The gut microbiome is a crucial component that regulates numerous bodily functions, including inter-organ communication with the central nervous system (CNS), known as the ‘microbiome–gut–brain axis.’ Disruptions in microbiome composition, manifesting as dysbiosis, are identified in ADHD and have recently been considered a key pathophysiological factor. Structural and functional changes in the microbiome during ADHD may underlie systemic inflammation and neuronal dysfunction, highlighting its importance in the etiopathogenesis of this disorder. Early childhood and adolescence are particularly vulnerable periods in this context, as they involve the active maturation of both the microbiome and neural structures. This article discusses the contribution of five major bacterial phyla associated with the mechanisms of systemic inflammation in ADHD: Actinomycetota, Bacillota, Bacteroidota, Pseudomonadota, and Verrucomicrobiota. Future research is encouraged to focus on short-chain fatty acids and lipopolysaccharide-binding proteins as potential biomarkers of dysbiosis-induced systemic inflammation.»

Mental disorders in patients in intensive care units (ICUs) represent a clinically significant and diagnostically complex problem requiring a multidisciplinary approach. Despite the seriousness of their consequences, recent studies have shown insufficient awareness among medical personnel of critical illness diagnostic algorithms. The situation is exacerbated by the paucity of scientific publications devoted to the specifics of mental disorders in anesthesiology and intensive care, highlighting the need for further systematic research in this area. Raising clinical staff awareness of the specifics of mental disorders in critically ill patients, implementing clinical protocols, and developing uniform diagnostic and therapeutic standards remain pressing challenges. This article examines the most common psychopathological conditions, including delirium, catatonia, febrile schizophrenia, neuroleptic malignant syndrome, as well as cognitive and affective disorders that arise in critical illness.

Particular attention is given to differential diagnosis, neuropsychological testing, and modern approaches to treatment using pharmacological and non-pharmacological methods. The need for systematic monitoring of patients’ mental states and the integration of psychiatric care into intensive care is substantiated. Promising research areas in this area are highlighted. These conditions not only complicate the course of the underlying disease but also significantly impact the prognosis, length of hospitalization, and quality of life of patients after discharge. A promising direction for the development of psychoreanimatology is the integration of psychiatric assessment into intensive care. Only such a systematic and prognostically oriented approach will allow not only treatment but also genuine improvement in the functional outcomes and mental health of severely ill patients.

This article presents the results of a comprehensive analysis of the dynamics of general (prevalence) and primary (incidence) morbidity of mental and substance use disorders among the adolescent population (aged 15–17) in the Russian Federation from 2018 to 2024. The study is based on data from official federal statistical reporting (Forms No. 10, No. 11) and reports from the Federal State Statistics Service (Rosstat). The methodology included calculating intensive indicators per 100,000 population, analyzing their dynamics, assessing trend significance using the Wald–Wolfowitz runs test, and calculating growth rates.

The analysis revealed divergent trends: a statistically significant increase in general (+13.2%, p<0.05) and primary (+26.4%, p<0.05) morbidity of non-psychotic disorders, particularly affective and neurotic disorders, occurred against a backdrop of a marked decrease in indicators related to alcohol use (general morbidity decreased by 55.2%, p<0.05). At the same time, stability and even a slight increase in drug addiction indicators were noted (total +5.6%, p < 0.05), which, according to the authors, is associated with the transformation of the psychoactive substance market toward synthetic drugs and their active digital distribution. The results are interpreted within the context of the biopsychosocial model, the neurophysiological vulnerability of the adolescent brain, changes in diagnostic approaches, the impact of the COVID-19 pandemic, and the digital transformation of the drug distribution market. The need for the development of comprehensive psychoprophylaxis and low-threshold support services in educational institutions, as well as the strengthening of interagency cooperation to address new challenges, is substantiated.

Background. In military personnel with combat experience, posttraumatic symptoms frequently co-occur with anxiety, depressive symptoms, and anger-related manifestations, making it difficult to distinguish PTSD from other stress-related disorders when relying solely on screening instruments. Clinical verification is therefore essential not only for evaluating the diagnostic utility of self-report measures, but also for clarifying the structure of comorbid emotional symptoms. Objective. To assess, in a clinically examined sample of military personnel with combat experience: 1) the agreement between PTSD screening with the PCL-5 and the clinical diagnosis established by a semi-structured interview; 2) differences in posttraumatic, anxiety, depressive, and reactive anger symptoms between participants with and without clinically verified PTSD; 3) in an exploratory manner, the latent structure of relationships between posttraumatic and comorbid emotional symptoms. Material and methods. This cross-sectional pilot study included 54 military personnel treated in a military hospital after combat exposure.

Diagnostic verification was performed by a psychiatrist using a semi-structured clinical interview in accordance with ICD-10 criteria. The following instruments were used: PCL-5, PHQ-9, GAD-7, and DAR-R. Statistical analysis included descriptive statistics, Mann-Whitney U test with rank-biserial correlation effect sizes, and diagnostic agreement analysis with calculation of sensitivity, specificity, predictive values, Cohen’s kappa, exact McNemar test, and ROC analysis. Results. Clinically verified PTSD was diagnosed in 12 of 54 participants (22.2%), whereas probable PTSD according to the PCL-5 threshold was identified in 23 participants (42.6%). For the PCL-5 in relation to the clinical PTSD diagnosis, sensitivity was 83.3%, specificity 69.0%, positive predictive value 43.5%, negative predictive value 93.5%, overall accuracy 72.2%, and Cohen’s kappa 0.39. The exact McNemar test showed a significant asymmetry in disagreement between methods (p=0.0045). ROC analysis demonstrated moderate discriminative ability of the total PCL-5 score, with an AUC of 0.701 (95% CI 0.566–0.837; p=0.0037); the optimal cut-off based on the Youden index was 21.5 points. Participants with clinically verified PTSD showed higher scores on the total PCL-5, the PCL-5 hyperarousal cluster, PHQ-9, GAD-7, total DAR-R anger reaction, and anger-related functional impairment; the strongest group difference was found for anxiety (GAD-7: p=0.0014; rrb=-0.607). Exploratory factor analysis showed good factorability of the data (KMO=0.824; Bartlett’s test p<0.001); in the one-factor solution, all indicators loaded highly on a common factor explaining 61.0% of the variance, suggesting a general continuum of posttraumatic and comorbid emotional distress.

Discussion. The findings indicate that the PCL-5 has moderate diagnostic performance and is more suitable as a screening rather than a confirmatory diagnostic tool for PTSD. Positive PCL-5 results may reflect not only PTSD-specific symptoms but also a broader spectrum of anxiety, depressive, and anger-related disturbances. The factor-analytic findings additionally support the close interrelationship between posttraumatic and comorbid emotional manifestations in this clinical sample. Conclusion. In this clinically verified sample of military personnel with combat experience, the total PCL-5 score demonstrated moderate agreement with the clinical diagnosis of PTSD and a high negative predictive value, supporting its use as a screening instrument. Clinically confirmed PTSD was associated with more pronounced hyperarousal, anxiety, depressive symptoms, and anger dysregulation. Preliminary exploratory factor-analytic results suggest a common latent factor underlying posttraumatic and comorbid emotional distress, underscoring the need for comprehensive clinical assessment of emotional disturbances.

Social cognitive functions are defined as a set of skills necessary for social interaction and are of key importance for social functioning. Impairments in social cognition underlie social maladjustment in individuals with schizophrenia to a significantly greater extent than psychopathological symptoms or deficits in basic cognitive functions. The article describes an original social skills training for patients with schizophrenia spectrum disorders based on specially developed software using virtual reality (VR) technology. The program is designed according to the cognitive remediation principles: personalization, gradual increase in cognitive difficulty, metacognitive discussion, repetition, and motivational support. The structure of the sessions is described, comprising adaptation, diagnostic, training, and concluding stages, which ensures the reproducibility of the method across various clinical settings. Clear inclusion and exclusion criteria, along with emergency response protocols, minimize the risks associated with the use of immersive technologies. The training consists of several stages: an introductory stage (adaptation to the environment, mastering navigation) and a main stage (practice of interaction with virtual characters). The participant interacts with them by selecting responses to their behavior. After the VR session, a reflection with a specialist is mandatory in order to analyze strategies and address difficulties. The method provides a safe, controlled environment for practicing social skills. The effectiveness of the training program is evaluated based on a set of clinical and behavioral indicators. Assessment is appropriately conducted at two time points: immediately after completion of the course and delayed (if follow-up observation is feasible) after several months.

Objective. To comprehensively assess practicing psychiatrists’ clinical views, diagnostic practices, and therapeutic approaches to anhedonia in the Russian Federation. Materials and methods. A crosssectional survey was conducted from March to September 2025. A purpose-designed 27-item questionnaire covered detection and clinical significance of anhedonia, its impact on prognosis, and pharmacological and psychotherapeutic strategies. Eligible participants were physicians actively practicing psychiatry in the Russian Federation. The sample was recruited via targeted mailings to institutional clusters with subsequent link forwarding (i.e., elements of snowball sampling); the final cohort represents a purposive sample. Statistical analyses were performed in R 4.2.1 using base R and the psych package.

Results. A total of 1,021 physicians were included (mean age 40.8 years [SD 11.3]; years in practice 14.5 [SD 10.9]). Nearly all respondents explicitly assess anhedonia in depression (96.5%). In clinicians’ subjective estimates, anhedonia occurs in 40–80% of patients and is most pronounced in melancholic depression (55.6%). The transdiagnostic nature of anhedonia is acknowledged by most respondents (77.1%), most often in the context of schizophrenia/schizoaffective disorder and bipolar disorder. Anhedonia is viewed as a marker of unfavorable prognosis: impaired functioning (62.2%), slower improvement (59.5%), and increased suicide risk (51.8%). Consensus regarding psychotherapy was high (81.1%; cognitive behavioral therapy most frequently cited). Opinions on pharmacotherapy were divided: 52.0% considered some antidepressants more effective in pronounced anhedonia; the need for antipsychotics was more often not supported (56.9%). No substantial geographic differences between metropolitan areas and other regions were identified. Male physicians were somewhat less likely to endorse the necessity of psychotherapy for anhedonia. About half of the respondents noted that under antidepressant treatment, worsening or persistence of anhedonia was often accompanied by “emotional blunting” (feelings of flattened emotions, apathy) in patients. Conclusions. Russian psychiatrists regard anhedonia as a central and transdiagnostic symptom that affects prognosis and warrants proactive assessment. These findings support domain-oriented approaches to anhedonia and personalized algorithms for managing patients with depression.

Background. Nonsuicidal self-injury (NSSI) is a transdiagnostic clinical factor that may influence the choice of psychopharmacotherapy (PT) and patterns of treatment response. However, evidence on the association between NSSI and PT characteristics using real-world data (RWD) remains limited. The potential modifying role of genetic factors has also been insufficiently explored. Aim. To assess the impact of NSSI as a transdiagnostic phenomenon on PT features in patients with schizophrenia spectrum disorders (F2) and affective disorders (F3), and to analyze associations with polymorphisms in CYP2D6, CYP3A4, CYP3A5 and OPRM1. Methods. The study included 61 patients (median (Q1-Q3) age 21 (19–24) years; 54,5% female; 49,2% with F2; 75,4% reported lifetime NSSI). PT parameters were assessed based on medical records and clinical interviews. Current clinical status was evaluated using PANSS, CDSS, MADRS, UKU, and MARS. Pharmacogenetic testing was performed (genotyping of CYP2D6, CYP3A4, CYP3A5 polymorphisms) along with genotyping of OPRM1 rs1799971. Between-group comparisons were conducted using the Mann–Whitney U test and Pearson’s χ² test; general linear models (GLM) were applied to jointly evaluate the effects of NSSI and diagnostic group. Results. NSSI was associated with an earlier age at onset of the index disorder (p=0,002) and with longer mood stabilizer treatment (p=0,020 and p=0,013); GLM results supported the transdiagnostic nature of these associations. No between-group differences were observed in genotype frequencies for OPRM1/CYP2D6/CYP3A4/CYP3A5 or in CYP2D6 metabolic phenotype. Within the NSSI group, the minor allele of OPRM1 rs1799971 was associated with a shorter duration of antidepressant treatment (p=0,029), whereas the minor allele of CYP2D6 rs16947 (*2) — with a longer duration (p=0,039).

Conclusion. According to RWD NSSI is associated with longer mood stabilizer treatment irrespective of diagnostic group. OPRM1 and CYP2D6 polymorphisms may be related to antidepressant treatment patterns in patients with NSSI.

Speech disorders in patients with schizophrenia spectrum disorders are an early marker of disease progression. The article provides an analysis of the spoken narratives of individuals with schizophrenia and schizotypal disorder in terms of speech amount and content. Objective: to establish the speech features of patients with schizophrenia spectrum disorders. Material and methods: 53 male patients (average age 18,5±2,3 years) were examined: group 1 with schizotypal disorder (F21) (n=33, 62,3%); group 2 with schizophrenia (F20) (n=20, 37,7%). The control group included healthy young men (n=33, average age 19,1±2,0 years). The Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS) were used. The research was based on narratives obtained from reportage and retellings of «The Pear Film» by W. Chafe. We analyzed mean length of speech units (elementary discourse units) as well as the number of mentioned dynamic, static and sound elements of the film. Statistical analysis was performed using R and RStudio with the Kruskal-Wallis H-test and the Mann-Whitney test. Results: Statistical analysis showed that clinical groups have lower values than control group for all considered parameters, both in reportage and retellings (p<0,05). Pairwise comparison revealed significant difference between the clinical groups only in the number of sound elements in retellings (U=433,5, p=0,022). Conclusion: The results obtained indicate clear signs of a decrease in the amount and content of speech, which are already evident in the early stages of schizophrenic process and are likely to depend on the degree of the process’s progression.

Aim: To develop a clinical and psychological profile of treatment-adherent patients with somatoform disorders (SFD) in general medical practice by analyzing their diagnostic pathway and its association with cognitive-affective features. Materials and methods: A retrospective observational cohort study was conducted. From 350 patients with polymorphic somatic complaints, a cohort with verified ICD-10 F45 diagnoses was formed (n=261). An in-depth retrospective analysis (n=192) included a clinical interview, review of medical records, the Hospital Anxiety and Depression Scale (HADS), the Numeric Rating Scale (NRS-10), and qualitative assessment of alexithymia, catastrophizing, and health locus of control. Results: In the in-depth analysis subgroup, women predominated (87.2%), median age was 42 years, and median symptom duration before psychiatric referral was 5.2 years. Subjective symptom severity on NRS-10 reached 8 [7–9]. Median HADS-A score was 8 [6–11] and median HADS-D score was 4 [2–7]. A previous diagnosis of “vegetative-vascular dystonia” had been established in the somatic network in 71.8% of patients. Catastrophizing was identified in 79.5% and an external health locus of control in 89.7% of patients. Among 113 patients lost to follow-up, the main reasons were refusal to accept the psychogenic nature of their somatovegetative symptoms (n=40), low adherence (n=32), and difficulties in establishing a therapeutic alliance (n=41), against the background of fears of stigmatization and restriction of rights as a consequence of psychiatric treatment. External locus of control was significantly associated with a longer diagnostic pathway (p<0.01). In the studied cohort, 71.8% of SFD patients had comorbid anxiety disorders (F41). Conclusion: In the studied SFD cohort, selected without excluding anxiety disorders, the diagnoses of “VVD” and functional gastrointestinal disorders frequently co-occurred with SFD and comorbid anxiety pathology. External health locus of control was associated with delayed psychiatric referral. The obtained profile characterizes a subpopulation of patients who reached a psychiatrist and were adherent to treatment; catastrophizing and external locus of control remain key screening targets in this group.