraine The suicide is one of the essential problems of contemporary psychiatry. According to data of the WHO, suicide is among 10 leading causes of mortality in all countries and 3 leading causes of mortality in age from 15 to 35 years old. In Ukraine 35– 40 persons perish due to suicides and approximately 500 suicidal attempts are performed every day. 110


Among risk factors of suicides there are age, gender, antecedent suicidal behavior, somatic, family and psychosocial factors etc. An important role belongs to such factor as mental diseases including neurotic disorders. Our investigations defined clinico-psychopathological predictors of a suicidal behavior in neurotic disorders. It was demonstrated that such predictors were: – A high level of vegetative manifestations and impulsivity in anxiety-phobic disorders, auto-aggression and affective impairments in anxiety-depressive disorders, a significance of affective impairments in adaptive disorders, impulsivity in dissociative disorders, a significance of vegetative manifestations in somatoform vegetative dysfunction, a narrowing of interpersonal contacts in neurasthenia; – A high level of a nervous-psychic tension and introversion, predominance of psychasthenic and explosive radicals in the characterological profile; – A low level of a general internality, i.e. an inclination to a self-perception as a passive object of actions of other persons and external circumstances, and a specially low level of internality in a sphere of achievements; – Predominance of values of a personal life and a low significance of values of a professional and creative realization; a high internal conflictness concerning the most significant values; – A low variability and a low level of expression of psychological protections; – Regarding ways of manifestation of aggression it was characteristic an accumulation of aggression inside, a transformation of aggressive impulses inward as reactions of guilty. Some biological, ethnic-cultural, religious, social-psychological, and personality factors might be antisuicidal barriers. Measures to prevent suicides have to include primary (informative-educational activities on problems of suicidology for all the categories of population and a work with suicidents in a pre-suicidal period), secondary (a work with persons who have performed a suicidal attempt to obviate further ones), and tertiary (an aid for closely surrounding persons) prevention.

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Postvention suicide = the ultimate prevention? J.P. Soubrier Honorary executive board member of WPA Section on Suicidology, Paris, France Definition of Postvention Suicide was definitely adopted in early 70s. It was primarly uderstood as prevention of repetitive suicide attempts or tertiary suicide prevention. It became one of the most important suicidology topic in research and more and more in meetings. As a confirmation of a declaration of Edwin Shneidman in 1972 Postvention can be viewed as prevention for the next decade or for the next generation. It was a consequence of psychology autopsy studies and survivors of suicide programs. Today postvention is extended to differents groups and professional categories as a Public Prevention. It may then not too much to name it and propose THE ULTIMATE PREVENTION? This presentation will include brief history – developments of postvention and recent comments made by Norman Farberow.

Suicide and psychosis – an example of person centred suicide prevention W. Rutz University for Applied Sciences, Coburg, Germany Senior Consultant in Public and International Mental Health, Stockholm, Sweden Immediate Past European Regional Advisor for Mental Health, WHO European Office, Copenhagen Suicideprevention, both on individual as well as on aggregate level, has to be person oriented and taking into account the individual characteristics of suicidal persons and groups at risk. Person centered suicide prevention is here of essential importance, regarding the specific and suicideprovoking characteristics of pre- post- and psychotic persons. Thus they form an important complement to more protocol related and general strategies of suicideprevention and riskassesment.

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In this paper the specificities of suicidogenic factors in persons close to psychosis are shown, possibilities and difficulties in encountering them are described and the relationship of symptoms being elements of psychotic features to suicidogenic risk factors of helplessnes, deidentification, loss of predictability and control as well as existential emptiness and loss of dignity and social significancy are discussed.

Suicide in french prisons: some data and some questions J.P. Kahn University of Nancy, France Frequency of suicide has long been considered as an indicator of problems and tensions in a society. Suicidality in jail has been increasing dramatically over the last 50 years in France. Since it stayed around 4 per 100,000 prisoners in 1960, it reached 19/100,000 in 2008. Evolution of suicidality was hectic between the mid-seventies and the end of the ninetees. It then increased abruptly to peak at 26/100,000 in 1996. The phenomemon slowly decreased from then, during the following years but reincreased in 2008, with 19/100,000 suicides among prisoners. If compared to suicidality in men, aged 15–59 in the general population (to match age of the detained population), this trend cannot be found in the French general population, were suicide rates are rather stable (2.5 to 3.5/100,000), suggesting that this phenomemon is somewhat specific to the detained population. With rates as high as 20/100,000 detained prisoners, between 2002–2006 France has the highest suicide rates in prison, among the “Europe of the 15”, far before Denmark (13/100,000), Greece exhibiting the lowest rates (4/100,000). Several explanatory factors have been suggested, which will be discussed. Suicide prevention in prison remains a difficult task and deserves more detailed epidemiological and statistical studies.

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Conduction of suicide decreasing program in Tomsk region N. Kornetov Siberian State Medical University, Tomsk, Russia Introduction: Disintegration of USSR, period of formation of state capitalism entailed in population distress and identity crisis. Their manifestations were resulted in increase of psychosocial, depressive disorders (DD) associated with alcohol and psychoactive substance abuse. Suicide as an external form of exit from crisis condition, became wide spread phenomenon in Russia, after the Lithuania and Belarus. Objectives: To create an effective model of organization of special urban and rural crisis-proof systems with help lines, recognition of DD for non-psychiatrists on educational programs on Depressive Disorders for Primary Care (PC), General Medicine (GM), clinical psychology and social work services in Tomsk area (TA) to prevent suicides. Methods: Continual monitoring of suicides, crisis intervention of suicidal attempts, educational Program (EP) WPA/PTD on DD (Russian version) with three thematic monthly courses every year since 2004 in PC. Many mini trainings, roundtable discussions, local seminars, symposiums and large interdisciplinary conferences with colleagues from other Russian cities and European countries were taken place too. Results: We conducted the analysis of suicides in Russian Federation (RF), Siberian Federal Okrug (SFO) and TA during the last five years; we also assessed the dynamics of suicides reduction in TA under the influence of EP and services of social support. In 2004 the mortality ratio of suicides in PF, SFO and TA in comparative analysis was 34.3; 47.6; 38.3/100,000 accordingly. The differences were made between RF and SFO (p < 0.0001); TA and SFO (p < 0.002). In ТA the mortality ratio of suicides (MRS) was lower than in SFO (p < 0.002). During 5 years there was the trend of suicides’ decreasing for all three population groups. The smallest intensity of MRS was in SFO (p < 0.0183) and the biggest one in TA (p < 0.0001). Intermediate position belonged to RF (p < 0.0016). The analysis showed more intensive decrease of MRS from 2004 to 2008 in Tomsk Area as compared with Siberian Federal Okrug two times 114


as much; 47.6 versus 26.3/100,000 (p < 0.0001) and in Tomsk Area as against to Russian Federation 1.7 times; 34.3 versus 26.3/100,000 (p < 0.001). In assessment of the dynamics of MRS in TA with the population of 1 million since 2001 to 2009 MRS decreased with the rising of educational programs on recognition and therapy of depressive disorders by force of all described ways of prevention of suicides: 48.0; 41.1; 42.0; 38.7; 35.3; 28.1; 26.3; 20.6/100,000 (p < 0.0001). Discussion: MRS showed annual reduction of suicides across with educational programs on DD in PC, GM and rural sociological services. MRS in TA – 20.6/100,000 in 2009 was close to the same index in Mauritius Republic – (in 2007 – MRS was 20.8). This model can be extrapolated to other regions of the country with high MRS. Conclusions: The prevention of suicides is possible provided with the persistent and continual education of doctors of all specialties, clinical psychologists, social workers to recognize and manage depression and comorbid conditions with high risk of suicides.

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Symposium 12. A step forward for improving mental health services in low income countries Organized by WPA Section on Psychiatry in developing countries Chairs: Pedro Ruiz (USA), Afzal Javed (Pakistan) WPA Section on Psychiatry in Developing Countries: a step forward for improving mental health services in low income countries A. Javed Pakistan The WPA Section on Psychiatry was formed at the XIII WPA World Congress of Psychiatry in 2005 September in Cairo. It was formed to address the needs of developing countries (now also called Low and Medium income Countries by some colleagues) There are clear differences in the practice of psychiatry in these countries with less mental health professionals and material mental health resources, & now often facing additional problems of migration of trained psychiatrists and nurses to the already resource rich countries. Innovation, networking and basic training as well as better models of care using simple but effective paradigms need to be put in place if these countries are to provide better mental health services. Relying on existing models developed in different developed countries has sadly not worked. This Section is meant to network among psychiatrists who work in difficult circumstances to share experiences, ask for help and come up with innovations and volunteer training that will change mental health in developing countries. This symposium will focus on the objectives of this Section and will discuss a brief account of its activities since its inception. Reports and presentations from different parts of Europe will also emphasize the needs & priorities of these countries in different areas of mental health.

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Mental health care in Bosnia and Herzegovina – challenges, strengths and weaknesses E. Avdibegovic Department for psychiatry University Clinical cenetr of Tuzla, Faculty of medicine University of Tuzla, Bosnia and Herzegovina The context of the post-war situation and the transition from a socialistic state into a democratic state presents a complex challenge for Bosnia and Herzegovina (BiH). Consequences of the war in BiH (1991–1995) are multidimensional and affect entire society and all its sectors. Traumatisation by the war is a problem which affects the life of great part of the population. Bosnia and Herzegovina is facing problems that include lack of trust (towards the state), ethnic conflicts and inequality, high unemployment and poverty rates. Mental health is currently one of the biggest challenges in both administrative entities (Federation of Bosnia and Herzegovina and Republic of Srpska), and the prevalence of mental health disorders is very high. The strengths of mental health care cover the following aspects: services are available for all citizens, paid from a special national fund for healthcare, financed by mandatory health insurance; the reform of mental health services began 15 years ago and the focus has been onto the care in the community, and thereby establishing a network of 55 community mental health centers, and developing other services in the community, a multidisciplinary approach and teamwork, as well as cooperation between sectors. The weaknesses of mental health care include a low overall budget for mental health, no national politics and strategy for mental health, within ethnical and cantonal division of health institutions, unequal and insufficient educational program for psychiatrists, no education for psychiatry nurses, insufficiently developed research in the field of mental health, poor development of social welfare, and establishment of new “asylums” for mentally ill in a form of a big social institutions. Regardless of the above mentioned weaknesses and obstacles in the development of mental health service in BiH, a political will for further development of community mental health, as well as human resources, which are ready to carry the programs of reform, still exit. Overcoming the consequences of war and transition in 117


BiH is a big challenge not only for professionals in mental health but for mental health policy makers as well.

Psychosocial rehabilitation model, Hungary I. Kosza, J. Harangozo Béla Gálfi Psychiatric Teaching Hospital, Pomáz and Semmelweis University of Medicine Budapest, Centre of Community Psychiatry, Hungary The Psychiatric Hospital in Pom|z is the Collaborating Centre of the World Association for Psychosocial Rehabilitation (WAPR). This hospital is the model of the field with the whole scale of psychiatic treament. The acut ward has a territory of inhabitants in the part of Pest County. The department of rehabilitaion has a special program, and this department serves the whole country. Admission of patients is possible from any part of the country by the date agreement of admission in advance. In this department every patient has an individual rehabilitation program after the assessment, made by the staff and patients together. In the content of the program there are different therapeutic methods, as sociotherapies and different types of psychotherapy together with pharmacological treatment. A residential facility is the part of the model, what is a intermediary structure for the patients called SARA home with complete program. The hospital is the seat of the Hungarian Society for Psychosocial Rehabilitation. The scientific society has program included the support of consumers who can participate in this work by the Mental Health Forum, what has a website, opened for the public.

“Developing countries” – is it stigma for Eastern Europe A.F. Soghoyan1, 2, Kh.V. Gasparyan1 1 Yerevan

Mkhitar Heratsi State Medical University, Armenia

2 Psychiatric Medical Centre,

Yerevan, Armenia

Countries of Eastern European region are included in the list of developing countries due to economic circumstances. To represent (no matter if you are NGO or just a professional) so called “developing country” means that you are separated: with 118


less registration fee, with available grants for reforms in human rights, civil society, poverty reduction etc... Is it favorable? Yes, if the country has 0.1 psychiatrist per 100,000 population, or the number of psychiatric beds 0.5 per 10,000 population. We have to consider that countries of EE have a different statistics and number of Psychiatrists as well as number of psychiatric beds is mostly equal to the European figures. The number of Psychiatrists is more than 10 in developing countries, with only 35% less then appropriate number in Europe, and with 25% less beds accordingly. EE countries have huge potential human and organizational resources. Although the economic development in mentioned countries during the last 20 years is far from what is desirable. No doubt that this countries require a huge investments, which is normally is not possible for most of the governments, but creation of NGO field and culture indicates that there is a potential and outcome results could be positive with inadequate sources available. We concluded that one of the key elements is the issue of overcoming language barriers. Availability of English professional literature in Russian language and vise versa, translation of professional literature in Russian into English are two important steps in for solving problems in mentioned barrier. Our experiance of Russian version of the «Journal of World Psychiatry» showing that in this fild it is possible to get good results with good will and limited input.

Global cooperation for global mental health H. Wahlberg1, J. Hanson2, S. Ekblad3 1 WPA,

Board member, Northern Europe, Sweden

2 SEEC coordinator, Stockholm, Sweden 3 Dpt LIME,

Karolinska Institutet, Stockholm, Sweden

Mental health services’ development has been a WPA’s top priority for many years and an essential goal for the WHO several guidelines. Manuals have been 119


prepared on mental health, mental health policy and different aspects of mental health services’ development. The importance of a longitudinal collaboration between local and international agencies for the sustainability of mental health as a prerequisite for individual activities and social organization has not been fully recognized. Too often the best for children are ignored (Convention of the Rights of the Child). The priority given to mental health and mental health services’ development varies between countries as the implementation strategies and targets. The stigma is still very strong to mental illness. The share of development and emergency aid attributed to mental health has been poor. Up to now most of the local, national and regional mental health development projects have been hastily and insufficiently planned, implemented and coordinated. Donors lack interest in evaluation. A successful mental health development project needs to pay attention to the following: – Development goals based on the local conditions, cultures and needs; – Local leadership involving the authorities and the local professionals; – Transparency and public involvement, cooperation, twinning; – Synchronization of project aims with existing services and health policy; – The project should not harm existing services or drain existing resources; – Long-term involvement and a smooth transition; – New techniques for assessment and supervising local resources (eg. virtual encounter); – All projects must be planned for sustainability; – An evaluation connected with local and international universities that describe the outcome and impact and the difficulties and solutions. Many projects spend too much energy on public impression, promoting the agency in charge or the donor, travel and training abroad and too little on achieving outcomes. Development projects are often hampered by officialism, bad practise, slow decisions and repugnance to responsibility. Donors may stress the benefit to their countries, their views of democracy and environment on the expense of mental health. 120


Despite the difficulties there are several examples of successful mental health services’ development projects and cooperation. The presentation will give examples of development projects and evaluation. Mutual global cooperation between equal partners is a prerequisite for better services and global mental health!

Mental health condition of population in the Kyrgyz Republic T. Kadyrova I.K. Ahunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic Objective: To make the structural and comparative analysis of the prevalence of mental pathology in the Kyrgyz Republic in 2009. Methods: The statistic data of analytic and informatics department of the Republic Centre of Mental Health (Bishkek) were used and analyzed. The qualification of mental and behavioral disorders was considered in accordance with V chapter of ICD-10 (F00–F99). Results: The common prevalence of mental pathology has made 990.7 (per 100,000 populations) in the Kyrgyz Republic in 2009. In the structure of mental pathology (by ICD-10) the mental retardation there has taken the first place (436.1). Organic, including symptomatic mental disorders (251.1) and schizophrenia, schizotypical and persistent delusional disorder (185.7) have taken the following place. Further the mental disorders are following in regressive order: neurotic, stressrelated and somatoform disorders (35.5), disorders of psychological development (30.1), emotional and behavioral disorders at the children (22.2), disorders of adult personality and behavior (14.9), affective disorders of mood (13.4) and at once behavior syndromes associated with physiological disturbances and physical factors (1.8). In gender ratio men were suffering more often than women in 2.4. The prevalence of mental pathology in villages is 1.5 higher than in the city. The prevalence of mental retardation in villages is 2.5 more often than in city. Conclusion: The comparative and structural analysis of the prevalence of mental pathology among the population of the Kyrgyz Republic has revealed the preference position of organic pathology and mental retardation. These results promote the concrete prophylactic actions, first of all those, which are connected with natal disturbances. 121


Symposium 13. Stigma and how to fight it Chairs: Miguel Jorge (Brasil), Vasily Yastrebov (Russia), Norman Sartorius (Switzerland) Stigma and mental disorders: some historical and conceptual issues M. Jorge Brasil One important obstacle that patients with mental disorders in all regions of the world experience to get access to care is stigma related to their illness. The many sources of stigma are disseminated in different levels throughout communities and professional services. The origin of the term stigma and the historical roots of psychiatry as a medical specialty and of the current concept of mental disorders are important to understand why this phenomenon is so widespread worldwide. Stigma is related to other important phenomena such as stereotype, prejudice, discrimination and social distance, and has multiple faces that need to be identified in order to succeed when fighting against stigma.

The Rusian experience in stigma fighting V.S. Yastrebov Mental Health Research Center of Russian Academy of Medical Sciences, Moscow, Russia Comprehensive study of psychiatric stigma in Russia was started in the mid 90’s last century. Five theses have been performed, which were devoted to studying the social, psychological, cultural factors and their influence on the formation of stigma in patients of different nosological groups. Self-stigmatization phenomena in patients with certain mental disorders were studied too. Programs of de-stigmatizing were performed within the framework of public organizations in psychiatry and mental health facilities across the country. Further development of this work has received in the Public Council on Mental Health in the Chief Psychiatrist of the Russian Ministry of 122


Health. The special program of the World Mental Health Day (WMHD) was created for its realization in different regions of our country. The main place of this program was dealing with stigma, performance specialists and users in the media, publication and dissemination of popular literature, conducting programs of psychoeducation, attraction of authorities and public bodies to the actual problems of mentally ill and their families. Most interesting, the dynamics of WMHD in the territories of the country: five regions took part in its conducting in 2006 and in the coming years – up to forty regions. It is important that in recent years in conducting WMHD actively participated not only psychiatrists and users, but also representatives of mass media, public figures, representatives of local government and others. Two all-Russian competitions “For Self-Sacrifice in Mental Health Activity” were organized in the past two years. In 2009, according to different nominations (psychoeducation, psychosocial rehabilitation, etc.) ten winners have been chosen who received special diplomas, prizes and cash bonuses. Finally, an important role in enhancing the tolerance of the population to the mentally ill, psychiatry, overcoming of stigma played a special Federal Program “Preventing and Combating Socially Significant Diseases (2007–2011 years)”. In accordance with this program in 2009 was published and distributed 15 methodical recommendations and manuals devoted to stigma problem and carrying out measures to combat it.

Stigma and the media A. Tasman University of Louisville, Kentucky, USA For as long as people have been communicating the problem of stigmatization has been present. The shift of communication to a form in which a single communication could be duplicated many times produced a revolution in information exchange. Unfortunately, such a shift also made wide promulgation of misleading stigmatizing information much easier. This has been a historical problem in regard to political matters as well as discrimination against population groups for religious, ethnic, racial, and other reasons. We are well aware of the impact on stigmatization of 123


those with psychiatric illnesses. The 20th century was time when new technologies made dissemination of a wide range of information orders of magnitude easier than in the historical past. Radio, television, films, inexpensive print journalism in the form of newspapers, magazines, and books, and in recent decades the internet, have all had an impact on stigma of psychiatric patients and psychiatrists. This presentation will focus on the impact of print media and films in the latter part of the 20 th century. While the information age in which we now live provides amazing opportunities to share knowledge, there is an unfortunate aspect of the information explosion which can foster greater stigmatization. Examples from recent years will be used to illustrate this thesis.

WPA’s programme against stigma of mental illness: lessons learnt N. Sartorius University of Geneva, Switzerland Stigma related to mental illness is a central obstacle to the development of mental health programs. Its usual consequence is the discrimination of people with mental illness in all walks of life as well as the self-stigmatization of those who are mentally ill and their families. The World Psychiatric Association aware of the nefarious consequences of stigmatization started a global programme dealing with the stigmatization related to schizophrenia in 1996. More than twenty countries participated in the programme and the results of their efforts are described in numerous publications and were presented in many meetings as well as during global conferences focusing on stigma held in ermany, Turkey, Canada and the UK. The presentation will summarize the experience gained in the course of the programme and draw attention to the changes of paradigms on which anti-stigma activities are based suggesting that in the future anti-stigma programs rave to be radically different from those undertaken in the past if they are to be useful and help people with mental illness and their families.

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Stigmatization of psychiatry and psychiatrists: evidence and experience W. Gaebel University of Dusseldorf, Germany Introduction and objective: In light of the institutional goal of the WPA Action Plan 2008–2011 to enhance the image of psychiatry worldwide among the general public, health professionals and policy makers, the WPA established a Task Force on the Destigmatization of Psychiatry and Psychiatrists at its General Assembly in April, 2009. The topic is of great importance, as psychiatry lacks not only a good public image, but also attractiveness for future young professionals, and has problems retaining qualified, experienced staff. In order to provide an accurate picture of previous research on this topic and provide a basis for recommendations, the Task Force commissioned a literature review on the stigmatization of psychiatry and psychiatrists. The central results of this review will be outlined, leading to recommendations based on the evidence of the review as well as on the extensive experience of the members of the Task Force on ways and means of reducing the stigmatization of psychiatry and psychiatrists. Methods: In order to obtain an accurate picture of the stereotypes of psychiatry and psychiatrists, a literature review was conducted to identify publications dealing with the image of psychiatrists, psychiatry as a discipline, psychiatric facilities and psychiatric treatments. Results: The review of the literature revealed that strong negative attitudes towards psychiatry as a medical discipline, psychiatric treatments, and psychiatric facilities as well as psychiatrists exist among the members of the public, patients and their relatives, as well as among health professionals and psychiatrists themselves. The image of psychiatry and psychiatrists projected by the media often has little or no basis in reality, enhancing the prevailing stereotypes of prison-like psychiatric hospitals, ineffective, possibly even harmful psychiatric treatment methods, and manipulative, incompetent psychiatrists. This often contributes to the stigmatization, constitutes an obstacle to help-seeking behavior, and reduces the compliance of 125


patients. Even within the medical profession, psychiatry is ascribed a low status with the image of psychiatry as not being real medicine, with low prestige and low pay, perceived as a specialty lacking a sound scientific foundation, thus contributing to the worldwide problems in recruiting young medical doctors into psychiatry and retaining them as experienced staff. The review also revealed that only a very small proportion of the research so far has been dedicated to developing and evaluating the efficacy of interventions to combat stigma, making the efforts of the Task Force to assemble viable approaches to reducing stigma all the more important. Discussion/Recommendations: The recommendations on how to combat the stigma of psychiatry and psychiatrists as proposed by the Task Force are aimed at the WPA, national psychiatric societies, as well as the individual psychiatrist in order to achieve the strongest possible impact. Among other guidelines, a close collaboration with the media, including workshops for journalists and psychiatrists, but also an improvement of the image of psychiatry and psychiatrists in the public and among medical students through a combination of knowledge and contact with people with mental illness are proposed.

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Symposium 14. Managing mental health consequences of disasters Chairs: Valery Krasnov (Russia), Dusica Lecic Tosevsky (Serbia), George Christodoulou (Greece) Psychiatry of disasters: Russian experience V.N. Krasnov Moscow Research Institute of Psychiatry, Russia Psychiatry of disasters and emergency situations is a relatively new area of psychiatric knowledge and skills. The subject matter of this branch of psychiatry is mental health consequences of large-scale life-threatening events such as natural and technological disasters, ethnic conflict, military actions, terroristic acts.The intensive development of disaster psychiatry has started after the Chernobyl disaster in 1986, and all last years collected the experience in organization of psychological and psychiatric aid in acute condition and protracted consequences of different large-scale emergency situations. Certain tendencies have been evident during the last decades decrease in frequency of psychotic reactions, and increase in the number of affective spectrum, somatoform disorders, somatic disfunctions, and PTSD. Vast knowledge gained in studying of a wide variety of emergency situations as well as their consequences suggest that the following issues should be specifically considered: 1. Association among psychological and psychopathological features of responses to emergency situations; 2. Distinction between individual and group-related types of responses to emergency situations; 3. Management of rendering care to victims of emergency situations at each stage of psychological and psychopathological disturbances development; 4. Legal and ethical rules to rendering psychiatric care to victims of emergency situations. 127


5. Information aspects of emergency situation and their consequences and the need to cooperate and coordinate an activity of specialists with actions of mass media and operational staff. 6. Long-time rehabilitation measures with psychosocial support not only for the victims, but also for their family.

Disasters and their psychosocial consequences G. Christodoulou Hellenic Psychiatric Association, Hellenic Center for Mental Health and Research, Greece The psychosocial consequences of Disasters are discussed and the attention to them from the clinical and public policy viewpoints is highlighted. The circumstances under which psychopathological symptoms appear are discussed, the policy of the WPA Institutional Program (2005–2008) for the management of the behavioral consequences of disasters is reported and the public health measures for the most appropriate psychosocial management of disasters are proposed.

Traumatic events and posttraumatic stress disorder of the adult population in the longterm emergency situation in the Chechen Republic K. Idrisov Chechen State University, Grozny, Russia The 1994–1996 and 1999–2004 wars in the Chechen Republic had a direct impact on large number of civilians however we haven’t got epidemiological data about prevalence of traumatic events and Posttraumatic Stress Disorder (PTSD) in the Chechen community. Objectives: we studied a random sample of 1000 adults in five Chechen districts where there were war actions, and a control group of 200 adults from the Chechen area where there were no military actions. Both groups have been examined four times: 2002, 2004, 2006 and 2008. 128


Method: semistructural questionnaire based on the DSM-III-R criteria were used for revealing of PTSD. Results: Prevalence of traumatic events makes up 61% in the main group and 13% in the control group. PTSD prevalence was 31% in 2002 and it was much higher than in the control group (3.9%). During other periods of examination the frequencies of PTSD were comparable (about 4%) in the both groups, the main and the control. Frequency of PTSD strongly associated with frequency of traumatic events: those persons who had only one traumatic event have experienced PTSD in 34.4% of cases, two events – in 50.3% of cases, three and more events – in 78% of cases. The women have experienced PTSD more often than men. Frequency of development of PTSD increased by age growth, the persons older than 45 years are especially vulnerable. Most symptoms of PTSD reduce in the first two years after formation (in 50% of cases), however in the subsequent period the process of recover considerably slows down and in six years after formation of PTSD the symptoms remain actual in 1/3 cases. Conclusions: The organized violence develops high level of PTSD among the adult population. The women and the persons of older generation are more vulnerable towards PTSD. In case if the assistance is not given the PTSD transfer into chronic forms.

Years of stress – psychiatric consequences and challenges D.L. Tosevski1, 2, B. Pejuskovic1 1Institute of 2School of

Mental Health, Serbia

Medicine, University of Belgrade, Serbia

Many studies have shown that mass violence can endanger mental health of exposed population, especially of vulnerable groups such as children, adolescents, single mothers, refugees and torture victims. Posttraumatic stress disorder (PTSD) is a frequent consequence of traumatic experiences but also depression, anxiety, addictive behaviour, as single disorders or comorbid with PTSD. The aim of our research (as part of an international, multicentric study) was to assess prevalence of PTSD and 129


other mental disorders at citizens of Serbia seven years after traumatic experiences. The sample consisted of 640 subjects chosen by random walk technique in five regions of the country. The history of potential traumatic experience was assessed by the Life Stressor Checklist-Revised (LSCL-R), and actual presence of mental disorders by the MINI-5. Our findings have shown a high level of current (18.8%) as well as life-time PTSD (32.3%). Other disorders were registered as well – major depressive episode, (26.2%), recurrent depression (14.4%), major depressive disorder with melancholic features (13.5%), generalized anxious disorder (23.6%), agoraphobia (12.4%), and panic disorder (10.0%). Catastrophic events in our country and the region caused prolonged stress which manifests seven years after trauma of bombardment. The size of the problem is a burden for the health system and significantly decreases the quality of life of citizens of Serbia, but also is a challenge for psychiatrists, i.e. for diagnostics, treatment and prevention of enduring changes of the psyche and transgenerational transmission of trauma.

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Symposium 15. Community based interventions targeting depression and suicidality Organized by WPA Section on Suicidology Chairs: Danuta Wasserman (Sweden), Wolfgang Rutz (Sweden) An evidence based 4-level community based intervention to improve the care of depressed patients and prevent suicidality cost effectively U. Hegerl & the EAAD Consortium University of Leipzig, Clinic and Policlinic for Psychiatry and Psychotherapy, Germany The aim of the best practice project EAAD was to improve the situation of persons suffering from depression and of persons being at risk to die by suicide. This aim has been realized by 1) establishing community based 4-level interventions in model regions in the different countries and then 2) using these experiences and materials from this model region to expand the activities to other regions or nationwide in the respective countries. The regional interventions composed simultaneous activities on the following levels: (1) educating general practitioners in recognizing and treating depression, (2) raising public awareness for depression, (3) training community facilitators (such as priests, social workers, or teachers) about depression, and (4) offering support to high risk groups. The EAAD strategy and actions largely base on the results and experiences from the “Nuremberg Alliance against Depression”. The Nuremberg strategy showed a significant reduction in frequency of suicidal acts (2001 vs. 2000: –19.4%, p < 0.1; 2002 vs. 2000: –24%, p < 0.005) compared with the baseline year and a control region. Considering suicide attempts only (secondary outcome criteria) the same effect was found (2001 vs. 2000: –18.3%, p < 0.005; 2002 vs. 2000: –26.5%, p < 0.001). Also, in the follow-up year (2003),

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the reduction in suicidal acts compared with the baseline year in Nuremberg (2000 vs. 2003: –32.4%) was significantly larger than that in the control region (p = 0.0065). Today the 4-level approach has been implemented in nearly 100 regions Europe wide. Evaluation within EAAD projects showed that EAAD material can be readily adapted to different cultures. The strong bottom-up approach helps community members to identify with the local alliance against depression and this boosts motivation and civil commitment as well as self-help. EAAD intervention is also well accepted by the partners as well as the public which is shown in positive echoes from the media and in ongoing requests for being supported by EAAD in implementing their own local alliance against depression. In conclusion EAAD’s four-level approach helps to reduce suicidal acts and can be implemented across a range of different countries with and within different local contexts (and different health care systems). To ensure sustainability of the activities undertaken in EAAD I and II the nonprofit society EAAD was established in 2008 to further implement the 4-level approach in other regions (www.eaad.net).

Community facilitators’ attitude toward depression: a pilot study in 9 EAAD countries G. Scheerder, C. Van Audenhove & the EAAD Consortium LUCAS (Catholic University of Louvain), Leuven, Belgium Community facilitators (CFs), such as pharmacists, teachers, policemen, prison officers, social workers, geriatric caregivers and the clergy frequently come into contact with people with depression, and often maintain a trusting relationship with them. Therefore, they can be an important community resource in addition to healthcare professionals, in particular with regard to providing a first point of detection, supportive services and referral to adequate mental health treatment, and in decreasing stigmatization. Taking up such a role, however, is a new task for most CFs, for which they may be ill prepared. Therefore, postgraduate training for CFs is a prerequisite. Further, it is important to be aware of CFs’ attitudes toward depression, as these may affect the extent and quality of role implementation. 132


In the context of the European Alliance against Depression (EAAD), training programs are set up to build CFs’ capacity in dealing with depression. Prior to these trainings, baseline attitudes toward depression were assessed using a core set of EAAD attitude items. This covers the attitude toward depression and its treatment, perceived causes, preferred treatment options, and knowledge of depression symptoms. In total, data were gathered in 2670 community and health professionals from 9 EAAD countries and of a wide variety of professions. Results indicated that CFs and nurses had less favourable attitudes and more limited knowledge regarding depression when compared to mental health professionals and doctors. This may negatively affect professional collaboration, challenge optimal treatment and stigmatize patients. CFs’ and nurses’ knowledge and attitudes may be similar to those of the general population and be related to a lack of training in mental health issues.

Evaluation of interventions targeting suicidality A. Varnik, M. Sisask, P. Varnik Estonian-Swedish Mental Health and Suicidology Institute AND Tallinn University, Estonia Numerous suicide prevention projects and national plans have been developed, although their effectiveness, particularly in multiple interventions, is rarely evaluated or partially contradictory. In the projects financed by European Commission, EAAD (European Alliance Against Depression, finished in 2008) and OSPI (Optimised Suicide Prevention Programs and their Implementation in Europe, ongoing), special attention was and is paid to the evaluation of effectiveness of the multilevel model of community-based interventions to improve the detection and care of depressed patients and prevent suicidal behaviours. The main hypothesis of the current OSPI study is that the number of suicidal acts (suicides + non-fatal suicide acts) will decrease statistically significantly in intervention regions compared to the baseline and that this decrease is statistically stronger then changes observed in the corresponding control regions. Accurate evaluation of effectiveness contains several methodological difficulties. Settings for the basis for cross-nationally comparable suicide research needs common 133


definitions within the terminology

of

suicidal behaviours. Literature was

comprehensively surveyed for careful selection of criteria with respect to suicides (codes X60–X84 by ICD-10) and non-fatal suicide acts. An expert consensus conference with all project partners and EU-stakeholders will be held in which consensus regarding definitions will be found. An evaluation tool to assess suicidal acts in a cross-country comparable manner considering the different procedures in suicide reporting systems has already been created and implemented in 8 participating countries. In different intervention regions reporting systems were adapted for their comparability and recommendations will be made to harmonise registration procedures of suicides within EU countries. Non-fatal suicidal acts are assessed with the instrument developed by the WHO/EURO Multicentre Study Monitoring of Suicidal Behaviour. This adapted tool, available in English, German, Hungarian, Portuguese and Estonian languages, has been used in EAAD and OSPI projects. It is widely discussed that suicide statistics can be biased by ‘hidden suicides’, mainly under the codes of undetermined deaths (Y10–Y34 by ICD-10), but also under unintentional injuries (X85–Y09), unknown deaths (R95–R99) and deaths by senility (R94). Possible underestimation of suicides in European countries and suicide methods used in the project countries will be discussed.

Regional aspects of suicide behaviour: experience from Chuvashia E. Nikolaev, A. Kozlov, A. Golenkov Chuvash State University, Chuvash Republic Mental Hospital, Cheboksary, Russia Chuvash Republic that is situated in the Volga-Ural region of the Russian Federation for several decades is known as one of the Russian provinces with high level of completed suicides. The average rate is more than 60 cases per 100 thousand people of population here. In the last years this problem is in the center of scientific interest for medicine and humanities as well. The proven fact is that rural residents commit suicides two times more often than urban residents. At the same time the study of mentally healthy population shows that antisuicidal barrier is high enough in the residents of Chuvashia. 134


One of the most often means of suicide is poisoning here. Upon this point more than three thousand suicide poisoning cases were thoroughly analyzed. It was revealed that the rate of suicide attempts among all cases of poisonings was 37.9– 39.0%. In 6–8% of them suicidal actions were undertaken not for the first time. Women commited 62.3%, men – 37.7% of suicide acts. Family conflicts (71%), job and work problems (19%), stress situations while studies (12%) became the main provoking factors for suicide decisions. According to ICD-10 criteria 2.3% of all patients with suicide poisoning attempts could be considered mentally healthy. 89.3% of poisoning cases referred to non psychotic mental disorders. Acute stress reactions (37.5%), depression reactions (61.4%), personality disorders (1.1%) were among them. 9.4% of patients had schizophrenia or other psychotic disorders. Every third patient had made suicidal attempt in state of alcohol intoxication, 6% of them were alcohol dependent. One could reasonably search ethnic background for suicides in Chuvashia as the Chuvash consists here more than 2/3 of the population forming its dominating ethnic group. For the study of cultural characteristics of suicidal behaviour in the residents of Chuvashia the data on level of completed suicides for the last ten years in each administrative area of the province were analysed. It was revealed that all areas of Chuvashia could be relatively referred to three groups. The first group was formed by the central areas with a high level of suicides. The majority of the population here was the ethnic Chuvash (80–90%). The specific characteristic of the second group with medium level of suicides was the presence of ethnic population of Tatars (up to 11%) who practice mainly Islam. The third group with minimal level of suicides was characterized by prevalence of ethnic Russians (up to 73%). Thus, the highest level of suicides is typical for rural Chuvash population. The most frequent form of suicide is poisoning. Important role in coping with conflicts by means of suicide is played by alcohol. Familial problems should be regarded as basic provoking moments. All these data need to be summarized but even tentative results strongly support both biological and sociocultural substrate in suicide behaviour in residents of Chuvashia. 135


Symposium 16. The WPA curriculum project: competency based education and training in psychiatry for residents and medical students Chairs: Allan Tasman (USA), Jerald Kay (USA), Pichet Udomratn (Thailand) Teaching general psychiatry residents for secondary and tertiary health care A. Lindhardt Denmark This presentation will discuss the seven core competencies of general psychiatry education and training. These include competencies in the following domains: clinical expertise, health advocacy, research and scientific, collaboration, administration, communication, and professionalism. Specific competencies in each of these categories will be examined.

Teaching psychiatry to medical students J. Kay USA Because more than 500 million people worldwide suffer from mental and/or neurological disorders and one out four people will be affected by a mental disorder at some point in their life, it is imperative that all medical students from high and low resource countries receive substantive education and training in psychiatry. This presentation will address competency-based instruction in mental disorders and critical emotional states, their assessment and treatment, and the requisite attitudes for creating effective doctorpatient relationships. In particular, competencies for medical students in psychiatry must include, but are not limited to the: demonstration of professionalism, conduct of the psychiatric interview and history, assessment of mental status, recognition of psychiatric emergencies, and development of psychiatric formulations and treatment plans. 136


Competency based education in mental health for students and residents in low and middle income countries R. Jenkins UK This talk will describe the need for students and residents to have a clear conceptual understanding of mental health and mental illness, a familiarity with basic epidemiological information on prevalence, risk factors and consequences, to be familiar with presentations and management of the common disorders, to have an understanding of the public health framework of mental health promotion, prevention, treatment, rehabilitation, and prevention of mortality, and an understanding of service structures in LAMIC. In relation to clinical skills, as well as generic skills of communication, identification, multiaxial assessment, diagnosis, and multiaxial management (social, physical, psychological) , there are also some specific skills that all doctors should be proficient in, which include assessment of severity of depression, its duration, disability and impact on work, family, etc.; Assessment of suicidal risk and understanding when supervision is required; Ability to explain diagnosis and management plan to client and family; Ability to explain side effects of antidepressants and antipsychotics; Ability to educate about early warning signs of relapse; and the Ability to educate community health workers and others about the importance of mental health and key facts about mental health. Teaching methods will also be discussed.

Core cultural competencies in psychiatric education for medical students and residents R.D. Alarcon USA Comprehensiveness, Consistency and Creativity, as essential ingredients of a psychiatric education program encompass even more strongly a variety of cultural 137


“ingredients”. Within the context of general core competencies, the cultural components to both medical students and residents are the subject of the first part of this document. Several tables summarize the sets of Knowledge, Skills and Attitudes (the “What to Teach” of a curriculum), emphasizing an additive nature of the didactic scopes. The second part deals with Teaching Methodologies (the “How to teach”) for the same audiences, although differences between “developing” and “developed” countries are pointed out. The third part includes examples of didactic activities mainly related to topics of a cultural nature. Different instruments (i.e., “blackboard vs. power point”), subjects (i.e. “cultural psychotherapies”), and situations (i.e. “the generalist vs. the super-specialist”) are discussed before closing with descriptive examples of specific areas of assessment, and specific curricular material (courses) for the adequate training of medical students and residents in different regions of the world. Realistic approaches that should not lose sight of reachable levels of excellence, and constructive international and inter-regional cooperation, are emphasized.

Competency based evaluation A. Tasman WPA Secretary for Education, University of Louisville, Kentucky, USA For many years it has been apparent that evaluation of clinical skills and professional attributes in trainees requires different approaches than examinations of the trainee’s knowledge base. Written multiple choice evaluations, even when following a clinical problem solving format, have not been shown to correlate well with clinical performance in the real life setting. For many years orals examinations, often including the observation of a clinical diagnostic interview performed by the trainee, were considered the standard approach to assessing clinical competence. With the rise of competency focused education, new approaches to clinical evaluation have been developed which hold the promise for a better assessment of the trainee’s actual clinical abilities. Competency based evaluation involves multimodal assessments in a variety of settings, carried out by various individuals who interact with the trainee in both the clinical and classroom setting. This presentation will briefly describe the 138


specific aspects of a competency based evaluation program and discuss the implementation of such an approach.

Assessment of competencies for medical students in psychiatry P. Udomratn Prince of Songkla University, Hat Yai, Songkhla, Thailand There is no single tool that can be used to assess all competencies. Technology may have an important role in assessing competencies in high-resource institutions. However, we should choose appropriate assessment methods, which are suitable for our own learning environment. This presentation will address assessment methods including but not limited to: clinical performance ratings, 360 assessments, stimulated chart recall, standardized patients, objective structured clinical examinations, student portfolios, and role playing.

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Symposium 17. Dynamic psychiatry: an integrative approach Organized by WPA Section on Psychoanalysis in Psychiatry Chairs: Maria Ammon (Germany), Nikolay Neznanov (Russia), Viktor Wied (Russia) General abstract The authors will present first of all a personality model on integration of psyche, body and mind with healthy and ill possibilities caused by the surrounding group dynamic field. The structural approach is integrated in the identity understanding of Dynamic Psychiatry of Günter Ammon. The therapeutic conception and intervention methods are based on the structural personality understanding and on the integrative treatment concept of Dynamic Psychiatry by applying results from other scientific disciplines and pointing out the relevance of group dynamics, especially group therapy. The individual internalizes the structure and the energetic quality of group dynamic processes going along with social energetic networks and fields since early childhood, which again are externalized in relationships of present groups by means of reflective phenomena.

The integrative pharmaco-psychotherapy of depressions V.D. Wied St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The long-standing dispute in the world psychiatry – “monotherapy of depression or integrative therapy” – is presently over. It has been convincingly demonstrated that integrative approaches, as compared with psychotherapy or psychopharmacotherapy alone, ensure lower relapse rate and higher level of social adjustment during remissions. It is particularly due to the beneficial effect of psychotherapy on the medication adherence in patients. The integrative model is the more effective; the more are taken into account such parameters as symptoms intensity, resistance to the preceding drug 140


monotherapy, degree of chronicity, the presence of comorbid pathology or the age of the patients. The choice of psychotherapeutic methods plays a very essential role in the integrative model. The role of an intensive long-term analytic approach appears now to be rather modest as compared with short-term cognitive-behavioral or interpersonal approaches which include practical training of the coping behavior in everyday life of the patient. The higher the symptoms intensity, the less seem to be indicated exploration of an early childhood experience or working-through of a secondary disease gain. The problems of interpersonal relationships play an essential role in the psychodynamics of depressive disorders. Their solution decisively broadens the possibilities

of

psychopharmacotherapy. The

failures in

the

doctor-patient

relationships or inability to optimize conflict-laden relationships with meaningful figures in patient’s social environment can influence the course of psychotherapy and gravely contribute to the forming of drug resistance. The integrative model is not simply a mechanical combination of psychopharmacological and psychotherapeutic approaches. It represents a mutually adaptive interaction of methods in a therapeutic context where both of them would be possibly carried out quite differently as a monotherapy. Possible negative effects of the integrative therapy are always to be taken into consideration. For instance, rapid psychopharmacologically induced alleviation of a depressive suffering can paralyze the patient’s motivation towards subjectively wearisome search and elimination of personality based depressogenic mechanisms. On the other hand, a suggestively induced fear to be “poisoned by drugs” can produce inadequately high expectations towards psychotherapy and deficient adherence to medication. The monotherapy of depression, be it psychopharmacology or psychotherapy, is presently much more investigated area of psychiatry than integrative therapy. The latter is in need of a new generation of psychiatric research studies requiring transculturally standardized instruments for the measurement of the integrative therapeutic effect.

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Relations between parents’ interactive style in dyadic and triadic play and toddlers’ symbolic capacity S. Tyano FRCPsych, FAPA, HFWPA, Izrael Play has a major role in the evaluation and treatment of young children referred to mental health clinicians. The present study examined parental correlates of preschoolers’ symbolic play during dyadic and triadic play interactions. Boys’ play contained more aggressive themes and girls’ more nurturing. Mothers displayed more caring themes during play with both sons and daughters and fathers displayed more repair and construction themes. Mothers’ and fathers’ facilitative-creative interactive style in dyadic play predicted the level of the child’s symbolic play. Co-parenting style marked by cooperation and autonomy predicted symbolic play during a triadic family session. Child intelligence predicted symbolic play above and beyond the parent’s style during triadic, but not dyadic interactions. The findings have implications for early intervention directed at increasing symbolic play in young children.

Dynamic psychiatry – an integrative psychiatric-psychotherapeutic concept M. Ammon Berlin/Munich, Germany The author lines out the history of Dynamic Psychiatry starting from the 19 th century to the present integrative concept of Günter Ammon. The integrative model for psychiatric-psychotherapeutic comprises the following features and approaches: Holistic view of a person as an individual human being, influenced by the dynamics of the surrounded groups. The author will present the theoretical conception of development, with the personality structurology as a central integrative modell. The therapeutic conception and intervention methods of Dynamic Psychiatry as an integrative treatment concept will be demonstrated as verbal and non-verbal approaches. 142


The relevance of group dynamics for treatment of severe psychiatric disorders I. Burbiel Munich, Germany The group dynamic view of all human development in the individual as well as in groups is one of the central postulates of Günter Ammon’s Dynamic Psychiatry. According to this view, man, from birth on, experiences a number of conscious and unconscious contacts, expectations, desires, conflicts and controversies in different groups, which essentially form the psychic and bodily dimensions of his identity up to developmental processes in the brain. The individual internalizes the structure and the energetic quality of these experienced group dynamic processes going along with social energetic networks and fields, which again are externalized in relationships of present groups by means of reflective phenomena. It is the author’s concern, to show, of what importance this group dynamic view of human development can be for the treatment of severe psychiatric disorders.

Medication compliance: psychotherapeutic targets N.B. Lutova St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Compliance is a multidimensional problem, that is difficult to study, and it is the complex task for clinicians to identify why patients do not take their medications. The recent research attempts gave the progress in understanding the compliance issues resides in the number of potential causes associated with noncompliance. These findings may provide to develop clinical guidelines for the handling of noncompliance with treatment recommendations. Considering the serious consequences of noncompliance, strategies that would lead to improving of patients’ attitude towards treatment are very important. Different types of interventions aimed at improving compliance to antipsychotics are suggested: from interventions focused specially on noncompliance to generally oriented techniques. But the analyses of psychoeducation and conventional counselling show low efficacy of these strategies. The reports of the positive studies that “compliance therapy” reduced noncompliance were unfortunately not confirmed by other studies. 143


Many authors mentioned the greatest factor influencing compliance to be family and social support. The availability of family or friends to assist or supervise medications has been consistently associated with patient’s adherence. Thus, the majority of studies speak for a clear association of family support, extensive social networks, expressed emotions and treatment adherence. But does family attitude towards antipsychotics predict medication adherence? And what kind of attitudes towards antipsychotics does the family have? The investigation of these factors may increase the knowledge of compliance deficit and secure concise and focused therapy of medication adherence. The scale for the assessment of medication compliance in psychiatry was developed at the Bekhterev Psychoneurological Research Institute, St. Petersburg. The scale allows a systems compliance assessment, reflecting all the basic factor groups influencing the adherence to medication – drug-, patient-, doctor- and environment-related factors. The scale is filled out by the doctor in charge of the patient, after collecting the whole available information relevant to the compliance behavior. Here are essential anamnestic data, clinical state, subjective attitude towards medication and information about the drug intake from medical staff at hospital and from relatives at home. The scale items are calibrated according to the unambiguously discernible behavioral or attitudinal patterns of their quantitative degrees. The assessment of family attitudes towards antipsychotics was obtained from the inventory completed by family members of hospitalized patients. The inventory has been developed at the Bekhterev Psychoneurological Research Institute, St. Petersburg and provides the identification of four different types of family attitudes: “supportive”, “hostile”, “manipulative” and “avoidant”. Patients whose family have positive attitude towards medication demonstrated significantly better compliance level than those who have negative family attitudes. The significant level of correlations indicated that family attitude towards medication strongly accounts for all the basic the factor groups which influence patient’s adherence. This findings support the main reason for the involvement of the family in appropriate interventions to improve compliance. Futhermore, the appropriate evaluation of the psychodynamically generated type of family attitudes towards medication may provide clinicians with optimized better therapeutic strategies: focused and concise. 144


Symposium 18. Psychosomatic diseases in general medicine and in psychiatry Chairs: Anatoly Smulevich (Russia), Michelle Riba (USA), Tarek Okasha (Egypt) Distress assessment and management in cancer care M. Riba University of Michigan, USA A new cancer diagnosis or recurrence can result in various levels of depression or anxiety for adult and child cancer patients, and their families. The distress can arise from a multitude of factors: from the diagnosis itself; potential or perceived disruptions to quality of life including family, work, school, finances, and relationships; responses from the social support system, including miscommunications, too little or too much information; direct or side effects from treatments, either primary or adjuvant; direct or indirect result of the cancer itself; current or past psychiatric history; etc. Since patients also often have cancerrelated pain, fatigue, and symptoms from the cancer or its treatment that can mimic or look very much like depression and anxiety, the challenges for diagnosis and treatment are great. How do we increase awareness about the importance of recognizing depression and anxiety? How do we determine best ways to screen for distress and then provide treatments for these symptoms when they occur? How do we provide interventions for various types and stages of cancers, patients of different genders, ages, cultural backgrounds, past psychiatric histories? This presentation will provide ways to address these very important and critical issues in psychooncologic care.

Clinical systematic and pharmacotherapy of psychosomatic disorders A.B. Smulevich, S.V. Ivanov Mental Health Research Center of Russian Academy of Medical Sciences, Moscow, Russia Clinical systematization of psychosomatic disorders is a serious challenge because of limited data and absence of widely accepted definition and classification of psychosomatic 145


nosology. The systematic presented is based on the psychiatric assessment of 3500 patients with cardiologic, pulmonological, gastroenterological, oncological, endocrinological, and dermatological pathology. Psychosomatic disorders are distributed in three main clinical categories with different subtypes: 1) somatization disorders (personality and neurotic level); 2) somatoform psychotic disorders; 3) psychosomatic (somatogenic or psychogenic) disorders. Somatization disorders include inherited somatoperception abnormality (somatoperceptive personality disorder); neurotic pathology expressed with medically unexplained somatic symptoms (somatoform disorders); mixed somatic-psychiatric disorders associated with somatic abnormality (visceral neuroses). Somatoform psychotic disorders include somatopsychosis (Wernicke), hypochondriac delusion and factitious disorders. Psychosomatic disorders include nosogenias (psychogenic reaction to the somatic illness circumstances), somatogenias (asthenia, somatogenic depression and somatogenic psychosis), endoformic disorders (affective disorders, transient psychosis, schizophrenic reactions), somatic disease triggered psychiatric disorders and stress related somatic (psychosomatic) diseases. Psychoharmacotherapy of psychosomatic disorders assumes all classes of psychotropic drugs (anxyolitcs/hypnotics, antidepressants, antypsychotics, etc.). Newel drugs are more preferable and should be administered in lower dosages with slower titration comparing to psychiatric patients. Mane factors influencing on choice of psychotropic medication are drug safety profile, somatic pathology (nosology, severity), age, concomitant pharmacotherapy (drug-drug interactions).

Affectivity-stress model of depression: implementation in rheumatology practice D.Yu. Veltishchev1, T.A. Lisitsyna2, O.B. Kovalevskaya1, A.S. Marchenko1, O.F. Seravina1, A.E. Zeltyn1, E.N. Drojdina1, J.S. Fofanova2, V.N. Krasnov1, E.L. Nasonov2 1 Moscow

Research Institute of Psychiatry MoH, Russia

2 State Research Institute of

Rheumatology of RAMS, Moscow, Russia

The problem of interdisciplinary dialogs among rheumatology, psychiatry and medical psychology and the absence of effective models for such communication 146


complicate the investigations in the field of mental disorders in rheumatology practice. Psychopathology and treatment of depression in patients suffering systemic rheumatic diseases (systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis) is not investigated well and not methodologically generalized still. New neurobiological findings in depression and the results of immunological studies in rheumatology are showing the productive perspective of the diathesis-stress approach in the development of common research strategy based on similar pathogenesis pathways of mental and rheumatic pathologies. The prevalence of stress related depressive spectrum disorders is extremely high among in-patients of State Institute of Rheumatology Russian Academy of Medical Science, reaching 80% in some groups. The study develops the diathesis-stress approach evaluating the psychological types of affectivity as diathesis markers, determining stress factors perception and psychopathology of depressive spectrum variants. The preliminary results of the interdisciplinary study are showing high efficacy of affectivity-stress model in diagnosis of depressive spectrum variants for elaboration of treatment approaches in patients suffering systemic rheumatic disorders.

Somatoform disorders and medically unexplained physical symptoms: an Arab perspective T. Okasha Institute of Psychiatry, Ain Shams University, World Psychiatric Association, Egypt As our societies become more diverse and the world evolves into a global village, the need to integrate culture into medicine and psychiatry becomes more critically important. In Arab the culture, the humanitarian interaction with a doctor is valued as much, if not more, than his or her technical ability or scientific knowledge. The humanitarian nature of this interaction depends on the way the doctor deals with the patient and his or her family and the extent to which the doctor expresses respect for, and acceptance of local cultural norms. The society is more family centered than it is individual centered and there is interdependence rather than autonomy. There is no 147


doubt that culture has a marked influence on the presentation of psychiatric symptoms, the understanding of theses symptoms and the different methods of traditional therapies used in each culture. Due to understaffed mental health facilities, it is essential that the general practitioner help in the diagnosis and management of psychiatric disorders under the title of unexplained somatic symptoms which is an essential part of the undergraduate psychiatric training. In this talk the main differences between traditional and western societies will be reviewed with special emphasis on the diagnosis of somatoform disorders in the Arab culture as well as methods of teaching unexplained physical symptoms to medical students.

Physical health considerations in the mentally ill: adopting an integrated approach to patient care H. Millar Consultant Psychiatrist at the Carseview Centre; Dundee, Scotland There is clear evidence to demonstrate that people across the spectrum of severe mental illness carry an increased burden of both metabolic and cardiovascular disease. As a result people with severe mental illness have a reduced life expectancy by approximately 20% and approximately 50% of people suffering from severe mental illness have co-morbid physical illnesses. Patients in this group are less likely to seek out medical care and therefore a higher proportion of their illnesses go undiagnosed and untreated often for years. In addition, people with psychiatric illnesses often find it difficult to access mainstream healthcare services which can appear rather fragmented and difficult to navigate. As clinicians it is important that we are aware of the increased burden of cardiovascular and metabolic risks to ensure early health screening programmes and long term medical follow up. It is necessary to offer practical guidance for these individuals to identify and modify the risk factors in order to improve their overall physical and mental health. As part of the management plan, it is important to ensure 148


that there is regular review of the effectiveness of medication in order that patients are prescribed the lowest risk agent to improve long term adherence and outcomes. There is no prescriptive “best model” for a health screening programme but it is clear that a co-ordinated person centred approach is required using an integrated care approach. Clear pathways are essential to ensure proper referral between community practitioners, psychiatrists and other specialist services in order that this patient group can access these services when required. This presentation outlines the main physical health considerations of the severely mentally ill population and demonstrates that by adopting a holistic approach to care that clinicians can impact on the physical wellbeing of this population and improve their quality of life.

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Symposium 19. Spirituality and mental heath global perspective Chairs: Pedro Ruiz (USA), Russell D’Souza (Australia) General abstract Spirituality in recent times has become an area that has been discussed at important professional meetings and conferences. This area has in the past, been alienated by the world of psychiatry. In medicine the dividing lines between religion and science have been clearly drawn. This artificial separation is in marked contrast to the earliest roots of medical practice. In many parts of the world a holistic view of the person has survived this is seen in Chinese medicine, in the healing arts of the American Indians and in our own culture as seen among Indigenous Australian peoples. The last fifty years have seen a gradual rapprochement between science and faith. The western model of the dichotomised mind body has been challenged on many fronts. The converging influences with the impact of Eastern religious thought, emergence of New Age thinking, the popularity of alternative health providers have all called for a more holistic understanding of health related issues. There is increasing awareness across professions of the importance in the area of spirituality and religiosity holds to many patients. Thus there have been suggestions and research validating the incorporation of aspects of spirituality and religiosity into multidisciplinary assessments and interventions for patients with psychological and physical illness. The domain of spiritual aspects of psychiatric patients has been overlooked in psychiatric assessments and in planning management of these patients. Reasons for neglect often cited include among others is the emphasis on psychiatry solely as a scientific model, and the presence of a religiosity gap (or spiritual gap) between clinicians and their patients. This symposium will offer presentations from international leaders in mental health care on the areas of Spirituality Religion and Mental Health from a global

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perspective. Which will allow an avenue for informed deliberations on these important dimensions of patients with mental illness?

The Science of well-being – Spiritual values and well-being: a need in mental health care R. D’Souza Northern Psychiatry Research Centre, Department of Psychiatry, Melbourne University, Australia Mental health professionals and their patients are increasingly aware of the basic need of all human beings for a source of meaning that is greater than one’s self. This growth in awareness is driven by the professional’s practical goal of reducing disability from mental disorders and by the heart felt wishes of the suffering for their therapists to recognize of the need for self transcendence. This has resulted in mental health professionals and the general public’s growing awareness of the need to foster spirituality and well-being in clinical practice. We now see a groundswell of professional work to focus on the development of health and happiness, rather than merely to fight disease and distress. This presentation will consider the practical necessity to reduce disability, and understanding the science of well-being including the stages of self-awareness on the path to well-being. Considering the interpersonal neurobiology view of well-being, ultimately discussing the developing of well-being through therapies such as Cloninger’s “The happy life-voyages to well-being” and D’Souza’s The Spiritually Augmented Well-being therapy. I would emphasize that each person must question all authorities and focus on providing private exercises by which they can obtain answers for themselves. This allows attention to spirituality based on principles of psychobiology with roots in compassion and tolerance, rather than on the basis of dogmatic judgments that are rooted in fear and intolerance. Thus only by addressing spirituality in a scientific and non judgmental manner can we make psychology and psychiatry into a science of well-being that is able to reduce stigma and disability of psychological disorders 151


Religion & mental health: a Latin American perspective P. Ruiz Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, USA Religion and Spirituality have held a dominant place in the psyche of Latin American communities. Illness and mental illness have traditionally received care from religious healers and mental health professionals. This presentation will examine the early links between religion and mental health and its role in coping and seeking meaning with in this population. The presentation will review the current situation and move to elucidate ways in which mental health professionals might use these traditions to incorporate and collaborate appropriately in achieving best mental health and well-being outcomes for the Latin American community

Hinduism and mental illness perspectives D. Bhugra Royal College of Psychiatrists, UK Spirituality traditionally has held the place in achieving health and mental clarity in the Indian Sub continent. Hinduism the main religion of this region has an ancient history and tradition of serving the populations in that region for over 3000 years. The ancient books relate to regions and spiritual influences of Hinduism in maintain and establishing positive mental health and well-being. While Sanskrit is used as the medium of these traditions this presentation will trace the intertwined place of health, positive mental composition and Hindu religious traditions. The presentation will elaborate these understandings to serve as a catalyst in collaborative models in achieving positive mental health and management of mental illness for these and other similar communities

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The role of spirituality in psychiatric care E.H. Pi Department of Psychiatry, USC Keck School of Medicine, Los Angeles, USA Spirituality

has

been

reported

to

correlate

with

improvement

in

psychopathology, psychosocial functioning and treatment outcome. This improvement has been explained based on that spirituality constitutes insight, meaning, purpose, happiness, well-being, hope, and beliefs that circumstances are not meaningless or in vain. This presentation will review and discuss the clinical significance of spirituality that arises in psychiatric assessment; identify spiritual issues that play a role (positive vs. negative) in the course of therapeutic process; integrate spiritual considerations with other therapeutic approaches; incorporate patients’ own spiritual beliefs into psychiatric treatment to maximize the therapeutic benefits; and delineate a crosscultural perspective of spirituality in mental health, particularly in treating culturally diverse Asian populations.

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Symposium 20. Mental health problems in primary care: diagnosis and prevention Chairs: Levent Kuey (Turkey), Valery Krasnov (Russia), Tsuyoshi Akiyama (Japan) Special issues of diagnosis, prevention and management of mental health problems in primary care L. Kuey Istanbul Bilgi University, Istanbul, Turkey Mental disorders, psychosocial problems, and comorbidity of physical diseases and mental disorders in the community constitute a major public health / mental health problem across the world. Besides their high prevalence rates, these disorders and sub-threshold cases decrease the quality of life and cause high disability. Considering the low rates of consultation of the patients with mental disorders and even when consulted, the high rates of misdiagnosis and under-treatment contribute to the high burden on the health level of the society and health delivery systems. On the other hand, primary care health setting enhances the possibility of early detection, treatment and rehabilitation of mental disorders and related psychosocial problems. Acess routes of people with mental health probems to mental health settings via the primary care level have unique features. The consultation rates are determined by the characteristics of the disorder, by the avaliability of services, economic resources and social security systems, and by the attitudes and stigma towards specific mental disorders and towards psychiatry and psychiatric treatments. This presentation will mainly discuss the diagnostic problems and clinical symptomatology of mental disorders at primary health care level and issues of prevention and management.

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Student mental health in primary care: early diagnosis and prevention M. Kulygina Mental Health Research Centre, Moscow Research Institute of Psychiatry, Russia Research shows that a significant number of students experience mental health difficulties and need support during their education. It is connected with the age and psychosocial specifics of this population group. Emotional and psychological problems concerning education, interpersonal relations, and identity formation can seriously affect academic performance, as well as the mental state, physical health and quality of life of students. In order to prevent mental disorders, to provide appropriate mental health care and to develop psychological competence of students, University counseling center is usually organized as a primary setting. Psychosocial model of student mental health care in the institution should be founded on the programme of medical and psychological accompaniment of education and on the principles of multiprofessional teamwork. The staff consists of psychologists, psychotherapists, psychiatrists, physicians and social workers. Psychodiagnostic, counseling, therapy and prevention are the main tasks of such primary service. Mental health needs of students are identified during a regular complex medical assessment once a year. Other ways to recognize mental disorders become available when students appeal for care of their own free will or when they are referred by other medical specialists. Early diagnosis is based on a complex of psychosomatic and psychosocial factors. Sleep disturbances, weight and mood fluctuations, hormonal and immune abnormality, meteosensitivity, as well as psychological age different from the biological one, low index of psychological comfort and support seeking as a maladaptive coping strategy have a special meaning for the recognition of risk groups of non-psychotic and affective spectrum disorders. Preventive measures include trainings of social skills and psychoeducational course which is organized for improving general attitude to mental health issues and for awareness rising.

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Why the process of psychiaric expansion in general medical practice is so delayed? Case of Belarus R.A. Evsegneev Byelorussian Medical Academy for Postgraduate Education, Minsk, Belarus The expansion of psychiatry into the general health service system is one of the most important direction of its recent development. Unfortunately this process in the countries of Eastern Europe and former USSR is going rather slowly. In the case of Belarus it could be demonstrated by the following: – no more then 4-5% of total number psychiatrists in the country (about 1000 in sum) are working in general medical care system; – common mental disorders including depression, bipolar disorders, anxiety and neurotic disorders, dementias, alcohol and drug abuse are recognized in GMP very rare and sporadically; – no regular collaboration between psychiatrists and general practitioners; – the use of psychotropic drugs in GMP including antidepressants and antipsychotics is next to nothing. The main obstacles for the collaboration between psychiatry and GMP are very prolonged tradition of separation, lacking of interest of GPs in the early detection and treatment of mental disorders and insufficient level of the training of GPs in the area of psychiatry and related subjects.

Communication style of the primary care physicians A. Bobrov Moscow Research Institute of Psychiatry, Russia Doctor-patient relationships are the important indicator of physicians’ professionalism. The aim of the work was to reveal the main attitudes, which determine the communication style of the primary health care doctors with their patients.

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Method: 99 physicians were questioned to reveal their attitudes to the basic principles of cooperation with the patients, including separated responsibility, priority of the patient’s interests, acceptance of his opinions, influence of the medical administration and the patients’ relatives and friends, mutual respect, quality of the medical problems discussion and emotional support. The data were statistically processed in accordance with the factor analysis algorithms. Results: Three main factors, defining the key attitude styles of the physicians to their patients, were revealed and interpreted. The first factor included variables, characterizing doctors’ regard to their patients, acceptance of the patients’ opinions, and acknowledge of the colleagues’ and administration’s influence. This factor reflects the partnership communication style, which is mostly close to the modern ethical medical code. The second factor consisted of two contrast poles: the physicians’ need to be unconditionally respected as professionals and the necessity to give a priority to the patients’ interests. Bipolar structure of the second factor points out at the inner conflict between the professional self-esteem and the requirements to meet the needs of the patient. As a result some doctors develop an alienated communication style: the patient’s interests and the interests of his relatives are not accepted; the doctor avoids his professional responsibility and denies his role in emotional support of the patient. At the same time the physician’s urge to self-affirmation begins to play unsound prominent role in the doctor-patient relationships. This factor reflects also the opposite situation when the doctor’s collaboration with the patient and other involved persons is carried out in the frame of the subordinate communication style at the expense of the professional self-esteem suppression. The third factor includes the variables, which reflect physician’s neglect of the people, surrounding the patient, his intent not to inform the patient properly, and to declare his full responsibility for the health of the patient. This style corresponds to the authoritarian position of the physician, which is justified in conditions of the urgent medical aid and is unacceptable in primary care setting. 157


Conclusion: In the process of reorganization of the primary care services one should take into consideration the variety of the physicians’ communication styles and specifically press for correction of psychologically determined non-constructive forms of the doctor-patient interactions.

Need of guidance: practical collaboration between psychiatrists and other physicians T. Akiyama, K. Sugiura Japan In my presentation I expand a scope beyond our relationship with primary care and discuss much needed but not ideally performed collaboration between psychiatrists and physicians of other departments. The focus lies on how we can ensure patients’ right to receive appropriate treatment for their physical illness. A few important issues should be considered. 1. Treatment for physical illness is based on explanation and informed consent. When people’s decision-making capacities are limited due to psychiatric symptoms such as delirium, thought disorder or dementia, how should we assess this limitation and modify explanation? 2. Serious physical treatments require high level of cooperation from patient. When the cooperation cannot be obtained, the treatment plans need to be compromised. How should we assess the appropriateness of the compromised plan? Related with this issue, for example, surgical operation to disorganized patients is a great challenge. Patients may barely understand the necessity and give consent. But when the actual procedures start, they may not cooperate. As psychiatrists how can we help them? 3. Palliative care requires very well informed and judged consent. Terminally ill patients, who develop delirium before they give consent, then, are not eligible for care at palliative unit. Ordinary wards are too busy to care them. They may end up being in a psychiatric ward, where the nurses are not trained to provide palliative care. 158


4. Patients with a multiple physical illnesses pose the greatest challenge. Physicians of other departments agree to treat patients, if they have one prominent physical illness, preferably treatable. When patients have a multiple, complicated physical illnesses and a psychiatric disorder, no physicians want them in their ward. Then patients may end up being treated in a psychiatric ward, and psychiatrists ask for help from various physicians, who give often contradicting consultations. World Psychiatric Association needs to consider developing a guideline so that psychiatrists can better collaborate with other physicians in these situations.

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Symposium 21. Gender aspects in psychiatry Chairs: Anne-Maria Moeller-Leimkuehler (Germany), Maya Kulygina (Russia) Gender differences in suicide and depression from a stress perspective A.M. Moeller-Leimkuehler Department of Psychiatry, Ludwig-Maximilians University, Munich, Germany Gender-related rates of depression and suicidality implicate a double gender paradox: while the life-time risk of depression in women is two- to threefold compared to men, their suicide rate is low, but their rate of attempted suicide is three times higher compared to men. In contrast, the suicide rate in men is at least three times higher, but their depression rate is only half as much as the women’s rate. Although this is well-known for a long time, existing explanations are not sufficient. In this presentation, depression and suicidality are explicated in the context of gender-related stress exposure, stress vulnerability and stress response. In particular, the question is discussed, whether the concept of male depression contributes to explain the gender paradox in depression and suicide in men.

Male suicidality in changing societies – “from Gotland to Europe”. A public health issue in need of person centred primary prevention and health promotion W. Rutz International and Public Mental Health, Stockholm, Sweden University for Applied Sciences, Coburg, Germany In Europe’s countries of heavy societal transition, especially male patterns of suicide reflect seismographically the stress load in a country, induced by societal and individual transition.

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Suicidality is hereby embedded in a cluster of stress related morbidity and mortality, mediated by risk taking behaviour and lifestyles, cardiovascular and cerebro vascular morbidity and mortality as well as addictive behaviour and violence. As recent Swedish and European figures indicate, male suicide rates are the highest in societies where a stressful transition even afflict gender roles that until recently had been quite traditional. They seem even closely connected to male’s shortcomings in their ability to cope with changes regarding their hierarchical and societal status, dignity, self estimation social significance and sense of existential cohesion. Most male suicides are committed without help seeking and contact with medical or other support systems. Thus, problems are aggravated by males traditional inability to seek help and be compliant – combined with the incapacity of mental health support structures to provide services that not only are accessible but also acceptable for men. In addition to this, there are problems of diagnosing males typical “atypical” symptoms of depression and suicidality by traditional depression assessment criteria, leading to both under diagnosis of male depressive states as well as a consequent male over suicidality. Consequently, epidemiological studies clearly indicate that males depressive disorders and suicidality constitute a major mental and public health worldwide. They include societal manifestations that cause not only individual economic consequences and suffering, but also afflict the economy and health of networks of families and friends as well as the very fabric of a society, its moral and ethical values as well as social structures. New and gender specific primary preventive strategies and diagnostic tools are needed to screen for and to prevent, diagnose and monitor male depression and suicidality. Cognitive approaches could be developed to get suicidal males to ask for help in time and to develop the compliance necessary for adequate treatment and follow up.

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Mental health of women who are victims of domestic violence M. Kachaeva1, V. Rusina2 1 V.P. Serbsky

National Research Centre for Social and Forensic psychiatry, Moscow, Russia 2 Voronezh Regional Clinical

mental hospital, Russia

Domestic violence against women is a troubling phenomenon in Russia. Recent sociological studies suggested that violence against women takes place in one out of the four Russian families. Unfortunately there are no laws on domestic violence in Russian legislation. Meanwhile there is a noticeable growth of interest to this problem from researchers and scientists. Much good work is also being done by nongovernmental organizations that render help and support to the victims of domestic cruelty. The research has revealed that intimate partner abuse against women often results in psychological and mental health problems. Clinical assessment of women who were victims of violent behavior of husbands or partners has revealed different depressive symptoms, anxiety, low self-esteem, stress and somatic disorders, suicidal tendencies. The most serious consequences of violence against women are the cases when victim becomes perpetrator. Women of this clinical group underwent forensic psychiatric assessment as they had committed homicides of their husbands and partners whose violence escalated in frequency and severity. The research shows the necessity of domestic violence prevention either by civilized legal provisions or by multidisciplinary research with the participation of public health specialists, psychologists, sociologists. This research will help to address the problem to politicians and policy makers in order to create national plan of actions to combat violence against women.

Violence and psychic trauma symptoms in delinquent girls E. Dozortseva, K. Syrokvashina V.P. Serbsky National Research Centre for Social and Forensic psychiatry, Moscow, Russia In the studies of delinquent behaviour and psychic problems in juveniles a high rate of post-traumatic stress disorder (PTSD) symptoms in young offenders was found. 162


The prevalence of the PTSD in juvenile delinquents has a distinct gender specific and was much higher in girls than in boys. As the concept of the “cycle of violence” states that the experience of violence and abuse in childhood yields in violent behaviour in adulthood, it could be supposed that psychic trauma caused by negative experiences would be higher in delinquents with the most aggressive offences. The goal of the study was to explore relationships between aggressiveness and trauma experiences in adolescent girls incarcerated in juvenile prison for committing serious crimes. The sample included 49 girls from 15 to 19 years of age. 27 of them committed severe violent crimes against persons (murder, severe bodily harm), 22 commited violent and non-violent property crimes (robbery, theft). Psychic trauma indices were assessed according to the PTSD criteria of ICD-10 on the basis of a special semistructured interview. Aggressive tendencies (indices of aggressiveness and hostility) were explored by Buss-Durkee’s inventory and projective Hand-test. Additionally girls’ somatic complaints, depression, anxiety and self-attitude were studied. The data comparison between the groups have found that B (re-experiencing traumatic events), D (post-traumatic arousal), F (impairment of social functioning) criteria and the total score of PTSD were significantly higher in girls with severe violent crimes against persons (frustrated and hostile aggression) than in a group with property crimes (instrumental aggression). Positive correlations between PTSD criteria scores and aggression indices from Buss-Durkee’s inventory were found in both groups. However only in the girls with violent crimes against persons trauma and aggression indices had strong correlations with indices of somatic complaints, depression, anxiety and low self-attitude, i.e. with the whole somatic, emotional and personality structure. The results support the hypothesis about positive relationships between psychic trauma experiences and violent behaviour in delinquent girls and show specific involvement of trauma in psychic functioning in girls with violent crimes against persons expressing frustration and hostile aggression. 163


Age-related stress and women mental health in menopause M. Kulygina Mental Health Research Centre, Moscow Research Institute of Psychiatry, Russia Menopause period is accompanied by a great reconstruction of female organism and of the general social environment of the woman. Biopsychosocial model of climacteric can be determined through the concept of age-related stress which is mainly connected with age transition. Massive external and internal changes occur on the three levels of functioning: biological, social and psychological. Biological changes caused by gormonal deficit and aging process affect the somatic and mental state as well as the body image. Social changes are related to partnership, to parent-children interactions, to professional career and to social roles rotation. Psychological changes take place in the cognitive, emotional, motivational spheres and lead to a search for a new meaning of existence, for new values and behavioral patterns. Stress vulnerability also determines the spectrum of mental disorders. Women after 40 get into one of the risk groups on manifesting non-psychotic mental pathology. Anxiety, depressive, somatoform and stress-related disorders are the most frequent cases in patients with peri- and postmenopausal syndrome. Educational programmes such as “School of Climacteric” are considered to be an appropriate format of prevention and primary care for women in menopause. This complex approach should focus on psychological aspects concerning tactics and strategy of teaching. Revising individual psychological problems in the frame of therapy and education is a necessary condition for the age-related stress management and for working-out of coping strategies.

Study of gender identity among women with functional hypothalamic amenorrhea V.A. Agarkov, E.V. Uvarova, S.A. Bronfman, K.V. Samokhvalova, T.I. Ponomarjova Institute of Psychology Russian Academy of Sciences, Moscow, Russia I.M. Sechenov Moscow Medical Academy, Russia Functional hypothalamic amenorrhea (FHA) accounts for 15–35% of cases of secondary amenorrhea. Some authors consider psychological factors such as 164


personality traits and gender identity disturbance, among important factors of FHA etiology. The focus of this study was gender identity 'as a more deep-seated sense of maleness or femaleness’ among women with FHA. We used short variant of MMPI (developed by F. Beresin) and 10 TAT cards (1, 2, 3BM, 3G, 5, 6GF, 7GF, 9GF, 13MF, 18GF). Participants were divided into two groups. Eumenorrheic women from “control” group (n = 10) had an average age of 20.7 years (SD = 3.1), women from “FHA” group (n = 14) had an average age of 19.1 years (SD = 1.4). TAT stories were subjects to content analysis method developed by R. May (1980) for assessment of male/female patterns of gender identity. Besides that, we made intergroup comparison of frequencies of themes of motherhood, intimate and sexual relationships in TAT stories. Statistical analysis has not revealed reliable differences in motherhood theme occurrence between “control” and “FHA” groups. However we found defense tendency to ignore the pregnant women figure pictured at 2nd TAT card among women from “FHA” group. At the same time themes of intimate and sexual relationships occured significantly more often in TAT stories of “norm” subjects. Statistical analysis of the data obtained by May’s content analysis method revealed that TAT stories of women from “FHA” group demonstrated higher occurrence of male narrative pattern in comparison with “control” group. These results have confirmed hypothesis concerning predominance of masculine aspects in basic gender identity among women with FHA. MMPI profile of “FHA” group is characterized by increasing of 5, 7 and 9 scales. Increasing of 5th scale corresponds to weak identification with feminine gender role and strong male identification. MMPI profile of “FHA” group shows that women with psychogenic amenorrhea tend to exhibit masculine behavior patterns: initiative, dominancy, self-confidence, outwardly directed aggression. These tendencies are combined with perfectionism and rigid behavior. These results support confirm our hypothesis concerning immature feminine identity, conflict attitude towards expression of femininity in intimate and sexual relationships and tendency to accept traditional masculine social and cultural role. 165


Symposium 22. Current clinical problems in the therapeutic approach to schizophrenia Chairs: Hans Jürgen Moeller (Germany), Sergey Mosolov (Russia), Mikhail Ivanov (Russia) Background facts for a chronic course of schizophrenia H.J. Moeller University of Munich, Germany Schizophrenia is a chronic disorder with a high risk of poor outcome in terms of symptoms and social functioning and also progressive brain alterations. The relapse rate is high and each relapse can induce further aggravations, both in psychosocial as well as in neurobiological terms. The poor prognosis of schizophrenia compared to affective disorder has been recently demonstrated in our Munich 15-year follow-up study on first hospitalised patients with schizophrenia or affective disorders. In addition to neurodevelopmental disorder, a neuroprogressive brain disorder is increasingly being hypothesized to explain a further decline especially in the poor outcome subgroup of schizophrenic patients. A recently published study suggests that different patterns of MRI-measured brain alterations in schizophrenic patients might be associated with different psychological syndromes. Another study demonstrated that MRI measured brain alterations can predict the transition from the prodromal phase to the full blown psychosis. Postmortem human brain and developmental animal studies document multiple and diverse effects of developmental genes (including schizophrenia susceptibility genes), at sequential stages of brain development. Increased specificity for the most relevant environmental risk factors such as exposure to prenatal infection, and their interaction with susceptibility genes and/or action through phase-specific altered gene expression now both strengthen and modify the neurodevelopmental theory of schizophrenia. 166


PET and SPECT imaging of receptors of the dopaminergic and serotinergic systems contributed to a better understanding of alterations in these two systems. Among others, dopamine D2 receptor alterations were described as being associated with either positive or negative symptoms of schizophrenia. Also a higher dopamine release after amphetamine challenge compared to normal controls was found, thus providing evidence for the dopamine hypothesis of schizophrenia. Functional MRI studies demonstrated deficits in those circuits which are involved in information processing as basis for the neurocognitive disturbances of schizophrenic patients.

Achieving remission in population of schizophrenic outpatients: validation of international remission criteria A.V. Potapov, S.N. Mosolov Moscow Research Institute of Psychiatry, Russia Background: A standardized definition of remission in schizophrenia has been proposed. It includes the symptomatic (low symptom threshold in core 8 PANSS symptoms) and duration (six consecutive months) criteria. The selected symptoms based on three dimensions (positive, negative, disorganization) and present distinguishable components of the disease. However, these criteria ignore different clinical forms and courses of schizophrenia according to ICD-10 as well as social and cognitive functioning. Method: At the first stage a population study of a remission rate with 6-months follow-up period for assessment of symptomatic stability was conducted in two health care districts of outpatient service in Moscow. The key inclusion criteria: outpatients with ICD-10 diagnosis of schizophrenia and schizoaffective disorder. A homogeneous cohort of outpatients was assessed with symptomatic criteria of remission, PANSS and GAF. Patients were observed during six consecutive months for the assessment of stability (a period without change of PANSS total score > 20% and/or > 1 point of items of positive subscale PANSS – P1, P2, P3, P6 regardless of baseline status severity) in a group of patients who had not met symptomatic remission as well as maintenance of remission in a group of the outpatients who had satisfied symptomatic remission in 167


the cross-sectional study. At the second stage the stable patients that had not satisfied the symptomatic criteria of remission were included in 1-year pharmacotherapeutic study. Long-acting risperidone was assigned to the patients at the first district, while patients at the second district continued to receive routine treatment in the outpatient service (control group). Rating was done at baseline and in 3, 6, 12 months of the study with PANSS, PSP, ROMI and SAS. Clinical and sociodemographic variables were tested for their ability to predict remission. Results: 203 outpatients were accessible for analysis. 64 (31.5%) patients met the criteria of symptomatic remission and 139 (68.5%) did not. After six months of follow-up period 158 (77.8%) patients were stable (irrespective of remission status). Among them 53 (26.1%) patients fulfilled to the remission criteria and 105 (51.7%) patients did not satisfy the symptomatic criterion of remission. The majority of 53 patients in remission had schizoaffective disorder, remittent or episodic course of paranoid schizophrenia. Logistic regression analysis found that these diagnoses were associated with a strong probability of achieving symptomatic remission (OR = 5.9, p < 0.001). The group of 105 stable patients that did not meet remission criteria generally consisted of patients with more severe clinical types of schizophrenia. In pharmacotherapeutic study 42 and 35 stable patients were included in long-acting risperidone group and control group, respectively. After 12-months therapy 21.4% patients in first group and 5.7% in second group met symptomatic remission. Reduction of total and subscale PANSS scores and improvement of social functioning were more significant in the first group as compared to the control group. Multiple regression and Analysis of Covariance confirmed that episodic course of schizophrenia was main factor associated with achievement of remission. Conclusions: The results of these studies showed that a symptomatic threshold of international criteria was valid mostly for patients with episodic course with progressive deficit, episodic remittent courses of schizophrenia and schizoaffective disorder.

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Atypical versus conventional antipsychotics in treatment of acute schizophrenia M. Ivanov, M. Shipilin, M. Yanushko, D. Kosterin St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The comparative analysis of influence upon target symptoms in course of schizophrenia relapse treatment with second generation antipsychotics- aripiprazole, risperidone and quetiapine is represented in the paper. The main goals of the undertaken research were to figure out the differences in onset of the antipsychotic effect and to study the peculiarities of impact of different antipsychotics

upon

psychopathological

structures

in

patients

with

acute

schizophrenia with good clinical response to treatment. 86

inpatients

from

Biological

Psychiatry

Department

of

Bekhterev

Psychoneurological Research Institute (Saint-Petersburg, Russia) were taken into the study. All the patients had the diagnosis of paranoid schizophrenia (F20.01 in terms of ICD-10). The patients were divided into three groups – 26 patients were treated with aripiprazole (mean dose 26.5 mg a day), 30 patients received risperidone (mean dose 4.7 mg a day), 30 patients were treated with quetiapine (mean dose 480 mg a day). The control group included 35 patients treated with haloperidol (mean dose 18.8 mg a day). The duration of study was 6 weeks. All the patients received antipsychotics as monotherapy, treatment started immediately after their admission to the hospital ward. Efficacy outcomes included clinical evaluation and scores on the Positive and Negative Syndrome Scale (PANSS) at the start and then on the 1, 2, 3, 4, 5 and 7-th week of treatment. For the detailed analysis there was used PANSS total score and also 5 factor model of PANSS – “Positive symptoms”, “Negative symptoms”, “Thought disorganization”, “Hostility-excitement”, “Anxiety-depression”. Only the patients who showed the reduction of PANSS total score ≥ 20% from initial were included into final analysis. Results: All second generation antipsychotics demonstrated equal efficacy in reduction of positive symptoms, similar to haloperidol at the end of study. In course of therapy with aripiprazole there was observed more tardive reduction of affective components of paranoid syndrome, such as signs of tension, anxiety linked with 169


delusions in comparison with patients who received quetiapine and risperidone. That finding, maybe, can explain the delay of reduction of positive symptoms during the course of treatment with aripipirazole. At the same time in cases when the affective signs of paranoid syndrome were represented mildly, therapy with aripiprazole demonstrated better results in reduction of positive symptoms during the first 3 weeks of treatment in comparison with quetiapine and risperidone.

Risk factors for metabolic disorders in patients with schizophrenia N. Neznanov, I. Martynikhin St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia St. Petersburg I.P. Pavlov State Medical University, Russia Background: The prevalence of obesity, metabolic syndrome (MS) and diabetes mellitus (DM) is significantly higher in patient with schizophrenia than in the general population, but the causes of this phenomenon are not clear yet. Our hypothesis was that four groups of factors may lead to metabolic abnormalities in patients with schizophrenia, such as effects of antipsychotic medications, symptomology of schizophrenia (anxiety, depression, apathy etc.), unhealthy lifestyle and potential association between pathogenesis of schizophrenia and metabolic disturbances. Methods: 163 paranoid schizophrenia (ICD-10) patients (81 men, 82 women) admitted to one of the Saint-Petersburg psychiatric hospitals were examined. The average age in the men was 39 years, in the women – 45.1 years. The average schizophrenia duration was 12.7 years (SD 11.1). Comparative analyses were performed using a randomly selected sample from a cohort of 1561 St. Petersburg bank employers matched to the patient with schizophrenia 1:1 on the basis of gender, age, and body mass index (BMI). The pairs were found for 138 patients. Evaluation of MS status was performed using the NCEP ATP III (2001) criteria. Results: In comparison with the control group, the patients with schizophrenia had higher frequency of MS (35.5 vs. 12.3%), higher values of waist circumference, insulin resistance, elevated serum concentration of triglycerides and decreased content of high-density lipoprotein cholesterol. At the same time, the subjects in the 170


control group had higher values of plasma glucose and total cholesterol. The level of blood pressure did not differ between groups. For the schizophrenic patients neither the duration of schizophrenia and the number of hospitalizations, nor years of antipsychotic treatment (corrected to patient’s compliance) were significant predictors of MS status (in a logistic regression model with age and gender as covariates). There were no significant correlations between schizophrenia’s clinical features (i.e. severity of positive and negative symptoms, anxiety, depression based on PANSS rating), lifestyle and metabolic disturbances. However, the incidence of behavioral risk factors of cardiovascular diseases (CINDI criteria) was as follows: smoking – 73%; physical inactivity – 78%; overweight (BMI > 25 kg/m2) – 41.7%, fruit and vegetables deficiency (< 400 g/day) – 75.6%. Sixty percent of the patients admitted that they limit meat and sweets consumption because of lack of money. Conclusions: Patients with schizophrenia have high prevalence of metabolic syndrome and susceptibility to the development of abdominal obesity, insulin resistance and dyslipidemia. The duration of schizophrenia and duration of antipsychotic treatment haven no correlations with metabolic disturbances. For this reason, metabolic disturbances existing before the manifestation of schizophrenia appear to have an important role in the association between schizophrenia and MS. Behavioral factors that have been revealed in Russian patients with schizophrenia can be divided into predisposing to metabolic disorders (hypokinesia, high smoking incidence, lack of fresh fruit and vegetables) and “protective” (lack of high-calorie foods due to economic reasons) ones.

Different strategies of antipsychotic treatment in patient with schizophrenia E.V. Snedkov, K. Badry, S.F. Sluchevskaya St. Petersburg I.I. Mechnikov State Medical Academy, Russia The deficiency in treatment efficacy of patients with schizophrenia could be explained by different strategies of antipsychotic treatment traditionally used in the general psychiatric clinic. The choice of treatment strategy could be influenced by 171


several objective and subjective factors. The objective factors include the pharmacogenetic and pharmacokinetic characteristic of the patient, individual course of the disease, social environment of the patient, etc.; subjective – unreasonable prescription of antipsychotic drugs by psychiatrists. The aim of the study was to investigate different strategies of antipsychotic therapy which are traditionally used in psychiatric hospital № 2. In our research 575 medical files were scrutinized by a retrospective analysis. The main objects of the research were: the dosage regime, changing of antipsychotic drugs, the combinations of neuroleptics, the durations and quality of remissions, compliance, side effects and complications of the treatment in combination with socialdemographic, morbid and comorbid factors, the dates of paraclinincal and objective assessment. Results: The biggest part of the acute psychotic patients with schizophrenia (68.3%) while being treated as inpatients were prescribed the neuroleptics combination as 2 or 3 antipsychotic drug simultaneously. Almost 40% of psychiatrists are adherent to combinatory treatment and 18% of them prescribe extra (mega) dosage schemas. Only a third part of the physicians wait for the 4–6 weeks for the result and does not change the strategy. The psychiatrists who are experienced for more then 10 years and work in male wards are most of the others are adherent for the combinatory treatment. Only 27.5% of psychiatrists use the tables of equivalents of chlorpromazine to neuroleptics. Prescription of neuroleptic cocktails is the leading reason of the dosage exceeding in high (600–1000 mg CHMZ/day) and extra high (more than 1000 mg CHMZ/day) summary doses. The consequences of overdose strategy are the delaying of acute episode relief, retardation of recovery period, worsening of the remission quality, development of side effects. The tendency to use combinatory strategy is correlated with young age onset of schizophrenia in male, low psychosocial status, absence of family history of any psychiatric disease, loneliness, old age. In elderly population monotherapy strategy is used only in 15.6%. The pharmacological response in patients with family history of schizophrenia is better while using monotherapy strategy. The prolonged acute episode and low quality remissions are more often in lonely patients and those with somatic disorders. 172


Only 18.5% of patients sample regularly follow the treatment regime. The lowest index of compliancy is registered in patients with combinatory treatment of 2 classical neuroleptics. Patients with comorbid drug abuse dependency is also show low compliance and low quality remissions. The successful compliance is more or less guaranteed by the prescription of the prolonged injective forms of neuroleptics. The optimal doses of neuroleptics for schizophrenia patients are in the 300–600 mg of chlorpromazine equivalent range. The equivalent dosage of atypical neuroleptics has no specific advantages in sense of efficacy, relapse prophylaxes, compliance. But monotherapy of atypical antipsychotic treatment provides a better quality remission. Concerning the management of side effects we revealed that 57.5% of psychiatrists prescribe anticholinergic drug as a prophylaxy (simultaneously with classical neuroleptics) and 40% even in the absence of extrapyramidal symptoms. This is the statistically reliable reason for the delaying of acute episode relief and worsening of the remission quality. The consequences are: the hyperclicemia, which could become a reason for metabolic syndrome in future, elongation of Q-T interval in ECG, etc.

Schizophrenia with obsessive-compulsive symptoms: diagnostic approaches and treatment considerations I. Reznik, A. Weizman Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel Background: Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. We are distinguish three main subgroups of these patients: 1) those, who met full criteria for OCD before the onset of schizophrenic process (so called “OCD-schizophrenia”); 2) those, who began to exhibit OC symptoms around the outbreak (i.e. in prodromal phase) or at any time during the course of schizophrenia (so called “schizo-obsessive disorder”); 3) schizophrenic patients having transient OC symptoms on different stages of their disease, or under specific circumstances (infections, i.e streptococcal; iatrogenic, i.e. under some atypical antipsychotic agents [AAAs], etc.) Different etiopathological origins of OC symptoms make this type of schizophrenia to be a heterogeneous entity in phenomenological as 173


well as in therapeutic aspects. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. Objectives: Here we present our model of the clinical typology of schizophrenia with prominent OC symptomatology and some possible predictors of response of OC and schizophrenia symptoms on AAAs administration. Methods: We present a case series study describes our experience with clozapine (n = 21), risperidone (n = 14), olanzapine (n = 16), quetiapine (n = 13) and ziprazidone (n = 11) as a sole agents (n = 33) and in combination with serotonin reuptake inhibitors (SRIs): clomipramine (n = 9), fluvoxamine (n = 7), fluoxetine (n = 6), paroxetine (n = 9), citalopram (n = 8), sertraline (n = 4), in patients with OCDschizophrenia (n = 39) and schizo-obsessive disorder (n = 36). Results: In patients with OCD-schizophrenia treatment, with AAAs (other than clozapine), the better results (significant reduction of OC as well as schizophrenia symptoms) were achieved in combination with SRIs, w hile the olanzapine showed the fastest overall improvement. In schizo-obsessive patients, treatment with AAAs (including clozapine) as monotherapy was the better therapeutic modality, and the risperidone showed the best results. Quetiapine and ziprazidone (as sole agents and with SRIs) were shown as approximately equal in their antipsychotic and antiobsessive activity and overall safety. Conclusions: AAAs had been reported as inducing de-novo or exacerbating the preexisting OC symptoms in some schizophrenia patients. However, there are also some data on a positive effect of AAAs in schizophrenia patients with OC symptomatology and our findings are in line with these reports. Meanwhile, the effects of different AAAs (with or without SRIs) on psychotic and OC symptoms are vary, probably due to different origin of OC symptoms. Based on our model of the clinical typology of OC symptoms in schizophrenia, we suggest that: 1) schizo-obsessive patients might be successfully treated with AAAs alone; 2) in OCD-schizophrenia AAAs monotherapy may be less efficient and in some cases even may worsen OC symptoms, so it should be treated concomitantly with SRIs. Further investigations are needed to substantiate our observations and to elaborate the most effective and safe therapeutic approaches to these difficult-to-treat group. 174


Symposium 23. Towards a new classification Chairs: Valery Krasnov (Russia), Norman Sartorius (Switzerland)

Problems of classification in Russian psychiatry: focus on affective spectrum disorders V.N. Krasnov Moscow Research Institute of Psychiatry, Russia The paper deals with present-day classification of mental disorders regarded from the positions of Russian-speaking psychiatrists.Consideration of depressive and anxiety disorders, in particular in the context of long term research within the stationary and settings of the primary care, points to close links between these disorders. The concept of a psychopathological commonality among affective spectrum disorders is set forth with references to earlier studies and the data of other Russianlanguage writers. The affective spectrum disorders cover a broad continuum: (1) typical affective disorders, uncl. BD I and II types, unipolar mania and depression, cyclothymia, double depression; (2) intermediate affective disorders: dysthymia and other anxiety depression of neurotic type, atypical affective disorder connected with organic or severe somatic pathology; (3) stress-related disorders, somatoform disorders. Affective disorder is not only emotional disorder. Psychopathological structure of each affective syndrome contains emotional psychovegetative, psychomotor, conative (motivations and drives), cognitive (executive functions and ideations), sensorial components. Dynamic changes of hierarchy of the components are connected with psychophysiological reactivity.

175


The effects of classifying mental disorders N. Sartorius University of Geneva, Switzerland The classifications of mental disorders are reflections of knowledge about them at a point in time. Every so often the classifications have to be revised to reflect new evidence and new agreements about the organization of health services and their informatics support. The immediate and direct effects of revisions of the classification are easier to predict and control than those remote and indirect. Indirect effects of revisions are often neglected although they have an influence on the directions and funding of research, on the education of health personnel and on the image of psychiatry and of medicine. The presentation will focus on these effects of the revisions of the classification of mental disorders gaining in importance now that the process of revision of the International Classification of Diseases and of the Diagnostic and Statistical Manual of the American psychiatric Association is in full swing.

The Emergence of sub-threshold psychiatry A. Okasha Institute of Psychiatry, Ain Shams University, Cairo, Egypt Many studies have shown that we are faced in our daily clinical practice with many patients, who do not fulfill the criteria of either ICD10 or DSMIV. They may be included under atypical, unspecified or not elsewhere classified. Subthreshold cases or prodromata of psychotic or non psychotic clinical cases are encountered frequently in clinical practice, and because of some ethical and nosological issues their needs are unmet. Pharmacological intervention in such conditions is denied in some countries especially with managed care, where maximization of profit and minimization of cost is the main objective. Many clinical disorders ensure a better outcome and better assimilation in society and reduce residual manifestations. This presentation will discuss and clarify the ethics of treating patients suffering from subthreshold diagnosis in psychiatric disorders. Recent data suggest that the impairment and disability caused 176


by subsyndromal disorders are almost equal to the syndromal ones. Our current classifications have no room for such disorders in spite of the suffering of those patients. This creates an ethical dilemma to clinicians who would like to help but restricted by the fact that there are no guidelines for the treatment course or outcome of these disorders. There is a lack of evidence based information about such a category. We need more scientific data and research studies to evaluate the value of treating such disorders. Are we in need in our diagnostic systems to include a new category of subthreshold psychiatry? Can the inclusion of dimensional model in diagnosis assimilate such disorders? Is there an emergence of a specialty of subthreshold psychiatry?

Analysis of a patient database to examine the “Goodness of fit” to an externalising/emotional categorical classification G. Mellsop1, A. Bower2, S. Baxendine2 1 Waikato Clinical School, University of Auckland, 2 Te Pou (National Centre of Mental Health Research),

New Zealand

Hamilton, New Zealand

Background: It has been proposed that there would be gains in the validity of the psychiatric classification system if many of the present “neurotic” or personality disorders were subsumed into two over-arching groups, externalising and emotional disorders. Aim: If diagnostic sub-categories from the first digit coding structures within ICD-10 do have clinical phenomenology commonalities aligning with the major externalising/emotional distinction, this would be further support for its potential utility. It would provide some “face validity” support to the proposed classification. Method: The distributions of the HoNOS derived information in relation to the proposed clusters of emotional disorders and extrinsic disorders and then separately to their constituent diagnostic categories, were examined. Results: Statistically significant differences in the profiles between the emotional and the extrinsic groupings are consistent with the proposed classification. The HoNOS measures of self harm, depression, and drug and alcohol consumption 177


were the three most significant discriminators between the two groups. However, details of the profile differences within the two groups suggest further examination is required.

Psychotic disorders in DSM-V and ICD-11 W. Gaebel University of Dusseldorf, Germany The revision of the current classification systems ICD-10 and DSM-IV is fully underway. A topic-specific workgroup on psychotic disorders had been established by the American Psychiatric Association to deal with the important question of how psychotic disorders will be classified in DSM-V. For ICD-11, a recent workshop jointly sponsored by the German Association for Psychiatry and Psychotherapy and the World Health Organisation in Düsseldorf (Germany) provided an initial assessment for the need for changes in the classification of psychotic disorders with a view to establish a psychosis workgroup in the framework of the revision process of ICD-10 by the WHO. Summing up the results of these initial parallel efforts, some critical issues arose which can only be addressed by clarifying the concept underlying the group of psychotic disorders: First, which mental disorders should be included in the putative group of "psychotic disorders", and what would be a useful and scientifically valid definition for the term "psychotic". Definitions of "psychotic disorders" vary and will be discussed in this presentation. Second, scientific issues arose as to the role of novel scientific evidence for a revised classification of psychotic disorders, especially concerning the fields of genetic research and research into the natural history of the disease course of schizophrenia. In the first draft of DSM-V published in early 2010, a suggestion was made to drop the subtypes like "paranoid" and "hebephrenic", to introduce a "psychosis risk syndrome", and to add dimensional assessment criteria. Currently, the international response to these first proposals is being evaluated with a view to publish a revised set of draft criteria in late 2010. 178


The “Matrix of Mental Formation”: A concept on the symbolic character of consciousness and a diagnostic tool alongside the use of descriptive approaches (ICD/DSM) in psychopathology N. Andersch South London and Maudsley NHS Foundation Trust (SlaM), London, UK Looking at mental stability, recent belief systems have changed: our different levels of consciousness are no representations of the outside world, but joint creations (Gestalten) between the evolving categorial pattern of the subject and its social field, and: the entities both correspondents are dealing with are not empirical sense data but symbols throughout. In general science the quote of philosopher Ernst Cassirer, that man is not the “animal rationale” but the “animal symbolicum” has found its true confirmation: what makes human nature different from all animal is a symbolic construct, as are our language, mathematics and our progressing tools of work-specification Entering clinical psychiatry you would expect this basic knowledge to be a pillar of psychopathological theory – as in mental crisis our symbolic matrix brakes down, our pattern-based architecture of reality gets lost and our construct of language is severely affected. But – until today – the symbolic message has not hit home. The well recognizable character of symbolic levels of breakdown in crisis continues to being ignored, treatment opportunities towards a reconstruction of symbolic formations are lost. The emerging transcultural invariants of experience – basic buildingstones towards a universal model of psychopathology – remain unused. Instead, the psychiatric establishment is rolling out an outdated descriptive model of disorder, which no respectable science, be it biology, mathematics or physics would dare to present to its members or to the public as the frontline of progress. It is eighty years ago that Philosopher Ernst Cassirer published his remarkable studies on the theory of symbolic forms and on the psychopathology of symbolic consciousness. They were based on his mathematical studies and his work about Symbol- and Gestalttheory but took their strongest emphasis from an intense clinical and 179


theoretical cooperation with neurologists, psychiatrists and psychologists. Cassirer emphasized the permanent change of symbolically created “frames of reference” and their impact on the make-up of consciouness and on mental dysfunction. Yet his idea about the spectacular unfolding of human possibilities was based on a limited system of trans-cultural “symbolic forms” and the even more basic pattern they are made of. Since then, there have been seemingly contradictory symbol-theories within the different approaches to psychopathology but also an ongoing progress towards a joint model of symbol formation among researchers from the US, Russia, Germany, France and other countries. The time is ripe for a unifying concept which could be used alongside ICD and DSM catalogues, providing some balance to their very unilateral descriptive results. In this presentation a “Matrix of Mental Formation” is presented which allows linking the endless variety of clinical symptoms to basic invariants of limited relational pattern. A new definition of mental health can also be drawn from this approach.

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Symposium 24. Psychiatry and clinical psychology: common issues and tasks Chairs: Meinrad Perrez (Switzerland), Alla Kholmogorova (Russia) Common issues and different tasks? The contribution of psychology to the development of modern classification and assessment of mental disorders M. Perrez Department of Psychology, University of Fribourg, Switzerland Psychiatry and Clinical Psychology deal with the etiology, classification and diagnosis, therapy and prevention of mental disorders. Both disciplines analyze mental disorders primary in the light of their own disciplines: Psychiatry from the biological perspective, and psychology from the psychological perspective. The commandment of the present and the future requires an interdisciplinary analysis. The subject implies psychological and biological facets. Both disciplines have to contribute their specific research skills and their scientific knowledge in the process of a better understanding of mental disorders. Psychology has by its own research- history a rich methodological culture at its disposal. In my talk I will discuss some recent developments in psychology, which are likely to contribute to the development of the classification and diagnosis of mental disorders significantly. The first issue will concern the psychometric status of ICD- and DSMclassification systems. With respect to the example of personality and depressive disorders, I will show that the traditional classification systems stand back far beyond the possibilities of modern psychometric methodology. In the future different scaling methods will offer a much richer base of psychopathological relevant information. The second issue will be dedicated to the assessment of patient-reported outcome measures. Most important information with regard to the patient’s health status comes directly from the patient. How to assess it? What are the limits of the 181


traditional way of retrospective and summarizing self-report? New possibilities emerging from the Ambulatory Assessment approach will be reviewed and discussed. With respect to the classification and assessment issues I will exemplify the added value to expect when both disciplines take profit from the synergy of the specific resources of clinical psychology and psychiatry.

Factors of integrative psychotherapy for affective spectrum disorders effectiveness A. Kholmogorova, N. Garanian, T. Dovzhenko, O. Pugovkina, S. Volikova, I. Nikitina, G. Petrova, T. Judeeva Moscow Research Institute for Psychiatry, Russia Research goal: To identify the successfulness factors of integrative psychotherapy for affective spectrum disorders, whish is aimed at the system of targets, including macrosocial, familial, personal and interpersonal levels and synthesize the most effective methods in treating them, based on cognitive-behavioral approach. Methods: With the aim of effectiveness factors identification battery of 17 tests has been elaborated, measuring psychopathology symptoms (SCL-90-R, Derogatis; Clinical Global Impression Scale, CGI), everyday stress level (Daily Hassle Scale, DHSrevised, J. Holm, A. Holroyd; Life Events Scale, M. Perrez), family dysfunctions Freiburger allgemeiner Fragebogen, Inventory of emotional communications in family, Kholmogorova, Volikova), personality traits (Perfectionism Inventory, Hostility test, Garanian, Kholmogorova; PBQ, Beck et al; «Big-Five», Goldberg) and quality of interpersonal relations (Perceived Social Support Scale, Sommer, Fydrick; Social avoidance and distress scale, Watson, Friend; Therapeutic Alliance scale). Results: 41 patients with affective spectrum disorders have been enrolled into study. Predictors of preliminary termination along with predictors of successful shortterm psychotherapy have been identified. Factors, prolonging the duration of treatment, have been outlined. Obsessive-compulsive symptoms as well as avoidance personality traits were found to be associated with longer therapy’s duration. Presents 182


of schizoid personality traits were supposed to increase the risk of preliminary termination.

Main

factors,

which

impede

the

straightforward

short-term

psychotherapy, were defined. At the personality level – high hostility level, low capacity of conflict’s internalization; at the familial level – low level of emotional openness an readiness to accept the existence of family problems; at the interpersonal level – low social integration and decreased capacity for developing therapeutic alliance. Predictors of good outcome include relatively young age, high level of everyday stress and specifically in the field of inner conflicts (which requires the developed ability to aware them), low hostility level, high tolerance towards other people, openness in describing the problems, particularly, familial, good capacity for developing and strengthening therapeutic alliance.

Psychotherapy for patients suffering of affective disorder: a common issue and a different task for clinical psychology and psychiatry M. Hautzinger Eberhard Karls University, Psychology Department, Tuebingen, Germany Depression and Bipolar Disorders are very common. Patients suffering of these affective disorders represent about 50% of in psychiatric and psychological clinics. Despite this common issue, the understanding and the treatment of affective disorders are quite different in both fields. Psychology

starts

from

a

social

(interactional,

epidemiological)

and

psychological (cognitive, emotional) understanding but integrates also biological mechanisms. Etiological and basic research leads to successful interventions (cognitive-behavioural, interpersonal). This presentation will discuss these successful psychotherapies on the background of controlled treatment outcome studies including patients suffering of acute depression, chronic depression, recurrent depression but also of bipolar affective disorder. It should become clear that psychotherapies are in symptom reduction as well as in relapse prevention evidence based treatments for affective disorders. They represent an alternative to pharmacotherapy in mild to moderate 183


depression. They should be combined with antidepressive medication or mood stabilizer in more severe or chronic depression and in bipolar disorder.

Taxonomy of psychotherapists’ errors V. Ababkov St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The report presents a systematized list of errors made by psychotherapists in dealing with the organization and conduct of clinical psychotherapy. This taxonomy has been compiled based on the analysis of scientific literature and the lessons learnt from the author’s many years of scientific and psychotherapeutic work. Four major groups of errors are identified and divided into subgroups and specific errors. The psychotherapists do not like to talk and write a lot about their errors. Usually they prefer to talk and write about success and progress. At least, the examination of this topic confirms the fact. There are not many special works about psychotherapists’ errors. The basic work by B. Schwartz, J.V. Flowers (2006) and others, and some less comprehensive, scientific papers present different general causes of therapists’ errors and ways to lose and damage patients. However, they are not related to any special clinical topics. Our taxonomy is based on four interrelated components of the psychotherapy process with patients suffering from different disorders: the psychotherapy (contract, relation, techniques etc.), the patient (disorder, personality, culture etc.), the psychotherapist (professional, personal qualities etc.) and the society (macro- and micro-social factors). According to these components there are four main groups of psychotherapists’ errors: 1) the errors related to the evaluation of the patient (two subgroups: diagnostic and differentialdiagnostic errors – 5; the errors related to psychological diagnostics – 6); 2) the errors related to the selection and realization of psychotherapy (nine subgroups: the errors related to the neglect of scientific data – 2; the errors of the initial psychotherapy stage – 3; the lack of cooperation with the patient – 3; the destruction of the psychotherapist-patient relationships – 3; the establishment of wrong boundaries between the psychotherapist and the patient – 5; the errors of a professional 184


confrontation with the patient – 2; the errors in the field of compliance – 4; the errors in the sequence of the psychotherapeutic process – 4; the errors of the final psychotherapeutic stage – 4); 3) the errors related to the psychotherapist (two subgroups: the errors related to the self-esteem of the psychotherapist – 4; the errors leading to the burn-out syndrome of the psychotherapist – 4); 4) the errors related to the evaluation of social impacts (two subgroups: the neglect of macrosocial influences – 2; the neglect of microsocial influences – 3). The errors mentioned are not universal for all forms and methods of psychotherapy. The types of errors in the realization of psychotherapy depend on the forms and methods of psychotherapy.

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Symposium 25. Psychiatric aspects of epileptology Chairs: Vladimir Kalinin (Russia), Vladimir Mikhailov (Russia), Andrey Dubenko (Ukraine) Clinico-epidemiological substantiation of disease prognosis in patients with epilepsy-related mental disorders B.A. Kazakovtsev, V.G. Bulygina V.P. Serbsky National Research Centre of Social and Forensic Psychiatry, Moscow, Russia A

complete

structural-dynamic

study

of

511

patients

treated

in

psychoneurological dispensaries was carried out. We have found that the epilepsyrelated clinical picture of psychoses develops differently in the disease courses of the three main types: favourable disease course, disease course with delayed exacerbation, and unfavourable disease course. The favourable disease course type is defined by the following factors: – a relatively late clinic manifestation; – a uniform frequency of disease onset and low changeability of the structure of paroxysms; – the prevalence of hyper social traits in patients’ personality structure; – the prevalence of affective disorders in the structure of psychosis; – prolonged preservation of work ability. The delayed-exacerbation type following a sufficiently long (10–15 years) period of a favourable clinical course is characterized by the following factors: – onset of a subacute-course stage with a polymorphous picture of paroxysmal symptoms; – prevalence of delusional experience in the structure of psychosis; – aggravation of memory and cognitive disorders; – a gradual reduction in patients’ level of social and employment adjustment. The unfavourable clinical course is associated with the following factors: – an early development of generalized paroxysms and a serial type of their course; 186


– development of catatonic disorders; – a relatively fast (5–10 years) development of epileptic dementia and fast development of disability. Our findings confirm the data of psychoneurological dispensaries’ reports stating a rather high incidence of psychoses and dementia in patients with epilepsy. The signs (symptoms) of psychosis in the course of disease were found in 64.1% of all cases, signs of dementia – in 51.8% of the cases. The combinations of psychosis and dementia amounted to 74% in the examined patients with epilepsy. Non-psychotic mental disorders or “personality change” without psychotic and dementia symptoms were found in 20.7% of the cases; psychoses without dementia – in 23.1% of the cases; psychoses with dementia – in 41.1% of the cases; dementia without psychosis – in 10.6% of the cases. 35.3% of the patients with psychosis of epilepsy had mainly affective disorders; 34.9% of the patients – delirious symptoms; 29.8% – polymorphous psychotic disorders with catatonic symptoms. These findings allow making a conclusion that the above mentioned types of productive psychopathological symptomatology develop in an epileptic population with practically equal frequency.

Clinical and psychological features of affective disorders and suicidal behavior in patients with epilepsy M.V. Olina, I.M. Paschkova, M.Ya. Kissin, E.V. Borisova The City epileptology centre, St.-Petersburg, Russia Institute of Experimental Medicine, St. Petersburg, Russia Epilepsy is one of the most common chronic diseases, characterized among other symptoms also by the affective and cognitive disorders. The prevalence of epilepsy in the population is 0.8–1.2%. In recent years worldwide trend to an increase in suicides is observed. Mental disorders are a significant component of clinical epilepsy, complicating its course. The prevalence of depression varies from 20 to 55% in patients with difficult to control seizures. From 5 to 14% of patients with epilepsy commit suicide or commit suicide attempts (1.1–1.2% in the general population). The 187


number of suicides among patients with epilepsy is 5 times higher than in the population and occupies the third position among the causes of death in this patient group. The purpose of this investigation was to experimental psychological study of affective disorders and risk factors of suicidal behavior in patients with epilepsy. We studied 150 patients diagnosed with epilepsy. The first group (70 persons) comprised epileptic patients without suicidal thoughts. The second group (80 persons) included epileptic patients with suicide attempters. We used State Trait Anxiety Inventory, Beck Depression Inventory, Personality Inventory Big Five and some other tests. The development of depressive disorders was typical for patients with newly diagnosed disease and with a long history of disease (more than 10 years long), for patients with epilepsy with frequent polymorphic seizures and for patients with the dominance of unproductive types of reaction to illness. Changes in the EEG in these patients were found in the temporal-frontal regions. For patients with the presence of suicide attempts was found a characteristic combination of depressive symptoms with increased anxiety and emotional instability. The severity antisuitsidalnye motives were significantly reduced. In the structure of suicidal behavior prevailed repeatedly, mostly impulsive suicide attempts. Affective self-control in these patients with epilepsy was significantly reduced due to the presence of emotional and affective disorders. The electrophysiological changes dominated in the frontal regions. We concluded that these results allow us to use the system for early diagnosis of affective disorders for the prevention of suicidal behavior in patients with epilepsy.

Motor lateralization, focus laterality, and alexithymia as risk factors for co-morbid affective and anxiety disorders in patients with epilepsy V.V. Kalinin Moscow Research Institute of Psychiatry, Russia Although affective and anxiety disorders are thought to be the most frequent in patients with epilepsy , and occur nearly in 30–50% of patients, the real risk factors for their development remain poorly known. The history of depression in the past, complex partial seizures, hypofrontality, and left-sided focus are regarded as main risk 188


factors for the development of affective disorders in patients with temporal lobe epilepsy (TLE). The role of other probable factors i.e. motor lateralization and alexithymia in this context has not been properly studied. The current study has been carried out in order to reveal the possible role of mentioned factors (motor lateralization, focus laterality and alexithymia degree) for depression and anxiety development in patients with TLE. One hundred and five patients have been included into the study. The SCL-90 scale and Toronto Alexithymia scale (TAS-26) were used for psychopathological assessment of patients. The handedness was evaluated using Annett’s scale. Among studied patients were 74 righthanders and 31 left-handers; 25 alexithymic and 80- nonalexithymic persons. Leftsided foci were observed in 52, right-sided foci – in 53 persons. MANOVA was used for analysis of interrelationship between nominal fixed factors (Handedness, Alexithymia and Focus laterality) and dependent variables of SCL-90, Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A). MANOVA revealed that Alexithymia exerts maximal effect on psychopathological variables in comparison with focus laterality and handedness, and the maximal values for the most SCL-90 constructs have been revealed due the interaction of alexithymia with left-handedness, on the one hand, and with right-sided focus, on the other hand. Quite the contrary, the minimal values of SCL-90 constructs have been observed in nonalexithymic patients with left-handedness and in combination right-sided foci with nonalexithymia. In other words, alexithymia combined with left-handedness or with right-sided focus is thought to be Conditio sine qua non and risk factor for development of psychopathological disorders in patients with TLE. The further study on analysis of alexithymia/nonalexithymia origin in patients with epilepsy is required. It could shed light on pathogenesis of psychiatric disorders in epilepsy.

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A study of social stigmatization in patients with epilepsy in Russia V.A. Mikhailov, L.I. Wasserman St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Within the framework of the WHO Project “Rehabilitation and Quality of Life in Patients

with

Epilepsy”,

carried

out

by

the

St. Petersburg

V.M. Bekhterev

Psychoneurological Research Institute, we studied the social aspects of stigmatization in patients with epilepsy. The study was carried out using a structurized stigmatization-of-patients-with-epilepsy questionnaire (SPEQ) developed by the Laboratory of Clinical Psychology and the Department of Rehabilitation of Neurological Patients at the Bekhterev Institute. We examined 694 respondents (male and female, aged from 15 to 72 years, residents of 12 geographical regions of Russia). The data obtained have revealed a high level of stigmatization in this category of patients in Russia. The overwhelming majority of the respondents (78.6%) consider epilepsy an incurable disease whose diagnosis in themselves or in their relatives they (71.1%) would prefer to conceal. A considerable part of the respondents (13.9%) distrust persons with epilepsy. 26.2% of the respondents were hesitant to answer the question whether persons with this type of disease can be trusted. Still more distressing was the respondents’ opinion considering the epileptic patients’ opportunity to get a job: 64.2% of the respondents think that employers will not hire a person with this disease, though the majority of the respondents (54.9%) believe that the intelligence of patients with epilepsy, in general, is not lower than that of healthy people. Almost half of the respondents (46.5%) think that most people are afraid of persons with epilepsy, and 24.9% of the respondents think that practically healthy people often “look down” on persons treated for epilepsy. Our population studies have shown that only 20.6% of all the respondents admit that this disease is curable. 61.3% of the respondents believe that only an abatement in the disease manifestations is possible, but not a complete recovery; 11.0% prognosticate a temporary amelioration, whereas 1.3% believe that therapy is useless. One-fifth (20.1%) of the respondents do not admit the possibility that children with 190


epilepsy can be educated in ordinary schools. 20.1% think that early-age children with epilepsy should be educated in special correctional kindergartens only, and 15.3% of these respondents would not allow their children to communicate with their coevals suffering from this disease. The majority of the respondents (91.3%) assume a positive attitude to the possibility for patients with epilepsy to marry. However, only 33.5% of the respondents answered that they might marry a person with epilepsy, whereas 64.8% of the respondents would not wish to throw in their lot with an epileptic patient. The majority of the respondents (71.7%) is rather loyal and admits the right of the ill to keep their disease secret when applying for a job. However, almost one-third of them (28.5%) still think that it is necessary to restrict the epileptic patients’ rights by obliging them, when applying for a job, to notify the administration of the institution about their disease (24.1%) and to carry the consent of the staff (4.2%). 15.5% of the respondents expressed their principal opinion that persons with epilepsy should not hold executive positions at all. 88.2% of the respondents assessed their awareness about epilepsy as insufficient believing that the mass media should pay more attention to epilepsy-related issues (83.6%). At the same time, 11.8% of the respondents think that they are informed about the problem quite adequately, and 15% do not see any necessity to cover the problem in more detail. Our study has shown the necessity to develop effective medical and social measures aimed at the destigmatization of patients with epilepsy.

Iatrogenic causes of inadequate therapeutic efficacy in patients with epilepsy A.E. Dubenko, T.A. Litovchenko Institute of Neurology, Psychiatry and Narcology of АMS of Ukraine Kharkiv Medical Academy of Postgraduate Education, Ukraine Adequate therapy of patients with epilepsy results in stable remission in 60– 75% of patients, whereas in routine epileptological practice, remission percentage and therapeutic efficacy are considerably lower. Prolonged lack of remission in patients 191


with epilepsy after initial seizure onset leads not only to pharmacoresistance, but also to the development of different psychiatric disorders in patients. Therefore, adequate therapy at the disease onset is a major factor of long-term absence of psychiatric disturbances in patients with epilepsy. We analyzed 1000 clinical cases of newly diagnosed epilepsy and of initial prescription of AEDs in patients who had been discharged from the hospital where they had been admitted to due to the development of epileptic seizures (Analysis 1). Analysis 1 findings: In 35% of the cases, the AED dose prescribed was lower than the therapeutic one; in 24%, the frequency of AED intake was insufficient; in 4%, the daily dose distribution was extremely uneven; in 13%, the range of one-time or daily dose was considerably wide; in 5%, the AEDs doses were too high; in 34%, the titration regimen was inadequate; in 33%, the AED intake duration was too short (usually under 3 months); in 14%, recommendations for antiepileptic therapy did not indicate a specific drug or indicated several AEDs; in 6%, AED intake was recommended only in case of condition deterioration or seizure development. In 35% of the cases, therapy began with phenobarbital intake. Only 7% of the patients were diagnosed as having epilepsy, whereas the rest of the patients were diagnosed as having an epileptic syndrome, a paroxysmal syndrome, an epileptiform syndrome, etc. Only 13% of the cases indicated the type of seizures, and only 3% of the cases indicated the form of epilepsy (cryptogenic, symptomatic, or idiopathic). In 32% of the cases, the etiology of symptomatic epilepsy was not confirmed by any data, and epileptic seizure was the basic clinical manifestation of the disease and the basic confirmation of the etiological diagnosis. 43% of the patients without any psychopathologic symptoms were recommended to be observed at psychoneurological dispensaries. We also analyzed the causes of long-term lack of remission in 281 patients who finally had attained long-term remission due еto adequate treatment (Analysis 2). Analysis 2 findings: Erroneous diagnosis of the type of seizure was found in 27% of the cases. In 18% of the cases, the prescribed AEDs did not correspond to the type of seizure. In 14%, AED combinations were used without taking into consideration their 192


pharmacokinetic and pharmacodynamic interaction. 21% of the patients were treated with epileptogenesis-activating drugs. Therapy regimen violations and early withdrawal of AEDs were found in 36% of the cases. Nonepileptic seizures (erroneous diagnosis of epilepsy) were found in 11% of the patients. Thus, erroneous diagnosis and therapeutic tactics can be the major causes of therapeutic failures in patients with newly diagnosed epilepsy as well as in patients whose long-term treatment turned out to be ineffective. The elimination of the iatrogenic factor can improve significantly therapeutic indices in patients with epilepsy and prevent further development of psychiatric disturbances in them.

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Symposium 26. Concepts and progress on person-centered psychiatry and medicine Chairs: Juan Mezzich (USA), Helen Millar (UK) General abstract This symposium will review concepts and progress on person-centered medicine (at large) and psychiatry (in particular). Currently being advanced in collaboration with leaders and colleagues of the World Health Organization, World Medical Association and several other international medical and health bodies coorganizing three Geneva Conferences on this paradigmatic perspective, personcentered medicine seeks to articulate science and humanism to shift the priorities of our field from disease to patient to person. To this effect, it promotes a psychiatry and medicine of the person, for the person, by the person and with the person. The symposium presentations will discuss the bases and development of person-centered medicine and psychiatry from various conceptual and international perspectives.

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Workshop 1. Humanistic aspects in psychiatric practice Facilitators: Michael Musalek (Austria) General abstract The development and introduction of Evidence-based Medicine some twenty years ago marked a milestone in medical history. Unlike ‘Eminence-based Medicine’ – which had previously dominated the field and in which just a few recognised experts determined medical standards – Evidence-based Medicine (EbM) uses statistical findings from cohort studies as the basis for rational medical practice. EbM is ultimately based on the doctrine of neo-positivism, according to which only empirically verifiable data are regarded as meaningful. With statistical significance thus becoming the essential criterion, empirical findings from control-group-secured cohort studies and probability relationships are translated into medical truths. Strict interpretations of EbM (of the kind we are increasingly encountering today), in which findings from statistical meta-analyses come to be recognised as confirmed knowledge, immediately exposed the limitations of EbM in clinical practice, leading some authors to refer to EbM as “corset medicine”. Alongside a number of other limitations, the main problem ensuing from today’s rather narrow interpretations of EbM is that the criteria used for quality assurance in medical research are being directly transferred to quality assurance in clinical practice. In reality, however, the medical researcher and the doctor administering treatment find themselves in completely different situations. Only a few years after the development of EbM, without actually mentioning it specifically, H.G. Gadamer wrote an essay entitled “Über die verborgene Gesundheit” (On Hidden Health, 1991/1993) in which he expressed the desire to see greater awareness of the differences between medical research and the actual art of healing – a difference that automatically existed between knowledge of things in general and the specific application of knowledge in the individual case, between theoretical treatises or hypotheses and the practical application of knowledge. 195


In the natural sciences, at least, research analysis must inherently be based on a positivist-reductionist approach. The latter has the patient divided into individual components and functions that then become the subject of research as constructs of illness. The “subject of treatment” in clinical practice is, however, never just a single component, a single function or a particular construct of illness, but always a sick human being in all his or her complexity. Whereas the main job of the researcher is to provide an analysis that is easy to follow and can be checked by others – in other words an analysis that correctly reduces, separates and abstracts data – the task of the clinician is to help alleviate the patient’s suffering as far as possible and to induce and support a process of healing. The basis for a psychiatry understood not only as a scientific discipline but also fundamentally as an art of healing applied in clinical practice is not simply the analysis of pathologically determined factors, but rather the synthesis of all the individual pieces of information to which psychiatrists have access on account of their academic knowledge, their experience and their observations and assessments and which enable them to formulate a multidimensional treatment plan that reflects the complex nature of human beings. Adhering to the findings of individual studies without seeking to synthesise them in any way not only fails to improve the possibilities for treatment (which is said to be the supreme objective of EbM), but inevitably leads to a restriction and hence a deterioration of the treatment situation. As a rule, individuals do not behave like the average members of a study group. People suffering from mental illnesses are not clones of study groups; they are originals. Not to mention the fact that – contrary to what the prevailing symptom-based medicine would have us believe – in everyday clinical practice what we encounter is not the illnesses themselves but rather whole human beings suffering from particular pathological states. Considerations like these formed the starting point for evolving a form of psychiatry that focuses not only on fragments and constructs but again on the whole person. This approach, which we call Human-based Psychiatry (HbM), no longer finds its theoretical basis in the positivism of the modern era, but rather owes its central maxims to the post-modernist ideal that ultimate truths or objectivity in identifying 196


the final cause of illness remain hidden from us for theoretical reasons alone: all being is always dependent on context and thus subject to change; language as the basis of our thinking has multiple meanings, and it changes in and through its use; the observer always remains part of the system, so that he himself becomes an important part of the input leading to the results that he then describes as “objective”. A medicine built on such foundations must not necessarily culminate in an “anything goes” situation without truths or reference points. On the contrary: HbM as envisaged here, focuses on the whole person. The absence of ultimate truths opens up the possibility of simultaneously recognising different, even apparently contradictory truths, which may emerge in the course of multidimensional diagnosis. The main theoretical premise of HbM, the dependence of being on context, enables the simultaneous coexistence of several apparently contradictory “truths”. EbM and HbM are thus not mutually exclusive opposites; rather, despite superficial differences in methods of diagnosis and treatment, EbM must be integrated into HbM as an indispensable component of the latter. Since the chief focus of HbM is no longer a pathological construct but rather a human being suffering from an illness, the multidimensional diagnostics of HbM as an extension of traditional categorial diagnostics (the domain of EbM) must be primarily oriented towards individual phenomena. The aim is to analyse the phenomenon itself and above all the underlying mechanisms from different perspectives (e.g. psychological, biological, interactional, economic and social etc.) in order to create a basis for a pathogenesis-oriented therapy. Mental illnesses are not concrete constructs, which simply emerge and then continue to exist merely for this reason. Rather they are dynamic processes subject to a certain patho-plasticity whose course is determined by disease-preserving factors. Hence multidimensional diagnostics of this kind must likewise always be processoriented. Illness in general and mental illness in particular arise not only as natural phenomena but also in the narratives associated with them. These narratives not only provide meaning that is intertwined with the pathological process but actually interfere in the pathological process as disease-preserving factors and thus themselves 197


become elements determining the illness. Understanding pathological events and the narratives connected with them thus has a special role to play in a differential process of diagnosis. Probably the most important difference between EbM and HbM is in the treatment aims. In HbM the goal is no longer simply to make illnesses disappear but rather to allow the previously sick patient to return to a life that is as autonomous and happy as possible. In other words: the human being with all his or her potential and limitations once again becomes the measure of all things. This also implies, however, that the multidimensional diagnostics of HbM are oriented not only towards symptoms, pathogenesis, process and understanding but also to a great degree towards the patient’s resources. HbM treatment above all involves a completely different therapist-patient relationship. The former monologue directed at medical analysis should be replaced by a warm-hearted dialogue; where “psychoeducation” used to play a primary role, a more profound understanding must now evolve based on the principle of reciprocity. The treatment of the individual now focuses not exclusively on his or her deficiencies but instead on resource-oriented strategies. The idea is to create the space and the atmosphere in which all that can be done for the person afflicted by mental illness becomes possible. In contrast to earlier moralising approaches to therapy, in which the therapist told the patient, like a kind of coloniser or a missionary, what was right or wrong with his life, HbM therapy focuses on patients’ wishes and potentials for development, which the therapist strives to find out in the course of real dialogue. A human-centred treatment of this kind should not only look at the patient’s deficiencies but of course at his or her resources as well. This would also require the development of a new aesthetic in psychiatry, to create an appropriate basis for a therapeutic process of this kind. Particularly helpful in this respect is the work of social aesthetics published in recent years. A. Berleant, one of the fathers of social aesthetics, wrote in a seminal article in 2005: “Social aesthetics is … an aesthetic of the situation. … Like every aesthetic order, social aesthetics is contextual. It is also highly perceptual, for intense perceptual awareness is the foundation of aesthetics. Furthermore factors 198


similar to those in every aesthetic field are at work in social aesthetics, although their specific identity may be different … creative processes are at work in its participants, who emphasize and shape the perceptual features.” The main components of social aesthetics are “full acceptance of others (esteem), heightened perception (perception of all sensuous qualities), freshness and excitement of discovery (fascination), recognition of the uniqueness (person/situation), full personal involvement (engagement/opening), relinquishment of restrictions and exclusivity, abandonment of separateness (places/atmospheres), and mutual responsiveness”. A social aesthetic for psychiatry, which has already begun but must be further developed, has the task of cultivating interaction between the patient and the therapist – in particular the initial contact, which is so important for the further progress of treatments – to fill empty rituals and modes of behaviour in the therapeutic setting with humanity, to create a fruitful atmosphere in the treatment room and to incorporate genuine friendliness in the day-to-day hospital environment, to deconstruct barriers and to open up boundaries and to facilitate enjoyable situations and relationships despite the suffering caused by illness in order to open to the patient aesthetically agreeable perspectives for the future. Treatment options and forms of therapy that have been and can continue to be developed from such a social aesthetic do not, as in evidence-based medicine, put the disease construct at the centre of the diagnostic and therapeutic interest, but have as their primary aim reopening the possibility of a largely autonomous and joyful life for the patient. A humanistic therapy approach of this kind, in which the person once again becomes the measure of all things, can only be realised in clinical practice via multidimensional diagnosis methods and treatment within the scope of inter-disciplinary cooperation.

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Workshop 2. Facilitators: Robert S. Pynoos (USA), Melissa Brymer (USA) UCLA/Duke University National Center for Child Traumatic Stress Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles

Part I. Modernizing disaster mental health This workshop will provide and overview of modern principles and strategies for public disaster mental health preparedness and response. It will summarize the accumulated scientific knowledge, strategies for triage, needs assessment, and surveillance, and for tiered and stratified approaches to post-disaster mental health planning and intervention. Learning Objectives: 1. Participants will gain an appreciation of scientifically-based principles of public disaster mental health. 2. Participants will enhance their understanding of modern approaches to child and family disaster mental health. 2. Participants will recognize the essential components of a modern public disaster mental health model.

Part II. Acute disaster response: providing psychological first aid Psychological First Aid (PFA) has become the standard of practice in the immediate aftermath of mass casualty events, with recommendation of the ISAC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. This workshop will review the core skills of the Psychological First Aid (PFA) Field Operations Guide developed by the National Center for Child Traumatic Stress and the National Center for PTSD. PFA is an evidence-informed acute intervention for children, 200


adults, and families impacted by disasters and terrorism. It is designed to reduce the initial distress caused by disasters and to foster short- and long-term adaptive functioning and coping. Participants will actively practice these skills and learn how to adapt them with culturally diverse populations and in different settings. Learning Objectives: 1. Participants will be able to describe the evidence-informed principles underlying the intervention strategies of Psychological First Aid. 2. Participants will be able to understand the eight basic objectives and intervention strategies of Psychological First Aid. 3. Participants will be able to identify ways to adapt Psychological First Aid in diverse settings and with different populations.

Part III. Resilience and recovery: applying skills for psychological recovery This workshop will offer a practical training of the Skills for Psychological Recovery (SPR) Intervention developed by the National Child Traumatic Stress Network and the National Center for PTSD. SPR is an evidence-informed modular approach to help children, adolescents, adults, and families in the weeks and months after disasters and terrorism beyond the period where Psychological First Aid is utilized. SPR is a strength-based skills-training model designed to accelerate recovery, enhance coping, and increase self-efficacy. This workshop will review the six core empirically-derived skill sets and will engage participants in practicing SPR skills. Learning Objectives: 1. Participants will be able to describe the evidence-informed principles underlying the intervention strategies of Skills for Psychological Recovery. 2. Participants will be able to name the basic objectives and intervention strategies of Skills for Psychological Recovery. 3. Participants will be able to identify ways to adapt Skills for Psychological Recovery in diverse settings and with different populations. 201


Workshop 3. Basic course in disaster management Organized by WPA Disaster Psychiatry Section Introduction: Mario May (Italy) Facilitators: Norman Sartorius (Switzerland), Moty Benyakar (Argentina), Russell D’Souza (Australia), Mohandas (India) General abstract In 2005 an estimate of 162 million people were affected by disasters, over 105,000 people died and damages totalled over $176 million (WHO-2006). Concern for weather related disasters have increased in the past decade. Every disaster natural or human made places extreme demands on health care and mental health care in particular. Disasters affect large and diverse populations. How the psychological response to a disaster is managed may be the defining factor in the ability of a community to recover. Interventions require rapid effective and sustained mobilization of resources (Ursano & Freedman). Facilitating recovery depends on the leadership’s knowledge of a community’s resilience and vulnerability as well as understanding of the distress, disorders and health risk behavioural responses to the event. A coordinated systems approach across the medical care systems, public health systems and emergency response systems is necessary to meet the mental health care needs of a disaster region. This workshop of the WPA Disaster psychiatry section will offer a basic course in disaster management with objectives: 1.To familiarize the participants with the psychological consequence of exposure to disasters; 2. To acquaint the participants with the principles of evidence based interventions in the aftermath of disasters and 3. To help the participants to prepare a roadmap for their communities for prevention, post vention, recovery and rebuilding from disasters. The faculty of expert disaster management psychiatrists who have been part of working in the aftermath of several recent disasters will discuss recognizing psychological consequences of disasters, psychological assistance in disasters; 202


paradoxes and challenges, evidence based interventions in the aftermath of disasters, the role of spirituality in trauma recovery, pharmaceutical managements of traumatic stress and dealing with compassion fatigue; helping the helper. Learning Objectives: 1. To familiarize the participants with psychological consequences of exposure to disasters; 2. To acquaint the participants with the principles of evidence based interventions in the aftermath of disasters; 3. To help the participants to prepare a road map for their communities for prevention, intervention and recovery from disasters.

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Workshop 4. Psychodrama in psychotherapy Facilitators: Paula Marisa Cerveira Alves Carrisso, Rui Manuel Freire Lucas, Ilda Maria de Jesus Pulquério Vieira Murta, Maria Manuela Madeira Fraga (Portugal) General abstract According to Moreno’s ideals and premises, we will present the psychodramatic method, through a real session of Psychodrama which theme will be centred on the paradigmatic and inaugural sessions of Moreno, the founder of Psychodrama. To promote an interaction between the participants, as well as an inner understanding of this psychotherapy, we will utilize as protagonists volunteered members of the audience who whish to participate. Afterwards, we will promote the discussion, namely on theoretical aspects, psychodramatic techniques and therapeutic objectives.

Focus-group. Stakeholders collaboration for person-centered healthcare Chairs: Juan Mezzich (USA), Maya Kulygina (Russia) General abstract This focus group will involve the participation of 8-12 health stakeholders (psychiatrists, psychologists, general medical practitioners, social workers, nurses, patients/users, families/carers, advocates) to discuss conceptual and strategic approaches for advancing person-centered healthcare.

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Panel discussion 1. Ethical and legal aspects of mental health care at different times Chairs: Jerker Hanson (Sweden), Wolfgang Rutz (Sweden), Valery Krasnov (Russia) General abstract Ethical principals are at the same time both eternal and bound to time and culture. They can be contradictory and are not always easy to follow. Ethical considerations can be subject to advanced philosophical discussions at the same time as they must be used in everyday activities – not at least in mental health work. Facts and evidence are important issues but of those does not follow what should be (Hume). Laws are to be followed – usually not a great problem. Stigmatization of mentally ill patients and disregard of psychiatry as a profession unethically favour isolation of patients and mental health care and may also prevent transparency and rehabilitation of patients in society. Trends in societies and in health care now, earlier and in the future impose challenges. It is not always clear in who´s interest actions in mental health care are taken: the interests of patients, families, staffs, pharmaceutical and other health care companies, share holders, societies, political parties? In this panel discussion, ethical and legal problems in mental health care in different situations will be discussed as well as the possibility and sometimes the need to act against prevailing codes and routines.

Ethics in psychiatry: the lessons we learn from nazi-psychiatry M. von Cranach Germany After summarising the historical facts the reasons why it was so important to us to uncover this terrible past will be discussed. Then some ethical issues, like psychiatry in times of war, the controversies around bioethics and biopolitics, the concepts of 205


responsibility and conscience, the role of hierarchies, the curable-uncurable dichotomy, the difference between treating diseases or ill persons will be addressed.

Law and ethics in Russian psychiatry during the past 20 years D. Bartenev, Yu. Savenko Mental Disability Advocacy Center, St. Petersburg State University, Russia Independent Psychiatric Association of Russia, Moscow During the past 20 years there has been a radical change in understanding the role of law and ethics in Russian psychiatry. During the soviet era the reading of these norms was totally ideological and it was only in 1989 when they have obtained the meaning universally recognized in the medical practice. The first steps in this direction were an open approval of the Statement and Viewpoints on the Rights and Legal Safeguards of the Mentally Ill, adopted by the WPA General Assembly in Athens, followed by adoption of the Law on Psychiatric Care and Citizens’ Rights in Its Provision (1992) and approval of the Madrid Declaration on Ethical Standards for Psychiatric Practice (1996). Subsequent recognition by Russia of international human rights treaties and the jurisdiction of the European Court of Human Rights, as well as endorsing the Mental Health Action Plan for Europe, has reflected a definite process of accepting international legal and ethical standards, although an actual route of such process has not been smooth or straightforward. Among the problems of current importance for Russian psychiatry is still a significant discrepancy between compliance with the legal and ethical norms in practice and the formal standards – the discrepancy being caused by the lack of effective guarantees for such norms, as well as by the lack of recognition of own professional independence by Russian psychiatrists, especially by those working for the State health care institutions. Thus, development of the Ethical Code of Forensic Psychiatrists (2002) was followed by taking forensic psychiatry under a full control of the State and therefore since 2003 legal and ethical regulations in this sphere were replaced by purely administrative ones. In 2004 the provision of section 17 requiring “a high quality of psychiatric care” was taken out from the Law on Psychiatric Care. For 18 years since adoption of the law the Government has not fulfilled its obligation to establish “patients’ 206


advocacy service” required by section 38 of the law which has significantly undermined the guarantees in this Law aimed at promoting patients wellbeing. The work of such service would not only allow improving the quality of psychiatric care, but it would also contribute to increasing the importance of its ethical and legal standards, and to identifying its systemic problems to deliberate by the professional community. The Russian Ministry of Health has not been involving scientific community to contribute to development of new legislation: this has recently been the case with the Law on Medicines which disregarded the Seoul amendments to the Ethical Principles for Medical Research Involving Human Subjects with regard to research on legally incapable individuals. The need for bringing Russian incapacity laws in accordance with international standards has not been recognized the Russian lawmakers, with the exception of several progressive initiatives for strengthening procedural guarantees for the persons lacking legal capacity. Unfortunately judicial practice has been of a little help in defining the role of ethical standards in regulating psychiatric care due to a very limited recourse by mental health users to legal mechanisms for protecting their rights. In this regard the Constitutional Court of Russia has made a remarkable step forward by issuing recently several progressive judgments emphasizing personal autonomy of patients in their relationship with the State.

The road to compulsary treatment for out patients in Denmark A. Lindhardt Director of Mental Health Sevices in Copenhagen, Denmark Compulsary admissions and treatment in Denmark is regulated in the law on psychiatry from 1989 with additions in 1997 and 2005. A new proposal is brought forward in 2010. Preconditions for compulsary admissions of treatment is that the patient is suffering form a psychosis as stated by a medical examination immediately prior to the admission og treatment, that the patient either constitute a danger to self or others or is in immediate need of treatment. So far compulsary treatment can only be administrated to patients in hospitals. 207


The change of service organisation towards an out patient and community based model has demonstrated inefficience towards “hard to treat” psychotic patients – often those with additional substance abuse. Therefore the governments want to extend the possibility of compulsary treatment to the community. There have been strong reactions to this from the professionals and from patient organisations. This movement will be discussed with focus on underlying values and ethical implications.

Ethical challenges in medicine and psychiatry G. Christodoulou Hellenic Psychiatric Association, Hellenic Center for Mental Health and Research, Greece The Moral theories in Medicine and Psychiatry are presented and discussed. It is emphasized that these theories (virtue ethics, casuistry, deontological theory, utilitarianism, principlism and ethics of care) should be regarded in a complementary way and not in isolation. Additionally, the most important Ethics Codes, starting from the Hippocratic codes are reviewed, with special emphasis on the recent (2008) revision of the Declaration of Helsinki on the ethics of medical research. The importance of observing ethics principles and codes in the protection of human rights is highlighted.

Efficient mental health care, patient security and patient integrety – ethical dilemmas? J. Hanson Coordinator SEEC, Stockholm, Sweden Treatment, care and rehabilitation in psychiatry should be as efficient and safe as in other medical disciplines. This is not always the case, which can be judged as unethical. Therefore, it is important to follow up results and to make comparisons between different modes of care, between clinics and on long-time bases. However, 208


that cannot be done without registration of data from individual patients, on an aggregated level, However, which also implies that data must be un-identified when leaving the organization responsible for the person, so that it will not be possible to identify the patient again. The work of staff should also be monitored, preferably automatically when using computerized records. Results, as well as interpretations should be made transparent. Analysis of data might be quite difficult needing professional skills. Adverse events in health care have earlier often focused on personal level, focusing on faults made by staff individuals. Patient security can, however, be more fruitfully and proactively approached on a system level – as is done in aviation. This needs also continuous registration of data from the health care system. In most countries there is a fear of “big brother’s watching”, which gives a scepsis towards central registers. Even, Hippocrate emphasized the privacy of consultation. Perhaps, many psychiatric patients first want to be understood and consoled, not treated. However, if psychiatry is to develop as a medical discipline the conflicts between transparency and integrity have to be addressed, ethically and practically.

Ethical problems in Psychiatry – an international perspective W. Rutz University for Applied Sciences Coburg, Germany; Senior Consultant Public and International Mental Health, Stockholm, Sweden; Past Regional Advisor for Mental Health, WHO Europe During history and even recent times our psychiatric profession has many times been a garant af human dignity and humanistic ethics but also been repeatedly at risk to become abused as instrument for totalitarian societies and inhuman policies, neglect of human rights and utilitaristic approaches on public health. Today an ever increasing economic and market adapted view in health care organisations and health care “production” on rentability and economic profit maximation – even increasingly adopted by political forces – risks to become a forceful instrument in marginalizing 209


individual and human right regarding the right to treatment and health but even the access to well known health determinants: integrity, selfdetermination, existential cohesion and social significancy. Two main threats to psychgiatric professional ethics appear to be evident in Europe: The influence of private economical and powerfull forces on research, prevention and treatment focussing on profit maximation and marketing strategies and the influence of societal and political decisionmakers on professional ethics and patient advocacy as an integrated element of psychiatric humanistic action. These factors and other actual ethical problems in professional everyday action will be elucidated and discussed. National and international awareness is needed.

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Panel discussion 2. Person-centered clinical communication: the ways to advance mental health care Chairs: Juan E. Mezzich (USA), Mohammed Abou-Saleh (UK) General abstract This panel discussion will examine the various ways in which clinical communication can be improved to advance health care. This may include utilizing a broad

bio-psycho-social

theoretical

framework,

encouraging

and

facilitating

engagement, empathy, and empowerment, and promoting the autonomy and dignity of the person to advance the resolution of health problems and the promotion of health and quality of life. Distinguished panelists from Eastern Europe and across the world will review person-centered clinical communication patterns and prospects through brief (5-7 minute) presentations.

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Panel discussion 3. Integrative correction of mental and behavioral disorders in children and adolescents Chairs: Miroslaw Dabkowski (Poland), Edmond Eidemiller (Russia), Sergey Igumnov (Belarus), Yury Shevchenko (Russia) The supervision in psychotherapy and psychiatry N. Alexandrova, M. Gorodnova Child Psychiatry, Psychotherapy and Clinical Psychology Department of the Medical Academy of Postgraduate Studies, Saint-Petersburg, Russia The supervision is known to be obligatory in the education of psychotherapists, psychiatrists, psychologists. In Russia the supervision has started to develop recently. In the Department of Child Psychiatry, Psychotherapy and Clinical Psychology of the Medical Academy of Postgraduate Education 100 questionnaires filled by students during 2009 year were analyzed. We have found that there were 48.6% psychotherapists (seniority M = 10.8 years), 22.6% psychiatrists (seniority M = 3.8 years), 22.2% clinical psychologists (seniority M = 3.8 years) who wanted to have supervision. The analysis of 183 participant forms of supervision group discovered the following: for the first time 25.5% of psychotherapists, 56.9% of psychiatrists, 36.8% of clinical psychologists took part in supervision. Only 37.3% of psychotherapists and 9.8% of psychiatrists had their own supervision. Clinical psychologists had no suchlike experience. The fear of critic and estimation may explain the low interest to supervision among specialists. Moreover the most specialists work in the professional isolation. In our department we made the model of supervision in a group. The main purpose of supervision for psychotherapist is to realize the technology of the psychotherapeutic process. The main purpose of supervision for psychiatrists is to realize the diagnostic, differential diagnostic and therapy processes. The model of supervision consists of 6 stages and moves it possible be with the group for all 212


members. The members group who does not take part in the supervision observes their own feelings, thoughts and ideas. They write down it in the “The member form of the supervision group”. When the group is over everyone tell about realizing their own professional work and qualification. The results showed that 100% of respondents scored down the “useful” of supervision, 84.2% – planned to have own supervision in the future.

Clinical, psychological features of posttraumatic stress disorder, and rehabilitation model in children – victims of act of terrorism in Beslan I. Dobryakov, I. Nikolskaya Medical Academy of Postgraduate Studies, Saint-Petersburg, Russia Act of terrorism in Beslan (1.09.2004) resulted in a death-roll of more than three hundreds children and adults also became a cause of posttraumatic stress disorders (PTSD) in both survivors and witnesses. Authors of the paper developed a program of the psychological aid for PTSD patients, which was supported by UNICEF and had been implementing in Beslan from October 2004 till December 2005. Children with PTSD demonstrated some specific clinical and psychological features which determined creation of rehabilitation model. As adults they showed a high level of anxiety. Their anxiety was often transformed into hyperactivity, affinity to unstructured and aggressive games, paradoxically associated with tendency to solitude. Therapeutic contact was difficult to establish and some of our patients revealed signs of selective mutism. They tried to communicate only with close relatives, using single words in whisper and single gestures. This behavior can be explained by an intensive desire to block everything which might remind anything about psychological trauma. All our patients demonstrated various signs of specific eating behavior; the most frequent type was hyporexia, and a variety of dissomnias (insomnias, parvus nocturna, enuresis, sleepwalking, and sleeptalking). There were no complaints on flash-back memories, though indirect signs pointed out their existence. On the basis of our field experience on delivering psychological aid, we developed the rehabilitation model of PTSD patients in Beslan. This model is based on 213


systemic approach which means involving all the family of PTSD patients into psychotherapy. The main steps of this model were: 1. Educational trainings for the local mental health specialists; 2. Creating a motivation in PTSD families by organizing round tables and informal discussions at schools, where teachers, parents and children were invited to participate in; 3. Family examination, which was provided by a team of four specialists: two counselors from St. Petersburg and two educated local specialists; 4. Discussion of the results; 5. Formation of both psychological and medial diagnosis; 6. Developing individual rehabilitation programs; 7. Rehabilitation itself; 8. Providing careful supervision.

Analytical-systemic family psychotherapy at neuropsychic disorders in children, adolescents and adults E.G. Eidеmiller1, S.E. Medvedev2 1 Medical Academy of Postgraduate Studies, Saint-Petersburg, 2 S.R. Mirotvortsev Clinical Hospital,

Russia

State Medical University, Saratov, Russia

Use of cybernetics foundations in psychology in the latter half of the XX century promoted the development of system family psychotherapy. It occurs to be natural that formation of new therapeutic approaches was accompanied by the separation tendencies. It often brought to negation of classical psychoanalysis and clinical psychiatry theses; at the worst – to formation of antipsychiatric conceptions. A narrative approach, which was arisen in the frame of system viewpoint, in its definition strives for separation from classical family psychotherapy. Analytical-Systemic Family Psychotherapy (ASFP) is the original model of family psychotherapy that represents synthesis of a psychoanalysis paradigm, the system and narrative approaches. Integrating classical and postclassical system conceptions, as well as taking into consideration individual characteristics of psychotherapeutic 214


participants, ASFP promotes creation of personal development and self-actualization for every member of a family with the basis of healthy resources of family system. The development of psychotherapeutic demands from manipulative (X) to parental (Y) and matrimonial (Z) efficacy contributes to formation of a positive future image and optimizes the functioning of family system as a whole. The study of a family history in the context of pathologizing family inheritance helps to take the transgenerational aspects of predisposition to neuropsychic diseases into account. The work in the context of analytical-systemic model makes possible to organize a constructive interaction of mental health specialists (psychiatrist, psychotherapist, psychologist, social worker) both between themselves, and family members of a patient suffering from neuropsychic disorder. ASFP size allows helping patients and their families in the presence of chronic and therapeutically resistant unhealthy processes. ASFP gives opportunities to treatment and rehabilitation of patients with acute “social age” reduction, children and adolescents unmotivated to psychotherapy. At present, the ASFP efficacy is under research in the work with patients’ families with various neuropsychic and psychosomatic disorders, including families of children suffering from chronic diseases of respiratory organs and gastrointestinal tract. The increase of the efficacy of rehabilitation measures with use of ASFP in comparison with rational psychotherapy at paranoid schizophrenia was proved in comparative, parallel and randomized research.

Suicidal behaviour of adolescents and young people in modern megapolises: diagnosis, prophylaxis, correction S. Igumnov, A. Gelda, T. Gelda, S. Davidovski Republican Research and Practical Center of Mental Health, Minsk, Belarus The research objects are people aged 15–24, Minsk citizens, who committed parasuicides and suicides. The goal of the research is retrospective suicidological analysis of socio-demographic characteristics and prospective complex research of suicidological behavior in the cohort of Minsk citizens aged 15–24. In the process of 215


research we have used the socio-demographic, biographic, experimental psychological, clinical psychopathological and examined predictive factors of high risk of suicidal behavior formation in the cohort of Minsk citizens aged 15–24. To conduct retrospective suicidological analysis we included in the research 1051 parasuicide and 99 suicides altogether, and to conduct prospective suicidological examination we included in the study 114 parasuicides. As a result of research it was found, examined and displayed (p < 0.05–0.001) that the relative factors of the risk of performing suicidal actions in the cohort of Minsk citizens aged 15–24 are gender (women are 1.3 times more likely to perform suicidal attempts and men are 4.8 times more likely to commit suicides), age of 21–24 (43– 63% of suicidal actions), alcoholic intoxication (the moderator of 60% male suicidal actions, 37% female suicidal attempts and 53% female suicides), level of education (1.7 times more risk for women with incomplete high school education and 1.2 times more risk for men with complete high school education), social (1.4 times more risk for women studying at specialized secondary education institutions and higher education institutions, 1.5 times more risk for employed and 1.6 times more risk for unemployed men) and marital status (for women under 18 – 2.6 times more risk, divorced and widowed – 3.4 times more, cohabiting without de facto marriage registration – 1.8 times more, and for single men of marriage age – 1.8 times more). The obtained and analyzed research data are the basis for the development of the program of suicide prophylaxis measures among young population of modern megapolises.

Complex correction of psychosomatic disorders in pediatric clinic A. Severnyi Research Centre of Mental Health, Russian Academy of Medical Sciences, Moscow, Russia Research aim: to define true criterions of approach to the correction of psychovegetative disorders in children and adolescents who receive a treatment in pediatric clinic. Material: 457 children at the age of 3 to 17 years observed from 6 months to 8 years suffering from diverse functional somatic-vegetative disorders – paroxysmal 216


tachycardia, functional hyperthermia, vegetovascular dystonia, nonspecific dermatitis, functional disturbances of breath, dystonia of gastrointestinal tract and others. Psychopathological symptomatology of these patients was very multiform: mainly depressive affective disorders, including bipolar ones, affective-delirious states, personal disorders, neurotic and neurotic-like symptom complexes, psychoorganic including epileptiform pathology. Parents of ill children show affective, neurotic and personal pathology of borderline level. Families of ill children are characterized as hopeless, hyperprotectant, rigid, and incapable of dissolve of conflicts. Further dynamics of psycho-vegetative syndrome after reduction of manifest state in the case of reiteration of exacerbations consists in gradual prevalence of psychopathological symptoms and deletion of somatic-vegetative disorders. In whole we can say about psycho-vegetative diathesis with varied level of depth and progression in children suffering from functional somatic-vegetative disorders. Results: When psychopharmacological therapy in concordance with syndromic psychopathological structure and with an allowance for peculiarities of somaticvegetative disorders, and also with involving in correctional process of parents of ill child it does in overwhelming majority of cases the positive effect of treatment including complete recovery of social activity and personal development. Discussion: It was formulated the principles of correction of psycho-vegetative pathology in children: 1) family approach; 2) complexity (collaboration of pediatrician, psychiatrist, psychotherapist/family therapist, pathopsychologist, combination of specific

somatotrophic

psychotherapy

of

ill

therapy child

and

with his

psychopharmacological family);

3)

minimal

therapy sufficiency

and of

psychopharmacological therapy; 4) combination with social therapeutic steps with the view of a possibility of psychological trauma in microsocial environment; 5) when prescription of psychopharmacological medicines it should take into account necessity of its maximal vegetative neutrality, minimal allergenicity, compatibility with somatotrophic medicines, intensification of role of psychopharmacological therapy and evening-out of somatotrophic therapy during further course of psycho-vegetative syndrome. Organizing forms of psychiatric help for children with psychovegetative 217


pathology: 1) psychotherapeutic consulting room in pediatric outpatient’s clinic; 2) special psychosomatic unit or psychosomatic consulting-correctional room for the service of the all departments of multiprofile pediatric hospital.

Multilevel correction of forming psychopathies Y. Shevchenko, V. Korneeva Russian Medical Academy of Postgraduate Studies, Moscow, Russia There can be marked out several levels of influence on forming psychopathic structure of personality. The first level is medicamental, including general biological medicine both of somatic orientation (“a sound mind in a sound body”) and of psychotropic activity. They in their turn are subdivided into means simplifying work of the brain, its ripening and compensation of residual-organic insufficiency and medicaments of symptomatic orientation. The second level is neurophysiological, providing the influence on brain energy, corticosubcortical and interhemispheric coordination, spatio-temporal orientation, anticipation, unconditioned self-regulation. It is provided with the neuropsychological (sensorimotor) method of correction and body-oriented psychotherapy. The third level is syndromic, oriented to the fundamental qualitativephenomenological determinants of patoharaktrerologichesky syndrome. Here we use all arsenal of individual psychotherapy in the whole range – from the suggestive to the rational pole. The harmonization of personal-characterological structure is carried out by smoothing of pathologic dominating and reinforcement of deficitarny qualities and by sanogenny and compensative orientation of strong side of personality. The fourth level is behavioral, aimed at concrete “behavioral targets”. Some of them are in need of suppression (for example fears, aggressive and self-aggressive actions, manifestation of chemical and physiological addiction). And others require in purposeful methodical forming (obedience to superiors, execution of general rules, observance of security moments, inculcation of social skills, self-service, studies and etc.). These ensure adequacy of child’s behavior and arouse sympathy by people. 218


Mentioned tasks are reached by methods of behavioral psychotherapy (behavioralcognitive psychotherapy of children and teenagers, 2003) , by using principles of biological feedback, by making “family contract”, by successive transfer of responsibility for making decision, by placing a child in conditions that prevent decompensation of weak point of his or her characterological structure. The fifth level is educational and reeducational (remedial pedagogical). It is oriented to the harmonization of personality and its socialization, forming of superior needs, aggression direction in a safe channel, development of potential strong qualities and inherent abilities that can compensate partial immaturity of other characteristic qualities and raise child’s attractiveness for people. The most important thing here is family, group and collective psychotherapy, therapeutic pedagogy, social training in conditions of specially created situations and life scripts (realized like natural experiments) based on principles of unity, succession and individualization of upbringing. Juvenile age is especially topical in terms of prophylaxis of abnormal personality forming. On the one hand it is fraught with decompensation in the form of “pathological progressing pubertal crisis”. And on the other hand it gives additional ways of sanogenny and harmonious influence on a person because of his selfeducation.

Prevention of borderline psychic disorders in children N. Sukhotina Moscow Research Institute of Psychiatry, Russia Borderline psychic disorders (BPD) are mostly the disorders of neurotic and pathocharacter spectrum, which are mostly caused by psychogenic factors and in most of the cases “organic predisposition” and interrelation of disorder with personality traits can be found. Thus nature of BPD is complex and multifactor therefore prevention of it requires complex approach considering psychogenetic nature and conditions of its leading role. Intolerance towards external effects is one of these conditions. 219


Therefore new medical concept – quality of psychic health – appears. From the physiological point of view adaptation-compensative resources of the organism are the measure of individual health, including psychic health. Poor adaptation resources develop into sensitivity to weather and heliophisical factors affecting change of psychic tone, various vascular-vegetative disorders and psychosomatic dysfunctions. Inadequacy of vegetative supplying of organs results into faster lassitude in case of psychic and physical stress. As for social adaptation, it can be measured with personalaffective reactions, stability of emotional sphere, figures if will, quantities of cognitive sphere. Thus primary prevention of BPD should be directed into detection of children with poor psychic health and improvement of adaptation-compensative resources, stabilization of personal sensitivity to different psychogenias. Results of our researches indicate that a preventive intake of neurometabolic drug expands adaptative traits of organism when optimizing of somatic-vegetative, cognitive and emotional components of psychic activity. The aim of secondary prevention is minimizing of psychosocial risk factors by the methods psychological-educational correction, behavior and other types of psychotherapy.

Application of neuropsychological correction for overcoming disturbances of psychic development К. Umalas International Association of Neuropsychological Sensomotoric Correction Experts, Riga, Latvia According to the data of the academic year 2008/2009 collected and summarised by the State Special Education Centre Methodology Department on preschool age children, who are being educated in pre-school establishments or groups of five and six years old children at school, it follows that teachers in cooperation with support experts have identified various kinds of disturbances in 11% out of 81,025 children aged between 1.5–7(8) years and undergoing general pre-school education program, 6% of children are undergoing special education program and out of them 220


34% are children with medium and very serious health and development disturbances and are enrolled in special pre-school education establishments. Until recently in Latvia correction methods focused on symptoms and not etiopathogenesis were more widely used, and they were focused on elimination of certain symptoms. Physicians quite often do not have any means for eliminating development disturbances, which have formed during maternal pregnancy, and they consider that these are inborn and cannot be eliminated. Actually, it is true – there is a range of problems, which are not possible to solve with medicines or homeopathic means. It is 5 years, since experts of Latvia have been using the neuropsychological sensomotoric correction method developed in their work with children, for elimination of disturbances of psychic development by Russian Medical Academy for Postgraduate Education, Department of Children psychiatrics, psychotherapy and medical psychology, Prof. J.S. Shevchenko and Dr. V.A. Korneyeva. The method comprises a series of breathing and movement exercises, which are gradually made more complicated, thus activating the structures of the brain corticalis, promoting the control of tonus, development of balance, development of synkinesis, development of perception of the total image of one’s body and stabilisation of the static kinetic balance. Besides the above, the operational provision of the sensomotoric interaction with the external environment is renewed, self-regulation processes and functions of understanding of the meaning of psychomotoric proceses are stabilised, and they are focused on formation of the optimum functional status of the frontal brain sections, the process of thinking, development of attention and memory, synesthesis and self-regulation processes. The program of neuropsychological sensomotoric correction is intended for a period of at least 9 months depending on the deficiency of the brain structures and dynamics of their functional development. It is continuous daily effort, when twice a week individual classes are lead by an expert and during the other 5 days of a week exercises have to be performed under parental supervision. The method is applicable for children starting from the age of 5 years and its highest efficiency can be seen until the age of 14 years. The operational functionality of brain and interaction of functions renewed in the result of correction is stable, and a repeated correction of the 221


functional operation of brain structures is not necessary. Besides correction of psychomotoric development the efficiency of this method permits to improve communication abilities of a child, stabilises the emotional background. As from year 2005 we have carried out the neuropsychological correction for 38 kids with psychic development disturbances related to immaturity of the brain stem and corticalis structures or organic damages of the brain mechanisms during early ontogenesis stages. The following disturbances were observed in these kids: slow speed of psychic development, immaturity of a personality, disturbances of cognitive processes, intellect disturbances, asthenic conditions related to somatic diseases, infantilism of various forms, speech, reading and writing defects. As until today the neuropsychological sensomotoric correction has been fully completed for 23 kids. Following the performance of the neuropsychological sensomotoric correction considerable improvement of the situation was observed in all children: levelling of the psychic development, improvements of behaviour, memory, attention and coordination of movements. Difficulties in relation to this program include a situation when parents turn to an expert and understand problems of their kid on the level of behaviour and learning programs, but it is very seldom that they would be ready to accept peculiarities of development of their kid. The assessment of a kid’s problems in the family can be varied: they can be perceived both as normal and of little importance. The above can be caused by the following: unwillingness to face existing problems or an unconscious wish not to accept a fact that a child has some development problems. Therefore, quite often it is necessary to face problems, which are related to the stability of parents’ motivation to perform high quality work within the framework of correction. Despite the labour intensity of the method and the long term of the correction process, this method is efficient and in practice it is applied both in Latvia and Russia. Currently the method is gaining its popularity also in the Republic of Lithuania and Estonia.

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Age-specific and therapeutic dynamics of cognitive deficit in children suffering from endogenous mental illnesses N. Zvereva, A. Khromov, A. Koval-Zaytsev Mental Health Research Centre, Moscow, Russia Moscow State University of Psychology & Education, Russia Goal is psychological study of various types of cognitive deficit in children with endogenous mental diseases. Participants: The study includes 4 samples of children and adolescents suffering from different types of mental disorders. These 4 samples were combined into 2 types of psychological assessment of cognitive functioning for each sample: agespecific & therapeutic dynamics. The age-specific dynamics assessment includes: 1) Cross-sectional investigation of 303 patients (215 boys) with mean age 12.2 ± 2.6 years with diagnosis F20, F21; 2) Longitudinal observation of 52 patients (37 boys) from 1 to 3 years between successive admissions with approximately same age & diagnosis. The therapeutic dynamics assessment includes: 3) Study of neuroleptic influence on attention functioning of 124 patients (83 boys), mean age 11.9 ± 2.7 years &diagnosis F20, F21; 4) Study of polypeptide influence on cognitive functioning of 55 patients (47 boys) aged from 4 to 8 years & diagnosis F84.0, F84.1. We used some different memory and attention tests for 1–3 dynamics type. PEP was used for sample 4. Results: Age-specific development of memory has been found to increase generally from 7 to 12–13 years and tends to decrease from 13 to 16 years in patients with psychosis as well as in control (normal). Another memory test using mediated memorization of distant by implication words has shown difficulties in patients reflected in decreasing of memory volume with age in contrast with the control group. This fact may be evidence of connection between memory functioning and thinking disorders in patients. 223


Longitudinal analysis has shown improvement of memory and attention functioning. Common evaluation discovered that development of the memory level and execution time for attention task has reduced both in younger (before 10 years at base-line) and elder (above 10 years) group. Results of age-specific (both crosssectional and longitudinal) analysis for F20 and F21 patient’s group has differed from each other. In general F20 group has shown to be more accurate in cognitive functioning than F21. Influence of the neuroleptic treatment also differed for those groups of patients. Patients in F20 group have shown increase in execution time for attention task (i.e. their attention has become worse). The execution time for attention task for F21 group patients has decreased after treatment. The assessment of polypeptide treatment with PEP has shown increase of cognitive functioning in F84.0 group in contrast with the F84.1 group. Conclusions: – Memory and attention development of children with mental diseases satisfy general regularity of normal cognitive development according to age with lower results. Patients with diagnosis F20 have constant cognitive deficits in memory and attention which do not reduce with aging. – Cognitive functioning of children with mild forms of psychosis (F21 & F84.0) is more reactive on neuroleptic and polypeptide treatment. Cognitive functioning of children with severe and atypical psychosis (F20; F84.1) is more resistant to such treatment.

Features of family education in families of adolescents suffering from computer addiction V. Malygin, E. Smirnova Moscow State University of Medicine and Dentistry, Russia Internet addiction is a type of non-chemical dependencies. An addiction can be called non-chemical when the object of dependence is a behavioral pattern, rather than psychoactive substance. In Western literature the term “behavioral or non224


pharmacological addiction” is more often used to refer to these types of addictive behavior. While studying the phenomenon of computer addiction we have carried out an investigation of the features of family education as risk factors for the formation of Internet addiction. This study is the first in a series of works devoted to the studying miscellaneous edges of the problem of Internet addiction. The study was attended by 27 young people aged 13 to 16 years (17 boys and 10 girls) and 8 mothers. The criterion for selection of testees was computer addiction. All adolescents were students of grades 8–10. Were identified following features of communication in families of the addicts: – 100% of surveyed teens show disharmonious view of their family; – 92% of teenagers note features of disharmony in contact with their mother; – In 87% of families there are differences in the perception of the family by the adolescent and his or her mother; – In 75% of families desire of emotional closeness does not lead to its emergence; – 25% of observed families show symbiotic relationship between children and parents; – In 87% of families there is a lack of requirements, prohibitions and penalties; – 62% of mothers are not able to work with their children in collaboration and cooperation; – 38% are able to work in pairs, but get tired quite fast and begin to suppress the child; – 90% of girls feel the emotional distance with their fathers; – Fathers are deprived of the traditional male role; – 26% of mothers suffer distrust of men. It was proved that mothers of adolescents, prone to Internet addiction, can be divided into two groups by the type of family education: – Following the parenting style with features of hypoprotection (75%), which are divided into two types: those who emotionally reject the child and those who treat children as equal partners; 225


– Following the parenting style with features of hyperprotection (25%), which are also divided into dominant and indulge. In our work we have witnessed a great number of characteristics of inharmonious communication in families of computer addicts and young people prone to addiction. Study of each of these features in detail can be a continuation of a series of studies on the aspect of computer addiction. We consider studying the disorders in the perception of the family as one of the most interesting aspects of investigations in the field of family predictors of computer addiction.

226


Panel discussion 4. Early career psychiatrists in Northern Europe – advantages and drawbacks – what can the psychiatric associations do? Chair: Henrik Wahlberg (Sweden) General abstract The aim “No health without mental health” presupposes good mental health services. Good mental health services require good psychiatrists because there is “No good mental health without good psychiatrists”. A good psychiatrist is the outcome of a long process, the selection of a specialty with a good reputation and perceived as interesting, a good all-round training and good teachers, good practice, professional support, appreciation, a collegial network and good opportunities for lifelong learning and development. Young and early career psychiatrists from Northern Europe will present their views on the process and the advantages and drawbacks in their training and practice. They will also describe the opportunities and conditions they meet when they start off for work after finishing their training. Representatives of the Psychiatric Associations in Northern Europe will inform about their policy and achievements to support young and early career psychiatrists. Many young and early career psychiatrists choose to gather part of their training abroad and work temporally in various countries. The perceived advantages and drawbacks may influence the interest in this and can have a global impact. Young psychiatrists in Northern Europe meet and share their experiences.

227


Panel discussion 5. Psychotherapeutic training in Europe: the present-day and perspectives Chairs: Yakov Kochetkov (Russia), Maria Orlova (Russia), Olga Karpenko (Russia) Psychotherapy training in the United Kingdom N. Christodoulou University College London Hospital, Mental Health Liaison Team, London, UK As part of their exposure to the holistic model of psychiatric management, all psychiatric trainees in the UK receive formal training in psychotherapy, regardless of their chosen sub-specialty. Training in psychotherapy is linked to progression milestones and theoretical knowledge of psychotherapy is included in professional examinations. In this presentation, we will outline how psychotherapy is included in psychiatric training in the UK and suggest important points for wider consideration.

Psychotherapy training in Europe: the present-day and perspectives in Bosnia and Herzegovina A. Delic1, E. Avdibegovic1, 2, I. Pajevic1, 2, M. Burgic-Radmanovic3, 4, D. Babic5, 6 1 Department for Psychiatry, 2 School of

University Clinical Centre Tuzla,

Medicine, University of Tuzla, Bosnia and Herzegovina

3 Department for Psychiatry, 4 School of

Clinical Centre Banja Luka,

Medicine, University of Banja Luka, Bosnia and Herzegovina

5 Department for Psychiatry, 6 School of

University Clinical Hospital Mostar,

Medicine, University of Mostar, Bosnia and Herzegovina

The issue of psychotherapy as a part of training programme in psychiatry is showing whether the three-dimensional approach to psychiatry – bio-psycho-social – is part of the official definition of the speciality in the different countries. Basics of psychotherapy (knowledge of the theory) are an integral part of psychiatric training in Bosnia and Herzegovina (B&H). Supervision of psychotherapy cases, 228


personal therapeutic experience and practical training is offered only within the extensive psychotherapy training, which is organized out-of-work and is self-paid. There is a lack of qualified psychotherapists and their distribution is centred around a few of the major cities. Different training institutes working as members of international associations provide diploma course in Bosnia and Herzegovina, while the space and organization of training is provided by local facilities. These courses are usually given 4–6 times a year (block training). Different modalities of psychotherapy are being taught (group analysis, cognitive-behavioral therapy, systemic therapy, Gestalttherapy, transactional analysis etc.). It is felt among trainees and young psychiatrists that the lack of adequate and extensive training in psychotherapy is a draw back to their clinical practise. With the aim of committment to the highest standard of excellence and ethical conduct, and to be able to deliver the highest quality of professional care, it is important to make an extensive psychotherapy training mandatory part of postgraduate curriculum in psychiatry, to decide on the principle of psychotherapy training, to define a unique national requirements, and to provide realistic and flexible structures in order to fulfil the requirements.

Psychotherapy training in Europe: the present-day and perspectives in Russia Y. Kochetkov Moscow Research Institute of Psychiatry, Russia The psychotherapy in Russia has a long history. At the same time long disconnection with the western psychotherapeutic traditions leads to the differences in the psychotherapeutic education in Russia and abroad. The main problem of psychotherapeutic education in Russia is diversity in the educative systems. Only few educational programs have traditional structure: theoretical part, supervision, individual psychotherapy. This happens because we don`t have National long-term educative programs of the actual psychotherapeutic approaches (cognitive and interpersonal psychotherapy). Though there are attempts to create such programs. In the development of education programs we should consider experience of native psychotherapy and clinical psychology. 229


Oral presentations 1 Chairs: Edmond Pi (USA), Elena Molchanova (Kyrgyz Republic) Issues of doctor’s primary training in mental health skills: a comparative study in two federal districts of Russia O.B. Blagovidova1, A.A. Churkin2, Z.S. Charkimova3 1 Far Eastern State Medical 2 V.P. Serbsky

University, Khabarovsk, Russia

National Research Centre for Social and Forensic psychiatry, Moscow, Russia

3 Ministry of Health of

the Chechenskaya Republic, Groznii, Russia

Introduction: Mental health issues must be part of pre-service training for all primary care workers, and must continue on an ongoing basis throughout their careers. Howewer, neither attempts to train primary care workers nor the use of practice guidelines have shown any change in disappointing findings: most studies routinely show that less than a quarter of the morbidity is recognized. People with mental health problems require much more time, and not all GPs are willing to take them in their practice. While routine screening using validated brief screening questionnaires is important, it is not sufficient. Motivation to improve comes from knowledge and inspiration, not orders. Objectives: To determine social and psychological factors which influence the work of primary care doctors in the field of mental health. Method: A survey and psychological testing conducted with primary care doctors in Far Eastern and South Federal Districts of Russia. Design: In 2009, 797 primary care doctors from 19 subjects of the Russian Federation responded to a questionnaire assessing their social and demographic characteristics, their knowledges of common mental disorders and answered psychological tests assessing their achievement motivation, burn-out syndrome, the level of anxiety and depression. Results: No significant differences were found between Far Eastern and South Federal Districts of Russia. Less than 10% of the responders had postgraduate 230


education in mental health and communicative skills. 70% of the doctors showed an unsatisfactory level in mental health issues. Most of the primary care doctors referred their patients to psychiatrists only in cases of acute psychotic states; however they acknowledged the great prevalence of depression and somatoform disorders among their patients. 80% of the physicians considered that education in this area was quite important for them. Conclusion: Primary care doctors needed achievement motivation; more satisfaction with their incomes; ability to absorb new ideas and new information, irrespective of their age, gender, work experience and years spent in medical practice. Carefully designed educational and training programmes need to be tailored to address the particular weaknesses of primary care doctors training.

Complex cognitively-guided psychotherapy for anxious disorders with panic attacks R. Tukaev1, 2, O. Korabel’nikova2, A. Kuznetsov1, V. Kuznetsov1, K. Sryvkova1 1 Moscow

Research Institute of Psychiatry, Russia

2 Russian Medical Academy of

Postgraduate Education, Moscow, Russia

The complex method of psychotherapy for anxious disorders with panic attacks (agoraphobia with panic attacks, social phobia with panic attacks, specific phobia with panic attacks and panic disorder) is developed. Its components are psychoeducational, causal, cognitively-guided psychotherapy, and hypnotherapy. The immediate and one-year follow-up evaluation of efficiency of complex psychotherapy is produced. The immediate evaluation (n = 106) reveals significant improvement in 66 cases (64.7%), improvement in 32 cases (31.4%). The one-year follow-up evaluation (N = 54) reveals significant improvement in 29 cases (53%), improvement in 19 cases (35%). The results indicate clinical effectiveness of the developed complex method of psychotherapy.

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Sensory correction of psychosomatic desadaptation in the age-related aspect E.B. Gayvoronskaya, O.V. Gurko Voronezh N.N. Burdenko State Medical Academy, Russia The purpose of this investigation was to study the possibilities of applying multisensory therapy in critical age periods of reproductive decline, in order to improve the aging persons’ life quality. We have studied 100 persons (50 females, 50 males) at age of 40–60 in the psychosomatic hospital environment and divided them into 2 groups (25 females and 25 males per group). Patients of the first group unlike those of the second group were undergone a sensory correction course. Clinical-psychopathological and experimental-psychological methods were used. Sensory correction was realized in a sensory room environment. The course of sensory correction was structured as follows: 15 sessions in small groups (4–6 persons), each of 1 hour duration twice a week with the retesting in 2 weeks after the end of the course. For retesting, we used the Hospital Anxiety and Depression Scale, the SF-36 questionnaire, Rodgers & Diamond’s social and psychological adaptation, the Eysenck questionnaire for the self-esteem of mental states. Psychosomatic disadaptation associated with age-related psychophysiological dynamics was found to develop in specific mental and physical phenomena in the critical periods of hormonal imbalance. These phenomena are manifestations of agerelated psychosomatic crises with their own clinical and psychological content (the concept of these crises was developed by the authors). Clinical content of psychosomatic disadaptation is represented by various psychosomatic phenomena such as menstrual disorders in climacteric (females) and partial androgen deficiency (males), by the development of various somatic pathologies, vegetovascular disorders and anxiety-depressive reactions. Psychological level of symptom formation is described in the model of integrated experiences presented, which may become a base model for the structured study of any psychosomatic disorder. The model includes target-symptoms – nonspecific and 232


specific to a particular disorder - for corrective influences. Specific target symptoms “as a whole” form specific psychological phenomena, one of which is age-related dissociation in persons at the stage of reproductive decline. According to the results of retesting, application of sensory correction to group 1 persons compared to group 2 persons revealed a statistically reliable positive dynamics of such integral parameters as adaptability, PCS and MCS in SF-36 questionnaire, anxiety, depression, and aggressiveness. Thus, sensory correction of psychosomatic disadaptation in reproductive decline opens new opportunities for improving the aging persons’ life quality due to the enhancement of adaptive capacity and prevention of development of pathological climacteric, partial androgen deficiency and somatic pathology.

Mental health and quality of life: possibility of psychotherapy in rehabilitation of women with cancer of reproductive system A.Yu. Berezantsev, L.I. Monasipova, S.V. Strajev V.P. Serbsky National Research Centre for Social and Forensic psychiatry, Moscow, Russia Moscow oncologic dispensary № 3, Russia 155 women aged 28–69, with a cancer of reproductive system were observed for the purpose of studying the interrelation between mental health and quality of life on the basis of Moscow oncologic dispensary № 3. Materials and methods: 110 patients (70.97%) were women with a breast cancer, 21 (13.55%) – with a cervical cancer; 7 (4.51%) – with an uterus cancer ; 17 (10,97%) – with a ovarian cancer. The questionnaires which help to specify clinical, psychopathological, personal characteristics of patients, and quality of life parameters were used. Results: 104 (67.1%) patients were diagnosed with mental disorders of borderline register and 51 (32.9%) was diagnosed with prenosological disorders. Symptoms of anxiety and depression prevailed. Coping-strategy and psychological defence mechanisms research revealed inefficiency of coping-strategies and intensive application of deadaptive psychological defence in the majority of patients. Correlation between expressiveness of 233


psychopathologic semiology (anxiety, depression, fatigue) and results of the Questionnaire of Quality of Life (QoL) was noted. Women experienced higher level of anxiety and depression, had poorer quality of life score. High score on the Questionnaire of Somatic complains correlated with higher level of anxiety. It was established four basic variants of a combination of real quality of life problems and their subjective estimate by patients. Subjective estimate of QoL in the ratio of objective parameters of social adaptation in 71 patients was adequatenegative, in 45 patients – adequate-positive, in 7 patients – inadequate-positive, in 32 – was inadequate-negative. The adequate-negative and adequate-positive estimations of QoL prevailed in patients with asthenia. The inadequte-negative estimation correlated with depressive and anxiety symptomatology. 45 patients underwent a course of psychotherapy in format of group and individual hypnotherapy by R.D. Tukaev. 15 patients underwent a course of individual cognitive-behavioral therapy. After hypnotherapy was conducted, the growth of quality of life from 2.34 score (8.8%) to 7.2 (24.3%), on an average on 5.7 (19%) was registered. After conduction of cognitive-behavioral psychotherapy quality of life indicators increased from 2.34 (7.8%) to 9.25 (30.8%) score, on an average on 5.6 (18.6%). Conclusions: Dynamics of the mental status in the course of psychotherapy suggested about the efficiency of psychotherapeutic intervention for borderline mental disorders in women with a cancer of reproductive system.

Acute transient psychosis – focus on stressful life events before the first episode M. Rusaka1, E. Rancans2 1 Riga Centre of Psychiatry

and Addiction Disorders, Latvia

2 Riga Stradins University, Department of

Psychiatry and Narcology, Latvia

Background: Acute psychosis with brief onset, polymorphous symptomatology and rapid resolution has been described in different countries under the different 234


name. It has been called “delusional Flash”, “psychogenic psychosis”, “cycloid psychosis” or “bouffée délirante”. In ICD-10 classification it is defined as “acute and transient psychotic disorder” (ATPD; F23) and comprise 8–9% of all psychotic disorders. Little is known about disorder with unclear nosological status and usually favourable prognosis. The incidence of ATPD has been described in a range 1–2 per 100,000 populations, with a higher rate in females. There have not been studies regarding stressful life events before first episode, clinical features, course and outcome and associated sociodemographic characteristics of ATPD carried out in Latvia up to now. Aims, methods and materials: The aim of study was to describe stressful life events before the first episode and to analyse longitudinal changes of ATPD diagnosis and associated sociodemographic characteristics of patients in Latvia. In retrospective chart review study all first time hospitalized patients fulfilling ICD-10 criteria for Acute and transient psychotic disorders (F23) treated at the Riga Centre of Psychiatry and Addiction Disorders, Latvia during a 2-year period (01.01.2004–31.12.2005) were included. During an average of 5.1 years follow-up period, after the index episode, patients were assessed using standardised instruments. Results: During a 2-year period 191 patients were first time hospitalized with ATPD, 56% (106) females. Over an average of 5.1 years follow-up period 55% (105) of patients were not rehospitalised, 59% of them were females (p = 0.05). In the subgroup of rehospitalised patients diagnosis in 68% (59) of them later changed to schizophrenia (85% in males; p = 0.007). Stressful life events before first episode were found in 71 patients, higher for females (43; p = 0.06). Most common stressful life events like death of significant other was present in 18%, separation/divorce 18% (21% females and 4% in males; p = 0.08). Change of job or school in 24% (36% in males; p = 0.04), serious illness/operation 9%, “moving house” in 17% (36% in males and only 5% in females; p < 0.001). Serious problems in family 18%, at work 17%, major journey 20%. Unemployment during index episode was present in 73 patients (45% males, and 33% females; p < 0.001).

235


Conclusions: ATPD were more prevalent in females. Half of the patients were hospitalized only once during follow-up period. In subgroup of rehospitalized patients most common diagnostic change was to schizophrenia, with higher rates in males. Stressful life events before the first episode presented in 40% ATPD patients, with higher rates for females. During index episode was present higher rates of unemployment, “moving house”, change of job or school

in males, but

separation/divorce in females. Further prospective research on the topic is necessary.

Kyrgyz traditional culture and psychopathology E. Molchanova American University in Central Asia; Slavonic University in Kyrgyzstan, Bishkek, Kyrgyz Republic Problem: Neither the ICD-10th, nor DSM-IV-TR provides mental health specialists in the Kyrgyz Republic with acceptable diagnostic tools in cases where culture not only determines the content of psychopathological experiences, but also plays the major role in developing abnormal behaviors. The influence of an ancient traditional culture on modern Kyrgyz society is easily observed in the rural areas of modern Kyrgyzstan. Kyrgyz ancient beliefs and rituals, myths and traditional healing practices

influence

the

interpretation

of

two

syndromes,

“Albarsthy”

and

“Kyrgyzchylyk.” Procedure: This case-study research is devoted to the description of these two culture-bounded syndromes well-known to mental health practitioners in Kyrgyzstan, but not labelled as mental disorders in either the ICD-10th or the DSM-IV-TR. Results: The first culture-bounded syndrome is known among Kyrgyz clinical psychologists as “Albarsthy” syndrome, which is usually understood by professionals as a variant of somatoform disorder. Albarsthy is a mythological hero with a negative magical power and aggressive intentions. The person with Albarsthy syndrome is distressed by feeling a variety of unpleasant sensations during night times. These sensations are always associated with the strong feeling of a presence of a supernatural force and are understood by the client as a result of the hero’s, Albarsthy, actions. 236


The second is known as “Kyrgyzchylyk” syndrome. It looks like a psychotic episode with schizophreniform symptoms of a very specific cultural-based content. In the frameworks of the traditional cultural understanding this episode indicates to the client and his/her relatives the existence of supernatural abilities in a person and is considered to be a sign of his/her future spiritual mission (Kyrgyzchylyk). When the mask of Kyrgyzchylyk syndrome hides the onset of schizophrenia, it will be very unlikely for the client and his/her relatives to seek professional help. Conclusion: Two problems can arise from ICD-10th in Kyrgyz circumstances. The first is the possibility of overpathologizing those behaviours that result strong cultural influences on individuals’ cognitions, and the second is the possibility of overnormalizing a mental disorder. Albarsthy and Kyrgyzchylyk syndromes are good examples of how the distinctions between psychopathology and cultural-based peculiarities are important to determine. However, the creation of universal classification system may present other problems.

237


Oral presentations 2 Chairs: Mohammed Abou-Saleh (UK), Izjyaslav Lapin (Russia) Toward integration of neurophysiological and molecular-genetic, and fMRI analysis in schizophrenia I.S. Lebedeva1, V.E. Golimbet1, V.G. Kaleda1, A.V. Petriakin2, A.N. Barkhatova1, N.A. Semenova3, T.A. Akhadov2 1 Mental Health Research Center of Russian Academy of Medical Sciences, Moscow, Russia 2 Research Institute of 3 N.N. Semenov Institute of

Urgent Children’s Surgery and Traumatology, Moscow, Russia Chemical Physics of Russian Academy of Sciences, Moscow, Russia

The aim of the current study was to discriminate the neurophysiological abnormalities of information processing in patients with schizophrenia, to determine the relationships with hemodynamic response in several brain structures and to analyze the impact on neurophysiological data of some molecular-genetic factors. The samples comprised 70 patients with schizophrenia (F20, ICD-10), examined against the marked reduction of psychopathological symptoms, and 30 mentally healthy control subjects (all subjects were right-handed, aged 18–45). Auditory ERPs in the “active” oddball paradigm were recorded on the Brain Atlas (Biologic, USA) and BrainSys (Russia) mapping systems, with 80% of non-targets (1000 Hz, 60dB) and 20% of targets (2000 Hz, 60dB) stimuli. Peak amplitudes and latencies of N100, P200 (ERP to non-targets), N100, N200, P300 (ERP to targets), MMN (difference wave) were analyzed. DNA was extracted from the white cells of venous blood by Master Pure kit (Epicenter, Madison WI). The COMT Val158Met polymorphism was assayed using an ABI SnaPshot ddNTP Primer Extention kit and the products were analyzed in an ABI 310 DNA analyzer. 7 patients and 8 controls underwent FMRI (EPI BOLD, T2 EPI, TR 2000 мс, TE 30 мс, EPI Factor 69, FOV 240, Thk 4 мм, NSA 1, 150 dynamics) on 3T Phillips Achieva scanner (Holland) equipped with Eloquence (In-Vivo- Phillips, Holland) device. The similar oddball paradigm was applied. 238


Main findings comprised the followings: in patients with schizophrenia the reduction of N100 to target and non-target stimuli and MMN waves and prolongation of N200, P300 were found. As compared to controls, in patients the hemodynamic response (HR) was significantly higher in supramarginal gyri. In patients, the BOLD signal in the left supramarginal gyrus was positively correlated with amplitudes of N100 (non-targets) and P200. In controls, the higher HR in superior temporal gyres correlated with lower N100 to target amplitude, higher HR in supramarginal gyri correlated with higher N100 (non-targets) latencies. In patients with Met\Met genotypes the lower P300 latencies were found. The findings repeat the previously reported data on the wide spectrum of abnormalities in the neurophysiological mechanisms supported information processing in schizophrenia. The results also stress the robustness of anomalies in the earlier ERP components which were found in patients even against the background of the reduction of psychopathological symptoms. The impact of COMT polymorphism (which determine the variability of dopamine, primarily in the prefrontal cortex) on ERP characteristics in patients with schizophrenia was moderate. The structure of correlations between ERP and fMRI data was different in patients with schizophrenia and norm assuming the qualitatively different involvement of tested brain structures in information processing in schizophrenia. The study was partly supported by RBRF 09-04-12193-ofi_m grant.

Peculiarities of structure of synapses and properties of synaptosomal benzodiazepine receptors in the ontogenesis of human brain in norm and during alcoholization of the mother T.V. Shushpanova, A.V. Solonsky, V.Ya. Semke Mental Health Research Institute SB RAMSci, Tomsk, Russia In elucidation of mechanisms of brain disontogeny in offspring of mothers using alcohol in period of pregnancy major part is played by neuromorphologic and neurochemical investigations. Ultra-structure of embryonic human brain has been well studied, especially at the stage corresponding to 2–3 months of intrauterine 239


development, however, influence of maternal alcoholization on development of embryo’s brain of person and process of synaptogenesis and have been studied inadequately. Alcohol potentiates action of GABA-agonists, benzodiazepines, barbiturates. It has been noticed that acute impact of the alcohol reinforces GABAergic transmission, increases affinity of the benzodiazepine receptors for 3H-diazepam; chronic alcoholization increases selectivity of reverse agonists of benzodiazepine receptor (BDR). In alcohol withdrawal syndrome, affinity of benzodiazepine and low affine GABA-receptors of the brain decreases. Provided data indicate presence of relationship between action of ethanol and functioning of GABA-benzodiazepine receptor complex. However, character of this relationship is little studied. Objective of present investigation appeared to be a study of dynamic of formation and development of synaptic contacts and benzodiazepine receptors of synapses of the embryonic brain at weeks 7–15 of development obtained from healthy women and alcoholic ones. For electronic-microscopic investigation, the embryonic brain was fixed. Microscopic sections were made on the ultratom “Ultracut-E” (Austria), contrasted in a special device “Ultrosteiner” (Sweden) and reviewed on electronic microscope JEM – 100CX of the firm “Jeol” (Japan). Properties of benzodiazepine receptors (BDR) were examined with radio receptor binding of the selective ligand 3H-phlunitrazepame (“Amersham”) with raw synaptosomal fraction of the brain of embryos, in end concentrations 0.2–10 nM. End concentration of membranes according to protein has constituted 0.3 mg/ml. Nonspecific binding was identified in presence of the non-radioactive ligand in concentration 10 mcМ. Constant of dissociation (Кd) and maximum number of sites of specific binding (Bmax) were identified with the method of the analysis of curves of saturation in co-ordinates of Sketchward. In cells of brain of embryos obtained from women suffering from alcoholism becoming slower formation of synaptic structures as compared with the norm was found what may be the cause of an alteration of neuromediator transmission. Because

240


specific receptors to alcohol have not been distinguished, of special value is interaction of ethanol with familial receptor systems of the brain. Increase of number of synaptic contacts in dependence on term of development of embryo brain and alteration of properties of benzodiazepine receptors (BDR) of synaptosomal membranes with increase of term of development of embryo have been established what is expressed in decrease of affinity of receptors and increase of their density. In cells of the embryo brain obtained from women suffering from alcoholism slowing of formation of synaptic structures as compared with norm and transformation of properties of synaptosomal BDR has been found out, what may be a cause of alteration of neuromediator transmission.

The role of folate in the pathogenesis of depression and its treatment M. Abou-Saleh Division of Mental Health, St. Georges, University of London, UK Depressive illness is a global public health problem and ranks the 4th most important cause of mortality and disability. Its treatment is often successful and the majority of patients recover with appropriate treatment including continuation and maintenance treatment for severe and recurrent depression. However, a large minority (30–40%) of depressed patients do not respond to standard antidepressant medication and require additional treatment. Its aetiology has been extensively investigated and among the exogenous factors studied is folate deficiency which has been shown to be associated with depression in clinical and general populations. The mechanisms for folate’s therapeutic effects in depression have been related to onecarbon metabolism involving the processes of methylation and hydroxylation of putative factors involved in the chemical pathology of depression .These findings prompted studies of the efficacy of folate supplements in the treatment of depression which showed that folate supplement (500 micrograms per day) to antidepressant medication is effective in women. For men, the 500 μg dose of folic acid was insufficient to lower their plasma and homocysteine levels and to cause an improved response rate. We suggest the use of 2 mg of folic acid, which would be expected to 241


increase plasma folate to more than 20 mg/ml in both sexes. Trials of antidepressant treatments take a long time to carry out, and continuation and maintenance studies take even longer. Adding 2 mg of folic acid to antidepressant treatment would be easy in everyday clinical practice. The daily supplement could be easily taken. It is inexpensive and safe. If the results of long-term trials were negative, then we would have done no harm, but if they were positive, then we would have saved a lot of lives and suffering.

Still fresh and inspiriting – kynurenines as common neurochemical links in stress, anxiety, depression, alcoholism, epilepsy I.P. Lapin St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Detailed overviews on these problems have been published several times in English (1988, 1989 and 2000) and in Russian (1998, 2004). Experimental and clinical data on the neuroactivities of kynurenines (KYNES), endogenous metabolites of an aminoacid tryptophan, as well as respected ideas and perspectives were cumulated in the Laboratory of Psychopharmacology of this Institute during 1970–1995. The Citation Index of these publications was very high. Many scientific institutions elsewhere joined those studies. After closing the laboratory due to some “reorganization” bureaucratic measures the studies on KYNES in this Institute were over. The activity was switched into the clinical trials of new psychotropic drugs. However, the background for further studies in the field of KYNES is still valid and promising. Neither objections nor criticisms have appeared since that time. Why not to go on? Why to ignore fresh priorities in this field? To repeat and to summarize. The most promising areas of research appeared to be the following. STRESS. A concrete role of the balance between various KYNES in long-distance after-effects of chronic emotional stress when the level of KYNES is high during many months after stress. In particular, in the affective disorders resistant to standard anxiolytics. ANXIETY. A correlation between endogenous both anxiogens (kynurenine – Kyn, quinolinic acid – Quin) and anxiolytics (kynurenic –Kyna and 242


nicotinic acids, melatonin – Mel) in concrete clinical forms of anxious states. Phenylethylamine (PEA) as a panic-producing trace amine and it relationships with mentioned endogenous anxiogens and anxiolytics among KYNES. A home nootropic and anxiolytic drug Phenibut (beta-phenyl-GABA) and baclofen (chlor-phenibut) as selective antagonists of PEA and antipanic drugs. Synergism of Quin, an endogenous inhibitor of MAO-B, an enzyme degradating PEA, and PEA as anxiogens. DEPRESSION. Further evidence for the role of Kyn and Quin as endogenous antagonists of serotonin and factors of therapy-resistant depressions. Antagonism of KYNES to antidepressants, particularly SSRI (selective serotonin reuptake inhibitors). ALCOHOLISM. A relationship between elevated level of Kyn and psychiatric and vegetative symptoms in the AWS (alcohol withdrawal syndrome) similar to that in the neurological symptoms of AWS demonstrated earlier. To check previous data on Quin as a metabolite involved in the abnormalities of paradoxic phase of sleep (unrelated to its anxiogenic effect). EPILEPSY. Kyn, according to experimental data, is an endogenous convulsant. It is involved in grand mal seizures in patients with epilepsy. Further evidences are required to check the problems of the probable role of Kyn as well other endogenous convulsants (3-hydroxy-KYN and Quin) and anticonvulsants (Kyna and picolinic acid, Mel, taurine) in petit mal seizures and in epileptic patterns of personality in patients. Search for other endogenous anticonvulsants seems to be promising in further understanding of a balance between endogenous convulsants and anticonvulsants in various forms of epilepsy. Various comorbid disorders, e.g. GAD (generalized anxiety disorder) and depression or alcoholism and depression which have KYNES as common neurochemical links, are the promising targets to go further in understanding of biological backgrounds of these disorders. The author does realize that even for the biological psychiatry the items mentioned above are not any heart-breaking news or the problems for discussing now the concrete disorders. However, he does hope that the information presented here could serve at least as KEY WORDS when looking through the information in Internet or/and Index Medicus. 243


Poster presentations Diagnostic stability in childhood schizophrenia vs. childhood bipolar disorder W.M. Bahk, Y.S. Woo, H.J. Moon, Y.-E. Jung College of Medicine, Catholic University of Korea, Seoul, Korea Objectives: The psychotic features in childhood and adolescence can be seen in many psychiatric disorders. The purpose of this study was to analyze alterations of the diagnosis or diagnostic stability of DSM-IV diagnosis in children and adolescents who showed psychotic features at the first diagnosis and were finally diagnosed as schizophrenia or bipolar I disorder after more than 3 years from the first diagnosis. And we compare the clinical variables and diagnostic stability between finally diagnosed schizophrenia and bipolar I disorder. Methods: Subjects of this study were under the age of 18. They were admitted to the St. Mary’s hospital, Seoul, Korea having first episode psychotic symptoms between 1996 and 2005. Among these patients, we selected only the patients who could follow up for more than 3 years after the first diagnosis. And then, we divided these patients into two groups – the patients who were finally diagnosed as schizophrenia (schizophrenia group) and the patients finally diagnosed as bipolar I disorder (bipolar I group). We conducted retrospective medical record review to compare epidemiological data, clinical variables and diagnostic stability between two groups. Results: Sixty-seven patients had completed this study. The total number of the patients finally diagnosed as schizophrenia (schizophrenia group) was 49 (male 22, female 27), and the total number of the patients finally diagnosed as bipolar I disorder (Bipolar I disorder group) was 18 (male 5, female 13). The distribution of the gender was not significantly different between two groups. And also, the age of onset, the age of the final diagnosis, the number of admissions for the misdiagnosis during the follow-up period was not significantly different between two groups. The family history of schizophrenia was higher in the schizophrenia group than the bipolar I 244


disorder group, and the family history of bipolar I disorder was higher in the bipolar I disorder group than the schizophrenia group. Diagnostic stabilities were higher for the schizophrenia group than the bipolar I disorder group: 20/49 (40.8%) vs. 5/18 (27.8%), but there was no statistical differences. And we also divided the total patients into two groups according to the first diagnosis, schizophrenia and bipolar I disorder. The ratio of being maintained for the first diagnosed schizophrenia into the final diagnosis was 20/21 (95.2%), and the ratio of being maintained for the first diagnosed bipolar I disorder into the final diagnosis was 5/12 (41.7%). So first diagnosed schizophrenia was twice more stable diagnostically than first diagnosed bipolar I disorder. Conclusions: The results of this study suggest that finally diagnosed schizophrenia and bipolar I disorder was not statistically different from the diversity of first diagnosis. But the first diagnosis was very predictable factor for diagnostic stability. When the first diagnosis was schizophrenia, diagnostic stability to maintain the diagnosis after more than 3 years was about twice higher than when the first diagnosis was bipolar I disorder.

The broad effectiveness and tolerability of Bupropion XR in patients with depressive disorders: a multi-centre, 3 months, non-interventional, observational study W.M. Bahk1, C.U. Pae1,2, D.I. Jon3, Y.C. Shin4, B.H. Yoon5, K.J. Min6 1 College of Medicine, The Catholic University of Korea, Seoul, 2 Duke University medical Center, 3 College of Medicine, 4 Kangbuk Samsung Hospital,

Korea

NC, USA

Hallym University, Anyang

School of Medicine, Sungkyunkwan University, Seoul, Korea

5 Naju National Hospital, 6 College of Medicine,

Naju, Korea

Chung-Ang University, Seoul, Korea

This study was to evaluate the effectiveness and tolerability of bupropion extended release (XR) in the treatment of patients with depressive disorder defined with the criteria of DSM-IV for major depressive disorder (MDD), dysthymia and 245


depressive disorder NOS for 3 months in a naturalistic treatment settings. The data of 774 participants were analyzed. The primary outcome was 7-item Hamilton Depression Rating Scale (HAM-D 7) and the secondary outcome measures were Clinical Global Impression Scale-Severity (CGI-S) and-Improvement (CGI-I), and Sheehan Disability Scale (SDS), which were assessed in the baseline (visit 1) and one months (visit 2) and 3 months (visit 3) after treatments. The adverse events were systematically collected by Treatment Emergent Adverse Events (TEAEs) and patients’ subjective report. The total scores of HAMD-7 significantly decreased from the baseline (13.1) to the endpoint (5.9) by approximately 55% after 3 months treatment with bupropion XR. Fifty nine percent of patients felt very much improved or much improved at the endpoint after treatment of bupripion XR, while 74% of patients showed more than moderate severity measured by CGI-s at the baseline. The total scores of SDS also significantly decreased at the end of treatment. After treatment, 17% of patients felt any of adverse events, in which dry mouth and headache were the most common side effects and most of the side effects were judged as mild intensity. Notably weight gain and sexual dysfunction were minimal. At the end of treatment, 75.7% of patients were still on bupropion XR and the mean dose of bupropion XR was 243 mg/d during the study.

A cross-cultural comparative study of prevalence and predictive models of depression in schizophrenia N.G. Christodoulou1, S. Johnson1, P. Bebbington1, V.P. Kontaxakis2 1 University College London Research Department of

Mental Health, London, UK

2 University of Athens Medical School, Department of

Psychiatry,

Eginition Hospital, Athens, Greece Background and Aim: Depression is very common in schizophrenia, and is often under-recognised and under-treated. This has grave consequences for patients, as depressive symptoms are associated with great morbidity and mortality. This is why it is important to identify which features of a patient’s presentation may indicate that they are depressed. Various clinical and epidemiological factors have been linked to 246


depression in schizophrenia, both clinical (e.g. negative and positive symptoms, insight, etc) and epidemiological (e.g. gender, geographical, etc), but the way that these factors define depression in different cultural groups has not been extensively investigated. The latter was the aim of the current study. Methods: We compared the prevalence and predictors of depression in two culturally distinct groups of in-patients with schizophrenia from the UK (N = 60) and Greece (N = 101). The two groups were cross-sectionally interviewed using the following clinical scales: Calgary Depression Scale for Schizophrenia, Positive and Negative Symptoms Scale, Global Assessment of Functioning, Scale for the assessment of Unawareness of Mental Disorder. We used these data as independent parameters in regression models for depression, and compared the models cross-culturally. Results and Conclusions: Our two groups were clinically very different between them. Regardless of this, depression (defined as CDSS score > 6) was equally common in the two groups (25% UK vs. 24.8% GR). In addition to this similarity in rates, we also found that the regression equations appeared very similar. This serendipitous finding raises the hypothesis that depression in schizophrenia may depend on characteristics that are present throughout the schizophrenic spectrum

Results and suggestions from the pilot phase of the trainees’ questionnaire of the psychiatric association of Eastern Europe and the Balkans (PAEEB) N.G. Christodoulou1, M. Mitkovic2, O. Karpenko3, B. Dunjic Kostic4 1 University College London Hospital, Mental Health Liaison Team, 2 Institute of 3 Moscow 4 Institute of

London, UK

Mental Health, Belgrade, Serbia

Research Institute of Psychiatry, Moscow, Russia

Psychiatry, University Clinical Center, Belgrade, Serbia

Background and Aims: Psychiatric training in the countries of Eastern Europe and the Balkans is as diverse as the countries themselves. There are important differences, conceptual, structural and operational among others, all of which affect the compatibility of training between the countries. At PAEEB we view those differences not as obstacles, but as opportunities for complementary exchange training 247


schemes. In the context of this idea, we set up a questionnaire in order to firstly identify complementary elements in the different countries’ training schemes, and therefore identify potential exchange possibilities. Results: The pilot phase of the questionnaire ran between August and November 2009, and yielded interesting results. Firstly, we identified a universal need for more communication and an agreement on the need for exchange schemes between our countries. Secondly, we identified clear structural differences between training schemes. In terms of exchange aspirations and wishes, trainees mentioned psychotherapy consistently as a needed element, followed by research training. They also identified financial issues and language barrier as the most significant problems. Conclusion: The results of the pilot phase of our survey are encouraging towards setting up a training exchange network between the country-members of PAEEB. Finally, perhaps the most important collateral conclusion is the enthusiasm of the participant trainees.

Schizoaffective disorder in a patient with Klinefelter syndrome B. Ferreira1, N. Borja-Santos1, C. Vieira, S. Xavier1, B. Trancas1, A. Luengo1, A. Neto1, C. Klut1, J. Grasa1, J. Tavares2, G. Cardoso3 1 Department of

Psychiatry of Prof. Dr. Fernando da Fonseca’s Hospital, Amadora, Portugal

2 Department of 3 Head of

Psychiatry of Júlio Matos´s Hospital, Lisboa, Portugal

Department of Psychiatry of Prof. Dr. Fernando da Fonseca’s Hospital, Amadora, Portugal

Klinefelter syndrome, a random chromosomal condition consisting of an additional copy of the X chromosome in each cell, affects 1 in 500 to 1,000 males, and has an impact on male sexual development. Klinefelter syndrome may also impact physical, social, and language development. Psychiatric syndromes ranging from mild cognitive impairment to psychoses have been associated with this condition. We report the case of a 39-year-old male patient with schizoaffective disorder resistant to psychopharmacological treatment. As a child he showed learning disabilities, and at the age of 20 developed mystic, grandiose and persecutory 248


delusions and aggressive behaviour towards his family, leading to the diagnosis of schizophrenia. Since then, several admissions to acute inpatient unit occurred. Delusions, thought disorder and mood fluctuations dominated the episodes. Treatment with antipsychotic medication and mood stabilizers did not achieve the remission of symptoms. Electroconvulsive therapy was proposed but refused. In the last 5 years cognitive deterioration lead to social and work dysfunction, although executive function, abstract thinking and affects were preserved. This pattern of cognitive deficits, quite atypical of schizophrenia, contributed to the questioning of the initial diagnosis. On physical examination the patient was 174 cm tall, and showed scarce facial and pubic hair, a mild degree of gynecomastia and testicular atrophy. Serum testosterone concentration was low, LH and FSH levels were abnormally high, and bone densitometry revealed osteoporosis. Karyotype analysis confirmed an XXY pattern, upon which replacement androgen therapy was initiated. Klinefelter syndrome is the most frequent chromosomal aneuploidy. Cases in which the identification of characteristic somatic phenotype is not clear make diagnosis difficult. Literature descriptions of undifferentiated psychotic syndromes are found, however, reference to schizoaffective disorder is scarce if some. The resistance to psychopharmacotherapy and the atypical clinical presentation could be a trait of patients with this condition.

The Italian National integrated epidemiological surveillance in mental health A. Gigantesco, I. Lega Italian National Institute of Health, Mental Health Unit, Roma, Italy Following a three-month pilot phase, the National Integrated Epidemiological Surveillance in Mental Health (S.E.M.E. project) has started on 22 June 2009. The S.E.M.E. project, funded by the National Centre for Diseases Control and Prevention of the Ministry of Health, aims to test an innovative national sentinel surveillance system of the most severe mental disorders that are public health concerns because of their associated substantial suffering and disability burden. 25 Centers of Mental Health, 249


selected throughout the country, participate to the project. The Mental Health Unit of the Italian National Institute of Health coordinates the activities of the participating centers and performs collection, and analysis of data.

Association study of A2a adenosine receptor gene polymorphism in panic disorder W. Kim, D.I. Jon, J.M. Woo Seoul Paik Hospital, Inje University, Seoul, Korea Hallym University Sacred Heart Hospital, Kyuonggi, Korea Objective: The adenosine A2a receptor (A2aAR) is thought to be implicated in the pathogenesis of panic disorder because caffeine, a potent antagonist for A2aAR, can precipitate panic attacks, and because disruption of the A2aAR gene increases anxiety-behaviors in mice. Recent studies demonstrated that the A2aAR 1976C>T genetic polymorphism confers susceptibility to panic disorder in Caucasian, though not in Asian. The present study tested the hypothesis that the A2aAR 1976C>T genetic variant confers susceptibility to panic disorder in Korean. Methods: 258 patients with panic disorder and 117 healthy controls participated in this study. Genotyping was performed by polymerase chain reactionbased method. Results: Genotype (P = 0.389) and allele (P = 0.655) distribution of adenosine A2a receptor (A2aAR) polymorphism patients with panic disorder was not significantly different from those of the controls. However, panic disorder with major depressive disorder showed significant association with 1976C allele (P = 0.008) and A2aAR 1976C>T genotype (P = 0.008). Conclusion: This study suggested that the adenosine 1976C>T polymorphism may have a potential role for susceptibility to panic disorder with major depressive disorder in the Korean population. This calls for consecutive studies in order to understand the association of A2aAR polymorphism and various psychiatric disorders.

250


Application of multifactor physiotherapy effects in complex therapy of depression V.V. Kuznetsov, O.S. Antipova, O.S. Glazachev, O.S. Trofimova Moscow Research Institute of Psychiatry, Russia I.M. Sechenov Moscow Medical Academy, Russia Program elaboration of complex therapy for patients suffered from depression is one of the acute problems of modern psychiatry. One of the most important components of such programs is optimization of physiological reactivity of the organism at the expense of training eustress influence to speed up the remission formation. Thereupon non-graded combined application of some physiotherapy factors, realized by rehabilitation complexes of VibroSaun type or Alfa-capsule is of interest. The objective of that investigation is a development of science grounded approaches for application of multifactor physiotherapy impacts different regimen within the limits of complex therapy of patients suffered from depression taking into account the analysis of dynamics of their clinical psycho-pathological state and autonomic reactivity. Design and methods of investigation: 28 patients aged from 18 till 60 with a diagnosis depressive episode in light or medium degree by ICD-10 were tested. All patients were subjected to a basic course of pharmacotherapy: antidepressant of SSRI group (Fluvoxamine, Sertraline), vitamin-therapy, cerebral-protectors. The main group (n = 16) was divided into two sub-groups: in the first sub-groups (n = 10) the basic pharmacotherapy on the third week was supplemented by polysensory physiotherapeutic influence (10 procedures in Alfa-capsule daily, 5 in a week: functional music, aromatherapy, vibratory massage in a capsule with 28–37 oC); in the second sub-group (n = 6) the basic treatment was supplemented with oxyhyperthermia (10 procedures in Alfa-OxySpa Capsule, 5 sessions in a week). Patients of a control group had only a basic course of pharmacotherapy. Methods of testing were the

following:

clinical-psychopathological,

clinical-anamnestic,

evaluation

of

autonomic state and reactivity on the analysis of heart rate variability (HRV). 251


Autonomic status and reactivity in the main group was measured before and after the first and the tenth physio-procedures. In control group – on the third, fourth and sixth week s of therapy program. According to the results of the clinical-psychopathological analysis the main group of patients showed more quick restoration of sleep, increase in endurance of loads, decrease in dysphoric and asthenic reactions, reduction of anxiety. Data of autonomic check up show that all groups register the increase in initially reduced total HRV which testifies to the growth of adaptive potential of the organism and as a rule to the improvement of the emotional state. In control group on the background of the increase of total HRV, the activity of cerebral ergotropic systems decreased and a tendency

to

hypercompensatory

activation

of

sympathoadrenal

baroreflex

mechanisms was observed. In case of application of multifactor physiotherapeutic influence on the 4th–6th weeks of therapy, the activation of cerebral ergotropic mechanisms maintained and even increased in some patients especially under oxyhyper-thermic treatments. It may be related to mild, moderate stress-initiated mechanisms of multifactor physiotherapeutic effects and demands more attention to the choice of combinations and intensity of effecting factors for every concrete patient. In subgroup 1 by the tenth procedure

restoration

of

parasympathetic

tonus

and

autonomic

reactivity

optimization were observed. These data could be used for the development of varied approaches to the application of multifactor physiotherapeutic influences in complex therapy of depression.

Conversion disorder: review R. Freire Lucas, P. Carrisso University Hospital of Coimbra, Portugal Conversion disorders tend to be poorly understood and diagnosis can be difficult. In this presentation, we aim to clarify what conversion disorders are and how 252


they can be distinguished from other psychiatric disorders that involve physical symptoms. Prevalence, prognosis and relationship to organic disease are controversial areas; we outline what is known about them and provide some historical context. Aetiological theories and management strategies are discussed, the latter with the aid of case vignettes.

Delusional state R. Freire Lucas, J.L. Pio Abreu University Hospital of Coimbra, Portugal Concluding the literature in definition, pathogenesis, nosological position and treatment of delusions we are confronted with a wide range of opinions. The various definitory approaches and their value in clinical practice will be discussed as well as the manifold results concerning the pathogenesis of delusions, which showed that delusions are caused by complex interactions of various mental, physical and social factors. The choice of a particular delusional theme is determined by gender, age, civil status, social isolation, and special experiences (“key experiences”) whereas the incorrigible conviction is based on cognitive disorders and/or emotional derailments and reinforced by social factors. But delusions cannot be longer reduced to psychopathological manifestations once established and therefore persisting. The delusional conviction is a dynamic process which only persists if disorder maintaining factors become active. These disorder maintaining factors are not necessarily corresponding with the delusion’s predisposing and triggering factors. We will also raise some classificatory problem. Assumptions concerning nosology and classification of delusions have ranged from an independent nosological entity to the attribution to a certain mental disorder, to multicategorical classification models. Previous polydiagnostic studies indicate that delusional disorders are neither a nosological entity nor due to one particular disorder (e.g. schizophrenia) but represent nosologically non-specific syndromes which may occur superimposed on all mental disorders. Most of the so-called primary delusions (or delusional disorders in a 253


narrower sense – delusions not due to another mental disorder) have to be considered as diagnostic artifacts caused by the use of diagnostic criteria in particular classification systems. Finally, we will focus on differential diagnostics and differential therapeutics. As delusions represent nosological non-specific syndromes with a multifactorial pathogenesis

modern

integrative

treatment

approaches

(including

psychopharmacological, psychotherapeutic and socio-therapeutic methods) have to be based on a multidimensional differential diagnosis of all the predisposing, triggering, and disorder maintaining factors. In this context the disorder maintaining factors provide the basis for effective, pathogenesis-oriented treatment of the actual symptomatology, whereas the predisposing and triggering factors provide information for planning prophylactic long-term treatment.

Psychiatry is a branch of medicine, not a specialty J.L. Pio Abreu, E. Fradique, R. Freire Lucas University Hospital of Coimbra, Portugal The imprecise status of Psychiatry may be due to Cartesian dualism and the mind/body assumption. We can clarify this status resorting to an alternative ontology. Popper’s Worlds 1, 2 and 3, and the corresponding concepts of matter, energy and information, from Von Bertalanffy and his General Systems Theory, are candidates for a new ontology. Applying them to the history and present structure of Western Medicine, we can assume that General Surgery is the branch of Medicine which deals with bodily matter, Internal Medicine deals with energy and Psychiatry is the branch which deals with information. The respective basic disciplines are Anatomy, Physiology and Psychology. None of them is a medical specialty, because specialties such as Neurology, Urology and Cardiology, deal with a sub-system of the organism and may have a surgical, medical or even psychiatric emphasis. In the same way that the body/mind problem seemed important for Cartesian dualism, this triadic structure of Medicine may also inform a new ontology. The recent history of Philosophy may be interpreted as an attempt of looking for it. 254


Some data on psychiatric disorders in called up youth A.E. Melik-Pashayan Yerevan M. Heratsy State Medical University, Armenia Background: The investigation of the psychic status of called up men is of major importance for providing of the medical training of the youth for military service. Objective: The purpose of the present research is to study the psychic disorders of the called up males verified as not adaptable for military service. Design and Method: The study was realized via a clinical method together with using medical documentation of 150 called ups admitted to military-psychiatric expertise in “Nork” Republican Center of Psychic Health. Results: Out of 150 cases 110 (73.3%) called up men developed psychic disorders, which were divided into 3 groups: psychoses (1.8%), non-psychotic disorders (40%) and mental retardation (58.2%). Only 26.6% of them were characterized with healthy psychic status. Psychopathies and residual features of organic cerebral affection constituted 16.4% each. Certain difficulties regarding the diagnostics of the psychopathies were due to limited short-term observation and incompletely filled up documentation (e.g. characteristics etc.). The righting behavior associated with cut traces on the hands caused additional difficulties. Conclusion: The data obtained allow assume that the documentation of the called up males should be completely filled up in the military commissariat, and that the observation period should be prolonged to escape the diagnostic errors.

Cultural foundations for three-dimensional approach in psychotherapy E. Nikolaev Chuvash State University, Cheboksary, Russia In our opinion the essence of psychotherapy today should refer to patient’s position in three-dimensional cultural system. Urbanistic dimension shows degree of person’s acceptance of relevant values of urban residency. The most often source of psychological problems here is in the system of family relations. Another issue is the 255


system of personal resources and social support for the purpose of preservation of person’s harmony with the community and nature. World view dimension reflects spiritual structure of a personality. Rational or irrational world view fills personality with the meaning of life and appeals to elimination of uncertainty situations in various spheres. Thus the rationality of thinking promotes better embedding of a personality into system of psychotherapy. Irrational views of some patients do not meet with approval in structures of regular medical and psychological help. Therefore they are frequently held back by the patients. The importance of sociotypical dimension is connected to transition from values of traditional culture to values of informational society. This process is accompanied by increase of individualistic traits in all spheres of life and is reflected in state of individual and public health. In perspectives when family and system of natural social support considerably lose their protection potential there is a great demand for the system of professional psychiatric and psychological help. Thus vector of sociocultural transformation is directed from rural, irrational and traditional culture to urban, rational and technogenic one. This process is universal for any ethnic group. The base for differentiation of sociocultural approaches in psychotherapy is assumption that efficiency of psychotherapy is determined by conformity of means, forms and methods of influence used by therapist with expectations of patient and his willingness to reveal own activity during the therapy. The receptive approach is greater focused on clinical, psychological and sociocultural groups of the patients who understand their disorder as a result of reduction of adaptive opportunities owing to external factors which are difficult to control. Deep analysis of personal problems is not stipulated here. The basic work is conducted with pathological symptoms and consequences of problem situations the elimination of which is regarded as highly effective therapy by the patient. The productive approach on the contrary provides inducement of patient’s activity that is impossible without insight of the psychogenic character of the problem. Initiative in therapy belongs here to a patient equally with therapist. Therapist 256


encourages patient’s active position, stimulates aspiration to positive changes in feelings, emotions, behavior, in direction of personal growth. The essence of the given approaches corresponds to persons with different sociocultural status determined by the values of urban, rational, and technogenic cultures.

Memory abnormality in schizophrenia T. Savina, O. Gerasimova, N. Tscherbakova Mental Health Research Centre, Russian Academy of Medical Sciences, Moscow, Russia Background: There are a number of data indicating to several aspects of memory activity abnormality in schizophrenia. It is necessary to investigate these abnormalities and its contribution in pathogenesis of schizophrenia. Aim: In order to investigate mnestic activity peculiarities in aspects of memorizing semantic images and visual images 50 patients and 25 controls were examined. Methods:

Psychological

pictogram

method

(Luria)

as

well

as

neuropsychological Luria’s scheme for visual memory were used. Qualitative and quantitative (retention productivity score (RPS, %); scores of spatial orientation of graphical stimulus (SOGS), delayed recall parameters, order of stimulus recall and volume of visual memory) characteristics were analyzed. Correlation analysis between RPS and deviant parameters of visual memory was done. Results: The results demonstrated that the RPS was less in patients compared with controls (p < 0.01). Qualitative peculiarities of pictogram in patients showed disintegration between conception and reflecting its image. This disintegration indicated to disturbances of adequate actualization of information on the basis of past experiences. Among parameters of visual memory SOGS and volume of visual memory in patients was worse than in controls (p < 0.001). These data indicate to spatial characteristics image impairment in schizophrenia which is synchronous with its semantic component impairment. The correlation between RPS and SOGS was revealed. 257


Discussion: The obtained data demonstrate the impairment of basis process of information decoding in mnestic activity structure in schizophrenia as well by semantic aspect and visual one. This impairment is representative for important links in pathogenesis of schizophrenia connecting with disorder of mental activity organization.

Character of autonomic regulation at the different stages of depression during active antideperssant treatment O.S. Trofimova, O.S. Antipova Moscow Research Institute of Psychiatry, Russia Importance of current research is determined by the need to find the clinical and functional evaluation criteria for the systemic patterns of changes in physiological reactivity of the patient at various stages of treatment of depression. Objective: optimization of treatment of patients with depression based on analysis and evaluation of clinical and psychopathological state and autonomic reactivity during active treatment using modern antidepressants. The main group included 62 patients, 20 men and 42 women (mean age 35.27 ± 8.9 years) with a diagnosis of mild or moderate depressive episode. Control group: 64 healthy subjects, 18 men and 46 women (mean age 30.75 ± 8.6). Methods:

The

clinical-psychopathological,

clinical-anamnestic,

Hamilton

Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS-17), analysis of heart rate variability (HRV) to evaluate the autonomic regulation. Results: Before therapy compared with the group of healthy individuals patients in the main group had significantly lower rates overall HRV (TP, SDNN) both at rest and during the orthostasis. This demonstrates the functional tension of stressrealizing systems and narrowing the range of adaptive capacity. In a state of functional rest balance of activity of sympathetic (LF, %), parasympathetic (HF, %) and cerebral ergotrophic systems (VLF, %) remained the same as normal during depression. This suggests integrity, but also depletion of mechanisms of “mutually simulative antagonism” in moderate depression. Significant differences between groups were 258


found in the balance of activity of the various departments of the autonomic nervous system during orthostasis. Apparently in depression, there is a decrease in activity of peripheral adrenergic system (LF, %), and the maintenance of the orthostatic load is achieved through activation of suprasegmental ergotrophic systems (VLF, %) at the level of limbic-reticular complex. Despite the positive dynamics of clinical status and improvement in scores of Hamilton scales, during the initial phases of antidepressant therapy there was no change in indicators of autonomic regulation. Conclusion: The formation of remission in depression is a multistage process that involves system changes of the emotional and physiological reactivity of the patient in answer to different environmental and therapeutic effects. The different components of the reactivity recovered unevenly, faced with a reduction of the emotional component of a disease state with retention of autonomic dysfunction. Inadequate therapeutic tactics can lead to chronic disease with residual autonomic, anxious and asthenia-like symptoms.

The prescription of Lamotrigine: results from a survey of psychiatrists in Korea Y.S. Woo1, D.I. Jon2, K.J. Min3, W. Kim4, B.H. Yoon5, W.M. Bahk1 1 College of

Medicine, The Catholic University of Korea, Seoul, Korea

2 College of 3 College of 4 Paik

Medicine, Hallym University, Anyang, Korea

Medicine, Chung-Ang University, Seoul, Korea

Hospital, College of Medicine, Inje University, Seoul, Korea 5 Naju

National Hospital, Naju, Korea

Objective: Lamotrigine have shown acute and prophylactic antidepressant effect in several double-blind, placebo-controlled trials. Recently, lamotrigine use has increased in Korea because of its long-term effectiveness in clinical setting. In this cross-sectional survey, we examined the prescription pattern and adverse event profile of lamotrigine in psychiatric practice. Methods: The study was carried out in 42 mental health services and a total of 67 psychiatrists participated in this survey. The survey was conducted from October 259


2008 to March 2009. Each psychiatrist was asked to complete a questionnaire for the patients to whom lamotrigine was prescribed for the first time. The patients’ clinical statuses were assessed by administering the clinical global impression–bipolar version-severity (CGI-BP-S) and DSM-IV symptom criteria. The clinical diagnosis, prescribed medications, adverse events, and the age and sex of patients were included in the questionnaire. Results: A total of 617 questionnaires were returned and included in the analysis. The mean age of patients was 36.7 ± 19.2 years and 402 (65.2%) were women and 215 (34.8%) were men. The mean CGI-BP-S mania score was 1.9 ± 1.0 and mean CGI-S depression score was 4.2 ± 1.2. The mean starting dose of lamotrigine was 28.3 ± 14.5mg/day. Bipolar I depression was the most common diagnosis of the patients (n = 300, 48.6%). Lamotrigine was also prescribed for bipolar II depression (n = 219, 35.5%), bipolar I mixed (n = 37, 6.0%), bipolar disorder NOS (n = 29, 4.6%), schizoaffective disorder, bipolar type (n = 21, 3.4%) and bipolar I unspecified (n = 13, 1.9%). The patients’ clinical statuses assessed by DSM-IV symptom criteria were depression (75.7%), subsyndromal depression (15.6%), mood elevation (4.1%), subsyndromal mood elevation (3.4%) and euthymia (1.3%). Lamotrigine monotherapy was used in 6.9% of the patients. Most patients prescribed lamotrigine treated with concomitant medications; lamotrigine was used in combination with antidepressants in 44.9%, with other mood stabilizers in 32.3% and with antipsychotics in 50.6% of the patients. The overall frequency of adverse events was 11.9% in lamotrigine treated patients, and the most common adverse events were nausea/vomiting (4.0%), headache (2.8%), skin rash (1.7%) and dizziness (1.4%). Conclusion: Lamotrigine was prescribed most often for patients with depressive phase of bipolar disorders. Most patients prescribed lamotrigine were treated with antidepressant, mood stabilizer or antipsychotics combination.

260


Thermoregulation in schizophrenia: a hot topic P.Y. Xiu1, T.A. Ariyanayagam2, S. Masand3, A.D. Patil4, M. Agius5, 6, R. Zaman5, 6 1 School of

Clinical Medicine, University of Cambridge, UK

2 Medical School, 3 School of 4 School of 5 Psychiatry,

University College London, UK

Medicine, King's College London, UK

Medicine and Dentistry, Barts and the London, UK

Bedfordshire and Luton Partnership Trust, Bedford, UK 6 University of

Cambridge, UK

Introduction: Schizophrenia associated with thermal dysregulation has been demonstrated in several studies, as well as being noted in the observations of clinicians for many years. However, while there is an abundance of research, many of the results have proven to be contradictory, in particular regarding the confounding effect of antipsychotic medication. To this end we will review the evidence concerning abnormal thermoregulation. Understanding the thermal dysregulation may give us an insight into the pathogenesis of schizophrenia, and a potential role for orexins in the disease. Objectives: To analyse current experimental literature on thermoregulation in schizophrenia in medicated and unmedicated patients. Methods: PubMed – searched with MeSH term “schizophrenia”, with additional terms; “thermoregulation”, “orexin” or “hypocretin”. Results: While there may be disagreements in various studies, the weight of the early evidence points to untreated schizophrenic patients having lower baseline core temperatures, while later studies with neuroleptics showed an increase. Several studies also showed an impaired heat loss in schizophrenic patients, both in medicated and unmedicated patients. Meanwhile, orexins have been linked to heat production and heat loss during sleep. There are also studies showing that orexins are activated by antipsychotics, and also project to thalamic nuclei that show reduced volume and connectivity in schizophrenia. 261


Conclusion: The thermal dysregulation seen in schizophrenia is a complex process, and the underlying pathogenesis remains to be uncovered. This mechanism may involve orexins, which may also play a part in both the pathogenesis of schizophrenia and the relief of symptoms by antipsychotics.

Effect of Ziprasidone after switching from Olanzapine on the subjective estimates of sleep in the 8 weeks treatment of mania B.H. Yoon1, W.M. Bahk2, D.I. Jon3, K.J. Min4, H.B. Lee5, W. Kim6 1 Naju

National Hospital, Naju, Korea

2 Catholic University of

Korea, Seoul, Korea

3 Hallym University Hospital,

Anyang, Korea

4 Chung-Ang University Hospital,

Seoul, Korea

5 Seoul National Hospital, Seoul,

Korea

6 Inje University Hospital, Seoul,

Korea

Objective: Sleep disturbance is a characteristic feature of bipolar disorder, and both the quality and quantity of sleep are typically adversely affected during episode. The purpose of this study was to evaluate the subjective estimate of sleep after ziprasidone treatment after switching from olanzapine in bipolar mania patients. Methods: Patients with DSM-IV diagnosis of manic or mixed episode were included. They were treated with olanzapine other mood stabilizers and switched to ziprasidone due to inadequate treatment response or intolerability. The doses of ziprasidone and mood stabilizers were flexible according to the clinical judgment. Clinical improvements were rated by severity of illness of Clinical Global ImpressionBipolar version (CGI-BP-S) and Montgomery-Asberg Depression Rating Scale (MADRS). Modified version of Leeds Sleep Evaluation Questionnaire (LSEQ) was used to assess the subjective measures of nighttime sleep and hangover, which included the factors covering four areas: 1) getting to sleep (GTS), 2) quality of sleep (QOS), 3) awakening from sleep (AFS), and 4) behavior following wakefulness (BFW) or hangover during the next day. All assessments were done at baseline and week 4 and 8 after treatment. 262


Results: Fifty-seven patients were enrolled and 8 (14%) were dropped out. They showed significantly improvement during 8 weeks of treatment in YMRS, CGI-S, MADRS and BPRS. No significant changes were found in BARS and SARS. All sleep parameters of modified LSEQ were improved at week 4 and 8 without impairment of daytime hangover after switching to ziprasidone. Conclusion: This result based on LSEQ suggests that switching to ziprasidone improved multiple dimensions of subjective estimate of sleep, including sleep quality and sleep duration, without daytime dysfunction.

Switching from Olanzapine to Ziprasidone in patients with bipolar disorder: an 8-weeks, multi-center open-label trial B.H. Yoon1, W.B. Bahk2, H.B. Lee3, Y.J. Kwon4, Y. Woo5, M.D. Kim6 1 Naju National Hospital, Korea 2 St Mary

Hospital, The Catholic University of Korea, Seoul, Korea 3 National Seoul Hospital, Seoul,

Korea

4 Suncheonhyang University Chonan Hospital, 5 Daejeon St Mary’s Hospital,

Korea

The Catholic University of Korea, Daejeon, Korea

6 Cheju National University Hospital, Korea

Objectives: This study was done to evaluate the efficacy and tolerability of ziprasidone switching in bipolar disorder patients who showed unsatisfactory responses or intolerable adverse events with their previous atypical antipsychotics, especially olanzapine. Methods: Patients with DSM-IV diagnosis of bipolar disorder (manic or mixed episode) who showed unsatisfactory response or intolerable adverse events with olanzapine treatments were included. Olanzapine was switched to ziprasidone as flexible doses and their previous mood stabilizers (lithium or valproate) were maintained without dosage change. Young Mania Rating Scale (YMRS), Clinical Global Impression-Severity of Illness (CGI-S), Montgomery-Asberg Depression Rating Scale (MADRS) and Brief Psychiatric Rating Scale (BPRS) were used for efficacy and Barnes 263


Akathisia Rating Scale (BARS) and Simpson Angus Rating Scale (SARS) were used for adverse events. Body weight and lipid profiles were evaluated during 8 weeks of trial. Results: Fifty-seven patients were enrolled and 8 (14%) were dropped out. Mean doses of ziprasidone at week 1, 2, 4 and 8 were 71.7 mg, 95.7 mg, 104.8 mg and 110.5 mg, respectively. They showed significantly improvement during 8 weeks of treatment in YMRS, CGI-S, MADRS and BPRS. No significant changes were found in BARS and SARS. Mean weight loss during ziprasidone treatment was –1.7 kg. Blood glucose and lipid profiles (total cholesterol and TG, except HDL-cholesterol) were also significantly improved. Conclusion: This result showed that switching to ziprasidone was efficacious and well tolerable option which showed negative responses to olanzapine.

264


Collection of abstracts A transcultural study of parental influences on the preschool children’s behavior and health V. Ababkov1, M. Perrez2, D. Schoebi2 1 St.

Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia 2 Fribourg University,

Fribourg, Switzerland

Material: Working parents having children of preschool age: 60 couples from St. Petersburg (Russia) and 203 couples from Fribourg (Switzerland). Instruments: A questionnaire, specially developed by a group of experts. The parents answered the questions concerning their work satisfaction, marital relationships satisfaction, emotional problems of a child, problematic behavior (externalizing) of a child, somatization (somatic disorders) of a child, parents’ adherence to family values (familiarism), individualism, traditionalism, modernism, social support, etc. The investigators compared and analyzed the parents’ answers in search of correlations. Main results: The correlations of 10 parameters (scales) of the questionnaire have revealed significant correlations of the behavioral and somatic problems in children with the parameters of the males of Fribourg: 7 positive correlations (PC) and 1 negative correlation (NC) for the parameter (scale) “emotional problems of a child”; 10 PC and 2 NC for the parameter “problematic behavior (externalizing) of a child”; 7 PC and 3 NC for the parameter “somatization”. There were other rare significant data for the scale: “relationship satisfaction, traditionalism, social support”. The same correlation was found for the females of Fribourg: 6 PC and 1 NC for the parameter (scale) “emotional problems of a child”; 6 PC and 2 NC for the parameter “problematic behavior (externalizing) of a child”; 5 PC and 1 NC for the parameter “somatization”. There were other rare significant data for the scale: “modernism, social support”. The same correlation was found for the males of Saint-Petersburg: 3 PC and 2 NC for the parameter (scale) “emotional problems of a child”; 2 PC and 5 NC for the 265


parameter “problematic behavior (externalizing) of a child”; 7 PC and 1 NC for the parameter “somatization”. There were other rare significant data for the scale: “familiarism, individualism, traditionalism”. The same correlation was found for the females of Saint-Petersburg: 4 PC and 3 NC for the parameter (scale) “emotional problems of a child”; 5 PC and 4 NC for the parameter “problematic behavior (externalizing) of a child”; 2 PC and 1 NC for the parameter “somatization”. There were other rare significant data for the scale: “work satisfaction, familiarism, individualism, traditionalism”. The results have shown the significant differences associated with the parents’ gender and place of residence, their sociopsychological and cultural characteristics, and family values that influence children’s behavior and health. The authors consider the specific individualized interactions between the above parameters. These data can be taken into account when choosing the most appropriate forms and methods for family stress prevention, correction of children’s behavior and improvement of their health.

Formation of pro-social orientation in adolescents with deviant behavior A.F. Abolonin, A.I. Mandel Mental Health Research Institute SB RAMSci, Tomsk, Russia Problematic adolescents represent a risk group regarding the development of addictive and delinquent forms of behavior. In order to study the influence of extreme social-household conditions on deviant behavior, we have conducted an investigation of psychological health of 52 under-age offenders (mean age 15.1 1.4 years), staying at a summer camp for junior lifesavers. All of them had been repeatedly detained in a state of alcohol intoxication; they had committed offences of various gravity and had been under account in under-age persons’ affairs commissions in association with delinquent behavior. The basic direction of work with adolescents consisted in the training of children’s skills in safe survival in the environment according to the programs of savers’ work in extreme situations. 266


The examination conducted has shown that alcohol was regularly consumed by 85% of adolescents; 23% took in substances; 40.3% of them proposed to try drugs; 19.2% of adolescents had relatives using substances. More than a half of adolescents (61.6%) pointed out significant stressful events: 11.5% have experienced the death of their relatives or friends; 17.3% – severe illness of relatives; 5.8% were under investigation, 11.52% had tense conflict situations at the place of their study or living. The program of the camp included training in basic tourist and savers’ skills; orientation in the area; alpinists’ training; pre-parachute training; sailing practice on yachts and trimarans; psychological training; extreme medicine and medicine of catastrophes; quick march with strengthening of obtained skills. The psychological investigation has shown at the completion of the program an increase in the degree of self-control, care for physical state, occurrence of inner isolation (high indices on scales 1, 7, 8 according to the MMPI test); thereby there was a decrease in the indices on the scales of impulsivity, affective rigidity, optimism (4, 6, 9 according to the MMPI test), which testified to a suppression of spontaneous activity, oppositional and deviant behavior. Thus, the investigation conducted confirms that such factors as the placement of under-age offenders in a situation that requires making efforts to survive, and the provision of a psychological atmosphere directed at the disavowal of the former stereotypes of behavior, promote the suppression of psychopathic reactions, the correction of deviant behavior and the formation of skills in socialization.

Neuroimaging in diagnosis of depressive disorders E.Y. Abritalin, A.V. Korzenev, V.A. Fokin, D.A. Tarumov, A.V. Lebedev, A.V. Sokolov, A.V. Vorobyov S.M. Kirov Military Medical Academy, St. Petersbourg, Russia We investigated 36 depressive patients using several neuroimaging methods (functional magnetic resonance imaging (fMRI), voxel-based morphometry (VBM), diffusion-tensor imaging (DTI). We have found some functional and structural abnormalities in the limbic structures within all groups of patients. Almost all of these 267


structures are parts of so-called frontal-subcortical circuits. Those patients with different types of depression showed both similar and dissimilar changes. FMRI results primarily have shown that patients with depressive disorders vs. controls have the decreased activations in the left head of caudate nucleus and orbitofrontal cortical areas. The results of structural neuroimaging (VBM and DTI) revealed the deficiency of tracts in fornix, corpus callosum and cingulate gyri. Maximal similarities of the results from DTI were identified between patients with “reactive” and “organic” depressions. Patients with “endogenous” depression had a unique pattern of microstructural changes. The decreasings of fractional anisotropy were found specifically in the body of corpus callosum (opposite to its anterior regions in “reactive” and “organic” groups). There were also the decreasings of grey matter density in anterior department of the left cingulate gyrus, left dorsolateral prefrontal and visual cortical areas, bilaterally – in orbitofrontal and inferior temporal cortical areas and ventral anterior parts of thalamus. Maximal similarities of the changes in gray matter density were also identified between “reactive” and “organic” group. There were similar thalamic changes, bilateral decreasings of gray matter density in insular cortical areas (contrary left ones in “endogenous” group), striatal changes (head of the right caudate nucleus in “reactive” group and bilateral changes in “organic” group) and decreasings in the right cerebellar amygdala and left visual cortex. Observed similar (for patients with different types of depression) changes can be a neurobiological substrate of depression syndrome of different genesis. The differences observed may show that the depression can be caused by various pathological processes. The similarities identified in patients from “reactive” and “organic” groups suggest a possible presence of some microorganic predisposition for the development of reactive depressive processes.

268


Ericksonian and cognitive-behavioral approaches to treatment of panic disorder E.G. Agasaryan, B.D. Tsygankov, T.V. Lebedeva Moscow State University of Medicine and Dentistry, Russia Background: Panic disorder treatment effectiveness is limited. The first-line treatment is cognitive-behavioral therapy. There are no studies which evaluated the effectiveness of Ericksonian therapy for panic disorder. Purpose: To evaluate the effectiveness of integrated psychotherapy (IP), based on Ericksonian hypnosis (EH) techniques, in combination with pharmacotherapy for panic disorder treatment in comparison with cognitive-behavioral therapy (CBT) with pharmacotherapy and only pharmacotherapy. Methods: 120 patients with confirmed panic disorder and panic disorder with agoraphobia were randomized using the blind method to three groups: IP with pharmacotherapy (IP + PT – 40 patients), cognitive-behavioral therapy with pharmacotherapy (CBT + PT – 40 patients) and only pharmacotherapy (PT – 40 patients). The mean age of the patients was 27.5 ± 6.7, mean panic disorder duration – 2.3 ± 1.2 ages. The pharmacotherapy used in all groups was identical (anafranil 100–150 mg/day). In integrated psychotherapy, Ericksonian hypnosis was modified for patients with panic disorders. IT consisted of four phases with specific goals for each of them. The phases were similar to CBT, but their goals were achieved using EH methods. The goal of the first phase was cognitive restructuration, which was achieved by indirect suggestions, especially metaphors. The goal of the second phase was the reduction of anxiety sensitivity. With this purpose we used the “hypnotic interoceptive exposure” (the patients in hypnotic states imagined frightening bodily sensations and were coping with them). The goal of the third phase was a preparation to the exposition in vivo. It includes the “hypnotic exposition”, in which patients imagine an exposure in vivo in a calm state. The fourth phase was exposure in vivo. The treatment effectiveness was assessed with the Anxiety Sensitivity Index (ASI), Sheehan Panic and 269


Anticipatory Anxiety Scale (PAAS), agoraphobia cognitions questionary (ACQ) and mobility inventory (MI) for evaluation of agoraphobia severity. Results: The patients who received IT + PT showed at the end of the treatment significantly lower MI than the patient who received CBT + PT (36.2 ± 3.2 vs. 42.3 ± 2.9; p < 0.05). There were no significant differences between the patients who received CBT + PT and IT + PT in PAAS (14.3 ± 5.2 vs. 10.8 ± 3.5; p > 0.05), ASI (25.1 ± 3.0 vs. 23.2 ± 4.2; p > 0.05) and ACQ (17.9 ± 3.5 vs. 17.3 ± 2.4; p > 0.05). Patients who received only PT had at the end of treatment statistically significantly lower scores in MI, ASI, ACQ and PAAS than the patients who received CBT + PT and IT + PT. Conclusion: Integrated psychotherapy in combination with pharmacotherapy is more effective than pharmacotherapy only in the treatment of the panic disorder. Integrated psychotherapy is more effective than CBT in terms of agoraphobia reduction and at least as effective as CBT in reducing anxiety sensitivity and panic disorder severity.

Affective disorders in primary care in general practice E. Aghekian Yerevan State Medical University, Armenia Depressive and anxiety disorders are highly prevalent in primary health care. And it is difficult for general practitioners (GP) to diagnose these disorders, especially if affective disorders appear as “somatic complains”. According to the literature about 10% of visits to GP are due to depression, but only 10–30% of them are diagnosed by GP. Objectives: The present work aimed to reveal the affective disorders in primary care patients, who visit general practitioner with somatic disorders. Methods: Prospective study was done. We estimated the psychiatric status with Spilberger Anxiety Scale and Zung Depression Scale. The diagnosis of mental disorders was carried out according to ICD-10 criteria. Results: 203 patients, including 96 men and 107 women, aged from 18 to 65 were examined in two outpatient departments without psychiatric units of Yerevan city. According to the mentioned scales anxiety were found in 91 patients (44.8%) and 270


depression in 42 cases (20.7%). Anxiety as well as depression was more frequent in females, their frequency was increased with age for both genders and correlate with presence and kind of somatic pathology. Conclusion: General practitioners are the health professionals of first contact and long-term care. Because the affective disorders are highly prevalent in population it is very important for GP to recognize those abnormalities and organize conformable treatment.

Experience of the use of drugs in antyhomotoxic gerontological practice V.G. Agishev, I.A. Monakhovа, N.I. Kulikova Skvortsov-Stepanov Municipal Psychiatric Hospital № 3, St. Petersburg, Russia Possibilities of treatment of patients with mental disorders in later life are limited, because largely irreversible changes occur at the cellular level, depleted reserves and compensatory capabilities of the organism. Search tools that could slow down the process, would identify the degree of reversibility of the clinical picture of severe dementia, and led us to try to use antihomotoxic drugs. The aim of this work was the treatment of patients antihomotoxic drugs late age, with a pronounced intellectual-memory decline, dementia, against the background of a vascular lesion of the brain with mental illness duration of 2 years or more. As the object of the study were selected for the treatment of patients (25 people) – 24 women and 1 man, aged 70 years and older. At the conclusion of a neurologist and therapist expressed vascular pathology with symptoms of cerebrovascular disease and encephalopathy dyscirculatory 2 stages and 3 stages. Acute cerebrovascular accident in history was in 4 patients. At the beginning of treatment, all patients have different complaints of dizziness, headache, tinnitus, unsteadiness of gait, increased mental and physical fatigue, loss of memory, deterioration in the weather changes, within reason, it creates alarm, fear, sleep disturbance. The treatment was carried out as follows: Gepar-compositum – 5 days daily, then 3 times a week for 2.2 ml/m number 10. Coenzyme – 2.2 ml/m 3 times a week. Ubiquinone – 2.2 ml/m 3 times a week. Tserebrum-compositum – 2.2 ml/m in a week 271


of therapy, 2 times a week, number 10. Vertigohel and Eskulyus – 10 drops 3 times a day during the entire course of therapy. To assess the overall state of cognitive functions and social and service opportunities of patients before and after treatment we used a clinical method for a semi-structured psychiatric interview, the assessment methodology of cognitive functions MMSE, using a questionnaire “list of symptoms”. At the same time as in the frequency of occurrence of the symptom, and in its degree of severity (depth). Especially pronounced improvement (objective and subjective) the general condition of patients, the disappearance of anxiety, depressive complaints and hypochondriacal character, whining. In 90% of the cases observed pronounced increase in mood. In 80% disappeared headaches, dizziness, unsteadiness when walking, and numbness of extremities. Decreased irritability, a tendency to emotional outbursts and an improvement of sleep. Improvement of cognitive function occurred in 12% of cases. To a greater degree it concerns such functions as the active attention, the ability of his former store information in memory, orientation in the environment. Thus, this study showed that Antihomotoxic therapy can be successfully used for the treatment of patients with late age. In these patients disappear complaints related to the vegetative-vascular disorders, improves overall health, mood and increases vitality. The effect of treatment on cognitive function depends on the limitations of clinical dementia. The clinical picture of pronounced dementia, prescription of not more than 1.5 years can reduce fully. The method is simple, convenient, has no contraindications, does not cause side effects and is easily tolerated by patients.

The sex role conflict B.Ye. Alekseyev Medical Academy of Postgraduate Studies, St. Petersburg, Russia Traditionally, the sex role conflict is considered as an emotional experience of a real or imaginary discordance between one’s sex role behavior and reference sex role patterns. At the same time the meaning of the sex role behavior in itself is not taken into consideration and the conflict is regarded as the problem of the sexual dentity. However, 272


more often such variant happens when the unsuccessful realization of expectations relevant not only to the psychosexual sphere occurs. It is also related to the aims and purposes of the person as a whole. It means that the experience of the sex role discordance is caused by the inefficiency of behavior in achieving some other aims confronting the person. In this behavior the decisive importance has the sex role qualities. The proposed model of the organization of the sex role behavior of different levels allows approaching the analysis of the sex role conflict in a new way. When the sex role conflict is studied leaving out an operational component of behavior, the systemic unity of the man’s mental life is artificially disturbed and considerable contradictions arise in the interrelations between the categories. Therefore it is expedient to perform the analysis of the sex role conflict comparing its behavioral and identification components. Besides, it is necessary to take the social and sociopsychological context into account. For instance to give priority to masculine qualities in evaluation of that context in both males and females. The characteristics of the conflict depend on the circumstances in which the stage of formation of the sex role behavior happens. Factors transforming this conflict began to effect on both the formation and the duration of symptoms. These factors can be divided into external and internal. Among the former, the processes of teaching and learning in the family as well as a possibility and quality of communication in the peer group have the most significant consequences. Internal factors are systematically generalized in the base natural preconditions of the sex role behavior that is in the M-F dimension. They are also determined by the mental condition. So mental illness with early onset may seriously influence the sex role behavior. In other instances, when the mental illness manifests itself at a more mature age, disontogenesis of the psychosexual development may become apparent in the form of diathesis of the psychosexual sphere. It is characteristic of the premorbid development of patients. Particularly it manifests itself in the discordance between the sex role behavior and gender identity. It by itself may become a source and at the same time an index of the sex role conflict. Diathesis also manifests itself by an incongruence of structural levels of the sex role behavior itself, which hampers regulative and integrative function of the sexual identity (2006). 273


Thus, the emotional experience or some discordance between sex role behavior and reference sex role standards, or experience and adaptation tension due to the necessity to reorganize a sex role behavior taking into account another situational and personal disposition underlie intrapersonal conflict. The cause of discoordination between the sex role behavior and orientations relevant to it can consist in personal dispositions with respect to which the regulated behavior does not appear as the goal in itself, but as the means, a tool. In case of insufficiency of the resources of overcoming it can lead to maladaptation, development of neurotic states or in mental illnesses becomes a destabilizing factor. In connection with complexity of the structure of the sex role conflict and diversity of its mechanisms of development integrative psychotherapy appears to be the method of choice in correction of the problems under consideration.

Bipolar depression of the II type: psychopathology, therapy E.Yu. Antokhin, V.G. Budza, E.M. Kryukova, V.A. Bardyurkina, O.N. Baldina Orenburg State Medical Academy, Russia 37 patients with difficult depressive episode without psychotic symptoms were examined: 17 – in the structure of bipolar depression of the II type (BD II), 20 – recurrent depression (RD). Methods: clinico-psychopathological with the data verification according to SCL-90-R, statistic – Mann–Whitney U-test, Spearmen Rank Order Correlations, Wilcoxon Matched Pairs test. Among patients BD II, as opposed to the patients RD, the stronger direct correlation interconnection of “depression” and “somatization”, “obsessivness” is defined (r-Spearmen 0.62–0.81). Compared indications of depression level and basical “index of symptoms’ evidence” (p > 0.05) in droups, the patients BD II as opposed to the patients RD at p < 0.05 the indications of “alarm” (2.08 and 1.67), “somatization” (1.97 and 1.68), “obessivness” (1.76 and 1.4) are higher. These data may show the “residual manic equivalent” in the form of somatization, obessivness symptoms in the structure of the BD II depression, its atypical type and differential – diagnostic symptoms with depression in RD structure are identified. The effectivness of hospital complex therapy of BD II patients is 274


estimated. During 56 days the patients got Seroquel therapy in a dose 150–600 mg a day, group behavioral and cognitive therapy, sociotherapy. Up to the 10th day of the treatment the indications of “alarm” (p < 0.05), “depression” (p < 0.05), up to 14th day “somatization” (p < 0.05), up to 21st day “obessivness” (p < 0.05) were reduced. After hospital complex therapy patients got supporting Seroquel therapy in a dose 50–200 mg a day. In catamnesis in 6 months 11 patients were examined, their state was defined as “stably positive”. These data indicate that the complex therapy of BD II patients, including Seroquel therapy is effective.

Coping behavior in nursing psychiatric and somatic clinics E.Yu. Antokhin, E.T. Baydavletova, V.G. Budza, V.F. Druz, E.B. Chalaja, P.O. Bomov Orenburg State Medical Academy, Russia In order to determine strategies for coping behavior (coping) in nursing psychiatric clinic in comparison with medical staff of the somatic clinic 120 nurses were examined. 60 nurses of a psychiatric hospital are the basic group, 60 nurses of a somatic hospital are in the comparison group. Methods of investigation: experimentalpsychological (Heim’s questionnaire), statistical (Mann–Whitney U-criterion). It has been established: regardless of the professional scope of most pole of instability in the parameters “constructively unconstructive” a nurse is cognitive sphere by virtue of the uniform distribution of the frequency of use as adaptive and nonadaptive coping strategies. Nurses psychiatric clinic in comparison with nurses somatic clinics often use non-adaptive version of the coping strategies in the behavioral field “retreat”, as well as in the emotional sphere of “aggression”, which leads to the rise of social disadaptation. At nurses working in somatic, compared with psychiatric nurses identified significantly frequent use of not adaptive coping strategies in the behavioral field “actively avoiding”.

275


Psychology of development of personality and behavior of children in families of divorcing parents L.N. Avdeyenok, M.M. Aksenov Mental Health Research Institute SB RAMSci, Tomsk, Russia Among trends that adversely affect the psychological state of children, special place belongs to growth of divorce. Each year, due to divorce (according to statistics), about 350 thousand children are deprived of one parent usually the father and brought up in single-parent families. Analysis of divorce and its impact on child development has enhanced the diagnostic criteria for mental health with neuropsychiatric disorders of children and adolescents. The most persistent motives of divorce among men is a social-psychological connotation. This is a most often motif of the “do not get on”, “loss of love, and betrayal of the spouse” type. Psychological comfort, absence of quarrels and scandals, flexible wife, respect her hand – that is what usually men seek. In women, the dominant motives are drunkenness and alcoholism of the husband, in 75% of cases – with major scandal and fights, verbal abuse, betrayal, and frequent quarrels between the spouses. In age period in women divorce more than 30 years. In men, the greatest number of divorces from 30 to 40 years. After 40 years women’s and men’s divorce rate is reduced. The negative psychological consequences of divorce are manifold. As a result, divorce destroys an important form of social contact between people, kinship, which significance in life of every human being is very large, since they greatly contribute to the continuity of cultural and spiritual traditions that promote positive family relationships and primarily affect children and adolescents. In most cases, the disintegration of the family means the deterioration of the material and living conditions of its members, reducing their activity and disability. Left alone with children without a husband, a woman is forced to perform a number of unusual features to it. Hence, there are problems in education of its one-sidedness, handicap, and categorical, excessive feminist pattern. Suffering and emotional relationship “mother-child”, what will often be tense, uneven, which contributes to the emergence of neurotic states and behavioral disorders. Adverse reactions in children observed shortly after the divorce, and even 276


more obvious they are a year and in the future are already in adulthood. In a situation of divorce for children to celebrate such pathocharacterological reactions as anger, irritability, increased vulnerability, feelings of isolation and alienation, phobias, somatovegetative disorders, feelings of guilt, anxiety. No better position is in those cases where a child for a period of divorce sent to the parent family of one of the spouses. The child lives in two homes feeling constantly splitting, which is a prerequisite to the development of neurosis, described as Solomon neurosis.

Symptomatic and functional remission of depression: dimensional and categorical approaches A. Avedisova, L. Kanaeva, K. Zakharova, R. Akhapkin V.P. Serbsky National Research Centre for Social and Forensic psychiatry, Moscow, Russia Objective: Comparative analysis of remission quality and durability in patients treated with SSRI and SNRI for depressive episode and recurrent depression. After a randomized 6-week fluoxetine (n = 60) or venlafaxine (n = 70) open-label lead-in phase, patients who attained remission were included in a 1-year observational study with antidepressant withdrawal to assess the interplay between residual symptoms and relapse/recurrence. Evaluation methods included: HAMD-17, Beck Depression Inventory, SDS. Results: Remission rates (NAMD ≤ 7) during treatment with SSRI and SNRI were approximately the same (31.1% vs. 31.6%), whereas nonresponders rate was statistically higher in patients receiving SSRI (15.6% vs. 11.7%, p = 0.03). Analysis of remission onset showed that the highest percentage of SNRI patients achieved remission after 3–4 weeks of therapy (63.1%), whereas 50% of SSRI patients achieved remission after 5–6 weeks of therapy (p < 0.001). The therapy effectiveness was clearly related to the time of the primary response (PR – NAMD ≤ 25): in case of PR at 1st week 16.9% of patients became remitters and 7.8% – responders (p = 0.001). When the PR happened at 2nd week 18.5% of patients became remitters, 14.6% – responders and 6.9% – partial responders. Among the patients whose PR started from 3rd week only 277


7.8% became remitters, 9.3% – responders and 10% – partial responders (p < 0.05). When the PR happened at 4th week and later remission was not formed. Depending on the residual symptoms presence/absence in the structure of remission, as well as its phenomenological features, 4 variants of remission were identified, ranked by the degree of deterioration in social adjustment (SDS) – asymptomatic, asthenic, anxious and hypothymic. During SNRI therapy more favorable types of remission predominated (anxious – 38.9%, asymptomatic – 27.7%, asthenic – 22.2%), whereas treatment with SSRI increased the percentage of adverse hypothymic type of remission – 19.2% (p < 0.001). To assess the remission stability the data of a prospective study were analyzed to estimate the relapse frequency at this period. Percentage of relapces in the SNRI group was 30%, in the SSRI group – 37.5% (p = 0.06). Studied factors (full/partial remission, recurrence and functional improvement) were essential in determining the remission stability. Regardless of antidepressant use, relapse rates were higher in patients with the presence of residual symptoms, with the recurrence variant of disease, and especially with lower levels of social adaptation. In patients with asymptomatic remission relapse rate during SNRI therapy was 16.6%, while SSRI therapy – 14.3%, whereas the presence of residual symptoms was 35.7% and 42.1% respectively. In both treatment groups 50% of patients with recurrent depressive disorder experienced worsening. Among the patients with depressive episode only 10% in the SNRI group (p = 0.03) and 20% in the SSRI group got worse (p = 0.07). Patients who achieved functional remission during SNRI treatment had no relapse, which has been observed in 20% of such SSRI patients. In case of non-functional remission this rates significantly increased in the SNRI (46.1%, p = 0.001) and in the SSRI groups (57.1%, p = 0.05). Conclusion: Identifying the predictive value of residual symptoms and functional adaptation in the structure of remission reflects the clinical (longitudinal, dimensional) approach in psychiatry with importance of evaluating all features of patient’s condition, but not just the dichotomy assess the presence/absence of depression. 278


Сompliance therapy and optimization of psychopharmtherapy of schizophrenics S.M. Babin, A.M. Shlafer Orenburg regional clinical psychiatric hospital № 2, The Orenburg regional psychotherapeutic center, Russia Specialists have recently become greatly interested in the problem of schizophrenics failure to comply with the therapy mode. Agreement of a patient to fulfill doctors’ recommendations is called “compliance” (Lapin I.P., 2000) the term is a synonym of conformity, obedience, making concession, adjustment, agreement as per thesaurus. Kemp R. jointly developed (2000) compliance therapy method employing cognitive-behavioral method combined with motivation interviewing aimed at the increase of critical attitude to the disease and medical recommendations compliance improvement. The research objective: The research key objective is the investigation of interaction of psychotherapy (compliance therapy) and psychopharmtherapy in the process of schizophrenics’ complex treatment. Material and methods: The research was carried out as per the patients of the Orenburg Regional Psychiatric Hospital №2 and included 53 schizophrenics (24 male and 29 female) from 18 up to 60 years old (average age 32,6±2,5 years). The patients distribution as per ICD-10 diagnostic sections is listed below: paranoid schizophrenia (F20.0) – 35 patients, catatonic (F20.2) – 10 patients, simple schizophrenia (F20.6) – 8 patients. Clinical, experimental psychological and statistic research methods were used. Compliance therapy was provided by psychotherapists as personal therapy 1-2 times a week, the total quantity of sessions up to 8-10, the total treatment duration period up to 1,5 month. The experimental psychological investigation was being carried out dynamically before the interference and after compliance therapy. The evaluation was as per parametric Student T-criterion and non-parametric paired Wilkokson T criterion. Statistically significant were considered the data with min. level р 0.05), although patients with IA presented a larger quantity of the complaints (80.0% vs. 0.0% in SA; V = 0.516, p = 0.02). The lowest self-reported evaluations of health (0–1) presented by patients with AP (77.8% vs. 11.1% in FA and 11.1% in DA) (V = 0.655, p = 0.01). Furthermore, AP 388


was significantly associated with the self-reported evaluation by the patients of the unfavorable influence of pain on the quality of their life (2.833 ± 0.469 vs. 0.500 ± 1.837 in another IA and SA; V = 0.890, p = 0.02). At the same time patients with DA showed the lowest self-reported evaluations of unfavorable pain influence on the quality of their life (0–1 in 100.0% DA vs. 12.5% in another IA and SA; V = 0.764, p = 0.02). However, patients with FA showed the lowest self-reported evaluations of joints pain (0–1 in 60.0% vs. 10.0% in another IA and SA; V = 0.500, p = 0.02). The most interesting finding of this investigation was following: only patients with IA, answering the semi-structured interview, asserted that there are certain obstacles to their recovery (100.0% in IA vs. 0.0% in SA), personifying these “subjective obstacles” as “husband” – 25.0%, as “mother” – 18.8%, as “subject himself” – 18.8%, but it is more frequent – as “someone” – 50.0%) (V = 0.750, p = 0.01). Thus, rheumatoid arthritis is significantly associated with the insecure attachment styles; among them the anxious-preoccupied style was prevailed. The insecure attachment patients presented more complaints and perceived interferences to their recovery in the relationship partners. The specific associations of the anxious and avoiding attachment styles with the different health-related cognitions were found in the study.

Suicidal behavior in adolescents convicted with mild mental retardation E.N. Krivulin, A.S. Beckov, E.V. Ohtyarkin, S.V. Golodnyi Ural State Medical Academy of Additional Education Health Institute, Chelyabinsk, Russia Study psychodisadaptation states in adolescents’ institution is relevant. Most researchers believe that the depressive reaction is determined manifestations prison disadaptation (PD) and often serve as predictors of suicidal behavior, ahead of other symptoms. Aim of the study was the allocation of risk factors for suicidal behavior in adolescents with mild mental retardation (MMR) in the first six months of their social isolation. 389


Materials and methods: Clinico-psychopathological study was condacted for 118 adolescents of Chelyabinsk colony with signs of mild mental retardation (MMR). All surveyed were males aged 15–18 years. On the basis of substance dependence was identified 2 groups of observations. Group I (n = 62) consisted of adolescents with MMR and signs of substance dependence. II group – the MMR people with no signs of substance dependence (n = 56). Symptoms of substance dependence were consistent category of International Classification of Diseases X F1.x21 – currently abstinence, but in conditions precluding use. Clinical manifestations of mental defect were determined asthenic, unbalanced version sthenic, dysphoric and atonic forms of MMR. Results of the study: In the first 6 months of social isolation in 77.4% (n = 48) surveyed in group I and 82.1% (n = 46) II group developed a neurotic depressive reaction level as a manifestation of PD. The diversity of clinical manifestations of depressive reactions allowed allocating dreary, astheno-apathetic, obsessive-phobious, hypochondriacal, anxious, dysphorialike and delinquent types of depressive reactions (DR). Study of the prevalence autoaggressive behavior in accordance with the type of DR and clinical form of the MMR showed the following. In adolescents with asthenic form of MMR suicidal behavior was noted when astheno-apathetic and anxious type of DR were characteristic of group I patients. For unbalanced sthenic forms of MMR were inherent in the structure of suicides dysphorialike, obsessive-phobic and anxious types. The first two types of adjustment disorder dominated by people I group. The two groups with dysphoric form MMR autoaggressive behavior met with dysphorialike and delinquent types of DR. All adolescents with atonic form MMR suicidal behavior was observed in astheno-apathetic and depressed types of manifestations of PD. Among the stressful environmental factors that contribute to DR with suicidal behavior have been identified – discrimination because of humiliation, insults, harassment or involvement in homosexual relationships, the inability to take a hierarchical position among the convicts, waiting, or the lack of visits from relatives, as well as educational or manufacturing conflicts. 390


Prevention of suicide in PD in mentally retarded adolescents should be aimed at maximum leveling of stressful environmental factors, reduction of depressive reactions among adolescents and the creation of stable personality antisuicide installations.

The structure of the psychological adaptation in patients with schizophrenia depending on duration of a disease E.M. Kryukova, E.Yu. Antokhin, V.G. Budza, N.E. Lazareva Orenburg state medical academy, Russia Orenburg regional clinical psychiatric hospital № 1, Russia To study the structure of psychological adaptation in patients with schizophrenia in comparative aspect depending on duration of a disease 140 persons were examined. 97 schizophrenia patients with the first psychotic episode are the basic group (average age 31.88 ± 8.06 years), 43 schizophrenia patients (average age 40.37 ± 9.55 years) with more than 5 years duration of process are in the comparison group. Methods of investigation: clinical-psychopathological, pathopsychological (Heim’s questionnaire – coping

diagnostics,

“Life

style

index”

questionnaire,

“Self-stigmatization”

questionnaire), statistical (Student T-criterion). It has been established along schizophrenia chronisation psychological defence structure protection gains the most disadaptive and pathoprotective content. On schizophrenia patients with the First Psychotical Episode (FPE) “negation”, “compensation”, “reactive formation” dominates. In the comparison group “negation”, “regression”, “replacement”, “reactive formations” are the leading factors, and the level of intensity considerably increasing. The level of self-stigmatization increases, its dominating form changes: rate shift of autopsychotic and socioreversive form of self-stigmatization to the compensatory and socioreversive forms. The use frequency of adaptive coping-mechanisms in behavioral and cognitive spheres by schizophrenia patients with the FPE is more than the use level of relatively adaptive and no adaptive coping-strategies. In emotional sphere relatively adaptive coping-strategies dominate. On duration of the disease (more than 5 years) relatively adaptive and (or) no adaptive copings become dominative in the coping structure of all three spheres, but the use level of adaptive coping-strategies considerably decreases. 391


Somatoform disorders and health care system O.I. Kudinova Kharkiv Medical Academy of Postgraduate Education, Ukraine At the present stage of a society development in Ukraine among based medical care problems the special priority has been provided the problem of somatoform vegetative disorders. Prevalence somatization clinical disturbances in patients with frustration various nosologic accessories and necessity of development of clinical criteria of differential diagnostics with somatic diseases were the precondition for studying this area. At the same time, in Ukraine the diagnosis “Vegetative-vascular dystonia” which is ciphered G 90.8, according to ICD-10 instead of “Somatoform disoders” F40.0–F48 is used. It leads unreasonable treatment significant contingents of neurotic patients in neurological departments. On the basis of complex study 727 patients of city policlinic and hospital are conducted determination of structure and prevalence of somatoform disorders in ambulatory-policlinic practice in the conditions of Kharkiv-city. Clinic-epidemiological and clinic-statistical research allowed defining the structure of somatoform disorders in ambulatory-policlinic practice. Organ neuroses with cardiorespiratory functional violations make 10%, organ neuroses with functional violations of gastrointestinal system violations of the urinal system

5.7%, organ neuroses with functional

12.2%. Set personality psychological, social-

psychological and social constituents of somatoform disorders. On that ground has been developed complex level differentiated system of medical- psychological and psychotherapy correction of somatoform disorders with the 75% higt efficasy.

Preventive programs for various groups of the population I.E. Kupriyanova Mental Health Research Institute SB RAMSci, Tomsk, Russia Objective of the investigation was identification of the level of mental health of various groups of the population and development of preventive programs. 392


We have examined levels of mental health in teachers of four schools of Tomsk (n = 254). Clinical-dynamic analysis has allowed distinguishing the high level of psychological tension realized in disorders of neurotic spectrum (12%), pre-neurotic states (53.3%), and organic pathologies of vascular and traumatic genesis (3.3%). We have studied causes adversely influencing mental health. Of most adversity from them are psychogenias, conditioned by material-household difficulties, familial relations, and interpersonal conflicts. We have identified potential risk groups in structure of pre-neurotic states (51.8%) and real risk groups (48.2%) of development of borderline neuro-mental pathology. We have developed multi-level preventive programs including

an

educational

module,

psychocorrecting,

psychotherapeutic,

psychopharmacological components. Clinical-epidemiological investigation of mental health of the military men (n = 92) has revealed presence of pre-neurotic disorders in 48.7% of cases, borderline neuromental disorders – in 9.9%, healthy persons in mental and somatic background have constituted 41.4%. Currently we develop preventive programs including assessment of not only level of mental health but also assessment of somatic state of the patients with distinguishing the pathologically functioning system with the help of computer biocolor-modeling (system of “Strannik”).

Diagnostic problems and changing of immunological response in patients with general paresis O. Kushnir St. Petersburg I.I. Mechnikov State Medical Academy, Russia Neurosyphilis is a slowly progressive and destructive infection of the brain or spinal cord. It occurs in untreated syphilis many years after the primary infection. Neurosyphilis occurs in 15 to 20% of all late or tertiary syphilis infections (about 10 to 20 years after the primary infection), and is a progressive, life-threatening complication. There are 4 different forms of neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, and general paresis. The prevalence of general 393


paresis is increased among the patients of psychiatric facilities during last 5 years. Clinical pathomorphosis is also become evident last time. The expansive form of general paresis, which is considered the classical form in previous years and is accompanied by delusion of grandiosity (megalomanic), nowdays, is the very uncommon. Dementia becomes the most prevalent sing of the disease. The most common diagnosis during admission is dementia of unknown etiology. The neurolues dementia is very similar and usually misdiagnosed as Alzheimer disease. In case of delusion and hallucination the state is mixed with schizophrenia, organic brain syndrome or hallucination disorder. The positive nontreponemal tests are usually ignored or undervalued or considered clinically irrelevant by psychiatrist. The withdraw of informed consent to spinal puncture is making the diagnostic procedure out of time. The disease is rapidly progressing and sometime brings to the death in a period of 1 year after the diagnosis even in case of huge antibiotics treatment. The negative response to the specific treatment could be explained by changed reactivity of the patient and weak sensitivity of Treponema Pallidum to antibiotics. We observed 8 patients in the psychiatric hospital with general paresis in the period of 2009. The different issues of immunological state were investigated. The following parameters were considered: the total amount of white cells, monocytes, eosinophiles, lymphocytes, population of T-, B- и subpopulation of T-lymphocytes, CD3+, CD4+, CD8+. The immunoregulatory index was counted (IrI) – CD4+/CD8+. The level CD3+ limphocites, which represents the level of adult differentiated lymphocytes, which is able to take part in immunological response, is in the normal limits in the most of the patients. The level of lymphocytes CD4+, which is responsible for help-inductor functions in immunological response and other immunoregulatory functions, was raised in 6 patients. The absolute values of CD8+ lymphocytes, which are responsible for suppress-cytotoxic functions in immunological response were raised in 3 patients, decreased in 2 patients. The increasing amount of CD8+ cells is possibly becomes the undesirable issue in immunological response in inflectional process, though they could inhibit antibody synthesis to the antigens of Treponema Pallidum. This is confirmed by the decreasing of absolute and relational amount of B-lymphocytes in 50% of patients. 394


Both these factors in summary decrease the immune response and decrease efficacy of the treatment. Immunological index (IrI) was increased in one patient, was the on the normal level in rest of the patient. In summary, revealed changing in immune response of patients with progressive paralysis show the dysfunction of the cell immune system in these patients, and which is followed by the resistance to the treatment. Neurosyphilis remains an important public health problem. New cases are not adequately detected, and delay in diagnosis is common: often clinical presentation does not follow the traditional course; mental changes may imitate other types of dementia and psychiatric disorders. The patient’s refusal to procedure of spinal puncture is making the diagnosis postponed. The resistance for treatment, rapid progression of dementia and treatment complications are formed due to the immunologicaly changed status.

Infantile autism concepts: between old and new A. Lakic, A. Jovanovic Clinic for neurology and psychiatry for children and adolescents, Belgrade, Serbia Summary: Autistic disorder (AD) is chronic, serious mental health condition in childhood and is not very rare. Leo Kanner, in 1943, first described autism, in a small group of children who demonstrate extreme aloofness and total indifference to other people. In addition, in 1944 Hans Asperger described children who demonstrated symptoms similar to those of Kanners patient with exception that cognitive and verbal skills were higher. This specific behavioral syndrome was called infantile autism and conceptualized as an infantile psychosis. But, the term infantile autism firs appeared as a separate entity with specific criteria in DSM-III (1980.) In DSM-III, first time, autism is conceptualized as pervasive developmental disorder. DSM-III-R, in the 1987, listed broadened AD criteria and the new subthreshold category of PPD-NOS and in one way, promoting overinclusivness and overdiagnosis. 395


The DSM-IV (1994.) criteria have better specificity than DSM-III-R criteria and, first time, included Asperger syndrome. Professionals working in this field, over the past two decades, have introduced the term autism spectrum disorder (ASD) to reflect the broader spectrum of clinical characteristic that now define autism and that is progress. Until now, despite all efforts, exact causes of this disorder(s) remain unknown and that is old. But, researches in field of autism, included classification e.g. conceptualization to drive at complete understanding and recognition of nature and causes of this disorder.

Quality of life. New concept in research and practice in childhood and adolescence A. Lakic, A. Jovanovic Clinic for neurology and psychiatry for children and adolescents, Belgrade, Serbia Abstract: Is quality of life (QoL) new word for old ideas? Yes, although the word was first time introduced in 1975 as a key term in medical indexes. World Health Organization in 1991 defined the QoL as “the individual perception of his or her position in life, within the cultural context and value system he or she lives in, and relation to his or her goals, expectations, parameters and social relations. It is a broad ranging concept affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships and their relationship to salient features of their environment”. The holistic orientation of concept in practice suffers from various problem within them the assessment and the measuring are prominent. Despite these facts in practice exists numbers of useful instruments. Youth and theres well-being are in the first place at all national strategies. Authors discuss possible areas for implementation of QoL concept in childhood and adolescence. The same important points for QoL researches are: the children with chronic illness, the children with disabilities or special needs and children in welfare systems. The results of these researches will be basis for implementation and 396


evaluation of focus oriented programs and services and authors emphasize the importance of research in this field.

Pathomorphosis of neurotic phobias N.D. Lakosina, A.V. Pavlichenko Russian State Medical University, Moscow, Russia An objective of the study was to investigate a modern pathomorphosis of neurotic phobic disorders. Were analyzed works of researchers of the department of Psychiatry of the Russian State Medical University for the past 45 years, involving a study of more than 315 patients with neurotic phobias. The features of phobias observed in the 60–70-years of the last century, included the following: acute stressful events were the main triggers of phobic disorders; panic attacks consisted of autonomic symptoms and fear of dying from heart disease; intrusive structure of phobias; phobias could be replaced by obsessions (aggressive impulses, pathological doubts); majority of patients have an episodic course; active coping strategies with phobic disorders; subthreshold depression was secondary to the phobias. Signs of a favorable prognosis were considered the prevalence of panic attacks and phobia in one situation. Symptoms of poor outcome were obsessions and fears out of the house. Pathogenesis of phobias was associated with paradoxical form of response and increased excretion of norepinephrine. Treatment included phenothiazine neuroleptics and sedative benzodiazepines. The following features of the modern phobic disorders are pointed out: exacerbation of phobias precede the combination of pathological changes in social psychological and biological background; panic attacks involve autonomic symptoms, conversion symptoms, social phobias and various hypochondriacal fears; predominate phobias of several means of transport; overvalued structure of phobias; passive strategies of coping with fears; dynamics is due to the expansion of avoidance behavior; chronic progressive course of phobias; depression appear as comorbid disorder. The favorable prognosis may be related to such features as an acute onset after stress, late exacerbation of symptoms and active coping strategies. Symptoms of 397


poor prognosis are conversion symptoms, depressions and pathological changes in biological background. The pathogenesis of phobias is based on two main findings: reduced 5-HT1A receptors and benzodiazepine receptors binding. Treatment includes serotoninergic antidepressants and anxiolytics. А pathomorphosis of neurotic phobias are associated with reasons such as illness, treatment, patient and social environment. Despite significant advances in the study of the pathogenesis and psychopharmatherapy, the prognosis of modern neurotic phobias cannot be called favorable, which may be due to the negative influence of social factors.

A systems-oriented model for the development of psychiatric services O. Limankin City Mental Hospital № 1, St. Petersburg, Russia Psychosocial rehabilitation has become an integral part of the present-day psychiatry and is developing now as an important independent branch of medical science. At the same time, it is obvious that in order to evaluate quantitative parameters of an efficient rehabilitation system we need to develop integrative indicators for this evaluation. The methods and tools presently used in psychiatry do not allow encompassing the whole diversity of the evaluated indicators. The systems approach, which has been already widely used in different areas of science and professional activity, may contribute to the solution of this problem. Introduction of this method into psychiatry provides the possibility to develop a systems-oriented model of psychosocial rehabilitation. In this way we will be able to maximally engage the modern rehabilitation strategies and the interests of all the parties involved into the rehabilitation process, as well as to gain a holistic view of all relevant factors and their hierarchy. An important component of the suggested approach is the method of hierarchy analysis and hierarchy modeling of main stages of psychosocial rehabilitation. This approach, in our opinion, should adequately describe interactions taking place between all the participants of the rehabilitation process and the multilevel 398


hierarchical nature of ties between components and factors of different origin. It should also facilitate both planning the rehabilitation process, which should be done with due account for the interests of all parties involved, and evaluating its effectiveness. In realization of the suggested approach, a research has been conducted in St. Petersburg in the form of a poll among professionals and users of psychiatric services. The aim or the research was to find out their opinions about the state of the existing psychiatric care system and the perspectives of its development. The respondents of the poll represented the following groups: managers of all psychiatric facilities in place, psychiatrists, social work specialists and medical psychologists with psychiatric facilities, psychiatric hospital nurses, social workers and relatives of mental patients. The total number of those polled accounted for 660 people. The research was conducted in the form of a single-stage poll on the base of a special questionnaire. The sections of the questionnaires covered the following areas: legal and ethical issues, structure and quality of psychiatric care, forms of private psychiatric care, and management of a psychiatric facility. The questions were grouped and formulated according to the level of information awareness and competence of the respondents; nevertheless, a considerable number of questions were aimed at all groups of the respondents. Special sections of the questionnaire were designed for the respondents to freely express their views and suggestions on possible improvements of psychiatric care. The form of data collecting was the guarantee of anonymity and confidentiality of the opinions expressed. The collected data was processed according to the method of hierarchical models and provided the basis for expert analysis of the current state of psychiatric care. This revealed the needs of people with mental disorders in various types of care; more specifically, the research made it possible to define the role of outpatient and inpatient care in the whole system, which is important for the development of an optimal model of regional psychiatric service in a megapolis, such as St. Petersburg. 399


Ethical and legal issues of art therapy O. Limankin City Mental Hospital № 1, St. Petersburg, Russia Wide introduction of art therapy in treatment and rehabilitation programmes of psychiatric facilities reveals the need for discussing a range of specific aspects of ethical, deontological and legal nature, which are linked with art-therapy practice but until recently have not provoked much discussion in scientific press. First of all, what is meant here is the regulation of use of art-therapy products. The largest number of art-therapy works is created by patient artists in the studios of psychiatric facilities (both inpatient and outpatient) using the resources and materials of the studios and with assistance of specialists (doctors, psychologists etc.). In this context, it is important to identify who is the owner or disponent owner of the product and what are the rights of the parties – the author (patient) and the studio (facility) – to use and dispose of it. Exhibitions of art work by mentally ill, or the outsider artists, are becoming more and more popular practice. On the one hand, the patient’s participation in such event has a positive socializing effect, increases the person’s self-esteem, and reduces their stigmatization and autostigmatization. On the other hand, the very fact of public display of the patient’s art works at such exhibition obviously breaks the confidentiality of the person’s psychiatric history. In what way and to what extent the information about the authors should be disclosed for the public, or the question whether there is the need of author’s consent not only for the disclosure of information about him but also for exhibiting his works, and in what form should this consent be expressed – all these problems remain unregulated. Some additional issues appear when art works by mentally ill are reproduced in printed editions (medical literature, special monographs or art books). There appear legal issues relating to the author’s rights to publication, copying his works, and the author’s royalty. Similar collisions should be solved in case of non-public use of art products – for educational, scientific, and pedagogical purposes. 400


The problem is not overestimated, and its importance is growing as far as various psychosocial programmes and art-therapy are being more widely introduced into psychiatric practice. For example, the Kaschenko First St. Petersburg City Mental Hospital runs an art studio programme under the guidance of two professional artists. The outcomes of its functioning include not only numerous exhibitions of art works by patients at the museums of Russia and Europe, but also a considerable art collection – about 12 thousand items. The problem of using them as educational aids or interior decorations, exhibiting and copying them in printed editions is considered to be quite complicated, mainly, in terms of ethics, due to the problem of author’s consent and author’s rights while most of the patients have already left the hospital. The experience of colleagues from abroad justifies the existence of similar problems even in countries with well-developed legal systems. As can be seen from the above, the issues of ethical, deontological and legal nature relating to the use of art therapy products need further development and regulation.

Neuroimmune disturbances in patients with endogenous psychiatric disorders and epilepsy L.V. Lipatova, B.G. Butoma St. Petersburg V.M. Bekchterev Psychoneurological Research Institute, Russia The aim of the study: To research the character of neuroimmune disturbances in patients with endogenous psychiatric disorders and epilepsy and evaluate their role in genesis of these diseases. Materials and method: Clinical and immunological status was examined in three patient groups: in 57 patients with paranoid, simple, schizothypic and schizoaffective forms of schizophrenia, 19 patients with affective disorders (cyclothymiacs and recurrent depressive disorders) and in 98 patients with symptomatic epilepsy. We defined sensitization of lymphocytes (LAT – leucocytes adhesion test) to 4 neurospecific antigens: S-100 protein, Gal–C-I, brain myelin protein, membrane protein and main immune parameters: СD3+, CD4+, СD8+, IRI, index 401


of phagocytes (basal and stimulated NSТ-test, reserve coefficient of NSТ-test), maintenance of plasma immunoglobulin (Ig) A,G, E. Results: In most patients of studying groups were revealed hyper sensitization to

neurospecific

antigens

and

immunodeficiency

syndrome

with

T-cells

immunodeficiency prevalence and low phagocyte function, intensification of reduction the phagocyte activity in case of accumulation of neurospecific antigens in blood plasma. Similar dynamic was registered for Ig of plasma spectrum. These findings were represented by allergic, infectious and autoimmune syndromes clinically. All testing neurospecific antigens were fond out in 72.7–82.6% of patients with schizophrenia and 76.9–83.3% of patients with affective disorders (maximum in patients with simple and paranoid forms of schizophrenia and recurrent depressive disorders). Even distribution of neurospecific antigens in these two groups was displayed. Another neurospecific antigens “picture” showed in epilepsy: 96.9% patients had hyper sensitization to neurospecific antigens and most of them – to S-100 protein (89.4%) and brain myelin protein (46.3%), which are presented as immunochemical markers of brain glia elements, to Gal–C-I (41%) which is characterized with neuronal localization, and only 9.5% – to membrane protein. This is attester the destructive process in atrocities, Shawnee’s cells and olygodendrocyties which are responsible for neuron’s trophies, electrolytes metabolism, neuronal impulse conducting, and processes of irritation and inhibition of neurons. Conclusion: Data about peculiarity of immune status of psychiatric patients with endogenous psychiatric disorders and epilepsy could be used for additional diagnostic criteria of immune pathological syndromes and open new opportunities for pathogenetic therapy and use of the immune correctors for treatment of these hard curative diseases.

402


Application experience Zoloft (sertralin) at therapy of depressions at patients with MDD I.V. Lobanova Yaroslavl State Medical Academy, Russia The goal of the work is studying Zoloft efficacy in treatment of MDD. Except the clinical analysis, case records of previous hospitalizations, out-patient cards were studied. The clinical estimation was supplemented with HAM-D scale. The estimation of results were made prior to the beginning of treatment, for 10, 20, 42 days of therapy. As result of research it has been received: in all groups as a whole authentic decrease in depressive semiology at all stages. At severe depression and depressions in which structure there are facultative symptoms more significant improvement it is revealed in the first 10 days and 20–42 days of therapy. Responders rate – 69.23%. At moderate depression and more simple on structure depressions symptoms improvement were more gradual. Responders rate – 100.0%. At patients without hereditary burden on mental diseases initially depression was severe, but in the course of therapy improvement of depressive symptoms was intensive and by 42 day indicators were without significant difference. Dynamics of improvement of depressive symptoms were not uniform. Adverse events: weakness, indispositions, headache, gastroenteric frustration took place at 18.94% of patients. They were not expressed, cancellations didn’t demand.

A multicenter pharmacoepidemiological and cost-effectiveness study of 2-year outpatient treatment with atypical antipsychotics for schizophrenia E. Lyubov Moscow Research Institute of Psychiatry, Russia Objectives: Pharmacoepidemiologic and cost-effectiveness evaluation of 24month treatment with atypical antipsychotics (AA): Risperidone Long-Acting Injection, Quetiapine, And Olanzapine vs. treatment with typical neuroleptics in schizophrenia (ICD-10) outpatients. 403


Patients and methods: A total of 75 patients (50.7% female), age 40.92 ± 2.99 years, with schizophrenia during 7.78 ± 7.58 years were included in a multicentre (four Russian regional outpatient clinics) study. Clinical and resource use information was collected retrospectively, for the 24 month before starting AA, start and prospectively, for the same period. Results: The majority (46.7%) of patients required a switch in antipsychotics because typical neuroleptics were not well tolerated or because partial symptomatic response (70.7%). 90% of patients remained on their AA start dose level. Quetiapine treatment appeared to have less extrapyramidal and metabolic symptoms vs. other AA and previous conventional neuroleptics (all p < 0.001). There was a reduction (p < 0.001) of rehospitalisations (0.7 vs. 0.3 per patient before and after the start AA, respectively). The median duration of hospitalisation episode decreased from 25.2 days to 2.2 days per patient (p < 0.001). There was a reduction in the anticholinergics (from 32% to 1.3% at baseline and at 24 months, respectively), benzodiazepines (from 32% to 21.3%, respectively) use (all p < 0.001). The incremental cost-effectiveness ratio was Roub (2009) 6 236, 280 and 1 783 per remission day gained for Risperidone LA, Quetiapine, Olanzapine treatment, respectively. Quetiapine seems cost saving rather than the other AA options. Conclusions: The long-term treatment with AA was associated with better clinical outcomes and higher costs in schizophrenia patients. Additional effectiveness and cost-effectiveness trials of AA are needed to provide broader information allowing evidence based choice in schizophrenia treatment with AA in a real world practice.

Supported employment for people with psychiatric disabilities E. Lyubov1, N. Levin2 1 Moscow 2 All-Russia Society of

Research Institute of Psychiatry, Russia

Persons with Psychiatric Disabilities “New Choices”, Moscow, Russia

Objectives: to study the short-term individual work trajectories and generic work patterns of participants in a pilot program of supported employment. 404


Patients and methods: we reinterviewed 18 participants (61% male; age 39.2 ± 5.0 years) with schizophrenia worked at a competitive job 3 to 6 month after the program enrollment. Data were analyzed by using quantitative and qualitative methods. Results: Participants reported that several kinds of supports facilitated their vocational careers. Working a few hours at a time rather than a whole day and working a few days a week rather than a whole week were most often rated as very helpful. Other highly rated factors were having someone to provide encouragement to try working, having medications adjusted, knowing more about disability benefits, and having someone to help find jobs. Working did not affect the amount of contact that they had with practitioners and family or changes in medication. A large majority reported that they went to the hospital less often when they were working. Participants also reported numerous positive benefits related to work, ranging from illness management to self-esteem to social activity. Psychiatric illness was the major barrier to work. Conclusions: The short-term work trajectories, both vocational and nonvocational, for people with severe mental illness who have participated in supported employment appear to be quite positive.

Features of family education in families of adolescents suffering from computer addiction V. Malygin, E. Smirnova Moscow State University of Medicine and Dentistry, Russia Internet addiction is a type of non-chemical dependencies. An addiction can be called non-chemical when the object of dependence is a behavioral pattern, rather than psychoactive substance. In Western literature the term “behavioral or nonpharmacological addiction” is more often used to refer to these types of addictive behavior. While studying the phenomenon of computer addiction we have carried out an investigation of the features of family education as risk factors for the formation of Internet addiction. This study is the first in a series of works devoted to the studying 405


miscellaneous edges of the problem of Internet addiction. The study was attended by 27 young people aged 13 to 16 years (17 boys and 10 girls) and 8 mothers. The criterion for selection of testees was computer addiction. All adolescents were students of grades 8–10. Were identified following features of communication in families of the addicts: – 100% of surveyed teens show disharmonious view of their family. – 92% of teenagers note features of disharmony in contact with their mother. – In 87% of families there are differences in the perception of the family by the adolescent and his or her mother. – In 75% of families desire of emotional closeness does not lead to its emergence. – 25% of observed families show symbiotic relationship between children and parents. – In 87% of families there is a lack of requirements, prohibitions and penalties. – 62% of mothers are not able to work with their children in collaboration and cooperation. – 38% are able to work in pairs, but get tired quite fast and begin to suppress the child. – 90% of girls feel the emotional distance with their fathers. – Fathers are deprived of the traditional male role. – 26% of mothers suffer distrust of men. It was proved that mothers of adolescents, prone to Internet addiction, can be divided into two groups by the type of family education: – Following the parenting style with features of hypoprotection (75%), which are divided into two types: those who emotionally reject the child and those who treat children as equal partners; – Following the parenting style with features of hyperprotection (25%), which are also divided into dominant and indulge. In our work we have witnessed a great number of characteristics of inharmonious communication in families of computer addicts and young people prone 406


to addiction. Study of each of these features in detail can be a continuation of a series of studies on the aspect of computer addiction. We consider studying the disorders in the perception of the family as one of the most interesting aspects of investigations in the field of family predictors of computer addiction.

Socio-psychological characteristics of pathological gamblers V. Malygin, B. Tsygankov Moscow State University of Medicine and Dentistry, Russia The study involved 110 pathological gamblers. The average age of the game addicts was 26.8 ± 6.3 years. 51.6% (n = 57) were married, 20.9% (n = 23) unmarried, 27.3% (n = 30) divorced. Most (74.5%, n = 82) had a general secondary and secondary special education, 25.4% (n = 28) higher and incomplete higher. 39 people (36.0%) from those who applied for help had suffered from alcohol dependence in the past. More than half of the observed (53.6%, n = 59) had heredity aggravated by parents’ alcohol addiction. Obviously, in these cases the previous disorder is not reduced, but one form of addiction is replaced for another. The average portrait of Russian pathological gambler may be represented as follows. This is a man aged 21–30 years, in half of the cases unmarried or divorced (47.9%), with secondary education (71.1%) with heredity burdened by parentage alcohol dependence (52.1%) and a third of testees (35.6%) suffered from alcohol dependence themselves. The study of personality characteristics proved that among pathological gamblers accented characterological traits were revealed significantly more often than in the control group (83.6% and 14.3%, respectively), with a predominance of excitable, hypertemic, anxiety and cyclothymic types, emphasizing the importance of intensity of certain traits in desadaptation and the formation of gambling dependent behavior as a pathological variant of adaptation. In stressful situations, pathological gamblers were significantly more likely, compared with the control group, to use such PDM (psychological defence mechanism) as denial, repression, projection and regression, which indicates that “low adaptive” type of behavior. 407


Leading coping strategies in stressful situations for pathological gamblers are confrontation, distancing and escape-avoidance that are considered maladaptive and unsuccessful strategies for overcoming a difficult situation. For character types with predominance of excitable features most typical are confrontational coping strategies of overcoming stress and psychological defense mechanisms of denial and repression. For hypertemic type confrontational coping becomes also the most typical coping strategy, and the most commonly used defense mechanisms – projection and denial. For anxiety-type coping strategies of distancing and psychological defense mechanisms in the form of regression become typical. Thus a pathological gambling may be a consequence of the lack of individual ability to cope with stress, due to immaturity and the inefficiency of their own adaptive mechanisms, which include psychological protection as compensation of stress and coping strategies as coping with stress.

Predictors of panic attacks in alcohol-dependent patients D.A. Maryasova, D.B. Tsygankov Moscow State University of Medicine and Dentistry, Russia Pathogenic mechanisms of comorbidity of alcoholism and panic disorder have not been properly studied yet. The aim of this study was to examine clinical predictors of panic attacks in alcohol-dependent patients. Patients (n = 107) with comorbidity of alcoholism and panic disorder were included in this study. Also two control groups were studied: 20 alcohol-dependent patients without panic attacks and 20 patients with panic disorder and without alcohol anamnesis. Basic research methods were statistical and clinicoanamnestical, studying symptoms and syndromes of different disease periods and premorbidity. For the purpose of revealing of risk factors of panic attacks at alcohol-dependent patients a complex assessment of social, genetic, biological, neurologic and psychological features of subjects with comorbid pathology was performed. 408


In both groups with alcoholism there were predisposing causes for alcohol dependence such as inheritance, addictive behavior with different psychoactive substances abuse in the tender age, delinquent behavior with administrative and criminal violations, asocial behavior, and residual cerebral dysfunction. Also defined were some premorbid clinical patterns which were specific for patients with comorbidity of alcoholism and panic disorder and control group with panic disorder but were not found out in patients with alcoholism and without panic attacks. Described was burdened familial history with panic and anxiety disorders, significally more single-parent families, high incidence of incomplete higher education and unemployment (p < 0.05). The main causes for alcohol abuse were social desadaptation and psycho-traumatic situation in the past. Patients with comorbid pathology

suffered

from

subclinical

affective

lability,

school

phobia

(didaskaleinophobia), vegetative and blood pressure disturbance, loop of thermal control more often than alcohol-dependent patients without panic attacks (p < 0.05). So there are a number of premorbid predisposing causes for panic attacks in alcohol-dependent patients. It is necessary to take them into account while developing therapeutical strategies.

Measurement of quality of life of out-patients with schizophrenia S.Yu. Maslovsky, V.L. Kozlovsky St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The purpose of the present study consists in development of method of estimation of quality of life (QoL) of schizophrenic patients which are taking maintenance antipsychotic therapy. Development of the given method was based on the account of the factor of psychotropic drug influence with use of two standard tools – questionnaires WHO QoL-100 and QoL-SM. The last instrument (QoL – Specific Module) was developed in regional centre of World Health Organization in Bekhterev Psychoneurological Research Institute by G.Burkovsky et al. (1999) especially for patients with endogenous psychoses. 409


Materials and methods: Materials of study were the data of WHO QoL-100 and QoL-SM which have filled 74 patients with schizophrenia on maintenance antipsychotic therapy. Patients of the first group (42 patients) received atypical antipsychotic risperidone; patients of the second group (32 patients) received traditional antipsychotics – trifluoperazine or haloperidol. Antipsychotic medications were applied in the therapeutic recommended dozes necessary for maintenance of a stable remission state. Patients of the first and second group did not differ at an authentic level among themselves on clinical, psychopathological, and socialdemographic parameters. For processing of results the statistical data files including variants of answers to questions on each point of questionnaires have been generated. Accordingly, data files for patients receiving atypical antipsychotic risperidone or traditional antipsychotics, were identical on character of representation. The algorithm of statistical processing was spent in view of the factor of an accessory of patients to the first or second group. After carrying out of discriminant analysis under the factor of drug accessory “statistical classification” divisions of patients into groups has been received (depending on received antipsychotic). Further “ideal matrixes” data for patients have been generated according to received antipsychotic. Patients who “were not stacked” in designed “statistical classification”, were excluded from the further processing. At the final stage of development “ideal statistical” matrixes were exposed by factor analysis with allocation of principal components. Results and discussion: The described statistical method has allowed receiving the measuring instrument which takes into account influence of pharmacological factor at parameters of QoL that allows estimating subjective QoL of schizophrenic patients on maintenance antipsychotic therapy. Being a derivative of known instruments (WHO QoL100 and QoL-SM) the given questionnaire possesses more compact characteristics and at comparison with analogues does not concede to them in sensitivity an estimation of subjective parameters of QoL. Application and processing of results with use of the given method demands smaller time expenses in comparison with analogues.

410


Borderline personality disorder and trauma in homosexual male sex workers in Russia A. Maximov, A. Kholmogorova Moscow University for Psychology and Pedagogy, Russia Moscow Research Institute for Psychiatry, Russia Background: Homosexual male prostitution is a rapidly spreading phenomenon in post-Soviet Russia. But surprisingly little is known about it. There has been no psychological research whatsoever into this subject, whereas the studies of female prostitution have been carried out for years already. Meanwhile, every Russian major city has a vast population of male sex workers (MSW), who usually live in sheer poverty, often on the streets, and face great social as well as psychological problems having no chance to get essential help. Objectives: This research looks at the psychological profile of a MSW. It focuses on borderline personality disorder (BPD) that is known to be prevalent among female prostitutes, and traumatic experience, which is supposed to be one of the pathways to prostitution. Another focus is on the cross-cultural difference in the psychological profiles between MSW from Russia and the West. Methods and procedure: Three groups were interviewed, including: 1) 20 Russian MSW; 2) 20 MSW from the US, Western Europe and Australia; 3) a control group of ten Russian gay men who have never been paid for sex. The respondents were interviewed either in the street or on the Internet. The interview included a number of open questions about a participant’s life story and traumatic experiences he might have encountered. To evaluate whether or not the interviewees could qualify for BPD, the scale of dysfunctional beliefs in BPD (Butler et al., 2002) was applied. Results: The research showed that about 40% of the Russian sample are very likely to have BPD (cf. 25% in the Western sample and 10% in the control group). The rates of traumatic experiences are as follows: 85% of the Russian sample admitted to having had experience of violence before they became MSW (cf. 70 and 40%). Physical and severe sexual abuse was reported by 65% and 45% of the Russian respondents respectively (cf. 50 and 40% in the Western sample, 30 and 10% in the control group). 411


90% of the Russian sample come from single-parented homes (cf. 60 and 80%), 40% said they lost a parent or both (cf. 25 and 10%). Conclusions: BPD is likely to be much more common among MSW than among gay men not involved in prostitution. MSW from both samples tend to have lives full of traumatic experience, which results in retraumatisation with the ultimate outcome of getting engaged in prostitution. The Russian sample showed higher rates of BPD and traumatic experiences. This can be attributed to the unfavourable conditions of life in Russian lower class homes, where most MSW hail from. The rates of sexual abuse do not differ much between Russia and the West, which may imply that sexual abuse is one of the main risk factors for prostitution.

Depression during an acute episode of schizophrenia and its impact on treatment response G. Mazo1, 2, A. Chomsky1 1 St.

Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia 2 St.

Petersburg State University, Russia

Depressive symptoms are common in patients suffering from schizophrenic disorders and strongly associated with the overall subjective quality of life. Depression in schizophrenic disorders may occur prior to an exacerbation of the illness, after recovery from an acute episode, and particularly during an acute psychotic exacerbation of schizophrenia. Depression in the schizophrenia is associated with more relapses, a greater risk for suicide. The aim of the present study was to examine the relevance of depressive symptoms during an acute schizophrenic episode for the prediction of treatment response. Method: The 122 inpatients – 76 (62%) were male and 46 (38%) were female – were included in this study. All patients had provided informed, written consent to participate in the study. All patients were with the diagnosis of schizophrenia (paranoid, disorganized, catatonic or undifferentiated subtype) according to the ICD412


10 criteria. Subjects were aged between 18 and 65 years. Exclusion criteria were a history of major medical illness and symptoms of drug or alcohol dependence. Psychopathological characteristics were assessed with the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) (Kay, 1991). Following Oosthuizen et al. (2001), in the present study a PANSS depression score was calculated which comprises the PANSS items “somatic concern” (G1), “anxiety” (G2), “guilt feelings” (G3), and “depression” (G6). Ratings were performed at admission (before therapy, after 2 weeks and after 6 weeks), during the inpatient treatment phase. Patients were treated under naturalistic conditions. All patients have traditional and atypical antipsychotics. Results: Depression is a common and devastating comorbid syndrome in patients suffering from schizophrenic disorder. 40.9% patients have depressive symptoms during all over an acute episode of schizophrenia. All patients were seperated on 2 groups: – 1 group is patients with depressive symptoms during all over an acute episode of schizophrenia. – 2 group is patients without depressive symptoms during all over an acute episode of schizophrenia. There were 68% responders (decrease PANSS score more than 30% during the treatment) in 1 group patients. There 66% were responders in 2 group patients. There were used method of mathematical models to expose the differents between responders and nonresponders with depressive symptoms during all over an acute episode of schizophrenia. We have obtained data that therapeutical sensibility depends of depressive structure. Conclusion: Therefore, the hypothesis that depressive symptoms are predictive of a favorable treatment response was not supported by the present study. But therapeutical sensibility depends of depressive structure. Bipolar depression connects with negative treatment response.

413


Risk factors of pharmacogenic weight gain in patients with a depressive disorder G. Mazo1, 2, T. Shmaneva1 1 St.

Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia 2 St.Petersburg State University, Russia

Depressive disorder is a general medical problem due to high comorbidity with a great number of somatic diseases, especially diabetes and cardiovascular diseases. Pharmacotherapy of depressive disorder causes a number of neuroendocrinologic effects, including metabolic syndrome, hyperprolactinemia syndrome, and changes in function of thyroid gland. Special attention should be given to the problem of change in body mass. The importance of studying this aspect of neuroendocrinologic dysfunction is explained by the fact that weight gain significantly increases the risk of diseases such as hypertension, dislipidemy, diabetes 2 type, and cardiovascular diseases. Therefore a retrospective analysis of case histories of patients that underwent treatment in St. Petersburg V.M. Bekhterev Psychoneurological Research Institute in 2003–2008 has been carried out. This analysis is aimed at studying risk factors contributing to the development of pharmacogenic weight gain which was registered after increase in body mass of over 5% during pharmacotherapy. Recurrent depressive disorder was observed in 30% of patients, bipolar type of a current came to light in 62% of cases, depressive episode met in 8% of observable patients. Hypothyroidism has been most often revealed from a somatic pathology which was observed at 22% of patients. The data obtained leads to conclusion that sex, age, and hypothyroidism are the risk factors for the development of pharmacogenic weight gain in patients with a depressive disorder. Pharmacotherapy used is equally important as above mentioned factors. Evaluation of weight gain depending on pharmacotherapy showed that the most frequent pharmacogenic weight gain is revealed in the group of patients treated with combination therapy with use of tricyclic antidepressants and atypical antipsychotics. 414


There is the following tendency in decrease of manifestations of this side effect: in 75% of cases pharmacogenic weight gain was revealed in the group of patients treated with combination therapy with use of tricyclic antidepressants and typical neuroleptics; in 66% of cases – in therapy with a combination of antidepressants, in 66% – in treatment with modern antidepressants and typical neuroleptics; in 20% of cases – in combination therapy with modern antidepressants and atypical antipsychotics, and in 14.2% – in monotherapy with use of modern antidepressants. The results of the analysis clearly showed that use of combination therapy contributes to a greater weight gain. And use of atypical antipsychotics and typical neuroleptics increases percentage of pharmacogenic weight gain, especially when combined with tricyclic antidepressants.

A neuropsychological perspective in pharmacotherapy of cognitive disorders after traumatic brain injury (a literature reivew) Z.A. Melikyan1, 2, Y.V. Mikadze1, O.S. Zaitsev2 1 M.V. 2 N.N.

Lomonosov Moscow State University, Russia

Burdenko Neurosurgery Institute, Moscow, Russia

TBI launches a complex cascade of potentially traumatic processes – local contusions, diffuse axonal and cytotoxic injuries, toxic elevation of neurotransmitters’ level (glutamate, dophamine, norepinephrin, serotonin and acetilcholin). Distructive effects of the neurotransmitters’ elevation are most pronounced in the areas of their high concentration – hippocampus, striatum, frontal lobes and basal frontal areas, which leads to a number of emotinal and cognitive disorders most commonly in attention, working memory, executive fucntions, speed of information processing, memory and speech. Neuropsychological approach allows qualifying structure of cognitive deficits and correlating it with the functioning of certain brain regions. Combining neuropsychological approach with psychopharmacotherapy allows developing optimal treatment recommendations for better outcomes. 415


Psychopharmacotherapy

should

consider

neuropsychological

syndrome

structure, brain areas involved and the whole spectrum of psychophysiological changes following TBI as various agents differ in their mechanism of action. For example non-specific neurotropic agents (e.g. nootropil) have positive effect on many aspects of cognition; others target specific components of cognitive functions e.g. amiridin improves cognitive functions mediated by left hemisphere whereas Lglutamic acid improves cognitive functions mediated by right hemisphere; and still other agents have mosaic mechanism of action – improving some aspects of cognition and adversely affecting others. Psychopharmacotherapy is subject of current research therefore both evidensebased recommendatios and clinical opinions exist. According to recommendations methylphenidate, dextroamphetamine, amantadine, donepezil, bromocriptine are best for speed of information processing and arousal, they facilitate patients’ involvement in rehabilitation and speed up recovery. Cholinesterase inhibitors are best for memory problems; they also facilitate arousal, attention, executive functions and speech. Bethablockers are recommended for aggression. Under the existing clinical opinions SSRIs and tetracyclic antidepressants are more preferable then tricyclic antidepressants as they may adversely affect cognition. Atypical neuroleptics are more preferable to traditional ones. Kvetiapin is good for agitation, and Risperidon – for delirium and hallucinations. Valproates, SSRIs and tricyclic antidepressants are recommended for agression. Thus the optimal approach to developing tactics of psychopharmacological treatment should combine neuropsychological characteristics of cognitive disorders, pathology and metabolic disorders of the involved brain structures.

Contemporary problems of biomedical ethics in narcology V. Mendelevich Kazan State Medical University, Russia In the context of biomedical problems of narcology the main topics are: the provision of patients’ rights, confidentiality, stigmatization and decriminalization of 416


the patients. Narcology was not judged from the biomedical ethics’ point of view till the present time. It was connected with the status of drug addicts, who were not treated as real patients. There are several critical problems of biomedical ethics in this sphere now: 1) The problem of realization of the principle of “An Informed Agreement”; 2) Drugfree strategy as a rule for making treatment; 3) Neomoralistic approach; 4) Ban on the opioid substitution therapy (OST) in some countries. The problem of the principle of “An Informed Agreement” is that a patient with alcohol or drug addiction during the treatment does not get all the amount of information, important for taking deliberate decision about the choice of the therapy, or gets this information in a strained way. One of the basic principles of the Russian narcology is the principle of “Straight Away Refusal from Psychoactive Substances (PAS) Usage”. At bottom of fact, a person’s wish to fulfill this condition leads to an amount of help that a person can get from the official medicine and remains to be determinative for a person’s ability to get into a hospital or to be included into rehabilitation programmes. This condition is the independent refuse of taking psychoactive substances before the treatment prescription. However there is an ethical question of how could it be possible to ask a person to get rid of pathological psychoactive substance craving before the treatment starts. It can be supposed that the existence of such a condition is based on the position of narcology experts who see PAS craving symptom as a “bad habit” or “moral defect”. HIV-positive active IDUs face the same problem. These people are refused to get ARV therapy because they break rules of hospitals (they continue to take PAS). One of the most critical and disputable ethical problem is the question about ban on the OST in some countries. The essence of the problem is what should be considered ethical and what should be considered immoral. Firstly, this leads to the ethic evaluation of “refusal from the drug addiction treatment, because the addiction continues”. Secondly, there is another ethic question “is it possible to offer a person another drug that the person would refuse from some other drugs and would become less dangerous for the society”. Thirdly, the opponents say that “Harm Reduction 417


programmes ideology has “more respectable attitude to drug users, than any other medical approach has”. The subject of particular attention is the ethical side of the OST. This subject is often the main factor that influences the existence of a ban on the method. According to the social research the 5th part of the respondents and the 4th part of the narcologists protest against OST because it is “immoral”. The OST dependence should be seen as the most ethic and humane methods. But the ban on the therapy should be seen as violation of the norms of biomedicine ethic and medicine law. In conclusion, it can be said that the special attitude of the medicine community to the problems of narcology caused by the generated strategy of civilization and suppression of strategy biomedical ethics with concepts of humanism, justice and the welfare of the patient.

Clinical, individual-personality and socio-enironmental determinants of the quality of life in patients with epilepsy V.A. Mikhailov, S.A. Gromov, L.I. Wasserman, N.G. Neznanov, S.D. Tabulina, E.S. Eroshina, S.A. Korovina, E.N. Mironova, A.V. Sinyakova St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The aim of the study was to make a multidimensional analysis and a systemic assessment of clinical, individual-personality and socio-environmental factors determining the quality of life (QoL) in patients with epilepsy. The basic instrument of the study was the WHOQoL-100, a questionnaire developed by the World Health Organization for QoL studies. We studied 600 male and female patients with different disease duration, seizure types, personality changes, epilepsy forms and socio-demographical indices. The results of the QoL-in-patients-with-epilepsy study have shown that the patients assessed the majority of their QoL parameters as fair, which testifies to the patients’ high rehabilitation potential. 20% of the patients assessed their QoL as poor. Extreme assessments (very poor or very good QoL) were found in an insignificant percentage of the patients. 418


The epileptic patients’ subjective QoL assessments differed depending on the disease clinical manifestations (forms of epilepsy, type and severity of seizures, etc.) and showed lower QoL indices in the patients with a localization-related disease form in comparison with the patients with generalized epilepsy. This testifies to a more desadaptive disease course in the patient group with a localization-related form. Lower QoL indices were found in the patients with complex partial and polymorphous seizures. A negative correlation was found between the frequency and severity of seizures, on the one hand, and the subjective QoL assessment, on the other hand: the higher frequency and severity of seizures, the lower the subjective QoL assessment is. A significant role in QoL assessment belongs to such indices as the patient’s age, disease onset age and disease duration. This can be proved by the fact that the highest QoL indices were found in the young patients. A correlation was found between the subjective QoL assessment and the course of disease: the lowest QoL indices were typical in the pharmaco-resistant patients. A correlation was found between the degree of therapeutic effect and the degree of improvement of QoL indices: the most significant QoL differences were found in the patients with seizure control in the course of rehabilitation therapy and subsequent disease remission. Numerous correlations were found between socio-environmental factors and subjective satisfaction with different aspects of life functioning. Significant (negative) correlations were found between the overall level of social frustration and all domains and facets of the WHOQoL-100 (according to Kendall). The higher the level of the blocking of the patient’s social demands, the lower the subjective QoL index is. Sociogenetic factors (the patients’ dissatisfaction with their social and financial status) appeared to be the most frustrating ones. A correlation was found between the level of social adjustment and subjective QoL assessment. The persons with disabilities showed lower QoL indices in comparison with the similar indices of the working persons. A comparative experimental-psychological study of groups of adolescent patients with epilepsy and of their parents, on the one hand, and of healthy 419


adolescents, on the other hand, has allowed us to state that the disease affects considerably the QoL of patients with epilepsy as well as of their relatives. QoL indices depend significantly on the patient’s psychoemotional condition. Anxiety and depressive disorders impair the subjective assessment in all spheres of daily living activities. The data of the study of individual-personality characteristics in the mechanisms of deterioration of the psychological adjustment and QoL in patients with epilepsy have shown that the intensity of problem-solving coping strategies and of search for social support in patients with epilepsy is average, whereas the intensity of the avoidance strategy is low. Stress-coping strategies correlate significantly with the subjective QoL assessment.

Effects of a switch from bupropion SR to bupropion XL on sleep architecture in patients with unipolar or bipolar depression R. Milev, L. Lazowski, L. Gedge, D. Murray, D. Summers, R. Jokic Queen’s university, Kingston, Canada Objective: The primary objective of this study is to determine the effect of a switch from twice-daily bupropion SR to the same full dose of once-daily bupropion XL treatment on sleep efficiency in patients with major depressive disorder or bipolar disorder currently experiencing a depressive episode. Secondly, sleep architecture measured by polysomnograph, subjective sleep quality and illness severity will be compared when treated with bupropion SR versus bupropion XL. Methods: This is a prospective, blinded assessment, open-label, repeated measures study. Sleep architecture was analyzed by overnight polysomnography and subjective sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Illness severity was determined using the Montgomery Asberg Depression Rating Scale (MADRS). Polysomnographs and clinical scales were administered at baseline, 2– 4 days and 21–28 days after switching to bupropion XL. Results: There is no significant difference in sleep efficiency between bupropion SR and bupropion XL treatment, although sleep efficiency tended to increase after a 420


switch to bupropion XL. A switch from bupropion SR to burpropion XL did not significantly alter sleep continuity or sleep architecture as measured by PSG, with the exception of the respiratory distress index (RDI) and total number of hypoapneas which significantly decreased after 21–28 days of bupropion XL treatment compared to bupropion SR treatment measurements. There was no significant difference in PSQI scores; however Epworth scores significantly increased after 21–28 days of bupropion XL treatment compared to bupropion SR. MADRS scores significantly decreased after 21–28 days of bupropion XL treatment, indicating an improvement in mood compared to treatment with bupropion SR. The intention to treat population was comprised of 20 patients with major depressive disorder or bipolar disorder currently experiencing a major depressive episode. Conclusions: There is no difference in sleep efficiency or sleep architecture between bupropion SR and XL treatments. Bupropion XL improves mood and subjective sleep quality compared to bupropion SR, likely due to increased treatment adherence.

Complex psychological and psychophysiological support of persons with adaptation disorders E. Miroshnik A.I. Burnazyan Federal Medical and Biophysical Center, Moscow, Russia The development of efficient methods of treatment and prevention of adaptation disorders is an important concept both in the sphere of psychiatrics, integrative medicine and experimental psychology. In order to analyze the efficiency of application of innovative psychological technology of conscious health improvement “Mobile office of emotional health”, extended psychophysiological program “Antis-stress” Color and Sound Matrix - CSM (certification No. РОСС RU.0001.10 АИ58, ref. No.33 dated 02.11.09) psychological characteristics and adaptation status data of 20 high school students having adaptation disorders (F43.2) were studied. 421


Investigation methods included the following procedures and tests: “Expressportrait”, “Defensive behavior”, “Defensive ideation”, “Creative potential”, “Pulse-antistress”, “Individual minute”, “Rhythms of visual perception” and “Functional comfort”. Considering determined individual characteristics the parameters of CSM promoting psychoemotional condition optimization and optimization of impaired biorhythms were adjusted. Assessment of persons participating in the trial was made twice: before the conduction of correction and two weeks after the corrective work. As a result of investigation a positive influence of “Antis-stress” Color and Sound Matrix to the psychoemotional condition in responders was detected. All test subjects showed the improvement of cognitive and emotional activity indices, the rhythms of visual perception improved as well. In all cases adaptation status improvement was detected. Before the correction conduction all test subjects showed an adaptation status as “stress” reaction, and after the correction the reaction of 12 persons changed (5 persons – activation, 6 persons – training, 1 person – increased activation), 8 persons showed an improved responsiveness level (lower degree stress). The results of conducted analysis certify a big potential of comprehensive psychological and psychophysiological approaches implemented in the innovative psychological technology of conscious health improvement “Mobile office of emotional health” for correction of psychoemotional health and adaptation status of students with adaptation disorders.

The psychological pathomorthosis of the neurotic disorders E.B. Mizinova St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The epidemiological structure of sick rate of the mental diseases during last three decades certificates us about high specific weight of patients with neurotic disorders and growing tendency to its increasing in spite of improving the methods of its diagnosing, treatment, rehabilitation and prophylactic. The changes which were conducted in Russia from the beginning of the nineties appear as in a high sick rate of 422


neurotic and psychiatric diseases as in obvious modification of neurotic disorders: their clinical symptoms and psychological characteristics. Mostly wide in the modern world literature the clinical pathomorthosis of the neurotic disorders is elucidated, especially the changes of its forms, types of flowing, symptoms and syndromes. There are publications dedicated to the psychological pathomorthosis of the hysteria. Other part of materials are devoted to the problems of neurotic disorders’ pathomorthosis most probably reflects the increasing level of abilities of differencial clinical diagnosing (false pathomorthosis). Till our days the psychological reasons of the clinical pathomorthosis are little known and so we can say about wide sphere of the neurotic disorders keeping in sight their changed classification. The modern pathomorthosis is correlated with pathogenetic mechanisms of the neurotic disorders as well as psychological. The necessity to correct forms and methods of the psychotherapy which is basic drug in this pathology is topical very much. Nowadays traditional nosocentric psychiatric basis can be added by the adaptional in which the main role is personal getting over stress action. The accent is on active and purpose behavior and patient should displace indefinite mechanisms bonding problem and stress situation. This is connected by the elaboration of short and rentable forms and methods of the psychotherapy. So, the studying of the psychological laws keeping in the basis of the clinical pathomorthosis of the neurotic disorders and is very important for theory and practice and it helps to develop modern medical psychology and psychotherapy. With the purpose of researching the psychological pathomorthosis of the neurotic disorders in the department of the neurotic disorders and psychotherapy in Bechterev’s Institute during the last 30 years (1979–2009) the multidimensional studying

is

conducted

using

the

clinical,

experimental

psychological,

neuropshysiological, neuropsychological, and other laboratory and experimental tests.

423


ICD-10 and “domestic” classification systems in Kyrgyzstan: why are mental health specialists not happy with ICD-10? E. Molchanova, T. Galako, M. Zubareva, A. Mukambetov American University in Central Asia, Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic Problem: International Classification of Disorder, 10th edition is the official classification system, which was introduced to Kyrgyz psychiatry and clinical psychology in 1994. Since that time, clinical psychologists and psychiatrists have used it for diagnostic labels, but also continue to rely on their previously received knowledge from the ICD 9th edition, classical textbooks in Russian, and individual practical experience. Why hasn’t the ICD-10th edition been fully adopted by mental health care providers? Procedure: Three specialists in psychiatry and one specialist in both psychiatry and clinical psychology from Kyrgyz State Medical Academy, Slavonic University in Kyrgyzstan and American University in Central Asia examined 140 detailed reports (patients’ case histories) in order to determine the extent of correspondence between clinical descriptions and diagnoses which were applied by the resident psychiatrists of Republican Center for Mental Health, Osh mental hospital and Chui mental health center. Every specialist received the equal number of patients’ case histories to determine whether ICD-10 criteria were used properly in diagnostic procedure. Results: The discrepancy between clinical descriptions and ICD-10 diagnosis were revealed in 25% patient case histories. Although the diagnostic procedures seemed to be limited, the contents of patients’ case histories demonstrated a proper explanation of symptoms with detailed descriptions of patients’ experiences and dynamics of their development. Resident psychiatrists perceive ICD-10 as a convenient and simpified “destigmatizational” list of diagnostic labels for mental disorders while prefering to use the “domestic” classification system, which is a cognitive schema of a disorder, constructed by previously received knowledge from ICD-9th, classical textbooks in Russian, and individual practical experience. 424


Conclusion: Mental health care specialists in Kyrgyzstan use ICD-10 as convenient labeling tool, while their diagnostic process is based on their previously constructed knowledge. It seems that ICD-10, as it is used in Kyrgyzstan is a fiction which does not fulfill its object and it is not the relatively most valid at the time being’ (rephrased Karl Jasper’s definition of a classification system).

Study of the therapeutic properties of Ropren® in the treatment of Alzheimer’s type dementia I.A. Monakhova, V.S. Soultanov, V.G. Agishev Skvortsov-Stepanov Municipal Psychiatric Hospital № 3, St. Petersburg, Russia Solagran Limited, Melbourne, Australia In economically developed countries, Alzheimer’s disease is the main cause of senile dementia in the middle-aged and elderly. In cases where the levels of enzymes involved in neurotransmission are decreased, initiation of timely treatment leads to the prevention of the progression, and possibly to the regression of cognitive disorders. For treatment of AD it is preferable to use therapeutic substances of plant origin. These have low toxicity and can potentially be used for an extensive period of time. The search for new pharmaceuticals with minimal side effects is topical for the treatment of various neurodegenerative diseases because of the toxicity of synthesised compounds and the possibility of their prolonged use in treatment. One such substance is Ropren®, consisting of polyprenols extracted from Picea abies (L.) Karst (Norway spruce) green needles. Prenols are plant analogues of the endogenous transport lipid, dolichol, which regulates protein glycosylation in the dolicholphosphate cycle during glycoprotein synthesis. It is assumed that as Ropren ® has polyisoprene linkages like dolichol, it has membrane-active properties that are very important in all mitochondrial diseases, including AD. The purpose of this study was to evaluate the efficacy of the polyprenol substance Ropren® in the treatment of Alzheimer’s type dementia. Clinical trials were conducted at the Municipal Psychiatric Hospital № 3 on 25 patients, aged from 54 to 78. The average history of the disease in the patients was 425


2 years. All patients were diagnosed with Alzheimer’s type dementia caused by vascular brain damage. The treatment course was 3–4 months and the test substance was administered at a dose of 144 mg/day, a 25% oil solution of Ropren®. The evaluation of the efficacy of Ropren® was based on the international scale of cognitive disorders (MMSE), the unified scale for the evaluation of Parkinsonism, electroencephalography

data

(EEG),

biochemical

blood

indices,

and

butyrylcholinesterase (BuChE) and monoamine oxidase (MAO) activity in the blood serum. In patients treated with Ropren®, positive changes were found by the end of the second month of treatment. This was evident in both the frequency and the severity of the studied symptoms. The results of the trials demonstrated the positive effect of Ropren® on cognitive function. There was marked improvement of cognitive function in 40% of the patients based on all analysed parameters. In 48% of the patients, there was a less pronounced effect in accordance with psychosomatic status. The efficacy of the test substance on cognitive function depended on the duration of clinical dementia. Based on the EEG data, the clinical condition improved in 80% of the patients, characterised by the disappearance of delta waves and paroxysms, the appearance of α-rhythm. The test substance had a normalising effect on BuChE and MAO activity in the blood serum. Symptoms of Parkinson’s syndrome reduced as early as 1 month. This is a good prognostic factor for the treatment of this disease. None of the patients had any side effects during administration of this therapeutic substance. Based on the data, it was concluded that Ropren® has good potential as a treatment of neurodegenerative disease of the Alzheimer’s type.

The first forensic psychiatry expert’s report in Serbia D. Mrakovic, N. Buder, S. Kulishic Hospital “Laza Lazarevic”, Belgrad, Serbia The history of medicine in Serbia has begun with the foundation of hospitals within Monastery of Hilandar and Studenica in XII and XIII century. In these hospitals there were special departmants for mentaly ill people. The first Hospital on the Balkans for mental ill people “Dr Laza Lazarevic” was founded in Belgrade in 1862. 426


Aims: The purpose of this abstract is to present the first forensic psychiatry expert's report in Serbia from 1863. This expert's report took place in the Hospital “Dr Laza Lazarevic”. Metodhods: Description of forenzic expert's report of patient K.Dj. She has comitted homicide after epileptic seizure. Results: The result of the expert’s report was compulsory treatment in this hospital. Conclusion: It is believed that with this first expert’s report in the history of Serbian medicine the era of new medical discipline has begun. That discipline is forenzic psychiatry.

Our experience of using Valdoxan in the treatment of atypical endogenous depressions V. Mrykhin, I. Shurkova, V. Yemtsev Rostov State Medical University, Rostov-on-Don, Russia In the day hospital and ambulatory observations, there were assessed 50 patients in age of 18 to 60 years (mean age 37.3 ± 7.5 years) suffering from atypical endogenous depressions. The group of patients consisted 28 persons (56%) with diagnosis depressive episode (18 men – 36% and 32 women – 64%) and 22 persons (44%) with recurrent depressive disorder. Among them 41 patients (82%) had moderate severity, and 9 patients (18%) had mild severity. 30 patients (60%) were diagnosed with masked depressive syndrome, 8 patients (16%) with depressiveipochondric

syndrome,

5

patients

(10%)

with

depressive-derealization-

depersonalization syndrome and 17 patients (34%) with asteno-depressive syndrome. The mean duration of current depressive episode was 2.7 ± 1.4 months and mean duration of disease till recruitment in the study was 4.6 ± 1.9 years. The drug used for treatment was Valdoxan – a new antidepressant with an innovative pharmacological profile. For all the patients Valdoxan was prescribed in starting dose of 25 mg/day once in the evening. In the of satisfactory effect absence within first 2 weeks of therapy, the 427


dose was increased to 50 mg/day starting from the 15th day of therapy. The total duration of therapy was 8 weeks. During the study a chance was preserved to prescribe one anxiolytic or one hypnotic for 7 days. To access the effectiveness of treatment the scales used were HAMD-17, CGI-S and CGI-I. The drug tolerance of Valdoxan was assessed on basis of adverse events, registered during the whole study period. The mean HAMD-17 score at recruitment was 21.9 ± 5.7; prevailed patients (82% from the whole group) with the CGI-S score of 4.60% of patients continued taking the starting dose of Valdoxan – 25 mg/day. 40% of patients needed doubling the dose. The concurrent therapy was prescribed in 36% of the cases. All of the patients totally completed the 8-week therapy. The total mean score of HAMD-17 was progressively decreasing at each subsequent rating. The severity of depression started reducing from the 1st week of therapy. After the 8-week therapy period 68% of patients were registered as having improved and much improved scores according to CGI-I. At the 3rd week of therapy the responders increased from 8 to 32% and reached up to 80% at the end of 8-week period. After 3 weeks of Valdoxan therapy the 36% of patients received remission (reduction of total HAMD-17 score up to ≤ 7) and after the completion of 8-week therapy the 60% of patients were registered to be in remission. The best results were obtained in the patients having the asteno-depressive (76.5%) and the masked (70%) variants of depression. The less respondent to therapy were

patients

with

hipochondric

syndrome

(37.5%)

and

derealization-

depersonalization syndrome (20%). Valdoxan in dose of 25–50 mg/day helped to receive fast and effective normalization of sleep starting from the 1st week of therapy. The adverse events were registered only in 10% of patients. The most frequent amongst them was headache, found in 8% of patients.

428


Depressive disorders at patients with cholelithic illness E. Mukhametshina, K. Yakhin Kazan State Medical University, Russia The problem of somatogenic mental infringements last years gets the increasing value. The mental disorders revealed at it are long the current somatic illnesses, aggravate a condition of the patient and complicate a clinical picture of somatic disease. The purpose of research was studying psychopathological displays at patients with cholelithic illness. As a result of research at these patients the leading part belongs to various displays asteno-depressive (48 person), disturbing – depressive (10 person) and histerodepressive (5 person) symptoms. The analysis of a questionnaire nevrotization has shown low values on a scale of depression (–4.7) and vegetative frustration (–2.4). Analysis MMPI has shown expressiveness of depressive frustration and somatisation alarms. The analysis of questionnaire Quality of life has shown, that those patients who long time suffer cholelithic illness and in which clinical picture conducting somatic symptoms are the pain, a nausea, infringement of appetite parameters, basically, the “Pain and discomfort” (49%), “Medical aid” (23%), “Dream” (28%) are reduced on such spheres as. They estimated the life defective. Principal causes of decrease (reduction) were: necessity to be treated, prospect of operative intervention, strict observance of a mode and a diet.

Experience with Cipralex in the treatment of depressive disorders in cancer patients E. Mukhametshina, K. Yakhin Kazan State Medical University, Russia The problem of cancer remains one of the most pressing and debated among experts of different profiles. According to WHO, each year about 7 million new cases of malignant tumors. Any oncological disease is accompanied by a somatic manifestations as well as psychological and psychopathological changes.

429


Depression in cancer patients significantly aggravates the clinical course of underlying disease, but also affects the prognosis of the disease. Our studies suggest that patients with depression in malignant tumors have a worse functional status, lower quality of life, they rarely return to work. We have examined 57 women diagnosed with breast cancer and uterine body. In 21 surveyed (36.8%) diagnosed with breast cancer (3 pers.) and uterine cancer (18 pers.) aged 25 years and 54 years were diagnosed as depressive symptoms. 16 patients was radical surgery, followed by chemotherapy and radiotherapy, 5 patients carried only radiotherapy. All surveyed were aware of their diagnosis. As the leading mental disorders has been identified depression. The severity of depression was consistent with a light (17 people) and moderate (4 persons) depressive episode in ICD-10. Cipralex was prescribed in doses of 10 mg/day (1 day reception). All patients received the drug in the hospital. The duration of therapy was 6 weeks. All patients who received study medication completed the study. In the course of the study cipralex l possible to achieve improvement in 80.9% of surveyed patients. Available to date indicate that cipralex provides sufficient efficacy and safety in treating depression in patients with malignant tumors. Appointment of the drug relieves patients from symptoms of depression, improves their clinical condition in general, and may favorably affect the prognosis of the disease.

Psychotherapeutic care in Ukraine, problems and prospects B.V. Mykhaylov Kharkiv Medical Academy of Postgraduate Education, Ukraine The psychotherapeutic care in Ukraine is carried out in structure specialized psychiatric, psychoneurological and somatic hospitals and polyclinics of public health services. Since independence, Ukraine still has inefficient public health care system, with its unbalanced structure of services, especially in mental health care. In 2008 parameters of mental illness and disturbances of behavior was 243.3 per 100 thousand population and in comparison with 1990 decreased per 2.5%. 430


Maximal parameters of mental illness and disturbances of behavior in 1995 consisted 263.1 per 100 thousand population. In structure of parameters of mental illness and disturbances of behavior, in 2008 (72.7% or 176.1 per 100 thousand population) prevailed nonpsychotic. The basic organizational unit of the psychotherapeutic care is the cabinet of psychotherapy, which common number on 1.01.2009 year was 223, from them at the psychiatric network 134 (61%), at the somatic – 89 (that makes about 39%). The psychotherapeutic care is carried out within the limits of medical and psychological model. Thus since 1997 the speciality medical psychology and a staff of the doctorpsychologist is entered. From now on in a medical network medical psychologists with medical (85 person) and psychological (315 person) base education are working in parallel. The general deficiency of the staff is made nearby by 600 persons. The basic problem is defficiency posts of psychotherapists in specialized and somatic networks according to operating specifications. The general deficiency of physical persons makes 1000 persons. The psychotherapeutic network requires immediate expansion, especially in somatic treatment-and-prophylactic hospitals and polyclinics. The staff could be taken from psychiatrists after reduction psychiatric beds which would pass training for a new profession on corresponding faculties and chairs of psychotherapy of postgraduate education organizations.

Vestibular dereception as a method of amnesia treatment (preliminary results) A.G. Naryshkin, I.V. Galanin, A.L. Gorelik, M.N. Abramovskaja St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Strongly pronounced mental disorders are not only part of

some

psychopathological diseases, but sometimes they are their basis. For example, fixational amnesia with Korsakov syndrome and polymorphal amnesia (which are part of the Walter-Bruel triad) wihth psychoorganic syndrome are 431


the leading ones in the structure of such diseases. Besides, in spite of all achievements of contemporary medicine therapy, memory imperfections stay unchanged at best. Much more often the continuation to progress was leading in the end to profound disablement of the patient. In the tract of inner ear there is otolithic organ which is responsible – among many other functions – for perception of gravitational constant. Under the influence of this, one of the basic afferentations, the growth, formation and functioning of all brain structures and of the organism as a whole take place. Diminution or ceasing of this powerful biologically determined stream of afferent information results in the formation of new bonds between the associational zones of the cortex by the actualization of the other afferent sources of information (visual, otholitic, etc.) Transtympanic chemical vestibular dereception (TCVD) greatly minimizes the stream of signals responsible for perception of the force of gravitation. In response to this fact the brains – being a polymodal system – sets and forms new associational functional bonds. The consequence of this process is the alterations in the range of stable pathologic system within the brains. This method is well used during the treatment of different extrapyramidal pathology (cervical dystonia, Parkinson’s disease, atetoidal hyperkineses, vegetative state, etc.). TCVD method has been applied by us during the treatment of 11 patients with profound distortion of memory. 9 of these suffered from the Korsakov syndrome, 3 – psychoorganic syndrome (as the result of cranium-brain trauma). Ruff obvious distortions of memory were the leading ones in the clinical picture. The positive effect after application of TCVD was marked even in the first days of treatment, and it continued to grow later on. According to pathopsychological and neuropsychological studies in a month after application of TCVD the level of memory reached the lower boarder of the norm. Vessel and neuro therapy makes possible to intensify this process. The data of long term observation (average period of 3.4 ± 0.63 years) allow to assert that the application of TCVD not only leads to suspension of the process of

432


memory infringelment, but also leads to their reverse development. In most cases this effect was achieved without medicine treatment. After TVCVD we marked not only the decrease of memori disorders, but also the improvement of cognitive functions, the decrease of irritation and aggression so typical of such patients. Though the premorbid level was not reached in any of the cases, 8 (of the 11 treated patients) returned to their social activities and work. The results of TVCVD application in the mentioned group of patients which are presented to be discussed here suggest a new method of forming of new up-to-date view on the physiological mechanisms of the memory and also the processes on which its disorders are based.

Mental health of women at reproductive age with dysmenorrhea R.F. Nasyrova Mental Health Research Institute SB RAMSci, Tomsk, Russia Under contemporary conditions associated with steadfast growth of social, economic, ecological, technogenic and personal extremality, the most typical mental state of women was stress. Overlapping the emotional stressful states, somatovegetative component in totality with genetic predisposition provokes psychosomatic disorder in reproductive system. After informed consent we have examined 100 female patients with dysmenorrhea at the age of 18–45 years (mean age has constituted 31.5 ± 1.8 years). The examined one presented with degree of stressful load constituting 163.57 ± 19.73 scores according to T.H. Holmes Scale, what corresponded to 30% of risk of physical reaction toward the stress. Overwhelming majority of women presented with combination of various psychotraumatic factors prolonged over the time. Personal features of female patients were characterized by presence of severe anxiety radical (in average 45.58 ± 4.15 scores according to Spilberger-Hanin Scale), what demonstrated presence of neurotic conflict. In addition, we have documented high indices of reactive anxiety (48.59 2.37 and 46.76 433

3.14 scores, respectively) in the


examined. Obtained data showed a selective sensitivity and predisposition to stressor influences in female patients. Revealed mental disorders in the included into investigation group were represented basically by neurotic reactions and states. Neurotic reactions in the examined contingent were initial stage of formation of mental disorders which distinctive feature was fast regression of these manifestations to carrying out the appropriate therapy. Neurotic states were characterized by increase of polymorphism and resistance toward psychopathological manifestations. Neurotic developments were manifested as disturbances of personality and social adaptation. Neurotic disorders in women were diagnosed in 96% of the examined. It has been revealed that in the examined persistent neurotic states predominated. During consideration of syndrome rank of neurotic disorders the attention is provoked by that according to prevalence the first place was occupied by depressive states (in 34% of cases), then anxiety and asthenic ones (in 28% and in 22% of cases, respectively). Dissociative and phobic manifestations were diagnosed in 16% and 12% of women, respectively. Co-morbidity of psychopathological syndromes has been revealed in 42% of the examined. Thus, mental disturbances in dysmenorrhea are represented by their high prevalence what exerts negative influence on social adaptation, course and prognosis of the illness. Obtained data base the necessity of creation of highly effective therapeutic and preventive strategies used in these disorders in psychiatric and gynecological practice. The investigation has been performed within Grant of President of Russian Federation for state support of young Russian Scientists (№ of Grant МК-3743.2008.7).

The development of clinical psychotherapy R.K. Nazirov, V.V. Holyavko, S.V. Lyashkovskaya, V.Ya. Sazonov St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The need to integrate the vast world of psychotherapeutic directions, methods, models and approaches in the medical organizational and methodological context 434


frame serves to established conception of clinical psychotherapy – to make a scientific leap – to become a postnonclassical science of “rules” of the phase transition, described by this same scientific paradigm – revolutionary, without intermediate steps. One interesting aspect of clinical psychotherapy research will be subjectivism – language systems will be “objectified” by an important part of clinical psychotherapy – clinical linguistics, which, along with psychopathology, clinical psychology becomes one of its integral components. The concept of clinical therapy as a postnonclassical medical science will require a rethinking of the system approach: it would be based on complex systems arising from the chaos, capable of self-organization and goal-setting; a causal relation with equal force can work from past to future and turnover; the basis of psychotherapeutic intervention need to be reviewed – complex system (such as a identity, for example, or neurotic disorder), the extremely stable, but in special cases are able to perceive the super-weak impact. Perhaps with these positions we will be able to finally explain the scientific reasons for almost equal effectiveness of long-term and short-term forms of psychotherapy. On the practical side, valid assignment of components of the individual psychotherapeutic program is determined by a system of psychotherapy targets taking into account indications and contraindications as: 1) clinical condition of the patient; 2) his personal and psychological characteristics; 3) level of socio-psychological adaptation in a specific clinical situations; 4) features of the psychotherapeutic contact in the dyad “therapist–patient”; 5) proven ability of selected psychotherapeutic method. Clinico-psychological analysis of all these groups of factors may determine indications to the choice of main psychotherapeutic method on a particular stage of treatment, necessary forms of psychotherapy, as well as application supportive methods of psychotherapy and psychosocial rehabilitation. The idea is simple on one hand, but on the other... The fact that one of serious limitations of current models of “monomethodic” psychotherapy is a claim of virtually

435


all “major” psychotherapeutic techniques as panacea: a gestalt therapy would never justify the need for the use of dynamic psychotherapy and vice versa. A clinical psychotherapy as it is above all psychotherapeutic methods – it is interested exclusively in clinical effectiveness, so the base is not a methods of psychotherapy, but its possibility to solve concrete problem in the structure of individual psychotherapy program of a particular patient. In conclusion, it should be emphasized that the realization of this concept at present faces a great lack of scientific information. This, however, should not lead to the temptation to abandon the medical model of psychological care. Simply, we face many challenges on the organization of scientific research.

The development of outpatient psychotherapy R.K. Nazirov, S.V. Lyashkovskaya, M.B. Remeslo, V.V. Holyavko, V.Ya. Sazonov St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The development of theoretical, practical and organizational prerequisites for outpatient psychotherapy is determined by growing importance of institutions of partial hospitalization in the system of psychiatric and psychotherapeutic aid, as evidenced in various study results and actively developing number of substantive topics. In scientific and practical premises of outpatient psychotherapy is included the use of psychotherapy in a neuropsychiatric dispensary, the patient’s clubs, its combination with therapy employment therapy, the departments outpatient psychiatry, the region's psychotherapeutic center, as well as the worldwide trend toward deinstitutionalization of mental health services and the development of outpatient psychiatry. Combined application of different methods and forms of psychotherapy with the implementation of the brigade form of psychological counseling may be implemented on the basis of a clinical unit with ambulatory psychotherapy (nosocomial psychotherapeutic center), which can be regarded as a separate (fourth) main form of psychotherapeutic assistance, along with available and proven to work in Russia (psychotherapy study, psychotherapeutic hospital and regional psychotherapy center). 436


Outpatient psychotherapy as a research and practical conception that can be viewed as the embodiment of modern clinical-psychotherapeutic approach, which would allow clinical integration of various methods and forms of psychotherapy, using technology of controlled social environment, and create differentiated and dynamic conditions for psychotherapeutic treatment of a range of mental illness outside the hospital. The term “outpatient psychotherapy” was proposed by J.V. Popov, N.G. Neznanov and R.K. Nazyrov in 2003. In the same year began practical implementation of ideas of outpatient psychotherapy and its brief history: in the V.M. Bekhterev Institute in 2003 was created the cabinet of outpatient psychotherapy, and in 2006 it was reorganized into the Department of outpatient psychotherapy and rehabilitation of mentally ill. Over the seven years of its existence, as experience was gained, the scientificorganizational system of outpatient psychotherapy was elaborated, adapted and modernized, such as: planning, patient flow and qualification filling department, organizational support of the department work; structural and functional elements of the department functioning; differential treatment for patients; the individual structure of psychotherapy programs; management of quality of ongoing assistance. In the department the is provided psychotherapeutic care for patients with a wide range of patients with mental disorders self-seeking aid and choosing ambulatory psychotherapy at admission, patients sent from the hospital psychotherapy department for “ambulatory aftercare”, as well as patients undergoing treatment at other departments of the V.M. Bekhterev Institute.

Existential-oriented group therapy for the patients with schizophrenia G. Nyukhalov Regional Psychotherapeutic Center of the Orenburg regional clinical psychiatric hospital №2, Russia The great value was always given to psychotherapy in treatment programs for the patients with schizophrenia. It has been described by many authors. Most part of researches is based on foreign experience or has mainly experimental character. 437


Existential approach to psychotherapy is one of the most dynamic and developing, both in Russia and abroad. This direction has its theoretical foundations in Europe (K. Yaspers, L. Binsvanger, M. Boss, V. Frankl), as well as in the U.S. (P. Tillich, R. May,

J. Bugental,

I. Yalom)

and

Russia

(L.I. Shestov,

N.A. Berdyaev,

M.K. Mamardashvily). Nowadays

the

most

efficient

and

economical

is

short-term

group

psychotherapy. However, the group psychotherapy for patients with schizophrenia is a little investigated. Subject of present research is development of existential-oriented group therapy (EOGT) for the patients with schizophrenia. Research tasks are: – To describe a theoretical basis of the EOGT for the patients with schizophrenia; – To develop the setting for the EOGT for the patients with schizophrenia; – To investigate processes and mechanisms of therapeutic action of the EOGT for the patients with schizophrenia; – To find out dynamics of specific individually-psychological characteristics of group participants; – To determine the similarities and differences in EOGT at inpatient and outpatient stage of complex treatment and rehabilitation program. 120

schizophrenic

patients

have

been

studied

in

the

Regional

Psychotherapeutic Center of the Orenburg regional clinical psychiatric hospital № 2. The diagnostic process was corresponded to criteria of ICD-10. The psychological investigation was being carried out before the interference and after therapy. The tests were: – SJO (PIL) The Purpose in Life test (Leontiyev D.A., 2006); – Self-actualization test (Kalina N.F., 1993); – The Ways of Coping Questionnaire (Lazarus R.S., Folkman S., 1980); – Coping strategy investigation method (Heim E., 1988); 438


– Symptomatic questionnaire SCL-90-R. For the first time in Russia the EOGT for the patients with schizophrenia is described and investigated. A pilot study of specific psychological characteristics is spent. The EOGT for the patients with schizophrenia is short-term, cost-effective, it considers the biopsychosocial approach. There is a possibility of application this group therapy into any phase (inpatient and the outpatient) of contemporary complex treatment and rehabilitation programs. Also it can increase the efficiency of program. This therapy has been introduced and successfully applied in inpatient ward of dynamic psychiatry. It continues to be effectively applied in the Regional Psychotherapeutic Center of the Orenburg regional clinical psychiatric hospital № 2.

Specialized psychiatric care at the end of lipe S.S. Odarchenko Omsk Clinical Psychiatric Hospital, Russia State of psychological, mental and physical health of the population of Russia continues to serve as the most important effective indicator of the development of dynamic situation and prognostic characteristic of public life. Essential parameters in the assessment of optimal possibilities of formation of healthy harmonic personality are gender and age indices. National priorities at the contemporary stage of coming-tobe of public and individual health originate from many-century strategies of providing family and personality well-being, comprehension of moral values and traditions of past life, perfection of the atmosphere of consent, mutual support in the system of relations of “fathers and children”, development of spirit of collectivism and heredity. In this context of extraordinary relevance is strive of the personality at all stages of its vital activity for mobilization of all biopsychosocial

“factors of

stability”

(I.V. Davydovsky), providing obligatory and effective activation of reserve abilities of every individual under contemporary conditions of increasingly complicated public life. Achievement of desired result in the line of providing the successful and favorable life in final phase of its dynamic is possible during many-sided complex, 439


differential, individual (with account for age, sex, sociocultural and other peculiarities) influence on social and biological basis of the personality depending on its dynamic characteristic. Rendering the effective assistance to the man at finishing stage of his vital activity is accompanied by potentially significant and fully evidence-based improvement of emotional and physical life. It is achieved during coordinated efforts of medical, psychological and social workers in close collaboration on overcoming anxious, depressive, suicidal, and painful and the other body experiences of an elder, aging individual. On this way the special weight should be contributed by borderline gerontopsychiatrists those are working “in the foreground” of assistance rendering to patients in the end of their life, in acquirement by them of “last resort”, in satisfaction of thirst for happy and beneficial existence. It is necessary up to the end of one’s days to maintain vital optimism, love of fellow men, kind-heartedness and inexhaustible energy, think about biological wasting away philosophically, and ready for calm and balanced assessment of one’s last, inevitable mental crisis. The special attention is worth to pay to issues influencing on decision of gerontopsychiatrists and psychiatrists to provide assistance to insufficiently covered geriatric population. Physicians and social workers who observe in their personal practice geriatric patients should participate in focal discussion of groups investigating factors impacting characteristics of their current practice. Personal topics, issues of the environment and quality of teaching are important parameters interacting in the final choice of the practice. The main trend within training programs should include perfection of knowledge by teachers themselves, various exposures of patients and teaching to them of essential kills of high quality. These programs should rely on objectively significant evidence aimed on better preparation of residents and improvement of probability of the choice regarding introduction of geriatric patients into their practice. Evolutionary (ontogenetic) approach during consideration of psychogenias of later period of life envisages differentiating the studied contingent according to 2 phases of age dynamic – involutionary stage of old regress. The most perspective here must be to consider development of scientific trends associated with perfection of 440


specialized geriatric subdivisions, creation of medico-genetic service for assessment of status and corresponding correction of combined pictures (including borderline and addictive ones). Complex psychotherapeutic work with such patients should be conducted by the way of rational resolution of specific psychological problems occurring in every of age phases and “crises”. The most relevant section in this direction is to recognize forming the new facilities of psychological and psychiatric service within distinguished by us borderline geriatric psychiatry. Manifesting in recent decades trend of aging of the population requires the allsided modernization of various fields of the life influencing on economic, social, demographic and moral development of the society. Under contemporary conditions the aim of sociotherapeutic and medication impact is not only removal of psychopathological manifestations but modification of abnormal style of life, improvement of its quality under conditions of real being, prevention of clinical symptoms at earlier (premorbid) stages of dynamic.

Dance psychotherapy in rehabilitation of patients with paranoid schizophrenia with dificiency disorders N.Yu. Oganesian Medical Academy of Postgraduate Education, St. Petersburg, Russia Nowadays due to the growth of treatment cost of psychiatric patients it’s actual that psychotherapeutic treatment in in-patient departments exists, but also development of psychotherapy methods that help to carry out the supporting therapy after patient’s leaving the in-patient department at dispensary observation. Dance psychotherapy as non-verbal method allows carrying out the correction of motor, emotional and behavior skills of schizophrenic patients. Kinesthetic skill turns out to be the basic pattern language of schizophrenic patients by means of which body starts to recollect psychically its feelings and produce ways of self realization from outer space. Aim of research – development of theoretical concept, system of methodological ways and criteria to evaluate the efficiency of dance psychotherapy that allow to explore its influence on psychomotor system of patients with paranoid 441


schizophrenia with dificiency disorders at rehabilitation stage that influences resocialization process. Object of research – schizophrenic patients with dificiency disorders (n = 300), that were treated at psychoneurological department at CPH № 6, and (n = 40) in CPH № 6 at present. Dance psychotherapy practice that is its reduced form of ten sessions, that was carried out in CPH № 6 and at in-patient department allows saying about successful combination of individual and group forms of work in rehabilitation of schizophrenic patients. In psychomotor dynamic research of schizophrenic patients there were used psychological methods apart from methods “Analysis of corporal intellect component” and “Corporal analysis” (based on video sessions) that were generated by the author, and those allow to add the research of clinical finding of schizophrenic patients at different psychic levels, marked by L.M. Vekker. Paranoid schizophrenic patients with dificiency disorders while dance psychotherapy show quite adequate evaluation of motor-emotional and communicative expression during dance (94%) apart from motor improvement (95%), verbal expression of situational emotions (87%), stated above is supported by mathematical evaluation of research results (p < 0.001). This can be explained, in our opinion, by using more understandable ways of kinesthetic communication as stimulus material is dance and movement itself that influence indirectly on verbal skills. Summarizing, the introduction of dance psychotherapy into complex of clinical and psychological interferences allows intensifying the rehabilitation process.

Incidence and correlates of delirium in a West African mental health clinic B.A. Ola MBChB, FWACP, FMCPsych, Nigeria Objective: To determine the incidence of delirium in those patients presenting to a psychiatric clinic in Nigeria and to examine if any demographic or clinical variables were correlated with this diagnosis. 442


Method: A prospective survey design; 264 consecutive new referrals to a psychiatric clinic in Nigeria were assessed for the presence of delirium using a standardised diagnostic scale. Data was analysed for normality and appropriate statistical test employed to examine the relationships between the presence of delirium and demographic and clinical variables. Results: Of individuals presenting to the mental health clinics, 18.2% had delirium. No demographic variable was significant regarding the presence or absence of delirium. With regard to clinical variables duration of current symptoms, referral source and the presence of comorbid physical illness were significantly associated with the presence of delirium. Most delirium was due to infections. Nearly all patients with delirium were prescribed psychotropic medication (95.2%), and most attributed their symptoms to a spiritual cause. Conclusion: Delirium presents more commonly to psychiatry services in the less developed world compared to the West. Development efforts should focus on recognition and management of delirium to improve outcomes and maximise resources.

In-patient factors affecting empathy and affiliation of personnel Ye.S. Orudzhev, Ye.A. Kozlenko, Ye.Yu. Zubova Volgograd State Medical University, Russia Volgograd Regional Psychiatric Hospital № 1, Russia Stigma as biased negative assessment of another person having psychiatric disorder affects emotional attitude of personnel towards the patients. Allowing for the stigmatization problem when delivering in-hospital health care, we believe that nosologic type and history of the illness might affect the empathy and affiliation of health care and social workers. In order to determine the impact of in-patient factors on empathy and affiliation of personnel of Volgograd Regional Psychiatric Hospital No. 1 we have interviewed 256 health care and social workers using special author's questionnaire. 443


The presence of certain psychiatric disorder determined the levels of empathy and affiliation of the personnel and their attitude to educational and professional activities of the patients. Thus over the half of health care and social workers interviewed believe that patients with schizophrenia (74.0%), dementia (72.5%), intellectual retardation (70.2%), organic personality disorder (64.9%), epilepsy (64.2%) and alcoholism (51.3%) after being discharged from the hospital need only elementary intellectual activities (watch TV, read slick fiction) when using disability benefits, since benefits and social security of those having psychiatric disorders give them a chance to reduce physical load and give up work activities. Moreover, those interviewed believe the patents diagnosed with alcoholism require elementary intellectual activities definitely rare than those with schizophrenia (p = 0.01), dementia (p = 0.01) and intellectual retardation (p = 0.01). Significantly less number of interviewees share the opinion that after being discharged from the hospital patients with alcoholism (42.3%), organic personality disorder (25.3%), intellectual retardation (17.0%), schizophrenia (14.7%), dementia (11.3%), and epilepsy (10.2%) shall have conditions created for professional self-fulfillment. Besides, health care and social workers believe that patients with alcoholism shall have conditions for professional activities being created definitely more often than those with schizophrenia (p = 0.01), intellectual retardation (p = 0.01), dementia (p = 0.01) and epilepsy (p = 0.01). Minor part of the interviewees agreed that patients with epilepsy (26.0%), dementia (12.5%), schizophrenia (11.3%), intellectual retardation (11.3%), organic personality disorder (10.2%) and alcoholism (6.0%) shall have favorable or special working conditions (shorter hours, no frequent contacts with people). Therefore, the lowest level of empathy of psychiatric hospital personnel and reduced affiliative trends in relationships with the patients is determined by psychiatric disorders being predominant for patients with schizophrenia and alcoholism.

444


The influence of stigma on results of treatment and rehabilitation of combatants A.V. Ostapenko, S.A. Kolov Volgograd Regional Clinical Hospital for Combat Veterans, Russia Introduction: The support provided by surrounding environment and influential people gains considerable significance for normal adaptation of combatants in the remote period of combat stress. Stigma proves to be an important factor for psycho-social dysadaptation of combatants. The objective of the present study is to evaluate the impact of stigma on therapy results. Material and methods: The study involved a total of 395 people, among them 299 combatants and 96 members of the medical staff treating them. The first group consisted of 209 combatants receiving milieu-therapy in the Psychotherapeutic ward of the Volgograd Hospital for Veterans. The second group of 90 combatants was control. The third group comprised 18 medical men dealing with the 1st group; the fourth group included assisting medical staff. The third group, in comparison with the fourth one, showed a higher level of personal involvement and awareness of veterans’ problems. To evaluate the obtained results Symptom Check List-90-Revised instrument (SCL-90-R) was applied. Social-psychological method was used for estimating stigma alongside with our own modified stigmatization questionnaire. Results and discussion: It was found out that unlike the second group (Δ 2М3-М4 ) the first group demonstrated credibly better results of treatment (i.e. reduction of measures)

for

every

scale:

Somatization

(p < 0.001);

Obsessive-compulsive

(p < 0.0001); Depression (p < 0.0001); Anxiety (p < 0.0001); Hostility (p < 0.0001); Paranoid ideation (p < 0.001) and so forth. The analysis of stigma showed that stigmatization proved to be higher for many indices in the fourth group in comparison with the third one. The respondents from the third group take more seriously psychic status of the combatants (p < 0.001), consider them to be more responsible for their families (p < 0.01) and work 445


(p < 0.001), to be trustworthy (p < 0.05), and are more optimistic about treatment of such patients (p < 0.05) and etc. Conclusion: Thus, a higher level of stigmatization shown by the medical personnel leads to worse results of treatment. Elaborating complex measures aimed at destigmatization of medical men may significantly improve therapy results for such patients.

Using typical and atypical neuroleptics in therapy of patients with paranoid shift-like schizophrenia with organic stigmatization S.A. Ovsiannikov, T.Ju. Balanina Moscow State University of Medicine and Dentistry, Russia The treatment of atypical neuroleptics paranoid schizophrenia is being discussed actively with its advantage of less expressed extrapyramidal side effects. We have studied 100 patients with paranoid shift-like schizophrenia with organic stigmatization. The main of our evidence was comparative analyzis of therapy atypical and typical neuroleptics. It was found that using atypical neuroleptics could not stop acute delirium status and formed quality remission. Monotherapy of atypical neuroleptics show the less effectiveness in this group of patients under study by comparison with other variants of therapy with expressed effect. The combination of two atypical neuroleptics is unimportantly surpassed monotherapy. In group of patients who took typical neuroleptics, the numbers of courses with expressed effect were prevalent when using “traditional doses”. In group of patients who took atypical neuroleptics all the patients had side effect such as weight gain, especially when using monotherapy. On the base of our data most effectiveness was found that the least expressed neurological and metabolic side-effects showed variants of therapy of typical neuroleptics in “minimum-sufficient doses” and combination therapy of atypical and typical neuroleptics. 446


Psychological factors of social anxiety T. Pavlova, A. Kholmogorova Moscow State University of Psychology and Education, Russia Research goal: Our research was devoted to psychological factors of social anxiety. The aim was to explore the link between psychological factors (personal, interpersonal and familial) and social anxiety in youth and children. There were three groups of people being tested (167): students of linguistic specialty (40 people), children of preschool age (101 children) and parents of these children (22 people). Methods: It has been elaborated a battery of 11 tests, measuring emotional state (Beck Anxiety Inventory, A. Beck et al., adaptation N. Tarabrina; Beck Depression Inventory, A. Beck et al., adaptation N. Tarabrina), personality traits (Perfectionism Inventory, Garanian, Kholmogorova, Udeeva; Hostility test Garanian, Kholmogorova; Personal Beliefs Questionnaire PBQ J. Beck, A. Beck), quality of interpersonal relations (Perceived Social Support Scale F-SOZU-22, Sommer, Fydrich), family dysfunctions (Inventory of emotional communications in family, A. Kholmogorova, S. Volikova), social anxiety symptoms (Scale of social avoidance and distress, SADS, Watson, Friend; Scale of fear of negative evaluation, FNE Watson, Friend; Brief Social Phobia Scale (BSPS), Questionnaire for child’s shyness expert assessment). Results: The results of students’ selection showed that subjects with high levels of social anxiety have higher levels of anxiety and depression. Subjects with high levels of social anxiety showed higher levels of hostility and perfectionism (particularly to scales “attributed to others perfectionism”, “high standards of activity”, “polarized thinking” (thinking in terms of “all or nothing”), and “emotional control”). Data of hostility were similar to patients with anxiety and depressive disorders (according to Udeeva and Garanian research). High level of social anxiety is significantly more common for subjects with dominant dependent and avoidant types of character (by A. Beck classification).

447


Level of social support is significantly lower in subjects with high level of social anxiety. More shy people notice that they have fewer acquaintances that are able to help them by taking care of the apartment or provide moral support for example. According to results of students’ selection, such family factors as high levels of parental criticism, induction mistrust to other people, parental overembeddedness in child’s life are significant in development of high level of social anxiety in children. In senior preschool age, according to results of expert assessment, about seventy percent of children have problems associated with social anxiety. According to the results of study family factors of shyness in parent-child selection, parents of more shy children are tend to blame their children for acts of anger and aggression, to be angry at manifestation of dissatisfaction from their children and often criticize their children for the mistakes they made.

Gerontosexology today A.Y. Perekhov, V.A. Soldatkin Rostov State Medical University, Rostov-on-Don, Russia In society there are many preconceptions associated with sexuality in old age. The modern society itself produces the phenomenon of ageism – bias to people on the basis, that they are old. Among women of age 55–59 years 40% did not have sex the last 3–4 years, among women aged 65–70 years this percentage reaches up to 70. Only 45% of men aged 75 years report that they don’t have sexual partner. Modern Sexology states that sexual function in humans is the natural and normative almost until the end of life; only the quantitative indicators get down. The overall worsening of health and absence of sexual partners can really complicate the life of old people, but there is no reason to believe that in this age the person should not receive sexual satisfaction. The level of sexual activity of the old person mostly depends not on age and not even on the existence of somatic diseases, but depends on the former sexual activity, presence of sexual partner, or sexual culture. In old age dramatically increases in percentage the number of sexual disorders related to somatic disorders. From the primary (inorganic) potency disorders meets abstinent form associated with a big interruption in sexual 448


activity (“detraining”) in old people, denying not only from the paired sexual activity, but also from masturbation. Reliably increases sexual dysfunction in old people due to rise in mood disorders (depression and the various options of anxiety states). Big problem remains provoking sexual disorders by medication (in age 65–70 years the average number of drugs taken daily – 4.5 names). These drugs include: histamine receptor blockaders, glucocorticoids, hypotensive medications, antidepressants, neuroleptics, tranquillizers, barbiturates and many others. Of particular interest are sexual problems for aged persons, i.e. over 75 years. We identified that men have following problems: lack or severe decline of erection – 58%, the absence of ejaculation and orgasm – 25%, fear of failure – 27%. It should be noted that even in aged persons, psychological (neurotic) problems occupy a big proportion in the structure of sexual disorders.

The violation of ethical norms of veracity in modern Russian psychiatry A.Y. Perekhov, V.A. Soldatkin Rostov State Medical University, Rostov-on-Don, Russia The norm of veracity in medical ethics is relatively new requirement, which occurred due to concretization of patient’s autonomy principle. It implies the duty of doctor and patient to speak the truth. Two problems arise before psychiatrists. From one side he knows and can tell the nosological diagnosis, but he is not always sure how the disease will progress in future. On the other side, he understands that patients often want to hear the words, which could calm them down. So arises the tendency to lie him, or tell just a small part of the truth, assuming that the real information will only harm the patient, especially taking in account the stigmatization of many diagnoses. 20 years ago in the psychiatric surveys, 90% of respondents reported that the patient should not be given the information of his diagnosis, about the treatment difficulties and possible complications. But even today in Russia, although in less amount, remains that point of view – up to 55% of physicians believe the closed information to be justified. They often refer to the need of medical secrecy, which is ridiculous, as medical secrecy is the duty of the doctor to keep the patient’s information confidential from another people and not from the patient himself, and these problems regard to privacy and not to veracity. 449


In daily life a large number of patients while discharging from the hospitals do not receive any information about their diagnosis; many of them get extremely vague, inaccurate information. Almost no one of patients has on hand extracts from the medical history; at best they have information about cipher of their diagnosis as per ICD-10, for ambulatory psychiatrist. In excuse of this they bring many legal provisions on secrecy of information for seriously ill patients. In fact, a physician does not want to spend time and effort on writing medical history, detailed interview with the patient, the reasoning of his diagnosis, as well as atavistic fright, delayed since totalitarian power. Another explanation of concealing diagnosis is related with the dominant principle of paternalism in the Russian Psychiatry, when all mentally ill patients are perceived as “foolish children”. There is a whole system of moral justification like this approach: information of the diagnosis may worsen mental condition of the patient, arouse depression, and provoke suicide. “The deception for the benefit” according to this point of view – it is a big benefaction. However, the violation of ethical norms of veracity by psychiatrists often carries a triple damage: (a) delivers moral suffering to patient, humiliating his human dignity; (b) pandering xenophobic sentiments towards persons with psychic disorders, strengthening their alienation in society; (c) marking psychiatry as dehumanizing part of medicine. Almost always mentally ill patients want to hear from doctor the information about his illness. But in fact they don’t have interest in medical terminology, but explanations of what is happening with them. According to us mentally ill patients should receive true information about their diagnosis both orally and in writing, except only those patients, who due to their psychic condition don’t understand the value of their actions or cannot motivate them.

Psychic disorders and rehabilitation in heart failure patients N. Petrova1, A. Kutuzova2 1 St. 2 I.P. Pavlov

Petersburg State University, Russia

St. Petersburg State Medical University, Russia

Emotional disorders are well-known in heart failure (HF) patients. Recent randomized studies have demonstrated that moderate long-term physical training 450


reduces HF patients’ (HF) decreased exercise capacity and dyspnoea. Possibly the positive effect of cardiac rehabilitation could be associated not only with the endhurance increase. The objective is to assess the effect of in-hospital individual moderate both psychological and physical rehabilitation in HF patients. Subjects: Stable 280 patients (193 male, 87 female, age, 61 ± 0.8 years) with ischaemic stable HF (most of them II (45%) – III (37%) NYHA class) were randomized to training (n = 173) or control (n = 107) group. The programme consisted of every day

continuously-increasing

moderate

walking,

psychotherapy

and

psychofarmacological treatment. The quantity of sessions depended on hospital stay endurance. Methods: 6-minute walk test (6WT) and quality of life (QoL) (SF-36 Health Survey), Zung and Spielberger self-rated scales, Life-Style Index; coping-strategies (Haim test) were assessed at baseline, pre-discharge 3 and 12 months after discharge. Pain, fatigue, palpitation, dizziness, shortness of breath and legs tiredness appearing during 6MW were evaluated using Borg’s Category-ratio scale, the ratios were summarized. Results: QoL and 6MW results did not differ between two groups at baseline, 52% of the patients were depressed and 95% of them had anxious disorders. Psychological adaptive strategies were strained (p < 0.03) and dominating coping behaviour was nonconstructive. The prevalent reasons of low 6 WT performance (< 300 m) in NYHA I-II patients were depression (ß = –0.171; p = 0.013) and anxiety (ß = –0.212; p = 0.05). The expected outcome of psychosomatic approach to treatment was QoL improvement (p < 0.05) and 6WT increase (p < 0.001). Control group patients had less pronounced effect on QoL exercise capacity and subjective 6WT tolerance (p < 0.05). Extra benefit of physical rehabilitation was associated with affective disorders improvement (p < 0.02). Patients who completed treatment programm exhibited normalization of depressive symptoms while control group patients happened to stay depressed (p < 0.02). None of the changes in control group were significant (p > 0.05). Conclusion: Extra benefit of physical rehabilitation was associated with depression and anxiety decrease in ischaemic HF patients. 451


Psychotic episode in schizophrenic patients N. Petrova St. Petersburg State University, Russia The sample of 70 schizophrenic patients was observed. Women were 45% and men 55%. 22% of patients were patients were married. 19% were students. The patients were in the age group: 17–58 (age 38.2 year). The most common type of schizophrenia was Paranoid Schizophrenia (65%). On the second place came F23 (10%) acute and transient psychotic disorder: F23.1 (Acute polymorphic psychotic disorder with symptoms of schizophrenia) and F23.2 (Acute schizophrenia – like psychotic disorder) were encountered. On third place was F20.6 Simple schizophrenia (9%). The age of onset of the schizophrenia varies between men and women, where males tend to have a younger onset. Male patients showed more frequent pretrial symptoms in negative, cognitive, and obsessive-compulsive symptom dimensions than female patients did. In psychotic episode negative symptoms and attenuated positive symptoms were frequent in males, whereas attenuated positive symptoms and mood symptoms were frequent in females. The women had less days of treatment than man. The outcome did not seem to depend on the work status of the patients. The outcome seems to be better for patients with a job. People with high education had 81 days of treatment in average. It is 16% less than total average. Atypical antipsychotics were prescribed to 19% patients and 85% had positive outcome. Typical were prescribed to 26% patients and 83% had good outcome. Both atypical and typical were prescribed to 49% with 91% good outcome. 84% of all patients had positive outcome after the treatment in hospital. 76% of the men had positive outcome and 90% of the women had positive outcome. Divorced women with high education, job and receiving therapy with both atypical and typical antipsychotics got the best results in this sample. So, the antipsychotic drugs that were most effective in the treatment of schizophrenia were atypical and typical antipsychotics prescribed together. It is perhaps so that married people, people with high education have better outcomes after treatment. The worst prognosis has widows. Men need more days for treatment compared to women. The outcome did not seem to depend on the work status of the patients. The outcome 452


seems to be better for patients with a job. The side effects have shown influence on the level of compliance of patients as well as social factors. Atypical antipsychotics are associated with lower risk of post schizophrenic depression.

Quality of life and psychosocial adjustment to aging N. Petrova St. Petersburg State University, Russia The purpose of this study was to describe and compare the health-related quality of life (QoL) in aging and in order to test the applicability of the SF-36 in this population with different disorders (heart failure, diabetes, brain dysfunction). The QoL data were obtained from psychological methods: The Wechsler Adult Intelligence Scale (WAIS) – measure of intellectual assessment; the Lucher Color test, Sixteen Personality Factor Questionnaire (16 PF, Cattell), the Level of Subjective Control aimed at studies of locus of control, Test on Coping Mechanisms by E. Heim, Toronto Alexithymia Scale (TAS) and linked with comorbidity and clinical data. Evaluative procedures included linear, multiple regression and factor analysis. 60 aging men (age – 62.7 ± 9.05 years) were investigated. Compared to general population, they experienced lower values of QoL in the majority of figures, especially for physical functioning, social activities, vitality and bodily pain scales. The differences in QoL between groups of patients were shown. The positive dynamics of QoL is associated with the improvement of results of the “six minute walk” test. Psychological features of aged people were described. Frustrated necessity in communication and recognition, psychological dependence were found out. Social activity (volunteer) is considered to be one of the effective coping in aging for people with internal locus of control in the sphere of interpersonal interaction. The prevalence of constuctive coping mechanisms and the ability to solve the problem may co-exist with neurotic conflict “between aim and behavior”, with the dominant of the obstacle. The cognitive dysfunction and emotional instability are typical. The effect of psychological and pharmacological treatment is discussed. We can conclude that QoL 453


must be strongly suggested as one of the measurements indicator that demonstrates psychosocial adjustment to aging.

Classification of mental diseases the author’s vision B.N. Piven Altai state medical university, Barnaul, Russia On the basis of his own large clinical experience and results of vast scale researches of patients with exogenno-organic diseases of brain, depressive disorders and comorbitic forms of mental pathology the author considers the requirements which, in his opinion, the classification of mental diseases should conform to. The classification should cover and reflect a wide range of information concerning the essence of mental pathology. And sections of the classification should be reported with the help of common methodical and methodological approaches. The classification should be based on the acquired experience and methodology of different psychiatric schools and directions and thus assist to dialogue and mutual understanding of their representatives. The nosological principle should be the most important one for the classification construction. The classification should contain the idea about perspective development of mental pathology. And it should have the ability for improvement according to new knowledge in psychiatry. The indispensable requirement to the classification is its simplicity and proper practical application in diagnostic process, training psychiatrists at all its stages, in research activities. Due regard for requirements a number of operating ICD lacks is considered to eliminate them in a new variant. The accurate exposition of the section “Organic, including symptomatic, mental disorders” with differentiation of the headings entering is necessary. It is essential to differentiate depressions on nosological accessories as efficiency of their treatment is in defined on the account of their nature. 454


It is imperative to introduce the section devoted to comorbidic forms of mental pathology in classification. These forms occupy an important place in the general structure of mental diseases. They have the clinic-dynamic regularities dictating necessary diagnostic approaches and both medical-rehabilitation and preventive measures.

Disturbances of the chronophysiological mechanisms in maniacal states S.V. Platov Psychoneurological City Dispensary № 7 (with an in-patient department), St. Petersburg, Russia Topicality of the problem: The concept of disturbances of the normal rhythmical organization is one of the most used hypotheses for the explanation of the pathogenesis of formation of polar affective disturbances. Depressive states serve as a model of these theoretical constructs, the former are tied up with the two premises: on the one hand – disturbances in the circadian system of regulation, on the other hand – neurobiological vulnerability, mainly in the form of genetically predetermined defects at the neurotransmitter level. The chronobiological organization of organism can be defined as hierarchically organized multyfrequency spatial and temporal system of biorhythms. When the proportion of these integrated functions is disturbed as it can be case in certain mental disorders, changes can arise in mood, cycle of sleep and wakefulness, fluctuations of temperature and changes in the secretory fluctuations of hormones. In this case often it is difficult to say definitely, which role these deviations play – predictive, final or epiphenomenological, however there have been accumulated much enough evidence of the role of the endogenous circadian system in pathophysiology of these disturbances. Biorhythmic investigations of pathophysiological mechanisms of the other pole of affective pathology – maniacal states – look still less effective. They are mainly focused on the dynamic evaluation of developing attacks of maniacal structure bearing transient character (fast cycles) as well as variants of inversion of phases and circumstances contributing to them considered from chronophysiological positions. 455


The influences of the environment (light or darkness) as well as behavior (sleep or lack of it) on the development of maniacal states are evaluated. The cases of polar affective disturbances in males as the objects devoid of the clearly marked rhythmic of physiological hormonal fluctuations were of especial interest. The aim of the study: Investigation of the disturbance of chronobiological mechanisms of development of maniacal states from the viewpoint of the sleepwakefulness cycle displacement and mobility of psychophysiological parameters with determination of the peak of diurnal activity and correlation with the clinical manifestations. Materials and methods: 28 male patients satisfying the BAD (bipolar affective disturbances) criteria were examined, 11 of them presented classical manifestations of hyperthymia, and in 17 maniacal states had heterogenous properties. The control group included 32 persons. Our investigations comprised analogous groups of patients subject to maniacal states (in gradations of the Beck-Rafaelsen and Young Scales), duration and stability of existing disturbances, their situational correspondence to the time of the day, as well as monitoring of the sleep-wakefulness and relaxation-activity rhythms being under comparison. Techniques used included those recording indexes of particular psychological functions, methods of actimetry with monitoring of the relaxation-activity cycle and registration of indicators allowing to evaluate relative amplitude (maximum-minimum), stability within 24 hours (power of interaction with the rhythm setting factors) and day-after-day variability (degree of fragmentation). Results and discussion: The results of the study carried out are indicative of the existence of certain correlations between the clinical type of maniacal state and the signs of phasic displacement of the sleep-wakefulness and relaxation-activity cycles with the peak of diurnal activity registered with corresponding techniques. The earlier time of the day was occupied by the displaced phasic activity the less marked was heterogeneity of the symptomatology and the more the clinical picture approached the simple mania. Respectively in the cases of more complex maniacal pictures no marked displacement of phasic activity was traced.

456


Thus the clinical picture of maniacal states with predominance of “pure” manias serves as the determinative moment in the evaluation of the rhythmic discoordination and displacement of phasic activity in maniacal states to the earlier time.

Exogenous organic brain diseases of people with pulmonary tuberculosis A.V. Plotnikov Altai Psychiatric Hospital № 3, Barnaul, Russia Altai State Medical University, Barnaul, Russia It’s generally accepted that exogenous organic brain disorders are one of the most widespread form of mental pathology. That kind of disorder was detected with a big frequency in patients suffering from tuberculosis, creating additional difficulties in treatment sick of tuberculosis. Therefore, the problem of a combination of mental disorders, in particular, organic disorder of a brain, and tuberculosis of lungs, is rather topical. Nevertheless, there are not a lot of contributions about this idea. It’s suggested in available scientific literature, that principal causes of the raised disorder of a tuberculosis can be: lowered immunobiological reactance of an organism as a result of painfully changed central nervous system, caused by a psychosis the defective meals or refusal of food, change of hygienic skills and requirements. Absence of social and working activity also is important. Research work is spent on the basis of psychiatric hospital for patients suffered from mental disorders in combination with lung tuberculosis. At present we have investigate all patients treated in 2009 with specially worked up form. The work purpose: To establish clinic-dinamic appropriateness of exogenous organic brain disorders and lung tuberculosis. Research methods: clinical method, pathopsycological method, epidemiological method and statistical method. Research problems: To determine the prevalence of exogenous organic brain disorders in the general structure of a mental pathology at sick of a lung tuberculosis, exogenous organic brain disorders of person with lung tuberculosis, to study influence of tubercular process on a current of exogenous organic brain disorders, to create 457


background for optimization of the treatment-and-prophylactic help to the persons having a combination of exogenous organic mental frustration and a tuberculosis of lungs. In total 152 patients have been treated in 2009. From them organic diseases of a brain suffer 45 (29.6%). From them men 39 (86.7%), women 6 (13.3%). 26 patients at the age of 25–55 years (57.8%), 19 are more senior 55 years (42.2%). On an aetiology organic brain disorders following distribution has been received: toxic genesis 29.41%, traumatic genesis 26.47%, vascular genesis 20.59%, infectious genesis 1.47%, unspecified genesis 22.06%. The onset of mental disorder was earlier in 46.67%, the onset of lung tuberculosis was earlier in 22.22%, the onset at the same time was in 15.56%, we have not exact data about 15.56%. Summary: 1. The problem of organic disorder of a brain at the persons, suffering lung tuberculosis, remains known insufficiently. 2. It is necessary to continue the investigation because the clinical presentation of patients with combination of organic brain disorders and lung tuberculosis is intricate.

From indoor to outdoor care. Review of the reform process of psychiatry in Greece (1985–2009) D. Plounipidis Athens University, Greece Psychiatric practice in Greece has been profoundly modified since 1980’s. The guidelines of the reform have been decided by Greek authorities and they have been actively assisted by the European Union: 1. Creation of a network of outdoor services and sectorisation of these units. 2a. Progressive diminution and closure of traditional psychiatric hospitals. 2b. Diminution of psychiatric hospitals was accompanied by the development of a network of halfway houses and other housing structures in the community. 3. Development of psychiatric beds in general hospitals, more or less seen as an alternative to psychiatric hospitals. 458


4. Mobile units in rural areas. 5. Several units of psycho social rehabilitation of chronic mental patients, 6. Pilot units for autistic and psycho geriatric patients. The reform process has achieved many of its goals; – a very important diminution of beds in psychiatric hospital; – a network of housing units; – a network of outdoor services and rehabilitation units, which are still insufficient. Some crucial problems will be discussed: – networking/sectorisation of indoor and outdoor services; – financing the process of the reform; – harmonization of existing practices with renovating ones. The outcome of a reform process depends on the interaction of the above mentioned material, administrative and also subjective factors.

Calcium channel blockers: an alternative to anticholinergics in the treatment of extrapyramidal symptoms in schizophrenic patients? M.Yu. Popov St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia In certain clinical situations (e.g. acutely agitated schizophrenic patients) currently available atypical antipsychotics cannot be considered the best therapeutic choice, because in general they appear to be inferior to conventional neuroleptics in terms of sedation/inhibition and in time of onset of clinical effects. But the use of the latter medications is limited by their side effects, including extrapyramidal symptoms (EPS). Anticholinergic medications usually used for the treatment of EPS are only partially effective; moreover they may reduce the efficacy of antipsychotic therapy. Thus, new strategies aimed towards alleviating motor side effects of conventional antipsychotics are needed. Among the drugs potentially effective for this indication, calcium channel blockers should be considered. 459


The objective of the study was to evaluate efficacy of nifedipine in the treatment of EPS associated with haloperidol use in schizophrenic patients. Patients with acute episode of schizophrenia were randomly assigned to receive either haloperidol (15 mg daily) or combination of haloperidol (same doe) with nifedipine (60 mg daily) for a period of 6 weeks. EPS were assessed using Barnes Akathisia Rating Scale (BARS), Simpson-Angus Rating Scale (SARS) and Abnormal Involuntary Movement Scale (AIMS). The scales were administered at the baseline and at the end of week 2, week 4 and week 6. Antipsychotic efficacy was assessed by Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression scale (CGI) administered at the baseline and at the endpoint. Data were analyzed using descriptive statistics and analysis of variance (ANOVA). Overall 51 patients were assigned to treatment, 25 subjects received combination of haloperidol and nifedipine, and 26 – haloperidol. No differences between treatment groups in demographic and clinical variables and in the baseline rating scales scores were found. The mean change from the baseline to the end of week 6 in BARS total score was 1.44 (SD 1.80) in combination group versus 1.19 (2.21) in haloperidol group (F = 0.191, p = 0.664). The mean change in SARS total score was 1.04 (1.77) versus 2.08 (2.19) respectively (F = 3.447, p = 0.069). And the mean change in AIMS total score was 0.32 (0.85) versus 0.96 (1.15) (F = 5.100, p = 0.028). No significant differences between two treatment groups in the mean changes from the baseline to the endpoint in PANSS total score and in CGI scores were observed. Thus, two out of three EPS scales demonstrated that adding nifedipine to haloperidol was beneficial: for Parkinsonian syndrome evaluated by SARS and for dyskinesia assessed by AIMS (the latter effect was statistically significant). At the same time nifedipine did not reduce antipsychotic efficacy of haloperidol. These results demonstrate that calcium channel blocker nifedipine might be considered a therapeutic alternative to anticholinergic drugs in the treatment of certain EPS syndromes induced by antipsychotic therapy.

460


Multiple adolescent suicides Yu.V. Popov, A.A. Pichikov St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The actuality of suicidal behaviour is increasing throughout the world. Besides, the number of children and adolescents who performed suicidal actions is increasing significantly. According to WHO’s statistics (2003), Russia is ranked first in terms of the number of adolescent suicides among children aged from 15 to 19. According to the same statistics, every year about 2,500 adolescents commit suicide in Russia. A tendency to repeat suicidal attempts is characteristic for adolescents. The goal of the present work is to reveal psychological factors causing the adolescents to repeat suicidal attempts. In accordance with the goal of this research a clinical psychological examination of 150 adolescents (74 girls and 76 boys aged from 14 to 20 inclusively) has been carried out. Various psychological methods have been used. The patients were divided into 3 groups, 50 patients in each: 1. With one suicidal attempt or steady suicidal intents not repeated in the course of two years of case monitoring (26 boys aged 17.73 ± 2.34 and 24 girls aged 16.71 ± 1.49) 2. With two and more suicidal attempts (22 boys aged 17.73 ± 2.95 and 28 girls aged 16.39 ± 1.88) 3. Without suicidal tendencies (28 boys aged 16.56 ± 2.04 and 22 girls aged 16.76 ± 2.36) – control group. The results of the research showed that the following types of character accentuation are most popular among adolescents with repeated suicidal attempts: lability (1st group – 20%, 2nd group – 30%), hyperthymic temperament (1st group – 15%, 2nd group – 30%), and schizo-hysteroid type (1st group – 12%, 2nd group – 20%). Adolescents with suicidal behaviour differ from adolescents without suicidal tendencies in that they suffer from depression more often (1st group – 55.96 ± 15.58 points out of 100, 2nd group – 58.89 ± 15.63 points, 3rd group – 40.11 ± 7.82 points), but the degree of depression does not correspond with the frequency of repeated suicidal attempts. 461


Comparison of the peculiarities of aggression of adolescents with one suicidal attempt and repeated suicidal attempts showed that there are statistically significant differences

in

negativism

(57.92 ± 21.53

and

67.35 ± 21.09),

suspiciousness

(48.96 ± 26.76 and 63.47 ± 20.87), and sense of wrong (54.94 ± 23.41 and 69.3 ± 21.49). Adolescents with repeated suicidal attempts use such insufficient coping strategies in frustrating situation as “escape” (13.40 ± 4.54), “estrangement” (9.26 ± 3.15), which are characteristic for adolescents with suicidal tendencies on the whole, but adolescents with repeated suicidal attempts are more eager to seek for social support in comparison with adolescents with one suicidal attempt (11.92 ± 2.63 and 10.31 ± 3.54). Thus, on the ground of the obtained data, we can conclude that psychiatrists need a complex approach towards adolescents with repeated suicidal attempts including mandatory psychological examination with the choice of a more targeted psychotherapeutic aid depending on the level of different types of aggression, psychic tension, depression, and use of coping strategies.

Psychotherapeutic work with adolescents V.A. Potapova V.P. Serbsky National Research Centre for Social and Forensic psychiatry, Moscow, Russia Psychotherapeutic work with an adolescent is very difficult – he/she is hardly constrained within dyadic therapeutic relations. It is enough difficult in the therapeutic situation to find the correct distance, observe the cadre because he/she is constantly confronted by the adolescent in the same way his/her intra-psychic space is confronted by his/her sexual fantasies, biological drives coming from the changing body. The adolescent is running from this persecutory sensuality either into his/her inner world or into the outer response this is why work with the adolescent proper represents a great difficulty. In the process of our investigation basing on theory of psychosexual development of the Freud, theory of separation of individuations of Mahler, 462


psychoanalytic meta-psychology and method of clinical analysis firstly we have notices the following basic phenomena playing an structure forming role in formation of various ways of development of mental disorders in adolescent period: type of relations with the object, barrier of defense from over-arousal, Self as a structure of mental apparatus, super-Self as a structure of mental apparatus. Complex analysis of above listed factors has allowed distinguishing 3 basic structures of mental disorders in adolescents. – Type A, uniting all the above listed phenomena and innate, basically for neurotic structure of the personality, developing conversion (pseudo-somatic) symptoms. – Type B, innate for psychotic and borderline personality structures and developing severe hypochondriac disorders, compulsive fears of infection. – Type C, innate for little mentalized mental structures, with un-developed intrapsychic world with collapsed mental space not able to create a buffer from neurotic symptom or delusion and developing sever somato-psychoses.

Basic information sources in disease reversal Ye. Prytova1, S. Trushchelev2 1 Moscow

Psychoneurological dispensary № 4, Russia

2 State Medical Refresher Institute of

the Ministry of Defence, Russia

Objective: Cases have been reported increasingly often of drug therapy noncompliance and medical recommendation change by patients proper. Actually drug non-compliance incidence with psychiatric patients has reached an exorbitant 80%. Medical experts and researchers point out that numerous medical achievements may never be put into effect unless doctors and their patients reach agreement on pooling efforts to get over the disease. To effectively address the contradiction, one should be aware of information sources and the patients’ needs. The research objective is to study the basic information sources of schizophrenic patients. 463


Methods: A single-stage continuous research includes schizophrenic patients who have visited the doctor of their own accord and excludes patients with high-grade schizophrenic defects. The research protocol has been approved by the local ethics committee. The research questionnaire comprises 58 questions. A total of 120 questionnaires have been handed out, with 104 of these returned filled in. Results: We have established that most patients (94.2%) have repeatedly seen their psychiatrist, with their disease duration in most cases (95.1%) exceeding one year. Most patients need to have the general idea of their disease. When asked if they knew what they had been diagnosed with, 49 (47.1%) of the 104 respondents polled answered in the affirmative. The subsequent study showed that only 22 of the 49 positive answers proved correct. In this context the final percentage of correct answers made up 21.2%. We have established that respondents see as basic the following sources of information about their disease, in descending order (n = 95): the attending medical doctor – 86 (90.5%); reference books – 4 (4.2%); family members – 4 (4.2%); TV- and radio-broadcasts – 1 (1.1%). The respondents were asked to indicate the basic source of information about their medical preparation. 84 respondents answered as follows: the attending medical doctor – 61 (72.6%), the instruction leaflet – 13 (15.5%), the chemist – 6 (7.1%), the Internet – 1 (1.2%), a policeman – 1 (1.2%), relatives and friends – 1 (1.2%), others – 1 (1.2%). 60 respondents (65.2%) of the 92 are unaware of contraindications. Conclusions: The survey results prove that the basic source of information is the doctor. On the one hand, this is a show of the patients’ confidence in their doctor, while on the other; it is evidence of the patients’ passiveness in the effort to stockpile knowledge of their disease. The situation points out the need for promoting the relevant medical service to the patients.

464


Effects of rTMS and ECT on memory of depressive patients O.D. Pugovkina, A.B. Kholmogorova, E.E. Tsucarzi Moscow Research Institute of Psychiatry, Russia Objective: The aim of this study is to evaluate changes of cognitive functions as possible side effect of ECT and rTMS in treatment resistant depressive patients. Methods: Patients were classified as recurrent depression (ICD-10) conforming to full resistant depression criteria. Patients were randomly matched into 2 groups: group A was treated with ECT (20 patients), group B – rTMS (20 patients). Changes in memory activity related predominantly to the effect of applied therapy were studied by a battery of psychological tests, assessing verbal and nonverbal memory: Remembering a list of 10 words (after A. Luria), Benton Visual Retention Test (BVRT). We used equal forms of tests in order to exclude “the learning effect” which can appear from the necessity of using test battery several times (before the course of stimulation, on 7th day, on 14th day – at the end, and a month later the end of the therapy). Reduction of Depressive symptoms assessed by HAM-D (Hamilton Depression Scale). Results: In group A we observed no considerable correlation between the level of cognitive functioning and Depression Scale’s scores by the end of therapy process. In spite of improvement of depressive symptoms (responders 65% of patients, decrease of depressive symptoms more than 50% at HAM-D), memory parameters in these patients could be degraded. In group B (responders 55% of patients) were marked significant improvement of non-verbal memory (BVRT – 30.4% increase, p < 0.05), and verbal memory (8.7%, p < 0.05). As compared with control group of healthy persons memory functioning level of depressive patients was significantly low even after the course of rTMS (p < 0.01). Conclusions: rTMS-procedures have no negative effect on memory as contrasted to ECT. 465


Cognitive behavior therapy to improve skills of counselor in South Africa S. Rataemane University of Limpopo, South Africa Treatment centers in South Africa were surveyed to assess modalities of therapy offered

for

various

levels

of

counselors

for

alcohol

and

drug

abuse.

Most counselors confirmed that they used an eclectic approach but few could clearly state the components of such an approach. However, in the main, it included aspects of 12-step approach, motivational interviewing and brief psychotherapies. Counselors were further assessed for knowledge of CBT in managing addictions. There was a distinct lack of the systematic application of CBT to improve compliance and enhance well-being of patients. A three-winged study was designed with the distance learning component (video-conferencing, teleconference and internet); in vivo training and control group to improve the CBT skills of counselors at selected sites. This presentation will share preliminary data demonstrating that distance learning, which had reach to more counselors, was almost as effective as in vivo training in retention of CBT skills by trained counselors. This approach is recommended where there are few trainers in large countries. But it necessitates understanding of use of basic technology to transfer information.

The system of training physicians psychotherapists and clinical psychologists in clinical psychotherapy M.B. Remeslo, A.S. Yakovis St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Psychotherapy – is one of the rapidly developing specialties of modern medicine, emerging at the junction of the general theory of pathology, psychiatry, medical and social psychology, corrective and developmental pedagogy, psycholinguistics, and a number of other areas. It characterizes today by active development of methodological, scientific and institutional bases and a range of areas of practical application in the clinic for the task of protecting and promoting mental health. 466


Now there is a need to further improve the effectiveness of teaching psychotherapy at various stages of postgraduate education. Psychotherapy as an emerging scientific specialty has its own theory and methodology. Variety of directions and methods of psychotherapy leads to a lack of a unified approach in psychotherapy training. Even more complicated is the situation in training of medical psychologists, which is often limited by mastering of different methods of psychotherapy, without reliance on fundamental basis. V.A. Tashlykov (1995) identifies three models of psychotherapy training: “technical”, “informational” and “personal”. During postgraduate training, these models can implement each other or rotate, successively become dominant. Analysis of experience of teaching psychotherapy in the V.M. Bechterev Institute, the experience of other training centers for therapists and medical psychologists allow developing the integrative concept of the didactic teaching of psychotherapy, which involves the promotion of learning specialists from the technical to the identity model. To achieve basic educational goals the application of modern methods of training, including forms of active learning, determination of the sequence of disciplines and sections of psychotherapy, the control of the education is necessary. Professional making of psychotherapists includes sequential mastery of the main sections of psychotherapy – the general psychotherapy, a narrow psychotherapy (using scientifically-based methods of psychotherapy), clinical psychotherapy – conduct of psychotherapy for patients of different clinical groups. Achievement of the main educational purpose includes such forms of learning as: lectures, seminars, workshops, training practice on clinical bases, personal-and professional-oriented training, working under the guidance of a supervisor (an experienced teacher). The modern model of psychotherapy training contains four mandatory components: theory, work with the personality of the therapist (personal therapy), practice and supervision. Active development of a brigade model of psychiatric and psychotherapeutic assistance led to the need for joint training of multiprofessional team participants, who 467


carry psychotherapy, and emphasis in the training of clinical psychotherapy is on the active cooperation of psychotherapists and medical psychologist at the joint realization of individual psychotherapy programs.

Visual plastic arts therapy efficacy in the treatment of burnout syndrome in nurses who work in mental hospital L. Renemane1, I. Gzibovska2 1 Riga Stradins University,

Latvia

2 Daugavpils Mental Health Hospital,

Latvia

Introduction: Burnout syndrome (BS) is a frequently under-recognized problem that is defined as the “psychological syndrome of emotional exhaustion depersonalization”, and reduced personal accomplishment that can develop in people who work with other people in some capacity. For nurses, who work in psychiatric wards, BS was found in 62.9% of respondents in Europe. The economical crisis influences the psychological, physical and financial status of medical workers, due to reforms in medicine (staff reduction, decreased income,

increase of job

responsibilities) especially in Latvia. Qualitative medical care can be provided only by nurses with a higher health potential. In order to test the symptoms of BS in psychiatric nurses and to test the efficacy of group visual plastic arts therapy for nurses with BS we have performed a comparison study. Objective: To investigate the effectiveness of visual plastic arts therapy on the average index of BS in psychiatric nurses. Methods: A comparison study of 100 nurses who work in Mental Health hospital was done. Respondents filled in the Maslach Burnout Inventory – Human Services Survey (MBI-HSS) to assess BS. 60 nurses were selected; whose MBI-HSS index was more than average index of MBI-HSS of all participants. Respondents were divided into 2 groups: experimental group (EG) – 30 nurses and control group (CG) – 30 nurses. EG nurses participated in 12 visual plastic arts therapy sessions: 3 groups with 10 persons in each. Sessions were designed by the authors based on cognitive behavioral therapy principles to decrease the symptoms of BS. The 1st session included 468


introduction of participants, base rules and goals discussion. 2 nd–10th sessions – visual plastic arts therapy sessions, to promote creative expression to disclose individual needs, emotions and problems, and resources in art or other creative work that reflect these, to decrease the symptoms of BS. 11th–12th sessions – gala sessions, graduate leave-taking, conclusions and art therapy results discussion. EG and CG respondents filled in MBI-HSS to assess the symptoms of BS. Results: The average index of BS in psychiatric nurses by MBI-HSS was 48.71. Visual plastic group arts therapy was developed and implemented for EG psychiatric nurses, which reduces the average index of burnout, average index after sessions was 53.8 (p = 0.000, Mean 13.300, Std. Dev. 10.996, Std. Error mean 2.008). KG respondents’ average index of burnout with 1 month interval was 67.46 and 67.93. Conclusions: BS in psychiatric nurses was detected in 60% of cases. Visual plastic group arts therapy is effective in the treatment of burnout syndrome and improves the physical and emotional feelings of nurses, which invaluably helps to cope with the professional responsibilities in medical work.

Efficiency of anti-relapse olanzapine therapy vs. amytriptyline, haloperidol at treatment depressive-delusional disorders A.S. Ritskov Yaroslavl State Medical Academy, Russia The goal of the study was comparative long-term studying of action olanzapine at depressive-delusional disorders within the framework of MDD and affectdominant type of schizoaffective disorder. Study was continuation of 6-week active supervision in which all patients (83 patients) have been allocated on two groups: olanzapine (43 patients) and amytriptyline, haloperidol (40 patients). The amount of the patients, graduating active 6-week supervision, has made in each group on 40 patients. Active registration of results was in 3, 6, 9, 12 months. In intermission cases anti-relapse olanzapine therapy was in a doze of 5 mg per day , amytriptyline 20–50 mg per day; at remissions – up to 10 mg olanzapine, up to 50–75 mg per day amytriptyline and, if necessary, up to 5 mg haloperidol per day. By the end of 3-month of supervision 469


therapy received, accordingly on two groups, – 29 and 39 patients; by the end of 6-th month – 26 and 33, by the end of 9-th – 24 and 28; 12-th – 21 and 25. In 1 year intermission took place at 18 surveyed in olanzapine group (from 21; at 3 by 1 year relapse proceeded) and in 16 – amytriptyline group (from 25; at 1 process has accepted continuous character, at 6 remission, at 2 relapse proceeded). In group olanzapine repeated relapses within one year it was not observed. Single relapse took place at 10 patients. In parallel group the amount of relapses in 2 times is higher (at 20) and proceeded more severely, from them 5 repeated. At olanzapine anti-relapse therapy relapses in most cases 7 (17.5%) proceeded more mildly and were shorter (on the average 53.23 ± 3.89). More severe 2 (5.0%) were registered basically at those patients whom the relapse of active 6-week supervision was not the first. In the second group the amount of more severe relapses, in comparison with relapses, proceeding during active 6-week supervision, was higher: 8 (20.0%) and their duration averaged – 68.9 ± 3.83 days. In both groups the more mildly relapses were ascertained at MDD. Thus, amount of relapses at olanzapine therapy less, they proceeded more mildly, “ripening of remission” took place. Repeated relapses were registered only in group of traditional therapy.

Multi-family group intervention in the first episode clinic N. Rivkina Moscow Research Institute of Psychiatry, Russia Background: Combination of optimal pharmacotherapy & family-oriented interventions proved to be more effective in the improvement of social functioning. Nevertheless, there is a lack of evidence in the effectiveness of differentiated interventions in regard to the interfamily relationships. The aim of the study was the implementation of multi-family group intervention (MFGI) & evaluation of its efficacy in patients with first episodes of schizophrenia. Patients: 51 patients (1st group) having been treated in the First Episode Clinic (FEC) within in the integrated program (combination of pharmacotherapy & 470


psychosocial interventions with multi-family group therapy). The comparison group (2nd group, 51 patients) included patients who had been treated in FEC earlier in the identical integrated program without family intervention. Patients fulfilled criteria for schizophrenia and associated disorders according to ICD-10. For each participant of 1st group recruited into the study, at least one caregiver (key relative) who provided support. Methods: Patients were assessed with PANSS, questionnaire of social functioning & quality of life, social support questionnaire. The assessment process of relatives was done with original semistructured interview, which evaluated the impact of illness on family communication, multiple choice questionnaires of general awareness of psychiatric illness & schedule of family burden. Family intervention were focused on the individual approaches of patients and were differentiated in connect with the clinical characteristics of the onset & according to the relatives-patients interactions. Multifamily group therapy consisted of stress management, communication & illness problem solving training, psychoeducation. The efficacy was evaluated according to the comparative pairwise analysis using initial demographical and clinical characteristics of patients. Clinical & social parameters of patients as well as the relative’s assessment were measured at admission and in 1 year follow-up (34 pairs). Results: The parameters of clinical outcomes such as relapse rates, dynamics of PANSS, level of complete remissions were comparable in both groups. However, comparing to the patients of 2nd group patients within family approach showed better social functioning, kept former social contacts (55.6% & 38.46% respectively, р < 0.01), were more satisfied with emotional support. Furthermore, patients who have been treated in integrated program including MFGI were more adherent to therapy during the 1year of follow-up, were more likely to be treated as outpatients (55.6% и 38.46% respectively, р < 0.01). MFGI demonstrated the decrease of relative’s stress level, burden of the family, increase of the awareness about psychiatric conditions, patient’s maladaptive behavior (from 2.86 ± 2.14 to 3.74 ± 1.26, р < 0.001), course of illness & prognosis which correlated with the decrease of criticism (from 471


68% to 44%) & emotional over-involvement (from 71.88% to 42.85%) in the interactions with patients. Conclusions: MFGI within integrated program of management of patients with first episode psychosis in 1-year follow-up showed significant increase of psychosocial functioning in patients, reduction family burden.

Borderline and narcissistic personality disorders: necessity of inclusion for the qualifier of mental disorders D.V. Romanov Samara State Medical University, Russia Present version of ICD does not include borderline personality disorder and narcissistic personality disorder as independent headings. However the clinical reality shows constant growth of this kind of pathology. The reasons of the given phenomenon are studied insufficiently. Borderline personality disorder has a considerable number of social consequences connected with depressions and suicides, chronic infringements of family and communicative adaptation, and also sexual behavior impairment, dependence on drugs, alcohol and food. The majority of patients with narcissistic personality disorder feel distress during all life. This kind of personality disorder is more hidden. Partners and children of patients usually suffer from chronic frustration and subject to psychosomatic diseases. The clinical picture of decompensations of these personality disorders typically includes depressive, anxiety and functional somatic disorders with propensity to a chronic current. Low detectability in psychiatric service unites the patients, suffering from borderline and narcissistic personality disorder. Both categories of patients avoid the reference to the psychiatrist because of fear of stigmatization and social consequences of the reference. Majority of patients keep partial criticality toward their disorder. They resort to the help of the psychologist, but that is not effective in such kind of personality disorders. Insufficient knowledge of psychiatrists of the given kinds of pathology is the frequent reason of erroneous diagnostics. Borderline personality disorder wrongly regards as dissocial and hysterical personality disorder, affective disorders, in case of presence of 472


transient psychotic symptoms – as schizophrenia. Narcissistic personality disorder confuses with schizoid or paranoid disorders or it is not distinguished at all. There is a requirement for working out of educational programs for psychiatrists which have to include questions of diagnostics, clinics, biological therapy and psychotherapy of the specified personality disorders. Both categories of patients form weak and fragile compliance, therefore training to establish compliant relations with these patients especially important. Introduction of corresponding headings in the international and domestic classification of mental disorders will improve possibilities of revealing of the given kind of pathology.

Cognitive control and memory in healthy APOE-e4 carriers with a family history of Alzheimer’s disease I.F. Roschina1, B.B. Velichkovsky2, N.D. Selezneva1, S.I. Gavrilova1, Yu.A. Chudina2, Z.A. Melikyan2 1 Mental Health Research Center of Russian Academy of Medical Sciences, Moscow 2 Institute of

Cognitive Studies, Kurchatov National Science Center, Moscow, Russia

Aim: To study the dynamics of cognitive control and episodic memory in healthy carriers of APOE-e4 genotype, which are relatives of patients with Alzheimer’s disease (AD), in the course of a dedicated cognitive training. Methods: A computerized test battery was developed, including three tasks of control functions (antisaccade task, N-back task, letter-digit task) and two episodic memory tasks (delayed recognition of associative pairs in verbal and spatial domain). The battery was administered three times with a one week interval. Subjects: 5 APOE-e4 carriers and 5 subjects without APOE-e4 genotype were studied. All subjects had a parent with AD. Both groups were matched on sex, age, education level and occupational status. All subjects underwent a clinincal and a neuropsychological screening, which showed no clinical symptoms of dementia in the subjects. Results: In the course of the training, both groups displayed a similiar tendency to increase the accuracy in cognitive control tasks. However, in APOE-e4 carriers the 473


accuracy increase was more pronounced (for instance, in the antisaccade task and in the 2-back task). APOE-e4 carriers experienced a more pronounced reduction in reaction time in cognitve control tasks. For example, APOE-e4 carriers showed a clear advantage over the non-carriers in a test for the switching function (letter-digit task), with non-carriers having switch costs twice as large as the APOE-e4 carriers. Also, while APOE-e4 carriers reliably improved the speed of performance in the antisaccade task, APOE-e4non-carriers failed to show any improvement. Recogniton accuracy for verbal associates did not improved in both groups. Recognition accuracy for spatial associates improved more for APOE-e4 non-carriers. Verbal recognition latency was higher for APOE-e4 carriers, and there were no between-group differences in spatial recogniton latency. Conclusions: The results show dissociation in cognitive performance of APOEe4 carriers and non-carriers, which are first-degree relatives of patients with AD. APOE-e4 carriers show no executive deficits, and display signs of increased cognitive palsticity in the control domain. On the other hand, APOE-e4 carriers perform worse on a number of episodic memory indicators, for example, spatial recognition accuracy, and show decreased cognitive plasticity in episodic memory domain. Increased cognitive plasticity of executive functions in APOE-e4 carriers can be used to compensate for the deficits in episodic memory functions repeatedly associated with this genotype. The study was supported by grant № 09-06-01035a from Russian Foundation for Humanities.

Suicide attempts and ideation in type 1 diabetic patients M. Roy1, A. Roy2 1 UMDNJ-New

Jersey Medical School, Newark, USA

2 Psychiatry Service, Department of

Veterans Affairs, New Jersey, USA

Objective: To examine suicidality and its correlates in type 1 diabetic patients. Methods: Four hundred and thirty nine type 1 diabetic patients and 404 controls underwent a semi-structured interview that asked if they had ever attempted suicide. 474


Patients completed the Beck Depression Inventory (BDI). Diabetic patients and controls were compared for their rate of suicide attempt. Diabetic patients who had or had never attempted suicide were compared on socio-demographic and clinical data. Results: Significantly more of the diabetic patients than controls had attempted suicide (12.5 vs. 3.5%, respectively), p < 0.001.) Diabetic attempters were significantly more likely to be female, depressed, and to report a history of smoking, alcohol abuse, and drug abuse than diabetic non-attempters. Multivariate analyses showed that female sex, history of alcohol abuse, and depression were significantly and independently associated with having attempted suicide among diabetic patients. Conclusion: Patients with type 1 diabetes have a raised risk of attempting suicide. Suicide risk in diabetics appears to be multifactorial and includes gender, developmental, psychiatric, and substance abuse determinants.

Structure of anxiety-depressive disorders and level of social adaptation in patients of a cardiological institution A.I. Rozin¹, N.P. Garganeyeva², E.D. Schastnyi¹ ¹ Mental Health Research Institute SB RAMSci, Tomsk, Russia ² Siberian State Medical University, Tomsk, Russia Objective: To study structure of anxiety-depressive disorders in patients of cardiological institution, to assess level of social adaptation in this cohort of patients. Material and methods: Based on rehabilitative unit of clinics of Cardiology Research Institute SB RAMSci we have carried out non-randomized screening investigation of 354 patients with verified diseases of cardiovascular system with HADS. Patients with clinical and sub-clinical level of anxiety and depression according to HADS (more than 8 scores) have been consulted by the psychiatrist. Also self-report scale of social adaptation was administered. Diagnosis of mental disorder was made according to diagnostic criteria of ICD-10. Results: Psychiatrist has consulted 203 patients; from them in 29.55% (60 patients) depressive disorders have been revealed. These patients have entered the investigated group, which mean age has constituted 62.03 ± 9.56 years (minimum age 475


38 years, maximum 83 years). Distribution according to sex was as follows: men have constituted 46.67%, women 53.33%. Anxiety-depressive disorders have been diagnosed in 46 patients (76,67%) with ischemic heart disease, angina pectoris FС II 26.67%, FC III 23.33%, instable angina 26.67%; in 10 patients (16.67%) – hypertensive illness, in 4 (6.7%) – with other disorders (myocarditis, congenital heart disease). Syndromologically depressive disorders have been represented: depressive syndrome in 26.67% of cases, asthenic-depressive syndrome 23.33%, depressivedysphoric in 13.33%, anxiety-depressive 23.33%, depressive-hypochondriac 13.34%. Concerning diagnosis according to headings of ICD-10 these syndromes were revealed within: depressive episode of moderate degree 26.67%, dysthymia 30%, recurrent depressive disorder, current depressive episode of moderate degree 16.67%, organic affective disorder 10%, mixed anxiety-depressive reaction 10%, depressive episode of mild degree 3.33% and depressive episode of severe degree 3.33%. Patients received social adaptation self-report questionnaire, mean value of summarized score was 33.9 ± 7.9. During comparison of level of social adaptation it was obtained that in patients with alexythymia level of adaptation according to social adaptation self-repot scale was reliably lower (35.57 ± 7.79 scores versus 31 ± 7.53; p < 0.05). Level of adaptation also was higher in patients with insight of presence of depressive disorder as compared with those who attributed symptoms of depression to complications and manifestations of cardio-vascular pathology (36.13 ± 7.37 scores versus 31 ± 8.62; p < 0.05). Also statistically significant differences of level of social adaptation have been obtained during comparison of groups of working patients and patients with disability (39.8 ± 4.82 scores versus 32 ± 6.27; p < 0.01). Conclusions: Obtained data about syndromological and diagnostic structure of borderline mental disorders, level of social adaptation in patients of the cardiological institution may be used for building the differentiated psychotherapeutic and psychopharmacological programs of rehabilitation of this group of patients with close collaboration of cardiologists and psychiatrists.

476


Safety of emotionality of the medical personnel of psychiatry E.V. Ruzhenskaya Regional clinical psychiatric hospital “Bogorodsky”, Ivanovo, Russia The term “burning out”, “combustion” has been offered more than 35 years ago for the description of demoralisation, disappointment and extreme weariness which observed at workers of psychiatric facilities. Now we regard it as an essential component of professional health of employees. Research objective – the studying of level of emotional burning out of different professional groups of the medical staff working in psychiatry. Materials and methods: By a technique “Diagnostics of level of emotional burning out” 2503 employees of psychiatric service are tested. 603 doctors have taken part in research (from them 182 organizers of public health services and 421 doctorclinical physicians) and 1900 persons of paramedical staff (237 organizers of a nursing care and 1663 practicing nurses). The received results: Three quarters (75.61%) the experts working in psychiatry, have no generated syndrome of emotional burning out, 13.78% have a beginning burning out, more than 6.7% of employees it is generated. The doctors have no syndrome of burning out (80.1% of psychiatrists that authentically differs as from the general results (p < 0.02), and from the data on average medical staff (p < 0.01). The experts directly contacting with mentally sick – the practical doctors and the nurses are less protected from burning out. Formation of a syndrome of burning out begins in a group of employees of 40–49 years (occurrence of statistically significant decrease in a share of the personnel without burning out – 71.29%, p < 0.05, increase in quantity of the personnel with beginning burning out – 17.03%, p < 0.05, and also the highest percent of persons with the generated burning out – 7.26). Employees from 60 years also are more senior show an optimum profile from all sample – the greatest quantity of experts without burning out – 82.32%, p < 0.01, and the least with beginning (10.14%, p < 0.05) and the generated syndrome of emotional burning out (3.48%, p < 0.05). In public health services there is no burning out more often the medical personnel – 81.23% (among organizers of public health services – 85.46%), 477


and in the medical sisterly environment the indicator decreases to 72.95% (at organizers of a nursing care – 81.28%). At the medical staff working in psychiatric facilities of system of social protection of the population the greatest safety concerning emotional burning out shows average medical staff (80.98%), and among the practical nurses – above (81.20%) than the organizers of a nursing care (79.4%). The medical personnel has no burning out only in 63.16%, and among the organizers of public health services this indicator is 47%, at the practical doctors-psychiatrists of boarding schools – 76.06%. In research the direct interrelation between an indicator of emotional burning out of employees and level of satisfaction work is revealed. The big safety from a syndrome of emotional burning out of the personnel, completely satisfied with work is traced and statistically confirmed in all investigated groups. Conclusions: Inclusion research of level of emotional burning out of the experts of the psychiatric service in the monitoring of a condition of their professional health, use of the address psychological support of the physicians, as from outside is necessary for the administration of establishments, and within the limits of programs of experts’ preparations of the psychiatric service.

The motivation of the medical personnel of psychiatric service to the actions for increasing vocational training E.V. Ruzhenskaya Regional clinical psychiatric hospital “Bogorodsky”, Ivanovo, Russia The increasing of professional competence of the medical personnel is impossible without experts’ personal participation in this process. Aim of research: Studying of the motivational characteristic of employees of psychiatric service in questions of improvement their professional skill. Materials and methods: The research was spent by a questioning method in which 2503 employees of psychiatric service have taken part. They are experts with the higher and average medical education, working in all establishments of a psychiatric profile of 4 areas of the central Russia. 478


Results: The motivational potential of the personnel in the relation to increasing the level of professional competence is innovative; it should have the readiness for introduction of new technologies. This potential in the experts of psychiatric service is high, 82.1% of the physicians working in psychiatry think of the introduction of new technologies in the professional work positively. And this percent is high both in medical, and in the sisterly environment. However 14.7% are indifferent to these innovations, and 3.1% are negative. In different professional groups distinctions are revealed. Nurses evade from innovations (15.5% in comparison with 11.3% in medical group, р = 0.01 are indifferent, t = 2.9711), but openly say about it in negative way (2.5% in comparison with 5% at doctorspsychiatrists, р = 0.02, t = 2.5620). At audit of a condition after-diploma formations, it has been found out that only 54.4% of employees participate in educational actions monthly, 23.4% – in half a year. The reasons for insufficient participation in educational programs of 33.7% of experts connect it with absence of the information on spent educational actions, 37.2% specify in impossibility of presence owing to industrial congestion. 5% of physicians refer to passive or active unwillingness of administration of a medical institution to promote their participation in actions for improvement of professional skill. Besides, at 9.9% of employees personal disinterest in formation is revealed. More employees with low motivation to professional perfection are among the average medical personnel (11.3% in comparison with 5.5% among doctors, р = 0.001). Than half of employees (48.3%) are interested in educational actions for law questions of rendering of the psychiatric help. The average medical personnel in this connection have shown the big readiness for increasing the law literacy (51.9% in comparison with 37% among doctors-psychiatrists, р = 0.001). This tendency is traced both among organizers of a nursing care, and among simple nurses. As a whole the medical personnel of psychiatry in the majority is motivated to increasing of the professional level, 44.8% mark the constant requirement in constant after-diploma formation and 50.1% test it periodically. The general motivation level of a nursing staff much lower and authentically differs from indicators of medical group. 479


Only 22.9% of nurses test a constant and 56.9% – periodic requirement for formation, and 16.8% – deny it. Conclusions: The motivational potential of doctors-psychiatrists, working in psychiatry exceeds indicators of an average medical. The basic direction of its increasing is the priority in service establishments, accurate structure and availability of educational actions.

Mental disorders of Republic Altai inhabitants I.D. Sanasheva, I.I. Sheremeteva Gorno-Altai Republic Mental Hospital, Russia Altai State Medical University, Barnaul, Russia The materials on mental disorders research of the Republic Altai inhabitants (Russia) are presented in this paper for the first time. Such researches have appeared not to be carried out before. It should be noted that modern ethnocultural portrait of indigenous population of the Republic –Altaians has been developing for the millennium and has been in many aspects caused by long contacts of ancient Turkic, Mongolian, Ugoran, Samodian and Kett tribes. The

structure

of

the

most

expressed

mental

disorders

demanding

hospitalization, and their spreading among the population with the account of national identity of patients was analyzed. The research was carried out under the medical documentation of the Republican mental hospital which is the only one giving the inpatient helps to the Republic population. The medical documentation of all patients treated in hospital within a year has been studied. The research was based on the data of the Republic population and its national structure. According to the census of the year 2002, 20,2947 people lived in the Republic. Out of them Altaians – 67,854 people (30.6%), Russians – 116,510 (54.7%), representatives of other nationalities – 18,583 (12.0%). According to the results of the research the spectrum of mental diseases with Altaians and Russians appeared to be of the same type. However some indicators of pathology had differences. So, if the relative density of sick with schizophrenia among 480


them had no essential distinctions (37.8% and 33.6% respectively) the total indicator of organic diseases of brain in Altaians was considerably above (44.5% and 28.9%). Altaians had more seldom aged patients suffering from psychosis than Russians (2.3% and 8.9%). For 100 thousand populations of different ethnos the number of the patients needed the hospital help was a little more in Altaians, in comparison with Russians (308.0 and 288.4 respectively). Thus Altaians had more indicators of schizophrenia (116.4 and 97.0 respectively), organic disease of brain (73.7 and 54.1), epilepsy (29.5 and 13.8) and intellectual backwardness (33.9 and 15.5) and more low on psychoses of late age (7.4 and 25.8) and frustration of a person (23.6 and 31.8).

Neurocognitive deficits in patients with schizophrenia: the relevance of the study on the clinical models A.P. Savelyev, A.A. Spikina, A.G. Sofronov Medical Academy of Postgraduate Education, St. Petersburg, Russia Evaluating the evolution of views on the key factors in schizophrenia symptoms can be traced to the positive shift of the poles on the negative, and at present, cognitive disorders. Given the pharmacological resistance of cognitive impairment, as well as the fact that the very typical antipsychotics are still remaining drugs of choice for many professionals, can cause secondary negative symptoms, one can understand the relevance of research of psychopharmacological agents, which reduce cognitive disorders. Patients with schizophrenia often have saved intelligence and at the same time show a loss of memory, attention, executive functions, as well as problem-solving behavior. Analysis of published data clearly shows an improvement in cognitive function in patients taking atypical antipsychotics. In addition, highly relevant today, the concept of quality of life in patients with schizophrenia implies that there is adequate social functioning, directly related to the level of neurocognitive functioning. In addition, not only schizophrenia, but also the affective disorders, including major depression and bipolar disorder suggest the presence of cognitive impairment in the structure of psychopathology. There is a hypothesis that cognitive dysfunction remains 481


after remission, especially with manic bipolar disorder. Based on recent data on the morphofunctional basis of the formation of neurocognitive deficits, increases the relevance of research psychopharmacological agents, correcting this pathology, in particular, drugs which affect the sigma-1 receptors playing a role of specific link in the central nervous system, they have a potential impact on neurotransmitter systems such as glutamatergic, noradrenergic, dopaminergic, serotonergic and cholinergic as well as the production of brain-derived neurotrophic factor. In therapeutic doses of fluvoxamine binds to sigma-1 receptors in the same degree as with the serotonin transporters (80%). As an adjuvant therapy in addition to the antipsychotic treatment of fluvoxamine can be used to correct negative symptoms and cognitive deficits in schizophrenia, which is the subject of our further research.

Correlations between morphological (MRI) characteristics of subcortico-limbic structures and brain function peculiarities in patients with schizophrenia T. Savina, V. Orlova, N. Efanova, L. Gubsky, D. Kupriyanov, N. Anisimov International University of Fundamental Education, Moscow Representation; M.V. Lomonosov Moscow State University, Russia The number of subcortico-limbic structures abnormalities in schizophrenia has been described. Relationships between these abnormalities and the peculiarities of brain function must be studied. Aim: To investigate the correlations between morphological characteristics of subcortico-limbic brain region and psychological emotion and cognition parameters 57 patients with schizophrenia were studied. Methods: 3 mm coronal T1-weighted 3D magnetic resonance images were obtained on magnet 0.5 Tomikon S50, Bruker (Germany). Volumes of caudate, nucleus lentiformis, hippocampus and amygdale in both hemispheres were calculated. Psychological methods of Polyakov’s school were used. Evaluation of precision of identifying emotions and memory parameters was done. 482


Results: The results showed reduction of both caudate (tendency, significant reversed asymmetry – p < 0.05), reduction of both nucleus lentiformis (tendency), both amygdale reduction (tendency) and hippocampus reduction (tendency, significant asymmetry with left-side reduction – р = 0.002). The degree of right amygdale reduction correlated with the degree of disturbance precision of identifying emotions (r = 0.56, p < 0.05), both caudate volumes and both nucleus lentiformis volumes reduction with the frequency of using non-emotional interpretation parameters (r = from –0.3 to –0.4; p < 0.05). Some subcortical-limbic structures parameters correlated with the degree of alteration of the psychological memory characteristics (r = from 0.4 to 0.5, p < 0.05): such a characteristic as productivity of voluntary retention by reproduction data which reflects disturbances of voluntary regulation of mental activity correlated with the degree of both hippocampus reduction, the retention productivity score correlating with the left caudate volume reduction. Conclusion: The results revealed the correlations between subcortico-limbic brain structures abnormalities severity and the psychological characteristics corresponding to negative disorders (emotionality and cognitive deficit). So the data obtained pointed at the involvement of subcortico-limbic brain structures in pathogenesis of schizophrenia.

Affective disorders in patients with various cardiovascular diseases M. Semiglazova, T. Dovzhenko, V. Krasnov Moscow Research Institute of Psychiatry, Russia Objective: To investigate specific psychopathological and clinical-functional features of affective disorders, the influence of depressive and anxiety disorders on development of various cardiovascular diseases and dynamics of the conditions during the complex therapy (cardiotropic drugs and antidepressants without cardiotoxic effects). Methods: 518 subjects with various cardiovascular diseases (Arterial Hypertension II stage – AH, Acute Myocardial Infarction – AMI, Chronic Heart Failure – 483


CHF, Coronary Heart Disease – CHD, Neurocirculatory Disease – NCD) and with or without (control group) concomitant affective disorders were observed. The clinicalpsychopathological and clinical-functional examinations were performed. Results: Affective disorders were found in 40.8% in group AMI, 61.45% – CHD, 60.4% – AH, 53.7% – CHF and 82.25% in the group of NCD. The statistical analysis has discovered that group with AH and CHF had significantly greater level of anxiety and depression than patients with AMI. Patients with concomitant affective disorders had significantly lower quality of life (p = 0.002). The distinct positive dynamics with diminishing affective, asthenic, somato-vegetative features was recognized in the group with complex therapy. At the same time, reduction of the scores of Hamilton rating scales for depression and anxiety in the groups of patients with AMI was more rather than in patients with the long-term type of organic heart disease – AH of the II stage and CHF. Most expressed favorable changes in intracardiac hemodynamics, left ventricular structurally-geometrical indexes were exposed in the groups of AH and AMI with complex therapy. Conclusion: The presence of anxiety and depressive disorders in patients with cardiovascular diseases have significantly influence on their clinical presentations and associate with lower health quality of life. The presence of antidepressant in complex treatment not only impacts beneficially on depressive syndrome but improves indices of intracardiac haemodynamics and structural-geometric parameters of the left ventricle and improves quality of life. This data may be used for optimization of affective disorders therapy in patients with various cardiovascular diseases.

Classification of personality disorders V. Semke Mental Health Research Institute SB RAMSci, Tomsk, Russia Classification of personality manifestations is impossible without considering theoretico-methodological problems of contemporary personology, first of all, its clinical branch. Its scientific development will help clarification of complex causal interrelationships, carrying out practical therapeutic-diagnostic work, heightening 484


quality of social-correcting interventions. The base for this work may be theory and methodology of young science of valeopsychology and clinical psychology, elucidating the type in nosological concepts (unit, variants etc.). Clinical-pathogenetic grouping of borderline states with subsequent extrapolation of results obtained onto zone of normal personology has allowed distinguishing four groups of borderline states – neurotic, pathocharacterological, neurosis-like, psychopathia-like). Especially it is important to mention stage of pre-illness where question is about emergence of abnormal, non-differentiated in their content of personality reactions which clinical manifestations reflect early, “pre-nosological” period of the disease development. The

scale

of

distinguishing

personality

characteristics

encompasses

pathocharacterological reactions, states, developments and “residua” or type. With a positive influence of microenvironment, contrary (in prognostic relation) variant of dynamics in the form of smoothing and then complete removal of psychopathic aspect (process of “depsychopathization”) is gradually achieved. One of the most important tools of subtle cognition of borders between healthy and ill personality is dynamic analysis of basic typologies studied. The idea of development triumphing in the past century in psychology and natural science, allows assessing the most vulnerable “main” moments in evolutional considering of normal and abnormal characters. “Dynamics” represents every change, be it a short-term (phase) deviation from initial status or more prolonged and stable, periodically emerging reformation of previous clinical picture.

Psychiatric morbidity in the Leningrad Region in 2000 – 2009 N.V. Semenova1, A.S. Kisselev1, 2 1 St.

Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia 2 I.P. Pavlov


In the last decades a continued growth of the prevalence and incidence of mental disorders among the population of Russia was observed. The worsening of the nation’s mental health level can be regarded as one of the main indicators of ill-being of society and the cause of serious economic losses for the State. 485


The aim of the study: Analysis of the major epidemiologic indices characteristic of the population’s state of health in the Leningrad Region. Methods: clinico-epidemiological, statistical (the Fisher exact test). Results: Over the first decade of the XXIst century a considerable growth (p < 0.01) of the prevalence rate of mental disorders took place in the Leningrad Region: from 2097 cases per100 thousand of the population in 2000 up to 2720 cases per 100 thousand of the population in 2009 (1.26 fold). And this tendency can be traced both in males – from 1187 cases per 100 thousand of the population in 2000 up to 1470 per 100 thousand in 2009 (1.2 fold) and females – from 913 cases per 100 thousand in 2000 up to 1250 cases in 2009 (1.33 fold). The part of patients with psychoses did not undergo any considerable changes (p = 0.17). In 2000 the proportion of psychoses totaled 38.53% of all mental disorders and in 2009 – 38.04%. The proportion of psychoses among males and females also remained practically unchanged – 32.15% in 2000 and 34.72% in 2009 in females, 42.94% and 41.95% in males respectively. The number of patients with non-psychotic mental disorders increased significantly (p < 0.01) over the period under consideration (1.64 fold); the increase was registered statistically reliably both among females (1.86 fold) and males (1.49 fold). In 2000 the proportion of non-psychotic disorders totaled 33.12% of all mental disorders and in 2009 – 43.06%. The part of non-psychotic mental disorders in the group of females totaled 30.53% in 2000 and 42.60% in 2009; in the group of males – 35.11% and 43.45% respectively. The mental retardation prevalence rate decreased significantly (p < 0.01) over the period under consideration (1.19 fold). In 2000 the proportion of mental retardation totaled 28.35% and in 2009 – 18.99%. In the group of females the proportion of mental retardation decreased over 10 years 1.29 fold – from 26.51% down to 15.44% and in the group of males 1.12 fold – from 29.77 down to 22.01 respectively. The observed decrease is statistically reliable (p < 0.01) both for males and females.

486


Thus in the Leningrad Region over the period of 2000–2009 there was registered the growth of the prevalence rate of mental disorders mainly due to the increase of the part of non-psychotic mental disorders. The prevalence of psychoses among the population remains practically at the same level, and the prevalence of mental retardation is gradually lowering.

The incidence of mental disorders in the Leningrad Region, 2000 to 2009 N.V. Semenova1, A.S. Kisselev1, 2 1 St.

Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia 2 I.P. Pavlov


The incidence rate is an index sensitively responding to the changes of environmental conditions. The analysis of this index in the 10-year period gives an idea of the frequency of occurrence and dynamics of illnesses as well as effectiveness of the complex of sociohygienic and therapeutic measures directed at its reduction. The aim of the study: The analysis of the main epidemiologic indices characteristic of the state of health in the population of the Leningrad Region. Methods: Clinico-epidemiological, statistical (the accurate Fisher’s test). Results: In the period of 2000–2009 a significant growth (p < 0.01) of the incidence rate of mental disorders took place in the Leningrad Region: from 261 cases per 100,000 of the population in 2000 up to 326 cases per 100,000 in 2009 (1.25 fold). This growth can be traced in both males – from 149 cases per 100,000 in 2000 up to 193 in 2009 (1.29 fold) and females – from 111 per 100,000 in 2000 up to 133 in 2009 (1.2 fold). The incidence of psychoses is growing reliably (p < 0.01), for the last ten years it increased 1.76 fold. In 2000 psychoses were found in 24.13% of those seeking psychiatric assistance and in 2009 their proportion equaled 34.02%. A higher incidence of psychoses in females has been retained (31.74% in 2000 and 38.99% in 2009) versus (18.46% in 2000 and 30.59% in 2009) in males respectively, but the growth of the incidence is more marked in males (2.14fold in 10 years) than in females (1.47 fold). 487


In the period under investigation the incidence of non-psychotic mental disorders increased reliably (p < 0.001) as well (1.17 fold); the increase was statistically reliably registered (p = 0.02) both in females (1.09 fold) and males (1.22 fold). However, in the last ten years the proportion of non-psychotic disorders registered for the first time is gradually lowering: from 60.46% in 2000 down to 56.50% in 2009. The proportion of non-psychotic mental disorders in females decreased from 58.67% in 2000 down to 53.37% in 2009 and in the group of males – from 61.8% down to 58.66% respectively. The incidence of the mental retardation in the period under investigation decreased reliably (p = 0.02) 1.3 fold, mainly in males (decrease 1.47 fold, p < 0.01), rather than females (decrease 1.05, p = 0.03). However, in the structure of the general incidence, the proportion of the incidence of mental retardation reduced considerably (p < 0.01): from 15.41% in the general population in 2000 down to 9.48% in 2009, from 9.59% down to 7.54 in the group of females and from 19.75% down to 10.75 in the group of males respectively. Thus in the Leningrad Region in the period of 2000–2009 the increase of the incidence of mental disorders was observed, more than one half of cases representing non-psychotic mental disorders. The incidence of psychoses increased mainly in males. The incidence of mental retardation decreased both in absolute values and in proportion to the general incidence. Changing of the dynamics of the incidence for the period under investigation took place mainly in the masculine part of the population.

The analysis of the indices of prevalence and incidence of mental disturbances in the Leningrad Region, 2008–2009 N.V. Semenova1, I.V. Lupinov2, Yu.N. Botsmanovskiy2 1 St.

Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia 2 Leningrad Regional Psychoneurological Dispensary, Russia

The aim of the study: The analysis of the dynamics of the main epidemiological indices of mental illnesses in the Leningrad Region, 2008–2009. 488


Results: On the whole in 2009 the growth of the prevalence index of all mental disturbances by 1.2% can be observed as compared with 2008, mainly due to the increase in the number of patients who receive consultative and medical assistance. As compared with the prevalence index of all mental illnesses in RF the respective index in the Leningrad Region is lower by 17.2% (in 2008 it was lower by 18.2%), that is its gradual approximation to that generally existing in Russia can be observed. The prevalence of psychoses and dementias (including schizophrenia) in the Leningrad Region is higher by 18.7% than in RF on the average while that of nonpsychotic mental disorders and mental retardation is lower that generally in Russia by 32.8% and 28.3% respectively. It evidences the predominance of patients with the gravest psychiatric pathology among the full number of those under the psychiatric observation in the Leningrad Region. As compared with 2008, in 2009 a heightening of the morbidity index of all mental disorders by 1.2% and that of the incidence by 18.9% in the Region’s population is also observed. At the same time, the incidence index in the Leningrad Region remains lower than the respective value over RF – by 7.6 in 2009 – although distinct dynamics of its growth can be traced (in 2008 it lagged by 21.8% behind the respective value over Russia). The growth of the morbidity index mainly owing to the consultation group of observation with the growth of the incidence index evidences the betterment of identification of patients with nervous and mental disorders, especially those suffering from psychoses and dementias as well as nonpsychotic disturbances. In 2008 the number of patients with disability in the Leningrad Region was higher by 15.8% than the average value in Russia and in 2009 exceeded it by 11.5%. 96% of the contingent of the disabled consists of gravely disabled persons. These data confirm the tendency to chronification of the mentally ill due to insufficiency of their medical, sociopsychological and vocational readjustment in the ambulatory link of the psychiatric service. A grave degree of invalidation connected with mental disorders, and desocialization of patients are probably caused by the lack of rehabilitative orientation in the work of the Regional psychiatric service and necessary structures 489


(day hospitals, sheltered workshops, hostels for patients who lost social connections, etc.) and methods of realization of this work especially in the extramural link (for instance multidisciplinary teams) as well as insufficient supplying the patients with modern medicinal preparations.

About the role of postburn cosmetic defects in survivors’ adaptation I.V. Shadrina Chelyabinsk State Medical Academy, Russia Influence problem of undergone burn disease on the personality formation and its adaptation, expecially in children and teenagers is studied very little. The work in question is a research fragment of neuro-psychiatric disturbances of distant burn disease consequences. The follow-up age is 12 ± 1.8 years. The purpose of this experiment is to learn the relationship of person’s defect perception and his environment. The teenagers (n = 52) with postburn cosmetic defects with different injury degree were joined in a psychotherapeutic group. The persons under investigation estimated their defect injury degree according to 5 point score system, and then they did it among other members of the group. An average estimation of defect injury degree was determined by the group in every member of the group. This estimation was compared with the objective defect injury degree. All the survivors evaluated other’s defects as more disfiguring ones. The subjective estimation of their own defects also exceeded the objective one. Sociometric status of every member of the group was also studied. First of all the group referred to the status of “outcast” and “isolated” persons that individual whose appearance was the most disfigured. During the process of getting accustomed to each other the estimation changed and appearance stepped aside. By the end of the studies in 3 months the group underestimated even strongly marked defects if the teenager became “the leader” according to the status. So even among “unfortunate brothers in arms” a person with disfigured appearance was rejected initially. The reaction of the surrounding persons on the disfigured defect is supposed to be levelled in high standard of social adaptation, and in low one it is on 490


the contrary overestimated. However, as catamnesis showed the level of social adaptation in usual social environment became low in the majority of survivors with disfigured defect in spite of the fact that they were the leaders in the course of group psychotherapy. It is likely to be explained by the peculiarities of juvenile age when the adaptation is difficult even for the healthy people. That is why it is quite embarrassing and sometimes even impossible joining the social environment having disfigured appearance. The results are statistically reliable (p < 0.005). The research confirmed the hypothesis: the more defect is not perceived by social environment, the more it is not perceived by the person himself. It is due to the formation of supervaluable cosmetic defect complex – Kvasimodo complex, and it is also due to its social person deprivation. In the presence of this factor the aggravating problem is the location of the defect on visible body parts (face, hairy part of the head neck, hands and arms). Pubertal age is the aggravating factor. In the course of aging the relationship of disfigured defect perception by the society and the survivor itself is retained. Thus in the light of the formed relation towards the person the interpretation of interindividual connections takes place and the level of social adaptation is also determined. With the aim of prevention of survivors’ neuropsychiatric disturbances it is necessary to perform reconstructive plastic operations during the first year of injury. That is necessary to consider in psychological psychotherapeutic work with the survivors.

Psychopathia-like disorders in patients with opiate addiction L.K. Shaidoukova, D.N. Usmanov Kazan State Medical Academy, Russia The authors have investigated 87 heroine addicts with the purpose to study personality changes in these patients. All of them were investigated in the hospital. Besides clinical psychopathological investigation, they filled out an inquiry form and had an experimental psychological investigation. It was found that 50% of patients had showed psychopathic character features before onset of their drug abuse and 50% developed psychopathia-like characteristics in the course of opiate abuse. The authors 491


describe the groups with affective, behavioral, and affective-and-behavioral disorders and distinguish six most common psychopathological behavior forms. They present the results of investigation of patients’ emotional, volitional and cognitive characteristics as well as their perception, memory and self-image. They conclude that changes in the “character of psychopathisation” should be taken into account in psychotherapy and rehabilitation measures.

Neuropsychological assessment as a prognostic index in systemic and progressive diseases (the example of approach on patients with multiple sclerosis) E. Shakhbazova, Y. Mikadze. M.V. Lomonosov Moscow State University, Russia The question of how demyelinization effects cognitive development in children and adolescences with multiple sclerosis is currently matter of debate. The dissociation between MRI data and results of neurological assessment has been shown in experimental works. It is known that the volume of white matter damage doesn’t often correlate with the level of neurological deficit or problems in cognitive functioning. The aim of current research is to provide information how neuropsychological profiles of patients with multiple sclerosis differ from one another according to clinical presentation’s characteristics. It is obvious that such clinical variables as age of manifestation and duration of disease, frequency of relapses give us information also about demyelinization. Neuropsychological assessment consisted of Luria's Diagnostic Principles and neuropsychological tests in the Neuropsychological Assessment of Children, test of memory Diacor (Y. Mikadze, N. Korsakova), Raven’s Progressive Matrices Test, and Stroop Test. Twenty nine children at the age between 8 and 17 were assessed. All participants had diagnosis of proven multiple sclerosis. There were 15 females and 14 males. All participants had normative scores in Raven’s test, 24% in the sample had lower than normal scores on Stroop’s test (W, C paper sheets). The frequencies of 492


symptoms in Luria’s battery tests were counted and subdivided into groups according to the 7 neuropsychological factors. Regardless of age and educational level deficit of visuo-spatial and executive fuctions were the most frequent. Participants had more severe deficit in all tests if the disease had manifested up to 10 years old. Those who had been assessed at the period of relapse had severe deficit in the tests on visual perception and visual attention, lower speed of information proceeding to compare to other patients. Moreover, patients with second and first progressive multiple sclerosis were less successful in the visual perception and attention tests. Between groups comparison of neuropsychological profiles according to different clinical parameters show us the possibility to use neuropsychological data as additional markers of pathological process. Strong relationship between deficit in visual perception and attention tests and clinical data suggests that some of neuropsychological tests can be used as prognostic index and criteria of therapy’s effectiveness. We believe this approach can be useful in research of other systemic and progressive diseases.

Inflammatory markers in the schizophrenic patients I.V. Shcherbakova Moscow State University of Medicine and Dentistry, Russia The role of infection and inflammation in schizophrenia has been discussed actively during the last years. According to the epidemiological researches the risk of schizophrenia increases in child after СNS infection such as meningitis, in case of maternal infection and induction of pro-inflammatory cytokines during the pregnancy. Some studies testify to the activation of autoimmune reactions against neurospecific proteins, the high level of proinflammatory cytokines (IL-6, IL-8, TNF) in blood and the intrathecal synthesis of antibodies in schizophrenic patients. The purpose of the present study is to determine blood inflammatory markers in relation with clinical features of schizophrenia. In total 257 inpatients and out-patients of the Mental Health Research Center and Psychiatric Hospital № 1 was recruited from 1998 to 2005 for estimation of 493


activity of plasma kallikrein-kinin system (KKS), alpha-1-proteinase inhibitor (α-1PI), neutrophil elastase (NE) and concentration of C-reactive protein (CRP). The study group consisted of 112 adults, 114 teenagers and 31 children with schizophrenia diagnosed based on ICD-10 and traditions of common practice of domestic psychiatry. A comparison group of 165 age and sex-matched healthy control was also collected. Peripheral blood samples were taken before (n = 257) and after treatment (n = 20). The immunoenzyme and enzymatic methods were used. Possible correlations between inflammatory indicators and clinical features were studied twice – on group of teenagers (n = 71) and adult patients (n = 28). Psychopathology was assessed by categorical application of the Positive and Negative Symptom Scale (PANSS). Exclusion criteria for all the study participants were autoimmune and inflammatory illness, and actual substance abuse disorders. All patients demonstrated high activity of plasma KKS, NE, functional activity of α-1PI, significant elevation in CRP concentration, in comparison with the healthy controls. The analysis of these indexes after antipsychotic treatment and reduction of psychotic symptoms has shown some degree of normalization of activity of KKS and NE. There were no statistically significant differences in the CRP and α-1PI levels. Investigation of relationships between inflammatory variables and PANSS subscale scores has revealed positive correlation between activity NE and expressiveness of negative symptoms in two independent groups of patients. The conclusion: regular inspection of various age groups of schizophrenics has revealed biochemical changes as characteristic of inflammatory reactions. The maximum expressiveness of these reactions was observed in acute stage of illness. One of the inflammation markers – NE is directly connected with negative symptoms of schizophrenia. Thus, the inflammation factors are involved in pathogenesis of schizophrenic process.

494


The perspective of music therapy in psychological treatment of patients with language disorders K.M. Shipkova Moscow Research Institute of Psychiatry, Russia Music therapy has already used widely by psychiatrists, general therapists and psychotherapists. At the same time music as a special kind of neurophychological treatment aims to overcome language disorders is seldom used in practice of rehabilitation programmes and still not developed enough. On the other hand, it is well-known that music perception is the result of the right hemisphere activity, thus we has concluded this may be used for treatment of left-hemisphere-damaged aphasics. Our goal was investigate the relation of different kind of classic music with extend of the language recovery. Four patients with moderate severity of aphasia have taken part in the programme. The aphasic patients studied in the chronic phase of the left hemisphere vascular lesion. Two persons had got acoustical-mnestic aphasia (fist group) and another one (second group) efferent aphasia (according to Luria). Each patient has undergone individual treatment which consisted in ten lessons conducted by a neurophychologist. During it aphasics had to solve a task to describe a picture. In doing it, the patients listened to the music which had the same emotional character as the picture. We have analyzed 120 aphasics’ texts. The main importance was to measure the productivity of speech (words per minute), the quality of speech (errors). We also paid attention to the index of dynamics from the first to the last lesson. The results of our research showed that the most effective was the influence exerted on the language by a piece of the worried music. In the first group the productivity of speech went up 1.5 times in contrast to the circumstances when they did not listen to this music. What is more, the quality of speech became better, as they made few mistakes such as a verbal paraphasia and grammatical errors. The patients from the second group made none improvement in productivity but there was a positive sign in the quality of speech. The quantity of errors decreased significantly. 495


Either cheerful or neutral music did not stimulate enough the process of language recovery; sometimes individual factors could be very influential there, for example interest for the picture and reaction to music. These preliminary results make us pay attention to the importance of using music therapy in recovery of human brain functions.

Social adaptation of the patients with depressive disorders for the first time admitted to the psychiatric hospital E. Shmunk Siberian State Medical University, Tomsk, Russia Introduction: Depressive disorders are common especially in general medicine. They reduce quality of patients’ life and adaptation resources. Objectives: To investigate the level of social functioning and some characteristics of prehospital period of patients with depressive disorders for the first time admitted to the psychiatric hospital. Methods: The research was conducted in Tomsk Regional Psychiatric Hospital. After informed agreement 102 patients with depressive disorders (DD) were examined with RDC of ICD-10 (Cooper J., 1994). For the assessment of the level of social functioning Social Adaptation Self-evaluation Scale (Bosc M. et al., 1997) was used at baseline and after 42 days of antidepressive therapy. Results: The average duration of DD before psychiatric examination was 19.1 months (up to 312 months). The mean age was 43.8 ± 11.5 years. Most patients had first depressive episode (61.8%), second 8.9%, third 2.9% and 4.9% had “double depression”. The most part of the patients (61.8%) with DD saw their primary care (PC) doctors, 47.1% of them did it more than twice. Almost half of all investigated patients (49%) were aware of special psychiatric care, but 22.5% were afraid of psychiatrists. The average number of visits to PC was 3.6 (up to 49), the average number of investigations was 2.4 (up to 8). The most part of visits to primary care (PC) fell on patients with heart complaints (р = 0.02), the lesser part on patients with the loss of 496


energy (р = 0.0007). Patients with heart and gastrointestinal complaints had more investigations (р = 0.01; р = 0.03). More visits to the PC were associated with low level of social functioning (r > –0.2, р < 0.05). At baseline most patients had low social adaptation level. By 42 day the majority of those who visited PC still had low social adaptation and most part of those who didn’t had good adaptation (58.9% vs. 69.2%; p = 0.004). ). The most part of patients (72.5%) took any medications during their observation in PC. Older patient had more prescriptions (r = 0.28, р < 0.05). 38.2% of patients took tranquilizers and only 23.5% antidepressants, but 54.2% of them had suboptimal dosages. Low level of social functioning correlated with older age, duration and severity of depression, number of previous episodes, PC attendance and taking tranquilizers (р < 0.05). Discussion: In real clinical practice patients with DD still haven’t enough opportunities for early diagnostics and treatment. The level of social functioning of patients with DD depends on PC visiting and taking inadequate treatment. Conclusions: Patients who visited primary care doctors had low level of social functioning.

Clinical efficacy of neuroprotective therapy in patients with poststroke vascular dementia V. Shprakh, I. Suvorova Irkutsk State Institute of Postgraduate Education, Russia The main aim of vascular dementia treatment is to avoid and prevent the progression of cognitive impairment and progression of vascular dementia. To study efficacy and safety of prolonged course of neuroprotective therapy as Cerebrolysin in patients with poststroke vascular dementia 48 patients with mild and moderate dementia (20 males and 28 females, mean age 64.3 ± 5.9 years) have been studied. Diagnosis as “Vascular Dementia” was determined in accordance with ICD-10 and NINDS–AIREN criteria. Clinical-neurological and MRI-investigation were carried out for all patients. The study of clinical efficacy and safety of prolonged course of 497


Cerebrolysin therapy in poststroke vascular dementia was conducted during the open randomized clinical study. All patients with dementia were divided into two groups with mild and moderate dementia. The infusion of Cerebrolysin was assigned for them. The study period was 36 months and during the study period five courses of cerebrolysin therapy were performed for 4 weeks of each course. A potential of 3-years course of Cerebrolysin therapy to slow down the progression of cognitive impairment in patients with poststroke dementia has been studied in the open study. Efficacy and safety of Cerebrolysin were assessed clinically and with a battery of widespread scales and neuropsychological tests. The improvement of cognitive, functional and motor activities in patients with mild and moderate dementia indicates the high effectiveness of Cerebrolysin. A prolonged neuroprotective therapy allows to prevent the progression of cognitive impairment in patients with dementia, so by the finish of 3-years study in 8 (34.8%) patients with mild dementia the MMSE summary score was more then 24 points, consequently the moderate cognitive impairment was diagnosed for these patients; in 6 (26.1%) patients with moderate dementia the MMSE summary score was more then 19 points, thus the mild dementia was diagnosed for these patients. Conclusion: A prolonged neuroprotective Cerebrolysin therapy allows preventing the progression of cognitive impairment and development of poststroke vascular dementia.

Vascular сognitive impairment and risk factors for vascular dementia V. Shprakh, I. Suvorova Irkutsk State Institute of Postgraduate Education, Russia Vascular dementia and vascular cognitive impairment are important causes of cognitive decline in the elderly. It has now been shown that vascular risk factors have measurable negative effects on the brain and are associated with cognitive impairment. We reviewed vascular factors that might be responsible for cognitive decline in vascular dementia and vascular cognitive impairment and the corresponding interventions that might prevent cognitive impairment as we age. 498


To study the status of risk factors in patients with vascular dementia, 144 patietns with mild and moderate subcortical vascular dementia (55 males and 89 females, mean age 70.75 ± 3.5 years) and 128 with mild and moderate poststroke vascular dementia (46 males и 82 females, average age 64.9 ± 4.6 years) have been studied. Diagnosis as “Vascular Dementia” was determined in accordance with ICD-10 and NINDS–AIREN criteria. Clinical-neurological and MRI-investigation were performed for all patients. For patients with subcortical vascular dementia a coronary heart disease and hyperlipidemia were significant risk factors for aged from 50–59 years, coronary heart disease and diabetes mellitus were significant risk factors for aged from 60–69 years, hyperlipidemia was significant risk factor for aged from 70–79 years. In accordance with MRI-results a cerebral white-matter lesions in thalamic, basal ganglion and bilateral subcortical leukoaraiosis were significant risk factor for dementia. For patients with poststroke vascular dementia a coronary heart disease was significant risk factor for aged from 50–59; coronary heart disease, diabetes mellitus, overweight and hyperlipidemia were significant risk factors for aged from 60–69, diabetes mellitus, overweight and hyperlipidemia were significant risk factors for aged from 70–79. The stroke-related factors were cerebral infarction in left hemisphere, frontal and temporo-occipital infarction, thalamic, basal ganglion; cerebral white-matter lesions. Conclusion: All determined vascular risk factors being potentially eliminated and resolved and therapeutic actions for patients with vascular cognitive impairment timely performed will allow avoiding the vascular dementia development.

The cerebral MRI findings in patients suffering from atypical endogenous depression I.N. Shurkova, А.O. Bukhanovsky, V.V. Mrykhin Rostov State Medical University, Rostov-on-Don, Russia Examined were 70 patients (56 females and 14 males) suffering from atypical depressive disorders. Their mean age was 37.6 ± 5.0. The studied group comprised 23 499


patients diagnosed with a depressive episode and 47 patients suffering from recurrent depressive disorder. 44 patients’ typing showed moderately serious depression, and in 26 patients depression was mildly serious. In 59 patients (49 females and 10 males) revealed were pathological changes manifested as expanded lateral and 3rd ventricles, reduced frontal, orbital frontal, medial prefrontal, temporal and bregmatic cortex areas, ventral striatum, as well as gray and white matter of the hippocampus. Evident reduction of the hippocampus volume in depressive patients (as compared to the group of sane probands) after the first depressive episode reaches 10% for the gray matter and up to 25% for the white matter. The above cerebral changes were more frequent and obvious in senior patients who long suffered from the disease, in the patients with a large number of depressive phases in anamnesis, in the patients with chronic drug resistance, and in the patients with depersonalization-derealization and hypohondriac depressive disorders.

Тhe clinical features, dynamics and treatment of atypical endogenous depressions I.N. Shurkova, А.O. Bukhanovsky, V.V. Mrykhin Rostov State Medical University, Rostov-on-Don, Russia Examined were 160 atypical endogenic depressive patients (36 males and 124 females) of 35.7 ± 4.0 years’ mean age. The group comprised 72 patients diagnosed with a depressive episode and 88 patients suffering from recurrent depressive disorder. The typing of 107 patients showed moderately serious depression, while in 53 patients depression was mildly serious. Studied were the socio-demographic characteristics, biomedical factors, constitutional predisposition, and illness characteristics. The patients were divided into 4 groups of 40. The 1st group was prescribed sertralin, 200 mg as a daily dose; the 2nd group was treated with maprotilin, 200 mg as a daily dose; in groups 3 and 4 similar therapy was combined with 10 daily séances of endonasal infra-red laser 500


radiation. The latter had the following parameters: wavelength – 0.89 microns; pulse capacity – 2.8 Vt; frequency of following of pulses – 3,000 Hz; exposition – 256 sec. Combined antidepressant + laser therapy appeared more operative. Maprotilin application leads to faster symptomatology reduction, while sertralin caused less negative side-effects. The best therapeutic results were achieved with asthenic-depressive and larvaldepressive

patients;

more

therapy-resistant

were

hypohondriac

and

depersonalization-derealization disorders. A sooner therapeutic effect could be noted in the first depressive episode patients and low-degree depressive disorder patients. The lower the affect strength and the greater the specific weight of the optional symptoms, the less successful the depression therapy. The less the illness duration, the greater the probability of drug resistance formation. The adequacy of treatment of the first depressive episode in many instances determined the further illness stereotype and the forecast.

Rehabilitation of patients with alcoholism with the use of original anticonvulsant and peculiarities of pharmacokinetics of the preparation in these patients T.V. Shushpanova, V.Ya. Semke, T.P. Novozheyeva, N.A. Bokhan Mental Health Research Institute SB RAMSci, Tomsk, Russia It is known that optimizing of disrupted homeostasis during (after) acute or chronic PAS is provided with specific and nonspecific mechanisms such as microsomal cytochrom-P450, dehydrogenases etc. The analysis of some literature data and our own clinical-biochemical investigations results (under observation there were 68 patients, men only from 17 to 62 of age with different levels of alcohol abuse) has shown that activity of microsomal cytochrom-P450 is closely associated with such phenomena as individual tolerance to alcohol, rate of alcohol dependence formation and alcohol-induced splanchnesthetic complications character. Sensitization of cytochrome P-450 system to action of psychoactive substances with inductive properties under influence of alcohol can become a significant problem 501


of psychopharmacotherapy. We investigated the effect of long-term dosing of original anticonvulsant Galodif® on activity of the liver cytochrome P-450 system of alcoholics by means of antipyrine test. Methods: As a test-drug antipyrine was used. 68 patients were examined. Concentration of antipyrine in saliva was determined by spectrophotometry assay (B.B. Brodie 1949, in Semenjuk A.V. modification, 1982). Pharmacokinetic parameters were counted by model-independent method of statistical moments of K. Yamaoka: period of half elimination (T1/2, h), total clearance (Cl t, ml/min), average time of residual drug in organism (MRT, h) average time of elimination (MET, h), area under the pharmacokinetic curve (AUC, mkgh/ml). Statistical analysis Student t-test was used. Results: Clinical efficacy of Galodif in alcoholic patients with comorbid organic brain

impairment

has

revealed

in

addition

to

known

anticonvulsant

normothymoleptic, analgesic and vegetostabilizing effects of its therapeutic action. Among affective disturbances Galodif is effective for correction of dysphoric manifestations. Also the preparation has shown greater efficacy in the treatment of cerebral (cephalgic, diencephalic paroxysms), cardiovascular (cardialgia) and myofascial (local muscle-tonic hyperkinesias like cramps) symptom complexes in structure of AWS. The use of antipirine in the control of the drug kinetics in patients with psychic disturbances (including alcoholism) inclusive of the model of choice of therapy is based on the data of the clinical monitoring and provides a possibility to considerably optimize the process of treatment of psychiatric disorders. We observed increase of CLt of antipyrine after 14 days treatment course of Galodif, decreased T1/2 and MRT. Galodif® accelerates antipyrine elimination in both inspected groups. However, activation of the oxidizing metabolism of xenobiotics in the patients group with alcoholism is more expressed (more than 5 times) as compared with controls. It is possible that psychopharmaceuticals that have inductive properties, against a background of the alcohol influence can make a contribution into inductive features of alcohol.

502


To the question of the role of disorder of circadian rhythm disturbance in the pathogenesis of PTSD V.Y. Slabinsky, S.A. Podsadnyi St. Petersburg I.I. Mechnikov State Medical Academy, Russia One of the most important problems of modern psychiatry is studying of PTSD in those people who had suffered accidents that are predestinated by medical, psychological, socio-economic factors. Despite the increasing attention of researchers to the problem of PTSD, there is no prevailing hypothesis of pathogenesis in the available literature. Great psychiatrists of the 20th century E. Kretschmer, S. Freud and others considered PTSD as “physioneurosis”, suggested considering such reactions as physiological, uniting all “catastrophical reactions” in a vasomotor complex characterized by monotony of vegetative appearances. The data which confirmed this theory had been collected in the further and later researches. T.W. Uhde considers that the deprivation of the sleep plays the leading role in the development of stress disorders, which arises after occurrence of a psychotraumatic situation and provokes further aggravation of the day symptomatology. According to the information given by O.V. Vorobyeva, 24 hour deprivation of the sleep, with the majority of sick people (58%) causes deterioration of the condition in the form of strengthening of anxiety, accompanied by authentic increase of desynchronization in encephalogram in the state of wakefulness. In the research devoted to differentiation of panic attacks, arising at night and during the day it has been shown that the first ones are distinguished by prevalence of disturbing symptomatology, and the second ones – by prevalence of depressive manifestations. M.Y. Bashmakov and co-authors assume a much more expressed “biologicality” of night-shift, and, accordingly, a stronger “psychgeny” of the day-shift disorders. A.F. Gorodienko concludes about the disorder of circadian rhythmics of vegetative nervous system of the patients with the responsive symptomatology. According to the data obtained by the author, the time of appearance of paroxysms coincides in due course with the maximum display of circadian rhythmics’ disorders, the various indicators characterizing activity of vegetative nervous system. The data obtained are confirmed by the results of psychological 503


researches. There are some facts that the relaxation coming during the “deep sleep”, can play the role of the trigger of these disorders. According to E. Rossi there are questions of psychodynamics and early awakening in the foreground, which means that the psychophysiological system is overloaded also when the person consciously tries to cope with the psychotraumatic situation and connects this phenomenon with resistance of people to immersing into the regenerative ultradian rhythm and fear of pleasure. The data obtained allow putting forward a hypothesis about the important role of circadian rhythms’ disorders, as a display of integrating activity’s disorder of nonspecific structures of the brain in the pathogenesis of PTSD.

Structural versions of the delirious forms of the functional psychoses of the reverse splitting P.G. Smetannikov Medical Academy of Postgraduate Education, St. Petersburg, Russia The research carried out by us with the clinico-psychopathological method has made it possible to single out 2 following types of the functional delusional psychoses of the reverse development: 1. Presenile type, which for the first time appears after 40–60 years of age. 2. Senile type of these psychoses, which appears after 65–70, 80 years. 1. Presenile delusional psychoses. With most frequent – the paranoiac structure of delusion the patients usually produced single, routine in content, systematized delusional ideas of damage and persecution about the neighbors at the apartment which toss up by them into the saucepan (on the common gas stove) inedible spoiling; secretly, in the absence of patients, they walk to them “under the lock”, spoil their things in order to get them out from the apartment and occupy their living area. It is specifically that the patients would say following: neighbors want only to damage their health, but not to poison and not to kill them (because of the fears of responsibility), and patients themselves do not speak about “the band”, they categorically protest and fight against being sent in the psychiatric hospitals. Memory and intellect in them is completely safe. 504


2. With the senile type of the delusional psychoses of the reverse development (with the beginning after 65–70 years) the patients with so-called in psychiatric literature “late paraphrenia”, corresponding to senile dementia, also produce the systematized paralogical small scale delusion of persecution, damage of the everyday content, asserting that the neighbors, desiring to get out them from the apartment, in every way possible harm them in the kitchen, secretly they walk to them “under the lock”, etc. But in contrast to the patients with the first – presenile – type of psychosis, the patients of this subgroup assert that the neighbors implicate into the pursuit their familiars, the tenants of other apartments and for the greatest threat for the patients is created by “the band”, which sometimes tracks after the patients on the street for the purpose of getting opportunity for their murder. In the structure of delusion in presenile patients clearly prevailed the ideas of damage, and the ideas of pursuit, without reaching “ominous” objective occurred in the background of the clinical pattern. However, in the patients of the senile type of these psychoses waning ideas stepped back in the background, and to the foreground in the clinical pattern came out the completed by the full development persecution ideas. And, in contrast to the presenile patients, the patients of senile type turned to the psychoneurological dispensary for help, always agreeing with their direction into the psychiatric hospital, as considering that their pursuing “band” there will not penetrate, and they will be rescued and they do not want to be discharged from psychiatric hospital in order “to remain among the living”. The signs of dementia in these patients do reveal neither doctors nor psychologists. Only the age-qualification weakening of memory is present, and nothing more. Conclusions: The specific differences existing in the structure of delusion with these psychoses, which do not relate to the senile dementia, have great differentialdiagnostic and rehabilitative value.

505


About the preferable psychotherapeutic approach in the treatment of different clinical types of depressions (methodological aspects of psychotherapy) D.A. Smirnova Samara State Medical University, Russia Psychotherapy is not just an effective method of treatment of mentally ill. Psychotherapy becomes a scientific discipline according to the modern development of its methodological basis. Theory of evidence based therapy, data of effectiveness, targets of interventions, vocabulary and lexicon of different psychotherapeutic approaches, compilation of techniques, appropriate ways of synthesis of techniques and system approach are studied and elaborated by scientists and specialists in psychotherapy worldwide. Psychotherapy is a language based method. Language is a diagnostic and therapeutic tool at once. Targets of interventions are found out and interventions themselves are carried out through the speech. Psycholinguistic method becomes the basic one to clear up the psychotherapy as a science. Study of patients’ speech (n = 124) revealed the psycholinguistic features of different clinical types of mild depressions. Superficial and deep structures of written and oral speech were studied with the use of standard procedures. Representative strategy of discourse, lack of narrations and the most pronounced semantic reduction are revealed at melancholic depression (n = 38). So the melancholic affect is appropriate mainly for the psychoanalytic approach. The trend of melancholiacs to produce successive associations is a resource for psychoanalytic approach but not for the dynamics to recover. Cognitive and behavioral therapy would be able to dissociate pathological succession, stimulate a new way of cognition, create a new sense and restore the lost ones. High coherence of facts and judgments, narrative strategy of discourse characterized the anxious depression (n = 45). The psychoanalytic approach with its method of free associations would be the way to stop pathological explanation and get weaken the strain of obsessive reflection in anxious depressives. Also the imaginative 506


therapy would be preferential for melancholic and anxious patients both when gets away from the locus of pathological thinking and comes back to the state of healthy emotions. Short and unfinished sentences, missing words and facts are specified to the asthenic and hypodynamic depressions (n = 41). The fatigue breaks the effectiveness of any therapy where the patients do have to take part or communicate in behavioral, including verbal, way. To fill the semantic lacunas and emptiness of drives, senses and verbality, caused by astheniс affect, is also the possibility of imaginative therapy such as an Erikssonian hypnosis, for instance. Just then after catching emotional resources in a trance state, the existential and humanistic therapy could go on to restore simultaneously the lacked semantic spaces, senses and behavior.

Features of thinking in mildly depressed patients depending on the type of leading hypothymic affect (clinical psychopathology through the prism of psycholinguistic research) D.A. Smirnova Samara State Medical University, Russia Data of prevalence and disease incidence of mild depression rapidly grow up both in the system of psychiatric survey and primary medical care. Patient’s speech is an objectively defined phenomenon. According to the anthropocentric paradigm, language is regarded as a unique “mental process”, “language production is a key to access”, and “word is a means to commit an individual processing his complete experience of interaction with the outside world”. Language and thinking are interrelated. “The idea occurs in the word”, “language was originally connected with thinking” and realizes the epistemological function as “a way of cognition”. Speech is the only source of information about patient’s mental state when mild depression is diagnosed. 124 patients with mild depression and 77 healthy individuals were studied. Clinical, psychometric, psycholinguistic and statistical methods were used. 201 texts written on the theme of the current state of life were investigated. Patients were divided into three clinical groups: melancholic (M, n = 38), anxious (A, n = 45), and asthenic-hypodynamic 507


(AH, n = 41) depressions. Clinical criteria, which correlate with the leading hypothymic affect and contribute to differentiate the types of mild depression, have been clarified. The criteria were the affective component, the semantics of associative component, the leading component of the depressive triad, the vector of the prevailing perception of time category. The most pronounced pathological changes in speech, which affect mainly semantic structures, were occurred in the group M. Superficial level of speech was damaged in the most way in the group AH. Speech sounded more similar to healthy and reflected the most amount of resource signs in group A. Psycholinguistic features expressed the distortion not only of the content but also of the structure of thinking in the mildly depressed patients. Representative strategy of cognition, presence of successive judgments and rare abstract and reasoning constructs were noted in the group M. Missing of words and facts, more frequent abstract judgments and dissociation inside the judgments while maintaining the overall coherence of context were specified for the group AH. Increasing coherence of

facts,

more

frequent

reasoning

judgments,

strengthening

of

semantic

interrelationship between following judgments, preferential manner of explanation and the narrative strategy of thinking in whole were observed in the group A. Data revealed the distortion of structure and semantics of speech in patients with mild depression which testified the most pronounced psychopathological disorders of thinking at melancholic type and higher adaptability in the anxious depressive state.

Use of paliperidone during long-term remission in attack-like schizophrenia A.B. Smulevich, A.S. Tiganov Menthal Health Research Centre of Russian Academy of Medical Science, Moscow, Russia Objective: to evaluate the effectiveness of paliperidone during long-term remission in attack-like schizophrenia. Matherial and methods: In Department of borderline mental pathology and psychosomatic disorders (head − RAMS academician A.B. Smulevich) MHRS RAMS (director − RAMS academician A.S. Tiganov) 33 patients (13 male, 20 female) were 508


examined with clinico-psychopathological methods; age ranged from 34 to 62 (mean age 49.6 ± 8.4) years; who were in remission (duration > 5 years) after hallucinatorydelusional/catatonic schizophrenia attacks. Clinical presentation by the time of examination was limited to asthenic (27%), neurosis-like (13%) symptoms, affective disorders (23%), sensitive referential ideas (17%), 20% − EPS phenomena. Effectiveness and safety were evaluated with the Scales: Clinical General Impression (CGI), Positive and Negative Symptoms (PANSS), UKU for antipsychotics, Quality of Life Questionnaire (SF-36). Paliperidone doses ranged from 3 to 12 mg. Results: the course was completed by 30 patients, 26 (79%) were responders. By the end of the study in responder group decrease in CGI was 2 points. The most prominent dynamics in PANSS was documented in scale of General psychopathological symptoms (from 53 to 44 points), in scale of Negative symptoms (from 26 to 22 points), in scale of Positive symptoms (from 28 to 23 points). Improvement of life quality in scale SF-36 was revealed in all the measures, predominantly in – “Vitality” “Physical functioning” and “Social functioning”. Twenty two patients were treated with paliperidone

as

monotherapy;

the

others

if

indicated

additionally

took

antidepressants, hypnotics or mood stabilizers. Sixteen (48.5%) patients in the first week of therapy experienced transient adverse effects (mild EPS, anxiety), which reduced after dose lowering and didn’t require therapy withdrawal. Conclusion: paliperidone is effective and safe as a maintenance therapy in attack-like schizophrenia remissions, the drug contributes to reduction of residual psychopathological symptoms, improving life quality.

Russian-American psychiatric collaboration 1986–2010 E. Sorel George Washington University, Washington, D.C., USA Russian-American psychiatric collaboration has been robust and has prospered during the past twenty five years. The author presents his initial visit, to the then Soviet Union, leading a Good Will Mission of American psychiatrists and psychologists to Moscow and Leningrad, in June 509


1986, and its catalytic role to future Russian-American collaborations, in the years that followed, in the 1990’s and 21st century. That and subsequent visits took place during the age of perestroika in the mid and late 1980’s, with a focus on patients’ rights, psychiatric abuses for political purposes. The collaboration moved swiftly into the 1990’s and early 21 st century with a focus on diagnostic manuals, disasters psychiatry, psychiatry & primary care integration, social, psychological & cultural aspects of psychiatry and others. They were greatly facilitated by professional organizations such as the Russian Society of Psychiatrists & Narcologists, American Psychiatric Association, the World Psychiatric Association, and the World Association for Social Psychiatry as well as by policymakers’ initiatives such as the Gore-Chernomyrdin Commission. Now, in the 21st century, Russian & American psychiatrists continue their work on disasters psychiatry and on the challenging and rewarding integration of psychiatric medicine & primary care as well as in other domains. The author addresses current challenges and opportunities in America’s health system reform process and the invaluable role that psychiatric medicine can play through the integration of psychiatry & primary care at training, education, services, research, and health policy levels. These challenges and opportunities of psychiatry & primary care integration are likely relevant not only to Russia and America but also to other low, middle & high income countries as health systems’ fragmentation is one of the major impediments to achieving equity, betteer access and quality. The author addresses strategies for enhancing access, quality and outcomes and transforming health systems.

The influence of inclusion of neurocognitive training in the complex therapy of patients with schizophrenia A.A. Spikina, A.P. Savelyev, A.G. Sofronov Medical Academy of Postgraduate Education, St. Petersburg, Russia Neurocognitive deficit in patients with schizophrenia is one of the most important medico-social problems of modern psychiatry today. The social importance of this problem means that there are many people at the active age among patients 510


with schizophrenia and many of them are invalids. According to numerous researches it is supposed that neurocognitive deficit occurs in 85% of patients with schizophrenia that allows considering it as a cardinal attribute of schizophrenic process. Besides, parameters of the forecast of schizophrenia in the sense of presence or absence of semiology, social adaptation and quality of life directly depend only on safety of neurocognitive functions of patients Neurocognitive deficit is resistant to the pharmacological treatment. Permanent research of methods of cognitive functions correction leads us to active studying not only of pharmacological, but, very important psychosocial ways. Inclusion of rehabilitation programs for the neurocognitive training appears to be one of the perspective ways. Proceeding from these preconditions, we used a combination of training of cognitive deficiency and pharmacotherapy with atypical antipsychotics. Groups of patients with the diagnosis of paranoid schizophrenia, taking the course of treatment in the rehabilitation department of psychoneurological dispensary № 1 were formed. One group received only pharmacotherapy while the second combined pharmacotherapy with training of cognitive deficiency. Proceeding from division of neurocognitive deficiency by the degree of severity (mild, moderate and grave) in trainings groups were included patients with mild and moderate degrees of severity. For the evaluation of results we used clinical scales (PANSS) and experimentalpsychological techniques (For the evaluation of memory we used: learning of 10 words (A.R. Luria’s test, 1969); Benton’s Visual Retention Test (Benton, 1960), Stroop’s Color interference Test (Stroop J.R., 1935), reproduction of stories, the “Encryption” Test (Wechsler D., 1955). For the evaluation of attention: Trail Making Test A and B (Reitan R.M., Wolfson D., 1993). For the evaluation of executive functions – the “Labyrinthes” Test (Wechsler D., 1955), Research of social functioning of patients – PSP Scale). Intensive training is performed during the stay of patients in the rehabilitation department 2 times a week. The duration of each session is no more than 60 minutes. The total number of sessions in the stage of intensive training is 10–12. The supporting stage is directed at maintenance and stabilization of cognitive skills acquired during 511


the intensive stage, and also strengthening of the studied material, with the subsequent inclusion of patients in social programs. Inspection of patients was performed prior to the beginning of training and after the end of sessions. So according to inspection the increase in all parameters was marked (from 6.2% up to 16.6%), the maximal improvement is necessary on a visual memory and minimal on function of attention. At control research in 6 months positive results have been retained. A follow-up research in a year is planned. Conclusions: As a result of training of cognitive processes in patients from the first group (combination of pharmacotherapy and neurocognitive training) we received parameters of increase in rate of activity, improvement of concentration of attention, increase of adequacy of thinking and the volume of long-term memory. We also noted tendencies to increase in the volume of operative short-term memory.

Psychosomatic (rythmological) model of depression in cardiology E.A. Stepanova1, A.V. Andryuschenko2, K.A. Albantova2 1 Mental Health Research Center of Russian Academy of Medical Science, Moscow, Russia 2 I.M. Sechenov Moscow

Medical Academy, Moscow, Russia

Background: Recently depression in general medicine is being studied with interdisciplinary approach. It enables to use as clinical, as multivariate statistical data analysis in the context of psychopathological structure for depression, its interrelations and comorbidity with somatic disease, influence of affective disorder on a severity, course and treatment of internal pathology. Preliminary analysis of results obtained in the epidemiological project “SYNTHESIS” (2009) allowed revealing differences of depression in cardiology in comparison with oncology, dermatology and rheumatology. It also detected a need for study of chronobiological rhythms of depression in cardiology with interdisciplinary approach. Objective: To perform clinical crossectional, retrospective and follow-up analysis of depressions comorbid to cardiological conditions and functional cardioneurotic disorder with emphasis on psychosomatic (rythmological) model. 512


Study design: The study sample consisted of 177 subjects with depression (101 patients with ischemic heart disease (IHD) including angina pectoris functional classes 2–3, subacute myocardial infarction, arrhythmias and chronic heart failure; 76 patients with cardioneurosis). From the sample the experimental group (n = 103; 68.2%) with circadian and/or chronobiological rhythms of depression (58 patients with IHD and 45 patients with cardioneurosis) was formed. All the patients were examined clinically according to standard cardiological algorithm and psychopathologically with the use of ICD-10 criteria for recurrent depression and novel criteria for depression in general practice. Results: After the analysis of a set of rhythmic depressive symptoms (i.e. affective rythms acquired from cardiological pathology and cardioneurosis) two basic types of comorbidity were established: codependent (acceptor and donor types) and autonomic. In acceptor type comorbidity (41%) depression acquired the rhythm of IHD or cardioneurosis exacerbations. Contrastly in donor type comorbidity (21%) depression had its own chronobiological rhythm transmitted to recipient cardiological condition (IHD or cardioneurosis). In autonomic type comorbidity (38%) depression with its chronobiological rhythm remained independent from the course of cardiological disturbances. Conclusion: Chronobiological rhythm is one of the basic dimensions in psychosomatic

model

of

depression.

The

data

obtained

confirm

that

psychopathological qualification of chronobiological rhythms in depression comorbid to IHD and cardioneurosis is of high clinical relevance. The rythmological model requires further study and implementation in clinical practice.

The psychotherapeutic montage: the systems of Meyerhold and Gurdzhiev in psychotherapy A. Stroganov Altai State Medical University, Russia The modern humanitarian space, characterized by abundance and polyvariance of mental stresses, dynamic growth of nervous loadings, appearance the new sorts of 513


mental trauma influences predetermines the necessity of further development of psychotherapy. The main direction of the last decades search in this area is the integration movement in psychotherapy. We found the common algorithm of transformations from theatre systems to psychotherapy methods and devised the original transdrama psychotherapy school, using the integration method of reconstructive psychotherapy by Karvasarsky, Isurina, and Tashlykov experience. We evolved the new methods: the epic therapy, based on the theatre system of Brecht, the method of act-analytic correction, based on the theatre system of Stanislavsky and the method of atmosphere correction, based on the theatre system of M. Chekhov in the network of this school. The next point of the transdrama psychotherapy development is foundation of the psychotherapeutic montage, based on the method of Meyerhold’s and Gurdzhiev’s systems. This method contains consecutively phased correction of personality being in mental crisis including secondary and tertiary forms of personality disorder and uses the patient’s creative potential to break off the crisis, aiming at social rehabilitation, psychological adaptation and formation of mentally ill patient’s psychological resistance. The average duration of the psychotherapeutic montage treatment is 10–12 weeks. The main postulates of the method: 1. The Meyerhold’s theatre system and Gurdzhiev’s mental system are the bases of the psychotherapeutic montage method. 2. The psychotherapy process is the sphere of the psychotherapeutic montage. 3. The psychotherapeutic montage aims at correction of personality and treatment of neuroses. 4. The patient’s attention is focused on important fragments of his life – the subject of the method. 5. The patient’s personality is examined and corrected from the side of directivity, motivation and ego-conception. 6. The psychotherapist forms and controls the process of psychotherapy. 514


7. The psychotherapy explication and the psychotherapist-patient alliance are the most important components of psychotherapy. 8. The success of psychotherapy is achieved due to patient’s own work. 9. The personality correction begins from the crisis cause’s realization and leads to patient’s gain the problem-solving attainments in emotional and situational spheres. 10. The psychotherapeutic montage’s arsenal includes the imagination, attention and improvisation exercises and the special Gurdzhiev’s exercises. 11. The results of the psychotherapeutic montage are the attainments in own work and the psychological resistance of the patient. The first results of the psychotherapeutic montage clinical approbation in rehabilitation, treatment of neuroses and narcology are successful.

Prevention of borderline psychic disorders in children N.K. Sukhotina Moscow Research Institute of Psychiatry, Russia Borderline psychic disorders (BPD) are mostly the disorders of neurotic and pathocharacter spectrum, which are mostly caused by psychogenic factors and in most of the cases “organic predisposition” and interrelation of disorder with personality traits can be found. Thus nature of BPD is complex and multifactor therefore prevention of it requires complex approach considering psychogenetic nature and conditions of its leading role. Intolerance towards external effects is one of these conditions. Therefore new medical concept – quality of psychic health – appears. From the physiological point of view adaptation-compensative resources of the organism are the measure of individual health, including psychic health. Poor adaptation resources develop into sensitivity to weather and heliophisical factors affecting change of psychic tone, various vascular-vegetative disorders, and psychosomatic dysfunctions. Inadequacy of vegetative supplying of organs results into faster lassitude in case of psychic and physical stress. As for social adaptation, it can be measured with personal-affective reactions, stability of emotional sphere, figures if will, quantities of cognitive sphere. 515


Thus primary prevention of BPD should be directed into detection of children with poor psychic health and improvement of adaptation-compensative resources, stabilization of personal sensitivity to different psychogenias. Results of our researches indicate that preventive intake neurometabolic drugs expand adaptative traits of organism when optimizing of somatic-vegetative, cognitive and emotional components of psychic activity. The aim of secondary prevention is minimizing of psychosocial risk factors by the methods psychological-educational correction, behavior and other types of psychotherapy.

Dynamic aspects of PTSD psychiatric trauma and clinical picture of Karabagh war Armenian volunteers S.G. Sukiasyan, M.J. Tadevosyan Center of Mental Health Stress, Yerevan, Armenia Disorders differentiation in soldier-enemy – Mujahidin, Taliban, Chechen, Vietnam soldiers (for whom the war had absolutely different moral-psychological, political and even biological value) remains largely unexamined in great body of current PTSD- related literature. However, Karabagh war volunteers have their significant place in the context of issue mentioned above. According to ICD-10 trauma is an emotional or psychological injury, usually resulting from an extremely stressful or life-threatening situation. Our own clinical experience with “life-treating stressful” patients help us to hypothesize that both PTSD psychic trauma and clinical picture longtime dynamic endure significant essential and formal changes, leading to adaptation disorders. First, combat-related trauma, under certain social-political and economical conditions, transformed into moral trauma, battering person’s moral values, experiencing abjection, shame, grievance, injustice. Second, PTSD transforms from mostly social – psychological phenomena to clinical phenomena. Third, PTSD almost always develops chronological and pathogenetic comorbity with somatic or psychic pathology, 516


generally organic brain injury. Finally at the certain stages of PTSD rent adjustment is inevitable. The problem is enhanced by the fact that we deal not with a regular, professionally trained (physically, morally, ideologically) combat army but with the volunteers whose patriotic outburst was not complemented by adequate training. From our point of view it has led to more destructive influence of combat- related stress. At the same time having found no estimation, recognition and support by the government, their patriotic outburst in its turn became a factor causing the further PTSD development. Most of all people of high moral standards, contrite, with accentuated and psychotic personality (with sensitive-asthenic pole prevalence) become especially vulnerable. They have high sense of duty before a society, native land, and family. They were the first to appear at the battle-front, that`s why they were traumatised stronger than the others. These people, more then others are exposed to trauma causing depressive, anxiety, phobic, somatophorm and other disorders.

Psychiatric aspects of general condition of the patients of diagnostic centre: somatic psychic disorders S.G. Sukiasyan, S.P. Margaryan, N.G. Manasyan, A.A. Babakhanyan-Ghambaryan, A.N. Pogosyan, A.L. Kirakosyan, M.M. Ordyan Centre of Mental Health, Yerevan, Armenia Complex clinical-psychopathological and psychological investigation of the patients, who applied to the medical association “Diagnostics” with the aim of examination has been carried out by us in the bounds of the study of affective and stipulated by stress psychic disorders. We have used “Determining interrogatory of asthenia, depression and hypochondria”, directed to reveal patients with somatic psychic disorders in general somatic net, with the aim to work out mechanisms and methods of early revealing mentioned psychic disorders as one of the aspects of psychic pathology formation on the base of our early investigations. 517


122 patients were examined by non-selective method. The level in 7 and more points according to each interrogatory testifies about the pathological character of investigated disorders. 73 patients (59.8%) display pathological level of asthenia, 51 patient (41.82%) – depression, and 25 patients (2.45%) – hypochondria. The average level of asthenia was 9.18 ± 0.21, of depression – 9.70 ± 0.27, of hypochondria – 8.84±0.33. The coefficient of somatization was 26.02 ± 0.51 and was more than 21 points at 44 patients (36.06%). From above-mentioned it follows that in general somatic net on the level of specialized diagnostic organization, where patients with different forms of indisposition (somatic and psychic) apply, almost 60% of examined display asthenic manifestation, 40% display depressive symptoms, and every fifth (20%) display the anxiety about their health on the level of neurotic (not delirious) hypochondria. Besides, more than one third of patients (36%) display the disorders of somatized circle both in “clean” and in form. It is interesting to mark that the same coefficient of somatization (26 points) was displayed at the patients of “Stress” centre, examined by the same methods though two times more patients (74%) there display somatized disorders.

The structure of initial of “syndrome of indisposition” in the patients of the “STRESS” diagnostic S.G. Sukiasyan, S.P. Margaryan, N.G. Manasyan, A.A. Babakhanyan-Ghambaryan, A.L. Kirakosyan, A.N. Pogosyan, M.M. Ordyan Mental Health Centre, Yerevan, Armenia Worked out by us “Guiding interrogatory of the patient”, recommended for the investigation of somatoform disorders was used with the aim to study the character and structures of psychic disorders in the patients of a diagnostic centre. 122 patients were examined, who displayed anxiety concerning their health long before their applying to the diagnostic centre. The condition of anxiety concerning their health before applying to the specialized clinics we conditionally called 518


“syndrome of indisposition”. More than a half of the patients (n = 73, 74.8%) noted the “indisposition syndrome” on the average during 6.32 ± 0.92 years. In 22 patients 22.45% the “indisposition syndrome” began to be watched on the average 4.15 ± 0.51 months. Moreover, the anxiety appeared only in 3 patients (3.06%) 7–15 days before they applied to the doctor. So the patients more often ignored and underestimated the importance of their indispositions and applied for the specialized help after 6 years on the average. Data obtained with the help of the interrogatory were ranged by us as follows: algetic sensations, vegetative sensations, disorders of energetics and psychic disorders proper. Data obtained by us showed that first of all algetic sensations dominate in the patients of the diagnostic centre: they more often had pains in the stomach (n = 57, 51.9%), in the back (n = 79, 64.75%), in the head (n = 89, 72.95%), display sexual dysfunctions (n = 12, 9.84%) and menstrual disorders (n = 23, 27.05% of women). Vegetative disorders revealed more than ten as stomach-intestinal and urogenital dysfunctions and disorders (constipations, diarrhea, or frequent urination) – n = 60, 49.18%. Disorders of “energetics” like collaps, tiredness, decline of the level of being awake are marked in 100 patients (81.97%), dream disorders – in 74 patients (60.66%). From psychic disorders low mood with depression (n = 84, 68.85%), anhedonic disorders (n = 86, 70.49%), the feeling of anxiety or impatience, “nervousness” (n = 85, 69.7%), sudden bouts of fear or panic have been marked for the last month (n = 47, 38.52%). The given interrogatory allows determining the character of the “indisposition syndrome”. The analysis of data obtained evidences that somatic component of the syndrome was 7, 88 ± 0.28 points on the average, and psychic component was 2.44 ± 0.12. With the level of depressive component was 1.39 ± 0.07 points, and of anxious one was 1 .06 ± 0.07. Subjectively, the patients of the diagnostic centre (n = 70, 54.38%) estimated their condition as satisfactory one.

519


Results of use of Ropren® in treatment of chronic alcoholism V.S. Soultanov, V.I. Roschin, I.A. Monakhova, V.G. Agishev Solagran Limited, Melbourne, Australia St. Petersburg Forest Technical Academy Skvortsov-Stepanov Municipal Psychiatric Hospital № 3, St. Petersburg, Russia The high consumption level of various alcoholic drinks and the progressive increase in patients suffering from alcoholism has made this one of the most significant medical and social problems. Aim of the research: The safety and efficacy of Ropren® (polyprenols extracted from Picea abies (L.) Karst (Norway spruce) green needles) in the treatment of patients with 2nd-stage chronic alcoholism was evaluated. Ropren®, a substance with low toxicity, was compared with the basic therapy recommended by international therapeutic standards. Methods: The evaluation of this therapy was based on the following criteria: the duration of the treatment, inhibition of abstinence syndromes, the effect on psychosomatic status based on the “list of symptoms” questionnaire and the depression/anxiety scale (HADS), changes in symptoms of polyneuropathy (PNP) as per the international Young’s scale, and clinical and biochemical analysis of the blood and urine. The trials were conducted at the Municipal Psychiatric Hospital № 3. Two groups of patients were formed: the experimental group of 60 patients received treatment with Ropren® and detoxification treatment, whereas the other group 30 patients received standard basic therapy, which included detoxification treatment, benzodiazepine-type tranquilisers, group B vitamins and cerebroprotectors. Ropren® (a 25% oil solution) was administered to the patients for 30 days at a dose of 8 drops, 3 times per day before food. Up to 95% of the patients suffering from alcoholism had PNP, and 100% of the patients had a subclinical form of anxiety/depression. Results and Discussion: Ropren® reduced the degree of polyneuropathic manifestations more significantly than the standard treatment in the control group. Of 95% of patients with alcoholism combined with PNP, 10% recovered after treatment 520


with Ropren®, and 85% showed regression and reduction of symptoms from the severe stage of the disease to a less severe stage, as per Young’s scale. Most of the patients from the experimental group showed an effect from the treatment by the 15 th day. Noticeable improvement in neurologic state was found in 81.4% of patients who were treated with Ropren®, evident as a reduction of focal cerebral neurologic symptoms. As a result of the clinical trial, the obvious benefits of Ropren® for inclusion in therapy for patients suffering from chronic alcoholism were identified. When the efficacy of both treatments was compared, Ropren® was more effective. Regression of abstinence syndrome, relief from post-alcohol depression and polyneuropathic disorders occurred on the average 2 times faster, than when basic therapy was used. In addition, the efficacy of the treatment with Ropren® increased with the duration of the disease, whereas the efficacy of the basic therapy decreased with the duration of the disease. The substance was safe and well tolerated by patients, with no side effects or allergic reactions found in any patients for the whole period of the treatment. Another important fact was that Ropren® enabled a reduction in the number of parenteral interventions (injections). Further studies of Ropren® for the treatment of chronic alcoholism and drug addiction are promising.

Assessment of problem video game use and its relationship with psychopathology V. Starcevic, G. Porter, D. Berle, P. Fenech University of Sydney, Sydney Medical School, Australia Objective: There have been controversies regarding the recognition of problem video game use (or “video game addiction”) and its relationship with psychopathology. The aim of this study was to shed more light on these issues. Method: We conducted an international, anonymous online survey, which consisted of the Symptom Checklist 90 (SCL-90), a measure of overall distress and psychopathology, and Video Game Use Questionnaire (VGUQ). In addition to collecting various informations, the main purpose of the VGUQ was to identify problem video game users by means of our provisional criteria. These criteria reflect the crucial features of 521


problem video game use – loss of control over playing video games and specific, multiple adverse consequences – and were developed on the basis of the concept of behavioural addiction and the relatively specific aspects of problem video game use. Results: A total of 1945 survey participants completed all questions. Respondents identified as problem video game users (n = 156, 8%) differed significantly from others on variables that provided independent, preliminary validation of our provisional criteria for problem video game use. They played longer than planned and with greater frequency, and more often played even though they did not want to and despite knowing that they should not do it. Problem video game users scored significantly higher than non-patients (normal population) on the global symptom severity of SCL-90 and on all dimensions of psychopathology. Their scores were especially high on obsessive-compulsive tendencies, interpersonal sensitivity, depression, and paranoid ideation. Conclusions: People with problem video game use can be reliably identified by means of a questionnaire and on the basis of our provisional criteria. These criteria require further validation. Problem video game use is strongly associated with various aspects of psychopathology in causally complex relationships. This has important implications for the conceptualisation, classification, and management of problem video game use.

The effect of novel anxiolytic drug Selank on the psychophysiological parameters of patients with generalized anxiety disorder T.S. Syunyakov, E.S. Teleshova, S.A. Syunyakov, G.G. Neznamov State Zakusov Institute of Pharmacology Russian Academy of Medical Sciences, Moscow, Russia Choice options for anxiolytic drug to treat patients continued to perform their usual functions are limited in out-patient settings due to possible treatment negative influences on cognitive and sensomotor capabilities: attention, perception, reaction times, memory and motor activity. Therefore special attention is dedicated to investigation of influence on the parameters mentioned above of new non522


benzodiazepine anxiolytics. One of these compounds, synthetic heptapeptide Selank, has a molecular structure (Thr-Lys-Pro-Arg-Pro-Gly-Pro) with brutto formula C17H63N11O19 and molecular mass 870. Clinical studies determined it’s high and comparable to benzodiazepine anxiolytic Medazepam therapeutic effectiveness in treatment of generalized anxiety disorder, related to simultaneous realization of drug’s anxiolytic and psychostimulating effects. As a part of standardized 2-week, placebo-controlled study Selank effects on the psychophysiological parameters have been evaluated, using validated scales and methods, in 30 patients aged from 18 to 50 years old, diagnosed with generalized anxiety disorder (GAD) according to DSM-IV-TR criteria. Results of the study suggest that Selank possesses beneficial effects on simple sensomotor reaction, parameters of attention (stability, volume and distribution), choice-reaction time, short-term visual memory, reaction to moving object and overall task performance. Most significant changes involved improvement of following parameters: distribution of attention (p < 0.001), short-term visual memory and an overall task performance (p < 0.05). Also, there was shown the tendency to improve reaction time and accuracy of reaction to moving object (p < 0.1). Thus, in contrast to benzodiazepines, the influence of peptide drug Selank, possessing anxiolytic and psychostimulating activities, on the psychophysiological parameters is characterized by improvement of sensomotor functions, indicating lack of behavioral toxicity. These promising results may suggest using of Selank in treatment of anxiety disorders in outpatients population doing their regular activities.

The clinical and epidemiologocal aspects of gerontopsychiatric disorders in Armenia K. Tataryan Mkhitar Heratsi Yerevan State Medical University, Armenia Objective: The study presents the clinical and epidemiological aspects of presenile and senile mental disorders in Armenia. Relevant issues in the field of 523


gerontopsychiatry are presented and analyzed; recommendations have been made and justified on an organizational level. Methods: The study is based on an analysis of data from the case histories over the past ten years of 224 elderly patients hospitalized at the Nork Republican Center for MH, of data over the past ten years from the out-patient cards of 289 elderly patients who were examined and received treatment at the Nor Arabkir Polocliclinic as well as on the results of examinations of the mental state of 45 residents at the Nork elderly home. Results: Based on the epidemiological and nosological structure of mental disorders, it was revealed that 224 patients received in-patient treatment between 1995 and 2004, the majority (57.1%) was aged 60-65 years; women were predominant (59.4%) in all age groups. In the given time period, 289 patients sought outpatient treatment. The majority (57.1%) here also consisted of the 60–65 year age group and women. A comparison of socio-demographic indicators (living conditions, education, and source of income and so on) showed that these factors were largely similar in the in-patient and out-patient groups. The exceptions were the indicator for seeking medical attention, which was 1.3 times higher in the out-patient group as well as the indicator for the presence of somatic disease, with such diseases detected 2.7 times more frequently in the out-patient cases than with hospitalized patients. A study of the gerontopsychiatric structure of diseases showed that the diagnosis in the in-patient cases consisted largely of psychotic disorders and dementia, while in the out-patient cases non-psychotic disorders dominated, with the exception of senile dementia (28%). A study was also conducted of the cognitive function of residents at the Nork elderly home, which constitute a group with high risk. According to the results, 29% of the residents had mild cognitive disturbances, which was a condition between age-related changes and dementia, with a high probability of the development of dementia within the following 3–5 years. The cognitive functions of patients were tested both through individual interviews and through the use of the mini-mental state examination (MMSE). Based on the results obtained, a “risk group” for the development of dementia

524


in elderly patients was distinguished. The need for prophylactic measures was established. Conclusion: Taking into consideration the fact that Armenia does not have a gerontopsychiatric service, the need was established for the organization of such a service and the importance within it of primary care was emphasized.

Psychosomatic peculiarities of asthmatic children L.A. Temmoeva Kabardino-Balkaria State University, Nalchik, Russia We have studies psychosomatic peculiarities of 100 asthmatic children. 35 of them had a mild form of bronchial asthma, 53 in a moderate form and 12 children had a severe form. Together with basic therapy half of the children have been treated by a mountain climate treatment. The main method of studying the psychosomatic peculiarities is the method of clinical examination, which is complemented of all the patients shows a harmonic type of reaction type for the disease during the period of remission in flat country. One third of the patients have an anxious-phobic type of reaction. More often we have registered an egocentric type, while 24 patients show a neurasthenic type. The type of reaction depends on the severity of the disease: children with mild bronchial asthma have harmonic and egocentric types of reaction. Children with moderate and severe bronchial asthma have an anxious-phobic and neurasthenic types. And only 16 children have a condition of emotional stability, Two third of the patients shows elevated neurotizm, the other have disturbances in their adaptation and emotional lability. Mountain climatic treatment has changed the type of reaction. In more than half of cases we have registered a harmonic type of reaction. We have obtained lowering of level of anxiety and aggressiveness, which witnesses the efficiency of this therapy. Drawing tests reveal the absence of the disease image as depicted in them.

525


Depressive and anxiety disorders in patients with rheumatic diseases A.F. Terentyeva Yaroslavl State Medical Academy, Russia The purpose: to study intercorrelations of depressive and anxiety disorders with peculiarities of rheumatoid process. 193 patients with rheumatism at the age from 20 till 70 years were studied. All patients were divided into 4 groups: without depressive disorder (51 persons) and with depressions (mild – 45, moderate – 55, severe without psychotic symptoms – 42). At the majority (60%) the beginning of rheumatoid process was preceded by quinsy, and also cold, a scarlet fever, a pharyngitis, overcooling. Depressive symptomatic was registered by the scale of depression of Hamilton, anxiety symptoms were registered by the scale of anxiety of Hamilton and the scale of Shihana. The therapy assessment was spent at the first contact with the patients. Besides, accompanying somatic diseases were registered. During supervision the following data was obtained. Intensity of depressive symptoms was depending on age of the patients: mild and moderate depressions authentically took place in the age of 41–50 years, moderated and severe – 51 year and in elderly, so moderate depressions met in both age groups. As for the activity of rheumatoid process, it was not observed in a group without depressive disorder. The activity of rheumatoid process increased in the process of depression’s intensifying, thus significant differences in activity of rheumatism were marked only between mild and severe depressions. Absence of insufficiency of blood circulation or mild insufficiency (1 degree) are characteristic for mild depressions or their absence, insufficiency of blood circulation of 2 and 3 degrees – in the moderate and severe depressions. The moderate and severe depressions arose mainly with underlying heart diseases and rhythm infringements. Among the accompanying somatic pathology were also marked: hypertensive illness, ischemic heart disease, bronchial asthma, diabetes 2 types, vertebral osteochondrosis, the stomach ulcer, and all diseases in indemnification stage. Moderate and severe depressions were observed more often with underlying somatic diseases (especially vascular), while the accompanying somatic diseases were observed less often or were absent in the cases of mild depressions or without 526


depression. Besides, anxiety increased in patients with the moderate and severe depressions as well as in patients with accompanying somatic diseases. Thus, the occurrence and severity of depression and anxiety in rheumatism are influenced by many factors, including the age of the patients as well as the presence and severity of an accompanying somatic pathology.

Closapine in acute psychosis V.A. Tochilov, O.N. Kushnir St. Petersburg I.I. Mechnikov State Medical Academy, Russia Closapine (аzaleptin) is widely spread in our country. However its properties and characteristics are still insufficiently understood. Closapine is registered in the USA for treatment of resistant forms of schizophrenia and for decrease the risk of suicide behavior in patients with schizophrenia and schizoaffective disorder. The psychotic syndrome in the Parkinson disease is the additional indication in Europe. The dates of long term Closapine intake have been gradually collected. It was found out that Closapine effect during long supporting therapy differs from effect of typical neuroleptics. The results show efficacy of Closapine on the negative symptoms of schizophrenia. There was noticed that the quantity of acute episodes decreased, the duration of remissions was shortened. It was revealed that the efficacy of the Closapine is at least the same as typical antipsychotics in schizophrenic patient. Our own dates show the higher efficacy in patients with affective- delusion and oneiroid syndromes. This anxiolytic property of Closapine defines antipsychotic effect. Closapine could be indicated either as monotherapy or in combination in patients with bipolar and schizophrenia patients. For a long time Closapine has proved itself as a medication for the treatment of severe depressive episode with psychotic symptoms in bipolar, shizo-affective disorder, recurrent depression. In these cases Closapine effect is seen in the first days. From the brief review follows that Closapine is the medication of a choice for therapy of acute episodes of schizophrenia, bipolar and recurrent depression, shzisoaffective psychosis. Our experience proved that efficiency directly depends on a grade of acute 527


state condition, expressiveness of anxiety and excitation. If there is an alternative for treatment of a chronic schizophrenia – in the form of atypical antipsychotics, there are no alternatives for the therapy of acute psychoses – only Closapine. For safe use it is necessary to know side effects. In psychiatric practice too much atypical antipsychotics are used, which are exceed Closapine in safety but conceded in efficacy. That’s why indication of Closapine as a maintaince therapy is not justified. However Closapine is an effective antipsychotic medication and, despite serious side effects, indication of Closapine is strongly recommended in acute psychosis.

Psychoeducation and insight in schizophrenia S. Trushchelev State Medical Refresher Institute of the Ministry of Defense, Russia Schizophrenia is a severe and persistent disease that damages the lives of not only those it afflicts but their families and friends. If the disease progresses, patients are gradually lost social ties, knowledge, and habits of work. Many of them are disabled. They may not be able to hold down jobs or even perform tasks as simple as conversations. Some may be so incapacitated that they are unable to do activities most people take for granted, such as showering or preparing a meal. Many are homeless. Antipsychotic drugs are often very effective in treating certain symptoms of schizophrenia, particularly hallucinations and delusions; unfortunately, the drugs may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness. Some patients restore enough to live a life relatively free from care with the help of drugs. The drugs really work and, if so, how long do you need to keep taking them for? After all, many of antipsychotics not only expensive but also often cause undesirable side reactions. Negative social stereotypes are important. They often increase the social distance between the patient and society. Contacts of patients are decreasing with colleagues, friends and relatives. In one study, we found that patients do not seek to build strategies to overcome the disease. Patients don’t know his disease. The main source of information for patients is their physician. 528


The amount of time that lapses from onset of symptoms to diagnosis and treatment can often help to predict outcome as well. The sooner someone is treated for schizophrenia once symptoms begin, the better the overall likelihood for improvement and recovery. However, at this time, the average length of time between the onset of psychosis and first treatment is many years. We developed psychoeducational approaches to increase patients' knowledge of, and insight into, their illness and its treatment. It is supposed that this increased knowledge and insight will enable people with schizophrenia to cope in a more effective way with their illness, thereby improving prognosis. Our concept is to improve mental health care provides psychoeducation to patients and the general population, changing social attitudes. Expanding access to treatment for people living with mental illness and helping them to achieve higher levels of recovery cannot happen without public support. That involves addressing public attitudes. Public education, heightening public awareness, and correcting public misperceptions will go a long way to eliminating the barriers that exist for so many. That’s easier said than done, but a framework for progress has slowly emerged over the past ten years to provide hope for the future. Strategies need to be expanded and intensified.

Suicide and aggression in out-patient contingent of psychiatric patients V. Tsuprun Moscow Research Institute of Psychiarty, Russia Growth of suicidal rate in population and increased level of violence in society make this problem socially significant. Evident fact is that these social trends have an affect on contingent of psychiatric patients. To assess ratio (correlation) between suicidality and aggression in out-patient psychiatric practice three similar groups of a patient were investigated (in sum 150 persons). The first group – patients with suicidal and aggressive behavior (S+A), the second – patients with aggress only (A), the third – patients with suicidal behavior 529


only (S). There was prevalence of patients with different types of schizophrenia and less degree – patients with affective disorders. Male were predominated over female. All patients were clinical-and-psychological examined with use of psychological scales. Obtain data was statistically processed. The correlation between group S+A and group A shows reliable differences in depression and anxiety levels and in couple of psychopathological symptoms. There were no differences between all groups in general, physical, indirect and verbal aggress and in other psychopathological characteristics. Comparison of the first group (S+A) with group of suicidents (S) were reliable indicated that general anxiety, personal anxiety, sense of fault, marked sluggishness and obsessive-compulsive symptoms were prevail in group S+A. Thereby,

our

findings

giving

rise

to

tell

about

less

intensity

of

psychopathological symptoms at patients with aggressive behavior, than at patients with combination of suicidal and aggressive behavior. This fact needs more differentiated relation to patients with both signs of suicidality and aggressiveness. Design of adequate strategy and tactics in out-patient management of this patients will promote a prophylaxis both suicidal and aggressive behavior of psychiatric patients in out-patient conditions.

Clinical characteristic of depression in women having children with infantile cerebral paralysis N. Ustinova Kazan State Medical University, Russia The aim of our research was to study depressive disorders in women exposed to long-term psychological traumatic experience connected with their child disease (infantile cerebral paralysis). Between 134 women having such kind of disable children 74 women (55%) had depressive disorders, that is greatly exceeded prevalence of depression in common population. 530


Clinical variants of depression were performed: 1) adjustment disorders (F43.2) – 24 women (18%), 2) depressive episodes (F32.0) – 20 women (15%), 3) dysthymic disorders (F34.1) – 30 women (22%). Clinical characteristic of adjustment disorders were: brief depressive reaction, prolonged depressive reaction and mixed anxiety and depressive reaction. Depressive episodes more often were mild, only 6 women exposed moderate depressive episode. Clinical characteristic of dysthymia were somatize variant (with features of multiple, recurrent, and frequently changing physical symptoms based on chronic depressive mood) and pathocharacterologic variant (with personality changing). The correlation between time of exposing to longterm psychological traumatic experience (age of child) and clinical variants of depression was revealed. Mother’s adjustment disorders were prevailed on the beginning stages of child disease. This kind of disorders have been replacing to dysthymia in the course of time. Prevalence and clinical variety of depressive disorders among mothers having children with infantile cerebral paralysis which have been given are important in rehabilitation not only children, but their mothers as well.

Psychogenesis and psychotherapy of panic disorders E.B. Varshalovskaya1, T.V. Sokolovskaya2 1 Federal Almazov Heart, 2

Blood and Endocrinology Centre, St. Petersburg, Russia

Medical Academy of Postgraduate Studies, St. Petersburg, Russia

Events of last decades have shown that alongside with bio-physiological concepts of panic disorders etiopathogenesis, psychogenic and personal factors play a key role in their origin. The results of clinical and psychological researches in such patients have shown marked intrapersonal problematics caused by blocking of positive and negative emotional experiences. Such a mechanism can originate in early childhood as a result of specific family upbringing tactics, when expression of positive emotions is not encouraged and negative emotions result in punishment with severeness. Researches of mutual relations in parental family have shown that mothers of the patients were imperous, prepotent women for whom this hypercontrol over social success and normative rules of conduct of the child were combined with 531


absence of its full emotional acceptance. In most cases such behavior of the mothers was a result of marked problematics of matrimonial diad which was solved by nonconstructive methods that, certainly, resulted in problems in the family and, as a rule was replaced by hypercontrol over children by their mother. The result of this situation was specific mother’s behavior: setting rigid behavioral limits, demand of supersuccess under any circumstances with marked critical score of any child’s achievements. The mother’s provocative behavior resulted in child being anxious and resulted in his participation in competitive struggle at nonconscious level for “rightness of ideas”. Our growing up patients have been accumulating negative emotions towards the parents which were superseded and created the stress, being nonconscious need for hyperapproval of the ego-position, that quite often resulted in attempts to relieve the stress by alcohol and narcotics and has aggravated an intrapersonal problematics. High normativity and motivation to hypersuccess, on the one hand, and unstable selfestimation with marked uneasiness – on the other hand, in certain situations of feebleness have created intolerable sense of loneliness and anxiety, transforming in panic attack. For these patients these panic attacks were a kind of protective-coping behavior. Treatment of such patients requires deep pathogenetic psychotherapy aimed at recognition of interconnection between semiology and psychological problems, at acting out of children's negative emotional experience, at liberation of spontaneous emotional expression.

Diagnosis and treatment of lingering forms of neurotic disorders in dynamic psychiatry paradigm A.V. Vasilyeva St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Among the different forms of the neurotic disorders the lingering forms present a real challenge for the specialists and their input in daily practice is constantly increasing partly because of the social-economic changes and disappearance of the supportive social environment partly because of the shift in the value system with the idealization of the borderline behaviour. 532


The introduction in 1998 of ICD-10 in the psychiatric practice brought about pure syndrome diagnostic approach with the neglecting of the personality structure and etiological and pathogenesis issues. It is a common place, that polymorphisms of the symptoms is one of the main features of the lingering forms of the neurotic disorders, that explains why these patients get different diagnosis with the discontinuation of the treatment process and distortion in the epidemiological figures as main consequences. We suggest to use the additional personality diagnostic axis in the daily practice with a thorough psychodynamic assessment of the patient to evaluate at the very beginning the probability of the lingering development of the neurotic disorder. According to G. Gabbard the psychodynamic approach with a special way of thinking about both patient and clinician that includes unconscious conflict, deficits and distortions of the personal structures, and internal object relations and that integrates these elements with contemporary findings from the neurosciences proposes the main guidelines for well-designed clinical interview for making the appropriate diagnosis. Here the ideas of the dynamic psychiatry of G. Ammon can be really very useful. First of all the consideration of mental disorders on the gliding spectrum defines the possibility of the neurotic level disturbances not only in person with neurotic structure but in more severe patients as well. That makes one of the main tasks of the diagnostic interview the evaluation of the personality structure. To perform this task it is necessary to estimate the peculiarities of the object-relation system, the organization of the psychological defence mechanisms, special defence patterns can be understood as an arrest in the individual personality development, the features of the primary group dynamic and the dynamic stereotypes of the patient, in the mental status such phenomena as reality testing skills, affect toleration, the ability to distinguish internal and external reality. The other important issue is the assessment of pathogenic and protective factors in patient’s anamnesis. All the findings form the targets for a longterm dynamic-oriented psychotherapy with the limited confrontation and “repeat and repair” of the dynamic conflicts as a main principle. The therapeutic system of the combination of different group therapies, combining the verbal and non-verbal 533


methods is highly recommended. The regularly dynamic supervision that allows to achieve the higher level of personality integration for the patient and to prevent burnout syndrome is also very important.

Predictors of the thymoanalytical therapy efficacy in patients suffering from psychiatric disorders S.V. Vaulin, M.V. Alexeeva Smolensk State Medical Academy, Russia Depressions if they are not dependant on nozologic factors can easily promote the development on suicidal behavior. Prognosing growth of depression disorders world-wide stimulates more effective strategies to prevention. Basic treatment strategies to combat depressive illness nowadays present in the form of thymoanaleptic therapy in depressive patients associated with suicidal risks in different stages of suicidal behavior formation. We observed 112 patient of psychiatric clinic during admission for suicidal attempt, and managed to divide the research group into 3 categories depending on persistent suicidal risks. The 1st group involved persons, committed a suicidal attempt, corresponding with WHO protocols. The second group was presented with uncompleted suicidal attempts, i.e. those who committed serious suicidal attempts. And the 3d group presented the patients with persistent suicidal behavioral tendencies during the post-suicidal period (i.e. suicidal-fixed post-suicidal attack). The dynamic analysis in suicidal groups, starting from the appearance of suicidal ideas in the period of presuicide attack, revealed the difference of expression and correction of negative and positive affection in the structure of depressive symptomocomplex. The results of our investigation strongly support the expression trend to autoagressive actions which do not depend on the severity of the depressive disorders. The suicidal risks degree, the seriousness of suicidal attempts and also suicidal tendencies fixation should strongly correlate with the depressive syndrome structure, and in particular – with the negative affection expression. 534


Thus, every selected group of patients requires different tactics and strategies of treatment regimen, prophylactic pharmacotherapy inclusive. Depresants with their selective actions to neuro-mediator systems, which allow using differentially therapeutic actions under suicidal behavior, combined their influence to positive and negative affection in various depression stages. The expression of positive and negative affection symptoms may act as the affective pharmacotherapy efficacy in suicidal behavior, which may allow increasing the quality of suicidal attempts prevention and undercompleted suicide cases.

Art-therapy, social rehabilitation, psychotherapy of mental disorders E.V. Veshenvetskaya, S.V. Lyashkovskaya, N.S. Medvedeva, A.R. Nazirova St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia In modern psychiatric institutions of different countries the issues of improving the methods, tools and techniques that enhance the effectiveness of psychotherapeutic work are becoming increasingly important. ART-therapy or psychotherapy by art as a method increases its wide use, based on the capacities of modern and classical art. It currently is expanding the range of visual arts, including the use of sand, clay, plastics, photo, computers, and various modern means of expression. Today the basic directions in art therapy are actively developing. Passive art therapy the use for treatment of already existing works of art through analysis and interpretation by the patient. Active art therapy is encouraging patients to creation, which in itself is a key therapeutic factor. The eclectic art therapy is a combination of passive and active art therapy. The specifics of the art-therapy we use are determined by the orientation of therapeutic factors, and levels of adaptation of the patient: from the socio-personal, through identity-associated to associative-communicative, socio-communicative. On the socio-personal level in the base adaptive action lays creative, harmonizing, integrating power of aesthetic, creativity, which is inherent in art. Adaptive action in itself is the power of art, which has its manifestations: creation, 535


harmonization, integration. On the personal-associative level compensation and adaptive aspects are achieved due to a voltage drop as reaction on different conflicts, oppressive experiences in the creative process, and sublimation of these experiences. On the associative-communicative level therapeutic effect is achieved by connecting the relevant cognitive operations: the discussion of awareness of the conflict, the establishment

of

psychotherapeutic

contact.

Psychotherapeutic

access

to

psychopathological experiences is done with the use of projections and reaction occurring during the interaction. On the socio-communicative level the adaptive resource is applied possibilities of creativity – the person enjoys all of creation. In organic lesions physiological level is important, and in the choice of the method the accent is made on physical, clearing-kinetic effect of creativity on the body and the psyche of patient. Therapeutic mechanisms and psychotherapeutic target are determined by the general philosophical and theoretical basis of the specialist. These are applicable – creativity, sublimation, projection, and employment. The perspective of the development of art therapy in our clinic is the practical application of art therapy as diagnostic and therapeutic correctional tools in identityoriented therapy, as well as the use of art therapy techniques and methods in the context of psychodynamic and cognitive-behavioral psychotherapy.

Psychosocial prevention of psychoactive substances use among university students I.V. Voevodin Mental Health Research Institute SB RAMSci, Tomsk, Russia The students are a vulnerable group for mental and behavioural disorders due to psychoactive substance use, so the prevention and studying of the psychoactive substances use situation is one of the major objectives. In our research in 2002 at the universities we found out the prevalence of alcohol abuse (without dependence) among male students of 49.3%, among female students of 24.7%. Prevalence of illicit drugs using (including single experience) has made 30.6% among young men and 536


9.9% among girls. In the second research in 2009 prevalence of alcohol abusing among young men of 38.7% and among girls of 31.4% were revealed. Prevalence of drug using among young men has decreased to 22.5% and has increased among girls up to 24.3%. Therefore, preventive maintenance should take into account the tendency of the “feminization” of the psychoactive substances using. Until recently in Russia the “intimidation” was the leading strategy of the addictive behaviour prevention among the young people who belong to the risk group for mental and behavioural disorders due to the use of alcohol and drugs. Stigmatization of such persons, compulsory registration, and the state control of their behaviour, expulsion from educational institutions and so on also were wide-spread. Low efficiency of this approach was noted by Russian scientists since 1980th years. Now the development of the new psychosocial prevention methods and destigmatization of drug using and alcohol abusing students is one of the main tasks of the Russian psychiatric help system reformation. The results of the researches which were carried out in the Mental Health Research Institute, Tomsk, confirm that the usage of the parameter complex “coping behaviour” (E. Heim), “rationality of cogitative sphere” (A. Ellis), “social-psychological adaptation” (M. Bosc), “personal features” (MMPI) and “presence of anxiety and depression” (HADS) is promising during realization of the psychosocial prevention. These parameters are the basis of the group training, and individual work with students from the risk group.

Validation of the children’s depression inventory (CDI, M. Kovacs) S.V. Volikova1, 2, O.G. Kalina2, A.B. Kholmogorova1, 2 1 Moscow Research Institute of Psychiatry, Russia 2 Moscow

City University of Psychology and Education, Russia

Many scientists note the increase of the number of children with depressive symptoms. Necessity arises timely to find an instrument for bringing to light depressive states among children and adolescents to prevent chronic disease and attempted suicide. Foreign scientists use the Children Depression Inventory (CDI, 537


M. Kovacs) for these purposes. The aim was raised to make validation of the inventory on the Russian selection. 1522 pupils aged from 7 to 17 were examined. All the validation procedures were described (exploratory factor analysis, confirmatory factor analysis, construct validity and internal consistency). On the base of the exploratory factor analysis we found 5 scales to be valid: negative mood, school problems, negative self-attitude and social exclusion, low self-effectivity, self-depreciation (for the elder adolescents the last one includes also somatic complaints). Confirmatory factor analysis proved fitness of the 5-scales model in the Russian version of the CDI. The construct validity was determined by correlations between CDI-scales with the Personality Anxiety Scale (A.M. Prichojan). These results showed good correlations (Spirmen’s rho from 0.21 to 0.41). As M. Kovacs stated the CDI was sensible to changes of the children’s states and it was used for determination of the dynamics while depression states cure. That’s why the retest reliability in this case can’t be determined because of the nature of the construct by itself. Cronbach’s alphas are from 0.49 to 0.72 depending on the scales. Thus the reliability of the single scales is not sufficient. Cronbach’s alpha for the integral scale, measuring the total level of the depression state is rather high (0.83). Thus these statistical procedures showed the most importance of the integral point (the total point of the depression) rather than the points of the subscales.

Problems of patients with epilepsy and ways to overcome them T. Von, S. Trushchelev State Medical Refresher Institute of the Ministry of Defense, Russia Aim: To analyzed in the publications a problems circumference of peoples with epilepsy. Methods: Complete retrospective study. We performed a content analysis of scientific publications using PubMed database (National Medical Library, USA) as a source of information. Results: At the beginning of January 2010 we identified PubMed bibliographic records matching the specified term: 200 “epilepsy AND stigma”, 562 “epilepsy AND 538


driving”. In analyzing the information flow of publications related to stigma, it was found that 67 reports (33.5%) discussed the problems of patients, associated with the disease, reported in 41 (20.5%) – the problem of patient-related side effects of drugs, 20 publications (10.0%) – compliance issues. Found that patients increase the excitement after the announcement of the diagnosis of disease. Their worries need to observe a particular way of life and social restrictions (a ban on driving, the restriction of employment, social prejudice and social stigma, the high cost of medicines). These restrictions are identified as important by 48–60% of patients. Social stigma has been difficult and significant problem for 24–33% of patients, long-term drug addiction – for 33%. Not familiar with the instructions of the admission of drugs 58% of patients. In the 3 publications noted that lack of information has 58–67% of patients. In the 8 publications noted the importance of advocacy. Patients with epilepsy have been long restricted driving. In recent times, in this affair is the marked liberalization. In studying the problem we noted that the frequency of accidents involving drivers with epilepsy in the US is 29–38%, Germany – 30%. Risk of accidents in epilepsy was 1.9 (with cardiovascular disease and diabetes – 1.6 and 1.8). Similar results were obtained in the UK and Finland. In Brazil, Greece, India, Russia, Japan, the constant restriction comes after the first attack, in Canada and the US – at 3 months after the attack, in Germany – at 6 months. International Bureau of Epilepsy in conjunction with other organizations in 1994 for patients with epilepsy developed recommendations for driving. Conclusion: In overcoming the problems of patients with epilepsy can play a significant role of information systems development support to patients and their relatives. Need to develop this work as medical technology and the app form of work with patients. We can effectively control the epilepsy with modern medicines. In this connection it is necessary to revise legislation and in the absence of seizures within 6 months, subject to regular medicine and outpatient treatment of patients could be allowed for cars.

539


Clinical features of an initial stage mixed vascular – Аlzcheimer’s dementia E.O. Voronina, V.G. Budza Orenburg State Medical Academy, Russia Inspection of 100 patients at the age from 48 till 67 years is spent. The basic group was made by 28 patients with a combination of an Alzheimer’s disease and vascular dementia (F00.02). The control group included 47 patients with vascular disease of a brain (F01) and 25 – with an Alzheimer’s disease (F00.0). Сombination vascular and Alzheimer’s processes Initial the stage in most cases proceeded on amnestic to a variant, as well as in control group (71.43% and 96%, р < 0.05), that corresponds to a classical stereotype of development of an Alzheimer’s disease. At mixed mixed vascular – Аlzcheimer’s dementia arose atypical for Initial a stage of atrophy Alzheimer’s of display, in particular, absence of spontaneity which met on Initial a disease stage in the basic group in 10.7% of cases while in control group this type Initial a stage is diagnosed by us in one case. The Psychotic variant Initial a stage was often enough marked in our sample of patients of the basic group at mixed vascular – Аlzcheimer’s dementia (18%) whereas in control group with an Alzheimer’s disease of that it was not observed. The general for these psychoses was simplicity of productive semiology and longer intervals between Initial psychotic displays and typical demonstrations atrophyc process. At a combination of atrophy Аlzcheimer’s with braun – vascular disease on инициальном a stage a visible place occupy productive psychotic frustration, besides the informative infringements; vascular defeat of a brain in a combination to an Alzheimer’s disease promotes at the initial stage of illness to development aspontaneity a variant dementia.

The program of psychosocial rehabilitation of adolescents suffering from a schizotypal personality disorder V.B. Voronkova St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia The problem of psychosocial rehabilitation is of vital importance during the last years. The tasks of such rehabilitation consist in recuperation of cognitive, 540


motivational, emotional resources (including skills, knowledge, abilities to cooperate, to solve problems, etc.) of mental patients with maladaptive behaviour. At the present moment there are a lot of rehabilitation programs that include different units such as elements of psychoeducation, trainings of social skills, confidence, etc. Thus, the combination of medical therapy and psychosocial rehabilitation provides a comprehensive biopsychosocial approach to treatment of mental diseases. We did a pilot study; the aim of it was the development of a program of dynamic rehabilitation of adolescents suffering from a schizotypal personality disorder. A comprehensive approach was taken as the basis of our program. This approach includes personal resource mobilization, initial vocational guidance and work with a patient’s immediate environment having the purpose of optimal social integration. The research work was carried out with 19 adolescents aged 15–17 that have been diagnosed with schizotypal disorder. At a preparatory stage of the study a trial of medical therapy for reduction of clinically apparent psychopathological symptoms was made; as well as the analysis of the coping strategies (“The Coping Strategy Indicator”, Amirkhan J., 1990, adapted by N.A. Sirota, V.M. Jaltonsky, 1996), and classification of types of family upbringing with the help of E.G. Eidemiller’s Questionnaire “The Analysis of Family Relations”. It was discovered that a nonconstructive coping strategy – “avoidance” was mostly used by these patients and the problems in family relations were found out. The main stage of the study consisted of individual psychointervention talks, sessions of family psychotherapy, initial vocational guidance on the basis of differential-diagnostic questionnaire based on classification of professions of E.A. Klimov. Then group sessions with the elements of psychoeducation and a training of social skills took place. During these sessions the adolescents learned structural forms of social interaction. Within the framework of psychoeducational programs the information about the essence of a schizotypal disorder, the supposed factors that led to decompensation, the states that needed therapeutic treatment, the effects of psychotropic medication was given to the adolescents and their parents. Thus, as a result of the conducted work in 14 cases out of 19 the adolescents and their parents followed therapeutic recommendations much more attentively and were 541


oriented to further cooperation with a doctor. The patients observed improvement in their health, gave an adequate estimation of their state and social perspective. Based on preliminary results, we can draw a conclusion about the necessity in combining psychoeducational programs with psychotherapy for formation of constructive coping behaviour of adolescents.

Clinical prediction Aripiprazole efficacy in treatment of schizophrenia K.K. Yakhin, T.R. Gazizullin Kazan State Medical University, Russia Introduction: One of the most actual problems in treatment of schizophrenia is selection of effective neuroleptic based on patient individual drug sensitivity. Only clinical-like investigations (naturalistic kind) could be useful in this field. According this point we performed clinical trial of aripiprazole efficacy in treatment of schizophrenia and tried to expose individual clinical features (prediction factors) for successful therapeutic response. Aim: The aim of this study was to evaluate common efficacy of aripiprazole in patient with schizophrenia and to expose individual prediction factors for therapeutic response in 70 days treatment period. Patients and methods: This was naturalistic study of 15–30 mg dose aripiprazole. 62 patients male gender, inpatient, aged 18–65 years, fulfilling criteria for ICD X schizophrenia were included in this study. Informed consents were obtained. Exclusion criteria were: current and clinical relevant organic, neurological and cardiovascular disease, alcohol and drug abuse. The primary efficacy parameters were obtained by total PANSS score from beginning to endpoint of study. Clinical improvement was defined as ≥ 20% reduction in total PANSS score for patientsresponders and ≤ 19% for non-respondent patients. The next step of this study included factor analysis by PANSS in patients-responders and non-responders for exposing clinical profile in predicting successful or unsuccessful therapeutics response. Results: A total of 62 patients entered the trial, 33 patients (53%) have ≥ 20% reduction in total PANSS score (responders), 29 patients (47%) have less reduction 542


(non-responders). According responders PANSS factor analysis data, first factor model was completed by negative syndromes (blinded affect, emotional withdrawal, uncooperativeness etc.), second factor was fulfilled by positive syndromes (hallucinations, delusions, hostility, poor impulse control etc.), third factor completed by depressive disorder (depression, somatic concern, anxiety, feel of guilty). PANSS factor analysis for patient non-responders demonstrated different type syndromes (positive and negative) within one factor model. It indicates deeper psychic disintegration. These results could be informant in predicting therapeutic response before expensive drug administration.

Psychological diagnosis and psychocorrection as components of the treatment-and-rehabilitation process in epilepsy O.N. Yakunina St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Currently, psychological methods are widely used in the diagnosis of personality traits of epileptic patients revealing the structure and degree of intensity of the disturbances. The aim of the study: Gaining qualitative and quantitative evaluation of psychological phenomena ranging from the characteristics of sensorimotor activity, memory, attention, thinking, peculiarities of emotional reaction up to the integral characteristics of the intellect, relations system, psychological defense mechanisms, coping strategies. Material and results: 513 adult patients with different clinical manifestations of epilepsy. Among them 123 patients at the initial stage of the disease, 250 patients with a long-term course of epilepsy and 120 patients with the remission of epileptic attacks. Furthermore, 20 patients with subclinical manifestations of the disease were examined. 105 patients were observed in the dynamics of the restorative indoor treatment, a number of patients in the course of the entire period of rehabilitation during several years. The working experience of many years evidences that psychological diagnosis considerably complements that clinical and is more accurate 543


at the early stages of the illness. Quantitative evaluation of the results of investigation allows using the methods of the mathematico-statistical data analysis, which heightens the validity of conclusions and practical recommendations. Psychological diagnosis made at different stages of the illness traces the dynamics of changes in patients’ personality both in the process of the development of the disease and during the regression of its clinical manifestations when obtaining control over the attacks, providing the information on the type of the course of disease. In the genesis of the development of the patients’ personality traits there is contained their polyfactorial causation by the clinical, psychological and social factors. A combination of morphological and neuropsychological disturbances of the brain substrate, early onset of the disease its protracted course, frequent polymorphous attacks resistant to medicamentous therapy, unfavorable microsocial factors heighten the risk of the formation of mental defect in patients. For the patients suffering from epilepsy the disease is a powerful source of the emotional stress causing neurotic reactions and neurosis-like states connected with the restriction of the mode of life and sociopsychological difficulties. Conclusions:

Psychological

investigation

has

definite

importance

for

optimization of medicamentous therapy, psychological correction, vocational and military medical evaluation. Psychological correction of the personality traits of epileptic patients is performed on the basis of clinical and psychological investigation and heightens the level of the patient’s adaptational possibilities.

Association of depression and anxiety alone and in combination with chronic low back pain in primary care pations N.V. Yalceva, D.A. Yalceva Yaroslavl State Medical Academy, Russia Objective: To assess the influence of depression and anxiety comorbidity on pain intensity, pain-related disability, and health-related quality of life. Methods: Screening questionnaire, semistructured psychiatric interview, Hamilton depression rating scale (HDRS), and Hamilton anxiety rating scale (HARS). 544


All patients (n = 122) had chronic (>or = 6-month duration) Low Back Pain. Patients with depression were oversampled and represented 100% of the study population. Patients were categorized according to pain comorbidity with depression, anxiety, or both. We used analysis of variance and multivariate analysis of variance models to assess the relationships between independent and dependent variables. Results: 1540 outpatients from 18 to 55 years in several primary care settings have been studied with screening questionnaire, semi structured psychiatric interview. 50.5% of the outpatients studied showing different (depressive and anxious) disturbances. In the majority of cases, the anxiety symptoms overlapped with depression. 19.2% of the patients were identified with depression by standardized clinical instruments according to ICD-10 criteria, the HDRS score was 15 or more. At the same time, there were different combinations of depression with anxiety and somatoform disorders, a patient HARS score average of about 17. 122 of 1540 patients suffered from Low Back Pain. Participants had a mean age of 45.1 years; 82.8% were women. 50.8% (n = 62) had pain and depression, 49.2% (n = 60) had pain, depression, and anxiety. Patients with pain and both depression and anxiety experienced the greatest pain severity (p < 0.0001) and pain-related disability (p < 0.0001). Psychiatric comorbidity was strongly associated with number of days of disability in previous 6 months (p < 0.0001), with 27.0 days by those with pain and depression, and 39.4 days in those with all three conditions. Conclusions: The comorbidity of depression and anxiety in Low Back Pain patients is strongly associated with more severity pain, greater disability, and poorer quality of life.

Art-analysis – new method psychotherapy of borderline patients V. Zaitsev, Е. Kutsaja, T. Кhmilova St. Petersburg I.I. Mechnikov State Medical Academy, Russia Non-verbal forms of psychotherapy are an essential component in the treatment of borderline patients because the majority of psychological causes of those diseases emerge at the pre-verbal end early verbal stages of psychic development. We have 545


suggested a novel psychotherapeutic approach integrating a psychoanalytic Principe of free associations and traditional art-therapy process. This method was called “artanalysis” because this name reflects not mechanistic combination, but logical integration of art-therapy and principles of traditional psychoanalytic therapy. The therapeutic session consisted of three phases: 1) art-therapeutic focusing on the problem; 2) successive drawing based on associations related to each of the previous drawings; 3) verbal interpretation of the material obtained. After that therapist try to focus the patient attention and emotion on the series of drawings, which reflected symbols of the real internal object or object relations. As a result patient had an opportunity to externalize on paper problem-related symbols and signs in a non-verbal way. In the course of analysis of the series of drawings associations we took note of an interesting phenomenon, which we termed “graphical regression”. “The graphic regression” includes all three traditional components of regression: topical, formal and temporal. The topical component creates conditions for an ability to recall; the formal component protects the patient’s graphic associations from the influence of secondary processes and creates the constant symbols of various situations. The temporal component of regression allows to connect formal revert to significant situation with different aspects of psychic pathogenesis – in relation to the process object formation, in relation to the stage of psychological development or in relation to the evolution of “self”. There are possibilities not simply to change last problems in the present, but safely actually recreate a conditions of their occurrence, simulating transfer similar to the child relations with transitions objects described by D. Winnicot. Thus, the patient gains possibility to develop cognitive-emotional , but without verbal component to own internals symbols related with fixation on some early stage of development especially “symbiotic” and “separation-individuation” or to symbol of conflict in oedipal relations. Our five-year experience of art analysis in the course of group and individual psychotherapy, a great amount of drawings and clinical data evident show the high diagnostic and therapeutic efficiency of new approach in the psychotherapy of borderline patients, especially with obsessive-compulsive syndrome. 546


Markers of psychosocial acclimatisation of patients with cerebrovascular encephalopathy in the course of rehabilitation D.V. Zakharov, O.A. Balunov St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia Introduction: Change of demographic situation in Russia and augmentation of the share of cerebrovascular pathology is a sufficient argument for optimization of rehabilitation process of patients with dyscirculatory encephalopathy. The purpose of the work: To study the dynamics of indicators of quality of life in patients with chronic cerebrovascular pathology with moderate cognitive dysfunction in the course of rehabilitation. Materials and methods: In this work were analysed the indicators of the “quality of life” (QoL) in 102 patients with cerebrovascular encephalopathy of 2 stages of the disease, aged 56–70 years who were hospitalized in the Department of Psychoneurological Rehabilitation of the Bekhterev Scientific Research Institute. None of the patients had strokes in the past history. For the verification of diagnoses of cerebrovascular encephalopathy we have performed MRI, TCDG, psychometric and psychopathological research with all patients. “Quality of Life” was studied and estimated by means of the Russian version of the WOOHQL-100 questionnaire. The analysis of value judgment has shown that quality of life developed on many components, sometimes only indirectly concerning medical process, but playing an important role in daily functioning and self-service. So, enrichment in spheres “level of independence and physical sphere” confirmed efficacy of regenerative therapy. However, together with augmentation of autonomy of patients their requirements for adequacy of environment has increased, level of claims of patients to comfort of stay indoors, safety and conveniences in the street, necessity of reception of greater volume information has raised. Enrichment of indicators of social activity probably spoke for the stay of patients in more comfortable psychotherapeutic climate of clinic, benevolent dialogue between them and the personnel while in daily life they experienced difficulties in interaction with family and “out-of-family” environment. The consequences of problem mutual relations of the patient and society are reflected also 547


in the assessment of sphere “environment”. Safety and comfort of conditions out of doors made an essential contribution to formation of the assessment of environment. There was some enrichment of the attitude of patients towards trips in public transport that is an original marker of enriching of independent existence of patients. With the dilating of terrain of walks patients became more exacting to comfort of environment: to presence of benches in the street, availability of public toilets, etc. Conclusion: The analysis of indicators of QoL allows specifying influence of regenerative treatment on various spheres of ability to live of patients of advanced age with cerebrovascular encephalopathy. The fact of negative attitude of aged patients to the insufficient help from medico-social and public services, to shortcomings of the system of organization of social protection, availability of the information and quality of environment is observed.

The dynamics of paroxysmal schizophrenia with long-term remissions N.V. Zakharova, N.A. Il’ina Mental Health Research Centre, Russian Academy of Medical Sciences, Moscow, Russia Objective: 1) To investigate the clinical presentation of long-term remissions; 2) To elicit the interdependence of the long-term stable remission possibility and the duration of the prodromal and active periods in paroxysmal schizophrenia; 3) To correlate the acquired personality disorders in late stages of paroxysmal schizophrenia with the psychopathological structure of the earlier attacks. Materials and methods: Thirty six outpatients (9 male, 27 female, mean age 49 ± 9.7 years) with paroxysmal schizophrenia were examined using prospective follow-up clinical method over a period of 2008–2009. Obligatory inclusion criteria were: duration of the remission for 5 years and more, satisfactory occupational status. Results: Two variants of the course in paroxysmal schizophrenia with longterm remissions were distinguished: syndromal (full) and symptomatic (with signs of continuous sluggish course). The first is formed after the single/series of catatonic onsets and is characterized by marked negative alterations, better social adaptation. The second develops after dissociative-paranoid onsets and is characterized by 548


residual non-manifest psychopathological disorders, despite of less negative personality alterations.

Analysis of the general psychological characteristics of successfulness of coping with the family stress in patients with endogenous psychoses N.M. Zalutskaya St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Russia In the present study, we were focused on the patients’ opinion concerning the degree of intensity and duration of their emotional balance impairment occurring after quarrels with family members. Most of patients evaluated their attempts to cope with the emotional discomfort occurring as the result of conflicts with their parents as being “always or almost always” unsuccessful and failing to lead to a substantial reduction of the emotional discomfort. Patients who regarded their coping as being unsuccessful demonstrated significantly more expressed impairments of their functioning in everyday life, at work and at training (GAS Scale). The level of negative symptomatology and general psychopathology (PANSS) in subjectively unsuccessful patients was significantly higher compared to patients regarding their attempts to restore emotional stability as successful. We did not reveal significant difference in mechanisms of psychological defence (SBAK Test, FBS Test) and in coping mechanisms (SVF Test, Lazarus Test) between the two groups. This makes possible to assume that there is no direct connection between use of any special way of the reduction of emotional discomfort and efficiency of coping with stress. But it should be noted that a psychodynamic content of the same variants of coping in patients from different groups can differ. Comparison of the values reflecting the level of formation of the central personality functions showed that patients with unsuccessful coping behavior demonstrated more expressed disorders of the structure of personality and had higher values on subscales of “Deficitary aggression” and “Destructive anxiety” and lower values on the scale of “Constructive outer dissociation”. This is indicative of more expressed disorders of preoedipal period of the personality development in patients with subjectively unsuccessful coping. These patients demonstrate significantly more 549


expressed impairments of several mechanisms of narcissistic regulation including “Weak Self”, “Insignificant Self”, “Negative corporal Self”, “Archaic Leave”. The data demonstrate occurrence in patients with unsuccessful coping of the more expressed signs of the Ego weakness which is the basic disorder in schizophrenia. Our data allow suggesting the differentiated approach to the choice of the methods of psychotherapeutical aid to patients with endogenous psychoses. The use of the methods directed to “mechanical” correction of coping could be ineffective if it does not take into consideration personality problems of this category of patients. At the same time, directed use of cognitive approach could be highly efficient.

Influence of some groups of antiepileptic drugs on the cognitive functions of patients with epilepsy N. Zaviazkina Kyiv Center of Forensic Psychiatric Expertise, Ukraine Aim: To search and compare the changes of mental functions during the medical course of different antiepileptic drugs. Contents: During the medical course it was examine 132 patients with Epilepsy at the age of 15–53, among them 71 males, 61 females. Most of them are the young people at the age of 40 (52%) with more than 10 years disorder’s duration. The patients with symptomatic epilepsy and highest frequency of paroxysms are predominating. Most of them (67 patients) had from 1–2 to more attacks per month: 37 patients had the daily paroxysms, and 12 patients had more than 1 paroxysm per day. According to the International classification of epileptic paroxysms (ILAE, 1981) the patients had been classified by: generalized paroxysms – 59 patients (45%); partial paroxysms – 73 patients (55%). Depending on the type and frequency of paroxysms, duration of disorder, and additional researches’ data, the patients obtain (in mono or poly therapy) Valproic acid drugs (35 patients), Carbamazepine (54 patients), and Lamictal (43 patients). For the first time it proves that these antiepileptic drugs have no negative effect for patient's mental functions, but according to the special taking have positive effects 550


for patient's mental status, such as: extension of short-term memory and long-term memory, improvement of mental processes, acceleration of sensomotor reactions reactions, increase of capacity of work, improvement of social aspects of activity. Conclusion: Receiving results could be use in diagnostic activity as criteria of prognosis and effectiveness of treatment with anti epileptic drugs, in view of psychological status of patient, and choice of correct rehabilitation measures for correction of psychic disorders.

551


Index Ababkov V., 184, 265

Antokhin E.Yu., 274, 275, 391

Abolonin A.F., 266

Antonova O.M., 56

Abou-Saleh M., 241

Aragona M., 43

Abramovskaja M.N., 431

Argunova Y., 60

Abritalin E., 383

Aristova T.A., 75

Abritalin E.Y., 267

Ariyanayagam T.A., 261

Agarkov V.A., 164, 298

Arystova T.A., 304

Agasaryan E.G., 269

Avdeyenok L.N., 276

Agbayewa M., 106

Avdibegovic E., 117, 228

Aghekian E., 270

Avedisova A., 277

Agishev V.G., 271, 425, 520

Aytuganova A., 313

Agius M., 261

Azizian A., 348

Akhadov T.A., 238

Babakhanyan-Ghambaryan A.A., 517, 518

Akhapkin R., 277

Babic D., 228

Akiyama T., 158

Babin S.M., 279

Aksenov M.M., 276

Baburin I.N., 280

Al Hadithy A.F.Y., 51

Badry K., 171

Alarcon R.D., 137

Bagaev V.I., 281

Albantova K.A., 512

Bahk W.B., 263

Alekseyev B.Ye., 272

Bahk W.M., 244, 245, 259, 262

Alexandrova N., 212

Balanina T.Ju., 446

Alexeeva M.V., 534

Baldina O.N., 274

Ammon M., 142

Balunov O.A., 282, 283, 547

Andersch N., 179

Baranov А.В., 284

Andryuschenko A.V., 512

Bardyurkina V.A., 274

Angelopoulos N.V., 363, 364, 365

Barkhatova A.N., 238

Angst J., 35

Bartenev D., 59, 206

Anisimov N., 482

Baxendine S., 177

Antipova O.S., 251, 258

Baydavletova E.T., 275 552


Bebbington P., 246

Bulygina V.G., 186

Beckov A.S., 389

Burbiel I., 143

Belous I.V., 285

Burgic-Radmanovic M., 228

Ben-Efraim Ya., 94

Burkovskyi G.V., 75

Benko L.A., 305

Burmikina O.A., 354

Berezantsev A.Yu., 233, 285, 287

Butoma B.G., 75, 304, 401

Berle D., 521

Butorin G.G., 305

Berrios G.E., 39

Butorina N.E., 305

Bersnev V.P., 288

Byshok S.O., 307

Bessmertniy A.V., 290

Canive J.M., 57

Bhugra D., 152

Cardoso G., 248

Blagovidova O.B., 230

Carli V., 86, 95

Bobrov A.S., 156, 291, 292, 294, 351

Carrisso P., 252

Bocharov V.V., 381

Castaldo G., 95

Bogdanov A., 62

Chalaja E.B., 275

Bokhan N.A., 295, 501

Charkimova Z.S., 230

Bomov P.O., 275

Chekhlaty E.I., 308

Borisova E.V., 187

Chekhonin V.P., 56

Borja-Santos N., 248

Cheon J.S., 360

Botsmanovskiy Yu.N., 488

Chiariotti L., 95

Boukhovets I., 297

Cho H.S., 324

Bower A., 177

Chomsky A., 310, 412

Bronfman S.A., 164, 298

Christodoulou G., 128, 208

Brouwers J.R.B.J., 51

Christodoulou N., 228, 246, 247

Bruggeman R., 51

Chudina Yu.A., 473

Bryabrina T., 300

Chumakova O.N., 302, 311, 312

Buder N., 426

Churkin A.A., 230

Budza V.G., 274, 275, 391, 540

Cranach von, M., 205

Bukhanovsky А.O., 499, 500

Crowell T., 106

Bukhtoyarov O.V., 302, 311, 312

D’Souza R., 151 553


Dalsaev M., 313

Efimcev A., 383

Dalsaeva R., 313

Eidеmiller E.G., 214

Damani E., 364

Ekblad S., 119

Danilova L.J., 314

Eregepov E.V., 375

David E., 105

Eregepov N.B., 375

Davidovski S., 215

Ermakova N.G., 325

De Santi S., 316

Eroshina E.S., 418

Delic A., 228

Ershov E., 327

Detke M., 316

Evsegneev R.A., 156

Dguga N.P., 317

Evsyukov A.A., 334

Dobbelsteyn C., 106

Fastovzev G.A., 56

Dobretsov G., 53

Fedorenko O., 51

Dobryakov I., 213

Fedotova Ju., 328

Dokukina V., 318

Fenech P., 521

Dokukina Т., 318, 344

Ferreira B., 248

Dolnykova A., 320

Filippov P.A., 330

Donov A.V., 334

Fofanova J.S., 146

Dorofeyeva O.A., 321

Fokin V., 383

Dorozhenok I.U., 322

Fokin V.A., 267

Dovzhenko T., 182, 483

Foutsitzis D., 331, 332

Dozortseva E., 162

Fradique E., 254

Drojdina E.N., 146

Freire Lucas R., 252, 253, 254

Druz V.F., 275

Furminger L., 106

Dubenko A.E., 191

G.A. Lialios, 364

Dunjic Kostic B., 247

Gaebel W., 74, 125, 178

Dwivedi Y., 55

Galako T., 424

Dyakonov A.L., 338

Galanin I.V., 431

Dоrovskikh I.V., 323

Galeyeva K.V., 335

Edgar J.C., 57

Garanian N., 182

Efanova N., 482

Garganeyeva N.P., 334, 369, 475 554


Gasanov R.F., 84

Hamarhanova O.V., 292

Gasparyan Kh.V., 118

Hanson J., 119, 208

Gavrilova S.I., 64, 473

Harangozo J., 118

Gayvoronskaya E.B., 232

Hautzinger M., 183

Gazizullin T.R., 542

Hegerl U., 131

Gedge L., 420

Herrman H., 99

Gelda A., 215

Holyavko V.V., 434, 436

Gelda T., 215

Hoven C.W., 82

Genereux H., 106

Huang M.X., 57

Gerasimova O., 257

Hugonot-Diener L., 63

Gigantesco A., 249

Icelli I., 104

Glazachev O.S., 251

Ichitovkina Ye.G., 342

Glushko T.V., 335

Idrisov K., 128, 343

Gogberashvili T., 336

Igumnov S., 215, 344, 346

Golenkov A., 134

Il’ina N.A., 548

Golimbet V.E., 238

Imanbekov K.O., 375

Golodnyi S.V., 389

Ishkhanyan B., 348

Gorelik A.L., 431

Israelyan N.R., 349

Gorodnova M., 212

Istikoglou C., 331, 332

Grasa J., 248

Ivanov M.V. (Moscow), 350

Grigorieva E.A., 338

Ivanov M.V. (St Petersbourg), 169

Gromov S.A., 418

Ivanov S.V., 145

Gryzunov Yu., 53

Ivanova L.A., 294, 351

Gubsky L., 482

Ivanova S.A., 51

Gurina O.I., 56

Ivanova T., 352, 386

Gurko O.V., 232

Ivashinenko D.M., 354

Gurova L., 41

Iznak A.F., 356

Gurovich I.Ya., 53, 77, 78, 339

Iznak E.V., 356

Guseva O.V., 340

Janguildin Y.T., 357

Gzibovska I., 468

Jarbussynova B., 358 555


Javanbakht M., 359

Kay J., 136

Javed A., 102, 116

Kazakovtsev B.A., 186

Jenkins R., 137

Keller S., 95

Johnson S., 246

Kharitonov S., 376

Jokic R., 420

Кhmilova T., 545

Jon D.I., 245, 250, 259, 262, 324

Kholmogorova A., 182, 378, 411, 447,

Jorge M., 122

465, 537

Jovanovic A., 395, 396

Khromov A., 223

Judeeva T., 182

Kim K.R., 324

Jung Y.-E., 244

Kim M.D., 263

Kachaeva M., 162

Kim W., 250, 259, 262

Kadyrova T., 121

Kirakosyan A.L., 517, 518

Kahn J.P., 113

Kisselev A.S., 485, 487

Kaleda V.G., 238

Kissin M.Ya., 187

Kalina O.G., 537

Klueva J.S., 354

Kalinin V.V., 188

Klushnik T.P., 362

Kalinina М.А., 362

Klut C., 248

Kanaeva L., 277

Kochetkov Y., 229

Kanellos P., 331, 332

Kolomeets N.S., 50

Kang N., 106

Kolotilshchikova E.A., 379

Karaoulanis S.E., 363, 364, 365

Kolov S.A., 380, 445

Karaush I.S., 366

Komar A., 53

Karavaeva T.A., 367

Komissarov P., 316

Karpenko O., 247

Kontaxakis V.P., 246

Kartashova I.G., 369

Kontzevoy V.A., 356

Karvassarsky B.D., 370

Korabel’nikova O., 231

Kaskayeva D.S., 334

Koren E., 85

Kasumov R.D., 288

Korman T.A., 381

Kasumov V.R., 288

Korneeva V., 218

Katkov A.L., 372, 373, 375

Kornetov N., 114 556


Kornetova E., 51

Kulishic S., 426

Kornilov V.V., 356

Kulygina M., 155, 164

Korovina S.A., 418

Kuoppasalmi K., 91

Korsakova E.A., 304

Kupriyanov D., 482

Korzenev A., 267, 383

Kupriyanova I.E., 335, 366, 392

Kosten T.R., 90

Kurgak D.M., 295

Kosterin D., 169

Kushnir O., 393, 527

Kosza I., 118

Кusmenko L.G., 362

Коtlayrov V.L., 362

Kutsaja Е., 545

Kotsubinskaya Y.V., 384

Kutuzova A., 450

Kotsubinskyi A.P., 75, 304

Kuznetsov A., 231

Kovalevskaya O.B., 146

Kuznetsov V.V., 251

Kovalyov A.I., 385

Kwon Y.J., 263

Koval-Zaytsev A., 223

Lakic A., 395, 396

Kozlenko Ye.A., 443

Lakosina N.D., 397

Kozlov A., 134

Lapin I.P., 242

Kozlovskaya G.V., 362

Lazareva N.E., 391

Kozlovsky V.L., 317, 409

Lazowski L., 420

Krahmaleva O., 386

Lebedev A., 267, 383

Krasnov V.N., 34, 127, 146, 175, 483

Lebedeva I.S., 238

Krasnova V., 378

Lebedeva T.V., 269

Kravtsova S.V., 288

Lee E., 324

Kremleva О.V., 388

Lee H.B., 262, 263

Krivulin E.N., 389

Lega I., 249

Kruglov L.S., 67

Levin N., 404

Krupitsky E., 88

Lezy-Mathieu A.-M., 63

Kryukova E.M., 274, 391

Liakos N., 364

Kudinova O.I., 392

Lialios G.A., 23

Kuey L., 154

Limankin O., 327, 398, 400

Kulikova N.I., 271

Lindhardt A., 136, 207 557


Lipatova L.V., 401

Maruta N.A., 110

Lisitsyna T.A., 146

Maryasova D.A., 408

Litovchenko T.A., 191

Masand S., 261

Lobanova I.V., 403

Maslovsky S.Yu., 409

Loonen A.J.M., 51

Maximov A., 411

Lopushanskaya T.A., 384

Maximova N., 53

Luengo A., 248

Mazo G., 412, 414

Lukjanov V.V., 308

Medvedev S.E., 214

Lupinov I.V., 488

Medvedeva N.S., 535

Lutova N.B., 143

Melik-Pashayan A.E., 255

Lvov A.N., 322

Melikyan Z.A., 415, 473

Lyashkovskaya S.V., 434, 436, 535

Mellsop G., 177

Lyubov E., 403, 404

Mendelevich V., 416

Machamer P.K., 44

Mendonssa Lima de, C. Au., 108

Magonova E.G., 291

Meshandin I.A., 67

Maj M., 33

Mihalevich I.M., 294

Makarov I.V., 84

Mikadze Y., 336, 492

Malanina A.V., 366

Mikadze Y.V., 415

Malygin V., 224, 405, 407

Mikhailov V.A., 190, 418

Manasyan N.G., 517, 518

Mikhaylova N.M., 69

Mandel A.I., 266

Milev R., 420

Mann J.M., 95

Millar H., 148

Marchenko A.S., 146

Miller G.A., 57

Marchenko Y., 59

Min K.J., 245, 259, 262

Margaryan S.P., 517, 518

Minzer M., 318

Markina O.A., 357

Mironova E.N., 418

Markou G., 331, 332

Miroshnik E., 421

Markova I.S., 48

Misionzhnik E., 53

Martynikhin I., 170

Misyuk N., 318

Marusic A., 95

Mitkovic M., 247 558


Mizinova E.B., 422

Novozheyeva T.P., 501

Moeller H.J., 36, 166

Nyukhalov G., 437

Moeller-Leimkuehler A.M., 160

O’Brien C., 89

Mokhnachev S.O., 92

Odarchenko S.S., 439

Molchanova E., 236, 424

Oganesian N.Yu., 441

Monakhova I.A., 271, 425, 520

Oh B.H., 360

Monasipova L.I., 233, 287

Ohtyarkin E.V., 389

Monfort J.-C., 63

Okasha A., 176

Moon H.J., 244

Okasha T., 147

Morozov P.V., 47

Ola B.A., 442

Mosolov S.N., 167

Olina M.V., 187

Mouzas O.D., 363, 365

Ordayn N., 328

Mrakovic D., 426

Ordyan M.M., 517, 518

Mrykhin V., 427, 499, 500

Orlova V., 482

Mukambetov A., 424

Orlovskaya D.D., 50

Mukhametshina E., 429

Orudzhev Ye.S., 443

Murray D., 420

Oskolkova S.N., 56

Mykhaylov B.V., 430

Osman D., 316

Nagorova E.D., 298

Ostapenko A.V., 445

Naryshkin A.G., 431

Ovsiannikov S.A., 446

Nasonov E.L., 146

Ovsyannikov S.A., 47

Nasyrova R.F., 433

Pae C.U., 245

Nazirov R.K., 434, 436

Pajevic I., 228

Nazirova A.R., 535

Papouli F., 331, 332

Neto A., 248

Paschkova I.M., 187

Neznamov G.G., 321, 522

Patil A.D., 261

Neznanov N.G., 37, 170, 418

Pavlichenko A.V., 397

Nikitina I., 182

Pavlova T., 447

Nikolaev E., 134, 255

Pechlivanoglou P., 51

Nikolskaya I., 213

Pejuskovic B., 129 559


Penchul N.A., 75

Rancans E., 234

Perekhov A.Y., 448, 449

Rataemane S., 466

Perrez M., 181, 265

Remeslo M.B., 436, 466

Petriakin A.V., 238

Renemane L., 468

Petrov A.M., 304

Repin A.N., 335

Petrova G., 182

Reznik I., 173

Petrova N., 450, 452, 453

Riba M., 145

Petrunko O.V., 292, 294

Ritskov A.S., 469

Pi E.H., 153

Rivkina N., 470

Pichikov A.A., 461

Rizouli K.A., 364

Pilt E., 60

Rizoulis A.A., 363, 364, 365

Pio Abreu J.L., 253, 254

Romanov D.V., 322, 472

Piven B.N., 454

Roschin V.I., 520

Platov S.V., 455

Roschina I.F., 473

Plotnikov A.V., 457

Roy A., 96, 474

Plounipidis D., 458

Roy M., 474

Podsadnyi S.A., 503

Rozin A.I., 334, 475

Pogosyan A.N., 517, 518

Ruiz P., 152

Polonifis N., 331, 332

Rusaka M., 234

Polosaeva N.N., 330

Rusina V., 162

Ponomarjova T.I., 164

Rutz W., 112, 160, 209

Popov G., 45

Ruzhenskaya E.V., 477, 478

Popov M.Yu., 459

Ryabukchin I.A., 56

Popov Yu.V., 461

Ryadovaya L., 51

Porter G., 521

Safonova N.Yu., 71, 282, 283, 384

Potapov A.V., 167

Samarin D.M., 302, 311

Potapova V.A., 462

Samokhvalova K.V., 164, 298

Prytova Ye., 463

Sanasheva I.D., 480

Pugovkina O., 182, 465

Sarchiapone M., 95

Rakhmazova L.D., 80

Sartorius N., 36, 124, 176 560


Savelyev A.P., 481, 510

Shipkova K.M., 495

Savenko Yu., 61, 206

Shlafer A.M., 279

Savina T., 257, 482

Shmaneva T., 414

Sazonov V.Ya., 434, 436

Shmukler A.B., 53, 78, 339

Schaffner K.F., 44

Shmunk E., 496

Schastnyi E.D., 475

Shprakh V., 497, 498

Scheerder G., 132

Shurkova I., 427, 499, 500

Schimonova G.N., 362

Shushpanova T.V., 239, 501

Schoebi D., 265

Shvetsova A.V., 292, 351

Schultz E.V., 280, 304

Sinyakova A.V., 418

Selezneva N.D., 473

Sisask M., 109, 133

Semenova A.V., 56

Slabinsky V.Y., 503

Semenova N.A., 238

Slezin V.B., 280, 304

Semenova N.V., 66, 71, 485, 487, 488

Sluchevskaya S.F., 66, 171

Semiglazova M., 483

Smetannikov P.G., 504

Semke A.V., 51, 80

Smirnova D.A., 506, 507

Semke V.Ya., 239, 369, 484, 501

Smirnova E., 224, 405

Seok J.H., 324

Smith A.K., 57

Seravina O.F., 146

Smith R., 42

Severnyi A., 216

Smolina N., 53

Shadrina I.V., 490

Smulevich A.B., 145, 508

Shaidoukova L.K., 491

Snedkov E.V., 171

Shakhbazova E., 492

Snowdon J., 106

Shamrey V., 383

Sofronov A.G., 481, 510

Shcherbakova I.V., 493

Soghoyan A.F., 118

Sheinina N.S., 75

Sokolov A.V., 267

Sheremeteva I.I., 480

Sokolovskaya T.V., 531

Shevchenko Y., 218

Sokolowski M., 94

Shin Y.C., 245

Soldatkin V.A., 448, 449

Shipilin M., 169

Solonsky A.V., 239 561


Sorel E., 509

Tavares J., 248

Soubrier J.P., 112

Teleshova E.S., 522

Soultanov V.S., 425, 520

Temmoeva L.A., 525

Spikina A.A., 481, 510

Terentyeva A.F., 526

Sryvkova K., 231

Teymori S.J., 359

Stanko E.P., 344

Tiganov A.S., 508

Starcevic V., 521

Tiihonen J., 91

Steffen S., 101

Titarenko A., 320

Stepanova E.A., 512

Tochilov V.A., 527

Stepanova T.S., 288

Tokarev V., 53

Stolyarov I. D., 304

Tosevski D.L., 129

Stoyanov D.S., 44

Trancas B., 248

Strajev S.V., 233, 287

Trofimova O.S., 251, 258

Stroganov A., 513

Trushchelev S., 463, 528, 538

Sugiura K., 158

Tscherbakova N., 257

Sukhotina N., 219, 515

Tsirkin S., 74

Sukiasyan S.G., 516, 517, 518

Tsucarzi E.E., 465

Summers D., 420

Tsuprun V., 529

Suvorova I., 497, 498

Tsygankov B.D., 269, 357, 407

Syrejshchikova T., 53

Tsygankov D.B., 408

Syrokvashina K., 162

Tukaev R., 231

Syunyakov S.A., 321, 522

Tusi M., 106

Syunyakov T.S., 522

Tyano S., 82, 102, 142

Tabulina S.D., 418

Udomratn P., 139

Tadevosyan M.J., 516

Umalas К., 220

Tarumov D., 267, 383

Uranova N.A., 50

Tarusina I., 320

Usmanov D.N., 491

Tasman A., 123, 138

Ustinova N., 530

Tataru N., 105

Uvarova E.V., 164, 298

Tataryan K., 523

Uzbekov M., 53 562


Van Audenhove C., 132

Weizman A., 173

Varnik A., 109, 133

Wied V.D., 140

Varnik P., 109, 133

Wilffert B., 51

Varshalovskaya E.B., 531

Williams J.B.W., 316

Vasilyeva A.V., 532

Woo J.M., 250

Vaulin S.V., 534

Woo Y., 263

Velichkovsky B.B., 473

Woo Y.S., 244, 259

Veltishchev D.Yu., 146

Woody G., 89

Vershinina E.O., 335

Xavier S., 248

Vertogradova O., 53

Xiu P.Y., 261

Veshenvetskaya E.V., 535

Yakhin K., 429, 542

Vichreva O.V., 50

Yakovis A.S., 466

Videtic A., 95

Yakunina O.N., 543

Vieira C., 248

Yalceva D.A., 544

Vinnikova M.A., 92

Yalceva N.V., 544

Vinogradova L., 61

Yanushko M., 169

Vlavianou A., 332

Yastrebov V.S., 122

Voevodin I.V., 536

Yeghiyan M., 348, 349

Voityatskaya I.V., 384

Yemtsev V., 427

Volikova S., 182, 537

Yoon B.H., 245, 259, 262, 263

Von T., 538

Zaitsev O.S., 415

Vorobyov A.V., 267

Zaitsev V., 545

Voronina E.O., 330, 540

Zakharov D.V., 547

Voronkova V.B., 540

Zakharova K., 277

Vostrikov V.M., 50

Zakharova N.V., 548

Wahlberg H., 119

Zalutskaya N.M., 549

Wallcraft J., 100

Zaman R., 261

Wasserman D., 83, 86, 94

Zaviazkina N., 550

Wasserman J., 94

Zaytseva Y., 77, 78, 339

Wasserman L.I., 190, 418

Zeltyn A.E., 146 563


Zhebentyaev V., 346

Zubova Ye.Yu., 443

Zimina I.S., 50

Zvartau E., 88

Zlokazova M.V., 281, 342

Zvereva N., 223

Zubareva M., 424

564

Научное издание

Traditions and Innovations in Psychiatry: WPA Regional Meeting materials, 10–12 June, 2010, St Petersburg, Russia.

Ответственный редактор: Н.В. Семенова Дизайнеры: Г.В. Осадчий, В.Ю. Шувалова Компьютерная верстка: В.Ю. Шувалова Редакторы: И.П. Лапин, А.Д. Пономарев, Н.П. Янкина. Корректор: И.В. Стефанович

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Plenary lectures

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