Depression, Mood Disorders and Bipolar Spectrum: One or Different Diseases?

The concept of mixity is the essential cognitive cornerstone for quantifying and understanding unstable mood and restlessness, which are components of all mood disorders, diseases that always present fluctuations in mood, from the depressive component to the restless one and to the hypomanic and manic one. The GT-MSRS Mixed States Rating Scale becomes an essential means for early diagnosis.

Frequent Extrasystolic Arrhythmia: Perceived Psychological Well-Being Evaluation.

BACKGROUND: To estimate quality of life (QOL) in patients with frequent extrasystolic arrhythmia (ES) using the SF-36 Health Status Survey. MATERIALS AND METHODS: The patient group consisted of 634 individuals (42-79 y.o) with ES >700 per 24 hours, as diagnosed by Holter ECG, and the control group included 106 patients (38-79 y.o.) with ES <700 per 24 hours. None of the patients had atrial fibrillation. The "early" ES subgroup A (n=192) experienced ES preceding the transmitral blood flow peak in the cardiac cycle (peak E) according to pulsed wave Doppler in transthoracic echocardiography (EchoCG). The "late" subgroup B (n=442) had ES after the transmitral blood flow peak, irrespective of the electric topic localization. Laboratory and instrumental methods included standard lipidograms, Holter ECG, EchoCG, Doppler ultrasound of brachiocephalic arteries, and coronary angiography. For QOL evaluation, we used the SF-36 Health Status Survey. RESULTS: The patient groups did not differ with respect to main laboratory findings, instrumental parameters, and comorbidities, with the exception of type and quantity of ES. Physical and mental health to the SF-36 Health Status Survey indicated lower summary point scores in patient subgroup A ("early" ES) in comparison with the control group. The parameters were non-significantly lower in subgroup B. CONCLUSIONS: The SF-36 Health Status Survey serves to assess the QOL in patients with ES. Frequent ES, especially its "early" variant in which ventricular systole precedes the transmitral blood flow peak in the biomechanic cardiac cycle is a predictor for lower QOL scores in patients with cardiovascular pathology.

Primary Psychosis, Geriatric Depression and Cognitive Reserve: Protective Factor and Therapeutic Trajectors.

Cognitive reserve (CR) is essential in reducing natural cognitive decline. Identified in neurodegenerative pathologies, it also increasingly plays a role in the development of the symptomatic processes of numerous psychiatric pathologies. CR could help identify subgroups of elderly patients affected by primary psychosis and mood disorders and evaluate their correlation with diagnostic and therapeutic trajectories. Our observational study assessed the correlation between cognitive reserve and cognitive and psychopathological trajectories in a group of elderly inpatients in health residential centers. After two years of observation, the results indicate a correlation between cognitive reserve levels and psychopathological and cognitive trajectories. No significant variations or correlations were observed between another investigation factor, aberrant salience, and the symptoms in the above trajectories.

Suicidality in Youngers: an Observational Study in Outpatient Unit.

Suicidality (meaning ideation, self-harm and attempt to suicide) are major public health problems in adolescence and represent a worldwide public health concern. Non-suicidal self-injury (NSSI), often simply called self-injury, is the act of harming your own body on purpose, for example by cutting or burning yourself. NNSI is a common mental health threat among adolescents and it's usually not meant as a suicide attempt. Unfortunately, suicide is the second most common cause of death in young people worldwide and represents a public health problem. For this reason, we analyzed retrospective data from patients admitted in the Psychiatric Hospital from July 1st 2023 to June 30th 2024 to identify clinical features, risk factors of suicidality by analyzing the assessment we administered at time of hospitalization: Patient Health Questionnaire (PHQ-9), Ask Suicide Questionnaire (ASQ), G.T. MSRS scale. Within the 50 subjects of the sample, 30 patients attempt to suicide (60%); the large majority (90%) met the criteria for mixed state. This study shows that there is a high prevalence of mixed states in the inpatient unit admission, which is demonstrated both from the prescription of mood stabilizers, and confirmed by the diagnosis of mixed states rated with the scale. The use of structured interview with patient and families add on assessment suicide risk scale are fundamental, in order to guide a tailored psychopharmacological treatment, and improve prognosis.

Psychopathological and Therapeutic Trajectories of Inpatients Affected by Mixed States and Bipolar Spectrum Disorders.

In clinical practice, mental health professionals face diagnostic and therapeutic challenges daily. The diagnostic identification of mixed states allows the management of diagnostic and therapeutic trajectories appropriately. In our study, we evaluated 484 patients at a psychiatric rehabilitation center. The initial pre-admission diagnosis of the mixed state of 3.71% (at baseline) increased to 32.23%. The observation period was three years. The therapeutic efficacy of the pharmacological association of Antidepressants (Ads) or Second Generation Antipsychotics (SGAs) with a mood stabilizer (sodium valproate, lithium, lamotrigine, gabapentin, and pregabalin) was evaluated. An improvement in psychopathological symptoms was observed in different groups analyzed. The most significant differences were observed with the association SGAs + mood stabilizer [olanzapine + valproate sodium (p=0.005); risperidone + pregabalin (p=0.072)] and SSRIs + mood stabilizer [escitalopram + valproate sodium (p=0.005), vortioxetine + mood stabilizers (valproate or gabapentin). However, these are preliminary data and are under evaluation.

The Population Typology of Conspiracy Beliefs About Sars-Cov-2 Origin in Russia Based on Predictive Modelling of COMET-G Study Data: Incoherent Attitude Indicator as a Predisposing Factor for Developing Mental Disturbances.

BACKGROUND: We examined the prevalence and spread of conspiracy beliefs about the origins of the COVID-19 pandemic among representatives of the Russian population. Our study aimed to identify belief clusters and develop predictive models to understand the factors that influence conspiracy beliefs, particularly in the context of how they might evolve in response to socio-political events and cause mental disturbances, thus in relation to specific pathways of the infodemic and psychodemic waves that spread among vulnerable population groups. METHODS: Data respondents to the international COMET-G study living in Russia during pandemic period (n=7,777) were analyzed using descriptive statistics, K-means clustering, and various machine learning models, including gradient boosting. We identified distinct populations depending on predominant beliefs about COVID-19 pandemic origins, and applied game theory (Shapely additive explanations) to determine the most influential variables in predicting cluster membership. RESULTS: Four distinct belief clusters emerged, which we designate as Naturalists, Conspiracists, COVID-Sceptics, and the Incoherent Attitude groups. The Incoherent Attitude cluster constituted 20.8% of the sample, and was particularly associated with mental health signs such as sleep disturbances and the use of psychotropic medications. Internet use and mental health-related factors, as well as the respondents' education level, were key predictors of mental disturbances with mediating effects of the conspiracy views across all clusters. Conspiracy beliefs about COVID-19 origin were highly fluid/variable, often being shaped by external sociopolitical factors rather than objective health data. CONCLUSIONS: The cluster with Incoherent Attitude regarding COVID-pandemic origins, which had an association with psychoticism, showed a greater predisposition for mental health problems, than did the Conspiracist, Naturalist and Sceptic clusters. We suppose that underlying psychoticism bears a relation to their sleep problems and resorting to use of psychotropic medications. These results emphasizes the global health need for implementing target-focused and selective strategies that address public misinformation and promote the adoption of critical thinking skills to mitigate the impact of conspiracy theories, considering the factors of education level and pre-existing mental disorders.

Risk Assessment Suicidality Scale (RASS)-Based On-Line Calculator Targeting Early Prevention of Suicides in General Population: from COMET-G Study Results Towards Integration of the Screening Tool into Routine Clinical Practice.

BACKGROUND: Suicide is a major global health concern, particularly among young people. This study evaluates an online suicide risk calculator based on the Risk Assessment of Suicidality Scale (RASS), which is designed to enhance accessibility and early detection of suicide risk. METHODS: The study involved 444 participants who completed the RASS via an online calculator. Results were compared with data from the COMET-G study's Russian sample (n=7572). Descriptive statistics, correlation analysis, and two-way ANOVA were used to analyze the data. RESULTS: The mean age of participants was 22.71 years (SD=7.94). The mean total RASS standardized score was 837.7 (SD=297.8). There was a significant negative correlation between age and RASS scores (r=-0.463, p<0.0001). The online calculator sample showed significantly higher RASS scores compared to the COMET-G sample, with 71% of online users scoring above the 90th percentile of the COMET-G sample. CONCLUSION: Our study demonstrated the advantage of the on-line suicidality risk calculator based on the RASS scale as a sensitive tool in detecting suicidal behaviours and measuring the severity of suicidality risks, offering a capability for broad reach and immediate assessment during clinical conversation between doctor and patient. Moreover, the RASS on-line psychometric instrument, when being freely distributed among the general population over internet sources, enabled to attract vulnerable groups of respondents with significantly higher suicidality risks. Future research should focus on integrating such tools into comprehensive suicide prevention programs and developing appropriate follow-up monitoring strategies for high risk-cases.

Negative Symptoms and Cognitive Deficits in Primary Psychoses: an Observational Study in a Psychiatric Rehabilitation Centre.

Negative symptoms (NSs) and cognitive deficits (CDs) negatively affect patients' quality of life with primary psychosis. Our observational study evaluated the percentage of NSs in a group of inpatients of a psychiatric rehabilitation facility and the variation of the interaction with CDs during the COVID-19 pandemic. The results showed a significant correlation between NSs and CDs in the first observation period (PANSS - FSNS p=0.001; BNSS p=0.023; Epitrack p=0.00) and a stabilization of the results between the first and second observation periods (PANSS - FSNS: p=0.094; BNSS p=0.466; Epitrack p=0.026).

G.T. MSRS On-Line Calculator Targeting the Early Diagnosis of Mixed Affective States: the Multicenter Study Project Design on the Approbation and Validity of the Three Language Versions of the Rating Scale.

BACKGROUND: Mixed affective states (MS) are often misdiagnosed by the clinicians and lead to the inappropriate treatment strategies contributing to the severe forms, poor outcome with higher rates of comorbid conditions and worse remission quality in affective and bipolar disorders, as well as to a decreased psychosocial functioning of these patients. The development of reliable tools for the MS assessments or so called the phenomenon of mixity in affective disorders, is still an unmet need of psychiatric research and clinical practice. In this paper, we present PC program "Multilingual IBM-PC on-line calculator for early diagnosis of the mixed affective states" based on the Giuseppe Tavormina Mixed States Rating Scale (G.T. MSRS) (Russian, English, Italian language versions) created by the ICERN group using programming language JavaScript, working for such operation systems (OS) as Windows, Linux, MacOs, Android, iOS, and aims to contribute to the accurate assessment of the presence and severity of the mixed states among affective disorders. SUBJECTS AND METHODS: The G.T. Mixed States Rating Scale on-line calculator consists of 11 items which evaluate various aspects of MS in patients with major depression, bipolar or recurrent depressive disorder. A total score is automatically calculated, considering the type of affective temperament according to the Akiskal's and Tavormina's schemas, thus, the specific sub-groups of MS are differentiated based on the ranges: Medium-light (2-6), Medium (7-12), and High (13-19) Mixity level. The study will enroll 330 participants during two (three months follow-up) visits (110 native speakers in each of the three languages) of both genders aged from 18 till 55 y.o. with the diagnoses of depressive episodes, major depression, bipolar or recurrent depressive disorder according to the DSM-5 criteria. Assessments will be provided by the two investigators (second one will be blinded to the G.T. MSRS results obtained by the first researcher), based on the use of DSM-5 clinical interview, Young Mania Rating Scale, Montgomery-Åsberg Depression Rating Scale, Clinical Global Impression - Severity scale (CGI-S), Clinical Global Impression - Improvement scale (CGI-I), Patient Global Impression of Change (PGIC). RESULTS: The study will assess the agreement between the diagnostic category/clinical impression and the on-line G.T. MSRS calculator use results, its test-retest reliability, and diagnosis stability for further assessment of the on-line G.T. MSRS calculator validity and clinical utility. Secondary variables will evaluate internal reliability and such statistical analyses as Cronbach's alpha, Cohen's Kappa, biserial correction, and agreement between initial and follow-up diagnoses. CONCLUSIONS: Current multicenter validation study of the on-line G.T. MSRS calculator will enhance the understanding of the mixity phenomenon and its clinical implication, aiming to improve the treatment strategies to manage the course of mental disorder, quality of life and psychosocial functioning in patients with affective (bipolar) disorders, accompanied by MS, and a clinical recommendation for the routine administration of the user-friendly on-line G.T. MSRS version in clinical practice.

The Interference of Negative Symptoms of Schizophrenia on Cognitive Domains: a Long-Term Observational Study on the Role of Clozapine.

The negative symptoms of schizophrenia are responsible for patients' worse quality of life. The association with cognitive deficits impairs clinical and psychopathological conditions. Our small 5-year observational study evaluated the efficacy of clozapine in negative and cognitive symptoms in schizophrenia inpatients. The overall results showed a significant improvement in the mean total scores of the BNSS and PANSS (at baseline (T0) vs five years (T3)). The improvement was also in some negative subscales (PANSS Negative Factor subscale) but not in others and the Epitrack tool. The overall results showed that clozapine is a useful therapeutic tool that does not affect the cognitive decline of these patients.

The Role of Fatigue and Satisfaction of Compassion, and Hopelessness in Healthcare Workers in the Alzheimer's Disease in the Post-COVID-19 Pandemic.

The COVID-19 pandemic has left emotional consequences for healthcare workers. Dramatic results are obtained on compassion fatigue, burnout, and hopelessness in healthcare workers (HCWs) of older adults with Alzheimer's disease. Our study evaluated differences in these factors during and after the pandemic in 48 HCWs. The results showed a statistically significant difference in the Satisfaction of Compassion (P=0.014; during vs post-pandemic) and in the subscale of Secondary Trauma (P=0.005) and Burnout (P=0.49) in CFSS. The results were not statistically significant on the BHS scale (P=0.285). However, hopelessness was found in a higher percentage of HCWs at the end of the pandemic than during the pandemic period (respectively: 35.67% vs 31.67%).

Neuronetwork Approach in the Early Diagnosis of Depression.

BACKGROUND: Depression is a common mental illness, with around 280 million people suffering from depression worldwide. At present, the main way to quantify the severity of depression is through psychometric scales, which entail subjectivity on the part of both patient and clinician. In the last few years, deep (machine) learning is emerging as a more objective approach for measuring depression severity. We now investigate how neural networks might serve for the early diagnosis of depression. SUBJECTS AND METHODS: We searched Medline (Pubmed) for articles published up to June 1, 2023. The search term included Depression AND Diagnostics AND Artificial Intelligence. We did not search for depression studies of machine learning other than neural networks, and selected only those papers attesting to diagnosis or screening for depression. RESULTS: Fifty-four papers met our criteria, among which 14 using facial expression recordings, 14 using EEG, 5 using fMRI, and 5 using audio speech recording analysis, whereas 6 used multimodality approach, two were the text analysis studies, and 8 used other methods. CONCLUSIONS: Research methodologies include both audio and video recordings of clinical interviews, task performance, including their subsequent conversion into text, and resting state studies (EEG, MRI, fMRI). Convolutional neural networks (CNN), including 3D-CNN and 2D-CNN, can obtain diagnostic data from the videos of the facial area. Deep learning in relation to EEG signals is the most commonly used CNN. fMRI approaches use graph convolutional networks and 3D-CNN with voxel connectivity, whereas the text analyses use CNNs, including LSTM (long/short-term memory). Audio recordings are analyzed by a hybrid CNN and support vector machine model. Neural networks are used to analyze biomaterials, gait, polysomnography, ECG, data from wrist wearable devices, and present illness history records. Multimodality studies analyze the fusion of audio features with visual and textual features using LSTM and CNN architectures, a temporal convolutional network, or a recurrent neural network. The accuracy of different hybrid and multimodality models is 78-99%, relative to the standard clinical diagnoses.

Mood Disorders and Type of Work: What Interaction? An Italian study.

Very often we talk about interference of work activities with the onset of mood disorders: thinking of work as a potential protracted stressful event that can interfere with the mood balance of the population. It emerges from this study, with 1140 patients evaluated in 18 years, that there is no particularly stressful work (or non-work) activity which induces predominantly the onset of an acute phase of a mood disorder.

The Listening Experience in a Group of Adolescents with Mood Disorders.

At the Istituto Superiore "Grazio Cossali" secondary school in Orzinuovi (Brescia province) for COVID-19 pandemic emergency, and active listening project through individual and group counselling was proposed. Seven sample classes were selected for which a questionnaire was specifically designed, the students (male and female) were between the ages of 14 and 18. From the results of the questionnaire and the clinical observation, a part of the students show mood disorders with depression type symptoms, attention and concentration difficulties, decrease in academic performance, difficulty in managing emotions, irritability, behavioural fidgeting, displays of anxiety. Furthermore, the individual listening desk was set up to which all the students at the school had access. The primary objective of the project was that of improving emotional, relationship and behavioural issues. Several methodologies were used, such as: participant observation, brainstorming, psychoeducation, active listening, communicative feedback, reactivation of resources. From the active listening carried out in group and individually, the emotional awareness triggered an improvement in the ability to manage emotions in the student, reactivating their own personal resources and improving mood.

Emergency, Fear, Worry and Intolerance of Emotion.

The emerging worry from emergency situations transforms into pervasive worry in some people, this due to its intensity, duration and intrusiveness, which significantly interferes with daily life. From the emotion of emergency, fear, through repetitive thought forms, we focus on worry. Its characteristics and underlying meta-beliefs are briefly analysed. Worrying exacerbates negative emotions and for many patients the feeling of not being able to tolerate the anxiety and anguish resulting from constant brooding. Brief hints of therapy are proposed, useful for intervening in these forms of pathological worry.

Hope in Psychiatric Patients: An Observational Study in a Psychiatric Rehabilitation Centre.

INTRODUCTION: The COVID-19 pandemic has led to the re-evaluation of some fundamental aspects for the management of emotions and psychological dynamics. Hope and its lack are important factors that have been especially evaluated in caregivers and HCWs. Instead, our study aimed to explore hopelessness among psychiatric rehabilitation center residents with Primary Psychosis. METHODS: We recruited 116 inpatients affected by Primary Psychosis (schizophrenia, bipolar disorder, major depression disorder and personality disorder). Hopelessness was sought through the BHS, during the covid-19 pandemic period. They were compared with data from previous studies on HCWs (HealthCare Workers), in the same period, and in the same centre. RESULTS: The results obtained in this group of patients showed high total scores on the BHS scale (mean total score: 7.28±SD 3.73). These data are significantly higher than those found in HWs in the same pandemic period (mean total score: 3.74±SD 3.62). Among the different disorders the borderline personality disorder patients have presented the highest score (mean total score: 8.00±SD 3.50). CONCLUSION: Understanding resident - and HCWs- level variations in hopelessness may be important for targeting interventions to improve the outcome of residential psychiatric patients.

Metabolic Alterations and Drug Interactions: The Role of the Association between Antipsychotics / Mood Stabilizers and Cognitive Deficits.

Alterations in the metabolic profile are one of the main consequences of the use of drug therapies in psychiatric patients. In particular, dysfunction of the metabolic profile (lipid and glycidic) is very frequent in patients taking antipsychotics, especially second-generation ones, and antidepressants. Similar alterations, albeit, to a lesser extent, were highlighted with the use of mood stabilizers. There are some clinical conditions in which clinicians add antipsychotics and mood stabilizers. Our study analyzed this interaction in 116 inpatients. Data showed an overall increase in metabolic parameters in all patients analyzed. However, no statistically significant differences were found in some subgroups of patients. The correlation between metabolic alterations and cognitive dysfunctions in these patients was also analyzed (not statistically significant).

Cryptogenic Stroke In The Context of Pandemic-Related Stress: The Role of Arterial Hemodynamics.

BACKGROUND: Up to 45% of ischemic strokes are cryptogenic, which is an impediment to proposing preventative measures. In this investigation we aimed to study underlying heart arrhythmias in patients with cryptogenic stroke, taking into consideration the context of the COVID-19 pandemic and stressful lockdown conditions. SUBJECTS AND METHODS: In this cross-sectional study we observed 52 patients with cryptogenic stroke >1 month after acute presentation, and a control group consisting of 88 patients without stroke. All patients undewent the laboratory and instrumental investigation consisting of the following: lipid spectrum; hemostasiograms; hemoglobin A1c; transthoracic or/and transesophageal echocardiography; 24-hours monitoring of ECG; computer tomography or magnetic resonance imaging of the brain. We studied the hemodynamics of the common carotid arteries using Doppler ultrasound imaging and digital sphygmography (SG). RESULTS: The groups were indentical with respect to the preponderance of study parameters (sex, age, comorbidities, instrumental and laboratory data). The ischemic stroke group had a statistically significant difference in the prevalence of the first type of extrasystolic arrhythmia according to our gradation of extrasystoles, which are ventricular systoles of extrasystolic contraction appearing before the transmitral blood flow peak (peak E in echocardiography). We observed that earlier ventricular systoles of extrasystole in the cardiac cycle predicted for greater growth of hemodynamic and kinetic parameters. Calculating the indices of a four-field table established the significant relationship between the moment of appearance of extrasystolic ventricular contraction in the cardiac cycle and the risk for cryptogenic stroke (normalized value of the Pearson coefficient (C`) of the two paramaters was 0.318). CONCLUSIONS: Extrasystolic arrhythmia appeared as an additional risk factor of earlier stroke. The most dangerous type of arrhythmia was when the ventricular contraction of the extrasystole appeared before the transmitral blood flow peak in the cardiac cycle. This observation could present a risk-marker for brain-related cardiovascular complications such as stroke, which might be patients suffering from different internal diseases, especially in the context of environmental stress conditions of the current pandemic and its related lockdown measures.

Mixed States: Diagnosis, Assessment and Diagnostic Stability.

Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time. In our clinical practice, we noticed a diagnostic stability using assessment to early identify mixed feaures. Mixed states are often underdiagnosed, with important consequences in terms of worsening prognosis, frequent admission to the hospital, higher suicide risk and poorer quality of life. In order to be diagnosed with the new specifier in the case of major depression/maniac, the new DSM-5 specifier will require the presence of at least three manic/hypomanic symptoms (or depressive in case of maniac episode) that don't overlap with symptoms of major depression. For this reason, we analyzed retrospectively data from patients admitted in the Psychiatric Hospital from January 1st to December 31th 2021 to identify clinical features of the mixed states by administering the G.T.-MSRS scale. Within the 691 subjects of the sample, the large majority (74% of man and 76% of women) met criteria for mixed state; of those only about 34% of man and 31% of women were discharged with a diagnosis of Affective Disorder, however 70% in both man and women were prescribed a mood stabilizer. This study shows that there is a high prevalence of mixed states in the inpatient unit admission, which is demonstrated both from the prescription of mood stabilizers, and confirmed by the diagnosis of mixed states rated with the scale. The scale can be a useful instrument to detect early in the course if the hospitalization the presence of mixed state, in order to guide a tailored psychopharmacological treatment, and improve prognosis.

Educational Initiative about the COVID-19 Pandemic-Related Neuropsychiatry for Early Career Professionals in EU: The Impact of the Novel Virus on Brain, Mind, and Society.

BACKGROUND: The COVID-19 pandemic brought challenges to governments, healthcare systems (including, mental healthcare services), clinicians and researchers in the EU and worldwide. A range of neurological (e.g., brain fog, encephalitis, myalgia) and psychiatric (e.g., affective disorders, delirium, cognitive disturbances) complications of a novel nature have been observed in patients during the acute phase of illness, which often persist as a Long-COVID state for months after the primary recovery. The pandemic has progressed to a psychodemic and syndemic, affecting communities with social distress, panic, fears, increased home violence, and protest movements that derive from conspiracy theories and hostile attitudes towards vaccination and lockdown measures. In response to this complex scenario of major social changes, universities must face the need to equip the new generation of doctors with novel special skills. SUBJECTS AND METHODS: The study course (50 hours duration; 20 lectures, three webinars, three e-discussion forums, five local seminars, two social events, three intermediate assessments and a final test for certification; bilingual Russian/English hybrid format, information materials, video-content, interactive web-page and social media) was developed by the team of the International Centre for Education and Research in Neuropsychiatry (ICERN), and is unique for the EU. The course integrates the most relevant data on SARS-Cov-2-related neuropsychiatry, and COVID-19' pandemic impact on mental health and society, including assignment of the vulnerable groups of students and healthcare professionals. The major topics covered during the course are (i) Novel virus, (ii) Brain, (iii) Society. The project takes place originally in Samara State Medical University. The ICERN Faculty includes academic staff from France, Hungary, Italy, Russia, Switzerland, invited speakers from the WHO Regional Office for Europe and World Psychiatric Association (EU Zones) members, some of them employed at ICERN by remote work contracts. The format of the educational process for students is hybrid suggesting both remote and face-to-face events. Distant learning participants and EU lecturers are to attend on-line via zoom platform, whereas local participants and staff work face-to-face in the ICERN video-conference room. The course is addressed to a broad audience of doctors, undergraduate and postgraduate students, and researchers from EU wishing to upgrade their knowledge in the pandemic-associated neuropsychiatry. RESULTS: The evaluation process supposes three intermediate assessments and a final test for certification. On-line assessment is to be performed at the project web-page - 10 randomly selected questions with scoring from 1 to 10 each. The Pass Score is 70-100. At the end of the course all the participants receive certificates of Samara State Medical University according to the ERASMUS policy book, as planned in 2021. CONCLUSIONS: We formatted this course as essential for the target audience to improve their resources of professional adaptability in the field of neuropsychiatry and mental healthcare management during challenging times. The ICERN course in pandemic-related neuropsychiatry is essential for early career health professionals and targets the principles of "academia without borders" in the context of international medical knowledge exchange. In the conditions of the changing social situation this educational content is necessary for the young doctors to acquire the add-on skills on flexibility to switch toward new professional approaches in the times of need. The long-term outcomes in pandemic-related neuropsychiatry are still to be seen, though the first feedback on the course content is already promising for the academic community.