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The negative impact of depression on the course and outcome of somatic disorders is well-known and has a solid theoretical basis. The analyses of prospective studies confirm the role of depression as an independent and significant risk factor for widespread chronic somatic disorders including such severe and life-threatening conditions as cardiovascular diseases, diabetes and oncological pathology. The majority of somatic disorders and depression are the part of the big class of hereditary diseases with multifactorial character and polygenic nature. It is likely, that the genetic risk diversity of these diseases in population is close. There is also a high probability of genetic risks levels overlap (or of common «cluster») of two or more diseases in one individual, with one disorder being major depression. In that case such diseases could be considered «genetically comorbid» and manifestation of one disease could alter the risks of other. Precise and informative diagnostic tools could detect subsyndromal depression that could be the prognostic sign of the high risk and rapid manifestation of somatic diseases. Thus, patients with depressive disorder could be considered as a group with high risks of diverse range of somatic pathology. The coalescence of fundamental biomedical scientists and internists (psychiatrists and other physicians) could lead to the elaboration of specific complex preventative measures including social ones.

Aim. To estimate a diagnostic algorithm for anxiodepressive disorders (ADD) in coronary patients in general therapeutic practice. Material and methods. A total of 163 coronary patients were examined using Seattle, Moriski and Green, Hospital questionnaires for anxiety and depression. Patients with clinical and subclinical anxiety and/or depression by Hospital testing responded to Hamilton anxiety and depression questionnaire. An analysis of clinical, anamnestic and socioeconomic parameters was made to create a multifactor model for ADD detection in coronary patients basing on the method of multiple logistic regression. Results. A model of ADD dependence Z = -3.446 [presence or absence of anxiety and/or depression in the past]-2.451[presence or absence of stress for a year] - 2.452 [drinking alcohol or rejection of alcohol] + 0.071 [the disease perception in percent from Seattle angina questionnaire]. In certain combination of responses (presence or absence of parameters) and digital result in 7 combinations the patients can be diagnosed to have ADD. Conclusion. The diagnostic algorithm proposed helps ADD detection in coronary patients in general therapeutic practice without participation of psychotherapists and medical psychologists.

The article notes that the Western model of civilization based on the cult of individual legal freedom, including a clear and optimistic picture of the future developing according to the laws of liberal progress based on this cult, has been significantly shaken in recent years due to the post-informational stage of development of society, and especially with the advent of the Internet. These factors contributed to the strengthening of distressing influences in society, leading to anxious expectations of the population as a reaction to the redundancy of the uncontrolled flow of information and, as a consequence, to the growth in the 21st century of the massive demand for global security. During the SARS-CoV-2 pandemic, biopolitical projects of total security have entered into the sphere of practical politics, with Western society failing to consider the issue of public security vs. human rights in an analytically impartial and critically free capacity as scientists, including specialists in the field of public health, did 10-15 years ago. The situation that has arisen reinforces the negative socio-psychological tendencies noted above. This circumstance makes it necessary to consider the situation of a pandemic from the point of view of the special role of its network information support and the nature of organizational and methodological measures aimed at combating disease.The article examines the socially destructive and socio-psychopathological aspects of the network era, fraught with the threat of the development of mass psychosis, which was most clearly manifested in the situation of a pandemic, regardless of the specific ideological attitudes of a particular social group. The network factor and organizational and methodological measures aimed at combating the coronavirus are analyzed in detail. It is concluded that it is necessary to correct the non-optimal trends that were revealed at the height of the network era both in public sentiment and in the actions of the authorities, in terms of a more effective fight against the SARS-CoV-2 pandemic. To this end, it is proposed to take into account the laws of the network era and be actively present in the Internet space, creating from within an informational counterbalance to the observed negative trends. Specific directions in the implementation of this work are listed.

The purpose of the study: to give a comprehensive characteristic (clinical-immunological, psychosocial, psychopathological) of women with HIV / viral hepatitis C (HCV) co-infection, to determine the presence of structural and functional changes in the brain using neuroradiological research methods. Material: The main study group consisted of 200 women with HIV / HCV co-infection and 200 women diagnosed with HIV infection without HCV. The criteria for inclusion in the study were: age from 18 to 45 years; the presence of a confirmed HIV / HCV co-infection or HCV monoinfection; the absence of the use of psychoactive substances (except alcohol) during 6 months prior to the study; non-pregnant. Methods: clinical; socio-demographic; laboratory; instrumental. In the future 36 women were selected from the main and comparison groups by the method of paired comparisons, identical to each other in age, at the initial stages of HIV infection, with a CD4 lymphocyte count of over 350 cells/µl; taking antiretroviral therapy for no more than 12 months; not receiving HCV antiviral therapy; without concomitant diseases; not using any substances during 6 months before the study. The studies of the structure and metabolism of the central nervous system were performedthem: magnetic resonance imaging (MRI) and positron emission tomography / computed tomography (PET / CT) with fluorodeoxyglucose (FDG). Results: Women with HIV / HCV, unlike women with HIV monoinfection, are more predisposed to the development of psychopathological conditions with a significant frequency of asthenic and anxiety disorders against the background of mild and moderate cognitive impairment, which is probably due to both the presence of concomitant HCV and the use of substances in the past. Patients with HIV / HCV revealed neuroradiological features in the form of vascular and HIV-encephalopathic changes, a high incidence of glucose hypometabolism. The relationship between the localization of signs of glucose hypometabolism and the identified anxiety, cognitive and insomniac disorders has been determined. The algorithm of examination and management of patients with HIV infection and HCV is proposed.

Introduction. There is a problem in predicting the efficacy and safety of antipsychotic therapy. Dopamine receptor D1 is one of the targets of antipsychotics. Peripheral blood lymphocytes (PBL) are the research object of neurotransmission receptors.The objective was to study DRD1 gene expression (mRNA, protein level) in PBL as a possible biomarker of olanzapine and haloperidol therapy prognosis.Methods and Materials. Sample: 106 patients diagnosed with schizophrenic spectrum disorder. Study design: prospective longitudinal follow-up with drug administration by randomization. Assessment of mental status and development of Parkinsonism: Positive and Negative Syndrome Scale (PANSS) and Simpson-Agnus Scale (SAS), respectively. PBL was study material. DRD1 mRNA level was determined by real-time PCR. DRD1 protein concentration in PBL was measured by enzyme immunoassay.Results. Haloperidol (but not olanzapine) treatment for 28 days, leads to DRD1 protein concentration decrease in PBL in a manner dependent on its initial level. DRD1 mRNA level in PBL remained unchanged during the treatment. Patients with effective therapy by olanzapine had lower DRD1 mRNA levels. Side effects of the therapy (Parkinsonism, weight gain) were not associated with studied DRD1 parameters.Conclusions. Haloperidol treatment leads to a decrease of DRD1 protein concentration in PBL, which depends on the initial protein level. Effective olanzapine therapy is associated with reduced DRD1 mRNA level in PBL before the treatment.

In order to study the point of view of doctors supervising patients with dementia regarding the methods and tactics of treating diseases that occur with severe cognitive impairment, their experience in the use of drugs and criteria for choosing a drug for long-term treatment of dementia, an online survey of 197 specialists was conducted.The majority of Russian physicians surveyed prefer basic therapy for dementia, while the main criteria for choosing a drug for long-term therapy are effectiveness and safety of the drug. Despite the absence of drugs capable of complete curing of dementia, Russian doctors have certain expectations and goals when prescribing therapy, in particular, the hope for the longest possible preservation of the quality of life and capacity of patients, as well as slowing down the progression of the disease. 90% of respondents consider it necessary to continue (and even start) therapy even at a severe stage, despite the depletion of the effect. Memantine has become the main drug of choice in different regions of Russia as a drug with a wide range of registered indications, the fewest side effects and a low percentage of patient refusals.

Currently, a growing amount of data is emerging on the role of various environmental factors (nutrients, gut microbiota, etc.) on formation of depression. The impact on these factors can be effective not only in treatment of major depressive disorder, but also in its early prevention. Therefore, a more detailed study of environmental factors in depression can lead both to a better understanding of the etiology and pathogenesis of the disorder and to optimization of approaches to its treatment. The aim of the review was to assess the potential role of a number of environmental factors associated with nutritional aspects and characteristics of individual microflora, as well as to review the prospects of a strategy for affecting these factors in treatment and prevention of depression.

Despite the emergence of new antidepressants with different mechanisms of action, a large number of problems in antidepressant therapy remain. Considering the known antimicrobial activity of antidepressants, the role of the microbiota in the thymoanaleptic activity of these drugs is of high interest. In recent years, important data have been obtained on the role of the gut microbiota in the regulation of behavior and the pathophysiology of a number of mental disorders, including depression. Of particular interest is the assessment of the normal intestinal microbiota role in the course of the therapeutic process. The emerging bi-directional interactions between drugs and microorganisms may be critical for personalized drug selection and future drug development. However, at the present time, this problem remains poorly understood. The proposed manuscript articulates the main directions that are of clinical importance and can become an object for further study in this area.The research results indicate that the effect of antidepressants on the microbiota is a promising area, the study of which could provide many important findings for clinical practice. This type of therapeutic manipulation can provide an opportunity for intervention in order to potentiate the activity of antidepressants or to minimize side effects. The problem with this method of intervention is enormous complexity, when manipulations can have both positive and negative effects simultaneously, depending on different strains of microorganisms influencing different therapeutic effects. More research is needed to understand what changes occur in the microbiome with acute and chronic administration of specific antidepressants. Perhaps this will contribute to the development of microbiomodulatory tactics for individualized interventions.

Antipsychotic-induced parkinsonism is an undesirable reaction from the extrapyramidal system that occurs against the background of taking antipsychotics (AP), more often in patients with schizophrenia. Antipsychotic-induced parkinsonism belongs to the group of secondary parkinsonism. Its prevalence in the world is about 36%. It is assumed that this undesirable AP reaction is genetically determined. In recent years, numerous associative genetic studies of predisposition to the development of antipsychotic-induced parkinsonism have been conducted. However, the research results are contradictory.Purpose. Review of the results of studies of genetic predictors of antipsychotic-induced parkinsonism in patients with schizophrenia.Materials and methods. We searched for full-text publications in Russian and English in the RSCI, PubMed, Web of Science, Springer databases using keywords and combined searches for words over the past decade.Results. The review considers candidate genes encoding proteins/enzymes involved in the pharmacodynamics and pharmacokinetics of AP. We analyzed 23 genome-wide studies examining 108 genetic variations, including SNV/polymorphisms of 26 candidate genes involved in the development of AIP in schizophrenic patients. Among such a set of obtained results, only 22 positive associations were revealed: rs1799732 (141CIns/Del), rs1800497 (C/T), rs6275 (C/T) DRD2; rs167771 (G/A) DRD3; VNTR*9R DAT1; rs4680 (G/A) СOMT; rs6311 (C/T) 5HTR2A; rs6318 (C/G), rs3813929 (С/Т), haplotype-997G, -759C, -697C и 68G HTR2C; rs2179652 (C/T), rs2746073 (T/A), rs4606 (C/G), rs1152746 (A/G), rs1819741 (С/Т), rs1933695 (G/A), haplotype rs1933695-G, rs2179652-C, rs4606-C, rs1819741-T и rs1152746-G, haplotype rs1933695-G, rs2179652-T, rs4606-G, rs1819741-C и rs1152746-A RGS2; haplotype TCCTC ADORA2A; rs4795390 (C/G) PPP1R1B; rs6265 (G/A) BDNF; rs12678719 (C/G) ZFPM2; rs938112 (C/A) LSMAP; rs2987902 (A/T) ABL1; HLA-B44; rs16947 (A/G), rs1135824 (A/G), rs3892097 (A/G), rs28371733 (A/G), rs5030867 (A/C), rs5030865 (A/C), rs1065852 (C/T), rs5030863 (C/G), rs5030862 (A/G), rs28371706 (C/T), rs28371725 (A/G), rs1080983 (A/G) CYP2D6. However, at the present time it should be recognized that there is no final or unique decision about the leading role of any particular SNV/polymorphism in the development of AIP.Conclusion. Disclosure of genetic predictors of AP-induced parkinsonism development may provide a key to the development of a strategy for personalized prevention and treatment of the neurological complication of AP-therapy of schizophrenia in real clinical practice.

Summary. The aim of the study was to identify nosologically nonspecific signs of hospitalism in patients of a gerontopsychiatric hospital and to develop, on their basis, a method for screening diagnostics of hospitalism.Materials and methods. We examined 194 inpatients aged 55 to 91 years, hospitalism was detected in 102 people, 92 people made up the comparison group. The survey was carried out at the stage of preparation for discharge in the form of a semi-structured interview, supplemented by the collection of anamnestic and follow-up data.Results. The most common signs of hospitalism in this sample were the deterioration of the mental and somatic state before discharge (78% of the examined patients of the main group, a confidence interval (CI) of 68–85%), a long duration of the current hospitalization (73%, CI 64–82%), violations of compliance (73%, CI 63-81%), long duration of inpatient treatment in anamnesis (71%, CI 61-80%), deterioration soon after discharge (67%, CI 52-80%), a large number of hospitalizations during the entire period of illness (67%, CI 57-76%), lack of discharge intention (62%, CI 51-72%), tendency to increase the duration of hospitalizations (54%, CI 43-64%), high level of anxiety before discharge (50% , CI 34-66%), reduction in the intervals between hospitalizations (49%, CI 38-59%), p

Threats to life and health, the public health crisis associated with the COVID-19 pandemic, have led to 1) accelerated development of vaccines, 2) adverse psychological reactions in the population.Aim: to identify differences in stress, anxiety, protective behavior strategies, and the socio-demographic characteristics of online survey participants, who reported opposing attitudes to SARS-CoV-2 vaccination.Materials and Methods. In December 2020-January 2021, 131 respondents were assessed (men—21.4%). The Psychological Stress Scale (PSM 25), original questionnaires to evaluate pandemic concerns and protective behavior strategies with special question about COVID-19 vaccine acceptance were used. Effect sizes obtained using Cohen’s d and Cramer’s V measures were calculated for groups, the differences between which were significant (p≤0.05).Results. A 47.3% sample, having PSM-25 rates above the threshold (100 points), showed a distress reaction to the pandemic due to anxiety stress. Compared to the spring of 2020, the number of concerns associated with a noticeable stress growth (ES≥0.34) increased from two to six. Psychological distress, concerns about the possible lack of medication for daily intake, harsh social consequences and self-isolation were associated with only foreign producer vaccine acceptance (ES=0.3-0.5). Absence of excessive fears for own life, concerns about the lack of personal protective equipment and unacceptance of gloves as a measure to prevent infection (ES=0.3-0.4) were important factors associated with any producer vaccine acceptance. Men, comparing to women, were more positive in vaccine acceptance.Conclusion. The anxiety distress is an important factor in the rational attitude to coronavirus infection vaccine.

Patients with substance use disorders represent a vulnerable population who are at risk of getting coronavirus due to several factors related to their clinical, psychological, and psycho-social characteristics. The goal of this study was to examine the features of a medical condition in patients with alcohol use disorder who are admitted to the addiction hospital and to describe the specific issues of the addiction care RF region during a pandemic.Material and methods. The online survey has been distributed to 55 addiction psychiatrists from the third-level medical organizations of 4th federal districts (including Northwestern, South, Volga, and North Caucasian) from June 09 to June 20, 2020. The survey consists of 17 items (13 questions were focused on the features of progress and clinical signs of alcohol dependence in hospitalized, in-patient individuals during April-May, 2020; 4 questions were focused on the organizational issues of addiction care in the RF regions during the COVID-19 pandemic).Results. Based on the expert`s assessment, the number of admissions at inpatient and outpatient clinical settings was reduced during the pandemic. In addition, the intensity of alcohol withdrawal among patients who were hospitalized during April-May, 2020 were significantly more severe compared to patients who were hospitalized during February-March, 2020 (Pearson’s chi-squared test). Moreover, alcohol withdrawal was more severe and was associated with alcohol withdrawal delirium (4,7%) or seizures (4,7%) in 9,4% of cases among patients with COVID positive status, which exceeds the data of epidemiological studies. The intensity of alcohol withdrawal delirium among patients with COVID positive status was more severe compared to those who had COVID negative status. During April-June, 2020, the few addiction clinics were temporally closed due to quarantine but a majority of clinics were not (n = 14 (25,5%) vs. n = 41 (74,5%)).Conclusion. During the COVID-19 pandemic, the state of patients hospitalized for treatment of alcohol dependence may be considered more severe, compared to the period February-April 2020.

Antipsychotic-induced parkinsonism (AIP) is one of the prognostically unfavorable complications of psychopharmacotherapy in patients with schizophrenia. Many studies have investigated various drugs that are used to treat this neurological side effect. This review analyzes drugs that are used and may be perspective for the treatment of AIP. We searched for full-text publications in Russian and English in the following databases: E-Library, PubMed, Web of Science, Springer, using keywords and combined word searches over the past decade (2011—2020). The review covers drugs that are promising for the correction of AIP, including anticholinergic drugs; NMDA receptor antagonists; dopamine receptor agonists; selective inhibitors of monoamine oxidase B; catecholamine transferase inhibitors; melatonin preparations; melatonin receptor agonists; benzodiazepines; herbal preparations traditionally used for the prevention and correction of extrapyramidal syndrome of various etiologies. Currently, a small number of medications are used in clinical practice for the treatment of AIP. However, not all of them are registered in the Russian Federation. Along with the differences in the mechanisms of AIP pathogenesis in specific patients, the limited choice of AIP treatments makes it difficult to solve the problem of adverse neurological complications of psychopharmacotherapy in schizophrenia.

The report is dedicated to the landmark work by V.A. Karlov “Epilepsy in children and adult women and men”, 2nd edition, released in 2019. Here, there are discussed crucial aspects underlying a theory and application for epilepsy treatment reflected in the monograph that underline a great importance for complete all-encompassing analysis of experience and advances in domestic and foreign epileptology described in the book.

The purpose of the study was to summarize data from foreign studies about the use of virtual reality (VR) technology in the treatment of patients with various mental disorders.Materials and methods: we selected and analyzed articles from MEDLINE / PubMed databases during the period from 2000 till 2020, as well as relevant references in the bibliography of the analyzed articles. 45 articles were included in further analysis from 575 English-language articles.Results: The use of VR technologies in the treatment of mental disorders appears to be one of the promising directions in psychiatry. The successfulness of these methods in patients with eating disorders, anxiety-phobic disorders, and obsessive-compulsive disorder is supported to be evidentiary information. There is evidence of the effectiveness of such methods in patients with schizophrenia, particularly, one of the most significant results is an increase in social functioning. The absence of side effects data makes it possible to consider t VR therapy as a safe method. It is needed to make further study the areas of application of VR therapy and conduct research to identify possible side effects of this method.Conclusion: The obtained results are important for drawing attention to the prospect of using VR technologies in Russian psychiatry and demonstrate the need for further study of this method.

Introduction. Drug-induced dyskinesia is an iatrogenic undesirable side reaction from the extrapyramidal system that occurs during the administration of drugs, most often antipsychotics in patients with schizophrenia. At the end of the 20 th century, studies were conducted on the search for candidate genes and the carriage of single nucleotide variants of antipsychotics-induced tardive dyskinesia. Purpose of the study – to analyze research results reflecting candidate genes and their single nucleotide variants associated with antipsychotic-induced tardive dyskinesia. Materials and methods. We searched for full-text publications in Russian and English in the eLIBRARY, PubMed, Web of Science, Springer databases using keywords (tardive dyskinesia, drug-induced tardive dyskinesia, antipsychotics, antipsychotics, typical antipsychotics, atypical antipsychotics, genes, polymorphisms) and combined searches for words over the past decade. Results. The lecture discusses candidate genes encoding proteins/enzymes involved in the pharmacodynamics and pharmacokinetics of antipsychotics Conclusion. Timely identification of individual genetic characteristics of the patient can contribute to the development of diagnostic test systems and in the future selection of the safest and most effective antipsychotic therapy.

The search for new approaches to the mental disordersclassification is one of the priority tasks in modern psychiatry. Current approaches evaluate mental disorders in isolation, ignoring the fact that they are a multisystem pathology that affects not only mental functions, but also a wide range of somatic manifestations. However, there is more and more reason to consider mental disorders as multisystem diseases. This approach is of interest not only for explaining the high comorbidity of somatic and mental disorders, but also in studying the pathophysiological mechanisms that determine the risks and course of multisystem diseases. This strategy can be the basis for the fundamentally new approaches to the systematics of mental disorders with both theoretical and practical significance. To integratesuch an approach, it is necessary to determine the “starting point”, which may be the evaluation of mental disorders andinherited metabolic disorders interaction.

One of the many negative consequences of the COVID-19 pandemic is the “secondary epidemic” of negative psychological effectsThe aim of the study was to identify socio-psychological factors associated with adaptive behavior in the population.Materials and methods: an on-line survey of 1957 Russian-speaking respondents over 18 years old was performed from 30.03.2020 to 05.04.2020. The level of anxiety distress was verified with the psychological stress scale (PSM-25). Dispersion analyses were used (p

The biopsychosocial model, as well as a number of approaches and paradigms based on it (scientific, clinical, preventive, therapeutic), currently cause a lot of criticism up to the complete denial of its use in psychiatry possibilities. The aim of this paper is to propose a modern interpretation of the biopsychosocial model in psychiatry for the further studies of the mental disorders etiopathogenesis and for the research of new opportunities for their therapy and prevention. Progress in biological medicine and the emergence of new research technologies today open up new opportunities for the actual interpretation of the biopsychosocial model and its application for the modern biopsychosocial paradigm, which can be used both as a research strategy and for the relevant scientifically based methods of therapy and prevention. Thus, it is important to understand that the biopsychosocial model is not a competitor or antithesis of the biomedical model, but allows one to expand the biological boundaries beyond a simple description of the organs and systems functioning.

Over the last century frequency of diagnosed catatonic states continuously decreased. This phenomenon can be explained through hypothesis of pathomorphosis of psychiatric diseases. Pathomorphosis is an important aspect of mental diseases, including catatonic states, especially therapeutic pathomorphosis. Changes in clinical presentation of psychosis led to under-recognition of catatonic signs, that cause incorrect diagnostic and treatment tactics. The aim of this study is to investigate clinical and psychopathological features of psychosis with catatonic features and actual differences in clinical presentation compared to traditional descriptions and earlier clinical cases. Two groups of patients was explored. First is patients, which admitted to psychiatric hospital due to psychosis with catatonic features. Second group contains archival clinical cases of patients, which were treated since 1969 to 1972, before introduction of atypical antipsychotics to clinical practice.

Purpose. To analyze the results of classical and modern studies reflecting the pathophysiological mechanisms of antipsychotic-induced tardive dyskinesia.Materials and methods. We searched for full-text publications in Russian and English in the databases of E-Library, PubMed, Web of Science and Springer published over the past decade, using keywords (tardive dyskinesia (TD), drug-induced tardive dyskinesia, antipsychotics (AP), neuroleptics, typical antipsychotics, atypical antipsychotics, pathophysiology, etiology and combinations of these words). In addition, the review included earlier publications of historical interest.Results. The lecture proposed theories of development of AP-induced TD, examining its effect on dopaminergic receptors, dopaminergic neurons, neurons of the basal ganglia, and other theories: activation of estrogen receptors, disorders of melatonin metabolism, disorders of the endogenous opioid system, oxidative stress with predominant oxidation processes, blockade of 5-HT2-receptors, a decrease in the pyridoxine level, genetic predisposition, interaction of AP with the brain trace element – iron, carbonyl stress and immune inflammation and the role of the neurotrophic factor.Conclusion. The disclosure of the mechanisms of AP-induced TD will allow the development of a strategy for personalized prevention and therapy of the considered neurological complication of the AP-therapy for schizophrenia in real clinical practice.

The aim is to study the influence and assessment of mental and emotional states in patients with arrhythmias.Materials and methods. Literature search was performed using the following resources: PubMed, Web of Science, Scopus, as well as in the search system Google Scholar by the key words “psychoarrhythmology”, “neural-cardiac axis”, “psychocardiology”, “arrhythmogenesis”, and “stress-induced arrhythmia”. Articles should be freely available and should represent the most relevant information on the topic. Studies were selected by the largest sample and citation index.Results. In this review of studies on the correlation of psychosocial factors and constitutional features of personality in patients with arrhythmias, the available data on the pathogenesis of cardiac pathology, including the main arrhythmological disorders in nervous excitation caused by negative emotions and stress are presented. The article also reflects the importance of a multidisciplinary approach to risk prediction, potential risk modifiers and approaches to the treatment of cardiac pathology, taking into account the psycho-emotional state of the patient.Conclusion. Reducing the severity of the disease requires a comprehensive approach, in particular, psychodiagnostics, psychocorrection, psychotherapy and psychopharmacotherapy. Further development of this approach to this problem will lead to the creation of new programs for early diagnosis, prevention and treatment of cardiac pathology.

Background. There is evidence that sleep disorders may be significantly linked to the development of the substance use disorders (SUD). However, data about the prevalence of the sleep disturbances among patients with SUD in Russia are relatively limited.Aim. To evaluate the frequency of the sleep disturbances among patients (n = 196) with alcohol (ÀD, n = 102), opioid (ÎD, n = 55) and polysubstance dependence (PD, n = 39) seeking addiction medical care.Materials and methods. We conduct a cross-sectional study of sleep disturbances among patients in St. Petersburg in 2017–2018. The modified Insomnia Severity Index (ISI) was administered to assess sleep during different periods of time: lifetime, the past 12 months, and the past 30 days.Results. All groups demonstrated relatively high presence of different sleep disorders (range: 49.0–76.5% among 196). The sleep disturbances over the past 30 days were more common in the AD group (60.8– 73.5% among 102) with the early morning awakening as the most frequent complaint. In the PD group the prevalence of lifetime sleep disturbances was high (94.9–100.0% among 39), whereas insomnia disorders were relatively rare over the past 30 days. However, it was sleep disturbances over the past 30 days that were statistically significantly more often (p < 0,05) observed in the group of patients who actively consume narcotic substances (40.2–87.2%), compared with the group of patients in remission (0–16.7%).Conclusion. The results demonstrated the high prevalence of insomnia among patients with SUD and suggested that the remission have a positive effect on the symptoms of sleep disorders. Further studies of the association between sleep disturbances and SUD progression are needed.

In connection with the increase in the proportion of the elderly population, the multifaceted adverse significance of Alzheimer’s disease has recently been widely discussed, including its role as a cause of death. However, not always obvious influence of this disease on vital functions dictates the need for a differentiated methodological approach in this matter.The authors consider the differences in the effects of generally accepted variants of the course of Alzheimer’s disease on the prognosis of patients, as well as the fact that clinically and morphologically mixed forms of this pathology with cerebrovascular disease are increasingly detected, which in turn leads the complications of the latter to be a cause of death in respective cases.The general principles of the approach to solving the issue of the cause of death in elderly and senile people under the combined effect of the described cerebro-atrophic changes are formulated. At the same time, a sequence of arguments is proposed to consider Alzheimer’s disease as the cause of death.

Schizophrenia is a socially significant disorder with a high prevalence among young and middle-aged people. Movement disorders, or extrapyramidal syndrome, are potentially reversible antipsychotic-induced adverse effects (AEs) that stigmatize patients and worsen quality of life. Tardive dyskinesia (TD) is a neurological AE in the extrapyramidal system, which is accompanied by abnormal involuntary non-rhythmic choreiform or athetoid movements (hyperkinesis) that occur during the long-term use of antipsychotics. The reversible and persistent forms of TD are identified. The article analyzes the prevalence and predictors of TD, as well as the issues of its diagnosis.

Melatonin - the most well studied factor of the circadian rhythm - attracts much intereset in regard to a disease-modifying therapy for epilepsy. In some forms of epilepsy, circadian dysrhythmias and sleep disorders can trigger the development of epileptic seizures, while in others - seizures develop from the REM-phase of sleep.The aim is to review and analyze studies on the efficacy and safety of exogenous melatonin as an additional medication for disease-modifying therapy in pediatric and adult patients with epilepsy.Materials and methods. The search was conducted for Russian and English articles reflecting the results of studies on the efficacy and safety of exogenous melatonin in patients with epilepsy. We used the following databases: ELibrary.ru, Web of Science, Scopus, Clinical Case, PubMed, Cochrane Database of Systematic Reviews. The search was carried out using the keywords: melatonin, epilepsy, epileptic syndrome, disease-modifying therapy, children, adolescents, adults, safety, efficacy, reduction of seizures, adverse drug reactions, quality of life. The following materials were included in the search: full-text articles in Russian and English; original research papers; Cochrane reviews; clinical observations; publication dates - from 2003 to 2018. We did not reviwed: abstracts; theses; monographs; handbooks; textbooks; materials published before 2003. In total we found 986 publications; of those, 114 met the inclusion criteria.Results. Clinical studies on the efficacy and safety of exogenous melatonin in a disease-modifying therapy for epilepsy in children and adults are rare, conducted in small groups of patients, and differ in their design. These findings do not allow recommending melatonin, at the present time, for widespread use in the routine clinical treatment of epilepsia. Notably, determining the optimal daily dose of exogenous melatonin is rather difficult because this drug has both proconvulsive and anticonvulsant effects. Therefore, such a disease-modifying therapy requires a personalized approach to achieve a balance between these two actions of melatonin.Conclusion. The role of exogenous melatonin as a treatment modality in epilepsy remains unclear, although this approach is considered possible for disease-modifying therapy. Large-scale clinical studies on the efficacy and safety of exogenous melatonin in epilepsy are needed. Currently, the use of exogenous melatonin in epilepsy is not regulated by law.

The article is devoted to the problem of dualism of medicine as a whole and psychiatry, in particular, given that the psychiatry is a science, which includes both biological and humanitarian components. The issue of the contradictions between the concept of «evidence-based medicine» and the principles, on which humanitarian methods of treatment for mentally ill patients are based, is considered. It is concluded that developing a full-fledged theory of the biopsychosocial approach to the diagnosis and therapy of people with mental disorders is necessary.

The work annotates the goals and objectives of the planned joint Russian-Israeli research project aimed at a comprehensive assessment of the data obtained during the examination of patients with mild cognitive decline and autism spectrum disorders. The process of their analysis will be based on complex methods, the effective use of which requires readily available means of operating with clinical and biological data, which, in turn, can be implemented through modern cloud and high-performance computing technologies. It is planned to use the new approach associated with the use of newSQL database as an API, and then use the distributed computing tools for working with heterogeneous data, which will lead to features in the analysis of correlations in multidimensional data arrays. For this purpose it is planned to use the methods of multidimensional statistical analysis and modern methods of machine learning.

In our study we have analyzed MRI of mediobasal parts of temporal lobes in healthy volunteers and patients with Alzheimer disease in early stage based on medical literature and our experience. We have determined method of defnition and volume evaluation of different hippocampal subfelds.

Summary. Te aim of the study was to study the clinical signifcance of changes in bioelectric activity for the purpose of identifying them as biological markers of mental disorders in patients with HIV infection. A cross-sectional study was conducted to diagnose mental disorders and search for neurophysiological markers in 62 patients with HIV infection at the St. Petersburg Center for the Prevention and Control of HIV and Infectious Diseases.Results: 50% of patients with HIV infection without abuse disorders have mental disorders characterized mainly by adaptive reactions and mild cognitive impairment. Normal indicators of bioelectrical activity were determined in 16.1% of 62 patients. In the majority of patients (59.7%), bioelectrical activity was determined with a predominance of excitation in the medio-different areas and a decrease in activity of the cerebral cortex. In 41.9% of patients, the processes of CNS excitation were increased in the form of an intensifcation of the reaction to photostimulation. Neurophysiological differences were revealed in patients with neurotic and stress-related disorders and organic changes in the CNS. For neurotic disorders in comparison with organic disorders, the EEG was normal or the disorganized type with predominance of alpha and beta activity were more likely, while in the case of organic disorders the desynchronous type of EEG was more ofen noted. Te development of psycho-organic syndrome in HIV patients is confrmed by deep restructuring of bioelectrical activity in the anterior parts of the brain.

Schizophrenia is a socially significant mental disorder characterized by early onset and high time and financial expenditure on treatment. The basic drugs in these patients are antipsychotics that are highly effective against the positive and negative symptoms of schizophrenia, but at the same time have a wide range of adverse reactions (ARs). The clinical effect and tolerability of antipsychotics are variable and depend on the characteristics of genetically determined mechanisms (transportation, biotransformation, and elimination).The paper describes a clinical case of a female patient with schizophrenia who has been noted to be unresponsive to antipsychotic therapy for some years after the onset of the disease. After pharmacogenetic testing, she was found to be homozygous for the nonfunctional allelic variant CYP2D6*4 (1934 G>A, rs3892097), which was the reason for the complete shutdown of isoenzyme 2D6 activity and the development of ARs in the use of initial doses of antipsychotic drugs, as well as for an increase in the severity of ARs with aggravation of psycho-producing symptoms with an even slow titration of the daily dose.

Tere are 44 patients (5 males and 39 females), aged 56 to 90 years were included in the study. To assess the tolerability and safety of the drug, undesirable events were recorded, associated and not associated with taking the drugwith taking the drug, a physical examination of patients was performed, an ECG was recorded and a biochemical blood test was performed at each visit of the patient to the center. During the observation period, two undesirable events chronologically associated with taking the drug were recorded During the study, none of the patients was excluded from the program due to the development of side effects and none of the patients refused to take the drug. We did not fnd any statistically signifcant increase in the incidence of cardiac pathology in patients taking the study drug, nor worsening of the already existing symptoms on the background of taking the drug for six months. Te observed growth trends in the level of blood creatinine a give grounds to recommend monitoring of kidney function in the patients taking the drug. In general, noogerone showed good tolerability, despite the elderly age of its patients and the high prevalence of concomitant somatic diseases in the sample.

Antipsychotics are the main pharmaceutical agents in treatment of schizophrenia and other mental disorders. According to literature data up to 60% of patients with schizophrenia have antipsychotic-induced metabolic disturbances. The main objective of pharmacogenetic studies is search for predictors of the response to therapy and definition of likelihood of development of undesirable phenomena. The main findings in the field of pharmacogenetics of metabolic disturbances were analysed. Recently, significant progress in the field of pharmacogenetic research was made which confirmed results of the previous studies and revealed new candidate genes. Ambiguous results in pharmacogenetic studies may be a reflection of complexity of pathogenesis of antipsychotic-induced weight gain, an influence of a set of epigenetic factors on mechanisms of its development. All this complicates design of the studies directed at identification of the candidate genes participating in realization of metabolic disturbances during intake of neuroleptics. Improvement of pharmacogenetic studies will provide the best understanding of how these genes are associated with antipsychotic-induced metabolic disturbances. Inclusion of pharmacogenetic approach in clinical guidelines is necessary, but now it is complicated that is associated mainly with the insufficient level of validity of the genetic markers studied and their ethnic heterogeneity. Use of pharmacogenetic testing improves rational therapy and contributes to the most efficient and safe therapy.

Our comparative study of psychosocial, behavioural, and clinical characteristics involved 46 HIV-negative individuals with opioid dependence (HIV-IDUs), 57 HIV-positive opioid-dependent individuals (HIV+IDUs) and a control group of 90 healthy subjects (CG). All opioid dependent participants were injecting drug users (IDUs). Results reported in Part 2 are based on our analysis of the following tests: The Buss - Durkee Hostility Inventory (BDHI), State-Trait Anger Expression Inventory (STAXI), Folkman and Lazarus’ Ways of Coping Questionnaire (WCQ), Purpose-in-Life Test (PIL), Sixteen Personality Factor Questionnaire (l6PF), WHO Quality of Life questionnaire (WHOQOL-100), and the modified Link’s Stigma Scale (LINK). Our analysis demonstrated that IDUs (independently of their HIV status) showed higher results on the BDHI’s subscales of assault, verbal hostility, irritability, guilt and the total score; STAXI’s subscales of trait anger and anger expression-out; LINK’s drug use and HIV-related stigma and discrimination; behaviour is dominated by non-adaptive coping strategies of distancing, self-control, escape-avoidance (WCQ) and the vigilance (L), apprehension (O), tension (Q4) personality characteristics (16PF) compared to the control group. All participated IDUs demonstrated lower results compared to that in the control group on all subscales and the total score of the Purpose-in-Life test and lower quality of life in the domains of physical and psychological health, social relationships and level of independence, as well as the total score of WHOQOL-IOO. Coping strategies of the positive reappraisal and ‘planful’ problem solving (WCQ) are more rare and the personality characteristics of rule-consciousness (G), sensitivity (I), abstractedness (M), self-reliance (Q2), perfectionism (Q3), and motivational distortion (MD) (16PF) are decreased compared to the control group. Compared to HIV-negative IDUs, HIV-positive IDUs demonstrated higher scores on the ‘resentment’ and ‘guilt’ subscales, and the overall hostility index (BDHI); ‘trait anger’ and ‘anger expression-out’ subscales of the STAXI; HIV-related stigma and discrimination (LINK) and lower scores on the reasoning (B), emotional stability (C), and perfectionism (Q3) subscales of the 16PF; psychological and level of independence domains of WHOQOL-100; purpose in life, locus of control-life, and life process or emotional richness of life (PIL).

One of the most important parts in biomarkers research is finding of atrophic changes in strategic for cognition brain structures. In the study one of the structural neurovisual bi-omarkers of neuronal damage were analised - MRI visual scale of atrophy. 94 patients with early signs of Alzheimer disease were examined. Using of visual scales show atrophy slight and mild of mediobasal temporal lobe in 64 patients (68%), interuncal distance was Increased in 27 patients (28%). Atrophic changes of the cortex of parietal lobe were not found in most of patients.

The article shows the significanceof the post-stroke affective problem. The main types of psychopathological syndromes and their specificity for patients with cerebral stroke are discussed. The paper investigates the possibility of using D-, L-gopantenicum/rac-gopantenicumacidum (Pantogamactive) to reduce the severity of anxiety and depression in recovering period of ischemic stroke patients. The authors show the effectiveness and safety of the use of Acidumhopantenicum-D, L in the rehabilitation course of post-stroke patients.

The objective of this study was to evaluate the efficacy of the noojerone in patients with moderate Alzheimer disease and to compare obtained data with results of clinical trials of memantine. This was a 24-week open - label post-marketing clinical trial conducted in Department of Geriatric Psychiatry St. Petersburg V.M. Bekhterev Psychoneurological Research Institute. Participants were 44 outpatients with moderate AD and Mini-Mental State Examination scores of 10-19 at start - point. This study have demonstrated efficacy in modifying course of AD and no significant deterioration activities of daily living and frequency and severity of behavioral symptoms, comparable with the results of memantine clinical trials.

There are researched psychosocial components of hospitalism in elderly patients with affective disorders. We were using clinical and psychological semi-structured interview as a method focused on the investigation of relations in the parent and the relevant families of patients. In addition there were being used personality and family relationships questionnaires, locus of control personality research. According to the survey, there have been found out signs indicating de-emphasis of family, reducing of emotional involvement in family relationships and distancing from relatives in patients with hospitalism compared with the control group.

We undertook this observational study among 435 patients (365 men and 70 women) who were divided into 3 groups based on the severity of the brain damage (clinical features and results of neuropsychological assessment, magnetic resonance imaging, electroenchephalography, transcortical Doppler): 1. Patients with alcohol dependence syndrome F10.2х) without comorbid psychiatric disorders; 2. Patients with alcohol dependence syndrome F10.2х) and mild comorbid organic brain disorder F06.7x; 3. Patients with alcohol dependence syndrome F10.2х) and moderate comorbid organic brain disorder (F06.7x). We assessed the severity of emotional disorders, alexithymia and interhemispheric asymmetry and compared these features between the groups. We found that the severity of the organic brain damage play important role in the association between the interhemispheric asymmetry and the severity of emotional disorders and alexithymia in patients with alcohol dependence. The complex analysis of the data shown that left-handedness and a functional asymmetry toward the left are the protective factors for the emotional disorders and alexithymia in the group of patients without organic brain disorder. Moreover, right-sided cerebral deficiency and a functional asymmetry toward the right are associated with higher risk of the emotional disorders in patients with alcohol dependence.

Free radical processes, the degree of their intensification are one of the main pathogenetic factors in the development of many diseases in old age. The purpose of this study was to identify the severity of OS in patients with mild cognitive decline (presumably Alzheimer’s disease), with mild cognitive decline in vascular etiology, in persons suffering from a depressive disorder compared to a control group of the same age. A special vulnerability of the glutathione system was found in patients of all the examined groups, in particular, in people with depression, in comparison with healthy elderly people. A decrease in the activity of glutathione peroxidase, significantly more pronounced in the examined patients with late depression, was revealed. The data obtained agree with the IDEA existing in modern science on the role of OS as a key element in the pathogenesis of depressive states.

This paper is devoted to some of the infrastructural problems of neuroinformatics in the context of existing analog-to-digital systems and high-performance solutions. We surveyed results and analyzed some of the existing methods required in various experiments. Special attention was devoted to the problem of the human brain simulation, based on a combination of digital and analog subsystems. Paper shows various approaches to modeling of interactions between brain neurons and explores different algorithms. We consider different applications of cloud solutions to neuroinformatics problems. Paper highlights areas of particular interest such as working with external storage, distributed data processing and visualization of acquired results. For each of them we survey existing options for creating cloud-based distributed computing solutions that can solve important challenges faced by researchers in their work.

The traditional approach to human brain modeling suggests modification of modern systems and microcircuits as long as their performance reaches a permissible limit. A different hybrid approach is based on neuromorphic computing. The idea we utilize is combination of artificial neural networks with specialized microcircuits. The architecture of the microchip needs to reproduce the mechanisms of the human brain and to be a kind of hardware support for neural networks. Existing models of the brain even on powerful supercomputers require significant computation time and are not yet able to solve problems in real time. Since the human brain consists of two parts with different functions and different data processing principles, there is a very promising approach which suggests combining digital and analog systems into single one. In current collaboration we incorporate some results of study of activity of human brain as a base of building of hybrid computational system and foundation to the approach of running it.

Antipsychotics are the main drug group in the treatment of disorders of the schizophrenic spectrum. At the same time, this drug group requires long-term use, has a narrow therapeutic breadth and a large spectrum and high severity of undesirable drug reactions, the manifestation of which is largely determined by the patient’s genotype. In this connection, the severity of undesirable drug reactions in drugs of the first and second generation of antipsychotics is different. Atypical antipsychotics, unlike typical antipsychotics, have a significantly lower chance of causing extrapyramidal disorders, though they primarily induce metabolic side effects, consisting of significant weight changes, glucose metabolism dysregulation, and dyslipidemia. These unwanted drug reactions significantly reduce adherence to therapy and can lead to serious complications in the future. At the same time, experience with the use of atypical antipsychotics has shown that the severity of unwanted reactions differs within the group of atypical antipsychotics and, more importantly, even for one drug taken by different patients, is a variable index. The reason for this phenomenon lies is in the polymorphism of the pharmacokinetic and pharmacodynamic factors involved in the metabolism of atypical antipsychotics and the different chemical structure of the drugs. The study of the effect of various combinations of polymorphic variants of the pharmacokinetic and pharmacodynamics factors on the development of antipsychotic-induced metabolic disorders is a complex and high-priority task of personalized medicine.

The aim: to identify changes in mental status due to receive HAART and comprehensive assessment of the biological, behavioral and social factors in adherence to treatment in HIV-infected patients with endogenous mental disorders. Material: The study involved 53 patients with HIV infection and schizophrenia / affective spectrum comorbidity. Results: In the tolerability and adherence to ARV therapy affects not only the neurobiological vulnerability, but also a change in the mental state and condition of the patient social life. After the start of ART mental state of patients with endogenous mental disorders often deteriorates. Depending on their degree of penetration into the central nervous system were observed pronounced effect of ART on the structure of psychopathological symptoms and the course of mental illness in general.

Complicated cascade of shared biological components with a genetic basis and, probably, common triggers of the genetically posed risk are involved in the comorbidity of depressive symptoms and somatic disorders. This suggests that, under certain conditions, it can manifest both a single disease and a cluster of disorders with different phenomenological characteristics, united by common genetically mediated pathophysiological mechanisms. Based on the analysis of epidemiological, clinical, pathophysiological and genetic studies, we substantiated the hypothesis of cluster genetic comorbidity of depression and somatic diseases.