Psychopathology and Addiction Medicine 1.1 March 2016
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RESEARCH
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| Psychiatry during the era of addiction medicine: modern diagnostic and therapeutic realities |
| Vladimir Mendelevich |
Abstract. This article analyzes the modern psychiatric reality. Over the past decades, the incidence rate of mental disorder and substance abuse has drastically changed. Now, this ratio is one to two. We drew attention to the some increasing the number of psychotic disorders due to the use of the “new (designer) drugs”. All it leads to the conclusion that the problem of increasing the frequency of paintings schizophreniform psychotic disorders due to substance use requires a particular study. An analysis of the possible role of cannabinoids and psychostimulants in the pathogenesis of schizophrenia is also paramount. The question, which covers the problems of the ethical justification and feasibility study of the therapeutic effects of drugs in cases of drug-resistant psychiatric symptoms, needs more attention.
pp. 2–10
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| A single-blind, placebo-controlled, randomized clinical trial of trazodone for the treatment of affective disorders in alcohol-dependent patients in early remission |
| Evgeny Krupitsky, Sofia Yerish, Ksenia Rybakova and others |
Abstract.
Background and Objectives: Results of clinical trials of antidepressants for alcohol dependence are controversial, possibly due to the inclusion of patients with and without co-morbid affective disorders, as well as the use of antidepressants with different mechanisms of action. In this study trazodone was tested for the treatment of alcoholics with co-morbid depression.
Methods: Sixty-one patients with mild to moderate depression were randomized into trazodone (150 mg/day) and placebo treatment groups. Patients were treated for three months. All the study subjects were scheduled to come to the clinic on a weekly basis for medical management, psychiatric evaluation (severity of depression and anxiety, craving for alcohol), control of alcohol use and compliance with the study medications. To assess depression and anxiety, the Hamilton scales, Montgomery-Ashberg Scale, Spielberger state-trait inventory and Zung scale were used. Alcohol craving was assessed by the Obsessive-Compulsive Drinking Scale, Pennsylvania Alcohol Craving Scale, and Visual Analog Scale of Craving for alcohol. Alcohol consumption was evaluated by the Time Line Follow Back technique and by monitoring gamma-glutamyl transpeptidase activity in blood. The overall treatment effect was assessed by the Clinical Global Impression scale. The study design was single blind.
Results: Trazodone was significantly superior to placebo in the treatment of depression, anxiety and craving for alcohol. Trazodone also moderately reduced drinking. There were more adverse events in the trazodone group than in the placebo group.
Conclusions and Scientific Significance: Trazodone is an effective medication for co-morbid affective disorders in alcohol-dependent subjects.
pp. 11–18
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| An influence of a psychiatrist’s diagnostic directive at the bipolar affective disorder course |
| Evgeny Snedkov, Peter Muchnik |
Some Russian psychiatrists are still misdiagnosing schizophrenia in patients whose condition by criteria of ICD-10 corresponds to bipolar affective disorder (BAR) diagnosis. The misdiagnosis influence on the medicines selection and immediate and long-term results in the acute and prophylactic therapies of patients suffering BAR are poorly understood. For a certain part of Russian psychiatrists the underdiagnosis BAR was conditioned by subjective reasons. The recognition of schizophrenia instead BAR is accompanied by the unjustified appointment of neuroleptics not only for a relieving attack but also as a means of preventive treatment. Antipsychotics are poorly tolerated by patients with BAR, have a negative impact on the family and the labor status, are cutting the intermissions duration and are worsening their quality.
pp. 27–36
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| Neurocognition and social cognition as a distinct consruct in schizophrenia: an overview |
| Oksana Bukovskaya, Alexander Shmukler |
Abstract: Schizophrenia is a chronic and severe mental disorder characterized by positive and negative symptoms and occurs worldwide in approximately 1% of the population. Over a decade of research demonstrates that neurocognition and social cognition are to some degree relevant to symptoms in schizophrenia and thus could serve as an additional substrate for medical intervention. Consistent with expectations, the severity of negative symptoms is the only variable that is significantly related to a total number of impaired performances across a broad range of neuropsychological function in all the reviewed studies. Concerning the data on social cognition impairment, the results relating to specific schizophrenia symptoms have been ambiguous thus far. Some studies have found connections between the theory of mind impairment and positive symptoms while others have found associations with negative symptoms. Several have produced no evidence of any relationship to symptoms. Further research is important as the results of such studies could assist in the clinical identification of specific groups of patients, and in the development of corrective procedures for use in rehabilitation programs.
pp. 37–55
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REPORT
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| The mental condition of women combatants in various stages of adaptation |
| Natalia Petrova |
Summary: The influence of stay in the zone of military operations on the mental state of female soldiers has studied the example of 49 women who passed military service under the contract. A significant frequency (70%) of mental disorders, including PTSD (20%) of the women combatants have detected. Two types of reactions in the dynamics of adaptation to the stress associated with the stay in the zone of military conflict have identified.
pp. 56–59
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| Cycloid Psychosis and Cycloid Dissociation |
| R. Durst, S. Raskin, H. Robbins, G. Katz, J. Zislin, |
The investigation into the interrelationship between the cycloid psychosis and dissociative states is called for to arrive at a deeper understanding of the phenomenology, treatment, and prognosis of these complex syndromes when they coexist, appear secondary to one another or represent entities along one continuum. Patients were suffering from dissociative states, and cycloid psychosis present a difficult therapeutic challenge for the physician. They switch abruptly from one state to another, often leading the therapist to interpret the situation as “resolution of symptoms,” “manipulation,” or “organic manifestations necessitating thorough neurological investigation”. The recognition of the syndromes mentioned above has significant implications, both theoretical and therapeutic. We believe that recognition of this diagnostic category is likely to prove beneficial in preventing maladjusted schizophrenic stigmata and recurrent hospitalization of patients suffering from this syndrome.
pp. 60–63
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| The phenomenon of a visualization in obsessive-phobic disorders |
| Vladimir Krylov, Dmitry Butylin |
Summary. The appearance of visualized obsessive memories and perceptions is a clinical-psychopathological symptom which testifies to the overall severity of obsessive-phobic disorders. The direct reflection of obsessive feelings in the content of visual images is characteristic for neurotic states. As a direct and symbolic reflection of the obsessive experiences into visual images takes place in schizotypal disorder.
pp. 64–68
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CASE STUDY
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| Sexual desire and intimacy in the postmodern culture |
| Caesar Korolenko |
Abstract. The problem of the intimacy and the sexual desire in the postmodern culture is analyzed. 20 clients women, 21-47 ages, were observed. Data of their anamnesis were obtained from the clients and their relatives. Psychological and psychiatric interviewing were provided. MMPI and Millon tests were used. All clients revealed narcissistic and/or borderline traits which did not accede the level of narcissistic and borderline personality disorders. The clients needed psychological help that was connected with complaints on the reduced desire and little intimacy in the familiar interpersonal relationships. The insufficient psychobiological symbiosis between the clients in the period of the infancy and the parents, especially, the mother was established and evaluated as the factor that distorted the development of cohesive identity. It was found that the clients have expressed the deficit of the imagination, the low capability of symbolization and mentalization. They complained about the feeling of inner emptiness and the boredom. The one-sided fixation on the physical ability of sexual performance corresponded with the fear of the failure and low sexual desire.
pp. 69–73
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