Psychiatric legacy of the Chernobyl disaster (April 26, 1986, Ukraine) remains global burden for the society till now, however its causes are at issue. The Great East Japan Earthquake with trio impact (earthquake, tsunami and radiation accident at the Fukushima Daiichi Nuclear Power Plant, March 11, 2011) provides the new challenges to emergency psychiatry.

Implementation of the Chernobyl disaster psychiatric lessons into the mental health care in Fukushima.

Analysis of own studies in interaction with current evidences on cerebral radiation effects.

Stress-related (somatoform, anxiety, PTSD) disorders, depression and suicides, cognitive impairment, cerebrovascular pathology, and alcohol abuse are the main neuropsychiatric aftermath in exposed adults. Chernobyl survivors exposed at the brain development period (in utero and 0-1 years at the accident) have somatoform disorders, emotional and behavioural disorders, including attention deficit and hyperactive disorder (ADHD), cognitive impairments, paroxysmal disorders, and congenital abnormalities. Is there an increased risk of epilepsy, schizophrenia, neurodegenerative diseases, and multiply sclerosis among exposed individuals should be explored in further international studies.

Psychiatric aftermath of Fukushima will be similar to the Chernobyl disaster one. Recommendations include: annual general medical and neuropsychiatric examinations, early diagnostic and treatment of physical and mental problems, mother’s mental health care, psychological care for children and their parents, individual relevant educational programs, never separate children from parents and relatives, radiation risk perception management. There is a strong necessity to develop and implement the international mental health care system for the survivors of radiation accidents.

High rates of anxiety symptoms among medical students have been observed in many studies. Autonomic symptoms are indications of anxiety somatization. Reports about gender variations in anxiety and autonomic lability are contradictory and require further researches.

To investigate changes of state anxiety, autonomic symptoms among medical students in various study periods and role of gender variations.

54 medical students (28 female and 26 male) of I.M. Sechenov Moscow State Medical University were recruited in this study. Participants were assigned unique identification codes. We used State and Trait Anxiety Inventory (STAI) and Vein’s Autonomic Symptoms Questionnaire (VASQ). State anxiety and autonomic symptoms were defined three times: 2 weeks, one day before the exam and after examination. ANOVA, correlation and t-statistics methods were used to analyze data.

Changing of study situation influenced lability of state anxiety (ANOVA, F= 3,23; p= 0,04). We found gender differences in autonomic symptoms’ penetration in 1st (p= 0.05), 2nd (p< 0.05) and 3rd (p< 0.01) periods; state anxiety varied in 2nd period (p< 0,05) only. Correlation between autonomic symptoms and gender was found in 1st (r= 0,46; p= 0,003) and 2nd (r= 0,901; p< 0.001) periods; correlation between state anxiety and gender was moderate in 2nd period (r= 0,55; p< 0.001).

Statistical significance was achieved between a level of anxiety and various studying situations. Correlation between gender and both state anxiety and rate of autonomic symptoms was found. State anxiety and degree of autonomic symptoms was significantly higher in female.

To show gender-role pattern age-specificity.

1. 1) S. Bem questionnaire

2. 2) gender-role A.B. Heilbrun ACL-scale

3. 3) above mentioned scale modified by A. Kocharian

Sex-linked dynamics of gender-role pattern formation in ontogenesis has been revealed. Continual-alternative pattern is normal for boys up to 15-16-year age when M and F exclude one another. Correct passage of masculine filters ensures boy’s “breakaway” from “almighty mother” and leads in adolescence to “male chauvinism” phenomenon that performs healthy development. Similar aged girls show continual-adjunctive pattern with no M and F exclusion. Masculinity gives girl certain advantages and normally doesn’t exclude femininity features generation. Since 15-16-year age both sexes demonstrate androgyny pattern formation. This is regular for population of Ukraine while deviations predispose to problems in partner communication.

The developed methodology allows to evaluate actual type of gender-role personality pattern.

1. 1) age-associated dynamics of structural gender-role personality patterns formation exists, deviations are serious prerequisites for partner communication problems;

2. 2) this dynamics is sex-linked;

3. 3) special developed psychometric scale allows to evaluate actual type of gender-role personality pattern.

Ego-boundary disturbance (EBD) in schizophrenia is a unique psychopathological cluster characterized by passivity experiences (involving thoughts, actions, emotions and sensations) attributed by patients to some external agency. Aberrant mirror neuron activation may explain impaired self-monitoring and agency attribution underlying these ‘first rank’ symptoms.

We aim to study mirror neuron activity (MNA) in schizophrenia patients with and without EBD using transcranial magnetic stimulation (TMS).

50 right-handed schizophrenia patients (DSM IV) were evaluated using the Mini-International Neuropsychiatric Interview and the Positive & Negative Syndrome Scale. They completed a TMS experiment to assess putative premotor MNA. Motor evoked potential (MEP) was recorded in the right first dorsal interosseous muscle (FDI) with (a) 120% of resting motor threshold (RMT) and (b) stimulus intensity set to evoke MEP of 1 millivolt amplitude (MT1). These were done in 3 states: actual observation of an action using the FDI, virtual-observation (video) of this action and resting state. The difference of MEP between resting to action-observation states formed the measure of MNA.

MNA measured using MT1 and 120% RMT paradigms for real-observation was significantly lower in the 18 patients with EBD (thought-broadcast/withdrawal/insertion, made-act/impulse/affect and somatic passivity) than the 32 patients without EBD (t=2.75, p = 0.009; t = 2.41, p = 0.02 respectively for the two paradigms). The two groups did not differ on age, gender, education and total symptom scores.

Schizophrenia patients with EBD have lower premotor MNA. This highlights the role of MNA dysfunction in the pathophysiology of this unique and intriguing symptom cluster in schizophrenia.

It has been reported that cognitive functioning in major depressive disorder (MDD) can be affected by various factors, such as symptom severity, personality dimensions and stress hormone activity. However, the relative role of each is largely unknown.

Seventy-six non-remitted patients with MDD were recruited. Symptomatology was assessed by the 21-item version of the Hamilton Rating Scale for Depression and the Hopkins Symptom Checklist (HSCL). Personality was assessed by the Temperament and Character Inventory (TCI). Neurocognitive functions, including verbal and visual memory, delayed recall and attention/working memory were measured by the full version of the Wechsler Memory Scale-Revised. Neuroendocrine function was determined by the reactivity of cortisol and dehydroepiandrosterone-sulfate (DHEAS) to the combined dexamethasone/corticotropin releasing hormone test. To quantify cognitive impairments in patients, age-, sex- and education- matched 187 healthy controls were also recruited and administered the same neuropsychological test.

MDD patients performed significantly worse than controls on visual memory and delayed recall. A stepwise multiple regression analysis predicting performance of each cognitive domain from five HSCL dimensions, seven TCI dimensions and hormonal variables, controlling for age, gender and education, revealed that higher cooperativeness was the only significant predictor towards better verbal memory, that less somatization symptoms and lower self-directedness were significant predictors towards better visual memory, and that lower age, less anxiety symptoms and lower DHEAS levels after dexamethasone administration were significant predictors towards better delayed recall.

Besides symptomatology, some personality dimensions and neuroendocrine function may, at least partly independently, contribute to memory impairment in MDD.

Problems of self-injury behaviour (SIB) now are extremely actual in normal and abnormal adolescence, however, amount of psychological researching is limited (Gratz K.L., Polskaya N.A.). Here we use combined definition of SIB as the intentional, direct injuring of body tissue usually done without suicidal intentions.

Adolescents 13-17 years old:

Experimental group 1 - 17 patients (schizotypal disorder - EG1).

Experimental group 2 - 11 patients (psychopathic syndrome - EG2).

Control group - 20 normally developed adolescents.

Determining of risk factors for self-injury behaviors among adolescents with different mental disorders.

1. 1. SIB scale (N.A.Polskaya)

2. 2. Emotional Intelligence Scale - EQ (D.Goleman)

3. 3. Aggression questionary (Buss A.H. & Perry M.)

4. 4. Dembo-Rubinshtein self-assessment test

We assess correlation between SIB and other analyzed parameters in both experimental groups.

1. 1. index of SIB and EQ -0,730 (p < 0.001)

2. 2. index overall scores of aggression questionary and SIB 0,725(p < 0.001)

3. 3. index anger and physical SIB 0,651 (p < 0.01)

4. 4. index self-assessment of character and SIB -0,690(p < 0.01)

1. 1. index of SIB and EQ0,661(p < 0.05)

2. 2. index hostility and psychological SIB 0,650 (p < 0.05)

Control group haven’t any correlations.

Similar correlations of SIB and EQ was obtained in experimental groups.

Correlation between anger score and physical SIB was shown in EG1.

Correlation between hostility score and psychological SIB was shown in EG2.

It was found antithetic correlation between self-assessment of character and SIB in EG1.

The aging of the world population implies challenges in the area of diagnosis in geriatric psychiatry.

The Test Your Memory (TYM) is a short cognitive instrument designed for the detection of Alzheimer’s disease (AD). Its diagnostic utility for application in Polish clinical practice was evaluated in the study.

The Polish version of TYM as a screening instrument in AD and MCI patients versus healthy control subjects were evaluated.

In this study 66 patients with probable AD (mean age 74,4 ± 9,1), 71 patients with MCI (mean age 66,3 ± 10) and 94 healthy controls (mean age 71,6 ± 8,3) were assessed. The Polish version of TYM was used after receiving permission from the author and conducting translation and validation process.

The average total TYM score were 45.4 in healthy controls, 41.1 in MCI patients and 23.4 in AD patients. The statistical analysis illustrated that TYM differentiate the AD patients from MCI patients, as well as from healthy control group. Nevertheless, it was found that the tool was not useful in conducting the differential diagnosis between MCI patients and healthy controls. Post hoc testing showed significant impairment in performance for participants aged ≥ 75 and educated in primary level between those educated in secondary and higher level.

The Polish version of the TYM is a useful instrument and is seen as a superior screening test in clinical practice. However the age and the level of education of respondents should be considered as important factors affecting the interpretation of the final score.

Cognitive impairment in the remote period of Acute Radiation Sickness (ARS) is an expected outcome.

This study was undertaking to examine the contribution of irradiation on the intelligence deterioration.

In 14-15 years after the Chernobyl accident a cross-sectional IQ-study on ARS-patients (n = 29) and normal controls (n = 24) was done. Verbal (VIQ), Performance (PIQ) and Full (FIQ) IQs were assessed by adapted version of the Wechsler Adult Intelligence Scale (WAIS). Pre-exposure IQ was estimated with the regression equation by Dr. Beilin Gao (China).

VIQ and FIQ is lower in ARS-patients. Dose of 1 Gy could be realized in FIQ deterioration on 4.1-6 scores at 1-3.8 Gy. FIQ reducing on 1 score could be resulted by 0.17-0.24 Gy. According to pre-exposure IQ estimations, IQ deterioration in ARS-patients is in 2-3 times much more than in control. In ARS-patients this IQ deterioration is significant (more than SD). Non-radiation confounding factors are analyzed.

Refusal of alternative explanations of the cognitive deficit among ARS-patients could testify to radiation nature of this effect. Reducing of VIQ and FIQ are the evidence of brain organic syndrome with paramount involvement of the left, dominating, hemisphere in the remote period of ARS.

Insomnia is a frequent symptom of depression and vice versa. Both are prevalent in epilepsy and can worsen the course of disease.

To assess relationship of insomnia with depression and anxiety in epilepsy.

Adult patients with all-cause epilepsy diagnoses attending a tertiary epilepsy and sleep centers were interviewed regarding insomnia symptoms. Patients were divided into two groups: with (IG) and without (WIG) insomnia. Depression and anxiety were assessed by Hamilton’s depression (HAMD) and anxiety (HAMA) scales. T-test was used for statistics.

58 patients with epilepsy aged 18-64 (mean age - 33.8, 21 females - 36.2%) were enrolled. Among these patients 31 had insomnia complaints (53.4%). The groups did not differ in terms of mean age: 33.1 for IG and 34.3 for WIG (p>0.05). Mean values for HAMD and HAMA in the groups were as follows: HAMD - 16.3 for IG, 11.04 for WIG; HAMA - 18.3 for IG, 13.4 for WIG. For both scales there was an increase in levels of depression and anxiety for epilepsy patients with insomnia. The difference reached statistical significance for depression (p = 0.004). Anxiety was also numerically more prevalent in IG but this difference was not significant (p = 0.055).

Results of our study show that insomnia is a frequent co-morbidity in epilepsy. We found that depression is more prevalent in patients with concomitant epilepsy and insomnia than in patients without difficulties initiating or maintaining sleep. Anxiety also seems to be more marked in insomniac epilepsy patients but to a lesser degree.

Whether PTSD following radiation emergency has psychopathological, neurocognitive and neurophysiological peculiarities is at issue.

To explore features and cerebral basis of “radiation” PTSD in the Chernobyl accident survivors.

The cross-sectional study included 241 people, 219 of whom have been diagnosed with PTSD according to the DSM-IV criteria, among them 115 clean-up workers [liquidators] of the Chernobyl accident (34 with acute radiation sickness), 76 evacuees from the Chernobyl exclusion zone, 28 veterans of the war in Afghanistan, and 22 healthy unexposed individuals. Psychometric examinations, neurocognitive assessments, computerized electroencephalography, and cerebral vascular Doppler were used.

“Radiation” PTSD includes: “flashforward” phenomenon and anticipating stress (projection of fear and danger to the future); somatoform disorders, depression, trait and state anxiety; neurocognitive deficit (impaired memory and attention, auditory-verbal memory and learning, proactive and retroactive interference; cerebellar and stem symptoms, intellectual changes). The intima-media component thickness of common carotid arteries, and common and left internal carotid arteries stenosis rates are increased in the liquidators. Changes of bioelectrical brain activity as a decrease of beta- and theta-power together with an increase of alpha-power were found in the Chernobyl accident survivors with PTSD.

PTSD following radiation emergency is characterized by comorbidity of psychopathology, neurocognitive deficit, and cerebrovascular pathology with increased risk of cerebral atherosclerosis and stroke. Cerebral basis of this PTSD is proposed to be an abnormal communication between the pyramidal cells of neocortex and hippocampus, and deep brain structures.

Depression and apathy are among the most common psychiatric and behavioral disorders associated with Parkinson’s disease (PD). This two psychiatric disorders are major determinants of quality of life for patients with Parkinson’s disease.

The main objective of this study was to establish the prevalence and demographic and clinical correlates of depression and apathy in a sample of inpatients with Parkinson’s disease.

To identify depression and apathy in a group of patients diagnosed with Parkinson’s disease and to allow appropriate treatment to improve their quality of life.

A number of 44 inpatients with Parkinson’s disease were investigated with the Starkstein’s Apathy Scale (AS), the 17-item Hamilton Depression Rating Scale (HDRS-17), the Hoehn and Yahr staging (HY), the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Mini -Mental State Examination (MMSE).

Apathy coexisted with depression in 34.1% of PD patients, compared with depression without apathy in 4.6%, and apathy without depression in 22.7%. Apathy was associated with higher UPDRS score, lower MMSE score and earlier HY stages. Depression was correlated with more advanced HY stages and younger age of patients with Parkinson’s disease.

Apathy and depression are common in patients with Parkinson’s disease. Therefore these two conditions should be screened and considered in the management of patients with Parkinson’s disease.

Cognitive deficit in endogenous mental disorders in children and adolescents is studied less than in adults, particularly age of onset influence. There is very few data about the connection between degree of cognitive deficit and age of psychiatric illness onset in children and adolescents. It’s difficult to determine the specificity of cognitive deficits depending on the clinical form of endogenous mental disorders (schizophrenia).

93 patients (11.8 ± 2.3 years) with childhood schizophrenia (F20.8, 26 patients), schizotypical disorders (F21, 59 patients), unspecified schizophrenia (F2x.x, 8 patients). We used adaptation of ICD-10 for RF.

Assessment of degree of cognitive deficit relative to age of onset and diagnosis.

Tests assessing cognitive processes: memory, attention, thinking. Z-scales were used for estimation of cognitive deficit.

Age of onset was divided into three periods: early, preschool and school age. The least degree of all cognitive functions occurs in patients with school age of onset. F20.8 and F2x.x with early and preschool age of onset have severe thinking deficit.

F21 demonstrates decreasing of cognitive deficit degrees in all functions with increasing of age of onset. Degree of cognitive deficit is connected with clinical diagnosis. Patients with F20.8 have strong deficit in all cognitive functions (memory, attention, thinking). F21 patients demonstrate a variety of cognitive deficit degrees including age norm outstrip. F2x.x patients keep intermediate position.

Age of onset might be important in determination of degrees of cognitive deficit. The last depends on diagnosis, age of onset & kind of cognitive process.

Metabolic side-effects of antipsychotics increase morbidity and non-compliance rates. Interestingly, preliminary evidence suggests that metabolic side-effects correlate with response to antipsychotic treatment. Few studies have examined the nature of this association in a prospective study design. We conducted an exploratory, naturalistic, prospective, trans- diagnostic study to examine this association.

To study the relation between metabolic side-effects and clinical improvement with antipsychotics, in psychotic illnesses [non-affective psychoses and mania-1st episode].

100 (84 drug-free for at least one month) patients with psychosis initiated on antipsychotic treatment alone (65% on risperidone) were assessed on Brief Psychiatric Rating Scale (BPRS), visual analogue scale for appetite, anthropometric measurements (weight, waist circumference, body mass index), and serum lipid and glucose profiles at baseline, 2-4 weeks (n = 71) and 8-12weeks (n = 39).

Subjects who dropped out at first/second follow-ups did not differ from those who followed-up, in age, sex, illness duration and BPRS scores. On forward stepwise multiple linear regression analysis, early (2-4weeks) increase in appetite and triglyceride levels (R2 = 0.257; p = 0.003) together predicted 26% variance in treatment response (BPRS score reduction) at first follow-up. At second follow-up 16% of variance in treatment response was predicted by early (2-4 weeks) increase in triglyceride levels (R2 = 0.169; p = 0.009) alone.

Early appetite and triglyceride changes predicted antipsychotic treatment response. Future research should

1. (a) examine neural mechanisms that operate in both appetite regulation and antipsychotic action to further the understanding of psychosis and its treatment, and

2. (b) identify early markers of treatment response

Despite the growing literature on the co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, there is a lack of studies addressing the co-occurrence of OCD spectrum disorders, such as hypochondriasis, and schizophrenia.

The aim of the study was to investigate the prevalence rates of OCD and Hypochondriasis in schizophrenic patients treated with clozapine versus other atypical antipsychotics (AAPs).

We enrolled 24 consecutive schizophrenic patients treated with clozapine attending the ‘Clozapine Clinic’ of the University of Florence and 24 consecutive schizophrenic patients treated with other AAPs. Patient’s assessment was performed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hypochondriasis Y-BOCS (HY-BOCS) and the Global Assessment of Functioning Scale (GAF).

Considering the whole group (n = 48), we found an OCD prevalence rate of 29.2% (n = 14) and a hypochondriasis prevalence rate of 22.9% (n = 11). We found a significant correlation between Y-BOCS and HY-BOCS scores (p = .007) suggesting an association between OCD and hypochondriasis in these patients. We also found a significant negative correlation between H-YBOCS scores and GAF scores (p = .006). Clozapine-treated patients had a higher rate of OCD (37.5% vs 20.8%). and hypochondriasis (37.5% vs 8.3%) than other AAP-treated patients.

We found a higher prevalence rate of OCD and hypochondriasis comorbidity in schizophrenic patients than in general population. The prevalence rate of OCD and hypochondriasis was higher in clozapine-treated patients versus other AAP-treated patients. Furthermore, the severity of hypochondriasis symptoms was correlated to a lower level of global functioning.

Anorexia nervosa (AN) has been inconsistently associated with impaired decision-making. Several methodological issues may underlie these discrepancies such as comorbid conditions or the assessment of this complex cognitive function with a single test.

Sixty-eight adult women suffering from AN and 49 female controls were included. All completed a clinical assessment and a battery of neuropsychological tests assessing specific aspect of decision-making [IGT, Balloon Analogue Risk Task (BART), Probabilistic Reversal Learning Task (PRLT) and Brixton Test].

People with AN had poorer performance on the IGT and Brixton task, compared to controls. In addition, the AN group made less risky choices on the BART. Performances were similar on PRLT. Of importance, AN patients with a current major depressive disorder showed similar results to those with no current major depressive disorder.

These results suggest broad impaired decision making-process in people with AN characterized by inhibition in risk-taking and mismanagement of uncertainty. These impairments seem not related to mood

Previous studies have shown that the polymorphisms in COMT gene and environmental factors affect the risk of drug dependence, but there’s no research shown in relapse of heroin dependence, and the mechanism underlying remains uncertain.

Examine the interaction between allelic variants of the catechol-O- methlytransferase (COMT) gene and environmental factors (encountering drug-related environmental situations, social support) in contribution to relapse in heroin dependence.

Construct the gene-environment interaction model in order to understand the mechanism for relapse in heroin dependence.

The 249 heroin dependent subjects who followed up at one year after abstinent by using the natural history interview (NHI), social support rateing Scale (SSRS), and other questionnaires were genotyped for eight tagging single nucleotide polymorphisms (SNP) on the COMT gene. General Multifactor Dimensionality Reduction (GMDR) was used to construct the gene-environment interaction model which impacting relapse in heroin dependence.

The relapse group had higher frequencies of encountering drug-related environment (EDE) and G allele and GG genotype frequencies on COMT gene rs4680 locus and less Social Support Scale scores than that in the abstinence group. Logistic regression analysis showed that encountering more drug-related environment and GG genotype carriers were the risk factors for relapse in heroin dependence. GMDR analysis showed that the COMT gene was interact with the frequency of EDE and social support level to impact the relapse in heroin dependence.

Gene-environment interaction between COMT gene and the frequency of EDE and social support were related to heroin dependence relapse.

Recent findings support sex-specific effects of PDYN polymorphisms on association with opioid addiction (Clarke et al. 2012). We have demonstrated that PDYN haplotypes, which include rs2281285, are associated with alcohol dependence and propensity to drink in negative emotional situations (negative craving) (Karpyak et al 2012). The rs2281285 variant may contribute to regulation of alternative PDYN mRNA transcription specific to brain area or physiological condition.

To investigate sex-specific effects of the PDYN rs2281285 variant on risk for alcohol dependence.

To examine the association of the PDYN rs2281285 variant with alcohol dependence in male and female subjects.

rs2281285 was genotyped in the investigation cohort of 816 (554 males) alcohol dependent subjects (DSM-IV-TR) and 1248 (603 males) non-alcoholic controls and in the replication cohort of 467 (347 males) alcohol dependent subjects and 431 (224 males) non-alcoholic controls. Logistic regression models were used to test for sex-specific associations after controlling for age.

As previously reported, significant association of the PDYN rs2281285 variant with alcohol dependence was found in the investigation (p = 0.008, odds ratio = 1.299), but not the replication cohort (0.223, OR = 0.118). However, sex-specific analyses revealed stronger association in males (p = 0.002, OR = 1.493) but not females (p = 0.684, OR = 1.066) in the investigation cohort, and a trend for association in males (p = 0.086, OR = 1.352) but not females (p = 0.808, OR = 0.947) in the replication cohort.

Our findings support association of PDYN rs2281285 variant with alcohol dependence in male but not female subjects. Future studies should investigate functional mechanisms of this effect.