[Willingness to expend effort for rewards in individuals at clinical high-risk for psychosis: a relationship with the severity and stability of negative symptoms]

OBJECTIVE

To identify the deficit in willingness to expend effort and its association with negative symptoms in the high-risk for psychosis (CHR) group.

MATERIAL AND METHODS

The study included young men: 45 patients, who met CHR criteria and were treated for a depressive episode, and 15 controls. All subjects completed a modified version of the Effort Expenditure for Rewards Task (EEfRT). The CHR group was assessed with the SOPS, SANS and HDRS at the beginning and at the end of treatment. EEfRT was performed only at the end of treatment.

RESULTS

The CHR group was significantly less likely to choose high effort tasks across reward probability and magnitude levels compared with the control group (all p<0.001). No significant correlations were found between the rate of selecting the high effort task and the negative syndrome domains of amotivation and diminished expression. The subgroups of CHR with stable and transient (i.e., with a reduction >50% during treatment) negative symptoms, which were identified by a cluster analysis, did not differ in the willingness to expend effort.

CONCLUSION

The study confirmed a decrease in the willingness to expend effort in the CHR group; however, this deficit was only weakly correlated with negative symptoms and persisted after the symptoms reduction during treatment, which requires future studies to investigate mechanisms underlying impaired effort expenditure for rewards in CHR.

[Attenuated negative symptoms in the structure of youth depression]

OBJECTIVE

To detect negative symptoms in adolescent depression, to determine their psychopathological structure and predictive significance.

MATERIAL AND METHODS

Seventy-one young in-patients (average age 19.5±2.4 years) (main group) and 52 in-patients (average age 19.8±2.7 years) (comparison group) with the diagnosis «Depressive episode» according to ICD-10 F32.1, F32.2 were examined. Inclusion criterion in the main group was attenuated negative symptoms (ANS) in adolescent depression. Clinical-psychopathological and psychometric examination was carried out using HDRS, SOPS, SANS. The statistical analysis was done by Statistica 12.

RESULTS

Adolescent depression with ANS was more persistent than depression in the comparison group (27.5±17.2 month versus 7.0±6.3, p<0.001), there was higher level of positive symptoms and disorganization symptoms on the respective SOPS sub-scales (7 [5; 9] and 4.5 [3; 8.75], p=0.002; 8 [6; 10] and 5.5 [3.25; 7], p<0.001, respectively). According to the psychopathological structure of the negative symptoms, patients in the main group were divided into a subgroup (n=38, 53.5%) with the predominance of emotional spectrum disorders and a subgroup (n=33, 46.5%) with the predominant involvement of the volition spectrum. ANS in the negative SOPS sub-scale were significantly higher (p=0.045) in patients of the subgroup with volitional disorders. Also, a total HDRS score, reflecting the severity of depressive symptoms, was significantly higher compared to a subgroup with the predominance of emotional spectrum disorders (p=0.038).

CONCLUSION

The results show that it is possible to clinically verify negative symptoms in the adolescent depression, which makes it possible to assign such patients to the risk group of manifestation of schizophrenia, and to assign depression with ANS to the model of the initial stage of schizophrenic process.

[History of the development of domestic psychiatry: the period 1940-1980]

The article briefly presents an analysis of the development of domestic psychiatry (with an emphasis on research in the field of psychopathology and nosology) from the post-war period (the Great Patriotic War) to the era of "perestroika". With the founding of the Institute of Psychiatry of the USSR Academy of Medical Sciences under the leadership of V.A. Gilyarovsky, the study of endogenous diseases was based on a multidisciplinary approach, in which the clinical-psychopathological research method was combined with clinical/biological ones. The most important role of the subsequent school of A.V. Snezhnevsky in describing the syndromes and forms of the course of schizophrenia (G.A. Rotshtein, R.A. Nadzharov, A.B. Smulevich, A.K. Anufriev), its age aspects (E.Ya. Sternberg; M.S. Vrono, G.P. Panteleeva, M.Ya. Tsutsulkovskaya; V.M. Bashina) is reflected. The contribution to psychopathology of other leading Russian psychiatrists, who worked mainly in Moscow and Leningrad research institutions of that period, was noted: students of P.B. Gannushkin - O.V. Kerbikov, V.M. Morozov, D.S. Ozeretskovsky, S.G. Zhislin, as well as G.K. Ushakov, A.E. Lichko, M.M. Kabanov, G.V. Morozov, M.V. Korkina, A.A. Portnov, I.N. Pyatnitskaya and others. The priority of A.V. Snezhnevsky and G.K. Avrutsky with colleagues for the introduction of neuroleptics and other new psychotropic drugs in the treatment of mental illnesses is emphasized. The review ends with the activities of M.E. Vartanyan who headed the country's leading scientific institution in the difficult «perestroika» era and developed the biological approach to mental illness further with the creation of international research programs.

[Therapeutic drug monitoring of antipsychotic drugs in routine psychiatric practice]

OBJECTIVE

To evaluate the relationship between daily doses of antipsychotic drugs, their serum concentrations, and characteristics of patients treated for schizophrenia or schizophreniform disorder in day-to-day clinical practice.

MATERIAL AND METHODS

A total of 187 patients were included in the study, 77 (41.1%) patients were on monotherapy, and 110 (58.9%) patients received two or more antipsychotics. Patients age was 27.8±8.1 years, and their body weight was 79.8±15.6 kg. The sample was represented mainly by young men (93.0%). The proportion of smokers was 37.4%. The appropriate HPLC-MS/MS method was used for the simultaneous analysis of 8 antipsychotics and its active metabolites. Serum concentrations of the drugs aripiprazole (ARI), chlorpromazine (CPZ), haloperidol (HAL), zuclopenthixol (ZUC), clozapine (CLO), risperidone (RIS), quetiapine (QUE), olanzapine (OLA), norclozapine (N-desmethylclozapine, NOR), 9-hydroxyrisperidone (9-OH-RIS), dehydroaripiprazole (DGA) were measured. The serum concentration/dose ratio (C/D) was employed as the primary outcome measure, as doses were not kept constant during the study. The active antipsychotic fraction (drug+active metabolite, active moiety - AM) was also evaluated for RIS and ARI. In addition, the metabolite/parent ratio (MPR) was evaluated for RIS and ARI.

RESULTS

A total of 265 biological samples were obtained, 421 and 203 measurements of the concentration of drugs and their metabolites were carried out, respectively. Overall, 48% of antipsychotics levels were in the expected therapeutic ranges, 30% were below therapeutic ranges, and 22% were above them. A total of 55 patients underwent dose adjustments or drug changes due to ineffectiveness or side-effects. It has been found that smoking reduces the level of C/D for CLO (p<0.01, Mann-Whitney test). We have established that comedication with CLO significantly increases the C/D ratio of QUE (p<0.05, Mann-Whitney test). We have not revealed any influence of weight and age of the subjects on the C/D. The dose-concentration regression relationships are formalized for all AP.

CONCLUSION

Therapeutical drug monitoring (TDM) is an essential tool to personalize antipsychotic therapy. Careful analysis of TDM data can contribute significantly to the study of the impact of individual patient characteristics on systemic exposure to these drugs.

[Borderline personality disorder in young adults: features of psychopathology and patterns of course]

OBJECTIVE

To identify the psychopathological features of borderline personality disorder (BPD) in adolescence, determine the trajectory of its further course, and develop criteria for differential diagnosis.

MATERIAL AND METHODS

Clinical/psychopathological and psychometric methods were used to study 143 patients. The patients were divided into two groups: a clinical group - 73 patients, who were inpatients or outpatients in the clinical departments of the Mental Health Research Center (MHRC) in 2019-2022, and a follow-up group - 70 patients who were inpatients or outpatients in the MHRC clinic in 2006-2010.

RESULTS

The structure of BPD in adolescence was clinically heterogeneous, which allowed distinguishing three typological varieties: with phenomena of «affective storm», which was characterized by the dominance of affective disorders, including after completion of adolescence, with some stabilization of personality structure (type I); with the dominance of addictive patterns of the type of «adrenalinomania», in which one of the key positions was occupied by craving impairments, with a constant need to search for new extreme hobbies, the use of psychoactive substances, which persisted after the end of adolescence (type II); with the predominance of «cognitive dissociation», which was characterized by the most polymorphic picture of disorders, with the predominance of self-identification disorders with dissociative disorders that retain their severity after the end of adolescence (type III). An integrative assessment of outcomes showed that rather favorable results (47.37%) (χ²=23.37, p=0.001) prevailed at type I, type II was characterized by rather unfavorable (59.26%) and unfavorable results (22.22%) (χ²=12.75, p=0.013) and type III by rather unfavorable (79.17%) and unfavorable (8.33%) outcomes (χ²=16.75, p=0.002). In the nosological evaluation of the follow-up group, 80.0% of patients were diagnosed with BPD, in the rest of the patients there was a change in diagnosis: in 14.3% for schizotypal disorder, in 5.7% for an attack-like form of schizophrenia (χ²=13.8, p=0.008; χ²=14.5, p=0.006).

CONCLUSION

BPD in adolescence was confirmed in the majority of cases in adulthood. The results confirm that the typological variants of BPD are of prognostic value and can serve to further develop therapeutic and socio-rehabilitation measures.

[Application of the biofeedback method in the therapy of depression]

In order to systematize the modern literature data on the effectiveness of biofeedback in the treatment of patients with depressive disorders, clinical efficacy and prospects for use in psychiatric practice, publications in the MEDLINE / PubMed, eLibrary databases from 2013 to 2023, as well as relevant references in the reference lists of the analyzed articles, were selected by the keywords «biofeedback», «depression», «depression therapy», «electroencephalogram», «non-drug treatments for depression». The analysis of data has shown that the biofeedback method demonstrates a certain therapeutic potential in the treatment of depression. It can be used to augment therapy in case of insufficient therapeutic effect, with low patient compliance, as well as poor tolerability of psychopharmacotherapy and in the presence of residual symptoms after pharmacological treatment. The method allows the correction of the psycho-emotional state, improves the balance between the parasympathetic and sympathetic divisions of the autonomic nervous system, and contributes to a more stable clinical effect. At the same time, further studies are needed, with the inclusion of large samples of patients from various nosological groups and with an analysis of the comparability of the effects of various biofeedback protocols.

[Existential youth depressions]

OBJECTIVE

To determine the clinical and psychopathological features of existential depression in youth.

MATERIAL AND METHODS

53 male patients (16-25 years old) with diagnosis F31.3, F31.4, F32, F33 with existential themes of depressive experiences were studied by clinical and psychopathological method.

RESULTS

The axial symptom of existential was over-value ideas about the meaninglessness of their own and human life with ideas of self-abasement, insolvency, low value, imperfection of society, which in most of the studied cases (79.2%) was accompanied by various degrees of severity suicidal thoughts and intentions. Three varieties were identified: with the prevalence of reflections on the meaninglessness of life (39.6%); with the prevalence of neurotic religiosity (28.3%); with an existential philosophical interpretation (32.1%).

CONCLUSION

As a result of the study, the heterogeneity of existential depressions, a significant role of psychogenic factors in their formation were revealed, as a high suicidal risk. Existential depressive states differed in duration, severity of depressive symptoms, high frequency of non-suicidal self-neglect and suicidal risk.

[Psychopathological correlates of depression with non-suicidal self-harm in non-psychotic mental illnesses of adolescence]

OBJECTIVE

To determine the main clinical and psychopathological features of the relationship between depressive states and non-suicidal self-injury (NSSI) in mental illnesses of the non-psychotic register in adolescence.

MATERIAL AND METHODS

Clinical data of 128 patients (77 males and 51 females), who presented with depressive states and NSSI in non-psychotic mental disorders during adolescence, were analyzed. The patients were examined at the Clinic of the Mental Health Research Center during the period 2020-2023. The mean age of the patients was 19±4.1 years.

RESULTS

Based on the data from studying depression and NSSI in adolescence, we developed a typology, identifying three variants of affect and auto-aggressive activity interactions. The affect-dominant type (25.8%) was characterized by a predominance of affective pathology (p<.05), with the occurrence of impulsive NSSI (45.5%) and demonstrative NSSI (30.3%) (p<0.05). The personality-dominant type (43.0%) was based on pathocharacterological abnormalities (60.0%), where NSSI were represented by impulsive (25.5%), depersonalizing (27.3%), and addictive variants (32.7%) (p<0.05). The reciprocal type (31.3%) exhibited pronounced polymorphism, combining high affect variability with a tendency towards auto-aggressive behavior of varying severity and manifestations of NSSI (p<0.05). In terms of nosological distribution, schizotypal disorder predominated (45.0%) followed by predominantly borderline personality disorder (30.0%) and bipolar affective disorder (25.0%) (p<0.05). In terms of nosological distribution, schizotypal disorder predominated (45.0%), followed by predominantly borderline personality disorder (30.0%) and bipolar affective disorder (25.0%) (p<0.05).

CONCLUSION

Three types of correlation between depression and NSSI were identified, the formation of which was due to the pathoplastic influence of the age factor, nosological affiliation and a certain, including pathological personality structure. Statistically significant regularities between variants of NSSI and types of their interrelation were revealed. The results can be considered as differential diagnostic and prognostic markers of their further trajectories and, therefore, contribute to the creation of new therapeutic strategies, timely diagnosis and earlier intervention.

[Juvenile depression as at-risk state for psychotic disorders]

OBJECTIVE

To establish the risk of psychotic disorders in juvenile depression and to study the role of negative symptoms in its formation.

MATERIAL AND METHODS

Seventy-four in-patients (19.6±2.3 years old), who were hospitalized for the first time in the clinic for a depressive episode, were examined. Psychometric scales HDRS, SOPS, SANS were used. The risk of manifestation of psychotic disorders was established in the presence of attenuated positive symptoms (APS) with values of at least one of the points P1, P2, P3 and P4 of the corresponding SOPS subscale more or equal to 3. The overall risk of schizophrenia spectrum disorders was established in the presence of attenuated negative symptoms (ANS) with values of at least one of the points H1-H6 of the negative SOPS subscale is more than or equal to 5. Statistical analysis was carried out using the Statistica 12 program.

RESULTS

During the psychometric assessment of patients at admission, four groups were identified based on the presence of APS and ANS: group 1 (APS+ANS), group 2 (APS), group 3 (ANS) and a comparison group without APS/ANS. It was found that the presence of APS and ANS in the structure of depression increased its severity (U=109.0; p=0.009). Assessment of the ANS severity on the negative subscale of SOPS and on the SANS demonstrated quantitative differences with the highest representation of negative symptoms in the corresponding groups (APS+ANS and ANS) with significant differences in total scores in the comparison group (U=93.0; p=0.004 and U=85.0; p=0.002). When studying the structure of negative symptoms according to the SANS subscales, patients with APS differed in a lower degree of severity of negative symptoms only according to the «Avolition-Apathy» subscale (U=141.5; p=0.028). Patients from the comparison group, despite significant differences in other psychopathological symptoms, showed lower values only for the SANS subscales «Affective flattening» (U=112.0; p=0.02) and, to a greater extent, «Avolition-Apathy» (U=84.0; p=0.002).

CONCLUSION

Based on the presence of prodromal symptoms in the structure of juvenile depression and their dynamics during therapy, one can assume not only a different degree of risk of endogenous psychoses, but also their nosological affiliation.

[Structural features of the brain in individuals with youth depression at a clinical risk for psychosis]

OBJECTIVE

To establish the structural features of the brain (cortical and subcortical) in depressive patients at clinical risk for psychosis.

MATERIAL AND METHODS

Nineteen right-handed male patients with youth depression, who were assessed for high risk of psychotic manifestation, and 20 healthy controls underwent MRI and clinical examination. T1-weighted images were processed in FreeSurfer 7.1.1. For each subject average values for the cortex thickness and area, volumes of subcortical structures, and separately volumes of the amygdala nuclei were obtained. Intergroup comparisons and correlations with clinical scales (SOPS, HDRS) were calculated.

RESULTS

Patients showed decreased gray matter thickness in the left (p=0.002) and right (p=0.003) postcentral gyri and increased thickness in the right posterior cingulate cortex (p=0.003) and rostral anterior cingulate cortex (p=0.001).

CONCLUSION

These findings may reflect cortical changes at early stages of the psychotic process, including the gray matter loss in some areas and the opposite phenomena in others (it cannot be ruled out that the latter may be the result of altered ontogenesis and/or certain compensatory changes).

[Features of inflammatory reactions in patients with juvenile depression with a clinically high risk of psychosis]

OBJECTIVE

To determine the levels of pro-inflammatory and anti-inflammatory cytokines and inflammatory markers such as C-reactive protein, leukocyte elastase, α1-proteinase inhibitor, autoantibodies to neuroantigens in the blood of patients with adolescent depression with clinical high risk for psychosis (CHR-P) and to study the relation of these biological markers to the features of psychopathological symptomatology of the patients.

MATERIAL AND METHODS

Eighty young adults, aged 16-24 years, with the first depressive episode (F32.1-2, F32.38, F32.8) were studied. Based on the presence of attenuated positive symptoms in the structure of depression, all patients were divided into two groups: with CHR-P (clinical group, n=58) and without CHR-P (comparative group, n=22). The HDRS-21, SOPS, and SANS were used for psychometric assessment of the patients. Serum levels of cytokines TNF-α, IL-6, IL-8, IL-10, and concentration of C-reactive protein (CRP) were determined. Leukocyte elastase (LE) activity, α1-proteinase inhibitor (α1-PI) activity, and plasma levels of autoantibodies to S100B protein and myelin basic protein (MBP) were assessed.

RESULTS

Both groups of patients were characterized by the high levels of inflammation as assessed by LE (250.5 (226.2-280.8) nmol/min·ml vs 248.3 (226.8-284.5) nmol/min·ml) and α1-PI activity (44.4 (37.5-50.1) IE/ml vs 45.2 (36.4-49.9) IE/ml). Higher levels (p<0.05) of IL-6 (1.22 (0.64-2.2) pg/ml), CRP (0.93 (0.18-3.18) mg/l), and TNF-α/IL-10 (0.34 (0.2-0.47)) were detected in the group with CHR-P. This group was also characterized by higher levels of antibodies to the S100B protein 0.78 (0.69-0.84 units of opt.density) compared with the group without CRH-P (p<0.05). In each clinical group, different correlations between clinical, psychometric and biological parameters were revealed.

CONCLUSIONS

The results confirm the involvement of inflammation in the development of depression in youth and indicate a different role of the inflammatory markers analyzed in the formation of CHR-P. The differences in the spectrum of inflammatory markers in depressed patients suggest a more pronounced pro-inflammatory potential in the group with CHR-P.

[Psychopathology of depressive-delusional states with religious content]

OBJECTIVE

Identification of psychopathological characteristics of depressive-delusional states with religious content, development of a typology, determination of formation features, nosological assessment.

MATERIAL AND METHODS

A total of 79 patients (47 female, 32 male, mean age 27±6.5 years) with depressive-delusional states with religious content within the affective and schizophrenia spectrum disorders were studied. Clinical-psychopathological, psychometric (PANSS, HDRS, S. Huber CRS) and statistical methods were used.

RESULTS

Based on the psychopathological structure, specific mechanisms of development of delusions and themes of the religious experiences, three types of depressive-delusional states were identified: type 1 - with a predominance of depressive delusions congruent with affect and delusional ideas of guilt, sinfulness, abandonment of God (14 patients, 17.7%; 6 women, 8 men; mean age 28±4.5 years; HDRS score 33±5.6, the total PANSS score 71±5.3, the PANSS positive subscale score 15.8±3.7); type 2 - with the addition of incongruent delusional constructs, persecutory disorders and acute sensory delusions to the existing depressive religious delusion, with the phenomenon of confessional ambivalence (27 patients, 34.2%; 16 women, 11 men; mean age at attack manifestation 25±9 years; HDRS score 29.6±4.4, the total PANSS score 87±6.2, the PANSS positive subscale score 23.5±4.2); type 3 - depressive-paranoid states with a predominance of Kandinsky-Clerambault syndrome of religious content (38 cases, 48.1%; 20 women, 18 men; mean age at attack manifestation 23.4±2.5 years; HDRS score 32.7±3.7, the total PANSS score 102±7.3, the PANSS positive subscale score 32.5±4.5).

CONCLUSION

The study of depressive-delusional states with religious content has shown their clinical-psychopathological heterogeneity. The religious experiences served as a pathoplastic factor, which essentially modified the clinical-psychopathological picture of the disease due to presence of the specific religious phenomena. The identified types of depressive-delusional disorders with religious content had different diagnostic value.

[Augmentation therapy of resistant schizophrenia with rhythmic transcranial magnetic stimulation]

OBJECTIVE

To identify the clinical efficacy of rhythmic transcranial magnetic stimulation (rTMS) in resistant schizophrenia.

MATERIAL AND METHODS

The study included 44 male patients with resistant schizophrenia, divided into 4 groups: with depressive (group 1; n=11, 25.0%), with hallucinatory (group 2; n=12, 27.3%), with negative (group 3; n=11, 25.0%) and with delusional symptoms (group 4; n=10, 22.7%). Patients received rTMS, the parameters of which were determined depending on the typological variety, for 3 weeks (15 sessions). Psychometric assessment was carried with PANSS, CGI-S, CGI-I, SANS, CDSS, AHRS when included in the study (0 day), after stimulation (21 days) and by the end of the study (42 day) that allowed evaluation of both the severity of the therapeutic effect and its duration.

RESULTS

By the end of the course of stimulation, patients of the first three groups developed a distinct positive effect corresponding to a significant reduction in the total PANSS score: group 1 - 24.4% (p=0.002), group 2 - 8.3% (p=0.02), group 3 - 11.7% (p=0.001), which remained stable by day 42 in patients of the first (p=0.001) and second (p=0.005) groups. In patients with delusional symptoms (group 4), a subpsychotic state developed with a corresponding increase in the total PANSS score by 9.7% (p=0.007) requiring a course of relief therapy, which showed effectiveness by the end of the observation (day 42), indicating that resistance was overcome.

CONCLUSION

The study demonstrated the validity of rTMS as an adjuvant method of treatment in the resistant schizophrenia. To implement the potential of rTMS, it is necessary first of all to take into account the structural features of the condition, as well as to continue improving the stimulation technique itself (increasing the duration of the course, developing supportive courses).

[Assessment of the initial period of schizotypal disorder in childhood]

OBJECTIVE

To identify developmental features, the presence of hereditary burden, social adaptation, the structure of early psychopathological disorders in pediatric patients with schizotypal disorder (STD) and their relationship with the age of manifestation and the clinical structure of the disease.

MATERIAL AND METHODS

The study included 150 patients aged 7 to 16 years with a diagnosis of SD, of which 48 were female and 102 were male. Based on the age of onset of the first stable psychopathological disorders, at the stage preceding the diagnosis of SD, 5 groups of patients were identified: up to 3 years (n=38), from 4 to 6 years (n=36), from 7 to 10 years (n=15), 11-13 (n=41), 14-16 years old (n=20). The study used clinical-psychopathological, clinical-catamnestic, with a retrospective analysis, neurological, pathopsychological, psychometric and statistical research methods.

RESULTS

A high frequency of deviations from normative parameters in early psychomotor development was found in 99 (65%) patients with STD. Mental retardation was observed in 23 (15%) patients, dissociation in mental development was detected in a significant number of patients - 62 (41%). At the same time, the most significantly more frequent and pronounced were violations in the two youngest groups with the onset of psychopathological disorders up to 6 years. In these groups, there was also more often a deficit in three areas at once - emotional, motivational and volitional (38%) compared with the 4th group (13%). In groups 1 and 2, a deficit in intellectual development was also characteristic, which was reflected in academic indicators. High performance in the primary grades was observed in 16% of patients in the 1st group versus 60% in the 5th, and poor performance was found in 37% in the 1st group and only 5% in the 5th. The relationship of clinical variants of STD with the selected groups was revealed. The diagnosis of schizotypal personality disorder was significantly more often (66%) diagnosed in patients from group 1 compared with groups 3 and 5. In group 2, this diagnosis was established in a third of cases. The diagnosis of the psychopathic variant of STD was predominant in patients with the onset of the disorder between 7 and 13 years of age. The neurosis-like variant had a clear tendency to become more frequent with older age, reaching statistically significant differences in group 5 compared to group 1.

CONCLUSION

The age of onset and duration of persistence of psychopathological disorders determines the level of negative changes that have formed at the stage of the disease preceding the onset of distinct clinical symptoms of STD. Age at onset determines the predominant positive disorder.

[Premorbid features of youth depression patients with attenuated schizophrenic symptoms]

OBJECTIVE

To establish the premorbid features in youth depression patients with attenuated symptoms of schizophrenia (ASS) and in a comparison group, with an analysis of the course of age crises, signs of personality disorders, level of premorbid functioning and their relationship with the level of functioning after five-year follow-up.

MATERIAL AND METHODS

Two hundred and nineteen youth depression patients with ASS (according to ICD-10: F32.1, F32.2, F32.28, F32.8) (main group) and 52 patients with «pure» adolescent depression without ASS (comparison group) were examined. A total of 124 patients from the main group and 27 patients from the comparison group were examined in 5-year follow-up. The Perceptual Awareness Scale (PAS) was used to assess premorbid functioning and the Personal and Social Performance (PSP) scale was used to determine function at the time of the follow-up. The method of χ2 was used to analyze qualitative data. The correlation analysis was performed with Spearman's rank correlation coefficient. Results are presented as median values [Q1; Q3].

RESULTS

The main group of patients with ASS have worse psychopathological symptoms compared with the comparison group (χ2=4.74; p=0.029). Premorbid functioning was also lower in the period 12-15 years (0.4 [0.33; 0.5]) and 16-18 years (0.47 [0.385; 0.585]) than in the comparison group (0.3 [0.23; 0.43] and 0.37 [0.23; 0.462], respectively, (p<0.05)). Negative correlation has been established between average PAS scores in the age of 12-15 and 16-18 years and the five-year follow-up on the PSP scale (r=-0.276, p<0.05 and r=-0.359, p<0.05 respectively).

CONCLUSION

Similar characteristics of the premorbid period in childhood and an increase in differences starting from the pubertal period reflect the pathogenetic significance of the pubertal crisis and suggest compensatory mechanisms that, in patients with youth depression with ASS, are able to restrain the development of the endogenous process for a certain time, but subsequently become exhausted, which leads to persistence of psychopathological symptoms in intercrisis periods and serves as the first clinical marker of the onset of schizophrenia.

[Doomsday delusions of religious content (apocalyptic version)]

OBJECTIVE

To define psychopathological and phenomenological characteristics of the apocalyptic variant of end-world delusion with religious content (EWDRC) in schizophrenia, to identify features of clinical dynamics of delusional disorders and their interaction with delusional behavior of patients.

MATERIAL AND METHODS

A total of 28 patients with schizophrenia (F20.01, F20.02 according to ICD-10) and EWDRC were examined. Clinical-psychopathological and follow-up methods were used.

RESULTS

The development of the end-world delusional ideas occurred in unstructured affective-delusional disorder with acute sensual delusion. Two types of EWDRC were differentiated: with predominance of perception delusion or picturesque delusion. These types differed by acuity and massiveness of psychotic symptomatology, the mono- or polythematic character of delusional disorders, affect type, as well as by the duration and intensity of the development of delusional stages, and in their phenomenological specifics.

CONCLUSION

Delusional ideas of the end of the world in schizophrenic patients develop in the structure of the syndrome of acute sensory delusions with a predominance of delusions of perception (type I) or visual-figurative delusions of the imagination (type II), which have different duration, degree of dominance and depth of psychopathological disorders.

[Prognosis of the functional outcome of schizophrenia using a multigene panel]

OBJECTIVE

To compare the groups of schizophrenic patients with different levels of functional outcome and different frequency of risk variants in polymorphic loci of five candidate genes to create a multigene panel and to test its predictive ability for long-term outcome of the disease.

MATERIAL AND METHODS

According to the proposed typology, the patients included in the studies were divided into three groups, which differed in the level of social functioning. Group 1 was characterized by the highest level, in group 2 this indicator was significantly lower, and in group 3 the lowest. The multigenic panel included genes for serotonin receptor type 2a (5-HTR2A T102C), serotonin transporter (5-HTTLPR), C-reactive protein (CRP -717A>G), angiotensin II receptor type 1 (AGTR1 A1166C), and brain neurotrophic factor (BDNF Val66Met). A multi-gene risk score was calculated for each patient by summing the total number all his/her risk alleles. For each polymorphism, a score of 2 was assigned to homozygous high-risk genotypes, a score of 1 to heterozygous genotypes and a score of 0 to homozygous low-risk genotype. Accordingly, the multi-gene risk score for a patient could vary from 0 to 10 risk alleles.

RESULTS

A significant effect of the group on the multi-gene risk score was shown (p<0.0001). Between-group differences were significant as well (p<0.01). In group 1, there were no carriers of ≥6 risk alleles, and the number of carriers of less than 5 alleles exceeded 50%. In group 2, the number of carriers of ≥6 risk alleles was 19.4%, and in group 3 - 31.7%. Moreover, in these groups there were no carriers of 0-2 risk alleles, while in group 1 their number was 20.7%.

CONCLUSION

The multi-gene risk score predicts the level of functional outcome in patients with schizophrenia. In the case of a smaller number of risk alleles (0-4) in an individual, a favorable functional outcome can be predicted with a high probability in the long-term period of the disease.

[Rhythmic transcranial magnetic stimulation in the treatment of resistant depression in schizophrenia]

Rhythmic transcranial magnetic stimulation (rTMS) has long been actively used in the treatment of depressive disorders in various mental illnesses. At the same time, the question of the predictability of the results of this method for an individual patient remains open. Based on the existing ideas about the relationship of rTMS mechanisms with changes in the state of neural networks, one of the most perspective line is the search for prognostically significant neurophysiological markers. The study analyzed a wide range of EEG characteristics and evoked potentials recorded before treatment in the groups of responders and nonresponders in patients with depressive symptoms in schizophrenia, who have completed a course of rhythmic transcranial magnetic stimulation. The study revealed associations between an unfavorable treatment outcome and greater coherence in the alpha range (mainly in the caudal regions bilaterally) and less coherence in the beta1 range (involving temporal leads and left-hemisphere asymmetry). At the same time, such indicators as the amplitude of the N100 wave and the negativity of the mismatch were uninformative in terms of predicting the effectiveness of therapy.

[Chronic endogenous depression of youth]

OBJECTIVE

To identify psychopathological features of chronic endogenous depression that develops in youth and determine most significant diagnostic and prognostic criteria.

MATERIAL AND METHODS

Sixty-two male inpatients were examined who had suffered from a chronic depressive state over 2 - years in their youth (16-25 years old) and were treated at FSBSI MHRC clinic in 2008-2010. The exclusion criteria were the presence of psychotic episodes, severe deficiency symptoms, as well as clinically significant somatic, neurological and mental disorders that complicated the study. Clinical-psychopathological, psychometric (HDRS, SANS and SOPS) and statistical methods were used.

RESULTS AND CONCLUSION

Youth chronic endogenous depression is characterized by the dominance of symptoms of negative affectivity in their structure. In addition, there are disorders that differ from those of an affective spectrum. Based on the analysis of psychopathological characteristics of youth chronic endogenous depressions, two typological varieties are identified: unitary depressions (type I) and supplementary depressions (type II). Among type II depressions, 2 subtypes are distinguished: with neurosis-like and with psychopathic- like disorders. The presence of psychopathic disorders in the structure of depression is a prognostically unfavorable sign.

[Depression is a XXI century challenge]

Depression is one of the most relevant and discussed problems at the present stage of psychiatry's development, both in numerous scientific studies and in the media. Described for the first time several millennia ago, depressive states have been embodied in numerous cultural monuments dating back to antiquity and ancient Egypt. As early as the fifth century, Byzantine literature described "gratuitous sorrow" (John Cassian the Roman), corresponding to the modern understanding of endogenous depression.

[Endogenous depressions with religious experience]

OBJECTIVE

To identify the specifics of psychopathology and phenomenology of religious experience in depressed patients, for early diagnosis of mental disorders masked by a «religious facade», and prevention of suicidal activity.

MATERIAL AND METHODS

The study included 115 patients (41 men, 74 women) with depression contained religious distress in affective disorders (38 observations) and schizophrenia (77 observations), F31.3, F31.4, F32.1, F32.2, F33.1, F33.2 and F20.0, F20.4, F21 according to ICD-10.

RESULTS

According the psychopathological structure of depressive states, five types of depression were identified. The predominant type was melancholic depression (61%). Based on characteristics of religious experience, types of depressions were distinguished as follows: with congruent religious ideas of guilt and sinfulness; with the loss of «living» faith, God-forsakenness; with overvalued doubts about the choice of faith; and with «spiritual hypochondria».

CONCLUSION

Mental disorders, in particular depressive states, which have a religious «facade» often remain unrecognized due to the specific religious content, which often leads to severe and sometimes irreversible consequences as suicidal activity. Thus, these conditions require early diagnosis and specific approaches to the treatment.

[Immune-inflammatory markers in remission after a first-episode psychosis in young patients]

OBJECTIVE

To study clinical, psychopathological and immunological features of remission after first-episode psychosis in young patients to determine the patterns of this stage and the possibility of using the results for monitoring, prognosis and optimization of therapy.

MATERIAL AND METHODS

Fifty patients, aged 15-25 years, mean age 20.8±2.2 years, experiencing first-episode psychosis (F20, F25) and 45 healthy age-matched young men (mean age 19.2±3.2 years) were examined. The average age of psychosis manifestation was 19.8±2.5 months. Clinical, psychopathological, psychometric (PANSS and HDRS) and immunological («Neuro-immuno-test» technology) examinations were carried out at the psychotic state, during period of psychopathological symptoms reduction and further for 1-2 years until complete/significant reduction of psychotic symptoms.

RESULTS

Three stages of remission are revealed: I - the stage of reduction and modification of leading psychotic symptoms, II - the stage of stabilization of mental functions, III - the stage of reintegration of mental functions. It has been shown that each stage corresponds to different features of clinical symptoms and also certain spectra of immune markers (activity of leukocyte elastase, α1-proteinase inhibitor and level of autoantibodies to S100-B and OBM proteins) in blood serum of patients. The differences in the spectra of immune parameters at the second stage of remission in patients with affective (depressive) disorders define various patterns of post-psychotic development of disease. The most representative are immunological features of the third stage of remission.

CONCLUSION

The dynamics of immune markers in the course of remission can be considered as a biological criterion for assessment of the outcome of the first first-episode psychosis and the completeness of remission.

[Clinical and pathopsychological features of youth depression with attenuated schizophrenic symptoms]

OBJECTIVE

To determine the clinical and pathopsychological features of youth depressions with attenuated schizophrenic symptoms (ASS), and their significance for early differential diagnostic and nosological assessment.

MATERIAL AND METHODS

Twenty young patients (19.7±3.7 years) with the first depressive episode with attenuated schizophrenic symptoms (ASS) (ICD-10 items F32.1, F32.2, F32.3) (basic group) were divided into subgroup 1 with attenuated positive symptoms - APS (19.3%) and subgroup 2 with attenuated negative symptoms - ANS (45.1%). Eleven young patients (19.4±2.9 years) with the classic depressive episode without ASS (ICD-10 items F32.1, F32.2) were included in a control group. Psychometric scales HDRS, SOPS, SANS, pathopsychological methods and Adult Personality Traits Questionnaire (APTQ) were used.

RESULTS

Statistically significant differences in the severity of depression were not found. A higher SOPS total score (p=0.006) and a greater severity of negative symptoms on SANS (p=0.006) were detected in patients of clinical groups compared with the comparison group. Distortion of the generalization process was detected in 60% of cases, impairments of immediate memorization were found in 30%, and the non-constructive nature of associations in 10%. Indirect data on greater emotional integrity of patients from the comparison group was obtained.

CONCLUSION

The presence of similar clinical and psychological abnormalities in the youth depressions with ASS allows us to attribute these phenomena to the possible risk factors for the development of schizophrenia.

[Suicidal behavior in patients with mental disorders in youth]

OBJECTIVE

To study suicidal behavior in young adult patients with different mental disorders.

MATERIAL AND METHODS

Two hundred and fifty patients (190 men and 60 women) who committed suicide attempts in youth age over the years 2009-2019 were studied.

RESULTS

The most common psychological and social characteristics of young adults who attempt suicide, which set prerequisites and define the very mechanisms of suicidal behaviors, are determined. The following psychopathological types of suicidal attempts in this group of patients are identified: 1) Impulsive (30.1%); 2) Demonstrative (20.2%); 3) Overvalued (19.8%); 4) Depersonalization-related (14.9%); 5) Psychotic (10.1%); 6) Self-torturing (4.8%). The types of suicidal attempts correlate with nosologic forms. This finding is important in terms of differential diagnosis and working out therapeutic and socio-rehabilitation strategies.

CONCLUSION

The dynamic study of the patients showed that the suicidal risk persists throughout the entire period of youth, including after medical intervention. Therefore, long-term and systemic individual pharmaco- and psychotherapy is required.

Multimodal MRI of Conduction Tracts and Anatomy of the Cerebral Gray Matter in Familial Risk of Affective Disorders and Schizophrenia

The present study analyzed diffusion characteristics of white matter tracts and grey matter anatomy in 48 mentally healthy participants, including first-degree relatives of patients with schizophrenia (N=13) and affective spectrum disorders (N=13). The subgroup with familial risk of schizophrenia displayed abnormalities in the structural connectivity and increased cortical thickness in the superior frontal gyrus. No differences in the analyzed characteristics were revealed in the subgroup with familial risk for affective disorders. The results are discussed within the framework of the concepts of endophenotypes and processes reflecting compensatory and protective mechanisms.

[Executive control of language production in schizophrenia: a pilot neuropsychological study]

OBJECTIVE

To test the general hypothesis about executive deficits in language production in schizophrenia as well as more specific hypothesis that this deficit would be more pronounced in the case of higher demand on executive functions.

MATERIAL AND METHODS

Twenty-five patients with schizophrenia and twenty-seven healthy controls were asked to tell a story based on a series of pictures and then to give an oral composition on the given topic.

RESULTS AND CONCLUSION

Schizophrenia patients, compared to controls, demonstrated poorer programming as well as shorter text and phrase length in both tasks. Oral composition on the given topic in patients was characterized by the presence of agrammatism, need for leading questions due to the difficulties of story plot generation as well as higher variance in syntactic complexity and text length. Therefore, the authors revealed executive deficit in language production, more pronounced in the task with less numerous external cues for planning and sequential text explication, in schizophrenia patients.

[Features of the long-term course of young-onset schizophrenia: a clinical and follow-up study]

OBJECTIVE

To determine the features of the course of young-onset schizophrenia based on the long-term follow-up results (20-25 years).

MATERIAL AND METHODS

The results of the long-term follow-up study of 320 patients with young-onset schizophrenia referred for psychiatric care in an outpatient clinic in Moscow from 1990 to 1994 were analyzed. Correlations between typological variants of the patient's condition during the follow-up and features of the dynamics of the schizophrenic process at different stages of the disease were studied. Clinical-psychopathological, clinical follow-up, clinical-epidemiological and a psychometric method were applied.

RESULTS AND CONCLUSION

The severity of symptoms at all stages of the disease correlates with typological variants of conditions at the stage of long-term follow-up. In the first type, there is an accumulation of personality desorders and the most prognostically favorable variants of the initial stage, manifestations of psychotic states, the disease often manifests with only one episode and has a regressive character, the disease process fades quite quickly, mainly high-and medium-quality remissions are formed. In the second type, there is an accumulation of less favorable signs - prolonged variants of the initial stage with a predominance of negative disorders, hallucinatory-delusional manifestations of psychoses with exacerbations after 10-12 years, the high frequency of progressive forms of disease course and remissions of moderate to low quality. Type 3 is characterized by the most severe combinations of positive and negative symptoms, paranoid forms of the initial stage, paranoid and catatonic manifestations of psychoses, a high number of relapses at all stages of the course, low-quality remissions and frequent transition of the disease to a continuous form.

[Continuous cycling bipolar affective disorders in youth]

OBJECTIVE

To reveal psychopathological characteristics and core dynamic patterns of continuous cycling bipolar affective disorders in youth.

MATERIAL AND METHODS

One hundred and seven patients (62 men and 45 women), including 59 patients of the clinical group and 48 of the follow-up group, were examined.

RESULTS AND CONCLUSION

Three types of continuous cycling bipolar affective disorders in youth are described: rhythmic, dysrhythmic and pseudorhythmic. A correlation between the dynamics of affective disorders in youth and the nosological affiliation of each of the identified types of continuous cycling course was found. The results may be useful for solving differential/diagnostic, prognostic and therapeutic tasks.

[Neurophysiological characteristics of juvenile schizophrenia patients examined at the very remote follow up stage]

OBJECTIVE

To determine neurophysiological characteristics of patients with long-term follow up (>20 years) and to find correlations between neurophysiological parameters and clinical features of schizophrenia.

MATERIAL AND METHODS

The patients were divided into three groups: with predomination of personality changes (group 1, n=17), with negative disorders (group 2, n=23) and with positive and negative disorders (group 3, n=40). A psychopathological method and electroencephalography with evoked potentials testing were used.

RESULTS AND CONCLUSION

In group 3, the statistically significant higher frequencies of theta-rhythm and lower of alpha-rhythm were found. Also, theta frequency correlated with PANSS positive scores. The significant intergroup differences by auditory oddball P300 were lacked. The findings are discussed in view of the hypothesis of theta-rhythm as a marker of hippocampal-prefrontal connectivity.

[The influence of religiosity on depressive disorders and suicidal behavior]

This review of the literature is focused on the positive influence of religiosity on recovery after depression and on the protective role of religiosity against suicidal activity. Despite the inconsistent results on the role of religiosity in treatment of mental diseases, to date there is a sufficiently large body of literature showing the beneficial effect of religiosity and describing specific therapeutic approaches and suicide prevention programs.

[Neuroanatomical brain profile of juvenile shiftlike schizophrenia: morphometry of grey matter in the prefrontal cortex and subcortical structures]

AIM

To determine neuroanatomical peculiarities of grey matter in some regions of the prefrontal cortex and several subcortical structures in patients with juvenile shift like schizophrenia (F20 ICD-10).

MATERIAL AND METHODS

Forty-three young male patients and 54 mentally healthy men without family history of mental diseases underwent structural MRI with T1 high resolution images.

RESULTS

As compared to mentally healthy subjects, there was a decrease of grey matter thickness in all tested regions of the prefrontal cortex in patients. No between-group differences in subcortical structures volumes were found. No correlations between structural changes and psychopathological symptoms were observed.

CONCLUSION

Structural abnormalities of the frontal lobes in juvenile shift like schizophrenia are not associated with severity of psychopathological symptoms.

[The effectiveness of high-frequency rhythmic transcranial magnetic stimulation in endogenous depressive disorders in youth]

AIM

To search for neurophysiological predictors of the effectiveness of rhythmic transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in patients with depressive disorder of various nosology.

MATERIAL AND METHODS

Thirty-four young male patients with protracted treatment resistant depression were studied using psychopathological, psychometric methods and encephalography. A search for predictors of therapeutic efficacy was carried out in a wide range of neurophysiological indicators using different high-frequency rTMS protocols (10 Hz and 20 Hz)..

RESULTS AND CONCLUSION

The most significant changes were obtained using rTMS with a frequency of 20 Hz. A favorable effect of treatment was correlated with higher spectral power of the alpha- and beta 1-rhythm bands in EEG.

[Procognitive effects of transcranial magnetic stimulation in the light of neurocognitive deficit in schizophrenia]

Transcranial magnetic stimulation (TMS) is a relatively new method of non-invasive therapy of mental and neurological diseases that has great potential of therapeutic and diagnostic application. In schizophrenia, TMS may exert a positive effect on cognitive deficit. However this issue remains open. The authors analyze recent studies focused on the dynamics of neurocognitive deficit in TMS therapy and consider clinical effects of TMS in schizophrenia. The analysis has shown that TMS is successfully implemented in treatment of auditory positive symptoms and studies on its effect on negative symptoms of schizophrenia are perspective. Procognitive effect was found in working memory domain, and partially in perception domain within the perception of faces and facial expressions. The data on regulative functions, attention, speech, and nondeclarative memory remains controversial. It has been concluded that further research is needed to clarify the place of TMS in schizophrenia therapy.

[Genetic variations associated with premorbid personality in patients with schizophrenia]

AIM

To search for genetic variants associated with premorbid personality in patients with schizophrenia.

MATERIAL AND METHODS

The sample included 272 men diagnosed with schizophrenia or schizoaffective disorder. Patients were divided into 3 groups based on premorbid personality difficulties: mild (group 1, n=110), moderate (group 2, n=113), marked (group 3, n=49). The following polymorphisms were genotyped: 5-HTR2A (T102C), 5-HTTLPR, BDNF (Val66Met), CRP (-717A>G).

RESULTS

A significant increase in the frequency of the CC (5-HTR2A T102C), LL (5-HTTLPR) and Met/Met (BDNF Val66Met) genotypes was identified in group 3 compared to group 1. Frequencies of CC and LL genotypes were significantly higher in group 2 compared to group 1 as well. The differences between group 2 and group 3 were found only for the Met/Met genotype. There were no between-group differences in the frequencies of CRP (-717A>G) genotypes.

CONCLUSION

5-HTR2A (T102C), 5-HTTLPR, BDNF (Val66Met) polymorphisms previously reported to modify schizophrenia course are also associated with premorbid personality in schizophrenic patients.

[Therapeutic drug monitoring of risperidone and its active metabolite 9-hydroxyrisperidone in the treatment of schizophrenia]

AIM

To conduct a routine therapeutic drug monitoring (TDM) and analyze its results for the optimization of pharmacotherapy.

MATERIAL AND METHODS

Fifty-six inpatients (in total 68 samples) with various forms of schizophrenia were enrolled. High performance liquid chromatography with mass-spectrometric detection was used for quantitative determination of risperidone and 9-hydroxyrisperidone in the serum.

RESULTS

Concentrations of risperidone and 9-hydroxyrisperidone were correlated with drug dose. Total concentrations in the blood at doses from 2 to 8 mg per day were distributed as follows: 44.1% were in the therapeutic, 29.4% in sub-therapeutic (<20 ng/mL) and 26.5% in conditionally toxic range (>60 ng/mL).

CONCLUSIONS

Concentrations of risperidone and 9-hydroxyrisperidone did not follow the normal distribution. The results showed that monitoring of the total concentration of risperidone and its metabolite 9-hydroxyrisperidone was an effective tool for testing and quality control for the purpose of individualization of pharmacotherapy.

[Glutathione reductase and glutathione-S-transferase in blood cells in schizophrenia and schizophrenia spectrum disorders]

AIM

To compare glutathione reductase (GR) and glutathione-S-transferase (GST) enzymatic activities in blood cells (erythrocytes and platelets) of patients with schizophrenia spectrum disorders and in the control group and to search for correlations of these biochemical parameters with clinical psychiatric assessments of the patient.

MATERIAL AND METHODS

The study included patients (97 men) with schizophrenia spectrum disorder (schizophrenia and schizoaffective disorders) in an acute state of exacerbation of psychotic symptoms and 33 men without mental pathology. Symptom severity was measured with the PANSS before and after antipsychotic therapy. GR and GST activities were determined spectrophotometrically.

RESULTS

There were no significant between-group differences in the activities of erythrocyte GR and GST. In platelets, the GR activity was lower in all patients' groups than in controls, whereas the GST activity in patients with schizophrenia relapses and in patients with schizoaffective disorder (SD) was lower than in controls (p<0.05) both before and after treatment. Differences between subgroups of first-episode patients (schizophrenia and SD) and patients with schizophrenia relapses were found not only in the levels of erythrocyte and platelet GR and GST activities, but also in the changes of these enzymatic activity levels under antipsychotic treatment, as well as in links binding these enzymatic activities and PANSS scores.

CONCLUSION

The decreased level of GR and GST, the glutathione-dependent enzymes, contributes to the reduction of antioxidant defense in schizophrenia spectrum disorders. The correlations linking the basal levels of GR and GST activities with the results of clinical assessments after treatment allow us to consider these parameters as potential biomarkers for predicting treatment response.

[The relationship between psychiatry and religion in the works of Russian psychiatrists]

This review analyzes the works of Russian psychiatrists on the relationship between religion and clinical psychiatry. Beginning from the first half of the 19th century a lot of Russian psychiatrists in their writings dealt with the issues of religiosity and mental health as well as with psychopathology and clinical studies of mental states with a religious delusion. They studied psychopathological features of the phenomenon of 'hysterics', the syndromes of religious metaphysical intoxication and demon possession. One of the founders of social psychiatry D.E. Melekhov considered religious faith as the most important personal resource for rehabilitation activities. Differentiation of non-pathological religious experience from mental illnesses with a religious plot remains understudied in the literature. The analysis of the literature on the relationship between religion and psychiatry makes clear that psychiatrist's accurate understanding about the peculiarities of the religious life of patients is necessary for a successful therapeutic alliance.

[The dynamics of psychopathological symptoms of ultra high risk for psychosis in young patients with non-psychotic mental disorders]

OBJECTIVE

Based on the results of 5-year follow-up study, to describe the dynamics of psychopathological symptoms in young patients with non-psychotic forms of mental diseases met the criteria of ultra-high risk for schizophrenia who received preventive psychopharmacotherapy.

MATERIAL AND METHODS

The study included 32 young men, aged 16--25 years, presented with the symptoms of ultra-high risk of schizophrenia during the first hospitalization in 2009--2011. Follow-up was carried out in 2014--2015 (mean follow-up 5.79±0.36 years). According to ICD-10, patients were stratified into 3 groups: mood disorders, personality disorders and schizotypal disorders.

RESULTS AND CONCLUSION

According to the characteristics of subsequent development of these disorders, four types were singled out: mechanisms of the development of acute sensitive delusions (I), interpretative delusions (II), catatonic disorganization (III) and cognitive disorders pathognomonic for schizophrenia spectrum disorders (IV). Correlations between these types and nosologic disorders and their different reversibility under treatment were found. These types can be considered as predictors of outcome over the follow-up period.

[Endogenous episodes of juvenile psychosis with religious delusions]

AIM

To identify clinical and psychopathological features, conditions of formation and prognostic significance of delusions with religious content in endogenous psychotic states in adolescence.

MATERIAL AND METHODS

Fifty-three male patients, aged from 16 to 25 years, with juvenile endogenous psychosis, with a psychotic episode with religious content of delusion were examined. Clinical, psychopathological, psychometrical (The Dawkins scale) and statistical methods were used.

RESULTS AND CONCLUSION

General psychopathological features of psychotic states with religious delusions, according to the specificity of adolescent age, were identified. Common types of religious delusional episodes, forming by primal interpretive (delusion of sin, delusion of demonic possession) and sensual (messianic and antagonistic delusion, religious oneiroid) mechanisms were distinguished. A role of the previous religiosity, including overvalued religious ideas, was clarified. It was found out that the duration of the pre-manifest stage, hospitalization and the period of 'untreated psychosis', was longer in patients with religious delusions compared to patients with other types of delusions. Patients with interpretive mechanism of delusion formation demonstrated the subsequent intensification of religiosity that was not common for psychotic episodes with the sensual mechanism of delusion formation.

Impaired monocyte activation in schizophrenia: ultrastructural abnormalities and increased IL-1β production

Monocyte activation is consistently reported in patients with schizophrenia (SZ). We aimed to study the ultrastructure of monocytes and monocyte production of IL-1β in drug-free patients with SZ and controls. Monocytes from young (18-30 y.o.) healthy and SZ men in relapse were studied. Electron microscopy and morphometry were applied to estimate areas of monocytes, volume density (Vv), areas, and number of organelles. The production IL-1β by monocytes was estimated by the ELISA method. Group differences were examined using ANCOVA. Pearson's correlation coefficients were used to examine the effects of possible confounding variables. Correlation analyses were applied to detect the relationships between the parameters of monocytes measured and between the parameters measured and the IL-1β production. Area of nucleolus, Vv and area of mitochondria and lysosomes, and the number of lysosomes were significantly increased in patients as compared to controls. Area of mitochondria was correlated significantly with Vv and area of lysosomes, and the number of lysosomes was significantly correlated with area of monocyte and Vv of vacuoles only in the control group. The production of IL-1β by monocytes was higher in patients than in controls (p = 0.01) and was correlated with Vv of lysosomes (r = 0.68, p = 0.04) and area of lysosomes (r = 0.78, p = 0.013). The data provide new evidence for over activation of monocytes in SZ and disturbed metabolic relationships between lysosomes, mitochondria, and vacuoles.

MRI Study for the Features of Brain Conduction Pathways in Patients with an Ultra-High Risk of Endogenous Psychoses

Diffusion parameters of brain tracts (n=18) were studied in 27 men with ultra-high risk of endogenous attack-like psychoses and 27 mentally healthy men of the same age group (fractional anisotropy; and average, radial, and axial diffusion). Correlation analysis was performed between these parameters and severity of mental disorders (SOPS scale). The indexes of radial diffusion and axial diffusion were shown to change in the left anterior thalamic radiation and right posterior cingulum bundle, respectively. Our results are consistent with published data that disturbances in the frontal and temporal lobes play an important role in the pathogenesis of schizophrenia. The degree of mental disorders correlated with diffusion parameters in the left and right anterior cingulum bundle.

The serotonin transporter gene 5-HTTLPR polymorphism is associated with affective psychoses but not with schizophrenia: A large-scale study in the Russian population

BACKGROUND

Affective syndrome is thought to be a key feature that differentiates schizophrenia from schizoaffective disorder (SA) and bipolar disorder with psychotic features (BDP). However genetic underpinnings of these differences remain unresolved.

OBJECTIVES

We compared clinical variables of affective psychoses (SA, BDP and schizophrenia with affective symptoms (AFF SCZ)) and schizophrenia without affective symptoms (non-AFF SCZ) and searched for a genetic variant that may differentiate affective psychosis from non-AFF SCZ.

METHODS

A total of 2677 subjects, including 831 patients with affective psychosis, 785 patients with non-AFF SCZ and 1061 healthy controls, were used. Clinical symptoms were assessed with the PANSS. The sample was genotyped for 5-HTTLPR polymorphism of the serotonin transporter gene.

RESULTS

The diagnostic groups differed significantly on demographic and clinical variables. The percentage of men was higher, the current age and age at illness onset were lower in non-AFF SCZ and SA compared to AFF SCZ and BDP. The severity of positive and negative symptoms decreased significantly from group to group in the following manner: non-AFF SCZ>AFF SCZ>SA>BDP. There was the association between 5-HTTLPR polymorphism and affective psychosis (p=0.01). The frequency of the SS genotype was higher in the affective psychosis group compared to non-AFF SCZ and controls. No differences in the genotype distribution were identified between the non-AFF SCZ group and controls.

LIMITATIONS

Difficulties in the differentiation between non-AFF SCZ and AFF SCZ or SA and between AFF SCZ and SA due to uncertain diagnostic boundaries between these conditions.

CONCLUSIONS

SA is intermediate between non-AFF SCZ and BDP in the severity of positive and negative symptoms. The first episode patients, carriers of the SS genotype have a higher risk of developing affective psychosis than non-AFF SCZ. This finding carries implications for the prognosis of psychosis outcomes in the first-episode patients.

(1)H-MRS and MEGA-PRESS pulse sequence in the study of balance of inhibitory and excitatory neurotransmitters in the human brain of ultra-high risk of schizophrenia patients

The MEGA-PRESS pulse sequence was used for determination of overlapping signals in the (1)H-MRS spectra of the human brain. For the first time, the balance of GABA glutamate/glutamine concentrations was estimated quantitatively in the human brain of patients with ultra-high risk of schizophrenia. It was found that GABA concentration and GABA/GLX ratios were significantly reduced in the left frontal lobe of UHR subjects.

[Relationship of Executive Functions and Processing Speed with Cortical Gray Matter Morphometry in Healthy Adults and at The Early Stages of Schizophrenia]

13 male patients with schizophrenia and 18 age-matched healthy men underwent structural magnetic reso- nance imaging and completed the Stroop task which included the switching condition. As compared to con- trols, the patients showed slowing of color naming in the neutral condition and a reduction ofgray matter vol- ume and thickness in the frontal and temporal areas. In healthy subjects, the time of color naming was neg- atively correlated with gray matter volume in the left cuneus. In the schizophrenia group, there was a positive correlation between the time of color naming and cortical thickness in the middle and inferior frontal gyri of the right hemisphere. These results indicate a change in structural-functional relationships at the early stages of schizophrenia.

[Polymorphism C366G of gene GRIN2B and verbal episodic memory: No association with schizophrenia]

The present study searched for associations between gene GRIN2B (glutamate receptor, ionotropic, N-methyl-D-aspartate, subunit 2B) and component processes of verbal episodic memory in schizophrenic patients. The Rey Auditory Verbal Learning Test (RAVLT) as a part of a large neuropsychological battery was administered to 302 patients with schizophrenic spectrum disorders (sample PI). Also, 285 patients (sample P2) and 243 healthy controls (sample C2) performed the “10 words” test that measures short-term memory. The GRIN2B rs7301328 (C366G) polymorphism was genotyped for each subject. There were no associations between the polymorphism and any measure of the RAVLT either in the whole PI sample or in a subsample of patients with a severe cognitive deficit. The GRIN2B influenced immediate recall and proactive interference in the “10 words” test in the control group: homozygotes CC recalled fewer words and showed a lower effect of proactive interference than carriers of other genotypes. The results suggest that the C366G polymorphism could influence verbal episodic memory in the general population, but this influence is absent in schizophrenic patients.