Vol 7, No 3 (2026)

BACKGROUND: The prevalence of substance-induced psychotic disorders (SIPDs), particularly those induced by synthetic psychostimulants and high-potency cannabinoids, represents a global public health concern.

АIM: To analyze the trends and factors associated with hospitalizations for SIPDs in the Russian Federation between 2000 and 2024.

METHODS: A retrospective epidemiological study was conducted using annual aggregate population-level data from federal statistical surveillance. Variables included hospitalization rates for psychotic disorders induced by illegal and legal psychoactive substances, dependence syndromes, and the quantities of illicit drugs seized. Data were analyzed using nonparametric statistical methods.

RESULTS: Two clusters were identified in the trends of the general drug use situation: 2000–2013 and 2014–2024. In the second period, the rate of hospitalizations for patients with SIPD was six times higher, and the structure of substance use-related morbidity underwent a transformation: a 2.9-fold decrease in the annual hospitalization rates for opioid dependence syndrome, accompanied by a 16.4-fold increase in hospitalizations for psychostimulant dependence syndrome, a 3.1-fold increase for cannabinoid dependence, and a 7.4-fold increase for dependence on other psychoactive substances and their combinations. According to the regression analysis, half of the variability in the hospitalization indicator for SIPD is explained by the hospitalization indicator for dependence on psychostimulants or other psychoactive substances and their combinations, while the other half is explained by the hospitalization rate for dependence on cannabinoids.

CONCLUSION: The sixfold increase in the hospitalization rate for SIPDs observed in Russia since 2013 may be linked to changes in general drug use patterns — rise in the hospitalization rates for dependence syndromes on synthetic stimulants, cannabinoids and other psychoactive substances and their combinations, accompanied by a decline in hospitalizations for opioid dependence.

BACKGROUND: While numerous studies highlight elevated mental health challenges in medical students globally, existing reviews have largely focused on specific regions or populations and rarely compare international and local students. International medical students often face additional challenges related to cultural adaptation, language barriers, and systemic problems that may exacerbate these risks.

AIM: To synthesize evidence on the prevalence, causes, and specific interventions for anxiety, depression, and burnout among international medical students, comparing outcomes with local populations across diverse regions.

METHODS: A comprehensive search of electronic databases was performed using relevant keywords. Data were extracted, tabulated, and narratively summarized to report prevalence ranges, common causes, and intervention types, with comparative analyses conducted across geopolitical and cultural contexts.

RESULTS: Twenty-four studies (≈ 10,000 students) met inclusion criteria. The prevalence ranges for anxiety and depression were 22–53% and 15–48%, respectively. Burnout evidence was considerably limited; among the three included studies, two used validated standardized measures (one pre-pandemic showing moderate burnout, one pandemic-era reporting high levels of exhaustion in nearly 100% of students), while a third used a non-standardized questionnaire, precluding robust conclusions. Key causes included academic/clinical workload, cultural and language barriers, environmental challenges, and COVID-19 disruptions. Interventions targeting social connectedness and resilience showed promising reductions in psychological distress.

CONCLUSION: International medical students face substantial, complex, region-specific mental health risks that may be mitigated through culturally tailored support services. Future research should prioritize longitudinal and intervention studies, standardize culturally sensitive assessment tools, and directly compare international and local cohorts. Policymakers and educational institutions should implement support frameworks addressing transition-related vulnerabilities and systemic barriers to well-being and academic success.

Approximately a quarter of patients with major depressive disorder have low-grade systemic inflammation, with higher rates in difficult-to-treat subgroups; service-level prevalence within European public mental health services for difficult-to-treat depression (DTD) remains undetermined. Emerging data suggest that inflammation does not operate as a simple linear cause of major depressive disorder, but rather as a modulator of corticostriatal circuits, altering reward processing, effort–cost estimation, feedback-based learning and decision-making. This can give rise to a depressive phenotype characterized by motivational anergia, effort avoidance, attenuated responsiveness to conventional treatments, frequent relapse, and a substantial burden for patients, clinicians and services. In this viewpoint we propose an operational model for community mental health services based on: (1) a pragmatic and accessible inflammatory stratification pathway using a focused biomarker panel (high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β); (2) the integration of a circuit-based perspective into the functional formulation of DTD; and (3) the reorganization of community and outpatient mental health provision around point-of-care biomarker testing, standardized protocols, and explicit attention to equity of access. Unlike existing frameworks that require specialist biomarker infrastructure, this model articulates a tiered pathway in which point-of-care hs-CRP is feasible at community level, within routine publicly funded provision, while IL-6, TNF-α and IL-1β phenotyping is reserved for district specialist hubs.