[Comprehensive treatment of adynamic depression with the combined use of traditional psychopharmacotherapy, transcranial magnetic stimulation and virtual reality technologies]. / Kompleksnoe lechenie adinamicheskikh depressii s sochetannym ispol'zovaniem traditsionnoi psikhofarmakoterapii, transkranial'noi magnitnoi stimulyatsii i tekhnologii virtual'noi real'nosti.

OBJECTIVE: To study the efficacy and safety of activity-dependent neuromodulation using transcranial magnetic stimulation with intermittent theta flashes (iTBS) as priming stimulation with multimodal parameters of the virtual environment (VR) for the treatment of adynamic depression in comparison with psychopharmacotherapy (PFT). MATERIAL AND METHODS: The comparative study included 85 patients with adynamic depression who were randomized into four groups: iTBS + VR + PFT (n=19), iTBS + PFT (n=19), VR + PFT (n=23), PFT (n=24). The duration of therapy was 20 days, the procedures were carried out daily, with a break for weekends, followed by an assessment of side-effects and control over compliance with the patient's drinking regimen. The study was conducted by clinical, standardized and statistical methods. RESULTS: After 4 weeks of therapy, a final analysis of efficacy and safety indicators was performed. When testing the main statistical hypothesis of the study, the combined therapy of adynamic depression with the use of traditional PFT, iTBS and VR technologies proved to be more effective than traditional PFT. A significant decrease in the parameters of adynamic depression after 4 weeks on the Hamilton psychiatric rating scale for depression by 76%, according to the Clinical Global Impression scale - by the severity of the disorder by 65%, the dynamics of the overall improvement by 76% versus 55% (p=0.0199), 37%, (p=0.0033) 43% (p=0.0047), respectively, in the PFT group. CONCLUSION: Activity-dependent neuromodulation using transcranial magnetic stimulation with intermittent theta flashes (iTBS) as priming stimulation with multimodal parameters of the virtual environment is an effective and safe way to treat adynamic depression, having an advantage over traditional psychopharmacotherapy.

[Transfer from paliperidone of one-month action to paliperidone of three-month action in schizophrenia spectrum disorders: clinical aspects, pharmacological strategies, therapeutic prediction]. / Perevod s paliperidona odnomesyachnogo deistviya na paliperidon trekhmesyachnogo deistviya pri rasstroistvakh shizofrenicheskogo spektra: klinicheskie aspekty, farmakologicheskie strategii, terapevticheskaya prediktsiya.

OBJECTIVE: To analyze clinical and therapeutic features of the transfer of patients with schizophrenia spectrum disorders from paliperidone palmitate of one-month action (PP-1M) to paliperidone of three-month action (PP-3M). MATERIAL AND METHODS: Data on the psychopharmacological therapy regimens of 677 patients with verified diagnoses of schizophrenia spectrum disorders (F20, F21, F25) treated with PP-3M drugs after PP-1M therapy were studied. RESULTS: The study showed the high efficacy of ultra-long-acting paliperidone therapy in 82.2% of patients with schizophrenia spectrum disorders. The unfavorable dynamics of the mental state in patients when transferring from the drug PP-1M to PP-3M was 14.0%, the return to therapy with PP-1M or tablet forms was 3.8%. Successful management of patients on PP-3M was not associated with sex and age, but was correlated with some clinical and therapeutic indicators. The most successful therapy with PP-3M was noted with the earlier appointment of PP-3M mainly as monotherapy, provided the previous stable condition on shorter-acting paliperidone preparations (including tablet forms). Predictors of a favorable prognosis of PP-3M therapy are also diagnostic categories such as paranoid schizophrenia, episodic type of course with increasing or stable personality changes and pronounced affective disorders in the structure of the clinical picture of the disease. CONCLUSION: The results demonstrate the high efficacy of PP-3M and its significant rehabilitation potential, which allows improving the quality of life and social functioning of patients, as well as optimizing the provision of psychiatric care to this contingent of patients, which is of particular importance in the conditions of the COVID-19 pandemic.

[Questions of primary diagnosis of schizophrenia in middle-aged and older patients]. / Voprosy pervichnoi diagnostiki shizofrenii u patsientov srednego i starshego vozrasta.

OBJECTIVE: An analysis of clinical and social characteristics of patients aged 40 years and older with primary diagnosis of schizophrenia (F 20-21) in a psychiatric hospital. MATERIAL AND METHODS: We studied 114 medical records of patients aged 40 and over who were admitted to a psychiatric hospital for a two-year period (2018-2019) with a first-time diagnosis of schizophrenia (F 20-21) based on the results of inpatient examination and treatment. RESULTS: The analysis shows that 90% of patients were aged 40-59 years, 59.6% of them were women. In every third patient (33.3%), clinical signs of psychosis were observed for five or more years before hospitalization and diagnosis, and in 14.9% for more than 10 years, the average duration of psychosis before diagnosis was 5.1 years. Markers of psychosis were non-specific factors of family adaptation, working capacity, and substance use, which revealed relationships with gender characteristics and age of diagnosis of psychosis. Better adaptation parameters correlated with the female sex and later diagnosis of schizophrenia, lower indicators were more typical for the male sex and earlier diagnosis. CONCLUSION: Signs of increasing social maladjustment should be alarming to the patient's relatives, as well as social and medical services. In addition, the timely diagnosis of psychosis requires psychoeducation of the population, training of social workers and primary health care professionals.

[Social, demographic and clinical characteristics of female patients with schizophrenia and HIV]. / Sotsial'no-demograficheskie i klinicheskie osobennosti VICh-infitsirovannykh zhenshchin, bol'nykh shizofreniei.

OBJECTIVE: To evaluate social, demographic and clinical characteristics of women with schizophrenia and HIV. MATERIAL AND METHODS: Medical histories of patients who were in inpatient treatment during 2017 were retrospectively studied. A total of 174 medical histories were analyzed, but the final analysis included 40 HIV-infected patients (main groups) and 48 patients without HIV infection (comparison group). These groups included patients with a diagnosis of schizophrenia or acute polymorphic psychotic disorder. All patients with HIV infection were examined by a specialist and an immunological analysis was performed. Correlation analysis was performed between quantitative clinical indicators (duration of illness, number of hospitalizations, the number and duration of remissions, etc.) and immunological parameters. RESULTS AND CONCLUSION: Patients with schizophrenia and HIV infection are more often hospitalized and stay in the hospital longer than patients with schizophrenia without HIV infection, which may in part be determined by the social problems of this cohort of patients. There is a relationship between individual indicators of the immune status of the patients, the duration and some features of the course of mental illness. Regular treatment of HIV infection correlates with a lower frequency of hospitalizations in a psychiatric hospital due to an exacerbation of the mental state.

[Clinical-epidemiological and social-demographic characteristics of patients newly diagnosed with schizophrenia in 2013-2017]. / Kliniko-epidemiologicheskaya i sotsial'no-demograficheskaya kharakteristika patsientov s vpervye ustanovlennym diagnozom «shizofreniya¼ v 2013­2017 gg.

OBJECTIVE: To evaluate the dynamics of clinical-epidemiological and social-demographic characteristics in a continuous sample of patients with newly diagnosed schizophrenia in 2013-2017. MATERIAL AND METHODS: An analysis of the continuous study of medical records of 4708 patients, aged 14 to 77 years, with newly diagnosed schizophrenia, who referred to Moscow psychoneurological dispensaries, was performed. RESULTS AND CONCLUSION: Patients of young working age prevailed in the sample; the onset of symptoms of the disease in men was noted at an earlier age than in women. The disease at an early stage was accompanied by a professional decline and a significant disability. Schizophrenia was most frequently diagnosed in the first visit. There was a clear correlation between an increase in the number of compliance violations and an increase in the duration of the disease. Assessment of the frequency of visits to primary care psychiatrists and admissions to hospitals and day hospitals indicates the increased effectiveness of outpatient psychiatric services in Moscow.

[Some current trends in the use of prolonged injectable antipsychotics in the conditions of modernization of the psychiatric service]. / Nekotorye sovremennye tendentsii primeneniya prolongirovannykh in"ektsionnykh antipsikhotikov v usloviyakh modernizatsii psikhiatricheskoi sluzhby.

OBJECTIVE: A pharmacoeconomical analysis of the use of prolonged injectable antipsychotics in the treatment of patients with schizophrenia in Moscow over 2015-2019 in the context of the reform of the psychiatric service. MATERIAL AND METHODS: The authors studied the economic costs of treatment of psychiatric patients with prolonged injectable antipsychotics on the pharmaceutical market in Moscow for five years on the example of patients diagnosed with paranoid schizophrenia (ICD-10 F20.0) based on the dynamics of the registered contingent of patients with schizophrenic spectrum disorders over the past fifteen years including the period of active modernization of the psychiatric service. RESULTS AND CONCLUSION: A constant increase in public spending on treatment, including therapy with prolonged injectable neuroleptics (both first-generation drugs and atypical antipsychotics), was shown. At the same time, the increase in the use of atypical antipsychotics is ahead of schedule. The number of patients receiving treatment with prolonged injectable haloperidol and zupentixol increased approximately twice during this period, the number of patients receiving treatment with injectable risperidone and paliperidone palmitate increased by more than 3 and 13 times, respectively. There is a significant increase in public spending on the purchase and use of these drugs for the treatment of privileged categories of patients, most of this applies to injectable forms of paliperidone, the cost of using these drugs has increased more than 20 times over a five-year period. These trends indicate a shift in emphasis towards outpatient psychiatric care and improvement of approaches to treatment of patients with schizophrenia, which indicate a new stage in the development of out-of-hospital treatment and rehabilitation systems based on the latest achievements of psychopharmacology and the development of social support systems for patients with schizophrenia spectrum disorders.

[Complex Program of Neurocognitive Rehabilitation for Elderly Patients Suffering from Mild Cognitive Impairment Syndrome in Medical Rehabilitation Department «Memory Clinic¼].

The article introduces a complex program of neurocognitive rehabilitation into the system of dementia prevention in patients with mild cognitive impairment syndrome. It took about a year to prepare and form a complex program of neurocognitive rehabilitation (the Program). The researchers have also developed clear algorithms of the specialized medical rehabilitation unit Memory Clinic. The conducted study has proved the effectiveness of cognitive functions improvement in patients with mild cognitive impairment after participation in the Program in Memory Clinic. The authors, Professor Kostyuk, and Research Institute for Healthcare Organization and Medical Management have prepared Medical Rehabilitation Guidelines for Elderly Patients with Early Signs of Cognitive Deficits (Structural and Functional Model). The guidelines serve as a tool for practice distribution and transforming them into a project Memory Clinic.

[The problem of diagnosis and treatment of depression by primary care physicians]. / Problema diagnostiki i lecheniia depressii vrachami pervichnogo zvena.

Because of the high prevalence of nonpsychotic anxiety-depressive disorders, the authors discuss the necessity and possibility of their diagnosis and treatment by primary care physicians. Arguments supporting this suggestion are presented.

[Clinical features of depressive episode with onset in adolescence and the risk of bipolar depression]. / Osobennosti depressivnogo épizoda s debiutom v podrostkovom vozraste i risk razvitiia bipoliarnoi depressii.

AIM: To study clinical features of depressive episode with the onset in late adolescence associated with the risk of bipolar affective disorder (BAD). MATERIAL AND METHODS: Forty patients with BAD (ICD-10 F31), who experienced depressive state at the age of 15-18 years corresponding to the diagnostic criteria of 'Depressive episode' (F32), were examined. The duration of follow-up was from 3 to 5 years. Clinical-psychopathologic, follow-up, statistical methods were applied. RESULTS: Duration of depressive episodes did not exceed 6 months in 70% of patients with BAD. Characteristic clinical features included the frequent presence of psychomotor retardation, anergia, anhedonia, melancholy, irritability, affective instability with increased emotional reactivity, hypersomnia. Other 'atypical' depressive symptoms were less characteristic. There was a significant incidence of suicidal tendencies, comorbid psychopathic-like behavioral disorders and substance abuse. In most cases, the depressive state was accompanied by a deterioration in social functioning and led to educational maladaptation. CONCLUSION: Characteristic clinical features of bipolar depression manifested in late adolescence were a relatively short duration, the prevalence of typical depressive symptoms (melancholy, psychomotor retardation), irritability, increased emotional reactivity, hypersomnia, a significant incidence of suicidal tendencies.