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Biomedical subjects

A B Smulevich

Publications and source records attributed to A B Smulevich.

At least 19 recordsLinked to original sources
PubMed2003

[Slow-progressive schizophrenia (actual problems of clinical appearance and systematics)].

Slow-progressive schizophrenia is a slow-progredient endogenous process characterized by a prevalence of either negative disorders which do not reach final stages as in a case of psychotic types, or positive symptom complexes showing affinity to psychopathological appearances of "borderline" level (obsessions, somatoform, dissociate, nonpsychotic affective disorders, over-value formations). The clinical systematics of slow-progressive schizophrenia is built on a model implying a prevalence of either negative or positive disorders. Respectively, in the terms of "negative" schizophrenia, there are disease variants featured by a predominance of basic manifestations of an endogenous process: slow-progredient simple, asthenic, and senestopathic schizophrenia. Positive schizophrenia following the pattern of pseudoneurosis is represented by the following variants: neurotic-like, hysteric, depersonalization, visceral neurotic, hypohondriac as well as reactive schizophrenia.

Diagnosis, Differential↗
PubMed2002

[Visceral neuroses: clinical approaches to the problem].

Visceral neuroses are regarded as psychosomatic pathology represented by functional symptom complexes common for both psychic (personality, psychopathologic disorders of anxietyphobic, affective, hypochondriac spectrum) and somatic pathology. Two hundreds fourteen patients: 67 with hyperventilation syndrome (HVS), 77 with Da Costa syndrome (DCS), 70 with irritable bowl syndrome (IBS) have been studied. The study suggest that visceral neuroses represent a group of independent diseases. In contrast to converse neuroses, a topical projection (respiratory, cardiovascular system, gastrointestinal tract, etc.) of visceral neuroses reflects not only a psychosomatic disorder's specificity but also the course and prognosis regularities inherent to them. HVS course is wavy with periodic exacerbations and incomplete remissions, DCS one is phased (remissive), IBS is chronic without distinct phases and intervals. HVS and DCS are comorbid to milder psychic (personality and anxiety phobic disorders) and somatic pathology. IBS is associated with not only more severe mental disorders (overvalued, hypochondriac, affective) but also with chronic somatic diseases (alimentary system).

Adult↗
PubMed2002

[Schizophrenia and schizophrenia spectrum disorders in general hospital].

The prevalence and clinical presentation of schizophrenia and schizophrenia spectrum disorders in general hospitals were studied. The disease incidence rate was estimated at 3.1% that was 3 times higher than that in general population. Slow-progredient (latent) schizophrenia with comorbid functional visceral disorders ("organoneurotic" schizophrenia) occurs most frequently. Once manifested, the latter was associated with somatoform disorders during the disease course and developed concomitantly with neurotic and overvalued hypochondria symptoms. The authors suggest that several variants of complex relations between the endogeneous disease (schizophrenia) severity and functional somatic disorders. Slow-progredient (latent) disease reveals an affinity to a number of somatic disorders associated with neurotic and overvalued hypochondria. In more severe disease forms combination of endogenous process with somatoform disorders is accompanied by development of hypochondria with stable algias. In progressive (paranoid) schizophrenia, association with somatoform disorders occurs only at the initial stage of the process. Somatic sensations trigger formation of delusion symptom complexes of cathestesic delusion type.

Adult↗
PubMed2001

The inhibitory effect of Selank on enkephalin-degrading enzymes as a possible mechanism of its anxiolytic activity.

Examination of patients with various forms of anxiety and phobic disorders (according to DSM-4 criteria) demonstrated a considerable shortening of enkephalin half-life and reduced total enkephalinase activity in the blood during generalized anxiety, but not during panic disorders and agoraphobia. This was probably related to low blood concentration of endogenous inhibitors of enkephalin-degrading enzymes in patients with generalized anxiety disorders. Heptapeptide Selank (Thr-Lys-Pro-Arg-Pro-Gly-Pro), which attenuates behavioral anxiety reactions and does not cause side effects typical of most anxiolytics, dose-dependently inhibited enzymatic hydrolysis of plasma enkephalin (IC50 15 microM). Selank was more potent than peptidase inhibitors bacitracin and puromycin in inhibiting enkephalinases. These results suggest that high efficiency of Selank in the therapy of anxiety and phobic disorders, including generalized anxiety, is due to its ability to inhibit enkephalin hydrolysis.

Anti-Anxiety Agents↗
PubMed2001

[Clinical course, internal picture of the disease and pathogenic reactions in patients with bronchial asthma].

AIM: To study clinical features of bronchial asthma (BA) associated with internal picture and nosogenic reactions. MATERIAL AND METHODS: Clinical features of BA were studied in 108 patients (38 males and 70 females, mean age 44.7 +/- 1.4 years, mean BA duration 6.6 +/- 0.76 years) treated in the clinic of the I. M. Sechenov Moscow Medical Academy in 1995-1998. RESULTS: Clinical and statistical analysis of BA clinical course allowed to single out three leading variants of BA course: persistently obstructive (stable and definite respiratory disturbances with progressive deterioration of bronchial permeability), moist (associated chronic bronchitis, allergic rhinosinusopathy, chronic maxillary sinusitis, intestinal dysbacteriosis, repulsive symptoms, e.g. discharge of much sputum et cet), paroxysmal (short-term episodes of asphyxia arrested by inhalations of beta 2-agonists, absence of stable respiratory disorders). The above variants of BA course significantly correlated with types of the internal picture (IP) and types of nosogenies. Persistently obstructive, moist and paroxysmal BA variants were characterized with vital, defensive and coping IP, respectively, neurotic reactions with hypochondria, hypochondriac depressions; pathocharacterological sensitive reactions; neurotic and affective reactions with "la belle indifference" and "euphoric pseudodementia", respectively. CONCLUSION: The above correlations can be used for planning and conduction of psychocorrective measures aimed at optimisation of patient-doctor compliance.

Adult↗
PubMed2001

[Personality disorders: old and new problems].

Correlations were found between the structure of personality disorders (PD) (neurotic--borderline personality organization) and the regularities of PD dynamics. Taking into consideration the regularities of interaction of psychopathologic manifestations with positive symptomatology, three types of PD dynamics were psychopathologically identified, which show information on polar (compensation--decompensation) processes: 1) that in form of personality development; 2) that in form of PD-associated quasipsychoses; associated with DP; 3) that in form of transformation of characterological disorders into psychopathologic ones. The first two types of dynamics, which appear as as actualization of pathocharacterological formations in the pattern of mental disorders, reflect decompensation processes. In neurotic personality (emotionally labile, anxious, dependent, sensitive schizoids, etc) there is a deep (in terms of personality development) reorganization of characterological abnormalies. In borderline personality (paranoid, expansive schizoids, anancasts, borderline, etc.), aggravation and chronic pattern of mental disorders occurs with dynamics of PD-associated quasipsychoses. The third type of dynamics is not accompanied by aggravation of pathocharacterological manifestations and reflects compensation process. Separation of the isolated symptom complexes, PD derivatives (steady-state catathymically charged pathocharacterological formations are symptom-forming) is possible in any type of personality organization, but more frequently is observed at complex forms with a high proportion of facultative complexes and accentuations.

Humans↗
PubMed2000

[Psychopathological phenomena and personality disorders (the issue of dynamic aspects of psychopathologies)].

An analysis of the interaction between pathocharacterological and psychopathological (affective, anxious-phobic and hysterical) phenomena within "borderline psychiatry" (reactions, phases, development) gives evidence to the existence of 2 clinically heterogeneous variations of comorbid interactions. The first variation: primary psychopathological syndromes manifesting without any significant correlation with personality disorders and transform into pathocharacterological ones (neurotic, postreactive) personality development by means of "amalgamating" mechanism. The second variation: secondary (in regard to personality disorders) psychopathological phenomena forming on the basis of constitutional personality traits by means of "splitting off" mechanism and are defined as personality disorders with predisposition to manifest positive psychopathological symptomatology. Formation of isolated obsessive and dissociative disorders within the structure of "basic" pathocharacterological phenomena (variation 2) predicts a future absence of growing severity of personality disorders (i.e. a dynamics traditionally defined as the development--variation 1) and stabilization of psychopathic traits with features of compensation of the latter. The possibilities of pathological dynamics in psychopathic personality with a "splitting off" of the isolated psychopathological syndromes exhausted; for decades neither growing severity of personality disorders, nor an exacerbation of those psychopathological complexes which provided a primary base for manifestation of positive symptomatology may be observed.

Adult↗
PubMed2000

[Organic neuroses as psychosomatic problem].

To study a role of psychogenic and somatogenic factors in the development of organic neuroses, 302 patients were examined: 199 with cardioneurosis and 103 with irritable-bowel syndrome (IBS) with mental and subclinical somatic pathology or without it. Two types of organic neuroses were distinguished: a conversive one--somatized hysteria (psychogenically determined subsyndromal hysterohypochondriac phobic or affective reactions with clear difference of algesic and autonomic disorders from symptoms of the somatic pathology, with polymorphism of the involved organic systems); and autonomic neurosis that is a central link in the structure of psychosomatic correlations, which, on the one hand, was overdone by clinical manifestations of the somatic pathology (mitral prolapse--35%, ventricular extrasystoles--12%, etc. in cardioneurosis, lymphoid hyperplasia of colonic mucosa--100%, dysbiopsis--10%, etc. in IBS); on the other hand, autonomic neurosis is a somatopsychic component of psychopathologic disorders of anxious-phobic, affective and hypochondriac sphere (panic disorder--59%, generalized anxiety--15%, anxious depression--18% in cardioneurosis, melancholic or hypochondriac cyclothymic depressions--76%, hypochondriac development--24% in IBS). Psychosomatic correlations were considered in autonomic neurosis in the context of some continuum, where somatic disorders amplified by functional disorders are on the one pole and true mental pathology including somatoautonomic disorders--on the other pole. Recommendations have been formulated on therapy of organic neuroses with anxiolytics, antidepressants and atypical neuroleptics in combination with somatotropic drugs.

Adult↗
PubMed2000

[Clinical effect and tolerance of paxil (paroxetine) in management of panic disorders].

AIM: To determine clinical efficiency and tolerance of paxil (paroxetin) in the treatment of panic disorders. MATERIAL AND METHODS: An open, non-comparative 7 week study entered 60 patients (mean age 36.6 +/- 3.22 years) with panic disorders and agoraphobias with panic disorders. Paroxetin was given in a single daily dose 20-60 mg/day in the morning. The results were assessed by Hamilton and Sihan scales, scale of clinical impression, by reduction of panic attacks. RESULTS: In 72.2% of patients panic attacks ceased or occurred less frequently (by 50%). Anxiety relieved by 67 +/- 4.6%. The number of the responders was greater while the effect occurred faster in patients with panic disorders. The drug was well tolerated, side effects occurred in 43.3% of cases. They were mild or moderate. CONCLUSION: Paroxetin has a prominent anxiolytic and antiphobic action, is well tolerated and is effective in panic disorders and agoraphobia with panic disorders.

Adult↗
PubMed2000

[Psychopharmacotherapy and management of psychiatric care in somatic hospital].

A clinical trial was made of 1994 patients admitted to a large general hospital in Moscow during a day in two seasons (spring, autumn). The aim of the study was to detect patients of a general hospital in need of psychotropic drugs, to assess their psychic condition and to develop recommendations for optimization of psychiatrist's consulting. It was found that 49.3% of the examinees need psychotropic drugs (at least one). 37.5% need tranquilizers, 20.7%--nootropic drugs, 21.2%--antidepressants, 5.9%--neuroleptics.

Antidepressive Agents↗
PubMed1999

[Therapy of cardio-neurotic diseases in general practice: clinical experience with atarax].

An open study of efficiency and safety of atarax (hydroxisine) enrolled 55 outpatients (23 males and 32 females, mean age 45.91 +/- 1.91) with generalized anxious and somatoform disorders running as cardioneurosis as well as nosogenic reactions (maladaptation), manifestations of cardiovascular pathology (acute myocardial infarction, angina of effort functional class II-III, postinfarction cardiosclerosis, essential hypertension in 5, 13, 2 and 5 patients, respectively). The patients received atarax for 28 days (daily dose 50 mg). The course was completed in 54 patients. In 47 of them, the overall score value by Hamilton Anxiety Scale dropped by 10 scores, the reduction being more obvious in patients with somatic anxiety. Hydroxysine is well tolerated and safe both in patients with somatic pathology and those with cardiovascular disorders.

Adult↗
PubMed1999

[Psychosomatic disorders (clinical picture, epidemiology, therapy and models of health services].

53.6% of the patients of general hospital suffer from psychosomatic disorders (PSD). Two-dimensional (psychologic/ clinical) model of psychosomatic interrelations is presented which proposes the estimation of the influence of both somatic and psychological factors within PSD pathogenesis. The clinical classification of PSD includes 4 types: somatization (somatoform disorders)--organ neuroses--27%; psychogenic (nosogenic) reactions--57%; stress-related exacerbation of the medical illness (symptomatic lability)--14%; exogenous (somatogenic) reactions--1%. Except psychotherapy, PSD treatment demands pharmacological intervention (including tranquilizers, antidepressants, cerebroprotectors and neuroleptics). Pharmacotherapy should be proceeded with the account of both its possible somatic effects and its interaction with conventional medical agents. The results of the follow-up study prove superiority of psychopharmacotherapy over psychotherapy in terms of long-term efficacy. The most effective model of the organization of psychiatric care in PSD clinic is liasion psychiatry (psychiatrist consults and general practitioner treats). Inpatient treatment of non-psychotic PSD patients requires an organization of specialized units within a general hospital.

Combined Modality Therapy↗
PubMed1999

[Clinical aspects of somatic disease and internal course of the disease (heart ischemia and bronchial asthma model)].

Criteria of subjective severity (SS) and subjective control of the condition (SC) associated with establishment of the disease internal picture (DIP) were determined in 67 patients with verified coronary heart disease (CHD) and 68 with verified bronchial asthma (BA). Essential for SS were: severity of the subjective symptoms, features of the somatic condition debut, the speed of the disease progression. Essential for SC were the following components: effectiveness of self-care, severity of noticeable or ugly symptoms, features of the triggers (attack provokers). SS and SC criteria can be used for differentiation of the interventions to change the patient's attitude to their disease and therapy in the direction of more compliance with the doctor.

Asthma↗
PubMed1997

[The clinical and psychological aspects of the reaction to disease (the problem of nosogenias)].

"Nosogenias" is the term describing some reactive states. They account for 15-90% of all the patients of somatic hospital. They are due to constellation of some psychotraumatic events related to somatic disease. A total of 166 patients were examined, among them 55 patients with ischemic heart disease, 56 cases with hypertension and 56 ones with bronchial asthma. The results evidence for the existence of two independent vectors which characterise "extremal" points of continuum of disease perception. The importance of somatic trouble (hyper- or hyponosognomia) was the basis of the first vector while the degree of completeness of independent and the whole image of disease as something which differed from "self" (ego-dystonic and ego-syntonic perception of disease) was the basis of the second vector. Combination of the above vectors with clinical and psychological characteristics in the whole clinical pattern of disease was recorded.

Analysis of Variance↗