Ludwig van Beethoven—a psychiatric perspective

SummaryBiographical accounts of famous artists usually try to relate the life story to the works (and vice versa). This gives the work a special “colour”, often the context for understanding for today’s recipients. This interrelation is complex and often judgmental, sometimes manipulative. Thus, medical (including psychiatric), characterological and psychodynamic assessments and interpretations must be made with great caution. Primary sources may be scanty and diagnostic concepts may have changed (Mozart died of hitzigem Frieselfieber [prickly heat fever]; in Hölderlin’s lifetime, schizophrenia or bipolar disorder did not yet “exist”). The attempt at a diagnostic classification often says more about the author and his time than about the artist (for example, the assessment of Robert Schumann’s or Friedrich Hölderlin’s mental illness). Against this background, elements of Ludwig van Beethoven’s biography are presented from a psychiatric perspective. In summary, Beethoven can be diagnosed with an alcohol use disorder. A pronounced hyperthymic temperament is likely to have had a clearly positive influence on the course of the disorder. In particular, no influence of the alcohol use disorder on the musical quality of the work can be proven. A clear episodic course of affective symptoms as in bipolar disorder is not demonstrable. The deafness caused a severe reduction in quality of life.

MODERN SCIENTIFIC VIEWS ON THE CLINIC, SYSTEMATICS, DIAGNOSIS AND PATHOPERSONALOGY OF ENDOGENOUS PSYCHOSIS WITH EPISODIC COURSE (LITERATURE RIVIEW)

The aim of the study. To study the literature in order to identify modern scientific views on the clinic, systematics, diagnosis and pathopersonalogy of endogenous psychoses with episodic course. Results. The analysis of the literature shows that the diagnostic and classification approaches of endogenous psychoses with episodic course, are focused on polymorphic and variable symptoms of exacerbation of the disease. This leads to diagnostic mistakes, errors in the appointment of maintenance therapy, deterioration of compliance and further deepening of social maladaptation of patients. Refusal to develop the mechanisms of pathogenesis on the basis of the nosological approach will inevitably lead to a regression of the level of treatment and rehabilitation approaches - from ethiopathogenetic to symptomatic. Conclusions. Thus, at present, the importance of diagnostic techniques aimed at assessing and differentiating persistent symptoms of the disease in the period of remission of endogenous psychoses and relate to pathopersonalogical transformations. Research and correct diagnostic assessment of this multicomponent cluster of psychopathological symptoms allows to assess the nosological affiliation of a particular clinical case and to determine the necessary pharmacological and social rehabilitation effects in order to correct existing pathopersonalogical transformations and prevent exacerbation of endogenous psychosis.

Glutamate Level’s in Blood Serum of Patients with Schisophrenic Spectrum and Bipolar Affective Disorder

The objective: the involvement of glutamatergic neurotransmitter systems in the pathogenesis of schizophrenic spectrum disorders and BD has been repeatedly proven. But today, there are no methods available to evaluate the glutamate metabolism in patients with mental disorders. The paper presents differences in the level of glutamate in the blood serum of patients with a schizophrenic spectrum disorder, bipolar disorder, and healthy individuals.Patients and methods: the study included 224 people. 179 patients were presented with paranoid schizophrenia, simple schizophrenia, schizotypal disorder, acute polymorphic disorder, schizoaffective disorder and BD.Results: in this work shows that the level of glutamate in patients in all studied groups is statistically significantly higher than in healthy individuals, except for acute polymorphic psychotic disorder. Serum glutamate concentration in patients with schizotypal disorder is 1.6 times higher than in healthy individuals. The significant differences in glutamate levels were detected in patients with schizotypal disorder and OCD (p = 0.045), and patients with paranoid schizophrenia (p = 0.012). The concentration of glutamate is also increased in patients with simple schizophrenia compared to patients with paranoid schizophrenia (p = 0.039). In addition, it was observed a glutamate increase in healthy individuals compared in patients with a continuous course of schizophrenia (p = 0.001), in patients with an episodic course with progressive deficit (p = 0.0211) and in patients with a schizophrenia duration of more than 12 years.Conclusions: thus, the concentrations of glutamate in the blood serum of patients are depending on the severity of the course of schizophrenia and maybe an additional paraclinical criterion for the diagnosis of schizotypal disorder.

Characteristics of personality in patients with endogenous psychoses with an episodicаl course in the context of post-manifest pathopersonаlogical transformations (comparative analysis)

Solution of the problems of differential diagnosis, treatment and social rehabilitation of patients with endogenous psychoses with episodic course is one of the most complex and urgent problems of clinical psychiatry, which is caused by polymorphism and variability of symptoms, decrease or loss of critical attitude toward the disease, with grave social and economic consequences. The aim of the study is to establish, on the basis of the results of the comparative analysis of the characteristics of the personal profile, the features and nosospecific differences of post-manifest pathopersonаlogical transformations in patients with schizophrenia, schizoaffective disorder and affective disorders in remission / intermissions. The study examined the personality characteristics of endogenous psychoses with an episodic course in remission / intermission conditions and established signs and nosospecific differences in post-manifest pathological transformations in patients with schizophrenia, schizoaffective disorder, and affective disorders. Existing pathopersonalogical transformations are characterized by signs of multidirectional tendencies of compensatory tension of personal resources, which is confirmed by the presence of several moderately elevated (65-75 T-points) indicators of individual scales and a simultaneous increase in indicators of both hyposthenic (2nd and 7th scales) and hypersthenic ( 4th and 9th scales) registers. In schizoaffective disorder, such scales are the 2nd (65.36±12.28 T-points), 4th (73.23±11.83 T-points), 8th (68.40±12.33 T-points) and 9th (66.05±12.02 T-points); in affective disorders, these are the 2nd, 4th and 8th scales (67.72±13.96, 67.08±9.53 and 65.90±10.08 T-points, respectively); for schizophrenia, such scales are the 2nd (72.37 ± 16.80 T-points), 4th (69.47±12.48 T-points), 7th (66.59±15.69 T-points) ) and 8th (71.73±19.95 T-points). The obtained data can be used as a component of the differential diagnosis system and personified psychotherapeutic support.

TYPOLOGY OF PATHOPERSONOLOGICAL TRANSFORMATIONS IN PATIENTS WITH SCHIZOAFFECTIVE DISORDER

The issue of diagnostics, treatment and social rehabilitation of patients with endogenous psychoses with episodic course remains one of the most urgent problems of psychiatry, which, despite the considerable advances of science and practice, has not found a definitive solution. Significant difficulties of nosological separation in the group of endogenous psychoses with episodic course and evaluation of the pathopersonological aspect of the clinic are related to schizoaffective disorder. The aim of the study was to establish a typology of pathopersonological transformations in patients with schizoaffective disorder based on the analysis of clinical-psychopathological, medical-psychological, clinical-ethological characteristics of remission. On the basis of “Regional Clinical Psychiatric Hospital” (Zaporizhzhіa) 102 persons with the established diagnosis of schizoaffective disorder were examined. The main methods of the study were clinical psycho-pathological, psychodiagnostic, patho-psychological, clinical-anamnestic, clinical-medical, social-medical and statistical analysis. As a result of the conducted research, on the basis of the analysis of clinical-psychopathological, medical-psychological, clinical-ethological characteristics of remission, the typology of pathopersonological transformations was established. The presence and prevalence of 4 main types of pathopersonological transformations in schizoaffective disorder (“affective-labile” (20.1 % of the contingent), “paranoid-dysthymic” (17.3 %), “hysteroid-agonistic” (25.9 %), “Neurocognitive-deficient” (16.9 %) and “mixed” (19.8 % of the contingent)), which differ in clinical-anamnestic, clinical-psychopathological, medical-psychological, neuropsychological and clinical-ethological characteristics and cause social (labor and family) maladjustment of varying degrees. The clinical-anamnestic, clinical-psychopathological, medical-psychological, neuropsychological and clinical-ethological features identified in the study can be used to determine the type of pathopersonological transformations and its severity in patients with schizoaffective disorder and, accordingly, quantitative characteristics of individually needed psychopharmacological, psychotherapeutic and social rehabilitation activities and evaluation of their effectiveness in dynamics.

Clinical-psychopathological and medical-social characteristics of patients with endogenous psychoses with an episodic course in the context of post-manifestation pathopersonological transformations

The determination of the nosological affi liation of a separate clinical case in the group of endogenous psychoses is a decisive factor in adequate psychopharmacotherapy. The clinical aspects of post-manifestation pathopersonological transformations of endo genous psychosis with an episodic course remain the least studied and require study to improve the quality of diff erential diagnosis, treatment and rehabilitation. The aim of this study was to conduct a comparative analysis of personal characteristics, types of attitude toward the disease and adaptability of patients with schizophrenia and schizoaff ective disorder. On the basis of the Regional Clinical Psychiatric Hospital (Zaporizhzhia, Ukraine), 312 patients were examined, among them 102 patients with aff ective disorders; 102 patients suffering from schizoaffective disorder and 108 patients diagnosed with schizo phrenia, paranoid form, episodic course. The main research methods were clinical-psychopathological, clinical-follow-up, clinical-anamnestic and medical-social, as well as medicalstatistical analysis. The study revealed signs and nosospecific diff erences in indicators of social (labor and family) maladjustment, as well as positive, negative and general psychopathological disorders (according to PANSS) in endogenous psychoses with an episodic course, confi rming the presence of post-manifestation pathopersonological transformations. In the group of endogenous psychosis with an episodic course, pathopersonological transformations in schizoaff ective disorder are characterized by the most complex structure and are a nosospecific marker. Further studies of remission/intermission in endo genous psychosis open up the possibility of developing a differential diagnostic system and algorithms for providing personalized medical and rehabilitation care. Keywords: schizoaffective disorder, affective disorders, schizophrenia, clinic, social maladjustment, differential diagnosis, pathopersonological transformations

Type of course of schizophrenia and polymorphisms of neuronal protein kinase genes on the model of PIP5K2A, GSK3B and AKT1

The role of protein kinases in schizophrenia is being actively studied. However, the effect of protein kinase gene polymorphisms on the clinical manifestations of the disease has been little studied. We examined 384 patients diagnosed with schizophrenia in accordance with ICD-10 (F20) (269 patients with a continuous course of schizophrenia; 115 patients with an episodic course of the disease). Genotyping of polymorphisms PIP5K2A (rs10828317, rs8341, rs746203), GSK3B (rs334558), AKT1 (rs3730358, rs1130214) was carried out by real-time PCR method. An association of rs8341 PIP5K2A with the type of course of schizophrenia was revealed. The CT genotype was associated with a continuous type of schizophrenia, the TT genotype with an episodic one. Disorders of the phosphoinositide pathway may be a possible cause of the transition to a more severe continuous course of schizophrenia.