An interview with Professor Lyubomir Ivanovich Aftanas, Dr. Med. Sci., academician of the Russian Academy of Science; Director of the Scientific Research Institute of Neuroscience and Healthcare; Head of the Experimental and Clinical Neuroscience Section; Director of the Centre for Non-invasive Brain Stimulation at the clinic of psychosomatic medicine, Scientific Research Institute of Neuroscience and Healthcare; Chairperson at the Chair of Neuroscience of the Institute of Medicine and Psychology, Novosibirsk State University. Lyubomir Ivanovich told us about the fundamental achievements of the neuroscience in the study of integrative brain activity and psychosomatic connections for the last 15 years, which evidence the ongoing quiet revolution in mental health. Also, he shared his experience in the use of artificial intelligence technologies and described in detail priority studies conducted at the Scientific Research Institute of Neuroscience and Healthcare. Professor Aftanas places special emphasis on the activities under the auspices of ENIGMA. The study of the microstructural and functional markers of major depressive disorder continues; neuroimaging predictors of the resistant forms of depressions and the efficiency of rhythmic transcranial magnetic stimulation (rTMS) are being analysed. The results are more than promising. The interview is concluded with a discussion of the currently developed non-invasive diagnostic methods for affective disorders and neurodegenerative diseases.

Study objective. To develop knowledge of the epileptic status (ES) in early post-op period in patients with diffuse brain gliomas.

Design. Single-centre retrospective study.

Materials and methods. The study group included 280 patients with diffuse brain gliomas: 156 males (55.71%) and 124 females (44.29%). The average age of subjects was 45.81 ± 15.90 years.

To identify the diffuse glioma sub-type, 118 patients underwent an examination of frequent mutations of genes IDH1 (exon 4) and IDH2 (exon 4) in tumour tissue using a high-resolution analysis of PCR product melting profile and sequencing.

Results. ES in early post-op period developed in 3.57% of cases (n = 10) and manifested predominantly with motor symptoms (paroxysmal, myoclonic, focal motor symptoms).

Epilepsy diagnosed before surgery was not a risk factor of ES in early post-op period. Awake surgeries, aiming at determination of the functionally significant (verbal, motor) areas of the brain, as well as the use of intraoperative neurophysiological monitoring (direct cortex stimulation during surgery) did not increase the rate of ESs. It has been demonstrated that ES in patients with diffuse brain gliomas can develop after a longer surgery (p = 0.0129) or longer anaesthesia (p = 0.0251). The association between ES in early post-op period and cerebral complications has been reported: in patients with complications, the rate of ESs was 17.07% vs. 1.26% (p < 0.00001). in patients without complications.

The rate of early ESs did not drop with preventive antiepilepsy drugs prescribed to patients with diffuse brain gliomas without pre-op epilepsy, as well as with prolonged sedation with propofol and artificial lung ventilation.

Conclusion. ES in early post-op period requires separate diagnostic and treatment algorithms. 

Aim. To investigate parameters of mineral metabolism and bone mineral density in patients with long-term administration of anticonvulsants and healthy volunteers.

Design. Observational cross-sectional study with including two comparison groups.

Materials and methods. The study included 100 patients receiving anticonvulsants for more than 12 months and 58 healthy volunteers without antiepileptic drugs. Clinical neuropsychiatric examination, analysis of laboratory parameters of microelements and hormones associated with bone metabolism, and radiologic examination of bone mineral density using quantitative computed tomography (CT-densitometry) were performed on all study participants.

Results. The comparative analysis of laboratory parameters of micro-elements and hormones associated with bone metabolism revealed statistically significant differences in mean values of calcium ionized, vitamin D, free thyroxine and prolactin between the groups of patients receiving anticonvulsants and healthy participants (p (U) = 0.044, p (U) = 0.052, p (U) = 0.001, p (U) = 0.003, respectively). Statistically significantly higher levels of vitamin D deficiency (p (χ²) = 0.010, p (χ²) = 0.016) were found in patients with long-term use of anticonvulsants of different generations, in contrast to healthy individuals. The comparative analysis of vitamin D indices and changes in bone mineral density according to CT-densitometry in the groups of patients with long-term anticonvulsants and healthy participants showed no statistically significant differences (p (χ²) = 0.851, p (χ²) = 0.174, respectively). Patients receiving anticonvulsants had significantly higher levels of ionized calcium (p (χ²) < 0.001) compared to healthy participants, which is a marker of the prevalence of the process of osteoresorption over osteogenesis.

Conclusion. The results of the study confirm the negative effect of anticonvulsants on mineral metabolism and bone density. The results of the study may be important for the development of diagnostic and therapeutic measures in patients taking anticonvulsants for the early prevention of bone metabolism disorders and the development of osteoporosis.

Aim. To identify the features of movement recovery performed on a horizontal plane by the foot of the affected lower limb and associated changes in maintaining body balance in patients with mild to moderate central paresis, and to identify factors for their improvement.

Design. Clinical prospective randomized interventional longitudinal pilot study.

Materials and methods. The study included 115 patients with ischemic stroke in the carotid basin, who received medical assistance according to standards and clinical guidelines. The patients were divided into two groups: the main group (I), in which stabilometric training was included in the rehabilitation measures, and the comparison group (II), in which it was not performed. Additionally, both groups were divided into subgroups with mild and moderate paresis depending on the degree of strength loss in the foot. At the beginning and end of the course, all patients underwent testing of available movements on a horizontal plane along the proposed rectilinear trajectory to the limitations corresponding to the image on the monitor screen reflecting the game situation. Foot movements were performed sequentially in the frontal plane by abduction and adduction in the hip and flexed knee joints of the paretic lower limb and in the sagittal plane by extension in the knee with simultaneous flexion in the ankle joint in combination with adduction, abduction and rotation of the foot. Then the direction was changed, and the patients flexed the knee and extended the ankle joint of the paretic lower limb. Only patients from Group I practiced these movements during repeated training. Functional testing of the motor sphere, stabilometric tests were conducted, emotional-volitional and cognitive disorders that could affect the effectiveness of the training were identified.

Results. Targeted work on repeated performance of given rectilinear single-plane movements over a short course (10 sessions of 10 minutes 4 times a week) was accompanied by an improvement in balance, primarily in individuals with a moderate degree of muscle strength reduction in the foot. Improvement of stabilometric indicators in Group I reflected the effectiveness of the training. Sensitive indicators were the speed of movement of the center of pressure, area and energy intensity of the statokinesiogram. When analyzing the factors influencing the correction of movements, it was found that the greatest effect was produced by high motivation, preservation of cognitive functions, absence of anxiety and depression with active inclusion of visual control in the implementation of the motor act throughout the rehabilitation course.

Conclusion. Motor rehabilitation with targeted correction of foot movements in patients with central paresis of the lower limb after stroke led to an improvement in balance in a short time, especially in patients with a moderate degree of muscle strength loss in the foot. Patients with mild foot paresis in stroke should be recommended a training course in practicing foot movements, consisting of at least 6 sessions of 10 repetitions each, and with moderate paresis — of 8 sessions of 10 repetitions. Correction of rectilinear single-plane movements in the frontal plane is formed later by one training session than in the sagittal plane. 

Aim. To study the psychological characteristics and microstructural changes of the brain, according to magnetic resonance imaging (MRI), in healthy volunteers with pineal cyst to determine their clinical significance.

Design. A prospective case — control study.

Materials and methods. The study involved conditionally healthy volunteers. Based on brain MRI data, study groups were formed: the main group consisted of 33 people with pineal cyst, the control group consisted of 30 people with normal epiphysis structure. The groups were comparable in gender and age. We conducted neurological examination, experimental psychological and neuropsychological examinations, MRI of the brain with post-processing of the data obtained by MR Voxel-based morphometry, determination of the level of melatonin in saliva using enzyme immunoassay.

Results. The results of experimental psychological and neuropsychological examinations have shown the tendency of people with a pineal cyst to be absorbed in worries, thoughts about something, as well as to express anxiety. According to MR Voxel-based morphometry, it was found that during cystic transformation of the pineal gland, there are zones of increased cortical thickness in both parietal lobes, each of which is located in the central sections of the postcentral gyrus on the left and the superior parietal gyrus on the right.

Conclusion. Psychological features in the presence of a pineal cyst indicate the need to include an experimental psychological examination in the protocol of patient management to identify risk groups for affective disorders. The data obtained by us on microstructural changes in the cortex of the parietal lobes during cystic transformation of the epiphysis indicate the variability of the normal structure of the brain substance and require further clarification.

Aim. Identification of the features of primary and comorbid signs of borderline personality disorder (BPD) in teenagers.

Design. Open-label cohort study.

Materials and methods. A pilot clinical evaluation was performed for a full cohort of teenagers admitted to psychiatric in-patient clinic in 2021–2022, the condition of which corresponded to the International Classification of Diseases, revision 11, BPD criteria. The study included 74 teenagers aged 11–17 years old, of which 72 were females. The mean age was 16.6 years old.

Results. All 74 patients had comorbid disorders; complex comorbidities were observed in 31 (41.9%) patients. Forty-seven (63.5%) patients had a history of bullying. Anxiety and post-stress disorders preceded clinical manifestations of the BPD symptoms in 64 (86.5%) cases. Self-harm and attempted suicide were recorded in 58 (78.4%) patients; problems with self-identification, including gender preferences, were observed in 56 (75.7%) patients, problems with interpersonal relationships — in 64 (86.5%) patients, and dissociative symptoms — in 41 (55.4%) patients. Multiple personality disorder identification as “we”, “multiple personalities”) was observed in 12 (16.2%) cases. Clinically significant signs of various eating disorders were diagnosed in 16 (21.6%) patients. After being treated in an in-patient clinic, 65 (87.8%) teenagers demonstrated significant improvement. Most challenging was the management of patients with substantial dissociative symptoms, persistent “gender identity disorder” and trends to use abnormal psychological defence mechanisms.

Conclusion. Interim data show that manifestation of symptoms and comorbidities, as well as a short-term response to therapy in teenagers differ from those in adults with BPD, favouring BPD with adolescent onset as a relatively separate sub-type and justifying a dimensional approach for the search and optimisation of early therapeutic interventions in teenagers with BPD.

Aim. To study the types of remission and levels of peripheral inflammatory cytokines as potential biomarkers of remission in patients at the early stages of schizophrenia.

Design. A naturalistic study.

Materials and methods. Forty-eight patients (25 women and 23 men) were examined at the initial stages of schizophrenia during the period of remission (age — 28.3 ± 5.8 years). The duration of the disease was 2.7 ± 1.3 years, the average age of disease onset — 25.8 ± 5.5 years. The average number of relapses reached 1.8 ± 0.7. 19 (40%) of patients had one psychotic episode in their anamnesis, 24 (50%) — two, 5 (10%) — three. The control group included 86 people, 38 men and 48 women, aged 18 to 30 years without mental, autoimmune disorders, exacerbation of chronic somatic diseases (standard relatively healthy group, the level of proinflammatory cytokines in participants tended to zero). The study used a clinical and psychopathological method and a standardized assessment using the Positive and Negative Syndrome Scale (PANSS).

Results. The average duration of remission was 11.4 months. In the early stages of schizophrenia, the paranoid type of remission was predominant (48%). The thymopathic type of remission occurred in 18% of cases, apathetic and hypochondriacal — 10% each, pseudopsychopathic — in 8%, asthenic — in 6%. General psychopathological symptoms were most pronounced in hypochondriacal, residual negative symptoms — in the apathetic type of remission. In the hypochondriacal type, the severity of positive and negative symptoms did not differ, and in the paranoid type, residual positive symptoms prevailed over negative ones. The thymopathic type of remission was distinguished by the least severity of residual symptoms. In 70% of patients in the early stages of schizophrenia, a significant increase in blood cytokine levels was found compared to those in the control group. The levels of interleukins (IL) 6, IL-9, IL-10, IL-13, IL-22, tumor necrosis factor α, CCL20/MIP3-α increased to the greatest extent (p = 0.001). The level of IL-22 correlated with the total PANSS score (r = –0.52; p = 0.008), and the level of IL-6 — with the composite PANSS index (the difference between the sum of the scores of positive and negative symptoms) (r = 0.46; p = 0.022). The strongest cytokine reaction was observed in the paranoid and pseudopsychopathic variants due to an increase in the content of IL-6, IL-33 and IL-13. The longer the duration of the present remission, the lower were the levels of IL-33 (r = –0.45; p = 0.023), IL-17A (r = –0.40; p = 0.049), IL-17F (r = –0.59; p = 0.002).

Conclusion. The available data indicate an important role of cytokines in the development of schizophrenia. The presented results may have prognostic value for assessing the stability of remission, the studied cytokines — serve as potential biomarkers of schizophrenia remission and therapeutic targets for pathogenetic therapy.

Aim. A comparative analysis of the effectiveness of neuroleptics in patients with paranoid schizophrenia with deficit changes at the personal level and non-suicidal auto-aggressive actions (NAA) who are on compulsory treatment.

Design. Full-scale non-randomized longitudinal study

Materials and methods. The study included 237 patients with paranoid schizophrenia during maintenance therapy: 76 people were on risperidone monotherapy, 61 patients received quetiapine, and 100 patients took haloperidol. The clinical effectiveness of therapy was determined by comparative analysis of the frequency of exacerbation of psychotic symptoms, the severity of negative disorders, the frequency of acts of non-suicidal auto-aggression and the level of social functioning. In addition to clinical observation, the Scale of Negative Psychopathology (SANS) and the Social Functioning Scale (PSP) were used. Fisher's test and ANOVA analysis of variance were used to statistically evaluate the data.

Results. All drugs helped reduce the incidence of exacerbation of psychotic disorders, while only with the use of risperidone and haloperidol positive changes in antipsychotic activity were statistically significant (p < 0.01). All drugs helped reduce the severity of negative disorders. When taking risperidone, a statistically significant decrease in disorders associated with flattening and rigidity of affect and attention was noted (p ≤ 0.05). Haloperidol caused a decrease in flattening and rigidity of affect, attention and speech disorders, and apato-abulic syndrome (p ≤ 0.05). All drugs statistically significantly reduced the risk of NAA (p ≤ 0.05), and also contributed to an increase in the level of social functioning of patients, and in patients taking haloperidol, statistically significant changes in this indicator appeared earlier. By the end of the study, while taking each of the drugs included in the study, statistically significant positive changes in the studied parameters were noted (p ≤ 0.05).

Conclusion. The first-line drug for patients with paranoid schizophrenia with deficient personality changes and NAA who are on compulsory treatment is haloperidol. An alternative treatment method for this group of patients may be the administration of risperidone.

Aim. To substantiate the implementation effectiveness differential programs medical and social rehabilitation voluntarily hospitalized patients with paranoid schizophrenia to reduce the hospitalizations number.

Design. Comparative prospective study.

Materials and methods. The study included 100 patients with paranoid schizophrenia, the retrograde duration and anterograde observation was ≥ 3 years. Based on the clinical study clinical and social determinants, three patient’s groups were identified depending on the identified motives for self-seeking psychiatric care: a paranoid motive group (PM) associated with delusional behavior (35%); nonrare psychopathological motives group (NPM) associated with other mental disorders not associated with delusional symptoms (38%); non-psychopathological motives group (NM) not associated with psychopathological symptoms (27%). Further, based on the clinical indicators compliance assessment according to the Positive and Negative Syndrome Scale (PANSS) with the social adaptation level according to the Personal and Social Performance Scale (PSP), patients groups were identified based on the disease clinical picture, cognitive, negative and positive symptoms, as well as adaptation potential, social functioning level and life indicators quality: compensated group (compensation in clinical and social aspects — 15%); decompensated group (clinical and social decompensation — 53%); adapted group (severe clinical disorders with satisfactory social compensation — 20%); conflict group (mild clinical manifestations (the non-psychotic register disorders) and severe social decompensation — 12%).

Results. Based on the clinical indicators compliance assessment with the social functioning level for various groups of patient’s social adaptation, differential programs have been developed aimed at reducing the hospitalizations number, including various psychosocial interventions kinds. The psychotic attacks frequency in the PM group did not change significantly with a sufficiently significant decrease in the independent requests number for psychiatric care from 1.6 ± 0.2 to 1.4 ± 0.3 (t > 2, p > 0.95). In the NPM group, both the psychotic attacks frequency and the number of independent visits decreased (in both cases, t > 2, p > 0.95). In the NM group, it was not possible to achieve a statistically significant decrease in the independent requests number for psychiatric care with an observed significant decrease in the psychotic attacks frequency (t > 2, p > 0.95). The hospitalizations duration in the NPM and NM groups was significantly reduced (72 ± 9 to 67 ± 6 and 38 ± 4 to 34 ± 6 bed days (t > 2, p > 0.95), respectively) while simultaneously increasing the outpatient treatment days’ number from 53 ± 4 to 59 ± 9 and from 42 ± 8 to 48 ± 6 (t > 2, p > 0.95), respectively. At the same time, the remission increased duration only in the NPM group from 0.62 ± 0.25 to 0.73 ± 0.19 year (t > 2, p > 0.95). Clinically, the affective (depressive) symptoms severity according to the Calgary Depression Scale for Schizophrenia decreased in the NPM and NM groups (10.2 ± 1.4 to 9.0 ± 1.6 score and 7.3 ± 0.8 to 6.6 ± 0.9 score (t > 2, p > 0.95), respectively), and the psychopathological symptoms severity according to the PANSS scale significantly decreased only in the NM group from 91 ± 4 to 87 ± 6 scores (t > 2, p > 0.95).

Conclusion. Basically, the clinical and social medical care for patients with paranoid schizophrenia are the synergistic complementarity psychiatric care and social rehabilitation, mandatory psychotherapeutic and psychoeducational support for medicines prescriptions.

Aim. Identification of the features of the psycho-emotional state of nurses of a multidisciplinary clinic, COVID hospital and outpatient clinic during an unfavorable epidemiological situation of coronavirus infection.

Design. A prospective cohort study in parallel groups.

Materials and methods. In 2020–2021, a study was conducted on the psychoemotional state of nursing staff working in medical institutions in Samara. All the subjects were divided into groups according to their place of work: the 1^st group included nurses working in COVID hospitals (n = 39), the 2^nd group represented nurses who worked in a multidisciplinary clinic (n = 41), the 3^rd group consisted of nurses performing their professional duties in an outpatient clinic (n = 39), the 4^th group (control) included people not related to medicine, mainly economic and technical specialties (n = 160). The analysis of the psycho-emotional state was carried out on the basis of the results of the Maslach Burnout questionnaire, designed to assess and identify the state and degree of formation of phases of emotional burnout.

Results. The indicators of emotional burnout in nurses working in the COVID hospital and in the polyclinic were significantly higher than in the control group, as well as in the nurses group of the multidisciplinary clinic. An extremely high level of emotional burnout was observed only in nurses working in the “red zone”, and they also more often had a high level of emotional burnout than in other groups. In the conditions of a polyclinic, the degree of emotional burnout in nurses was also significantly higher than in a multidisciplinary hospital.

Conclusion. Increased stress and the presence of signs of professional burnout are primarily noted when nursing staff work in a COVID hospital, to a somewhat lesser extent — in those working in an outpatient clinic, and nurses of a multidisciplinary clinic are even less susceptible to them. The data obtained confirm the expediency of continuing scientific research on the psychoemotional state of nursing staff during periods of unfavorable epidemiological conditions for timely preventive measures aimed at preserving the health of this category of medical workers.

Aim. To analyze the prevalence and significance of speech disorders in patients after stroke and to study the theoretical aspects of the diagnosis of cognitive disorders in patients with post-stroke speech disorders.

Key points. We have processed data from 1 500 information sources on domestic (Elibrary.ru, Rucml.ru) and foreign (PubMed, Medlineplus, The Cochrane Collaboration) medical information databases. Information was obtained on the prevalence and significance of speech disorders in the structure of post-stroke defect. Their influence on social adaptation, disintegration of the psyche, and the effectiveness of neurorehabilitation both in relation to aphasia itself and in relation to its concomitant disorders is shown. Various mechanisms of formation of aphatic disorders as one of the manifestations of general brain dysfunction are considered. The problems that arise when conducting psychodiagnostic measures in patients with speech disorders using standard screening techniques are outlined.

Conclusion. Based on the results of studying the diagnostic capabilities of existing scales for assessing cognitive functions in patients with speech disorders, recommendations are proposed for the formation of a new universal standardized Russian-language screening tool covering the entire field of cognitive status, applicable also in patients with speech disorders and allowing to obtain a single score corresponding to the accepted parameters for building an individual rehabilitation route. 

Aim. To present the data on impaired mimics and, indirectly, emotions in patients with cognitive disorders, obtained with the methods of mimics function assessment, which are used in scientific research and clinical practice.

Key points. Cognitive disorders are common in patients with neurological deficits. In diagnostics of neural diseases, including those manifesting with cognitive deficit, it is essential to identify impaired mimic functions. The analysed studies show the association between neurodegenerative processes in certain brain structures and impaired emotions (via mimics).

Conclusion. There are currently insufficient data on the objective characteristics of impaired mimics in patients with cognitive deficits.

A unified clinical method should be developed for the assessment of mimics and emotions in order to identify cognitive disorders. 

Aim. A synthesis of scientific literature data on the association of autism spectrum disorders (ASD) with gastrointestinal dysfunction and disturbances of the intestinal microbiota.

Key points. ASDs belong to a group of neurodevelopmental disorders associated with genetic, epigenetic and environmental factors, and include conditions that are heterogeneous in clinical presentation and severity of psychopathological symptoms. ASD is often comes with various symptoms of gastrointestinal tract dysfunction referred to impaired intestinal barrier permeability. The consequence is the pervasion of external agents (food antigens, toxins, bacterial metabolites) into the blood and initiation or maintenance of the inflammatory process, which is the most important pathophysiological link in ASD. Particular attention is paid to the analysis of the mechanisms of impaired intestinal barrier permeability. It is necessary to develop strategies aimed at reducing the level of inflammation in complex therapy of patients with ASD.

Conclusion. Patients with ASD, in addition to psychoneurological symptoms, often present somatic problems, which, however, may not be timely recognized due to their nonspecificity and the difficulty of differentiating behavioral reactions either associated with the disorder or being just a reaction to somatic ill-being.Moreover, the whole complex of clinical manifestations is mediated by a single systemic dysregulation of immunological and metabolic reactions and is inherently a different reflection of one process, requiring profound multidisciplinary treatment and the use of various therapy approaches.

Aim. Analysis and systematization of the results of domestic and foreign studies of drug-induced QT prolongation and the risk of Torsade de Pointes (TdP) associated with the use of antidementia drugs to update the knowledge of practicing neurologists about the possibility of predicting and preventing life-threatening cardiac adverse drug reactions.

Key points. Dementia is a syndrome that accompanies various neurodegenerative diseases, which causes significant maladjustment and disability in the patient. Anti-dementia drugs are used to slow down the progression of dementia which require long-term (lifelong) appointment. Therefore, the safety profile of these drugs is important in practice, in particular such conditions as the long QT syndrome and the development of ventricular tachycardia (TdP). The authors searched for full-text domestic and foreign publications (full-text versions of original articles, clinical cases, systematic reviews, meta-analyses, Cochrane reviews) in Russian and English, available in knowledge-intensive bibliographic databases (eLIBRARY, PubMed, Scopus, Springer, ClinicalKeys, OxfordPress, Google Scholar, MedCredit, DrugBank, PharmGKB), by keywords and their combinations. The study was conducted in accordance with the requirements for the PRISMA 2022 systematic review. The search depth is 10 years (2013–2023).

Conclusion. The systematic review demonstrated the variable effect of antidementia drugs on the processes of repolarization and depolarization of the ventricular myocardium: shortening of the QT interval, no effect, borderline prolongation of the QT interval, prolongation of the QT interval. Donepezil has the lowest cardiac safety profile. Studies of galantamine have yielded conflicting results. The lowest risk of QT prolongation and TdP development was observed with rivastigmine and memantine. There is insufficient data on the cardiac safety of the new generation of antidementia drugs: aducanumab, lecanemab and donanemab.

Aim. To provide a comprehensive and up-to-date analysis of the clinical, diagnostic, and therapeutic aspects of the first psychotic episode, this scientific review was conducted. The review is based on relevant publications from PubMed/MEDLINE, eLIBRARY.RU, RSCI, Google Scholar, and other databases published over the last five years.

Key points In recent decades, there has been an increase in the number of scientific studies that demonstrate the effectiveness of early intervention for the first psychotic episode. Psychosis can be associated with various mental disorders, such as schizophrenic spectrum disorders, bipolar disorder, and depression with psychotic features. The prevalence of these disorders during a person's lifetime is approximately 1.94% for non-affective psychotic disorders and 0.59% for affective psychotic disorders. The first manifestations of psychosis can occur at a young age and can lead to difficulties in personal, family, professional, and social life. Early detection and intervention can improve treatment outcomes and prognosis.. At the same time, lack of timely medical care can affect the effectiveness and duration of antipsychotic therapy. This can lead to increased risk of hospitalizations, decreased quality of life, and an unfavorable outcome for the patient.

Conclusion. The social significance of the problem is determined by the fact that, according to the World Health Organization, acute psychosis is in third place among the most disabling diseases, and major psychotic disorders reduce the average life expectancy by 10 years. One of the main directions of modern medicine is preventive and life-saving rehabilitation aimed at preventing repeated hospitalizations and improving the social adaptation of patients. The study of the interaction of various aspects of the occurrence, course and outcome of the first psychotic episode allows us to assess the dynamics, current programs of psychosocial rehabilitation and treatment of the disease.