The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.

Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).

Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.

Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

Background: currently, it has been proven that the pathogenesis of endogenous mental disorders is associated with the process of neuroinflammation in the brain of patients. It is also known that chronic neuroinflammation, accompanied by a violation the permeability of the blood-brain barrier. It is accompanied by the activation of platelets that generate procoagulant microparticles, which leads to a disturbance of the hemostasis system, causing an increase in blood clotting in patients. Objective: to investigate the dynamics of procoagulant activity of blood in patients with endogenous mental disorders before and after psychopharmacotherapy.

Patients and methods: the study included 185 patients aged 16 to 64 years with the following mental disorders: schizophrenia with attack-like/attack-progressive/continuous type of course (F20.00–2), affective disease (F31.1–5; F32.0–3; F33.0–3), schizotypal disorder with affective fluctuations (F21.3–4). The thrombodynamic test (TD) was performed on T-2 Trombodynamis device according to the manufacturer’s instructions (Hemacore LLC, Moscow, Russia). All patients received standard pharmacotherapy according to their condition.

Results: a significant decrease of procoagulant activity of spontaneous clots in the patients’ blood after psychopharmacological treatment is observed. Our data on the positive dynamics of changes in the values of TD test’s indicators in most of the examined patients suggest that a decrease in the coagulation activity of the patients’ blood as a result of treatment may be associated with the anti- inflammatory effect of antipsychotics and antidepressants.

Conclusion: for the first time, it was shown that there is a positive dynamic in changing the values of the main parameters of the TD test in most patients with endogenous mental diseases. The results of TD tests can be the basis for monitoring the response to therapy.

Objective: to construct a mathematical model that predicts the state of depression by immunological parameters in the blood plasma of older people to further predict the development of the disease.

Patients and methods: 55 hospitalized patients of late age (mean age 69.2 ± 6.9 years) with a depressive episode were included in the study. The control group consisted of 41 elderly people (average age 66.6 ± 6.2 years) without depressive disorders. The activity of inflammatory and autoimmune markers in the blood plasma of patients and control groups was determined: the enzymatic activity of leukocyte elastase (LE), the functional activity of the α₁-proteinase inhibitor (α₁-PI), the level of autoantibodies to neuro-specific antigens S100B and the myelin basic protein (MBP). Statistical data processing was performed using the R (R version 3.2.4) and STATA (version 12.1) programs. We used point-bead-correlation to measure the strength and direction of the relationship between the binary variable and continuous variables and logistic regression to predict the probability of occurrence of events of interest by the values of one or more independent variables (predictors).

Results: in patients with depressive disorders, a statistically significant increase in the functional activity of α₁-PI (p ≤ 0.05) and the level of autoantibodies to the neurospecific S100B antigen (p ≤ 0.05) was revealed compared with the control. LE activity and MBP level did not differ from the control (p = 0.12 and p = 0.1, respectively). Based on immunological parameters in elderly patients with depression, a mathematical model is constructed. The accuracy of the correct prediction of outcomes using the model as a whole was 83.33%, which indicates a high predictive efficiency of this model.

Conclusion: the results of mathematical analysis obtained in this work indicate that immunological parameters such as the functional activity of α₁-PI and S100B are statistically significantly associated with the likelihood of depression in the elderly. Indicators such as enzymatic activity of LE and the level of autoantibodies to MBP did not have a statistically significant effect on the desired probability.

Objective: study of the prolonged effects of a three-month course of therapy with citicoline, carried out three times for three years, to prevent the progression of cognitive deficit in 1st-degree relatives of patients with Alzheimer’s disease (AD).

Study participants: the study involved first-degree relatives of patients with an established diagnosis of AD.

Study design: an openlabel comparative three-year prospective study of the dynamics of cognitive status in two groups of relatives, one of whom received citicoline therapy (1st group), and the other did not (2nd group). The 1st group made up 48 relatives (11 — with mild cognitive impairment syndrome and 37 — with signs of minimal cognitive dysfunction). 32 relatives who had not received drug treatment for 3 years (8 of them had objectively confirmed signs of minimal cognitive dysfunction, in 24 people — cognitive functioning corresponded to the normal aging) were included to 2nd group. The groups did not have significant differences in demographic characteristics and distribution of the ApoE4(+) genotype carriers.

Methods: clinical and psychological, psychometric, ApoE genotyping, statistical.

Results: in the therapeutic group, a significant improvement in the cognitive status was found in 75.0% of the treated relatives with cognitive disfunction on most scales and tests, with the exception of the clock drawing test. In the group of relatives who did not receive drug therapy, there was a significant deterioration of cognitive functioning — in 2 cases with the formation of mild cognitive impairment syndrome, in 21 cases — with the appearance of minimal cognitive signs.

Conclusion: the results of a three-year preventive course of citicoline therapy showed a significant positive effect of the drug on the cognitive status of the 1st degree relatives of AD patients who had signs of cognitive impairment that did not reach the level of dementia.

Background: basing on the hypothesis that oxidative stress participates in schizophrenia pathogenesis, the authors suggested that the activities of glutathione reductase (GR) and glutathione-S-transferase (GST), the enzymes metabolizing the central antioxidant glutathione, are altered in patients with schizophrenia spectrum disorders.

Objective: determination of activity of platelet glutathione reductase (GR) and glutathione-S-transferase (GST) in patients with late-onset schizophrenic spectrum disorders (LOS - spectrum psychoses) and evaluation of their possible connection to clinical indicators.

Patients and methods: 28 female in-patients aged 45–86 years with LOS-spectrum psychoses were examined: schizophrenia (n = 16), schizoaffective disorder (n = 6), chronic delusional disorder (n = 6). A control group of women of the same age range without mental and neurological diseases was recruited. Platelet GR and GST activities in patients were determined before and after the course of pharmacotherapy, and in the control group - only once.

Results: assessment of the patients’ symptoms’ severity using PANSS, HAMD, and MMSE was carried out before and after the course of pharmacotherapy (at the 28th day of the therapy course). The efficacy of therapy was determined by the change in the PANSS and HAMD total score. While the GR activity did not differ significantly in patients and in the control group, GST activity was found substantially and significantly reduced in patients (before and after the course of therapy) compared with the control group, although GST activity in patients did not significantly change during their treatment. In both cases (GR and GST), three patients were observed among the patients with enzymatic activity exceeding > 1.5 times the medians in the group. After the course of treatment, the activity of enzymes decreased to a level within the range of control values or values for other patients.

Conclusion: the results of a pilot study indicate the promise of determining the activity of GR and GST in a group of patients with LOS-spectrum endogenous psychoses to distinguish among them subgroups with glutathione metabolism abnormalities that correlate with clinical and pathopsychological features.

Objective: the comorbidity of schizophrenia and tobacco and alcohol addiction modifies the clinical manifestations of both diseases, impairs compliance, increases the risk of aggressive behavior and contributes to the criminalization of patients. In order to study the characteristics of tobacco smoking and alcohol consumption by patients with schizophrenia, we conducted a medical and sociological study of the specified contingent.

Patients and methods: 104 in-patients with diagnosis of schizophrenia admitted to psychiatric hospital were interviewed in February 2020. All patients participating in the study have reached the age of 18. The research program is presented by the “Questionnaire for the study of smoking and alcoholic behavior in patients with mental disorders”. Evaluation of smoking status included K. Fagerström’s test, A. Leonov’s test “Why do I smoke?” To determine the motivation to smoke, smoking index was calculated to determine the risk of developing COPD, and the AUDIT test was used to assess alcohol consumption. Statistical processing of the results of the questionnaire survey was using the SPSS-17 software. The prevalence of smoking among patients with schizophrenia is high (56.8%). Most (86.4%) of them are heavy (66.1%) and hardcore (20.3%) smokers. A high degree of dependence was revealed, the smoking experience averages 27.6 years, and the number of cigarettes smoked per day ranges from 10–20 and even up to 60 pieces. The patients are characterized by early onset of smoking (15.2 years) and the prevalence of high (47.5%) and medium (18.6%) degrees of nicotine addiction. The prevalence of alcohol consumption among patients with schizophrenia is very high (36.5%). Most (73.7%) patients consume alcohol either regularly (31.6%) or habitually (42.1%). Every fifth (21.2%) stopped drinking alcohol due to poor health.

Conclusions: high prevalence of smoking and alcoholic addiction in patients with schizophrenia increases the medico–social significance of this comorbidity.

Objective: the article presents the results of a study of the neuropsychological profile of cognitive functions in patients with endogenous depression, in the structure of which overvalued formations are revealed. The study of cognitive processes in patients with such disorders will help determine prognostic criteria and contribute to the development of optimal recommendations for personalized therapy of these conditions.

The aim of the study was to determine the characteristics of cognitive functioning and its dynamics in patients with endogenous depression with overvalued formations.

Patients and methods: using clinical-psychometric, neuropsychological, pathopsychological methods, 45 patients were examined. 26 men (average age 28.7 ± 7.3) and 19 women (average age 34 ± 8.6) had a manifest or repeated depressive state within the framework of an affective disease (F31-34 according to ICD-10) with the phenomenon of overvalued formations. The control group was represented by a similar in number, comparable in terms of sex and age group of patients (45 patients) with a depressive state that forms within the affective phase (F31-34 according to ICD-10), without overvalued formations.

Results: in the course of the work, differences were found in the structure of the neurocognitive deficit of endogenous depression with overvalued formations from that of depressions without the phenomenon of overvalued formations. As a result of neuropsychological screening of patients in the group of endogenous depressions with overvalued formations, data were obtained on dysfunction of the anterior sections of the predominantly left hemisphere and related regulatory deficiency. Conclusions: patients with endogenous depressions occurring with a predominance of overvalued formations in the clinical, a neurocognitive deficiency of the regulatory domain is characteristic, which is different from that in depressions without the phenomenon of overvalued formations.

Rationale: The problem of intra-hospital infections around the world (including in Russia) has played a huge role in recent decades.

The aim of the work: consider the issue of nosocomial infections using an example of a psychiatric hospital and show the significance of this problem.

Material and methods: review and analysis of the current state of the problem; analysis of the

situation of nosocomial infections for 2016–2018 in psychiatric inpatient departments of GBUZ “OPB im. K.R. Evgrafova”, Penza (for 1000 beds).

Results: the main problems of intra-hospital infections in the world and Russia are considered; Analysis of the etiological structure of intra-hospital infections in hospitals of various profiles; Features of intra-hospital infection are considered and analysed; Etiological structure and antibiotic resistance in Penza psychiatric hospitals have been studied.

Conclusion: WBI laminating on the main disease, weighs the clinical course of the disease, makes diagnosis and treatment difficult, impairs the prognosis and outcome of the disease, which retains its importance and determines the directions of solving this problem.

Introduction: at the end of the last century, the macrophage-T-lymphocyte theory of the development of mental disorders was formulated. It underlines the important role of monocytes/macrophages and cytokines produced by them in the pathogenesis of schizophrenia, bipolar affective disorder (BAD) and depression. The first part of our review is dedicated to the analysis of the mechanisms of cellular and molecular interactions of activated monocytes/macrophages synthesizing proinflammatory CD16 receptors with endothelial cells, platelets, and microglia cells in the pathogenesis of systemic immune inflammation, including CNS as a result of violation of the integrity of the blood-brain barrier (BBB), activate microglia and cause the development of neuroinflammation in patients.

The aim of work: to analyze and summarize the results of the main scientific publications for the role of cell-molecular mechanisms of the monocyte-macrophage immunity link activation in the pathogenesis of schizophrenia, BAD and depression. Material and methods: keywords “proinflammatory monocytes, cytokines, chemokines, molecules of cell adhesion, microglia, neuroinflammation, mental disorders” were used to search for data published over the past 20 years in domestic and foreign studies in PubMed, eLIBRARY, Science direct and EMBASE.

Conclusion: the present review is dedicated to the analysis of the latest research data concerning an increase in the number of active circulating monocytes/macrophages and an increased level of proinflammatory cytokines, chemokines and receptors for them produced by monocytes in patients with schizophrenia, BAD and depression, what allows to associate these disorders with systemic immune inflammation. The data reasearches on cellular and molecular mechanisms of proinflammatory monocytes/macrophages interaction with microglia cells that initiate neuroinflammation in the CNS and lead to destabilization of brain function and the development of psychotic disorders are presented. The association of high levels of proinflammatory cytokines with somatic comorbidity, including metabolic syndrome, diabetes, atherosclerosis and other systemic diseases is shown in patients with mental disorders.

Findings: the presented review of the research data allows us to better understand the cellular and molecular aspects of activation of the monocyte-macrophage immunity link in the development of neuroinflammation and cognitive decline in the pathogenesis of mental disorders, as well as helps in the search for informative biomarkers of the positive treatment of these disorders and the new approaches in the treatment of patients, based on the complex use of psychotropic and anti-inflammatory drugs.

Background: steady progression of dementia is characterized with various rates, which specified clinical differentiation of dementias with rapid and slow increase of cognitive decline severity. The search for clinical factors, hypothetically responsible for differences in late age dementia progression rate, is one of the aspects of investigation of late age dementias.

The objective was to generalize the results of the study of separate clinical factors effect on the differences in the late age dementia progression rate.

Material and methods: papers in MEDLINE/PubMed bases from 1990 to 2020 were selected and analyzed according to the key words: “late age”, “dementia”, “progression rate”, “age of onset”, “non-cognitive disorders”, “nosomodifying therapy”, as well as relevant papers in the literature of the analyzed works.

Conclusion: various parameters of the disease were studied as associated with dementia progression pattern. As regards part of them the results achieved compliance in recognition of association with dementia progression rate. As for the others this evidence is ambiguous. There are large discrepancies in attitudes to gender differences, while early age of disease onset, initially great intensity of neuropsychiatric disorders are concordantly admitted as associated with dementia rapid progression. The researchers are united with steady idea of nonlinear character of dementia progression at the stages of mild, moderate and severe dementia.

The results of study of comorbidity are basically similar with regard to recognition of SFD influence, first of all, of arterial hypertension on dementia progression rate. The evidence of the efficacy of nosomodifying therapy, decelerating dementia progression, is unanimously considered an urgent problem. The development of new dementia pathogenesis concepts and the search for new therapy targets, are conducive to the solution of this problem. The results of the investigated direction of studies confirm the hypothesis of the fact that dementia progression occurs according to various pathogenetic mechanisms, which determine the dementia increasing rate. The management of patients with dementia in practice presupposes taking into account of various factors, influencing dementia progression rate, for planning of the volume and character of medical care.

Background: Despite a large number of studies devoted to religiosity and religious coping of patients with mental illness, many issues remain uncertain or contradictory.

The aim of the review: to present the analysis of domestic and foreign scientific publications on the problem of the religious life of patients, differentiation of normal and pathological religiosity, peculiarities of religiosity in patients with delusion with religious content, religious coping.

Materials and methods: using keywords “normal religiosity”, “pathological religiosity”, “religious delusion”, “spiritual emergency”, “religious coping” papers were selected and explored in MEDLINE/PubMed, Scopus, eLIBRARY, Google scholar, Cyberleninka databases from 1990 to 2020.

Conclusion: most researchers found out positive effect of religiosity on mental health. Religious coping is great resource for rehabilitation of patients with schizophrenia and schizophrenia spectrum disorders. At the same time, studies devoted to the problems of the influence of religiosity on the formation of delusion with religious content, its prognostic value, demonstrate contradictory results, partly due to the bias of psychiatrists towards the religiosity of patients. It seems important to minimize existing contradictions in order to improve the quality of life for patients, and increase compliance in the course of further research.

Introduction: the study of burnout syndrome intensifies over time. In 2020, MEDLINE/PubMed database contains more than 18,000 publications on this phenomenon. In its development, the concept of burnout has passed through several heterogeneous periods. Objective: to provide the description of the origin and development of the burnout concept, the features of the social environment within which this syndrome was actualized, and the current state of this problem.

Material and methods: publications on the burnout syndrome were analyzed. The search was performed using the keywords “burnout”, “history” in the MEDLINE/PubMed, eLIBRARY, and Google Scholar databases. The “snowball” method was used to search for publications in the literature lists of relevant studies.

Results: the phenomena similar to burnout were registered long before the start of its academic study. The initiation of scientific research on burnout occurred mainly due to global social changes associated with the increasing role of social professions and the increasing burden on workers employed in them. The results of the analysis of publications made it possible to distinguish several stages of burnout studying, which differed in the methodology of empirical research, the range of subjects included in the risk group for this phenomenon, and the number of competing psychological models of burnout. Despite the growing number of papers on burnout, issues related to the clinical status of this syndrome, its discriminant validity, methods of its prevention and coping are still relevant. The effectiveness of an interdisciplinary approach to the study of burnout can be flawed by excessive expansion of the concept and loss of its substantiveness.

Цель: по данным научных публикаций представить анализ свойств новейшего антипсихотика третьего поколения карипразина, частичного агониста дофаминовых рецепторов с уникальным предпочтительным взаимодействием с D3- относительно D2-рецепторов.

Материалы и метод: по ключевым словам «шизофрения», «негативные расстройства», «терапия», «карипразин» проведен поиск и анализ научных статей в базах данных MEDLINE, PubMed и в других библиографических источниках за период с 2000 по 2020 г.

Заключение: обобщены данные преклинических и клинических исследований препарата с последовательным анализом параметров фармакодинамики, фармакокинетики, клинической эффективности, переносимости и безопасности на всех этапах терапии шизофрении, включая купирующую терапию обострений и длительную поддерживающую терапию с профилактикой рецидивов. Сформулированы предварительные рекомендации по применению карипразина в клинической практике с учетом особенностей фармакологических и клинических характеристик препарата.