Vol LVII, No 4 (2025)

This article analyzes the phenomenon of mannerism, considered in psychiatry as a psychopathological symptom. The phenomenon is based on mechanisms of self-presentation. Both mentally healthy individuals and those with mental and behavioral disorders are capable of presenting themselves to the world. The paper explores the specific manifestations of mannerism in personality disorders, manic, paraphrenic, hebephrenic, and catatonic syndromes, pathological fantasizing, as well as in cases of homosexual orientation and transgender identity. Using the example of the renowned Russian actress Renata Litvinova, the phenomenon of mannerism is also examined as an artistic device. The article concludes that mannerism is not a uniform or integral phenomenon—under different psychological and psychopathological conditions, it may appear in various forms and have distinct mechanisms of psychogenesis. The traditional definition of mannerism, which includes artificiality, affectation, pretentiousness, unnaturalness, and theatricality of behavior, is based on the assumption that such behavior is consciously employed to achieve communicative goals, particularly to attract the attention of others or significant figures. In addition, mannerism may reflect underlying psychopathological symptoms and serve as their external equivalent.

This article presents the results of a narrative scientific data review addressing the problem of evaluating psychotherapy effectiveness. The traditional evidence-based approach commonly used in medicine is analyzed, and the methodological challenges of applying it to the study of psychotherapy outcomes and other psychological interventions are described. At present, the need for strictly implementing evidence-based principles in psychotherapy is being cautiously reconsidered. Researchers are shifting the focus from attempts to objectify psychotherapy effectiveness toward examining client satisfaction with the quality of psychological care. Researchers have shown increasing interest in subjective measures of psychotherapy effectiveness, focusing on such evaluation aspects as satisfaction with the therapeutic process, enhanced self-understanding, increased autonomy, and greater social engagement. The significance of client and therapist expectations regarding psychotherapy outcomes, as well as the impact of anticipatory (predictive) abilities, is highlighted. It is concluded that a new perspective on the concept of psychotherapy effectiveness should include not only objective assessments of changes in a client’s psychological state but also the client’s subjective perception of these changes. In this regard, the development and adaptation of feedback scales (the Outcome Rating Scale and the Session Rating Scale) are considered important for monitoring the effectiveness of psychotherapeutic work with clients.

BACKGROUND: In recent years, increasing attention has been paid to the quality of life and life expectancy of patients with multiple sclerosis. The influence of various factors related to the disease and its course, pharmacologic treatments, and comorbid conditions on patient longevity has been actively studied, as life expectancy is considered a key indicator of therapeutic success.

AIM: Review of current data on disease duration, mortality and its causes in patients with multiple sclerosis.

METHODS: This review was based on materials from Russian and international scientific literature databases, including the electronic scientific library CyberLeninka, the Medline bibliographic database, the national electronic library eLibrary, and the abstracting and indexing databases Scopus, SpringerLink, and PubMed. Publications from the past 5–10 years were analyzed, including systematic reviews, case reports, and original research articles. The search was conducted using the following keywords: рассеянный склероз / multiple sclerosis, продолжительность жизни / life expectancy, выживаемость (survival), смертность/mortality, причины смертности / risk factors.

RESULTS: Life expectancy in patients with multiple sclerosis is reduced by approximately 6–10 years, and mortality associated with this condition is significantly higher compared with that in the general population. Individuals with multiple sclerosis demonstrate decreased overall survival and an increased risk of death from cardiovascular, respiratory, and infectious diseases, as well as from accidents and suicide.

CONCLUSION: Multiple sclerosis substantially affects life expectancy and increases the risk of premature death in patients. Long-term prognostication of disease progression remains challenging due to the limitations, fragmentation, and incompleteness of available data. Further research is needed, as identifying and understanding the risk factors for premature death are essential for ensuring timely and effective medical care throughout the course of the disease.

Alzheimer disease represents a major medical and social challenge owning to the complexity of its diagnosis, especially at the preclinical stage. This underscores the need for noninvasive and cost-effective screening methods. This review summarizes current evidence on using ophthalmic imaging modalities and artificial intelligence technologies for early detection of Alzheimer disease. The diagnostic potential of retinal biomarkers identified with optical coherence tomography and optical coherence tomography angiography is detailed, including thinning of the peripapillary retinal nerve fiber layer, reduced macular and choroidal thickness, decreased capillary perfusion density, and deposition of pathological proteins. These changes correlate with cerebral condition and can be detected at preclinical stages of Alzheimer disease. The article describes the roles of machine-learning algorithms and neural networks in automated image analysis, demonstrating their ability to identify complex imaging patterns and substantially improve diagnostic accuracy (AUC > 0.9). It also addresses methodological limitations and implementation challenges—including variability of results, insufficient specificity, and the black-box nature of artificial intelligence. We also highlight the high potential of multimodal approaches that combine retinal imaging with MRI and positron emission tomography. The evidence presented supports the feasibility of developing standardized protocols for the use of retinal biomarkers and artificial intelligence technologies as tools for large-scale screening of at-risk populations, enabling their integration into clinical practice for earlier initiation of therapy.

BACKGROUND: Due to its high prevalence and severe disability outcomes, ischemic stroke remains one of the major challenges in modern neurology, requiring detailed investigation aimed at developing more effective therapeutic and preventive strategies. It is generally believed that more severe cases of stroke are associated with thrombosis or occlusion of major intracranial arteries; consequently, most published studies have focused on the rapid removal of the thrombus. Patients with severe stroke without thrombosis of cerebral arteries confirmed by CT angiography (NIHSS score >6) receive treatment according to current clinical practice guidelines; however, dedicated diagnostic pathways for verifying the cause of stroke and approaches to secondary prevention in this subgroup have not yet been fully defined.

AIM: This study aimed to investigate clinical, radiological, and laboratory characteristics in patients with ischemic stroke according to the presence or absence of carotid artery thrombosis as detected by CT angiography performed in the emergency department.

METHODS: The study included 194 patients with confirmed moderate or severe ischemic stroke treated at a regional vascular center between 2021 and 2023. A comparative analysis was performed between two groups of patients stratified according to the presence (comparison group, n = 98) or absence (main group, n = 96) of large cerebral artery thrombosis as detected by CT angiography during the acute phase of ischemic stroke.

RESULTS: Patients with ischemic stroke without evidence of obstructive carotid artery thrombosis on CT angiography were older (68.6 ± 10.5 years) than those with thrombosis (64.9 ± 10.8 years; p = 0.04). Statistically significant sex-related differences were observed (p < 0.001). Among the 96 patients in the main group, 61.6% (n = 59) were women and 38.4% (n = 37) were men, whereas in the comparison group, 37.7% (n = 37) were women and 62.3% (n = 61) were men. Cryptogenic stroke was significantly more common in the main group (p < 0.001), whereas atherothrombotic stroke predominated in the comparison group. Echocardiography in patients of the main group more frequently revealed left atrial enlargement and/or areas of fibrosis and hypokinesia (p < 0.01) compared with the comparison group; these findings are recognized predictors of atrial fibrillation.

CONCLUSION: The prognosis during the acute phase of ischemic stroke in patients without carotid artery thrombosis verified by CT angiography is more favorable than in those with thrombosis. The findings suggest that patients with moderate and severe ischemic stroke in the carotid territory without detectable arterial thrombosis require long-term follow-up to assess the incidence of recurrent stroke, as well as extended (≥ 72-hour) Holter monitoring, which may improve the detection of cardiac rhythm disturbances.

BACKGROUND: Risky alcohol use and alcohol dependence are common among patients with opioid dependence during remission; however, therapeutic options for co-occurring addictions remain limited.

AIM: This work aimed to conduct a preliminary evaluation of the efficacy and safety of nalmefene in combination with behavioral counseling in patients with opioid dependence in remission and active alcohol dependence.

METHODS: A pilot open-label clinical study (August 31, 2017–September 13, 2018; Saint Petersburg) included eight patients with opioid dependence in remission and active alcohol dependence. The intervention comprised daily use of oral nalmefene (36 mg) and weekly individual sessions of structured behavioral counseling based on motivational interviewing and cognitive behavioral therapy, aimed at maintaining remission and preventing relapse. Efficacy was assessed by opioid abstinence (according to urinalysis and self-reports), abstinence from alcohol and other psychoactive substances (self-reports), and retention in the program over 24 weeks.

RESULTS: This study was terminated early due to multiple withdrawals of consent caused by adverse events or relapse in opioid dependence. Adverse effects (insomnia, fatigue, anxiety, irritability, agitation, nausea, tremor, muscle pain, increased blood pressure, and opioid craving) were observed in six participants, suggesting a possible withdrawal-like reaction triggered by nalmefene in this population, despite the fact that all participants had abstained from opioid use for at least two months prior to enrollment.

CONCLUSION: The findings presented in this study reveal challenges in the use of nalmefene among patients with opioid dependence in remission and alcohol abuse, emphasizing the importance of further research to evaluate the potential of nalmefene use in individuals with combined dependence on different psychoactive substances.

In contemporary psychiatry, there is an increasing number of patients presenting with comorbid symptomatology that includes dissociative, obsessive–compulsive, and affective components. Such conditions complicate diagnosis by masking psychiatric disorders as neurological condition, which often leads to errors in clinical routing and treatment. This paper presents a clinical case of a patient with co-occurring dissociative and obsessive–compulsive disorders and analyzes diagnostic and management challenges in polymorphic psychiatric symptomatology. A clinical and psychiatric assessment was performed in a 34-year-old woman with long-standing motor, speech, and affective disorders initially interpreted as manifestations of neurological disease. The evaluation included psychopathological interviewing, observation, and instrumental studies (EEG, MRI). The patient exhibited pronounced motor and speech abnormalities, compulsive rituals, episodes of depressed mood, and dependency on close relatives. No evidence of organic condition was found. The condition met the ICD-10 criteria for mixed dissociative disorder (F44.7), obsessive–compulsive disorder (F42.2), and moderate depressive episode (F32.1) with underlying mixed personality disorder (F61). This case illustrates the importance of a multidisciplinary approach in the assessment of atypical motor disturbances. The comorbidity of dissociative and obsessive symptoms requires differential diagnosis with extrapyramidal disorders and comprehensive therapy that accounts for underlying personality condition.