Search

Introduction: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. Materials and methods: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. Statistical analysis: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. Results: Clinical depression was detected in 13.16% with male doctors and ‘non-binary genders’ having the lowest rates (7.89 and 5.88% respectively) and ‘non-binary gender’ nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). Conclusions: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

During the COVID-19 pandemic healthcare workers have been under pressure of high workload and an increased risk of contracting the SARS-Cov-2 virus, while confronting the most tragic and devastating aspects of the pandemic-related medical realities. These factors could lead to severe distress with potential consequences for productivity in performing professional duties, and substantially increased risk for affective reactions, including clinical states of anxiety, depression and suicidality as compared to the general population. Thus, we aimed to investigate the changes in rates of anxiety, depression and suicidality in response to the pandemic among medical staff as compared to a sample of the general population and to the period of prepandemic time.This study is part of the large-scale, international multicentre COMET-G project. We assessed the extents of anxiety, depression and suicidality risks using the Stait-Trait Anxiety Inventory (STAI) with a cut-off score 39/40, Center for Epidemiologic Studies Depression Scale (CES-D) with a cut-off score 23/24, and the Risk Assessment Suicidality Scale (RASS) with a cut-off score 499/500, respectively, in samples of Russian healthcare workers and the general population.Among 7777 respondents participating in the study, responses to a query about occupation indicated 1216 healthcare workers. 45.8% of medical staff vs 40.4% of non-medical staff (χA larger proportion of healthcare system staff, as compared to the general population, reported a significant increase in anxiety in response to the pandemic. Compared to medical doctors, other healthcare system workers had a significantly higher prevalence of depression and suicidality rates. Exploratory analysis suggested that it was not the occupation per se, but rather the burden of meaningful working duties that could be associated with psychological defense mechanisms against depression and suicidality among medical staff.

Fountoulakis K.N., Karakatsoulis G.N., Abraham S., Adorjan K., Ahmed H.U., Alarcón R.D., Arai K., Auwal S.S., Berk M., Bjedov S., Bobes J., Bobes-Bascaran T., Bourgin-Duchesnay J., Bredicean C.A., Bukelskis L., Burkadze A., Abud I.I.C., Castilla-Puentes R., Cetkovich M., Colon-Rivera H., Corral R., Cortez-Vergara C., Crepin P., De Berardis D., Delgado S.Z., De Lucena D., De Sousa A., Stefano R.D., Dodd S., Elek L.P., Elissa A., Erdelyi-Hamza B., Erzin G., Etchevers M.J., Falkai P., Farcas A., Fedotov I., Filatova V., Fountoulakis N.K., Frankova I., Franza F., Frias P., Galako T., Garay C.J., Garcia-Álvarez L., García-Portilla M.P., Gonda X., Gondek T.M., González D.M., Gould H., Grandinetti P., Grau A., Groudeva V., Hagin M., Harada T., Hasan T.M., Hashim N.A., Hilbig J., Hossain S., Iakimova R., Ibrahim M., Iftene F., Ignatenko Y., Irarrazaval M., Ismail Z., Ismayilova J., Jacobs A., Jakovljević M., Jakšić N., Javed A., Kafali H.Y., Karia S., Kazakova O., Khalifa D., Khaustova O., Koh S., Kopishinskaia S., Kosenko K., Koupidis S.A., Kovacs I., Kulig B., Lalljee A., Liewig J., Majid A., Malashonkova E., Malik K., Malik N.I., Mammadzada G., Mandalia B., Marazziti D., Marčinko D., Martinez S., Matiekus E., Mejia G., Memon R.S., Martínez X.E.M., Mickevičiūtė D., Milev R., Mohammed M., Molina-López A., Morozov P., Muhammad N.S., Mustač F., Naor M.S., Nassieb A., Navickas A., Okasha T., Pandova M., Panfil A.-L., Panteleeva L., Papava I., Patsali M.E., Pavlichenko A., Pejuskovic B., Da Costa M.P., Popkov M., Popovic D., Raduan N.J.N., Ramírez F.V., Rancans E., Razali S., Rebok F., Rewekant A., Flores E.N.R., Rivera-Encinas M.T., Saiz P., de Carmona M.S., Martínez D.S., Saw J.A., Saygili G., Schneidereit P., Shah B., Shirasaka T., Silagadze K., Sitanggang S., Skugarevsky O., Spikina A., Mahalingappa S.S., Stoyanova M., Szczegielniak A., Tamasan S.C., Tavormina G., Tavormina M.G.M., Theodorakis P.N., Tohen M., Tsapakis E.M., Tukhvatullina D., Ullah I., Vaidya R., Vega-Dienstmaier J.M., Vrublevska J., Vukovic O., Vysotska O., Widiasih N., Yashikhina A., Prezerakos P.E., Smirnova D.

Antidepressants (AD) are widely used in the treatment of mood disorders and administered for mental disorders coded across other diagnostic categories. However, inaccuracy in AD prescription may lead to unresponsive cases, decreased compliance, and treatment discontinuation. Following a one-way cross-sectional study design, we aimed to analyze the AD prescription patterns in routine clinical practice in Moscow, as compared to clinical guidelines, taking the capital as representative of the Russian national experience.We studied 537 medical case records of inpatients and outpatients who had received treatments on an arbitrarily chosen day, focusing on classes, doses, drug combinations, and switching patterns for AD prescription. All statistical calculations (descriptive statistics, between group comparisons using Fisher exact, binominal and Pearson chi-square tests, significant at two-tailed p0.05) were performed with the IBM SPSS 27.15% of inpatients and 52% of outpatients with mental disorders received ADs. ADs were prescribed for major depressive disorder and other diagnoses, including the majority of schizophrenia spectrum disorders and non-organic conditions. Selective serotonin reuptake inhibitors, particularly fluvoxamine, were used most often for outpatient and inpatient settings, but at lower average dose rather than recommended, while tricyclic ADs were more likely to be correctly administered for severe depression. ADs were often prescribed within combined treatment rather than monotherapy, but clinical recommendations were not strictly followed in relation to the drug choice, combination with antipsychotic agents and switching strategies.The clinical reality of AD prescriptions in the studied psychiatric setting differed from the clinical guidelines, insofar as the choice of AD medication did not always follow evidence-based recommendations. Choice and dosage of ADs should properly follow duration and severity of the illness, and the clinical profile of disorders.

The COVID-19 pandemic has substantially contributed to increased anxiety rates among the general population worldwide. Pandemic-related health anxiety and worries about getting COVID-19 can lead to generalized anxiety and anxiety somatization, which, together with insalubrious daily life habits, are risk factors of worsening somatic health in people with SARS-Cov-2 infection.The current study is a part of the COMET-G project (40 countries, n=55589; approved by the Ethics Committee of the Aristotle University of Thessaloniki), which represents an intermediate analysis of data collected anonymously via online links from a national sample of the Russian general population (n=9936, 31.09±12.16 y.o., 58.7% females) to estimate anxiety using STAI-S and self-reported changes in anxiety and life habits (physical activity, nutrition and weight, internet use, sleep) during the lockdown. All statistical calculations (descriptive statistics, between group comparisons using chi-square test, MANOVA, ANOVA, significant at p0.05) were performed with IBM SPSS 27.Overall STAI-S scores were 29±5.4, a subjective feeling of anxiety increase was reported in 40.3% of respondents (43.9% significantlyin females), worsening to clinical anxiety in 2.1% (2.4%in females). 54.2% of respondents reported decreased physical activity, 33.1% gained weight, 72% used internet more often, 52.6% experienced worries related to the information about COVID-19 (56.8%in females). 88% experienced worsened sleep quality, 69.2% stayed up until late, 23.2% took sleeping pills, and 31% had nightmares in which they felt trapped. To ANOVA, such life habits as reduced physical activity during the lockdown, increased time spent online, internet browsing about COVID-19, tendency to stay up late, use of sleeping pills and disturbing dreams with scenario of being trapped were significantly related to worsening of clinical anxiety. However, eating behaviour, weight changes, and social media use did not contribute to the clinical anxiety increase.Factors of decreased physical activity and sleep disturbances related to the lockdown, as well as excessive internet browsing for information about COVID-19, emerged as risk factors for increased anxiety, more notably in women than in men. Preventive measures should be targeted against relevant factors imparting anxiety in the vulnerable population.

Introduction: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. ----- Material and methods: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. ----- Statistical analysis: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. ----- Results: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. ----- Conclusions: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

The concepts of schizophrenia and other primary psychotic disorders have been changed a lot since their beginnings more than century ago due to many factors such as the dominance of a certain hypothesis during a particular period of time, the development of new clinical research and specific treatments as well as different understanding of the boundaries between mental disorders. It was appeared the diagnosis of schizophrenia spectrum disorders which still based only on clinical symptoms. Whether psychotic disorders can be better represented dimensionally or categorically remains a challenging question. Regarding schizophrenia and other primary psychotic disorders, there are some important changes in DSM-5 and ICD-11 concerning the use of quantitative assessment of psychopathological domains, course of psychosis and remission as well as giving more attention to cognitive issues. The main differences between these classifications are the structure of corresponding sections and different criteria of some disorders. Before the ICD-11 implementation in 2022 into clinical practice, it is highly recommended to conduct a set of trainings for clinicians along with the comments to Diagnostic guidelines for Schizophrenia and other primary psychotic disorders.Концепции шизофрении и других психотических расстройств за более чем столетнюю историю их возникновения претерпели существенные изменения, связанные с доминированием определенной системы взглядов в конкретный период времени, появлением новых клинических данных и новых видов лечения. Появилось понятие «расстройства шизофренического спектра», диагностика которых до настоящего времени базируется только на клинических признаках. Спор о том, являются ли указанные расстройства преимущественно дименсиональными или категориальными состояниями, остается открытым. Важные изменения в отношении шизофрении и других психотических расстройств нашли отражение в DSM-5 и МКБ-11. Речь идет о введении дименсиональной (количественной) оценки различных психопатологических доменов, течения заболевания и ремиссии, а также о повышении значимости когнитивного снижения. К основным различиям между классификациями можно отнести структуру соответствующих разделов, а также разные критерии диагностики некоторых расстройств. Внедрение МКБ-11 в клиническую практику предполагается в 2022 г., что делает необходимым подготовку соответствующих комментариев к диагностическим разделам указанной классификации и проведение образовательных циклов для врачей.

The article describes the current state of scientific publications in the field of psychiatry in the Russian Federation. Issues of academic dissertations, lack of access to recent Russian language research in foreign databases, and recent reforms in the Ministry of Education and Science for overcoming these limitations are discussed in detail. Four exemplary dissertation studies published in Russian language are summarized. The first research examines the contribution of patient's verbal behavior to the reliable diagnosis of mild depression, identifying objective signs for distinguishing it from normal sadness; the mood component influenced the whole mental status and was represented in both structure and semantics of patients' speech. The second paper describes the course of panic disorder with agoraphobia, with the notable results that debut of panic disorder with full-blown panic attacks, often declines to a second accompanied with agoraphobia, which after several years gives way to limited symptom attacks and decreased agoraphobic avoidance. The third study describes the high prevalence of affective and anxiety disorders in patients with diabetes mellitus type 1 and 2, and the role of personality traits in adherence to treatment in patients with poor glucose control. The fourth project uses functional MRI for probing the features of neuronal resting-state networks in patients with temporal lobe epilepsy; the association with affective symptoms provides a model for investigating the pathophysiology of mood disorder.

Four influential papers that have appeared recently in the main psychiatric journals from Russia are summarized. The first paper examines socio-demographic profile and clinical manifestations and data of people with mental disorders attending the private psychiatric clinics. It was seen that about 50% of private mental health settings’ patients had never consulted a public psychiatric service before seeking help at private psychiatric clinics. Private mental health services have proven their effectiveness in the treatment of non-psychotic disorders and intervention in early onset psychoses. The second paper describes neuropsychological and evolutionary approaches in understanding the comorbidity between depressive and anxiety disorders. It suggests that if anxiety disorder manifests as the first diagnosis, it is more likely that the person will have depression than vice versa. The next article concludes that there is a specific vulnerability of different groups of somatically ill patients to particular mental disorders: cancer is mainly associated with dissociative disorders and asthenia; patients with cardiac disorders are more likely to have comorbid anxiety disorders, hypochondriasis and severe depression. Patients with dermatological illnesses are more likely to have obsessive–compulsive disorder, delusional disorder and mild depression. The last paper discusses some social–psychological and neuro-immunological parameters of people with “dangerous” professions. Using mathematical method, the authors created a model that can decrease the negative influence of work-related extreme factors.

The Diagnostic Interview for Psychoses (DIP) was developed to enhance the quality of diagnostic assessment of psychotic disorders. The aim of the study was the adaptation of the Russian language version and evaluation of its validity and reliability.Ninety-eight patients with psychotic disorders (89 video recordings) were assessed by 12 interviewers using the Russian version of DIP at 7 clinical sites (in 6 cities of the Russian Federation). DIP ratings on 32 cases of a randomized case sample were made by 9 interviewers and the inter-rater reliability was compared with the researchers' DIP ratings. Overall pairwise agreement and Cohen's kappa were calculated. Diagnostic validity was evaluated on the basis of comparing the researchers' ratings using the Russian version of DIP with the 'gold standard' ratings of the same 62 clinical cases from the Western Australia Family Study Schizophrenia (WAFSS).The mean duration of the interview was 47±21 minutes. The Kappa statistic demonstrated a significant or almost perfect level of agreement on the majority of DIP items (84.54%) and a significant agreement for the ICD-10 diagnoses generated by the DIP computer diagnostic algorithm (κ=0.68; 95% CI 0.53,0.93). The level of agreement on the researchers' diagnoses was considerably lower (κ=0.31; 95% CI 0.06,0.56). The agreement on affective and positive psychotic symptoms was significantly higher than agreement on negative symptoms (F(2,44)=20.72, p0.001, η2=0.485). The diagnostic validity of the Russian language version of DIP was confirmed by 73% (45/62) of the Russian DIP diagnoses matching the original WAFSS diagnoses. Among the mismatched diagnoses were 80 cases with a diagnosis of F20 Schizophrenia in the medical documentation compared to the researchers' F20 diagnoses in only 68 patients and in 62 of the DIP computerized diagnostic outputs. The reported level of subjective difficulties experienced when using the DIP was low to moderate.The results of the study confirm the validity and reliability of the Russian version of the DIP for evaluating psychotic disorders. DIP can be recommended for use in education and training, clinical practice and research as an important diagnostic resource.Цель исследования. Диагностическое интервью для психозов (ДИП) разработано с целью повышения качества диагностики психотических расстройств. Настоящее исследование - апробация ДИП в России с оценкой валидности и надежности русскоязычной версии. Материал и методы. 98 больных с психотическими расстройствами (89 видеозаписей) исследовались 12 интервьюерами с помощью русскоязычной версии ДИП на базе семи клинических центров шести городов Российской Федерации. Для определения межэкспертной надежности оценки ДИП 32 случаев из рандомизированной выборки, выставленные 9 интервьюерами, сравнивались с оценками ДИП исследователей, анализировались коэффициенты общего парного согласия и каппа Коэна. Валидность рассчитывалась на основании сравнения оценок ДИП интервьюеров и 62 тех же самых клинических случаев из базы семейного исследования шизофрении Западной Австралии в качестве золотого стандарта. Результаты и заключение. Средняя продолжительность интервью составила 47±21 мин. Статистика каппа продемонстрировала значительное и почти полное согласие для большинства пунктов ДИП (84,54%) и значительное - для диагнозов МКБ-10 с применением компьютерного диагностического алгоритма ДИП (κ=0,68; 95% ДИ 0,53, 0,93). Степень согласия на основании клинических выводов исследователей была существенно ниже (κ=0,31; 95% ДИ 0,06, 0,56). согласие при оценке аффективных и позитивных симптомов было статистически значимо выше, чем негативных (F(2,44)=20,72, p0,001, η

There is an increasing literature about the implementation of the staging model in many mental disorders. According to this approach, there are four stages of a psychiatric disorder: prodromal stage, acute manifestations, residual phase, chronic. In this study, we empirically investigate whether additional clinical variables such as clinical manifestations and comorbid disorders may be useful to modify the staging model to panic disorder (PD).We distinguished inpatient sample (n = 79) with a diagnosis of “panic disorder” according to the DSM-IV criteria. We propose that the inclusion of prodromal stage of PD does not make clinical sense since the different unspecific neurotic symptoms may proceed to a variety of anxiety and depressive disorders. First stage was characterized by the situationally predisposed panic attacks (PA) with both somatic and cognitive symptoms. Comorbid disorders included somatoform disorders and generalized anxiety disorder (GAD). During second stage individuals experienced agoraphobic avoidance until traveling in public transport. On the other hand, spontaneous PA were accompanied by the only somatic but not cognitive symptoms. The most common patterns of comorbidity were GAD and alcohol misuse. Third stage was associated with the absence or limited symptom attacks and chronic agoraphobia. Major depression and obsessive-compulsive disorder might be an integral part of the clinical manifestations. This study supports that the staging model in PD might be updated by the detailed description of clinical manifestations and comorbid disorders at each stage that may help the practitioners to choose the best strategy for the treatment of a particular patient.Disclosure of interestThe author has not supplied his declaration of competing interest.