A leukocyte-inhibitory index (LII) is the ratio of the proteolytic enzyme leukocyte elastase (LE) to its inhibitor, an α₁- proteinase inhibitor (α₁-PI). LII characterizes the activity of the proteolytic system and can be considered as a potential objective criterion that determines both the course and the outcome of the disease. The changes of LII in schizophrenia patients with clinically diagnosed asthenia (schizoasthenia) and patients with schizophrenia without clinical signs of this syndrome were revealed. The objective: to study the possibility of the 95% confidence intervals for a comparative assessment of LII in patients with schizoasthenia and patients with schizophrenia without clinical signs of asthenic syndrome to obtain correct statistical conclusions. Patients and methods: Overall, 95 patients aged 20–55 years with paroxysmal-progressive (F20.x1) and paranoid (F20.00) schizophrenia were examined: 61 patients in the total sample were clinically diagnosed with asthenic symptom-complex. The enzymatic activity of LE and the functional activity of α₁-PI were determined in blood serum. LII was calculated according to the formula. The confidence intervals were built using 4 different methods: Fieller’s theorem, delta method, regression methods and bootstrap method. Results: the statistical analysis indicates that the 95% confidence intervals of these indicators for the examined patient groups do not overlap. Therefore, these indicators relate to different populations, which mean the examined groups are characterized by different variants of the ratio of the proteolytic system components. Conclusion: the assessment of LII can serve as an objective statistically correct criterion for presence or absence of asthenic disorder in patients with schizophrenia in addition to clinical examination.

Purpose: psychopathological differentiation of gender identity disorder (GID) that occurs as part of depressive episode; creating a typology for developing diagnostic and prognostic criteria. Material and methods: 63 patients (46 women and 17 men) who applied to the FSBRI MHRC from 2016 to 2019 were examined by a clinical psychopathological method. All patients were diagnosed with a depression being part of schizotypal disorder or histrionic personality disorder or mixed histrionic and schizoid personality disorder. Results: Clinical and psychopathological analysis of gender identity disorder occurring as a part of depressive episode showed its heterogeneity, varying severity, as well as a diverse relationship with other psychopathological disorders, which required an in-depth and detailed study. We have identified the following typological varieties: type 1 — GID as a part of depersonalization disorders, type 2 — GID as a part of dysmorphophobic disorders, type 3 — GID as a part of histrionic disorders. Conclusions: The obtained results give us the opportunity to suggest that the diagnosis of the disease, in which the gender identity disorder is detected, can help predict its further course and possible outcomes.

Background: the comparative aspect of the clinical-diagnostic and prognostic evaluation of long-term remissions treated with antipsychotics of various generations in patients with shift-like schizophrenia remains poorly studied and retains scientific and practical actuality. The purpose of the study: a comparative study of the therapeutic effect of antipsychotics of different generations on clinical-psychopathological peculiarities and the dynamics of 2-year remissions after acute paranoid states in patients with shift-like schizophrenia. Patients and methods: 34 female patients (average age made up 26.9 years old) were diagnosed in shift-like schizophrenia with a clinical picture of the attack as acute paranoid syndrome (F20.02 according to ICD-10). 16 patients received treatment with typical neuroleptics (TN), other 18 patients received atypical neuroleptics (ATN). The study was conducted as an open prospective, using clinical-psychopathological, clinical-catamnestic and clinical-psychometric methods. The mental state of patients was assessed four times: upon admission to the hospital in acute psychosis (1 point), when entering remission (2 points), after 1 and 2 years of remission (3 and 4 points). In psychometric assessment was used calculated for 1 patient indices of the main total score of all signs (MTS) and main score of 1 sign (MS) of the PANSS scale and its subscales of positive (P), negative (N) and general psychopathological (G) syndromes. Results: at the end of the active treatment with both types of antipsychotics at the 2 point of assessment, was reduced MS of positive symptoms P+G subscales from 3.3 to 1.7 scores on TN and from 3.8 to 2.2 scores on ATN, with a remission and stabilization of the achieved improvement with reduction of MS at 4 points up to 1.5. MS of negative symptoms by the 2 nd  year of remission on ATN decreased from 2.7 to 2.0 in parallel with the reduction of positive signs by P + G; on TN there was an increase in MS indices of subscale N from 2.3 to 2.7 scores. The assessment of negative disorders is discussed as “secondary” negative due to the phenomenologically is assumed with the symptoms of the positive syndrome and the effects of neurolepsy. Conclusion: TN and ATN exhibit a similar “antipsychotic” effect in the treatment of acute paranoid psychoses in shift-like schizophrenia patients with the formation of long-term high quality remissions, stabilization of degrees of reducted productive psychopathological symptoms and with the absence of the progredience disease. To optimize the therapeutic effect of both types of antipsychotics, it is recommended correction of the regime and the term in transition from active to maintenance therapy and prescription of neurolepsy correctors to reduce severity in the picture of “secondary” negative symptoms.

The use of antipsychotic therapy in patients with schizophrenia is associated with the development of a wide range of adverse events, among which akathisia is one of the most common. Objective: to assess the risk of akathisia in patients with schizophrenia receiving various antipsychotic therapy. Patients and methods. A continuous method examined 250 inpatients with a verified diagnosis of schizophrenia. The akathisia assessment was performed using the Barnes Akathisia Rating Scale (BARS). The odds ratio was estimated using the MedCalc® online calculator. Results: akathisia was detected in 92 (36.8%) examined. The combination of two antipsychotic drugs has an increased risk of akathisia in patients with schizophrenia OR = 1.69 (95% CI: 1.0–2.88; p = 0.04), however the use of conventional and atypical drugs was associated with a reduction in risk (OR = 0.45 (95% CI: 0.21–0.95; p = 0.037)). Patients receiving basic therapy zuclopenthixol decanoate had increased risk of akathisia 4 times as compared to haloperidol decanoate (OR = 3.85 (95% CI: 1,26–12,22; p = 0.021)). Conclusions: It was shown that the choice of antipsychotic therapy should be based not only on the actual mental state of the patient, but also considering the potential risk of akathisia.

Background: the study of clinical and neurophysiological aspects of non-suicidal self-injurious behavior (NSSI), as one of the forms and risk factors for suicidal behavior in adolescents, including those suffering from mental disorders, is an urgent medical and social scientific task. Objective: To identify the features of EEG in depressive adolescent females with NSSI compared with EEG of age norm. Patients and methods: the study included 60 female patients aged 16–25 years with NSSI in the structure of endogenous depressive conditions, and 20 healthy subjects of the same gender and age. Clinical, psychopathological, psychometric, neurophysiological and statistical methods were used. Topographic EEG mapping revealed differences in the background EEG quantitative parameters of two studied groups. Results and discussion: spectral power values of alpha-2 (9–11 Hz) and alpha-1 (8–9 Hz) EEG frequency components in occipital-parietal and temporal leads, of theta-2 activity (6–8 Hz) in central-parietal leads, as well as of delta activity (2–4 Hz) in frontal and anterior temporal leads were higher in the left hemisphere, reflected increased activation of the right hemisphere. Generalized bilaterally synchronous alpha-theta bursts were registered regularly in EEG of NSSI patients, as well. Conclusions: the spatial distribution of EEG frequency components in depressive patients with NSSI indicates relatively decreased functional state of the cortex, especially of the left hemisphere and of its anterior regions, responsible for voluntary control of activity, with higher level of activation of temporal regions of the right hemisphere, associated with formation of negative emotions, and increased excitability of brain limbic-diencephalic structures, that may underlie poor controlled impulsive behavior.

Background: prescribing antidepressants in the treatment of bipolar depression remains highly controversial due to the inconsistence between routine clinical practice and the results of controlled trials. Purpose: to assess the validity of antidepressants use in bipolar depression from the point of view of evidence-based medicine. Material: database search (Scopus and MEDLINE) followed by analysis of studies concerning the efficacy and safety of antidepressants in bipolar depression treatment. Сonclusion: the search found 23 studies. There was a high degree of inconsistency in the results, apparently related to the methodology. Only two studies compared the effectiveness of antidepressants in monotherapy with placebo, with no differences found in the study with 740 participants and in the study with 70 participants with type 2 bipolar disorder antidepressants were found to be more effective than placebo. Nevertheless, both studies had significant methodological issues. In 6 studies comparing the effectiveness of the combination of antidepressants with mood stabilizers against the combination of mood stabilizers with placebo, only the effectiveness of fluoxetine in combination with olanzapine was revealed, other antidepressants were ineffective. At the same time, studies where antidepressants were compared with each other in combination with mood stabilizers revealed a significant clinical response to therapy. Analysis of routine clinical practice studies has shown that antidepressants are prescribed very often, for about 50% of patients with bipolar depression. International guidelines for therapy differ quite widely on the use of antidepressants in bipolar depression, but in principle allow their use. Thus, despite the contradictory literature data, the use of antidepressants in bipolar depression is justified from the point of view of evidence-based medicine for certain groups of patients with taking into account risk factors.

Objective: to provide the description of researchers’ views evolution and provide the review of modern scientific literature on nosological affiliation and clinical features of catatonia. Material and methods: Scopus, PubMed, Cochrane Library, eLIBRARY databases were searched for literature (44 000 papers) using the keyword ‘catatonia‘. Based on the selection criteria, the search has been found the clinical cases, cohort and random studies, dedicated to psychopathologic description of catatonia, accompanied by affective disorders, autism and hysteria. 50 papers issued between 2000 and 2020 were selected for the analysis. Conclusions: catatonia, traditionally treated as a symptom of schizophrenia, currently is predominantly interpreted as a “transnosological syndrome”, which accompanies various (both mental and somatic) diseases. The clinical manifestations of catatonia in affective disorders, autism and hysteria have their own distinctive features, also the presence of catatonic symptoms is associated with a greater severity of the underlying disease, low quality of remissions, which explains why the experts are wary of the endogenic factors.

Purpose: analysis of the literature on the influence of socio-psychological factors on the complimentary behavior of patients with schizophrenia. Material: according to the keywords “schizophrenia”, “compliance”, “adherence to treatment”, “awareness of the disease”, “psychological factors”, “social factors”, “psycho-education”, “family therapy”, articles of domestic and foreign authors were selected and studied, devoted to the problem of compliance with schizophrenia patients and published in the last two decades. To compile a literature review, articles in the MedLine/PubMed, eLIBRARY, databases were selected and analyzed, relevant links in the literature lists of the analyzed articles. Discussion: analysis of publications showed that at present, numerous factors have been identified that affect the compliant behavior of schizophrenia patients, among which factors associated with the clinical picture of the disease, cultural and religious characteristics of individuals, medication, the organization of medical care, and many others have been identified. The article most thoroughly discusses the socio-psychological factors of schizophrenia patients’ compliance — the internal picture of the disease, the emotional response of the patient and his relatives to the disease, the therapeutic alliance with specialists of the psychiatric service and a number of other factors. The relationship of the schizophrenia patients’ compliance with their cognitive, emotional and motivational-behavioral spheres of personality was considered. Conclusion: compliance of patients with schizophrenia can improve the combination of drug therapy with psychoeducational work. A psychoeducation program should be available to most of them. Given the influence of relatives on the formation of compliance with schizophrenia patients, it is necessary to include family therapy in treatment and rehabilitation programs of psychiatric institutions.

The aim of the review: the analysis of modern Russian and foreign literature dedicated to the problem of determining diagnostic criteria for clinical high risk of psychosis (CHR-P) and outlining the therapeutic approaches based on the pathogenic mechanisms of their development. Material and method: the publications found by searching queries for keywords in Russian and English in the MEDLINE/PubMed and eLIBRARY databases for the time period from 2010 to 2020 were then analyzed. Conclusion: the review presents a modern definition of the CHR-P group, along with a clarification of individual diagnostic criteria, which include attenuated psychotic symptoms (APS), brief limited intermittent psychotic symptoms (BLIPS), genetic risk with deterioration of premorbid functioning, as well as basic symptoms (BS). We found heterogeneity of the CHR-P group with different levels of manifestation and outcomes and indicated the involvement of different pathogenic mechanisms in their formation. These findings determine the development of various approaches to treatment, which involve the assessment of the ratio of potential benefits and the risks of side effects. The obtained data, on the one hand, attest to the prospective viability of the therapeutic approach to the patients with CHR-P with the possibility of influencing the course of the disease, delaying its manifestation and improving long-term outcomes, and, on the other hand, the lack of universal standards of therapy at present. Tactics of treatment are determined basing on an individual approach to the patient with a comprehensive psychopathological assessment of complaints, clinical state and its dynamics.