Essential tremor (ET) is a heterogeneous disease with a high prevalence and disability. Traditionally, the disease was considered benign with the presence of tremor, the severity of which increases during the observation period. The severity of trembling varies widely from mild, not requiring therapy, to disabling. That is making difficulties to assess the prevalence of the disease. However, disability in patients with ET can occur not only due to the severity of tremor.
The underestimated side of the disease, despite a long history of study, remains non-motor manifestations, including cognitive decline. Cognitive decline in essential tremor, compared with the general population, has a greater risk of transformation into dementia. In patients with ET, in comparison with other cognitive domains, executive functions are predominantly affected. Patients are also characterized by low awareness and concern about changes in intelligence. In the study of the brain using voxel morphometry, a heterogeneous group of changes that contradict each other was revealed. Most often, a change in the density of the cortex of different parts of the brain is detected in comparison with the control group. The most affected area of the brain is the precuneus. This may explain the executive dysfunction in patients and highlight the likely neurodegenerative nature of essential tremor. The absence of preventive therapy, the high incidence of changes in intelligence emphasizes the need for close monitoring of patients.

Bipolar affective disorder (BD) is a complex mental illness that presents diagnostic challenges due to its heterogeneous nature. As a result, identifying potential markers for the disorder is crucial for effective diagnosis and treatment. Resting-state functional magnetic resonance imaging (rs-fMRI) is a promising non-invasive technique that provides a window into the pathophysiological characteristics of psychiatric and neurological diseases in vivo. The amount of data accumulated in the scientific community regarding changes in spontaneous activity and functional connectivity of brain regions in BD necessitates a comprehensive synthesis to determine the spectrum of disorders. Accordingly, a systematic review of reviews was conducted to summarize the changes characteristic of patients with BD as measured by fMRI. Qualitative synthesis of results of nine systematic reviews and six meta-analyses has allowed the definition of changes in spontaneous activity and functional connectivity most characteristic for BD, confirming the unity of functional disturbances of this nosological unit. The findings of the review indicate that the manic state in BD is often associated with increased activity of the amygdala and decreased functional connectivity between the amygdala and frontal regions. Conversely, the depressive phase is characterized by abnormalities of functional connectivity within the default mode network, particularly in relation to the posterior cingulate cortex. Changes in functional connectivity during periods of euthymia may reflect residual manifestations of one of the exacerbation phases or may be associated with a history of a psychotic episode. Furthermore, a comparative analysis of possible methods of quantitative fMRI data synthesis has been conducted for the first time in Russia, which is a valuable contribution to the field.

The review is devoted to the classification, diagnosis and differential diagnosis of transient loss of consciousness. The pathophysiology of transient loss of consciousness is described. It is concluded that the criteria for the differential diagnosis of transient disorders of consciousness need further development and validation. The problem of paroxysmal disorders of consciousness is interdisciplinary in nature and requires the combined efforts of doctors of different specialties to develop a unified algorithm for clinical, laboratory and instrumental diagnostics, determine management tactics and correct patient routing.

The article presents excerpts from the documents of the past of domestic psychiatry. Their analysis allows, with the help of primary sources, to assess the difficult period of the middle of the last century in the development of biological science, scientific and practical psychiatry in our country. The intertwining of ideological, pseudoscientific, personal and career interests at that time, as in many areas of science, pushed aside the problems of creative scientific developments and created for many professionals an atmosphere of distrust, suspicion, and discredit of leading specialists.

Introduction. Although scientific literature demonstrates a relationship between prolactin levels, the efficacy of aripiprazole therapy, and negative symptoms in patients with schizophrenia, many questions regarding these problems remain controversial.

Objective to study dynamics of clinical and hormonal parameters in patients with chronic schizophrenia during aripiprazole therapy.

Materials and methods: 60 patients with schizophrenia were studied: 42 male (70%) and 18 female (30%), aged 20 to 65 years (mean age 52.84±17.40 years) on inpatient aripiprazole treatment with the mean daily dosage of 15.33±4.52 mg. Comparative analysis of prolactin parameters was carried out taking into account the following factors: effectiveness of therapy, age, duration of the disease, severity of negative symptoms (according to the PANSS scores). Responders included patients with a reduction in total PANSS score of 20% and more.

Results: the effectiveness of aripiprazole monotherapy after switching from previous antipsychotic treatment in patients with chronic schizophrenia was noted in 71.7% of patients. The effectiveness of therapy does not depend on the background values of the hormone: at high rates, prolactin levels decrease, and at low rates, they increase. Meanwhile, a certain pattern was revealed between the dynamics of scores of the negative PANSS scale and the level of prolactin: responders with high background levels showed the decrease of prolactin levels given the decline of the PANSS scores, and in responders with low values, the hormone levels increased. In non-responders, low background scores of the negative scale and their slight changes during therapy were accompanied by an increase in prolactin levels. The data obtained in relation to non-responder patients who showed negative correlations between the levels of prolactin, age, dosage of the drug and the duration of the disease require a more careful attitude to the appointment of aripiprazole due to the likelihood of a decrease in their prolactin levels to abnormally low values.

The aim of the study was to investigate the structure of delirium in elderly patients with different outcomes of coronavirus infection.

Materials and Methods. The study was carried out on the basis of Hospital for War Veterans, St. Petersburg. The study involved  30 patients: 13 male and 17 female (median age (Med) 70.5, interquartile range (IQR) 62-83) with clinical diagnosis: "New coronavirus infection COVID-19 (PCR+), F05.86 other delirium in association with other viral and bacterial neuroinfections. Peculiarities of delirium manifestations were studied using Delirium Rating Scale-Revised-98 (DRS-R-98). Current physical condition was monitored using The National Early Warning Score (NEWS2) for COVID-19.

Results: All patients had moderate to severe disorders of the wake-sleep cycle on the DRS-R-98 scale. In addition, perceptual and long-term memory impairments were common. A significant correlation (p<0.05) was found between the severity of the physical condition and disorders of the sleep-wake cycle, lability of affect, formal thought disorders, motor agitation, and disorientation. In addition, there were significant correlations (p<0.05) between delirium symptoms and physical status scores on the NEWS2 scale. In lethal patients, more pronounced disturbances were recorded on sleep-wake indicators (Med.3.0, IQR 2.0-3.0 vs Med.2.0, IQR 2.0-3.0, p=0.0327) and motor agitation (Med.2.0, IQR 1.0-2.5 vs Med.1.0, IQR 0.0-2.0, p=0.441). A logit regression model showed that the variables "respiratory rate," "heart rate," and the final NEWS2 score could be considered predictors of disease outcome.

Conclusion. Delirium, one of the most frequent manifestations of acute brain dysfunction, is a serious complication of COID-19 in hospitalized patients and a strong predictor of adverse outcome of coronavirus infection in older patients.

The authors have attempted to design and verify a model of comprehensive (medical, social and psychological) prognosis in cardiovascular disease, which would cover aspects of patients’ illness, treatment and life functioning. A multidisciplinary set of methods was used to realise the aim. The study included 437 patients suffering from coronary heart disease or chronic heart failure, both of ischaemic and non-ischaemic etiology, who were referred for cardiovascular surgery, and who had undergone surgical intervention.

Part II of the article presents the results of the 3 final stages of the study. These are the following: 5) The studied indicators were divided into the following subgroups: “Current state factors” (reflecting the patients’ current psychological state, characterising their cognitive and emotional-affective spheres) and “Baseline factors” (reflecting relatively stable characteristics of the disease, socio-behavioural and personal features of the patients). 6) A new factor analysis was performed, resulting in 11 secondary factors: 5 in the group of “Current state factors” (“Psychological well-being”, “Quality of life in the face of cardiac disease”, “Reduced non-verbal cognitive functions due to anxiety”, “Positive mood and cognitive state”, “State of mnestic function”) and 6 in the group of “Baseline factors” (“Non-constructive behaviour in the face of disease”, “Occupational motives and severity of cardiovascular disease”, “Psychosocial risk factors for coronary heart disease”, “Patient motivation, tension and severity of chronic heart failure”, “Social support and resilience”, “Adherent behaviour and rational thinking”). 7) We used mathematical modelling and a neural network to determine the prognostic value of the above factors and to construct a systematic prediction model that will be capable of predicting the value of all “Current state factors” at any given time (days after surgery) with an accuracy of up to 80%. In the future, we plan to design a model for the “Baseline factors”.

The identification of prognostically relevant patients’ characteristics at the stage of preparation for cardiac surgery can help to optimise psychological help for the patient during this time and individualise the postoperative rehabilitation programme.

Post-traumatic stress disorder (PTSD) is a mental disorder that develops as a result of a powerful psycho-traumatic effect of a threatening or catastrophic nature, accompanied by extreme stress, the main clinical manifestations are repeated experiences of elements of a traumatic event in a “here and now” situation in the form of flashbacks, recurring dreams and nightmares, which accompanied more often by anxiety and panic, but possibly also by anger, anger, feelings of guilt or hopelessness, a desire to avoid internal and external stimuli that resemble or are associated with the stressor. PTSD tends to form personality disorders, and is also characterized by a high prevalence of comorbid pathology. Recently, data have been accumulated on changes in the brain neurotransmitter systems and neuroendocrine disorders in patients with PTSD, as well as on the presence of morpho-functional, neuroinflammatory, and other neurobiological features. Improvement of existing and development of new pharmacotherapy algorithms is an important component of care provided to patients with PTSD. Despite the leading role of psychotherapy in the treatment of this disorder, prevention of chronicity and relapses, in order to achieve a quick effect and form patients' adherence to treatment, within the framework of a personalized approach, the use of psychopharmacotherapy is recommended, the effectiveness of which should be evaluated during the entire course of therapy.

The aim of the study was to evaluate the possibility of using cariprazine for the treatment of productive and negative symptoms in schizophrenic spectrum disorders in a hospital setting.

Materials and methods: A group of 35 patients with leading productive and negative symptoms in patients with schizophrenic spectrum disorders treated in a psychiatric hospital constituted the material of the study. The condition of patients was objectified according to the Clinical Global Impression Scale (CGI-S and CGI-I) and the Positive and Negative Syndrome Scale (PANSS) — at the beginning of the study and in dynamics on the 30th and 60th day of treatment. The mean PANSS score at the beginning of the study was 94.45±14.49 points. After the drug administration, the patients were followed up for up to 60 days.

Results: Cariprazine was administered both as first-line treatment and after prior therapy. The dose range was from 1.5 mg to 6 mg daily. In 3 patients (8.57%), cariprazine therapy was discontinued due to the development of adverse events or worsening of the condition. The remaining 32 patients (91.43%) showed positive dynamics.

Conclusions: The study showed high efficacy of cariprazine when administered for the treatment of productive and negative symptoms in schizophrenic spectrum disorders in a hospital setting. The drug was well tolerated in the majority of patients.   

This article presents a review of modern scientific data concerning the safety and efficacy of the use of Metadoxil at different stages of the treatment of alcohol use disorder (from acute alcohol intoxication to the alcohol withdrawal syndrome, to the post-withdrawal period and remission stabilization), as well as a review of the advantages of Metadoxil use in such patients, due to the neuro- and hepatoprotective effects of this medication. Authors also describe a clinical case from their own practice. In the aforementioned case, the use of Metadoxil as a part of combination therapy contributed not only to the stabilization of remission of the alcohol use disorder, but also to diminishing of symptoms of comorbid mental (obsessive-compulsive disorder) and somatic (alcoholic fatty liver disease) diseases.