The review article examines the formation of a model for integrating the provision of assistance to the population with problems in mental health in the primary health care, the appropriateness of revision of the legislative framework in Russia. The experience of different countries in diagnosing and treating certain mild mental disorders (in particular disorders of the anxiety and depressive spectrum) with the participation of primary care settings is discussed. A consultative model of psychiatric care is being negotiated, which involves a multidisciplinary approach involving internists and mental health professionals, and potentially allows for optimization of resource costs and greater access to health services.

The aim of the study was to analyze the psychopathological structure of endogenous depressions, to establish the associations of its structure with the course and prognosis of the disease. Material: 124 in-patients with the diagnosis of recurrent depressive disorder (out of the annual total of 409 treated at the Republican Vilnius Hospital University department in August 2014 — July 2015) — 92 females and 32 males, aged from 19 to 82 (average SD 55,37 ± ± 13,11). Manifestation of disease was between 16 and 59 years (average 37,56 ± SD 12,57). Duration of disease was between 2 and 37 years (average 14,35 ± SD 9,40). Methods: mainly psychopathological clinical and clinical-catamnestic ones, in addition rating scales MADRS and CGI, psychological examination. Results: 6 types of depression were singled out: anxious (52,42%), hypochondriac (22,58%), melancholic (13,71%), apatheticadynamic (4,84%), anesthetic (4,03%) and dysphoric depression (2,42%). All cases of depression were of severe level, with MADRS fluctuating between 30–39 scores (35,6 ± 7,9), and CGI-S — 5,4 ± 0,9. Majority of cases were anxious and hypochondriac depressions. All types had long duration of episodes (from half to 3 years), some cases much longer. The clinical pictures and psychological peculiarities of separate types were analyzed, as well as the diagnostic and prognostic signifcance of the established typology was discussed. Conclusions: сlassic forms of depression were rare. In the most of cases complex polymorphic symptoms prevailed (senestopathic, hypochondriac symptoms, depersonalization, obsessions, phobias, various overvalued ideas), had long duration of episodes. Our study showed the increasing complexity of endogenous depressions, tendency to poor prognosis and growing resistance to antidepressants.

Introduction: recently, depression is considered as a disease with a known organic basis and changes in the concentration of neurotrophin BDNF, which in particular applies to patients with advanced age with cerebral-vascular pathology. In modern literature, the notion of vascular depression stands out, but data on the possibilities of its therapy and associated biochemical changes remain very scarce. Objective: оbtaining data on the depth of reduction of the manifestations of vascular depression during treatment, the dynamics of BDNF concentration, and the possible dependence of the latter on inflammatory processes. Material and methods: 23 patients with an average age of 71,4 ± 2,5 years who met the criteria of vascular depression were studied. The Cornell Depression scale, the CGI scale were used, the concentration of BDNF and C-reactive protein (CRP) was determined. Results: by the time the CGI therapy began, moderate mental disorders according to CGI had been established in all patients, and in the dynamics of its implementation, there were 2 variants of changes-signifcant (65,2%) and a slight improvement. The severity of vascular depression in elderly patients, as a rule, is at a moderate level. The majority of patients achieve signifcant therapeutic changes, especially in terms of correcting feelings of sadness, reducing the phenomena of inhibition and smoothing the daily fluctuations of affect. According to the Cornell scale, it was found out that the possibilities of deeper reduction affect the feeling of sadness, the degree of activity, the phenomena of inhibition and the daily fluctuations of affect. An increase in the concentration of the brain neurotrophic factor was revealed in both main variants of the therapeutic effect. Its dependence on the depth of reduction of psychopathological symptoms is not established. Similar ratios are revealed in terms of CRP. Conclusions: improvement of the state in the treatment of vascular depression is accompanied by an increase in the concentration of BDNF, but, apparently, this component is only one of the links of complex compensatory neurochemical changes.

Objective: to determine the clinical and psychological characteristics of the cognitive sphere of mental activity, prognostically signifcant for the appearance and/or deterioration of cognitive defcits in relatives of 1st degree of relationship of patients with Alzheimer's disease (AD) on the basis of a 4-year clinical and psychological follow-up evaluation. Material: cohort of 236 relatives of the 1st degree of relationship of patients with AD. Methods: clinical-psychopathological, clinical-catamnestic, neuropsychological and psychometric, statistical. Results: over the period of 4-year catamnesis, the number of relatives of the frst degree of relationship of patients with AD with cognitive impairment doubled: from 22,5 to 44,9%. Of these, the incidence of MCI syndrome increased from 4,7 to 11,9%. Possible risk factors for the appearance and/or deterioration of cognitive functioning are established: 1) cognitive impairment (impaired concentration, difculties in learning new information and remembering events of the distant past), revealed by objective examination; 2) retrospective data on the presence of cognitive constitutional features (low school performance, difculties in remembering digital information, spatial orientation, mastering manual skills, reducing concentration, the presence of more than 3 types of constitutional defciency); 3) neuropsychological parameters of cognitive functions (low parameters of kinetic and spatial organization of praxis, defciency of constructive activity, shortage of short-term auditory-speech and visual memory in terms of parameters of the volume of memorization and retention of traces, reduction of neurodynamics and voluntary attention and control). The obtained data can be used as the basis for corrective and rehabilitation measures aimed at preventing the appearance and/or deterioration of cognitive functions in individuals with the highest risk of developing AD.

The aim of the study: analysis of clinics and psychopathology of continuous cycling affective disorders in youth in order to determine coredynamic patterns. Material and methods: 54 patients (35 men, 19 women) in age 16–25 years with continuous cycling endogenous affective disorders were studied during their inpatient admission in MHRC in 2014–2017 with one of the following ICD-10 diagnosis: F31.0, F34.0, F25.0. Patients were observed clinically with thorough research of their anamnesis and analysis of current psychopathology and its previous dynamics. Results: the age of the onset of continuous bipolar spectrum disorders in youth is one of the factors that effects its dynamics over the following years. There are two points when the disease manifested more often. Taking into account this fact and prevailing clinical phenomena, the frequency and sequence of affective phases we developed the typology of the continual course of affective disorders in youth: type I — rhythmic dynamics, type II — dysrhythmic dynamics with two subtypes: 1) juvenile and 2) psychotic. Conclusion: patients presenting with the continual flow of affective disorders in youth demonstrate psychopathological heterogeneity of isolated affective phases. Signifcant differences in the timing of manifestation and patterns of the phase alternations were found. This dynamic is extremely risky in terms of suicide and self-injury actions. These observations are intended to improve the diagnostic and prognostic evaluation of this complicated patient sample therefore the study of the catamnesis is required in the follow-up study.

Objective: to evaluate chronobiological pattern of depression and its impact on the therapeutic regimen. Material and methods: the study included 100 depressive patients. All participants completed a questionnaire package (MADRS, HDRS-21, CGI, cyclicity index, Questionnaire Scoring Subjective Characteristics of Sleep, PSQI, TOB, SPAQ, MEQ). Results: sleep disturbances were highly prevalent in recurrent group (4,1 ± 1,1 points; MADRS, item 4; time to fall asleep — 53,58 min, PSQI), diurnal variation of symptoms with morning worsening, compared to single episode (p < 0,05). Shortening of the «individual minute», especially in the age group 60–77 years (mean value: 39) reflected the severity depression severity in the sample. The TOB test demonstrated a subjective slowing of time (23,9 ± 4,04 points). Seasonal depression (SAD) was revealed in 13% of cases. Three main chronotypes (morning — 12%, evening — 30%, and mid-range — 58%) were identifed. Eveningness had associated with a positive family history of affective disorders, an early onset (30,43 ± 12,9; p < 0,01), younger age at the time of treatment (42,73 ± 16,04; p < 0,05), large number (4 [2; 6], p > 0,05) and length of episodes (months) (3 [2; 5], p < 0,05), a more severe depression and intensive treatment program (antianxiety agents, hypnotics). Antidepressants were more effective given at morning in ETs, at evening — in MTs. Conclusions: biological rhythms are individual characteristics that should be taken into account when prescribing antidepressants and other agents.

The purpose of this study was to examine the efcacy and tolerability of trazodone monotherapy in comparison with routine treatment in patients with mixed anxiety-depressive disorder. Material and methods: the study was performed in the sample of 115 patients: 60 — the main group (trazodone monotherapy), 55 — control group (routine treatment) using the clinical-psychopathological method and psychometric scales (UKU, HAMD-17, Holmes–Ray scale, Shihan social adaptation scale). In the course of the study, the dynamics of psychopathological manifestations, the impact on social adaptation, the adverse effects and their severity in each group were recorded. The duration of the study was eight weeks. Results: trazodone monotherapy showed high efcacy in a mixed anxiety-depressive disorder, comparable to the effect achieved with the administration of several drugs in routine practice. Conclusion: civen the effectiveness, favorable safety profle and economic benefts, trazodone monotherapy is recommended for the treatment of patients with mixed anxiety-depressive disorder.

Objective: to develop the comprehensive medical rehabilitation program for patients after cervical cancer treatment (surgical or combination therapy) and to assess its clinical effectiveness and impact on the quality of life. Material and method: the study included 92 patients (mean age 35 ± 2 years) with induced menopause, resulting from cervical cancer treatment (stages T1bN0M0 — T2bN0M0), who were divided into 2 groups. The main group included 50 patients, the control group included 42 patients. The patients from main group underwent pathogenetically substantiated rehabilitation procedures (dietotherapy, individual and group psychotherapy with pre-rehabilitation stage, physiotherapy, phytotherapy, immunotherapy and preformed physical factors). A.M. Wein scale (for neurovegetative disorders), the hospital anxiety and depression scale (HADS) and the SF-36 questionnaire (for quality of life) were used to evaluate the program effectiveness at the beginning and at the end of the study. Results: the results shows neurovegetative disorders, anxiety and depression levels decrease by 17,3; 23,2 and 13,6% respectively. The quality of life assessment revealed an emotional functioning and social functioning increase by 6,8 and 9,8% respectively. Conclusion: the research demonstrated effectiveness of developed medical rehabilitation program. It reliably reduces neurovegetative manifestations, raises emotional and social functioning levels and positively affects patient’s quality of life.

The aim of study: to compare platelet properties — their number, degree of activation in patients with different severity of schizophrenia: risk of schizophrenia (high and ultra-high risk), in patients with 1-st attack of schizophrenia and chronic patients with schizophrenia Materials and methods: we used several psychometric scales — SOPS scale to assess the risk of schizophrenia, PANSS scale — to assess the severity of psychotic symptoms in patients with schizophrenia. Activation of the platelets during gel fltration was estimated from the difference in the number of cells at the inlet and outlet of the column. Results: the results showed a consecutive reduction of the platelets number in platelet-rich plasma (PRP) obtained by centrifugation, in patients with increasing severity of schizophrenia — patients with risk of schizophrenia (high and ultra-high risk), 1-st attack of schizophrenia, chronic schizophrenic patients. The number of platelets after centrifugation in patients with high risk of schizophrenia is 1,56 times (p < 0,009) exceeds this value in patients with the 1-st attack of schizophrenia and 4,30 (p < 0,000001) times exceeds in chronic patients with schizophrenia. It was also shown the signifcant differences in the properties of platelets in patients with 1-st attack versus chronic patients with schizophrenia: the number of platelets after centrifugation in patients with 1-st attack of schizophrenia is 2,75 times (p < 0,0001) higher than the number of cells in chronic schizophrenic patients. The number of platelets from chronic schizophrenic patients is 1,8 times (p < 0,001) less than the number of platelets from healthy donors. The number of cells in patients with 1-st attack of the disease does not differ from corresponding values in healthy donors. Gel fltration in patients at the height of mental disorders revealed the platelet activation in all groups of examined patients. Conclusion: it was assumed that the higher values of number of platelets in patients with risk of schizophrenia make for the more positive output of the attack without mental deterioration, and a less signifcant number of platelets after centrifugation in patients with schizophrenia was the factor leading to the deterioration of the patient.

Aim of the study: to present a review on the role of oligodendrocytes and myelin in cognitive dysfunctions in schizophrenia. Material and method: systematic review of the literature data. Results: the present review focuses on the role of oligodendrocytes and myelin in cognitive functions, pathology of oligodendrocytes and myelin in the brain in schizophrenia, association between oligodendrocytes/myelin disturbances and cognitive dysfunction in patients with schizophrenia and the effects of treatment on oligodendrocytes and cognitive impairment. The notion that oligodendrocytes and myelin pathology contributes to cognitive dysfunction in schizophrenia is supported by the results of neuroimaging, genetic, biochemical and morphometric studies of the brain in patients with schizophrenia. Conclusion: stimulation of oligodendrogliogenesis and myelinogenesis in the cerebral cortex can be a new treatment strategy for cognitive impairment in schizophrenia patients.

The aim was to present a review of national and foreign research studies of overvalued ideas since XX century and until recently. Method: systematic review. Conclusion: regarding existing studies of the phenomenon of overvalued ideas the major directions of further research of psychopathological features were highlighted and analyzed. The boundaries of the concept, the main criteria of diagnosis and psychopathological peculiarities of the phenomenon of supervalued formations are analyzed.

The aim of the study is to analyze literature data about the possibility of the combination of neurodegenerative and vascular mechanisms in the development of old age dementia. Material and method: this review describes the analysis of the literature on the participation of neurodegenerative and vascular mechanisms in the development of dementia. The literature review concerned the assessment of its pathogenic mechanisms and the possible relationship between these processes. It was analyzed the modern approaches to pharmacological correction of these disorders, including the range of biochemical activity and mechanisms of action of the main directions of therapy of dementia. Conclusion: the analysis of literary data demonstrates the commonality of risk factors, the presence of intersecting pathogenetic processes and the possibility of the additive and synergistic interaction of vascular and atrophic brain processes.

The aim of the study is to demonstrate the need to improve the system of psychotherapeutic treatment of cancer patients and to identify the factors affecting it. Material and methods: the article focuses on the cancer patients psychorehabilitation problem and describes the basic therapy principles, as well as the psychotherapeutic methods used for this purpose. Conclusion: managing cancer patients, same attention should be paid to psychotherapy as to therapeutic and surgical aspects. Affecting inner picture of the disease could dramatically improve the quality of life and increase an efciency of the treatment, so the psychotherapy should be involved on all stages of patients’ management. It’s advisable to perform the psychotherapy in specialized rehabilitation centers.

The aim was to review the main types of vertigo and the basic strategy of treatment. Results: there are fve main types of vertigo: vestibular, postural, lipotimic, cervicogenic and functional. The notion of persisten postural-perceptive verigo was accepted last years. Three clinical situations concerning vertigo are considered: 1) single long-term episode of vertigo commonly vestibular; 2) recurrent episodes of vertigo; 3) chronic vertigo. Conclusion: ethiopathogenetic approach to treatment of vertigo is based on syndrome and nosological assessment.

O. Bumke’s concept of the division of mental disorders in two main nosological groups: functional and exogenous-organic, according to the division of psychopathological symptoms in two different groups: 1) distinguished from the normal psychological phenomena only in durability and intensity and 2) not observed in norm, is analyzed. Schizophrenia was considered by O. Bumke in a broad sense as an exogenous-organic psychosis. When compared with E. Kretschmer’s concept of continuum (schizothymic temperament — schizoid psychopathy — schizophrenic process), apart from the negation of the constitutional understanding of schizophrenia, O. Bumke supposed the described by E. Kretschmer different types of schizoid psychopathies as variants of the norm and did not recognize (similar to Kurt Schneider) the schizoid psychopathy. Wherein the diagnostic boundaries of schizophrenia according to O. Bumke were not so broad as in E. Bleuler’s concept.