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Escitalopram in the treatment of panic disorder

Introduction. Panic disorder is one of the most common forms of borderline mental pathology and varies throughout life, from 1,6% to 2,2%. Pharmacotherapy of panic disorder have traditionally included the use of benzodiazepines and antidepressants. Recently, however, the use of benzodiazepine derivatives significantly limited due to the formation of drug dependence and withdrawal symptoms after long-term treatment. In a series of anti-depressant efficacy in relation to cases of panic disorder proved most tricyclic antidepressants, but the need for long-term (often multi-year) therapy, given the high risk of adverse events often lead to premature cancellation of therapy or the use of deliberately ineffective doses. Recently, the place of first choice drugs in anxiolytic therapy took selective serotonin reuptake inhibitors (SSRIs). SSRIs have proven reliable antidepressant activity, but also show efficacy in various anxiety disorders, including panic disorder. The development of SSRIs with low frequency of side effects to optimize treatment of panic disorder.

SSRI citalopram is a racemic mixture of R-(right-hand) and S-(left-) isomers. The ability of citalopram inhibit reuptake of serotonin at therapeutic doses sold exclusively through S-isomer - estsitaloprama. It is shown that does not exceed Escitalopram Citalopram on indicators of efficiency and portability.

Escitalopram has a broad spectrum of anxiolytic activity, as evidenced by the results of a placebo-controlled studies on samples of patients with anxious depression, social anxiety, generalized anxiety and panic disorders.

The purpose of this study was to evaluate the safety and efficacy estsitaloprama in treating patients with panic disorder.

Material and methods. The study included patients with panic disorder (according to ICD-10) held stationary and / or outpatient treatment at the Division for the study of borderline mental diseases and psychosomatic disorders MHRC RAMS.

Exclusion criteria: Comorbidity of panic disorder with disorders of hallucinatory-delusional register, chronic alcoholism, drug addiction, associated organic diseases of central nervous system and severe somatic pathology in the phase of decompensation, a history of severe allergic reactions. The study did not include patients with severe depressive symptoms - more than 20 points on a scale assessing depression Montgomery-Asberg Scale (MADRS).

Escitalopram was appointed after the abolition of previous therapy for at least seven days. Dosage regimen is as follows: 1st week of therapy - 5 mg / day (single dose), the 2nd week of therapy - 10 mg / day (single dose). Starting from the 3rd week, the drug used in a flexible dosing up to the maximum - 20 mg per day. Not permitted for any other psychotropic therapy except for the appointment of a hypnotic (zolpidem) in cases of persistent insomnicheskih disorders.

The duration of treatment was 10 weeks. Assessment of the dynamics of the state held on the 1st, 2nd, 4th, 6 th and 10th weeks of therapy. We used the following rating scales: The scale of the overall clinical impression (CGI), modified scale panic and anxiety waiting Shihan (PAAS), Scale of phobias in the modification of Marx and Sheehan. The criterion of efficiency for the final evaluation of the results of treatment are "better" or "marked improvement" on general clinical impressions.

Safety assessment of therapy takes into account physical examination, laboratory parameters, and documented adverse effects (on the modified scale assessment of side effects - UKU).

The results of the study. Of a sample comprised 30 patients (17 men, 13 women, mean age - 35.7 years). In most observations panic disorder was of a chronic nature - the average duration was 5.6 years. In 9 patients recorded episodic phobic avoidance of situations and only in 6 - signs of persistent agoraphobia.

Among the concomitant affective disorders dominated by small depression (15 cases), in two cases revealed diagnostic features of dysthymia.

Evaluating the therapeutic effect estsitaloprama must first note that the actual anxiolytic effect was somewhat delayed. During the first week of treatment did not reveal positive dynamics, as in the frequency of panic attacks, and in an anxious wait and avoidant behavior.

On the contrary, at this stage of therapy was associated with increased intensity of the main manifestations of panic disorder. Performance analysis of the Modified scale panic and anxiety waiting Sheehan suggests that during the first week of therapy there has been increasing the frequency of panic attacks, which mainly concerns the intensity of spontaneous rather than situational panic attacks, due to some activating effect of the drug.

This is supported by evidence and dynamics of scale figures phobias in the modification of Marx and Sheehan. During the first week of therapy have been no significant changes in terms of intensity, as phobic disorders, and avoidant behavior. It should be noted that in this study were not used tranquilizers, which are usually encouraged to nominate as a "cover" in the first week of SSRIs in the treatment of panic disorder.

Starting from the second week of therapy, a marked decline in the number and intensity of the limited spontaneous panic attacks, while other indicators of symptom severity of panic disorder (primarily deployed panic attacks) did not demonstrate statistically significant dynamics.

The distinct therapeutic effect was detected from the fourth week of therapy, when recorded statistically significant decrease in intensity as the main manifestations of panic disorder and phobic disorders that accompany them. This trend can be traced back to the end of treatment (10 weeks of therapy).

By the time the study was completed in the majority of cases reported the formation of remission. In 77.4% of cases dealt with the full reduction of symptoms or weakly expressed subsyndromal disorders, no significant impact on the social adaptation of patients. In 22.6% of cases the results of therapy are regarded as ineffective - registered a slight improvement (clinically manifested only a slight decrease in the overall level of frustration with the persistent anksioznyh evading behavior), or the absence of positive dynamics. In one case, therapy was discontinued in mind the acute manifestations of panic disorder.

Security. The study found that quite different Escitalopram was well tolerated. There have been no clinically significant changes in the baseline indicators of vital functions, electrocardiography and laboratory tests.

Recorded adverse events generally typical for the entire group of selective serotonin reuptake inhibitors: increased anxiety (45.16%), nausea (25.8%), diarrhea (41.9%), headache (19,3%), dizziness ( 19,3%), hyperhidrosis (19.3%), somnolence (19.3%), while their intensity was maximal only at the beginning of treatment. As seen from the data presented adverse events were observed mainly in the first two weeks of therapy. All adverse events were expressed moderately, only in one case, the intensity of adverse events required early termination of treatment. In other observations of adverse events did not appear to cause changes in dosage regimen of the drug.

Discussion. The study revealed that Escitalopram has high activity with respect to the main manifestations of panic disorder, including detailed and limited spontaneous and situational panic attacks.

The therapeutic effect of etsitaloprama can be divided into the following stages: general protivotrevozhnoe action is realized in the 2nd week of therapy, actually antipanichesky and antifobicheskie effects are fixed, starting with the 4th week of therapy. The results suggest that the 10-week course of therapy estsitalopramom in most cases is sufficient for the formation of clinical remission.

The study attempted to determine the spectrum of anksioznyh disorders with preferred response to monotherapy estsitalopramom. With this purpose was analyzed clinical features of panic disorder in the groups of responders and nonresponderov. It was found that the group of responders is significantly dominated by patients with the dominance of spontaneous panic attacks when deployed on the unexpressed phenomena agoraphobia (limited agoraphobia). Under nonresponderov contrast, marked mainly situational panic attacks, accompanied by persistent agoraphobic avoidance.

These findings can not be considered definitive in view of the fact that the studied sample consisted mainly of patients with low severity of avoidant behavior. Accordingly, further studies are needed to analyze the effectiveness of monotherapy estsitalopramom in samples with different variants of panic disorder. However, you can suggest that in cases of persistent agoraphobia Escitalopram should be combined with other psychopharmacological medications series (eg, antipsychotics). This study also confirmed previously obtained data on the high security estsitaloprama. Recorded adverse events did not significantly affect the basic parameters of social functioning, which allows to count on a sufficiently high level of compliance by patients prescribed treatment regimen and improve the overall effectiveness of treatment.


The effectiveness of the drug Escitalopram (Tsipraleks) in the treatment of panic attacks

Anxiety disorders - a group of syndromes characterized by excessive anxiety, intense fear, internal stress and / or somatic symptoms in the absence of the real situation of threat. About 50% of individuals in society during their lifetime experience a variety of episodes or duration of the threshold, or subporogovyh anxiety disorders. Pharmacoeconomic studies suggest that one third of all costs for treatment of mental illness in general had to treat anxiety. At the same time a large group of patients do not seek medical attention and remain untreated. In turn, untreated anxiety, and residual symptoms of anxiety are the basis for a more severe psychopathological syndromes.

Pharmacotherapy of anxiety disorders remains an area of active study and the main issue remains the treatment of anxiety drug choice of the first stage.

Different groups of drugs (benzodiazepines, up from anticonvulsants) show to be effective in many anxiety symptoms, but most researchers justified considering antidepressants from a group of selective serotonin reuptake inhibitors (SSRIs) as first-line choice for treatment of virtually all anxiety disorders. So in the U.S. for the treatment of anxiety already registered: Paroxetine, Escitalopram and venlafaxine. The most significant experience in the use of SSRIs have accumulated in the treatment of panic disorder. Antidepressants for the treatment of paroxysmal anxiety used since the mid sixties of last century, nevertheless, a significant percentage of patients is resistant to treatment, side effects may also limit the use of SSRIs. Therefore constantly being sought drugs with higher efficiency and better tolerated (SSRIs - second generation). One of the most promising areas of research is to improve the pharmacological activity of the drug due to changes in the molecular geometry of the antidepressant.

So an attempt was made to improve the pharmacological properties of citalopram, highlighting the most active isomer. When comparing the S-and R-enantiomers was found that Escitalopram (S-enantiomer of the active substance) is 30 times more powerful inhibitor of serotonin reuptake than its optical antipode. Estsitaloprmama advantage over citalopram, and is on the speed of development of clinical effect. According to the multicenter clinical trial in 76% of cases was well tolerated Estsitaloprama regardless of the dose. Dynamics of adverse events has regredientny nature, ie by the end of 2 nd week of treatment, most manifestations of poorly expressed and loses both objective and subjective importance.

Estsitalapram (Tsipraleks) showed high anxiolytic effects in placebo-controlled studies in patients with social phobia, generalized anxiety disorder, panic disorder and anxiety symptoms associated with major depression. The study of the efficacy and tolerability tsipraleksa in outpatients with panic disorder in conditions close to real clinical practice, the doctor-neurologist.

The purpose of this open study was to evaluate the effectiveness and tolerability of 10-week course Estsitaloprama (Lundbeck) in a dose of 5-10 mg / day in the treatment of panic disorder according to the dynamic characteristics of clinical and psychometric indicators. The main assessment of the effectiveness produced by frequency of panic attacks (PA) at the 10th week of treatment compared with the baseline values (before treatment) and medication effects on comorbid conditions.

Subjects. Twenty-seven outpatients satisfying the criteria of ICD-10 for panic disorder with or without agoraphobia were included in the study from September to November 2005. All patients had typical PA - typicality index is 0.68. Among the studied patients were 18 (66,7%) women and 9 (33,3%) males, mean age was 35,9 ± 9,1 years (from 24 to 61 years). The average age of debut of the PA amounted to 33,8 ± 8,1 years (from 23 to 57 years). 85,2% of the subjects were of active working age.

It was found that more than half of the patients observed a combination of clinical syndromes: autonomic dysfunction, algic manifestations, motivational and insomnicheskih violations. Among algic manifestations of the most frequent headache in 29,6% (n = 8) patients with PA.

Previous treatment. All patients failed or poorly taken a number of drugs over their condition. In some cases, there was a combination or experience the use of different drugs (antidepressants, anxiolytics, neuroleptics, beta-blockers)

Design and methods. Patients were examined in the background, on 2 nd, 4 th, 6 th and 10 th weeks of continuous therapy Estsitalopramom. To assess the status of the patients had used clinical neurological examination, psychometric testing using a scale of anxiety Sheehan (Sheehan, 1983), questionnaires Beck Depression Inventory (Beck, 1961) and quality of life in panic attacks, 10-point visual analogue scale (VAS) for self- general health. Tolerance was assessed by a modified scale of assessment of side effects UKU (Udvalg for Kliniske Undersogelser Scale); subjective assessment of treatment efficacy Estsitalopramom assessed by a 5-point scale for the entire course of therapy patients were your own blog assess the dynamics of the state.

Baseline indicators. Upon initial examination of patients of the study group complained of heart palpitations, fluctuations in blood pressure, respiratory disorders (hyperventilation, asthma attacks, "" inhalation of insolvency "," lump in the throat), headache by type of tension headaches, increased anxiety and internal tremor, the fixation on their health status, decreased performance and a sense of helplessness, swoon (darkening of the eyes "), sleep disturbance (difficulty falling asleep, early awakening)," ringing in the ears. " In a fit of each of the patients had multiple symptoms.

Neurological status. The vast majority of patients in the neurological status were identified: recovery of tendon reflexes in the arms and legs with extension reflex zones, with non-pathological brush marks (b. Rossolimo, pp. Hoffmann), dissociation of reflections on the axis (with the feet more alive than with hands) symptom chvostek I-II degree, humidity brushes, nystagmus in the extreme leads, easy asymmetry (flattening) nasolabial fold. This category symptom frequently encountered in the status of patients with tervogu.

Most patients (37%) indicated the relationship of disease with stressful situations at home and / or at work, as the main factors triggering the development of the first attack of the PA.

The results of treatment. The overall effectiveness of therapy estsitalapramom (tsipraleksom) was 81% (22 responders). The frequency of panic attacks decreased in most patients, and in 17 (63%) of them demonstrated complete reduction of panic attacks in the 10th week of treatment. Analysis of the dynamics to weekly antipanicheskoy efficiency tsiproleksa showed that a significant reduction in the total frequency of panic attacks compared with background values (5.2 0.7) occurred on the 3rd week of treatment (2,2 +0,37 p <0,05) . Reduction of the number of deployed ahead of the abortive attacks (attacks that contain less than 4 symptoms). According to the records of the patients significantly decreased the frequency and intensity of attacks (from high to call an ambulance to the complete absence), the duration of one episode (from 24 hours up to several minutes), number of symptoms in a fit of (13 to 1) at the end of therapy.

In the background investigation of all patients (100%) had both spontaneous and situational (100%) bouts of PA, at the end of therapy: spontaneous seizures none of the patients were not marked, situation persisted in 10 patients and were abortive in nature.

Scheme of the drug. Most patients (n = 23) medication was prescribed: the initial dose of 5 mg / day for 1 week, with the subsequent transition to 10 mg / s with good tolerability. Objectively, all indicators of psychometric tests was significantly changed for the better (the degree of depression on Beck from 20,3 ± 12,5 to 3,5 ± 2,2, the degree of depression on Shihan from 49,7 ± 18,1 to 7,0 ± 5 4, the quality of life in the PA with 434 ± 182 to 167 ± 95) during 10 weeks of therapy.

Tolerance was generally appreciated by both patients and treating physicians as good. Side effects were observed only in the period of initial treatment.

Conclusion. Analysis of the clinical characteristics of patients enrolled in the study showed that in practice there gipodiagnostika somatic syndromes outlined panic and low appointing adequate therapy. At the onset of the disease this category of patients' symptoms associates with somatic pathology, which is an obstacle to the appointment of appropriate psychotropic therapy.

The study showed that for estsitaloprama in conditions close to free clinical practice is characterized by a high antipanichesky effect (81%) comparable to antipanicheskim effect obtained in clinical placebo-controlled studies. It manifests itself in 2-3 weeks of therapy, primarily regression are deployed attack is generally characteristic of antidepressants.

Estsitaloprama indisputable advantage is its effectiveness against related agoraphobic, and depressive disorders. Dynamics of reverse development of depressive symptoms and symptoms of agoraphobia corresponding regressions panic attacks, but the symptoms of agoraphobia have been the most resistant to treatment that can recommend a longer course of treatment - 3-5 months.

High efficiency estsitaloprama in patients who had negative experiences of treatment with antidepressants, suggests the possibility of using this drug for the treatment of resistant cases.

Thus, Escitalopram can be recommended as monotherapy or in polytherapy basic drug for the treatment of panic disorder in neurological practice. His additional anxiolytic action and good tolerability make it possible to provide treatment without loss of quality of life for the patient.

A pathological liar - a psychological personality type, a man who often lied, trying to impress others.

In the medical literature, this type of personality was first described more than 100 years ago. Some psychologists believe that pathological liars are different from ordinary liars that pathological liar believes that telling the truth, and at the same time to get used to the role. Many, however, does not fully agree with this interpretation, but agree that pathological lying - a special mental state. Although the term "pathological liar" and not used in clinical diagnosis, the majority of psychiatrists believe that this type of personality is a result of mental illness or low self-esteem.

Scientists from the University of California at Los Angeles recently demonstrated [1] that the brains of pathological liars is different from the norm so that his prefrontal cortex reduced volume of gray matter (neurons) and increased volume of white matter (nerve fibers). These results indicate that the prefrontal cortex plays a role in this characterization of the individual.

To investigate cases of pathological lying and their causes is important because false witnesses may impede the investigation or cause improper conviction.

Evaluation criteria of Internet addiction

Researchers using various criteria by which you can judge on Internet addiction. So, Kimberly Young led four features:

1. Obsessive desire to check e-mail.
2. Constant desire to read to the Internet.
3. Complaints surrounding the fact that a person spends too much time on the Internet.
4. Complaints surrounding the fact that people spend too much money on the Internet.

A detailed set of criteria leads Ivan Goldberg. In his view, one can say Internet addiction in the presence of 3 points from the following:

1. The amount of time you'd spend on the Internet to achieve satisfaction (sometimes a feeling of pleasure from the communication network borders on euphoria), markedly increases.
2. If a person does not increase the amount of time he spends on the Internet, the effect is markedly reduced.

Comment: The first and second paragraph reflects the emergence of such phenomena as tolerance. Similar signs can be observed in smokers, alcoholics and drug addicts, when for pleasure must constantly increase the dosage. In this case, "dose" is the amount of time spent on staying in the virtual world.
3. The user makes attempts to withdraw from the Internet or even less to spend in it less time.
4. Termination or reduction of time spent in the Internet, a user to feel unwell, which develops within a few days to a month and is expressed by two or more factors:
* Emotional and motor excitation
* Anxiety
* Obsessive thoughts about what is happening in the Internet
* Fantasies and dreams about the Internet
* Arbitrary or involuntary movement of his fingers, reminiscent of the printing on the keyboard.

Comment: These emotional changes that occur with a person trying to cancel or shorten their stay in the network, point to a psychological dependence on the Internet and the language of the psychiatrist names "denial syndrome" or "withdrawal syndrome". In this case, it is very different from the "abstinence syndrome" of smokers, drug addicts, alcoholics and people overeat (gluttons), as they have developed not only psychological but also physical addiction to harmful substances and their removal is experienced much heavier. The advantage of the Internet - according to the absence of a physiological component. Withdrawal is a user or a reduction in violation of social, professional or other activities.

5. Using the Internet to avoid the "syndrome of failure".
6. Internet is often used for large amounts of time, or more often than was intended.
7. Significant social, occupational, leisure expire or are reduced in connection with the use of the Internet.
8. Using the Internet continues despite knowledge of the existing or permanent physical, psychological, social, occupational problems that are caused by the use of the Internet (lack of sleep, family (marital) problems, delays in scheduled for the morning meeting, neglect of professional responsibilities, a sense of abandonment or significant other) .

In other studies of Internet addiction has been established that Internet-dependent part of "relish" their Internet access, a feeling of nervousness, being off-line, lying about time spent online, and they feel that the Internet gives rise to problems at work, financial status, as well as social problems. K. Young cites other researchers in which students suffer academic failure and uhudsheniya relations, and that this is associated with uncontrolled use of the Internet.

Thus, guided by the above listed characteristics of Internet addiction, you can judge their own Inetrnet-dependence or the availability of that of their acquaintances. Psychotherapeutic experience shows that if a person admits in his presence or that kind of addiction, whether it be dependent on hazardous substances or from the Internet, it tries to cope with it alone or with people close to him, as well as professionals (psychiatrists, drug treatment, psychotherapy or psychologists).

It is not critical attitude toward their own problems (ie, denial of their existence), and makes people addicts, alcoholics or addicted to the Internet and so on, because people do not recognize themselves as such and deny the problem. For example, the motto of an alcoholic: "I leave at any time to drink if I want. And if I still have a drinking bout, it's what I did not want it to quit." I compare Internet addiction with other addictions, as I believe a similar mechanism of their appearance, as will be discussed later. Certainly, compared with the dependence on harmful substances Internet addiction is not as harmful as weakly manifests itself on a physical level.
I love my computerPrichiny of Internet addiction

K. Yang, exploring Internet addiction, found that they often use chat rooms (37%), MUDs (28%), teleconferencing (15%), E-mail (13%), WWW (7%), information protocols (ftp, goper) (2%). These network services can be divided into those associated with communication, and those with communication are not related, but are used to obtain information. The first group includes chat rooms, MUDs, newsgroups, e-mail, to the second - information protocols. Young notes that the study also found that Internet-independent use mainly to those aspects of the Internet, which allows them to gather information and maintain the previously established contacts. Addicted to the Internet primarily use those aspects of the Internet, to enable them to meet, socialize and share ideas with new people in cyberspace. That is, most Internet-dependent uses services associated with communication. Young distinguishes two groups among the Internet-dependent: hanging on communicating for the sake of communication (91%) and hanging on the information. At the same time according to the survey Web-dependent attracted by such features of networks, such as: anonymity (86%), accessibility (63%), safety (58%) and ease of use (37%).

Hence, the researcher concludes that Internet-dependent used the network for social support (through membership of a particular social group: participation in a chat or a teleconference) sexual gratification; possibility of creation of virtual character (a new "I") that produces a reaction others, obtaining recognition of others. Under the social support of the authors have in mind not just emotional support, but also a sense of belonging to a certain group of people, the establishment of useful contacts.

Social support in this case through the inclusion of rights in some social groups (IM, MUD, or teleconference) on the Internet. "Like any society, culture of cyberspace has its own set of values, standards, language, symbols, which are adapted to individual users."

According to Young, if enabled in the virtual group, Internet-dependent become able to take a greater risk of emotional expression by a contrary view of other people's opinions - about religion, abortion, etc. That is, they are able to defend their point of view, to say no ", to a lesser extent, fear of evaluation and rejection of others, than in real life. In cyberspace, can express their opinions without fear of rejection, confrontation or condemnation, because other people are less accessible, and because the identity of the device can be masked.

We have already cited a comparison of Internet addiction with other addictions, in particular from harmful substances. This comparison is not accidental, since the creation of certain kinds of relationships implies a certain type of personality. This personality type will be called dependent, since people with such traits are at risk with regard to substance abuse and psychological dependence on another person, depending on the food web of dependence. These features are an extreme lack of independence, not the ability to refuse to say "no" (that is called by people of weak will) because of fear of being rejected by others, vulnerability of criticism or disapproval, no desire to take responsibility and make decisions, and how consequence of the strong subordination important people, all of which characterizes a passive approach to life when a person refuses to first come into contact with others and make their own decisions. In addition, the dependent personality type characterized by fear of loneliness and the desire to avoid it, it is often social maladjustment, which is characterized by a narrow circle of contacts (possibly communicate with many people, but very superficial), no ability to express and share their experiences with others, not prosperity close relationships, impulsivity, no ability to plan your time, achieve your goals and plan their activities well (as a consequence may be the lack of permanent job). These people often refuse to previously set goals and as a consequence are in a state of depression.

Thus, thanks to communicate on the Internet, people are inclined to create dependency, compensate for their needs in communication and a sense of security.
www.go2bed.comPosledstviya Internet addiction

It should be noted that, compared with addiction to alcohol and drugs, Internet addiction, to a lesser degree of harm to human health, not destroy his brain and would seem to be quite safe, if not for the apparent decline of work capacity, performance in a real society. As a drug, communication on the Internet can create an illusion of prosperity, the apparent ability to solve real problems. Although studies show that Moscow psychologists, many Internet-dependent aware that will not get any real support in the network, and do not regard the Internet as a medium that ensures communication.

In medicine, known methods of treatment of withdrawal ("lomok" the common people), which develops within a few days after the rejection of the drug, say heroin, with transfer of patients to a "soft" drugs such as methadone. In this sense, for many alcoholics, drug addicts, smokers and other people who are prone to build strong relationships, the Internet has become more "light" drugs, and a chance to get rid of more serious relationships. I have known alcoholics and drug addicts who have reduced substance abuse, and many do refuse them, thanks to hours-long sessions on the web. That is, they have been replaced by a dependence on another. By the same principle work many methods of psychotherapeutic treatment of dependencies: replace the habit for more "environmentally friendly", safe. For example, in a group of anonymous alcoholics and drug addicts become addicted to communication in the group.

Also, Internet addiction is more "environmentally friendly" in comparison with the relations of religious sects, where people openly manipulated in order to establish power and material gain. It is known that members of these religious movements, monthly must sacrifice a certain amount of money, they gradually lose their own will and go crazy. So, a religious cult in this case is a masquerade, hiding the true intentions of the leaders. In sect also falls dependent, instilled in people.

So, due to its characteristics: anonymity, accessibility, invisibility, security, ease of use, the Internet provides an invaluable service to people suffering from addictions, allowing them to abandon the past, and at the same time can be harmful for adolescents and youth, who instead of socializing in the real world, find the time to socializing in virtual world. But who knows, may exist in parallel worlds - our future, and we are just preparing for life in other dimensions.

Pathological hoarding - the desire to accumulate various unnecessary things, expressed in such an extent that it prevents a normal life to the person, and often others. (However, the drives themselves usually do not notice.)

Often the person is a pity to throw an unnecessary thing, because it "might come in handy. In the village is not so bad, because there is always plenty of room to store stuff: barns, attics, etc. - finally, you can just throw stuff in the yard. In the city the same apartment from such things is quickly becoming crowded.

A more serious stage of pathological hoarding - when a person begins to actively collect all sorts of discarded things. Assembled well formed in the pile, that's all and end - usually no benefit from his "wealth" such collectors do not extract. Sometimes they steal unattended or forgotten things.

In Church Slavonic passion for collecting things called msheloimstvo, and Orthodox traditions is considered a sin. Sometimes it is jokingly called "the Elijah syndrome". Another name - sillogomaniya.