Background: the drugs cariprazine and aripiprazole, from the group of third-generation antipsychotics, are recommended for both inpatient and outpatient treatment of schizophrenia, primarily to correct negative symptoms and minimize the risk of endocrine side effects caused by previous generations of drugs. The relevance of this study is due to the lack of research, including data from domestic psychiatric practice. The objectives of this research are to conduct a direct comparison of the effcacy and safety profiles of cariprazine and aripiprazole for the treatment of schizophrenia. Eliminating this information gap will undoubtedly contribute to optimizing the therapeutic process by personalizing the choice of antipsychotic medication. The aim of this study is to compare the therapeutic efficacy and safety of cariprazine versus aripiprazole during inpatient treatment for schizophrenia. Patients and Methods: an eight-week observational study was conducted at the V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology. Thirty-eight inpatient patients participated in the study, including 20 men and 18 women, aged 18 to 68 years, with a diagnosis of paranoid schizophrenia (F20.0) who had a positive response to therapy (at least a 30% reduction in total score on the Positive and Negative Syndrome Scale [PANSS]). Two groups of patients were formed based on monotherapy with atypical antipsychotics of the third generation: group I received cariprazine, and group II received Aripiprazole. Clinical and psychopathological assessments, psychometric measurements (PANSS and UKU scales), anthropometric measurements, and laboratory tests were conducted. Statistical analysis was also performed. Results: the analysis of psychometric indicators in dynamics showed that in both groups, there was a significant reduction in symptoms, as measured by the total PANSS score, by 14.0 (95% CI (2.2–25.8), p = 0.026) and 12.0 (95% CI (3.4–20.6), p = 0.013), in the first and second groups respectively. At the same time, among patients taking cariprazine, the decrease in negative symptoms on the PANSS subscale was statistically significant, amounting to – 4.3 points (95% CI (–9.3 — –0.3), p = 0.039). During 8 weeks of aripiprazole therapy, no significant changes in metabolic parameters were observed. In contrast, in the group of patients receiving cariprazine, a reduction in body weight of 1.8 kg (95% CI (1.3–2.3), p < 0.001) and a decrease in total fat percentage of –2.3% (95% CI (–3.3 — 1.3), p < 0.001) were observed. Conclusions: the results of this study suggest that cariprazine monotherapy may be more effective than aripiprazole for treating negative symptoms. Both, cariprazine and aripiprazole, have shown good tolerability and a low risk of side effects.

Background: despite the presence of multidisciplinary researchs the neurobiological pathways of borderline personality disorders (BPD) in youth are studied insufficiently. Neuroimaging methods found some structural and functional changes in fronto-limbic system associated with social communication and emotions regulation. The increased impulsivity characteristic of BPD suggests the decreasing of inhibiting control of emotions and behavior due to state of prefrontal cortex. The aim of the study: to assess the features of the spatial organization of brain activity in patients with different clinical subtypes of borderline personality disorder (BPD). Patients and Methods: the study included 52 patients aged 16–25 years (mean age 20.4 ± 3.2 years) with BPD (F60.31, according to ICD-10). Methods: clinical-psychopathological, psychometric, neurophysiological, statistical. Based on clinical and psychopathological characteristics, three groups of patients with different subtypes of BPD were identified. In all patients, a pre-treatment multichannel resting EEG was recorded with measurements of EEG coherence in narrow frequency subbands. Between-group differences in clinical and neurophysiological parameters were identified using nonparametric statistics criteria. Results: differences between the groups of patients were revealed in terms of the spatial organization of the EEG — in the number of “highly coherent” functional connections (with coherence coefficients above 0.9). High values of the number of such connections in the alpha2 sub-band of the EEG in the fronto-central-temporal regions reflect a relatively better functional state of the prefrontal cortex. Conclusion: the noted features of the spatial functional organization of brain activity in groups of patients with different subtypes of BPD may underlie differences in their clinical conditions, control of emotions and behavior.

Background: oxidative stress and glutathione antioxidant system are pathogenetic chains involved both in the pathogenesis of schizophrenia and schizophrenia spectrum disorders (SSD), and in the development of catatonia, which is often found in schizophrenia and SSD. The aim: is to stratify patients with periodic catatonia in schizophrenia and SSD, based on the activity of platelet and erythrocyte enzymes of glutathione system and to comparatively analyze the activity of the enzymes in patients with different forms of catatonia. Patients and Methods: patients with schizophrenia and SSD with hypo-; para- and multi-kinetic forms of periodic catatonia (n = 13, 11 and 15, respectively) and mentally healthy persons of control group (n = 21) were included into the study. Activities of glutathione reductase and glutathione-S-transferase were determined by spectrophotometric kinetic methods in extracts of platelets and erythrocytes from the blood of patients and the control group. Results: when clustering patients by these four biochemical characteristics, two clusters were obtained with the enzymatic activities significantly differed from the levels in the control group, and significantly uneven distribution of patients with different forms of catatonia was observed between the clusters: χ2 = 20.3, p < 0.0001 (with Yates’ correction) for patients with hypo- and para-kinetic catatonia; χ2 = 16.9, p < 0.0001 (with Yates’ correction) for patients with para- and multi-kinetic catatonia. Conclusions: patients with different forms of catatonia are characterized by different patterns of changes in the activity levels of the studied enzymes relatively to the control ranges. Determining the activity of glutathione enzymes in the blood of patients with SSD is informative for in-depth stratification of such patients, including in differentiating the forms of catatonia in SSD, and these biochemical parameters can serve as an addition to clinical characteristics to clarify the form of periodic catatonia.

Background: assessment of the effectiveness of antipsychotic therapy is generally based on the knowledge, experience of the psychiatrist, and psychometric scales. However, all changes in a person’s mental state can be both a consequence and a cause of changes in biochemical processes, one of which is the complement system (CS). In addition to the fact that CS is the most important factor in innate immunity, its proteins, especially C3, are ubiquitous and directly involved in organismal and cellular homeostasis. CS includes its connection with coagulation, which compensates for the lack of activation potential of the cascade proteolytic complement system, as the first link of immunity. The deficiency is associated with excessive consumption of CS proteins in pathologically altered processes, which also determine mental pathologies. A change in the level of this connection allows one to determine changes in the overall level of homeostasis, for example, as a result of treatment. A new marker for assessing the level of coagulation-complement coupling, equal to the difference in the functional activity of CS in plasma and serum (d), may increase the reliability of assessing the effectiveness of therapy. Objective: justification for the use of this marker of the complement system in combination with mental state assessments on psychometric scales and electroencephalography results to analyze the effectiveness of therapy for patients with autism and schizophrenia aged 8–14 years. Patients and Methods: the study included 7 patients aged 8 to 14 years (10 ± 2.2) with a diagnosis “Childhood autism, F84.0 (ICD-10)” and 11 patients aged 11 to 14 years (13 ± 1.4) with a diagnosis “Schizophrenia, F20 (ICD-10)”. The assessment of the condition before and after treatment was carried out using the following scales: for patients with autism — CARS (Childhood Autism Rating Scale), BFCRS (Bush–Francis Catatonia Rating Scale), CGI-S (General Clinical Severity Scale); for patients with schizophrenia — PANSS (Positive and Negative Syndrome Scale) and CGI-S. A neurophysiological study of all patients was carried out with spectral analysis and topographic mapping using the NeuroKM computer system (Russia). A calculated parameter equal to the difference (d) of the functional activity of the complement system (faCS) in plasma and serum was used as a biological marker of CS. FaCS was assessed using the method on the ciliates Tetrahymena pyriformis and the Biolat device. Results: in 14 out of 18 patients, positive changes in mental state were observed, which corresponded to positive changes in marker d, as well as positive changes in ratings on scales and EEG results, in accordance with all assessments, 14 out of 18 patients from both groups showed positive changes in their condition, in 3 patients resistance to psychopharmacotherapy and minimal positive dynamics of the condition were noted; the marker of the complement system in these patients decreased slightly upon discharge; in one patient assessments of the biological marker and scales were contradictory. Conclusion: in most patients (14 out of 18 people), the selected therapy was effective, and the new candidate marker d of the complement system changed in the same direction (its normalization was noted) with clinical symptoms and neurophysiological parameters. The results of the study suggest that the candidate marker d reflects changes in the patients’ conditions as a result of treatment.

Background: the damaging effect of ethanol on cells, systems and organs determines the relevance of studying the role of the immune system in the pathogenesis of alcohol dependence (alcoholism). The literature reported contradictory data on the effects of alcohol on the cellular immunity that is conditioned by various research techniques, approaches to the formation of the groups, disease stages. Objective: to determine the phenotypes of lymphocytes of the peripheral blood from patients with alcohol dependence in the time course of the post withdrawal state. Patients: 52 male patients aged 30–60 years were examined who were diagnosed according to ICD-10 with Mental and Behavioral Disorders due to the Use of Alcohol (dependence syndrome — F10.21 and withdrawal syndrome — F10.30), their disease duration was 15.0 ± 9.5 years, including 12 patients with alcoholic liver disease (ALD). The investigations were conducted in the time course of the post-withdrawal state: after alcohol detoxification (1 point) and by days 14–17 of the treatment (2 point). 25 conditionally healthy men served as controls, comparison group included 20 men with neurotic disorders. Methods: populations/subpopulations of lymphocytes were determined on the cytometer BD FACS Calibur (Becton Dickinson, USA); the reagent kits of the same firm were used. T-lymphocytes (CD3⁺), B-lymphocytes (CD19⁺), T-helpers/Т-inducers (CD3⁺ CD4⁺), cytotoxic Т-lymphocytes (CD3⁺ CD8⁺), NK cells (CD3^–CD16⁺ CD56⁺) were revealed in percent to the population of lymphocytes and in absolute values. Results: in point 1 of the study, patients, in relation to controls and the comparison group, had an elevated percent of Т-lymphocytes and Т-helpers-inducers, a reduced number of NK cells. After 14–17 days of therapy, CD3⁺ lymphocytes remain elevated, B-lymphocytes decrease; in the group of patients with alcoholic liver disease (ALD) NK cells remain reduced. Conclusion: the immune phenotype of alcohol-dependent patients at an early stage of the post-withdrawal state was characterized by the elevation of CD3⁺, CD4⁺, reduction of NK cells. During therapy, some populations are normalized, except for T-lymphocytes, B-lymphocytes as well as NK cells in the group with ALD. Immune imbalance indicates instability of the post-withdrawal state and the need for additional treatment.

Background: Currently, many researchers suggest that for patients with schizophrenia, impulsivity more often manifests in the form of impairment of the control of the impulse of action. The most widely used instrument for research of this disorder is the Go/No-Go test. There is evidence that the indicator of this test in patients with schizophrenia shows not only increased impulsivity, but also increased auto- and heteroaggression. In this regard, the study of this aspect of impulsivity seems relevant in patients with schizophrenia. The aim of the study: to assess the severity of violations of impulse control of action in patients suffering from an episodic form of schizophrenia in a state of prolonged drug remission and their association with residual psychopathological manifestations. Patients and Methods: the study group made up 16 patients (14 men and 2 women), average age 48.2 ± 8.8 years, mean duration of disease 25 ± 10.6 years, age of manifestation 20.7 ± 4,0 years, duration of stable condition averaged 7,0 ± 5,0 years, duration of stable therapeutic regimen 5.6 ± 3.2 years, total score according to the PANSS scale was 64 ± 17. The control group consisted of healthy subjects (average age 44.5 ± 10.5 years) who did not consult a psychiatrist. The assessment of the patients’ condition was carried out using PANSS, the Barratt scale and the Go/No-Go test. Results: patients were less likely to give correct answers in the Go/No-Go test, especially in relation to relevant stimuli, while the indicators of correct responses to an irrelevant stimulus did not differ between the groups, though the reaction time was longer in patient’s group. The overall average reaction time was longer in the group of patients. This result may show the complexity of any type of signal for patients and a greater amount of resource for processing all types of stimuli relative to a healthy group. The indicator of the motor component of the Barratt scale was correlated with the average reaction time (R = 0.58) and the average reaction time to the relevant stimulus (R = 0.59). There were no links between any indicators of the Go/No-Go test and psychometric indicators on the PANSS scale. Conclusion: the hypothesis of a violation of the control of the impulse of action and its connection between motor impulsivity and residual mental disorders in this study was only partially confirmed: violations were detected, but they were not associated with residual psychopathological manifestations. Significantly greater mutual influence was found in the study of patients’ self-assessment of impulsivity, cognitive test scores and psychometric indicators of psychopathological disorders. 

Background: According to some data in more than 50% of patients, suffering from bipolar disorder (BD) for a long time, cases of repeated changes in the diagnosis of affective disorder for schizophrenia are known in clinical practice. These observations served as the basis for the theory of the “psychopathological continuum,” referred to as “the phenomenon of overlapping disorders of the affective and schizophrenic spectra”. The objective of the investigation was to study the phenomenon of “syndromal shift” in a diagnosed bipolar I disorder with a long course and the presence of affective and schizophreniform episodes. Patients and Methods: A total of 91 patients with diagnoses of bipolar I disorder were examined, whereas during the illness in at least one episode psychotic symptoms incongruent with affect were observed, but the diagnosis did not change during the course of the disease. The duration of follow-up observation was 12–15 years. Three groups of patients were identified as follows: with a predominance of affective, schizoaffective, or schizophreniform episodes. The analysis of episodes and comparison of these groups was carried out using psychometric scales (Cornell Dysthymia Rating Scale, CDRS; Young Mania Rating Scale, YMRS; Positive and Negative Syndrome Scale, PANSS; Global Assessment of Functioning, GAF). Results: this study examined the characteristics, similarities, and differences of bipolar disorder I episodes based on the analysis of the long-term follow-up observation of patients. Diagnostic criteria were developed, taking into account the dominance of different types of episodes during the course of the disease. The course was polymorphic with not only affective phases, but also with schizoaffective and schizophreniform episodes, occurring with varying frequency. Significant differences were found in cases of the course of the disease with a predominance of mood disorders with schizoaffective and schizophreniform episodes. This was especially clear in relation to such parameters as the age of the first appointment with a psychiatrist and the quality of global functioning. Conclusions: despite the phenomenological similarity, the course of bipolar disorder I, reveals stable differences between types with a predominance of affective, schizoaffective, or schizophreniform episodes. The syndromal shift and the zone of overlapping disorders are formed as a result of the “antagonistic influence” of the “mood disorders” prototypes and schizophreniform manifestations. The choice of diagnostic strategy should take into account BD polymorphism in order to ensure adequate treatment and prevention of relapses, since the boundaries of these diagnostic categories are labile and permeable.

Background: antipsychotics are widely used in psychiatry. Clozapine remains an indispensable antipsychotic due to its effectiveness. However, it has a wide range of undesirable effect, including an increased risk of QT prolongation, a potentially fatal complication that can lead to Torsade de Pointes (TdP) and sudden cardiac death. Objective: to systematize information for practicing psychiatrists about a personalized approach to the prevention of QT interval prolongation in patients with mental disorders when taking clozapine. Methods: a search for full-text articles published from 02/01/2014 to 02/01/2024 was carried out in PubMed, eLIBRARY.RU, Google Scholar. Results: this review analyzed and summarized the results of studies on the effect of clozapine on the QT interval, the role of risk factors and hereditary predisposition in the development of clozapine-induced prolongation of the QT interval and Torsade de Pointes in patients with mental disorders. The main mechanism of clozapine’s cardiotoxic effect is dose-dependent inhibition of potassium channels in the cardiomyocyte membrane. Clozapine is extensively metabolized in the liver, which may cause significant interindividual variability in its pharmacokinetics. A decrease in the rate of metabolism of clozapine may lead to an increase in its concentration in the blood, and thereby increase the risk of developing cardiotoxic adverse reactions. To reduce the risk of clozapine-induced QT prolongation, it is advisable to use predictive pharmacogenetic testing. Conclusion: Generalized data on the effect of clozapine on the duration of the QT interval and the risk of developing TdP in patients with mental disorders may be needed by psychiatrists when selecting the dose and duration of clozapine. Predictive pharmacogenetic testing can help reduce the incidence of potentially fatal ventricular arrhythmias.

Background: stereotypes are non specific manifestations of mental illnesses of various etiologies. Stereotypes affect the dynamics and severity of the manifestations of the underlying disease and require drug therapy. The aim of the study is to analyze published studies on pharmacotherapy of stereotypes in people with autism. Materials and Methods: according to the keywords “autism”, “autism spectrum disorder”, “stereotypes”, “stereotypic movements”, “repetitive actions”, “habitual movements”, “treatment effectiveness”, articles in English and Russian were searched in the databases MEDLINE/PubMed, Scopus, Web of Science, eLibrary for the period from 2005 to 2024. Conclusion: an analysis of published works has shown that there is no specific drug therapy for stereotypes in autism spectrum disorders to date. It is still not clear how appropriate an attempt to reduce stereotypical actions is, taking into account existing theories about the self-regulating role of repetitive behavior. The medical elimination of stereotypes is necessary when they reach the level of violence, severe obsession, hinder purposeful activity and the implementation of psychological and pedagogical correction.

Background: the normal brain functioning is provided by a brain system maintaining pools and balance of concentrations of the main high-energy compounds, such as ATP and creatine phosphate (CrP), with its main components — creatine (Cr), creatine phosphate (CrP) and creatine phosphokinase (or creatine kinase, CK), the last is catalyzing the reaction of high-energy phosphate residue transfer between ATP, Cr and CrP. The purpose of this review is to analyze the results of studies on the elements of the Cr — CrP system: Cr, CrP and CK in healthy persons and in patients with mental and neurodegenerative disorders and to consider the possibilities of using Cr — CrP-targeted therapy for mental and neurodegenerative disorders. Methods: using combinations of keywords “creatine”, “creatine phosphate”, “creatine kinase”, “schizophrenia”, “bipolar affective disorder”, “Alzheimer’s disease” and “pharmacotherapy”, a search was conducted for sources in the Medline/PubMed, Scopus and RSCI databases. Conclusion: a critical examination of the original articles, both clinical and experimental, including studies performed on animal models, provides a good reason to believe that the involvement of the Cr — CrP system in the pathogenesis of mental illnesses has been confirmed and opens up further prospectives for Cr — CrP-oriented therapy of mental and neurodegenerative disorders, however, further clinical studies of the Cr — CrP system in psychiatry are necessary.

Background: the development of views on childhood schizophrenia has more than a century of history, but is still far from complete, due to significant differences in diagnostic approaches. Objective: to analyze the evolution of views on schizophrenia in children from the prenosological stage to the present, with an emphasis on the main directions and contradictions in the study of this disease. Materials and Methods: a narrative review made up the sources available in the literature, using the combinations of keywords “childhood schizophrenia”, “early onset schizophrenia”, “schizophrenia”, “autism” in the databases Medline/PubMed, Scopus and RSCI. Conclusion: after the period of the unified essence of schizophrenia for childhood and adulthood recognition by most psychiatrists, within the framework of the concept of early dementia with specific clinical manifestations, there is a divergence of views at different age periods. Two directions in the study of childhood schizophrenia are being formed, differing in approaches to the diagnosis and interpretation of the disease in children. Currently, there is a debate about the unity of schizophrenia with a variety of its clinical manifestations in different age periods. The accumulation of research results showing the similarity of clinical manifestations, genetic changes, biological parameters and family burden in schizophrenia, schizotypal and some forms of autistic disorders create prerequisites for considering these diseases within the framework of an etiological continuum.

Background: despite the wealth of dosage forms in modern pharmaceuticals, patients with mental pathology mainly use oral forms of drugs. The aim of article is to present the state of the art on practical administration of different drug forms in clinical psychiatry. Method: assessment and discussion of registered drug forms of original substances significance capable to increase the treatment effectiveness. Results: tablet forms are the most relevant in psychiatry, but they are also very diverse: from oral dispersible tablets to film-coated tablets with modified release of the active substance. However, manufacturers do not specifically emphasize the specifics of using a particular dosage form in psychiatry. For patients with chronic disorders, when carrying out long-term basic therapy, long-acting parenteral drugs are used, manufactured using modern technologies that make it possible to control the release of the substance in the current daily dose for weeks and a month after a single consuming. Conclusion: the use of oral forms of drugs may be important for monitoring compliance in patients in hospital settings, and long-acting forms are relevant for treating patients in outpatient practice. 

Background: a subjective change which occurs rapidly in the external environment causes depression, stress and anxiety in an individual, which in turn works as an urge to experience certain fluctuations in his/her constant behavior. Symptoms of depression may vary according to the lifestyle of the individual and the syndrome exhibits diverse patterns of disabilities. The traumatic experience in childhood increases chances of depression and fear in an individual’s mind, and the longevity or the depth of such events is often determined by the severity of these experiences. These traumatic experiences gradually develop into psychiatric disorders and eventually manifest as bipolar disorder which is considered as the higher form of all depressions. Individuals with bipolar disorder experience intellectual disability due to certain seasonal triggers. The aim of paper was to examine the cause of bipolar disorder and its anomalies with the real-time experiences shared by Jen Gotch in her memoir novel The Upside of Being Down. Method: analyzing the text aims at creating a genuine understanding of the complex problems faced by bipolar patients in the society, to make them realize and prioritize mental health over physical health. Furthermore, the study emphasizes the importance of a proper and scientific understanding of the seasonal triggers and how they are considered a boon rather than a curse to the society. A number of bipolar cases were thoroughly investigated, and a large number of patients were screened, and their reactions and observations were meticulously recorded to make the study possible. Conclusion: from the qualitative and quantitative study done, it is clear that understanding and controlling seasonal triggers is crucial for people with bipolar disorder. Mood disorders, especially bipolarity in particular can be seriously influenced by the changing seasons. The optimal approach is to view mental and physical health as complementary, with both playing essential roles in one’s overall health and quality of life.

The article is devoted to the 100th anniversary of the birth of Viktor Stepanovich Guskov, Ph.D. of Medical Sciences and Head of the Department of Psychiatry at the Perm Medical Institute. In 1954, he graduated from the medical faculty of the Ivanovo Medical Institute, and after that, he completed his clinical residency in psychiatry. Since 1959, he has been working as an assistant at the Department of Psychiatry at the Voronezh Medical Institute. In 1966, based on a competition, he was elected as head of the Department of Psychiatry at the Perm Medical Institute, where he worked until 1997. He is the author of more than 140 publications, including 10 monographs. One of the most signi cant works of his is the “Terminological Dictionary of a Psychiatrist” written in 1965, which included almost 4200 words, expressions, terms and phrases. In addition, he was actively engaged in public work, was a Member of the Crime Control Commission, and introduced into the work technical tools in education. He was awarded the Order of the Great Patriotic War. He has 14 government awards.