scholarly journals Clinical Features of Youth Depression with Attenuated Symptoms of the Schizophrenic Spectrum

Psychiatry ◽  
2021 ◽  
Vol 19 (1) ◽  
pp. 16-25
Author(s):  
M. A. Omelchenko
Keyword(s):  
Mental Health ◽  
Depressive Episode ◽  
Negative Symptoms ◽  
Mental Health Research ◽  
Research Centre ◽  
Psychotic Symptoms ◽  
Control Group ◽  
Youth Depression ◽  
Icd 10 ◽  
Type 3

Objective: establishment of clinical and psychometric features of youth depression with attenuated symptoms of the schizophrenic spectrum (ASSS) for early differential diagnosis and nosological assessment.Patients and methods: clinical and psychometric examination of young 219 inpatients (average age 19.6 ± 2.4 years), first admitted to the clinic “Mental Health Research Centre” from 2011 to 2020 with the first depressive episode with ASSS. Control group of inpatients (52 patients) with “classical” youth depressions without ASSS (average age 19.6 ± 2.4 years). Diagnosis  according ICD-10: F32.1, F32.2, F32.28, F32.8.Results: the psychopathological structure of youth depression with ASSS is characterized by the following types: (1) depression with attenuated psychotic symptoms (APS), which were divided into the subtype (1a) depression with APS and (1b) depression with brief limited intermittent psychotic symptoms (BLIPS); (2) depression with attenuated negative symptoms (ANS), comprising two subtypes (2a) with most emotional damage and (2b) with volitional impairment, and type (3) with attenuated symptoms of disorganization (ASD) in the structure of depressive episode. Clinical and reliable psychometric differences have been established between depressions with ASSS and «classical» youth depressions without ASSS. Conclusions: youth depression with ASSS is definitely different from “classical” youth depression without ASSS. Differences have been found in  the psychopathological structure of youth depression with ASSS, resulting in a typological differentiation.

scholarly journals The Clinical Course and Prognostic Problems of Youth Depressions with Attenuated Schizophrenic Symptoms

2021 ◽  
pp. 42-52
Author(s):  
V. G. Kaleda ◽  
M. A. Omelchenko
Keyword(s):  
Depressive Episode ◽  
Functional Outcomes ◽  
Negative Symptoms ◽  
Clinical Course ◽  
Control Group ◽  
Youth Depression ◽  
Early Markers ◽  
Spectrum Disorders

Objective Clinical and follow-up verification of Attenuated Schizophrenic Symptoms (ASS) in the first youth depressive episode as early markers of the schizophrenic process, establishing further variants of the course of the disorder and its outcomes.Materials and methods. 124 young inpatients (averaged age 19,6±2,3 years) with the first depressive episode with ASS were examined. The control group consisted of 27 patients with youth depression without ASS. All patients have been tracked for at least five years. The average follow-up period was 7,1±1,6 years. The HDRS, SOPS, SANS and PSP scales were used to assess the symptomatic and functional outcomes. Statistical analysis was carried out using STATISTICA 12.Results. The typological classification of youth depressions (ASD) with ASS has been developed with the identification of three main types: (1) with attenuated positive symptoms (APS), (2) with attenuated negative symptoms (ANS), and (3) with attenuated symptoms of disorganization. Youth depression with ASS, compared to the control group, is more likely to move into chronic forms, has reliably worse functional and symptomatic outcomes, and is more associated with the diagnosis of schizophrenic spectrum disorders at five years follow-up.Conclusion. Attenuated schizophrenic symptoms in the structure of youth depressions have high affinity to each other, indicating a common pathogenic mechanism of their formation, and also have predicate value as risk factors for schizophrenia.

A study of danger perception in adolescents in normal and endogenous mental pathology

2014 ◽  
Vol 6 (1) ◽  
pp. 310-322
Author(s):  
M.I. Veschikova ◽  
N.V. Zvereva
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Diagnostic Techniques ◽  
Mental Health Research ◽  
Control Group ◽  
Schizotypal Personality ◽  
Health And Disease ◽  
Hand Test ◽  
Academic School ◽  
Mental Pathology

We describe a pilot study of perception of the environment danger (the content and the degree of threat) in health adolescents and mental pathology. We provide a complex of diagnostic techniques for the assessment of categorization of ambiguous safe/unsafe situations, ways to respond to threats and aggression, developed by the authors. The complex includes two parts: 1) a study of aggression (Wagner Hand test, Rosenzweig Picture-Frustration study), 2) danger perception of different origin study (modified Drawn Apperception Test, incomplete sentences (authors set), danger assessment based on photos). The study involved adolescents aged 13-17 years. The experimental group consisted: 22 patients (13 boys) of Mental Health Research Center and Scientific and Practical Center for Children and Adolescents Mental health with diagnoses of schizophrenia, schizotypal personality disorder, and personality disorder. The control group: 24 pupils of general academic school (13 boys) in Moscow. The study identified structure of subjective danger in adolescents, key dangers, differences in the perception of danger in adolescents in health and disease.

An Approach to Comorbidity Between Obsessive-Compulsive Disorder and Schizophrenia

2016 ◽  
Vol 33 (S1) ◽  
pp. S495-S495
Author(s):  
A. Gomez Peinado ◽  
S. Cañas Fraile ◽  
P. Cano Ruiz
Keyword(s):  
Mental Health ◽  
Obsessive Compulsive Disorder ◽  
Negative Symptoms ◽  
Behavioral Therapy ◽  
Psychotic Symptoms ◽  
Simultaneous Presence ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Salud Mental ◽  
Competing Interest

IntroductionAn association has been observed between obsessive symptoms in Obsessive Compulsive Disorder (OCD) and psychotic symptoms in schizophrenia, being sometimes difficult to establish a clear limit between them. The term “schizo-obsessive disorder” was proposed to describe the resulting disorder of comorbidity of OCD and schizophrenia, although it has not been definitely settled.ObjectiveTo analyze the incidence of coexistence of OCD and schizophrenia symptoms and the way it modifies the treatment and prognosis of the illness.MethodReview of some articles published in Mental Health journals such as “Salud Mental” and “Actas Españolas de Psiquiatría”.ResultsSome studies about psychotic patients have determined 15% as the average of comorbidity of OCD and schizophrenia. The probability of having OCD is six times bigger if there is psychotic pathology associated.The fact that obsessive and psychotic symptoms get together in some patients shades the prognosis bringing more negative symptoms, more depressive humor, a larger cognitive impairment, more resistance to treatment and more relapses than we can observe in OCD and schizophrenia isolated.The pharmacological treatment usually consists in neuroleptic plus anti-obsessive drugs, together with cognitive-behavioral therapy. Sometimes, when there is a very bad evolution, it is required to consider psychosurgery as one necessary option, even though its use in this context is not much widespread.ConclusionsThe simultaneous presence of OCD and schizophrenia is more common than we could expect only by chance and makes the prognosis worse, being difficult to find a truly effective treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Outcomes of an effectiveness trial of cognitive–behavioural intervention by mental health nurses in schizophrenia

2006 ◽  
Vol 189 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Douglas Turkington ◽  
David Kingdon ◽  
Shanaya Rathod ◽  
Katie Hammond ◽  
Jeremy Pelton ◽  
...  
Keyword(s):  
Mental Health ◽  
Negative Symptoms ◽  
Community Sample ◽  
Symptom Burden ◽  
Treatment Resistance ◽  
Psychotic Symptoms ◽  
Behavioural Intervention ◽  
Mental Health Nurses ◽  
Cognitive Behavioural

BackgroundLittle is known about the medium-term durability of cognitive–behavioural therapy (CBT) in a community sample of people with schizophrenia.AimsTo investigate whether brief CBT produces clinically important outcomes in relation to recovery, symptom burden and readmission to hospital in people with schizophrenia at 1-year follow-up.MethodParticipants (336 of 422 randomised at baseline) were followed up at a mean of 388 days (s.d. =53) by raters masked to treatment allocation (CBT or usual care).ResultsAt 1-year follow-up, participants who received CBT had significantly more insight (P=0.021) and significantly fewer negative symptoms (P=0.002). Brief therapy protected against depression with improving insight and against relapse; significantly reduced time spent in hospital for those who did relapse and delayed time to admission. It did not improve psychotic symptoms or occupational recovery, nor have a lasting effect on overall symptoms or depression at follow-up.ConclusionsMental health nurses should be trained in brief CBT for schizophrenia to supplement case management, family interventions and expert therapy for treatment resistance.

scholarly journals Markers of systemic inflammation and systemic endotoxinemia in patients with acute endogenous psychoses

2020 ◽  
pp. 34-41
Author(s):  
С.А. Зозуля ◽  
И.Н. Отман ◽  
О.А. Юнилайнен ◽  
И.А. Аниховская ◽  
Т.П. Клюшник ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Inflammatory Markers ◽  
Clinical Symptoms ◽  
Psychometric Evaluation ◽  
Pathological Process ◽  
Psychotic Symptoms ◽  
Control Group ◽  
Leukocyte Elastase ◽  
Endogenous Psychoses ◽  
Icd 10

Актуальность: Современные исследования свидетельствуют о вовлеченности воспаления в патогенез эндогенных психических расстройств. Показано, что активность врождённого иммунитета (высокие показатели лейкоцитарной эластазы (ЛЭ) и а1-протеиназного ингибитора (а1-ПИ)), а также уровень аутоантител к нейроантигенам отражают остроту и тяжесть патологического процесса в мозге. В качестве одного из факторов, инициирующих системное воспаление, рассматривается патогенный формат системной эндотоксинемии (СЭЕ) - эндотоксиновая агрессия (ЭА), - патологический процесс, обусловленный избытком эндотоксина (ЭТ) в кровотоке. Цель: определение взаимосвязи между показателями системного воспаления и СЭЕ у больных с эндогенными психозами, необходимое для оценки роли ЭА в патогенезе изучаемой патологии. Материалы и методы: Обследовано 25 пациентов женского пола в возрасте от 23 до 49 лет (32,6 ± 8,9 лет) с эндогенными психозами (F20, F25 по МКБ-10). Все пациенты находились в остром психотическом состоянии. Психометрическая оценка проведена с помощью шкалы PANSS. Контрольная группа состояла из 25 психически и соматически здоровых женщин соответствующего возраста. В крови пациентов определяли активность воспалительных маркеров ЛЭ и а1-ПИ, а также уровень антител к нейроантигенам S100-B и ОБМ (технология «Нейро-иммуно-тест»), концентрацию эндотоксина (ЭТ) («Микро-ЛАЛ-тест») и активность антиэндотоксинового иммунитета (АЭИ) (технология «СОИС-ИФА»). Данные проанализированы с помощью непараметрических статистических методов (IBM SPSS Statistics 23). Результаты: В сыворотке крови пациентов выявлено статистически значимое повышение активности ЛЭ и а1-ПИ, а в 44% - наличие аутоиммунного компонента к нейроантигенам. У 24% больных на фоне существенного повышения активности маркеров воспаления наблюдалось повышение концентрации ЭТ, сопровождающееся недостаточностью АЭИ (преимущественно к гидрофильной части молекулы ЭТ), что является неблагоприятным фактором, усугубляющим клиническое течение заболевания. У 76% пациентов концентрация ЭТ оставалась в пределах нормативных значений и сопровождалась различным уровнем АЭИ, что, вероятно, может являться следствием ранее перенесённой ЭА. Выявлены корреляции между исследуемыми биологическими показателями, а также их связь с тяжестью клинической симптоматики по PANSS. Выводы: Полученные результаты свидетельствуют о взаимосвязи маркеров системного воспаления и показателей СЭЕ и их вовлеченности в патогенез эндогенных психозов. Background: Recent studies have suggested involvement of inflammation in the pathogenesis of endogenous mental disorders. The activity of innate immunity (increased activities of leukocyte elastase (LE) and a1-proteinase inhibitor (a1-PI)) and the level of autoantibodies to neuroantigens reflect severity of the pathological process in brain. The pathogenic form of systemic endotoxinemia (SE), that is, endotoxin aggression (EA), a pathological process caused by excessive endotoxin (ET) in the bloodstream, is considered as one of the factors initiating systemic inflammation. Objective: to determine the relationship between markers of systemic inflammation and indexes of systemic endotoxinemia in patients with endogenous psychoses to evaluate the role of EA in the pathogenesis of these disorders. Materials and methods: The study included 25 female patients aged 23 to 49 years with endogenous psychoses (F20, F25 according to ICD-10). All patients experienced exacerbation of psychotic symptoms. Psychometric evaluation was performed using the PANSS scale. The control group consisted of 25 healthy women. LE and a1-PI activities and levels of antibodies to S100-B and MBP (Neuro-Immuno-Test technology), endotoxin concentration (ET) (Micro-LAL-test), and antiendotoxin immunity activity (AIA) (SOIS-IFA technology) were measured in the patients’ blood. Results: The patients had significantly increased serum activities of LE and a1-PI. The autoimmune component to neuroantigens was detected in 44% of cases. In 24% of patients with significantly increased activities of inflammatory markers, ET concentrations were increased, and AIA (mainly to the hydrophilic part of the ET molecule) was deficient, which is an unfavorable factor that aggravates the clinical course of disease. In 76% of patients, the ET concentration remained within reference values; however, AIA levels were variable, which likely resulted from a previous EA. The studied biological indexes were shown to be correlated and linked to severity of clinical symptoms as determined with PANSS. Conclusion: The study demonstrated a relationship between systemic inflammatory markers and SE indexes and their involvement in the pathogenesis of endogenous psychoses.

scholarly journals Clinical and Epidemiological Characteristics of the Contingent of Elderly in-Patients in a Frame of the Modern Model of Psychogeriatric Care

Psychiatry ◽  
2021 ◽  
Vol 19 (1) ◽  
pp. 26-33
Author(s):  
V. G. Rotshtein ◽  
V. V. Ryakhovskiy ◽  
A. E. Shtinov
Keyword(s):  
Mental Health ◽  
Psychiatric Hospital ◽  
Health Research ◽  
Psychiatric Care ◽  
Psychiatric Service ◽  
Psychiatric Hospitals ◽  
Mental Health Research ◽  
Research Centre ◽  
Moscow City ◽  
Epidemiological Characteristics

Background: a system of reforming of psychiatric care in Russia has led to a reduction of beds in psychiatric hospitals. At the same time it is known about permanent high need among elderly patients in the appropriate psychiatric care. In this regard, it became necessary to study the adequacy of the assistance provided to the needs of patients.The aim of the research: to investigate and compare clinic-epidemiological characteristics of the contingent of the elderly and senile inpatients in the city psychiatric care system and at the research institution.Materials and methods: as a material for the research served data from the reports from Moscow Clinical Psychiatric Hospital #13 (MCPH #13) and the  clinic of Mental Health Research Centre (MHRC) about the patients older than 65 treated in 2017–2018.The results: this article contains comparative data about contingents of elderly psychiatric in-patients treated in the Moscow City Clinical Psychiatric  Hospital #13 and in the Mental Health Research Center (MHRC). Collation of the indicated contingents allowed to determine that city psychiatric care  satisfactorily meets needs of the severe psychiatric patients older than 65. However the experience of the clinic of the MHRC differs. This clinic has  some peculiarities: it does not use involuntary hospitalization and it gives preference to difficult cases, where diagnosis is unclear, and where there is a challenge to find an appropriate treatment regimen; patients that require  special care are also rarely admitted. This experience indicates that there is significant number of cases when hospitalization of patients with moderate  mental disorders is also absolutely necessary. The majority of such cases  consists of patients, suffering with depression and the necessity of their admission is dictated by the impossibility to adjust proper therapy in out- patient care.Conclusion: the contemporary Moscow city psychiatric service do not meet needs of the discussed category of patients for inpatient care. Whether it is  necessary to improve it, or to provide this niche to scientific and commercial institutions is a matter of further research. 

Problems of patients with schizophrenic disorders and of their families

1999 ◽  
Vol 8 (2) ◽  
pp. 117-130 ◽  
Author(s):  
Dino Lanzara ◽  
Ugo Cosentino ◽  
Anna Maria Lo Maglio ◽  
Antonio Lora ◽  
Anna Nicolo ◽  
...  
Keyword(s):  
Mental Health ◽  
Negative Symptoms ◽  
Psychiatric Symptoms ◽  
Principal Component ◽  
Family Burden ◽  
Positive Symptoms ◽  
Explanatory Variables ◽  
Service Information ◽  
Icd 10 ◽  
Schizophrenic Patients

SummaryObjective — To evaluate psychopathological symptoms, disabilities and family burden in schizophrenic patients and to analyse predictors of family burden and relatives' satisfaction. Design — Descriptive study of 203 patients with an ICD 10 — F2 diagnosis (schizophrenia and related disorders) in contact with the Desio Department of Mental Health on 31st December 1994. Setting — The Desio Department of Mental Health. Main outcome measures — The patients have been evaluated in three areas: disability (by ADC-DAS), psychiatric symptoms (by 24 items BPRS) and family burden (by Family Problems questionnaire). The outpatient, hospital and residential care contacts of the patients have been collected for six months by our service information system. For each area (DAS, BPRS and FP) a principal component analysis and a rotation of the significant components have been performed. Eleven factors, derived from three scales, have been retained as explanatory variables. Finally, a multiple regression analysis has been performed to assess the influence of explanatory variables on the set of response variables regarding family burden and relatives' satisfaction. Results — One third of patients suffer of moderate-severe positive symptoms, while negative symptoms are less frequent.

scholarly journals Cognitive approach to depression and suicidal thinking in psychosis

2000 ◽  
Vol 177 (6) ◽  
pp. 516-521 ◽  
Author(s):  
Max Birchwood ◽  
Zaffer Iqbal ◽  
Paul Chadwick ◽  
Peter Trower
Keyword(s):  
Negative Symptoms ◽  
De Novo ◽  
Psychotic Symptoms ◽  
Psychotic Episode ◽  
Positive Symptoms ◽  
Psychotic Depression ◽  
Acute Psychosis ◽  
Concomitant Increase ◽  
Cognitive Approach ◽  
Icd 10

BackgroundDepression in schizophrenia is a rather neglected field of study, perhaps because of its confused nosological status. Three course patterns of depression in schizophrenia, including post-psychotic depression (PPD), are proposed.AimsWe chart the ontogeny of depression and psychotic symptoms from the acute psychotic episode over a 12-month period and test the validity of the proposed course patterns.MethodOne hundred and five patients with ICD–10 schizophrenia were followed up on five occasions over 12 months following the acute episode, taking measures of depression, positive symptoms, negative symptoms, neuroleptic exposure and side-effects.ResultsDepression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms.ConclusionsThe results provided support for the validity of two of the three course patterns of depression in schizophrenia, including PPD. Post-psychotic depression occurs de novo without concomitant change in positive or negative symptoms.

scholarly journals Associations of CYP2D6, ABCB1 2677G>T/A and 3435C>T with effectiveness and safety of pharmacotherapy for acute psychotic episodes in adolescents over 28 days

2021 ◽  
pp. 39-49
Author(s):  
D. V. Ivaschenko ◽  
N. I. Buromskaya ◽  
P. V. Shimanov ◽  
R. V. Deitsch ◽  
M. I. Nastovich ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Adverse Reactions ◽  
Rating Scale ◽  
Psychotic Symptoms ◽  
Psychotic Episode ◽  
Global Assessment Scale ◽  
Increased Risk ◽  
Icd 10 ◽  
Time Of Admission ◽  
Positive And Negative Symptoms

Introduction. Pharmacokinetic genetic factors are prognostically relevant when prescribing antipsychotics to adult patients. Currently, there is a dearth of research on adolescents with an acute psychotic episode. Aim. To identify possible associations of CYP2D6, CYP3A4/5 and ABCB1 gene polymorphic variants with the efficacy and safety of pharmacotherapy in adolescents with an acute psychotic episode within 28 days. Materials and methods. The study included 68 adolescents with an established diagnosis of acute polymorphic psychotic disorder at the time of admission (F23.0-9 according to ICD- 10). All patients received an antipsychotic as their main therapy. Patients were monitored for 28 days. The effectiveness of antipsychotics was assessed using the Children’s Global Assessment Scale (CGAS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I). The safety of pharmacotherapy was assessed using the UKU Side Effects Rating Scale (UKU SERS), Sympson-Angus Scale (SAS), Barnes Akathisia rating scale (BARS). From each patient we obtained a buccal scraped epithelium, extracted DNA from it by sorbent method and detected carriage of genetic polymorphisms CYP3A4*22 (rs2740574), CYP3A5*3 (6986A>G, rs776746), CYP2D6*4, *9, *10 (rs3892097, rs4986774, rs1065852), ABCB1 1236C>T (rs1128503), 2677G>T/A (rs2032582), 3435C>T (rs1045642) by real-time PCR. Results. Carriers of ABCB1 2677G>T/A significantly less frequently demonstrated response to pharmacotherapy according to PANSS scale on day 14 compared to GG homozygotes (64.6 % vs. 94.7 %; p=0.014). Carriers of the ABCB1 3435C>T differed by a higher total UKU SERS score on day 14 compared to CC genotype carriers (9.21±5.95 vs. 5.1±4.48; p=0.037). Patients with «intermediate» CYP2D6 metabolism were more likely to have reduced sleep duration (13.6 % vs. 0 %; p=0.031). ABCB1 2677G>T/A (51 % vs. 15.8 %; p=0.012) and 3435C>T (46.6 % vs. 10 %; p=0.039) were more frequently associated with dry mouth. ABCB1 3435C>T carriers were also more likely to have orthostatic vertigo (34.5 % vs. 0 %; p=0.028). Conclusion. Carriage of the ABCB1 3435C>T was associated with greater efficacy of pharmacotherapy for acute psychotic episode in adolescents after 28 days, but also increases the risk of adverse reactions in the first 2 weeks of treatment. The ABCB1 2677G>T/A was associated with an increased risk of adverse reactions as well as less reduction of psychotic symptoms on day 14 of pharmacotherapy.

scholarly journals Association of polymorphism of HLA II genes with chronic adrenal insufficiency in APS 2,3,4 types – protective and predisposing genes.

2018 ◽  
Vol 2 (5) ◽  
pp. 01-05
Author(s):  
Troshina E.A
Keyword(s):  
Adrenal Insufficiency ◽  
Addison’S Disease ◽  
Multiple Organ ◽  
Research Centre ◽  
Control Group ◽  
Addison's Disease ◽  
Metabolic Markers ◽  
Specific Pcr ◽  
Protective Genes ◽  
Type 3

Endocrinology Research Centre, Moscow, Russian Federation. This research was conducted under the research grant RSF “Autoimmune endocrinopathies multiple organ failure that are genomic, postgenomic and metabolic markers. Genetic risk prediction, monitoring, early predictors, personalized correction and rehabilitation.” Project number is 17-75-30035. Introduction The aim of the study was to determine the association of chronic adrenal insufficiency with polymorphism of HLA II genes among patients with APS 2,3,4 types. The focus of the study was on the revealing of protective genes for Addison’s disease in APS 3 type patients. Materials and methods The case-control study involved 78 patients with APS 2, 3, 4 types and 109 healthy subjects. Alleles of the HLA II class genes, CTLA4 and PTPN22 were identified by the multiprimer allele-specific PCR method. The statistical analysis was carried out using the exact two-sided Fisher test. The association of the chronic adrenal insufficiency in patients with APS was determined by the value of the odds ratio (OR - odd's ratio), the value of 95% confidence interval (95% CI). Results Haplotypes DR3-DQ2 (OR = 4.06), DR4-DQ8 (OR = 5.78), genotype DR3/DR4 (OR = 19.7), DQA1*0301 allele (OR = 4.27), as well as genotype DQA1*0301/DQA1*0501 (OR = 13.89) predispose to the development of APS type 2, 3 and 4 in adults compared to the control group. APS patients were divided into two groups according to the presence of Addison’s disease (APS 2 and 4 types - and type 3 APS). Haplotype DR3-DQ2 (DRB1*17-DQA1*0501-DQB1*0201) (OR = 2.6), as well as the genotype DR3/DR4 (OR = 4.28) found the strongest association with the development of adrenal insufficiency in patients with APS. Haplotypes DRB1*01-DQA1*0101-DQB1*0501 (OR = 0.07), as well as DRB1*01 (OR = 0.08) have been determined as protective for the development of Addison’s disease. Conclusion Examination of APS type 3 patients without Addison’s disease for the presence of protective genes for the development of adrenal insufficiency will allow better predicting the risks of developing of the disease within the syndrome.

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