Biomedical subjects
Publications and source records attributed to A I Niss.
A quantitative (graphic) method has been developed for evaluation of the patient sensitivity to neuroleptics after 3 test doses. According to a special statistical analysis the critical values were determined which correlate with the appearance of early symptoms of side-effects.
As a result of studying 727 therapy courses conducted in 90 patients with attack-like schizophrenia, who suffered 294 attacks, it has been demonstrated that in case these patients have residual organocerebral failure, a special choice of "sparing" therapy is required. The treatment of these patients consists in the use of neuroleptics which do not provoke any marked extrapyramidal side effects (sonapax, eglonyl, leponex), tranquilzers and antidepressants possessing no cholinolytic effect (pyrazidol, nuredal). If the use of powerful antipsychotic neuroleptics and tricyclic antidepressants is required, it is indicated that they can be applied in the form of intravenous infusions. A modified method lying in the one-stage withdrawal of psychotropic agents turned out highly effective. Addition of resolving and dehydration remedies to psychopharmaco-therapy promoted neither enhancement of the drug efficacy nor minimization of the side effects.
Analyzed were 1999 courses of treatment in 212 patients with paroxysmal and paranoid schizophrenia. Twelve groups of side-effects were defined according to syndromal and structural principles. Compared to the uncomplicated schizophrenic patients, the ones with organic cerebral insufficiency had higher sensitivity to psychopharmacologic drug therapy. The number of untoward effects per one course of treatment in organically deficient patients was 1.5 times higher than that of the control group. It was also shown that cerebral organic insufficiency promoted the long-lasting and chronic extrapyramidal disorders. It also increased the rate of akathisia, akinetic-rigid syndrome, hyperkineses, fever, epileptiform paroxysms, circulatory-autonomic disorders. Side-effects were closely related to the nature of drug therapy.
An analysis of 1999 courses of psychopharmacotherapy (PPT) conducted in 90 patients with attack-like forms of schizophrenia and in 122 patients with the paranoid form has revealed an adverse effect of cerebro-organic insufficiency on PPT tolerance. In patients with the maximal degree of residual cerebro-organic insufficiency an elevated sensitivity to PPT occurred 2-2.2 times as often as in patients with a history of the minimal number of exogenously aggravated factors. PPT tolerance depended on both the nature of diseases and the age when they occurred. To evaluate the nature of pathogenic effect on the brain, all aggravating factors were divided into evidently cerebral, conditionally cerebral and other than cerebral ones. The highest intolerance was observed when evidently and conditionally cerebral aggravating factors were combined and when their combined development occurred in both early and late periods of ontogenesis.
A clinico-statistical study of therapy and rehabilitation of 37 patients with psychopath-like schizophrenia selected by the method of blanket sampling using a criterion of the loss of the working ability within 12 months and more showed high efficiency of comprehensive medicated and intensive socio-rehabilitative action (industrial therapy). The role of the stimulating component in the spectrum of psychotropic activities of neuroleptics in the treatment of psychopath-like schizophrenia was ascertained. The result of the work was the employment of 20 of the 37 patients studied. It was shown in 37 randomly selected disabled patients with slowly progressive (psychopath-like) schizophrenia that stimulating neuroleptics played a definite role in including methods of intensive socio-occupational therapy into the management of these patients.
Nine patients are described in whom psychopharmacotherapy was associated with the development of rare complications in the form of the syndrome of cortical disturbances, psychosensory disorders and toxic polyneuropathy. All patients presented residual organic insufficiency of the CNS, with some of them exhibiting endocrine-metabolic disorders as well.
Piracetam influence on the depth of consciousness loss and psychic function recovery was examined in two groups of 30 patients (study and control) selected at random. The study was carried out in conditions of a specialized department for patients with acute virus neuroinfections. Accelerated periods of egress from unconsciousness (including coma), high rate of reduction of psychoorganic and somatovegetative disorders followed by successful rehabilitation were characteristic of patients given piracetam from the disease onset. The results obtained permit recommending piracetam for wide use in neuroinfections.
The article deals with the modern concepts of the spectrum of the psycho- and neurotropic activity of neurometabolic stimulants, the correlation between the radicals of their clinical activity and the neurophysiological mechanism of their action. Comparative characteristics of some representatives of this series of agents are presented with emphasis on their specific position in the psychotropic drug systematics.
A new form of evaluating the state (formula) in patients with endogenous psychoses when being discharged from the mental hospital is proposed. This formula contains a differentiated estimation of the clinical and socio-working state, as well as a list of risk factors for relapses, treatment complications, social deadaptation and an assessment of the treatment efficacy. This form is directed towards a perfection of the continuity between inpatient and outpatient mental services in the treatment of patients.
The report contains successful results of ambulatory treatment of 54 patients with relapses of attack-like developing forms and exacerbations of continuous forms of schizophrenia. The basic principles in the treatment were intensity and dynamic influence of psychopharmacotherapeutical agents. As a rule under such conditions there were a rapid reduction in the acuity. The authors distinguish clinical, family-environmental and organizational-therapeutic indications, which may lie at the basis of the place of choice for treatment--hospital or dispensary (out patient clinic).
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