Психофармакологические тесты в диагностике аффективных расстройств

Таким образом, для выбора адекватной терапии приступов аффективных психозов необходимо понять структуру состояния больного, отражающую механизмы образования его синдрома. Для этой цели клинический метод успешно дополняется психофармакологическими тестами. Лечение аффективных и аффектив­но-бредовых больных (кроме маниакальных) целесообразно начи­нать с пробного терапевтического курса анксиолитиками (феназепамом, лепонексом) или с диазепамового теста. В зависимости от трансформации клинической картины, указывающей на основ­ное биологическое расстройство, на «блок», являющийся основой патологического состояния, в дальнейшем назначаются антиде­прессивные или энергизирующие препараты. Создается впечатление,  что сфера применения нейролептиков в терапии аффективных приступов должна быть весьма ограниченной рамками маниакаль­ных и маниакально-параноидных состояний, в комбинации с нормотимиками.

 Точилов В.А. - ОБ ИССЛЕДОВАНИИ СТРУКТУРЫ И ЛЕЧЕНИИ АФФЕКТИВНЫХ ПРИСТУПОВ

C-реактивный белок как предиктор резистентности к лечению депрессии, инфликсимаб в терапии резистентной депрессии

A new study suggests a drug used to treat autoimmune disorders and rheumatoid arthritis may help individuals with difficult-to-treat depression.

Prior studies have suggested that depressed people with evidence of high inflammation are less likely to respond to traditional treatments for the disorder, including anti-depressant medications and psychotherapy.

The study investigated the use of infliximab, a new biologic drug used to treat autoimmune and inflammatory diseases. Each participant was assigned either to infliximab or to a non-active placebo treatment.

A biologic drug copies the effects of substances naturally made by the body’s immune system. In this case, the drug was an antibody that blocks tumor necrosis factor (TNF), a key molecule in inflammation that has been shown to be elevated in some depressed individuals.

Study participants all had major depression and were moderately resistant to conventional antidepressant treatment.

When investigators looked at the results for the group as a whole, no significant differences were found in the improvement of depression symptoms between the drug and placebo groups.

However, when the subjects with high inflammation were examined separately, they exhibited a much better response to infliximab than to placebo.

Inflammation in this study was measured using a simple blood test that is readily available in most clinics and hospitals and measures C-reactive protein or CRP. The higher the CRP, the higher the inflammation, and the higher the likelihood of responding to the drug.

 Anti-Inflammatory Med May Ease Hard-to-Treat Depression

Сравнение CDSS и HAMD-17 у больных шизофренией

Background: The aim of this study was to compare two measures of depression in patients with schizophrenia and schizophrenia spectrum disorder, including patients with delusional and schizoaffective disorder, to conclude implications for their application.

Sampling and Methods: A total of 278 patients were assessed using the Calgary Depression Scale for Schizophrenia (CDSS) and the Hamilton Depression Rating Scale (HAMD-17). The Positive and Negative Syndrome Scale (PANSS) was also applied. At admission and discharge, a principal component analysis was performed with each depression scale. The two depression rating scales were furthermore compared using correlation and regression analyses. 

Results: Three factors were revealed for the CDSS and HAMD-17 factor component analysis. A very similar item loading was found for the CDSS at admission and discharge, whereas results of the loadings of the HAMD-17 items were less stable. The first two factors of the CDSS revealed correlations with positive, negative and general psychopathology. In contrast, multiple significant correlations were found for the HAMD-17 factors and the PANSS subscores. Multiple regression analyses demonstrated that the HAMD-17 accounted more for the positive and negative symptom domains than the CDSS.

Conclusions: The present results suggest that compared to the HAMD-17, the CDSS is a more specific instrument to measure depressive symptoms in schizophrenia and schizophrenia spectrum disorder, especially in acutely ill patients.

Evaluating Depressive Symptoms in Schizophrenia: A Psychometric Comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale

Тест шизофрении на основе нарушений координации движения глаз

MedWire News: Viewing tests that detect eye movement can accurately identify patients with schizophrenia, research shows.
Overall, schizophrenic patients had abnormal results on viewing tests that combined pursuit, scene viewing, and steady fixation tasks.
"Indeed, on this test no schizophrenia cases are misclassified as normal," report researcher Philip Benson (University of Aberdeen, UK) and colleagues.
Although abnormal eye movements have been documented in unmedicated psychotic patients, there has been almost no success in identifying marker traits associated with schizophrenia that can separate cases from healthy controls.
In the present study, published in Biological Psychiatry, 88 schizophrenia patients were presented with visual stimuli. Smooth pursuit involved tracking a circular target as it moved around the display screen. The ability to scan scenes of everyday objects and fixate on specific images was also assessed.
The free-viewing scanpaths were abnormally restricted in schizophrenic patients, report the researchers, and this was the single biggest discriminator of cases from healthy controls.
They also observed that these patients had impaired scores on the fixation-stability test. This test is a measure of saccade inhibition and can be used to "interpret aberrant patterns in picture viewing, saccade, and pursuit tasks," explain Benson and colleagues.
Additionally, horizontal and "Lissajous" pursuit of the moving images was abnormal compared with controls.
The differential effects were stable over time, and independent of gender, medication usage, and cigarette smoking.
In terms of the predictive validity of the eye-movement tests, re-test assessments and testing on patients with newly diagnosed schizophrenia showed the viewing test predicted schizophrenia in 87.8% of patients. Use of a probability model showed the test could achieve 98% discrimination between schizophrenics and control cases.
"This is a remarkable level of discrimination and well beyond that of other potential trait markers previously reported in schizophrenia," state the researchers.
Other benefits of the eye-viewing test include its low cost, ease of use, and that it can be used in the hospital or clinic on nearly all schizophrenic patients.

Eye-viewing tests identify schizophrenic patients

Оценка качества ремиссии и шкала Гамильтона

Objective: In treatment studies of depression, remission is typically defined narrowly, based on scores on symptom severity scales. Patients treated in clinical practice, however, define the concept of remission more broadly and consider functional status, coping ability, and life satisfaction as important indicators of remission status. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined how many depressed patients in ongoing treatment who scored in the remission range on the 17-item Hamilton Depression Rating scale (HDRS) did not consider themselves to be in remission from their depression. Among the HDRS remitters, we compared the demographic and clinical characteristics of patients who did and did not consider themselves to be in remission.

Method: From March 2009 to July 2010, we interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in ongoing treatment. The patients completed measures of depressive and anxious symptoms, psychosocial functioning, and quality of life.

Results: Approximately one-half of the patients scoring 7 and below on the HDRS (77 of 140 patients for whom self-reported remission status was available) did not consider themselves to be in remission. The self-described remitters had significantly lower levels of depression and anxiety than the patients who did not consider themselves to be in remission (P < .001). Compared to patients who did not consider themselves to be in remission, the remitters reported significantly better quality of life (P < .001) and less functional impairment due to depression (P < .001). Remitters were significantly less likely to report dissatisfaction in their mental health (P < .01), had higher positive mental health scores (P < .001), and reported better coping ability (P < .001).

Conclusions: Some patients who meet symptom-based definitions of remission nonetheless experience low levels of symptoms or functional impairment or deficits in coping ability, thereby warranting a modification in treatment. The findings raise caution in relying exclusively on symptom-based definitions of remission to guide treatment decision-making in clinical practice.

Why Do Some Depressed Outpatients Who Are in Remission According to the Hamilton Depression Rating Scale Not Consider Themselves to Be in Remission?

Тестирование тиреоидной функции у больных депрессией

In Depression & Your Thyroid, Ross lays out a step-by-step guide for testing and diagnosis. The first step is to figure out if you have any of the symptoms of low thyroid and to discuss this with your doctor. These are some of the signs of thyroid dysfunction. (You may experience only a few of these.)

• Fatigue
• Puffy face
• Oversensitivity to cold
• Difficulty concentrating or remembering things
• Tingling or numbness in hands and legs
• Hair loss
• Dry skin
• Weight gain
• Difficulty breathing
• Low blood pressure
• Low body temperature
• Slow pulse
• Slow reflexes
• Infertility or repeated miscarriages

Next, your doctor should conduct a physical examination, which will include checking your blood pressure, pulse, reflexes and thyroid gland. In people with low thyroid, blood pressure and pulse are low and reflexes are sluggish. Ross notes that during your physical exam, your thyroid gland tends to be normal.
Because people with low thyroid typically get cold easily and have a low temperature, Ross suggests keeping a record of your temperature every morning for five days. Keep a thermometer by your bed and check it before getting up or moving.
The first round of tests should include: Free T3; free T4; TSH (thyroid-stimulating hormone); antiperoxidase antibody and antithyroglobulin antibody. (Learn more here.)
The second round of tests includes a 24-hour urine sample for T3 and T4 hormones. (Sometimes the tests will include a TBII or thyroid-binding inhibitory immunoglobulin, but it’s not typically ordered.)
Doctors perform the third round of tests to absolutely confirm that a person has hypothyroidism. They may look at adrenal function, male and female hormones, virus and bacterial infections, intestinal parasites, molds, food sensitivities, minerals, toxic metals, liver, coagulation, antioxidants, amino acids and organic acids. Whether you have any of these tests will depend on your symptoms and the previous tests.

 Is Thyroid Dysfunction Driving Your Depression?

Лабораторная диагностика РДА

The urine test, which detects elevated levels of compounds called porphyrins, costs $50 to $100. Heyer said the test would become less expensive if used frequently as a way to screen babies.
James Woods, a researcher at the University of Washington who worked on the project with Battelle researchers, noted that everybody has the compounds in their urine, but the levels were clearly higher in certain children in the study. Also, although the study included only boys (who are much more likely to have autism than girls), Woods said that the test would likely work for both genders based on other research.
Heyer noted that although there’s been speculation that elevated porphyrin levels are related to mercury exposure in autistic children, the research team found no link to increased exposure to mercury. This leaves the question open of why the compounds are higher in some children with autism.

 Pilot Study: Urine Test Detects One-Third of Autism Cases

Дексаметазоновый тест и критерии DSM

Starting from discoveries in the early 19th century about the basics of the endocrine system, it traces the identification of adrenal steroids in the early 20th century and finally the landmark clinical studies of the 1970s and 1980s that almost resulted in the DST becoming a standard of psychiatric diagnosis. Unfortunately, DSM-III diagnostic criteria did not reliably identify patients with positive DST results. Instead of questioning the DSM criteria, the DST was discarded as faulty.

Endocrine Psychiatry: The Dexamethasone Suppression Test and Electroconvulsive Therapy

ранняя диагностика шизофрении

Early Detection of Schizophrenia

Brain Scans for Schizophrenia?

предикторы эффективности антидепрессантов

A new medical test — called a biomarker test — appears to help predict a patient’s response to a specific antidepressant. The test is non-invasive, painless and fast, taking about 15 minutes. Six electrodes (which measure brain activity) are placed around the forehead and on the earlobes (the electrodes don’t hurt — they are only measuring devices).

Here’s what the study found:

Subjects were then randomly assigned to continue with escitalopram or were given a different drug. A total of 73 patients who remained on escitalopram were tracked for 49 days to see if their results matched the prediction of the ATR biomarker. The ATR predicted both response and remission with an accuracy rate of 74 percent, much higher than any other method available.

The researchers also found that they could predict whether subjects were more likely to respond to a different antidepressant, bupropion, also known as Wellbutrin XL.

Test Predicts Depression Medication Response

диазепамовый тест

Надежным методом разграничения деперсонализации, депрессии и тревоги является диазепамовый тест (ДТ) . Он заключается в струйном (медленном) внутривенном введении раствора диазепама (седуксена). Обычная доза составляет 30 мг препарата, у пожилых и ослабленных больных иногда вводят 20 мг, при массивной деперсонализации дозу можно увеличить до 40 мг. Выделяют три основных типа ДТ. 1. Депрессивный: депрессивная симптоматика существенно не меняется, больной быстро засыпает или наступает выраженная сонливость. 2. Тревожный: быстро, часто «на игле», исчезает вся аффективная симптоматика (тревога, депрессия). Иногда наступает легкая эйфория. 3.Деперсонализационный (отставленный). В отличие от других вариантов ДТ, положительная реакция на тест наступает через 20-30 минут и выражается в исчезновении или частичной редукции деперсонализации: «все стало ярче, яснее», «появились какие-то чувства». У подавляющего большинства больных с острой деперсонализацией ДТ положительный, при хронической деперсонализации (продолжительностью многие месяцы или годы) – может выявиться неполный положительный эффект. В немногих случаях хронической деперсонализации положительная реакция на тест отсутствует. При депрессивно-деперсонализационном синдроме в нозологических рамках депрессивного расстройства возможны следующие ответы на ДТ: после редукции деперсонализации выявляется отчетливая депрессивная симптоматика или субдепрессия, иногда наступает эйфория или гипомания.


Ю.Л.Нуллер - Диагностика и терапия деперсонализационного расстройства.

Кортиколиберин-дексаметазоновый тест

Кортиколиберин-дексаметазоновый тест имеет большую специфичность в отношении депрессивных больных по сравнению с дексаметазоновым тестом. Если специфичность дексаметазонового теста не превышала 50%, то, по данным зарубежных авторов, специфичность кортиколиберин-дексаметазонового теста составляет 80-90% (11).

Тест состоит в том, что вечером больной получает дексаметазон - синтетический глюкокортикоид, по принципу обратной связи тормозящий активность гипоталамо-гипофизарно-надпочечниковой оси. На следующий день в 15.00 больному внутривенно вводят кортиколиберин, стимулирующий выброс АКТГ. В норме уровень кортизола и АКТГ остаётся очень низким, т.к. после подавления дексаметазоном ГГН-ось какое-то время не реагирует на стимуляцию. У пациентов с депрессией уровень кортизола и АКТГ резко возрастает через час после введения кортиколиберина, то есть подавление дексаметазоном оказывается недостаточным. Это отмечается в 90% случаев, что делает этот тест достаточно убедительным.
Я.А.Кочетков. - Депрессия и гипоталамо-гипофизарно-надпочечниковая система: новые стратегии изучения