Antipsychotic drugs are a critical modality in managing of schizophrenia. Although medications can be highly effective, response varies and some patients derive considerably less benefit than others. Long-term use of antipsychotic drugs is associated with the development of adverse reactions. Te safety advantages of the atypical drugs havebeen questioned because of their propensity to induce weight gain and alter glucose and lipid metabolism. Antipsychotic-induced weight gain is a common cause of self-discontinuation of treatment and a significant deterioration in the quality of life in patients with schizophrenia. Te severity of adverse reactions when taking antipsychotics in different patients varies, which be associated with genetic factors. Antipsychotic induced weight gain is a major health concern and unfortunately, there is no predictive tool to identify who are high risk individuals. Te LEP, LEPR and NRY genes represents a compellings candidates for genetic studies of antipsychotic-induced weight gain. Candidate gene selection should rely on current knowledge on the molecular pathways to weight gain, antipsychotic pharmacokinetics and pharmacodynamics, as well as possible disease-related genetic links to the side effects under study. Pharmacogenetics will provide rational treatment based on matching antipsychotics to a patient’s DNA profile, thus, potentially providing effective treatment with minimal side effects to outliers and mean responders to a given antipsychotic medication.

The article discusses the heterogeneous mechanisms of the pharmacodynamics of antidepressants that underlie the therapeutic response. Sharing the similar clinical activity, antidepressants determine the development of drug-induced homeostasis by means of different molecular mechanisms (selective or nonselective blockade of monoamine reuptake, inhibition of monoamine oxidase, blockade of certain monoamine receptors). However, an increase of serotonin and other monoamines concentrations in the synapses of the central nervous system is only the initiating factor in the development of specific clinical effects. The latter are probably determined by other neurochemical effects, including changes in the density of postsynaptic receptors and an increase in the synthesis of neurotrophic factors. However, the primary mechanisms that increase monoamine concentrations in the synapses might not always “work properly”, leading to the lack of efficacy of the initial antidepressant, while the probability of the therapeutic response to the subsequent antidepressant remains rather high. Thus, the efficacy of an antidepressant may depend on the baseline differences in the neurochemical state contributing to the pathological “depressive” homeostasis. The heterogeneous neurochemical effects of antidepressants can determine the dissociation of existing neuronal interactions, leading to the development of the new — druginduced — homeostasis. At the same time, it is possible that stimulation of general neurotrophic processes by antidepressants may contribute to the progression and chronicity of pathology due to the ambiguous influence on certain stages of the pathological process. This determines the significance of neurophysiological studies of central disturbances in depression and search of fundamentally new neurochemical targets for the treatment of depressive states associated with various mental disorders.

The purpose of the study was to summarize data from foreign studies about the use of virtual reality (VR) technology in the treatment of patients with various mental disorders.

Materials and methods: we selected and analyzed articles from MEDLINE / PubMed databases during the period from 2000 till 2020, as well as relevant references in the bibliography of the analyzed articles. 45 articles were included in further analysis from 575 English-language articles.

Results: The use of VR technologies in the treatment of mental disorders appears to be one of the promising directions in psychiatry. The successfulness of these methods in patients with eating disorders, anxiety-phobic disorders, and obsessive-compulsive disorder is supported to be evidentiary information. There is evidence of the effectiveness of such methods in patients with schizophrenia, particularly, one of the most significant results is an increase in social functioning. The absence of side effects data makes it possible to consider t VR therapy as a safe method. It is needed to make further study the areas of application of VR therapy and conduct research to identify possible side effects of this method.

Conclusion: The obtained results are important for drawing attention to the prospect of using VR technologies in Russian psychiatry and demonstrate the need for further study of this method.

The letter is devoted to the critical review of the basic concepts of the methodological article of Neznanov N.G., Kotsyubinsky A.P., Kotsyubinsky D.A. «Crisis of natural-scientific and human approaches in psychiatry».

The Scale for the assessment of negative symptoms (SANS) is one of the most widely used clinical assessment tools for negative symptoms.

The purpose of this study was psychometric analysis and modification of the SANS with the definition of criteria for assessing the severity of negative symptoms in the dynamics of therapy in patients with schizophrenia.

Material and methods: The study involved 157 patients with a diagnosis of schizophrenia, the age range of participants ranged from 18 to 59 years. Psychometric analysis was done on the base of the Rush measurement with the definition of criteria for assessing the severity of negative symptoms based on the index of minimum detectable changes for 95% probability (Minimum detectable change95%— MDC95%).

Results: Five SANS diagnostic items with low construct validity were identified. The technique was modified by excluding these invalid items. SANS was modified by eliminating of 5 invalid items. The modified version of SANS demonstrated high reliability (reliability index = 0.97) and discriminativeness (the ability to differentiate 12 metric levels of severity of negative symptoms). Factor analysis revealed the heterogeneity of the metric structure of the technique: points in the first group reflect the impoverishment of speech and emotional manifestations, points in the second group reflect the decrease of the patient’s involvement in various activities and restriction of social interaction. Thus, the two-dimensional structure of the SANS scale (“expression” factor and “motivation” factor) is fully consistent with the modern concept of negative symptoms, which allows to consider the total SANS score as an indicator of the severity of the negative syndrome construct. In the course of the metric analysis, the criteria for assessing the severity of negative symptoms in the dynamics of the therapy were determined.

Conclusion: The modified version of SANS has adequate psychometric characteristics. The diagnostic criteria are suitable for use in clinical practice and research.

Objective Clinical and follow-up verification of Attenuated Schizophrenic Symptoms (ASS) in the first youth depressive episode as early markers of the schizophrenic process, establishing further variants of the course of the disorder and its outcomes.

Materials and methods. 124 young inpatients (averaged age 19,6±2,3 years) with the first depressive episode with ASS were examined. The control group consisted of 27 patients with youth depression without ASS. All patients have been tracked for at least five years. The average follow-up period was 7,1±1,6 years. The HDRS, SOPS, SANS and PSP scales were used to assess the symptomatic and functional outcomes. Statistical analysis was carried out using STATISTICA 12.

Results. The typological classification of youth depressions (ASD) with ASS has been developed with the identification of three main types: (1) with attenuated positive symptoms (APS), (2) with attenuated negative symptoms (ANS), and (3) with attenuated symptoms of disorganization. Youth depression with ASS, compared to the control group, is more likely to move into chronic forms, has reliably worse functional and symptomatic outcomes, and is more associated with the diagnosis of schizophrenic spectrum disorders at five years follow-up.

Conclusion. Attenuated schizophrenic symptoms in the structure of youth depressions have high affinity to each other, indicating a common pathogenic mechanism of their formation, and also have predicate value as risk factors for schizophrenia.

The goal is to study the features of the cognitive reserve (CR) in HIV-infected patients admitted to the hospital, the relationship of CR with cognitive disorders, stress and coping strategies, taking into account the drug history.

Materials and methods. The study was conducted in the hospital of the Saint Petersburg Center for the prevention and control of AIDS and infectious diseases in 2019. Methods were used: 1) The Cognitive Reserve Index questionnaire (CRIq); 2) Montreal Cognitive Assessment (MoCA); 3) «Methods of coping behavior» by R. Lazarus. 4) Modified Impact of Event Scale (IES-R); 5) The Somatic Symptom Disorder — B Criteria Scale (SSD-12).

Results. The study involved 57 HIV-infected patients (43.9% — women). The median age was 39.6 years. The correlation analysis revealed a positive relationship between the KR index and the «non-professional activity» subscale (r = 0.847, p = 0.000), age (r = 0.299, p = 0.024) and MoCA indicators (r = 0.290, p = 0.029). Indicators of the KR subscale «professional activity» have a negative relationship with the indicators of coping strategies «distancing» (r = -0.379, p = 0.004), «self-control» (r = -0.355, p = 0.008), «positive revaluation» (r = -0.293, p = 0.030), «problem solving planning» (r = -0.283, p = 0.035). MoCA indicators in patients with HIV infection are associated with the CR «Education» subscale (r = 0.306, p = 0.021) and the General CR index (r = 0.290, p = 0.029). Obsessive feelings and thoughts related to the impact of HIV infection are more often experienced by patients who have never abused drugs and are involved in professional activities than by patients with experience of drug use.

Conclusion. Cognitive impairment and cognitive reserve in HIV-infected patients admitted to the hospital of the AIDS Center are related to coping behavior.

Quality of life indicators (QL) of patients are widely used in dermatological practice, but the influence of depressive and dissomnic symptoms on QL of patients with gender differences is not sufficiently studied.

Objective: to identify depressive and dissominal symptoms in patients with psoriasis and evaluate its impact on the quality of life of these patients taking into account gender differences.

Materials and methods: 34 patients with psoriasis were examined. Clinical examination included: analysis of complaints, medical history, assessment of dermatological status. Diagnosis of the presence and severity of depression was performed using a PHQ-9 patient health rating scale. Dissominal symptoms in patients with psoriasis were determined using the index of severity of insomnia ISI. To assess the quality of life, a dermatological index of quality of life (DLQI) was used.

Results and discussion. Sleep disorders were detected in 15 patients (44.1%), depressive symptoms were determined in all patients, a negative effect of the disease on the quality of life of patients was found in 32 people (94.1%).Correlation analysis of data from the entire population of patients revealed statistically significant correlations of DLQI with the severity of depressive symptoms (r = 0.45, p = 0.008) and sleep disorders (r = 0.35, p = 0.04). In women, DLQI significantly correlates with the severity of depression (r = 0.48, p = 0.04) and tends to be associated with sleep disturbances (r = 0.43, p = 0.07). In men, the relationship between DLQI and indicators of depression and sleep disturbances is significantly weaker and is not statistically significant ((r = 0.34, p = 0.22) and (r = 0.17, p = 0.55), respectively).

Conclusion.depressive symptoms and sleep disorders are interrelated with the quality of life of patients with psoriasis, and this relationship is more pronounced in women. Consequently, it is advisable to include effects aimed at normalizing mood and sleep in the program of complex therapy of psoriasis, taking into account gender differences.

The article reflects the results of the work of the psychiatric and psychotherapy services of the Hospital for war veterans converted into an infectious hospital in the context of the new coronavirus infection (COVID-19) pandemic. The aim of our study was to determine the frequency and nature of mental disorders in patients treated in hospital for a new coronavirus infection (COVID-19) between April and June 2020. The case histories of patients who received psychotherapy or psychiatric care in addition to the treatment of the underlying disease were studied retrospectively. The study included 557 patients, 266 men, 291 women, the average age was 62.36+18.65 years. The work used clinical and psychological methods using the international classification of diseases 10 revision (ICD-10), the diagnosis of a new coronavirus infection (COVID — 19) was carried out in accordance with the Temporary guidelines of the Ministry of health of the Russian Federation. As a result of data evaluation, it was revealed that the proportion of patients requiring consultation or treatment by a psychiatrist or psychotherapist was 557 (7,10%) patients of the total number of hospital admissions, of which emergency psychiatric care was indicated in 58 (10,41%) of cases. The transition of the hospital to an infectious diseases hospital mode has set new challenges for the psychiatric and psychotherapy service, which required organizational measures, therapeutic issues and confirmed the need for participation of mental health specialists in providing full-fledged medical care in the treatment of somatic disorders.

The aim of the study was to develop a new valid psychometric diagnostic tool for a multi-factor social network assessment of schizophrenic patients, called «The structural assessment of the social network of schizophrenic patients». The new development is based on the social network analysis model elaborated by S. L. Phillips (1981) and translated into Russian by Gurovich I. Ya. et al. (2007). The authors of this article additionally developed an algorithm for assessing the activity of patients on social networks of the Internet. Reducing non-informative variables and conducting a confirmatory factor analysis in a sample of 265 observations of schizophrenic patients (F20.0) aged from 18 to 55, recruited in four medical organizations (145 patients admitted to the hospital and 55 outpatients), resulted in determining a four-factor structure of the patients’ social network: «Objective parameters», «Internet activity», «Emotional aspect of social support» and

«Reciprocal support». The method has demonstrated high internal and external validity, as well as applicability in the clinical practice in schizophrenia due to the low resource consumption and compact applicability. Measurable factor indicators of the patients’ social networks obtained by using the structural assessment of the social network of schizophrenic patients allow to determine the targets for psychocorrectional interventions and to increase the effectiveness of psychosocial rehabilitation. In addition an automated method for calculating final indicators has been developed, as well as manual, practical recommendations and corresponding printed forms.

The article presents epidemiological study data on depressive disorders prevalence and dynamic of the population emotional well-being and affective disorders incidence in the world during the COVID 19 pandemic. Typical anxiety-depressive states are described with the emphasis on the specific COVID 19 stress syndrome. The article highlights the depression evolutional model as an adaptation mode to the unfavorable defined environmental conditions with the limited life-supporting resources, the nowadays pandemic situation can be definitely considered as one of them. The research data uniting psychodynamic and biological approach are considered in particular genetic specific of the serotoninergic regulation and environmental influence of the early adverse experience vulnerability with the later depressive disorders manifestation Additionally the research results on the bidirectional relationships between affective and immunological disturbances with the immune-metabolic syndrome description are presented. The peculiarities of the depression patients cognitive functioning are identified with specific personal negative rigid cognitive style and executive cognitive functions consideration. The combined therapy algorithm including implementation of SSRI antidepressants and cognitive-behavior psychotherapy, cognitive remediation programs is proposed.

Objective: to discuss problems of diagnostics and psychopharmacotherapy of associated depressive disorders and anxiety circle disorders.

Material and methods. The article is an analysis of a clinical case with the use of clinical and catamnestic method.

Results. Diagnostics of Generalized Anxiety Disorder, issues of its comorbidity with other mental disorders including anxiety and depressive disorders are discussed. The principles of panic disorder diagnosis are analyzed. Diagnostic criteria of associated anxiety and depression in ICD-10, DSM-5 and ICD-11 are considered. Modern approaches to the choice of therapeutic tactics in comorbidal anxiety and depression are given. The analysis of the patient’s treatment is carried out with the justification of the choice of drugs. The possibilities of combined therapy of associated anxiety and depression disorders using vortioxetine are demonstrated. Achievement of qualitative remission of mental disorder without residual symptomatology and full restoration of social functioning of the patient with associated depressive and anxious disorders is shown.

Conclusion. The clinical case demonstrates a characteristic chronic fluctuating course of GTR both in combination with different depths of depression and with other anxiety disorders (panic attacks). Diagnostic difficulties and therapeutic possibilities of a patient with double diagnosis: Generalized Anxiety Disorder and Depressive Episode have been analyzed.