Background : antidepressants (ADs) are recognized as first-line drugs in the treatment of depressive disorder. However, therapeutic response is only achieved in 50–75% of cases, necessitating the search for additional treatment strategies, including augmentation of antidepressant therapy. In this connection the study of atypical antipsychotics as adjunctive therapy, including cariprazine, is of particular interest. Numerous studies have demonstrated its efficacy and safety in the treatment of schizophrenia, bipolar affective disorder type 1, as well as major depressive disorder (MDD). At the same time its impact on MD symptomatic domains remains insufficiently studied. The Aim of review was to search for and analyze current data on the trans-symptomatic effect of cariprazine in MD treatment. Materials and Methods : The search was carried out using keywords and their combinations depending on the special features of search algorithms of scientific electronic databases PubMed, Google Scholar, Cyberlenika, ELibrary.ru. Results : in accordance with the developed criteria for inclusion and non-inclusion of publications in the study, 7 works devoted to the assessment of the efficacy and safety of cariprazine in MD patients with an insufficient response to antidepressant monotherapy were included in the final analysis. Conclusions : A literature review demonstrated the potential of cariprazine use in MD patients with insufficient response to antidepressant therapy. Data on the effects of cariprazine on individual symptoms of depression were obtained, allowing psychiatrists to make more informed decisions when selecting an antipsychotic for augmentation, based on a thorough psychopathological assessment of the patient's condition. In this case, it seems promising to study the relationship between the dosage of cariprazine and the severity of individual symptomatic effects, as well as to determine the optimal dose, taking into account the balance of efficacy and tolerability.
Background : previously, we identi ed interactions between microglia and oligodendrocytes in the prefrontal cortex in continuous schizophrenia (CSch). Aim of study : to examine ultrastructural changes in microglia and oligodendrocytes in contact with each other within the head of the caudate nucleus using post-mortem brain samples from patients with CSch compared to controls and patients with attack-like schizophrenia (ASch) and to identify associations between oligodendrocyte and microglial parameters across the study groups. Material and Methods : An electron-microscopic morphometric study of microglia and oligodendrocytes in the head of the caudate nucleus was conducted on autopsy material comprising 9 CSch samples, 10 Asch samples and 20 control samples from individuals without psychiatric pathology. Group comparisons were made by ANCOVA and Pearson correlation analyses. Results : A reduced numerical density of microglia was observed in the CSch compared to the control and ASch; reduced mitochondrial volume fraction and number were found in both groups, while an increased number of lipofuscin granules in microglia was noted in the CSch group compared to controls. In oligodendrocytes, an increased number of lipofuscin granules was found in the CSch, and reduced mitochondrial volume fraction and number were observed in both groups compared to the control group. The mitochondrial volume fraction in oligodendrocytes correlates positively with the number of mitochondria in microglia in the CSch and control groups. The volume fraction of lipofuscin in oligodendrocytes correlates positively with the number of lipofuscin granules in microglia in CSch. In this group, microglial nuclear area correlates positively with disease duration, whereas the areas of oligodendrocytes and their nuclei correlate negatively with it. Conclusion : Reduced energy metabolism and energy potential within microglia and oligodendrocytes may underlie the diminished reactivity of these cells in the caudate nucleus in CSch and ASch.
Background : it remains unclear whether religiosity in depressive-delusional states represents exclusively a pathoplastic factor or whether the patterns of its changes at different stages of the disease constitute an independent prognostic marker. The Aim was to identi cate patterns of religiosity transformation at various stages of the course of endogenous disorders accompanied by religious-depressive-delusional syndrome (RDDS), and to substantiate their differential diagnostic and prognostic signi cance. Patients and Methods : a total of 104 patients with endogenous mental disorders (F31.5, F33.3, F25.1, F20.01, F20.0 on ICD-10) with clinical picture RDDS were included. There are two groups of patients: a clinical group (n = 58) and a follow-up group ( n = 46; mean follow-up period 12.24 ± 2.7 years). Three typological variants of RDDS were identi ed: Type I (with predominance of affectcongruent depressive delusions) — 22 cases (21.2%), Type II (with acute sensory delusions) — 36 patients (34.6%). Type III (with predominance of Kandinsky–Clérambault syndrome) — 46 (44.2%) cases. Religiosity at the pre-manifest stage was assessed using the history analysis ( n = 58) based on G. Allport's religious orientation concept and C.Y. Glock's multidimensional model. The Centrality of Religiosity Scale (CRS; S. Huber) and the Religious Coping Scale (K. Pargament) were applied in remission and follow-up stages ( n = 46). Clinical-psychopathological, clinical-follow-up, psychometric, and statistical methods (χ 2 , Cramér's V) were used. Results : type-speci c patterns of religiosity dynamics were closely associated with disease follow-up outcome. Stable harmonious hyperreligiosity with a protective function developed (mean CRS score 4.1 [3.89; 4.37]) in Type I. Bidirectional changes in religious worldview were observed in Type II: in some cases religiosity declined (CRS subtype 1: 3.4 [3.33; 3.47]), in others it intensi ed (subtype 2: 4.1 [4.0; 4.2]). Pathological “patchwork” religiosity was found in Type III (CRS 4.48 [4.47; 4.6]), intricately associated with residual productive symptomatology. A statistically signi cant association was established between RDDS type and both the pattern of religiosity dynamics (χ 2 = 38.38; p < 0.001; V = 0.655) and follow-up outcome (χ 2 = 28.25; p < 0.001; V = 0.6). Conclusion : religiosity in religious depressive-delusional syndrome represents not only a pathoplastic factor determining the content of psychopathological experiences, but may also be regarded as a clinically signi cant indicator associated with the type of disease course and outcome, which substantiates the necessity of differentiated therapeutic management.
Background : The Dark Tetrad (DT) is accompanied by moral, aesthetic and sexual dysfunctions. Sexual crimes represent a serious psychological and social problem that continues to be a devastating challenge. Childhood emotional abuse and family dysfunction, behavioral problems, and sexual abuse are common risk factors for the development of paraphilias (PA) in adulthood. The question of identifying the connection between the manifestations of DT and disorders of sexual preferences in adults remains relevant. The Aim of review was to study scienti c publications identifying the mutual connections between manifestations of the Dark Tetrad of personality and paraphilic interests. Materials and Methods : search and analysis of domestic and foreign literature on the problem was provided on the websites PubMed, PubMed Central and elibrary.ru using keywords DT, paraphilias. Pseudo Paraphilias were not considered in the review. Conclusions : the correlation between behavior in various paraphilias, DT traits, and impulsivity as predictors of involvement in paraphilic behavior was assessed using domestic and international publications. Men showed greater interest in all paraphilias except masochism. The most common are sadism, masochism and voyeurism. A reciprocal relationship was found between paraphilic interests and DT traits. High scores on Machiavellianism are associated with lower involvement in voyeurism, exhibitionism, and sadism. Psychopathy predicts frotteurism, transvestic fetishism, scatophilia, hebephilia, pedophilia, and zoophilia. Sadism predicts the development of fetishism. Narcissism positively predicts involvement in both exhibitionism and voyeurism. Functional impulsivity signi cantly correlates negatively with both exhibitionism and transvestic fetishism. Dysfunctional impulsivity is included in the study as a signi cant predictor of voyeurism, scatology, and urophilia. Manifestations of DT lead to the development of disorders of sexual preferences. When assessing individuals with DT characteristics, it is necessary to identify A patient history of sexual preferences.
