Introduction

     Variety of reasons and peculiarities of displays and clinical courses of boundary mental disturbances (BMD) is universally recognized and arouses grand concern of public health service. Prevalence of pathology of neurotic circle and pessimistic forecasts about increase of its share among the reasons of temporary disability made BMD the subject of study of not only psychiatrists but physiologists, neurologists, cardiologists and physicians of other specialties as well. So, according to data given by WHO, anxious disturbances and mood disturbances have their place among the first ten most significant problems of public health service [4], being the most widespread mental diseases in 13 out of 14 countries, included into international mental health investigation program carried out by WHO recently.

     Depression is serious disadaptive disease with a high risk of developing recurrent episodes [5] that inevitably leads to sharp decrease of social activity, and quite often to invalidization. Comorbidy of depression and anxious disturbances make up from 40 to 80%. Anxious disturbances are notable for clinical heterogeneity, inclination to lingering illnesses and recurrence [1; 8]. The state of patients with boundary mental states along with a change of mental status is also characterized by presence of concomitant somatic disturbances, including violation of motor functions [2].

     Body of a standing person constantly makes oscillation motions in different fatnesses around some mean position. Many diseases cause considerable decrease of stability in vertical position that allowed to Romberg (1851) include into clinic the investigation of body stability when standing. Today for exact registration and analysis of body oscillations when standing stabilometry is applied – it is a method of registration of a projection of general center of body weight to support surface and its oscillations when patient is standing [3]. To provide a vertical position of a body, there are a lot of muscles used; their activity is regulated by different levels of central and peripheral nervous system, which receive information from visual, muscular, articular and vestibular receptors. The changes in any physiological systems both in muscular and central nervous system result in natural changes of vertical position. This is why this method gain more and more grounds in different spheres of medicine: neurology, orthopedy and traumotology, sports medicine, in the system of occupational selection etc.. In psychiatry this method is not widely used yet, in spite of the fact that the influence of different emotions on the state of motor system is really significant. In an accessible literature we managed to find only few investigations of depressed patients [6, 7], where influence of drug therapy on postural balance of those patients was studied. Consequently, a question about presence and character of motor disturbances of patients with boundary mental pathology stays open.

Purpose of work:

     To find out the peculiarities of postural balance of patients in depression and anxious state according to stabilometric examination data.

Materials and methods:

     The investigation was carried out on basis of Z.P. Soloviyev specialized clinical hospital _8 “Neurosis clinic”. In total there were examined 259 people of both sexes at the age from 17 to 55 years old, out of which 43 healthy people and 216 patients. The state of patients in all the cases was determined as not psychotic spectrum disturbances. Comparative group was represented by 43 healthy people - employees of the clinic at the age from 19 to 55 years old (average age was 35 +/- 1,75 years old), among which there were 12 men and 31 women. Patients were divided into two groups depending on nosological belonging. Group “D” was composed of 102 patients with affective mood disturbances (depression, class F3 according to ICD-10) at the age from 19 to 55 years old (average age 36,41 +/- 0,91 years old), out of them there were 52 women and 50 men. In group “T” there were 114 patients with neurotic, connected with stress, and other sometoformed disturbances (class F4 according to ICD-10) at the age from 18 to 55 years old (average age 34,88 +/- 0,75 years old), out of them there were 56 men and 58 women. Criterions for choosing patients for investigation were: age - not older then 55 years old, belonging of their disease to class F3, F4 according to MKB-10, absence of chronic somatic diseases in acute condition, coarse orthopedic or neurological pathology, extensive myopia (short-sightedness). Stabilometric investigation was carried out with the help of “MBN-STABILO” complex (NMF “MBN”, Moscow). There was used the complicated Romberg test: feet put together, eyes closed – hands outstretched. Registration of projection of the focal point (center of gravity), that is the center of pressure (CP) on support surface and its fluctuations was executed during 51 second in each position – with eyes opened and closed. There were the following stabilometric parameters analyzed: Romberg coefficient (QR) – relation of statokineziogram area in position “eyes closed” to the similar parameter in position “eyes opened”; pressure center coordinate (PC) in sagittal (Y) plane; conveying speed of CP (V) in mm/sec; statokineziogram (s95) area in mm2; measure of stability Stab. Stabilometric examination was implemented right on the day of patient’s arrival to the clinic before the treatment with psychoactive drugs was started. Static processing was fulfilled by standard means of variation statistics with the use of paired and unpaired Student’s “t” coefficient.

Results.

     The results of stabilometric examination of healthy people and patients of groups “D” and “T” are represented in table 1.

Table 1. The results of stabilometric examination and comparison of data got from the group of healthy people and from groups “D” and “T”.
There given the average values +/- standard error of the investigated parameters in groups of patients in comparison between themselves and with the group of healthy people.

     Sign * designates indices which have reliable differences from similar indices in the norm, p &Mac178;0,05,

     sign $ indicates indices which have reliable differences from similar ones in the norm, p &Mac178;0,01,

     sign & marks indices which have reliable differences from similar ones in the norm, p &Mac178;0,001.

     Conveying speed of CP with opened and closed eyes exceed the norm; when eyes either closed or opened the area of statokineziogram exceed the norm; when eyes are either closed or opened the stability index is less then norm. Romberg coefficient also exceeds the norm. Comparative analysis of parameters in both groups did not show any reliable differences.


Discussion.

     Acquired results show that patients with boundary mental pathology have typical postural disturbances. The extension of statokineziogram area in position “eyes closed” tells us about the decrease of amending influence of proprioreceptive field that results in stress of balance control system and becomes apparent in the increase of Romberg coefficient. The presence of this stress is proved by accelerated, in comparison with the norm, conveyance speed of CP that is true to both positions – with eyes closed and opened. The increase of conveyance speed of CP might be the result of both insufficient proprioreceptive afferentation and psycho-emotional state disturbances of the patients.

      On the whole, significance of visual analyzer of the examined patients increases with the decrease of proprioreceptive function. And nevertheless with the decrease of balance function the amendment of visual analyzer stays insufficient - that is proved by extension of statokineziogram area in position “eyes opened”. This is why the level of visual-motor connections of patients does not let them reach normative stability.

     Consequently, functional state of motor system of patients in depressive and anxious states is characterized by presence of stress in body balance control system, dysfunction of visual-motor connection, decrease of proprioreceptive sensibility, prevalence of visual analyzer in maintaining static equilibrium. These changes in postural system are not specific and are characteristic to the same extent for patients with depression and in anxious states that might be the evidence of their functional character.


Literature.
1. Avedisova A.S., Less J.E., Chahava V. O. Application of atypical antipsychotic under anxiety in boundary psychiatry clinic. Russian medical magazine, 2007. T 15, _10. – p. 888-892.
2. Krivoshey I. V., Skvortsov D. V., Shinaev N. N., Talabum E., A. // S. S. Korsakov magazine of neuralgia and psychiatry, - 2006. – 8. –p. 62-64.
3. Skvortsov D. V. / Clinical analysis of movements, stabilometry. – M.- “Antidor”. – 2000. – 199 p.
4. Dhillon S., Scott L.J., Plosker G.L. Estsitaloprom. Survey of application of the medication for anxious disturbances treatment (part I). // Psychiatry and psychopharmotherapy, 2007. T. 09, _3. – p. 63-68.
5. Forshall S, Nutt D. Maintenance pharmacotherapy of unipolar depression. Psychiat Bull 1999; 23: 370-3.
6. Laghrissi-Thode F., Pollock B.G., Miller M.C., Mulsant B.H., Altieri L., Finkel M.S. Double-blind comparison of paroxetine and nortriptyline on the postural stability of late-life depressed patients // Psychopharmacol Bull.- 1995.-31(4).- p.659-63.
7. Mamo D.C., Pollock B.G., Mulsant B., Houck P.R., Bensasi S., Miller M.C., Redfern M.S., Reynolds C.F. Effects of nortriptyline and paroxetine on postural sway in depressed elderly patients // Am J Geriatr Psychiatry.- 2002.- Mar-Apr.-10(2).- p.199-205.
8. Semaan W, Hergueta T, Bloch J, Charpak Y, Duburcq A, Le Guern ME, Alquier C, Rouillon F., Cross–sectional study of the prevalence of adjustment disorder with anxiety in general practice. Encephale. 2001 May–Jun; 27(3), _.238–44.

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