[Peculiarities of the dynamics of eating disorders in the structure of depressive states]. / Osobennosti dinamiki narushenii pishchevogo povedeniya v strukture depressivnykh sostoyanii.

OBJECTIVE: To determine the main trajectories of the association between eating disorders (ED) and depressive symptoms and their impact on the quality of the prognosis of the disease as a whole. MATERIAL AND METHODS: A total sample included 59 female patients, aged 15 to 25 years (average age 16.2+0.9), who were under outpatient and inpatient observation in the department for the study of endogenous mental disorders and affective states in the clinic at the Mental Health Research Center. RESULTS: The authors identified variants of the main trajectories of the association between ED and depression, taking into account the role and place of ED and interdependence with depressive symptoms. The following variants have been established: with a stable (44.0%, n=26), labile type of dynamics (25.0%, n=19) and dynamics according to the type of selective dissociation (22.4%, n=14). CONCLUSION: The study allows us to assume the development of fundamentally different trajectories of the conjugation of eating behavior and depression, showing prognostic capacity and different tropism for therapeutic interventions.

[The impact of depression symptoms on postmorbid adaptation of patients who have undergone SARS-CoV-2 infection (assessment from the position of the multimorbidity model)]. / Vliyanie simptomov depressii na postmorbidnuyu adaptatsiyu patsientov, perenesshikh SARS-CoV-2-infektsiyu (otsenka s pozitsii modeli mul'timorbidnosti).

OBJECTIVE: To evaluate the impact of psychosomatic and anxiety symptoms of depression on the formation of postmorbid adaptation in patients who have undergone SARS-CoV-2 infection. MATERIAL AND METHODS: The data of 54 patients, aged 18-55 years, with a current depressive episode who had outpatient SARS-CoV-2 infection were analyzed. The Hamilton depression rating scale (HDRS) was used and somatic condition was assessed using a general assessment of the patient's function limitation at the stage of reconvalescence. A linear regression analysis was performed to assess the association of psychosomatic and anxiety symptoms with somatic condition in SARS-CoV-2 infection, regardless of other factors. RESULTS: The multimorbidity model took into account, in addition to SARS-CoV-2 caused by organic somatic disorders, psychosomatic manifestations (B=-1.9, p=0.004) and anxiety (B=-3.7, p=0.04) symptoms of depression. Somatic anxiety was significantly correlated with a pronounced impairment of postmorbid readaptation (p<0.05), while mental anxiety did not demonstrate such a relationship (p=0.46). The observed trend seems to be due to the overlap of manifestations of somatic anxiety with the construct of residual somatic symptoms, even though there is no multicollinearity between them. CONCLUSION: Identification of clusters of symptoms associated with reduced opportunities for full recovery in the SARS-CoV-2-postmorbid period can significantly help in providing a high-quality and targeted psychopharmacological care.

[The structure of catatonia in depression and depressive-delusional conditions]. / Struktura katatonii pri depressiyakh i depressivno-bredovykh sostoyaniyakh.

OBJECTIVE: To determine the psychopathological structure of catatonia and its major components in depression and depressive-delusional conditions in affective and schizophrenia spectrum disorders. MATERIAL AND METHODS: Ninety-six patients (67 women and 29 men), aged 16 to 65 years, with depression and depressive-delusional conditions with catatonic features were examined (ICD-10 - F20, F25, F31, F33). Exploratory factor analysis with MLE data extraction and varimax rotation was used to determine the structure of catatonia. Thirty-one catatonic features were selected for the analysis. RESULTS: Heterogeneity of catatonic syndrome in depression and depressive-delusional conditions has been revealed. Four factors of catatonia have been extracted (KMO test=0.782, Bartlett test: χ2=2098, df=465, p<.001): Agitated (eigenvalue 5.64, 18.2% of variance), Hypokinetic (4.88, 15.7% of variance), Parakinetic (3.84, 12.4% of variance), Proskinetic (3.75, 12.1% of variance). The extracted factors can be considered as the subsyndromes of catatonia in depressive conditions. The agitated factor (31 patients, 32.3%) is manifested by an increase in psychomotor activity. The hypokinetic factor (75 patients, 78.1%) reflects a decrease in reactivity combined with negativism. The parakinetic factor (30 patients, 31.3%) is associated with negative symptoms of schizophrenia. The proskinetic factor (20 patients, 20.8%) doesn't occur separately from other catatonic features in depression and depressive-delusional conditions. CONCLUSION: The results are partially consistent with earlier investigations in other groups of patients with catatonic features. Schizophrenia is characterized by the presence of parakinetic manifestations of catatonia, the greater severity of hypokinetic manifestations and a higher degree of catatonia polymorphism, in contrast to affective disorders. The results indicate the heterogeneity of catatonia associated with the manifestations of depression and with concomitant symptoms. Catatonic subsyndromes may differ not only phenomenologically, but also neurobiologically.

[The status of leukocyte-inhibitory system of inflammation in different age groups of patients with endogenous depression]. / Status leikotsitarno-ingibitornoi sistemy vospaleniya pri endogennykh depressiyakh u patsientov raznykh vozrastnykh grupp.

OBJECTIVE: The comparison of inflammatory markers in different age groups of patients with endogenous depression and correlation of immunological parameters with the clinical features of depression. MATERIAL AND METHODS: The study included 140 patients with endogenous depression (ED) (F21, F31-F34, ICD-10) aged 15 to 82 years (39.8±23 years), including 55 patients of adolescent age (18.9±2.8 years), 30 middle-aged patients (38.7±10.3 years) and 55 elderly patients (69.1±7.1 years). The total duration of the disease differed from 5 months to 45 years. Psychometric assessment of patients was carried out using HDRS. The control groups consisted of 143 healthy people aged 16 to 75 years. The activity of inflammatory markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI), their ratio (leukocyte-inhibitory index, LII), the levels of antibodies to S100B and myelin basic protein (MBP) were determined in blood. RESULTS: Three immunological clusters were identified that correspond to different clinical variants of ED. A pro-inflammatory status with an activation of the leukocyte-inhibitory system is characteristic of 52.9% of patients (cluster 1). The clinical feature of this status is predominantly «classic¼ ED in the form of anxious, anxious-melancholic or anxious-apathetic depression without pronounced negative symptoms. Two other clusters are characterized by the imbalance of leukocyte-inhibitory system associated with insufficient a1-PI activity (cluster 2) and with insufficient LE activity (cluster 3). A common clinical feature of such ED is an atypical course with the predominance of apathetic-adynamic and dysphoric depression, the presence of negative disorders and a poor prognosis. The imbalance of leukocyte-inhibitory system associated with insufficient LE activity is typical mainly for elderly patients and is characterized by a longer duration of disease. CONCLUSIONS: The status of leukocyte-inhibitory system of inflammation is correlated with the clinical features of ED in different age groups of patients. LII can be considered as an additional paraclinical criterion for differential diagnosis and prognosis of ED.

[About diagnosis and therapy of bipolar disorder]. / K voprosu diagnostiki i terapii bipolyarnogo rasstroistva.

The author describes diagnostic criteria and clinical symptoms of bipolar affective disorder (BAD) and summarizes the results of clinical studies on using modern antipsychotics to optimize BAD treatment. Preliminary recommendations for the use of aripiprazole in treatment of BAD, including exacerbation therapy and long-term maintenance therapy to prevent relapses, are presented.

[Specific features of immunological reactions in elderly and young patients with exacerbation of schizophrenia]. / Osobennosti immunologicheskikh reaktsii u patsientov pozhilogo i molodogo vozrasta s obostreniem shizofrenii.

OBJECTIVE: To identify levels of inflammation markers (the enzymatic activity of leukocyte elastase (LE), the functional activity of the α1-proteinase inhibitor (α1-PI), autoantibodies to neurotrophin S100b and myelin basic protein (MBP)) in blood plasma of old- and young-aged patients with schizophrenia in comparison with features of the clinical course of schizophrenia. MATERIAL AND METHODS: Two age groups of patients with schizophrenia were examined. The 1st group consisted of 19 female patients, aged 60 to 78 years (mean age 67.3±5.4 years), with disease duration from 0.5 months to 29 years (9.7±7.6). The 2nd group comprised 24 female patients, aged 19 to 42 years (mean age 26.8±6.3 years), with disease duration from 0.15 to 6.6 years (3.3±2.4). Nineteen age-matched healthy women were included in two control groups. Inflammatory and autoimmune markers were measured in blood plasma using «Neuro-immuno-test technology¼. RESULTS: In the 1st group, a relative smoothness and rigidity of the productive symptoms profile, a reduction of disease progression and a tendency to the development of negative symptoms were established. The 2nd group was characterized by polymorphism, severity and dynamism of productive disorders, as well as the progression and lability of the schizophrenic process. The most significant differences in the spectrum of the analysed immune markers relate to the ratio of the activity of LE and its inhibitor α1-PI, i.e. proteinase-inhibitory index (PII). CONCLUSIONS: The identified multidirectional changes of PII in elderly patients compared to the controls may reflect the imbalance of the inflammatory response and the role of this imbalance in shaping the characteristics of psychopathological symptoms in these patients.

[Prognostic importance of the psychopathological remission structure at the initial stage of schizophrenia]. / Prognosticheskoe znachenie psikhopatologicheskoi struktury remissii na nachal'nom étape shizofrenii.

AIM: To identify main clinical and psychopathological models of remission in the initial stage of schizophrenia which were correlated with subsequent clinical and social prognosis. MATERIAL AND METHODS: The sample consisted of 116 patients diagnosed with paroxysmal-progressive schizophrenia (ICD-10 items F20.01-F20.09) in remission after the first or second episode. Clinical-psychopathological, psychometric (SPI-A), statistical methods were used. The separation of remissions in the initial stage of schizophrenia was based on the principle of longitudinal observation with estimation of correlations between deficit disorders and positive symptoms. RESULTS AND CONCLUSION: Depending on the predominance of one of the factors of the deficit symptom complex, the following modules were identified: remissions with domination of deficit expression factor and remissions with deficit apathy factor, which were correlated with the clinical and social prognosis.

[A history and overview of anhedonia in endogenous mental disorders]. / Évoliutsiia vzgliadov na fenomen angedonii pri éndogennoi psikhicheskoi patologii.

Anhedonia is the inability to experience pleasure. This disorder is heterogeneous across psychiatric disorders and is difficult for measuring and submitting to scientific analysis. Over the last several decades there has been increasing interest in the role that anhedonia plays in various psychopathologies. This article reviews the recent literature on anhedonia and its psychopathological features, which are important for prognosis in affective disorders and schizophrenia. Attempts to dissect various subtypes of anhedonia observed in negative syndrome and depression are reviewed as well.

[Clinical and psychopathological aspects of deficit disorders in the structure of initial stages of youth-onset endogenous psychosis].

OBJECTIVE: To study the structure of deficit disorders identified in the initial phase (first 5 years) of youth-onset endogenous psychosis. MATERIAL AND METHODS: Author examined 232 patients with the first episode of juvenile endogenous psychosis during the period from 2005 to 2015 using integrated phenomenological and clinical/psychopathological approaches. The follow-up was administered to 151 patients. RESULTS AND CONCLUSION: The working hypothesis on the formation of deficit symptom variants based on the mutual competition of its components was formulated. Identified typological species allowed to hypothesize the existence of continual series of variations of deficit disorders manifested as phenomena with multilateral dependencies, characterized by dynamism and a wide range of modifications and verifiable in remission at the initial stages of attack-like endogenous psychosis.

[Clinical and immunological correlations in endogenous depression].

OBJECTIVE: To study the possibility of using immunological parameters for the evaluation of the activity of endogenous process in depression and quality of response to psychopharmacotherapy. MATERIAL AND METHODS: Authors examined 42 patients, aged 20-55 years, with the prevalence of anxiety (n = 22) or apathy (n = 20) in the clinical picture of depression. The following immunological parameters were measured in the blood of the patients: degranulation activity of leukocyte elastase (LE), functional activity of alpha-1-proteinase inhibitor (alpha-1-PI); the level of autoantibodies to neuroantigen S-100B and myelin basic protein. RESULTS AND CONCLUSION: The involvement of inflammatory and autoimmune responses in the pathophysiology of endogenous depression was confirmed. Depression associated with increased levels of autoantibodies to brain neuroantigens (an autoimmune component) had a more complicated structure and showed the tendency to prolonged course and resistance to the therapy. The results suggest that some immunological parameters may be used as markers of patient's clinical status and quality and completeness of psychopathological symptom reduction.

Characteristics of Diffusion in the Corticospinal Tract of Patients with Early Stage of Schizophrenia: Diffusion Tensor Magnetic Resonance Imaging.

Specific features of diffusion in the cerebral corticospinal tract of patients with early stages of schizophrenia were studied using methods of diffusion tensor magnetic-resonance imaging and magnetic resonance spectroscopy. A decrease in the coefficient of fractional anisotropy in the posterior limb of the internal capsule and an increase in diffusion coefficient in the radiate crown and motor cortex were observed. The results reflect different mechanisms of changes in water diffusion in various areas of the corticospinal tract: changes in nerve fiber microstructure in the internal capsule of the left hemisphere and a decrease in their density in the motor cortex and radiate crown.

[The role of deficit symptoms in the psychopathological picture of remission at the initial stage of schizophrenia]. / Rol' defitsitarnogo simptomokompleksa v psikhopatologicheskoi kartine remissii na nachal'nom etape shizofrenii.

OBJECTIVE: To study the structure and dynamics of remission formation at the initial stage of schizophrenia. MATERIAL AND METHODS: The author examined 232 male inpatients with the first episode of juvenile endogenous attack-like psychosis at the stage getting to the first remission. RESULTS AND CONCLUSION: Remissions were stratified by the profile of deficit symptoms and influence of process/positive symptoms. Several variants of remission with the same profile of deficit symptoms were singled out.

[Specifics of emotional biases in decision making in juvenile endogenous attack-like schizophrenia].

OBJECTIVE: To identify the ability of schizophrenic patients to make decisions based on the mechanism of emotional learning (Damasio's somatic markers hypothesis). MATERIAL AND METHODS: Forty patients with the juvenile endogenous attack-like schizophrenia were investigated. Based on the clinical data, the patients were separated into three groups with different levels of negative symptoms. RESULTS AND CONCLUSION: In all groups the deficit in the emotional decision making mechanism increased along with the progress of the disorder and was connected with the decrease in the ability to adequately estimate self-emotional state, to integrate the ambivalent feeling and to make decisions in ambiguous environment based on the past emotional experience. The executive function and the mechanism of the emotional decision making were found to be independent neurocognitive mechanisms.

[Attitude to disease and psychotherapeutic strategies in youths with the first psychotic episode].

To study attitude to disease in patients with the first episode of juvenile endogenous psychosis (ICD-10 items F20, F25, F30.21 and F32.3), authors examined 89 male patients. There were common patterns in attitude to disease caused by the pathoplastic effect of juvenile age and some differences that were correlated with premorbid personality features and the psychopathological structure of the psychotic episode. Normonosognosic, hyponosognosic, hypernosognosic and disnosognosic types of attitude to disease were singled out. Hyponosognosic type was the most common in patients with the first episode of juvenile endogenous psychosis. Its were elaborated recommendations for differential use of psychotherapeutic strategies which took into account attitude to disease and age of the patient.

[The cytotoxic activity of natural killer cells in patients with the first episode of endogenous psychosis (a comparative study of test methods)].

Authors studied the cytotoxic activity (CA) of natural killer cells (NK) in 16 schizophrenic patients, aged from 18 to 25 years, with the first episode of psychosis. A significant decrease in CA NK was found in the total group of patients compared to healthy controls that suggested the dysregulation of natural immunity at this stage of disease. The addition of serotonin to the cell culture in vitro in concentrations 10-9 M stimulated the NK activity while the elimination of monocytes resulted in the significant reduction of CA NK. The parallel use of two methods for assessment of CA NK (a radioactive method and an easy and safe method using multifunctional particle size analyzer Multisizer MS-4) revealed similar results.

[Some structural and functional features of the dorsolateral prefrontal cortex and the corpus callosum genu and auditory information processing (P300) in healthy subjects and patients with juvenile schizophrenia].

Some structural and functional characteristics of the dorsolateral prefrontal cortex and corpus callosum genu were analyzed in comparison with electrophysiological markers of selective attention in 18 mentally healthy subjects and 22 remitted patients with juvenile schizophrenia. In both topography zones there were no statistically significant intergroup differences in N-acetylaspartate and choline compounds (by proton MR-spectroscopy), whereas fractional anisotropy (by diffusion tensor imaging) in the corpus callosum genu was lower in patients. Absence of significant correlations between the imaging characteristics and psychopathology scores and their weak correlations with P300 suggest a poor involvement of the analyzed structures in the processes which determine cognitive disorders in patients with juvenile schizophrenia.

[Characteristics of the pre-manifest stage in young patients with the first episode endogenous psychosis].

A retrospective study of pre-manifest personality traits in 120 young patients (16-25 years old) identified the clinical heterogeneity of the period preceding the first episode of juvenile endogenous attack-like psychosis. Depending on the degree of personality abnormalities, patients were stratified into 3 groups as having accentuated personality traits, personality disorders (psychopathy) or pseudopsychopathy, the latter divided into deficit and degenerative subgroups. Correlations between the degree of personality abnormality and the type of manifest episode and its nosological status were found.

[Some electrophysiological and hemodynamic characteristics of auditory selective attention in norm and schizophrenia].

Six patients in the state of remission after the first episode ofjuvenile schizophrenia and seven sex- and age-matched mentally healthy subjects were examined by fMRI and ERP methods. The auditory oddball paradigm was applied. Differences in P300 parameters didn't reach the level of significance, however, a significantly higher hemodynamic response to target stimuli was found in patients bilaterally in the supramarginal gyrus and in the right medial frontal gyrus, which points to pathology of these brain areas in supporting of auditory selective attention.

[Glutamine synthetase-like protein, glutamate dehydrogenase, and cytochrome c-oxidase in platelets of patients with the first episode psychosis in the course of treatment].

The authors searched for correlations between amounts of platelet proteins and results of psychometric tests in patients with the first episode psychosis (schizophrenia, schizoaffective psychosis) in the course of their combined antipsychotic treatment with haloperidol and clozapine. Psychometric evaluations (PANSS, BPRS) and analyses of platelet enzymes - glutamine synthetase-like protein (GSLP), glutamate dehydrogenase (GDH), and cytochrome c-oxidase (COX) - were carried out before, during, and after the treatment. These proteins were also analyzed in matched controls. All the parameters comprised a database, followed by statistical data processing using Statistica 6.0 (StatSoft) software, nonparametric statistics module. The patients before the treatment, when compared with controls, demonstrated significantly decreased COX activity (p=0,0000001) and increased GSLP amount (p=0,006) with a positive correlation between GSLP amount and PANSSneg (R=0,34, p<0,01). Those patients who displayed initially low COX activity (below median) demonstrated significant increase in COX activity after the treatment. Negative correlations were revealed between COX activity and PANSS, PANSSpsy scores during the treatment, i.e. the lower was COX activity, the more severe syndromes were observed. Negative correlations were found between the initial COX activity and PANSS, PANSSpsy, BPRS scores after the treatment, i.e., the higher was COX before the treatment, the less prominent syndromes were observed after the treatment. Significantly more "non-responders" by PANSSneg were found among the patients with low GSLP level (below median) than their calculated expected amount. The COX activity measured before the treatment was significantly lower in patients with schizophrenia than in patients with schizoaffective disorder (SAD) (p=0,038). In SAD patients, the initial COX activity was negatively correlated with PANSSpsy and BPRS scores after the treatment (R=-0,5, p=0,02), i.e. the lower was the COX the activity before the treatment, the more prominent syndromes were observed after the treatment.