No 1 (2025)

Background. Adjustment disorders are extremely variable and polymorphic in their clinical manifestations. Certain difficulties are presented by differential diagnostics of the leading syndromic component of this disorder, characterized by the predominance of anxiety or asthenic symptoms. The presence of mixed complaints that can relate to both syndromes, to a certain extent complicates the qualification of adjustment disorder by the main syndrome and creates difficulties in choosing the adequate therapy. Nowadays, mathematical modeling methods are actively used in the diagnostics of many diseases, including mental disorders. This approach allows formalizing the process of mental health assessment, integrating the results of clinical-psychopathological, psychological and immunobiological examination of patients into certain algorithms. Objective: to construct a mathematical model for diagnosing the course of adjustment disorder based on immunobiological parameters and anxiety levels in women. Material and Methods. A comprehensive (clinical-psychopathological, psychological and immunobiological) examination was conducted among 102 women aged 35-60 years with the diagnosis: Reaction to severe stress and adjustment disorders (ICD-10 code F43). Two groups were formed from the total sample depending on the prevalence of anxiety or asthenic syndrome: Group 1 (n=57) – Mixed anxiety and depressive reaction due to adjustment disorder (F43.22), adjustment disorder (adaptive reactions) (F43.25, F43.28); Group 2 (n=45) – adjustment disorder with predominant disturbance of other emotions (F43.23), adjustment disorder with predominant disturbance of conduct (F43.24). The anxiety level was assessed using the Spielberger-Khanin scale. The laboratory study included phenotyping of immunocompetent cells by differentiation clusters using flow cytometry and determination of cortisol concentration using enzyme immunoassay. The obtained data were statistically processed. Results. To build a diagnostic model of adjustment disorder by the leading syndrome, linear regression analysis was used, which allowed predicting the value of the dependent variable based on the known values of the predictor variables. The model included the level of personal anxiety, the number of T-lymphocytes, the number of lymphocytes with apoptosis readiness receptors, and the level of cortisol in the blood serum. A criterion variable was calculated; when its value was ≥1.76, adjustment disorder with the leading anxiety syndrome was diagnosed, and when the value was <1.76, adjustment disorder with a predominance of asthenic syndrome was diagnosed. The sensitivity of the mathematical model for diagnosing the course of adjustment disorder was 87.7%, and the specificity was 80.0%. Conclusion. A mathematical model has been proposed that provides the possibility of increasing the accuracy of differential diagnosis of adjustment disorder in women based on the underlying syndrome. Timely adequate diagnosis is aimed at the optimal choice of complex therapy tactics.

Background. Mental disorders occupy a leading position in modern medicine and bear the burden of significant economic costs associated with the treatment and rehabilitation of patients. Non-drug strategies of assistance have a number of significant advantages, including optimization of medical personnel resources, elimination of the need for the period of selection and titration of drug dosages, as well as avoidance of waiting for the effects of pharmacotherapy. Data are accumulating on the possibilities of using virtual reality technologies for the correction of mental disorders, which makes promising studies aimed at transferring relaxation practices to high-tech platforms. Objective: to study the possibilities of using virtual reality technologies in psychiatry by assessing the effect of the method on the psycho-emotional state of healthy volunteers. Hypothesis. Completing a course of sessions of a relaxation VR scenario helps to reduce the severity of anxiety and affective symptoms, improve night sleep in healthy volunteers. Material and Methods. The study sample included 19 healthy volunteers aged 23 (22; 24) years. The indices of anxiety, depression, and sleep disorders were assessed using the following questionnaires: Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Sleep Disorder Severity Questionnaires ‒ Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) before the study and after 5 sessions of immersion in a dynamic virtual environment using the PICO 4 PRO hardware and software system and VR relaxation computer programs. The session duration was 15 minutes. Statistical analysis of the data was performed using the SPSS (V.23.0) standard software package. Results. A statistically significant decrease in indices on all scales was revealed when using the proposed relaxation technique. Conclusion. The use of virtual reality technologies has demonstrated effectiveness in the correction of affective and neurotic symptoms in healthy individuals, which can subsequently be used to develop technologies for non-drug correction of affective and neurotic disorders in personalized patient therapy programs.

Background. Development of effective methods of personalized drug therapy and psychotherapy of nonpsychotic mental disorders is an important area of modern psychiatric practice aimed at ensuring optimal health and psychological well-being of patients. Objective: to determine the principles of diagnosis, treatment and stabilization of remission in patients with comorbid depressive and anxiety disorders of the neurotic spectrum based on an individualized approach. Results and Discussion. The article considers a clinical case of a patient with symptoms of depression and anxiety of psychogenic origin, indicative of diagnosis, treatment and stabilization of remission in patients with comorbid depressive and anxiety disorders of the neurotic spectrum. The process of establishing an accurate diagnosis, ways of choosing the tactics of pharmacological management of the patient, justification for choosing an effective method of psychotherapy are demonstrated. Using the example of a single case history and anamnestic data on the formation and development of psychopathological symptoms, the psychological mechanisms underlying the manifestation and maintenance of neurotic symptoms that prevent the stabilization of remission are analyzed. The process of personally oriented (reconstructive) psychotherapy is shown, short-term and long-term treatment results are presented. This case description was prepared in accordance with the CARE recommendations.

Background. Alcohol withdrawal syndrome (AWS) is an acute, life-threatening condition that occurs in individuals who regularly use alcohol and suddenly stop drinking it. One of the most dangerous manifestations of this syndrome is seizures, which can lead to death and have long-term negative consequences. Also, one of the important comorbid disorders in alcoholism is depressive disorders, which in turn aggravate the clinical picture and can lead to suicide. Objective. To determine the relationship between depressive manifestations in the post-abstinence period and seizures in the structure of AWS. Materials and Methods. In 2019-2023 a continuous screening of patients with alcohol dependence who underwent inpatient treatment (7-14 days of stay, post-abstinence period) was conducted at the Republican Clinical Narcological Dispensary (Republic of Bashkortostan). All participants underwent a neurological examination to rule out severe neurological pathology. Based on the screening materials, a comparative cross-sectional study of patients with alcohol dependence, accompanied by seizures after alcohol withdrawal, and without them was conducted. Using the inclusion, non-inclusion and exclusion criteria, a general study sample of patients (n=399) with a diagnosis: Mental and behavioral disorders due to alcohol use, dependence syndrome (ICD-10 code F10.2) was formed. The patients were divided into two groups: the main group (n=108) ‒ patients with seizures during the period of AWS, the comparison group (n=291) ‒ patients without seizures. The Montgomery-Asberg Depression Rating Scale (MADRS) was used to assess the severity of depression at the time of admission and changes in the severity of the condition as a result of therapy. Data analysis was carried out using software IBM SPSS Statistics 26. The normality of distribution of quantitative variables was assessed using the Shapiro-Wilk criterion. The Mann-Whitney U-test was used to compare two independent populations. Results. In patients with seizures in the structure of the AWS, the average score on the MADRS scale was statistically significantly (p=0.0001) 3.66 points higher than in the comparison group. A relationship with individual depressive symptoms, such as objective and subjective signs of depression, inner tension, impaired concentration, anhedonia, and pessimistic thoughts, was determined. Conclusion. In patients with seizures in the structure of the AWS in the post-abstinence period, statistically significantly (p=0.0001) more pronounced depressive symptoms were found than in patients without seizures.

Background. The study of psychopathological features of overvalued formations is determined by the lack of unity in understanding essential issues, such as volume, concepts, clear boundaries, and delimitation criteria. The importance of solving these issues is associated with the exceptional place that overvalued ideas occupy on the border of nonpsychotic and psychotic disorders. Objective: to study the features of overvalued formations in the structure of various mental disorders in minors with criminal aggression involved in destructive online communities. Materials. The study involved 34 minors aged 13-18 years who, in connection with their criminal prosecution, underwent a comprehensive forensic psychological and psychiatric examination at the Federal State Budgetary Institution “V.P. Serbsky National Medical Research Center of Psychiatry and Narcology” of the Ministry of Health of the Russian Federation. Two groups of respondents were identified from the total sample: 1) those who planned and/or committed attacks on educational institutions (n=25), 2) those who committed terrorist acts qualified as public justification and propaganda of terrorism in the Internet space, with the use of weapons, murder or attempted murder of two or more persons (n=9). Methods: clinical-psychopathological, psychological, and statistical. Results. Mental health disorders were detected in 88.1% of respondents. Among mental disorders, schizophrenia spectrum disorders (35.3%) and emerging personality disorders (29.4%) were noted with a higher frequency (35.3%). The following characteristics were common to all minors, regardless of the presence or absence of mental disorders: the formation of various overvalued formations, passion for destructive Internet content. Overvalued formations in the structure of mental pathology of minors with criminal aggression included a number of components, such as ideational, affective and behavioral, and represented a psychopathologically and plot-wise heterogeneous group. Variants of the ideational component of overvalued ideas in the aspect of hostility, aggression and violent actions towards representatives of certain territorial, ethnic and demographic communities were identified. The category of overvalued ideas includes ideas of radical Islam, promoting the ideology of the terrorist organization “Islamic State” (ISIS), prohibited in the Russian Federation, Slavophile ideas ‒ propagandizing the “purity of the Slavic nation”, Nazi ideas ‒ proclaiming the ideology of fascism. Correlation links between the presence of overvalued formations, aggressive behavior, manifestation of aggression towards living objects and the presence of paranoid syndrome elements in the clinical picture were revealed. Conclusion. The identified options are debatable and represent an object for further research. In general, the plot of overvalued ideas of minors reflects modern socio-ideological trends, as well as the influence of psychological changes occurring against the background of the social situation of development of children and adolescents in the era of digital socialization.

Background. The study of negative symptoms in schizophrenia requires, in addition to the clinical and psycho-pathological method, the use of other objective test diagnostic methods that would allow a quantitative assessment of the severity of negative symptoms. One of the methods for objective assessment of negative disorders in schizophrenia, allowing a quantitative assessment of their severity, is the psychometric method, among the advantages of which are the simplicity and compactness of the implementation, the presence of standardized rating scales that make it possible to reasonably assess the severity of symptoms, as well as compare the results of different patients with each other. Objective of the study: to present an overview of psychometric tools for assessing negative symptoms in schizophrenia. Materials and Methods. The search of scientific literature was conducted in the Google Scholar and PubMed scientific databases using the following keywords and phrases: schizophrenia, negative symptoms, test, scale, questionnaire, psychometric. Studies are highlighted that consider the psychometric properties of the original scales assessing negative disorders in schizophrenia. The results of studies on this topic are mainly published in English-language reviews and meta-analyses. Results and Discussion. The historical path of development of the psychometric method for assessing negative disorders in schizophrenia is followed, comparative characteristics of test methods are presented, and sources are indicated that present facts of Russian-language adaptation of specific scales, if any.

Background. The COVID-19 pandemic has had a significant impact on the mental health of the population, causing widespread depressive and anxiety disorders, especially among vulnerable groups. In the context of long-term social distancing, economic instability and increased stress, there is a need to study the psychiatric consequences of the pandemic, and this is especially important for the development of support measures for health workers, patients with mental disorders and people exposed to social isolation. This explains the demand for a systematic analysis of the mental health consequences of COVID-19 and effective methods for their correction. Objective: to review the published literature on the impact of the COVID-19 pandemic on the mental health of patients, their relatives, and medical staff. Material and Methods. The study of original research over the past 5 years from domestic and foreign scientific databases, selected by keywords: pandemic, mental health, psychological stress, anxiety, quarantine. Results and Discussion. Psychiatric symptoms of coronavirus disease include anxiety, depression, insomnia, chronic fatigue syndrome, post-traumatic stress disorder, obsessive-compulsive symptoms. Long-term self-isolation during the COVID-19 pandemic negatively affects the psychological health of the population, leading to the formation of post-viral fatigue syndrome, difficulty concentrating, daytime sleepiness, which together complicates a rapid recovery from the disease and a full return to professional duties. At the same time, young age and a history of psychological trauma increase the risk of psychological health disorders during the pandemic. Healthcare workers experienced high levels of anxiety and stress due to long shifts, the risk of infection, a lack of personal protective equipment and insufficient study of the new virus at the beginning of the pandemic. Conclusion. Patients with COVID-19 are subject to significant psychological stress after infection and may experience symptoms of post-traumatic stress disorder, comorbid depression, anxiety, and sleep disturbances. Patients who have recovered from COVID-19 continue to suffer from lingering symptoms such as chronic fatigue, diffuse myalgia, shortness of breath, headache, and difficulty concentrating, which significantly reduce their quality of life.

Background. The study of the relationship between tremor in Parkinson's disease and the level of depression is dictated by the high prevalence of these conditions in the population as a whole, especially among the elderly. Currently, depression is considered not only as a psychiatric, but also as an important general medical problem, which is determined by its high incidence in the population and association with a number of somatic disorders. Objective: to analyze domestic and foreign literature sources on the effect of tremor hyperkinesis on the development of depression in Parkinson's disease and essential tremor. Results and Discussion. The article shows that depression is a common non-motor symptom among patients with Parkinson's disease and essential tremor. Data are provided on the ability of tremor accompanying these diseases to worsen the quality of life. Tremor causes physical and psychological discomfort, stressful situations when performing simple tasks, negatively affects family relationships, which can potentially lead to depressive states. Data on depression as a premotor manifestation of the disease are presented. The results of a study on the prevalence of reactive depression in patients with resting tremor and a combination of resting tremor and postural/kinetic tremor are discussed. The combination of resting tremor and postural/kinetic tremor in Parkinson's disease worsens clinical indicators, with the prevalence of depression increasing to 28% over 5 years. Higher patient-rated tremor severity, but not physician-rated severity, predicts higher rates of depression. Physician understanding of different types of tremor and their impact on the development of depressive symptoms will help to find effective tools to improve the quality of life of patients with Parkinson's disease.

Background. Huntington's disease (HD) is an orphan disease with an average prevalence of 5.5 per 100 thousand population worldwide, characterized by an autosomal dominant type of inheritance, complete penetrance and a steadily progressive course with subsequent disability. The clinical picture of HD is described by a triad, which includes movement disorders, cognitive impairment and psychopathological symptoms. Diagnosis of the onset of HD often causes significant difficulties, since in many patients mental disorders can precede motor disorders. In this case, the likelihood of erroneous diagnosis of an endogenous disease, in particular schizophrenia, increases. Objective: to study the current problems of differential diagnostics of Huntington's disease and schizophrenia based on the analysis of a clinical case. Results and Discussion. The article presents a clinical case of a 33-year-old patient of a psychiatric hospital with schizophrenia and an adverse family history, demonstrating the difficulties of differential diagnostics of Huntington's disease with schizophrenia. Due to a hereditary burden on the father's side, a history of motor disorders, and a decrease in cognitive functions, Huntington's disease was presumably diagnosed, but this diagnosis was excluded due to a negative DNA test result. The diagnosis was: paranoid schizophrenia, the observation period is less than a year (ICD-10 code F20.9), which was confirmed by clinical-anamnestic and clinical-psychopathological methods (hallucinatory-paranoid symptoms in the anamnesis, increasing apathoabulic syndrome, disturbance of social adaptation and thought disorder, a positive response to treatment in the form of stabilization of the mental state, reduction of stiffness).