Consortium Psychiatricum | Peer-review medical journal
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READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “Consortium PSYCHIATRICUM” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “Consortium PSYCHIATRICUM” (further-the Journal) in accordance with the conditions stated below. I. 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Association of the COMT gene polymorphism rs4680 with cognitive impairment in schizophrenia: a narrative review
BACKGROUND: Cognitive impairment in schizophrenia patients is characterized by decreased functioning, reduced quality of life, and is a predictor of a more severe course of the disease. The rs4680 variant of the COMT gene (Val158Met), which encodes catechol-O-methyltransferase, affects dopamine metabolism in the prefrontal cortex and is a key genetic modifier of cognitive endophenotypes. However, the associations of the rs4680 alleles with the severity of cognitive impairment remain unclear. This review summarizes and critically re-evaluates the evidence on the role of rs4680 in the development of cognitive deficits in schizophrenia. AIM: To explore the associations of the rs4680 variant of the COMT gene with cognitive functions in schizophrenia. METHODS: A literature search of the PubMed database for the last 10 years (2014–2024) was performed with the search query “rs4680 schizophrenia cognition”. The review included 11 studies. RESULTS: In the majority of studies (9 out of 11), carriers of the Met allele demonstrated better cognitive parameters, such as verbal and visual memory, information processing speed, and regulatory functions (especially in men). Individuals with the Val/Val genotype demonstrated worse attention. Women in the Russian population with Met allele had better conceptualization and inhibitory control results, and men in the Han population with Met allele had a better association with memory and attention. CONCLUSION: The results of this review confirm the association between the rs4680 variant of the COMT gene and cognitive function. Although the quality of the studies included in this review was low, the overall results indicate that further investigation of this association is promising. The identification of a stable association between the COMT genotype and the severity of cognitive deficit provides the basis for a personalized approach in the management of patients with schizophrenia. Further studies on the validation of genetic markers in independent cohorts and the development of algorithms for the integration of genetic data with complex neurocognitive assessments and clinical endophenotypes are needed to make the clinical implementation of this approach successful.
Copyright (c) 2025 Maksimenko T.V., Zorkina Y.A., Efimova O.I., Andriushchenko A.V., Kostyuk G.P. https://creativecommons.org/licenses/by-nc-nd/4.0
The psychological Impact of COVID-19 lockdown on children and adolescents in Tunisia: a cross-sectional study
BACKGROUND: During the COVID-19 pandemic, Tunisia implemented a national lockdown between March and May 2020. This disrupted daily life and limited access to essential services. The restrictions significantly reduced social interactions and outdoor activities for children and adolescents, raising concerns about the psychological impact on this population. AIM: To assess the psychological impact of the COVID-19 lockdown on children and adolescents in Tunisia. METHODS: A cross-sectional study using a telephone survey was conducted among 514 Tunisian households in August 2020. We included parents of children aged five to 15 years. The collected data included sociodemographic characteristics, general information, and details on the establishment of routines and adaptive containment measures. A 26-item questionnaire was developed to assess anxiety and emotional and behavioral symptoms. Data were analyzed using descriptive statistics and chi-square tests. RESULTS: Parents reported depressive symptoms, anxiety symptoms and behavioral manifestations in 38.7%, 69.8% and 61.9% of their children, respectively. Among children, female sex was associated with significantly greater levels of depressive symptoms, sleep disturbances, and eating disturbances (p=0.002, p=0.034 and p=0.011, respectively). Children who had somatic chronic illnesses or whose parents had such conditions reported significantly greater levels of somatic complaints (p=0.037). Those whose fathers continued to work during the lockdown had a more positive attitude toward the COVID-19 pandemic (p=0.027). Children with anxiety symptoms had more positive attitudes towards the COVID-19 pandemic (p=0.002); however, those with depressive symptoms did not (p=0.19). CONCLUSION: The COVID-19 lockdown had a substantial psycho-logical impact on children and adolescents in Tunisia, as indicated by high rates of anxiety, depression, and behavioural disturbances. These findings may contribute to the formulation of evidence-based recommendations aimed at safeguarding the mental health of children and adolescents in future pandemic scenarios, thereby minimizing adverse psychological outcomes.
Copyright (c) 2025 Ben Hamouda A., Hamza M., Daoud M., Bourgou S., Charfi F., Harizi C., Fakhfakh R., Belhadj A. https://creativecommons.org/licenses/by-nc-nd/4.0
Comparative visual perception patterns in autism spectrum disorder and mild intellectual disability: a cross-sectional study
BACKGROUND: Visual perception plays a crucial role in cognitive and behavioral development. Individuals with autism spectrum disorder (ASD) and mild intellectual disability (ID) exhibit distinct patterns of visual processing that influence their learning and interaction with the environment. AIM: This study aims to compare the visual perception abilities of children with ASD and those with mild ID. METHODS: This study employed an experimental comparative design. The Bender Visual-Motor Gestalt Test was administered to assess visual-motor integration, perceptual organization, and spatial processing abilities. It was scored based on standard qualitative and quantitative criteria. Group comparisons were conducted using descriptive statistics and cross-group performance patterns. RESULTS: A total of 15 children (8 with ASD and 7 with mild ID), aged between 7 to 12 years, participated in the study. Children with ASD demonstrated superior spatial organization and attention to local details, whereas children with mild ID demonstrated significant difficulties in perceptual coherence, spatial alignment, and motor coordination. CONCLUSION: The study highlights the importance of developing tailored intervention strategies that address the distinct perceptual processing styles associated with ASD and mild ID. However, limitations such as a lack of detailed diagnostic criteria, absence of symptom severity differentiation, and failure to control for developmental age must be considered when interpreting the findings. Future research should aim to overcome these limitations by including standardized diagnostic measures, creating a larger and more diverse sample, and involving additional assessment tools for a more comprehensive analysis.
Copyright (c) 2025 Khamenehei N., Tokarskaya L.V. https://creativecommons.org/licenses/by-nc-nd/4.0
Shared psychotic disorder in the digital age: a case series of virtual “folie à trois”
BACKGROUND: This case series presents a unique manifestation of shared psychotic disorder “folie à trois” transmitted entirely through digital interactions. It is among the first documented clinical accounts demonstrating that immersive online alliances — without physical proximity — can serve as fertile ground for psychotic contagion. The report contributes to evolving psychiatric frameworks by highlighting the role of “virtual cohabitation” in shaping shared delusional systems. CASE SERIES PRESENTATION: Three young adult males from different cities in West Bengal developed a shared persecutory delusional system over three years of daily interaction within an online gaming guild. The inducer (Case A) presented with severe paranoia, digital surveillance delusions, and insomnia. Recipients (Cases B and C) displayed alignment with these beliefs, marked social withdrawal, and psychological dependency on the inducer. All patients were diagnosed with shared psychotic disorder. Interventions included second-generation antipsychotics (risperidone, olanzapine, aripiprazole), structured cognitive-behavioral therapy, digital hygiene protocols, and psychoeducation. Separation of digital communication among the triad facilitated therapeutic gains. All three demonstrated symptomatic improvement over 2–3 months, with partial restoration of social functioning. CONCLUSION: This case underscores that psychological proximity fostered through immersive digital platforms may suffice for the transmission of delusional beliefs. Clinicians must routinely explore virtual relationships and digital group identities as potential vectors of psycho-pathology. Early detection, digital boundary setting, and integrative therapy approaches are essential in managing such emerging presentations.
Copyright (c) 2025 Banerjee D. https://creativecommons.org/licenses/by-nc-nd/4.0
The perceived ability to cope with trauma scale: a Russian-language adaptation
BACKGROUND: The “Perceived Ability to Cope with Trauma Scale” (PACT) is designed to assess individuals’ perceptions of their ability to use various coping strategies when facing potentially traumatic events. These include focusing on the cognitive processing of the trauma (the “Trauma Focus” subscale) and overcoming the trauma (the “Forward Focus” subscale). The key advantages of the PACT scale include an emphasis on perceived self-competence, the absence of the “flexibility/rigidity” dichotomy, and moderate correlations with distress that confirm discriminative validity. AIM: To adapt the PACT scale for the Russian population and conduct a psychometric assessment of its Russian-language version. METHODS: The adaptation procedure included direct and reverse translations of the PACT scale and expert assessment of their quality. To validate the adapted version of the PACT questionnaire, a survey was conducted involving adults who had experienced at least one potentially traumatic event (with assessment according to the Life Events Checklist for DSM-5). The sample was made up of civilians and employees of emergency services (firemen, rescue workers, physicians, psychologists). The psychometric assessment included a check of the factor structure, assessment of sex, age, occupation, and post-traumatic status invariance, as well as assessment of internal consistency and test-retest reliability. The International Trauma Questionnaire and Depression Anxiety and Stress Scale-21 were used to test convergent validity. RESULTS: A psychometric assessment of the adapted version of the PACT scale was conducted with 1,054 respondents (56% male) with a mean age of 37.2 (standard deviation 9.54) years. Confirmatory factor analysis confirmed the two-factor structure of the scale, complete invariance by age and partial invariance by sex, occupation, and post-traumatic status. The reliability coefficients (Cronbach’s α and McDonald’s ω) showed good values for the “Trauma Focus” subscale (ω=0.810, α=0.806) and the “Forward Focus” subscale (ω=0.896, α=0.893). The test-retest reliability was partially confirmed. The convergent validity of the adapted version of the PACT scale was confirmed: symptoms of distress and post-traumatic stress were negatively correlated with the score on the “Forward Focus” subscale and positively correlated with the “Trauma Focus” score. CONCLUSION: The Russian-language version of the PACT scale is valid, reliable, and can be used to assess the perceived ability to cope with trauma for research or counseling purposes.
Copyright (c) 2025 Shmarina T.A., Chernov N.V., Kostyuk G.P. https://creativecommons.org/licenses/by-nc-nd/4.0
Mental health of forcibly displaced persons from Nagorno-Karabakh: a cross-sectional study
BACKGROUND: The international community is acutely facing a global problem of refugees and forcibly displaced persons. The situation is currently escalating into a crisis, creating serious humanitarian, social, and healthcare challenges. The forced displacement of the entire Armenian population of Nagorno-Karabakh in 2023 became an emergency in Armenia and highlighted a number of societal issues, including the mental health of the displaced population. What made this migration stand out was its dual nature: on the one hand, it was a flight across national borders to a neighboring country, and on the other hand, it was a return to the historical homeland with which they share a common history, culture, language, and religion. AIM: To evaluate the mental state of the persons forcibly displaced from Nagorno-Karabakh to Armenia and the risk factors underlying their developing anxiety and depression disorders. METHODS: We performed statistical data processing using hierarchical regression analysis. RESULTS: The study was conducted among 733 respondents. The majority of the forcibly displaced persons were women. Most of the refugees were married, relocated with their families, and had mainly secondary education. One in five reported a history of mental trauma. More than half of the respondents showed signs of depression and anxiety that required therapeutic intervention. These individuals exhibited significant impairments in functionality and capacity for work. CONCLUSION: The study revealed the severity and prevalence of anxiety and depression disorders in forcibly displaced persons. Forced displacement was the key factor in the development of mental disorders in this population. Demographic characteristics, such as sex, age, and marital status, also have a significant impact.
Copyright (c) 2025 Sukiasyan S.G., Soghoyan A.F., Baghdasaryan L.V., Grigoryan A.K., Karapetyan L.G., Tataryan K.K., Avanesyan G.M., Yaramishyan V.B., Hayrapetyan G.G., Harutyunyan Z.V., Bayatyan N.Y., Barseghyan A.A., Badalyan A.R., Budoyan A.S., Hovhannisyan H.R., Tonoyan A.D., Shaginyan H.A., Simonyan H.V., Avagyan A.V., Yesayan V.S., Makaryan T.S. https://creativecommons.org/licenses/by-nc-nd/4.0
Revisiting delirious mania in the context of neurosyphilis: a case report
BACKGROUND: Delirious mania (DM) is a severe neuropsychiatric syndrome characterized by the acute onset of delirium, psychosis and increased psychomotor activity. Its classification remains debated, with overlapping features of mania, catatonia, and delirium complicating diagnosis and treatment. The condition poses significant challenges in differential diagnosis, particularly in patients with comorbid medical conditions. CASE PRESENTATION: We report the case of a 52-year-old man with bipolar disorder who presented with acute agitation, disorientation, confabulation, incontinence, and severe behavioral disturbances, initially suggestive of DM. Despite targeted psychiatric treatment, his condition remained refractory until a syphilitic infection was identified, with a possible presentation of neurosyphilis, and treated with antibiotic therapy. Resolution of his symptoms followed, with the delirium persisting briefly after the mania had subsided, suggesting an organic contribution to his presentation. CONCLUSION: This case highlights the importance of considering organic etiologies, such as neurosyphilis, in presentations of DM. It also supports the view that DM may represent a syndromic entity with both psychiatric and medical underpinnings, rather than merely a subtype of bipolar disorder. Early identification and treatment of DM, along with any underlying medical conditions, are crucial for patient recovery.
Copyright (c) 2025 Hirsch D., Leone B., Bernabei L., Nicolò G. https://creativecommons.org/licenses/by-nc-nd/4.0
Erratum to “Comparative Analysis of Corpus Callosum Lipidome and Transcriptome in Schizophrenia and Healthy Brain” (Consortium PSYCHIATRICUM, 2025, Volume 6, Issue 1, doi: 10.17816/CP15491)
In the article by M.S. Osetrova et al. titled "Comparative Analysis of Corpus Callosum Lipidome and Transcriptome in Schizophrenia and Healthy Brain", published in the Consortium PSYCHIATRICUM journal (Volume 6, Issue 1), the editorial team made some technical errors. Without any malicious intent, the quantitative indicators in Figure 1 "Experiment design" were incorrectly stated: 1,254 genes instead of 14,254 in the RNAseq section and 385 peaks instead of 384 in the LC-MS section. The technical errors in Figure 1 have been corrected, and updated PDF and HTML versions of the article have been uploaded on the journal's website. The editorial team of the journal hopes that the mistakes could not significantly affect the perception and interpretation of the published work by readers, and should not become the reason for retraction. The editorial team apologizes to the authors and readers for the mistakes made.
Copyright (c) 2025 Osetrova M.S., Efimova O.I., Zavolskova M.D., Stekolschikova E.A., Vladimirov G.N., Senko D.A., Zhuravleva T.A., Morozova A.Y., Zorkina Y.A., Andreyuk D.S., Kostyuk G.P., Nikolaev E.N., Khaitovich P.E. https://creativecommons.org/licenses/by-nc-nd/4.0
Modern concept of depression pathogenesis: the contribution of I.P. Lapin’s research team
BACKGROUND: The advent of neuroleptics and antidepressant therapy marked a significant step forward in clinical psychiatry. Numerous experiments worldwide had been dedicated to a search for the potential neurobiological mechanisms underlying the potency of new psychopharmacological drugs. The first laboratory of psychopharmacology in the USSR was established in 1960 at the Leningrad Psychoneurological Institute. It was headed by Professor Izyaslav Petrovich Lapin. The foundational article by Lapin I.P. and Oksenkrug G.F. (The Lancet, 1969) continues to be cited 55 years after its publication, which determines the interest in the role of this research team in shaping temporal concepts of the pathogenesis of depression and the development of psychopharmacology. AIM: To analyze the contribution of Lapin I.P. and his research team to the development of experimental approaches for studying the mechanisms of depression. METHODS: We analyzed the articles and monographs authored by Professor Lapin I.P., both individually and in co-authorship, available in PubMed, Google Scholar, eLIBRARY.RU, and in the bibliographic collection of the V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology. RESULTS: This analysis highlights the significance of Lapin I.P. and his scientific team’s work in advancing our understanding of serotonin role in the mechanisms of depression and in the development of animal depression models. The scientific contribution of this team is an important milestone towards future research into the neurobiological mechanisms underlying depression, as well as the development of therapeutic approaches. CONCLUSION: Lapin’s scientific publications and the work of his team in the field of psychopharmacology have had a significant impact on the development of neuroscience and continue to be of unquestionable importance in advancing scientific practice more than 50 years later.
Copyright (c) 2025 Neznanov N.G., Tumova M.A., Freize V.V., Gerasimchuk E.S., Radionov D.S., Khobeysh M.A., Malyshko L.V., Anokhina M.V., Palchikova E.I., Sorokin M.Y. https://creativecommons.org/licenses/by-nc-nd/4.0
The role of the 5-HTTLPR gene variation of the SLC6A4 serotonergic system in the development of addictive disorders: a narrative review
BACKGROUND: Addictive disorders remain a global problem, affecting health, society and the economy. The etiopathogenesis of addictions, which have a multifactorial nature, is poorly understood, making it difficult to develop personalized treatment approaches. Of particular interest is the SLC6A4 gene, which regulates serotonergic transmission. The 5-HTTLPR variation of this gene is associated with the risk of addictions, but the data are contradictory due to the heterogeneity of clinical manifestations and pleiotropic effects of the gene. Integration of genetic, environmental and neurobiological factors into multidimensional models is becoming relevant. AIM: The aim of this study is to assess the role of 5-HTTLPR variations in the SLC6A4 gene of the serotonergic system in the development of addictive disorders. METHODS: The manuscripts were searched in the MEDLINE and eLIBRARY.RU databases using the keywords in Russian and English: “SLC6A4”, “5-HTTLPR”, “addictive disorders”, “pharmacogenetics”, “serotonin”, “antidepressants”, “ethnic differences”. After eliminating duplicates and a two-stage screening (by titles/annotations and full-text analysis) of the 1,561 discovered papers, the final review included 41 publications that meet the stated inclusion criteria. RESULTS: The S-allele of 5-HTTLPR is associated with an increased risk of addictions and comorbid affective disorders, but its role is ambiguous due to the heterogeneity of symptoms. Ethnic differences have been identified: the S-allele predominates (70.6–80.9%) in Asian populations, the L-allele in Europeans (38.5–66.7%). Unique neurobiological markers for S-allele carriers have not been established, and the pleiotropic effects of SLC6A4 are also observed in other mental disorders, which reduces its specificity for addictions. CONCLUSION: The inconsistency of the data on 5-HTTLPR highlights the need to take into account ethnic specificity and develop multivariate models that integrate genetic, environmental and clinical factors. This will improve risk prediction (development of addictions), personalization of therapy and the effectiveness of pharmacogenetic approaches, reducing the likelihood of adverse reactions.
Copyright (c) 2025 Krylov A.V., Pavlova N.I., Bochurov A.A. https://creativecommons.org/licenses/by-nc-nd/4.0
Association of polygenic risk scores for schizophrenia with psychosis-proneness indicators in the general population: a narrative review
BACKGROUND: Schizotypy (ST) and psychotic-like experiences and negative symptoms (PENS) are commonly used phenotypes in high-risk and early intervention research for schizophrenia and other non-affective psychoses. However, the origin of these phenotypes in the general population is poorly understood and their association with the genetic predisposition to psychoses has not yet been proven. AIM: The aim of this study is to answer the question of whether data on the relations of ST and PENS with polygenic risk scores for schizophrenia (SZ-PRS) support the hypothesis that these phenotypes are subclinical manifestations of genetic liability for schizophrenia. METHODS: Literature describing these relations in the general population was analyzed. The literature search was performed in the PubMed database using the following keywords in English: ((“schizotyp*” OR “psychotic-like experiences” OR “psychosis proneness” OR “psychotic experiences”) AND (”polygenic risk” OR “genetic liability” OR “polygenic score”)); the search in eLIBRARY.RU was conducted using the Russian words for “schizotypy”, “schizotypal features”, “psychotic experiences”, “psychotic experience”, “psychotic symptoms”, and “polygenic risk”, covering publications from 2009 to 2024. RESULTS: Of the identified records, 45 publications were found eligible. No expected positive correlations of SZ-PRS with common ST measures have been observed. For PENS, the results are inconsistent. Overall, SZ-PRS correlate more often with the PENS general factor and negative symptoms than with psychotic experiences per se. CONCLUSION: The literature does not provide convincing evidence of the association between SZ-PRS and ST/PENS. The search for the substantive psychological meaning of polygenic vulnerability to psychosis captured by SZ-PRS should be expanded to other personality processes and traits.
Copyright (c) 2025 Alfimova M.V. https://creativecommons.org/licenses/by-nc-nd/4.0
Russian version of the Inventory of Motivations for Suicide Attempts: validation in a clinical sample of adolescents
BACKGROUND: Understanding the motives for suicide attempts is a necessary condition of suicide risk assessment in adolescents. However, there is a lack of measures in Russian that assess these motives, particularly, in adolescent populations. The Inventory of Motivations for Suicide Attempts (IMSA) measures a variety of theoretically grounded intrapersonal and interpersonal motives and can be used in adolescent samples. AIM: To validate the Russian version of the IMSA in a clinical sample of adolescents with suicidal behavior. METHODS: The Russian-language adaptation of the IMSA was conducted on a clinical sample of 522 inpatient adolescents 12–17 years old (M=14.51±1.52), including 425 girls and 97 boys. All the adolescents were hospitalized in a psychiatric hospital due to a suicide attempt, suicidal intentions, or a history of suicide attempts. To test the convergent and discriminative validity of the Russian version of the IMSA, the Interpersonal Needs Questionnaire, Interpersonal Sensitivity Measure and Self-Concept Clarity Scale were used. RESULTS: Confirmatory factor analysis showed that the original 10-factor structure did not have a good fit. After modifications and removal of 12 items an 8-factor structure emerged, which had the following scales: Hopelessness, Psychache, Escape, Burdensomeness, Low belongingness, Fearlessness, Problem-solving, Interpersonal motivations. A generalizing Intrapersonal motivations scale was also defined. The fit measures for the final model were as follows: χ2(df)=1,757.23(808); CFI=0.911; RMSEA=0.053 (p=0.087); SRMR=0.058. All the scales in the Russian version of the IMSA displayed satisfactory internal (above 0.8 except for Problem-solving) and retest reliability (above 0.6 except for Interpersonal motivations) and statistically significant positive correlations with scales from the Interpersonal Needs Questionnaire and Interpersonal Sensitivity Measure and negative correlations with Self-Concept Clarity Scale. CONCLUSION: The IMSA displayed satisfactory psychometric properties in a Russian adolescent inpatient sample and can be used to differentiate between the motives for suicide attempts in adolescents.
Copyright (c) 2025 Polskaya N.A., Basova A.Y., Razvaliaeva A.Y., Severina Y.V. https://creativecommons.org/licenses/by-nc-nd/4.0
The neurophysiological features of anticipation in schizophrenia: a cross-sectional study of event-related potentials
BACKGROUND: It is known that disorders of mental activity in schizophrenia patients may be caused by an impairment in the actualization of past experience during anticipation (prediction), which leads to impairment in constructing predictions, comparing incoming sensory information with the predictions, and updating the predictions. Previous studies have shown that the probability of an expected event affects the components of event-related potentials in mentally healthy individuals. However, it has not yet been studied how changes in the probability of an expected stimulus influence the behavior of individuals with schizophrenia and their event-related potential measures. AIM: To compare the influence of event probability on the characteristics of brain potentials in patients with schizophrenia and healthy individuals. METHODS: The study included mentally healthy individuals and male schizophrenia patients. Electroencephalograms were recorded while participants performed a saccadic task within the Central Cue Posner’s Paradigm under conditions of varying probability (50% and 80%) of target stimulus presentation. Pre-stimulus (Contingent Negative Variation) and post-stimulus (Mismatch Negativity and P3) components of event-related potentials were analyzed upon the presentation of two types of target stimuli: standard (presented on the same side as the cue stimulus) and deviant (presented on the opposite side), under conditions of 50% and 80% stimulus congruence probability. RESULTS: The study involved 20 mentally healthy individuals and 18 schizophrenia patients. In healthy subjects, the amplitude of the contingent negative variation increased with high stimulus congruence probability, while the amplitude of the Mismatch Negativity (MMN) and P3 component was higher for deviant stimuli under conditions of high (80%) probability. In schizophrenia patients, changes in probability demonstrated no impact on the amplitude of the contingent negative wave, MMN, or P3. CONCLUSION: The characteristics of event-related potentials in patients with schizophrenia indicate impaired anticipation processes.
Copyright (c) 2025 Rabinovich E.I., Telesheva K.Y. https://creativecommons.org/licenses/by-nc-nd/4.0
Duration matters: anticonvulsant therapy linked to bone loss in interim cross-sectional study
BACKGROUND: Anticonvulsants are widely used in treating patients with mental and neurological disorders. Their long-term use increases the risk of a decrease in bone mineral density (BMD) and low-energy fractures. Despite the growing number of studies of drug-induced osteoporosis, the effect of anticonvulsants on bone microarchitecture remains poorly studied. AIM: To study the effect of treatment duration with different generations of anticonvulsants on bone mineral density and fracture risk. METHODS: We examined 100 adult patients with epilepsy who had been on anticonvulsants for more than 12 months and 58 healthy subjects who had never taken anticonvulsants. All the participants underwent a general clinical and neuropsychological assessment, as well as bone densitometry using quantitative computed tomography in three regions of interest (lumbar vertebrae L1, L2 and femoral neck). RESULTS: BMD reductions were observed in 47 patients (47%) taking anticonvulsants and 29 (50%) subjects in the control group. The mean duration of anticonvulsant therapy was 8.7 years (SD=8.05) in patients with normal BMD, 10.7 years (SD=7.07) in patients with osteopenia, and 9.5 years (SD=5.24) in patients with osteoporosis. Age was found to significantly affect BMD, while the duration of anticonvulsant therapy affected it to a lesser extent. Patients taking first-generation anticonvulsants had lower BMD (p=0.018). ROC analysis confirmed the existence of a relationship between the duration of anticonvulsant therapy and the risk of fractures (p<0.001). The “duration of anticonvulsant therapy” threshold at the cut-off point corresponding to the highest Youden index value was 10 years. CONCLUSION: Long-term treatment with conventional anticonvulsants adversely affects BMD and can lead to pathological bone resorption, increasing the risk of fractures in patients. New-generation anticonvulsants did not show any significant negative impact on BMD. The results of this study indicate the need for further research to better understand the effects of anticonvulsants on bone tissue.
Copyright (c) 2025 Sivakova N.A., Abramova I.V., Trukhina I.Y., Rybasova V.P., Sorokin M.Y., Kasyanov E.D., Lukina L.V., Mikhailov V.A., Mazo G.E. https://creativecommons.org/licenses/by-nc-nd/4.0
Comparative analysis of corpus callosum lipidome and transcriptome in schizophrenia and healthy brain
BACKGROUND: Functional and structural studies of the brain highlight the importance of white matter alterations in schizophrenia. However, molecular studies of the alterations associated with the disease remain insufficient. AIM: To study the lipidome and transcriptome composition of the corpus callosum in schizophrenia, including analyzing a larger number of biochemical lipid compounds and their spatial distribution in brain sections, and corpus callosum transcriptome data. To integrate the results of molecular approaches to create a comprehensive molecular perspective of the disease. METHODS: A total of 8 brain tissue samples (4 from healthy controls (HC) + 4 from schizophrenia patients (SZ)) were analyzed using high-performance liquid chromatography with mass spectrometry (HPLC-MS) and RNA sequencing for transcriptome profiling. Additionally, 6 brain tissue samples (3 HC + 3 SZ) were analyzed using matrix-assisted laser desorption/ionization mass spectrometric imaging (MALDI-MSI). This approach enabled the characterization of mRNA and lipids in brain tissue samples, and the spatial distribution of selected lipids within brain sections. RESULTS: The analysis revealed a general trend of reduced lipid levels in the corpus callosum of schizophrenia patients for lipid classes measured by mass spectrometric methods. Specifically, nine lipid classes detected via HPLC-MS showed significant differences in schizophrenia samples, with seven of them having lower median intensity. The results between HPLC-MS and MALDI-MSI were highly concordant. Transcriptome analysis identified 1,202 differentially expressed genes, clustered into four functional modules, one of which was associated with lipid metabolism. CONCLUSION: We identified a series of lipidome and transcriptome alterations in the corpus callosum of schizophrenia patients that were internally consistent and aligned well with previous findings on white matter lipidome changes in schizophrenia. These results add to the existing scope of molecular alterations associated with schizophrenia, shedding light on the biological processes potentially involved in its pathogenesis.
Psychometric properties and factor structure analysis of the inventory of statements about self-injury (ISAS) in a Russian non-clinical sample
BACKGROUND: The “Inventory of Statements About Self-Injury” (ISAS) is one of the most widely used and reliable psychometric tools for assessing non-suicidal self-injury (NSSI) and its motivations. The Russian adaptation of the ISAS, involving patients with nonpsychotic psychiatric disorders, demonstrated high internal consistency and a two-factor structure similar to the original. However, the reliability and suitability of ISAS in a non-clinical population remain unclear. AIM: To adapt the ISAS in Russian, evaluate its psychometric properties, and analyze its factor structure in a sample of Russian university students. METHODS: The psychometric properties and factor structure of the adapted ISAS version were evaluated through an anonymous online survey of Russian university students. Respondents had reported lifetime NSSI and scored above 4 on the ISAS-Functions subscale. Exploratory and confirmatory factor analysis (EFA/CFA) were performed on two randomly formed subgroups to evaluate the factor structure of ISAS. Additionally, the associations between the identified ISAS factors and the presence of suicidal thoughts and attempts over a lifetime and in the week before their participation in the study, as well as seeking psychiatric and/or psychotherapeutic care over a lifetime, were analyzed. RESULTS: The survey included 3,919 participants, of whom 1,149 (29.3%; 88.0% female) reported NSSI, with a median age of 20 (18; 22) years. The Russian ISAS demonstrated high internal consistency (Cronbach’s alpha = 0.851). EFA results supported the original two-factor structure. CFA results suggested an alternative three-factor structure of the ISAS, including “Signal”, “Regulation”, and “Influence” factors. Suicidal attempts were associated with the factors “Regulation” and “Influence”, suicidal thoughts with “Regulation” and female gender, and the seeking of psychiatric and/or psychotherapeutic care with “Regulation” and age. CONCLUSION: The adapted ISAS in Russian is a reliable tool with high internal consistency. The study proposed a three-factor structure, indicating a greater heterogeneity of the NSSI phenomenon compared to earlier understandings. The study demonstrated the association between two of the three identified factors with suicidal behavior and thoughts, and the seeking of psychiatric care.
Copyright (c) 2025 Kibitov A.A., Potanin S.S., Yagina O.M., Borodin V.I., Morozova M.A. https://creativecommons.org/licenses/by-nc-nd/4.0
Generalized bullous fixed drug eruption induced by chlordiazepoxide: a case report of a potentially lethal adverse effect
BACKGROUND: Fixed drug eruption is a type of adverse drug reaction affecting the skin, marked by recurrent rashes that appear at the same site each time a particular drug is taken. Generalized bullous fixed drug eruption (GBFDE) is a severe form of FDE characterized by vesicles or bullae and involvement of a significant portion of the body surface area. To date, no association between GBFDE and chlordiazepoxide has been reported in the literature. CASE REPORT: The authors present the case of a 40-year-old male inpatient in the psychiatry department of a tertiary care hospital in Assam, India. The patient was admitted in an alcohol withdrawal state and was initially prescribed chlordiazepoxide at a dose of 60 mg/day. He developed GBFDE within a day of chlordiazepoxide administration. The drug was discontinued, and he was treated with oral and topical corticosteroids instead, resulting in a significant improvement. CONCLUSION: Сhlordiazepoxide is a rare but potential trigger of GBFDE. Clinicians should closely monitor patients on chlordiazepoxide for possible signs of GBFDE.
Copyright (c) 2025 Singh R., Sudhanshu V., Shafiq M., Sharma M. https://creativecommons.org/licenses/by-nc-nd/4.0
Motives for new psychoactive substances consumption among young adults in Uzbekistan: a qualitative study protocol
BACKGROUND: New psychoactive substances (NPS) represent a global problem, especially among young people. In Central Asia, while the trafficking in NPS continues to grow, there remains a lack of data on the social, health and psychological consequences of their use. AIM: To investigate the motives behind the NPS use among young people in the Republic of Uzbekistan, as well as the medical and social characteristics of this group. METHODS: The study will include young people (18–35 years) who have used NPS in the preceeding 30 days (on the basis of self-reports) or are undergoing rehabilitation and plan to cease the NPS use within the next 12–18 months. Semi-structured interviews will reveal the reasons for NPS use, risk perception, stigma, barriers to seeking help, and the need for preventive and rehabilitation services. Interviews will take place at the Republican Mental Health Center and two specialized rehabilitation centers in Uzbekistan between November 2024 and the completion of enrollment (25–30 participants), but no later than May 2025. Additionally, a focus group of psychiatrists, psychotherapists, narcologists, and psychologists will evaluate the level of awareness amongst health care professionals as regards of NPS use and its prevalence, medical, and social implications. EXPECTED RESULTS: The study will identify the key motives of NPS use, usage patterns, and social and medical barriers of help-seeking. Findings will contribute to the development of prevention and rehabilitation strategies, including digital communication platforms and interactive educational programs. CONCLUSION: The study focuses on raising awareness about the consequences of NPS in the Republic of Uzbekistan. This is essential for developing effective public health prevention and rehabilitation programs.
Copyright (c) 2025 Zakhidova G.A., Pikirenia U.I., Syunyakov T.S., Prilutskaya M.V. https://creativecommons.org/licenses/by-nc-nd/4.0
Dialogical structure of the brain and the ternary system of the mind: the neurosemiotics of Yuri Lotman
Yuri Lotman (1922–1993) was a semiologist, literary critic, and cultural historian from Soviet Russia. He is credited with founding the multidisciplinary Tartu-Moscow School of Semiotics. As a cultural theorist and humanist, he was highly influential across many fields, but his contributions to theories about the brain as a semiotic system have often been overlooked. Topics such as the asymmetry of the brain hemispheres, the “untranslatable” specialization of their respective “languages”, interhemispheric dialogue, and the unity of consciousness were frequent subjects of discussion within the scientific community that formed around the multidisciplinary Tartu-Moscow (and Leningrad) group. Recently, scholars such as E. Andrews and T.V. Chernigovskaya have highlighted the influence and relevance of the “neurosemiotic” model proposed by Yu.M. Lotman in the late 1970s. However, our impression is that a fundamental aspect, which Yu.M. Lotman considered indispensable for the functioning of any “thinking system”, has been overlooked in the application of this model to contemporary studies of neurophysiology. This aspect is the intersemiotic translation device that Yu.M. Lotman calls the “semiotic boundary”. We can consider this as a “third” structure of intersection between the two hemispheres, which actively operates to translate specialized information systems reciprocally. In this paper, we will attempt to restore its significance according to an interpretation updated to the most recent discoveries in cognitive neuroscience.
Copyright (c) 2025 Sanna M. https://creativecommons.org/licenses/by-nc-nd/4.0
Comments on the article “Dialogical structure of the brain and the ternary system of the mind: the neurosemiotics of Yuri Lotman”
Copyright (c) 2025 Andriushchenko A.V. https://creativecommons.org/licenses/by-nc-nd/4.0
Integrating Rational Emotive Behavior Therapy, Compassion-Focused Therapy with Cognitive Retraining in Traumatic Brain Injury: A Case Report
BACKGROUND: This case report presents a novel approach to treating Traumatic Brain Injury (TBI) by integrating Rational Emotive Behavior Therapy (REBT), Compassion-Focused Therapy (CFT), and Cognitive Retraining (CR). It contributes to the literature by demonstrating the effectiveness of a comprehensive psychotherapeutic approach in managing complex TBI sequelae, particularly in the Indian context where such interventions are underrepresented. CASE REPORT: A 34-year-old Indian female presented signs of emotional dysfunction, cognitive impairment, social maladaptation, shamefulness, and self-deprecation following a TBI sustained 10 years prior. A mental status examination and psychological assessments revealed cognitive deficits, emotional instability, and irrational beliefs, all related to her injury and recovery. The treatment plan integrated REBT, to address the irrational beliefs; CFT, to manage the sense of shame and the insistence to self-criticize; and CR, to improve cognitive functions. This approach was tailored to the patient’s cognitive limitations and cultural context. Interventions included challenging irrational beliefs, self-compassion imagery, and cognitive exercises adapted to her specific deficits. Outcomes were measured using the Subjective Units of Distress (SUD) scale and clinical observations. The patient showed improvements in emotional regulation, cognitive functioning, and overall quality of life, as evidenced by reduced subjective distress (SUD down from 90 to 58) and enhanced daily functioning. CONCLUSION: This case demonstrates that an integrated psychotherapeutic approach combining REBT, CFT, and CR can effectively address the complex psychological and cognitive challenges of TBI patients. Tailoring interventions towards patient cognitive limitations and cultural context is crucial for a successful outcome. The case highlights the importance of incorporating diverse therapeutic modalities in TBI management, promoting a more holistic approach to recovery and enhancing the quality of life of TBI survivors.
Copyright (c) 2024 Mahajan S.N., Jain A., Chattopadhyay S., Themse S. https://creativecommons.org/licenses/by-nc-nd/4.0
The Mental Health of Refugees and Forcibly Displaced People: A Narrative Review
BACKGROUND: One of the pressing global issues today is the matter of refugees and forcibly displaced people migration. Refugee or forcibly displaced status has a significant impact on a person's mental health, with a high risk of developing depression, anxiety, post-traumatic stress disorder and psychotic disorders. AIM: To conduct a literature review and evaluate the mental health status of refugees and forcibly displaced people due to military action METHODS: The search of literature was conducted without any restrictions on the publication date, with a focus on articles from the past two decades. The search was conducted in the Google Scholar and PubMed databases using the following keywords and phrases: “migration”, “migrants”, “refugees”, “forcibly displaced people”, “mental health”, “mental disorder”, “psychiatric disorders”. This analysis included studies that discussed and evaluated the social, psychological, and clinical aspects of migration. The review included original research and meta-analyses published in English, Russian, and Spanish. Descriptive analysis was applied to summarize the results. RESULTS: The literature review showed that global migration levels have reached a high point, and this trend continues due to the existing geopolitical conditions. Even limited and difficult-to-compare epidemiological data demonstrate that more than a quarter of migrants suffer from mental disorders. These primarily include depression, anxiety, and post-traumatic stress disorders. Apart from creating and exacerbating problems for the refugees and forcibly displaced people themselves, they also pose serious challenges to the social services and healthcare systems of refugee-hosting countries. The literature review demonstrated that forced displacement plays a role in the development of mental disorders, and also emphasizes the significance of several associated factors. CONCLUSION: This review emphasizes the urgent need for standardizing screening methods for refugees and forcibly displaced people, creating unified approaches to diagnostic evaluation, as well as specialized training for mental health professionals. Large-scale programs are needed to support and implement sustainable global mental health measures in the countries affected by hostilities.
Copyright (c) 2024 Sukiasyan S.G. https://creativecommons.org/licenses/by-nc-nd/4.0
Comparison of Immune and Systemic Inflammation Parameters in Patients with a Depressive Episode in Bipolar Disorder and Major Depressive Disorder: A Scoping Review
BACKGROUND: Many studies have aimed to investigate and compare immune system and systemic inflammation parameters in patients with bipolar disorder (BD) and major depressive disorder (MDD) suffering from a depressive episode. However, no systematic review of the results has been conducted so far. AIM: The aim of this study was to conduct a scoping review of research studies comparing immune and systemic inflammation parameters in patients with BD and MDD during a depressive episode. METHODS: The search for studies was conducted in the Medline and eLIBRARY databases for the period from January 1994 to December 2022. Open-access articles written in English and Russian were selected. The review included original studies that compared groups of patients with BD and MDD (diagnosed based on the DSM-IV, DSM-5, or ICD-10 criterion) by immune and systemic inflammation parameters (such as the counts, ratio, and functions of blood cells, erythrocyte sedimentation rate, concentrations of immunoglobulins, cytokines, acute phase proteins, complement components, and autoantibodies). RESULTS: The review included 24 studies. Current depressive episodes in patients with BD were associated with higher concentrations of chemokines (C-C motif chemokine ligand 3 (CCL3), CCL4, CCL5, CCL11), platelet-derived growth factor B, and interleukin 9 (IL-9) (two studies in each case), whereas patients with MDD tended to have higher concentrations of soluble tumor necrosis factor receptor 1 and immunoglobulin G to oxidized low-density lipoproteins (two studies each). Patients with BD and MDD had comparable concentrations of IL-8 (five studies); IL-2 and IL-10 (four studies each); IL-13 and gamma interferon (three studies each); IL-17, IL-1Rα, the vascular endothelial growth factor, as well as white blood cells, monocyte, and platelet counts (two studies each). Contradictory results were obtained for the levels of tumor necrosis factor-α (the concentrations did not differ in five studies, were elevated in BD patients in five studies, were elevated in MDD patients in two studies), IL-6 (the concentrations did not differ in eight studies and were elevated in BD patients in four studies), C-reactive protein (the concentrations did not differ in six studies, were elevated in BD patients in two studies), IL-4 (the concentrations did not differ in three studies and were elevated in MDD patients in two studies), IL-1β and the neutrophil count (the levels did not differ in one study each and were elevated in BD patients in two studies). Several studies have demonstrated an association between immune and systemic inflammation parameters and the severity of depressive and anxiety symptoms, melancholic depression, age of mood disorder onset, body mass index, and imipramine equivalent. CONCLUSION: Some immune and systemic inflammation parameters are associated with a current depressive episode in patients with MDD or BD. These parameters may be considered as potential biomarkers for a differential diagnosis of these disorders.
Copyright (c) 2024 Kasyanova A.A., Sobolevskaia P.A., Limankin O.V., Petrova N.N. https://creativecommons.org/licenses/by-nc-nd/4.0
The Use of Melatoninergic Antidepressants for Stabilization of Remission in Depression Comorbid with Alcohol Abuse, Anxiety or Neuropsychiatric Disorders: A Systematic Review
BACKGROUND: Depression is one of the most common mental disorders and is associated with a significant increase in the risk of mental and somatic comorbidities. The chronobiological theory of the pathogenesis of depression explains the relationship between the symptoms of depression and disturbance of circadian rhythm regulation. Disrupted circadian rhythms are also observed in other disorders such as alcohol use disorder, anxiety disorders, epilepsy, and Parkinson’s disease. Therefore, there is a growing interest in the use of medications with a melatoninergic mechanism of action in the treatment of depression comorbid with the aforementioned disorders. AIM: This review aims to systematically examine the evidence for the use of melatoninergic antidepressants (agomelatine and fluvoxamine) in the treatment of depression comorbid with alcohol abuse, anxiety disorders (including phobic anxiety, panic, and generalized anxiety disorders), or neuropsychiatric disorders (such as epilepsy and Parkinson’s disease). METHODS: This systematic review included experimental studies, systematic reviews, and meta-analyses published in English and Russian, which examined the use of fluvoxamine and agomelatine in adult patients with recurrent depressive disorder (ICD-10) or major depressive disorder (DSM-5) comorbid with alcohol abuse, anxiety or neuropsychiatric disorders. The search was conducted in the PubMed, Cochrane Library and eLIBRARY scientific databases. The quality of the selected studies was assessed using the Cochrane Risk of Bias tool, which is used to evaluate the risk of systematic errors in clinical studies. The results were presented as a narrative synthesis and grouped by the comorbidities evaluated. RESULTS: A total of 20 articles were reviewed (with a pooled sample size of n=1,833 participants). The results suggest that melatoninergic antidepressants might help in reducing depressive and anxiety symptoms, improve sleep, decrease alcohol cravings, and alleviate the severity of motor symptoms in Parkinson’s disease. Moreover, the use of pharmacogenetic testing to select the medication and dosage may enhance its therapeutic effectiveness. CONCLUSION: The review demonstrates a significant lack of clinical data and guidelines on the use of melatoninergic medications for the treatment of depression comorbid with other disorders. In this regard, it is currently difficult to draw a definitive conclusion regarding the efficacy and safety of agomelatine and fluvoxamine in the treatment of these comorbidities. Available studies suggest an improvement in the clinical manifestations of the comorbidities. Future research directions might include the development and implementation of double-blind, randomized clinical trials to study the use of melatoninergic medications in patients with depression comorbid with other disorders.
Copyright (c) 2024 Klimanova S.G., Radionov D.S., Shova N.I., Kotsyubinskaya Y.V., Yarygina Y.V., Berezina A.A., Sivakova N.A., Starunskaya D.A., Yakunina O.N., Andrianova A.E., Zakharov D.V., Rybakova K.V., Karavaeva T.A., Vasileva A.V., Mikhailov V.A., Krupitsky E.M. https://creativecommons.org/licenses/by-nc-nd/4.0
Dynamics of Clinical Manifestations and Social Functioning in Schizophrenia: A Non-interventional Observational Study of Paliperidone Palmitat Dosage Forms
BACKGROUND: Over the past seven years, the use of long-acting forms of antipsychotic medication has significantly increased in Russia. Specifically, in Moscow, from 2016 to 2021, the proportion of prescribed injectable long-acting antipsychotics had increased more than sevenfold (from 3% to 23%). Studies have shown that the correct selection of target groups for such therapy can reduce the frequency of relapses requiring hospitalization, lower the costs of inpatient care, and shift the focus of therapy from multiple drug administrations to psychosocial work. AIM: This study was aimed at evaluating changes over time in psychosocial functioning, as well as clinical and psychopathological manifestations, in patients with schizophrenia during early remission and while on therapy with different forms of paliperidone: oral paliperidone (OP), paliperidone palmitate administered once monthly (PP1M), and paliperidone palmitate administered once every three months (PP3M). METHODS: The observational study included 155 patients: 54 patients who had been treated with another second-generation antipsychotic received OP, 50 patients who had been treated with another antipsychotic received PP1M injections, and 51 patients who had been in remission for four months after treatment with PP1M received PP3M. The duration of the follow-up period was 12 months. Assessment of personal and social functioning was conducted five times: before the start of treatment, and 3, 6, 9, and 12 months later. RESULTS: Treatment in all groups led to a statistically significant reduction in the severity of positive symptoms (p <0.001). Hallucinations proved more susceptible to therapy (p <0.001), while persistent delusions showed greater treatment resistance. Significantly more patients in the PP1M and PP3M groups had completed the entire program (n=24; 48.0%, and n=30; 58.8%, respectively) compared to the OP group (n=11; 20.4%). The PP3M group demonstrated the highest treatment adherence, with the largest number of patients completing the study, and a similar rate of exacerbations or inadequate efficacy compared to the other groups. CONCLUSION: Treatment with different forms of paliperidone provides a roughly equal pace reduction in the severity of schizophrenia, including positive and negative symptoms. The PP3M group had better adherence and the highest number of patients who fully completed the study.
Copyright (c) 2024 Reznik A.M., Karpenko O.A., Shumakova E.A., Mudrak A.V., м A.V., Nazimova S.V., Saifulina A.M., Eliseenko A.M., Matvievskaya T.K., Khannanova A.N., Revenko V.I., Scherbakov D.V., Martynyuk Y.L., Arbuzov A.L., Yacenko O.A., Alekseeva P.N., Berdalin A.B., Burygina L.A. https://creativecommons.org/licenses/by-nc-nd/4.0
Prevalence of Anxiety and Depressive Disorders in a Sample of Moscow Residents: Comparison of the GAD-7 and HADS Results with a Clinical Assessment
BACKGROUND: Anxiety and depressive disorders are the most common mental disorders. Detecting a disorder at an early stage can prevent the development of severe disorders and preserve the patient’s functioning ability. Simple and reliable screening tools based on self-completion of questionnaires can be used for this purpose. However, it is not always the case that the scores of the self-questionnaire align with those of the clinician. AIM: To estimate the prevalence of anxiety-depressive disorders using the GAD-7 and HADS self-report questionnaires compared to psychiatrist assessment. METHODS: The study included individuals aged 18 to 65 years, living in Moscow, Russia, without psychiatric disorders, who participated in an online study using the HADS (Hospital Anxiety and Depression Scale, HADS-A and HADS-D) and GAD-7 (Generalized Anxiety Disorder 7-item scale). Anxiety disorder was diagnosed when the total score was ≥10 on the GAD-7 and/or ≥10 on the HADS-A scale, and depression was defined when the total score was ≥9 on the HADS-D scale. Then, 82 randomly selected participants attended an anonymous consultation with a psychiatrist. RESULTS: The study included 1,097 individuals (72% female), median age 29 (23; 37) years. As a result of testing, anxiety disorder was found in 168 (15%); depressive disorder — in 152 (14%) respondents. At medical verification, anxiety was diagnosed in 18 (22%); depression — in 19 (23%) people. The sensitivity of the HADS-D subscale for physician-diagnosed cases of depression was 61%, and specificity was 73%. The sensitivity of the HADS-A and GTR-7 subscale in identifying cases of anxiety disorder was 58%, specificity 59%. Sixteen percent were first diagnosed with a personality disorder or schizotypal disorder. CONCLUSION: The level of anxiety and depression in our sample of the population of Moscow, Russia, was higher than the global level. Self-assessment based on the questionnaire seems to not fully reflect the real state of a patient, as evidenced by the differences with the psychiatrist’s assessment.
Copyright (c) 2024 Savenkova V.I., Zorkina Y.A., Ochneva A.G., Zeltzer A.I., Ryabinina D.A., Tsurina A.M., Golubeva E.A., Goncharova A.S., Alekseenko I.V., Kostyuk G.P., Morozova A.Y. https://creativecommons.org/licenses/by-nc-nd/4.0
How NGO staff understand Maslow's hierarchy of needs and MHPSS pyramid in Iraq: a pilot descriptive study
BACKGROUND: The Maslow's hierarchy of needs (Maslow's pyramid) and the Mental Health and Psychosocial Support (MHPSS) pyramid are integral frameworks in humanitarian settings whose aim is to address individual and community needs. However, confusion often arises among non-governmental organization (NGO) workers about the application and differentiation of these models. AIM: This study aims to investigate the extent of confusion among NGO workers in Iraq as regards the Maslow's and MHPSS pyramids, identify the causes of this confusion, and explore its implications in the context of humanitarian mental health support. METHODS: A pilot descriptive study was conducted in December 2023 through an online survey involving 61 local NGO workers from MHPSS components in Iraq. We created a measure to assess the participants’ familiarity with both models, their perceived differences, and their views on the models’ applicability in humanitarian contexts. RESULTS: Male participants represented 55.7% (n=34) of the sample, while females accounted for 44.3% (n=27). Most participants were aged 25–34 (57%, n=35) and 35–44 (34%, n=21). A majority held bachelor’s degrees (67.2%, n=41), with 21.3% (n=13) holding master’s degrees. In terms of occupation, 49.2% (n=30) were engaged in the protection sector (gender-based violence and child protection), followed by health (19.7%, n=12), education (4.9%, n=3), and MHPSS staff roles in other sectors (26.2%, n=16). The study revealed that 54.1% (n=33) of the participants struggled to understand or differentiate between Maslow's and MHPSS pyramids. The causes of this confusion were related to perceived structural similarities (18.03%, n=11), lack of awareness and knowledge about the MHPSS pyramid (63.93%, n=39), and a combination of both (18.03%, n=11). CONCLUSION: The study underscores the importance of better training and education for NGO workers to improve their understanding of the Maslow's and MHPSS pyramids. Addressing this knowledge gap can increase efficacy in humanitarian aid provision, ensuring that individual and community needs are adequately met in crisis situations.
Copyright (c) 2024 Ahmed D.R., Al Diab Al Azzawi M., Heun R. https://creativecommons.org/licenses/by-nc-nd/4.0
The rising cases of suicide among Nigerians: what are the risk factors, prevention, and remedies?
The escalating suicide rate in Nigeria, exacerbated by economic, political, health, and social crises, represents a pressing concern. The aftermath of the global COVID-19 pandemic and subsequent lockdowns has exacerbated this issue, particularly in African nations with bare-bones governmental support systems. This paper examines the underlying causes of the alarming number of suicides in Nigeria, utilizing interviews to explore the risk factors, preventative measures adopted, and crisis interventions. Our findings reveal that spousal conflicts, job loss, and bereavement are significant triggers of suicidal ideation. Recommendations include fostering supportive environments, crisis interventions, and psychological rehabilitation services. Urgent attention is warranted to address this growing trend and mitigate its socioeconomic repercussions in Nigeria.
Copyright (c) 2024 Abamara N.C., Ozongwu O.E. https://creativecommons.org/licenses/by-nc-nd/4.0
The modern concept of schizoaffective disorder: a narrative review
BACKGROUND: Schizoaffective disorder (SAD) is one of the most complex and controversial diagnoses in clinical psychiatry. Despite the significant changes that have occurred in the conceptualization of SAD in modern classifications and the publications of recent years, many unresolved issues remain regarding the disease, from the point of view of clinical psychiatry and basic neuroscience. AIM: The purpose of this paper is to summarize published data on the concept of SAD, its clinical characteristics, cognitive profile, potential biomarkers, as well as the place of the disease in the following modern international classifications: the International Classification of Diseases (ICD) 9th, 10th and 11th revisions, and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). METHODS: We undertook a review of the scientific studies in the relevant bibliographic systems and databases (eLIBRARY, PubMed) of the past 15 years. The descriptive analysis method was used to summarize the collected information. A total of 70 publications were selected for review, including different versions of international classifications of diseases (ICD and DSM-5). RESULTS: There has been some improvement in the inter-rater reliability of SAD criteria in modern classifications, but this has not yet led to a clearer understanding among mental health specialists, while the various subtypes of SAD identified so far fail to account for the heterogeneity in the clinical presentation of the disorder. The dimensional approach to diagnosing SAD, according to which the intensity of psychotic and affective symptoms can fluctuate over time and they can influence one another, more accurately reflects the disease’s ability to embody different forms. Basic research does not support the identification of a distinct cognitive, neuroimaging, or immunological SAD endophenotype that differs qualitatively from schizophrenia and affective psychoses. CONCLUSION: The conceptualization of SAD remains incomplete, and new approaches rooted in neuroscience are needed to better understand the coexistence of affective and psychotic symptoms.
Copyright (c) 2024 Pavlichenko A.V., Petrova N.N., Stolyarov A.R. https://creativecommons.org/licenses/by-nc-nd/4.0
Biological methods for diagnosing depressive symptoms in patients with schizophrenia: a narrative review
BACKGROUND: Depressive symptoms in patients with schizophrenia lead to more frequent exacerbations of the underlying disease, worsen the prognosis, and increase the risk of suicide. Clinical practitioners continue to face challenges in diagnosing this disorder. AIM: This study aims to analyze published material on biological markers of depressive symptoms in patients with schizophrenia. METHODS: The search of literature was conducted using the following electronic search engines (the total number of relevant papers found is also specified): ACCESSSS (n=150), Cochrane Library (n=48), PubMed (n=623), eLIBRARY (n=216), and Google Scholar (n=367). The final discussion included 67 papers consistent with the study aim and were published between January 1, 2018 and December 31, 2023. RESULTS: Based on the available scaterred data, it appears that plasma biomarkers (e.g. C-reactive protein, metabolic parameters, hormones, enzymes, neurotrophic factors) are limited in specificity when it comes to diagnosing depressive symptoms in schizophrenia. Our analysis of the neuroimaging findings showed that depressive manifestations are associated with a decrease in the volume of the gray matter in the parietal, frontal, and temporal lobes (particularly in Broca’s and Wernicke’s areas) and in specific regions of the prefrontal cortex (including the medial right superior frontal, medial orbitofrontal, and superior and middle frontal gyri). It has been suggested that the SIRT1, OXT, CDKAL1, and APOE genes are involved in the development of depressive symptoms in patients with schizophrenia. CONCLUSION: Understanding and identifying depressive symptoms in schizophrenia will improve the quality of care for patients with this disorder.
Copyright (c) 2024 Sultanova R.I., Gashkarimov V.R., Efremov I.S., Asadullin A.R. https://creativecommons.org/licenses/by-nc-nd/4.0
Mechanisms and functions of the cerebral-cognitive reserve in patients with Alzheimer's disease: a narrative review
BACKGROUND: The need for scientific knowledge about aging is predicated on the demand of modern society to extend the active life of a person. To maintain intellectual longevity, it is necessary to take into account not only the pathological, but also compensatory mechanisms that arise during aging. The cerebral-cognitive reserve (CCR) influences the rate of transition from pre-phenomenological stages to the clinical stage of the disease, thereby changing the prognosis of Alzheimer’s disease (AD). AIM: The aim of this work was to review meta-analyses from studies that have examined the principles and functions of the CCR in people with AD. METHODS: The work included 83 scientific publications devoted to the issues of the CCR in neurodegenerative diseases such as AD. The Results and Discussion sections of this article provide reviews of the results of 12 meta-analyses published from 2012 to 2024 and selected from the PubMed and eLibrary databases using the following keywords in English and Russian: “cerebral reserve”, “cognitive “reserve”, and “Alzheimer’s disease”. The scope of the definition was not limited, since the goal here was to determine the terminological boundaries of the concepts of “cognitive reserve” and “single brain reserve”. RESULTS: The modern understanding of AD as a biological continuum covering the preclinical, prodromal, and clinical phases of the disease makes it possible to infer that insufficiency of protective factors underlies the progression of AD. The cognitive reserve is involved in the sanogenetic protective mechanism during neurodegeneration. The cognitive reserve is a theoretical concept that reflects modern research’s understanding of how the integrative functioning of the brain (cerebral) and cognitive reserves extend the period of active intellectual longevity through energy-saving mechanisms. It considers these mechanisms as central to healthy mental activity and in slowing the progression of neurodegenerative diseases. At some point, an increase in excess interneuronal activity that reflects the hypercompensatory function of the reserve would accelerate the depletion of brain structures and contribute to clinical and psychopathological manifestations of AD. CONCLUSION: The concept of the CCR puts the spotlight on the need to determine the compensatory indicators of cognitive deficit in AD, assess the architecture and volume of the reserve, and develop and follow protocols for its maintenance. It appears just as crucial to adopt measures to prevent the Reserve’s depletion as early as at the preclinical stages of the disease. Elaborating protective and compensatory mechanisms that help to maintain the functional activity of the brain in conditions of neurodegeneration, that is, CCR, require further research and can form a conceptual basis for the prevention of AD, starting from the preclinical stages of the disease.
Copyright (c) 2024 Sidenkova A.P., Litvinenko V.V., Bazarny V.V., Rezaikin A.V., Zakharov A.V., Baranskaya L.T., Babushkina E.I. https://creativecommons.org/licenses/by-nc-nd/4.0
Mass spectrometry imaging of two neocortical areas reveals the histological selectivity of schizophrenia-associated lipid alterations
BACKGROUND: Schizophrenia is a psychiatric disorder known to affect brain structure and functionality. Structural changes in the brain at the level of gross anatomical structures have been fairly well studied, while microstructural changes, especially those associated with changes in the molecular composition of the brain, are still being investigated. Of special interest are lipids and metabolites, for which some previous studies have shown association with schizophrenia. AIM: To utilize a spatially resolved analysis of the brain lipidome composition to investigate the degree and nature of schizophrenia-associated lipidome alterations in the gray and white matter structures of two neocortical regions — the dorsolateral prefrontal cortex (Brodmann area 9, BA9) and the posterior part of the superior temporal gyrus (Brodmann area 22, posterior part, BA22p), as well compare the distribution of the changes between the two regions and tissue types. METHODS: We employed Matrix-Assisted Laser Desorption/Ionization Mass Spectrometric Imaging (MALDI-MSI), supplemented by a statistical analysis, to examine the lipid composition of brain sections. A total of 24 neocortical sections from schizophrenia patients (n=2) and a healthy control group (n=2), representing the two aforementioned neocortical areas, were studied, yielding data for 131 lipid compounds measured across more than a million MALDI-MSI pixels. RESULTS: Our findings revealed an uneven distribution of schizophrenia-related lipid alterations across the two neocortical regions. The BA22p showed double the differences in its subcortical white matter structures compared to BA9, while less bias was detected in the gray matter layers. While the schizophrenia-associated lipid differences generally showed good agreement between brain regions at the lipid class level for both gray and white matter, there were consistently more discrepancies for white matter structures. CONCLUSION: Our study found a consistent yet differential association of schizophrenia with the brain lipidome composition of distinct neocortical areas, particularly subcortical white matter. These findings highlight the need for broader brain coverage in future schizophrenia research and underscore the potential of spatially resolved molecular analysis methods in identifying structure-specific effects.
Copyright (c) 2024 Osetrova M.S., Zavolskova M.D., Mazin P.V., Stekolschikova E.A., Vladimirov G.N., Efimova O.I., Morozova A.Y., Zorkina Y.A., Andreyuk D.S., Kostyuk G.P., Nikolaev E.N., Khaitovich P.E. https://creativecommons.org/licenses/by-nc-nd/4.0
Clinical Characteristics and Treatment Responses of Patients in Delirious Mania: A Case Series
BACKGROUND: Delirious mania (DM) is a severe psychiatric condition having rapid onset of delirium, mania, and psychosis. It is an emergency condition as it has acute onset and is characterized by extreme hyperactivity. Catatonic signs may also be present. Very few cases have been reported from India, hence making it imperative to study its clinical characteristics and possible treatment, which can help in providing care to such patients in emergency settings. CLINICAL CASES DESCRIPTION: This paper describes four cases with a diagnosis of DM — demography, clinical features, investigations, treatment. All the patients had an acute onset and rapid progression of symptoms, with clinical symptoms of talkativeness, increased psychomotor activity, decreased need for sleep, aggressive and violent behavior, increased libido, increased appetite with delusion of grandiosity, disorientation to time/place/person, impaired memory of recent events, impaired attention with fluctuating course, negativism, echolalia, and echopraxia. CONCLUSION: There is a high likelihood of misdiagnosing DM in the absence of diagnostic guidelines. There should be an active search for the underlying aetiology in all cases of DM. Atypical antipsychotics and mood stabilizers may be used to treat less severe forms of DM. Modified electric convulsive treatment and intravenous benzodiazepines elicit a good response.
Copyright (c) 2024 Sahu R.K., Rana A. https://creativecommons.org/licenses/by-nc-nd/4.0
Using the Strategy of Genome-Wide Association Studies to Identify Genetic Markers of Suicidal Behavior: A Narrative Review
BACKGROUND: Several studies involving various suicidal phenotypes based on the strategy of the search of genome-wide associations with single nucleotide polymorphisms have been performed recently. These studies need to be generalized. AIM: To systematize the findings of a number of genome-wide association studies (GWAS) for suicidal phenotypes, annotate the identified markers, analyze their functionality, and possibly substantiate the hypothesis holding that these phenotypes reflect a nonspecific set of gene variants that are relevant as relates to stress-vulnerability as a key endophenotype of suicidal behavior (SB). METHODS: A search on the PubMed and related resources using the combinations “suicide AND GWAS” and “suicidal behavior AND GWAS” was performed. It yielded a total of 34 independent studies and meta-analyses. RESULTS: For the 10 years since such studies emerged, they have undergone significant progress. Estimates of the SNP heritability of SB in some cases are comparable with estimates of heritability based on the twin method. Many studies show a high genetic correlation with the genomic markers of the most common mental disorders (depression, bipolar disorder, schizophrenia, post-traumatic stress disorder). At the same time, a genomic architecture specific to SB is also encountered. Studies utilizing the GWAS strategy have not revealed any associations of SB with candidate genes that had been previously studied in detail (different neurotransmitters, stress response system, polyamines, etc.). Frequently reported findings from various studies belong in three main groups: 1) genes involved in cell interactions, neurogenesis, the development of brain structures, inflammation, and the immune responses; 2) genes encoding receptors for neurotrophins and various components of the intracellular signaling systems involved in synaptic plasticity, embryonic development, and carcinogenesis; and 3) genes encoding various neuro-specific proteins and regulators. CONCLUSION: In general, GWAS in the field of suicidology mainly serve the purpose of a deeper understanding of the pathophysiology of suicidal behavior. However, they also demonstrate growing capability in terms of predicting and preventing suicide, especially when calculating the polygenic risk score among certain populations (psychiatric patients) and in combination with tests of different modalities. From our point of view, there exists a set of markers revealed by the GWAS strategy that seems to point to a leading role played by stress vulnerability, an endophenotype that is formed during early development and which subsequently comes to play the role of key pathogenetic mechanism in SB.
Copyright (c) 2024 Rozanov V., Mazo G. https://creativecommons.org/licenses/by-nc-nd/4.0
Inflammatory Hematological Ratios in Adolescents with Mental Disorders: A Scoping Review
BACKGOUND: Inflammatory hematological ratios (IHRs), such as neutrophil to lymphocyte, monocyte to lymphocyte, and platelet to lymphocyte ratios, are associated with mental disorders, symptoms severity, and the disease phase. Evidence from the studies in adult patients has been summarized in systematic reviews and meta-analyses. The results of the studies in adolescents remain poorly systematized. AIM: To summarize the findings from the studies that investigated the relationship of IHRs with mental disorders in adolescent patients. METHODS: This scoping review included studies of IHRs in patients aged 10–19 years with mental disorders (other than anorexia nervosa), published in English by December 31, 2023. The search for relevant papers was performed in MEDLINE. The studies were categorized into two groups: studies with external controls (healthy adolescents) and studies with internal controls (patients in different phases of mental disorder, with or without self-harm/suicidal behaviors). RESULTS: A total of 11 studies were included in the review (all cross-sectional ones). The results of these studies demonstrate that 1) adolescents with mental disorders (major depressive disorder, psychotic disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, substance use disorders) have higher IHR values than individuals of the same age without corresponding disorders (5 studies); 2) IHR values are positively correlated with the severity of psychopathological symptoms (1 study); 3) higher IHR values are associated with the phase of the mental disorder — manic episode in bipolar disorder (1 study) and exacerbation of psychosis in psychotic disorders (1 study); and 4) higher IHR values are associated with self-harm/suicidal behaviors — suicide attempts (1 study) and non-suicidal self-injury (1 study). CONCLUSION: IHRs are associated with mental disorders in adolescents, and higher IHR values are associated with a more severe/acute clinical presentation (severity of symptoms, mania, acute psychosis, self-harm/suicidal behaviors). Further studies of higher methodological quality are needed to evaluate the diagnostic and prognostic value of IHRs as biomarkers of mental disorders in adolescence.
Copyright (c) 2024 Popov M., Popov Y., Kosterin D., Lepik O. https://creativecommons.org/licenses/by-nc-nd/4.0
Potential Neurophysiological Markers of Combat-Related Post-Traumatic Stress Disorder: A Cross-Sectional Diagnostic Study
BACKGROUND: Studies suggest that the components of brain-evoked potentials (EPs) may serve as biomarkers of the post-traumatic stress disorder (PTSD) caused by participation in combat operations; however, to date, research remains fragmented, with no studies that have attempted to combine different paradigms. In addition, the mismatch negativity component has not been studied in a Russian sample of veterans with PTSD. AIM: To identify objective neurophysiological markers of combat-related PTSD using the method of auditory-evoked potentials in active and passive listening paradigms. METHODS: The study included a recording of auditory EPs in an oddball paradigm in three settings: 1) directed attention to auditory stimuli, 2) passive listening while viewing a neutral video sequence, and 3) viewing a video sequence associated with a traumatic event. Combatants diagnosed with PTSD (18 people) were compared with mentally healthy civilian volunteers (22 people). RESULTS: An increase in the latency period of the early components of auditory EP (N100 and P200), an increase in the amplitude of the P200 component to a deviant stimulus, and a decrease to a standard one in the active listening paradigm were established in the PTSD group. There were no significant differences in the parameters of the P300 component. The characteristics of mismatch negativity in the passive paradigm were revealed: an increase in the phenomenon amplitude, both when shown a video sequence associated with a traumatic event and when shown a neutral video sequence. A binary logistic regression model constructed using the selected parameters showed that the identified characteristics can potentially be considered as diagnostic markers of PTSD in combatants, as the classification accuracy stood at 87% (sensitivity — 81%, specificity — 91%). CONCLUSION: Potential neurophysiological markers of PTSD are the following: the amplitude and latency of early components of auditory EPs in the paradigm of directed attention to stimuli and the amplitude of mismatch negativity during passive attention.
Copyright (c) 2024 Telesheva K., Savenkova V., Morozova I., Ochneva A., Zeltser A., Andreyuk D., Reznik A., Mukhin V., Melkonian G., Lytkina K., Mitrofanov A., Morozova A. https://creativecommons.org/licenses/by-nc-nd/4.0
Individual Burden of Illness Index in Bipolar Disorder Remission: A Cross-Sectional Study
BACKGROUND: A population-based method for estimating disease burden is commonly used. Nevertheless, these measurements do not entirely capture the comprehensive burden of illness on an individual patient. To address the problem, the Individual Burden of Illness Index (IBI index) Index was created and validated, specifically for major depressive disorder. The IBI represents the overall influence of the condition, encompassing distress from symptom intensity, functional impairment, and the patient’s quality of life. AIM: The aim of the study was to approve and validate the IBI index for the integral assessment of disease burden in patients with bipolar disorder (BD) in remission. METHODS: The cross-sectional study was conducted in the outpatient psychiatric services in Saint Petersburg, Russia, from April through October 2020. Eighty-five patients aged 18 to 45 (mean age 36.6±5.7 years) with BD (type I — 75%, n=64; type II — 25%, n=21) in remission were examined. The study procedure included a structured clinical interview and the use of clinical scales: the World Health Organization’s Quality of Life Questionnaire, Hamilton Rating Scale for Depression (HDRS), Young Mania Rating Scale (YMRS), and Personal and the Social Performance Scale. RESULTS: The principal component analysis in accordance with the adjusted one showed that the burden of illness in patients with BD in remission is directly related to the severity of residual depressive symptoms, reflected in the HDRS score: as the HDRS score increases (0.27, p <0.001), residual mania (-0.14, p <0.001), social functioning (-0.06, p <0.001), and quality of life (-0.04, p <0.001) decrease. In contrast, when there are remaining residual mania symptoms, as indicated by the YMRS score, the result tends to be a lower burden, better social functioning, and enhanced quality of life. CONCLUSION: The study has demonstrated through statistical means a successful adaptation and validation of the previously calculated IBI index for patients with BD in remission. Residual affective symptoms were shown to have different impacts on the social functioning of patients with BD in remission, indicating the need for a timely assessment and targeted therapy of these symptoms in such patients.
Copyright (c) 2024 Chumakov E., Ashenbrenner Y., Gvozdetskii A., Limankin O., Petrova N. https://creativecommons.org/licenses/by-nc-nd/4.0
Genetic Associations of Anhedonia: Insights into Overlap of Mental and Somatic Disorders
BACKGROUND: Anhedonia is characterized by a reduced ability to anticipate, experience, and/or learn about pleasure. This phenomenon has a transdiagnostic nature and is one of the key symptoms of mood disorders, schizophrenia, addictions, and somatic conditions. AIM: To evaluate the genetic architecture of anhedonia and its overlap with other mental disorders and somatic conditions. METHODS: We performed a genome-wide association study of anhedonia on a sample of 4,520 individuals from a Russian non-clinical population. Using the available summary statistics, we calculated polygenic risk scores (PRS) to investigate the genetic relationship between anhedonia and other psychiatric or somatic phenotypes. RESULTS: No variants with a genome-wide significant association were identified. PRS for major depression, bipolar disorder, and schizophrenia were significantly associated with anhedonia. Conversely, no significant associations were found between PRS for anxiety and anhedonia, which aligns well with existing clinical evidence. None of the PRS for somatic phenotypes attained a significance level after correction for multiple comparisons. A nominal significance for the anhedonia association was determined for omega-3 fatty acids, type 2 diabetes mellitus, and Crohn’s disease. CONCLUSION: Anhedonia has a complex polygenic architecture, and its presence in somatic diseases or normal conditions may be due to a genetic predisposition to mood disorders or schizophrenia.
Copyright (c) 2024 Kasyanov E., Pinakhina D., Rakitko A., Vergasova E., Yermakovich D., Rukavishnikov G., Malyshko L., Popov Y., Kovalenko E., Ilinskaya A., Kim A., Plotnikov N., Neznanov N., Ilinsky V., Kibitov A., Mazo G. https://creativecommons.org/licenses/by-nc-nd/4.0
Η Ψυχή. Study of the Soul and its feminine side
The progress in any field depends, first and foremost, on the people who work in it. Luckily, today the indispensable contribution of women to all areas of knowledge is widely recognized. However, it is crucial to continue advocating, challenging prejudices and promoting empowerment of women worldwide. International and regional platforms to address gender equality issues, the UN Women initiative and the annual Women's History Month, which is celebrated in March in many countries across the globe, are intended to emphasize the role of women in world history and the development of modern society. While mental sciences by their very name refer to Psyche, the young heroine of ancient Greek myths, women began to contribute fully to psychology and psychiatry as late as the beginning of the 20th century. Sabine Spielrein (1885) is known to be the first woman psychoanalyst. She was a student, a friend and a colleague of Freud and Jung. Karen Horney, born in the same year, was one of the key figures of neo-Freudism. At the end of the 19th century, Ivan Mikhailovich Balinsky gave lectures on psychiatry to the young women attending medical courses. Why do women increasingly choose the path once dominated by men? What motivates bright young women to pursue this career? Why have some of them dedicated their lives to caring for others’ mental health? We had an opportunity to talk to several female psychiatrists and psychologists, members of the editorial board and authors of Consortium Psychiatricum. We asked our interviewees, explorers of human mind, a few simple questions so that this time, they could open up their own souls and share. The key features that distinguish our interviewees are the desire to follow their vocation despite stereotypes, a true passion for science, the ability to empathize and to create a safe space for themselves and others wherever they go. We hope that their memories, reflections and guidance will inspire and support the next generation of women working in the mental health field.
Copyright (c) 2024 Dolgaleva M.O. https://creativecommons.org/licenses/by-nc-nd/4.0
Community-Based Psychiatric Care Provision in Hungary: Trends and Steps towards Progress
Psychiatric care has undergone several cycles of profound changes in the past centuries all over the world. In Hungary, community-based outpatient care has been showing signs of evolution since the 1950s. Initially, the system centered on assertive outreach and family involvement, especially for those with serious mental health problems. Such services remain available throughout the country, but the emphasis in the past decades has shifted towards mass care provision. In many places, community-based services are no longer provided, and where they are the approach is biomedical and less asuming of recovery. In other centers, the services provided are conceived with the eventuality of rehabilitation in mind and in close cooperation with community-based care providers. Community-based services providers, as part of the social fabric, offer as many psychiatric and rehabilitation services as possible for those with mental disorders within their communities. The main objective of community-based care is to achieve community re-integration and recovery from mental disorders. Today in Hungary, deinstitutionalisation and the introduction of community-based psychiatric care have been adopted even by large inpatient institutions. The replacement of institutional bed space and the provision of subsidised housing further underscore the importance of community-based psychiatric care provision. There is the opinion that, as a further course of development, the emphasis needs to now shift towards the nurturing of a community of experienced experts and creastion of user-led programs. In this new paradigm, the ability of a person with a mental disorder to make decisions and the bolstering of that ability are seen as vital. In order to achieve these objectives, it is essential that health and social seervices professionals cooperate. Hands-on experience is key in the provision and development of such services.
Copyright (c) 2024 Bulyáki T., Wernigg R., Kéri P., Ács A., Slezák A., Bodrogi A., Harangozó J. https://creativecommons.org/licenses/by-nc-nd/4.0
When Dhat Syndrome is Delusional: A Case Series
The Dhat syndrome is a culture-bound syndrome associated with anxiety and somatic and mood symptoms related to semen loss. It sometimes occurs in women, in whom it comes with vaginal discharge. Only a single case has been reported whereby Dhat delusion was associated with schizophrenia. In this case report, we dwell on two individuals suffering from a somatic-type delusional disorder with Dhat-like symptoms who had initially presented classical symptoms of the Dhat syndrome. Further studies are needed to explore the intersections of Dhat syndrome and psychoses, as well as the risk factors involved in mutual predisposition.
Copyright (c) 2024 Debanjan B., Debanjan B. https://creativecommons.org/licenses/by-nc-nd/4.0
Lost Self to Present Self: A Case Report of Narrative Therapy for a Woman with Acquired Brain Injury
BACKGROUND: Psychotherapy for people with acquired brain injury (ABI) is considered to be an important component of a holistic neuropsychological rehabilitation approach. This helps in making sense of the loss of the sense of self they experience. Gender, premorbid personality, and socio-cultural discourses guide this process of understanding. Narrative formulation takes these considerations into account and, thus, can be used for formulating therapeutic plans. AIM: To present a case report which highlights the use of narrative case formulation to understand the psychological, social, and cultural factors forming the dominant discourse of a woman with ABI. METHODS: Ms. VA, a 43-year-old female, presented herself with a diagnosis of hypoxic ischemic encephalopathy with small chronic infarcts with gliosis in the bilateral cerebellar hemisphere, myoclonic seizures, mild cognitive impairment, depression, generalized dystonia, and bronchial asthma. Along with neuropsychological rehabilitation and cognitive retraining, 25 sessions of psychotherapy using narrative formulation were performed. RESULTS: Following the therapy, microgains such as a developing strong therapeutic relationship, accommodating vulnerability in her narrative, and finding moments of independence and assertion within the constraints of ABI were observed. Acceptance of her current predicament vis-à-vis her lost self and finding meaning in her new self were facilitated. CONCLUSION: There is paucity of research detailing psychotherapeutic management of ABI, especially in India. Psychotherapy, particularly using narrative formulation, can be helpful in understanding the intersections of gender role and expectations, premorbid personality and ABI, and aiding the post-ABI rehabilitation and adjustment. Future work in this area can explore the socio-cultural aspects that play an important role in the therapy process.
Copyright (c) 2024 Mahajan M., Hegde S., Sinha S. https://creativecommons.org/licenses/by-nc-nd/4.0
Cannabis Hyperemesis Syndrome in a Recently Abstinent Chronic User: Assessment and Intervention
BACKGROUND: Cannabis Hyperemesis Syndrome (CHS) is a condition characterized by episodic bursts of vomiting and abdominal pain linked to cannabis use. The clinical picture mimics an acute abdomen and is often misdiagnosed, especially when the patient avoids reporting their cannabis use for legal reasons. CASE REPORT: We report on the case of a 33-year-old man that was brought to the emergency room with a history of 3 days of non-bloody, non-projectile, and non-bilious brownish vomit, coupled with severe epigastric and left hypochondriac pain, and a slight fever. He was a daily cannabis user for several years and had stopped using a week or so before the onset of the symptoms, as he was traveling to a country with more restrictive cannabis laws. His condition deteriorated rapidly, followed by emergency room attendance, thorough diagnostic work-up, and unsuccessful interventions, including intravenous treatment with the anti-emetic Ondansetron. The patient was referred to a psychiatrist after a suspected psychogenic etiology by the medical team. The history was suggestive of CHS and also included anxious, depressed mood with ‘brain fog’. The abdominal pain was the most severe complaint. A combination of tramadol, promethazine, and mirtazapine given on an outpatient basis led to full recovery within 10 days. CONCLUSION: CHS can occur soon after the interruption of chronic cannabis use and overlap with withdrawal symptom. A combination of anti-histaminergic, opioid-based medication, and antidepressant mirtazapine seemed an effective treatment of CHS, which resulted in a relatively quick recovery.
Copyright (c) 2024 Elsherif Y., Gouher S., Mohsin Abualhab M., El-Khoury J. https://creativecommons.org/licenses/by-nc-nd/4.0
Self-Stigma in Patients with Endogenous Mental Disorders: A Cross-Sectional Comparative Study
BACKGROUND: Self-stigma remains one of the most vexing issues in psychiatry. It complicates the treatment and social functioning of patients with endogenous psychiatric disorders. Identifying the specific features of self-stigma depending on the type and duration of the endogenous mental illness can help solve this problem. AIM: The aim of this study was to establish the level and specific features of self-stigma in patients with various types of chronic endogenous psychiatric disorders at different disease stages and to establish the correlation between the level of self-stigma and the attitude of the patient to his/her disease and treatment. METHODS: Clinical psychopathology assessment, psychometric scales and questionnaires: “Positive and Negative Syndrome Scale” (PANSS), “Questionnaire for Self-Stigma Assessment in Mentally Ill Patients”, and Russian versions of the “Insight Scale for Psychosis” (ISP), and “Drug Attitude Inventory” (DAI-10). The cross-sectional study included 86 patients with endogenous mental illnesses (bipolar affective disorder and schizophrenia spectrum disorders. RESULTS: The analysis of the results of the “Questionnaire for Self-Stigma Assessment in Mentally Ill Patients” showed that at the initial disease stages the highest level of self-stigma is observed in patients with bipolar affective disorder (M±σ=1.22±0.73; Me [Q1; Q3]=1.10 [0.83; 1.60]), while the lowest level was observed in patients with schizophrenia spectrum disorders (M±σ=0.86±0.53; Me [Q1; Q3]=0.77 [0.31; 1.25]). Patients with schizophrenia and schizoaffective disorder and a disease duration more than five years participating in a long-term comprehensive psychosocial rehabilitation program also demonstrated high rates of self-stigma (M±σ=1.20±0.57, Me [Q1; Q3]=1.26 [0.89; 1.47]). The study groups showed differences in terms of the structure of components of self-stigma and their severity; significant correlations were uncovered between the self-stigma parameters and the attitude of patients to their disease and therapy. CONCLUSION: The results of this study contribute to a better understanding of the specific features of self-stigma in patients with various endogenous disorders at different stages of the disease. These data can be used as part of a comprehensive psychosocial treatment program for this patient cohort, as well as for future research.
Copyright (c) 2024 Solokhina T.A., Oshevsky D.S., Barkhatova A.N., Kuzminova M.V., Tyumenkova G.V., Alieva L.M., Shteinberg A.S., Churkina A.M. https://creativecommons.org/licenses/by-nc-nd/4.0
Suicide Attempt Violence: Gender Differences, Diagnosis and Psychiatric Care Seeking in Mexico City
BACKGROUND: Suicide cases in Mexico have increased during the last two years and are the second-leading cause of death in the young adult population. AIM: To describe gender differences in violent suicide attempts as relates to diagnosis and the seeking of psychiatric care. METHODS: A descriptive retrospective study was conducted. The referral forms of 241 patients who had attempted suicide were analyzed. RESULTS: The mean age of the patients was 29.1 (SD=10.8) years, n=140 (58.1%) of the sample were women. Affective disorders were the most frequent diagnoses for both sexes. Women were more likely to delay seeking psychiatric care: 60 days versus 30 days of delay for men (p=0.009). Men were shown to more frequently resort to violent suicide methods. Both women and men who used violent suicide methods were shown to delay by more days the seeking of psychiatric care than those who were found to have used non-violent suicide methods. CONCLUSION: We found that patients who use more violent methods of suicide took longer before seeking psychiatric care. This delay in accessing psychiatric care can be thought to contribute to the fact that completed suicides are more frequent within that category of patients. The majority of suicide attempts occurred in the 17–24 years age group; therefore, it seems reasonable to analyze the existing barriers to seeking psychiatric care, mainly in the young adult population, and to design strategies to bring mental health services closer to this population group.
Copyright (c) 2024 Juárez-Domínguez D.A., Arteaga-Contreras K.M., Rangel H.C. https://creativecommons.org/licenses/by-nc-nd/4.0
Recurrent Psychotic Episodes Induced by Synthetic Cathinones in a Monozygotic Twin with Drug Addiction: A Case Report
We have described a clinical case of psychotic disorder induced by synthetic cathinones in one drug-addicted monozygotic twin. This clinical case is unique, because it offers the opportunity to observe many features of the singularity of the dependence syndrome in twin brothers: drug choice; motivation to use drugs; and the development of multiple, long-lasting psychoses in one of the brothers. We pursued a twelve-month follow-up of this case. The case substantiates the paucity of a fundamental understanding of mental disorders and highlights the importance of further research into the clinical features of drug-induced psychoses, especially those induced by novel psychoactive substances such as synthetic cathinones.
Copyright (c) 2023 Severtsev V.V., Budanova A.A. https://creativecommons.org/licenses/by-nc-nd/4.0
Endoxifen in Treatment of Individuals with Borderline Personality Disorder with Predominant Impulsivity: A Case Series
Endoxifen, a protein kinase C inhibitor, has been approved for use in manic episodes in India. One of the symptom traits that it predominantly targets is impulsivity. Impulsivity can also be a symptom dimension of other mental health conditions, one of which is Borderline Personality Disorder (BPD). Management of BPD is challenging, with limited pharmacological options that are symptom-directed and psychotherapy sessions that are fraught with early dropouts and lack of compliance. Impulsive behaviors represent a major reason for seeking help in BPD, especially with regard to non-suicidal self-injury, substance abuse, high-risk sexual behavior, aggression, etc. Here, we present a case series comprising five individuals with a diagnosis of BPD whose treatment regimens were changed and endoxifen added at a dose of 8 mg once daily. Clinical improvement was monitored using the Borderline Evaluation of Severity Over Time (BEST). All the subjects improved in the impulsivity domains as well as with regard to attention deficits, mood fluctuations, and overall functioning. Endoxifen is thus potential promising in terms of the management of BPD, but needs more extensive study to fully substantiate its clinical benefits.
Copyright (c) 2023 Banerjee D., Ray R. https://creativecommons.org/licenses/by-nc-nd/4.0
Biological Reductionism as an Obstacle to the Advancement of the Biopsychosocial Concept of Mental Disorders
The substantial progress in neurobiological technologies has narrowed the horizons of many psychiatrists, ultimately leading them to focus exclusively on biomedical research, primarily aimed at studying the biological basis of mental illnesses. This has led to an unjustified dominance of the biomedical paradigm in understanding the nature of mental disorders, while virtually ignoring the study of other components of the disease related to the psychosocial maladjustment of patients. This trend, largely associated with advancements in neuroscience employing neuroimaging techniques to study the brain’s activity as a biophysical object, has contributed to the development of such innovative field as evidence-based medicine. The methods of evidence-based medicine are seen as adequate in terms of determining the effectiveness of therapy for predominantly biologically determined components of mental illness (including the selection of medications) and only partially for psychological interventions. However, it seems that the predominant use of evidence-based medicine principles is insufficient for a holistic diagnostic approach, which includes a multilevel (diversified) representation of the criteria of effectiveness for pharmacological and psychological interventions. In this regard, it is promising to establish a scientifically and clinically productive combination of, on the one hand, the evidence-based concept of effectiveness assessments based on high-quality randomized scientific studies, and on the other, expert opinions of highly qualified scientific specialists, as well as practicing physicians with their personal professional experience in individualized therapy. This makes it reasonable to develop a personality-oriented personalized psychiatry, based on a biopsychosocial understanding of the nature of mental disorders, their holistic assessment, and the development of comprehensive therapeutic measures.
Copyright (c) 2023 Kotsyubinsky A.P., Kotsyubinsky D.A. https://creativecommons.org/licenses/by-nc-nd/4.0
The Interdisciplinary Diagnostics of Autism Spectrum Disorder Using DC:0-5TM: A Case Report
BACKGROUND: The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5TM) is widely used in many Western countries. For Russian specialists, such classification represents a relatively new tool for the comprehensive diagnosis of mental disorders in children from birth to the five-year-old threshold. The purpose for presenting this case study report is to showcase the practical application of the DC:0-5TM. AIM: This study aims to illustrate the diagnostic process according to the DC:0-5TM criteria using the example of a specific clinical case report involving the collaborative efforts of two specialists: a child psychiatrist and a clinical child psychologist. METHODS: DC:0-5TM consists of five axes. The main axis focuses on clinical diagnosis criteria for mental disorders, considering their age specificity. The remaining four axes allow one to take into account and specify data related to biological, social, and psychological factors, which play a crucial role in understanding the causes and characteristics of a mental disorder in a child. RESULTS: In the examined case, an analysis of symptoms by means of the Clinical Disorders axis revealed that they were consistent with the diagnostic criteria for autism spectrum disorder. The use of the remaining axes supplemented the clinical diagnosis with specific details about the adverse physical health factors in the child, a high cumulative stress burden, significant developmental delays in the emotional, speech, and social dimensions, as well as dysfunction in the mother-child dyad. Since the parents declined medication for their son, this information proved crucial in developing a support program for both the child and the family. CONCLUSION: The comprehensive diagnostic approach using the DC:0-5TM axes proved highly effective, not only in psychiatric diagnosis but also in establishing goals and objectives for subsequent intervention. Its application in psychiatric, clinical psychology, and corrective educational practices has the potential to make support for children in their early years a more personalized and family-oriented undertaking.
Copyright (c) 2023 Skoblo G.V., Trushkina S.V. https://creativecommons.org/licenses/by-nc-nd/4.0
The Use of Umbilical Cord Blood Nucleated Cells in the Treatment of Regressive Autism: A Case Report
BACKGROUND: Interest in the issue of childhood autism has surged in the recent decades. At the same time, despite the significant progress achieved in understanding the etiological and pathogenetic aspects of the condition, effective ways to treat it have continued to elude us. Stem cell therapy appears to hold great promise in the treatment and rehabilitation of patients with both neurological diseases (cerebral palsy, hydrocephalus) and mental disorders (autism, schizophrenia). METHODS: This article presents a case report describing the use of nucleated cord blood cells in a patient with regressive autism and resistance to standard therapies. The child’s condition was assessed before treatment and 6 and 12 months after. RESULTS: Clinical observation, psychometric, and instrumental diagnostic methods led to a significant improvement in the child’s condition in the form of perception development, reduction of somatosensory disorders, normalization of emotional status, and a development of social and communication skills. CONCLUSION: We assume that the result obtained may be associated with the normalization of the immunological status of our patient thanks to the cord blood cells therapy and consider it necessary to conduct further studies into the effectiveness of the method, taking the pathogenic mechanisms of autism into account.
Copyright (c) 2023 Morozova Y.V., Smirnov V.N., Makarov I.V., Emelina D.A. https://creativecommons.org/licenses/by-nc-nd/4.0
The Effects of Cognitive Impulsivity on the Duration of Remission in Alcohol-Dependent Patients
BACKGROUND: Cognitive impulsivity manifesting in impaired inhibitory control and decision-making impulsivity is observed both in alcohol-dependent and substance-dependent individuals and may affect the ability to maintain long-term (persistent) remission. AIM: To evaluate the effects of cognitive parameters of impulsivity on the duration of remission in alcohol-dependent patients. METHODS: The study included 83 patients with alcohol dependence and 51 mentally healthy study subjects as the control group. The distribution of patients by duration of remission was based on the DSM-5 criteria. Patients were divided into two groups according to the duration of their most recent remission: patients with early remission (n=48) and patients with sustained remission (n=35). Impulsivity was assessed using the Go/No-Go task, which included a response inhibition component (inhibitory control). Choice impulsivity was assessed using two cognitive tests that encompass its separate components: decision-making under risk (Cambridge Gambling Task, CGT), and decision making under uncertainty (Iowa Gambling Task, IGT). RESULTS: The study groups (patients and the controls) differed significantly in all domains of impulsivity: decision making under risk [GT: decision making quality (H(2, N=134)=30.233, p <0.001) and decision-making time (H(2, N=134)=18.433, p <0.001)] and decision making under uncertainty [IGT: selecting cards from “losing” decks (H(2, N=134)=9.291, p=0.009)]. The group of patients with sustained alcohol remission was characterized by longer decision times in CGT compared to the group of patients with early remission (z=2.398, p=0.049). Decision quality in CGT (z=0.673, p=0.999) and IGT scores (z=1.202, p=0.687) were not statistically significantly different between the groups of patients with sustained and early remission from alcohol dependence. The assessment of impulsive actions showed that the study groups were significantly different in terms of their ability to suppress their dominant behavioral response when performing the GNG task [false presses when seeing the “No-Go” signal (H(2, N=134)=28.851, p <0.001)]. The group of patients in sustained remission from alcohol dependence was characterized by better suppression of the behavioral response to the “No-Go” signal relative to the patients in early remission [H(2, N=134)=2.743, p=0.044)]. The regression analysis showed that the decision-making quality (t=2.507, р=0.049) and decision-making time (t=3.237, р=0.031) and the number of false presses when seeing the “No-Go” signal in the GNC task had a statistically significant impact on the duration of remission (t=3.091, р=0.043). CONCLUSION: The results of this study indicate that impaired decision-making processes and the ability to inhibit the dominant behavioral response have a significant impact on the ability of alcohol-dependent patients to maintain long-term remission.
Copyright (c) 2023 Galkin S.A. https://creativecommons.org/licenses/by-nc-nd/4.0
Serum Interleukin-6 in Schizophrenia: Associations with Clinical and Sociodemographic Characteristics
BACKGROUND: Recently a significant part of schizophrenia studies have been focused on the role of cytokines, especially interleukin-6 (IL-6). Some authors have suggested a pathogenetic role for IL-6 in schizophrenia and concluded that therapy that centers on suppressing IL-6 activity may prove beneficial for certain categories of patients with the disorder. However, many questions about whether the changes in IL-6 levels in schizophrenia are primary, related to symptoms or caused by therapy, are concomitant metabolic disorders, are related to smoking or other secondary factors remain unanswered. AIM: To assess the level of serum IL-6 in patients with schizophrenia in comparison with healthy controls, as well as to study its association with clinical and socio-demographic characteristics. METHODS: Some 125 patients with schizophrenia and 95 healthy volunteers were examined. The evaluation of IL-6 was performed by enzyme immunoassay. All patients were assessed using standardized psychometric instruments. Information from patient medical records on the course of the disease and treatment was analyzed. RESULTS: The level of IL-6 was significantly higher in the patients than in the healthy volunteers (z=2.58; p=0.0099), but among men the difference between the patients and volunteers was not significant. Statistically significant correlations were found between the level of serum IL-6 and the severity of the cognitive impairment of patients: (auditory [ρ=–0.31; p=0.00063] and working memory [ρ=−0.25; p=0.0065], hand-eye coordination [ρ=−0.29; p=0.0011], verbal fluency [ρ=−0.28; p=0.0019] and problem-solving capacity [ρ=−0.22; p=0.013]), total severity of schizophrenia symptoms (PANSS, ρ=0.22; p=0.016), PANSS positive subscale (ρ=0.18; p=0.048), and the age of manifestation (ρ=0.20; p=0.025) and disease duration (ρ=0.18; p=0.043). The level of IL-6 was the lowest in patients treated with third-generation antipsychotics, and the highest in those treated with first-generation antipsychotics (H=6.36; p=0.042). Moreover, in hospital patients, the level of IL-6 was significantly higher than in outpatients and inpatients hospitals (H=18.59; p=0.0001). CONCLUSION: The study confirmed that there are associations between the serum IL-6 level and schizophrenia, the age of the patient, duration of the disease and how late in one's life cycle it began manifesting itself, as well as a number of clinical characteristics. Considering that IL-6 is associated with a wide range of symptoms that are loosely controlled by antipsychotics, this biochemical marker needs to be studied to look into how closely its level tracks with an unfavorable course of schizophrenia. That would require further prospective studies.
Copyright (c) 2023 Zhilyaeva T.V., Rukavishnikov G.V., Manakova E.A., Mazo G.E. https://creativecommons.org/licenses/by-nc-nd/4.0
Efficacy and Safety Profiles of Antipsychotic Drugs as Viewed by Psychiatrists: A Comparative Analysis of Cariprazine and Risperidone
BACKGROUND: Physicians hold the belief that the treatment outcomes and the treatment strategy they eventually adopt is largely determined by the differences in medications. Despite numerous studies focusing on the decision-making processes of psychiatrists, including the choice of antipsychotics when prescribing pharmacotherapy, the impact of therapeutic drug profiling on physicians’ decision-making remains poorly comprehended. AIM: The aim of this study is to assess the quantitative differences in perceptions of antipsychotics by psychiatrists using cariprazine and risperidone as examples. METHODS: A total of 79 psychiatrists were interviewed anonymously in St. Petersburg, Russia. The physicians documented the clinical advantages they perceived drugs to possess relative to one another, following a predetermined principle: A >B, A=B, A < B (2-AC protocol). The comparison is based on eleven parameters that assess the effectiveness and safety of cariprazine or risperidone. It has been hypothesized that the pattern of responses (qualitative difference) and the degree of preference for each drug (quantitative difference) may not align with the data in the original meta-analyses. RESULTS: The perception parameter exhibited a greater difference than anticipated (δ — 0.889), while the threshold for differentiating between the drugs was lower (τ — 1.001). The response pattern only aligned with theory by 44.37%. The dispersion of responses was associated with the length of work experience. CONCLUSION: The perceived difference between the drugs significantly deviates from the theoretical data, both in terms of strength of perception and pattern (quantitative and qualitative differences).
Copyright (c) 2023 Gvozdeckii A.N., Dobrovolskaya A.E., Prokopovich G.A., Sofronov A.H. https://creativecommons.org/licenses/by-nc-nd/4.0
Corrigendum to “Schizophrenia: a narrative review of etiological and diagnostic issues” (Consortium Psychiatricum, 2022, Volume 3, Issue 3, doi: 10.17816/CP132)
There is an error occurred in the article “Schizophrenia: a narrative review of etiological and diagnostic issues” published in the Consortium Psychiatricum journal (Volume 3 Issue 3) by Sofia Oskolkova. Due to a technical error on author’s and editorial parts and without any malicious intent, the “Errors in diagnostics of schizophrenia” chapter links to incorrect references. The publisher made changes to the electronic version of the published article (PDF and HTML) on the journal’s website instead of the version with errors. The authors team and the editorial board of the journal are sure that the mistakes could not significantly affect the perception and interpretation of the published work by readers, and should not become the reason for retraction. The authors team and the editorial board apologize to the readers for the mistakes made.
Copyright (c) 2023 Oskolkova S.N. https://creativecommons.org/licenses/by-nc-nd/4.0
The future of psychiatry with artificial intelligence: can the man-machine duo redefine the tenets?
As one of the largest contributors of morbidity and mortality, psychiatric disorders are anticipated to triple in prevalence over the coming decade or so. Major obstacles to psychiatric care include stigma, funding constraints, and a dearth of resources and psychiatrists. The main thrust of our present-day discussion has been towards the direction of how machine learning and artificial intelligence could influence the way that patients experience care. To better grasp the issues regarding trust, privacy, and autonomy, their societal and ethical ramifications need to be probed. There is always the possibility that the artificial mind could malfunction or exhibit behavioral abnormalities. An in-depth philosophical understanding of these possibilities in both human and artificial intelligence could offer correlational insights into the robotic management of mental disorders in the future. This article looks into the role of artificial intelligence, the different challenges associated with it, as well as the perspectives in the management of such mental illnesses as depression, anxiety, and schizophrenia.
Copyright (c) 2023 Sahoo J., Narayan B.N., Santi N. https://creativecommons.org/licenses/by-nc-nd/4.0
Impact of online dating on the adolescent population: a brief review of the literature with special reference to the Indian scenario
BACKGROUND: Online dating is becoming more and more popular not only among the adult population, but also among adolescents, which comes with its own advantages and disadvantages. Adolescents are more vulnerable to a number of issues connected with online dating, including online grooming, bullying, emotional abuse, revenge porn, harassment, and lack of social interaction. AIM: We aimed to briefly review the available literature exploring the impact of online dating on adolescents, with special reference to the current Indian Scenario. METHODS: A brief literature search was conducted in PubMed and Google Scholar in September 2022 with no date limits. Keywords included various combinations of terms such as “online dating”, “dating applications”, “social media”, “mental illness”, “psychiatric disorders”, “adolescents”, and “mental health”. Original studies and review articles exploring the impact of online dating on adolescents and published in English were reviewed in our work. A descriptive strategy was used to summarise the findings. RESULTS: The impact of online dating on adolescents is discussed in the light of (1) issues associated with online dating among adolescents, (2) the international context, and (3) Indian context. CONCLUSION: Since the beginning of the COVID-19 pandemic, online dating has grown in popularity among adolescents, which has led to a number of worrying situations, including increased risk of sexually transmitted infections, dating violence, and mental health issues. All of these issues are described in the literature in the context of unsupervised use of technology, peer pressure, and desire to fit into the society. Data from India remain scarce on this topic, highlighting the need for research exploring the influence of online dating on adolescents.
Copyright (c) 2023 Chakravarty R., Jagota G., Sahoo S. https://creativecommons.org/licenses/by-nc-nd/4.0
Equivalence of the autism spectrum disorders diagnostics in children in telemedicine and face-to-face consultations: a literature review
BACKGROUND: The use of remote forms of mental health care has become widespread during the period of epidemiological restrictions due to the COVID-19 pandemic. Methodological and organizational issues remain insufficiently developed, including the level of equivalence of the use of telemedicine technologies in the diagnosis of autistic spectrum disorders. AIM: Study of the equivalence of diagnostic tools in the framework of telemedicine and face-to-face consultations in children with autistic spectrum disorders according to modern scientific literature. METHODS: A descriptive review of scientific studies published between January 2017 and May 2023 was carried out. The papers presented in the electronic databases PubMed, Web of Science, and eLibrary were analyzed. Descriptive analysis was used to summarize the obtained data. RESULTS: The conducted analysis convincingly indicates sufficient equivalence of remote tools used in different countries for level I screening, assessment scales, and structured procedures for diagnosing autistic spectrum disorders with a high level of specificity from 60.0 to 94.4%, sensitivity from 75 dog 98.4%, and satisfaction of patients and their legal representatives. CONCLUSION: The widespread use of validated telemedicine diagnostic systems in clinical practice contributes to the early detection of autistic spectrum disorders, increasing the timeliness and effectiveness of medical, corrective psychological, pedagogical, and habilitation interventions.
Copyright (c) 2023 Khairetdinov O.Z., Rubakova L.I. https://creativecommons.org/licenses/by-nc-nd/4.0
Machine learning techniques in diagnostics and prediction of the clinical features of schizophrenia: a narrative review
BACKGROUND: Schizophrenia is a severe psychiatric disorder associated with a significant negative impact. Early diagnosis and treatment of schizophrenia has a favorable effect on the clinical outcome and patient’s quality of life. In this context, machine learning techniques open up new opportunities for a more accurate diagnosis and prediction of the clinical features of this illness. AIM: This literature review is aimed to search for information on the use of machine learning techniques in the prediction and diagnosis of schizophrenia and the determination of its clinical features. METHODS: The Google Scholar, PubMed, and eLIBRARY.ru databases were used to search for relevant data. The review included articles that had been published not earlier than January 1, 2010, and not later than March 31, 2023. Combinations of the following keywords were applied for search queries: “machine learning”, “deep learning”, “schizophrenia”, “neural network”, “predictors”, “artificial intelligence”, “diagnostics”, “suicide”, “depressive”, “insomnia”, and “cognitive”. Original articles regardless of their design were included in the review. Descriptive analysis was used to summarize the retrieved data. RESULTS: Machine learning techniques are widely used in the functional assessment of patients with schizophrenia. They are used for interpretation of MRI, EEG, and actigraphy findings. Also, models created using machine learning algorithms can analyze speech, behavior, and the creativity of people and these data can be used for the diagnosis of psychiatric disorders. It has been found that different machine learning-based models can help specialists predict and diagnose schizophrenia based on medical history and genetic data, as well as epigenetic information. Machine learning techniques can also be used to build effective models that can help specialists diagnose and predict clinical manifestations and complications of schizophrenia, such as insomnia, depressive symptoms, suicide risk, aggressive behavior, and changes in cognitive functions over time. CONCLUSION: Machine learning techniques play an important role in psychiatry, as they have been used in models that help specialists in the diagnosis of schizophrenia and determination of its clinical features. The use of machine learning algorithms is one of the most promising direction in psychiatry, and it can significantly improve the effectiveness of the diagnosis and treatment of schizophrenia.
Copyright (c) 2023 Gashkarimov V.R., Sultanova R.I., Efremov I.S., Asadullin A.R. https://creativecommons.org/licenses/by-nc-nd/4.0
Current status, challenges and future prospects in computational psychiatry: a narrative review
BACKGROUND: Computational psychiatry is an area of scientific knowledge which lies at the intersection of neuroscience, psychiatry, and computer science. It employs mathematical models and computational simulations to shed light on the complexities inherent to mental disorders. AIM: The aim of this narrative review is to offer insight into the current landscape of computational psychiatry, to discuss its significant challenges, as well as the potential opportunities for the field’s growth. METHODS: The authors have carried out a narrative review of the scientific literature published on the topic of computational psychiatry. The literature search was performed in the PubMed, eLibrary, PsycINFO, and Google Scholar databases. A descriptive analysis was used to summarize the published information on the theoretical and practical aspects of computational psychiatry. RESULTS: The article relates the development of the scientific approach in computational psychiatry since the mid-1980s. The data on the practical application of computational psychiatry in modeling psychiatric disorders and explaining the mechanisms of how psychopathological symptomatology develops (in schizophrenia, attention-deficit/hyperactivity disorder, autism spectrum disorder, anxiety disorders, obsessive-compulsive disorder, substance use disorders) are summarized. Challenges, limitations, and the prospects of computational psychiatry are discussed. CONCLUSION: The capacity of current computational technologies in psychiatry has reached a stage where its integration into psychiatric practice is not just feasible but urgently needed. The hurdles that now need to be addressed are no longer rooted in technological advancement, but in ethics, education, and understanding.
Copyright (c) 2023 Vasilchenko K.F., Chumakov E.M. https://creativecommons.org/licenses/by-nc-nd/4.0
Level of patient satisfaction with online psychiatric outdoor services
BACKGROUND: The COVID-19 global pandemic exposed gaps in the treatment of common physical and mental disorders that had to do with things like lockdowns, poor convenience, fear of contracting COVID, and economic constraints. Hence, to address these treatment gaps while also limiting exposure to the COVID-19 infection, telemedicine in the form of telephone and internet consultations has increasingly become the recourse around the world. Our center adopted this trend and also launched a telepsychiatry initiative in order to better cater to the needs of patients with pre-existing mental health disorders and to ensure regular follow-ups and compliance with prescription regiments. AIM: The present study aimed to assess the level of patient satisfaction with the online psychiatric services/telepsychiatry. METHODS: The sample consisted of 100 patients with pre-existing mental health disorders. This was a cross-sectional study lasting 6 months. The DigiDoc app by Hospital Information Software (HIS) software, which is used to manage a patient’s appointment schedule, relevant clinical and lab details, along with follow-up prescriptions, was used to follow the selected patients for the purpose of this study. This software also provides a digital platform for video calls for online consultation. The Client Satisfaction Questionnaires-8 (CSQ-8) was employed to collect patient data for analysis. RESULTS: The mean total CSQ-8 score of the study sample was 21.01±5.80 (8–32), which corresponds to a low-to-moderate level of satisfaction with online psychiatric services/telepsychiatry. Most patients (45%) reported low satisfaction levels, followed by 37% who reported moderate levels of satisfaction. Only 18% of patients reported higher satisfaction with telepsychiatry. CONCLUSION: Despite the psychiatrists ability to provide adequate professional advice and psychoeducation through online psychiatric services, patients’ level of satisfaction proved moderate-to-low. This suggests a need to design standard protocols and guidelines in the search and provision of consultation services on online psychiatric service platforms that could help enhance patients’ levels of satisfaction.
Copyright (c) 2023 Jilani AQ, Khan A, Saloni, Kumar S, Singh J, Verma K, Siddiqui MA, Sinha R. https://creativecommons.org/licenses/by-nc-nd/4.0
Computational psychiatry approach to stigma subtyping in patients with mental disorders: explicit and implicit internalized stigma
BACKGROUND: Psychiatric stigma has potentially controversial effects on patients’ health-related behaviors. It appears that both stigmatization and motivation in psychiatric patients are heterogeneous and multi-dimensional, and that the relationship between stigma and treatment motivation may be more complex than previously believed. AIM: To determine psychiatric stigma subtypes as they relate to treatment motivation among inpatients with various mental disorders. METHODS: Sixy-three psychiatric inpatients were examined by the Treatment Motivation Assessment Questionnaire (TMAQ) and the Russian version of Internalized Stigma of Mental Illness scale (ISMI). K-Means cluster and dispersion analysis were conducted. RESULTS: Cluster 3 (25 subjects) was the least stigmatized. Cluster 1 (18 subjects) showed an “explicit stigma.” Cluster 2 (20 subjects) showed an “implicit stigma” that took the form of the lowest treatment motivation compared to other clusters. “Implicitly” stigmatized patients, in contrast to “explicitly” stigmatized individuals, showed a decline in 3 out of 4 TMAQ factors (Mean dif.=1.05–1.67). CONCLUSION: Cooperation with doctors, together with reliance on one’s own knowledge and skills to cope with the disorder, might be the way to overcome an internalized stigma for patients with mental disorders.
Copyright (c) 2023 Sorokin M.Y., Lutova N.B., Bocharova M.O., Khobeysh M.A., Wied V.D. https://creativecommons.org/licenses/by-nc-nd/4.0
EEG alpha band characteristics in patients with a depressive episode within recurrent and bipolar depression
BACKGROUND: The search for biological markers for the differential diagnosis of recurrent depression and bipolar depression is an important undertaking in modern psychiatry. Electroencephalography (EEG) is one of the promising tools in addressing this challenge. AIM: To identify differences in the quantitative characteristics of the electroencephalographic alpha band activity in patients with a depressive episode within the framework of recurrent depression and bipolar depression. METHODS: Two groups of patients (all women) were formed: one consisting of subjects with recurrent depressive disorder and one with subjects experiencing a current mild/moderate episode (30 patients), and subjects with bipolar affective disorder or a current episode of mild or moderate depression (30 patients). The groups did not receive pharmacotherapy and did not differ in their socio-demographic parameters or total score on the Hamilton depression scale. A baseline electroencephalogram was recorded, and the quantitative characteristics of the alpha band activity were analyzed, including the absolute spectral power, interhemispheric coherence, and EEG activation. RESULTS: The patients with recurrent depressive disorder demonstrated statistically significantly lower values of the average absolute spectral power of the alpha band (z=2.481; p=0.042), as well as less alpha attenuation from eyes closed to eyes open (z=2.573; p=0.035), as compared with the patients with bipolar affective disorder. CONCLUSION: The presented quantitative characteristics of alpha activity are confirmation that patients with affective disorders of different origins also display distinctive electrophysiological features which can become promising biomarkers and could help separate bipolar depression from the recurrent type.
Copyright (c) 2023 Bokhan N.A., Galkin S.A., Vasilyeva S.N. https://creativecommons.org/licenses/by-nc-nd/4.0
The History of Territorial Psychiatric Hospitals in Russia
The establishment of district psychiatric hospitals in the Russian Empire in the second half of the 19th-early 20th century is one of the most important stages in the development of domestic psychiatry. In fact, it was the first experience in the design and construction of psychiatric hospitals as large specialized autonomous complexes aimed not only at isolation of patients, but also at therapy of their condition. The idea of building such institutions was suggested by reality itself: city houses for the mentally ill under the jurisdiction of provincial and then zemstvo authorities were overcrowded, but there was a lack of specialized doctors, since psychiatry in Russia in the first half of the 19th century was only beginning to gain scientific prestige. In a sense, the development of Russian psychiatry and the evolution of the project of district hospitals for the mentally ill pushed each other: leading psychiatrists of their time took a most enthusiastic part in the development of the project, and the hospitals established through their efforts provided enormous practical material for studying mental diseases and methods of their therapy.
Copyright (c) 2023 Tselischev D.V., Chernyaev M.I. https://creativecommons.org/licenses/by-nc-nd/4.0
The mental health system in Bulgaria: socialist heritage and prospects
The article overviews the current system of psychiatric care in Bulgaria based on statistical data for the country. We attempted to look at the reality of the psychiatric care system in Bulgaria as regards its structural parts, the relationships between them, their resource provision, as well as its financing. Attention is focused on some practices and policies that seem inadequate to the needs of patients, their successful treatment, and successful social rehabilitation and integration. It can be said that in recent years the Bulgarian mental health care system has not changed much and that it has a long way to go. There are socio-economic difficulties in the country, and the system needs to evolve to improve the level of care provided to patients. More importantly, Bulgaria must invest in mental health education, in preventive psychiatry, and in developing a culture of clinical management and organization.
Copyright (c) 2023 Stoyanov D., Nakov V. https://creativecommons.org/licenses/by-nc-nd/4.0
Pregorexia: a psychotherapy strategy for eating disorders in pregnant women
Pregorexia refers to an eating disorder observed in pregnant women characterized by the adoption of extreme dieting and workout regime during pregnancy meant to ward off weight gain and keep body shape under control. Psychological factors such as a distortion of how one perceives their own body, concerns about visible signs of pregnancy, and fear of gaining weight have been identified as some of the underlying causes of pregorexia. This condition may have detrimental effects, such as stunted fetal growth, spontaneous miscarriage, and development of anemia by the pregnant woman.
Copyright (c) 2023 Fomicheva N.S. https://creativecommons.org/licenses/by-nc-nd/4.0
Possible role of nutritionists in multi-disciplinary teams managing patients with eating disorders in the Russian Federation
The goal of this publication was to weigh the benefits of including a nutritionist in a team of specialists managing patients with eating disorders (EDs). The article describes the professional status of nutritionists as of the first half of 2023, as well as their field of competence and limitations. The nutritionist is intended to play an auxiliary role in the team, primarily assisting the patient in following the recommendations of the attending physician(s). A nutritionist can also take preventive action by educating the population on the importance of good nutrition.
Copyright (c) 2023 Kamitova A.V. https://creativecommons.org/licenses/by-nc-nd/4.0
Prevalence of eating disorders in patients with bipolar disorder: a scoping review of the literature
BACKGROUND: Eating disorder (ED) and bipolar disorder (BD) exhibit certain phenomenological similarities rooted in eating behavior and emotional regulation. However, despite the growing body of research on the comorbidity of ED and BD, scientific data on the concurrent course of these disorders has remained poorly systematized. AIM: To conduct a scoping review of published data on the prevalence of various types of ED among patients with BD types I and II in the context of the sex and clinical features of the concurrent course of these disorders. METHODS: The analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The search was conducted in the MEDLINE electronic database. Studies were included if they were focused samples of patients diagnosed with BD and ED, and the Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions (DSM-IV, DSM-5), or International Statistical Classification of Diseases and Related Health Problems, tenth Revision (ICD-10), were used for the verification of the ED and BD diagnoses. The descriptive analysis method was used to summarize the review findings. RESULTS: A total of 41 studies were selected for the review. Lifetime ED in patients with BD ranged from 2.2% to 31.1%, and the prevalence rates of BD among patients with ED varied from 11.3% to 68.1%. ED nominally had a higher prevalence among individuals with BD type II and females. Additionally, the presence of ED in patients with BD was associated with earlier onset of mood disorder, a higher number of depressive episodes, higher levels of atypical depressive symptoms, suicide attempts, as well as a higher frequency of comorbid obsessive-compulsive and anxiety disorders, addictions, and various metabolic disorders. CONCLUSION: Despite the high degree of volatility in the results, the prevalence rates of a concurrent course of ED and BD are rather high. For this reason, screening for ED in patients with BD and vice versa holds significant value in the accurate diagnosis and selection of the most effective therapy. The patterns of comorbidity among different types of ED and BD, depending on gender, need further exploration in future research.
Copyright (c) 2023 Yakovleva Y.V., Kasyanov E.D., Mazo G.E. https://creativecommons.org/licenses/by-nc-nd/4.0
Pharmacological strategies for appetite modulation in eating disorders: a narrative review
BACKGROUND: A substantial increase in the prevalence of eating disorders has been noticed over the past decades. Priority in the treatment of eating disorders is justifiably given to psychosocial interventions. However, it is also well known that centrally acting drugs can significantly affect appetite and food consumption. AIM: To narratively review the available neurobiological data on the mechanisms of central regulation of eating behavior as a rationale to summarize pharmacological strategies for appetite modulation in eating disorders. METHODS: The authors have carried out a narrative review of scientific papers published from January 2013 to March 2023 in the PubMed and Web of Science electronic databases. Studies were considered eligible if they included data on the neurobiological mechanisms of appetite regulation or the results of clinical trials of centrally acting drugs in eating disorders. Relevant studies were included regardless of their design. Descriptive analysis was used to summarize the obtained data. RESULTS: The review included 51 studies. The available neurobiological and clinical data allowed us to identify the following pharmacological strategies for appetite modulation in eating disorders: serotonergic, catecholaminergic, amino acidergic and peptidergic. However, implementation of these data into clinical practice difficult due to an insufficient number of good-quality studies, which is particularly relevant for adolescents as there is a research gap in this population. CONCLUSION: The progress in neurobiological understanding of the mechanisms of central regulation of appetite opens opportunities for new pharmacotherapeutic approaches aimed at changing the patterns of eating behavior. Obviously, treatment of eating disorders is a much broader problem and cannot be reduced to the correction of eating patterns. Nevertheless, at certain stages of treatment, drug-induced modulation of appetite can play an important role among multi-targeted biological and psychosocial interventions. Translation of neurobiological data into clinical practice requires a large number of clinical studies to confirm the long-term efficacy and safety of pharmacotherapeutic approaches and to develop personalized algorithms for the treatment of various forms of eating disorders in different age groups.
Copyright (c) 2023 Popov M.Y., Lepik O.V., Kozlovskii V.L., Popov Y.V. https://creativecommons.org/licenses/by-nc-nd/4.0
Non-suicidal self-injuries and suicide risk in adolescent girls with eating disorders: associations with weight control, body mass index, and interpersonal sensitivity
BACKGROUND: Eating disorders (EDs) are associated with a risk of premature death, as well as suicidal and self-injurious behavior. A low or high body mass index (BMI) and weight control behavior can also have an impact on self-injurious and suicidal behavior. While some studies show that interpersonal sensitivity is a risk factor for EDs, affective disorders, and self-injurious behavior, in-depth studies of these issues have not been done. AIM: The present study investigates how self-injurious and suicidal behavior relate to weight control behavior, BMI, and interpersonal sensitivity in adolescent girls from a clinical population with diagnosed EDs compared with adolescent girls from the general population. METHODS: The main group was comprised of 31 girls with a diagnosis of ED (as the main diagnosis or co-occurring with affective disorders, M=15±1.13 years), being treated in in the Eating Disorder Clinic of the Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva. The comparison group consisted of 27 adolescent girls recruited from Proton Educational Center (M=15.51±1.09 years). The measures included a qualitative survey that yielded data on weight control behavior, and self-injurious behavior, a Blitz questionnaire probing the suicide risk (used only in the main group), and the Interpersonal Sensitivity Measure. Height and weight data were also recorded for BMI calculation. RESULTS: The qualitative analysis of weight control behavior yielded the following results: purging behavior, restrictive behavior, and corrective behavior. Participants in the main group used purging and restrictive behavior more often, whereas participants in the comparison group used strategies associated with a healthy lifestyle. The main group and participants who practiced purging and restrictive weight control in the overall sample had the smallest BMI. Self-injurious behavior was approximately evenly distributed both amongst the main and comparison groups. Self-cutting was the most prevalent type of self-injury. In the main group, self-injury was associated with a smaller BMI, while in the comparison group it was associated with an increase in the fear of rejection and overall interpersonal sensitivity. Based on the assessment of the suicide risk, six participants in the main group were deemed high-risk; they also displayed increased fear of rejection, dependence on the assessments of others, and overall interpersonal sensitivity. All girls in the suicide risk subgroup had non-suicidal self-injuries. CONCLUSION: The results of our study broaden our understanding of the risk factors of suicidal and self-injurious behavior in adolescent girls with EDs and reveal the characteristics of the type of weight control behavior used by this group in comparison with adolescent girls in the general population. Girls with EDs who were considered at the risk of committing suicide demonstrated high interpersonal sensitivity, which provides a rationale for further studying the general interpersonal mechanisms that underlie the pathogenesis of EDs, as well as that of self-injurious and suicidal behavior.
Copyright (c) 2023 Polskaya N.A., Basova A.Y., Razvaliaeva A.Y., Yakubovskaya D.K., Vlasova N.V., Abramova A.A. https://creativecommons.org/licenses/by-nc-nd/4.0
Factors associated with lifetime history of eating disorder in non-psychotic patients with suicidal ideation
BACKGROUND: Data on the sociodemographic, biographical, and clinical factors associated with a lifetime diagnosis of eating disorders (ED) in patients with non-psychotic mental disorders (NPMD) and suicidal ideation (SI) are scarce. METHODS: A cohort study was conducted at the Moscow Research and Clinical Center for Neuropsychiatry. The sample consisted of consecutive patients with non-psychotic mental disorders and SI, aged 18–45 years. Participants with a lifetime diagnosis of anorexia and/or bulimia (then in remission or recovery) were compared with those without ED in terms of their sociodemographic profile, clinical characteristics, lifetime traumatic events, and some behavioral patterns. All participants underwent the Russian version of the Self-Injurious Thoughts and Behaviors Interview and completed the Brief Reasons for Living Inventory, the State and Trait Anxiety Inventory, and the Beck Depression Inventory. RESULTS: A total of 892 patients with non-psychotic mental disorders and SI were included in the study. The mean age was 25.7 years, and 84% were assigned female at birth. Same-sex experience was more common in the ED group. Patients with an ED were more likely to have a history of physical and sexual abuse and to have witnessed domestic violence. The proportion of participants with piercings, tattoos, or severe body modifications was significantly higher in the ED group. Patients with a lifetime ED were more likely to engage in nonsuicidal self-injurious behaviors and to have a history of suicide attempts. CONCLUSION: Lifetime ED in NPMD patients with SI is associated with younger age, being assigned female at birth, having an alternative gender identity, having same-sex experience, having more than one psychiatric diagnosis, having been diagnosed with bipolar disorder, experiencing severe depression and anxiety, being exposed to multiple traumatic experiences, having various body modifications, practicing NSSI, and having a lifetime story of suicide attempts.
Copyright (c) 2023 Kustov G.V., Zinchuk M.S., Popova S.B., Mishin I.N., Voinova N.I., Yakovlev A.A., Akzhigitov R.G. https://creativecommons.org/licenses/by-nc-nd/4.0
Anorexia nervosa through the lens of primary health care practitioners in the Kyrgyz Republic
BACKGROUND: Anorexia nervosa was investigated in a large number of studies. Several of the studies in our review highlighted how important it is to factor in the opinion of health care practitioners if we want to improve the quality of the medical care provided to patients with anorexia nervosa. Additionally, the dominance of studies focused on anorexia nervosa within the Western culture raised the need for cultural diversity in such research. AIM: The present study endeavored to explore how primary healthcare practitioners in Bishkek, Kyrgyz Republic, perceive anorexia nervosa and people who suffer from it. METHODS: The study used the qualitative approach of Interpretative Phenomenological Analysis. Six semi-structured interviews with six primary health care practitioners from Bishkek were conducted. RESULTS: The analysis of the collected data pointed towards four themes: (1) Anorexia nervosa as a reaction to distressing events in the form of loss of appetite; (2) Attributing blame for developing anorexia nervosa by a patient to family members; (3) Local versus Western socio-cultural standards in the development of anorexia nervosa and seeking treatment; and (4) Denial of mental health disorders by patients. CONCLUSION: The discussion of the interpreted results led us to the conclusion that the perceptions of the health care providers in Bishkek represent the common prism through which anorexia nervosa is viewed in the larger population, which is constructed out of information received from the physical and virtual environments.
Copyright (c) 2023 Moldokulova Z., Molchanova E.S., Kosterina E.V. https://creativecommons.org/licenses/by-nc-nd/4.0
Risk factors of disordered eating in adolescent girls from a community sample: a multidimensional approach
BACKGROUND: Eating disorders (ED) are severe, chronic, and complex in nature mental illnesses that are difficult to treat. One of the ways to stave off EDs is by screening among adolescents to preempt the development of clinical forms of ED in risk groups. AIM: 1) to investigate the prevalence of ED risk among adolescent girls and compare subgroups at high and low risk of ED; 2) to investigate using a multidimensional approach those variables that can interact with temperament and character traits to predict ED symptomatology. METHODS: The cross-sectional observational self-report study of a community sample of adolescent girls 12–17 years old (n=298; M=14.77±1.13) was carried out in the city of Ryazan, Russia. The Russian versions of Eating Attitudes Test and Cloninger’s Temperament and Character Inventory-Revised were used. In addition, an original questionnaire (Risk Factors of Eating Disorders) was developed. Regression models (to test for significant moderation) and path analysis (to test for significant mediations) were used. RESULTS: Girls at risk of developing EDs are characterized by a heightened level of concern about weight and dissatisfaction with their body, tend to suffer from low self-directedness, higher novelty seeking and tendency to higher harm avoidance, display high alexithymia, experience self-distrust, negative emotionality and are dissatisfied with family relationships. They also suffer from low self-esteem and tend to be perfectionism and engage in risk behavior. Significant moderating effects were uncovered between the following ED risk factors: (1) self-distrust/risk behavior and BMI; (2) alexithymia/negative emotionality/self-esteem and cooperativeness; and (3) negative emotionality/risk behavior and self-transcendence. Family relationship dissatisfaction mediates the association between self-directedness/cooperativeness/self-transcendence and disordered eating. CONCLUSION: There are various mutual influences between the numerous ED risk and prevention factors, which all together determine the paths between the predictors and final outcome.
Copyright (c) 2023 Meshkova T.A., Mitina O.V., Aleksandrova R.V. https://creativecommons.org/licenses/by-nc-nd/4.0
The paradoxical moderating effects of metacognition in the relationships between self-esteem, depressive symptoms, and quality of life in anorexia and bulimia
BACKGROUND: Self-esteem and depressive symptoms contribute to a lower quality of life in people suffering from eating disorders. However, limited research has examined whether other factors may affect how these variables influence one another over time. Metacognition is a previously unexplored determinant that may impact the relationships between self-esteem, depressive symptoms, and quality of life in instances of eating disorders. AIM: This study sought to examine metacognitive self-reflectivity and mastery as moderators of the relationships between self-esteem, depressive symptoms, and quality of life and to determine if these relationships are different in people with anorexia compared with people with bulimia. METHODS: Participants with anorexia (n=40) and bulimia (n=40) were recruited from outpatient clinics. The participants were assessed on their metacognitive ability and self-reported on measures to assess their depressive symptoms, self-esteem, and quality of life. RESULTS: The results indicate that metacognitive self-reflectivity moderates the relationship between self-esteem, depressive symptoms, and quality of life in people with anorexia such that when self-reflectivity is high, lower self-esteem and higher depressive symptoms are associated with a lower quality of life. These relationships did not appear to be significant when self-reflectivity was low. In contrast, in the anorexia and bulimia groups, metacognitive mastery appeared to moderate the relationships between self-esteem, depressive symptoms, and quality of life such that when mastery was low, lower self-esteem and higher depressive symptoms were associated with a lower quality of life. These relationships did not appear significant when mastery was high. CONCLUSION: Metacognitive self-reflectivity and mastery seem to play paradoxical moderating roles in the relationships between self-esteem, depressive symptoms, and quality of life in people with anorexia and bulimia. These findings pave the way toward further research and have important clinical implications.
Copyright (c) 2023 Springfield C.R., Bonfils K.A., Chernov N.V., Moiseeva T.V., Sozinova M.V., Dmitryeva N.G., Lysaker P.H., Karpenko O.A., Kostyuk G.P. https://creativecommons.org/licenses/by-nc-nd/4.0
Celebrating a Storied History: Moscow Preobrazhenskaya Mental Hospital Marks its 245th Anniversary
In 2022, Mental-health Clinic No. 4 named after P. B. Gannushkin, one of the oldest mental health institutions in Russia known as Preobrazhenskaya Hospital before the October Revolution of 1917, celebrated its 245th anniversary. The history of the hospital reflects all stages of the evolution of the basic principles and aspects of mental health care in Russia. On many occasions, the institution served as a platform for eminent researchers and clinicians to achieve scientific breakthroughs and their application in practice. This article is a review of the major milestones in the history of the hospital. It highlights the great achievements of its psychiatrists and presents some previously unpublished archival documents that offer a new perspective on the history of Preobrazhenskaya Hospital.
Copyright (c) 2023 Burygina L.A., Golubev S.A., Filipchenko O.V. https://creativecommons.org/licenses/by-nc-nd/4.0/
Modern Approaches to the Diagnosis of Cognitive Impairment and Alzheimer’s Disease: A Narrative Literature Review
BACKGROUND: The aging of the world’s population leads to an increase in the prevalence of age-related diseases, including cognitive impairment. At the stage of dementia, therapeutic interventions become usually ineffective. Therefore, researchers and clinical practitioners today are looking for methods that allow for early diagnosis of cognitive impairment, including techniques that are based on the use of biological markers. AIM: The aim of this literature review is to delve into scientific papers that are centered on modern laboratory tests for Alzheimer’s disease, including tests for biological markers at the early stages of cognitive impairment. METHODS: The authors have carried out a descriptive review of scientific papers published from 2015 to 2023. Studies that are included in the PubMed and Web of Science electronic databases were analyzed. A descriptive analysis was used to summarized the gleaned information. RESULTS: Blood and cerebrospinal fluid (CSF) biomarkers, as well as the advantages and disadvantages of their use, are reviewed. The most promising neurotrophic, neuroinflammatory, and genetic markers, including polygenic risk models, are also discussed. CONCLUSION: The use of biomarkers in clinical practice will contribute to the early diagnosis of cognitive impairment associated with Alzheimer’s disease. Genetic screening tests can improve the detection threshold of preclinical abnormalities in the absence of obvious symptoms of cognitive decline. The active use of biomarkers in clinical practice, in combination with genetic screening for the early diagnosis of cognitive impairment in Alzheimer’s disease, can improve the timeliness and effectiveness of medical interventions.
Copyright (c) 2023 Ochneva A.G., Soloveva K.P., Savenkova V.I., Ikonnikova A.Y., Gryadunov D.A., Andryuschenko A.V. https://creativecommons.org/licenses/by-nc-nd/4.0/
Efficacy of a Relaxation Scenario in Virtual Reality for the Comorbid Symptoms of Anxiety and Asthenia in a General Hospital Setting: A Pilot Comparative Randomized Open-Label Study
BACKGROUND: Patients in general hospitals often display concomitant signs of mental maladjustment: low mood, anxiety, apathy, asthenia, all of which can have a negative impact on the course of the underlying disease and the recovery process. One of the non-pharmacological approaches that has gained wider acceptance in medical practice in recent years is the use of procedures based on virtual reality. AIM: Assess the efficacy of the new domestic, virtual reality application Flow as relates to symptoms of anxiety and asthenia in patients undergoing inpatient treatment. METHODS: The study was open-label and had a comparison group; the patients were assigned to the experimental or control group using a randomization table. The patients were assessed using the Spielberger State Anxiety Inventory; the Fatigue Symptom Rating Scale; the Well-being, Activity, Mood questionnaire; the Depression Anxiety Stress Scale; and the Clinical Global Impression Scale. Physical parameters were measured before and after each virtual reality session. The obtained data were statistically processed. RESULTS: The study involved 60 patients. In 40 patients, the treatment program included a course of five daily relaxation sessions in virtual reality; the control group consisted of 20 patients, who were treated in accordance with the usual practice of the institution. The addition of virtual reality sessions to the standard treatment course yielded significant advantage in terms of affective symptoms reduction in patients both after a single session and as a result of undergoing the full course, and several days after its completion. The patients in the experimental group also showed a significant decrease in blood pressure after the sessions, and this was most pronounced in individuals who initially had elevated and high blood pressure. CONCLUSION: The use of relaxation program courses in the virtual reality application Flow is an effective and promising means of non-pharmacological care for non-psychiatric inpatients showing symptoms of anxiety, apathy, depressive mood, as well as hypertension.
Copyright (c) 2023 Lepilkina T.А., Beniashvili A.G., Cheremin R.A., Malyukova N.G., Morozova M.A., Bogdanov M.A., Burminsky D.S., Potanin S.S., Rodkina S.V., Rupchev G.E., Eip M.N. https://creativecommons.org/licenses/by-nc-nd/4.0/
Treatment of Depression with Vortioxetine and Second Generation Antipsychotics During the Period of Remission Formation in Schizophrenia (Interim Data Analysis)
BACKGROUND: Depression in patients with schizophrenia worsens the course of the disease by increasing the risk of suicide, by complicating the clinical picture of the disorder, and by reducing the quality of the social functioning; its treatment is difficult, since monotherapy, even when involving modern antipsychotics, does not always prove successful. While the prescription of additional antidepressants (ADs) can improve the likelihood of a better outcome, the effectiveness of such augmentation in many cases is yet to be proven. Therefore, it is still important that one weighs the effectiveness of various combinations between most of the known ADs and some second-generation antipsychotic (SGA) in the treatment of depression that occurs at different stages of schizophrenia. In previous studies, the use of vortioxetine as an adjunct to an antipsychotic yielded a reduction in negative symptoms, a clinically significant improvement in cognitive functions that differed from its antidepressant effect, and good tolerability, which affects how committed to treatment a patient remains. AIM: To study the changes that occur over time in the clinical manifestations of depression, negative and cognitive impairment, as well as the social adequacy of patients receiving a combination therapy with second-generation antipsychotics and vortioxetine, which were prescribed in real clinical practice at doses approved in the Russian Federation. METHODS: We performed a comparative analysis of the changes in depression symptoms and negative symptoms, cognitive impairment, as well as function of 78 patients with severe manifestations of depression at the stage of exacerbation reduction and subsequent remission of paranoid schizophrenia. Combination treatment with SGA and vortioxetine was used in 39 patients, and 39 patients who had similar clinical manifestations received just SGA. During the observation period, the mental disorder severity and depression symptom severity were assessed 3 times (before the start of treatment, after three months, and after six months) using the Clinical Global Impression (CGI) scale and Calgary Depression Scale for Schizophrenia (CDSS), respectively; patients were also assessed using the Negative Symptoms Assessment-5 (NSA-5) scale, Perceived Deficits Questionnaire-20 items (PDQ-20) scale, and Personal and Social Performance (PSP) scale. RESULTS: According to the ANOVA results, by the end of the observation period, patients, regardless of their therapeutic group, showed a statistically significant decrease in the level of depression on the CDSS scale, the severity of negative symptoms on the NSA-5 scale, cognitive symptoms on the PDQ-20 scale, as well as an improvement in personality and society, judging by the increase in the total PSP scores. There were also significant differences between the compared main (SGA + vortioxetine) and control (SGA) groups in terms of the changes in the total score on the CDSS and PSP scales. An interesting aspect of the changes in the clinical scores was a noticeable improvement in the SGA + vortioxetine group after 3 months of treatment, in the absence of a similar improvement in the control group, and the achievement of approximately the same scores in both groups after 6 months. In particular, there were significant differences between the SGA + vortioxetine and SGA groups in terms of the mean CDSS (p <0.001), NSA-5 (p=0.003), PDQ-20 (p <0.001), and PSP (p=0.004) scores after 3 months. Analysis of the time before early withdrawal from the study showed that significantly more patients in the SGA + vortioxetine group completed the study program (n=27, 69.23%) compared with the SGA group (n=13, 33.33%) (χ2 =14.618, df=1, p <0.001, log-rank test. The mean survival time in the SGA group was significantly (p <0.001) less and amounted to 101.436 days (95% CI: 81.518–121.354), and in the SGA + vortioxetine group it amounted to 161.744 days (147.981–175.506). The relative risk of full study completion in the vortioxetine + SGA group compared with that in SGA was 3.618 (1.871–6.994). CONCLUSION: The addition of vortioxetine to the SGA therapy accelerates the reduction of the depression symptoms that occur at the stage of psychosis regression and early remission, contributes to the accelerated reduction in negative symptoms, positively affects the subjective assessment of cognitive impairment severity, and has a significant positive effect on the level of psychosocial functioning.
Copyright (c) 2023 Reznik A.M., Syunyakov T.S., Mudrak A.V., Zakharov N.B., Popova Z.B., Khoroshilova A.N., Khurbatova I.G., Saifulina A.M., Eliseenko A.M., Matvievskaya T.K., Khannanova A.N. https://creativecommons.org/licenses/by-nc-nd/4.0/
Dysregulation of Long Intergenic Non-Coding RNA Expression in the Schizophrenia Brain
BACKGROUND: Transcriptomic studies of the brains of schizophrenia (SZ) patients have produced abundant but largely inconsistent findings about the disorder’s pathophysiology. These inconsistencies might stem not only from the heterogeneous nature of the disorder, but also from the unbalanced focus on particular cortical regions and protein-coding genes. Compared to protein-coding transcripts, long intergenic non-coding RNA (lincRNA) display substantially greater brain region and disease response specificity, positioning them as prospective indicators of SZ-associated alterations. Further, a growing understanding of the systemic character of the disorder calls for a more systematic screening involving multiple diverse brain regions. AIM: We aimed to identify and interpret alterations of the lincRNA expression profiles in SZ by examining the transcriptomes of 35 brain regions. METHODS: We measured the transcriptome of 35 brain regions dissected from eight adult brain specimens, four SZ patients, and four healthy controls, using high-throughput RNA sequencing. Analysis of these data yielded 861 annotated human lincRNAs passing the detection threshold. RESULTS: Of the 861 detected lincRNA, 135 showed significant region-dependent expression alterations in SZ (two-way ANOVA, BH-adjusted p <0.05) and 37 additionally showed significant differential expression between HC and SZ individuals in at least one region (post hoc Tukey test, p <0.05). For these 37 differentially expressed lincRNAs (DELs), 88% of the differences occurred in a cluster of brain regions containing axon-rich brain regions and cerebellum. Functional annotation of the DEL targets further revealed stark enrichment in neurons and synaptic transmission terms and pathways. CONCLUSION: Our study highlights the utility of a systematic brain transcriptome analysis relying on the expression profiles measured across multiple brain regions and singles out white matter regions as a prospective target for further SZ research.
Copyright (c) 2023 Nguyen T., Efimova O.I., Tokarchuk A.V., Morozova A.Y., Zorkina Y.A., Andreyuk D.S., Kostyuk G.P., Khaitovich P.E. https://creativecommons.org/licenses/by-nc-nd/4.0/
The Experience of the Crisis Clinic at the Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
BACKGROUND: Suicidal behavior by children and adolescents has been and remains one of the most intractable of our social ills. Despite the general downward trend in suicide rates, children and adolescents remain one of the most at-risk groups. Suicidal behavior in all its manifestations is a biopsychosocial problem in which the superiority of one approach or the other cannot be unambiguously justified. It flows from this that strategies that aim to prevent suicide should weave together not just the medical and psychological aspects of the issue, but the social, legal, pedagogical, and other dimensions as well. AIM: To develop an integrated approach that could provide primary, secondary, and tertiary prevention of suicidal behavior in children, provide the routing of patients, and coordinate actions both between the outpatient link and inpatient specialized care and between different departments, primarily between the Moscow Department of Healthcare and the Department of Education. METHODS: We analyzed the dynamics of the number of admissions to the Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva of Moscow Health Department (Sukhareva Center) with suicidal manifestations in 2019–2022. Organization of the Crisis Care Clinic (Crisis Clinic), which specializes in helping children and adolescents aged 11 to 17 who find themselves in a situation of psychological crisis, have suicidal tendencies, display self-injurious behavior, experience grief, violence, or have suffered abuse. RESULTS: A comprehensive multi-disciplinary approach is identified as the most efficient way to treat and prevent suicidal behavior in children and adolescents. Psychopharmacotherapy is used to influence severe depressive symptomatology, reduce anxiety, moderate sedation, correct behavioral disorders, etc. In addition to medication, comprehensive psychotherapeutic assistance is recommended. The leading therapeutic approaches are cognitive-behavioral, including DBT, and family therapy, with the efforts of therapists concentrated on alleviating post-traumatic stress, depression, and behavioral problems, as well as resolving intrafamily conflicts. CONCLUSION: The need to remedy severe crisis conditions and their associated psychopathological repercussions (including suicidal and self-harming behavior) calls for coordinated efforts on the part of specialists from different fields of knowledge related to childhood and adolescence. Our analysis of the experience of working with children and adolescents in the Crisis Clinic at the Sukhareva Center shows that there is high demand for such highly specialized institutions and that the basic principles laid down at its creation, urgency, stage, and continuity of care, poly-professionalism with a focus on non-drug treatment methods, orientation towards the patient’s family are relevant.
Copyright (c) 2022 Eco-Vector https://creativecommons.org/licenses/by/4.0
DC:0–5™ Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Promotion in Russia
The purpose of the report is to inform the community of Russian pediatric mental health professionals about the international DC:0–5™ Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: its purpose, target age, structure and content of diagnostic axes, as well as about the steps already taken domestically to promote the Classification in Russia. We show that the diagnostic Classification is the brainchild of leading foreign experts in the mental health of children and that it is based on an analysis and extrapolation of a large body of clinical data from around the world and covers a wide range of mental disorders experienced by children during their first five years of life. The interdisciplinary focus of DC:0–5™ is emphasized, as well as the presence in it of a crosswalk to the DSM-5 and ICD-10 systems, and the possibility to supplement these classifications taking into account the age specificity of disorders. It was made note that this diagnostic classification is almost unknown among Russian specialists. The report briefly touches on the results of the research activities of the interdisciplinary research group of the Scientific Center for Mental Health (Moscow) carried out in the period between 2002 and 2017 and aimed at analyzing the diagnostic approaches proposed in the Classification and testing them on Russian sample populations. The release of the Russian version of DC:0–5™ in 2022 by the non-profit organization Caritas Social School (St. Petersburg), with the official consent of the DC:0–5™ developer and in cooperation with the Faculty of Psychology of St. Petersburg State University, and an accompanying DC:0–5™ introduction course developed by this team for Russian child mental health professionals were announced.
Recent Developments in Community-Based Mental Health Care in Japan: A Narrative Review
BACKGROUND: Since the 1950s, mental health care in Japan has been hospital-centered. A set of legislative initiatives were undertaken in 1995, emphasizing the importance of community-based mental health care. However, despite these attempts to develop a community-based mental health care system, the rate of inpatient-based treatment has remained high and the shift from hospital-centered care to community-based has still not fully materialized. AIM: This study aims to conduct a review of the available literature on the development of community-based mental health care in Japan between 2010 and 2020. METHODS: We conducted a standardized literature search in the electronic database Igaku Chuo Zasshi, aiming to identify original studies published between 2010 and 2020 that explored community mental health care in Japan. The included studies’ outcomes were categorized as performance surveys, service user reports, service provider reports, and educational activities. A descriptive-analytical method was implemented in the current review. RESULTS: A total of 25 studies were examined. Six studies reported surveys assessing the performance of community-based mental health care on the assertive community treatment (ACT), compulsory treatment, home-visit nursing care, physical complications, and a welfare medicine collaboration on a remote islands. Four studies investigated the perspectives of service users or their families on home-visit nursing care, social participation, community program, and legislative revision. Ten studies focused on social withdrawal, service providers perspectives on local population needs, supporting skills, care programs, and the professional growth of psychiatric social workers. Five studies focused on educational approaches for future healthcare professionals and efforts to improve mental health literacy among adolescents. CONCLUSION: This paper provided the first comprehensive review of Japan’s community-based mental health care. Between 2010 and 2020, community mental health care in Japan evolved in many directions, with the understanding that various needs should be met. Home-visit nursing care and ACT can be considered as the most thoroughly investigated and better developed. Research that adopt rigorous methodologies such as randomized controlled trials is required if the goal is to achieve solid conclusions.
Community Mental Health Care in Aotearoa New Zealand: Past, Present, and the Road Ahead
The healthcare system in Aotearoa New Zealand is currently undergoing a far-reaching overhaul. When it comes to mental health reforms, it is helpful to look at the road ahead, while paying attention to the road behind. Policies and services concerning the mental health and addiction sectors have undergone various reforms; first, during the transition from a hospital-centered to the current community-based system, and second, in the successive attempts to improve this system. In this article, we provide an overview of the current mental health and addiction health care system. We also discuss the impact of colonization on community mental health, the emergence of community-based mental health and addiction policy and services in Aotearoa New Zealand, and the challenges along the way. Finally, we identify five key areas requiring special attention during the current period of reform. Over all, we believe there is broad support for reducing the emphasis on individualized approaches to mental wellbeing and moving all systems and structures towards models inclusive of social context, including approaches that incorporate service users’ perspectives, family, communities, and culture. We look forward to policy and services with a much stronger orientation to the diverse needs of our population.
Predictors of Self-Harm Types in Members of Online Communities: Age As a Moderating Variable
BACKGROUND: Deliberate self-harm includes direct and indirect behaviors that cause harm to the body. Various manifestations of such behavior (e.g., non-suicidal self-injuries) are prevalent in adolescent and youth populations, and they often serve as precursors of subsequent suicidal behavior. The interpersonal dynamics that lead to self-harm behavior remain understudied. Interpersonal sensitivity, defined as an anticipation of criticism and fear of rejection in one’s relationships with other people, may become one such factor. AIM: The present study was conducted to investigate the relationship between interpersonal sensitivity, psychopathological symptoms, and types of self-harm. METHODS: The sample (n=804, 17–35 years, M=23.3±4.6 years) was recruited in online communities. A survey developed by the authors was used to measure the types of self-harm. Other measures included the Interpersonal Sensitivity Measure and Symptom Checklist-90-R. RESULTS: It was discovered that superficial self-injuries could be related to more severe types of self-harm, destructive for the body on the whole (e.g., risk-taking, deprivation, fasting, substance abuse). Fear of rejection and psychopathological symptoms emerged as predictors of both superficial self-injuries and self-destructive behavior. Although younger respondents (17–19 years old) were more likely to inflict on themselves superficial self-injuries, those who scored high on fear of rejection were more likely to report more severe self-destructive behavior. Acute psychological distress elevated this risk for both younger and older participants (27–35 years old). CONCLUSIONS: The results of the study point at the important role the dynamics of interpersonal relationships plays in perpetuating self-harm.
The Prevalence of Autism Spectrum Disorders in the Russian Federation: A Retrospective Study
BACKGROUND: There has been an increase in the prevalence of autism spectrum disorders (ASD) worldwide over the past decades. Studies have shown that the number of confirmed diagnoses correlates with the awareness of the disorder among the general public and the professional community, in particular, as well as the availability of formalized screening procedures and modern medical and educational tools for families raising children with ASD in regional population centers. Thus, comparing autism prevalence rates in regions of the same country helps identify regions with limited access to diagnostic services and adequate medical care. AIM: To estimate the overall number of individuals meeting the diagnostic criteria for ASD in Russia and determine the differences in the number of registered individuals with established diagnosis in the constituent territories of the Russian Federation. METHODS: We conducted a retrospective, observational study and analyzed data from official statistical reports (form 12 “Information on the Number of Diseases Registered in Patients Residing in the Service Area of a Healthcare Institution” for 2020–2021). RESULTS: A steady upward trend in the number of individuals with autism has been observed since 2014 in the Russian Federation as a whole and in the federal districts, although the prevalence rates differ from the global median prevalence of ASD (all-Russian figure by almost 40 times). In addition, regional differences (by 104.5 times) in the frequency of the diagnosis have been revealed: from a minimum of 1.7 to a maximum of 177.7 per 100,000 population. The percentile distribution of the number of individuals with ASD that are followed-up at healthcare facilities in the constituent territories of the Russian Federation was in the interquartile range (25–75th percentile), below the 25th percentile, and above the 75th percentile in 38, 26 and 21 regions, respectively. CONCLUSION: The study has shown significant differences in the ASD diagnosis rates by regions in the country against a backdrop of a low (compared to international data) number of registered cases of autism. The presented data suggest that, due to the lack of proper diagnosis, a significant number of individuals with ASD do not receive adequate medical care, nor do they receive social, psychological, or pedagogical support. Possible reasons for this probably include low awareness of new diagnostic approaches among psychiatrists; low level of involvement of pediatrics professionals in screening activities; and fear of stigmatization because of a psychiatric diagnosis in the absence of a developed medical care infrastructure that encompasses a social, psychological, and pedagogical support system for people with ASD.
Epidemiological Study on the Early Detection of Mental Disorders in Young Children in Russia
BACKGROUND: Assessing the risk of children developing mental, behavioral, and developmental disorders (MBDDs), including autism spectrum disorders (ASDs), as well as achieving early detection of such disorders, has become one of the most important undertakings for public mental health professionals worldwide. AIM: This study aims to evaluate the risk of developing MBDDs and the prevalence of MBDDs among young children (18–48 months old) in Russia. METHODS: A two-level epidemiological screening approach was developed and adopted for the purposes of this study. At the first level, the parents of all children between 18 and 48 months old were questioned using Russian national validated Screening Checklist for Parents for Identification of the Risk of Mental, Behavioral, and Developmental Disorders in Early Childhood in nine regions of Russia (Volgograd, Kirov, Moscow, Novosibirsk, Orenburg, Tver, Chelyabinsk, Yaroslavl, and Stavropol). At the second level, children identified at the first level of screening as being at risk of developing MBDDs were assessed by a child psychiatrist on a voluntary basis and diagnosed according to the International Classification of Diseases, Tenth Revision criteria. RESULTS: The present study revealed that the risk of developing MBDDs stands at 13.07% or 1,307 cases per 10,000 child population aged 18–48 months, whereas the prevalence of confirmed MBDDs is 1.51% or 151 cases per 10,000 among a Russian child population aged 18–48 months. CONCLUSION: Screening for the risk of developing MBDDs, including ASDs, in Russia among very young children is a promising area of preventive medicine. This initiative allows us to develop optimal algorithms for specialized care measures that could help prevent the development and aggravation of children mental health issues.
The Effect of Untreated Illness in Youth Depression: A Cross-Sectional Study
BACKGROUND: The existing research has mainly focused on exploring how the duration of untreated psychosis eff ects the further course of the disease. By contrast, the duration of an untreated illness (DUI) in youth depression and its impact on the further course of the disease has remained scarcely investigated. AIM: The current study aims to determine how the duration of untreated illness aff ects the severity of the symptoms during the fi rst depressive episode and the degree to which the symptoms are reduced after treatment. METHODS: Fifty-two young male patients (15–29 years old) were examined. First, they were hospitalized with a severe without psychotic symptoms (F32.2) and moderate (F32.1) depressive episode. The Hamilton Depression Rating Scale (HDRS), the Scale of Prodromal Symptoms (SOPS), and the Scale for Assessment of Negative Symptoms (SANS) were used to achieve the research goals. The examination was conducted twice at the time of patient admission to the hospital and before discharge. Our statistical analysis was carried out with the Statistica 12 software. The Mann–Whitney U test was used to compare the diff erences between two independent groups. The Spearman’s rank correlation coeffi cient was used to uncover any correlation between how long the illness has remained untreated and the severity of its clinical symptoms. RESULTS: All patients were hospitalized at the fi rst depressive episode. The average duration of an untreated illness was 35.8±17.0 months. The patients were divided into two groups: the fi rst group (59.6%, n=31), with a duration of the untreated illness of more than 36 months, and the second group (40.4%, n=21), with a duration of the untreated illness of less than 36 months. A cross-group comparison between the participants showed that the reduction of HDRS scores was signifi cantly higher in the second group (p=0.019) at the time of discharge, with no diff erences in the severity of depressive symptoms (p=0.544) at the time of admission. Comorbidity was detected in 83.9% of the patients in the fi rst group and in 42.9% of the patients in the second group. A greater therapy eff ectiveness was found to exist in the second group, as the depressive symptoms score on the HDRS scale (p=0.016; U=196.0) and prodromal symptoms score on the SOPS disorganization subscale (p=0.046; U=218.0) were found to have been reduced signifi cantly. CONCLUSION: The study showed that DUI has an impact on the reduction of depressive, negative symptoms and symptoms of disorganization in youth patients at the fi rst depressive episode. A high level of comorbidity has been uncovered, confi rming that a variety of non-psychotic and psychotic disorders in youth manifest themselves in depression at a prodromal stage, causing diffi culties in establishing diagnoses and requiring subsequent verifi cation. Future research might need to focus on exploring depressive symptoms as predictors of mental disorders in youth patients.
Comment on “Violence Against Psychiatric Trainees: Findings of a European Survey”
In Memory of Professor Petr Viktorovitch Morozov
In this obituary paper, we want to commemorate our dear colleague Professor Petr V. Morozov, who passed away on 17th July 2022. The death of professor Morozov is a great loss for the professional community. He was a world famous expert in psychiatry and held numerous top positions in professional associations: Secretary General of the World Psychiatric Association (WPA), vice-President of the Russian Society of Psychiatrists, an ECNP ambassador in Russia, an expert of the Council of Europe, a member of the Council of the European Psychiatric Association, a curator of the WPA-Servier Academy for young scientists, to name but a few recent positions.
Copyright (c) 2022 Board E. https://creativecommons.org/licenses/by/4.0
Development of Community Mental Health Infrastructure in Thailand: From the Past to the COVID-19 Pandemic
Thailand is an upper middle-income country located in the center of mainland Southeast Asia with a population of 66.17 million as of 2021. The aim of this review article is to illustrate the development of community mental health in our country. We have divided the article into five main sections: namely, the mental health service infrastructure, the community mental health system, human resources, mental health financing, public education, and links to other sectors. Mental health care has been integrated into primary care since 1982, resulting in a major shift in focus on mental health at the community level; however, mental health problems and the mental health gap in service accessibility remain present, especially during the current COVID-19 pandemic. Community mental health care has been extended to networks outside the health care system, including the community authorities. It has been provided with psychiatric care and rehabilitation, together with the promotion of mental health and prevention of mental disorders for improving accessibility to services, especially during a pandemic situation. Finally, future challenges to face community mental health have been outlined, such as insufficient staff to develop rehabilitation service facilities for people with chronic, serious mental illnesses; identifying supporting funding from other stakeholders; and mental health care for persons with long COVID living in the community.
Copyright (c) 2022 Wannasewok K., Suraaroonsamrit B., Jeungsiragulwit D., Udomratn P. https://creativecommons.org/licenses/by/4.0
Anorexia Nervosa as a Cause of Drug-Induced Thyrotoxicosis
The authors propose a case report analysis with a step-by-step exclusion of possible non-psychiatric medical causes of thyrotoxicosis in a young girl. The prolonged differential diagnosis eventually led to the diagnosis of drug-induced thyrotoxicosis due to anorexia nervosa in the patient. The analysis of the presented case report once again demonstrates the importance of a carefully curated medical history, including the psychiatric history, as well as a holistic and comprehensive analysis of all the clinical manifestations. We analyzed this case report of a patient with thyrotoxicosis due to anorexia nervosa in order to test the algorithm of differential diagnosis. All patient information was anonymized, and the patient gave informed consent to the submission of the case report for publication.
Copyright (c) 2022 Neudahina V.O., Soloveva K.P., Khanova A.N., Gubzhokovа D.M., Krivosheeva N.V., Stashevskaya V.N. https://creativecommons.org/licenses/by/4.0
Alcohol Addiction in War Veterans Treated in a In-patient Psychiatric Facility: Incidence, Comorbidity with PTSD Symptoms, Association with Combat Stressors
BACKGROUND: The dearth of and inconsistency in the data on the prevalence, risks of occurrence, comorbidity, and causation of stress-related disorders and alcohol use disorders in Russian veterans of local wars constituted the background for this study. AIM: To study the psychopathological structure, clinical changes, and the reasons for the mental disorders suffered by Russian veterans of local wars; in particular, to study the prevalence, pathogenic factors, comorbidity of alcohol addiction and alcohol abuse, together with symptoms of stress disorders, in Russian veterans undergoing inpatient treatment. METHODS: Our observational case-control study included 685 patients who were undergoing treatment in the psychiatric department of a military hospital: the Main group (veterans) consisted of 264 veterans of armed conflicts who had undergone inpatient treatment from 1992 to 2010; the Control group, 1, 296 patients, all servicemen and military pensioners who had undergone inpatient treatment during a calendar year and had never taken part in combat operations in the past; Control group 2, 125 military personnel (regular and reserve) who had not taken part in combat operations and corresponded to the patients of the main group in terms of the mean age and age distribution curve. We performed a clinical and psychopathological analysis of the symptoms identified in patients from the compared samples and, then, compared them with the ICD-10 criteria of post-traumatic stress disorder (PTSD) and alcohol-related disorders. This allowed us to establish the significance of the difference in their frequency and degree of association at the stage of the data analysis. RESULTS: We uncovered no difference in the prevalence of symptoms of alcohol addiction and alcohol abuse among veterans and other servicemen and military pensioners who had not taken part in combat operations. However, there was a tendency to underdiagnose alcohol addiction in veterans in general and those with symptoms of PTSD, in particular. That is, alcohol addiction was not diagnosed in most cases when the veterans displayed symptoms of stress or other mental disorders, in addition to the signs of alcohol addiction. In most such cases, a stress-related mental disorder or another mental disorder with identified signs was diagnosed and alcohol abuse was described as a concomitant disorder or a complication. There was no significant association between any form of alcohol addiction or abuse and the presence of stress disorder symptoms in our sample of veterans; on the contrary, symptoms of re-experience of trauma were more often observed in veterans who were not prone to frequent drinking. The incidence of combat stressors traced in the medical history did not differ in veterans with any form of alcohol abuse and veterans who were not prone to frequent drinking. However, the main group subjects with alcohol addiction more often displayed cases of addictive behavior during combat operations. Therefore, alcohol abuse during combat operations requires additional research to better establish its prognostic significance. CONCLUSION: This Study found no difference in the incidence of alcohol dependence and alcohol abuse among veterans and other officers. In the sample of veterans, there was no significant association between alcoholism and the presence of PTSD symptoms or a history of combat stressors. It is possible that the same risk of alcohol addiction in different categories of military officers is due to a compact of social stressors that equally had a more significant adverse effect on the entire population of Russian military personnel in the 90s of the last century and the first years of this century, as well as the massive abuse of alcohol, which could also equalize the risks of developing alcohol dependence in all groups of militaries.
Copyright (c) 2022 Reznik A.M., Syunyakov T.S., Arbuzov A.L. https://creativecommons.org/licenses/by/4.0
Clinical Effectiveness of Lurasidone Monotherapy in Patients with Acute Episodes of Schizophrenia and Associated Symptoms of Depression
AIM: We endeavored to evaluate the efficacy of Lurasidone at doses of 40–160 mg per day on symptoms of schizophrenia associated with symptoms of depression in real clinical practice in a Russian patient population. METHODS: One hundred sixty eight patients aged 18–65 years old, who at the time of the start of the observation were being treated in a hospital or day hospital due to an exacerbation of paranoid schizophrenia accompanied by symptoms of depression, were prescribed lurasidone. Treatment with lurasidone and other concomitant drugs, their prescription, withdrawal, selection, and dose modifications were determined based on the indications for the use of those drugs and the recommended doses in the instructions, clinical need, and patient interests, rather than by the goals of the study. During the observation period, the severity of depressive symptoms according to the Calgary Depression Scale (CDSS) and that of psychotic symptoms according to the Positive and Negative Syndrome Scale (PANSS) were assessed six times (before the start of treatment and then on the 4th, 7th, 14th, 28th, and 42nd days). RESULTS: A statistically significant reduction in the severity of the symptoms was observed with the use of lurasidone in doses ranging from 40 mg to 160 mg per day. The fastest and most significant (p <0.001) reductions in the total PANSS and CDSS scores were observed with lurasidone 120 mg. A somewhat lower efficacy of lurasidone was observed at a dose of 160 mg. The largest reductions in the total PANSS and CDSS scores with lurasidone 120 mg were associated with the highest survival rate and the longest median time from treatment initiation to discontinuation or follow-up. The most commonly reported side effects with lurasidone in this study (nausea, akathisia, tremor and drowsiness) were consistent with the known safety profile of the drug. Adverse events in most cases were assessed as mild, or occasionally moderate. CONCLUSION: A six-week prospective observational study of the real-world clinical effectiveness of lurasidone in doses ranging from 40 mg to 160 mg per day established statistically and clinically significant improvements in both psychotic and depressive symptoms in patients with acute exacerbation of schizophrenia and associated symptoms of depression.
Copyright (c) 2022 Reznik A.M., Syunyakov T.S., Akhmerova I.Y., Butylin D.Y., Vasilenko A.O., Gvozdetckii A.N., Gizatullin T.R., Gilmanshina G.V., Golosov E.A., Kolchev S. ., Linova L.P., Miron D.V., Mudrak A.V., Oleichik I.V., Sizov S.V., Tarakanova E.A., Chesnokova O.I. https://creativecommons.org/licenses/by/4.0
Association of Anxiety and Depression with Objective and Subjective Cognitive Decline in Outpatient Healthcare Consumers with COVID-19: А Cross-Sectional Study
BACKGROUND: In addition to the neurological complications affecting people infected with COVID-19, cognitive impairment symptoms and symptoms of anxiety and depression remain a frequent cause of complaints. The specificity of cognitive impairment in patients with COVID-19 is still poorly understood. AIM: An exploratory study of factors that may be associated with cognitive decline during the COVID-19 pandemic. METHODS: The cross-sectional multicentre observational study was conducted in a polyclinic unit in Saint Petersburg and in the regions of the North-Western Federal Region. During the study, socio-demographic parameters and information about the somatic condition of patients who applied for primary health care was collected. Emotional and cognitive state were investigated using the Hospital Anxiety and Depression Scale (HADS) and Montreal Cognitive Assessment (MoCA). Mathematical and statistical data processing was carried out using SPSS and RStudio statistical programs. RESULTS: The study included 515 participants, 60% (n=310) of which were women. The sample was divided into those who did (28.5%, n=147) and did not (71.4%, n=368) complain of cognitive decline. Patients with complaints of cognitive decline were significantly older, had lower levels of education and higher levels of depression and anxiety according to HADS (p <0.05). Patients with complaints of cognitive decline underwent the MoCA test (24.3%, n=125). The median MoCA test scores were within the normal range (Median=27, Q1=25, Q3=28), and cognitive decline (MoCA less than 26 points) was detected in 40% (n=50) of patients with complaints of cognitive decline. No significant correlations were found between the MoCA scores and the levels of anxiety and depression according to the HADS (p >0.05). Patients with mild severity of the COVID-19 course were more successful with MoCA subtests than patients with moderate and severe courses. CONCLUSION: We found no linear association between objective cognitive deficit and the affective state of respondents. Patients’ subjective complaints about cognitive dysfunction were mostly caused by their emotional state than an objective decrease of their cognitive functions. Therefore, in case of subjective complaints on cognitive decline, it is necessary to assess not only the cognitive but also the affective state of the patient. The severity of the COVID-19 course affects the functions of the cognitive sphere, including attention, regulatory functions and speech fluency. Mild and moderate severity of the COVID-19 correlates with clinically determined depression. The absence of this relationship with the severe course of the disease is probably explained by the significant somatic decompensation of patients.
Copyright (c) 2022 Gomzyakova N.A., Palchikova E.I., Tumova M.A., Kasyanov E.D., Sorokin M.Y. https://creativecommons.org/licenses/by/4.0
Professional values and educational needs in mental health professionals: survey results
BACKGROUND: Exploring the professional values and educational needs of future and practicing mental health specialists is required to develop effective measures aiming at improving their skills and interest in their work. AIM: Our aim was to explore professional values and educational needs of mental health specialists in Russia. METHODS: We conducted a survey that captured socio-demographic data, professional characteristics, professional values, and educational needs. Fisher's exact test, logistic regression, and the k-means cluster analysis were used in our statistical analysis. RESULTS: The survey included 133 participants, 71% of whom had completed their postgraduate education. The following items were mentioned as important professional values by the respondents: “Job opportunities”, “Stimulation of intellectual activity”, and “Work-life balance”. The most popular options for educational activities were English language (63.4%), the principles of evidence-based medicine (63.4%), and developing skills for conducting scientific research (59.4%). In comparison with practicing specialists, respondents who had not yet completed their postgraduate education were more interested in developing their curriculum vitae (39% vs. 60%, p=0.044) and communication skills (49% vs. 77%, p=0.0048). Compared to male respondents, female respondents were more interested in developing skills in conducting scientific research (47 vs. 70%, p=0.0165). A cluster analysis showed that specialists who attached more importance to almost all professional values, in comparison to those who did not, were more interested in activities aimed at developing their research skills (64% vs. 41%, p=0.0287), learning about the principles of evidence-based medicine (70% vs. 41%, p=0.0063), and participating in journal clubs (39% vs. 11%, p=0.0193). CONCLUSION: The present study suggests that job opportunities, intellectual stimulation, and work-life balance are the most important professional values for future and practicing mental health specialists. These findings might be used as a basis for developing educational activities for mental health specialists.
Copyright (c) 2022 Kibitov A.A., Chumakov E.M., Nechaeva A.I., Sorokin M.Y., Petrova N.N., Vetrova M.V. https://creativecommons.org/licenses/by/4.0
Schizophrenia: a narrative review of etiological and diagnostic issues
BACKGROUND: Despite the fact that schizophrenia has already been described historically and researched for a long time, this disorder remains unclear and controversial in many respects, including its etiology, pathogenesis, classification, diagnosis, and therapy. METHODS: Literature from the selected sources (elibrary.ru, Russian Science Citation Index and the Russian branch of the Cochrane Library) were searched and analyzed using the diachronic method. Priority was given to reviews, guidelines, and original research on schizophrenia written during the past 10 years. RESULTS: Historically, scientists have described schizophrenia as a single disorder, a group of disorders, or even as a combination of certain syndromes. The polymorphic symptoms and the most typical dynamics of various forms of schizophrenia have been systematized, but neither in Russia nor in other countries have the etiology and pathogenesis been proven. The reasons for the under- and overdiagnosis of schizophrenia cannot cover all possible objective and subjective difficulties arising in the diagnostic process. CONCLUSION: The existing literature shows that the problem of schizophrenia may not be regarded as settled for a long time. This largely depends on the position of society, the development of biological sciences, and the pathomorphosis of the disorder itself. Many aspects of schizophrenia can become clearer and less controversial with systematic studies based on previous data, as well as data obtained using new research methods.
Copyright (c) 2022 Oskolkova S.N. https://creativecommons.org/licenses/by/4.0
Revisiting Social Stigma in Non-suicidal Self-injury: A Narrative Review
Non-suicidal self-injury (NSSI) is highly prevalent in our community. Yet, there is a significant discrepancy between the number of individuals engaging in NSSI and those who seek treatment for NSSI. This discrepancy can be due to the high social stigma associated with the behavior. The impact of NSSI stigma is significant and can impair the quality of life in the individuals engaging in NSSI, delay help-seeking, reduce access to mental health care and further fuel misinformation. Even though the symptomatology, risks, and demographics of NSSI have received attention in terms of research, there is limited literature on NSSI stigma and its consequences. With that background set, this review provides a bird’s-eye view of the different levels of stigma in NSSI (public, self, and health care), associated discrimination, the various aspects of such stigmatization (NSSI-related language, physical scarring, misinformation, the media), and, finally, the collaborative clinical-outreach interventions for mitigating NSSI-associated social stigma. If NSSI is indeed recognized as a clinical disorder, future research would need to focus on these constructs of stigma and treat them with the same importance as the one given to clinical studies of intervention and symptomatology in NSSI.
Copyright (c) 2022 Banerjee D., Meheli S. https://creativecommons.org/licenses/by/4.0
Formation of a New Paradigm of Social Interaction: On Touching and on not Touching
The COVID-19 pandemic greatly accelerated the use of online technologies for communication, as opposed to contact involving physical presence and touch. This commentary further considers the consequences of this change in individual human terms, in everyday as well as medical situations. It is a kind of discussion paper, specially written for this journal. It develops two directions of argument, the first about the reality of embodiment, the second about figures of speech involving touch and movement, figures of speech about the actions of whole people rather than about mind (spirit) or body separately. The discussion reviews the nature of differences between communication involving physical proximity and physical distance (and electronic media), with comments on the positive and negative aspects of each. An emphasis on the significance of touch (and movement, since all touch involves movement) to people is linked to the basic aspects of the lifecycle in birth, reproduction, and death. In conclusion, the discussion emphasizes the traditional importance of touch and physical participation to people’s feeling for reality. New digital forms of relations disturb this feel, with significant consequences.
Copyright (c) 2022 Smith R. https://creativecommons.org/licenses/by/4.0
Community-Based Psychiatric Treatment in Romania: Past, Present, Future
Community psychiatry has its origins in the West, in the 1950s, when many institutions for the mentally ill were closed down in an effort to shift the focus from hospital-based care to community-based. The aim of the current paper is to review the available literature on the community-based psychiatric treatment in Romania. The Romanian Ministry of Health is dedicated to promoting mental health education and to creating a mental health system that ensures that every patient has access to care and treatments designed for their own particular needs. Today, in Romania, as across the entirety of Central and Eastern Europe, mental health systems are transitioning from hospital-based care to community-based services. The RECOVER-E project, the SEE Mental Health Project, the “Horizons” project, among others, showcase Romania’s mental healthcare system in terms of improving the chances of mental health patients’ recovery. Community Psychiatry in Romania is a budding field that can greatly aid in the management and treatment of patients with mental disorders from both urban and rural areas. By applying the principles of deinstitutionalization and community health care at a systemic level, resources may be invested in the creation of a strong network of specialists that treat patients in their own living spaces.
Copyright (c) 2022 Ciobanu A.M., Ciobanu A.C., Catrinescu L.M., Niculae C.P., Geza L., Ioniță I. https://creativecommons.org/licenses/by/4.0
Community Mental Health Services in Egypt
As far back as the 14th Century, Egypt had already developed mental health care in a community-based sense in Kalaoon Hospital in Cairo, 600 years before similar institutions were founded across the globe. By 2001, an Egyptian-Finnish bilateral comprehensive reform program was incorporated. A few years later, in 2007, the Minister of Health and Population initiated a proper appraisal of the mental health services in Egypt, which was aimed at achieving better integration and coordination in the mental health sector, as well as supervision and training on the national, governmental, and primary care levels. By 2009, the Mental Health Act of 2009 (Law 71) brought basic conceptual changes to the care of people with a mental illness in Egyptian institutions, replacing the outdated 1944 law that had been used in Egypt for decades. However, despite all of the important steps Egypt is taking to move toward more integrated mental health services, more effort and resources are still needed to fight against stigma and to develop a comprehensive multidisciplinary approach that is approachable and effective to all those who need it.
Copyright (c) 2022 Okasha T.A., Shaker N.M., Elgabry D.M. https://creativecommons.org/licenses/by/4.0
Organization of Psychological and Psychiatric Assistance to Refugees in a Prolonged Emergency
The article describes the experience of organizing psychological and psychiatric assistance to refugees in temporary accommodation centers (TACs). From 1999 to 2004, about 200,000 people, fleeing military operations during the counter-terrorist operation in the Chechen Republic, moved to neighboring Ingushetia, where they were placed in TACs. Analysis of the work with refugees shows that during a long stay in the TAC, refugees develop psychopathological and psychological issues including stress disorders, irritability, aggressiveness, disorders of adaptive functions, depression, anxiety, decreased initiative, "victim" complex, and damaged interpersonal relationships that significantly reduce their adaptive capabilities. Organizing comprehensive medical, social, psychological, and psychiatric care based on existing disorders can significantly improve the psycho-emotional state of refugees in a short time and prevent the aggravation and chronicity of these disorders.
Copyright (c) 2022 Idrisov K.A. https://creativecommons.org/licenses/by/4.0
Connection of Suicidal Behavior with COVID-19: Clinical Cases
The spread of the coronavirus infection has led to significant changes in people’s lives. Prolonged isolation, fear of infection, frustration, changing the usual stereotype life style, lack of information, loss of revenues, and fear of stigmatization, as well as the disease itself have all influenced people’s emotional and physical well-being. The impact of the viral infection itself on the human body, as well as the perception of a new reality, in some cases led to the formation of reactive, organic, or the exacerbation of existing chronic mental disorders. People with mental health problems are most susceptible to environmental influences and react acutely to rapidly changing circumstances. Often in critical situations, in a state of despair, patients see only one way to solve all problems — voluntary retirement committing taking own life. In this article, we present clinical cases that are descriptive in nature and are intended to illustrate the connection between depressive experiences and suicidal behavior amongst patients in a crisis situation when external circumstances were the reason for suicide attempts: loneliness as a result of restrictive measures, fear of infection or the disease itself, and the reason was a mental disorder that debuted earlier or re–emerged as a result of a viral infection. We have presented three clinical cases. All patients suffered from a new coronavirus infection of various severities and were treated in a psychiatric hospital, where they were transferred from an infectious diseases hospital or hospitalized directly in connection with suicidal actions. In each case, attention was paid to the organizational measures carried out, with an emphasis on the need for earlier screening of mental disorders, prevention of suicidal behavior in providing assistance to this contingent, and the development of the interaction between general medical and psychiatric services by the type of integrative care. The study is of interest to a wide range of specialists providing care to patients with COVID-19 or similar pathologies.
Copyright (c) 2022 Prokopovich G.A. https://creativecommons.org/licenses/by/4.0
Experiences of Kyrgyzstani Frontline Healthcare Workers during the “Black July” of 2020: a Qualitative Study
BACKGROUND: The peak of the pandemic in Kyrgyzstan occurred in July 2020 with highest infection rates, almost 1000 cases daily, compared to 100 cases prior to this date. The state health system was fatally unprepared to accommodate patients, mobilize medical staff, or provide clear instructions to the population. This study explores personal narratives of healthcare practitioners who were affected by and survived COVID-19 during the “Black July” of 2020 in Bishkek, Kyrgyzstan. METHOD: Healthcare workers (n=10) were interviewed using a semi-structured interview protocol. Interviews were transcribed then analyzed in accordance with interpretative phenomenological study guidelines. RESULTS: The narratives demonstrated both post-traumatic depreciation and post-traumatic growth, resulting in changes of attitudes, lifestyle, and identity. An important aspect of identity shift included an emerging desire for increased self-care, which was characterized by resistance against a heroic Hippocratic ideal to “to save everybody”. CONCLUSION: COVID-19 is perceived as a psycho-socio-cultural phenomenon, which has transformed the identities of healthcare workers in the Kyrgyz Republic. Further research is recommended into developing rehabilitation programs for healthcare workers.
Copyright (c) 2022 Molchanova E.S., Kharsun V.S., Kenzhebaeva Z.S., Alikanova A.S. https://creativecommons.org/licenses/by/4.0
Psychological Wellbeing and Psychological Distress in the Elderly during the COVID-19 Pandemic
BACKGROUND: The elderly population is deemed to be the most vulnerable to the effects of the COVID-19 pandemic. From March 2020 to April 2022, the implementation of psychological distancing is still being applied in Indonesia. In the light of the pandemic, mental health problems among the elderly require further exploration. This study examines the mental health status of the elderly during the COVID-19 pandemic in Indonesia and the factors that affect their mental health, such as loneliness and attachment to God. METHODS: A sequential explanatory type of the mixed-method approach was adopted for the purposes of this study. In particular, the researchers first conducted a quantitative survey, analyzed its results, and then explained them in more detail using qualitative research. RESULTS: The results show that loneliness is a predictor of mental health in the elderly, while attachment to God does not correlate with mental health. More specifically, we described that minimal activity, inability to meet children and grandchildren, and inability to recite the Qur’an were the main factors triggering sadness among the elderly during the COVID-19 pandemic. Furthermore, we defined that elderly people use productive and religious activities, and communication as main coping strategies. CONCLUSION: Loneliness has been a serious problem for the elderly during the COVID-19 pandemic, impacting their mental health. The findings of this research can be used as a basis or reference for maintaining the mental health of the elderly during the pandemic.
Copyright (c) 2022 Herdian H., Suwarti S., Estria S.R. https://creativecommons.org/licenses/by/4.0
Perceptions of the COVID-19 Pandemic and Psychological Distress amongst Russian Citizens during Spring 2020
BACKGROUND: The COVID-19 pandemic has affected the emotional state of a wide range of people around the world. Studying the social and psychological factors of psychological distress is required in the context of the pandemic in different countries. This study aims to explore the relationship between the emotional state of Russian citizens during the COVID-19 pandemic and their perceptions of it, and its dependence on various socio-demographic characteristics. METHODS: A socio-demographic questionnaire, the Russian version of the Perceived Stress Scale, the State Scale from Spilberger State-Trait Anxiety Inventory, and the modified version of the Brief Illness Perception Questionnaire were used for the purposes of this study. The data was analyzed via descriptive statistics, ANOVA, Exploratory Factor Analysis, Correlation Analysis, Scale Consistency Analysis, and Structural Equation Modeling (Path Analysis Method). RESULTS: The study sample consisted of 1192 Russian-speaking respondents. The findings suggest that psychological distress affects all components of the ideas about the pandemic. The "Psychological distress" variable positively influences the "Threat to life" and "Fear of an unknown disease" components of the ideas about the pandemic, whereas the "Control" component (ideas about the ability to control events) is ambivalent. On the one hand, the severity of psychological distress reduces the idea of being able to control events; on the other, the psychological distress experienced increases the feeling of threat and uncertainty, and stimulates the control of these feelings to be realized. In addition, significant differences were revealed in the nature of perceptions of the pandemic and psychological distress, as dependent on gender, age, type of employment, daily routine during self-isolation, income, as well as a fear of possible stigmatization with regard to COVID-19. It has been shown that underestimating the disease leads to improvement of psychological well-being. However, respondents who underestimated the danger of coronavirus paid less attention to the measures taken against the virus. If the respondent had relatives infected with COVID-19, they were found to perceive the COVID-19 pandemic as more threatening and less understandable. CONCLUSIONS: Through assessing a level of threat and fear of an unknown disease, we defined that psychological distress has a direct and mediated influence on the feeling of control over the pandemic. However, the results on the role of psychological distress and perceptions of the COVID-19 pandemic, taken together, appear rather contradictory. Further research exploring additional predictors of psychological well-being and distress during the COVID-19 pandemic is required to provide solid conclusions.
Copyright (c) 2022 Pervichko E.I., Mitina O.V., Stepanova O.B., Konyukhovskaya Y.E., Shishkova I.M., Dorokhov E.A. https://creativecommons.org/licenses/by/4.0
Monitoring of Intentional Self-Harm as a Tool to Detect Mental Disorders and Improve Access to Psychiatric Care
BACKGROUND: This article discusses the early diagnosis of mental disorders in connection with non-fatal intentional self-harm and suicide prevention. AIM: To substantiate the efficacy of an intentional self-harm monitoring system as a tool for detecting mental disorders and improving access to psychiatric care for people who have attempted suicide. METHODS: A cohort study was performed using materials obtained after the introduction of an intentional self-harm monitoring system and its implementation in the Stavropol Territory. We studied 2738 cases of intentional self-harm reported between 2016 and 2021. Study data were grouped using dual criteria based on a history of psychiatric follow-up, a history of psychiatric counseling, first/recurrent intentional self-harm, psychiatric examination after intentional self-harm, and a diagnosis of a mental disorder on psychiatric examination. RESULTS: The official suicide attempt registration system was found to identify less than 15% of attempts. The primary incidence of mental disorders in suicide attempters was 61.4 times higher than the primary incidence of mental disorders in the general population of the Stavropol Territory. A supposedly healthy suicide attempter was 169 times more likely to be diagnosed with a mental disorder than a member of the general population. Primary diagnoses of mental disorders were 14.8 times more common in multiple suicide attempters without a diagnosis of a mental disorder at the time of the last attempt than in first-time attempters. Access to psychiatric care increases the mental disorder diagnosis rate in general and in suicide attempters in particular. CONCLUSION: Monitoring of intentional self-harm is instrumental in the early diagnosis of mental disorders, suicide prevention, and improving access to psychiatric care for suicide attempters, also having an enormous research potential.
Copyright (c) 2022 Boev O.I., Bychkova O.G. https://creativecommons.org/licenses/by/4.0
Psychosocial and Psychiatric Factors Associated with Expected Fatality during Suicide Attempt in Men and Women
BACKGROUND: Differential factors that influence intention and subjectively perceived fatality during non-fatal suicidal acts amongst men and women have rarely been explored in the extant literature. Exploring these factors may help to understand how they influence medical outcomes and may also be used in a post-crisis counselling. This study aims to assess factors influencing intent in relation to expected fatality during suicidal acts in men and women. METHOD: In the current study, 433 individuals who attempted suicide (age 24.89±0.98 years, male/female ratio=1.29) were surveyed using the WHO-5 Well-Being Index, Beck Depression Inventory, Beck Suicide Intent Scale, Plutchik Feelings and Acts of Violence Scale, and Spielberger State/Trait Anger Scale. Life stress was evaluated as an accumulation of negative life events, whilst psychiatric disorders were assessed using CIDI 2.1 inventory. RESULTS: It was found that the higher expected fatality was associated with higher suicide intention scores, whereas the medical severity of attempts and violent/non-violent attempts distribution did not differ between groups. Although there was no difference in suicide intent scores and medical severity between men and women, men demonstrated a 2.4–3.5 times higher proportion of violent attempts, depending on the group. Higher perceived fatality was associated with lower general well-being, higher depression and violence, hopelessness, and total life stress in men, whereas among women higher perceived fatality was only associated with total life stress. Moreover, in men and women, higher intent and expected fatality was associated with a differential set of negative life events that occurred during childhood. The prevalence of mental health disturbances in the entire sample was about 50% and equally distributed among men and women. However, addictions prevailed among men, while neurotic and stress-related disorders were more common among women. Among those who expected more fatality the number of people with diagnoses and comorbidity was higher, especially in men. CONCLUSION: There is a difference in risk factors for expected fatality and intent in men and women attempting suicide, which may not necessarily result in severe medical outcomes but may help during the post-crisis counseling of suicide attempters. Expected fatality deserves more attention as a component of general intent. An in-depth study of this phenomenon may help to understand motives of men and women attempting suicide and help prevent future suicidal attempts.
Copyright (c) 2022 Rozanov V.A. https://creativecommons.org/licenses/by/4.0
Telomere Length as a Marker of Suicidal Risk in Schizophrenia
BACKGROUND: Schizophrenia and suicidal behavior are associated with shortening in the length of telomeres. The aim of the study was to compare the content (pg/mcg) of telomeric repeat in DNA isolated from peripheral blood cells in three groups of subjects: patients with schizophrenia and a history of suicide attempts, patients with schizophrenia without suicidal tendencies, and healthy control volunteers. METHODS: Relapses according to gender and age were examined in 47 patients with schizophrenia with suicidal behavior, 47 patients without self-destructive conditions, and 47 volunteers with healthy control and maintenance for the content of telomeric and the number of copies of mitochondrial DNA (mtDNA) in peripheral blood leukocytes. RESULTS: Analysis of determining the content of telomeric repeat (TR) in the DNA of massive weight gain in the series: patients with schizophrenia and suicidal attempts — patients with schizophrenia without suicidal observations — healthy controls (225±28.4 (227 [190; 250]) vs. 243±21 (245 [228; 260]) vs. 255±17.9 (255 [242; 266]), p <0.005. The same trend is observed for the number of mtDNA copies (257±101.5 (250 [194; 297])) vs. 262.3±59.3 (254 [217; 312]) vs. 272±79.9 (274 [213; 304]); p=0.012), but no significant differences were recorded. CONCLUSIONS: For the first time, the phenomenon of telomere shortening was discovered in schizophrenics with suicidal risk. The length of the telomere corresponds to the parameter of a biological marker — an objectively measured indicator of normal or pathological processes, but gaining an idea of its reliability is still necessary for verification with an assessment of its sensitivity, specificity, and positive and negative predictive value. The telomere may be considered a putative predictive indicator of suicidal risk.
Copyright (c) 2022 Zakharova N.V., Bravve L.V., Mamedova G.S., Kaydan M.A., Ershova E.S., Martynov A.V., Veiko N.N., Kostyuk S.V. https://creativecommons.org/licenses/by/4.0
Modeling Suicidality Risks and Understanding the Phenomenon of Suicidality Under the Loupe of Pandemic Context: National Findings of the COMET-G Study in the Russian Population
BACKGROUND: Suicidality is a complex clinical phenomenon reflecting vulnerability to suicidal behavior which can be explained via the biopsychosocial paradigm and in relationship with a variety of country-specific factors. Data on suicides within the Russian population are inconsistent (from 11.7 up to 25.1 per 100.000), whereas the population’s suicidality risks have not been investigated in detail. Suicidality estimates during the multifactorial influence of the COVID-19 pandemic could serve as a basis to learn more about this mental health indicator. METHODS: The current study is a part of the COMET-G international project (40 countries, n=55.589), which represents an analysis of data collected from Russia’s general population (n=7714, 33±12 y.o., 61% female) to estimate suicidality using the Risk Assessment Suicidality Scale (RASS) and its relationships with socio-demographic, clinical, and life-habit characteristics during the COVID-19 pandemic. The evaluation of the statistical data (descriptive statistics, ANOVA, LASSO linear regression, significant at α=0.05) was undertaken using TIBCO Statistica. RESULTS: According to the RASS, at least 20.68%, and up to 29.15%, of the general population in Russia demonstrated increased risk of suicidality during the pandemic. Modelling these risks pointed to the key vulnerabilities related to mental and behavioral disorders, such as (i) current severe depression and a history of mental disorders, (ii) bipolar disorder, (iii) use of illicit drugs surprisingly outranking the alcohol misuse, and psychiatric compounds (hypnotics), highlighting sleep quality deterioration, (iv) a history of suicide attempts and self-harm — though not self-reported changes in depression — in response were predictors of the risk of suicidality, which can be explained by the phenomenon of “learned suicidality”, a habitual behavioral suicidality pattern completion accumulated over the background. Such (v) socio-demographic indicators as younger age (disregarding the gender factor), a marital status of single, having no children, living with fewer people in the household, a recent increase in family conflicts, increased need for emotional support, decreased need for communication, and not believing in precautionary measures against COVID-19, contributed to the increase of suicidality risk in the context of the pandemic. CONCLUSIONS: The findings of this study revealed new suicide risk factors that should be taken into account in suicidality risk assessments for the Russian population and in the implementation of suicide prevention programs in the region.
Copyright (c) 2022 Syunyakov T.S., Pavlichenko A.V., Morozov P.V., Fedotov I.A., Filatova V.E., Gayduk A.J., Ignatenko Y.S., Spikina A.A., Yashikhina A.A., Patsali M.E., Fountoulakis K.N., Smirnova D.A. https://creativecommons.org/licenses/by/4.0
Problems with Suicidal Behavior Prevention in Adolescents: a Narrative Literature Review
BACKGROUND: Among the existing issues related to the health and quality of life of Russian adolescents, suicidal behavior is being actively discussed; however, the available comprehensive measures for prevention of suicide and attempts at suicide at this age do not provide an adequate solution. This is due to the fact that suicide is an integrative phenomenon, and the act of suicide itself is interpreted, in essence, as the “tip of the iceberg”. What is especially clearly manifested in adolescence is the fact that the readiness to commit suicide is associated not so much with the level of severity of mental pathology and personality dysfunction, but with the general social context lack of well-being of total trouble. Therefore, suicide prevention cannot be based purely on the timely identification of persons at risk for mental pathology. AIM: The purpose of this work is to analyze the available literature on current approaches that have demonstrated their efficacy in reducing suicidal behavior in adolescents. METHODS: The authors performed a narrative review of the relevant literature published between 2012 and 2021. They analyzed the works presented in the PubMed, MEDLINE, and Web of Science electronic databases. Descriptive analysis was used to generalize the data obtained. RESULTS: The article discusses preventive approaches to suicidal behavior in adolescents, which are most often studied, and which are also used in practical healthcare. It outlines the problems associated with the implementation and evaluation of the efficacy of these preventive programs. CONCLUSIONS: The continuing high rate of suicide among adolescents calls for an urgent concerted effort to develop, disseminate, and implement more effective prevention strategies. School-based approaches are the most convenient in practical terms, but they require systematic and long-term use of anti-suicidal programs. Digital interventions can reduce the economic burden of their use, including assessing suicidal risk and identifying psychopathology associated with suicidality.
Copyright (c) 2022 Pichikov A.A., Popov Y.V. https://creativecommons.org/licenses/by/4.0
The Evolution of Diagnostic Boundaries of Alzheimer’s Disease and Novel Therapeutic Options
Over the past three decades, the definition and diagnostic boundaries of Alzheimer’s disease (AD) have been repeatedly revised due to significant progress in understanding of the pathogenesis of neurodegeneration associated with Alzheimer’s disease and in the development of high-tech diagnostic methods. The current approach to AD diagnostics relies on the detection of biomarkers that reflect two main neuropathological processes involved in the primary neurodegeneration that underlies AD: abnormal amyloidogenesis, and neuronal degeneration. The currently available diagnostic tools are limited to the detection of cerebrospinal biomarkers and/or assessment of the abnormal amyloid and tau protein burden in the brain via amyloid and tau positron emission tomography (PET) ligands. Practical implementation (mostly in the research field) of the biological model of AD diagnosis has led to a significant expansion of its diagnostic boundaries with the inclusion of predementia AD stages: asymptomatic and symptomatic, the latter is clinically corresponding to amnestic mild cognitive impairment (aMCI-amnestic mild cognitive impairment). On the one hand, this approach significantly expands the possibilities to study and use preventive technologies aiming to avert or delay the progression of predementia cognitive impairment to dementia but, on the other, it is associated with a number of negative implications from both the clinical and ethical points of view. A significant limitation of purely biological diagnosis of AD based on biomarker levels is due to the low prognostic value of biomarkers, which can cause diagnostic confusion in certain circumstances. Moreover, since the future evolution of the asymptomatic stage is not yet clear and there are still no reliable ways to prevent the cognitive and behavioral symptoms associated with AD, disclosure of stressful information about this “terrifying” diagnosis to patients can cause irreversible damage by triggering depressive disorder, which is a risk factor of AD itself. The current knowledge about AD prognosis in amyloid-positive cognitively unimpaired patients is insufficient.The most adequate approach to early AD diagnostics appears to be the clinical and biological model, as recommended by the International Working Group (IWG 2021), which requires a combination of the clinical AD phenotype and the detection of biomarkers specific to this disease. The article discusses the potential directions for the development of biological diagnostic methods, including those based on the so-called peripheral (serum) biomarker technologies and promising directions for the development of biological methods of secondary AD prevention.
Copyright (c) 2022 Gavrilova S. https://creativecommons.org/licenses/by/4.0
Towards a WPA Position Document on the Human Rights of Older Adults with Mental Health Conditions
The increasing number of older adults in countries across the world is a huge challenge to those that are in charge of promoting, protecting, and implementing their human rights. This task is particularly difficult in the absence of a strong international framework addressing the principles required to guide the actions to combat all human rights violations. The existence of such a specific framework for older adults with mental health conditions is justified in view of the particular vulnerability of this section of the population by virtue of societal ageism, stigmatization, exclusion, as well as the disability and dependency which mental health conditions in old age may confer. The present article is a development of a previous statement by the International Psychogeriatric Association and the World Psychiatric Association Section of Old Age Psychiatry. As there is a call to all organizations to support efforts to combat Human Rights violations among older adults, a text will be submitted to the Executive Committee of the World Psychiatric Association to approve an official position statement on Human Rights of Older Persons with Mental Health Conditions.
Copyright (c) 2022 Lima C.A. https://creativecommons.org/licenses/by/4.0
Mental Health Promotion and Risk Reduction Strategies for Mental Disorders in Older Persons: Why Should Governments and Policymakers Care?
There is no health without mental health. These are both indispensable human rights and are prerequisite to living one’s life with dignity. Unfortunately, mental health systems have been in crisis, with burden of mental illness being among the ten leading healthcare-related issues worldwide, with no measurable reduction in such for over 30 years. Concurrently, the demographic clock continues to tick. Toady’s 703 million people aged 65 or older are projected to reach 1.5 billion by the year 2050. Of these, 20% will suffer with serious mental health conditions. At the heart of the global crisis for older people is ageism, frequently intersecting with ableism, mentalism, sexism, and racism. These biases result in the violation of older peoples’ human rights every day, with the resultant poor quality of life and premature death. They are compounded by major gaps in legislation, policies, and practices, rendering the central transformative promise of the UN’s 2030 Agenda to “Leave No One Behind” a very elusive goal. Evidence-based interventions designed to prevent or reduce the risk of common mental health conditions and psychosocial disability are already available. All governments and policymakers have a major role to play in the promotion of good mental health and the prevention of mental illness by integrating these into public health and general social policy. This requires adopting, implementing, and scaling up of evidence-based, cost-effective interventions to reduce the risk of the development of mental disorders and providing access to adequate treatment when needed for older persons. All governments and policymakers also have a pivotal role to play in leading and supporting a UN convention on the human rights of older people. A UN convention would help combat ageism at the national and international levels by ensuring integration of monitoring and enforcement mechanisms to effectively implement policies and laws that could address discrimination, inequity, and the protection of human rights of older people, including their mental health.
Copyright (c) 2022 Rabheru K. https://creativecommons.org/licenses/by/4.0
Symptomatic Profile of Cariprazine in the Context of ICD-11 Domains for Schizophrenia: Review of Clinically Oriented Studies
INTRODUCTION: One of the innovations in the ICD-11grouping "Schizophrenia and Other Primary Psychotic Disorders" is the implementation of six symptom domains intended to improve diagnostics and treatment of these mental conditions in clinical practice. In this respect, evaluation of the effects of various psychotropic drugs, primarily antipsychotic agents, on the specified psychotic symptom domains is a critical task. The antipsychotic agent cariprazine, registered in many countries worldwide (including Russia) for schizophrenia treatment, was selected as the psychotropic drug model for the purposes of the present review. METHODS: For the purposes of this review the MEDLINE, Cochrane Central Register of Controlled Trials, and PubMed databases were searched for randomized controlled trials comparing cariprazine with a placebo, or a placebo and one or several antipsychotic agents, and that was performed within the period from January 2014 to March 2021. RESULTS: Cariprazine has proved its efficiency in relation to all symptom groups of the ICD-11 domain "Positive Symptoms'', and may be considered a front-line therapy for treatment of the first and multiple episodes of schizophrenia, disorganized thinking, and behavioral disorders in the form of aggressiveness and hostility. Cariprazine has the best evidential base for treatment of various symptoms within the ICD-11 domain "Negative Symptoms'' among all antipsychotic agents. The data with regard to the effects of cariprazine on the domain "Depressive Mood Symptoms'' are controversial. No data concerning the effects of cariprazine on the domain "Maniс Mood Symptoms'' are available, but the effectiveness of cariprazine monotherapy for manic episodes without any psychomotor agitation signs in the instance of bipolar disorder has been demonstrated. The effectiveness of cariprazine therapy for the ICD-11 domain "Psychomotor Symptoms" has not been investigated, either within the framework of monotherapy or in the course of adjuvant therapy. The effectiveness of cariprazine has been demonstrated in treatment of the domain "Cognitive Symptoms", and the pro-cognitive effect of the drug has developed regardless of its impact on any other schizophrenia symptoms. The drug’s capability to improve the functioning of patients with schizophrenia was demonstrated regardless of the impact on psychotic symptoms. CONCLUSION: Cariprazine is the first-line drug for treatment of the domain "Negative Symptoms" as well as representing front-line therapy for the treatment of ICD-11 domains "Positive Symptoms" and "Cognitive Symptoms". Additional studies will be required in order to evaluate the effects of cariprazine on the ICD-11 domains "Maniс Mood Symptoms" and "Depressive Mood Symptoms".
Copyright (c) 2022 Pavlichenko A.V., Gubina A.S. https://creativecommons.org/licenses/by/4.0
“Love in the Later Years…”: Perceptions of Sex and Sexuality in Older Indian Adults — a Qualitative Exploration
BACKGROUND: The world faces global population ageing. With this demographic shift and increased life-expectancy, healthcare services are focused on healthy ageing. Sexual health is a vital yet neglected dimension of general health and wellbeing in older adults. This study aimed to explore sexual experiences and perceptions of sexuality among older people in India. METHODS: A qualitative approach with social constructivist paradigm was used. 20 participants aged above 60 years were recruited through purposive sampling until thematic saturation was reached. In-person, in-depth interviews were conducted using a semi-structured guide after an initial pilot study. They were audio-recorded, transcribed, and translated verbatim. Thematic analysis was conducted, and rigor ensured through triangulation and respondent validation. RESULTS: The overarching categories were “sexuality as a mode of resilience”, “emotional stability and intimacy as attributes of sexual pleasure”, and “lack of sexual rights awareness”. The main categories (themes) were sexual experiences (intimate touch, non-penile sex, personal meanings of sexuality), partner expectations (companionship, support, continuity of care, proximity), and barriers against sexual expression (social stereotypes, stigma, lack of audience in healthcare services). The older people were accepting of their sexual difficulties and coped through relationship dynamics. Participant voices are discussed with regard to the socio-cultural context. CONCLUSION: Sexual wellbeing is connected with “ageing well”. Our findings suggest that older people retain sexual desires and fantasies through changed patterns and expectations. Healthcare services, policymakers and academia need to be informed about older people’s sexual needs and rights.
Copyright (c) 2022 Banerjee D., Rao T. https://creativecommons.org/licenses/by/4.0
Mental Health of Older Adults: an Agenda for Action
The world’s population is ageing rapidly. Estimates by the United Nations (UN) and World Health Organization (WHO) suggest that between 2015 and 2050, the proportion of the world's older adults will almost double from about 12% to 22% [1]. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60. Older people face unique physical and mental health challenges that need to be recognized. Mental health and well-being are particularly important in older age. While most have good mental health, many older adults are at high risk of developing mental and neurological disorders, as well as other medical conditions. Similarly, as people age, they are more likely to experience a number of conditions at the same time [2]. Besides, there are numerous social, psychological, and ecological factors that can impact the mental wellbeing of older people.
Copyright (c) 2022 Javed A. https://creativecommons.org/licenses/by/4.0
Technology-based Neurocognitive Assessment of the Elderly: a Mini Review
Neurocognitive disorders in the elderly are on the rise all over the world. Neuropsychological assessment is vital to monitoring the progress of cognitive deficits. Over the years, there has been significant development in neuropsychological assessment to predict the development and progression of MCI and dementia. One such area of recent advancement in the field of neuropsychology is technology-based assessment. There are several types of technology-based assessments available based on the type of usage, site of the assessment, type of administration, type of device used for assessment, etc. Virtual reality-based assessments and digital assessments of neurocognitions for early identification of subtle cognitive deficits in patients with mild cognitive impairment (MCI) and major neurocognitive disorders (MND) represent two newly developed technologies. A few studies have demonstrated their efficacy; however, there remain several limitations and drawbacks to their usage within the elderly population. In this review, we have briefly discussed technology-based neuropsychological assessment, along with their usage and limitations.
Copyright (c) 2022 Sahoo S., Grover S. https://creativecommons.org/licenses/by/4.0
Loneliness Among the Elderly: a Mini Review
Loneliness is understood as a painful negative emotion. Since its introduction into the psychiatric literature in 1959, the understanding of loneliness has improved considerably, and is now understood to be a distinct entity to such issues as social isolation, solitude, and depression. However, there is still a lack of consensus on the general definition of loneliness. Similarly, different dimensions of loneliness have been described in the literature. It is understood in terms of either transient versus situational versus chronic loneliness; state versus trait loneliness; and the concept of unidimensional versus multidimensional loneliness. The reported prevalence of loneliness varies considerably in the literature, with evidence from metanalysis suggesting the prevalence of moderate loneliness that ranges from 31 to 100% with a mean of 61%, and that of severe loneliness ranging from 9 to 81%, with a mean prevalence of 35% among the elderly. Loneliness among the elderly is associated with significant adverse mental and physical health outcomes in the form of cardiovascular diseases, stroke, diabetes mellitus, arthritis, depression, anxiety, dementia, and even problematic internet use. Over the years, different instruments [University of California Los Angeles Loneliness Scale (UCLA-LS), De Jong Gierveld Loneliness Scale, Single-Item direct measure of loneliness] have been designed to assess loneliness among the elderly. Some of the interventions suggest that persons experiencing loneliness could benefit from improved social skills, enhanced social support, increased opportunities for social contact, and addressing maladaptive social cognition.
Copyright (c) 2022 Grover S. https://creativecommons.org/licenses/by/4.0
A Comparison of Regional Brain Volumes in Older Adults With and Without History of COVID-19
BACKGROUND: Recent studies have shown that SARS-CoV-2 can have neuropsychiatric consequences and has the ability to penetrate the blood-brain barrier. If SARS-CoV-2 has a specific route of entry into the brain, it may leave imprints in the form of specific changes in brain morphology. Older individuals are most vulnerable to the neuropsychiatric COVID-19 complications. This study aims to compare regional brain volumes in older adults individuals with and without COVID-19 history (COVID+ and COVID-, respectively). METHODS: Individuals over 65 years old who applied for treatment to the Memory Clinic (Mental-Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia) were assessed between October 2020 and April 2021. Their COVID-19 history was determined by the self-report and COVID-19 certificate. Individuals with severe neuropsychiatric or acute or severe chronic somatic or infectious disease and those taking medications potentially affecting cognitive functioning were excluded. All participants underwent MRI examinations followed by image segmentation and morphometric quantitative analysis. Regional brain volumes were compared in COVID+ and COVID- people. RESULTS: 207 participants were included in the study. The COVID+ group consisted of 24 participants. The comparison between groups revealed statistically significant differences in left amygdala area (median 1199.3 mm3 in COVID+ vs. 1263.7 mm3 in COVID-) and right postcentral gyrus volumes (median 8055.5 mm3 in COVID+ vs. 8434.0 mm3 in COVID-). Then case-control analysis was performed in individuals matched for gender, age and common somatic causes of structural brain changes (hypertension and/or diabetes mellitus type 2) for 22 subjects in each group. Statistically significant differences in regional brain volumes between groups were absent. CONCLUSION: We did not find strong evidence for any regional brain volumes changes in people older than 65 years with a history of COVID-19 in comparison to those without history of COVID-19. Though, given study limitations, these results cannot be generalized to other people who recovered from COVID-19.
Copyright (c) 2022 Syunyakov T.S., Sharaev M.G., Savilov V.B., Karpenko O.A., Kurmyshev M.V., Yarkin V.E., Ushakov V.L., Bibyaev A.N., Soloveva K.P., Andruschenko A.V. https://creativecommons.org/licenses/by/4.0
Healthy Longevity Among the LGBTQIA+ Population: From Neglect to Meeting Their Needs
The world is facing rapid population aging. This is associated with an increase in the number of older people from the lesbian, gay, bisexual, trans, queer, intersex, or asexual (LGBTQIA+) community. This population faces unique challenges, including ageism, sexual identity stigma, and self-stigma. The older LGBTQIA+ population are neglected by, and invisible to, healthcare interventions, research, and policy changes. In light of the paradigm shift in healthcare towards a rights-based approach, healthy aging has become an important construct. Healthy aging, according to the World Health Organization (WHO), is a “continuous process of optimizing opportunities to maintain and improve physical and mental health, autonomy, and quality of life throughout the life course”. This commentary highlights the unique vulnerabilities of the aging LGBTQIA+ population, advocates the inclusion of their voices at all levels of the healthcare system, and discusses the way forward to enable their ‘healthy aging’.
Copyright (c) 2022 Pereira H., Banerjee D. https://creativecommons.org/licenses/by/4.0
The WPA-IPS-SPF-AFPA Joint Panel Discussion Organized by the IPA: Voices from South Asia Regarding Older People’s Mental Health Advocacy and Services
Kicking off on 1 October with the United Nations’ International Day of Older Persons (UNIDOP) and concluding on 10 October in conjunction with World Mental Health Day, the OLDER ADULT MENTAL HEALTH AWARENESS WEEK was a brand-new ten-day initiative launched by the International Psychogeriatric Association (IPA). It was focused on raising awareness of the importance of Better Mental Health for Older People with virtual programs from all around the world on each of these ten days. As part of this Awareness Week, the IPA hosted a discussion entitled “Mental healthcare services and advocacy for the older people amidst COVID crisis: Voices from South Asia”, organized on October 6th, 2021 in conjunction with the World Psychiatric Association (WPA), Indian Psychiatric Society (IPS), Indian Association of Geriatric Mental Health (IAGMH), SAARC Psychiatric Federation (SPF), and the Asian Federation of Psychiatric Associations (AFPA). This is the event report of the same panel discussion which highlights the unique challenges to old age mental healthcare among the SAARC nations, calls for urgent collaborative action, and focuses on human rights and dignity-based mental healthcare for older adults in these rapidly ageing countries.
Copyright (c) 2022 Banerjee D., Javed A., Rao G., Saha G., Pradhan S. https://creativecommons.org/licenses/by/4.0
Outpatient Services for People with Mental Disorders in the Kyrgyz Republic: What Is Next?
The outpatient care service for patients with mental disorders in the Kyrgyz Republic is currently experiencing various difficulties. These are largely due to a number of organizational and socio-economic problems at the state level. Treatment of patients with mental disorders is still provided in state mental health centres, while psychosocial services at the community level are only now beginning to be developed. This article describes the directions of mental health care, as well as ongoing efforts to provide outpatient care for people with mental disorders. The actions of a few prolific nongovernmental organizations (NGOs) are proving insufficient to meet the needs of patients. There is currently a gradual and visible movement toward the development of the private sector in the field of mental healthcare. In order to overcome organizational difficulties, support from government structures and certain initiatives to create legislative grounds are needed.
Copyright (c) 2022 Molchanova E.S., Kosterina E.V., Yarova O.V., Panteleeva L.Y. https://creativecommons.org/licenses/by/4.0
Community-Based Mental Health Services in Azerbaijan: a Course Toward Development
Community mental health care in Azerbaijan was established in 2011 in the line with the country’s mental health reform. The main directions of the reform, as described in the National Mental Health Strategy, were deinstitutionalization, improving quality of care, integration of mental health into primary healthcare, and implementation of modern community-based services. Over the last decade, the number of beds in psychiatric hospitals has significantly decreased, and many psychiatrists and psychiatric nurses have been transferred to primary care facilities. At the same time, programs focusing on comprehensive care have been implemented in different regions of the country. Community mental health services currently employ various kinds of mental health professional including psychiatrists, clinical psychologists, social workers, occupational therapists, and nurses to ensure a multidisciplinary approach to care provision. Team-based care may focus on crisis resolution, psychosocial rehabilitation, case management, family support, and early intervention for psychosis. Among the barriers preventing development of community mental health services, one should note, in particular, stigma belittling the priority of mental healthcare, uncertainty in distribution of authority between the Ministry of Health and the State Agency for Mandatory Health Insurance, and a general scarcity of human resources, especially in the rural regions. Nevertheless, the mental health care in Azerbaijan is continuing its transition from an institutional model to community-based services.
Copyright (c) 2022 Ismayilov F.N. https://creativecommons.org/licenses/by/4.0
Grant Support as an Option for the Solution of Specific and Systemic Problems in the Activities of Non-Profit Organizations
The existing practices for the participation of non-profit organizations (NPOs) in solutions for social policy problems both in the Western world and in Russia are reviewed in this article, and a comparative analysis of the Russian and foreign experiences in this area is performed. A separate section of the article is devoted to studies of the grant support system for non-profit organizations in Russia. Systemic and specific problems are revealed. Conclusions are made on the imperfections of the evolving system for the interaction between the state and non-profit organizations, particularly in the area of project financing, as well as on the necessity for creating the conditions for the distribution of successful “pilot” projects by individual non-profit organizations within the entire territory of Russia.
Copyright (c) 2021 Gebel K.M., Geger A.E. https://creativecommons.org/licenses/by/4.0
Community Mental Health Services in Greece: Development, Challenges and Future Directions
The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental health care since at least the 1980s, the main recent Greek effort has been “Psychargos”, a program which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is ongoing. Future goals should be to improve the current framework of care and access to care by establishing community mental health services across the country that are fit for purpose, enhancing multidisciplinary collaboration and patient involvement, integrating community mental health care with physical and social care services, and ensuring that service development is driven by need. Crucially, such aims demand the adoption of a culture of clinical governance and a consistent shift from traditional therapeutic care to person-centred psychiatry and preventive psychiatry.
Copyright (c) 2021 Anargyros K.P., Lappas A.S., Christodoulou N.G. https://creativecommons.org/licenses/by/4.0
The Quality of Care Provided by Outpatient Mental Health Services in Georgia
Georgia has recently made a commendable effort to reform mental health care. The “Concept on Mental Health Care” adopted by the Government and the two strategic plans for 2014–2020 and 2021–2031, which aimed to develop comprehensive evidence-based, culturally appropriate, and human rights-oriented mental health care, have promoted the deinstitutionalization and development of community mental health services. Since 2018, new standards of care for mental health ambulatories and mobile teams have been imposed and implemented in the state programme and funded accordingly. The study aimed to investigate the quality of care in community mental health services. As a result, we monitored the mental health ambulatories in all major cities and regional centres of the country (in total, 16 ambulatories) and the mobile teams which had at least two years of experience (in total, 14 mobile teams). The data analyses showed that the new standards for ambulatories and mobile teams increased access to and coverage of mental health care across the country. However, further effort is still needed to achieve comprehensive treatment by mental health care services.
Copyright (c) 2021 Chkonia E., Geleishvili G., Sharashidze M., Kuratashvili M., Khundadze M., Cheishvili G. https://creativecommons.org/licenses/by/4.0
Community-Based Psychiatric Services in Sri Lanka: a Model by WHO in the Making
Sri Lanka is a lower middle-income, small island nation in the Indian Ocean, with a multi-ethnic population of 22 million. The healthcare system of the country is well established and relatively advanced, the delivery of which is free to the consumer. The health indicators of the country are impressive compared to regional figures. Psychiatric care in Sri Lanka has witnessed a rapid development over the last four decades, as the care model transformed from an asylum-based model, established during the British colonial times, to a district-wise hospital-based, care delivery model. Gradually, the teams that provided inpatient and outpatient services at the hospitals also started to provide community-based care. The newly added community-based services include outreach clinics, residential intermediate rehabilitation centres, home-based care, community resource/ support centres and telephone help lines. There is no or very little funding dedicated to community-based care services. The teams that deliver community services are funded, mostly indirectly, by the state health authorities. This is so, as these community teams are essentially the same psychiatry teams that are based at the hospitals, which are funded and run by the state health authorities. This lack of separation of the community and hospital teams without separate and dedicated funding is an impediment to service development, which needs to be addressed. However, paradoxically, this also constitutes an advantage, as the provision of care delivery from the hospital to the community is continuous, since the same team provides both hospital- and community-based care. In addition to the essential mental healthcare provision in the community with this basic infrastructure, each community service has improvised and adapted the utilization of other resources available to them, both formally as well as informally, to compensate for their financial and human resource limitations. These other resources are the community officials and the community services of the non-health sectors of the government, mainly the civil administration. Although sustainability may be questionable when services involve informal resources from the non-health sectors, these have so far proven useful and effective in a resource-poor environment, as they bring the community and various sectors together to facilitate services to support their own community.
Copyright (c) 2021 Rajasuriya M., Hewagama M., Ruwanpriya S., Wijesundara H. https://creativecommons.org/licenses/by/4.0
Acceptance and Commitment Therapy for Patients with a First Psychotic Episode
The search for the most effective methods of therapy for mental disorders is a priority for modern psychiatry. An approach to the early diagnostics and rehabilitation of patients experiencing psychotic episodes for the first time is proposed in the present article. The proposed approach is based on the combination of drug therapy and acceptance and commitment therapy (ACT) characterized by the development of the patient’s psychological flexibility, rather than controlling the disease symptoms. The article describes the main processes of the ACT model: acceptance, cognitive defusion, contact with the present moment, understanding of the inner world, awareness of significant values, and the regulation of purposeful behaviour for the implementation of these values. Recommendations for different stages of treatment were also developed by specialists of the First Psychotic Episode Clinic at the Mental Health Сlinic No.1 named after N.A. Alexeev. The psychological rehabilitation of patients with the use of ACT in the case of psychotic disorders with both negative and positive symptoms was elaborated. The application of acceptance and commitment therapy in the early diagnostics and treatment of patients experiencing a first psychotic episode results in fewer readmissions and improved psychosocial functioning in both inpatient and outpatient care.
Copyright (c) 2021 Chernov N.V., Moiseeva T.V., Belyakova M.A., Polyakova M.D., Sozinova M.V. https://creativecommons.org/licenses/by/4.0
Stigma and Quality of Life among People Diagnosed with Mental Disorders: a Narrative Review
INTRODUCTION: The anti-psychiatric movements that emerged in the early 1960s led to the appearance of stigma in psychiatry. The misunderstanding of the concept of mental disorder, the negative way in which associated hospitalization was perceived, the inclination to treat patients through psychological therapies, and the criticism of pharmacological treatment led to the discrediting of psychiatry. AIM: The current paper aims to review the available literature regarding the impact of stigma on the quality of life of people diagnosed with mental disorders. MATERIAL AND METHODS: A narrative review of relevant literature published between 1999 and 2021 was conducted. The authors analysed studies found on PubMed and the Web of Science electronic databases. The search terms combined two overlapping areas with keywords such as "stigma" and "mental disorders". A descriptive analysis was employed to synthesize the obtained data. RESULTS: Stigma continues to be an important challenge to the management of health conditions in people with mental disorders. A lack of comprehension may give the impression that all psychiatric patients are aggressive and are unable to function adequately. Such stigmatizing beliefs and habits have proven to be very difficult to change. CONCLUSIONS: Due to the stigmatization and repulsive attitudes in society, patients are reluctant to be linked to any form of mental disorder or to be seen as having any contact with mental health professionals. This undermines the beneficial effects of treatment, resulting in a poor quality of life and diminished socio-occupational functioning.
Copyright (c) 2021 Ciobanu A.M., Catrinescu L.M., Ivașcu D.M., Niculae C.P., Szalontay A.S. https://creativecommons.org/licenses/by/4.0
Plasma levels of neurotrophic factors are not associated with the severity of depression
Depression is one of the most common mental illnesses. Impaired neurogenesis is observed in depression. Studying the concentration of biochemical indicators in the blood that may be involved in the pathogenesis of depression, looking for associations with the severity of depressive symptoms can be useful as an objective diagnosis of the disease and predicting the severity of the pathology. We determined plasma concentrations of the monoamine neurotransmitters serotonin and dopamine, and neurotrophic factors involved in neurogenesis (BDNF, CDNF and neuropeptide Y) in depressed patients and healthy volunteers with the same socio-demographic parameters using enzyme immunoassay and mass spectrometry. All study participants were administered the Hamilton Depression Scale (HAMD), the Generalized Anxiety Disorder Questionnaire (GAD-7), and the Center for Epidemiological Studies (CES-D). The cumulative scores on the three scales examined were significantly higher in depressed patients than in controls. The concentration of serotonin, dopamine, BDNF, CDNF, and neuropeptide Y in plasma did not differ between the subject groups and was not associated with the scores on the scales. Positive correlations were found between the content of neuropeptide Y and serotonin, BDNF and CDNF in blood plasma. Thus, although these markers are related to the pathophysiology of depression, they do not correlate with the severity of symptomatology and possibly in plasma cannot reflect processes occurring in the brain.
Copyright (c) 2021 Zorkina Y.A., Syunyakov T.S., Abramova O.V., Yunes R.A., Pavlichenko A.V., Pavlov K.A., Khobta E.B., Susloparova D.A., Tsarapkin G.Y., Andreyuk D.S., Danilenko V.N., Gurina O.I., Morozova A.Y. https://creativecommons.org/licenses/by/4.0
Diagnosing and Treating Depression and Anxiety in Patients with Cardiovascular Disorders and Diabetes Mellitus in Primary Healthcare: Is Training of Physicians Enough for Improvement?
INTRODUCTION: Common mental disorders — anxiety and depression — are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation. AIM: To explore whether the rates of referrals to psychiatrists and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in primary healthcare facilities after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist). METHODS: Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n=400). The educational programme for PCPhs on the diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS >7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n=178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment according to the screening criteria used in the study for anxiety and depression for both samples. RESULTS: The proportions of patients with borderline abnormal and abnormal HADS scores (>7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS >7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases was it indicated in compliance with the screening criteria. In Sample 2, among patients with HADS >7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS >7 met a psychiatrist through PCPh referral. CONCLUSIONS: Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.
Copyright (c) 2021 Karpenko O.A., Melikhov O.G., Tyazhelnikov A.A., Kostyuk G.P. https://creativecommons.org/licenses/by/4.0
Community-Based Mental Health Services in Mexico
AIM: This article describes the general characteristics of community-based mental healthcare in Mexico. METHODS: Data from national surveys, special studies and statistics from the national information system during the period 2001–2017 are used. Available information on health systems, new regulations and the innovations implemented are reviewed, as well as research on psychosocial interventions conducted within the country. RESULTS: Data show a fragmented health system with services for workers and those without social security or private care. This is a treatment system essentially based on tertiary healthcare and not integrated into the general health system, with a significant treatment gap and delay in relation to the first treatment. At the same time, a slow but steady increase in the level of care provided at primary healthcare level and in specialized community services has been observed. This trend has been accompanied by an increase in the number of medical doctors, psychologists and, to a lesser extent, psychiatrists, incorporated into the primary healthcare services. At the same time, no new psychiatric hospitals have been built; there has been a proportional reduction in psychiatric beds but no increase in mental health services or beds allocated to first contact hospitals. Research initiatives have analysed the barriers to reform, and efficient interventions have been developed and tested for the community and for primary healthcare; special interventions are available for the most vulnerable but no formal efforts have been to facilitate their implementation. CONCLUSIONS: Evidence is available regarding the implementation of the transition from reliance on tertiary healthcare to reinforced primary care. At the same time, parity, financial protection, quality and continuity of care remain major challenges.
Copyright (c) 2021 Cordero Oropeza M., Berenzon S., Robles R., Real T., Medina Mora M. https://creativecommons.org/licenses/by/4.0
Community-Based Mental Health Services in India: Current Status and Roadmap for the Future
An estimated 197.3 million people have mental disorders in India, and majority of the population have either no or limited access to mental health services. Thus, the country has a huge burden of mental disorders, and there is a significant treatment gap. Public mental health measures have become a developmental priority so that sustainable gains may be made in this regard. The National Mental Health Program (NMHP) was launched in 1982 as a major step forward for mental health services in India, but it has only been able to partially achieve the desired mental health outcomes. Despite efforts to energize and scale up the program from time to time, progress with development of community-based mental health services and achievement of the desired outcomes in India has been slow. Public health measures, along with integration of mental health services in primary healthcare systems, offer the most sustainable and effective model given the limited mental health resources. The main barriers to this integration include already overburdened primary health centres (PHCs), which face the following challenges: limited staff; multiple tasks; a high patient load; multiple, concurrent programs; lack of training, supervision, and referral services; and non-availability of psychotropic medications in the primary healthcare system. Thus, there is an urgent need for a fresh look at implementation of the NMHP, with a focus on achieving sustainable improvements in a timely manner.
Copyright (c) 2021 Hans G., Sharan P. https://creativecommons.org/licenses/by/4.0
Comprehensive Clinical and Social Research at the Moscow Research Institute of Psychiatry: Translation into Clinical Practice
The article is devoted to the work of the Moscow Research Institute of Psychiatry to improve psychiatric care for patients with psychotic disorders. An important feature of this work was an integrated approach, in which the clinical picture of the disease was assessed in close connection with the patient's personal and psychological characteristics, social conditions of his life, therapeutic opportunities, rehabilitation potential and organizational structure of care. The article reflects the results of many years of work of the department of outpatient psychiatry and the organization of psychiatric care under the guidance of Professor I.Ya. Gurovich. The results of scientific research carried out by the staff of the institute in a traditional humanistic manner are presented. The translational nature of the research is emphasized by its inextricable link with clinical and social approaches. As a result of many years of work, a concept was developed to provide assistance to various groups of patients, starting with the first manifestations of the disease and ending with cases of long-term chronic disorders with a pronounced level of social maladaptation. As a result, a whole spectrum of new organizational forms of psychiatric care was proposed, such as departments (clinics) of the first psychotic episode, medical rehabilitation departments, assertive community treatment departments, designed for the most difficult patients. These organizational forms were fixed in the regulatory documents of the Ministry of Health and Social Development of the Russian Federation. To date, the above departments have been established in psychiatric institutions in many regions of the Russian Federation. Further development of this area is associated with neurobiological research to identify complex biomarkers of psychotic spectrum disorders. Thus, the research carried out at the present time preserves the tradition of an integrated clinical and social approach to the study of mental disorders. It is shown that an important advantage of this approach is their translational nature.
Copyright (c) 2021 Shmukler A.B., Movina L.G., Papsuev O.O., Salnikova L.I., Shashkova N.G., Kiryanova E.M. https://creativecommons.org/licenses/by/4.0
Ceramides: Shared Lipid Biomarkers of Cardiovascular Disease and Schizophrenia
INTRODUCTION: Schizophrenia, although a debilitating mental illness, greatly affects individuals’ physical health as well. One of the leading somatic comorbidities associated with schizophrenia is cardiovascular disease, which has been estimated to be one of the leading causes of excess mortality in patients diagnosed with schizophrenia. Although the shared susceptibility to schizophrenia and cardiovascular disease is well established, the mechanisms linking these two disorders are not well understood. Genetic studies have hinted toward shared lipid metabolism abnormalities co-occurring in the two disorders, while lipid compounds have emerged as prognostic markers for cardiovascular disease. In particular, three ceramide species in the blood plasma, Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1), have been robustly linked to the latter disorder. AIM: We aimed to assess the differences in abundances of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in the blood plasma of schizophrenia patients compared to healthy controls. METHODS: We measured the abundances of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in a cohort of 82 patients with schizophrenia and 138 controls without a psychiatric diagnosis and validated the results using an independent cohort of 26 patients with schizophrenia, 55 control individuals, and 19 patients experiencing a first psychotic episode. RESULTS: We found significant alterations for all three ceramide species Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) and a particularly strong difference in concentrations between psychiatric patients and controls for the ceramide species Cer(d18:1/18:0). CONCLUSIONS: The alteration of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) levels in the blood plasma might be a manifestation of metabolic abnormalities common to both schizophrenia and cardiovascular disease.
Copyright (c) 2021 Tkachev A.I., Stekolshchikova E.A., Morozova A.Y., Anikanov N.A., Zorkina Y.A., Alekseyeva P.N., Khobta E.B., Andreyuk D.S., Zozulya S.A., Barkhatova A.N., Klyushnik T.P., Reznik A.M., Kostyuk G.P., Khaitovich P.E. https://creativecommons.org/licenses/by/4.0
Clinical Features of First-episode Psychoses During the COVID-19 Pandemic
INTRODUCTION: The pandemic of the new coronavirus infection has become one of the most significant global social shocks in the past decade. It influenced the lifestyle of many people, including those with mental disorders. AIM: To compare the psychopathological structure of psychotic states in young patients (up to 40 years old) with first-episode psychosis before the COVID-19 pandemic and during the COVID-19 pandemic. METHODS: The research was conducted at the First psychotic episode clinic of the Mental-health clinic No. 1 n.a. N.A. Alexeev, Moscow, Russia. In total, 66 patients were enrolled, who met the inclusion criteria: first-in-life admission to a mental healthcare unit that occurred during the spring of 2019 (control group) or spring 2020 (experimental group), diagnosis on admission that belonged to the group “Acute and transient psychotic disorders” (F23.XX) of ICD-10. Patients with a disability or concurrent somatic or neurologic conditions were excluded from the study. Assessment of clinical and psychopathological characteristics with the allocation of the leading syndrome within the psychotic state, psychometric assessment according to the PANSS scale was carried out, the above indicators were compared between the experimental and control group. RESULTS: We observed statistically insignificant increase in the rates of affective and catatonic subtypes of psychoses, a decrease in the rate of the delusional subtype of paranoid syndrome. PANSS scores differed significantly for different clinical subtypes of psychoses, although the differences between the experimental and control groups showed no statistical significance. Additionally, in spring 2020, a considerable decrease in the total number of hospitalizations was revealed. CONCLUSIONS: The differences in the clinical and psychopathological structure of psychotic states revealed during the COVID-19 pandemic were statistically insignificant. Additional results of the study may indicate a decrease in the availability of mental healthcare for patients with psychoses, which requires further investigation.
Copyright (c) 2021 Zyablov V.A., Gusev M.A., Chizhikov V.S. https://creativecommons.org/licenses/by/4.0
Late ‘Early Intervention in Psychosis’: A Family School for Learning How to Live with Schizophrenia
The paper describes a family school for learning how to live with schizophrenia, which was founded in 1986 in Vienna, Austria, and is still running today. It was established in cooperation between professionals and the Austrian self-help association HPE of the relatives of persons with mental disorders. It addresses the needs of 10 families at a time, in cases where a son or a daughter was diagnosed with schizophrenia and had already experienced one or several episodes of the illness. The course lasts one and a half years and is organized according to the model of a weekly boarding school, where 10 children, the “residents”, stay in the school overnight from Sunday evening to Friday and take part in a structured program on cognitive, social and practical life skills. Ambulatory psychiatric treatment is taking place concurrently outside the school through local routine services. On weekends residents stay with their parents since the school is closed. Parents visit the school regularly to take part in joint activities with the residents. They also undertake night shifts in the school and attend a weekly parents’ group. In the regular encounters during everyday activities in the school, “learning by doing” occurs – parents get to know the daughters and sons of other families and can learn to distinguish between disease-related and personality-related behavior. Residents can have similar learning experiences in relation to the parents of other residents. The main aim of the school is that parents learn to provide “protected autonomy” for the daughters or sons in question, in order to assist them after the end of the course in leading a life characterized by as much autonomy as possible after the end of the school.
Copyright (c) 2021 Katschnig H., Sint P. https://creativecommons.org/licenses/by/4.0
Revisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental Disorders
INTRODUCTION: The limited practice of depot antipsychotics and psychoeducation use, recommended for overcoming the noncompliance of patients with severe mental disorders, is linked to a high incidence of treatment violation. Therefore, the development of personalized mental healthcare approaches is a crucial healthcare task. AIM: To describe and differentiate the role of clinical, social and psychological factors that lead to different level of treatment engagement of psychiatric inpatients. METHODS: Secondary analysis of findings from 91 inpatients, based on the Treatment Motivation Assessment Questionnaire and Medication Compliance Scale, as well as the Scale of Internalized Stigma of Mental Illness and Perceived Discrimination and Devaluation Scale. Factorial analysis, cluster analysis and analysis of variance with p-level=0.05 and the calculation of the effect size (ES) according to Cohen’s d and Cramer’s V were used. RESULTS: The nature of therapy compliance in various categories of patients is mediated differentially, including: the severity of negative symptoms (ES=0.29), the global level of functioning and work maladjustment (ES=0.23–0.26), various motivational and behavioral styles (ES≥0.74) and the intensity of psychiatric stigmatization (ES≥0.88). CONCLUSIONS: Consideration of the clinical, social and psychological factors should empirically determine the strategies for the personalized use of prolonged antipsychotics and socio-psychotherapeutic interventions when developing an individual treatment plan for psychiatric in-patients.
Copyright (c) 2021 Sorokin M.Y., Neznanov N.G., Lutova N.B., Wied V.D. https://creativecommons.org/licenses/by/4.0
Community Mental Health Services in Italy
In 1978, in Italy, approval of Basaglia’s reform law marked a shift from an asylum-based to a community-based mental health system. The main aim of the reform was to treat patients in the community and no longer in psychiatric hospitals. Following the Italian model, similar reforms of mental health care have been approved worldwide. The community-based model aims to promote integration and human rights for people with mental disorders on the basis of their freedom to choose treatment options. By 2000, all psychiatric hospitals had been closed and all patients discharged. Mental health care is organized through the Department of Mental Health, which is the umbrella organization responsible for specialist mental health care in the community; this includes psychiatric wards located in general hospitals, residential facilities, mental health centres, and day-hospital and day-care units. Approval of Law 180 led to a practical and ideological shift in the provision of care to patients with mental disorders. In particular, the reform highlighted the need to treat patients in the same way as any other patient, and mental health care moved from a custodialistic to a therapeutic model. Progressive consolidation of the community-based system of mental health care in Italy has been observed in the past 40 years. However, some reasons for concern still exist, including low staffing levels, potential use of community residential facilities as long-stay residential services, and a heterogeneity in the availability of resources for mental health throughout the country.
Copyright (c) 2021 Sampogna G., Del Vecchio V., De Rosa C., Giallonardo V., Luciano M., Palummo C., Di Vincenzo M., Fiorillo A. https://creativecommons.org/licenses/by/4.0
Gender Identity Disorders: Current Medical and Social Paradigm and the ICD-11 Innovations
Introduction. This article presents a review of current concepts of gender identity under normal and pathological conditions. Aim. To analyse the impact of the medical and social paradigm shift for clinical practice. Results and discussion. The modern academic literature devoted to gender identity disorders is characterized by a variety of terminology, a shift in emphasis from clinical judgement to a socially beneficial normocentric approach and a relatively few advanced, evidence-based research. There is also a lack of evidence for the gender theory underlying the new approach, which raises serious doubts about the validity of the medical and social paradigm revision. In the same time, the position of Russian psychiatrists remains to be more clinically oriented. Conclusion. Patients who declare the desire to reassign their gender have to be assessed by psychiatrists for differential diagnosis to exclude a mental disorder. In such cases, the destigmatization of mental disorders is more critical than the depathologization of gender identity disorders.
Copyright (c) 2021 Dyachenko A.V., Perekhov A.Y., Soldatkin V.A., Bukhanovskaya O.A. https://creativecommons.org/licenses/by/4.0
ICD-11 as a Paradigm Shift Phase in the Classification of Mental Disorders
Classifications of mental disorders change regularly. This fact requires analysis, taking into account changes in the epidemiological situation and changes in the organizational structure of mental health service, and development of its technical and human resources. The preliminary analysis of these changes presented in the article using the example of ICD-11 gives us reason to believe that they are almost unrelated to the diagnostic process improvement. On the contrary, each new classification is characterized by an increasing formalization and simplification of the criteria for separate clinical forms. The inevitable losses of clinical accuracy in psychopathological assessment of disorder are compensated for increasing opportunities to deliver care to a significantly greater number of patients.
Copyright (c) 2021 Krasnov V.N. https://creativecommons.org/licenses/by/4.0
Qatar Community Mental Health Care: Achievements and Challenges
Guided by international best practice and evidence-based medicine, the Qatar mental health service has undergone a major transformation in the last two decades, replacing the institution-based service with an accessible multidisciplinary community-based service. In this paper, we provide a brief historical background to mental health services in Qatar, and the progress and development towards community-based mental health-care provision. We also explore the challenges facing this new model of care in Qatar including social and cultural sensitivities, and the various solutions adopted to overcome these challenges. We outline the comprehensive plans envisaged to further develop Qatar community mental health services, including the provision of accessible, integrated and multimodal mental health care within primary care settings.
Copyright (c) 2021 Ahmed M., Ghuloum S. https://creativecommons.org/licenses/by/4.0
Community Mental Health Care in Serbia: Development and Perspectives
Community mental health care was developed in Serbia in 1982 at the Belgrade Institute of mental health. Treatment was provided through the primary health care system, with each health centre having its own mental health care team. However, in the process of psychiatric reform and deinstitutionalization, dedicated community centres had to be established, in accordance with the National Strategy for the Development of Mental Health Care. The first community-based mental health centre opened in the southern area of Serbia in 2005 and subsequently, other centres were established. The centres are organized independently of psychiatric hospitals and are located in local, self-government units, providing psychosocial treatment and the continuation of mental health care. In relation to the ongoing reform of psychiatry in the country, there are positive and negative issues. There are 41.41 beds per 100,000 of the population in psychiatric hospitals and 18.33 beds per 100,000 of the population in the psychiatric departments of general hospitals. Day hospitals, established throughout the country, provide patients with good quality care. Mental health care professionals are educated to a high standard and integrative, person-centred treatment is applied in most services. However, the level of stigma directed towards those with mental illness is still high and constitutes a barrier to treatment. Well-developed screening and early detection programmes to identify persons requiring mental health care are lacking, as are the records of patients with mental disorders. The future goal is to further reduce the number of beds in psychiatric hospitals, establish new community mental health care services throughout the country and ensure the prevention of mental disorders, as well as mental health promotion.
Copyright (c) 2021 Lecic-Tosevski D., Milosavljevic M. https://creativecommons.org/licenses/by/4.0
The Evolution of Approaches to Schizophrenia Diagnostics: from Kraepelin to ICD-11
This article presents the evolution of views on schizophrenia diagnostics over the course of 150 years, beginning from the pre-Kraepelin period and ending with concepts developed in recent decades. Consideration is given to the merits and demerits of contemporary official classifications (DSM-5 and ICD-11) as well as to alternative approaches, particularly in relation to scientific research, and their prospects for development. Special attention is paid to the Research Domain Criteria Project (RDoC) of the National Institute of Mental Health (NIMH). Another promising area discussed in this paper relates to network analysis as a method for the investigation of psychotic disorders, particularly schizophrenia.
Copyright (c) 2021 Shmukler A.B. https://creativecommons.org/licenses/by/4.0
Toward ICD-11 Implementation: Attitudes and Expectations of the Russian Psychiatric Community
Background. ICD-11 implementation will start in early 2022 in WHO member countries, including Russia. This process should be preceded not only by the official translation and wide distribution of ICD-11 statistical classification and diagnostic guidelines but also by clinicians’ training. For recent years ICD-11 development and innovations in the diagnosis of mental disorders were in the focus of attention of mental health professionals in all over the world. Objectives. This online survey aimed to identify the current views of the Russian psychiatric community on the upcoming implementation of ICD-11. Methods. A survey was composed in a Google form and circulated through the website of the Russian Society of Psychiatrists and other professional networks. Statistical and narrative analysis was provided. The sample was represented by 148 psychiatrists working in inpatient or outpatient clinical settings. Results. Expectations for the classification of mental disorders reported by the respondents were wider than the current purpose of ICD-10. In general, the Russian psychiatrists expressed their interests to forthcoming ICD-11 implementation. Positive attitudes to ICD-11 innovations were associated with the familiarity with the ICD-11 draft. Conservative or negative views were related to longer years of clinical experience. Early carrier psychiatrists were more practically oriented than ’old school’ clinicians. Conclusion. This survey may help to promote the ICD-11 by focusing on its advantages for clinical practice and develop targeted training programs.
Copyright (c) 2021 Kulygina M.A., Syunyakov T.S., Fedotov I.A., Kostyuk G.P. https://creativecommons.org/licenses/by/4.0
The Use of ICD-10 for Diagnosing Mental Disorders In Russia, According to National Statistics and a Survey of Psychiatrists' Experience
Purpose and methods. In order to assess the specifics of practical use of the ICD-10 Diagnostic Guidelines by Russian psychiatrists, official national statistics on the prevalence of a number of mental disorders in Russia in 2019 were compared with the results of meta-analyses of international epidemiological studies of these disorders. In addition, a number of items in the online psychiatrists' survey, relating to the diagnosis of schizophrenia, were analysed; 807 Russian psychiatrists took part in the online survey. Results. Analysis of national statistics showed that domestic clinicians diagnose some mental disorders significantly less often than might be expected, according to data obtained by international epidemiological studies. The number of cases of bipolar affective disorder registered in Russia is 90–150 times less than that for the prevalence of this disorder, according to meta-analyses of epidemiological studies; for depression, the result is 50–70 times; for anxiety disorders, the number is 25–50 times, and for autism, it is 30 times. Instead of the above disorders, diagnoses of organic non-psychotic mental disorders and schizophrenia might have been used unreasonably often. Between 2005 and 2019, diagnosis of childhood autism changed significantly (an increase of more than 100%), while the frequency of diagnosing other mental disorders remained unchanged. The results of the online survey also showed largely perfunctory use of the ICD-10 Diagnostic Guidelines, with a third of respondents reporting never checking the diagnostic schedules, and another third doing so from time to time. In addition, the low estimates given by survey participants regarding practical utility of the ICD-10 Diagnostic Guidelines, along with a large percentage of respondents who do not directly use diagnostic criteria in their work, indicate the need to improve the clinical usefulness of the diagnostic guidelines in the latest revision of the ICD, including convenience of use in practice. Conclusion. The results of analysis of the Russian national mental health service statistic indicate that at least some diagnostic categories are not used by Russian psychiatrists exactly as ICD-10 suggests. The revealed discrepancy between the principles of diagnostics observed by domestic clinicians and international criteria may interfere with the use of evidence-based treatment algorithms, negatively affecting the quality of psychiatric care. In light of the upcoming transition to ICD-11 and in order to unify approaches to the diagnosis of mental disorders in our country, it is necessary to update and improve educational programmes for psychiatrists.
Copyright (c) 2021 Martynikhin I.A. https://creativecommons.org/licenses/by/4.0
Depathologizing Sexual Orientation and Transgender Identities in Psychiatric Classifications
Introduction. This article presents the history and rationales of conceptualization and classification of homosexuality and transgender identity in both ICD and DSM. We review the efforts that have been made (and those that remain pending) to improve psychiatric classifications with new scientific knowledge, changing social attitudes and human rights standards. Method. We conducted a literature search of the classification of homosexuality and transgender identity as mental disorders. Result. We provide a historical description of these concepts in ICD and DSM, including fundamental points of disagreement as well as arguments that have been effective in achieving changes in both classifications. Conclusions. Fundamental changes have been made in the International Classification of Diseases Eleventh Revision (ICD-11) in terms of the classification of sexual orientation and gender identity based on scientific evidence and the ICD’s public health objectives. These changes might support the provision of accessible and high-quality healthcare services, and are responsive to the needs, experience and human rights of the populations involved.
Copyright (c) 2021 Robles R., Real T., Reed G. https://creativecommons.org/licenses/by/4.0
ICD-11 Revision of Mental Disorders: the Global Standard for Health Data, Clinical Documentation, and Statistical Aggregation
Mental health conditions in the World Health Organization (WHO) European Region affect more than 10% of the population, with 140,000 lives lost annually to suicide. Comorbidity with other diseases is high. However, basic mental health care is received by less than a third of patients. The COVID-19 pandemic has revealed the vulnerability of mental health services to disruptions and underscored the need to integrate mental health into response strategies. One of the flagship initiatives of the WHO European Programme of Work (EPW), 2020–2025: ‘United Action for Better Health in Europe’ is the establishment of a Mental Health Coalition at the European level. In this framework, reporting of health statistics using the International Classification of Diseases 11th Revision (ICD-11) will begin on 1st January 2022. Clinical utility, scientific rigour and wider cultural applicability were all of prime importance in the development of the ICD-11. The 11th Revision was the end product of the most extensive global, multilingual, multidisciplinary and participative process ever undertaken for this task, involving more than 15,000 experts from 155 countries, representing approximately 80% of the world’s population. With the adoption of the ICD-11 and the priority being given to mental health, new ideas based on the 30 years of research since the approval of the ICD-10 will be widely adopted and applied.
Copyright (c) 2021 Vujnovic M., Manukhina O., Reed G., Theodorakis P., Fountoulakis K. https://creativecommons.org/licenses/by/4.0
Cultural Issues Related to ICD-11 Mental, Behavioural and Neurodevelopmental Disorders
The challenge of producing a classificatory system that is truly representative of different regions and cultural variations is difficult. This can be conceptualized as an ongoing process, achievable by constant commitment in this regard from various stakeholders over successive generations of the classificatory systems. The objective of this article is to conduct a qualitative review of the process and outcome of the efforts that resulted in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders becoming a global classification. The ICD-11 represents an important, albeit iterative, advance in the classification of mental, behavioural and neurodevelopmental disorders. Significant changes have been incorporated in this regard, such as the introduction of new, culturally-relevant categories, modifications of the diagnostic guidelines, based on culturally informed data and the incorporation of culture-related features for specific disorders. Notwithstanding, there are still certain significant shortcomings and areas for further improvement and research. Some of the key limitations of ICD-11 relate to the paucity of research on the role of culture in the pathogenesis of illnesses. To ensure a classificatory system that is fair, reliable and culturally useful, there is a need to generate empirical evidence on diversity in the form of illnesses, as well as mechanisms that explain these in all the regions of the world. In this review, we try to delineate the various cultural challenges and their influences in the formulation of ICD-11, along with potential shortcomings and areas in need of more improvement and research in this regard.
Copyright (c) 2021 Sharan P., Hans G. https://creativecommons.org/licenses/by/4.0
Engagement of Russian Mental Health Professionals in the Development of WHO’s ICD-11
The World Health Organization (WHO) has officially approved the next version of its global diagnostic system, the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11). Processes to implement the ICD-11 are now underway. Developing the ICD-11 chapter on Mental, Behavioural and Neurodevelopmental Disorders, in line with WHO’s core priorities to enhance the clinical utility, reliability, and global applicability of the guidelines, necessitated a large-scale scientifically-rigorous research program. Such a program of global field studies engaged mental health professionals from across the world, with substantial contributions from clinicians in the Russian Federation. This paper systematically highlights the substantive roles played by Russian clinicians in all steps of development of the mental, behavioural, and neurodevelopmental disorder guidelines, including their participation in the following: 1) early formative field studies that informed the organizing principles and overarching structure of the ICD-11; 2) large-scale online studies that used a case-controlled methodology to evaluate the guideline’s clinical utility and the accuracy with which the new ICD-11 guidelines could be applied by global clinicians; 3) an online network of mental health professionals who provided direct feedback on the ICD-11 to WHO (also known as the Global Clinical Practice Network, www.globalclinicalpractice.net) with over 16,000 members from 160 countries, and with the Russian Federation being in the top five most represented countries in the network; 4) clinic-based field studies that tested the reliability and clinical utility of the ICD-11 diagnostic guidelines; and 5) development and participation in training programs that prepare clinicians in implementing the diagnostic guidelines in clinical settings. In these many ways, Russian clinicians have substantively and directly contributed to efforts to maximize the clinical usefulness, consistency, acceptability, and applicability of the ICD-11’s mental, behavioural, and neurodevelopmental disorder guidelines. This substantial engagement of clinicians will conceivably facilitate the adoption and use of the guidelines by clinicians in the Russian Federation and other Russian-speaking countries, as the ICD-11 is implemented over the coming years.
Copyright (c) 2021 Rebello T., Kulygina M.A., Krasnov V.N., Pike K., Reed G. https://creativecommons.org/licenses/by/4.0
Mental Health in Australia and the Challenge of Community Mental Health Reform
Australia was one of the first countries to develop and implement a national mental health plan, 30 years ago. This national approach belied the country’s federal structure, in which the federal government takes responsibility for primary care while state and territory governments manage acute and hospital mental health care. This arrangement has led to significant variations across jurisdictions. It has also left secondary care, often provided in the community, outside of this governance arrangement. This article explores this dilemma and its implications for community mental health, and suggests key steps towards more effective reform of this vital element of mental health care.
Copyright (c) 2021 Rosenberg S., Harvey C. https://creativecommons.org/licenses/by/4.0
Community-based Mental Health Services in Norway
Community-based mental healthcare in Norway consists of local community mental health centres (CMHCs) collaborating with general practitioners and primary mental healthcare in the municipalities, and with psychiatrists and psychologists working in private practices. The CMHCs were developed from the 1980s to give a broad range of comprehensive mental health services in local catchment areas. The CMHCs have outpatient clinics, mobile teams, and inpatient wards. They serve the larger group of patients needing specialized mental healthcare, and they also collaborate with the hospital-based mental health services. Both CMHCs and hospitals are operated by 19 health trusts with public funding. Increasing resources in community-based mental healthcare was a major aim in a national plan for mental health between 1999 and 2008. The number of beds has decreased in CMHCs the last decade, while there has been an increase in mobile teams including crisis resolution teams (CRTs), early intervention teams for psychosis and assertive community treatment teams (ACT teams). Team-based care for mental health problems is also part of primary care, including care for patients with severe mental illnesses. Involuntary inpatient admissions mainly take place at hospitals, but CMHCs may continue such admissions and give community treatment orders for involuntary treatment in the community. The increasing specialization of mental health services are considered to have improved services. However, this may also have resulted in more fragmented services and less continuity of care from service providers whom the patients know and trust. This can be a particular problem for patients with severe mental illnesses. As the outcomes of routine mental health services are usually not measured, the effects of community-based mental care for the patients and their families, are mostly unknown.
Copyright (c) 2021 Ruud T., Friis S. https://creativecommons.org/licenses/by/4.0
Organization of Community Psychiatric Services in Finland
Background. The Finnish psychiatric treatment system has undergone a rapid transformation from operating in institutional settings to a adopting a community-based approach, through implementation of national plans; this process was carried out quickly, due to a severe economic recession in the early 1990s. Methods. This paper is a narrative review, based on relevant documents by national authorities, academic dissertations and published scientific literature, between 1984 and 2018, as well as the interviews of key experts in 2019. Results. The municipality is currently the primary organization, responsible for all health services. Municipalities may also work together in organizing the services, either through “unions of municipalities” or hospital districts. Services are to a great extent outpatient-oriented. The number of beds is one fifth of the previous number, around four decades ago, despite the increase in population. In 2017, 191,895 patients in total (<4% of Finns) had used outpatient psychiatric services, and the number of visits totalled 2.25 million. Psychotherapy is mainly carried out in the private sector by licensed psychotherapists. Homelessness in relation to discharged psychiatric patients has not been in evidence in Finland and deinstitutionalization has not caused an increase in the mortality rate among individuals with severe mental disorders. Conclusion. Psychiatric patients have, in general, benefitted greatly from the shift from institutions to the community. This does not preclude the fact that there are also shortcomings. The development of community care has, to date, focused too heavily on resource allocation, at the expense of strategic planning, and too little on methods of treatment.
Copyright (c) 2021 Korkeila J. https://creativecommons.org/licenses/by/4.0
Immunoinflammatory Profile in Patients with Episodic and Continuous Paranoid Schizophrenia
Introduction. Associations of disturbances in innate and adaptive immunity during the clinical course of schizophrenia have been found in a number of studies. Yet, the relationship of immune parameters and systemic inflammation in relation to the clinical course of the disease and its prognosis, remains poorly understood, which highlights an interesting topic for further research. The goal of this study was to research the immuno-inflammatory changes in patients with clinical continuous and episodic paranoid schizophrenia, to assess the pathogenetic significance of these changes. Methods. Thirty-six patients with paranoid schizophrenia, of which 20 had episodic symptoms and 16 had continuous symptoms, consented to participate in the study, together with 30 healthy volunteers. In the study we assessed the parameters of innate immune response (serum levels of key pro-inflammatory and anti-inflammatory cytokines, C-reactive protein) and the adaptive immune response, including humoral-mediated immunity (serum immunoglobulins IgA, IgM, IgG, circulating immune complexes), as well as the cell link of adaptive immunity (key lymphocyte subpopulations). Positive and negative symptoms were assessed with the positive and negative symptoms scale; frontal dysfunction was assessed by Frontal Assessment Battery (FAB). Results. Both patient groups had higher than normal levels of C-reactive protein and IL-8. There was a significant elevation of circulating immune complexes among patients with continuous symptoms of schizophrenia, compared to patients with episodic symptoms and healthy controls. Levels of CD45+CD3+ lymphocytes (T-cells) differed between clinical groups, with higher values identified among patients with episodic symptoms and lower values among those with continuous symptoms. In addition, patients with episodic symptoms had significantly increased levels of CD45+CD3+CD4+CD25+CD127- regulatory T-cells. Finally, the level of CD45+CD3-CD19+ B-cells was significantly higher among patients with continuous symptoms vs. patients with episodic symptoms and the control groups. Markers of activation of humoral immunity were associated with the severity of frontal disorders in these patients. Discussion. Comprehensive data on the serum level of cytokines and the parameters of adaptive immunity among individuals with continuous schizophrenia, by comparison with patients with episodic schizophrenia, are practically absent in the literature. We have shown that among those with continuous schizophrenia, there are signs of systemic inflammation and chronic activation of the adaptive humoral immune response, while among patients with episodic symptoms of the disease, there are signs of systemic inflammation and certain activation of cell-mediated immunity, without significant changes in the humoral link of adaptive immunity. Conclusion. More studies are needed, but the data obtained in this study are important for subsequent clinical studies of new treatment methods, based on various immunophenotypes of schizophrenia.
Copyright (c) 2021 Malashenkova I.K., Krynskiy S.A., Ogurtsov D.P., Hailov N.A., Zakharova N.V., Bravve L.V., Kaydan M.A., Chekulaeva E.I., Andreyuk D.S., Ushakov V.L., Didkovsky N.A., Kostyuk G.P. https://creativecommons.org/licenses/by/4.0
Suicides in the COVID-19 Pandemic — Are We Well Informed Regarding Current Risks and Future Prospects?
Background. Suicides are predicted to drop in the acute phase of any crisis that poses a threat to the entire population, though data on this are inconsistent. A pandemic is the most severe global crisis one can imagine. There is an urgent need to identify objective trends in suicide rates across countries and populations in a real-time manner in order to be better informed regarding prospects and adaptation of preventive strategies. Objectives. To evaluate suicidal behaviour in a metropolis immediately after the introduction of severe containment measures due to the pandemic. Methods. Cases of completed suicides in St. Petersburg were obtained from the local city Bureau of Forensic Medical Examinations for the period 1 January 2016 to 31 July 2020. Data were accurately collected and monthly frequencies per 100,000 of the population in April-May 2020 (introduction of the most severe “stay at home” measures) were compared with corresponding data from 2016-2019. Confidence intervals were calculated according to Wilson. Results. Suicide frequencies in the population of St. Petersburg in April 2020 did not go up, in contrast, they were 30.3% lower than the average for the previous four years. The decrease in April was more pronounced in males than in females (36.3% and12.4%, respectively). When looking at age groups it was found that the biggest drop in suicides was in older males (> 55 years). In this group, suicide indices were 58.5% lower than average for the previous four years. However, in females, there was a 50% rise in suicides in June, while in young males (15-34 years) there was an 87.9% rise in May. Total number of suicides for the first half of 2020 was very close to the average seen in previous years. None of the registered changes were statistically significant. Conclusions. The analysis is preliminary and does not account for possible seasonality, however, we consider that the reduction in completed suicides immediately after crisis exposure deserves attention. It supports views that in the acute phase of the crisis, suicidal behaviour may decline, which may be quickly replaced by a rise. Such a rise in females and younger males points on possible risk groups and requires a response from society. More studies are needed to have a clearer picture of suicide dynamics in Russia during the different waves of the pandemic, and prevention should be prioritized regardless of the tendencies.
Copyright (c) 2021 Rozanov V.A., Semenova N.V., Vuks A.J., Freize V.V., Isakov V.D., Yagmurov O.D., Neznanov N.G. https://creativecommons.org/licenses/by/4.0
Since the Second World War mental health programmes and psychiatry have made significant advances. Countries, as well as the United Nations, have recognized the magnitude and severity of mental health problems, and numerous national programmes have been launched to deal with them. Technology relating to the treatment of mental disorders has advanced and significant progress has been made in terms of knowledge regarding the functioning of the brain. The awareness of the need to protect the human rights of those with mental illness has increased. National and regional programmes against stigma and the consequent discrimination of those with mental illness, have been launched in many countries. Associations bringing together those who have experienced mental illness and their relatives, have come into existence in many countries. While these are great steps forward, more work is necessary to complete these advances. In low- and middle-income countries, the vast majority of people with mental disorders do not receive adequate treatment. Even in highly industrialized countries, a third of people with severe forms of mental illness are not receiving the appropriate therapy. Laws concerning mental health are outdated in many countries. The protection of the human rights of the mentally ill is incomplete and imperfect. The emphasis on economic gain and the digitalization of medicine in recent years has not helped. On occasions, this has even slowed down the development of mental health services, and the provision of mental healthcare. Thus, psychiatry must still deal with the challenges of the past century, while facing new demands and tasks. Among the new tasks for psychiatry are undoubtedly reforms which will allow (i) the provision of appropriate care of people with comorbid mental and physical disorders, (ii) the application of interventions leading to the primary prevention of mental and neurological disorders, and (iii) a radical reform of the education of psychiatrists and other mental health workers, dealing with mental illness. Collaboration with other stakeholders in the field of mental health and medicine, will be of crucial importance in relation to all these tasks.
Copyright (c) 2021 Sartorius N. https://creativecommons.org/licenses/by/4.0
Emotional Response to Humour Perception and Gelotophobia Among Healthy Individuals and Patients with Schizophrenia and Depression, with Signs of a High Clinical Risk of Psychosis
Introduction. Investigating early changes in the emotional sphere within the schizophrenia course is a perspective direction in clinical psychology and psychiatry. Intactness of positive emotions, in particular, humour perception, may be a very important resource for patients. At the same time, humour perception is very sensitive to pathological conditions, such as the fear of being laughed at, known as “gelotophobia”. Those with gelotophobia perceive laughter as dangerous, rather than pleasant, and they can hardly distinguish between teasing and ridicule. Gelotophobia was confirmed to be expressed among people with mental disorders. Nonetheless, knowledge relating to the fear of being laughed at, was mostly generated among the non-clinical samples. Objectives. Thus, the aim of the study was to provide more clinical data on gelotophobia manifestations associated with schizophrenia spectrum disorders; the emotional response and facial expression of patients with gelotophobia were studied, in particular, regarding their perception of humour, including during the early stages of disorders, by comparison with healthy individuals. Methods. n=30 controls and n=32 patients with schizophrenia and with depression with signs of a high clinical risk of psychosis took part. Two short videos, comic and neutral, were shown to the participants, while videotaping their facial expression, followed each by a self-reported measure of emotional responses. Participants also completed the State-Trait Anxiety Inventory, the PhoPhiKat<30> and the Toronto Alexithymia Scale. Results. Gelotophobia was significantly higher within the clinical group. It correlated with a lower frequency of grins among the patients during the comic video, while this was not the case in the control group. Gelotophobia was related to state and trait anxiety in both groups, but only in the clinical group did state anxiety increase after watching the comic video. Gelotophobia correlated with alexithymia and was twice higher among the patients compared to the controls. Conclusion. Thus, gelotophobia has not only quantitative, but also qualitative specifics in patients with schizophrenia, and those with depression with signs of a clinically high risk of psychosis, compared to healthy controls.
Copyright (c) 2021 Volovik D.D., Omelchenko M.A., Ivanova A.M. https://creativecommons.org/licenses/by/4.0
The Virus Covid-19 and Dilemmas of Online Technology
Commentary on the COVID-19 pandemic must necessarily consider the medical issues in social and political context. This paper discusses one important dimension of the context, the long-term history of human activity as intrinsically technological in its nature. The pandemic has accelerated the use of technology to mediate relations between people “at a distance”. This involves not only a change in the skills people have (though acquiring these skills has become the central project of work for many people), but changes the sort of person they are. Our notions of “closeness” and “distance”, or of “touching” and “being touched”, and so on, refer simultaneously to states that are spatial and emotional, factual and evaluative. Inquiry into the differences in human relations where there is physical presence and where there is not raises very significant questions. What are the differences and why are they thought, and felt, to matter? What are the differences when the relationship is supposed to be a therapeutic one? What are the financial and political interests at work in enforcing relations at a distance by new media, i.e., “mediated” relations? How is a person’s agency affected by a lack of freedom to move or a lack of face-to-face contact? What happens to all those human relations for which physical presence was previously the norm, relations such as those performed in the rituals of birth, marriage and death, or in activities like sport and the arts? Can it be said that new technologies involve a “loss of soul”? The present paper seeks to provide a reflective and open-ended framework for asking such questions.
Copyright (c) 2020 Smith R. https://creativecommons.org/licenses/by/4.0
Long-Acting Injectable Drugs in the Maintenance Therapy of Patients with Schizophrenia
This article discusses case reports of treatment with paliperidone palmitate in comparison with data from recent publications. Second-generation long-acting injectable antipsychotics have been shown to provide better control of psychiatric manifestations, reduce the severity of negative symptoms, improve social functioning and quality of life of patients and relatives, and reduce the burden of disease for both the healthcare system and the caregivers. The case reports presented in this article demonstrate better quality of remission in schizophrenia patients treated with one- monthly and three-monthly paliperidone palmitate formulations, due to higher effi in preventing relapses, better safety and good tolerability regardless of patient age.
Copyright (c) 2020 Petrova N.N., Serazetdinova V.S. https://creativecommons.org/licenses/by/4.0
The Syndemic Approach in relation to Clinical Practice and Research in Psychiatry
The syndemic framework goes beyond the concept of comorbidity and considers how diseases interact within their wider environmental context, along with social and political factors, to mutually exacerbate negative outcomes. The syndemic approach enhances the way mental disorders are understood in terms of their aetiology, treatment and prognosis and therefore influences the direction of clinical practice, policy development and research priorities in the field of psychiatry. Using a syndemic framework to develop mental health policy globally can help address the mental health “treatment gap” in countries where resources are limited. In Russia, identified syndemics have been of particular relevance to mental disorders and further research using a syndemic framework will continue to build upon the strong background of integrated mental healthcare currently provided.
Copyright (c) 2020 Parry S.J., Thornicroft G. https://creativecommons.org/licenses/by/4.0
Diagnosis and treatment depression in schizophrenia
Depression is the third most common illness among patients with schizophrenia which negatively affects the course of the disease and significantly contributes to the mortality rate, due to increased suicide. Depression, along with negative symptoms and cognitive deficits, is one of the main factors that significantly decreases the quality of life and the disease prognosis in patients with schizophrenia. In addition, depression increases the frequency of exacerbations and readmissions, decreases the quality and duration of remissions and is associated with more frequent substance abuse and an increased economic burden. Data on the prevalence of depression among patients with schizophrenia are contradictory and are associated with a low detection rate of depression in such patients, a lack of clear diagnostic criteria and difficulties in differentiation between extrapyramidal and negative symptoms. The average prevalence of depression that meets the diagnostic criteria of major depressive episodes in patients with schizophrenia is 25% at a specific point, and 60% over the course of a lifetime; the frequency of subsyndromal depression is much higher. It is essential to distinguish between primary (axial syndrome) and secondary depressive symptoms (extrapyramidal symptoms, psychogenic or nosogenic reactions, social factors, etc.) to determine treatment strategies. The published data relating to randomized clinical trials for the development of evidence-based guidelines are limited. Current recommendations are based mainly on the results of small-scale trials and reviews. Certain atypical antipsychotics (quetiapine, lurasidone, amisulpride, aripiprazole, olanzapine, clozapine) are superior to typical antipsychotics in the reduction of depressive symptoms. Clozapine is effective in the management of patients at risk from suicide. The additional prescription of antidepressants, transcranial magnetic stimulation and electroconvulsive therapy are not always effective and are only possible following the management of acute psychosis in cases when antipsychotic monotherapy proved to be ineffective.
Copyright (c) 2020 Mosolov S.N. https://creativecommons.org/licenses/by/4.0
Community Mental Health Practice in the United States: Past, Present and Future
Similar to trends in Europe, approaches to mental illness in colonial America and recorded in early United States history were commonly characterized by incarceration and the removal of individuals from communities. In the mid-20th century, a major shift began in which treatment was offered in the community with the aim of encouraging individuals to rejoin their communities. In this paper, we will provide a brief history of community mental health services in the United States, and the forces which have influenced its development. We will explore the early antecedents of community-based approaches to care, and then detail certain factors that led to legislative, peer and clinical efforts to create ‘Community Mental Health Centers.’ We will then provide an overview of current community mental health practices and evolving challenges through to the present day, including the development of services which remain focused on recovery as the ultimate goal.
Copyright (c) 2020 Hamm J.A., Rutherford S., Wiesepape C.N., Lysaker P.N. https://creativecommons.org/licenses/by/4.0
Community-Based Mental Health Care in Britain
Community mental health care in the UK was established by two influential mental health acts (MHAs). The 1930 MHA legislated for voluntary admissions and outpatient clinics. The 1959 MHA required hospitals to provide local follow- up after discharge, required them to work closely with local social services and obliged social services to help with accommodation and support. An effect of this was to establish highly sectorized services for populations of about 50,000. These were served by multidisciplinary teams (generic CMHTs), which accepted all local referrals from family doctors. Sector CMHTs evolved a pragmatic approach with an emphasis on skill-sharing and outreach, depending heavily on community psychiatric nurses. The NHS is funded by central taxation, with no distortion of clinical practice by per-item service fees. It is highly centrally regulated, with a strong emphasis on evidence-based treatments. Since 2000, generic sector teams have gradually been replaced or enhanced by Crisis Resolution Home Treatment teams, Assertive Outreach Teams and Early Intervention Teams. Assertive Outreach Teams were resorbed into CMHTs, based on outcome evidence. The last decade has seen a major expansion in outpatient psychotherapy (Improving Access to Psychological Treatments (IAPT) services) and in specialist teams for personality disorders and perinatal psychiatry. The traditional continuity of care across the inpatient-outpatient divide has recently been broken. During the last decade of austerity, day care services have been decimated, and (along with the reduction in availability of beds) compulsory admission rates have risen sharply. Mental health care is still disadvantaged, receiving 11% of the NHS spend while accounting for 23% of the burden of disease.
Copyright (c) 2020 Burns T. https://creativecommons.org/licenses/by/4.0
Promotion of Mental Health Rehabilitation in China: Community- Based Mental-Health Services
Community-based mental health services are important for the treatment and recovery of patients with mental health disorders. The Chinese government has made the establishment of a highly eﬃcient community-based health service an enduring priority. Since the 1960s, community-based mental health services have been developed in many Chinese cities and provinces. National policies, including mental health regulations and ﬁve-year national mental health working plans, have been issued to support the development of quality of mental health services. The accessibility and eﬃciency of community-based mental health services are now highly promoted to community residents. According to the National Standards for Primary Public Health Services, community-based mental health services are one of the most important components of primary public health services. They are mainly provided via Community Health Service Centres (CHCs), by a combination of general practitioners, public health physicians, nurses and social workers. Patients receive individualized and continuous health services according to their rehabilitation status. These services include regular physical examination, health education, rehabilitation guidance, social function rehabilitation training, vocational training and referral services; family members also receive care and psychological support. Future work will focus on expanding mental health service coverage and usage, increasing awareness of mental health and decreasing stigma, and strengthening service capability to establish an integrated model to enhance the overall eﬃciency of mental health services.
Copyright (c) 2020 Zhu Y., Li X., Zhao M. https://creativecommons.org/licenses/by/4.0
Copyright (c) 2020 Kostyuk G.P. https://creativecommons.org/licenses/by/4.0
To Say or Not to Say: Medical and Social Project
Mental health and psychological education activities are being carried out in Moscow (the Russian Federation), along with measures aimed at prevention of social stigma in mental health care. The medical, social and educational project To Say or Not to Say has been developed by a group of experts from the Mental-health clinic No. 1 named after N.A. Alexeev, for Moscow residents. The title chosen for the project urges participants to make a choice: continue living with their problems or take a step towards solving them. A new educational activity format has been created and tested in the course of the project, and this format provides an opportunity to largely overcome the stigmatizing barriers that prevent people from seeking psychological and psychiatric help in Moscow. Sixteen events involving over 7,000 citizens have been held, and the psychiatrists engaged in the project have spent 2,280 man-hours in this volunteering activity. We believe that this educational activity could help to overcome social stigma in psychiatry, further research is needed to measure the effect of our educational project on social stigma associated with mental health.
Copyright (c) 2020 Abramova L.N., Shakhova E.V. https://creativecommons.org/licenses/by/4.0
Negative Symptoms of Schizophrenia: New Prospects of Cariprazine Treatment
Background. Cariprazine is a new piperazine derivative atypical antipsychotic, like aripiprazole and brexpiprazole. It has been approved for treating schizophrenia in many countries and has recently been included on the List of Essential Medicines in Russia. Unlike most other atypical antipsychotics, it shows high in vivo occupancy of dopamine D2 and D3 receptors at clinically relevant doses. In animal models, cariprazine has demonstrated dopamine D3 receptor- dependent pro-cognitive and anti-anhedonic effects, suggesting its potential for treating negative symptoms. This review summarizes the efficacy of cariprazine in the treatment of negative symptoms of schizophrenia. Methods. A literature search of databases covering international and Russian journals, for articles published between 1st January 2010 and 1st June 2020. Results. Cariprazine demonstrated at least comparable efficacy in the treatment of schizophrenia symptoms to active comparators including risperidone, olanzapine or aripiprazole. The drug has a good safety profile. It appeared to be associated with a lower risk of metabolic syndromes and most extrapyramidal symptoms. The positive effect of cariprazine on the negative symptoms of schizophrenia may be associated with the elimination of secondary negative symptoms. However, of all the atypical antipsychotics to date, only cariprazine has a convincingly, methodologically robust proven advantage over risperidone in eliminating the predominant negative symptoms of schizophrenia. Yet only four studies have investigated the effect of cariprazine on the negative symptoms of schizophrenia. There is a lack of research into its direct impact on emotional-volitional disorders, anhedonia, cognitive symptoms and personality changes. However, there is evidence to suggest cariprazine is effective in treatment-resistant cases, but this requires further confirmation. Conclusion. Cariprazine is an effective and well-tolerated agent for the treatment of schizophrenia and may be effective in cases where other antipsychotics have failed. Cariprazine has been shown to have a positive effect on negative symptoms. Further studies are needed to collect more data on long-term treatment of schizophrenia and especially negative symptoms.
Copyright (c) 2020 Reznik A.M., Arbuzov A.L., Murin S.P., Pavlichenko A.V. https://creativecommons.org/licenses/by/4.0
Islamophobia, mental health and psychiatry: South Asian perspectives
Asia is the largest and the most populous continent on earth. South Asia has a population of around 1.8 billion, thus constituting about one fourth of humanity. India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, the Maldives and Afghanistan are the countries in South Asia and many of them are Muslim-majority nations. Although India is predominantly a Hindu nation with a total population of 1.4 billion, there are more Muslims in India than in Pakistan and other South Asian nations. Hindus, Muslims, Christians, Sikhs and followers of other religions have lived peacefully in South Asia for centuries. However, certain incidents of communal violence and other untoward occurrences in South Asia suggest that Islamophobia is present here too. The authors discuss demography, cultures and the possible effect of Islamophobia on the mental health of the people of South Asia.
Copyright (c) 2020 Kallivayalil R.A., Jilani A.Q., Tripathi A. https://creativecommons.org/licenses/by/4.0
Community psychiatry in Portugal: a critical review
The mental health system in Portugal evolved from an institutional-centred system to a community-based system, a process which began in 1998 and has gathered pace since 2006. The approval and implementation of the Portuguese Mental Health Law and the Portuguese National Mental Health Care Plan has contributed to the implementation of institutions and regulations aimed at decentralized, local and less restrictive models of care. The implementation and evolution process has been steady and gradual, introducing many of the envisioned changes whilst adapting existing mental health institutions and services. The current article describes this transition process, attempting to identify the strengths and weaknesses of the Portuguese Mental Health System from a community-centred perspective.
Copyright (c) 2020 Frias P., Pinto da Costa M. https://creativecommons.org/licenses/by-nc-nd/4.0/
Community-based mental health services in Brazil
Introduction. The shift from the hospital-based model of care to community-based mental health services began three decades ago and is still an ongoing process in Brazil. Objectives. To update data on the development of the community mental health services network in Brazil in relation to service availability and structure, manpower, pattern of service use, financing, epidemiological studies and the burden of mental disorders, research and national mental health policy. Methods. Searches were constructed to collect data on indexed databases (Medline, Scielo), as well as governmental, NGOs and medical council sources, reports and the grey literature up until 30th March, 2019. Results. Community mental health services are unevenly distributed in the country. Brazil leads the world in terms of the prevalence of anxiety disorders, ranking fifth for depression prevalence. Violence and suicide rates are two growing factors which exacerbate the prevalence of mental disorders prevalence. An increased reduction of the number of psychiatric beds in the country, in addition to the unbalanced growth of services in the community, has resulted in treatment gaps and the underutilization of services and barriers to treating people with the most severe psychosis. Investment in mental healthcare is still scarce. However, mental health funding is not addressed according to the population´s needs and scientific evidence, resulting in a waste of resources and inefficiency. Programmes and service interruptions are common according to each government mandate. Conclusion. Successive changes in ideological perspectives have led to the introduction of policies which have caused fragmentation in the mental health system and services. A lack of evaluation and transparency of services and costs are the main barriers to integrating multiple services and planning long-term developmental phases.
Copyright (c) 2020 Razzouk D., Cheli Caparroce D., Sousa A. https://creativecommons.org/licenses/by/4.0
Cognitive behavioural therapy in virtual reality treatments across mental health conditions: a systematic review
Background. Virtual reality (VR) has been effectively used in the treatment of many mental health disorders. However, significant gaps exist in the literature. There is no treatment framework for researchers to use when developing new VR treatments. One recommended treatment across a range of diagnoses, which may be suitable for use in VR treatments, is Cognitive Behavioural Therapy (CBT). The aim of this systematic review is to investigate CBT treatment methods that utilize VR to treat mental health disorders. Objectives. To investigate how CBT has been used in VR to treat mental health disorders and to report on the treatment characteristics (number of sessions, duration, and frequency) that are linked to effective and ineffective trials. Methods. Studies were included if patients had a mental health diagnosis and their treatment included immersive VR technology and CBT principles. Data were extracted in relation to treatment characteristics and outcomes, and analysed using narrative synthesis. Results. Ninety-three studies were analysed. Exposure-based VR treatments were mainly used to treat anxietyrelated disorders. Treatments generally consisted of eight sessions, once a week for approximately one hour. VR treatments were commonly equal to or more effective than ‘traditional’ face-to-face methods. No specific treatment characteristics were linked to this effectiveness. Conclusion. The number, frequency and duration of the VR treatment sessions identified in this review, could be used as a treatment framework by researchers and clinicians. This could potentially save researchers time and money when developing new interventions.
Copyright (c) 2020 Dilgul M., Martinez J., Laxhman N., Priebe S., Bird V. https://creativecommons.org/licenses/by/4.0
Community-based psychiatry around the world
Copyright (c) 2020 Karpenko O.A., Kulygina M.A., Kostyuk G.P. https://creativecommons.org/licenses/by-nc-nd/4.0/
Lebanon is a medium-income country in the Eastern Mediterranean which has seen a surge in interest in mental health over the past two decades following years of stagnation. The mental health needs of the country at primary care level and for severe psychiatric disorders are underserved. Political instability, chronic underfunding and widespread stigma have all contributed to maintaining a traditional model of private clinics affiliated with inpatient and long-stay psychiatric units. A number of initiatives have recently been launched to cater for patients with psychotic disorders and also to offer partial hospitalization for others with mood-related conditions. In parallel, the Ministry of Public Health, with international funding, has been instrumental in its efforts to standardize care at a national level, particularly for early detection and treatment in primary care settings. The priorities of the national mental health programme are consistent with the global trend in shifting services to the community. Hurdles remain, in line with those facing countries with similar socio-demographics and resources. These include limited third-party coverage of mental health, absence of training opportunities in multidisciplinary community settings and some clinicians’ reluctance to update their ways of working. Development of a local workforce, familiar with evidence-based models of care and dedicated to providing a patient-centred approach in the least restrictive settings, is essential for consolidating community care in Lebanon. This would be reinforced by (overdue) legislation and implementation of a mental health law.
Copyright (c) 2020 El-Khoury J., Haidar R., Charara R. https://creativecommons.org/licenses/by-nc-nd/4.0/
COVID-19: сonsequences for mental health and the use of e-Mental health options
The current COVID-19 pandemic is associated with fear, insecurity, and perceived social isolation worldwide. In this editorial, we discuss the influence of the COVID-19 pandemic on mental health among the general population and among particularly vulnerable groups (e.g., people with pre-existing mental illness). Additionally, we explore the role of e-mental health options in times of social distancing. Preliminary empirical evidence indicates that a wide range of people have experienced mental health difficulties due to the COVID-19 pandemic and corresponding infection-control measures. E-mental health options are a feasible means of addressing psychological distress and mental illness during the pandemic. Thus, these options should be made available in a timely fashion. Future multidisciplinary research is needed to develop e-mental health strategies that specifically focus on the consequences of social isolation, economic hardship and fear of infection.
Copyright (c) 2020 Gaebel W., Lukies R., Stricker J. https://creativecommons.org/licenses/by/4.0
Impact of COVID-19 pandemic on anxiety, depression and distress – online survey results amid the pandemic in Russia
Background. In 2020, the COVID-19 pandemic evoked a variety of research into the virus and its effects on mental health. A variety of mental health and psychological problems have been reported: stress, anxiety, depressive symptoms, insomnia, denial, stigma, anger and fear. Objectives. To assess the level of anxiety, depression and distress in the general population during the lockdown in Russia and to reveal factors associated with distress. Methods. An online survey was carried out from 22–27 April 2020 (the fourth week of lockdown) among the general population (mostly Moscow residents). The survey questions covered general information about people’s social and demographic characteristics, experience of COVID-19, health condition (physical and mental), attitudes and views on the pandemic, and the need for psychological support. The survey included the Hospital Anxiety and Depression Scale (HADS) and evaluation of the preceding week’s subjective distress level using a visual numeric scale (from 0 to 10). We also asked respondents to specify the causes of distress, adopted from the WHO information sheet relating to the major psychological challenges of the COVID-19 pandemic. Results. In total, 352 responses were collected (men = 74, women = 278; age (M ± SD) = 36.81 ± 11.36 y.o.). Most respondents (n = 225, 63.92%) did not have any personal experience of the coronavirus infection. Normal levels of anxiety and depression scores were prevalent in the sample. Higher than normal levels of HADS anxiety/depression (> 7 scores) were observed in 105 (29.83%) and 59 (16.76%) respondents, respectively; mean (95% CI) scores for HADS anxiety/depression were 6.23 [5.77, 6.68] /4.65 [4.22, 5.08] (women) and 4.20 [3.32, 5.09] /3.46 [2.63, 4.29] (men), respectively. The leading causes of distress were: 1) the risk of financial problems in the future (n = 267, 76.3%); 2) violation of plans and the disruption to normal life (n = 235, 67.1%; and n = 240, 68.6%, respectively); 3) the health of elderly or chronically diseased relatives (n = 205, 58.6%) and 4) being in self-isolation (n = 186, 53.1%). Conclusion. The level of anxiety and depression during the COVID-19 pandemic in the study sample did not exceed the norm for the population in non-pandemic conditions. Our assessment of distress levels captured existing emotional problems, and distress levels were found to be connected with the reported need for psychological support.
Copyright (c) 2020 Karpenko O.A., Syunyakov T.S., Kulygina M.A., Pavlichenko A.V., Chetkina A.S., Andrushchenko A.V. https://creativecommons.org/licenses/by-nc-nd/4.0/
Schizophrenia and toxoplasmosis: association with catatonic symptoms
Introduction. The association between schizophrenia and toxoplasmosis has been demonstrated in a number of studies: the prevalence of schizophrenia is significantly higher in toxoplasmosis positive subjects than in those with T.gondii negative status. However, the clinical significance of this association remains poorly understood. Objectives. To identify clinical phenomena that are typical for toxoplasmosis-associated (T.gondii seropositive) schizophrenia compared to Toxoplasma-seronegative schizophrenia. Methods. A retrospective database analysis of serum samples from 105 inpatients with schizophrenia (ICD-10 code: F20; including 55 male patients; mean age of 27.4 ± 6.4 years) was carried out. The clinical examination involved a structured interview including ICD-10 and E. Bleuler’s criteria for schizophrenia and psychometric tests (Positive and Negative Scales of PANSS). Serum antibodies (IgG) to T.gondii were identified using ELISA. The statistical significance of any differences were evaluated using the non-parametric Mann-Whitney (U) and χ2 tests. Results. The proportion of seropositive patients in the sample was 16.2%. Comparing schizophrenia patients, who were seropositive or seronegative for toxoplasmosis, there were no statistically significant differences for the mean total PANSS score, mean PANSS-P, PANSS-N or PANSS-G scores. For the majority of PANSS items, differences were also statistically insignificant, except for G5 and G6—mannerism and posturing. Seropositive patients had a higher score for this item than seronegative patients: 3.5 versus 2.1 points (U=389.5; р=0.001). Depression, on the contrary, was less pronounced in seropositive than seronegative patients: 1.4 versus 2.4 points (U=509.5; р=0.023). In addition, in seropositive patients, the frequency of symptoms such as mutism according to ICD-10 criteria for schizophrenia was significantly higher (23.5% versus 3.4%, χ2=9.27, р=0.013), and the whole group of catatonic symptoms according to the E. Bleuler’s criteria for schizophrenia was higher (52.9% versus 28.4%, χ2=3.916, p = 0.048). Conclusion. The association between a positive toxoplasmosis status in patients with schizophrenia and catatonic symptoms has been revealed for the first time and should be verified in larger studies.
Copyright (c) 2020 Romanov D.V., Brazhnikov A.I., Andreyuk D.S., Zakharova N.V., Bravve L.V., Kovaleva V.A., Abbazova E.V., Goncharov D.B., Titova I.V., Domonova E.A., Kostyuk G.P. https://creativecommons.org/licenses/by/4.0