Background: in recent years, it has become relevant to study the effects of military operations on the mental health of veterans. The aim was to identify and evaluate the leading psychopathological symptoms in veterans of a special military operation (SMO), as well as to compare diagnoses upon admission and discharge from the hospital. Patients and Methods: 140 male veterans of local wars and armed conflicts who were treated at N.A. Alekseev Psychiatric Clinical Hospital No. 1 in the period from 2023 to 2024 were examined. The average age of the participants was 34.2 ± 8.3 years. During the study, a clinical and psychopathological analysis of the identified symptoms and risk factors in patients was carried out. Results: the study revealed a high prevalence of anxiety (75.7%) and depression (51.4%) among participants with a preliminary diagnosis of post-traumatic stress disorder (PTSD). An analysis of the symptoms of PTSD showed that intrusion (72.1%) is the most common. The high incidence of organic mental disorders caused by traumatic brain injury (TBI) (26.4%), PTSD (18.6%) and affective disorders (20%) was confirmed, in addition, the presence of patients with preliminary diagnoses of the schizophrenic spectrum (15.7%) was noted, which are subsequently confirmed. Conclusions: in clinical practice, the phenomenology of mental disorders due to combat stress is characterized by a variety of symptoms, many of which are not specific to PTSD and therefore are not included in the set of diagnostic criteria. The observed dominant severity of affective register disorders, behavioral disorders, asthenia and individual symptoms of organic brain damage determines the evolution of the diagnosis from the initial examination to the time of discharge with a decrease in the frequency of diagnosed PTSD. Despite the presence of leading or even typical symptoms of PTSD, attention should be paid to other complaints and psychopathological signs, since they can be predominant in the picture of the disease, have a significant impact on the patient’s quality of life and become the most important or promising target of therapy.

Background: despite numerous scientific studies, the topic of affective-mixed states in individuals diagnosed with bipolar disorder (BD) remains unexplored to a full extent due to difficulties in diagnosis, lower referral rates for medical advice, compared to depressive episodes, difficulties in developing correct therapeutic tactics and prognosis. The aim was to study the frequency of occurrence and structure of affective-mixed episodes in patients diagnosed with bipolar disorder. Patients and Methods: a total of 165 patients who underwent inpatient treatment for the first time at the Department for the Study of Endogenous Mental Disorders and Affective States of Mental Health Research Centre in the period from 2013 to 2023 were examined using clinical, psychopathological and statistical methods. All patients included in the study had a clinically confirmed diagnosis of bipolar disorder. Results: based on the affective characteristics, four groups of affective phases were distinguished: manic with mixed features, purely manic, depressive with mixed manifestations, and depressive without mixed features. The frequency rates of episodes with mixed features varied significantly from compared types of affective disorders. Patients with affective-mixed episodes were characterized by an early age of onset, a younger age at first hospitalization, frequent hospitalizations, and a high suicidal risk compared with patients without mixed features. Conclusion: the analysis made allow us to deepen our understanding of the BD course, clinical characteristics, and to formulate a therapeutic strategy for this patient population. The results obtained suggest the formation of a trajectory for future research in the field of bipolar disorder, including the development of an accurate definition of characteristics in patients with affective-mixed phases in bipolar disorder.

Background: the increase in the number of extreme situations threatening the life and health of law enforcement officers leads to the formation of maladaptive reactions and the development of clinical symptoms of mental maladaptation, which dictates the need to improve the quality of preventive and curative care, as well as to improve organizational approaches based on scientific analysis of morbidity. The aim was to assess the dynamics of desadaptation disorders prevalence and give a forecast of the need for employees of the internal affairs bodies of the Russian Federation in medical and psychological rehabilitation (MPR) after suffering borderline mental disorders. Materials and Methods: in order to assess the dynamics and predict the need for internal affairs officers in medical and psychological rehabilitation after borderline mental disorders, an analysis of statistical reporting forms for the period 2008-2023, according to the V class of diseases according to the International Classification of Diseases (ICD-10) was carried out. The study included disorders with a good prognosis and stable remission of painful manifestations after complex therapy. These disorders do not prevent the continuation of service as police officers and relate to ICD-10 categories: organic, including symptomatic mental disorders (F00–F09), mood disorders (affective disorders) (F30–F39), neurotic, stress related and somatoform disorders (F40–F48). The need indicators were calculated per 1,000 employees or in ppm (%). At the first stage of analysis, forecasting was calculated without taking into account external factors. At the second stage, the model was built taking into account the main external factor such as a participation in hostilities. To predict the need for MPR for the period 2024 and 2025, the ARIMA model was applied, the quality of the model was evaluated using the Akaike information criterion (AIC), the Bayesian information criterion (BIC), the Ljung-Box test for diagnosing autocorrelation of residues, the confidence interval was denoted as — CI. The Dickey-Fuller test (ADF) was used to check the stationarity of the time series. To determine the trend of acceleration and deceleration of the trend, an assessment of the change in the growth rate of need was carried out using the first and second derivatives. Results: an analysis of the dynamics of the need for ATS employees to conduct MPR after suffering mental disorders shows the variability of indicators for all groups of mental health disorders studied. The forecast model, built taking into account an external factor — the performance of operational and combat tasks in special conditions, demonstrates the expected increase in the MPR need for police officers in 2024 and 2025, which is associated with an increase in the number of extreme situations faced by employees, and, as a result, with an increase in mental maladaptation. Conclusions: further research and monitoring of the factors influencing the need for medical and psychological rehabilitation are critically important for improving the quality of rehabilitation measures and improving the mental health of police officers. The prospects for further research lie in the development of more accurate models for predicting the need for MPR, taking into account not only external stress factors, but also the individual characteristics of employees, which will optimize rehabilitation programs and increase their effectiveness in conditions of increasing professional loads.

Background: it has now been established that genetic factors play an important role in the pathogenesis of schizophrenia, metabolic syndrome, and cardiovascular diseases. Taking into account the literature data and our own scientific background, the general pattern of the pathogenesis of these disorders may be an imbalance in the work of nitric oxide synthase. The aim was to study the effect of metabolic syndrome and its individual components on the duration of the QTc interval in schizophrenia patients with different variants of NOS1AP gene carriage. Patients and Methods: 168 patients with schizophrenia aged 18–55 years were examined. The components of the metabolic syndrome were determined according to the criteria of the International Diabetes Federation from 2005. At the time of admission to the hospital, a standard 12-lead electrocardiogram recording was performed. The calculation of the QTc interval was carried out using the Bazett formula. The components of the metabolic syndrome were determined by colorimetric enzymatic method. Three single nucleotide polymorphic variants of the NOS1AP gene (rs12029454, rs10494366 and rs12143842) were selected for genotyping. Results: it was found that abdominal obesity had a significant effect on the QTc interval only in the case of carrying the GG rs12029454 genotype. The presence of arterial hypertension increased the duration of the QTc interval in patients with the genotype GG rs12029454, TT rs10494366 and TT rs12143842. It was also found that hypertriglyceridemia is an additional factor affecting the QTc interval in patients carrying the GG rs12029454 genotype. Conclusion: the results of the study confirmed our hypothesis that the nature of the relationship between the duration of the QTc interval and the components of the metabolic syndrome differs among different variants of the NOS1AP gene in patients with schizophrenia.

Background: neuroinflammation as a universal mechanism of development of endogenous mental disorders, including schizophrenia, is given close attention. Chemokines claim to be markers of the neuroinflammation  process within the framework of schizophrenia. Antipsychotics can affect the content of certain cytokines, but similar studies on chemokines are rare. The aim was to investigate the indicators of chemokines of the CXC subfamily in blood of patients with a first episode of schizophrenia, including indices dynamics during therapy with haloperidol and risperidone. Patients, control groups and methods: 80 patients aged 18 to 35 years with the diagnosis F20.09 («Paranoid schizophrenia, observation period less than a year»), in whom the indices of chemokines of the CXC subfamily: CXCL1 (GRO-α), CXCL5 (ENA-78), CXCL8 (IL-8), CXCL9 (MIG), CXCL10 (IP-10), CXCL11 (I-TAC) were studied in blood plasma by flow fluorimetry before and after 8 weeks of therapy with haloperidol (n = 40) or risperidone (n = 40). The control group was 35 healthy volunteers. Results: patients with schizophrenia onset had elevated levels of IL-8 and GRO-α and decreased levels of ENA-78, MIG, and I-TAC before therapy. When haloperidol was administered for 8 weeks, a significant increase in IL-8 and I-TAC was recorded. This was not observed with risperidone therapy. An increase in plasma concentrations of GRO-α, ENA-78, a tendency to a continued decrease in MIG, as well as a high rate of IL-8 are registered in first episode schizophrenia patients after 8 weeks of treatment regardless of the antipsychotic taken. Conclusion: abnormalities in the plasma content of a number of chemokines of the CXC subfamily are initially present in patients with a first episode of schizophrenia, indicating their possible involvement in the mechanisms of this disorder. Antipsychotics have a multidirectional effect on the dynamics of chemokine values in blood, which requires further research.

Background: the effectiveness of a primary screening system for psychiatric disorders in the population can be enhanced by using short scales with high psychometric properties. Aim: to evaluate the psychometric properties of the Russian version of the Kessler Psychological Distress Scale. Participants and Methods: the data from three online surveys conducted as part of the study “The novel coronavirus crisis and its impact on public health” are used. The first survey was conducted in May-June 2020, the second in January-February 2021, and the third in November-December 2021. The sample included 1,667 people. Results: both the full and short versions of the scale are characterized by high internal consistency and reliability. Convergent validity of the scales is confirmed by correlations with similar constructs and known factors of psychological distress. Conclusion: the scale can be used by practitioners and researchers to screen and evaluate the severity of nonspecific psychological distress in the Russian-speaking population.

Background: the most studies of the problem of moral hypochondria (MI) in schizophrenia and schizophrenia spectrum disorders (SSD) is devoted to the study of MI in the aspects of: 1) exacerbations; 2) remissions/residual states; 3) the continuing “sluggish” course of the endogenous process. Despite the results, that have been achieved, the psychopathological structure of moral hypochondria, which forms during prolonged hypochondriacal post-psychotic states, remains insufficiently studied. The aim was to study the psychopathology of moral hypochondria, developing in the post-psychotic period of schizophrenia and SSD. Patients and Methods: the study sample consisted of 21 patients of the department for the study of borderline mental pathology and psychosomatic disorders of the FSBSI «Mental Health Research Centre». Clinical, psychometric, statistical methods are used. Results: the aspects of formation of moral hypochondria, that realizes in the post-attack period of schizophrenia and SSD, are presented: 1) premorbid personality type (cluster B personality disorder with the inclusion of dimensions of the “as-if personality”); 2) two-stage course of the disease. The first stage is an acute psychogenic debut followed by an anesthetic depression; the second stage is a prolonged hypochondriacal state with symptoms of MI. The rationale for the admissibility of interpreting MH as one of the manifestations of post-processual personality development is formulated. The psychopathological characteristics of the phenomenon of transformation of positive psychopathological disorders into pathocharacterological formations are described. Conclusions: this study presents the formation mechanism of the personalized overvalued phenomena of moral hypochondria, originating in the structure of psychopathological disorders of the depersonalization spectrum.

Background: the relationship between the effectiveness of bilingualism, interhemispheric interaction and the cognitive sphere poorly understood. The aim was to assess combination factor of bilingualism in frame of “cognitive-lateral model” and to determine statistical characteristics of empiric parameters depending of bilingualism. Participants and Methods: 21 healthy persons were examined. Neurocognitive methods included the Compass and Tower of Hanoi tests. The profile of the lateral organization and the leading arm were determined. The intensity of interhemispheric interaction was assessed by determining the maximum angle of preservation of stereopsis. The set of factors of bilingualism was empirically assessed within the framework of the “cognitive-bilateral model”. The statistical characteristics of the empirical variables of the model are determined depending on the degree of mastery of a second/several languages. Results: correlations were obtained between the indicators of the lateral organization profile and the leading hand in the Annette test (r = 0.34), scores in the “Compass” task (r = 0.33), and the number of moves in solving the “Tower of Hanoi” problem (r = −0.45) and the intensity of interhemispheric interaction after cognitive load (r = −0.38). Using discriminant analysis, the discriminatory parameters of the model were determined, characterizing cognitive psychological characteristics, an indicator of lateral organization and the intensity of interhemispheric interaction in relation to the “effectiveness of bilingualism”. The discriminatory function included variables from the “Compass” and “Tower of Hanoi” cognitive tests with the greatest contribution from the lateral organization and leading hand profile indicators Classification based on the difference between group centroids was more than 90%. Conclusions: effectiveness of bilingualism study based on cognitive-lateral model could be perspective in studying of psychiatric and neurological pathology.

Background: the main goals of schizophrenia spectrum disorders therapy include not only achieving clinical improvement, but also the restoration of social functioning. This is especially relevant in light of the biopsychosocial concept of the development of this disease, which necessitates an integrated approach to considering its etiopathogenetic and therapeutic aspects. The main treatment and rehabilitation work with patients at the current stage of development of practical healthcare is carried out on an outpatient basis. This is facilitated by the reform of the psychiatric service with the reduction of the inpatient unit and the development of inpatient-substituting forms of mental health care. The aim of review was to analyze the scientific publications on the development of psychiatric care for schizophrenia spectrum disorders in outpatient settings. Material and Methods: using keywords “schizophrenia”, “outpatient care”, “long acting injectable antipsychotics” the source of articles on the possibilities of using long-acting antipsychotic drugs to improve compliance with the therapeutic regimen and prevent psychotic relapse was carried out in PUBMED, e-library and other bases for 10 years. The positive and negative aspects of the use of deposited dosage forms at the stage of maintenance antipsychotic therapy are considered. Additional psychosocial therapies are discussed as part of an integrated approach to treating patients with schizophrenia. Conclusion: the results of the review allow us to conclude that there is a need to develop pharmacological and psychosocial treatment of schizophrenia at the outpatient stage, with an emphasis on anti-relapse maintenance therapy and concomitant social rehabilitation.

Background: substance abuse disorder is widespread among schizophrenic patients. The choice of treatment strategy for a patient with a dual diagnosis presents significant difficulties for the clinician due to the peculiarities of the mutual influence of the two diseases, worse tolerance of psychopharmacotherapy, and low compliance. The aim of review was to analyze the scientific publications on the pathogenesis of comorbid substance use disorders in schizophrenic patients and current strategies of their treatment with antipsychotics considering drug interactions. Materials and Methods: a narrative review of scientific publications was compiled using available sources in the literature, including a search using combinations of keywords «шизофрения», «зависимость от алкоголя», «коморбидность» «антипсихотическая терапия», “schizophrenia”, “alcohol use disorder”, “SUD”, “comorbidity”, “antipsychotic drugs” in Google Scholar, ELibrary.ru, Scopus, PubMed databases. Conclusion: there are various theories designed to explain the mechanism of comorbid addiction formation in patients suffering from schizophrenia. One way or another at present, the common neurobiological basis of these disorders is no doubt, that determines the therapeutic strategy for this group of patients. The available publications shows promising prospects for the effectiveness of 3rd generation antipsychotics in the treatment of comorbid disorders, but further researches are needed.