Background: the study of metacognitive abilities in adolescents is crucial for understanding early mechanisms in the developmental of psychotic disorders. Evidence suggests that impairments in metacognitive monitoring and control may strengthen the association between neurocognitive deficits and attenuated psychotic symptoms in adolescence. However, existing studies are few, and their findings need to be systematized to clarify the characteristics of metacognition in schizotypal disorder (SD) specifically during adolescence.

The aim of study was to examine mental-state integration and monitoring in adolescents with SD.

Patients and Methods: a pilot cross-sectional study using psychometric instruments was performed on adolescents with SD (F21 in ICD-10; n = 11), nonpsychotic internalizing disorders (F41, F42, F43.2 in ICD-10; n = 6), and externalizing disorders (F90, F91 in ICD-10; n = 5). Statistical analysis included descriptive statistics, correlation analysis, between-group comparisons, and post hoc pairwise comparisons.

Results: compared with peers with nonpsychotic internalizing and externalizing disorders, adolescents with SD showed more pronounced identity disturbance and alexithymia.

Conclusion: the complex impairments in mental-state integration and monitoring in adolescents with SD resemble basic self-disturbance (BSD), which is characteristic of schizophrenia. Further research is needed to investigate metacognitive abilities in adolescents with SD and their relationship with BSD, as this complex may represent a potential predictor of psychosis risk.

Background: depressive symptoms often accompany schizophrenia, changing the severity and perception of its main clinical manifestations. The severity of psychopathological symptoms affects the course and development of the disease. Genetic studies have revealed a partial overlap of genetic risk between schizophrenia and depressive disorders. Objective: to find out whether the genetic associations of the severity of positive and negative symptoms of schizophrenia differ in patients with and without depressive symptoms. Patients and Methods: a comparative cross-sectional study of patients with schizophrenia was conducted. The study participants belonged to one of three ethnic groups: Russians, Bashkirs, and Tatars. The study included 390 patients, of whom 124 (31.8%) had signs of depressive disorder. The assessment of depressive symptoms was carried out using the CDSS scale. The PANSS scale was used to assess the severity of psychopathological symptoms. The following polymorphisms were selected to determine the genetic associations: MTNR1A rs34532313, MTNR1B rs10830963, CLOCK rs 1801260, HTR2A rs6313, PER2 rs934945, eNOS rs1549758, eNOS rs1799983. The data was analyzed using nonparametric statistical methods: the Mann–Whitney test, the Student's t-test, and the Pearson χ² test. Results: in patients with depressive symptoms, the carriage of the minor allele of polymorphism MTNR1A rs34532313 was associated with a lower severity of symptoms P4, N7; polymorphism HTR2A rs6313 — with a lower severity of P4; polymorphism PER2 rs934945 — with a lower severity of P7 of PANSS. In the group of patients without significant depressive manifestations, an association was found between the carriage of the minor MTNR1A allele rs34532313 and a greater severity of the P6 symptom. Conclusions: depressive symptoms in patients with schizophrenia can modify associations between polymorphic gene variants and the severity of individual psychopathological symptoms.

Background: the identification of distinct schizophrenia subtypes based on therapeutic response, as well as the search for biomarkers of clozapine response, is still in its early stages.

Objective: to establish the profile of structural and functional abnormalities of the brain in groups of ultra-treatment-resistant schizophrenia patients (UTRS) and clozapine responders (CRS), as well as the associations of the identied abnormalities with clinical characteristics.

Patients and Methods: two groups of right-handed male patients diagnosed with paranoid schizophrenia (F20.0) and healthy controls underwent MRI, EEG and clinical examination. The MRI data analysis included 15 patients of the CRS group, 18 patients of the UTRS group, and 21 healthy controls. In the EEG data analysis, the samples consisted of 12 and 15 patients, respectively, while the control group was selected separately and included 26 subjects. For the analysis of MRI data, T1-weighted images were processed using FreeSurfer 7.1.1. For each subject, values for the cortical, subcortical, and brain stem structures were obtained. For EEG analysis, spectral power (SP) values of theta, alpha and gamma rhythms were obtained. Intergroup comparisons and correlations with clinical scales (PANSS, CDSS) and antipsychotic dosage in chlorpromazine equivalent were performed.

Results: in the UTRS group, changes in subcortical structures similar to those in the CR group were observed, along with a decrease in the cortical thickness (in CRS compared to control — right temporal cortex; in UTRS — frontal, temporal, occipital, insular, and cingulate cortices bilaterally). Additionally, the theta rhythm SP was higher in both groups. The theta rhythm SP correlated with the average daily dose of antipsychotics in the UTRS group.

Conclusion: the results indicate that ultra-treatment-resistance is associated with more widespread and pronounced cortical thinning. The effects of the therapy were primarily noted in functional characteristics (theta rhythm SP), although indirect effects from changes in the state of the brain cannot be excluded.

Background: despite the significant number of studies devoted to the study of compliance and its role in the recovery process, existing assessment methods often demonstrate limited prognostic potential.

The aim of study: to investigate the specificity and differences of resourcefulness and resilience as factors of compliance in patients with qualitatively different mental disorders.

Patients and Methods: using the Resourcefulness for Recovery Inventory Scale, the Emotional Intelligence (EmIn) Questionnaire developed by D.V. Lyusin, and the Toronto Alexithymia Scale (TAS-20), 120 patients aged 18–25 years (mean age 22 ± 3.5 years) were examined. The sample was divided into four equal diagnostic groups: patients with neurotic, stress-related and somatoform disorders (F40–F48), with emotionally unstable borderline personality disorder (F60.31), with schizophrenia (F20), with mental disorders and behavioral disorders associated with the use of psychoactive substances (F10–F19). Statistical analysis was performed using the Welch criterion and correlation analysis (Spearman).

Results: significant differences were found between the groups in the level of resourcefulness and stability (RRI), emotional intelligence (EmIn) and alexithymia (TAS-20). Correlation analysis showed the presence of significant two-way relationships between emotional intelligence (EmIn) and factors contributing to recovery (RRI), as well as two-way positive correlations between the level of alexithymia (TAS-20) and the ability to recover (RRI).

Conclusion: it has been established that patients with neurotic disorders and borderline personality disorder have a higher ability for compliance and recovery compared to patients dependent on psychoactive substances and patients with schizophrenia. These results can be used in the elaboration of psychotherapeutic strategies aimed at increasing compliance and treatment effectiveness through the development of resourcefulness and emotional regulation.

Background: the problem of postoperative psychosis in patients with cerebral gliomas remains extremely poorly understood. It is assumed that the development of postoperative psychoses prolongs the period of hospitalization and worsens the prognosis of the underlying disease, but the evidence for this is extremely scarce.

The aim was to determine the risk factors for postoperative psychosis and their impact on the results of treatment of brain gliomas.

Patients and Methods: this prospective, single-center observational study included a random sample of patients with glial brain tumors. A psychiatrist examined all patients immediately before and after surgery, as well as upon discharge, after which the results of treatment were determined after 6, 12 and 24 months. The selection criteria were age over 17, initial intervention for a tumor, and a verified diagnosis of cerebral glioma. The main methods were clinical-psychopathological and clinical-statistical, with the determination of significant differences between groups of patients with and without psychosis.

Results: the study included 125 patients (61 women; 64 men), aged from 18 to 73 years (on average 46.4 ± 2.6 years). Postoperative psychosis occurred in 26 (20.8%) patients in the form of isolated psychomotor agitation in 9 patients, isolated confusion in 9, a combination of psychomotor agitation and/or confusion with hallucinations and/or delusions in 8. It was found that the main factors significantly contributing to the occurrence of postoperative psychoses were the age over 60 years (p = 0.00622), weight over 80 kg (p = 0.00466) and such indicators of preoperative mental and somatic health as the presence of cognitive disorders (p = 0.00022), diabetes mellitus (p = 0.03544), hypertension diseases (p = 0.00064), as well as taking psychotropic drugs in the preoperative period (p = 0.00455). Psychoses were less frequent in the presence of structural epilepsy (p = 0.00347). A significant relationship between the occurrence of psychosis and the characteristics of the tumor was noted only in terms of tumor volume (p = 0.04453). Other factors as a slightly more frequent occurrence of psychoses in: a) damage to the median structures, b) preoperative cerebral edema, c) right-sided localization of an isolated lesion of any lobe of one of the hemispheres, as well as a rarer occurrence in isolated damage to the frontal lobe were not significant. Psychosis developed in 4 out of 5 patients with surgical complications requiring postoperative revision (p = 0.00087). Patients with postoperative psychosis had a longer hospital stay (p = 0.00036) and a lower survival rate for 24 months after surgery (p = 0.003166).

Conclusion: to prevent postoperative psychosis in patients with cerebral gliomas, special attention should be paid to the preoperative somatic and mental state of patients. In cases of psychosis, it is necessary to conduct an intensive search for measures to reduce mortality.

Background: clozapine remains the drug of choice for treatment of resistant schizophrenia; however, its use is limited by the high risk of adverse drug reactions, including prolongation of the QTc interval. The role of genetic factors, in particular polymorphisms of the genes of transport proteins, in the development of this complication has not been sufficiently studied.

The aim of the study was to evaluate the association between low-function single nucleotide variants (SNVs) of the ABCB1 (rs1045642, rs1128503, rs2032582) and ABCG2 (rs2231142) genes and prolongation of the QTc interval in patients with schizophrenia taking clozapine.

Patients and Methods: the study included 129 patients with paranoid schizophrenia (F20.0 on ICD-10) receiving clozapine. Correction of the QTc interval was performed according to the Frederick formula. QTc interval prolongation was defined as an increase of ≥ 30 ms from baseline. Genotyping was performed using real-time PCR.

Results: an increased risk of QTc interval prolongation was found in women (OR 4.217; 95% CI: 1.556–11.430; p = 0.003) and older people (ρ(rho) 0.218; p = 0.02). Antipsychotic polytherapy was not associated with an increased risk of QTc interval prolongation (p = 0.097). No statistically significant association was found between single nucleotide variants of the ABCB1 (rs1045642, rs1128503, rs2032582), ABCG2 (rs2231142) genes and QTc prolongation (p > 0.05).

Discussion: foreign studies have shown a high risk of prolongation of the QTc interval when taking clozapine. In this regard, further study and clarification of the pharmacogenetics of clozapine and the search for predictors of prolongation of the QTc interval when taking it are required.

Conclusion: prolongation of the QTc interval is associated with female gender and older age. The studied single nucleotide variants of the genes of transport proteins do not have a significant effect on prolongation of the QTc interval during clozapine therapy. Regular electrocardiographic monitoring is recommended in patients at risk of prolongation of the QTc interval.

Background: there is evidence in research studies indicating that it is possible to establish early risk for psychosis by identifying cognitive dysfunction that precedes the development of psychotic states. The role of cognitive dysfunction as psychosis predictors in depressions with non-suicidal self-injury (NSSI) is unclear.

The aim was to study the correlation between the severity of cognitive deficits and features of non-suicidal self-injury in adolescent female patients with depression with attenuated psychotic symptoms in comparison with depressed patients without these symptoms.

Patients and Methods: the study included 89 female patients aged 16 to 25 years, suffering from depression of different nosology affiliation (F31.3–4; F34.0; F21.3–4 + F31.3–4; F60.X + F31.3–4 по ICD-10) with NSSI manifestations in the disease picture. Based on the presence or absence of attenuated psychotic symptomatology, the patients were divided into two groups: 46 depressed patients with attenuated psychotic symptoms (DAP) and 43 depressed patients with no attenuated psychotic symptoms and no history of psychotic disorders (DNP). Cognitive functions were assessed using the Brief Assessment of Cognitive Functions in Schizophrenia Scale (BACS), Wechsler's Similarities and Missing Details subtests, and the Interpretation of Proverbs methodology. The “Autonomy Scale” was used to assess the patients' functioning, interaction and level of social activity.

Results and Conclusions: in the DAP group, the Autonomy Scale scores — Total score, Ability to build a functional social network, and Content of conversation with a doctor were significantly lower than in the DNP group. Significant differences were found in the cognitive sphere scores: in the DAP group, the scores of Total Cognitive Functioning Score, Verbal Memory, and Verbal Fluency, as well as the Similarities and Missing Details tests and the Interpretation of Proverbs technique were lower than in the DNP group of respondents, which conrms the assumption about a lower level of cognitive functioning in patients with subpsychotic attenuated symptomatology. Patients in the DAP group with suicide attempts demonstrated higher autonomy scores, but reduced cognitive sphere scores (working memory), compared to DAP patients without suicide attempts. It was noted that patients who continued NSSI after discharge demonstrated a lower level of social skills and cognitive sphere than patients with DAP who discontinued NSSI. It was shown that the variety of “Mild way of NSSI” was significantly greater in the DAP group.

Background: effective psychiatric care involves maintaining the physical, psychological, social and economic well-being of the professionals providing it. Nursing staff of psychiatric institutions experience significant workloads associated with their professional activities.

The aim of the study was to identify the level of professional burden of nursing staff in psychiatric institutions and analyze its dependence on socio-demographic characteristics and working conditions for the implementation of health-preserving organizational and psychological measures.

Participants and Methods: 502 nurses of psychiatric institutions, divided into subgroups depending on the duration and intensity of activity. The «Questionnaire for Assessing the Burden of Psychiatric Institution Workers» was used to determine the characteristics indicating the presence of professional hardships.

Results: the work of mid-level medical personnel is characterized by high intensity. 46.41% work more than 40 hours per week. 88.85% combine three or more functions. The obtained indicators showed the average level of professional burden of psychiatric nurses. With an increase in the duration of work in psychiatric practice, the subjective feeling of deterioration in physical (p = 0.006) and mental well-being (p = 0.014) increases. This trend begins to be observed in mid-level medical personnel after 5 years of work and worsens over time. The intensity of contact with psychiatric patients is also associated with a feeling of physical ill-being. In addition, in nurses working more than 40 hours a week, the socio-psychological burden increases (p = 0.03).

Conclusions: when managing nursing staff to ensure high-quality and effective performance, it is necessary to take into account both socio-demographic factors (age, education, place of residence, marital status) and professional factors (length of service in psychiatric institutions, working hours associated with direct contact with patients, qualifications, etc.) that influence the formation of the professional burden of mid-level medical personnel.

Background: the presence of symptoms of Eating disorder (ED) in the structure of depression can potentially increase the risk of developing cardiovascular, endocrine and neurological diseases, which must be taken into account in the diagnosis and approaches to the treatment of these disorders.

The aim of study: conducting an exploratory analysis of the relationship between depression and the severity of ED depending on concomitant somatic diseases and mental disorders.

Patients and Methods: a cross-sectional study included 338 patients (63.9% females; the average age was 30.8 years). Their mental state was diagnosed as depressive episode (F32) or recurrent depressive disorder (F33) on the ICD-10. The study card recorded data on the presence of somatic diseases. All participants underwent a psychometric examination using the EAT-26 test.

Results: patients with depression and concomitant thyroid diseases had significantly more pronounced ED according to EAT-26. In addition, patients with a family history of thyroid disease tended to have not significantly higher scores on the EAT-26 scale. At the same time, the presence of thyroid disease in patients with depression was not associated with concomitant anorexia nervosa and bulimia nervosa.

Conclusions: patients with depression and concomitant thyroid disease have a higher severity of thyroid disease (TD), but not the increased frequency of clinically significant eating disorders. This result can be explained by the broader clinical characteristics of TD, which is quantitatively assessed by EAT-26 and which may overlap the symptoms of depression. The relationship between depression, TD and ED can be explained by the influence of thyroid hormones on the regulation of metabolism and neurovegetative functions, including through the leptin system. Further studies are required to confirm this hypothesis.

Background: therapeutic drug monitoring (TDM) is becoming particularly important in the context of growing interest in personalized medicine, due to its ability to increase the effectiveness and safety of psychopharmacotherapy.

The aim was to systematize and summarize current research data on the use of TDM in psychiatric practice.

Material and Methods: a narrative review was conducted using the PubMed database using keywords related to the use of TDM for various classes of psychotropic drugs (antipsychotics, antidepressants, mood stabilizers). The analysis included recommendations from the AGNP (Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie) working group as well as emerging methods for biological sample collection.

Results: analized articles supports a clinical evidence of the regular use of TDM for medications with a narrow therapeutic window (clozapine, lithium, valproate). The authors discuss the ability of TDM to help identify individual metabolic differences, assess treatment adherence, and prevent pseudo-resistance. Limited data are available on the concentration-effect correlation for most antidepressants. Alternative monitoring methods (e.g., saliva and dried blood spot testing) are shown as potential ways to improve accessibility of TDM.

Conclusions: TDM is an effective tool for optimizing psychiatric treatment, especially with antipsychotics and mood stabilizers. The adoption of non-invasive methods of bio-material sampling and increased awareness among healthcare providers may contribute to broader implementation of TDM in clinical settings.

Background: helping young people after a first psychotic episode (FPE) requires a comprehensive approach that focuses not only on the reduction of psychopathological symptoms but also on restoring social and occupational functioning as much as possible. Acceptance and commitment therapy (ACT) is a modern cognitive behavioral psychotherapeutic approach that allows working with psychotic patients in an age-appropriate manner, which makes it promising for use in the russian population.

Methods: using the keyword combinations “acceptance and commitment therapy”, “psychosis”, “meta-analysis”, “delusions”, “hallucinations”, etc., we searched the scientific literature in Google Scholar and PubMed databases for meta-analytic, review and other papers evaluating the effectiveness of ACT in working with psychotic patients.

Results: five meta-analyses and review papers were selected that provided the evidence sought. According to them, despite some contradictory and few data, the primary evidence assessment indicates a possible benefit of ACT in combination with psychopharmacotherapy in psychosis compared with conventional medication. There is evidence of reduced hospitalization and relapse rates with ACT, reduction of affective symptomatology and distress associated with experiencing psychotic symptoms, and there is some evidence of help in reducing the impact of productive psychotic symptoms on patient functioning. Negative symptomatology, in turn, has to date been less well researched in this regard. According to studies, the effectiveness of ACT as a form of psychotherapy begins to be noted after 3–4 sessions.

Conclusion: further research is needed to test this approach on a Russian-speaking sample, and foreign works on the assessment of effectiveness show the prospects for its introduction into clinical practice.

Modern advances in genomics, proteomics, and cell technologies have opened up new opportunities for studying the pathophysiological foundations of mental and neurological disorders. A key element for such research is well-characterized biomaterial collections associated with detailed clinical data. The creation of such resources allows for the advancement of personalized medicine, including the search for biomarkers for diagnostics, prognosis, and treatment efficacy. In this paper, we present the experience of creating and using the Biomaterial Collections Fund “NeuroResource” registered at the Mental Health Research Center.