No 3S (2015)

Selection of the optimal maintenance pharmacotherapy in bipolar affective disorder (BAR) is complicated by the limited availability of comparative evidence that makes the difference in the recommended first- and second-line drugs in various treatment guidelines. The article presents the evidence base for the main groups of drugs used for the treatment of BAR. It is noted that monotherapy with one of first-line drugs, which proved to be effective as a preventive measure, is justified for maintenance treatment in most patients with BAR.

Based on the survey of 117 children in the framework of forensic psychological and psychiatric examination, reactions to psychotraumatic situations such as high-conflict divorce typical for children of different ages are detailed. The limits of competence of general practitioners in writing opinions for the court at the request of one of the parent are discussed. It is emphasized that the ascertainment of a possible negative impact of communication or living with one of the parents on the mental condition of the child is not within the competence of general practitioners and is the subject of a special complex psychological and psychiatric examination in the framework of forensic investigation.

Currently, problems of comorbidity of somatic and mental disease are studied actively in the medicine. Combination of mental illness and chronic liver disease is of particular note. Management of such cases involves careful selection of psychopharmacological medication based on a weighted evaluation of its adverse undesirable effects, especially hepatotoxicity and possible metabolic interactions with drugs used for concomitant therapy. A clinical observation of the patient with paranoid schizophrenia, chronic hepatitis C and orthotopic liver transplant is presented (02.12.2011). He is taking immunnosupressive therapy constantly: tacrolimus, Mycophenolatis Mofetilum. Onset of mental illness refers, most probably, to 2011, when he first experienced verbal deceptions of perception and ideas of his special mission and relevance. In July 2014 the patient's mental condition has deteriorated significantly, with development of hallucinatory-paranoid state with catatono-oneiric inclusions, and he was hospitalized to psychiatric hospital. The main difficulty in the management of the patient was the choice of antipsychotics. As a pathogenetic treatment for schizophrenia, we used atypical antipsychotic olanzapine. The choice of this particular drug was dictated by the high clinical efficacy of olanzapine in the treatment of disease and low risk of adverse side effects - hepatotoxicity, extrapyramidal symptoms. This makes olanzapine the most preferred drug for the treatment of schizophrenia in a patient with hepatitis C and liver transplants.

For effective pharmacological correction of the various stages of Alzheimer’s disease (AD) should be used already developed the therapy algorithms. Cholinesterase inhibitors (CEI) approved as a standard first-line therapy in patients with mild to moderate AD. Memantine may be used as monotherapy or in combination with a CEI for patients with moderate AD, and as monotherapy for patients with severe AD.The results of generalised analysis show that memantine potentially effective and well tolerated in patients with moderate to severe AD. Memantine has a positive effect on cognitive function and also benefits for language function. It has a positive effect on the behavioral and psychotic symptoms, including irritability and aggression, which are known to be associated with rapid disease progression and increased caregiver burden. Since the mechanism of action of memantine different for CEI, we can suppose that memantine can be effective in patients with resistance or poor quality of response CEI. Furthermore, memantine can be administered in the early stage of AD, in patients with language disorders.