The objective: of the study was to present the main provisions of a new clinical and biological model of schizophrenia, which establishes links between disorders in the field of biological processes and the formation of positive and negative in the general psychopathological space of schizophrenia on the basis of the analysis of long-term results of clinical and biological research of the Mental Health Research Centre.

Material and method: by keywords “schizophrenia”, “biological hypotheses of schizophrenia”, “neuroinflammation”, “neurodegeneration”; “positive disorders”, “negative disorders”, “neuroimmune relationships”, “catabolism
of tryptophan”, “activation of microglia”, publications from PubMed/MEDLINE databases, RSCI and other sources were analyzed
over the past 10 years in comparison with the results of clinical and biological studies of schizophrenia at the Mental Health Science Center.

Results: comparison and analysis of current biological hypotheses of schizophrenia indicates that immunological studies are the most promising for solving the problem of establishing links between disorders of  neurobiological processes and psychopathological specificities of  schizophrenia. Within the framework of the new clinical and biological  model, a key role is assigned to the process of neuroinflammation, which determines the pathogenesis of both negative and positive disorders by various, albeit interrelated, molecular mechanisms. One of these mechanisms,  associated with the development of reversible positive symptom complexes, is based on an imbalance in the neurotransmitter  systems, which is formed as a result of the effect of proinflammatory  cytokines on tryptophan catabolism. Another mechanism that determines the  development of negative symptom complexes is associated with the influence of cytotoxic metabolites on the processes of neurodegeneration. 

Conclusion:  a new clinical and biological model of schizophrenia establishes a paradigm of the relationship between disorders in the sphere of biological processes determined by neuroinflammation/inflammation and the  formation of the main procedural dimensions — positive and negative disorders in the general psychopathological space of schizophrenia. This model makes it possible to clarify some general provisions related to the pharmacotherapy of schizophrenia and the relief of negative disorders, and also serves as the basis for the development of new approaches to early diagnosis, clinical and social prognosis. 

Objective: establishment of clinical and psychometric features of youth depression with attenuated symptoms of the schizophrenic spectrum (ASSS) for early differential diagnosis and nosological assessment.

Patients and methods: clinical and psychometric examination of young 219 inpatients (average age 19.6 ± 2.4 years), first admitted to the clinic “Mental Health Research Centre” from 2011 to 2020 with the first depressive episode with ASSS. Control group of inpatients (52 patients) with “classical” youth depressions without ASSS (average age 19.6 ± 2.4 years). Diagnosis  according ICD-10: F32.1, F32.2, F32.28, F32.8.

Results: the psychopathological structure of youth depression with ASSS is characterized by the following types: (1) depression with attenuated psychotic symptoms (APS), which were divided into the subtype (1a) depression with APS and (1b) depression with brief limited intermittent psychotic symptoms (BLIPS); (2) depression with attenuated negative symptoms (ANS), comprising two subtypes (2a) with most emotional damage and (2b) with volitional impairment, and type (3) with attenuated symptoms of disorganization (ASD) in the structure of depressive episode. Clinical and reliable psychometric differences have been established between depressions with ASSS and «classical» youth depressions without ASSS. 

Conclusions: youth depression with ASSS is definitely different from “classical” youth depression without ASSS. Differences have been found in  the psychopathological structure of youth depression with ASSS, resulting in a typological differentiation.

Background: a system of reforming of psychiatric care in Russia has led to a reduction of beds in psychiatric hospitals. At the same time it is known about permanent high need among elderly patients in the appropriate psychiatric care. In this regard, it became necessary to study the adequacy of the assistance provided to the needs of patients.

The aim of the research: to investigate and compare clinic-epidemiological characteristics of the contingent of the elderly and senile inpatients in the city psychiatric care system and at the research institution.

Materials and methods: as a material for the research served data from the reports from Moscow Clinical Psychiatric Hospital #13 (MCPH #13) and the  clinic of Mental Health Research Centre (MHRC) about the patients older than 65 treated in 2017–2018.

The results: this article contains comparative data about contingents of elderly psychiatric in-patients treated in the Moscow City Clinical Psychiatric  Hospital #13 and in the Mental Health Research Center (MHRC). Collation of the indicated contingents allowed to determine that city psychiatric care  satisfactorily meets needs of the severe psychiatric patients older than 65. However the experience of the clinic of the MHRC differs. This clinic has  some peculiarities: it does not use involuntary hospitalization and it gives preference to difficult cases, where diagnosis is unclear, and where there is a challenge to find an appropriate treatment regimen; patients that require  special care are also rarely admitted. This experience indicates that there is significant number of cases when hospitalization of patients with moderate  mental disorders is also absolutely necessary. The majority of such cases  consists of patients, suffering with depression and the necessity of their admission is dictated by the impossibility to adjust proper therapy in out- patient care.

Conclusion: the contemporary Moscow city psychiatric service do not meet needs of the discussed category of patients for inpatient care. Whether it is  necessary to improve it, or to provide this niche to scientific and commercial institutions is a matter of further research. 

Purpose: formation of multifactor regression models of adherence to treatment of patients with schizophrenia and schizophrenic spectrum disorders and their family members to identify the relationship with socio-demographic, clinical, psychological characteristics, family environment factors and the quality of psychiatric care in order to develop measures to  improve the compliance of these groups.

Patients and methods: the study involved 107 patients (44 men and 63 women), with diagnoses of schizophrenia (F.20), schizoaffective (F.25) and schizotypal disorders (F.21), eligible the ICD-10 criteria, as well as 105 of their relatives (27 men and 78 women). The following methods were used: сlinical and psychopathological, psychometric, psychological, statistical (correlation and regression analysis), methods of system analysis, method of hierarchy analysis.

Results: regression models were built and factors positively or negatively influencing adherence to treatment in groups of patients and their relatives,  formed depending on gender differences, awareness of the disease or its  denial, as well as on the clinical characteristics of patients, were identified. Gender factors affecting adherence to treatment in men include social functioning, education and income; for women — the motivation for treatment and characteristics of family relationships. In the groups of patients and their relatives, selected depending on the awareness of the disease or its denial, the dominant factors influencing compliance were the duration of the disease, the frequency of hospitalizations, patients’ disability,  the level of education of relatives, forgetfulness of taking medications, etc. In groups, depending on the clinical characteristics of patients, the compliance of patients and relatives was influenced by the age of the patient, the level of  motivation for treatment of patients and their relatives, the employment of patients and the level of their social functioning, conflict, hostile relations  in the family and a number of other factors.

Conclusion: knowledge of the factors that affect the adherence to treatment of schizophrenia patients and their family members will contribute to the development of practical measures to improve it. Psychosocial interventions have been proposed to increase adherence to treatment in patients with  schizophrenia and schizophrenic spectrum disorders and their families.

Objective: recently, much attention has been paid to the problem of autism spectrum disorders (ASD) in childhood. Despite the abundance of psychometric approaches to the diagnosis of autism in childhood, questions remain about the validity of their use in everyday practice. In recent years, works began to appear in the United States calling into question the practice of mandatory use of the “gold standard” methods for diagnosing ASD. Russia has many years of experience in multidisciplinary cooperation of medical psychologists and clinicians in child psychiatric practice, which makes it possible to more accurately determine the depth and severity of autistic manifestations, as well as to determine the dynamics of a child’s development, which will make it possible to provide targeted effective assistance. Aim: to develop diagnostic, clinical-psychopathological, psychological approaches to the diagnosis of autism spectrum disorders in childhood.

Patients and methods: the sample consists of 254 patients aged 4–17 years (average age 7.3 years) with different forms of ASD according to ICD-10 (heading F84). The patients were examined by clinical-psychopathological, clinical-dynamic, clinical-follow-up, psychological methods.

Results: the study made it possible to define the profiles of six main forms of ASD from a clinical and psychological standpoint: Asperger’s syndrome (F84.5); childhood autism dysontogenetic (F84.0); childhood psychosis (F84.02); Kanner’s syndrome (F84.01), syndromic atypical autism (F84.11),
and atypical childhood psychosis (F84.12).

Conclusion: the results obtained are presented in a multidisciplinary aspect, which allows the most accurately diagnose one form or another of autism spectrum disorders and to develop personalized routes of patient management.

Background: chronic endogenous depression in youth has a number of features associated with their severe atypia, work and social maladjustment, deterioration in the quality of life, high risk of suicidal and self-injurious behavior, difficulties in choosing therapy, difficulty in diagnosis and nosological evaluation. Until now, no special research has been done on chronic endogenous depression among young people of this age.

Purpose of research: to identify psychopathological features and dynamics of endogenous depression developed in youth, to work out a clinical typology. Patients: 62 young patients (16–25 years old) were clinically and psychopathologically examined, who were first admitted to FSBSI MHRC, within the period of 2017 to 2020 suffering from chronic endogenous depression state for more than two years. Clinically significant somatic, neurological, and mental pathology defined the criteria for exclusion.

Methods: for the research the clinical-psychopathological and psychometric methods were used. The patients were examined by the psychometric  method upon admission to the hospital and at the stage of reduction of psychopathological disorders upon discharge: the HDRS, SANS and SOPS scales included.

Results and conclusion: the clinical picture of youth chronic endogenous depression is characterized by pronounced polymorphism, atypia, erosion of  the thymic component, and the dominance of negative affectivity. Based on the analysis of psychopathological characteristics of endogenous depression in youth, two typological varieties were identified: unitary depressions (type  I) and supplementary depressions (type II). Among the type II depressions, 2 subtypes were distinguished: with neurosis-like disorders and with  psychopathic-like disorders. 

Background: to assess the effectiveness of therapeutic, psychotherapeutic, and psycho-correctional procedures the study of cognitive functions (memory) is necessary. There are few studies of treatment effectiveness through analysis of the dynamics of voluntary memory indicators in children and adolescents with schizophrenia.

Purpose: to analyze the dynamics of voluntary verbal memory indicators in children and adolescents with endogenous mental pathology during treatment in the short-term and medium-term.

Subjects and methods: clinical groups included 134 patients 7–17 years old with diagnoses of childhood type schizophrenia (F20.8xx3), schizotypal personality disorder (F21), undifferentiated schizophrenia (F20.3). The healthy control group for the assessment of short-term and medium-term dynamics included 64 pupils of secondary schools in Moscow, aged 10–16 years.

Methods: Learning of 10 Words, Paired Associations, the Digit Span subtest from WISC. All subjects were examined twice.

Results: therapeutic dynamics shows that the deficit level of immediate memorization volume and memorization effectiveness did not change in 55% and 65% of patients, respectively. Improvement (approaching the norm) of immediate memorization and memorization effectiveness was demonstrated by 26% and 21% of patients, respectively. Statistically significant changes in the state of associative memory during therapy were noted in the groups F21 and F20.3. The effect of specific drugs (neuroleptics,
nootropics, antidepressants) on memory in a separate sample of 36 patients showed a tendency for the positive effect of nootropics and antidepressants. In the medium-term (age-related) dynamics, patients in F21 and F20.3 groups demonstrated relative stability of memory indicators; a tendency towards positive dynamics was found in the F21 group.

Conclusions: a tendency to multidirectional therapeutic dynamics of immediate memory indices was revealed depending on the diagnosis, variability of indices during re-examination in connection with treatment with individual drugs. The dynamics of memory indices in the mediumterm reveals the differences associated with the diagnosis — a minimum of positive age-related shifts in the F20.8xx3 group and variants of dynamics that are close to normal in the F21 and F20.3 groups. The “learning effect” found in the developmental norm is not so noticeable or not noticeable at all in clinical groups.

Purpose: rapid cycle bipolar disorder may be more resistant to treatment than other bipolar disorders. However, the effect of the synergistic use of carbamazepine and lithium in the treatment of outpatients with rapid cycle bipolar disorder without psychiatric comorbidity has not been studied in a double-blind, placebo-controlled design.

Patients and methods: participants in a double-blind, placebo-controlled study met DSM-5 criteria for bipolar disorder with a rapid cycle between the ages of 18 and 65 years. The response and side effects of carbamazepine, lithium, and placebo were compared using analysis of variance (ANOVA) and chi-square tests. The respondent underwent F2, demonstrating superiority with respect to carbamazepine and lithium than in the case of placebo. Carbamazepine and lithium were generally well tolerated by the study patients, although a larger number of patients receiving carbamazepine and lithium (n = 2) early discontinued the study due to side effects.

Results: twenty-seven of the 36 participants taking the combined carbamazepine and lithium regimen responded at 12 weeks, compared with six of 38 participants who received a placebo (p < 0.001). Two common side effects that led to discontinuation of carbamazepine and the lithium group were allergic reaction and drowsiness. Frequent complaints of sweating and headache during placebo treatment occurred in two out of 38 men. There were no unexpected or serious adverse events.

Conclusions: the combined use of carbamazepine and lithium in the treatment of outpatients with rapid cycle bipolar disorder has demonstrated superior use of carbamazepine and lithium than placebo.

Introduction: hygienic education of the population includes a set of educational, upbringing, agitation and propaganda activities aimed at promoting a healthy lifestyle, preventing diseases, maintaining and strengthening health, increasing the working capacity of people, and prolonging their active life.

Material and methods: the analysis of 5 qualification works of a psychiatrist was carried out for the hygienic and health education. The depth of the  study was 24 years. When working on the material, the following methodological approaches were used: systemic, complex, dynamic, normative, quantitative and situational. Analysis methods included: historical, analytical and comparison. The following techniques were used for the analysis: groupings, absolute values, continuous and selective observations.

Results: psychiatric reception in the advisory department of GAUZ RK “CDC RK” is carried out by one specialist. Individual psychoeducation, psychiatric  education and psychoprophylaxis accompany the entire treatment process  of persons with mental disorders. The psychiatrist of the regional center is constantly engaged in psychoeducation of the population, works with the  medical staff of the institution and central regional hospitals, is engaged in methodological and research work. Discussion: health education in psychiatry in all forms contributes to a wider medical prevention of the development of pathology in the mental sphere, as well as to the improvement of already developing diseases and the prevention of relapse of already cured diseases. Despite the fact that the psychiatrist deals with such topics that are not of a pronounced psychological nature, they always include psychological problems, since they relate to human relationships, provide people with information, recommendations, advice and act on them emotively. 

Conclusions: sanitary and educational work in psychiatry is aimed at  increasing the level of knowledge of the population about mental disorders, mastering methods of protection from stress, the harmful effects of bad  habits. Individual health education accompanies the entire treatment process. 

Purpose of the work: analysis of changes in the views of domestic and foreign researchers on the clinical and biological features of manic-paraphrenic states developing within the framework of endogenous  paroxysmal states psychoses.

Material and method: by the keywords “mania, paraphrenia, manic,  paraphrenic”, “manic-paraphrenic state”, publications available to authors were selected in the databases MEDLINE/PubMed, Scopus, Webofscience, eLibrary.

Conclusion: the following areas of research have been identified: 1) the prevalence of manic-paraphrenic states at the present time; 2) evolution of researchers’ opinions regarding these psychoses throughout the entire period of the study of the issue; 3) a modern point of view on the nosology of manic-paraphrenic states and their place in current classifications of  mental disorders; 4) topical issues of the pathogenesis of such disorders.

The aim of review: to present the evolution of the concepts and pathokinesis of hyperthymia.

Materials and methods: according to the keywords “personality of the hyperthymic circle”, “hyperthymia”, “bipolar affective disorder”, “chronic hypomania”, publications were searched in PubMed/MEDLINE, RSCI and other sources from the middle of the 19th century to the present.

Conclusion: in science, historically, two intersecting psychopathological  concepts of hyperthymia have developed, positioning it as a single continuum of bipolar disorder and affective temperament/personality disorder. In recent years, thanks to the success and introduction of biological psychiatry, studies have appeared that confirm the structural-dynamic and pathogenetic integrity of hyperthymia.