Background: the search for predictors of readmission applicable in real clinical practice is still of interest to schizophrenia researchers. The prognostic value of antipsychotic therapy after discharge from the hospital and its relationship to the duration of the disease remain poorly understood. The aim was to identify risk factors for repeated hospitalization in patients with paranoid schizophrenia, taking into account the duration of the disease and the underlying antipsychotic therapy prescribed at the time of discharge from a psychiatric hospital. Patients and Methods: the study included 163 patients with paranoid schizophrenia (unselected sampling; women — 42.3% (n = 69), average age — 30.26 ± 7.05 years), discharged after inpatient treatment. Antipsychotic therapy was taken into account when the patient was discharged from the hospital, according to medical records for the period from 2018 to 2024. Antipsychotic drugs were divided into the first and second generations (respectively, FGA and SGA). Patients taking clozapine were excluded from the study. The method of taking the medicine (oral or injectable in the form of a depot) was taken into account. All doses of the drugs have been converted to standard daily doses (the equivalent of 5 mg of risperidone according to the WHO Defined daily dose method). The prognostic significance of the duration of the disease was also studied. The risk of re-hospitalization was assessed using the Cox regression method with mixed effects. Results: mean duration of follow-up was 3.87 [2.87; 4.08] years. The average dosage of the antipsychotic was 1.20 [0.99; 1.67] daily doses. Secondgeneration antipsychotics accounted for 76.2% in total structure of drug prescriptions. The share of extended forms of both generations accounted for 18.1% of appointments. With one SGA hospitalization, the risk of repeated hospitalization decreases with an increase in the standard dose (aHR = 0.24 (0.07; 0.83), p = 0.005). In the first episode, the overall risk of rehospitalization was lower relative to that of chronic patients (aHR = 0.49 (0.29, 0.82), p < 0.001). For the remaining combinations of factors “drug dose — antipsychotic generation — number of hospitalizations”, the trends are not unambiguous. Conclusions: the risk of rehospitalization at the first psychotic episode was reduced by 2.04 (1.22; 3.40) times regardless of the therapy received. When patients are prescribed SGA drugs (except clozapine) in a dose exceeding the standard daily dose, the risk of rehospitalization decreases by 4.17 (1.20; 14.29) times regardless of the duration of the disease.

Background: risk of bipolar disorder (BD) development in people with multiple sclerosis (MS) is much higher than in general population. However, there is a lack of studies developing the role of predictors of BD in patients with MS. Objective: to study sociodemographic, clinicopsychopathological and clinicofunctional characteristics significant to predict the development of BD in MS. Patients and Methods: 750 patients with MS were examined, 25 of them were diagnosed as bipolar disorder. The control group consisted of 25 MS patients without any mental disorder. The observation period was 10 years. The following scales were used: Beck Depression Inventory (BDI), Multidimensional Fatigue Inventory (MFI-20), Spielberger State-Trait Anxiety Inventory (STAI), visual analogue scale (VAS) for assessing pain, Paced Auditory Serial Addition Test (PASAT), Expanded Disability Status Scale (EDSS). Also, we identified significant stressful events. The diagnosis of BD was stated according to ICD-10 criteria. Multivariate models were developed using analysis of variance and multiple linear regression equation. Results: a multifactorial model of predictors of the development of BD with a high multiple correlation value (r = 0.80) was proposed. Factors with pronounced influence on the development of BD were: high rate of progression of MS, highly active course of MS, asthenia — 58.2.6 ± 2.6 points on the MFI-20 scale with an increase of 4.2%/year, localization of lesions in the periventricular white matter and in the left hemisphere cerebellum. Significant factors were: multiple lesions by the onset of MS, reactive anxiety — 56.62 ± 2.34 points on the Spielberger-Khanin scale with an increase of 2.43% per year, cognitive impairment with an increase of 4,97% per year; increase in the area of lesions in the brain by 1.67% per year. Age of onset of MS, age of onset of bipolar disorder, disability indicator according to EDSS, type of MS, disease-modifying drugs for MS use have not shown the significant influence on the development of BD in MS. Conclusion: the proposed model of predictors of the BD development in patients with MS can be used to predict the development of bipolar disorder and to provide personalized medical care.

Background: nonsuicidal self-injury (NSSI) behavior in adolescent girls is considered a clinically significant manifestation of emotional dysregulation associated with anxiety, depression, and impaired social adaptation. Considerable differences in the severity, functional significance, and predictors of such episodes make it difficult to develop a unified approach to the diagnosis and management of adolescents with NSSI. The aim was to identify and describe the clinical and social characteristics of adolescent girls with NSSI and to analyze their relationship with psychoemotional indicators. Patients and methods: the study included 186 girls aged 12–17 years, who were hospitalized in the “Specialized Psychoneurological Hospital” of Krasnodar Region in 2022–2024. Along with the clinical assessment of the past medical history and mental state, the following instrumental methods were used: Children's Depression Inventory (CDI) by M. Kovacs, the method of multidimensional assessment of children's anxiety, the questionnaire of social-psychological adaptation (SPA) by K. Rogers and R. Diamond, Reasons for Self-Injury Scale (N.A. Polskaya), Child and Adolescent Social Support Scale (CASSS) by K. Malecki. Hierarchical clustering, elbow method, and K-means algorithm were used for the analysis. Statistical processing was performed in Python and Statistica. Results: three stable clusters were identified as follows: with low, moderate and high severity of NSSI. Patients with high NSSI intensity committed severe and multiple self-harms. The mental state of these patients was characterized by high levels of anxiety and depression, decreased adaptation, and low levels of social support. The cluster with moderate NSSI severity was distinguished by the predominance of compulsive NSSI forms and an average level of psychological vulnerability. Patients with low NSSI severity demonstrated favorable results on all scales. Significant differences were obtained between patients of the three clusters on the scales of anxiety, depression, adaptation, and social support (p < 0.001). Conclusion: the cluster approach allowed us to form typical psychosocial profiles of girls with NSSI, which has practical significance for the development of differentiated and personalized approaches to prevention and therapy and psychosocial assistance programs.

Background: leptin and adiponectin, having neurotrophic and immunomodulatory properties, are considered as potential links between metabolic disorders and mood disorders. However, data on their levels in depression remain contradictory. The aim was to study the relationship of leptin and adiponectin levels with the clinical characteristics of recurrent and bipolar depression. Patients, Participants and Methods: in a cross-sectional study conducted on the basis of the St. Petersburg State Medical Institution P.P. Kashchenko Hospital. St. Petersburg, 50 patients with a depressive episode (DE) with mood disorders and 35 participants without mental disorders participated. The Montgomery-Asberg scale was used to assess depression. Serum levels of leptin and adiponectin were determined by enzyme immunoassay. Results: patients with mood disorders with current DE did not differ from healthy controls in terms of leptin level, but had significantly lower level of adiponectin. In direct comparison, patients with current DE with bipolar and recurrent depression did not differ in hormone levels. Women with current DE had higher levels of leptin and adiponectin compared to men. In the healthy control group, there were no significant differences between men and women in hormone levels. Leptin levels in patients and healthy controls were positively associated with body mass index. Hormone levels were not associated with the age of onset of the disorder, the severity of depression, the duration of the disease and the current DE. Conclusions: a decrease of adiponectin level was revealed in patients with current DE in mood disorders, while the level of leptin remained unchanged. The observed effects were independent of the nosology and clinical characteristics of depression, but were modulated by the patient's gender. It is necessary to take into account gender characteristics when studying the relationship between mood disorders and metabolic disorders.

Background: auto-aggressive behavior in persons of military-age is due to personality disorders (PD) in 90%. The features of self-harm in people of military age with PD compared with mentally healthy conscripts in modern conditions have not been sufficiently studied. The aim of the work was to systematize the variants of auto-aggressive behavior in military-age people with PD in order to improve differential diagnostic measures. Patients and Methods: 504 young men of military age (average age 18.7 ± 1.7 years) were examined in a psychiatric hospital. The participants were examined with clinical method and using the character accents questionnaire by A.E. Lichko and the ISAS questionnaire by E. Klonsky et al. Statistical processing included a comparative analysis according to the Fisher criterion and factor analysis (p < 0.05). Results: autoaggressive behavior occurs in 10.9% of cases among people of military age who are referred for examination in a psychiatric hospital. Auto-aggressive behavior among conscripts was most often represented by self-cutting: 92.1% in cases of PD vs 88.2% in mentally healthy conscripts who were sent for inpatient examination due to auto-aggressive behavior (χ² 0.21, p = 0.50). Episodes of skin cauterization were less common: 15.8% and 11.8% (χ² 0.15, p = 0.53); impacts on hard surfaces: 13.2% and 0% (χ² 2.46, p = 0.14), respectively. It has been established that in PD, self-harm is more severe, first committed at an earlier age, and more often repeated. Specific clinical features and motives of auto-aggressive behavior have been identified for certain types of PD: emotionally unstable (anti-suicide motivation, skin cauterization), dependent (revenge and interpersonal influence motivation, attempt to hide self-harm, critical attitude towards auto-aggression), schizoid (anti-dissociation, toughness and self-care motivation, isolated self-cuts), dissocial (interpersonal boundaries motivation) and anxiety (suicidal intentions and autonomy motivation, blows on a hard object). Conclusion: the systematization of variants of auto-aggressive behavior in people of military age with PD in comparison with mentally healthy recruits can be used in psychiatric examination to identify hidden variants of PD, as well as differential diagnosis of PD recruits and evasive behavior with a negative attitude towards military service. Identifying and studying the features of auto-aggressive behavior as a marker of mental disorders in people of military age is important for improving the quality of military recruitment and ensuring national security.

Background: oculomotor dysfunction is one of the most stable markers of schizophrenia. At the same time, the attention of researchers is mainly focused on the characteristics of macro eye movements in nervous and mental disorders, while the features of micro eye movements, in particular ocular microtremor (OMT) generated by the oscillators of the brainstem and cerebellum, poorly understood. The aim was to study the potential of OMT as a marker for objective assessment of changes in the functional state of patients with schizophrenia spectrum disorders. Patients, Participants and Methods: the study involved 30 healthy subjects, 47 patients with paranoid schizophrenia, 27 patients with schizotypal disorder and 20 patients with schizoaffective disorder. Instrumental recording of OMT was performed using the super–slow motion video recording method. Average values of OMT frequency and amplitude were calculated, as well as the frequency of OMT frequency values falling within the intervals of 0–40 Hz, 40–50 Hz, 50–60 Hz, 60–70 Hz, 70–100 Hz, 100–110 Hz and the average OMT amplitude in each frequency range. Results: patients differed from the healthy control group by a decrease in the high–frequency component (70–110 Hz) in the OMT spectrum with a simultaneous increase in the proportion of the low–frequency component (40–60 Hz). Intragroup comparison of OMT frequency indicators at the time of inclusion in the study and showed that significant changes were observed only in the group of patients with schizophrenia in the average OMT frequency and in the frequency of OMT frequency falling within the ranges of 60–70 Hz and 70–100 Hz after 8 weeks of antipsychotic therapy. Significant changes in the OMT amplitude during therapy were also observed only in the group of patients with schizophrenia and in the low–frequency component of the OMT. The average values of the OMT amplitude were higher in the groups of patients, regardless of their condition, compared with the values of the OMT amplitude in the healthy control. Conclusion: the potential of using OMT recording to assess the dynamics of the functional state in schizophrenia spectrum disorders can carry important, missing information about the neurophysiological mechanisms of the disease and serve as a tool for differential diagnosis and assessment of the dynamics of the condition.

Background: the relevance of this study is determined by the high prevalence of depressive disorders and the growing interest of clinicians and psychologists in the significance of suicidal-depressive (SD) internet memes as both a risk factor for suicide behavior and a potential coping resource. The limited empirical research in this area has been conducted online with psychometric assessment of respondents' depression. The aim of study is to investigate the specifics of the perception of various categories of SD memes by psychiatric patients with depressive syndrome. Patients, Control Group, Methods: the study involved 84 patients from the Mental Health Research Centre with a diagnosed depressive syndrome (F31, F32, F33, F21 according to ICD-10) and 42 individuals without diagnosed mental disorders (control group). Methods: assessment of funniness, comprehensibility, and aversiveness of 38 internet memes divided into 4 groups: SD memes with three types of punchlines (“the idea of depression/suicide”, “negative attitudes towards a depressed/suicidal person”, “alternative to depression/suicide”) and control memes (not related to depression or suicide); psychometric scales and questionnaires (BDI, BHS, PhoPhiKat, CHS, ISMI9); author's own development methods (assessment of suicide representations, assessment of humor creation ability); clinical interview. Results: the clinical group demonstrated lower comprehension of the control memes (p = 0,001). Qualitative analysis revealed patients' high sensitivity to SD humor — ranging from complete rejection to an active use as a coping mechanism. In both groups, memes with the “alternative to depression/suicide” punchline were rated as the least funny, and memes with a “negative attitudes towards a depressed/suicidal person” punchline were rated as the most unpleasant. Patients preserve the ability to generate humor in stressful situations but employ it less often. Conclusions: SD memes with different types of punchlines are perceived differently. Their use in everyday communication by internet users requires extreme caution due to the high risk of negative reactions. SD humor is perceived as more acceptable if it is created and disseminated by people with personal experience of mental disorders. Indicators of the depressive symptoms' severity may include both increased attraction to and total rejection of SD humor.

Background: lithium salts play a fundamental role in the treatment of depression with various etiopathogenetic causes. Lithium carbonate, — the most commonly used anxiolytic, — has numerous toxic effects, making it important to search for a less toxic anxiolytic. Given the numerous positive effects of the non-proteinogenic amino acid taurine, its lithium salt may be one of the newest and most promising anxiolytics. However, the specific activity of lithium taurate has not been studied during chronic administration. The aim of this study was to investigate the effects of lithium taurate on behavioral activity and anxiety in laboratory rats. Materials and Methods: two hundred non-inbred rats of both sexes were administered an aqueous solution of lithium taurate diluted in 2 ml of water intragastrically via an atraumatic tube once daily for 6 months at doses of 196 mg/kg (minimum), 273 mg/kg (average), and 350 mg/kg (maximum). The placebo group, which received an equivalent volume of water for injection intragastrically, and intact animals of both sexes served as controls. Behavioral activity and anxiety were assessed using the open field test. Results and Conclusions: lithium taurate in all dosages eliminates gender differences in the effects of stress from prolonged intragastric tube insertion.

Background: dysthymia, also known as Persistent Depressive Disorder (as defined in DSM-5), is a chronic form of depression characterized by less severe but enduring symptoms compared to major depressive disorder., Dysthymia often presents covertly in children and adolescents, masked as personality traits, behavioral peculiarities, or somatic complaints, which complicates timely diagnosis and treatment. The aim of review was to synthesize current evidence on dysthymia in children and adolescents, including its epidemiological profile, diagnostic criteria, clinical presentation, comorbidities, and contemporary treatment approaches. Material and Methods: a literature data search was conducted using databases such as Elibrary.ru, PubMed, Scopus, PsychINFO, MedLine, and Google Scholar, employing keywords including “dysthymia”, “major depressive disorder”, “children and adolescents”, “persistent depressive disorder”, and “comorbidity”. Articles published in Russian and English from 1984 to 2025 were included. A total of 464 sources were screened, 232 selected, and 72 analyzed in detail. Discussion: epidemiological studies show that dysthymia (or persistent depressive disorder) has maintained stable prevalence rates across various age and demographic groups over the past decades. The etiopathogenesis of adolescent dysthymia is complex and multifactorial, involving both biological (including genetic, neurochemical, neuroendocrine, and immunological) and psychogenic factors. Recent research indicates that dysthymia is not merely a subtype of major depression but represents an independent form of affective pathology with a distinct pathogenetic profile. The atypical presentation of depressive symptoms in children and adolescents complicates differential diagnosis between major depression and dysthymia. In both major depression and dysthymia, the following affective disturbances have been identified: low mood, loss of interest in school and daily activities, expressions of aggression and selfaggression, suicidal thoughts, and low academic motivation. Dysthymia is often inadequately treated; many patients do not respond to therapy or continue to experience residual symptoms after treatment. Conclusion: the issue of dysthymia in childhood and adolescence is of particular importance from both clinical and social perspectives. The questions of nosology, classification, diagnosis, and prognosis of chronic depressive disorders in this population remain the subject of ongoing debate. Despite its moderate affective symptomatology, dysthymia is characterized by a prolonged, debilitating course that impacts emotional development, cognitive functioning, school adaptation, and overall personality formation. An important direction for future research is the identification of different developmental pathways of dysthymia and the selection of treatment strategies tailored to specific etiopathogenetic subgroups.

Background: the issue of anesthetic management in patients with mental disorders is gaining clinical importance due to the increasing number of surgical interventions in this population. Pharmacological interactions between psychotropic drugs and anesthetics can significantly affect the depth, duration, and safety of anesthesia. These aspects require a comprehensive analysis from the perspective of modern psychopharmacology and anesthesiology. The aim of review was to analyze current research on the interactions between psychopharmacological agents and anesthetics, with an emphasis on identifying clinically relevant patterns and potential risks during the perioperative period. Materials and Methods: the search for foreign articles was conducted in the PsycINFO, PubMed, and SciSpace databases using a keyword search query: “interactions”, “side effects”, “anesthesia”, “psychopharmacology”, “pharmacokinetics” in various combinations. Russian-language articles were selected by searching the database eLibrary.ru by keywords: “interaction”, “anesthetics”, “anesthesia”, “psychopharmacology”. Discussion: the analysis of recent studies demonstrates that psychopharmacological agents can significantly alter the effects of anesthetics, presenting both therapeutic opportunities and clinical risks. Researchers emphasize mechanisms of pharmacokinetic modulation via cytochrome P450 isoenzymes and significant changes in central neurotransmitter systems. Particular attention is required for interactions associated with excessive sedation, serotonin syndrome, and cardiotoxic effects. Conclusion: understanding and accounting for interactions between psychotropic drugs and anesthetics not only enhances anesthesia safety but also contributes to better quality of care, which is particularly important for vulnerable psychiatric patients. Further studies are necessary to develop more precise algorithms for personalized perioperative care.

Background: the problem of pathopsychological diagnostics of thinking disorders using the methods “Object Classiflcation” and “Object Exclusion” (“The Fourth One is Extra”) lies in the contradictory interpretation of the results. Insufflciently clear development of standard answers may reduce the reliability of diagnostic conclusions. The aim of this review is to critically analyze the above problems and to propose an improved system of interpretation that will provide a more objective assessment and the possibility of empirical veriflcation. Material and Methods: review of scientiflc publications (papers, methodological guidelines, monographs). Discussion: two key limitations of the methods were identifled: (1) the inconsistency of interpretative criteria due to the vagueness of terminology, and (2) the lack of empirical data on standard (normative) and pathological responses, associated with the predominance of qualitative analysis in the domestic tradition. As a basis for empirical research, the most complete typology of responses to date has been developed, preserving the traditional theoretical framework of the pathopsychological understanding of thinking. The typology is based on A. Luria concept of word meaning development in ontogenesis. Conclusion: minimizing existing discrepancies in the interpretation of the results of applied methods aimed at classifying objects will improve the possibilities of diagnostics of thinking disorders using pathopsychological methods.

Background: therapeutic nutrition is an important component of the complex treatment of psychiatric patients, the individualization of which in the elderly requires special knowledge of gerontodietology. Scientifically based ideas about the nutrition specificities in mental disorders in elderly and senile people have not been sufficiently developed. The aim was to substantiate the need for differentiated approach to therapeutic nutrition in geriatric psychiatry. Discussion: generalization of gerontopsychiatric diseases pathogenetic concepts in the aspect of nutrition of old age people has scientific and practical significance. Degenerative (involutional) and vascular geneses, as well as combined (vascular-degenerative) pathogenesis, form organic brain lesions of varying severity and rate of progression. This is why the specificities of the course of mental disorders affect many metabolic processes in the body of the elderly. Studies have shown that 25–90% of elderly patients hospitalized in psychiatric hospitals experience the development of muscle wasting, about 50% suffer from protein-energy deficiency, hypovitaminosis, most often due to malnutrition. Therapeutic nutrition of psychiatric patients in both state and private medical institutions in Russia is provided in accordance with orders of the Ministry of Health using a unified nomenclature of diets (system of standard diets) to select a diet that compensates for metabolic deficiencies and involutional metabolic disorders, as well as eating disorders, associated with the influence of psychotropic pharmacotherapy, with its nutritional composition, Conclusion: the composition of diet types for different pathologies and in each specific clinical case depends on the characteristics of the course of the disease, its stage and pathogenesis, the state of the body's metabolic processes and eating disorders, associated with the influence of psychopharmacotherapy. The methodology for modifying differentiated diet needs considering last advances in understanding the problems of gerontology, geriatric psychiatry, comorbidity and pharmacological interactions.