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Krasnov V.N.,Moscow Research Institute of Psychiatry | Gurovich I.,Moscow Research Institute of Psychiatry
International Review of Psychiatry | Year: 2012

Russian psychiatry has a dramatic history, and until now has been at a transitional stage of development. It is facing problems not only common in world psychiatry, but also specific to eastern Europe, in particular Russia. Starting from the beginning of the 1990s, considerable changes have occurred in psychiatry, especially after 1992 when the law on psychiatric care and guarantees of citizens' rights in its provision was adopted. It became the ideological and legislative basis for reforms. However, there are definite obstacles to structural reforms in psychiatry. They are unfavourable technical conditions in many psychiatric clinics, hypercentralization of psychiatric services, shortage of clinical psychologists and social workers in psychiatry, some difficulties in cooperation between psychiatric and general medical institutions. Economic difficulties in the transition period of Russia's social development prevent the overcoming of these problems. They are being actively discussed and some of them are being gradually solved, e.g. the organization of team work in mental health services, the increasing number of specialists on social work, and the involvement of non-government organizations in psychosocial rehabilitation. © 2012 Institute of Psychiatry.


Sukhotina N.K.,Moscow Research Institute of Psychiatry
Zhurnal Nevrologii i Psihiatrii imeni S.S. Korsakova | Year: 2013

According to Russian and world publications, there is a growing prevalence of mental disorders among children and adolescences with the domination of mental retardation and nonpsychotic mental disorders. In this review, several main causes of growing prevalence of mental and behavioral disorders in these populations are specified.


Mosolov S.N.,Moscow Research Institute of Psychiatry | Ushkalova A.V.,Moscow Research Institute of Psychiatry | Kostukova E.G.,Moscow Research Institute of Psychiatry | Shafarenko A.A.,Moscow Research Institute of Psychiatry | And 3 more authors.
Journal of Affective Disorders | Year: 2014

Background There are no validated screening tools for Bipolar Disorder (BD) in Russia. Objective To validate the Russian version of the HCL-32 for the detection of Bipolar II disorder (BD II) in patients with Recurrent Depressive Disorder (RDD). Methods 409 patients with a current diagnosis of RDD were recruited. The diagnosis was confirmed by the validated Russian version of the Mini International Neuropsychiatric Interview (MINI). Another investigator interviewed the patients using the HCL-32 questions. Results The total HCL-32 score in patients with BD II was significantly higher than in patients with RDD: 18.2 (4.22) versus 10.85 (5.81) (p<0.001, d=1447). At the cut-off 14 points the sensitivity was 83.7%, specificity 71.9% (p<0.001). The Cronbach's alpha was 0.887 that means good internal consistency. The best discrimination was achieved with 8 items: decreased need for sleep, less shyness or inhibition, talkativeness, more jokes and puns, jumping thoughts distractibility, exhausting or irritating others and high and more optimistic mood. We proposed the reduced variant of the scale, that includes only these 8 variables, with sensitivity 90.5%, specificity 69.8% (AUC=0.88). Conclusions The Russian version of the HCL-32 displayed a good ratio of sensitivity to specificity and can be recommended as a validated screening instrument. An 8-item version of HCL needs further research. Limitations Limitations include the specific nature of the sample, the HCL-32 assessment carried out by a psychiatrist, no comparison with other BD screening scales. The results of the 8-item version may be sample and culture dependent. © 2013 Elsevier B.V.


Mosolov S.,Moscow Research Institute of Psychiatry | Ushkalova A.,Moscow Research Institute of Psychiatry | Kostukova E.,Moscow Research Institute of Psychiatry | Shafarenko A.,Moscow Research Institute of Psychiatry | And 3 more authors.
Bipolar Disorders | Year: 2014

Objectives: The prevalence of bipolar II disorder (BD-II) in Russia has never been studied. Therefore, we sought to identify patients meeting diagnostic criteria for BD-II among patients with a current diagnosis of recurrent depressive disorder (RDD) through the use of the Russian versions of the Hypomania Checklist (HCL-32) and Bipolarity Index scales for differentiating between BD-II and RDD. Methods: In a non-interventional diagnostic study, we selected 409 patients aged between 18 and 65 years from two medical settings with (i) a current diagnosis of RDD, (ii) an illness duration of at least three years, and (iii) at least two affective episodes. The diagnosis was based on clinical assessment and confirmed by the Russian version of the Mini International Neuropsychiatric Interview. All patients were assessed by the HCL-32, the Bipolarity Index, and the Personal and Social Performance Scale. Results: Among patients with a current diagnosis of RDD, 40.8% had a diagnosis of bipolar disorder (bipolar I disorder: 4.9%; BD-II: 35.9%). The average time lag from onset to a correct diagnosis of BD-II was 15 years and patients were treated only with antidepressants. The sensitivity of the Russian version of the HCL-32 at the optimal cutoff point (≥14.0) was 83.7%, and its specificity was 71.9%. The Bipolarity Index showed significant differences between the total scores of the patients with BD-II and RDD (31.8 versus 20.2; p < 0.0001). The optimal threshold was ≥22.0 (sensitivity 73.5%; specificity 72.3%). Conclusions: In Russia, diagnostic errors are an important cause of the non-detection of bipolar disorder, particularly BD-II. The Russian version of the HCL-32 and the Bipolarity Index, as additional tools, could be useful for bipolarity screening. © 2014 John Wiley & Sons A/S.


Gorobets L.N.,Moscow Research Institute of Psychiatry
Zhurnal Nevrologii i Psihiatrii imeni S.S. Korsakova | Year: 2015

Objective. To study the characteristics of prolactin secretion in patients with a first psychotic episode (FPE) with regard to disease severity, gender and patient’s neuromediator system state. Material and methods. Author studied 76 patients with schizophrenic spectrum disorders and 34 normals (control group). Results and conclusion. There was a significant negative sex-related correlation between the severity of psychopathologic symptoms and plasma prolactin levels. Based on the results, author attempted to explain the hormonal disbalance in the patients with FPE taking into account the state of monoaminergic mediator systems in patients. © 2015, Media Sphera. All rights reserved.


Mosolov S.N.,Moscow Research Institute of Psychiatry | Potapov A.V.,Moscow Research Institute of Psychiatry | Ushakov U.V.,Moscow Outpatient Psychiatric Service 21
Annals of General Psychiatry | Year: 2012

Background: A standardized definition of remission criteria in schizophrenia was proposed by the International group of NC Andreasen in 2005 (low symptom threshold for the eight core Positive and Negative Syndrome Scale (PANSS) symptoms for at least 6 consecutive months).Methods: A cross-sectional study of remission rate, using a 6-month follow-up to assess symptomatic stability, was conducted in two healthcare districts (first and second) of an outpatient psychiatric service in Moscow. The key inclusion criteria were outpatients with an International Classification of Diseases, 10th edition (ICD-10) diagnosis of schizophrenia or schizoaffective disorder. Remission was assessed using modern criteria (severity and time criteria), PANSS and Global Assessment of Functioning (GAF). Patients who were stable but did not satisfied the symptomatic criteria were included in a further 1-year observational study, with the first group (first district) receiving risperidone (long-acting, injectable) (RLAI) and the second group (second district) continuing to receiving routine treatment. Symptoms were assessed with PANSS, social functioning with the personal and social performance scale, compliance with rating of medication influences scale, and extrapyramidal side effects with the Simpson-Angus scale.Results: Only 64 (31.5%) of 203 outpatients met the criteria for symptomatic remission in the cross-sectional study, but at the end of the 6-month follow-up period, 158 (77.8%) were stable (irrespective of remission status). Among these only 53 (26.1%) patients fulfilled the remission criteria. The observational study had 42 stable patients in the RLAI group and 35 in the routine treatment group: 19.0% in the RLAI group and 5.7% in the control group met remission criteria after 12 months of therapy. Furthermore, reduction of PANSS total and subscale scores, as well as improvement in social functioning, was more significant in the first group.Conclusions: Only around one-quarter of our outpatient schizophrenic population met full remission criteria. Use of RLAI gave a better remission rate than achieved in standard care with routine treatment. Criteria for remission should take into account clinical course and functioning to support clinical care. © 2012 Mosolov et al; licensee BioMed Central Ltd.


Perugi G.,University of Pisa | Angst J.,Psychiatrische Universitsklinik | Azorin J.-M.,Hital Sainte Marguerite | Bowden C.L.,University of Texas at San Antonio | And 4 more authors.
Journal of Clinical Psychiatry | Year: 2015

Objective: To estimate the frequency of mixed states in patients diagnosed with major depressive episode (MDE) according to conceptually different definitions and to compare their clinical validity. Method: This multicenter, multinational cross-sectional Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX study enrolled 2,811 adult patients experiencing an MDE. Data were collected per protocol on sociodemographic variables, current and past psychiatric symptoms, and clinical variables that are risk factors for bipolar disorder. The frequency of mixed features was determined by applying both DSM-5 criteria and a priori described Research-Based Diagnostic Criteria (RBDC). Clinical variables associated with mixed features were assessed using logistic regression. Results: Overall, 212 patients (7.5%) fulfilled DSM-5 criteria for MDE with mixed features (DSM-5-MXS), and 818 patients (29.1%) fulfilled diagnostic criteria for a predefined RBDC depressive mixed state (RBDC-MXS). The most frequent manic/hypomanic symptoms were irritable mood (32.6%), emotional/mood lability (29.8%), distractibility (24.4%), psychomotor agitation (16.1%), impulsivity (14.5%), aggression (14.2%), racing thoughts (11.8%), and pressure to keep talking (11.4%). Euphoria (4.6%), grandiosity (3.7%), and hypersexuality (2.6%) were less represented. In multivariate logistic regression analysis, RBDC-MXS was associated with the largest number of variables including diagnosis of bipolar disorder, family history of mania, lifetime suicide attempts, duration of the current episode gt; 1 month, atypical features, early onset, history of antidepressant-induced mania/ hypomania, and lifetime comorbidity with anxiety, alcohol and substance use disorders, attention-deficit/hyperactivity disorder, and borderline personality disorder. Conclusions: Depressive mixed state, defined as the presence of 3 or more manic/hypomanic features, was present in around one-third of patients experiencing an MDE. The valid symptom, illness course and family history RBDC criteria we assessed identified 4 times more MDE patients as having mixed features and yielded statistically more robust associations with several illness characteristics of bipolar disorder than did DSM-5 criteria. © Copyright 2015 Physicians Postgraduate Press, Inc.


Kalinin V.V.,Moscow Research Institute of Psychiatry | Zemlyanaya A.A.,Moscow Research Institute of Psychiatry | Krylov O.E.,Moscow Research Institute of Psychiatry | Zheleznova E.V.,Moscow Research Institute of Psychiatry
Epilepsy and Behavior | Year: 2010

The aim of the current study was to evaluate the effect of seizure lateralization, handedness, and alexithymia on psychopathology in patients with temporal lobe epilepsy. One hundred five patients were included in the study. The Hopkins Symptom Checklist-90 (SCL-90) and Toronto Alexithymia Scale (TAS-26) were used for psychopathological assessment of patients. Handedness was evaluated using Annett's scale. Among the patients studied were 74 right-handers and 31 left-handers, and 25 alexithymic and 80 nonalexithymic persons. Left-sided foci were observed in 52, and right-sided foci in 53 persons. MANOVA was used for analysis of the interrelationship between nominal fixed factors (handedness, alexithymia, and focus laterality) and the dependent variables SCL-90, Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety. MANOVA revealed that alexithymia exerts maximal effect on psychopathological variables, and maximal values of SCL-90 constructs were observed for persons with alexithymia/left-handedness and alexithymia/right-sided seizure focus combinations. © 2010 Elsevier Inc. All rights reserved.


Popovic D.,University of Barcelona | Vieta E.,University of Barcelona | Azorin J.-M.,Hopital Sainte Marguerite | Angst J.,University of Zürich | And 4 more authors.
Bipolar Disorders | Year: 2015

Objectives: The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality. Methods: A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts. Results: The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p < 0.0001), psychotic features (15.1%, p < 0.0001), and atypical features (9.2%, p = 0.009) were more prevalent. MDE-SA patients' previous responses to treatment with antidepressants included more (hypo)manic switches [odds ratio (OR) = 1.97, 95% confidence interval (CI): 1.58-2.44, p < 0.0001], treatment resistance (OR = 2.07, 95% CI: 1.72-2.49, p < 0.0001), mood lability (OR = 1.98, 95% CI: 1.65-2.39, p < 0.0001), and irritability (OR = 1.80, 95% CI: 1.48-2.17, p < 0.0001). Multivariate analysis evidenced that risky behavior, psychomotor agitation and impulsivity, and borderline personality and substance use disorders were the variables most frequently associated with previous suicide attempts. In the MDE-SA group, 75 patients (11.9%) fulfilled Diagnostic and Statistical Manual (DSM)-5 criteria for MDE with mixed features, and 250 patients (39.8%) fulfilled research-based diagnostic criteria for a mixed depressive episode. Conclusions: Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed depressive states could represent a major step in suicide prevention. © 2015 John Wiley & Sons A/S.


Mosolov S.N.,Moscow Research Institute of Psychiatry | Potapov A.V.,Moscow Research Institute of Psychiatry | Ushakov U.V.,Moscow Psychiatric Outpatient Services | Shafarenko A.A.,Moscow Research Institute of Psychiatry | Kostyukova A.B.,Moscow Research Institute of Psychiatry
Neuropsychiatric Disease and Treatment | Year: 2014

Background: International Remission Criteria (IRC) for schizophrenia were developed recently by a group of internationally known experts. The IRC detect only 10%-30% of cases and do not cover the diversity of forms and social functioning. Our aim was to design a more applicable tool and validate its use - the Standardized Clinical and Functional Remission Criteria (SCFRC). Methods: We used a 6-month follow-up study of 203 outpatients from two Moscow centers and another further sample of stable patients from a 1-year controlled trial of atypical versus typical medication. Diagnosis was confirmed by International Classification of Diseases Version 10 (ICD10) criteria and the Mini-International Neuropsychiatric Interview (MINI). Patients were assessed by the Positive and Negative Syndrome Scale, including intensity threshold, and further classified using the Russian domestic remission criteria and the level of social and personal functioning, according to the Personal and Social Performance Scale (PSP). The SCFRC were formulated and were validated by a data reanalysis on the first population sample and on a second independent sample (104 patients) and in an open-label prospective randomized 12-month comparative study of risperidone long-acting injectable (RLAI) versus olanzapine. Results: Only 64 of the 203 outpatients (31.5%) initially met the IRC, and 53 patients (26.1%) met the IRC after 6 months, without a change in treatment. Patients who were in remission had episodic and progressive deficit (39.6%), or remittent (15%) paranoid schizophrenia, or schizoaffective disorder (17%). In addition, 105 patients of 139 (51.7%), who did not meet symptomatic IRC, remained stable within the period. Reanalysis of data revealed that 65.5% of the patients met the SCFRC. In the controlled trial, 70% of patients in the RLAI group met the SCFRC and only 19% the IRC. In the routine treatment group, 55.9% met the SCFRC and only 5.7% the IRC. Results of the further independent sample demonstrated that 35% met the IRC, 65% the SCFRC, and 56% of patients met both the symptomatic and functional criteria. In the controlled trial of RLAI and olanzapine, 40% and 35% of patients, respectively, met the IRC, while 70% and 55%, respectively, met the SCFRC. Conclusion: In schizophrenia outpatients, a greater proportion of stable cases is detected in remission by SCFRC in comparison with IRC. The SCFRC were more sensitive to the full spectrum of schizophrenia. The SCFRC appear to be valid as a tool and clinically useful as they produce a comprehensive assessment of treatment effectiveness for a wide range of patients. © 2014 Mosolov et al.

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