An interview with Professor Tatiana Pavlovna Klyushnik, Dr. Med. Sci., Director, Head of the Neuroimmunology Laboratory at the Federal State Budgetary Scientific Institution 'Scientific Centre for Mental Health' of the Ministry of Science and Higher Education of the Russian Federation. Tatiana Pavlovna told us that scientific work was her unconscious desire from school-days and that she has always wanted to understand the essence of diseases. The interview details new clinical and biological pathogenic hypotheses of mental disorders, in particular of schizophrenia, that do not only uncover the mechanisms behind psychopathologic symptoms, but also facilitate the advent of new therapeutic and preventive strategies, new diagnostic approaches. Currently, an array of capabilities to diagnose and treat psychosomatic disorders and borderline pathologies, anxiety, autism spectrum disorders is relatively wide. Professor Klyushnik explained the value of kynurenic hypothesis of mental disorders and how the description of molecular mechanisms of inflammation impact on neurotransmission disorders opens up new potential targets for pharmaceutical development. A description of key activities of the Scientific Centre for Mental Health wraps up the interview.

Objective: To present literature data and results of own studies of inflammatory biomarkers identified in schizophrenia patients for diagnostic and forecasting purposes.

Key points. Special attention is paid to the medical technique called Neuroimmunotest developed at the Scientific Centre for Mental Health and its use in the study of schizophrenia pathogenesis, immune system status in various psychopathologic disorders, as well as for disease monitoring, forecasting and therapy efficiency assessment.

Conclusion. The literature data and results of own studies demonstrate the key role of immune mechanisms, primarily of inflammation, in the development of psychopathologic disorders in schizophrenia patients. Classification of schizophrenia patients not only on the basis of clinical manifestations, but also using the immune marker profile makes it possible to objectify their condition and forecast the efficiency of personified therapy; therefore, this approach is of interest for practical application in clinical psychiatry. 

Aim: To analyse clinical, biochemical and social characteristics of patients with severe mental disorders and aggressive behaviour.

Design: observational cross-sectional study.

Materials and methods. We examined 110 patients of 18–60 years of age with severe mental disorders and persistent aggressive behaviour who committed acts of violence. For examination, we used clinical psychopathologic, psychometric, laboratory, mathematical and statistical methods.

Results. The subjects had disturbed upbringing with signs of violence, undereducation, family and occupational maladaptation, conflict relations with people around them, financial insecurity. Clinically, they demonstrated marked behavioural disorders with explosive episodes associated with hetero-aggressive trends, with decreased intellectual and volitional control and lack of compliance. There were statistically significant (p < 0.05) differences in biological parameters of a majority of patients vs. reference values and correlation between psychometric and biochemical data.

Conclusion. The results contribute to the identification of predictors of socially dangerous violent behaviour in persons with severe mental disorders.

Aim: study and analysis of psychopathological and clinical features of psychotic disorders associated with the use of synthetic cathinones.

Materials and methods. The study design was observational, comparative, prospective. The study involved 98 patients treated in the Acute Poisoning Unit, the Emergency Addiction Treatment Unit and the Line Addiction Treatment Unit. In terms of gender, males predominated (n = 58; 59.2%), females accounted for 40.8% (n = 40). Median age — 30 years (Q1–Q3 — 22–33). In the first phase of the study, patients were screened and included in the study according to inclusion/non-inclusion criteria; in the second phase, the clinical picture of psychosis was analysed, depending on the leading syndrome patients were divided into three groups; In the third stage, patients were monitored for 12 months. The Brief Psychiatric Rating Scale (BPRS) was used to objectify the assessment of the severity and dynamics of psychotic symptoms. In the third stage there was 79 participants in the study, the rest of the patients refused to continue participation after 2 months or more.

Results. There are three main clinical forms of psychotic disorders developing due to the use of synthetic cathinones: delirious, delusional, polymorphic. Each form had its own clinical and dynamical features. The delirious form was the heaviest: in the 1st day, patients had the highest score on the BPRS scale (Me = 80 (73–87)), but transient: psychosis was resolved within 1 day. With delusional form, the median score in the 1st day on the BPRS scale was 65 (59–82), in polymorphic — 66 (43–76). The vast majority of psychoses (91.8%) developed during intoxication. Some psychoses of delusional and polymorphic form, which developed beyond intoxication lasted notebly longer. The polymorphic form is the longest lasting, with symptoms lasting more than 2 weeks. Postpsychotic disorders were presented as asthenic and neurotic (anxiety-depressive) disorders, most pronounced and lasting (more than 6 months) in patients with a polymorphic form of psychosis.

Conclusion. The study showed that psychoses with a «exogenous» clinical picture (psychomotor agitation and nonspecific psychopathological symptoms) pass faster and psychopathological disorders go away simultaneously with agitation. At the same time, psychoses with a predominance of psychopathological disorders (delusions, hallucinations) are characterized by a longer course and require long-term therapy.

Aim: To study the characteristics of brain activity in male patients with recurrent and bipolar depression.

Design: This was a comparative controlled non-randomized experimental clinical study.

Materials and Methods: 59 male patients took part in this study before their medication started: 30 with bipolar and 29 with unipolar (recurrent) depression. Control group consisted of 27 healthy male volunteers. All investigated persons were aged 20 to 59 years. The participants had to sort photos of people and animals, of which 80 were neutral images and 80 showed angry/aggressive people or animals. Simple patterns (cues) were displayed two seconds prior to the pictures, and their relationship was not explained. A 128-channel EEG was recorded and brain responses were analyzed in 0–700 ms from cue onset. Differences between the neutral and emotional conditions (emotional modulation, EM) were statistically evaluated.

Results: All components in this study (P100, N170/VPP, P200, P380, and LPC/LPP) in various degrees showed EM dependent on the group and on the type of threatening stimuli. Topography of EM for N170/VPP in all groups and both types of stimuli was quite similar. None of the components unambiguously distinguished between the controls and nosographically different depressions.

Conclusion: Our results show that in the study of affective disorders and the search for markers for diagnosis, it is necessary not only to take into account the gender of patients, but also to use various cognitive tasks when recording EEG, and also to consider a set of neurophysiological parameters.

Aim: To study emotional disorders and response to stress in patients with multiple sclerosis (MS) at the diagnostic stage.

Design: Comparative prospective study.

Materials and methods. We examined 30 MS patients who were not taking any disease-modifying drugs. The age of patients was 34 ± 9 years; Kurtzke Expanded Disability Status Scale: 1.7 ± 1.3 points. Beck Self-Rating Depression Inventory and V. M. Bekhterev Self-Rating Depression Inventory, State-Trait Anxiety Inventory, Asthenic State Scale, Psychological Diagnostics of Coping Mechanisms, Coping Strategies questionnaire, were used.

Results. MS patients were divided into groups depending on the presence/absence of symptoms of depression (n = 18 and n = 12). The patients with depression had statistically higher (р < 0.05) number of asthenic manifestations and anxiety disorders, emotional releases with fixation on negative events. In order to reduce stress, patients chose to avoid the problem.

Conclusion. Identified emotional disorders aggravate the overall condition of MS patients, reduce stress tolerance and ability to social adaptation; they lead to more complex symptoms and possible disease progression.

Aim: To consider new approaches to psychosocial therapy in psychiatry and cooperation with patients.

Key points. The review describes a new direction of research in psychiatry and clinical psychology associated with new forms of collaboration with patients — those receiving mental health care. Among the foundations of this direction are the concept of personal and social recovery and the “Open Dialogue” approach to psychosocial therapy. The movement's leaders are patients and clinicians who involve patients in research as colleagues.

Conclusion. New forms of collaboration with patients — those receiving mental health care, involving them in actual participation in research as colleagues are the basis for establishing trust and therapeutic alliance for developing and selecting diagnostic and therapeutic methods. Expanding the scope of collaboration with patients directly or indirectly increases the availability of psychosocial interventions and psychosocial support and promotes disease prevention and mental health care.

Aim: To present a case study of patient S., who came to the psychiatric clinic because of a depressive episode after COVID-19 infection.

Key points. COVID-19 can cause various complications that last several weeks to several months after initial recovery. Young, healthy individuals can have post-COVID disorders even after mild COVID-19. Depression and anxiety disorders are among the consequences of past coronavirus infection.

Conclusion. This case study demonstrates that post-COVID patients develop persistent depres-sive disorders causing patient maladaptation and requiring drug therapy.

Objective: To evaluate the psychoneurological status of post-COVID-19 patients using diagnostic tests for psychoemotional state, cognitive functions, sleep disorders.

Design: a non-randomized single blind study.

Materials and methods. We conducted psychoneurological tests on 68 post-COVID-19 patients (38 women and 30 men) (mean age: women — 44.6 ± 6.4 years old, men — 46.8 ± 7.8 years old). The control group included 30 persons without a history of coronavirus infection. Neuropsychological tests were performed using the asthenia scale developed by L. D. Malkova and adapted by T. G. Chertova, Hospital Anxiety and Depression Scale, Spiegel Sleep Questionnaire, Epworth Sleepiness Scale, cognitive function testing (memorising 10 words, Munsterberg test, mechanical memory test).

Results. The main psychoneurological manifestations in post-COVID-19 patients are asthenoneurotic (23,5%) or anxiodepressive symptoms (25%), insomnia (39.7 %) and cognitive-mnestic disorders (32.4 %) associated with somatic-vegetative disorders (hyperhydrosis, palpitations, blood pressure fluctuations, dispeptric disorders, episodes of dizziness). A lot of patients had persistent smell and taste disorders (26.5 %), impaired visual acuity (25 %), impaired hearing (23.5 %), limb numbness and paresthesia (20.6 %).

Conclusion. Management of patients with coronavirus infection requires a comprehensive diagnostic approach involving assessment of their mental health. Psychoneurological features of post-COVID-19 patients demonstrate the need in improved efficiency of rehabilitation and therapeutic measures due to restoration of mental, cognitive, somatic-vegetative functions. SARS-CoV-2-associated symptoms of neural system involvement are a sign of unfavourable disease progression and outcome.

Aim: To study the association of the HTR2C gene rs6318, rs6313 of the HTR2A gene, rs4680 of the COMT gene, rs3785143 of the SLC6A2 gene, rs1799913 of the TPH1 gene, rs7997012 of the HTR2A gene with the development of neurotic disorders in young people living in the Krasnoyarsk Territory.

Design: A comparative study.

Materials and methods. The study included 133 clinically healthy volunteers. The age of the participants ranged from 16 to 24 years. Molecular genetic studies were carried out on the basis of the Laboratory of Medical Genetics of the V.F. Voino-Yasenetsky Moscow State Medical University of the Ministry of Health of Russia. Psychological testing was performed using the questionnaire of depressive symptoms of Beck, the scale of socio-situational anxiety of O. Kondash in the modification of A.M. Parishioner, Hospital scale of anxiety and depression, as well as carrier study of the association of single nucleotide variants (ONV) rs7997012 of the HTR2A gene, rs6318 of the HTR2C gene, rs6313 of the HTR2A gene, rs4680 of the COMT gene, rs3785143 of the SLC6A2 gene, rs1799913 of the TPH1 gene with neurotic disorders (anxiety and subclinical depression).

Results. According to multivariate analysis, the association of the COMT G gene allele carrier (odds ratio (OR) = 2.784; 95% confidence interval (CI): 1.291–6.001; χ2 = 6.986; p = 0.009) and the AH genotype (OR = 2,208; 95% CI: 1,032–4,724; χ2 = 16.716; p < 0.001) with subclinical depression according to the total index of the Beck scale. Carrying the SS genotype of the rs1799913 TRN1 gene increases the risk of learning anxiety by 3 times (OR = 3.011; 95% CI: 1.138–7.967; χ2 = 7.622; p = 0.023).

Conclusion. The carriage of the G allele and the rs4680 genotype and AG of the COMT gene is associated with subclinical depression, and the carriage of the SS genotype of the rs1799913 TRN1 gene increases the risk of learning anxiety by 3 times. Thus, the ONV of these genes can be considered as predictors of neurotic disorders, significant already at the subclinical level.

Aim: To describe the Russian and foreign experience in the use of non-invasive neuromodulation for pain management in patients with chronic lower back pain (LBP); to present various neuromodulation techniques and other rehabilitation methods which can be used in combination with neuromodulation in patients with LBP; to describe neuromodulation parameters and programs for an optimal analgesic effect.

Key points. LBP is a common (affecting 7.5 % of the world population) and socially significant condition (one of the leading causes of disability worldwide). The efficiency of drug pain management in chronic LBP is approximately 40 %, therefore, non-drug treatment options are required.

The neuropathic component of chronic LBP is associated with reorganization in cortex brain structures Hence, neural stimulation is a most promising approach to chronic LBP management, while transcranial direct current electrotherapy stimulation (TEdC) and rhythmic transcranial magnetic stimulation (rTMS) are the most efficient and safest neural stimulation methods. rTMS is an efficient and safe approach to the management both of nociceptive and neuropathic pain, which is a common component of chronic conditions, in particular of LBP. The main area of exposure is motor cortex areas (М1). As compared to TEdC, rTMS is better tolerated by patients and demonstrates better pain management results.

Conclusion. Pain syndrome is a significant limitation to rehabilitation in patients with LBP, and drug pain management is inefficient. We suggest that anaesthetic neuromodulation be included into a complex therapy of such patients. The most widely used and efficient neuromodulation techniques are TEdC and rTMS.

Aim: to assess the dynamics of the state of cognitive functions in the acute period of ischemic stroke.

Design: prospective study.

Material and methods. The study included a group of observation of patients in the acute period of ischemic stroke in the amount of 26 people. The cognitive sphere was assessed twice: on admission to the hospital on days 2-3, and on discharge on days 8-10. Scales used to assess the cognitive sphere: Mini Mental State Examination (MMSE) Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), The Clock-drawing Test (CDT). The emotional-volitional sphere was assessed using the Hospital Anxiety and Depression Scale (HADS). Data were considered statistically significant at p < 0.05.

Results. In a dynamic assessment, cognitive disorders in the observed group were most pronounced upon admission to the hospital. By discharge on days 8-10, according to the MMSE test, there was a positive trend, the increase was by 2b, MoCA by 2b, FAB by 1b, respectively, the results were significant (p < 0.001, p < 0.001, p = 0.001). In the analysis of subscales according to the MMSE test, improvements to the extract were according to word reproduction (p = 0.005), speech functions (p = 0.04). According to MoCA, the improvement in total scores was due to subscales: memory (p = 0.01), attention (p = 0.05), speech (p = 0.04), abstraction (p = 0.005). Changes in the FAB test were driven by the conceptualization function (p = 0.04) and the simple choice response (p = 0.008). Anxiety and depression were not detected in the studied patients.

Conclusion. During the acute period of ischemic stroke, the degree of cognitive impairment significantly decreases by 8-10 days against the background of ongoing treatment.

Aim: To assess the effect of multimodal virtual reality stimulation on gait and balance restoration in patients in acute and early recovery ischemic stroke.

Design: Comparative randomised clinical study.

Materials and methods. This study enrolled 67 patients with primary ischemic stroke which occurred during past 6 months, complicated with hemiparesis or lower limb monoparesis. Patients included 47 men and 20 women aged 44 to 75 years old. Patients were divided into two groups: in the study group (n = 36), the primary rehabilitation was supplemented with multimodal stimulation exercises on a training virtual reality set; controls (n = 31) had only primary therapy.

Rehabilitation efficiency was assessed using the Montreal Cognitive Assessment, Hospital Anxiety and Depression Scale, National Institutes of Health Stroke Scale (NIHSS), Medical Research Council Scale (MRCS), Tinetti Test, Rivermead Mobility Index.

Results. In the study group, a course of rehabilitation resulted in marked improvement in motor functions and functional independence. NIHSS symptoms intensity decreased from 5.5 [4.0; 7.0] to 4.0 [3.0; 5.0] points in the study group and from 6.0 [5.0; 7.0] to 5.0 [4.5; 6.0] points in the control group (p = 0.019). Rivermead Mobility Index increased from 7.0 [6.0; 10.0] to 10.0 [8.0; 12.0] points in the study group and from 7.0 [5.0; 7.5] to 8.0 [6.5; 10.5] points in the control group (p = 0.049). When multimodal stimulation was added, also a more prominent increase in the MRCS muscle strength of the lower limb was observed: an increase was 0.7 [0.3; 0.9] points in the study group and 0.4 [0.2; 0.7] points in controls (p = 0.046).

Conclusion. Multimodal stimulation is an efficient adjuvant approach to rehabilitation of patients shortly after an ischemic stroke.

Aim: To assess the influence of gait function activation on manifestations of hypomimia in patients with Parkinson's disease (PD).

Design: A comparative clinical study.

Materials and methods. The study enrolled 18 patients with stage of 2–3 PD according to Hoehn — Yahr Rating Scale aged 70 [65; 76] years. Analysis of facial expression in PD patients was analysed by using a proprietary method of computer video-analysis of facial muscle movement. Activation of the gait function used another proprietary method: the apparatus for functional foot therapy that mechanically activates the rear push of the foot at the moment of the lift of the foot from the supporting surface.

Results. Activation of the gait function has statistically significantly improved the mimic function of the face, in particular the blink frequency (p = 0.022), eyebrow movement amplitude along the Y axis in the «brow furrow» test (p = 0.048) and the amplitude of mouth movement while reading a text along the axis X (p = 0.012).

Conclusion. The confirmation of the decrease of hypomimia manifestations through affecting the condition of general hypokinesia creates the prerequisites for appearance of rehabilitation methods making it possible to perform simultaneously correction of these two symptoms.

Aim: To present a clinical case of the use of the wrist tapping method in a 30-year-old patient with structural focal epilepsy (SFE).

Key points. During 4 visits, we examined patient N., 30 years old, suffering from SFE, which developed against the background of a gunshot wound to the skull, with frequent focal seizures (FS) and bilateral tonic-clonic seizures (BTCS). After 6 months from the start of wrist tapping sessions (4th visit), using the application, the patient noted a 55% increase in quality of life due to the ability to stop AF and prevent the development of BTK. In 87.5% of cases, he was able to stop incipient motor hemifacial FS and prevent its transformation into BTCS. With regular use of the application by the patient, the incidence of FS decreased by 65.4% on the 4th visit compared to that on the 2nd visit. The patient highly rated the effectiveness and safety of the wrist tapping method (97.6%).

Conclusion. The use of the application allowed a young man with treatment-resistant post-traumatic SFE, without changing the dosage regimen and dose of the antiepileptic drug, to reduce the frequency of FS by 65.4% from baseline and significantly reduce the number of BTCS, significantly improving the quality of life.