PSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRY
Background: impaired intracortical myelination most pronounced in prefrontal cortex is tightly linked to inadequate information processing in schizophrenia. Previously we reported a significant decrease in the numerical density (Nv) of oligodendrocytes (Ol) and oligodendrocyte clusters (OlC) in layers 3 and 5 of the prefrontal cortex, Brodmann area 10 (BA10) in schizophrenia. To date there are few studies on the possible role of perineuronal oligodendrocyte satellites (Sat-Ol) in human brain pathology.
Aim of the study: to estimate the number of Sat-Ol per pyramidal neuron in layer 3 of BA10 in schizophrenia as compared to healthy controls and to evaluate the possible correlations between the number of Sat-Ol and NvOl or NvOlC in schizophrenia and normal controls.
Material and methods: we investigated the number of Sat-Ol per pyramidal neuron in sublayers 3a, 3b and 3c of layer 3 of BA10 in schizophrenia (n = 20) as compared to healthy controls (n = 20) in the same section collection previously used for the study of the NvOl and NvOlC.
Rеsults and conclusion: we found a significant reduction in the number of Sat-Ol in schizophrenia as compared to the control group (17 and 24% resp., p < 0.01). There were no correlations between the number of Sat-Ol and the NvOl or NvOlC. The comparison of current data to similar findings from our previous studies in BA39 and BA40 of the inferior parietal cortex indicates that specific features of oligodendrocyte alterations and their correlation patterns may be associated with specific activity-driven plasticity of corresponding networks in normal and schizophrenia brains.
Background: it is believed that very-late onset (after 60 years) of schizophrenia-like psychosis is associated with the impact of neurodegeneration. We hypothesized that patients with late-onset schizophrenia and cognitive decline have more factors related to organic brain pathology.
Objectives: to identify factors (clinical features of psychosis, anamnesis data and neuroimaging parameters) associated with cognitive decline in patients with late-onset schizophrenia.
Patients and methods: the sample made up 28 patients with ICD-10 diagnosis of late-onset schizophrenia with illness duration 10 years and less. Patients were examined by admission and 4 weeks later using PANSS and HDRS-17, at the second time-point cognitive functions were assessed (MMSE, MoCA, FAB, TMT-A, TMT-B, 10 words and 5 gures memorization tests). Ranged scores of atrophy and vascular changes on CT/MRI were used. The control group included 24 subjects aged 45 and older without depressive and psychotic disorders. Nonparametric statistics and cluster analysis were used.
Results: patients were divided into two clusters: Cluster 1 (with cognitive impairment) included 20 patients, Cluster 2 (without marked decline) — 8 patients. Patients of Cluster 1 had more negative symptoms, higher atrophic СТ-scores and leukoaraiosis on CT rate, as well as more frequent history of brain injury. Patients of Cluster 2 had more premorbid severe grief reactions. Patients of both clusters had more anxiety symptoms before manifestation of psychosis. Conclusions: cognitive decline in patients is associated with neurodegenerative factors that are not decisive pathogenesis cause of late-onset schizophrenia since numerous patients had speci c personality traits long before the psychosis onset.
The aim: to study the phenomenon of stereotypical catatonia in the clinical manifestations of schizophrenia throughout the disease process; to determine the relationship between the manifestation of catatonia, negative and cognitive symptoms and to establish the prognostic manifestations characteristics of endogenous process with a predominance of stereotypical catatonia.
Patients and methods: 28 patients with a verified diagnosis of schizophrenia, developing with predominance in the clinical picture the phenomena of catatonia among the hypokinesia manifestations, firstly occurring in the form of ideomotor slowness, diminishing of facial expressions with the emergence of motor symptoms and grimacing, evolving on the basis of premorbid motor features.
Results and discussion: a psychopathological description of the stereotypical catatonia phenomenon, manifesting itself as a psychomotor disorder, “evolving” on the basis of the motor and pathocharacterological constitution, duplicating and amplifying the manifestations of: a) negative symptoms with the formation of a general “motor-inactive syndrome”; b) cognitive symptoms with the formation of the pseudo-bradyphrenia — is given. The course of schizophrenia (and schizophrenia spectrum disorders) with a predominance of stereotypical catatonia is different. In some cases it’s a “single episode” type of schizophrenia, in other cases the disease develops in the form of the continuous (chronic) catatonic type of schizophrenia.Patients and methods
Background: currently the relevance of the problem of late depression and the study of their outcomes is determined by the increase in their prevalence, difficulties in diagnosis and therapy.
Objective: to study the outcomes of depression during a 3-year follow-up. This publication contains a clinical description of the study cohort of patients with late-life depression.
Patients and methods: a cohort of patients with depressive disorders who were treated in the gerontopsychiatric hospital of the FSBSI MHRC, followed up and re-examined 1 and 3 years after the discharge. The study sample at the time of inclusion made up 55 people aged 60 years and older: 17 men (30.91%) and 38 women (69.09%). The median age was 68 years [63; 76]. According to the ICD-10 classification, all patients were diagnosed with a depressive episode: 37 people (67.27%) had a depressive phase within recurrent depressive disorder (DDR — F33), 16 people (29.1%) had a depressive phase within bipolar affective disorder (BD — F31) and a single depressive episode (DE — F32) — in 2 patients (3.63%). All patients were examined using clinical, psychometric, immunological and follow-up methods (follow-up assessment was carried out after 1 year and 3 years). The favorable course was attributed to the formation of complete remissions or the recurrence of depression against the background of complete remission during the period of follow-up. An unfavorable option is the recurrence of depression against the background of incomplete remission, chronification of depression, the outcome of dementia and death.
Results and conclusion: a comparative study of the short-term (1 year) and remote (3 years) outcomes of depression showed in both cases a predominance of unfavorable cases of the course of the disease (52.9 and 54.9%, respectively). One year after 27 patients (52.9%) had incomplete remission with residual depressive disorders, and in 3 years follow-up 20 people (39.2%) had incomplete remission and 8 people (15.7%) had chronic depression. With the same frequency (three patients each; 5.9%), the outcome in dementia was observed, and 3 patients (5.9%) died. All cases of dementia and death were registered in the group of patients with an unfavorable course of the disease. This publication contains a clinical description of the study cohort of patients with late-life depression. The next communication will content the results of clinical and immunological comparison to search some predictive features in different types of depression outcome in aged.
Background: the results of previous studies suggest that the level of activation of inflammatory responses in the periphery correlates with the severity of cognitive impairment in patients with neurodegenerative diseases and can serve as an indicator of the activity of the current pathological process in the brain. Epigenetic factors are suggested to influence the regulation of (neuro)inflammation and cognitive recovery in elderly patients, which opens up a wide spectrum of therapeutic strategies for the treatment of age-associated diseases.
Objective: to evaluate the possible effects of a comprehensive neurocognitive rehabilitation program on cognitive functioning and blood immunological parameters of elderly patients with mild cognitive impairment (MCI).
Patients and methods: 507 participants of the “Memory Clinic” rehabilitation program with signs of MCI (F06.7, F06.78 according to ICD-10) were examined before the start of neurocognitive training and after its completion (after six weeks). Some patients (11.6%) were observed clinically one year after their inclusion in the program. Cognitive status was assessed using the Modified Hachinski Ischemic Scale, the Mini-Mental State Examination, the Montreal Cognitive Assessment, and the Clock Drawing Test. Enzymatic activity of leukocyte elastase (LE), functional activity of α1-proteinase inhibitor (α1-PI), and levels of antibodies to S-100B and myelin basic protein were determined in patients’ blood. The parameters of healthy donors were used as controls.
Results: immunological examination of patients before the rehabilitation program revealed increased LE and α1-PI activity in the overall group compared to controls (p < 0.001 and p < 0.05). Using a previously developed regression model to identify a high-risk group for Alzheimer’s disease (AD) among patients with MCI, all subjects were divided into two groups (cut-off value p = 0.65). Group 1 (low-risk of AD, n = 330) was characterized by increased LE activity and α1-PI (p < 0.001), Group 2 (highrisk of AD, n = 177) was distinguished by decreased LE activity (p < 0.001) accompanied by high α1-PI activity (p < 0.001). After neurocognitive training, differently directed variants of the dynamics of immunological parameters associated with the severity of patients’ cognitive impairment on psychometric scales were identified in each group. For the most of the examined patients (61.3%) the training program turned out to be effective, which was confirmed by the positive dynamics of the psychometric scores and relative normalization of the blood inflammatory markers (p < 0.05). The highest effect of the rehabilitation program was typical for patients not included in the high-risk group for AD (p < 0.001). Follow-up examination revealed stabilization of cognitive functioning in 93.2% of those examined, most of whom were patients with an initially low risk of developing the disease (p < 0.01).
Conclusion: neurocognitive rehabilitation of patients with MCI carried out in the “Memory Clinic” conditions can be considered as a social epigenetic factor modulating the current pathological process in patients with cognitive disorders, which is confirmed by objective immunological markers.
Background: the delay in language development is characterized by qualitative and quantitative underdevelopment of the vocabulary and the lack of formation of expressive speech. This violation belongs to the mildest speech pathologies, however, there is a high probability of the presence of concomitant mental pathology and the occurrence of adaptation problems at school age. In the etiology of delayed language development, its multifactorial nature has been established. Thus, there is a need to develop a tool that predicts the formation of a delay in speech development in children for the timely implementation of preventive measures.
Aim of the study: to develop a tool for predicting speech development delay in children under one year old using artificial intelligence algorithms.
Patients and methods: 196 children were examined. The mean age was 26.9 months (SD ± 5.5 months). The sample was divided into two groups: the first included patients with delayed speech development (n = 98), the second included children with normal speech development (n = 98). Speech status was assessed using a questionnaire to determine the speech development of a child aged 18 to 36 months (Language Development Survey). In assessing the risk factors for the occurrence of speech development delay, the “Anamnestic Card of the child” was used. To create a neural network that predicts speech delay in children under one year old, a model was developed and trained using the Keras library for the Python 3.0 programming language.
Results: the analysis of the accuracy of the neural network showed a high result — 89% of the cases during the training of the model were identified correctly. At the same time, the sensitivity of the model on the test sample was 100%, and the specificity was 90%.
Conclusions: the developed method can be used to create a tool for predicting speech development delay in children up to 3 years of age, which will allow for differentiated therapeutic and preventive measures that contribute to the harmonious development of the child.
SCIENTIFIC REVIEWS
Background: catatonia is an actual mental disorder with the controversy in prevalence data that is related to the problem of it’s conceptualization, clinical borders and pathomorphosis.
Objective: to analyse publications on the problem of the catatonia prevalence decrease from the beginning of the XX century to the present day and to designate potential factors of pathomorphosis that impact on frequency, as well as on clinical presentations of catatonia.
Materials and method: publications of original studies that provide catatonia prevalence data over the past 120 years.
Conclusion: pathomorphosis of catatonia both due to antypsychotics and psychosocial factors has affected the prevalence, as well as the conceptualization of catatonia. There is a transition from a syndrome construct, primarily characteristic for schizophrenia, to the transnosologic paradigm. This one leads to the revision of the boundaries of catatonia and change of the diagnostic criteria.
Background: during the COVID-19 pandemic, many mental health problems among the population have been exacerbated, which raised fears regarding possible increase in suicides. In response to that, studies of suicidal behavior all around the world have grown substantially. In many countries, given the constantly changing situation, research is based not only on national statistical data, which are usually 1–1.5 years late, but efforts are made to collect real-time information.
The aim: to integrate the results of observations regarding possible associations between suicidal behavior and pandemic waves and restrictive measures and offer explanations for the observed trends.
Materials: relevant papers were identified during the monitoring of domestic and foreign scientific databases.
Results: observations show that after the announcement of severe restrictive measures, despite the fact that the level of stress, anxiety, depression, addictions and other mental health disorders increased in the population, there was no increase in suicide mortality. On the contrary, in many countries, cities and regions, more frequently decrease in completed suicides, as well as in non-fatal suicidal behavior, was observed. The explanation of this phenomenon is related to the concept of crisis and lies in the field of sociological theories to a greater extent than in the field of the medical and psychiatric model of suicide. A pandemic is a typical example of a global crisis, which is characterized by an acute, chronic and recovery phase. After the crisis will be over and in the longer perspective, due to the anticipated serious changes in the lives of large contingents of people, it is necessary to be prepared for possible negative tendencies in suicidal behavior.
Conclusion: despite the fact that the current pandemic did not result in an increase of suicides, it is necessary to intensify research in the field of suicidology. Efforts aimed at developing, organizing and implementing more effective suicide prevention measures are needed. It is essential that they should be culturally and organizationally acceptable and adapted to the current level of intensity of information flows.
Background: increasing the number of studies in the field of motivational disorders in patients with schizophrenia in recent decades indicates the interest of specialists in various fields of science not only in substantiating its theoretical foundations, but also in the possibility of solving applied problems related to increasing motivation.
Objective: to present an overview of current domestic and foreign research on the relationship between clinical, socio-psychological, neurophysiological and other causes of motivational disorders in patients with schizophrenia in order to analyze the causes and mechanisms of motivational disorders.
Materials and method: we searched the MedLine/PubMed, Scopus, eLibrary, Google Scholar databases for studies using the keywords “schizophrenia, motivation, amotivation”, “negative symptoms and motivation”, “motivation and social factors”, “motivation and neurobiological aspects” and selected scientific publications for the last 10 years. Some studies of an earlier period, usually classics of psychiatry and psychology, which also paid attention to the problems of motivation and negative disorders, were found by relevant references. 83 studies meeting the search criteria were selected.
Results: the data presented in the review indicate that motivational disorders in schizophrenia are part of the structure of negative symptomatology and appear already in the prodromal stage of the disease. The authors find quite different approaches to systematization of negative symptoms in schizophrenia in Russia and abroad, where dominant are five-factor, two-factor, and hierarchical model of negative symptoms in schizophrenia, where five domains — blunting of affect, anhedonia, asociality, alogia, and avolition — are extremely important for diagnosis and correction of the disorders. Data from the literature indicate that the prognosis and outcome of schizophrenia, the response to therapy, both biological and psychosocial interventions, largely depend on the state of motivation. A high level of motivation is an important predictor of remission of schizophrenia. Most authors argue that motivation, both intrinsic and extrinsic, is a dynamic result of the interaction of clinical, psychophysiological, personal and socio-environmental factors. Intrinsic motivation is of primary importance for patients with schizophrenia, whose high level forms the basis for neurocognitive improvement. The review touches upon the neurobiological mechanisms of motivational disorders and presents the results of neuroimaging studies of motivational disorders.
Conclusion: an understanding the factors of impact and causes of impaired motivation in schizophrenia will enable researchers to develop effective strategies to improve it, which will generally improve the prognosis of schizophrenia and the quality of life of patients.
Background: the increase in the life expectancy of a modern person is accompanied by an increase in the prevalence of neurocognitive disorders. Various indicators associated with biological age are consistent with neurocognitive deficits. In the process of ontogeny, a complex symbiotic relationship develops between the host and the microbe. Presumably, they are realized along the microbiota-gut-brain axis. The participation of the intestinal microbiota in the ontogeny of the brain is assumed.
The purpose of review: based on a systematic review of the scientific literature, to summarize research data on the mechanisms of the influence of the intestinal microbiota on the aging processes of the central nervous system and the formation of cognitive disorders in Alzheimer’s disease.
Materials and methods: 27 Russian-language and 257 English-language articles were selected from MedLine/PubMed and eLibrary from 2000 to 2022 by the keywords “gut microbiota”, “neurocognitive disorders”, “aging”, “neurodegeneration”, “Alzheimer’s disease”. The hypothesis about the participation of the microbiota in cerebral ontogeny made it possible to select 110 articles for analysis.
Conclusion: this scientific review reflects the authors’ ideas about the systemic mechanisms of normal and pathological aging of the CNS and the multifactorial nature of the pathogenesis of neurocognitive disorders.
Background: the study of catatonia’s treatment methods is one of the most important researchers’ tasks, nevertheless the common therapeutic strategies of cupping the catatonic phenomena haven’t been created yet. The aim: review to therapeutic interventions for catatonic disorders in schizophrenia.
Materials and methods: according to the keywords “catatonia treatment”, “catatonia therapy”, publications found in the Scopus, PubMed, Cochrane Library, eLibrary databases were selected and analyzed.
Results: historical background, illustrating the development of catatonia treatment methods, is given; the results of the last decades scientific studies of catatonia’s treatment and preliminary results of own study, devoted to the effectiveness of diazepam and cariprazine in relieving catatonia manifestations are presented. Based on the studies’ results, presented in the review, it can be concluded that the most common modern method of treating catatonic disorders is the use of benzodiazepines, however, in some cases, the use of antipsychotics is also advisable. Electroconvulsive therapy (ECT) remains an important treatment for catatonic phenomena. There are also isolated clinical cases of successful testing of both: other pharmacological groups (antidepressants, dopaminergic and anticholinergic drugs, normothymic drugs, etc.) and non-drug interventions (transcranial magnetic stimulation — TMS) presented in modern research data.
Conclusion: the effectiveness of benzodiazepines in catatonia, associated with schizophrenia and schizophrenia spectrum disorders (SSD), remains controversial according to modern authors’ opinion. In turn, among antipsychotics, antipsychotics of the second and third generation seem to be safe for the treatment of psychomotor symptoms. In accordance with the results of our own study, catatonia in the structure of schizophrenia and SSD is heterogeneous and, depending on the psychopathological structure of catatonic disorders, a different reaction of psychomotor symptoms to therapeutic intervention was observed.
Introduction: bipolar affective disorder frequently presents residual symptoms even in interictal period, what in its turn causes problems in psychosocial functioning, cognitive impairment and poor quality of life. Nowadays, the treatment targets are focused not only on clinical remission, but also on functional recovery and in personal recovery, patients’ quality of life. Scientific review contains results of researches, aimed on therapy modalities, that can be effective in decreasing maladjustment, integration into society, prevention of social and labour deadaptation.
Purpose: to present an analysis of scientific data on currently existing approaches to the restoration of the psychosocial functioning of patients suffering from bipolar disorder and evaluate their effectiveness.
Materials and methods: the keywords “bipolar affective disorder”, “psychosocial intervention”, “cognitive-behavioral therapy”, “psychoeducation” were used to search scientific articles in the databases PubMed, еLibrary.
Conclusion: with a view to rehabilitation were used such modalities as psychoeducation, cognitive-behavioral therapy, family focused therapy. The question remains whether of these interventions are effective and should be integrated into treatment regimen of bipolar affective disorder.
Background: personalized approach considering the effectiveness and safety of the medication is the main goal of contemporary psychopharmacotherapy. Knowing special characteristics of any given drug allows a practitioner to choose the tactic meeting needs of the particular patient.
The aim of this narrative review was to summarize the data about use Brexpiprazole of in pharmacotherapy of different mental disorders.
Method: using the keywords “brexpiprazole”, “psychoses”, “treatment” we performed a scientific publications search in PubMed and PsychInfo databases over the last 10 years.
Results: brexpiprazole is supposed to resemble such third generation antypsychotics as aripiprazole and cariprazine, lacking their drawbacks. There is a history of using brexpiprazole in schizophrenia and unipolar depression. Pilot studies and clinical cases were presented on the possible perspectives in use of brexpiprazole, such as Alzheimer disease, posttraumatic stress disorder, borderline personality disorder and bipolar affective disorder. On the basis of the reviewed data we conclude that brexpiprazole is effective for cupping and maintenance treatment of schizophrenia, for augmentation in recurrent depressive disorder and is also perspective in other fields of psychiatry. Brexpiprazole has a favorable safety profile with low incidence of metabolic, extrapyramidal and hyperstimulation symptoms.
ВОПРОСЫ КЛИНИЧЕСКОЙ И БИОЛОГИЧЕСКОЙ ПСИХИАТРИИ
Rationale: considering the high frequency of occurrence of mental disorders in the general medical network, as well as due to the not always sufficient success of biological therapy of mental diseases and not uncommon poor tolerability, it is of interest to consider non-drug methods of spa treatment of these conditions. The analysis of the literature has shown that until recently, regarding non-drug methods of correction of mental disorders, as a rule, only studies on individual methods are given without considering the entire range of possible procedures that can potentially be used for therapy, or the information provided is very formal.
The purpose of this work was to consider non-drug methods of treatment of mental disorders used in the conditions of the sanatorium-resort industry and, according to modern principles of evidence-based medicine, to assess the available evidence of their effectiveness and safety; as well as new prospects for the use of well-known techniques.
Materials and methods: to search for possible non-drug methods of mental disorders correction and their mechanism of action, modern guidelines for balneology treatment and medical rehabilitation, electronic databases of the RSCI and MedLine were studied, the latter also searched for publications of studies confirming the effectiveness of the studied methods, which was carried out by keywords (names of relevant methods and mental dysfunctions, such as anxiety, depression, cognitive disorders, adaptation disorders, stress states, psychosomatics); the levels of evidence of effectiveness and safety were evaluated according to the National Standard of the Russian Federation GOST R 56034-2014.
As a result of the work carried out, the vast majority of methods of correction of mental disorders used in the sanatorium-resort area are covered. The information presented concerns not only stress-related disorders traditionally related to borderline psychiatry, but also diseases of a more severe register and cognitive impairments; depending on the etiology and clinic of mental illness, the described techniques may be applicable as the main or additional treatment methods; some of them have a high evidence-based level of effectiveness, the other seems promising for further study in terms of therapy of individual mental disorders.
Conclusion: the information provided may be of interest both for the scientific and practical fields of psychiatry, when solving problems aimed at improving the effectiveness of treatment and improving the quality of life of patients with mental illnesses.
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