24 research outputs found
BIPOLAR DISORDER β FROM ENDOPHENOTYPES TO TREATMENT
Introduction: There are a lot of unresolved issues associated with the classification, diagnosis, clinical management and
understanding of the underlying pathogenic mechanisms of bipolar affective disorder.
Aim: To search for discrete endophenotypes in BAD.
Subjects and methods: We studied various bipolar I and II and recurrent depression patient samples and healthy controls using
descriptive data, self and clinician-rated scales for neurological and psychopathological symptoms, neurocognitive instruments, and
inventories for temperamental and characterological features. We also looked into the efficacy, tolerability and cost/benefit ratio of
sodium valproate in the treatment of acute mania.
Results: BAD patients display deficits in the domains of memory, selective attention, working memory and psychomotor speed.
Sensory, motor and complex neurological soft signs can be considered part and parcel of the symptomatology of BAD. The evidence
linking hyperthymic temperament to the bipolar spectrum is not supported, while cyclothymia seems to be a marker of vulnerability
to affective psychopathology. In contrast to others, we found significantly lower self-transcendence in BAD patients compared to
controls. Early age of onset, abrupt onset, lability of mood and energy with late-day brightening and activation, discriminate bipolar
from unipolar depression. Sodium valproate (especially if started intravenously) is a highly efficacious, cost-effective treatment
approach for acute mania.
Conclusion: The discovery of BAD endophenotypes can enhance early diagnosis, prevent errors in treatment and help elucidate
the genetic vulnerability for this grave disease
Lifetime Bipolar Disorder comorbidity and related clinical characteristics in patients with primary Obsessive Compulsive Disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS)
IntroductionBipolar disorder (BD) and obsessive compulsive disorder (OCD) are prevalent, comorbid, and disabling conditions, often characterized by early onset and chronic course. When comorbid, OCD and BD can determine a more pernicious course of illness, posing therapeutic challenges for clinicians. Available reports on prevalence and clinical characteristics of comorbidity between BD and OCD showed mixed results, likely depending on the primary diagnosis of analyzed samples.MethodsWe assessed prevalence and clinical characteristics of BD comorbidity in a large international sample of patients with primary OCD (n = 401), through the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) snapshot database, by comparing OCD subjects with vs without BD comorbidity.ResultsAmong primary OCD patients, 6.2% showed comorbidity with BD. OCD patients with vs without BD comorbidity more frequently had a previous hospitalization (p < 0.001) and current augmentation therapies (p < 0.001). They also showed greater severity of OCD (p < 0.001), as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).ConclusionThese findings from a large international sample indicate that approximately 1 out of 16 patients with primary OCD may additionally have BD comorbidity along with other specific clinical characteristics, including more frequent previous hospitalizations, more complex therapeutic regimens, and a greater severity of OCD. Prospective international studies are needed to confirm our findings.Peer reviewe
Relationship of suicide rates with climate and economic variables in Europe during 2000-2012
The derived models explained 62.4Β % of the variability of male suicidal rates. Economic variables alone explained 26.9Β % and climate variables 37.6Β %. For females, the respective figures were 41.7, 11.5 and 28.1Β %. Male suicides correlated with high unemployment rate in the frame of high growth rate and high inflation and low GDP per capita, while female suicides correlated negatively with inflation. Both male and female suicides correlated with low temperature.
Data from 29 European countries covering the years 2000-2012 and concerning male and female standardized suicidal rates (according to WHO), economic variables (according World Bank) and climate variables were gathered. The statistical analysis included cluster and principal component analysis and categorical regression.
It is well known that suicidal rates vary considerably among European countries and the reasons for this are unknown, although several theories have been proposed. The effect of economic variables has been extensively studied but not that of climate.
The current study reports that the climatic effect (cold climate) is stronger than the economic one, but both are present. It seems that in Europe suicidality follows the climate/temperature cline which interestingly is not from south to north but from south to north-east. This raises concerns that climate change could lead to an increase in suicide rates. The current study is essentially the first successful attempt to explain the differences across countries in Europe; however, it is an observational analysis based on aggregate data and thus there is a lack of control for confounders.
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DISCUSSIO
Staging of Schizophrenia with the Use of PANSS: An International Multi-Center Study
Introduction: A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method.Methods: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21βΒ±β11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed.Results: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients.Discussion: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.<br /
An Investigation of Some Clinical and Psychological Aspects of Bipolar Affective Disorder // ΠΡΠΎΡΡΠ²Π°Π½ΠΈΡ Π²ΡΡΡ Ρ Π½ΡΠΊΠΎΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΈ ΠΈ ΠΏΡΠΈΡ ΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈ Π°ΡΠΏΠ΅ΠΊΡΠΈ Π½Π° Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΎΡΠΎ Π°ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²ΠΎ
[EN] Todayβs diagnosis of bipolar affective disorder (BAD) relies almost entirely upon cross-sectional phenomenology and the distinction between BAD I, BAD II and unipolar depression (UPD) is practically based on lifetime existence of increasing number and persistence of manic symptoms. Yet, findings from various contemporary studies support a dimensional concept of an affective disorders spectrum viewed as a unitary phenomenon which can be most comprehensively envisaged from a longitudinal perspective. Focusing on endophenotypes instead on phenotypes (clinical entities) would improve identification of objective markers which exceed the scope of clinical observation. Nature, after all, does not operate with symptoms: evolution forms the normal dimensions of functioning and if their underlying mechanisms are disturbed the deviations are graded, transnosographic, i.e. spectral! This investigation comprises 25 studies by the author alone or in teams led by him during the period 1996 β 2015 plus an additional attempt for a critical analytic review. The studies are spread over 10 areas of research. A total of 1543 individuals were studied (892 by their files only). 750 patients had BAD, 294 had UPD, 20 were in their first major depressive episode (MDE), 375 had OCD, 40 were firstβdegree relatives of the bipolar probands, and 64 were controls without DSM-IV-TR axis I disorders. We checked consistently a number of relevant aspects of BAD for their possible endophenotypic value and in the course of our research managed to delineate some relevant endophenotypic markers. Our findings confirm a delay of several years till the proper diagnosis of BAD. Results demonstrate that the application of the instrument HCL-32 for primary screening exposes thrice as much patients with βhiddenβ bipolarity than the routine use of DSM-IV-TR criteria. More than a quarter of our depressed bipolar patients do not respond to adequate antidepressant treatment. Such findings mark pressing need of a complex diagnostic algorhythm for BAD. Current formal diagnostic criteria remain too restrictive notwithstanding the significant progress in DSM-5. Optimization requires detection of wide array of βbipolar stigmataβ throughout the course of the disorder. The following distinguishers are significantly more frequent in BAD than in UPD: bipolar spectrum disorders in the family; sudden onset of the first lifetime MDE; onset before the age of 25 (average of 4.7 years earlier than UPD); much higher mean yearly frequency of depressive episodes; common residual symptoms persisting during the inter-episode intervals; marked lability of mood and energy during MDEs (and often also during remissions) with general activation and brightening of mood in late afternoon/evening; markedly disturbed concentration; hypersomnia. Persistent manic symptoms can be detected during MDE in both bipolar and unipolar patients. These results support strongly the notion that affective disorders form a broad dimensional continuum. The most conspicuous inter-group differences are not in severity/duration of depressed mood but in energy/activation. We are convinced that βcoreβ and βadditionalβ symptoms/diagnostic criteria of BAD need a careful reordering and that focusing on behaviour and not on mood is crucial for early detection of BAD. The long-term research of our team resulted in the construction of two diagnostic/predictive models of presence or conversion to BAD during current first/consecutive MDE. These models possess excellent sensitivity (83.7% and 90.7%, resp.), specificity (83.9% and 87.1%, resp.), and also display a very high practical predictive value (87.8% positive and 78.8% negative for a first MDE, and 90.7% positive and 87.1% negative for a consecutive MDE). The model for a first MDE comprises onset before age 25, evening brightening, high level of somatic anxiety (opposite value), markedly disturbed concentration, and presence of manic symptoms. Frequency of previous MDEs substitutes for manic symptoms in the model for a consecutive MDE. Our results demonstrate that high-level trait anxiety may be an important prerequisite for the development of an affective disorder. State anxiety associated with an affective episode is much higher in BAD than in UPD. Somatic anxiety is significantly more frequent in UPD than in BAD. 35 β 50% of the studied patients with UPD and BAD (without inter-group differences) suffer from lifetime comorbid anxiety disorders. The instrument BISS is a convenient and sensitive tool for detecting comorbid anxiety disorders as well as somatic presentations of anxiety. The comorbidity rate of other mental and medical disorders in BAD depends heavily on the used diagnostic algorhythm. Application of a dimensional approach describing an βaffective spectrumβ allows inclusion of the widespread individual symptoms from the βopposite poleβ as well as a more comprehensive grasp on psychiatric and somatic comorbidity. We found a high rate of early-onset OCD, hypothyroidism, and hypertension which all exert pathoplastic influences upon onset, symptom profile and course of BAD. Our results support the very high suicide risk found in BAD. Additionally, all patients with previous suicide attempts display a high-level trait anxiety measured by the STAI. Our comparative studies do not support either the inclusion of hyperthymic temperament in BAD or the existence of a tight association of the depressive temperament to UPD. There is no correlation between age and type of temperament or, in other words, the dimensions of temperament are manifest already early in life and remain stable during development. Hyperthymic temperament is significantly more scarce in BAD in comparison to healthy controls and UPD and is in fact the most uncommon temperament type among the bipolar patients studied; Dominant hyperthymic temperament is associated with a lower risk of mental (especially, affective) disorders and also with a lower suicide risk. Depressive temperament is less conspicuous in the group with first MDE and more prominent among UPD patients which can be either a result of the overlap between diagnostic criteria for either conditions or accentuation of some temperamental characteristics under the influence of the disorder. Anxious temperament is much more common in UPD which once again reminds one of the well-established (even at the genetic level) associations between neuroticism and depression. Dominant cyclothymic temperament is significantly more frequent in BAD (especially, in BAD I) and is practically absent in the UPD samples studied. It stands out as an important factor for the development of alcoholism and is also associated with high suicide risk. We are thus convinced that cyclothymia is an expression of a biologically determined primary dysregulation of energy and emotional stability, so it is not a βtemperamentβ but rather a component of the psychopathological bipolar spectrum. Its absence may even predict the absence of future (hypo) manic episodes. Bipolar patients display significantly higher impulsivity during an episode of either pole in comparison to healthy controls. Impulsivity level does not correlate with severity of depressive or manic symptoms. Thus, high impulsivity is obviously a trait characteristic of bipolar patients as a group and not just an epiphenomenon of the episode. There is also a trend to higher composite and motor impulsivity in manic/mixed episodes and to higher impulsivity of attention in depressive episodes of BAD in comparison to controls. There are measurable marked deficits in information-processing speed, sustained and selective attention, memory, and working memory. These are widespread in mania, more restricted in euthymia, and can also be registered in close relatives of bipolar probands (predominantly in inhibitory processes: selective attention/control on interference). Obviously, BAD is associated with characteristic deficits in certain cognitive domains which are broader and deeper in mania and diminish in remission to full recovery in some and to milder disturbances in other domains. Disturbed inhibitory control, wavering attention, and deficient working memory can explain at least partially the disorder in recall without any impairment in encoding processes as well as the diminished information-processing speed. Deficits grow more severe with each consecutive morbid episode. Compared to controls, BAD patients display a significantly greater total number of soft neurological signs (SNS) as well as significantly more SNS from each separate subgroup. Mean number of SNS does not distinguish either bipolars from healthy controls, or patients in mania from bipolar patients in depressive episode. Refining SNS profile and the profile of cognitive deficits together with registration of peculiarities in temperament and impulsivity components could delineate a more or less accurate βtopicalβ diagnosis of brain alterations in BAD and of their potential transformations at each stage along the long-term course of the disease. In fact, for us this was the ultimate reason to plan, start and steadily follow for already two decades the whole complex research programme. The most serious limitations of this complex investigation of BAD are as follow: relatively small patient and control samples, predominant application of observational, cross-sectional and retrospective designs, deficient standardization and varying quality of the separate studies altogether. BAD is a severe lifelong phenotypically variable disorder which is manifested through a βmulticolourβ spectrum of disturbances and which has an additional βovergrowthβ of various psychiatric and somatic comorbid conditions but is by its nature a unitary disease. The in-depth multifocal investigation of the various aspects of BAD can facilitate the construction of comprehensive algorhythms for recognition and intervention while defining endophenotype profiles can advance awareness of its true nature to a much higher level.[BG] ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°ΡΠ° Π½Π° Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΎΡΠΎ Π°ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²ΠΎ (ΠΠΠ ) ΠΏΠΎΡΡΠ°Π²Ρ ΡΠ΅Π΄ΠΈΡΠ° Π²ΡΠ΅ ΠΎΡΠ΅ Π½Π΅ΡΠ΅ΡΠ΅Π½ΠΈ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΈ. ΠΠ»ΠΈΠ½ΠΈΡΠΈΡΡΡΡ ΡΠ΅ Π»ΡΡΠ° ΠΌΠ΅ΠΆΠ΄Ρ Π½Π΅ΡΠ°Π·ΠΏΠΎΠ·Π½Π°Π²Π°Π½Π΅ ΠΈ ΡΠ²ΡΡΡ
Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΈΡΠ°Π½Π΅, Π·Π°ΡΠΎΡΠΎ Π΄Π΅ΡΠΈΠ½ΠΈΡΠ°Π½Π΅ΡΠΎ Π½Π° ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²ΠΎΡΠΎ Π»Π΅ΠΆΠΈ ΠΏΠΎΡΡΠΈ ΠΈΠ·ΡΡΠ»ΠΎ Π²ΡΡΡ
Ρ βΠ½Π°ΠΏΡΠ΅ΡΠ½Π°β, ΠΌΠΎΠΌΠ΅Π½ΡΠ½Π° ΡΠ΅Π½ΠΎΠΌΠ΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡ ΠΈ ΡΠ°Π·Π»ΠΈΡΠ°Π²Π°Π½Π΅ΡΠΎ Π½Π° ΠΠΠ I, ΠΠΠ II ΠΈ ΡΠ½ΠΈΠΏΠΎΠ»ΡΡΠ½Π°ΡΠ° Π΄Π΅ΠΏΡΠ΅ΡΠΈΡ (Π£ΠΠ) ΡΠ΅ ΠΎΡΠ½ΠΎΠ²Π°Π²Π° ΠΏΠΎ ΡΡΡΠ΅ΡΡΠ²ΠΎ Π²ΡΡΡ
Ρ ΠΏΠΎΠΆΠΈΠ·Π½Π΅Π½ΠΎΡΠΎ Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° Π½Π°ΡΠ°ΡΡΠ²Π°Ρ Π±ΡΠΎΠΉ ΠΈ ΡΡΡΠΎΠΉΡΠΈΠ²ΠΎΡΡ Π½Π° ΠΌΠ°Π½ΠΈΠΉΠ½ΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ. ΠΠ½ΠΎΠΆΠ΅ΡΡΠ²ΠΎ ΡΠ°Π·Π½ΠΎΠΎΠ±ΡΠ°Π·Π½ΠΈ ΡΡΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΈ ΠΏΡΠΎΡΡΠ²Π°Π½ΠΈΡ ΠΏΠΎΠ΄ΠΊΡΠ΅ΠΏΡΡ Π΄ΠΈΠΌΠ΅Π½Π·ΠΈΠΎΠ½Π°Π»Π½ΠΎΡΠΎ Π³Π»Π΅Π΄ΠΈΡΠ΅ Π·Π° ΡΠΏΠ΅ΠΊΡΡΡ Π½Π° ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²Π°ΡΠ° Π½Π° Π½Π°ΡΡΡΠΎΠ΅Π½ΠΈΠ΅ΡΠΎ ΠΊΠ°ΡΠΎ Π΅Π΄ΠΈΠ½Π΅Π½ ΡΠ΅Π½ΠΎΠΌΠ΅Π½, ΠΎΡΠΌΠΈΡΠ»ΡΠ½ Π½Π°ΠΉ-ΠΏΡΠ»Π½ΠΎΡΠ΅Π½Π½ΠΎ Π² Π½Π°Π΄Π»ΡΠΆΠ΅Π½ ΠΏΠ»Π°Π½. Π€ΠΎΠΊΡΡΠΈΡΠ°Π½Π΅ΡΠΎ Π²ΡΡΡ
Ρ Π΅Π½Π΄ΠΎΡΠ΅Π½ΠΎΡΠΈΠΏΠΎΠ²Π΅, Π° Π½Π΅ Π²ΡΡΡ
Ρ ΡΠ΅Π½ΠΎΡΠΈΠΏΠΎΠ²Π΅ (ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΈ), Π±ΠΈ ΠΏΠΎΠ΄ΠΎΠ±ΡΠΈΠ»ΠΎ ΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΡΠ° Π·Π° ΠΈΠ΄Π΅Π½ΡΠΈΡΠΈΡΠΈΡΠ°Π½Π΅ Π½Π° ΠΎΠ±Π΅ΠΊΡΠΈΠ²Π½ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠΈ, Π½Π°Π΄Ρ
Π²ΡΡΠ»ΡΡΠΈ Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈΡΠ΅ Π½Π° ΡΠ΅Π½ΠΎΠΌΠ΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΡΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅. ΠΡΠΈΡΠΎΠ΄Π°ΡΠ° Π½Π΅ βΡΠ°Π±ΠΎΡΠΈβ ΡΡΡ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ: Π΅Π²ΠΎΠ»ΡΡΠΈΡΡΠ° ΠΎΡΠΎΡΠΌΡ Π½ΠΎΡΠΌΠ°Π»Π½ΠΈΡΠ΅ Π΄ΠΈΠΌΠ΅Π½Π·ΠΈΠΈ Π½Π° ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΠ°Π½Π΅ ΠΈ ΠΏΡΠΈ ΡΠ°Π·ΡΡΡΠΎΠΉΠ²Π°Π½Π΅ Π½Π° ΠΏΠΎΠ΄Π»Π΅ΠΆΠ°ΡΠΈΡΠ΅ ΠΈΠΌ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΈ ΠΎΡΠΊΠ»ΠΎΠ½Π΅Π½ΠΈΡΡΠ° ΡΠ° ΡΡΠ΅ΠΏΠ΅Π½Π½ΠΈ, ΡΡΠ°Π½ΡΠ½ΠΎΠ·ΠΎΠ³ΡΠ°ΡΡΠΊΠΈ, Ρ.Π΅. ΡΠΏΠ΅ΠΊΡΡΠ°Π»Π½ΠΈ! ΠΡΠ΅Π΄ΡΡΠ°Π²Π΅Π½ΠΈ ΡΠ° 25 ΡΠΎΠ±ΡΡΠ²Π΅Π½ΠΈ ΠΏΡΠΎΡΡΠ²Π°Π½ΠΈΡ (ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈ ΡΠ°ΠΌΠΎΡΡΠΎΡΡΠ΅Π»Π½ΠΎ ΠΈ Π² ΡΡΠΊΠΎΠ²ΠΎΠ΄Π΅Π½ ΠΎΡ Π°Π²ΡΠΎΡΠ° Π΅ΠΊΠΈΠΏ ΠΏΡΠ΅Π· ΠΏΠ΅ΡΠΈΠΎΠ΄Π° 1996 β 2015 Π³.) ΠΈ Π΅Π΄ΠΈΠ½ Π΄ΠΎΠΏΡΠ»Π½ΠΈΡΠ΅Π»Π΅Π½ ΠΎΠΏΠΈΡ Π·Π° ΠΊΡΠΈΡΠΈΡΠ΅Π½ Π°Π½Π°Π»ΠΈΡΠΈΡΠ΅Π½ ΠΎΠ±Π·ΠΎΡ. ΠΠ±Ρ
Π²Π°Π½Π°ΡΠΈ ΡΠ° 10 ΠΎΠ±Π»Π°ΡΡΠΈ Π½Π° ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅. ΠΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈ ΡΠ° ΠΎΠ±ΡΠΎ 1543 ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄Π° (892 - ΡΠ°ΠΌΠΎ ΠΏΠΎ Π΄ΠΎΠΊΡΠΌΠ΅Π½ΡΠΈ). 750 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΡΠ° Ρ Π²Π΅ΡΠΈΡΠΈΡΠΈΡΠ°Π½ΠΎ ΠΠΠ ; 294 β Ρ Π£ΠΠ; 20 β Ρ ΠΏΡΡΠ² ΠΠΠ; 375 β Ρ ΠΠΠ ; 40 ΡΠ° ΠΏΡΡΠ²ΠΎΡΡΠ΅ΠΏΠ΅Π½Π½ΠΈ ΡΠΎΠ΄ΡΡΠ²Π΅Π½ΠΈΡΠΈ Π½Π° Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈ ΠΏΡΠΎΠ±Π°Π½Π΄ΠΈ; 64 ΡΠ° ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈ Π±Π΅Π· ΠΏΡΠΈΡ
ΠΈΠ°ΡΡΠΈΡΠ½Π° Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° ΠΏΠΎ ΠΎΡ I Π½Π° DSM-IV-TR. ΠΠ°Π»ΠΎΠΆΠ΅Π½ΠΈ ΡΠ° Π²Π°Π»ΠΈΠ΄Π½ΠΈ ΠΈ Π·Π½Π°ΡΠΈΠΌΠΈ ΠΈΠ½Π΄Π΅ΠΊΡΠΈ Π·Π° ΠΏΠΎΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»Π½Π° ΠΏΡΠΎΠ²Π΅ΡΠΊΠ° Π½Π° Π΅Π²Π΅Π½ΡΡΠ°Π»Π½Π°ΡΠ° Π΅Π½Π΄ΠΎΡΠ΅Π½ΠΎΡΠΈΠΏΠ½Π° ΡΡΠΎΠΉΠ½ΠΎΡΡ Π½Π° ΡΠ΅Π΄ΠΈΡΠ° Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ Π½Π° ΠΠΠ ΠΈ Π² Ρ
ΠΎΠ΄Π° Π½Π° ΡΠ°Π±ΠΎΡΠ°ΡΠ° ΡΠ° ΠΎΡΠ΅ΡΡΠ°Π½ΠΈ Π½ΡΠΊΠΎΠΈ Π²Π°ΠΆΠ½ΠΈ Π΅Π½Π΄ΠΎΡΠ΅Π½ΠΎΡΠΈΠΏΠ½ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠΈ Π½Π° Π±ΠΎΠ»Π΅ΡΡΡΠ°. ΠΠΎΡΠ²ΡΡΠΆΠ΄Π°Π²Π° ΡΠ΅ Π΄ΡΠ»Π³ΠΎΠ³ΠΎΠ΄ΠΈΡΠ½ΠΎΡΠΎ ΠΎΡΠ»Π°Π³Π°Π½Π΅ Π½Π° ΠΏΡΠ°Π²ΠΈΠ»Π½Π°ΡΠ° Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° ΠΠΠ . ΠΠ°Π΄ ? ΠΎΡ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π½Π΅ ΡΠ΅ ΠΏΠΎΠ²Π»ΠΈΡΠ²Π°Ρ ΠΎΡ Π°Π΄Π΅ΠΊΠ²Π°ΡΠ½ΠΎ ΠΏΠΎ Π΄ΠΎΠ·Π° ΠΈ ΠΏΡΠΎΠ΄ΡΠ»ΠΆΠΈΡΠ΅Π»Π½ΠΎΡΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Ρ Π°Π½ΡΠΈΠ΄Π΅ΠΏΡΠ΅ΡΠ°Π½Ρ(ΠΈ) ΠΏΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄. Π’Π΅Π·ΠΈ Π½Π°Ρ
ΠΎΠ΄ΠΊΠΈ ΠΏΠΎΠ΄ΡΠ΅ΡΡΠ°Π²Π°Ρ ΠΈΠΌΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½Π°ΡΠ° Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡ ΠΎΡ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ΅Π½ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅Π½ Π°Π»Π³ΠΎΡΠΈΡΡΠΌ. ΠΠΊΠ°Π·Π²Π° ΡΠ΅, ΡΠ΅ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½Π΅ΡΠΎ Π½Π° HCL-32 ΠΏΡΠΈ ΠΏΡΡΠ²ΠΈΡΠ½ΠΎ ΡΠΊΡΠΈΠ½ΠΈΡΠ°Π½Π΅ ΠΎΡΠ²Π΅ΡΡΠ²Π° ΡΡΠΈ ΠΏΡΡΠΈ ΠΏΠΎΠ²Π΅ΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΡΡ βΡΠΊΡΠΈΡΠ°β Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΎΡΡ, ΠΎΡΠΊΠΎΠ»ΠΊΠΎΡΠΎ ΡΡΡΠΈΠ½Π½ΠΎΡΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΈΡΠ°Π½Π΅ ΠΏΠΎ DSM-IV-TR. ΠΡΠΈΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈΡΠ΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ½ΠΈ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ Π·Π° ΠΠΠ Π²ΡΠ΅ ΠΎΡΠ΅ ΠΎΡΠΈΠ³ΡΡΡΠ²Π°Ρ ΡΠ²ΡΡΠ΄Π΅ ΡΠ΅ΡΡΡΠΈΠΊΡΠΈΠ²Π½Π° Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° Π²ΡΠΏΡΠ΅ΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΈΡ ΡΠΊΠΎΡΠΎΡΠ΅Π½ ΠΏΡΠΎΠ³ΡΠ΅Ρ Π² DSM-5. ΠΠΏΡΠΈΠΌΠΈΠ·Π°ΡΠΈΡΡΠ° ΠΈΠ·ΠΈΡΠΊΠ²Π° ΡΠ»Π°Π²ΡΠ½Π΅ Π½Π° ΠΏΡΡΡΡΠ° ΠΏΠ°Π»ΠΈΡΡΠ° βΠ±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈ ΡΡΠΈΠ³ΠΌΠΈβ ΠΏΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° Π²ΡΠΈΡΠΊΠΈ Π΅ΡΠ°ΠΏΠΈ Π½Π° Π±ΠΎΠ»Π΅ΡΡΡΠ°. Π Π΅Π³ΠΈΡΡΡΠΈΡΠ°ΠΌΠ΅ ΡΠ»Π΅Π΄Π½ΠΈΡΠ΅ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΈ ΡΠ°Π·Π³ΡΠ°Π½ΠΈΡΠΈΡΠ΅Π»ΠΈ Ρ Π£ΠΠ: Π²Π½Π΅Π·Π°ΠΏΠ½Π° ΠΈΠ·ΡΠ²Π° Π½Π° ΠΏΡΡΠ²ΠΈΡ ΠΠΠ Π² ΠΆΠΈΠ²ΠΎΡΠ°; ΡΡ. 4,7 Π³. ΠΏΠΎ-ΡΠ°Π½Π½Π° ΠΏΡΠΈ ΠΠΠ , ΡΠ΅ΡΠΏ. Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎ-ΡΠ΅ΡΡΠ° ΠΈΠ·ΡΠ²Π° ΠΏΡΠ΅Π΄ΠΈ 25 Π³.; Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎ-ΡΠ΅ΡΡΠΈ ΠΏΡΠ΅Π΄Ρ
ΠΎΠ΄Π½ΠΈ Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈ Π΅ΠΏΠΈΠ·ΠΎΠ΄ΠΈ; ΠΌΠ½ΠΎΠ³ΠΎ ΡΠ΅ΡΡΠΈ ΠΎΡΡΠ°ΡΡΡΠ½ΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ, ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΠ°ΡΠΈ ΠΏΡΠ΅Π· ΠΈΠ½ΡΠ΅ΡΠ΅ΠΏΠΈΠ·ΠΎΠ΄Π½ΠΈΡΠ΅ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»ΠΈ; ΠΈΠ·ΡΠ°Π·Π΅Π½Π° Π»Π°Π±ΠΈΠ»Π½ΠΎΡΡ Π½Π° Π½Π°ΡΡΡΠΎΠ΅Π½ΠΈΠ΅ΡΠΎ ΠΈ Π΅Π½Π΅ΡΠ³ΠΈΡΡΠ° ΠΏΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈΡΠ΅ Π΅ΠΏΠΈΠ·ΠΎΠ΄ΠΈ, Π° ΡΠ΅ΡΡΠΎ β ΠΈ ΠΌΠ΅ΠΆΠ΄Ρ ΡΡΡ
Ρ ΠΎΠ±ΡΠ° Π°ΠΊΡΠΈΠ²Π°ΡΠΈΡ ΠΈ ΡΠ°Π·Π²Π΅Π΄ΡΡΠ²Π°Π½Π΅ ΠΏΡΠΈΠ²Π΅ΡΠ΅Ρ; ΠΏΠΎΠ΄ΡΠ΅ΡΡΠ°Π½ΠΎ Π½Π°ΡΡΡΠ΅Π½Π° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡ; Ρ
ΠΈΠΏΠ΅ΡΡΠΎΠΌΠ½ΠΈΡ. ΠΠΎΠ½ΡΡΠ°ΡΠΈΡΠ°ΠΌΠ΅ Π·Π½Π°ΡΠΈΠΌΠ° ΡΠ΅ΡΡΠΎΡΠ° Π½Π° ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²Π° ΠΎΡ Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈΡ ΡΠΏΠ΅ΠΊΡΡΡ Π²ΡΠ² ΡΠ°ΠΌΠΈΠ»ΠΈΠΈΡΠ΅. ΠΠΊΠ°Π·Π²Π° ΡΠ΅, ΡΠ΅ Π½Π΅ ΡΠ°ΠΌΠΎ ΠΌΠ½ΠΎΠ³ΠΎ ΠΎΡ Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΈΠΌΠ°Ρ ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΠ°ΡΠΈ ΠΌΠ°Π½ΠΈΠΉΠ½ΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ Π² ΡΠ°ΠΌΠΊΠΈΡΠ΅ Π½Π° ΠΠΠ, Π½ΠΎ ΠΈ ΡΠ΅ ΡΠ°ΠΊΠΈΠ²Π° ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ ΡΠ΅ ΠΎΡΠΊΡΠΈΠ²Π°Ρ ΠΏΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ βΠ£ΠΠβ. ΠΠ·Π±ΡΠΎΠ΅Π½ΠΈΡΠ΅ Π½Π°Ρ
ΠΎΠ΄ΠΊΠΈ Π΄Π°Π²Π°Ρ ΡΠ΅ΡΠΈΠΎΠ·Π½ΠΈ Π°ΡΠ³ΡΠΌΠ΅Π½ΡΠΈ Π·Π° ΠΊΠΎΠ½ΡΠ΅ΠΏΡΠΈΡΡΠ°, ΡΠ΅ Π°ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΈΡΠ΅ ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²Π° ΡΡΠΎΡΡ Π² ΠΎΠ±Ρ Π΄ΠΈΠΌΠ΅Π½Π·ΠΈΠΎΠ½Π°Π»Π΅Π½ ΠΊΠΎΠ½ΡΠΈΠ½ΡΡΠΌ. ΠΠ°ΠΉ-ΠΏΠΎΠ΄ΡΠ΅ΡΡΠ°Π½ΠΈΡΠ΅ ΠΎΡΠ»ΠΈΠΊΠΈ ΠΌΠ΅ΠΆΠ΄Ρ Π΄Π²Π΅ΡΠ΅ Π³ΡΡΠΏΠΈ Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠ° Π½Π΅ Π² ΡΠ΅ΠΆΠ΅ΡΡΡΠ°/ΠΏΡΠΎΠ΄ΡΠ»ΠΆΠΈΡΠ΅Π»Π½ΠΎΡΡΡΠ° Π½Π° ΡΠΏΠ°Π΄Π° Π² Π½Π°ΡΡΡΠΎΠ΅Π½ΠΈΠ΅ΡΠΎ, Π° Π½Π° Π½ΠΈΠ²ΠΎ Π΅Π½Π΅ΡΠ³ΠΈΡ/Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡ. Π£Π±Π΅Π΄Π΅Π½ΠΎ ΡΠ²ΡΡΠ΄ΠΈΠΌ, ΡΠ΅ βΡΡΡΡΠ΅Π²ΠΈΠ½Π½ΠΈΡΠ΅β ΠΈ βΠ΄ΠΎΠ±Π°Π²ΡΡΠ½ΠΈΡΠ΅β ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ, ΡΠ΅ΡΠΏ. Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ½ΠΈΡΠ΅ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ Π·Π° ΠΠΠ ΡΠ΅ Π½ΡΠΆΠ΄Π°ΡΡ ΠΎΡ Π²Π½ΠΈΠΌΠ°ΡΠ΅Π»Π½ΠΎ ΠΏΡΠ΅Π½Π°ΡΠ΅ΠΆΠ΄Π°Π½Π΅, ΠΊΠ°ΡΠΎ ΡΠΎΠΊΡΡΠΈΡΠ°Π½Π΅ΡΠΎ Π²ΡΡΡ
Ρ ΠΏΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ΡΠΎ, Π° Π½Π΅ Π²ΡΡΡ
Ρ Π½Π°ΡΡΡΠΎΠ΅Π½ΠΈΠ΅ΡΠΎ, Π΅ ΡΠ΅ΡΠ°Π²Π°ΡΠΎ ΠΏΡΠΈ ΡΠ°Π½Π½Π°ΡΠ° Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° Π½Π° ΠΠΠ . ΠΡΠ»Π³ΠΎΠ³ΠΎΠ΄ΠΈΡΠ½ΠΈΡΠ΅ ΠΏΡΠΎΡΡΠ²Π°Π½ΠΈΡ Π½Π° Π½Π°ΡΠΈΡ Π΅ΠΊΠΈΠΏ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡ
Π° ΠΈΠ·Π³ΡΠ°ΠΆΠ΄Π°Π½Π΅ ΠΈ ΡΡΠΏΠ΅ΡΠ½ΠΎ ΠΈΠ·ΠΏΡΠΎΠ±Π²Π°Π½Π΅ Π² ΠΏΡΠ°ΠΊΡΠΈΠΊΠ°ΡΠ° Π½Π° Π΄Π²Π° ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ½ΠΎ-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ½ΠΈ ΠΌΠΎΠ΄Π΅Π»Π° Π·Π° Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π°/ΠΏΡΠ΅ΠΌΠΈΠ½Π°Π²Π°Π½Π΅ ΠΊΡΠΌ ΠΠΠ ΠΏΡΠΈ ΠΏΡΡΠ²/ΡΠ»Π΅Π΄Π²Π°Ρ Π³ΠΎΠ»ΡΠΌ Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄ Ρ ΠΎΡΠ»ΠΈΡΠ½Π° ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»Π½ΠΎΡΡ (ΡΡΠΎΡΠ². 83,7% ΠΈ 90,7%) ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡ (ΡΡΠΎΡΠ². 83,9% ΠΈ 87,1%). ΠΠΎΠ΄Π΅Π»ΠΈΡΠ΅ ΡΠ° Ρ ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΈΡΠΎΠΊΠ° ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠ° ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ½Π° ΡΡΠΎΠΉΠ½ΠΎΡΡ (87,8% ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½Π° ΠΈ 78,8% Π½Π΅Π³Π°ΡΠΈΠ²Π½Π° Π·Π° ΠΏΡΡΠ²ΠΈ Π΅ΠΏΠΈΠ·ΠΎΠ΄; ΡΡΠΎΡΠ². 90,7% ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½Π° ΠΈ 87,1% Π·Π° ΠΏΠΎΡΠ΅Π΄Π΅Π½ Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄) ΠΏΡΠΈ AUC ΡΡΠΎΡΠ². 90,5% ΠΈ 94,4% ΠΈ ΡΠ° Π»Π΅ΡΠ½ΠΈ Π·Π° ΠΏΠΎΠ»Π·Π²Π°Π½Π΅ ΡΡΠ΅Π· ΠΊΠΎΠΌΠΏΡΡΡΠΈΠ·ΠΈΡΠ°Π½Π° ΠΏΡΠΎΠ³ΡΠ°ΠΌΠ° Π·Π° ΡΠΊΡΠΈΠ½ΠΈΠ½Π³ΠΎΠ²Π° ΠΎΡΠ΅Π½ΠΊΠ° Π½Π° Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡΠ° Π·Π° ΠΏΡΠΈΠ½Π°Π΄Π»Π΅ΠΆΠ½ΠΎΡΡ Π½Π° ΠΈΠ½Π΄Π΅ΠΊΡΠ΅Π½ ΠΠΠ ΠΊΡΠΌ ΠΠΠ . ΠΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΈ Π½Π° ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠ΅ ΡΠ°: 1) ΠΏΡΠΈ ΠΏΡΡΠ² ΠΠΠ: ΠΈΠ·ΡΠ²Π° Π΄ΠΎ 25-Π³ΠΎΠ΄ΠΈΡΠ½Π° Π²ΡΠ·ΡΠ°ΡΡ; ΡΠ°Π·Π²Π΅Π΄ΡΡΠ²Π°Π½Π΅ ΠΏΡΠΈΠ²Π΅ΡΠ΅Ρ; Π²ΠΈΡΠΎΠΊΠΎ Π½ΠΈΠ²ΠΎ Π½Π° ΡΠΎΠΌΠ°ΡΠΈΡΠ½Π° ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΎΡΡ; ΠΏΠΎΠ΄ΡΠ΅ΡΡΠ°Π½ΠΎ Π½Π°ΡΡΡΠ΅Π½Π° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡ; Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° ΠΌΠ°Π½ΠΈΠΉΠ½ΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ ΠΏΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈΡ Π΅ΠΏΠΈΠ·ΠΎΠ΄; 2) ΠΏΡΠΈ ΠΏΠΎΡΠ΅Π΄Π΅Π½ ΠΠΠ: Π½Π°ΡΠ°Π»ΠΎ Π½Π° Π±ΠΎΠ»Π΅ΡΡΡΠ° Π΄ΠΎ 25-Π³ΠΎΠ΄ΠΈΡΠ½Π° Π²ΡΠ·ΡΠ°ΡΡ; ΡΠ°Π·Π²Π΅Π΄ΡΡΠ²Π°Π½Π΅ ΠΏΡΠΈΠ²Π΅ΡΠ΅Ρ; Π²ΠΈΡΠΎΠΊΠΎ Π½ΠΈΠ²ΠΎ Π½Π° ΡΠΎΠΌΠ°ΡΠΈΡΠ½Π° ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΎΡΡ; ΠΏΠΎΠ΄ΡΠ΅ΡΡΠ°Π½ΠΎ Π½Π°ΡΡΡΠ΅Π½Π° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡ ΠΏΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈΡ Π΅ΠΏΠΈΠ·ΠΎΠ΄; ΡΠ΅ΡΡΠΎΡΠ° Π½Π° Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈΡΠ΅ Π΅ΠΏΠΈΠ·ΠΎΠ΄ΠΈ Π² Ρ
ΠΎΠ΄Π° Π½Π° Π±ΠΎΠ»Π΅ΡΡΡΠ°. ΠΠΈΡΠΎΠΊΠΎΡΠΎ Π½ΠΈΠ²ΠΎ Π½Π° ΡΡΠ°ΠΉΠ½Π°, βΠ»ΠΈΡΠ½ΠΎΡΡΠΎΠ²Π°β ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΎΡΡ ΠΌΠΎΠΆΠ΅ Π΄Π° Π΅ Π²Π°ΠΆΠ½Π° ΠΏΡΠ΅Π΄ΠΏΠΎΡΡΠ°Π²ΠΊΠ° Π·Π° ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π½Π° Π°ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²ΠΎ. Π‘Π²ΡΡΠ·Π°Π½Π°ΡΠ° Ρ Π΅ΠΏΠΈΠ·ΠΎΠ΄Π° ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΎΡΡ Π΅ ΠΏΠΎ-ΠΈΠ·ΡΠ°Π·Π΅Π½Π° ΠΏΡΠΈ ΠΠΠ , Π° ΡΠΎΠΌΠ°ΡΠΈΡΠ½Π°ΡΠ° ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΎΡΡ Π΅ Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎ-ΡΠ΅ΡΡΠ° ΠΏΡΠΈ Π£ΠΠ. ΠΡΠΈ 35 β 50% Π² ΠΎΡΠ΄Π΅Π»Π½ΠΈΡΠ΅ ΠΈΠ·Π²Π°Π΄ΠΊΠΈ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ Π£ΠΠ ΠΈ ΠΠΠ ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠ°Ρ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠ°Π»Π½ΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ½ΠΈ ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΈ ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²Π°, Π±Π΅Π· ΡΠ΅ΡΡΠΎΡΠ°ΡΠ° ΠΈΠΌ Π΄Π° ΡΠ΅ ΡΠ°Π·Π»ΠΈΡΠ°Π²Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ ΠΌΠ΅ΠΆΠ΄Ρ Π΄Π²Π΅ΡΠ΅ Π°ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΈ ΡΡΠ±ΠΏΠΎΠΏΡΠ»Π°ΡΠΈΠΈ. ΠΠ½ΡΡΡΡΠΌΠ΅Π½ΡΡΡ BISS Π΅ Π΄ΠΎΡΡΠ°ΡΡΡΠ½ΠΎ ΡΠ΄ΠΎΠ±Π΅Π½ ΠΈ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»Π΅Π½ Π·Π° ΡΠ»Π°Π²ΡΠ½Π΅ ΠΊΠ°ΠΊΡΠΎ Π½Π° ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΈ ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΈ ΡΠ°Π·ΡΡΡΠΎΠΉΡΡΠ²Π°, ΡΠ°ΠΊΠ° ΠΈ Π½Π° ΡΠΎΠΌΠ°ΡΠΈΡΠ½ΠΈ ΠΏΡΠΎΡΠ²ΠΈ Π½Π° ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΎΡΡ. Π ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡΠ΅ ΠΈΠ·Π²Π°Π΄ΠΊΠΈ ΡΠ΅ ΠΎΡΠΊΡΠΈΠ²Π° ΠΌΠ½ΠΎΠ³ΠΎ ΡΠ΅ΡΡΠΎ ΠΈ ΡΠ°Π½ΠΎ ΠΈΠ·ΡΠ²Π΅Π½ΠΎ Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° ΠΠΠ , Ρ
ΠΈΠΏΠΎΡΠΈΡΠ΅ΠΎΠΈΠ΄ΠΈΠ·ΡΠΌ, Ρ
ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡ ΠΈ ΡΠ΅ ΠΎΠΊΠ°Π·Π²Π°Ρ ΠΏΠ°ΡΠΎΠΏΠ»Π°ΡΡΠΈΡΠ½ΠΎ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π²ΡΡΡ
Ρ ΠΈΠ·ΡΠ²Π°ΡΠ°, ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠ°ΡΠ° ΠΈ Ρ
ΠΎΠ΄Π° Π½Π° ΠΠΠ . Π Π΅Π³ΠΈΡΡΡΠΈΡΠ°Π½Π°ΡΠ° ΡΠ΅ΡΡΠΎΡΠ° Π½Π° ΠΏΡΠΈΡ
ΠΈΠ°ΡΡΠΈΡΠ΅Π½ ΠΈ Π½Π° ΡΠΎΠΌΠ°ΡΠΈΡΠ΅Π½ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄ΠΈΡΠ΅Ρ Π·Π°Π²ΠΈΡΠΈ ΠΏΠΎΠ΄ΡΠ΅ΡΡΠ°Π½ΠΎ ΠΎΡ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½ΠΈΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅Π½ Π°Π»Π³ΠΎΡΠΈΡΡΠΌ Π·Π° ΠΠΠ . ΠΡΠ·ΠΏΡΠΈΠ΅ΠΌΠ°Π½Π΅ΡΠΎ Π½Π° Π΄ΠΈΠΌΠ΅Π½Π·ΠΈΠΎΠ½Π°Π»Π΅Π½ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄, ΠΎΠΏΠΈΡΠ²Π°Ρ βΠ°ΡΠ΅ΠΊΡΠΈΠ²Π΅Π½ ΡΠΏΠ΅ΠΊΡΡΡβ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ²Π° ΠΈ Π²Π³ΡΠ°ΠΆΠ΄Π°Π½Π΅ Π½Π° ΡΠΈΡΠΎΠΊΠΎ ΡΠ°Π·ΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΡΠ΅ Π΅Π΄ΠΈΠ½ΠΈΡΠ½ΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ ΠΎΡ βΠΏΡΠΎΡΠΈΠ²ΠΎΠΏΠΎΠ»ΠΎΠΆΠ½ΠΈΡ ΠΏΠΎΠ»ΡΡβ ΠΏΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° ΡΠ°Π·Π³ΡΡΠ½Π°Ρ Π°ΡΠ΅ΠΊΡΠΈΠ²Π΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄, ΠΈ ΠΏΠΎ-ΠΏΡΠ»Π½ΠΎΡΠ΅Π½Π½ΠΎ ΠΎΠ±Ρ
Π²Π°ΡΠ°Π½Π΅ Π½Π° ΠΏΡΠΈΡ
ΠΈΠ°ΡΡΠΈΡΠ½ΠΈΡ ΠΈ ΡΠΎΠΌΠ°ΡΠΈΡΠ½ΠΈΡ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄ΠΈΡΠ΅Ρ ΠΏΡΠΈ ΠΠΠ . ΠΠΎΡΠ²ΡΡΠΆΠ΄Π°Π²Π° ΡΠ΅ Π½Π°Π»ΠΈΡΠΈΠ΅ΡΠΎ Π½Π° ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΈΡΠΎΠΊ ΡΡΠΈΡΠΈΠ΄Π°Π»ΠΈΡΠ΅Ρ ΠΏΡΠΈ ΠΠΠ . ΠΡΠΈ Π²ΡΠΈΡΠΊΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ ΠΏΡΠ΅Π΄Ρ
ΠΎΠ΄Π½ΠΈ ΡΡΠΈΡΠΈΠ΄Π½ΠΈ ΠΎΠΏΠΈΡΠΈ Π΅ Π½Π°Π»ΠΈΡΠ΅ ΠΏΠΎ-Π²ΠΈΡΠΎΠΊΠ° Π»ΠΈΡΠ½ΠΎΡΡΠΎΠ²Π° ΡΡΠ΅Π²ΠΎΠΆΠ½ΠΎΡΡ, ΠΈΠ·ΠΌΠ΅ΡΠ΅Π½Π° ΡΡΠ΅Π· ΠΎΠΏΠΈΡΠ° STAI. ΠΠ°ΡΠΈΡΠ΅ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»Π½ΠΈ ΠΏΡΠΎΡΡΠ²Π°Π½ΠΈΡ Π½Π΅ ΠΏΠΎΠ΄ΠΊΡΠ΅ΠΏΡΡ Π½ΠΈΡΠΎ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ΠΈΠ΅ΡΠΎ Π·Π° Π²ΠΊΠ»ΡΡΠ²Π°Π½Π΅ Π½Π° Ρ
ΠΈΠΏΠ΅ΡΡΠΈΠΌΠ½ΠΈΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ, ΡΠ΅ΡΠΏ. Π½Π° Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈ Π΅ΠΏΠΈΠ·ΠΎΠ΄ΠΈ ΠΏΡΠΈ Ρ
ΠΈΠΏΠ΅ΡΡΠΈΠΌΠ΅Π½ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ Π² Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈΡ ΡΠΏΠ΅ΠΊΡΡΡ, Π½ΠΈΡΠΎ ΡΠ°Π·ΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΎΡΠΎ ΡΡ
Π²Π°ΡΠ°Π½Π΅ Π·Π° ΡΠΈΠ³ΡΡΠ½Π° Π²ΡΡΠ·ΠΊΠ° ΠΌΠ΅ΠΆΠ΄Ρ Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ ΠΈ Π£ΠΠ. ΠΠΈΠΏΡΠ²Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡ ΠΌΠ΅ΠΆΠ΄Ρ Π²ΡΠ·ΡΠ°ΡΡ ΠΈ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ, Ρ.Π΅. ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½ΡΠΎΠ²ΠΈΡΠ΅ Π΄ΠΈΠΌΠ΅Π½Π·ΠΈΠΈ ΡΠ΅ ΠΈΠ·ΡΠ²ΡΠ²Π°Ρ ΡΠ°Π½ΠΎ Π² ΠΆΠΈΠ²ΠΎΡΠ° ΠΈ ΡΠ΅ ΡΡΡ
ΡΠ°Π½ΡΠ²Π°Ρ ΡΡΠ°Π±ΠΈΠ»Π½ΠΈ Π² Ρ
ΠΎΠ΄Π° Π½Π° ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΡΠΎ. Π₯ΠΈΠΏΠ΅ΡΡΠΈΠΌΠ½ΠΈΡΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ Π΅ Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎ-ΡΡΠ΄ΡΠΊ ΠΏΡΠΈ ΠΠΠ , ΠΎΡΠΊΠΎΠ»ΠΊΠΎΡΠΎ ΠΏΡΠΈ Π·Π΄ΡΠ°Π²ΠΈ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΠΈ ΠΈ ΠΏΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ Π£ΠΠ ΠΈ Π²ΡΡΡΠ½ΠΎΡΡ Π΅ Π½Π°ΠΉ-ΡΠ΅Π΄ΠΊΠΈΡΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½ΡΠΎΠ² ΡΠΈΠΏ Π² ΡΠ°Π·ΠΈ Π³ΡΡΠΏΠ°. ΠΠΎΡΠ²ΡΡΠΆΠ΄Π°Π²Π° ΡΠ΅ ΡΡΠΎΠ±ΡΠ°Π²Π°Π½ΠΈΡΡ ΠΏΠΎ-ΠΌΠ°Π»ΡΠΊ ΡΠΈΡΠΊ Π·Π° ΠΈΠ·ΡΠ²Π° Π½Π° ΠΏΡΠΈΡ
ΠΈΡΠ½ΠΈ (ΠΈ ΠΏΠΎ-ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΠΎ β Π°ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΈ) Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½ΠΈΡ ΠΈ ΠΏΠΎ-Π½ΠΈΡΠΊΠΈΡ ΡΡΠΈΡΠΈΠ΄Π΅Π½ ΡΠΈΡΠΊ ΠΏΡΠΈ ΠΏΠΎ-ΠΈΠ·ΡΠ°Π·Π΅Π½ Ρ
ΠΈΠΏΠ΅ΡΡΠΈΠΌΠ΅Π½ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ. ΠΠ΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈΡΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ Π΅ ΠΏΠΎ-Π½Π΅ΠΈΠ·ΠΏΡΠΊΠ²Π°Ρ ΡΡΠ΅Π΄ Π³ΡΡΠΏΠ°ΡΠ° Ρ ΠΏΡΡΠ² ΠΠΠ ΠΈ ΠΈΠΌΠ° ΠΏΠΎ-ΠΈΠ·ΡΠ°Π·Π΅Π½ΠΎ ΠΏΡΠΈΡΡΡΡΠ²ΠΈΠ΅ ΡΡΠ΅Π΄ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Ρ Π£ΠΠ, ΠΊΠ°ΡΠΎ ΡΠΎΠ²Π° ΠΌΠΎΠΆΠ΅ Π΄Π° Π΅ ΠΈΠ»ΠΈ ΡΠ΅Π·ΡΠ»ΡΠ°Ρ ΠΎΡ ΠΏΡΠΈΠΏΠΎΠΊΡΠΈΠ²Π°Π½Π΅ ΠΌΠ΅ΠΆΠ΄Ρ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈΡΠ΅ Π·Π° ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΠΈΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½ΡΠΎΠ² ΡΠΈΠΏ ΠΈ Π·Π° ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½Π°ΡΠ° Π°ΡΠ΅ΠΊΡΠΈΠ²Π½Π° Π±ΠΎΠ»Π΅ΡΡ, ΠΈΠ»ΠΈ Π°ΠΊΡΠ΅Π½ΡΡΠΈΡΠ°Π½Π΅ Π½Π° ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½ΡΠΎΠ²ΠΈ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ ΠΏΠΎΠ΄ Π²ΡΠ·Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ Π½Π° Π±ΠΎΠ»Π΅ΡΡΡΠ°. Π’ΡΠ΅Π²ΠΎΠΆΠ½ΠΈΡΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ Π΅ ΠΌΠ½ΠΎΠ³ΠΎ ΠΏΠΎ-ΡΠ΅ΡΡ ΠΏΡΠΈ Π£ΠΠ ΠΈ ΡΠΎΠ²Π° ΠΎΡΠ½ΠΎΠ²ΠΎ Π½Π°ΡΠΎΡΠ²Π° ΠΊΡΠΌ ΠΎΡΠ΄Π°Π²Π½Π° ΡΡΡΠ°Π½ΠΎΠ²Π΅Π½ΠΈΡΠ΅ (Π²Π΅ΡΠ΅ - ΠΈ Π½Π° Π³Π΅Π½Π΅ΡΠΈΡΠ½ΠΎ Π½ΠΈΠ²ΠΎ) Π²ΡΡΠ·ΠΊΠΈ ΠΌΠ΅ΠΆΠ΄Ρ Π½Π΅Π²ΡΠΎΡΠΈΡΠΈΠ·ΡΠΌ ΠΈ Π΄Π΅ΠΏΡΠ΅ΡΠΈΡ. ΠΡΠΎΡΡΠ²Π°Π½ΠΈΡΡΠ° Π½ΠΈ ΡΠΎΡΠ°Ρ, ΡΠ΅ Π΄ΠΎΠΌΠΈΠ½ΠΈΡΠ°ΡΠΈΡΡ ΡΠΈΠΊΠ»ΠΎΡΠΈΠΌΠ΅Π½ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ Π΅ Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎ-ΡΠ΅ΡΡ ΠΏΡΠΈ ΠΠΠ (ΠΈ ΠΎΡΠΎΠ±Π΅Π½ΠΎ β ΠΏΡΠΈ ΠΠΠ I), ΠΎΡΠΊΠΎΠ»ΠΊΠΎΡΠΎ ΠΏΡΠΈ Π£ΠΠ; ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ²Π° Π²Π°ΠΆΠ΅Π½ ΡΠΈΡΠΊΠΎΠ² ΡΠ°ΠΊΡΠΎΡ Π·Π° ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π½Π° Π°Π»ΠΊΠΎΡ
ΠΎΠ»ΠΈΠ·ΡΠΌ ΠΈ Π΅ ΡΠ²ΡΡΠ·Π°Π½ Ρ Π²ΠΈΡΠΎΠΊ ΡΡΠΈΡΠΈΠ΄Π΅Π½ ΡΠΈΡΠΊ. Π¦ΠΈΠΊΠ»ΠΎΡΠΈΠΌΠ½ΠΈΡΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π»ΠΈΠΏΡΠ²Π° Π² ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡΠ΅ ΠΈΠ·Π²Π°Π΄ΠΊΠΈ Ρ Π£ΠΠ ΠΈ ΠΌΠΎΠΆΠ΅ Π±ΠΈ Π΄ΠΎΡΠΈ ΠΈΠΌΠ° ΡΡΠ°ΡΡΡ Π½Π° ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡ Π·Π° Π»ΠΈΠΏΡΠ° Π½Π° Π±ΡΠ΄Π΅ΡΠΈ (Ρ
ΠΈΠΏΠΎ)ΠΌΠ°Π½ΠΈΠΉΠ½ΠΈ Π΅ΠΏΠΈΠ·ΠΎΠ΄ΠΈ. ΠΠΎΠ΄Π΄ΡΡΠΆΠ°ΠΌΠ΅, ΡΠ΅ ΡΠΈΠΊΠ»ΠΎΡΠΈΠΌΠΈΡΡΠ° - ΠΏΡΡΠ²ΠΈΡΠ½Π° Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π΅Π½Π° Π΄ΠΈΡΡΠ΅Π³ΡΠ»Π°ΡΠΈΡ Π½Π° Π΅Π½Π΅ΡΠ³Π΅ΡΠΈΡΠ½Π°ΡΠ° ΠΈ Π΅ΠΌΠΎΡΠΈΠΎΠ½Π°Π»Π½Π°ΡΠ° ΡΡΠ°Π±ΠΈΠ»Π½ΠΎΡΡ - Π½Π΅ Π΅ βΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½Ρβ, Π° ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½Ρ ΠΎΡ ΠΏΡΠΈΡ
ΠΎΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈΡ Π±ΠΈΠΏΠΎΠ»ΡΡΠ΅Π½ ΡΠΏΠ΅ΠΊΡΡΡ. ΠΠ΅Π·Π°Π²ΠΈΡΠΈΠΌΠΎ ΠΎΡ ΠΏΠΎΠ»ΡΡΠ½ΠΎΡΡΡΠ° Π½Π° Π°ΠΊΡΡΠ°Π»Π½ΠΈΡ Π±ΠΎΠ»Π΅ΡΡΠ΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄, Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΈΠΌΠ°Ρ ΠΏΠΎ-Π²ΠΈΡΠΎΠΊΠΎ Π½ΠΈΠ²ΠΎ Π½Π° ΠΈΠΌΠΏΡΠ»ΡΠΈΠ²Π½ΠΎΡΡ ΠΎΡ Π·Π΄ΡΠ°Π²ΠΈ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈ. Π’ΠΎ Π½Π΅ ΠΊΠΎΡΠ΅Π»ΠΈΡΠ° Ρ ΠΎΠ±ΡΠ°ΡΠ° ΡΠ΅ΠΆΠ΅ΡΡ Π½ΠΈΡΠΎ Π½Π° Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π½ΠΈΡΠ΅, Π½ΠΈΡΠΎ Π½Π° ΠΌΠ°Π½ΠΈΠΉΠ½ΠΈΡΠ΅ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ, Ρ.Π΅. ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ²Π° ΡΡΠ°ΠΉΠ½Π° Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠ°, Π° Π½Π΅ Π΅ΠΏΠΈΡΠ΅Π½ΠΎΠΌΠ΅Π½ Π½Π° Π΅ΠΏΠΈΠ·ΠΎΠ΄Π°. ΠΡΠ΅ΡΡΠ°Π²Π° ΡΠ΅ ΠΈ ΡΡΠ½Π° ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊΡΠΌ ΠΏΠΎ-Π²ΠΈΡΠΎΠΊΠ° ΠΎΠ±ΡΠ° ΠΈ ΠΌΠΎΡΠΎΡΠ½Π° ΠΈΠΌΠΏΡΠ»ΡΠΈΠ²Π½ΠΎΡΡ ΠΏΡΠΈ ΠΌΠ°Π½ΠΈΠ΅Π½/ΡΠΌΠ΅ΡΠ΅Π½ Π°ΡΠ΅ΠΊΡΠΈΠ²Π΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄ ΠΈ ΠΊΡΠΌ ΠΏΠΎ-Π²ΠΈΡΠΎΠΊΠ° ΠΈΠΌΠΏΡΠ»ΡΠΈΠ²Π½ΠΎΡΡ Π½Π° Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ΡΠΎ ΠΏΡΠΈ Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π² Π΄Π΅ΠΏΡΠ΅ΡΠΈΠ²Π΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄ ΡΠΏΡΡΠΌΠΎ Π·Π΄ΡΠ°Π²ΠΈ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈ. Π£ΡΡΠ°Π½ΠΎΠ²Π΅Π½ΠΈΡΠ΅ ΠΈΠ·ΡΠ°Π·Π΅Π½ΠΈ ΠΈΠ·ΠΌΠ΅ΡΠΈΠΌΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ Π² ΡΠΊΠΎΡΠΎΡΡΡΠ° Π½Π° ΠΎΠ±ΡΠ°Π±ΠΎΡΠΊΠ° Π½Π° ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡ, ΡΡΡΠΎΠΉΡΠΈΠ²ΠΎΡΡΡΠ° ΠΈ ΡΠ΅Π»Π΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΠ° Π½Π° Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ΡΠΎ, ΠΏΠ°ΠΌΠ΅ΡΡΠ°, ΡΠ°Π±ΠΎΡΠ½Π°ΡΠ° ΠΏΠ°ΠΌΠ΅Ρ ΡΠ° ΠΎΠ±ΡΠΈΡΠ½ΠΈ ΠΈ Π½Π°ΠΉ-ΠΈΠ·ΡΠ°Π·Π΅Π½ΠΈ ΠΏΡΠΈ ΠΌΠ°Π½ΠΈΠ΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄, ΡΡΡΠ΅ΡΡΠ²ΡΠ²Π°Ρ Π² ΠΏΠΎ-ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½Π° ΡΡΠ΅ΠΏΠ΅Π½ ΠΏΡΠ΅Π· Π΅ΡΡΠΈΠΌΠ½ΠΈΡΠ΅ ΠΏΠ΅ΡΠΈΠΎΠ΄ΠΈ ΠΈ ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠ°Ρ Ρ Π±Π»ΠΈΠ·ΠΊΠΈ ΡΠΎΠ΄ΡΡΠ²Π΅Π½ΠΈΡΠΈ Π½Π° Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈΡΠ΅ ΠΏΡΠΎΠ±Π°Π½Π΄ΠΈ (ΠΏΡΠ΅Π΄ΠΈΠΌΠ½ΠΎ Π² ΠΈΠ½Ρ
ΠΈΠ±ΠΈΡΠΎΡΠ½ΠΈ ΠΏΡΠΎΡΠ΅ΡΠΈ: ΡΠ΅Π»Π΅ΠΊΡΠΈΠ²Π½ΠΎ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅/ΠΊΠΎΠ½ΡΡΠΎΠ» Π²ΡΡΡ
Ρ ΠΈΠ½ΡΠ΅ΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΡΠ°). Π₯Π°ΡΠ°ΠΊΡΠ΅ΡΠ½ΠΈΡΡ Π΄Π΅ΡΠΈΡΠΈΡ Π² ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈ ΠΎΠ±Π»Π°ΡΡΠΈ Π½Π° ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΠΈΡΠ΅ ΡΡΠ½ΠΊΡΠΈΠΈ ΡΠ΅ ΡΠ°Π·ΡΠΈΡΡΠ²Π° ΠΈ Π·Π°Π΄ΡΠ»Π±ΠΎΡΠ°Π²Π° ΠΏΠΎ Π²ΡΠ΅ΠΌΠ΅ Π½Π° ΠΌΠ°Π½ΠΈΠ΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄, Π° ΠΏΡΠΈ ΡΠ΅Π·ΠΎΠ»ΡΡΠΈΡΡΠ° ΠΌΡ ΡΠ΅ Π²ΡΠ·ΡΡΠ°Π½ΠΎΠ²ΡΠ²Π° Π΄ΠΎ Π½ΠΎΡΠΌΠ° Π² Π½ΡΠΊΠΎΠΈ ΠΈ Π΄ΠΎ ΠΏΠΎ-ΠΌΠ΅ΠΊΠΎ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ - Π² Π΄ΡΡΠ³ΠΈ Π΄ΠΎΠΌΠ΅Π½ΠΈ. ΠΠ°ΠΉ-Π²Π΅ΡΠΎΡΡΠ½ΠΎ Π½Π΅ΡΡΡΠΎΠΉΡΠΈΠ²ΠΎΡΠΎ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅, ΡΠΌΡΡΠ΅Π½ΠΈΡΡ ΠΈΠ½Ρ
ΠΈΠ±ΠΈΡΠΎΡΠ΅Π½ ΠΊΠΎΠ½ΡΡΠΎΠ» ΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΡΠΎ Π½Π° ΡΠ°Π±ΠΎΡΠ½Π°ΡΠ° ΠΏΠ°ΠΌΠ΅Ρ Π±ΠΈΡ
Π° ΠΌΠΎΠ³Π»ΠΈ Π΄Π° ΠΎΠ±ΡΡΠ½ΡΡ ΠΏΠΎΠ½Π΅ ΠΎΡΡΠ°ΡΡΠΈ ΠΊΠ°ΠΊΡΠΎ ΡΠ²ΡΠ΅ΠΆΠ΄Π°Π½Π΅ΡΠΎ Π½Π° ΡΠ΅ΠΏΡΠΎΠ΄ΡΠΊΡΠΈΡΡΠ° ΠΏΡΠΈ ΡΡΡ
ΡΠ°Π½Π΅Π½ΠΈ ΠΏΡΠΎΡΠ΅ΡΠΈ Π½Π° Π΅Π½ΠΊΠΎΠ΄ΠΈΡΠ°Π½Π΅, ΡΠ°ΠΊΠ° ΠΈ ΡΠΌΡΡΠ΅Π½Π°ΡΠ° ΠΏΡΠΈΡ
ΠΎΠΌΠΎΡΠΎΡΠ½Π° Π±ΡΡΠ·ΠΈΠ½Π°. ΠΠ΅ΡΠΈΡΠΈΡΠΈΡΠ΅ ΡΠ΅ Π·Π°Π΄ΡΠ»Π±ΠΎΡΠ°Π²Π°Ρ Ρ Π²ΡΠ΅ΠΊΠΈ Π½ΠΎΠ² Π±ΠΎΠ»Π΅ΡΡΠ΅Π½ Π΅ΠΏΠΈΠ·ΠΎΠ΄ Π² Ρ
ΠΎΠ΄Π° Π½Π° ΠΠΠ . Π ΡΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ Ρ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈ ΠΏΡΠΈ ΠΠΠ ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠ°Ρ Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎΠ²Π΅ΡΠ΅ ΠΌΠ΅ΠΊΠΈ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈ ΠΏΡΠΈΠ·Π½Π°ΡΠΈ (ΠΠΠ) - ΠΊΠ°ΠΊΡΠΎ ΠΎΠ±ΡΠΎ, ΡΠ°ΠΊΠ° ΠΈ ΠΏΠΎ ΠΎΡΠ΄Π΅Π»Π½ΠΈ Π³ΡΡΠΏΠΈ. Π‘ΡΠ΅Π΄Π½ΠΈΡΡ Π±ΡΠΎΠΉ ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠ°Π½ΠΈ ΠΠΠ Π½Π΅ Π·Π°Π²ΠΈΡΠΈ ΠΎΡ ΠΏΠΎΠ»ΡΡΠ½ΠΎΡΡΡΠ° Π½Π° Π°ΠΊΡΡΠ°Π»Π½ΠΈΡ Π΅ΠΏΠΈΠ·ΠΎΠ΄. ΠΡΠΎΡΡ ΡΠ²ΡΡΠ΄ΠΈ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈ ΠΏΡΠΈΠ·Π½Π°ΡΠΈ Π½Π΅ ΡΠ°Π·Π³ΡΠ°Π½ΠΈΡΠ°Π²Π° Π½ΠΈΡΠΎ Π±ΠΈΠΏΠΎΠ»ΡΡΠ½ΠΈΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΎΡ Π·Π΄ΡΠ°Π²ΠΈΡΠ΅ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈ, Π½ΠΈΡΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Π² ΠΌΠ°Π½ΠΈΡ ΠΎΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Π² Π΄Π΅ΠΏΡΠ΅ΡΠΈΡ. ΠΡΠ΅ΡΠΈΠ·ΠΈΡΠ°Π½Π΅ΡΠΎ Π½Π° ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΠΈΡΠ΅ ΠΠΠ ΠΈ ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΠΈΡΠ΅ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ Π² ΡΡΡΠ΅ΡΠ°Π½ΠΈΠ΅ Ρ ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠ°Π½Π΅ Π½Π° ΠΎΡΠΎΠ±Π΅Π½ΠΎΡΡΠΈΡΠ΅ Π² ΠΏΡΠΎΡΠΈΠ»ΠΈΡΠ΅ Π½Π° ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΠΌΠ΅Π½ΡΠ° ΠΈ Π² ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΈΡΠ΅ Π½Π° ΠΈΠΌΠΏΡΠ»ΡΠΈΠ²Π½ΠΎΡΡΡΠ° Π±ΠΈ Π΄Π°Π»ΠΎ Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡ Π·Π° ΠΏΠΎΠ²Π΅ΡΠ΅ ΠΈΠ»ΠΈ ΠΏΠΎ-ΠΌΠ°Π»ΠΊΠΎ ΡΡΠ½Π° βΡΠΎΠΏΠΈΡΠ½Π°β Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° Π½Π° ΠΌΠΎΠ·ΡΡΠ½ΠΈΡΠ΅ ΠΏΡΠΎΠΌΠ΅Π½ΠΈ ΠΏΡΠΈ ΠΠΠ ΠΈ Π·Π° ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»Π½ΠΈΡΠ΅ ΠΈΠΌ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π²ΡΠ² Π²ΡΠ΅ΠΊΠΈ Π΅ΡΠ°ΠΏ ΠΎΡ Π΄ΡΠ»Π³ΠΎΡΡΠΎΡΠ½ΠΈΡ Ρ
ΠΎΠ΄ Π½Π° Π±ΠΎΠ»Π΅ΡΡΡΠ°. ΠΠΌΠ΅Π½Π½ΠΎ Π² ΡΠΎΠ²Π° Π²ΠΈΠΆΠ΄Π°ΠΌΠ΅ Π΄ΡΠ»Π±ΠΎΠΊΠΈΡ ΡΠΌΠΈΡΡΠ» Π½Π° ΡΡΠ»ΠΎΡΡΠ½Π°ΡΠ° ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½Π° ΠΏΡΠΎΠ³ΡΠ°ΠΌΠ° Π·Π° ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ Π½Π° ΠΠΠ , ΠΊΠΎΡΡΠΎ Π·Π°ΠΌΠΈΡΠ»ΠΈΡ
ΠΌΠ΅, ΡΡΠ°ΡΡΠΈΡΠ°Ρ
ΠΌΠ΅ ΠΈ Π½Π΅ΠΎΡΠΊΠ»ΠΎΠ½Π½ΠΎ ΡΠ»Π΅Π΄Π²Π°ΠΌΠ΅ Π²Π΅ΡΠ΅ Π΄Π²Π΅ Π΄Π΅ΡΠ΅ΡΠΈΠ»Π΅ΡΠΈΡ. ΠΠ°ΠΉ-ΡΠ΅ΡΠΈΠΎΠ·Π½ΠΈΡΠ΅ Π½Π΅Π΄ΠΎΡΡΠ°ΡΡΡΠΈ Π½Π° ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΡΠ½ΠΎΡΠΎ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎ ΠΏΡΠΎΡΡΠ²Π°Π½Π΅ Π½Π° ΠΠΠ ΡΠΏΠΎΡΠ΅Π΄ Π½Π°Ρ ΡΠ° ΡΠ»Π΅Π΄Π½ΠΈΡΠ΅: ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»Π½ΠΎ ΠΌΠ°Π»ΠΊΠΈ ΠΈΠ·Π²Π°Π΄ΠΊΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΈ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈ; ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π²Π°ΡΠΎ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½Π΅ Π½Π° ΠΎΠ±ΡΠ΅ΡΠ²Π°ΡΠΈΠΎΠ½Π½ΠΈ, Π½Π°ΠΏΡΠ΅ΡΠ½ΠΈ ΠΈ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΈ Π΄ΠΈΠ·Π°ΠΉΠ½ΠΈ; Π½Π΅ΠΏΡΠ»Π½ΠΎΡΠ΅Π½Π½ΠΎ ΡΡΠ°Π½Π΄Π°ΡΡΠΈΠ·ΠΈΡΠ°Π½Π΅ ΠΈ, ΠΎΠ±ΡΠΎ Π²Π·Π΅ΡΠΎ, Π½Π΅ΡΠ°Π²Π½ΠΎΠΌΠ΅ΡΠ½ΠΎ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ Π½Π° ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡΠ΅ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡ. ΠΠΠ Π΅ ΡΠ΅ΠΆΠΊΠ°, ΠΏΠΎΠΆΠΈΠ·Π½Π΅Π½ΠΎ ΠΏΡΠΎΡΠΈΡΠ°ΡΠ°, ΡΠ΅Π½ΠΎΡΠΈΠΏΠ½ΠΎ ΠΌΠ½ΠΎΠ³ΠΎΠΎΠ±ΡΠ°Π·Π½Π°, ΠΈΠ·ΡΠ²ΡΠ²Π°ΡΠ° ΡΠ΅ Ρ βΡΠ°ΡΠ΅Π½β ΡΠΏΠ΅ΠΊΡΡΡ ΠΏΡΠΎΡΠ²ΠΈ ΠΈ Π΄ΠΎΠΏΡΠ»Π½ΠΈΡΠ΅Π»Π½ΠΎ βΠΎΠ±ΡΠ°ΡΡΠ½Π°Π»Π°β Ρ ΡΠ°Π·Π½ΠΎΠΎΠ±ΡΠ°Π·Π΅Π½ ΠΏΡΠΈΡ
ΠΈΠ°ΡΡΠΈΡΠ΅Π½ ΠΈ ΡΠΎΠΌΠ°ΡΠΈΡΠ΅Π½ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄ΠΈΡΠ΅Ρ, Π½ΠΎ Π² ΡΡΡΠ½ΠΎΡΡΡΠ° ΡΠΈ Π΅Π΄ΠΈΠ½Π½Π° Π±ΠΎΠ»Π΅ΡΡ. ΠΠ°Π΄ΡΠ»Π±ΠΎΡΠ΅Π½ΠΎΡΠΎ ΠΌΠ½ΠΎΠ³ΠΎΠΏΠΎΡΠΎΡΠ½ΠΎ ΠΏΡΠΎΡΡΠ²Π°Π½Π΅ Π½Π° ΡΠ°Π·Π»ΠΈΡΠ½ΠΈΡΠ΅ ΠΉ Π°ΡΠΏΠ΅ΠΊΡΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ²Π° ΡΡΠ·Π΄Π°Π²Π°Π½Π΅ΡΠΎ Π½Π° ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»Π½ΠΎ ΠΏΡΠ»Π½ΠΎΡΠ΅Π½Π½Π° ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π° Π·Π° ΡΠ°Π·ΠΏΠΎΠ·Π½Π°Π²Π°Π½Π΅ΡΠΎ ΠΈ Π·Π° ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΠ°Π½Π΅ΡΠΎ ΠΉ, Π° ΠΈΠ·Π³ΡΠ°ΠΆΠ΄Π°Π½Π΅ΡΠΎ Π½Π° Π΅Π½Π΄ΠΎΡΠ΅Π½ΠΎΡΠΈΠΏΠΎΠ²Π΅ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ²Π° Π²Π½ΠΈΠΊΠ²Π°Π½Π΅ Π² Π΅ΡΡΠ΅ΡΡΠ²ΠΎΡΠΎ ΠΉ
Cigarette smoking in patients with obsessive compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS)
Obsessive compulsive disorder (OCD) showed a lower prevalence of cigarette smoking compared to other psychiatric disorders in previous and recent reports. We assessed the prevalence and clinical correlates of the phenomenon in an international sample of 504 OCD patients recruited through the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) network. Cigarette smoking showed a cross-sectional prevalence of 24.4% in the sample, with significant differences across countries. Females were more represented among smoking patients (16% vs 7%; p <.001). Patients with comorbid Tourette's syndrome (p <.05) and tic disorder (p <.05) were also more represented among smoking subjects. Former smokers reported a higher number of suicide attempts (p <.05). We found a lower cross-sectional prevalence of smoking among OCD patients compared to findings from previous studies in patients with other psychiatric disorders but higher compared to previous and more recent OCD studies. Geographic differences were found and smoking was more common in females and comorbid Tourette's syndrome/tic disorde
The European First Episode Schizophrenia Trial (EUFEST): Rationale and design of the trial
Background: Most studies comparing second generation antipsychotics with classical neuroleptics have been conducted in more or less chronic schizophrenia patients. Such studies were usually conducted in highly selected samples, and were generally designed and financed by the manufacturer of the drug tested. These and other facts have stimulated discussions regarding the effectiveness of the new generation of antipsychotics. Aims: The aim of the European First Episode Schizophrenia Trial (EUFEST) is to compare treatment with amisulpride, quetiapine, olanzapine and ziprasidone to a low dose of haloperidol in an unselected sample of first episode schizophrenia patients with minimal prior exposure to antipsychotics. Methods: 500 patients between the ages of 18-40 meeting DSM-IV criteria for schizophrenia, schizoaffective disorder or schizophreniform disorder are randomly allocated to one year of treatment with one of the drugs under study. The primary outcome measure is retention in treatment, defined as time to discontinuation of study drug. Loss of retention can be the result of insufficient clinical effect, or lack of tolerability or acceptance. Secondary measures include changes in different dimensions of psychopathology, side effects, compliance, social needs, quality of life, substance abuse and cognitive functions. Conclusions: At present, more than 400 patients have been recruited and randomized in the following countries: Austria, Belgium, Bulgaria, Czech Republic, Germany, France, Israel, Italy, the Netherlands, Poland, Rumania, Spain, Sweden and Switzerland: The study should be finished by the end of 2006 and it is expected that results will yield relevant clinical information with regard to the effectiveness of the second generation antipsychotics. This effort represents the first independently designed trans-European schizophrenia treatment trial
Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial
BACKGROUND: Second-generation antipsychotic drugs were introduced over a decade ago for the treatment of schizophrenia; however, their purported clinical effectiveness compared with first-generation antipsychotic drugs is still debated. We aimed to compare the effectiveness of second-generation antipsychotic drugs with that of a low dose of haloperidol, in first-episode schizophrenia. METHODS: We did an open randomised controlled trial of haloperidol versus second-generation antipsychotic drugs in 50 sites, in 14 countries. Eligible patients were aged 18-40 years, and met diagnostic criteria for schizophrenia, schizophreniform disorder, or schizoaffective disorder. 498 patients were randomly assigned by a web-based online system to haloperidol (1-4 mg per day; n=103), amisulpride (200-800 mg per day; n=104), olanzapine (5-20 mg per day; n=105), quetiapine (200-750 mg per day; n=104), or ziprasidone (40-160 mg per day; n=82); follow-up was at 1 year. The primary outcome measure was all-cause treatment discontinuation. Patients and their treating physicians were not blinded to the assigned treatment. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN68736636. FINDINGS: The number of patients who discontinued treatment for any cause within 12 months was 63 (Kaplan-Meier estimate 72%) for haloperidol, 32 (40%) for amisulpride, 30 (33%) for olanzapine, 51 (53%) for quetiapine, and 31 (45%) for ziprasidone. Comparisons with haloperidol showed lower risks for any-cause discontinuation with amisulpride (hazard ratio [HR] 0.37, [95% CI 0.24-0.57]), olanzapine (HR 0.28 [0.18-0.43]), quetiapine (HR 0.52 [0.35-0.76]), and ziprasidone (HR 0.51 [0.32-0.81]). However, symptom reductions were virtually the same in all the groups, at around 60%. INTERPRETATION: This pragmatic trial suggests that clinically meaningful antipsychotic treatment of first-episode of schizophrenia is achievable, for at least 1 year. However, we cannot conclude that second-generation drugs are more efficacious than is haloperidol, since discontinuation rates are not necessarily consistent with symptomatic improvement