Background : although treatment adherence in first-episode psychosis (FEP) recognized as a key prognostic factor and has been extensively examined in its quantitative aspects, existing studies largely lack a clinical and psychopathological typology of therapeutic behavior. The relationships between the structure of insight, cognitive characteristics, and psychopathological manifestations—factors that determine qualitatively distinct forms of adherence—remain insuficiently explored. The aim of study was to develop and empirically validate a clinical-psychopathological typology of treatment adherence in patients with FEP. Patients and Methods : the study included 123 patients aged 18 to 40 years diagnosed with schizophrenia (F20 on ICD-10). Assessments included the PANSS, CDSS, BCIS, MARS, the Proportion of Days Covered (PDC), and the PSP scale. Results : a typology of treatment adherence identified adaptive type (24%) characterized by developed insight, strong therapeutic persistence, and high adherence (MARS ≈ 9.1; PDC ≈ 93%). Maladaptive type (76%) subdivided into three subtypes. Hyper-reflective/manipulative subtype characterized excessive symptom focus, elevated self-reflection (BCIS ≈ 16.4), with hidden instability of treatment behavior. Ambivalent rationalizing subtype differs with partial awareness of illness, rationalization tendencies, and reduced adherence during outpatient care (MARS ≈ 4.7; PDC ≈ 74%). Resistant anosognosic subtype shown marked illness denial, extremely low adherence (MARS ≈ 1.4; PDC ≤ 35%), and high risk of treatment discontinuation (OR = 6.5 vs. adaptive type). Typological differences indicate that the structure of insight and psychopathological features are closely linked to therapeutic persistence and withdrawal from therapy risk. Conclusions : the proposed clinical-psychopathological typology differentiates patients by treatment discontinuation risk and provides a framework for targeted psychoeducational, pharmacological, and rehabilitative interventions. Distinguishing one adaptive and three maladaptive subtypes supports the implementation of personalized care strategies in FEP, with the potential to enhance long-term treatment outcomes and improve prognosis.
Background : the characteristics of negative symptoms of drug-induced psychotic disorders (PD) caused by narcotic substances (NS) remain incompletely understood, which impedes the differential diagnosis with schizophrenia . The aim was to compare the presentation and severity of negative symptoms after psychotic disorders induced by the narcotic substances and schizophrenic psychosis in determining their significance for differential diagnosis. Patients and Methods : an observational cross-sectional study was conducted involving 141 patients, who were divided into 4 groups: 1) 21 patients with PD caused by natural cannabinoids; 2) 56 patients with PD induced by the synthetic cathinones; 3) 29 patients with PD induced by the several NS; 4) 35 patients with schizophrenia. Negative symptoms were assessed using the CAINS clinical interview, adapted for the Russian-speaking population. Statistical analysis included nonparametric methods of comparing multiple groups and subsequent post hoc analysis. Results : patients with schizophrenia had statistically significantly more pronounced negative symptoms on the emotional expressiveness subscale compared to all groups of narcotic-induced psychoses (p < 0.001). According to the CAINS total score, patients with schizophrenia differed signficantly from the synthetic cathinones-induced PD and several narcotic-induced PD groups (p < 0.001), but not from the natural cannabinoids-induced PD group (p = 0.47). Patients with natural cannabinoids-induced PD demonstrated the most pronounced negative symptoms among all groups of narcotics-induced psychoses, which were similar to schizophrenia in all areas, except emotional expressiveness. The synthetic cathinones-indused PD and several narcotic-induced PD groups were characterized by significantly less pronounced anticipatory negative symptoms and better motivation in the social, professional, and recreational spheres than patients with schizophrenia. Conclusion : significant differences in the profile of negative symptoms between psychotic disorders induced by different NS were identified. PD induced by natural cannabinoids were the closest ones to schizophrenia in the severity of negative symptoms, which is clinically significant for differential diagnosis and planning rehabilitation measures.
The article analyzes the limitations of the dominant psychosomatic paradigm in modern psychiatry and general medicine. Based on epidemiological data and a critical review of theoretical foundations, the necessity for a new integrative model — “non-psychiatric psychiatry” — is substantiated. The concept focuses on the cerebral unity of mental and somatic functions as the subject of research, proposing a revision of diagnostic and therapeutic approaches in the context of increasing psychosomatic pathology in primary healthcare.
Background : the complexity of the pathogenesis of alcohol dependence is due to the specific effect of ethanol on brain structures with the formation of dependence and toxic effects on systems and organs, accompanied by inflammation and somatic pathology. The possibility of using the ratios of neutrophils, lymphocytes and platelets as markers of inflammation, information on the content of which can be obtained by routine methods of a complete blood count, are discussed in literature. The aim was to study the level of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII) in patients with alcohol dependence, obtained on the basis of a complete blood count, and to assess their relationship with the duration of the disease and somatic burden. Patients, control group : 95 men aged 30–60 years with the ICD-10 diagnosis of Mental and behavioral disorders due to alcohol use (dependence syndrome — F10.21 and withdrawal syndrome — F10.30) and 26 conditionally healthy men were examined. Methods : clinical blood analysis was performed on BC-3600 hematology analyzer. Blood was taken from patients after alcohol detoxification. Based on the absolute values of individual's hemogram, the NLR, PLR, and SII were calculated. Results : in patients with alcohol dependence, in relation to the control group, the platelet count was reduced, the NLR value was increased. The greatest increase in NLR was found in the group of patients with disease duration of more than 10 years, with combined somatic pathology of 3–4 body systems. Patients with SII 500 and above were characterized by the greatest somatic burden. Conclusion : the most significant marker of inflammation in alcohol dependence is NLR; SII above 500 can be used to stratify patients with severe somatic burden, prescribe an in-depth examination and adequate treatment at the early stages of hospitalization.
Background : depressive disorders are associated with reduced quality of life and impaired social functioning, with social anhedonia considered a key component of depression and as a factor of unfavorable course and prognosis. At the same time, there is limited evidence on how cognitive behavioral therapy (CBT) specifically affects social anhedonia and related quality of life indicators assessed by the SF-36, as well as on how changes in social anhedonia relate to the dynamics of depressive symptoms and subjective quality of life. The aim of study was to evaluate the clinical and psychological effectiveness of CBT in depression by analyzing changes in social anhedonia and quality of life, and to examine their interrelationships. Patients and Methods : this prospective study included 56 patients (34 in the CBT group and 22 in comparison group) receiving outpatient or inpatient care. The main group underwent short-term group CBT in combination with pharmacotherapy. The attention-control group received pharmacotherapy and regular supportive meetings perceived as a therapeutic intervention, but without the use of a CBT protocol. Clinical and psychological measures (MADRS, RSAS, and SF-36) were assessed before and after treatment. The analysis included within-group and between-group comparisons and correlation analyses (p < 0.05). Results : in the CBT group, MADRS scores decreased significantly from 30.4 to 14.8 (Δ = −15.6; p < 0.001); 55.9% of patients achieved a clinical response and 29.4% achieved remission. In the control group, the reduction was limited (Δ = −2.4; p = 0.011), with no responses or remissions. Social anhedonia (RSAS) decreased in the CBT group from 19.44 to 14.53 (p < 0.001) and showed no significant change in the control group. Quality of life assessed by the SF-36 improved predominantly in the CBT group. A greater reduction in social anhedonia in the CBT group was associated with increases in the mental component summary (MCS) (ρ = −0.54), mental health (MH) (ρ = −0.46), and physical component summary (PCS) (ρ = −0.42). Conclusions : CBT is associated with a reduction in depressive symptoms, a decrease in social anhedonia, and improvements in quality of life. Changes in social anhedonia are more strongly related to improvements in quality of life than to changes in depression severity, highlighting social anhedonia as an additional relevant clinical outcome.
Background : systemic inflammation plays a central role in pathogenesis of unipolar depression. In most studies focusing on inflammatory markers, unipolar depressive disorders are regarded as a single nosological category without subtype differentiation although the extent to which inflammatory mechanisms are involved varies across syndrome-based subtypes. Genetic polymorphisms affecting the expression of pro- and anti-inflammatory cytokines IL-4, IL-10, IL-6, IL-1B and C-reactive protein (CRP) may determine the syndrome-based structure of unipolar depressive disorders. The aim of study was to investigate functionally significant single-nucleotide polymorphisms (SNPs) of IL-4, IL-10, IL-6, IL-1B and CRP genes in patients with unipolar depressive disorders and their potential associations with syndrome-based subtypes. Patients, Materials and Methods : the study enrolled patients aged 18–65 years with a verified diagnosis of unipolar depression (ICD-10 codes F32, F33, F34.1, DSM-5 codes 296.2, 296.3, 300.4) who were they undergoing treatment from May 2021 to April 2024. Genetic analysis was conducted at the Laboratory of Clinical Genetics of the FSBSI “Mental Health Research Centre”. The allocation to each syndrome-based subtype was carried out in line with the leading symptoms according to ICD-10 and DSM-5 criteria (melancholic, atypical and anxious). Genotyping was performed using the High-Resolution Melting method (HRM) run on the Applied Biosystems QuantStudio 7 Flex Real-Time PCR System (ThermoFisher, the US). Statistical analysis was conducted using the R software. Results: a total of 93 patients ( n = 93) were divided into three groups by syndrome-based subtype: melancholic (n = 34; 36.5%), atypical ( n = 19; 20.4%) and anxious ( n = 40; 43%). The A-allele of IL-10 ( rs1800872 ) was associated with the melancholic subtype (OR = 1.95, adjusted р = 0.0247). The C/C genotype of IL-4 ( rs2243250 ) and the A/A genotype of CRP ( rs2794521 ) were both associated with the atypical subtype (OR = 3.61, adjusted p = 0.0121 and OR = 3.35, adjusted p = 0.0037, respectively). The anxious subtype was associated with the T/T genotype of IL-4 ( rs2243250 ) as well as the C/C and the C/G genotypes of IL-6 ( rs1800795 ). Notably, carriers of the IL-6 ( rs1800795 ) genotypes were either at a higher or a lower risk of developing anxious depression depending on their ethnicity (OR = 6.33; adjusted p = 0.013; OR = 0.004, adjusted p = 0.006). None of the syndrome-based subtypes were associated with the IL-1B rs16944 polymorphism. Conclusions : genetic polymorphisms of IL-10, IL-4, IL-6 and CRP were shown to be significantly associated with the melancholic, atypical and anxious subtypes of unipolar depression. Further research into these polymorphisms may contribute to the development of personalized diagnostic strategies and treatments for patients with unipolar depressive disorders.
Background: the problem of studying certain aspects of the quality of life of patients with mental disorders, including the neurotic spectrum, remains insufficiently disclosed. The level of quality of life is influenced by various factors, one of which is the nature of intra-family relationships, which largely depends on the indicators of social functioning. The aim was to identify and analyze indicators of social functioning that undergo changes against the background of the development of neurotic spectrum disorders and have an impact on intra-family relationships. Patients and Methods : a simultaneous prospective comparative study of individual aspects of social functioning affecting family relationships of patients with neurotic spectrum disorders before and after the development of neurotic pathology was conducted. The research material was data from an anonymous voluntary survey of 500 patients with diagnoses according to the International Classification of Diseases 10th revision (ICD-10) — F40–F48; F32; F06. A specially designed questionnaire was used, which included blocks for assessing family status, work, financial situation, fear of stigmatization, and the specifics of seeking specialized help. Results : against the background of the development of a neurotic mental disorder, the divorce rate increased 3-fold, and the level of conflict in families increased significantly. The deterioration of the financial situation due to the forced transition to a job with a lower salary was subjectively associated with an increase in the number of family conflicts in 69.4% of cases. A pronounced fear of intra-family stigmatization was noted by 31.2% of patients, while external stigmatization was noted by 39.6%. More than a third of patients (36%) first sought specialized psychiatric help only 2 years or more after the onset of the disease. One of the main reasons of late referral was the fear of stigmatization due to their disorder. Conclusion : indicators of social functioning such as marital status, financial status, and fear of stigmatization of an existing neurotic disorder show significant dynamics and are closely related to the nature of intra-family relationships in patients with neurotic spectrum disorders. Studying the specific effects of neurotic spectrum disorders is important for developing an integrated approach to therapy and rehabilitation.
Background : cyberbullying is one of the most prevalent forms of aggression in the digital environment, particularly among adolescents and young adults. Contemporary research demonstrates a direct association between involvement in cyberbullying and the development of a broad range of mental health disorders. The Aim was to systematize scientific publications on the typology, prevalence, risk factors, and psychological consequences of cyberbullying. Materials and Methods : a narrative review of 106 publications from 2015 to 2025 was conducted using the PubMed, Google Scholar, and eLibrary databases. The review included original studies, meta-analyses, and systematic reviews focusing on the epidemiology, psychological and behavioral predictors, diagnostic methods, and mental health consequences of cyberbullying. Results : cyberbullying demonstrates high prevalence rates, ranging from 2.8% to 57.5% across different populations. The primary risk factors for involvement include anxiety, depression, impulsivity, adverse family environments, and low levels of social support. The most severe consequences include depression, post-traumatic stress disorder (PTSD), suicidal tendencies, and self-harming behavior. Diagnostic methods involve both self-report questionnaires (e.g., COASI, CATQ) and machine learning systems, including neural network models. Conclusions : cyberbullying is a multifactorial psychosocial phenomenon with a significant impact on mental health. Effective prevention requires an interdisciplinary approach that includes digital literacy, social support, and early psychotherapeutic intervention.
Background : metabolic changes involved in the pathogenesis of late-life depression are associated not only with clinical heterogeneity of depressions, but also with responses to antidepressant therapy and its tolerability. The Aim was to study of the possibility of using models of enzymatic activity of energy, antioxidant and glutamate metabolism in late-life depression as additional biochemical predictors of the effectiveness and tolerability of antidepressant therapy. Patients and Methods : 50 hospitalized patients aged ≥ 60 years with a depressive episode of different diagnostic categories according to ICD-10 (F33.0–F33.3; F31.3–F31.4; F32.0–F32.2) who received 28-day antidepressant therapy were examined using clinical, psychometric and biochemical methods. The effectiveness and tolerability of therapy were compared in patients with “reduced” antioxidant and energy metabolism (44.2% of cases), with “multidirectional” enzymatic activity with reduced antioxidant, increased energy and glutamate metabolism (21.2%), and with “normal” metabolism (34.6%). The efficacy criteria were: response rate (50% reduction in baseline HAMD-17 score), change in mean HAMD-17 total score, and complete remission rate (≤ 7 points on HAMD17). Tolerability was assessed by the number, types and severity of side effects. Statistical analysis was performed using the Mann-Whitney U test and the χ 2 coefficient. Results : all patients with “normal” enzymatic activity were responders with a low incidence of side effects (25% of cases). Patients with “reduced” metabolism had a high frequency of acute side effects (73.9%, p < 0.01), while patients with “multidirectional” metabolism had a low degree of response to therapy (63.6%, p < 0.01). Patients in the last two groups are recommended additional therapy with antioxidants and neurometabolic drugs with stimulating or balancing action. Patients with “multidirectional” metabolism are also indicated for GABA-ergic drugs or “fast” glutamatergic antidepressants. Conclusion : models of enzymatic activity of antioxidant, energy and glutamate metabolism may, along with clinical characteristics, be additional predictors of the effectiveness and tolerability of antidepressant therapy. Their definition can be the basis for personalized indications for the administration of different types of adjuvants neurometabolic therapy inelderly depressive patients.
Background: the involvement of immune system in the development of affective disorders and alcohol dependence is recognized widely, while the contribution of immunoinflammation to the pathophysiology of combined forms of affective and addictive disorders remains insufficiently studied. The aim of this work was to investigate the clinical and dynamic features and to study the concentration of cytokines IL-1α, IL-1β, TNFα, IL-10, IL-13, TGFα in peripheral blood mononuclear cells of patients with alcohol dependence syndrome, affective disorder and comorbidity of alcohol dependence and affective disorder. Patients and Methods : 86 patients with alcohol dependence syndrome and affective disorders (F10.2, F31.3-31.5, F32, F33, ICD10) were examined. The SIGH-SAD, CGI and HARS scales were used. The concentration of cytokines in lysates of peripheral blood mononuclear cells was determined using the Magnetic Lumine Assay Kit (Cloud-Clone Corp., China) and xMAP Technology on a Magpix analyzer (Luminex, USA). Results : the lowest severity of the disease characterized the patients with isolated alcoholism, while the longest duration of both affective and alcoholic diseases, the severity of the disease, and the intensity of anxiety disorders were found in patients with comorbidity of disorders. Patients are characterized by the increase of cytokines IL-1α and IL-1β in patients with isolated affective and addictive disorders. Patients with comorbidity of disorders are distinguished by a decrease in the content of the studied proand anti-inflammatory cytokines. Conclusion : the conducted study revealed features in the clinical dynamics and spectrum of cytokines in patients with alcohol dependence, affective disorders and their comorbid course.
Background: instrumental assessment of hazardous alcohol use risk in patients with anxiety disorders studied insufficiently . The aim of study was to develop a software prototype for personalized assessment of the risk of hazardous alcohol consumption in patients with anxiety disorders based on machine learning and vibe -coding methods. Patients and Methods: the work analyzed data from 120 patients with episodic (group 1) and generalized (group 2) anxiety, divided into subgroups by the level of alcohol consumption. Using scales, key psychological markers were identified: the level of neuroticism, preventive and proactive coping. Results : based on these parameters, a binary logistic regression model with high predictive accuracy (AUC-ROC = 0.991) was built, allowing for a quantitative assessment of the likelihood of risky behavior. The prototype, developed using vibe-coding, implements a graphical interface for automating data collection, risk calculation using the model formula, and visualization of the results. The tool combines clinical interpretability and technical accessibility, allowing doctors and medical psychologists without programming skills to promptly assess risk in real time. The solution facilitates early detection of risk groups, personalization of therapy, and reduction of relapse rates. Conclusion : the importance of digital technologies in psychiatry and medical psychology is confirmed, but require further validation on representative samples and integration into telemedicine platforms. Future research should focus on improving the interpretability of AI models, ensuring data privacy, and expanding the functionality for monitoring autonomic responses via wearable devices.
Background : hyperprolactinemia is common in patients with mental disorders receiving antipsychotics. Cabergoline therapy for normalizing prolactin in these patients has been found to be effective. Cases of prolactin-secreting pituitary adenomas resistant to cabergoline have been described in the literature. Clinical observations of antipsychotic-induced/antipsychoticassociated hyperprolactinemia resistant to cabergoline therapy are rare in scientific publications. The aim of the study was to describe clinical cases and justify treatment approaches to hyperprolactinemia, associated with antipsychotics and resistant to cabergoline therapy. Patients and Methods : the study involved female patients with endogenous mental disorders undergoing inpatient treatment. Clinical, psychopathological, and laboratory examination methods were used. Case description: Case 1 — a 23-year-old female, mentally ill since the age of 17, was twice treated in mental hospitals for a depressive state within the framework of schizotypal disorder. A severe course of depression with a high risk of suicide and clear resistance to drug therapy was noted; a course of ECT was administered. The therapeutic effect was achieved through the use of antipsychotics, but an increase in prolactin levels was detected. Hyperprolactinemia was accompanied by weight gain, lactorrhea, and hair loss. Cabergoline at a dose of 3.5 mg per week was ineffective. With the correction of antipsychotic therapy, the level of prolactin in the blood returned to normal. Case 2 — a 37-year-old female, mentally ill since the age of 19, was repeatedly treated in mental hospitals for hallucinatory-delusional symptoms. Chronicity of the disease and pronounced resistance to drug treatment were noted. A course of ECT was administered to overcome resistance. Prescription of antipsychotics resulted in a significant reduction in hallucinatory-delusional symptoms and improvement in the patient's quality of life; however, the development of hyperprolactinemia was detected. Cabergoline at a dose of 3.5 mg per week was ineffective. Hyperprolactinemia was virtually asymptomatic (including the absence of hypogonadism), cabergoline was terminated, and psychopharmacotherapy was continued according to the previous treatment regimen. Conclusion : if cabergoline 3.0 mg/week is ineffective, antipsychotic-induced/ antipsychotic-associated hyperprolactinemia may be considered cabergoline-resistant. The choice of treatment tactics in this case should be carried out individually, taking into account the clinical manifestations of hyperprolactinemia, a comprehensive analysis of laboratory parameters, and the specificities of the course of the mental disorder.
Background : comorbid schizophrenia spectrum disorders and substance use disorders are associated with more severe illness course, frequent rehospitalizations, reduced quality of life, poorer social functioning, and worse prognosis. This study compared comorbid inpatients based on predominant symptom clusters. The aim of study was to investigate the relationship between the predominant psychopathological syndrome in hospitalized patients with schizophrenia spectrum disorders and substance use disorders and key clinical parameters: 1) achieving substance use remission; 2) treatment adherence. Patients and Methods : 188 patients with schizophrenia spectrum disorders and comorbid substance use disorders admitted to Psychiatric Clinical Hospital No. 1 named after N.A. Alexeev (Moscow, Russia) were examined. Mean age was 34.9 ± 9.9 years; 79.8% (n = 150) were males. Clinical and psychopathological (clinical examination and medical records) and statistical methods were used. Results : mean age was 34.9 ± 9.9 years; 79.8% (n = 150) were males. The diagnosis “Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances” predominated (n = 81, 88.05%) with opioids, cannabinoids, stimulants, and cocaine being the most used substances. The remission rate for substance use differed significantly (p < 0.001): it was 74.1% (n = 43) in cases with hallucinatory-paranoid syndrome, and 6.9% (n = 4) in cases with Psychopathy-like syndrome. Active substance users more frequently avoided taking maintenance therapy (47.3%, n = 44) (p < 0.001). A significant association exists between predominant psychopathological syndrome, substance use disorders course, and adherence. Pseudopsychopathic syndrome predicts the worst outcomes: significantly lower substance use disorders remission rates, poorer adherence. Hallucinatory-paranoid syndrome correlates with higher remission likelihood and better adherence. Conclusion : predominant psychopathological disorders critically impact relapse risk and treatment adherence. Rising comorbidity prevalence underscores the need for integrated treatment strategies involving addiction specialists.
Background : existing tools for assessing depression do not take into account its contextualized nature. One of the prevailing spheres of human activity is labor activity, which may cause the occurrence of depression associated with professional activity. Occupational depression is a depressive state associated with chronic work stress. Because occupational activity may be a significant factor in the development of depressive symptoms, the Occupational Depression Inventory (ODI) was developed to assess context-related depression, but it requires a comprehensive evaluation of its psychometric properties. The aim of study was to systematically review the psychometric properties of the ODI based on existing research articles. Materials and Methods : a systematic literature search and selection was conducted in the following databases: Lens.org, PubMed, OpenAlex, Crossref, Microsoft Academic, JSTOR, ScienceDirect, and Google Scholar. 246 publications were retrieved for preliminary screening. After screening and validation against inclusion/exclusion criteria, 16 publications were selected assessing the psychometric properties of the ODI on a sample of a total of 17 290 respondents from 15 countries in 10 different languages. Results: ODI is a valid and reliable tool for diagnosing work-related depression in many countries. The ODI demonstrates cross-cultural invariance, clinical relevance to current diagnostic standards, and functionality in different technical settings of psychological diagnosis. Conclusion: the ODI is a promising tool for screening occupational depression in research practice. Studies of prognostic validity, test-retest reliability, and adaptation for different occupational groups are needed to expand clinical application.
Background : psychogenic stress is one of the key modifying factors in the pathogenesis of chronic dermatoses. Contemporary research data indicate a bidirectional relationship between stress and skin diseases, mediated through neuro-immuno-endocrine mechanisms in which the skin functions as a peripheral stress-reactive organ. Despite numerous observations, factors determining patients' vulnerability to various types of stressogenic triggers of chronic dermatoses remain insufficiently investigated. The aim was to identify personality vulnerability factors in patients with stress-induced dermatoses in order to determine potential targets for psychocorrective interventions. Patients and Methods: a single-center cross-sectional study was conducted involving 115 patients (76 women, 39 men; mean age 47 years) with dermatoses that had manifested within three months following a stressogenic event. The examination included dermatological and psychopathological assessments, as well as psychometric and statistical tools: GAD-7, PHQ-9, PSS-10, DLQI, PID-5-BF, and IBM SPSS v.27. R e su l t s : dermatosis manifestation was associated with subjectively significant stressors in 72.9% of cases, while in 27.1% it was linked to objectively significant ones. Subjective triggers were most frequently reported in lichen planus (92.6%), eczema (86.2%), and rosacea (80%). Patients exposed to subjectively significant stressors demonstrated higher levels of anxiety and depression (GAD-7: 7.5 ± 5.4 vs. 6.5 ± 4.6; PHQ-9: 8.2 ± 4.7 vs. 5.4 ± 3.5, p < 0.05), perceived stress (PSS-10: 36.5 ± 8.8 vs. 27.3 ± 6.7, p < 0.05), pathological personality traits (PID5-BF: 42.7 ± 12.6 vs. 29.6 ± 11.4, p < 0.05), and a greater negative impact of the dermatosis on quality of life (DLQI: 18.4 ± 7.4 vs. 14.1 ± 8.2, p < 0.05). Conclusion: the findings demonstrate the predominance of subjective psychogenic determinants in the structure of stress-induced dermatosis manifestations. Among the identified stress vulnerability factors were features of the premorbid personality and somatoperceptive accentuation. These results underscore the need for integrating comprehensive clinical and psychometric assessment, along with psychocorrective approaches, into the standard management of patients with stress-induced forms of chronic dermatoses.
Background : tic disorders remain one of the urgent problems of child psychiatry due to their high prevalence, phenotype variability and the risk of school maladaptation. Comorbid psychopathology (primarily anxiety disorders and obsessive-compulsive disorder) modifies the clinical picture and determines the choice of a rational therapeutic strategy. The Russian-language literature does not sufficiently provide standardized approaches to early nosological verification, psychometric stratification of severity and functional deficiency, as well as algorithms for personalizing therapy based on comorbidity. The aim of study was to demonstrate the clinical heterogeneity of various forms of tic disorders and comorbid mental disorders in these patients using the example of a series of clinical cases. Patients and Methods : the article demonstrates clinical observations of three patients with tic disorders and comorbid mental deviations. Clinical-psychopathological, clinical-dynamic research methods were used to study the clinical manifestations of diseases in patients. Results : the presented clinical cases illustrate the clinical heterogeneity of tics, the features of the semiotics and severity of tics in various nosological forms of tic disorders in children and adolescents. Concomitant disorders such as anxiety disorder and obsessive-compulsive disorder have been demonstrated in patients with chronic tics and Gilles de la Tourette syndrome. Conclusion : The reviewed clinical observations show that a structured phenomenological and psychometric assessment of tics in children and adolescents increases the accuracy of early nosological verification. It has been established that comorbid anxiety-obsessive symptoms are a determining factor in the stratification of therapy. An approach to personalized psychopharmacotherapy based on the severity of tics and comorbidity profile is proposed, which forms a practical decision-making algorithm.
Background : the expression alteration of the HLA-G gene encoding the human leukocyte antigen G presumably impairs embryonic development and thus increases schizophrenia risk. Prior studies found the associations of the HLA-G rs371194629 (14bp INDEL) polymorphism with the disease risk and social functioning of patients. This work continued to explore the contribution of the rs371194629 polymorphism to key schizophrenia syndromes, presumably reflecting neurodevelopmental disorders. The aim was to assess the association of cognitive deficits and autistic traits with the rs371194629 polymorphism and the role of these phenotypes as mediators of the relationship between rs371194629 and social functioning in schizophrenia patients. Patients, Participants and Methods: the sample included 555 psychotic patients with schizophrenia spectrum disorders and 261 healthy subjects who underwent cognitive testing. In addition, the PAUSS as measure of autism trait severity was calculated for patients. Covariance analysis and structural equation modeling were applied to assess the association of cognition and autistic traits with rs371194629 and the potential role of these syndromes as mediators between genotype and social functioning measured with the Personal and Social Performance Scale . Results: the analysis revealed a nominally significant association of the DelDel genotype with reduced cognitive functioning in schizophrenia male patients ( p = 0,022). The rs371194629 polymorphism was not associated with the severity of autistic traits. The cognitive deficits and autistic traits were not mediators of the rs371194629 effects on social functioning. Conclusions: the results suggest the contribution of the HLA-G gene polymorphism to the severity of cognitive impairment in schizophrenia and are consistent with prior data that revealed the sex-dependent association of rs371194629 with schizophrenia and the relationship of the DelDel genotype with a less favorable disease course in the Russian population.
Background : the issues of diagnosis and prevalence of infectious complications (ICs) in patients with mental disorders remain insufficiently studied. Diagnosing ICs in this population is challenging due to poor patient cooperation, atypical presentation of infections, and masking of symptoms by the underlying psychiatric illness. Classical markers of infection are often non-specific or lack sensitivity, highlighting the need for more reliable diagnostic and prognostic criteria. The aim of study was to investigate the incidence and clinical-laboratory features of ICs in psychiatric patients to develop specialized algorithms for early diagnosis and treatment. Patients and Methods : a retrospective, non-interventional study was conducted based on the analysis of the “CLIOPS” database. The study included 727 patients (385 men and 342 women; mean age 62 ys), divided into two groups: without IC (n = 360) and with IC (n = 367). Anthropometric, demographic, clinical, and laboratory data were analyzed. Results : the most vulnerable group were patients with organic mental disorders (52.9% of all patients with ICs). The leading ICs were pneumonia (59.7%) and urinary tract infections (13.9%). Patients with IC had significantly more frequently: longer hospitalization, higher Waterlow scale scores, elevated CRP levels (99.2% vs 0.8%), leukocytosis (82.6% vs 55.8%), and changes in psychotic status (9.3% vs 1.7%). Fever was absent in 35.6% of patients with ICs. The strongest predictors of IC were: elevated CRP (OR = 50.2), fever > 38 °C (OR = 40.9), and altered mental status (OR = 6.02). Conclusion : diagnosing IC in patients with mental disorders requires a comprehensive approach due to the frequent absence of classic symptoms. The most significant markers of IC are elevated CRP and sudden decompensation of mental state. The lack of productive communication with the patient is a key factor complicating diagnosis. It is necessary to implement targeted screening algorithms for at-risk groups (patients with organic mental disorders), mandatorily including CRP testing and thorough assessment of mental state for early infection detection and therapy initiation.
Background: depressive symptoms often accompany schizophrenia, changing the severity and perception of its main clinical manifestations. The severity of psychopathological symptoms affects the course and development of the disease. Genetic studies have revealed a partial overlap of genetic risk between schizophrenia and depressive disorders. Objective: to find out whether the genetic associations of the severity of positive and negative symptoms of schizophrenia differ in patients with and without depressive symptoms. Patients and Methods: a comparative cross-sectional study of patients with schizophrenia was conducted. The study participants belonged to one of three ethnic groups: Russians, Bashkirs, and Tatars. The study included 390 patients, of whom 124 (31.8%) had signs of depressive disorder. The assessment of depressive symptoms was carried out using the CDSS scale. The PANSS scale was used to assess the severity of psychopathological symptoms. The following polymorphisms were selected to determine the genetic associations: MTNR1A rs34532313, MTNR1B rs10830963, CLOCK rs 1801260, HTR2A rs6313, PER2 rs934945, eNOS rs1549758, eNOS rs1799983. The data was analyzed using nonparametric statistical methods: the Mann–Whitney test, the Student's t-test, and the Pearson χ 2 test. Results: in patients with depressive symptoms, the carriage of the minor allele of polymorphism MTNR1A rs34532313 was associated with a lower severity of symptoms P4, N7; polymorphism HTR2A rs6313 — with a lower severity of P4; polymorphism PER2 rs934945 — with a lower severity of P7 of PANSS. In the group of patients without significant depressive manifestations, an association was found between the carriage of the minor MTNR1A allele rs34532313 and a greater severity of the P6 symptom. Conclusions: depressive symptoms in patients with schizophrenia can modify associations between polymorphic gene variants and the severity of individual psychopathological symptoms.
Background: there is evidence in research studies indicating that it is possible to establish early risk for psychosis by identifying cognitive dysfunction that precedes the development of psychotic states. The role of cognitive dysfunction as psychosis predictors in depressions with non-suicidal self-injury (NSSI) is unclear. The aim was to study the correlation between the severity of cognitive deficits and features of non-suicidal self-injury in adolescent female patients with depression with attenuated psychotic symptoms in comparison with depressed patients without these symptoms. Patients and Methods: the study included 89 female patients aged 16 to 25 years, suffering from depression of different nosology affiliation (F31.3–4; F34.0; F21.3–4 + F31.3–4; F60.X + F31.3–4 по ICD-10) with NSSI manifestations in the disease picture. Based on the presence or absence of attenuated psychotic symptomatology, the patients were divided into two groups: 46 depressed patients with attenuated psychotic symptoms (DAP) and 43 depressed patients with no attenuated psychotic symptoms and no history of psychotic disorders (DNP). Cognitive functions were assessed using the Brief Assessment of Cognitive Functions in Schizophrenia Scale (BACS), Wechsler's Similarities and Missing Details subtests, and the Interpretation of Proverbs methodology. The “Autonomy Scale” was used to assess the patients' functioning, interaction and level of social activity. Results and Conclusions: in the DAP group, the Autonomy Scale scores — Total score, Ability to build a functional social network, and Content of conversation with a doctor were significantly lower than in the DNP group. Significant differences were found in the cognitive sphere scores: in the DAP group, the scores of Total Cognitive Functioning Score, Verbal Memory, and Verbal Fluency, as well as the Similarities and Missing Details tests and the Interpretation of Proverbs technique were lower than in the DNP group of respondents, which conrms the assumption about a lower level of cognitive functioning in patients with subpsychotic attenuated symptomatology. Patients in the DAP group with suicide attempts demonstrated higher autonomy scores, but reduced cognitive sphere scores (working memory), compared to DAP patients without suicide attempts. It was noted that patients who continued NSSI after discharge demonstrated a lower level of social skills and cognitive sphere than patients with DAP who discontinued NSSI. It was shown that the variety of “Mild way of NSSI” was significantly greater in the DAP group.
