[Sexual dysfunction on the background of antidepressant therapy]. / Seksual'nye disfunktsii na fone antidepressivnoi terapii.

The review is devoted to the problem of sexual dysfunction caused by taking antidepressants. Sexual dysfunction is widespread, but it is not reported, and its impact on the quality of life and compliance of patients is underestimated. Partly because of its bidirectional association with depression, sexual dysfunction is difficult to diagnose. Possible mechanisms and risk factors associated with sexual dysfunction in patients with depression are considered. The data on the frequency of sexual dysfunction with the use of various antidepressants are given. Therapeutic strategies for sexual dysfunction associated with taking antidepressants are described. The advantages of agomelatin as an antidepressant associated with a low risk of sexual side effects are emphasized.

[Prescription of psychotropic drugs off label]. / Naznachenie psikhotropnykh preparatov vne zaregistrirovannykh pokazanii.

The review was written based on the analysis of available publications (Pubmed, other Internet resources) on the problem of off-label use of drugs. It reveals the concept of off-label prescribing and discusses modern approaches to the use of off-label drugs in domestic psychiatric and addiction practice. The problems of normative substantiation of prescribing off-label drugs are discussed. It has been established that, despite some progress in this matter, for patients in adult psychiatric practice, the use of off-label therapy is carried out only by decision of the medical commission. The issue of substantiating the prescription of off-label drugs on the basis of scientific and clinical studies and experience in the use of drugs at the legislative level remains relevant.

[Borderline personality disorder in clinical outpatient practice]. / Pogranichnoe rasstroistvo lichnosti v klinicheskoi vnebol'nichnoi praktike.

OBJECTIVE: To investigate Borderline Personality Disorder (BPD) and associated psychiatric disorders in real clinical practice. MATERIAL AND METHODS: Fifty patients (72% female; n=36; 28% male; n=14, aged 22.4±4.3 years) with ICD-10 diagnosis F60.31 «Emotionally Unstable Personality Disorder, Borderline Type¼ were examined. Research methods included a clinical follow-up method and psychometric assessment. RESULTS: The majority of patients were female (72%). Asocial environment and low social status were typical for the patients with BPD. The vast majority of patients (86%; n=43) were not diagnosed with BPD when they first consulted a psychiatrist. In 24% of patients comorbid psychiatric disorders were diagnosed, of which affective spectrum disorders were predominant. Depressive (94%) and anxiety (80%) syndromes were leading in the clinical presentation. BPD patients were characterized by the absence of somatic components of depression, vitality of affect. CONCLUSIONS: Women are predominant among patients with BPD in outpatient practice. Impairment of interpersonal interaction and antisocial environment were typical for them. Comorbidity of BPD and affective disorders, mostly anxious-depressive, was confirmed. Low diagnosability of BPD at the initial psychiatric examination was established.

[New goals for depression therapy]. / Novye tseli terapii depressii.

The review is devoted to the consideration of the effectiveness of treatment of depression, the ratio of symptomatic and functional remission, factors associated with the achievement of high-quality remission and recovery of patients. Currently, between 29 and 66% of patients do not fully recover from antidepressant therapy and have residual symptoms of depression. Persistent depressive symptoms, neurocognitive deficits predict increased risk of relapse, social disability, impair interpersonal relationships, and represent a barrier to functional recovery. The results of a comparative analysis of antidepressants in terms of their effect on the restoration of the functioning of patients with depression are presented. It has been established that the positive impact on the social functioning of patients should be an important criterion when choosing an antidepressant for supporting therapy. Effective therapeutic approaches that maintain symptomatic remission increase the potential for functional recovery.

[The problem of suicide in depression in the modern world]. / Problema suitsida pri depressii v sovremennom mire.

OBJECIVE: To analyze the literature data on the relationship between antidepressant therapy and suicide risk and the ways to prevent suicidal behavior in patients on antidepressant therapy. MATERIAL AND METHODS: A non-systematic review of publications was conducted using keywords in the following databases: ELibrary.ru, PubMed, Cochrane Database of Systematic Reviews. Inclusion criteria were meta-analyses, Cochrane reviews, epidemiological and original studies. RESULTS: Data from original studies are inconsistent, but more evidence-based epidemiologic studies support the preventive role of antidepressant therapy with regard to suicide. An increased risk of suicide with antidepressant therapy is seen in younger patients, especially in the first 2 weeks of treatment, in the absence of a therapeutic response. The initial dosage of antidepressants, possibly the type of antidepressant, is of some importance. The group at risk of committing suicide is those who have received psychotropic therapy in the previous year. CONCLUSION: There is no generally accepted model of prevention, but it is recommended that patients be observed during the first 4 weeks of treatment for depression, as well as during the period of antidepressant dose modification.

[Mechanisms of action and clinical effects of vortioxetine]. / Vortioksetin: ot mekhanizmov deistviya k klinike.

The opinion article is devoted to the analysis of a large-scale comprehensive systematic review of relevant and practically oriented studies of vortioxetine use in depression for the period to 2020. The mechanisms of multimodal action, issues of efficacy and safety of the drug, including direct procognitive effects, effects on anhedonia, anxiety, sleep disorders, analgesic and anti-inflammatory effects are highlighted. An increase in the efficacy of vortioxetine when the dose is increased to 20 mg/day is emphasized. Prospective directions for antidepressant research are outlined.

[On the treatment of bipolar affective disorder]. / K voprosu o terapii bipolyarnogo affektivnogo rasstroistva.

In the scientific review, in order to highlight the problem of bipolar affective disorder, a systematic review of the literature in PubMed and Google was conducted, epidemiological data were presented, issues of systematization and pharmacotherapy were considered, including modern meta-analyses and recommendations, including the effectiveness and safety of antipsychotic therapy. Special attention is paid to the place of quetiapine in the treatment of both manic and depressive symptoms of bipolar disorder. Relevant full-text articles, systematic reviews, meta-analyses identified by keywords were analyzed. The review did not include publication of clinical trial results.

[Second-generation long-acting injectable antipsychotics in clinical practice]. / In"ektsionnye antipsikhotiki-prolongi vtoroi generatsii v klinicheskoi praktike.

On the example of 5 clinical cases of paranoid schizophrenia at different stages of the development of the disease, the therapeutic tactics of using drugs from the group of second-generation injectable prolong antipsychotics to solve problems that arise during anti-relapse therapy are shown. The research data substantiating these approaches are presented. Various combination therapy options are discussed, including at the stage of drug replacement and the appointment of a second-generation long-acting injectable antipsychotic.

[Depression in the structure of schizophrenia: clinical and biochemical characteristics]. / Depressiya v strukture shizofrenii: kliniko-biokhimicheskaya kharakteristika.

THE AIM OF THE STUDY: Was to investigate clinical and biochemical correlates of depression in the structure of schizophrenia to improve its diagnosis and differential diagnosis and to deepen understanding of mechanisms of schizophrenia development. Material and Methods. Forty-two inpatients at the stabilization stage of paranoid schizophrenia, aged 29.5±5.9 years, of whom 64.3% were women, were examined. The duration of the disease was 5.6±6.3 years. We used clinical and psychopathological methods, clinical scales (PANSS, SANS, BACS, Calgary Scale), catamnestic and clinic-laboratory methods (determination of brain-derived neurotrophic factor BDNF, proinflammatory cytokine interleukin-6, C-reactive protein). Results. At the stabilization stage, depression in patients with paranoid schizophrenia occurred in 19% of cases, more frequently in women. Female patients were more severely depressed, which was associated with an increased concentration of C-reactive protein, while negative symptoms predominated in male patients as compared to females. The presence of depression correlates with a lower severity of psychopathological, primarily positive symptoms and with a greater severity of neurocognitive deficit in schizophrenic patients. BDNF level directly correlates with the severity of positive and negative symptoms, and the level of interleukin 6 at the stage of remission formation does not differ from that in healthy individuals. C-reactive protein levels are associated with the characteristics of the course of schizophrenia.

[Prevention of impulsive suicide with antidepressants in outpatients]. / Preventsiya impul'sivnogo suitsida s primeneniem antidepressantov u ambulatornykh patsientov.

Self-poisoning is a common method of suicide, for which various medications are used, including antidepressants. A non-systematic review of Russian-language and English-language publications, by keywords, in the databases: ELibrary.ru, PubMed, Cochrane Database of Systematic Reviews. The purpose of the review was to analyze the literature on new risk factors and methods of their reduction in suicides with self-poisoning with antidepressants. Every fifth (20%) self-poisoning performed with antidepressants. In self-poisoning attempts, one drug used in 55% of cases, and more than one drug was used in 45% of cases. Impulsive suicides account for up to half of all suicide cases. Risk factors for impulsive suicides include the presence of impulsive character traits, female gender, young age, and the use of psychostimulants. The WHO Regional Office for Europe's mhGAP-IG guidelines recommend limiting access to a patient at risk of suicide to a weekly dose of an antidepressant. Preferably, the use of antidepressants from the group of SSRIs in small forms of release.

[Cognitive impairment in remitted patients with bipolar disorder]. / Kognitivnye narusheniya u patsientov s bipolyarnym affektivnym rasstroistvom v remissii.

OBJECTIVE: To assess the frequency and severity of cognitive impairment as well as its correlations with clinical characteristics in remitted patients with bipolar disorder (BD). MATERIAL AND METHODS: Eighty-five patients with BD type I (64 patients) and BD type II (21 patients) in remission were examined (average age 36.6±5.7). Affective symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and Young's Mania Rating Scale (YMRS). Cognitive impairment was assessed using the Brief Neuropsychological Cognitive Examination (BNCE). RESULTS: Cognitive impairment was revealed in 43.5% of the patients. The frequency and structure of cognitive impairment in patients with BD type I and type II did not differ. The patients with cognitive impairment were characterized by decreased speed of mental processes, decreased working memory and attention deficit. The correlation of the total BNCE score with the age of the patients, duration of the disease, total HDRS and YMRS scores was revealed. CONCLUSION: The results demonstrate the affective nature of cognitive deficit in the patients. Cognitive impairment in remitted patients with BD is a significant therapeutic target.

[Comorbidity of depression and anxiety in clinical practice]. / Komorbidnost' depressivnykh i trevozhnykh rasstroistv v klinicheskoi praktike.

OBJECTIVE: The study was the comparative characterization of depressed patients depending on the presence of comorbid anxiety. MATERIAL AND METHODS: Thirty patients of the Clinic of neuroses named after acad. I.P. Pavlov Clinic of Neuroses. Comparison groups included 15 patients with comorbid anxiety and depressive disorders and 15 patients with depressive disorder without comorbid anxiety. The groups were comparable by sex and age. Clinical-catamnestic, clinical-therapeutic, and clinical-scale methods, including the Hamilton Depression and Anxiety Scales, were used during the study. RESULTS: The structure of clinically diagnosed comorbid anxiety and depressive disorders was shown to be characterized by high representation of somato-vegetative symptoms and higher level of depression in comparison to depressive disorder without comorbid anxiety. According to psychometric assessment results, the level of anxiety did not differ in comparison groups, while clinically, according to ICD-10 criteria, anxiety was not diagnosed, indicating a discrepancy between clinical and scale assessments of anxiety and depressive disorders and greater accuracy of clinical and scale assessment of the condition. The effectiveness of combined treatment, including psychotropic therapy and psychotherapy, was lower in patients with comorbidity of anxiety and depression according to parameters of the degree of reduction of psychopathological symptoms, duration of treatment, and quality of remission. The structure of incomplete remission was similar in patients with comorbid anxiety and depressive disorders and depression. CONCLUSION: The obtained data suggest the expediency of continuous systematization of affective disorders and the need to improve the diagnostic criteria of comorbid anxiety and depressive disorders on the basis of combined clinical and scale assessment.

[Prevalence, structure, and risk factors for mental disorders in older adults.]

This review focuses on assessing the prevalence and risk factors of mental disorders in older adults in the current era, including the COVID-19 pandemic. A systematic review of the literature in PubMed, Elsevier, Google, using keywords over the past 10 years was conducted. It is shown that data on the prevalence of psychiatric disorders in the elderly population, including in comparison with young adults, diverge significantly. The significant incidence of mental disorders among nursing home residents is highlighted. The relevance of non-psychotic disorders of the depressive and anxiety spectrum in older adults is demonstrated. The difficulty of diagnosing mental disorders associated with somatic pathology as well as cognitive disorders in elderly patients is demonstrated. Risk factors for mental disorders in older adults are socio-demographic as well as economic, psychological and somatic factors. The problem of mental health of the elderly under the COVID-19 pandemic associated with specific risk factors for mental disorders is characterized. The shortage of evidence-based research in the treatment of mental disorders in old age and the urgency to improve the organization of psychiatric care for such patients are noted. Understanding the structure and prevalence of mental disorders among the elderly will allow to optimize the work of the healthcare system.

[Apathy syndrome in depressed patients previously treated with selective serotonin reuptake inhibitors]. / Sindrom apatii u depressivnykh patsientov, poluchavshikh lechenie selektivnymi ingibitorami obratnogo zakhvata serotonina.

This review of literature considers apathy syndrome induced by selective serotonin reuptake inhibitors (SSRI). Epidemiology and etiology of this phenomenon are not clear. Clinical features, diagnosis of apathy, differentiating and correlations between apathy and depression are presented. The possible mechanisms of onset and strategies of therapy of SSRI-induced apathy are discussed. It has been concluded that, despite the clinical evidence of the relationship between apathy and SSRI treatment, evidence-based research is needed.

[The effectiveness and feasibility of preventive interventions for psychoses]. / Éffektivnost' i tselesoobraznost' preventivnoi terapii psikhozov.

In recent years, prevention of psychosis in people, who have early signs of its development, but do not fully meet the diagnostic criteria of mental disorder, has been an important issue of research in psychiatry. The article considers the approaches to the intervention in high-risk states of psychosis. At present, it can be considered obvious that early intervention in ultra-high-risk (UHR) individuals, most often consisting of cognitive-behavioral therapy and second generation antipsychotics, is safe, effective and cost-effective even in cases, in which psychosis develops because of the increase in the time before it occurs, reduction of the intensity of stress and improvement of outcomes by reducing the duration of untreated psychosis and lowering probability of hospitalization. Comparative studies of the first generation antipsychotics would be appreciated in UHR. The available data make it possible to state that not only the psychosis prevention should be the goal of interventions, but also trying to maintain personal and social functioning of people with UHR. The main purpose of interventions should be considered not to prevent psychosis, but to achieve more favorable outcomes.

[Morphofunctional status of inner ear's cells in case of experimental hearing loss]. / Morfofunktsional'noe sostoianie kletok vnutrennego ukha pri éksperimental'noi tugoukhosti.

AIM: To study ultrastructural changes in stria's vascularis cells of inner ear and determine possible ways of correction. MATERIAL AND METHODS: The work was carried out on male guinea pigs. After completion of the experiment, stria vascularis of inner ear was subjected to electron microscopic examination. RESULTS AND DISCUSSION: In the control group (receiving gentamycin sulfate in an ototoxic dose), signs of blood flow disturbance were revealed, as well as ultrastructural changes in stria's vascularis cells (expansion of intercellular space, deformation of organelles, thinning of glycocalyx, blebbing). Also, fragmented cells were found. These changes are characteristics for apoptosis. In experimental group (receiving gentamycin sulfate and melaxen), degenerative changes were less pronounced. An increase of cell's secretory activity was observed. CONCLUSION: Changes in stria's vascularis cells by using melaxen are less pronounced. Increase of cell's secretory activity in stria vascularis is a compensatory reaction and saves auditory function.

[The role of fraction analysis of ferritin in diagnostic of secondary hemophagocyte syndrome].

The secondary hemophagocytic syndrome is a life-threatening condition characterized by non-specifc manifestations: systemic inflammatory reaction, cytopenia, liver affection, high content of ferritin in blood serum. One of manifestations of secondary hemophagocytic syndrome is decreasing of level of glycated ferritin in blood serum expressed in percentage of total level. The detection of glycated ferritin can be applied for a differentiated diagnosis with cli9nically similar conditions, including septic process. The purpose of study was to determine clinical value of easurement of glycated ferritin for diagnostic and differentiated diagnostic of secondary hemophagocytic syndrome. The analysis was applied to samples of blood serum and clinical data of patients with diagnoses of secondary hemophagocytic syndrome (n=40), severe sepsis (n=24), cytolitic syndrome (n=36) and healthy donors (n=40). The total content of ferritin is established using rbidimetric technique ("BioSystems", Spain). The glycated ferritin was calculated. To determine level of of glycated ferritin the glycated fraction of ferritin was precipitated using concanavalin A, polymerized with sepharose 4B ("GE Healthcare", USA). The normal values of glycated ferritin made up to 78.3%-87.1%. Under secondary hemophagocytic syndrome decreasing of content of glycated ferritin made up to 25.0 ± 18.7% and was signifcantly lower than under sepsis (47.0 ±17.7%, p<0.001) and cytolytic syndrome(63.5% ±18.7%, p<0.001). According the results of ROC-analysis, the area under curve was maximal as compared with other markers of secondary hemophagocytic syndrome, including total ferritin, triglycerides, fbrinogen. At decreasing of level of glycated ferritin lower than 30.4% the applied technique provides clinical sensitivity 69%, specifcity 94.3%, accuracy 86.9% in applying differentiating diagnosis of secondary hemophagocytic syndrome. At calculation of absolute content of non-glycated ferritin it was discovered that its values correlate with concentration of triglycerides, international normalized ratio, aspartataminotransferase, alaninaminotransferase and total bilirubin in patients with secondary hemophagocytic syndrome (p<0.05). Therefore, decreasing of level of glycated ferritin permits to diagnose secondary hemophagocytic syndrome with higher accuracy.

[Multi-centre clinical assessment of the Russian language version of the Diagnostic Interview for Psychoses]. / Mnogotsentrovoe klinicheskoe issledovanie russkoiazychnoi versii diagnosticheskogo interv'iu dlia psikhozov.

OBJECTIVES: The Diagnostic Interview for Psychoses (DIP) was developed to enhance the quality of diagnostic assessment of psychotic disorders. The aim of the study was the adaptation of the Russian language version and evaluation of its validity and reliability. MATERIAL AND METHODS: Ninety-eight patients with psychotic disorders (89 video recordings) were assessed by 12 interviewers using the Russian version of DIP at 7 clinical sites (in 6 cities of the Russian Federation). DIP ratings on 32 cases of a randomized case sample were made by 9 interviewers and the inter-rater reliability was compared with the researchers' DIP ratings. Overall pairwise agreement and Cohen's kappa were calculated. Diagnostic validity was evaluated on the basis of comparing the researchers' ratings using the Russian version of DIP with the 'gold standard' ratings of the same 62 clinical cases from the Western Australia Family Study Schizophrenia (WAFSS). RESULTS: The mean duration of the interview was 47±21 minutes. The Kappa statistic demonstrated a significant or almost perfect level of agreement on the majority of DIP items (84.54%) and a significant agreement for the ICD-10 diagnoses generated by the DIP computer diagnostic algorithm (κ=0.68; 95% CI 0.53,0.93). The level of agreement on the researchers' diagnoses was considerably lower (κ=0.31; 95% CI 0.06,0.56). The agreement on affective and positive psychotic symptoms was significantly higher than agreement on negative symptoms (F(2,44)=20.72, p<0.001, η2=0.485). The diagnostic validity of the Russian language version of DIP was confirmed by 73% (45/62) of the Russian DIP diagnoses matching the original WAFSS diagnoses. Among the mismatched diagnoses were 80 cases with a diagnosis of F20 Schizophrenia in the medical documentation compared to the researchers' F20 diagnoses in only 68 patients and in 62 of the DIP computerized diagnostic outputs. The reported level of subjective difficulties experienced when using the DIP was low to moderate. CONCLUSION: The results of the study confirm the validity and reliability of the Russian version of the DIP for evaluating psychotic disorders. DIP can be recommended for use in education and training, clinical practice and research as an important diagnostic resource.

Analytical and numerical study of travelling waves using the Maxwell-Cattaneo relaxation model extended to reaction-advection-diffusion systems.

Within the framework of the Maxwell-Cattaneo relaxation model extended to reaction-diffusion systems with nonlinear advection, travelling wave (TW) solutions are analytically investigated by studying a normalized reaction-telegraph equation in the case of the reaction and advection terms described by quadratic functions. The problem involves two governing parameters: (i) a ratio φ^{2} of the relaxation time in the Maxwell-Cattaneo model to the characteristic time scale of the reaction term, and (ii) the normalized magnitude N of the advection term. By linearizing the equation at the leading edge of the TW, (i) necessary conditions for the existence of TW solutions that are smooth in the entire interval of -∞<ζ<∞ are obtained, (ii) the smooth TW speed is shown to be less than the maximal speed φ^{-1} of the propagation of a substance, (iii) the lowest TW speed as a function of φ and N is determined. If the necessary condition of N>φ-φ^{-1} does not hold, e.g., if the magnitude N of the nonlinear advection is insufficiently high in the case of φ^{2}>1, then, the studied equation admits piecewise smooth TW solutions with sharp leading fronts that propagate at the maximal speed φ^{-1}, with the substance concentration or its spatial derivative jumping at the front. An increase in N can make the solution smooth in the entire spatial domain. Moreover, an explicit TW solution to the considered equation is found provided that N>φ. Subsequently, by invoking a principle of the maximal decay rate of TW solution at its leading edge, relevant TW solutions are selected in a domain of (φ,N) that admits the smooth TWs. Application of this principle to the studied problem yields transition from pulled (propagation speed is controlled by the TW leading edge) to pushed (propagation speed is controlled by the entire TW structure) TW solutions at N=N_{cr}=sqrt[1+φ^{2}], with the pulled (pushed) TW being relevant at smaller (larger) N. An increase in the normalized relaxation time φ^{2} results in increasing N_{cr}, thus promoting the pulled TW solutions. The domains of (φ,N) that admit either the smooth or piecewise smooth TWs are not overlapped and, therefore, the selection problem does not arise for these two types of solutions. All the aforementioned results and, in particular, the maximal-decay-rate principle or appearance of the piecewise smooth TW solutions, are validated by numerically solving the initial boundary value problem for the reaction-telegraph equation with natural initial conditions localized to a bounded spatial region.

[Cognitive disorders in patients with schizophrenia at different stages of the disease].

OBJECTIVE: To study cognitive disorders in patients with schizophrenia at different stages of the disease. MATERIAL AND METHODS: Forty-five patients with paranoid schizophrenia with first and recurrent episodes were examined clinically and psychometrically using the PANSS. Neurocognitive functioning was assessed with the «Rey--Osterrieth Complex figure¼. RESULTS AND CONCLUSION: Differences were found not only between patients with chronic and first-episode schizophrenia, but also between first-time hospitalized and re-hospitalized patients within the first-episode group.