Tsygankov, Boris

Tyuneva, Alla

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ABSTRACTS Psychiatria Danubina, 2018; Vol. 30, Suppl. 1, pp 5-69 S9Paroxysmal (including psychopathological) symptoms were found in diffuse brain lesions in 14% of patients, in focal – in 28%. Typical regression of psycho-organic syndrome (from apathetic to asthenic variants, with sequence of emotional states in series of apathy - euphoria - dysphoria - melancholy – anxiety) was less often observed in group with focal damages as compared with diffuse ones. As a tendency there were revealed relationships between predominant brain damage localization and probability of occurrence of different variants of emotional disorders with apathy being more frequent in the cases of left frontal lobe lesions, euphoria in the cases of the right one, depression in cases of lesions located in the posterior part of the right hemisphere, and anxiety in posterior part of the left one. Cholinomimetics (Ipidacrin, Choline alphoscerat) were effective in cases with symptoms depended of brainstem structures, antiglutamatergic drugs (amantadine) and dopaminomimetics (levodopa) were successful in cases with predominant subcortical disorders. GABA-mimetics (such as Aminophenylbutiric acid and D-,L-hopantotenic acid) and polypeptides (Semax, Cortexin) were more effective in the cases with predominant deficit of the right hemisphere functions, cholinomimetics (Ipidacrin, Donepezil) and antiglutamatergic drugs (Memantine) were successful in cases with predominant left hemisphere disorders. Supported by the Russian foundation for basic research, grant  18-013-00967. * * * * *SIGNIFICANCE OF SOCIAL STRATUM IN THE FORMATION OF MENTAL DISORDERSWITH SEXUAL VIOLENCE VICTIMS Alla Tyuneva & Boris Tsygankov A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia The data of studies showed distinct interrelation between the cultural notions on what is acceptable in sexual behaviour and the frequency of registered rapes. The social strata with liberal views on gender relations are freer from rapes. The social strata with an "increased antagonism" between persons of different gender the tendency is identified to committing violent sexual acts. By official data the Ministry of Internal Affairs of Russia, in 2015 there had been registered 3,900 in-stances of crimes characterized as rape or an attempt of rape. However, the staffers women's' organi-zations of Moscow and the regions [beyond it] believe that these figures are understated. Modern Russia is characterized by rather conservative views on gender relations, which often manifests in blaming the victim in wrong behaviour and provocation of violence.  Over 2 ½ years there had been conducted a study of sexual violence victims in which participated 104 women from various social groups, with different education level, marital status, lifestyle, occupation. The average age of female participants of study was 27.7±1.5. The duration of the period assessed from the moment of an act of violence to consulting a psychiatrist varied from 1 month to 30 years (on average 9.3±1.3 years). The objective of this study was the studying of psychopathological structure, dynamics of formation and course of post-traumatic stress disorders with the persons who had been subjected to violence, on the example of women who suffered rape, as well as the identification of the factors leading to the formation of chronic mental disorders.  The method applied was one of random selection, the only selection criterion being the availability in the anamnesis of female patients of an episode of sexual violence. To assess the dynamics of observed conditions we applied the clinical anamnesis method, as well as the dynamic observation of the condition of those under observation. To determine the overall level of subjective distress we used the scale of effect of the traumatic.  The sampling did not include the women who developed psychogenic disorders on the backdrop of psychopathy, psychopathy-like conditions of various genesis, the person with signs of gross organic lesion of brain and the patients with psychotic symptomatology (delirium, hallucinations, etc.) at the time of examination, and those who suffered such psychotic states in the past. When analysing the data obtained, two groups had been distinctly defined: the first included the women, who, after getting mental trauma from violence found themselves in a microsocial environment favourable to them (19-18.3%). In this group mental disorders were limited to acute reaction on stress and a short disorder of adaptation. In the second group which made the majority (85-81.7%), such support from microsocial environment was lacking. By the time of counselling the patient of the second group had persistent neurotic disorders, such as neuroses, post-traumatic stress disorder (PTSD) or pathological characterological changes. The vast majority of female participants of study from the second group could tell about the suffered rape and ABSTRACTS Psychiatria Danubina, 2018; Vol. 30, Suppl. 1, pp 5-69 S10about the significance that it had for them after five and more years after the psychogeny suffered (on average 9.3±1.3). It was defined by a number of reasons: psychologically overwhelming influence of one and (or) both parents; fear of blaming on part of relatives (88.4%); "criticising and rejecting" mother (87.5%). The women from this group had such characteristic traits of character as lack of confidence in themselves, need for approval of their acts and decisions from outside (23-32.6%); unstable (9-8.7%) or decreased self-assessment (95-91.3%); not sufficiently flexible cognitive system of values. The suffered rape was perceived as a "catastrophe" and the personality did not see any choice and positive outcome for itself.Thus, lack of support of a victim of violence in microsocial environment and macrosocial environment, in combination with specific traits of the personality leads to the formation of mental disorders that are more complex by structure. * * * * *XENON THERAPY IN THE TREATMENT OF ANXIETY DISORDERS Boris Tsygankov, Alexander Dobrovolsky, Galina Ivanova & Irina Loginova A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia Background and aims: Anxiety disorders, accompanied by somatic discomfort due to autonomic instability, are most vividly represented by panic disorder. For this disease are characteristic frequent attacks of severe anxiety (panic) in combination with a set of vegetative disorders (palpitation, choking, nausea, chest pain, sweating, tremor, heat). Based on the pharmacokinetic effects of xenon, such as anti-stress, neuroprotective, adaptation and vegetative stabilization, its action on the glutamatergic system and its impact on lowering levels of "stress hormones" (adrenaline and cortisol). A method for the therapy of anxiety disorders, including the use of xenon inhalations for the purpose of arresting vegetative disorders, has been developed. Xenon therapy quickly acts on the autonomic link of panic attacks, thereby severing subjectively unpleasant or intolerable sensations, which are the basis of the "vicious circle" of panic attacks. Psychotherapy is represented by a cognitive-behavioral therapy (CBT). It is aimed at the treatment of agoraphobia, correction of cognitive representations that trigger a chain of negative perception and catastrophization of "bodily rattlers", as well as secondary behavioral disorders. The aim of the study is to examine the efficacy and feasibility of using xenon inhalations in the complex treatment of panic disorder. Subjects and methods: The application of the method was investigated on the example of 200 patients of the clinic of the Institute’s of Mental Health and Addiction Clinic (according to ICD-10 criteria). Two groups of patients were compared. Analyzed groups of patients were statistically reliably comparable in terms of socio-demographic, clinical and psychopathological characteristics and psychometric indicators, by the nature of the disease. In the first group, patients received standard psychopharmacotherapy in combination with CBT. Patients of the second group received a course of inhalation with xenon in addiction to psychopharmacotherapy and CBT. To assess the severity of anxiety disorders, the frequency and intensity of panic attacks, and the significance of their reduction, psychometric scales were used. Efficiency was assessed using Sheehan Patient-Rated Anxiety Scale, SPRAS, brief Neuropsychiatric scales Inventory (MINI), Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire Panic Screening Questions (Wayne J. Katon). Assessment of mental state was carried out before the initiation of therapy, during therapy, and also 60 days after treatment. Results: In patients of the second group, in comparison with the results of the first group, the intensity of autonomic disorders decreased more markedly, a significant reduction in the duration of panic attacks was observed, and the intensity of fear during a panic attack decrease, anxious anticipation of panic attacks decreased. Conclusions: The system of complex therapy of anxiety disorders proposed by the authors, including xenon therapy, psychopharmacotherapy and psychotherapy, is an effective method of treatment of panic disorder.

SIGNIFICANCE OF SOCIAL STRATUM IN THE FORMATION OF MENTAL DISORDERS WITH SEXUAL VIOLENCE VICTIMS

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