Vol 3, No 3 (2022)


Revisiting Social Stigma in Non-suicidal Self-injury: A Narrative Review

Meheli S., Banerjee D.


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.

Consortium Psychiatricum. 2022;3(3):6-19
pages 6-19 views

Schizophrenia: a Narrative Review of Etiological and Diagnostic Issues

Oskolkova S.N.


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.

Consortium Psychiatricum. 2022;3(3):20-35
pages 20-35 views


Professional values and educational needs in mental health professionals: survey results

Kibitov A.A., Chumakov E.M., Nechaeva A.I., Sorokin M.Y., Petrova N.N., Vetrova M.V.


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.

Consortium Psychiatricum. 2022;3(3):36-45
pages 36-45 views

Association of Anxiety and Depression with Objective and Subjective Cognitive Decline in Outpatient Healthcare Consumers with COVID-19: А Cross-Sectional Study

Gomzyakova N.A., Palchikova E.I., Tumova M.A., Kasyanov E.D., Sorokin M.Y.


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.

Consortium Psychiatricum. 2022;3(3):46-57
pages 46-57 views

Clinical Effectiveness of Lurasidone Monotherapy in Patients with Acute Episodes of Schizophrenia and Associated Symptoms of Depression

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.


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.

Consortium Psychiatricum. 2022;3(3):58-72
pages 58-72 views

Alcohol Addiction in War Veterans Treated in a In-patient Psychiatric Facility: Incidence, Comorbidity with PTSD Symptoms, Association with Combat Stressors

Reznik A.M., Syunyakov T.S., Arbuzov A.L.


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.

Consortium Psychiatricum. 2022;3(3):73-89
pages 73-89 views


Anorexia Nervosa as a Cause of Drug-Induced Thyrotoxicosis

Neudahina V.O., Soloveva K.P., Khanova A.N., Gubzhokovа D.M., Krivosheeva N.V., Stashevskaya V.N.


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.

Consortium Psychiatricum. 2022;3(3):90-97
pages 90-97 views


Development of Community Mental Health Infrastructure in Thailand: From the Past to the COVID-19 Pandemic

Wannasewok K., Suraaroonsamrit B., Jeungsiragulwit D., Udomratn P.


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.

Consortium Psychiatricum. 2022;3(3):98-109
pages 98-109 views


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.

Consortium Psychiatricum. 2022;3(3):110-124
pages 110-124 views

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