OBJECTIVE:To identify risk factors and predictors of the development of psychotic disorders in patients who used synthetic cathinones (SKat).MATERIAL AND METHODS:The study included 176 patients who used SKat, which was toxicologically confirmed. One hundred and eleven (63.1%) were male and 65 (36.9%) were female. The median age was 27 years (22-32 (Q1-Q3)). Patients were divided into main and control groups depending on the presence of a psychotic disorder. The main group (those who developed psychosis) consisted of 98 patients, the control groupincluded 78 participants. Clinical-psychopathological, parametric and statistical methods were performed to study predictors and risk factors for the development of psychotic disorders associated with the use of SKat.RESULTS:The study established factors influencing the incidence of psychosis. Older patients were more likely to develop psychosis (p=0.002). Patients who used SKat for more than 21 consecutive days developed psychoses more often (p=0.048). The use of α-pvp (α-pyrrolidinovalerophenone, alpha-pvp) more often led to the development of psychosis (p<0.001). Patients undergoing rehabilitation were less likely to experience the development of psychosis (p=0.009). The resulting regression model is statistically significant (p<0.001). Based on the value of the Nigelkirk coefficient of determination, the model explains 30.9% of the observed group variance. It has been established that the combination of the following factors increases the chances of developing psychosis: female gender, age, duration of daily use, the presence of signs of mental infantilism, fear of the dark in childhood. In turn, the experience of undergoing rehabilitation and any pathology of the mother's pregnancy reduces the risk of psychosis.CONCLUSION:The results are consistent with other studies of substance-induced psychoses. The observed patterns demonstrate that this is a special group of disorders that requires the attention of specialists. The results allow us to outline the field for further study, and may also be useful in the development of therapeutic and preventive recommendations.

OBJECTIVE:Assess the efficacy and safety of fluvoxamine, sertraline, citalopram, paroxetine, fluoxetine.MATERIAL AND METHODS:The study included 175 patients with alcohol dependence and depressive disorders. 161 had a diagnosis Alcohol Dependence Syndrome (ADS); 14 patients had a «dual diagnosis». All patients were randomized into 5 groups according to the drugs received. To assess the therapeutic efficacy of drugs, the following scales were used: visual analogue scale (VAS), Montgomery-Asberg Depression Rating Scale (MADRS), Hospital Anxiety and Depression Scale (HADS). The safety of drugs was assessed by the incidence of adverse events (AEs) or serious adverse events (SAEs).RESULTS:The drugs relieve depressive disorders: fluvoxamine by the 7th day of treatment, sertraline, paroxetine, citalopram by the 14th day, fluoxetine by the 30th day of therapy. A significant decrease in the level of anxiety when taking fluvoxamine and citalopram occurs by the 7th day, when taking sertraline and paroxetine - by the 14th day, and when taking fluoxetine - by the 30th day. The presence of an anticraving effect in SSRIs is confirmed by the obtained strong and average correlation coefficients between affective disorders and craving for alcohol. The correlation analysis allowed drawing the conclusions about the close connection of presenting features of the affective disorders (depression and anxiety) and craving. The anticraving effect is more expressive in fluvoxamine, sertraline, citalopram and paroxetine. The most common adverse reactions (increased insomnia and anxiety) are observed in: fluoxetine, citalopram, sertraline, paroxetine. Fluvoxamine has the most favorable safety profile.CONCLUSION:SSRIs can be effectively used for the treatment of depressive disorders in alcohol dependence.

The article presents the results of a randomized comparative study of Aripiprazole and Quetiapine in the treatment of patients with a dual diagnosis: schizophrenia and substance use disorders. During the study, 90 of the 266 male patients were screened. Among them, 54 individuals (60%) had a previously established diagnosis of mental disorder and 36 patients (40%) had no established psychiatric diagnosis. They were randomly randomized into three groups of 30 patients, each receiving an antipsychotic: Aripiprazole at a dose of up to 20 mg daily, Quetiapine at a dose of up to 600 mg daily, or Haloperidol at a dose of up to 30 mg daily. The efficacy of Aripiprazole and Quetiapine was evaluated using the following scales: PANSS, BPRS, VAS, and Substance Craving Scale (SCS). Drug safety was assessed by the development of adverse events, serious adverse events, or adverse reactions. Study results demonstrated the efficacy of atypical antipsychotics in the three groups. Analysis of independent variables showed significant differences between Aripiprazole and Haloperidol in PANSS and BPRS scores by Visit 4, in VAS scores by Visit 3, and in SCS scores by Visit 2. Intergroup analysis of independent variables showed significant differences between Quetiapine and Haloperidol in PANSS, VAS, and SCS scores by Visit 4. Intergroup analysis of independent variables showed significant differences between Aripiprazole and Quetiapine in the VAS and SCS scores. The correlation analysis allowed drawing conclusions about the close connection of the symptoms of schizophrenia and substance use disorders in patients with a dual diagnosis

BACKGROUND The article presents the results of a clinical therapeutic and follow-up study of patients with a 'dual diagnosis' (polysubstance dependence comorbid with schizophrenia: paranoid schizophrenia or schizotypal disorder). OBJECTIVE To study clinical/dynamic changes of polysubstance dependence in patients with schizophrenia (paranoid schizophrenia, schizotypal disorder) and to evaluate the duration and quality of therapeutic remissions. MATERIAL AND METHODS Two hundred and sixty-six male patients, including 176 patients with dependence syndrome and 90 patients with both dependence syndrome and schizophrenia, were studied. RESULTS Patients with the 'dual diagnosis' are characterized by early social maladjustment, earlier social deformation, lack of social skills and preference for a lonely lifestyle. The clinical and dynamic characteristics of dependence syndrome in patients with 'dual diagnosis' include older age of the first use of a psychoactive substance (PS), preference of alcohol as the first PS, experiment as the most frequent motivation for using PS (due to thought disorder), and the treatment of psychopathological disorders (PS like medicine) with a chaotic pattern being the most common in the use, a tendency to hospitalism. CONCLUSION The success of the treatment of patients with 'dual diagnosis' is possible by combining the therapy of endogenous disease and polysubstance dependence.

A combination of depression and alcohol use disorder (AUD) is a typical and most common example of a dual diagnosis at the intersection of general psychiatry and addiction psychiatry. A comorbidity of depression and AUD is more common than it can be brought about by mere coincidence, which might be explained to some extent by the synergetic effect of both diseases, with each of them complicating the course and worsening the prognosis of the other. Treatment protocols for patients with depression and comorbid AUD include antidepressants, specific medications for alcohol dependence, and psychotherapy. The first-line antidepressants in the treatment of patients with a comorbid combination of depression and alcohol use disorder, as in other clinical situations implying use of antidepressants, are selective serotonin reuptake inhibitors (SSRIs). Fluvoxamine has certain advantages over the other SSRIs in the treatment of patients with a depression and comorbid AUD.

OBJECTIVETo describe the structure of psychoses developed due to synthetic cannabinoids (Spice).MATERIAL AND METHODSForty-six men, aged 18-35 years, with psychosis during abstinence were studied and followed up for 2 years.RESULTS AND CONCLUSIONFour clinical variants with predominant delirious symptoms (27%) or hallucinatory symptoms (19%) or affective-delusions (21%) or mental automatisms (33%) were identified. The follow-up revealed the manifestations of schizophrenic process in 17% of the patients. Clinical and differential diagnostic characteristics of these variants in synthetic cannabinoids users are described.

The paper describes 2 case reports of non-medical use of Naphazoline (Naphthyzin). Both demonstrate that the peripherally acting alpha-adrenergic agonist Naphazoline obtains some addictive potential. The drug produces a feeling of euphoria, which resembles the perceived effects of psychostimulants. Both patients and people who consume Naphazoline for intoxication report increased tolerance after repeated use which indicates the addictive potential of the substance. To the best of our knowledge, this is the first examination of non-medical Naphazoline use and the first attempt to describe its addictive potential. Clinical psychiatrists should be aware of this phenomenon when addressing polysubstance use behavior.

This study was designed to evaluate synthetic cannabinoid (SC)-induced psychotic disorders in terms of their structure and clinical characteristics among hospitalized patients in Russia. It was a longitudinal, observational cohort study which included a total of 46 male patients who underwent the inpatient treatment in the intensive care unit or emergency department due to the SC-induced psychoses. Data on sociodemographic and disease-related characteristics, psychometric assessment scales obtained in face-to-face interviews, were recorded in all patients. The duration of catamnestic follow-up period was 2 years, with the major focus on manifestation of the schizophrenic process. Mean (SD) age of the patients with psychotic disorders induced by the SC use was 23.2 (3.5) years. Among 46 patients, 29 (63%) were SC-dependent and 17 (37%) were diagnosed with SC abuse. Average age at onset was 16.4 for psychoactive substances and 19.7 years for SC use. Marijuana was the most common first used substance. Based on our observations, we identified four clinical variants of the SC-induced psychoses. Our findings revealed that psychotic disorders are typical for the SC intoxication and most commonly influence young adults. Based on our observations, we identified four clinical variants of the SC-induced psychoses and revealed the signs which may indicate them. This study emphasizes the role of appropriate psychiatric management of SC-induced psychoses, since often only catamnestic long-term follow-up enables clinicians to determine the correct diagnosis and reveal the manifestation of the schizophrenic process.

The paper describes diagnostic criteria, clinical presentation and types of hallucinogen persisting perception disorder (HPPD), as well as current approaches to the treatment of this phenomenon using available scientific sources. Three case reports are also presented to demonstrate different types of this disorder. The first case report describes a 23-year old patient with a previous history of cannabis consumption who reported HPDD type I after the use of psilocybin mushrooms with small amounts of alcohol and hash. A month later, after cannabis use, the same visual and auditory distortions appeared again. During the following year, hallucinations recurred with the consumption of natural cannabinoids but not with alcohol intake. The symptoms have reduced within a year. Surprisingly, both other cases belonging to HPDD type II appeared in patients who consumed ecstasy, although MDMA is generally not considered a hallucinogen and hallucinations are not frequently reported after MDMA consumption. In both cases of HPPD type II after the use of ecstasy, the condition was very stressful and frightening. Both patients sought medical help and received tofisopam, lamotrigine and sertraline. After that, in both cases visual impairments have smoothed, but have not passed completely. Scientific sources suggest that HPPD may affect more than 50% of hallucinogen users and this disorder is often underdiagnosed. Therefore, patients suffering from HPPD can present in various clinical settings, and clinicians should be aware of this condition.

AIMThe randomized comparative study of aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction.MATERIAL AND METHODSIntra-group analysis of dependent variables on the scales PANSS, BPRS, VAS, SACS showed significant differences in the dinamics of the therapy in all groups. A comparative randomized study included 90 men admitted to an inpatient addiction unit. Of these, 54 (60%) had a previously established psychiatric diagnosis and 36 patients (40%) did not have an established psychiatric diagnosis. They were randomized into 3 groups of 30 patients each: group 1 received aripiprazole at a dose of up to 20 mg/day, group 2 received quetiapine at a dose of up to 600 mg/day and group 3 (controls) was treated with haloperidol at a dose of up to 30 mg/day. Treatment duration was 21 days. The efficacy of aripiprazole and quetiapine was evaluated with PANSS, BPRS, VAS and SACS on 10th, 14th and 21st day (visits 2-4). Drug safety was evaluated by recording adverse events or side-effects.RESULTS AND CONCLUSIONAn analysis of independent variables showed significant differences between aripiprazole and haloperidol in PANSS and BPRS scores at visit 4, in VAS scores at visit 3, and in SACS scores at visit 2. An intergroup analysis of independent variables showed significant differences between quetiapine and haloperidol in PANSS, VAS and SACS scores at visit 4 and between aripiprazole and quetiapine in VAS and SACS scores. According to the results of the correlation analisys it has been concluded that presenting features of schizophrenia are closely correlated with drug addiction (craving).

Многочисленные исследования последних лет указывают на увеличение коморбидной психиатрической патологии в популяции больных алкоголизмом. Представлен анализ клинического случая алкогольной зависимости, протекающей на фоне шизофренического процесса. Особое внимание обращено на трудности диагностики шизофрении, сочетанной с алкогольной зависимостью, а также особенности клинической картины алкогольной зависимости, протекающей на фоне шизофрении. Numerous research studies reveal that degree of incidence of psychiatric co-morbidity increases among patients with alcohol dependence at the present time. The analysis of the clinical case of the co-morbidities like as alcohol dependence and schizophrenia is presented. The clinical case shows difficulties in diagnostic of co-morbidity psychiatric disease, as well as the peculiarities of alcohol dependence on the background of schizophrenia.

Material and methods. The original study included overall 120 patients with ALD, who were randomized in two identical groups. The patients of the main group (group A) received 2 courses of therapy: the first - Phosphogliv 5 mg/day as intravenous bolus injection for 2 wks, followed by the oral intake of 2 capsules t.i.d. for 10 wks (the total treatment duration was 24 wks). Patients of the control group (group B) received placebo in the same regimen. The dynamics of serum alanine transaminase (ALT), aspartate transaminase (AST), liver scores by noninvasive FibroMax test was applied to assess the treatment efficacy and safety, along with change in quality of life of patients. Results. In 24 wks in group A in comparison to the group B significantly lower mean ALT level was found: 35,2±29,4 U/l vs 48,4±36,1 U/l (р =0,044), AST level became normal in higher rate of patients: 69,4% vs 47,7% (р =0,034), that had more prominent decrease in gamma-glutamyltranspeptidase (GGT) level - 47,4±36,5% vs 25,1±63,9% (р =0,039), the rate of patients with Aktitest A2-A3 range decreased - 8,5% vs 21,4% (p

Material and methods. The original study included overall 120 patients with ALD, who were randomized in two identical groups. The patients of the main group (group A) received 2 courses of therapy: the first - Phosphogliv 5 mg/day as intravenous bolus injection for 2 wks, followed by the oral intake of 2 capsules t.i.d. for 10 wks (the total treatment duration was 24 wks). Patients of the control group (group B) received placebo in the same regimen. The dynamics of serum alanine transaminase (ALT), aspartate transaminase (AST), liver scores by noninvasive FibroMax test was applied to assess the treatment efficacy and safety, along with change in quality of life of patients. Results. In 24 wks in group A in comparison to the group B significantly lower mean ALT level was found: 35,2±29,4 U/l vs 48,4±36,1 U/l (р =0,044), AST level became normal in higher rate of patients: 69,4% vs 47,7% (р =0,034), that had more prominent decrease in gamma-glutamyltranspeptidase (GGT) level - 47,4±36,5% vs 25,1±63,9% (р =0,039), the rate of patients with Aktitest A2-A3 range decreased - 8,5% vs 21,4% (p<0,05) with no patients remained in FibroTest F3-F4 range; significantly more pronounced improvement by the vitality and social functioning scales of «SF-36» questionnaire was registered. The safety profile was comparable in both groups. Conclusions. Expected effects of the drug include reduction of inflammatory activity in the liver, improvement of cholestasis at longer follow-up period, decrease in fibrosis severity, improvement of quality of life at favorable safety profile.

ЖУРНАЛ НЕВРОЛОГИИ И ПСИХИАТРИИ, 4, 2015; Вып. 2 Проблемы, связанные с высокой распространенностью злоупотребления алкоголем и алкоголизма не только в России, но и в мире, стоят достаточно остро перед медицинским сообществом. Несмотря на то что в России в течение последних лет происходит снижение общей и первичной заболеваемости алкоголизмом, тем не менее показатели по-прежнему остаются высокими. По данным Е.А. Кошкиной и соавт. [1], потребление алкоголя на душу населения в России в 2012 г. составил от 13 до 17 л. Суммарное число потребителей алкоголя, зарегистрированных наркологической службой в 2012 г., — 2 358 453 человека (1648,6 на 100 000 населения), что составляет почти 2% общей численности населения [2]. Подавляющее большинство больных алкоголизмом (90%) находятся в трудоспособном возрасте. В настоящее время наблюдается рост показателей госпитализации больных алкоголизмом (с 292,3 на 100 000 населения в 2011 г. до 295,6 в 2012 г.) Данные мировой статистики также показывают неуклонный рост потребления алкогольных напитков в разных странах. Потребление алкоголя на душу населения в Германии с 1960 по 2000 г. возросло с 7,3 до 10,1 л [3]. Во Франции, по отчетам межведомственной комиссии по борьбе с наркоманиями и токсикоманиями, потребление алкоголя на душу населения в 2011 г. составило 10,1 л [4]. По данным ВОЗ и Национального бюро статистики Китая, по-

Со второй половины сентября 2014 г. на территории Российской Федерации (РФ) стали регистрироваться случаи массовых отравлений неизвестным психоактивным веществом (ПАВ). В ряде регионов Центральной России и Ханты-Мансийском автономном округе были госпитализированы по экстренным показаниям более 2 тыс. человек с диагнозом «отравление синтетическим наркотиком неизвестного происхождения»; число летальных исходов составило более 40. В анализах мочи пациентов было выявлено вещество MDMB-(N)BZ-F тридиметилбутановая кислота каннабиноидной синтетической группы JWH. Федеральной службой по контролю за оборотом наркотиков (ФСКН) зафиксированы случаи его обнаружения во многих субъектах РФ [1]. Было установлено, что иногда изъятые у наркоторговцев «курительные смеси» содержали вещества, обладающие сильнейшим наркотическим действием. В то время они еще не были внесены в перечень наркотических средств, психотропных веществ и их предшественников, оборот которых в РФ запрещен в соответствии с законодательством и международными договорами. Однако уже в конце октября 2014 г. одно вещество из группы синтетических каннабиноидов — MDMB(N)BZ-F было внесено в соответствующий перечень. Тем не менее распространение употребления различных видов курительных смесей на территории России продолжается, не исключено появление новых наркотиков. 12 декабря 2014 г. Государственная Дума РФ приняла в первом чтении президентский законопроект, вводящий уголовную ответственность за оборот новых ПАВ, так называемых спайсов, и административную — за их потребление. Если законопроект будет принят, ФСКН получит