Objective:  to  study  the  clinical  characteristics,  dynamics,  nosological  qualifications  and  factors  involved  in  the  formation  of neurotic depression.

Material  and  methods:  60  patients  (women  —  55,  men  —  5)  with  an  average  age  36,9  ±  10,8  years  were  examined,  the  average  duration  of  depressive  phases  was  18,1  ±  10,8  months.  The  study  was  conducted  with  using  clinical,  catamnestic,  pathopsychological, statistical methods. Psychometric scales (HAM-D, MFI-20, SANS, PANSS) and questionnaires (Questionnaire of personality traits of an adult, SPQ-A, SCL-90, Holmes–Ray Stress Inventory) were used.

Results: the states combined by the term «neurotic depression» are clinically heterogeneous (depressions with victimization phenomena  with  the  separation  anxiety  and  depressions  with  love  addiction  —  erotomania),  primarily  in  the  content  of  the  catathymic complexes (anxiety-phobic and overvalued catathymic complexes). The differences in the structure of the denotation correlated  with  the  heterogeneity  of  clinical  manifestations  and  the  dynamics  of  depression.  The  clinical  picture  of  neurotic  depressions  in  patients  of  the  first  group  transformed:  the  initially  dominant  anxiety  was  replaced  by  negative  affectivity  (apathy, anhedonia), and there was an acquisition of endoform traits. In addition to affective pathology, which was detected in 38,2%, 61,8% of patients in this group had diagnosis of schizophrenic spectrum disorders. At the same time, most of the neurotic depressions with erotomania with overvalued attachment (76,9%) did not go beyond the affective phases of the neurotic register,which  are  realized  on  the  trajectory  of  personality  disorders.  It  has  been  established  that  the  main  personality  dimension  for  all  patients  participating  in  the  formation  of  neurotic  depression  was  the  phenomenon  of  victimization,  which  characterizes  the ability of patients to get into and stay in a psycho-traumatic (frustrating) environment for a long time. In addition, it was found that 83,3% of patients had premorbid traits of cluster A (DSM-5), along with the characteristic features of clusters B and C.

Conclusions: the heterogeneity of denotation of neurotic depression determined the differences in the clinical picture, dynamics  (with  different  social  and  labor  prognosis).  The  nosological  heterogeneity  of  the  conditions  combined  by  the  term  «neurotic depression» was established: along with affective pathology, the diagnosis of personality disorder and diseases of the schizophrenic spectrum was detected. The structure of the catathymic complexes is also interconnected with different personal predispositions with sensitivity to certain stressful triggers.

The aim of the study: was to analyze the prognostic value of psychopathological and clinical indices of delusional depressions, taking into consideration the specificities of delusion formation of depressive ideas and evaluation of diagnostic parameters of the disease.

Material and methods: a total 91 females (average age was 31,3 yrs.) were examined by using the clinical-psychopathological and clinical and follow up methods. In the dynamics of the endogenous diseases delusional depressions were diagnosed in them, with ideas of self-humiliation, of little value, self-accusation and guilt constituting the content of depressive delusion. According to  ICD-10  mental  status  of  the  patients  corresponded  to  F31.5;  F32.3  and  F33.3  items.  In  all  194  delusional  depressions  were  analyzed in the clinical pictures of first manifest and repeat episodes. Some patients were examined directly during the period of the delusional depression (48% of patients), others were examined retrospectively (51,6%) with the following personal author’s follow-up, in 40,7% the duration of follow up observation was from 5 to 10 and more years.

Results: during comparison of diagnostic parameters at various stages of the disease clinical indices were established, which at the level of statistic reliability correlated with nosological evaluation of the disease, its course, and the degree of its progression,  and  are  prognostically  the  most  significant.  In  manifest  period  at  the  l00%-level  of  concurrence  the  index  of  the  typology  of  delusional  depressions  was  in  the  lead,  which  was  developed  taking  into  consideration  their  psychopathological  structure and mechanisms of delusion formation of depressive ideas. The index of share holding of affect (manic and depressive)is prognostically significant in the formation of structure of delusional component of affective-delusional states, its maximumpresentation (from 100 to 85%) is conjugated with non-progressive, or relatively favorable course within the framework of affective  psychosis,  recurrent  and  cyclothymia  schizophrenia.  The  level  of  negative  personality  changes,  reflecting  the  degree  of the disease progression being detected before the development of delusional depression, is directly embodied in the indices of negative shift in the clinical picture of the subsequent remission and determines the prognosis of its quality. At pre-manifest stage the reliable signs of the prognosis have clinical specificities and the frequency of affective disorders (in the form of reactive, or autochthonous affective lability), as well as the depth of impairment of schizoid personality disposition up to the degree of accentuation, psychopathy, pseudopsycopathy.

Abstract: the aim: to study a follow-up of child autism spectrum disorders in adults.

Patients: in the original research 70 adults with child diagnoses of autism spectrum disorders were examined for the assessement of their mental and social status.

Methods: psychopathological, clinical and follow-up.

Results: Background and variable symptoms, typical for adults are defined, their clinical features and course are described.

Conclusion:  Some  questions  of  diagnostics  and  treatment  in  adults  are  significant  for  prognosis  in  clinical  practice  and  future scientific research.

The aim of the study was to investigate neurologic symptoms and to determine differential-diagnostic significance/value of their severity in schizotypal disorder and at various stages of schizophrenia in children.

Material and methods: A total of 80 children at the age of 5–10 years were included in the study. The children were observed for 1–5 years. The first group consisted of 38 patients with the diagnosis: schizophrenia, children’s type (F20.8xx3 according to ICD-10). The second group included 42 children with the diagnosis: schizotypal disorder (F.21 according to ICD-10). Methods of psychopatho-logical, pathopsychological and neurologic examination, as well as follow-up and statistical methods of investigation were used.

Results and conclusion: In children of both groups a wide range of neurologic symptoms was revealed, the diffuseness and topical shapelessness of which point out disintegration of multilevel system of motor analyzer. No topical differences of neurologic symptoms between the two groups were detected, while their intensity and frequency correlate both with the severity of illness and the stage of the stage of the disease (exacerbation/remission). In schizotypal disorder neurologic impairments are found reliably more seldom, than in schizophrenia, and the more expressed is acuteness of mental disorders, the more neurologic symptoms are noticed. The revealed neurologic symptoms may be considered as topical markers of morphological changes of the brain and the dynamics of endogenous process. Transitory and labile character of these symptoms point out the insufficiency of neuromediator mechanisms against the background of deficiency of extrapyramidal and cortical regulation outside the exacerbation of process.

Background information: The first supposition for conducting this study was hypothesis based on the analysis of literature data according to which there is the possibility of «partial» character of apathoabulic disorders («lability of volitional effort» by D.E. Melekhov). The second presumption was the selection of the construct of «selective» (according to Marin, 1990) «job apathy» (Schmidt G. et al., 2015) by the foreign scientists.

In the light of reasons supplied, of special interest is apathy to work in patients with schizophrenia, proceeding on the basisof a hysterical constitution — which is associated with obvious difficulties in diagnosing between partial abulia («job apathy») within the hysterical form of schizophrenia and the dynamics of hysterical psychopathy with the phenomenon of «pension neurosis».

A current hypothesis was based on the assumption that there is a special type of deficit symptoms in schizophrenic patients with hysterical personality, according to which apathoabulic disorders «invade» into the sphere of constitutional anomalies, act «under the mask» of intensified pathocharacterological disorders and are accompanied by partial misadaption of life and activities.

The purpose of this work was to study the negative symptoms in hysterical form of schizophrenia, proceeding with a predominance of partial apathoabulic disorders.

Materials and methods: the present study summarizes the results of observations of 10 patients who applied to the FSBSI NHRC due to exacerbation of schizophrenic process. The diagnostics included clinical and psychometric assessment techniques.

Results: the data obtained in the course of the study allowed us to figure out a special type of partial schizophrenic defect state, named as «hysteroabulia», according to which the negative symptoms affect voluntary activity (in particular — labour function), while recreational activity, being hysterical involuntary, doesn’t need to be volitional initiated, so may not reveal an apathoabolic disorder.

Background: the importance of identifying characteristics of texts written by patients with mental diseases of the endogenous circle is due to the fact that psychological and behavioral disorders in mental diseases manifest themselves in speech activity, including writing, and are little studied in the Russian-language sample.

The aim: is to identify the parameters of the texts characteristic of disorders of schizophrenic and affective spectrum, the analysis of the relationship of the selected parameters with clinical symptoms and personality.

Materials and methods: the study involved 29 patients with endogenous mental disorders (14 patients diagnosed with F2 according to ICD-10, 15 patients with F3) and 41 healthy people. Clinico-psychological, psychometric methods and statistical analysis were used. Everyone wrote an essay on the topic «Me, others, the world», answered Big Five personality traits, patients filled out the questionnaire SCL-90. Results: it is shown that patients are more focused on themselves, their texts often show an ambivalent or negative attitude toward themselves, a sense of isolation from the world, a sense of instability of the «fragility» of the surrounding world. «Torn» and «pretentious» texts were much more common in patients and «broken» texts were specific only for patients. It is shown that the presence of «pathological characteristics» in the text of patients is associated with the severity of clinical symptoms. Correlations of text «pathological» characteristics with clinical symptoms according to SCL-90 (scales of depression, anxiety, psychotism, general severity of the state, severity of distress) and personal characteristics (introversion, separation, naturalness, emotionality) are shown in patients.

Conclusion: thus, the proposed parameters for assessing the texts revealed the peculiarities of perception of oneself and other, a violation of the social orientation of the individual, a decrease in the ability to integrate contradictory and ambivalent phenomena into a holistic view of oneself and the world in the text of patients. «Pathological characteristics» of the text reflect the presence of clinical symptoms and are associated with personality traits.

The aim of the work: to analyze the prospects of the study of «social cognition» for solving diagnostic questions of geriatric psychiatry.

Materials and methods: By combining the key words «social cognition», «theory of mind» and «neurodegenerative diseases», «mild cognitive impairment», etc. in PubMed, ScienceDirect, PsycARTICLES databases was chosen and analyzed publications carriedout in the last decades in the format of reviews, meta-analyzes and longitudinal studies.

Results: Disturbance of the theory of mind (the concept used to evaluate «social cognition» see Part 1) is noted already with mild cognitive impairment. There are data on the better prognostic ability of the theory if mind tests compared to the available neurocognitive tests to assess the risks of developing frontal-temporal dementia. Its disturbances can occur before any signs of the neurodegenerative disease, estimated with the help of neurocognitive evaluation and neuroimaging study. Features of these disorders in different neurodegenerative diseases are shown.

Conclusion: The revealed sensitivity of the methods for assessing theory of mind, as well as the marked specificity of its disturbances in various neurodegenerative diseases, attests to the prospects of this research area for solving the problem of their early and differential diagnosis. Reviewed results require a comprehension from the point of view of the theoretical and methodological foundations of Russian psychiatry and clinical psychology.

The aim of work: to present the analysis of modern scientific publications on the issue of mental disorders and constitutional-personality characteristics of patients with pulmonary hypertension.

Material and methods: according to the key words «pulmonary hypertension», «pulmonary arterial hypertension» publications over the past two decades were selected and analyzed in the scientific bases PubMed, MEDLINE and others resource.

Results: to date, it is known that pulmonary hypertension is a severe pathological condition which is characterized by a progressive increase of pulmonary vascular resistance and leading to life-threatening complications. Pulmonary hypertension is a multidisciplinary problem. The steady increase in the severity of the main symptoms results in decreased physical activity, quality of life and socio-psychological disorders manifestation. This review carries out the literature data about prevalence and spectrum of mental disorders in dif ferent groups of pulmonar y hyper tension patients. In addition, there were analyzed researches aimed to study constitutional-personality characteristics, coping styles and forming certain types of internal picture of disease.

Conclusion: the general prevalence of anxious and depressive disorders are presented in the literature in the most developed form, however, the issues of the psychopathological structure of disorders, the constitutional-personality predisposition, the formation of the internal picture of the disease in pulmonary hypertension are not covered adequately.

E. Kahn’s stratification concept of psychopathic personalities based on the somewhat different view on norm that was used in Kurt Schneider’s concept of psychopathies but very similar to it on descriptive level is analyzed. In his description of psychopathic characters E. Kahn turned to the notion of personality norm of W. Stern outgoing from the personality goal-setting and corresponding adaptation of personality to the goals of society. E. Kahn’s understanding of temperament’s stratum psychopathies is compared with G. Ewald’s temperament concept, E. Kahn’s extended notion of temperament including emotional reactivity factor that was related by G. Ewald to the stratum of character is marked. E. Kahn’s structural approach to psychopathic characters as to personalities with «fictive» goals possesses certain similarity with some principles of A. Adler’s individual psychology. To the notions of «autistic» and «ambitendent» psychopathies E. Kahn attached another meaning than E. Bleuler who emphasized autism and ambivalence as basic symptoms of schizophrenia. Autism and ambivalence are for E. Kahn psychopathic symptoms, and according to his point of view schizoid psychopathy may be diagnosed only with the evidence of genetical relationto schizophrenia.

Purpose: the article deals with the actual problem of practical medicine — professional emotional burnout in nurses. The importance of prevention of emotional (professional) burnout in nurses increases due to the increase in the level of chronic non-communicable diseases that require long-term care of patients in hospitals. The activity of nurses is associated with intensiveworkloads, high returns required in solving labor problems, professional and legal responsibility for the results of actions.

Material and methods: training on the method of Balint Groups to prevent professional burnout in nurses, implemented in GBUZ «Psychiatric hospital No 3. V.A. Gilyarovsky DZM». A questionnaire test «Attitude to work and professional burnout» was developed, containing 137 statements reflecting certain emotional reactions and styles of attitude to work of «helping» professionals in the process of burnout development. Are included in the group of 6–15 people (ideally 8–10), working in the same or different medical or mental institutions, but non-service-related or hierarchical relationships. Results: аs a result of work with the average medical staff of psychiatric profile by the method of Balint Group, improvement of perception and understanding of communication with the patient, awareness of the therapeutic importance of interpersonal relationships and their boundaries was noted, the repertoire of communicative stereotypes was expanded, personal professional growth was achieved. Nurses who have been trained on the method of work in the Balint Group, began to better control their workand psycho-emotional load.

Discussion: the Syndrome of professional emotional burnout in medicine is considered as a factor negatively affecting the quality and effectiveness of the performance of professional duties of nurses and their relationships with patients and colleagues. The article provides justification and evidence of the effectiveness of the method of Balint Groups for the prevention of the syndrome of professional emotional burnout in a psychiatric clinic.

The aim of work: to present the analysis of current scientific publications devoted to the problem of late-onset schizophrenia.

Material and methods: According to the key words «late schizophrenia», «late-onset schizophrenia» and «very late-onset schizophrenia-like psychosis» publications over the last two decades were chosen and analyzed in PubMed, MEDLINE and other scientific bases.

Results: the publications are analyzed and the main stages of the historical development of the concept of late schizophrenia were described. Despite the lingering ambiguity of this concept, the possibility of both late manifestation of schizophrenia (after 40 years) and very late (after 60 years) was recognized. The review deals with the issues of classification, diagnosis, clinic and course of late schizophrenia. The results of modern paraclinical research methods are given. The relevance and prospects of further study of schizophrenic spectrum disorders in late age, their possible connection with organic changes in the brain is shown.

Conclusion: improving the diagnosis of schizophrenic spectrum disorders in late life creates prospects for the development of effective methods for their prevention and treatment. The use of biological (paraclinical) examination methods will help develop a personalized approach to the management of patients with late schizophrenia, determine the severity of organic pathology and determine the prognosis for disease.

19th Сongress of the Section of Epidemiology and Social Psychiatry of the European Psychiatric Association (EPA), Vienna, April 4–7, 2018.