Introduction: the abuse of synthetic cannabinoids may trigger the development of mental disorders characterized by distortions of disease processes that can cause incorrect diagnosis.

Objective: to study the phenomenon of the abuse of synthetic cannabinoids (Spice) as a trigger psychotic episode in psychiatric patients (with schizophrenia and personality disorders) and risk factors for developing paranoid schizophrenia.

Patients and research methods: 291 men were examined: 241 with dependence on synthetic cannabinoids — 101 of them were diagnosed with personality and behavior disorders in adulthood, 140 with a diagnosis of paranoid schizophrenia and 50 with a diagnosis of paranoid schizophrenia without drug dependence.

Research methods: clinicalpsychopathological, psychometric (SANS, CGI, MMPI), follow-up, statistical R (R version 3.2.4).

Results: intoxication conditions caused by synthetic cannabinoids can provoke the development of psychotic episodes and be a trigger for the manifestation of schizophrenia. There are four variants of narcotic intoxication: delirious, schizophrenic, with pseudo-hallucinations, with delirium. The personalities of patients addicted to synthetic cannabinoids are similar in the prevalence of emotionally unstable, rigid, introverted, deviant traits. Patients with personality disorders, dependent on synthetic cannabinoids, differed from typical drug addicts in such patterns of behavior as disorganization, conflict, unpredictability, spontaneity, thoughtlessness of actions, impulsivity, and nonconformity. The stigmatizing signs of the schizophrenic process in patients who are dependent on synthetic cannabinoids are the symptoms of abulia–apathy of mild severity. Patients with schizophrenia, dependent on synthetic cannabinoids, differed from patients without dependence on drugs by the phenomenon of the absence of an emotional defect expressed in the expressiveness of emotions, the desire for communication.

Conclusion: the phenomenon of synthetic cannabinoid abuse is a trigger of a psychotic episode in both schizophrenic patients and those with personality disorders in whom antisocial, schizoid and paranoid personality traits prevail. The abuse of synthetic cannabinoids is a risk factor for the development of paranoid schizophrenia, which differs from schizophrenia without drug dependence by a mild degree of stigmatizing symptoms of abulia–apathy and social activity during periods of short-term remissions.

Background: high prevalence of pre-dementia cognitive disorders (in particular mild cognitive impairment, MCI) in older people, unfavorable predictive value of MCI with a high risk of conversion to dementia, lack of a unified view of facultative, noncognitive psychopathological symptoms (NPS) in its syndromic structure, their clinical heterogeneity, close relationships with mild cognitive impairment syndrome is actualized by the analysis of the mutual influence of the components of MCI syndromes.

The aim: to investigate clinical and dynamic features and determine the prognostic value of non-cognitive psychopathological symptoms in MCI, including various psychopathological symptoms (affective, psychotic, behavioral disorders).

Patients and methods: a comparative dynamic prospective selective observational study of 264 older patients with MCI was carried out. The main study group included 189 patients with NPS; compared group made up 75 cases with MCI represented only by cognitive impairments. Repeated clinical, psychopathological and psychometric assessments (MMSE, MoCa, NPI) were performed at 12 and 24 months. Results: differences were revealed in the structure and dynamics of cognitive indicators in patients with dominance of affective, psychotic or behavioral symptoms. Patients with affective symptoms showed low scores on subtests of line drawing, phonemic fluency, and ability to verbal categorization (p < 0.05). In these individuals, with repeated measurements, the indices of delayed reproduction, retention, abstract thinking were significantly reduced in comparison with the results of the rest of the study participants (p < 0.05). Patients with psychotic symptoms showed the lowest indices of delayed reproduction, spatial-visual, speech tests, false reproductions both at the initial assessment and in the dynamics of observation (p < 0.05). But their parameters of counting, attention, working memory, “recognition” are higher in them than in representatives of other psychopathological subgroups (p < 0.05). It was found that mild cognitive impairment without psychopathological inclusions has a lower tendency to transform into dementia over a two-year follow-up period than MCI, in the structure of which non-cognitive psychopathological symptoms are present.

Conclusions: non-cognitive psychopathological symptoms of MCI are heterogeneous in terms of clinical and dynamic characteristics. The structure and dynamics of cognitive indicators is different in the affective, psychotic, behavioral subgroups of patients with MCI. Individuals with affective pathology had the highest rate of MCI conversion to dementia. In patients with MCI without neuropsychiatric symptoms, a favorable course of cognitive impairment was more common than in patients with MCI with non-cognitive psychopathological symptoms.

Background: early nosological qualification of juvenile depression and detection in its structure of specific phenomena of schizophrenic spectrum makes it possible to identify the onset of an endogenous process and to provide timely therapeutic intervention. This becomes possible using an integrated approach based on a psychopathological assessment of patients and the determination of individual immunological indicators of blood.

The objective: to determine the inflammation markers in patients with juvenile depression with attenuated symptoms of schizophrenic spectrum (ASSS) in relation to features of their clinical manifestation and response to therapy.

Patients and methods: 50 patients aged 16 to 25 years with fi rst depressive episode with ASSS (F32.1, F32.2, F32.28, F32.8), of which 26 patients with attenuated psychotic symptoms (APS) and 24 ones with attenuated negative symptoms (ANS). The control group consisted of 19 mentally healthy volunteers. The leukocyte elastase (LE) and D1-proteinase inhibitor (D1-PI) activity and the level of autoantibodies (AB) to S100E and MBP were measured in blood plasma. The ratio of LE to D1-PI activity was defined as a leukocyte-inhibitory index (LII). Clinical and psychometric assessment (HDRS, SOPS, SANS scales) as well as immunological examination were carried out at admission to the hospital and at discharge.

Results: the differences revealed in profiles of immunological parameters in patients with juvenile depression with ASSS reflect the different variants of the inflammatory response to pathological process. Regardless of the identified clinical group, only 24% of patients were characterized by a balanced immune response. The inflammatory response in 76% of cases was accompanied by varying degrees of insufficiency of neutrophils functional activity and an increase in D1-PI activity, i.e. reduced LII. In 44% of cases, a decrease in LII was also accompanied by an increase in the level of AB to S100E. The relationship between immunological profiles and clinical severity of depression with APS and ANS was confirmed. The patients with balanced immune response without an autoimmune component have the best therapeutic response.

Conclusions: the results extend the concepts of the pathogenetic mechanisms of juvenile depression with ASSS and indicate various variants of inflammatory response associated with this pathological condition. Immunological analysis complements the clinical examination of patients in terms of assessing the severity of condition, prediction of the disease course and response to therapy.

The aim was to identify markers of resistance of patients with depressive disorders to first-line antidepressant therapy in order to build predictive models of therapy effectiveness based on parameters of brain bioelectric activity.

Patients and methods: 74 patients with depressive disorder were examined and divided into two groups based on the degree of improvement in clinical symptoms according to the Hamilton Depression Rating Scale (HDRS): patients sensitive to therapy (n = 49) and insensitive to therapy (n = 25). All patients received syndrome-based antidepressants from the group of selective serotonin reuptake inhibitors for 28–30 days. Patients’ electroencephalogram parameters were recorded and evaluated before starting the course of therapy.

Results: it was found higher values of the spectral power of the theta, alpha and beta rhythm in the group of patients insensitive to antidepressant therapy. Based on the data obtained, a prognostic model of the effectiveness of therapy in patients with depressive disorders was built. The accuracy of this model was 83.3%.

Conclusion: thus, the mathematical approach used in our work and the results obtained complement c the data available in the literature on the pathophysiological mechanisms of depressive disorders and can be useful in clinical practice, which will undoubtedly affect the quality of therapy.

Aim: the primary purpose of this study was to explore the state of monoamine activity in children with tic disorder at a combined type of attention deficit disorder (ADHD).

Patients and methods: 404 children aged 6–10 years with a combined type of ADHD were divided into three subgroups according to the monoamine activity: 1 subgroup with a combination of hypofunction of dopaminergic and hyperfunction of the noradrenergic system — 120 patients, 2 subgroup with a combination of hyperfunction of the noradrenergic system with a relative balance of dopamine — 136 patients, 3 subgroups with biochemical parameters of monoamine indicators within the reference values — 148 children. The levels of monoamines, their precursors and metabolic products in daily urine were determined by high performance liquid chromatography with electrochemical detection: dopamine, norepinephrine, adrenaline and serotonin, their metabolites — homovanilic acid, vanillylmandelic acid, 5-hydroxytryptophan and 5-hydroxyindoleacetic acid, and their precursors tryptophan and tyrosine. To assess the severity of the symptoms of ADHD, the SNAP-IV scale was used, and tic severity was determined using the Yale global tick severity scale.

Results: сommon to all subgroups under consideration is characteristic that the severity of the tick correlates, fi rst, with increased impulsivity (1 subgroup р = 0.0001, 2 subgroup р = 0.045, 3 subgroup р = 0.015). The degree of manifestation of the main symptoms of ADHD in children has competitive behavior with tics, which is associated with decompensation of the biochemical balance of monoamine systems. In subgroup 1, there is an increase in the consumption of norepinephrine (p = 0.002) with a large formation of metabolites and a further weakening of the activity of the dopamine (p = 0.029) and serotonin (p = 0.038) systems. In subgroup 2, the dopamine system is deficient (p = 0.001) and the inhibitory function of the serotonin system increases (p = 0.003). In subgroup 3, the activity of the noradrenaline system increases with minimal participation of the dopamine system and a weakening of the influence of the serotonin system (p = 0.006).

Conclusion: in cases of comorbidity of ADHD and tic disorder in children, observation revealed a change in the state of noradrenergic and dopamine systems and weakening of the inhibitory effect of serotonin, which probably has an effect on the general psychopathological profile.

Objective: to study the relationship between neurobiological, immune parameters and alexithymia in patients with epilepsy.

Material and methods: 58 patients with epilepsy (26 men, 32 women) were studied. Temporal epilepsy was diagnosed in 25, frontal — in 16, and frontal-temporal — in 17 patients. The frequency and type of seizures, duration of remission, severity of seizures, level of alexithymia, and parameters of immunity analyzed. To assess the relationships, the analysis of variance MANOVA is used.

Results: the influence of alexithymia and immunological factors CD4+ , CD4+ /CD8+ and CD8+ on the frequency of complex focal seizures (CFS) was revealed. With high CD4+ , CD4+ /CD8+ values and low CD8+ values, the CFS frequency increases, which has an unfavorable prognostic value. The combination of alexithymia and right temporal focus also led to an increase in the frequency and severity of CFS. Statistically signifi cant correlations were found between the alexithymia and the intensity of immunity (CD4+ / CD8+ ).

Conclusions: the results obtained support the hypothesis of the so-called innate immune mechanisms of alexithymia. Determination of the level of alexithymia can be used to predict the course of epilepsy.

Background: the clinical polymorphism of depressive disorders, together with the available data on the different responses of patients to treatment, motivate modern neuroscience to search for models that can explain such heterogeneity.

Objective: to identify neurophysiological subtypes of depressive disorders.

Patients and methods: 189 patients with moderate depression in the structure of a depressive episode (n = 42), recurrent depressive (n = 102) and bipolar affective disorders (n = 45); 56 healthy subjects. Clinical-psychopathological, psychometric, neurophysiological and statistical research methods were used in the work.

The results: with the help of coherent EEG analysis, it is possible to identify at least 6 subtypes of the disorder, which characterize various branches of the pathogenesis of affective pathology, which go beyond the currently accepted nomenclature. The selected subtypes were determined by the profi les of dysfunctional interaction of various cortical zones in the alpha, beta and gamma ranges of the EEG. Subtype 1 was characterized by a decrease relative to the norm of imaginary alpha-coherence between the right parietal and left central, right parietal and left anterior temporal, as well as the right parietal and right anterior temporal EEG leads (P4-C3, P4-F7, P4-F8) and explained part of depressions, in the pathogenesis of which the leading role was played by violations of the promotion of positive and suppression of negative affect. Subtype 2 — an increase in beta-2-imaginary-coherence between the frontal leads of the left and right hemispheres, between the left frontal and right central cortex (F3-F4; F3-C4) and its decrease between the central cortical zones (C4-C3), in clinical terms this subtype was characterized by a persistent hedonic response and was associated with the clinical picture of atypical depression. Subtype 3 — an increase in imaginary alpha-coherence between the frontal (F4-F3) and its decrease between the central leads of the left and right hemisphere (C4-C3), correlated with the severity of depressive rumination. Subtype 4 — a decrease in imaginary alpha-coherence between the anterior temporal and frontal, as well as the anterior temporal and central cortex of the right hemisphere (F8-F4 and F8-C4), explained part of the depressions that developed against the background of avoidance personality disorder. Subtype 5 — a decrease in imaginary gamma coherence between the frontal and parietal, as well as the central and occipital cortical zones of the left hemisphere (F3-P3 and C3-O1), was associated with an outwardly oriented utilitarian style of thinking (alexithymia). Subtype 6 — a decrease in imaginary beta-1 coherence between the left central and right anterior temporal cortex (C3-F8), explained part of the depression with phobic and hypochondriacal disorders in the structure of recurrent depressive disorder. Such a clinical and biological typology seems new and promising in terms of searching for specifi c neurophysiological disorders in different types of depression and, accordingly, reaching differentiated therapeutic recommendations.

Background: сhild psychiatry is essential for preventing adult mental diseases, due to the timely detection of a disease and the initiation of treatment. Thus, the choice of the optimal model of care and the corresponding transformation of the service are important. This work should be preceded by the study of current perceptions of the service and the prospects for its development among specialists and representatives of patients.

The purpose: to study representatives’ expectations and fears related to the service, as well as to investigate the current needs of the professionals and their readiness for the service reform in Moscow.

Material and methods: 657 district child psychiatrists and employees of clinical departments of children mental hospital in Moscow, and 361 consumers of the service filled in paper questionnaires on October 7–10, 2019.

Results: neither the specialists nor the consumers have a general idea for the service development in Moscow. The professionals are more likely to consider their own field of work as a priority for development. The patient representatives expressed a wish for expanding service availability (including its territorial basis), while only 8% advocate the development of outpatient care as a priority. 49% of the specialists see a child as a main recipient of care, and 29% consider a family as a main recipient. 76% of the specialists found it difficult to answer the question about the existence of rules for interaction with a family. The experts consider the main request of a child as “condition stabilization” (85%), while the children themselves do not think in such categories. The myths about the service among the health workers and general population are similar, with the population expressing fears about being “registered” if they seek psychiatric help. At the same time, the loyalty of mental health specialists is comparable to the average in Moscow, primarily due to the high assessment of the staff.

Conclusion: the study revealed a number of the related issues which are important to consider when reforming the service.

Background: Alzheimer’s disease (AD) is the most common neurocognitive disorder and a global health problem. The prevalence of AD is increasing dramatically, and will double in two decades to reach 100 million cases worldwide. Therefore, the development of disease-modifying therapies that can delay or even prevent the onset and progression of AD has become a global priority.

Objective: to present a review of domestic and foreign modern studies covering the pathogenesis of AD and disease-modifying therapy.

Material and methods: the keywords “Alzheimer’s disease, late age, mild cognitive impairment, depression, therapy, cerebrolysin, effectiveness” were used to search for scientifi c articles in MEDLINE and PUBMED databases for the period 1980–2020.

Results and conclusions: since the pathophysiology of AD is multifactorial, it is not surprising that all attempts to change the course of the disease with drugs aimed at a single therapeutic goal were unsuccessful. Thus, combined multimodal therapy using several drugs with a single mechanism of action or multi-purpose drugs seems to be the most promising strategy for both effective therapy of AD and its prevention. Cerebrolysin, acting as a multimodal peptidergic drug with a proven neurotrophic effect, has not only an immediate therapeutic effect on AD, which may refl ect its potential benefi t for modifying the course of the disease. Numerous clinical trials have shown that cerebrolysin is safe and effective in the treatment of AD, and can also enhance and prolong the effectiveness of cholinergic drugs, especially in patients with moderate AD. In this review, we summarize the achievements in the study of the therapeutic signifi cance of the drug and its effect on the pathogenesis of AD, paying special attention to the mechanisms of neurotrophic action. The review presents the results of both preclinical and clinical studies of cerebrolysin in the treatment of AD and pre-dementia cognitive disorders, as well as late depression.

The aim was to review the understanding of the phenomena of “feeling” and “self-consciousness” in the concepts of the leading European scientists at the second half of XIX — beginning of the XX centuries.

Method: H.R. Lotze, I.M. Sechenov, A. Bain, W. Wundt, G. Stoerring, Th. Lipps, K. Oesterreich, E. Kraepelin and some others are analyzed.

Conclusion: while Th. Lipps, H.R. Lotze, W. Wundt and K. Oesterreich were striving for strict differentiation of the notions of “sensations” and “feelings”, A. Bain, I.M. Sechenov, G. Stoerring were not following an effi cient distinction of these phenomena. H.R. Lotze, I.M. Sechenov, A. Bain distinguished in the consciousness and self-consciousness the affective and intellectual components; Th. Lipps considered as the core of self-consciousness the feelings that were very manifold and accompanied different mental acts including the act of perception: “perceptions feeling”. G. Stoerring paid attention to the lack of the feeling of activity by depersonalization, and the Austrian psychiatrist and neurologist M. Loewy elaborated the concept of “ubiquitous” “action feelings” (Actionsgefuehle) that exist outside of “pleasure — displeasure” modality. According to M. Loewy’s concept every mental act is accompanied normally by two “feelings of act”: general and specifi c, in the abnormal case one or both of them may disappear. The clinical description of weakening or loss of the action feelings: impulse feeling, perception feeling of vital sensation, perception feelings of sensations from organs of sense, “feelings of the feeling process”, “thinking feeling”, M. Loewy accomplished by “personalizing” approach to the account of one of his patient, Russian female student. M. Loewy considered the depersonalization disorders in this case as a symbolic neurosis according to S. Freud and as a psychasthenia according to P. Janet. Although E. Kraepelin defi ned selfconsciousness as merely cognitive phenomenon he interpreted depersonalization as a kind of emotional disturbance including the disorders on the level of sensations in the frames of light depressive phase of the manic-depressive illness. The M. Loewy’s concept of the “action feelings” can be applied not only for the understanding of “neurotic” depersonalization but also for depersonalization cases on the ground of depressive and mixed phase affective states.

This publication is an analysis of the book by P.V. Morozov, R.A. Becker, Yu.V. Bykov, dedicated to the four most significant persons, who had an invaluable influence on psychiatry in the XX century (Emil Kraepelin, Eugen Bleuler, Sigmund Freud, Karl Jaspers). Among the advantages of the book on the history of psychiatry, one can stress out a successful extrapolation of the ideas of the “titans” to the current state of psychiatric science and a discussion of their work with the use of the actual language of current clinical psychiatry. This makes it possible to recommend the book not only to experienced psychiatrists and researchers, but also to young specialists, as well as residents and students. Another important achievement of the book is the successful disclosure of not only ideas, but also biographies of the “titans” placed in the scientific, historical, political, cultural and personal contexts.