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The paper is concerned with the questions of genesis of psychopathological symptomatics in terms of the theory of Academician G. N. Kryzhanovsky of determinant structures and generator activity. The complexity of experimental modelling of severe psychopathological disorders is indicated since not all psychopathological phenomena possess objective characteristics. It should be keep in mind that the psychopathological method itself is a subjective one. The stability of clinical manifestations of psychoses, e.g. schizophrenia, and reactions to the psychopharmacotherapy in an individual over a long period of time suggests the involvement in pathological process of determinant structures. Variety of clinical manifestations of schizophrenia is predetermined by unequal involvement of the brain hemispheres. In connection with this one may think about the determinant structures and generator mechanisms predominating in either hemisphere. Quantitative EEG investigation in schizophrenia patients with hallucinatory-paranoid and schizoaffective symptomatics showed that in the former group after a week long therapy using stelazine the activation of the left hemisphere prevailed, and in the latter group--of the right one. Stelazine predominantly blocks the hemisphere in which generator processes are weaker (the right one in the case of hallucinatory-paranoid syndrome, and the left hemisphere with the schizoaffective one). This accounts for a great probability of development of postpsychotic depression in the patients with the schizoaffective syndrome after administration of neuroleptic therapy. Phenomenologically similar psychopathological symptomatics, in particular a depressive one, can occur as a result of the activities of various determinant structures. Anxiety, unlike other psychopathological phenomena, is responsive to practically all types of psychotropic compounds with different mechanisms of action.(ABSTRACT TRUNCATED AT 250 WORDS)

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As a result of studying 727 therapy courses conducted in 90 patients with attack-like schizophrenia, who suffered 294 attacks, it has been demonstrated that in case these patients have residual organocerebral failure, a special choice of "sparing" therapy is required. The treatment of these patients consists in the use of neuroleptics which do not provoke any marked extrapyramidal side effects (sonapax, eglonyl, leponex), tranquilzers and antidepressants possessing no cholinolytic effect (pyrazidol, nuredal). If the use of powerful antipsychotic neuroleptics and tricyclic antidepressants is required, it is indicated that they can be applied in the form of intravenous infusions. A modified method lying in the one-stage withdrawal of psychotropic agents turned out highly effective. Addition of resolving and dehydration remedies to psychopharmaco-therapy promoted neither enhancement of the drug efficacy nor minimization of the side effects.

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The authors describe a new method of the treatment of patients with trigeminal neuralgias using electroconvulsive therapy. The method is based on the increase of beta-endorphin concentration as a result of electroconvulsive treatment. The treatment of 12 patients in accordance with the suggested method provided beneficial results and significant enhancement of the efficacy of therapy as compared to patients undergoing conventional treatment.

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In 123 patients the peculiarities of formation and effectiveness of insulin coma (IC) were studied under drug therapy as compared with 49 drug-free patients. Pharmacotherapy preceding the ICs produced uneven effect on its course. Artefact course of IC was most frequently observed after mageptil, chlorpromazine melipramine treatment, and to a lesser extent--after haloperidol, triphtazin, amitriptyline. It was virtually absent after benzodiazepines. The autonomic manifestations in IC and the harmony if its development and clinical picture, markedly changing under drug treatment, were exposed as predictors of the efficiency of IC therapy.

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Patients with febrile attacks of schizophrenia showed clinical and laboratory correlations between the severity of the clinical picture on the one hand and parameters of the leukocyte index of intoxication, ESR, the NaK ratio and 17-CS secretion, on the other. The authors consider the possible causes of elevated levels of dopamine in the urine and of beta-lipoproteins and creatine phosphokinase in the cerebrospinal fluid. The study has revealed anti-brain antibodies and sensitization of leukocytes to neuroleptics. A possible role of neural viral infection in the etiology and pathogenesis of the studies conditions is discussed.

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A total of 164 patients with schizophrenia and exogenic-organic psychoses resistant to psychotropic therapy were subjected to clinico-immunological examination. The inclusion into the multiple-modality therapy of the immunomodulator levamisole, besides the general improvement, had a positive effect on the psychopathologic symptomatology and helped to reduce a number of productive syndromes, deficit abnormalities and attendant extrapyramidal manifestations. Changes in immunological parameters showed a favourable course; it was expressed in depressed levels of neurosensitization, normalization of the concentrations of serum immunoglobulins, share and absolute amounts of T- and B-lymphocytes and elevation of their functional activity. The corrective effect of levamisole on humoral immunity seems to be a significant factor of overcoming tolerance to psychopharmacotherapy. The conducted study makes it possible to recommend the use of levamisole in the treatment of resistant forms of schizophrenia running an unfavourable course, exogenic-organic and other psychoses.

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On the basis of their observations and management of 23 cases of the neuroleptic malignant syndrome (MNS) the authors draw a conclusion that this syndrome is similar to extrapyramidal-psychotic side effects of neuroleptic therapy. Different variants of the course of this complication of neuroleptic therapy attended by hyperthermia are considered. The authors propose the term 'acute febrile neuroleptic therapy' which incorporates all hyperthermic variants of the course of this complication of neuroleptic therapy, varying from mild transitory one to the MNS. Criteria of the early diagnosis are presented.

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In somatic and psychiatric examination of 38 patients with masked depression under variable somatic masks the authors have revealed clear-cut symptoms of depressions and a high rate of somatic pathology. They believe that peripheral somatic disorders determine to a certain degree both nature and projection of the somatic mask. The questions of masked depressions are discussed.

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Analysis of the literature data on the use of various therapeutic approaches to the treatment of febrile schizophrenia has shown that so far psychiatry does not possess such methods of treatment which could allow the complete prevention of lethal outcomes in this disease. The article describes a new original approach to the treatment of patients with febrile schizophrenia, aimed at the correction of homeostatic disturbances with the complete refusal from neuroleptics in the febrile period of an attack. This therapeutic approach proved highly effective in 24 out of 26 patients and enabled preventing lethal outcomes in all cases. Study of the characteristics of febrile schizophrenia based on the authors' own observations and case reports made it possible to identify three variants of the time-course of the febrile attack. The article also considers the specificities of therapy with respect to the identified variants of the time-course of febrile attacks.

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Clinical and experimental studies into the phenomenon of adaptation to neuroleptic agents and into the methods of its overcoming were carried out. An experimental study of the long-term administrations of haloperidol revealed the formation of adaptation to the drug which can be overcome by a zigzag-like sharp elevation of the dosage followed by rapid reduction to the baseline level. The trial of this method under clinical conditions showed that it was expedient to use on a large scale the experimental findings on the specific features of the formation and prevention of the secondary therapeutic resistance.

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A study of a new regimen of insulin comatose therapy by intravenous instillation has shown the feasibility of determining the minimal comatose dose of insulin and achieving the comatose state in the first days of insulin therapy. This method makes it possible to utilize the advantages of insulin comatose treatment (a more marked arresting antipsychotic action and the remission persistence). At the same time insulin comatose therapy by intravenous instillation permits the physicians to overcome one of the major drawbacks of this treatment, namely the time lag of the therapeutic response associated with the period of time needed to select the minimal comatose dose which was characteristic of the old method.

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An analysis of certain regularities in drug pathomorphosis of psychoses in the form of transitions from psychotical states to pseudoneurotic showed a slowing in their progression, changes in the syndrome structure, an increase in the amount of incomplete or reduced conditions. This circumstance prompted reconsideration of some routine therapeutic approaches. The main recommendations include restriction of neuroleptics, expansion of the diagnosis of depressions, the use of methods of intensive psychopharmacology in combination with active rehabilitation, as well as introduction of new forms of organizational aid.

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A study of 246 patients (with schizophrenia, manic depressive psychoses and psychoorganic syndrome) treated by some drugs of a metabolic action (encephalotropic", "nootropic" drugs, piracetam, piriditol and pantogam) permitted one to determine the place of these preparations in a comprehensive treatment of mental disorders. On the basis of clinical studies of the above-mentioned preparations, the conclusion is made about desirability (and in some cases about necessity) of including them into pharmacotherapy. During such studies certain traits of the clinical effect in each of these drugs was examined, permitting the comparative spectra of the pharmacological activity of piracetam, piriditol and pantogam to be determined. The clinical studies of these patients indicate the necessity of a differentiated use of the mentioned drugs having in view the state of the patient and detected clinical profile of the drugs.

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The report contains some results of a 3 year study of combined intensive psychopharmacological and occupational therapy of 120 patients (on the basis of the Gannushkin City Mental Hospital N4 and 2 industrial plants) during the stage of a subacute development of the schizophrenic process. On the basis of clinical and methodological criteria the authors distinguish 3 groups of patients and 3 types of rehabilitative programmes respectively. The medical and socio-occupational effectiveness of the new modification of combined intensive psychopharmacological industrial therapy of schizophrenic patients has been confirmed.

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The report contains successful results of ambulatory treatment of 54 patients with relapses of attack-like developing forms and exacerbations of continuous forms of schizophrenia. The basic principles in the treatment were intensity and dynamic influence of psychopharmacotherapeutical agents. As a rule under such conditions there were a rapid reduction in the acuity. The authors distinguish clinical, family-environmental and organizational-therapeutic indications, which may lie at the basis of the place of choice for treatment--hospital or dispensary (out patient clinic).

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In 75 patients with a phasic development of endogenous psychoses the course of the disease before lithium treatment was characterized by statistically valid and successively increasing from attack to attack phenomena such as lengthening of attacks (phases) with a stable duration of the remissions and more frequent double phases. All of these phenomena were regarded by the authors as an unfavourable medicative pathomorphosis. The influence of lithium was expressed in the following symptoms: 1) prevention of hospitalization (56% of the cases); 2) significant shortening of the attacks (phases) and in some of the cases (19%)--their arrest; 3) transition from psychotic syndromes to cyclothymic; 4) a significant drop of double phases and a corresponding rise in the number of "pure" subdepressive states.

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