In the article the problem of compliance to treatment is discussed considering pharmacodynamics of different classes of psychotropic drugs. Use of antipsychotics is associated with a high risk of non-compliance. Antipsychotics can inhibit the endogenous reward system and decreasing its tone reduce adherence to treatment. Both antidepressants and anxiolytics increase the tone of the reward system. But if for antidepressants an increase in adherence is associated with the activation of the reward system limited by related clinical effects, for anxiolytics high adherence to treatment is associated to the rapid development of specific effect and an indirect increase in the tone of the reward system with an increase general subjective satisfaction with treatment. The tolerance associated with the chronic use of benzodiazepine anxiolytics secondarily worsens the situation leading to the development of pathological addiction.

Using animal models that translate key features of alcohol dependence, the field has faced remarkable achievements in identifying neurochemical substrates of this disease with dopamine and norepinephrine playing significant role. Moreover, recent utilization of optogenetics in alcohol research provides with an opportunity in specifying patterns of neurotransmission within dopaminergic and noradrenergic neural circuits that govern ethanol-addictive behavior. This review summarizes experimental findings to demonstrate the effectiveness of the latest technologies in revealing the mechanisms bridging catecholamines’ specific changes with alcohol seeking, consummatory and relapsing behaviors.

The article describes the psychological characteristics of the personality of patients with multiple sclerosis (MS), which can be identified as the main targets of psychotherapy for comorbid post-traumatic stress disorder (PTSD). A total of 127 patients with MS were examined, of which 61 patients had symptoms of PTSD that developed in connection with the underlying disease. The control group included 67 MS patients resistant to stress. To assess the structure of personality and psyche, Ammon’s I-structural test was used (G. Ammon, 1976, adaptation by Yu. Ya. Tupitsin, V. V. Bocharov, T. V. Alkhazova, E. V. Brodskaya, 1998). To determine the level of resilience, which is defined as the patient’s ability to navigate in a crisis situation and get out of stress with minimal damage to mental and physical health, D.A. Leontiev (D.A. Leontiev, E.I. Rasskazova, 2006).

As a result of the study, it was revealed that patients of the main group have significantly lower scores on all scales of the resilience questionnaire («involvement», «control», «risk acceptance»). At the same time, patients with PTSD are characterized by a higher level of destructive and deficient manifestations of selffunctions on the Ammon scale, in contrast to patients in the control group. Decreased characteristics of hardiness, the predominance of deficient and destructive personality structures are predictors of the onset of post-traumatic stress disorder in patients with MS. The revealed psychological phenomena should be the targets of psychoprophylactic and psychotherapeutic influence in complex programs for the treatment and rehabilitation of these patients.

The aim of the study was to study the clinical and typological features of eating disorders in patients with schizophrenia spectrum disorders.

Materials and methods. We studied 136 patients (84 women and 52 men) with schizophrenia spectrum disorders, aged 19 to 58 years, mean age 37.6±9.8 years; the average duration of the disease was 8.6+7.6 years. Criteria for inclusion in the study: age from 18 to 60 years, the presence of disorders of the schizophrenia spectrum, in accordance with the criteria for ICD-10 (F. 20; F. 25), informed consent for participation in the study. Exclusion criteria: organic diseases of the central nervous system, endocrine pathology, severe somatic and gynecological diseases, pregnancy and lactation. The design of the study was open, comparative, non-randomized. The study of patients was carried out once before the start of therapy. Research methods: anamnestic, clinical-psychopathological, psychometric, anthropometric and clinical-statistical.

Results: Clinical and endocrine features of the majority of the studied patients were: appetite deviations, varied in nature, intensity and frequency; an increase in body weight of varying degrees, the predominance of the external type of eating disorders, including as part of a mixed type (more than 60% of cases); a high degree of expressiveness of the emotional and restrictive types; a combination of a significant severity of the emotional type with the apathetic nature of affective disorders occurring within the framework of the underlying disease; single-phase variant of the flow of restrictive type. Clinical features in the studied patients with obesity were the stability of disorders and the combination of increased appetite and daily volume of high-calorie nutrition, incorrect family culinary traditions, the prevalence of mixed or external type.

Conclusion. The management of patients with schizophrenia spectrum disorders with eating disorders should be comprehensive, together with endocrinologists, therapists, nutritionists. An integrated approach should include: observation and counseling by narrow specialists, recommendations for the normalization of lifestyle, diet, the formation of a low-calorie diet and nutrition stereotype in the patient’s family.

The aim of this study is to identify and substantiate early cognitive dysfunction in patients with brain damage in the acute period of ischemic stroke.

Materials and research methods. The study included 140 elderly patients. The main group included 70 patients of Vascular Surgery Center with a diagnosis of ischemic stroke in the carotid pool, the control group consisted of 70 outpatients. Cognitive function and psycho-emotional background were assessed using the Montreal Cognitive Function Scale, tests for kinetic, constructive and ideation praxis, the Stroop test, the Boston Naming Test, the apathy rating scale, the Hospital Anxiety and Depression Scale, and the MFI-20 asthenia scale. Assessment of neuroimaging parameters was carried out usingcomputed tomography. Assessment of long-latency acoustic endogenous evoked potential P300 using the «oddball active» paradigm technique was used for neurophysiological examination.

Research results. Ischemic stroke was more often detected in the parietal, frontal lobes and basal ganglia. Moderate cognitive impairment was detected in 57.5% of patients with stroke and 27.5% of the control group. Dementia was diagnosed in 30% of patients in the main group and 5% of the control group. In patients with IS indicators characterizing the executive function, praxis, speech, attention, memory, depression, and apathy were statistically significantly lower comparing with the control group. The analysis of neurophysiological data revealed a statistically significant prolongation of the latency of the P300 wave in all leads and a decrease in the amplitude of the P300 peak in leads Cz and C3 in patients of the main group. Conclusion. Within the framework of this study, significant factors in the development of early post-stroke cognitive impairment were established. Dysfunction in attention, executive function, episodic memory, and speech is the result of a combination of causes directly related to cerebrovascular disease and pre-stroke factors. The evoked potential method reflects the degree of cognitive decline and can be used as a method for assessing the effectiveness of cognitive rehabilitation in stroke patients.

This paper examines the psychological aspects of adaptive-compensatory psychological mechanisms in patients with paranoid schizophrenia before and after social skills training. The features of self-regulation of behavior, the level of subjective control, life orientations and subjective perception of psychological characteristics of time are studied. The effects of social skills training were compared with a control group of patients who received only isolated drug therapy with psychotropic drugs. Positive dynamics was noted in both studied samples.

The patients who took part in the study improved their ability to control impulses, increased behavioral flexibility, awareness of their contribution to the current situation and rational acceptance of responsibility for what is happening. Life goals also took shape better, the sense of manageability of life and satisfaction with it increased. The present has become perceived by patients with paranoid schizophrenia as more structured, saturated and predictable, and the past as realistic and tangible, which has a positive effect, including on the emotional background of patients. The effects of the training were clearly manifested when compared with a group of patients receiving only drug therapy. With combined treatment (social skills training and psychopharmacotherapy), patients begin to perceive the past more realistically, assess their actions and activity level more soberly, integration, awareness and structuring of past experience increases. This will allow patients with paranoid schizophrenia to facilitate the planning of their behavior in the future, as well as to increase the adequacy of the formation of cause-and-effect relationships and perception of what is happening, which has a beneficial effect on the ability to adapt to life in society and compensate for existing violations.

The article is devoted to modern concepts of cognitive disorders in schizophrenia. Neurocognitive deficits can be expressed in impaired attention, auditory memory, motor skills, working memory, processing speed and executive function. The attention of researchers is currently being paid to the violation of the speed of information processing and character encoding that can lead to impaired social functioning in patients with schizophrenia. Two hypotheses about the dynamics of neurocognitive impairments in schizophrenia are also considered: the theory of «static encephalopathy» and progressive impairment of cognitive functions.

This review evaluates the results of a comparative analysis of the effectiveness of first and second generation antipsychotics in the treatment of cognitive dysfunction. As a result of the analysis of the available data, it was concluded that first-generation antipsychotics most likely do not directly impair cognitive abilities, but they can do so indirectly, due to the simultaneous use of anticholinergic drugs that compromise some neurocognitive abilities. Second-generation antipsychotics have an advantage over first-generation drugs, however, it has been argued that most antipsychotics lead to a slight improvement in cognitive functioning, and there is no specific effect on its specific domains.

An analysis of data on the relationship between oxidative stress markers and psychopathological characteristics and cognitive profile of patients with schizophrenia was carried out. In particular, the mechanism of stress-induced cell death in the prefrontal and anterior frontal regions and a decrease in brain volume in these regions, leading to a decrease in cognitive and executive functions, are considered. In addition, the mechanisms of association of redox imbalance with brain-derived neurotrophic factor (BDNF) depletion, hypofunction of the NMDA receptor, changes in the level of pro-inflammatory cytokines, neurogenesis, and cell apoptosis were considered.

Relevance: The COVID-19 pandemic is a global process that has an extremely negative impact on the psychological state of people, which increases the level of anxiety, distress, and other reactive states. The impact of SARS-CoV-2 infection on the human nervous system and psyche is being actively studied. This study aimed to compare neuroimaging data in healthy individuals during the COVID-19 pandemic during 6 months of follow-up.

Materials and methods: The initial model for comparing morphometric parameters was the «Central Nervous System Norm Bank», which includes MRI data of the brain of 131 healthy volunteers aged 20 to 70 years (including 72 women and 59 men), collected before the start of the pandemic COVID-19 and brain re-examination data six months later.

Results: The voxel-based morphometry data we obtained do not match the morphometry data for PTSD and anxiety disorder. This probably reflects the more widespread nature of changes in the brain associated with COVID-19 and caused by the duration of the pandemic, changes in people’s lifestyle and thinking, and a state of uncertainty. Thus, the morphometric data show the neuroplasticity of the brain of adult healthy volunteers. These changes underline the need to reduce stress levels in healthy people during the pandemic, which can be implemented through the provision of convincing and reliable information about this disease.

Conclusions: It would be additionally relevant to create opportunities for psycho prophylaxis, stress relief, which certainly increases the load on the psychotherapeutic service in a pandemic.

Suicidal behavior is characterized by the response of the individual to the conditions of the crisis situation experienced. The unrelenting interest of researchers around the world is aimed at studying the factors that determine the risk of suicidal intentions in patients with epilepsy.

Purposal. To determine the main types of attitude to the disease in patients with epilepsy and suicidal thoughts.

Materials and methods. 112 patients with epilepsy were examined and divided into 2 groups depending on the presence of suicidal thoughts at the time of the study: 1st group – with suicidal intentions, 2nd group – without it. The method «Type of attitude to the disease» were used.

Results. Thus, among the clinical factors of suicidal risk in patients with epilepsy, severe course of the underlying disease is the most significant, which is manifested by frequent seizures, serial course, and drug resistance form. It was revealed that patients with epilepsy with suicidal thoughts are characterized by the presence of «mixed» and «diffuse» types of attitude to the disease, with a predominance of maladaptive forms. The analysis of «pure» types of attitude towards the disease in two groups showed that there are fewer respondents with a «pure» type of attitude towards the disease in the group of patients with suicidal thoughts than in the group of patients without it. Along with the ergopathic and sensitive types, in the 2nd group of patients, the anosognosic type of attitude to the disease is also quite pronounced, and in the 1st group, patients with anosognosic, anxious and hypochondriacal types of attitude to the disease were identified.

Conclusion. Consequently, patients with epilepsy are characterized by: vulnerability, vulnerability, concern about possible adverse impressions that they can make on others with information about their illness; the desire, despite the severity of the disease, to continue working; lack of criticality to their own disease, which can lead to destabilization of the underlying disease and the formation of suicidal behavior.

The current article introduces a method of data collection that is of particular importance for research and individual case analysis of the experience and behavior of patients with mental disorders. Numerous questions cannot be adequately answered by conventional methods. In particular, the validity of diagnoses and the testing of hypotheses about the functional relationship of disturbed behavior with antecedent or concomitant internal and external conditions cannot be fully examined with traditional tools. In recent decades, psychology has strongly favored the use of the questionnaire (or interviews) in many domains, which, although economical in time, is considered an inappropriate data collection instrument for many types of questions. This is especially true when the aim is to investigate how people are actually feeling, thinking, and behaving at specific points in time in everyday life. For this purpose, Ambulatory Assessment (AA) was developed.

The article briefly describes the method, its history, and the conditions under which it is particularly useful or necessary in the field of Psychiatry and Psychotherapy. It also offers insight into AA research in the field of psychiatry and clinical psychology with regard to different types of research questions. Finally, limitations, challenges and opportunities in using ambulatory assessment are discussed.

The opinion article is devoted to the analysis of a large-scale 24-week multinational observational prospective cohort study «The effectiveness of vortioxetine in depression in real clinical practice» (BELIEVE). The study demonstrated the achievement of functional recovery of patients with depressive disorder when using vortioxetine, good efficacy and tolerability of the drug for the treatment of depression in a large and heterogeneous patient population representative of everyday psychiatric practice. A significant improvement in depressive and cognitive symptoms, productivity and quality of life of patients was achieved, while the greatest effect was observed when using vortioxetine as the first line of therapy. The results of the study confirmed the data of numerous RCTs devoted to the use of vortioxetine in the treatment of depressive disorder, and they can be used when choosing tactics of antidepressant therapy in conditions of routine psychiatric.