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Biomedical subjects

A B Smulevich

Publications and source records attributed to A B Smulevich.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1997

[Effect of thymoleptics in aspects of new clinical systematics of depressive syndrome].

Analysis of present concepts of clinico-pharmacological correlations in depression shows the necessity of search for new approaches to the problem. The original clinical model of depression, based on the idea of positive and negative affectivity in its structure is discussed. When applied to therapeutical strategy these principals elucidate new clinical signs for choice of appropriate class of antidepressants. The correlation between predominance of positive or negative appearance of depression and efficacy of antidepressants with selective and non-selective neurochemical action is suggested. A new clinical classification of antidepressants based on their influence on the negative or positive appearance of affective disorder is suggested. The speculations on certain neurochemical specificity of negative and positive disorders are presented.

Antidepressive Agents↗
PubMed1996

[The psychopathological structure of depressions].

The theoretical model of depression has been developed on the basis of 275 psychopathological observations of the affective disorders. The primary symptom complexes of hypothymia and alienation are considered to be the obligatory components of the syndrome structure. Depressions are ranged into the system with variants according to comorbid correlations between hypothymia and alienation. The anesthetic depression (in which the signs of vital affective suppression and alienation are characterized by total symptomatological comorbidity) considered to form the center of such system. The variations of affective disorders (vital, existential, "self-torture" depressions, "depression without depression") in which the comorbidity phenomenon is just partly realized and in which one of the symptom complex is totally expressed have the marginal position.

Depression↗
PubMed1994

[The psychopharmacotherapy of anxious-depressive states (the interrelationship of the structure of the comorbidity to the choice of drug therapy)].

The authors examined 65 inpatients aged 20-61 admitted to the clinic with obsessional-phobic and depressive conditions (comorbidity). According to DSM-III-R, the patients suffered from panic and major depressive disorders, dysthymia, atypical depression within schizoaffective disturbance. By the response of the patients to alprazolam (anxiolytic) and fluoketin (antidepressant) given by a special scheme, 3 types of comorbidity of obsessional-phobic and affective disturbances were recognized: 1) prevalent depression, 2) combination of dysthymia with marked obsessional-phobic disorders, 3) overcoming of obsessional-phobic and affective disorders. Type 1 and 2 patients benefited more from monotherapy with antidepressants or tranquilizers. Type 3 patients did well on combined chemotherapy with tranquilizers, antidepressants, neuroleptics.

Adult↗
PubMed1994

[Protracted hypochondriacal reactions (based on the type of hypochondriacal development) in myocardial infarct patients].

Clinical follow-up, MPT, clinical and instrumental cardiological evidence is available for 30 postmyocardial infarction patients. They exhibited hypochondriac reactions which persisted for more than 6 months. Three types of such reactions were recognized: somatization (I), cenesthetic (II), overvalued (III). I reactions were associated with homonomous body sensations, anxious and conversion disorders, avoidance behavior. II reactions cover heteronomous sensations with attendant autoaggressive behavior. Patients with reactions III had dominant ideas of complete health recovery, delirium-like fantasies. It is established that I reactions arise in personalities with neurotism radical, reactions II in those with rigidity and eccentric behavior, reactions III in patients with rigidity and conformity.

Angina Pectoris↗
PubMed1991

[Psychopathological characteristics of the dynamics and outcomes of asthenia].

The dynamics of asthenic syndromes was subjected to a psychopathological analysis in 200 patients. It has been established that asthenia may manifest not only as a transitory neurotic disorder (either completely reversible or preceding the formation of steady morbid manifestations of the other structure) but also represent a number of independent psychopathological disorders that determine the clinical picture of the disease at the main stages of its development. The essence of asthenic syndrome transformation may be reduced to polar change of the morbid manifestations: hyperesthesia--hypesthesia, with estrangement of bodily sensations and own activity. The dichotomy indicated may be distinguished as a prognostically informative differentiating sign. In the light of the typology suggested the authors consider not only the place of asthenia in the continuum of pathological disorders but also its correlation with negative alterations.

Adult↗