Psychiatry Center Research Articles

Social Frustration Level Questionnaire: Substantiation, Design, and Probation

The current preventive trends in clinical examination draw attention to the role of the external factors and stressful circumstances in psychodiagnostic research. Social frustration is an incapacity to fulfill relevant social needs because of a current situation. This term makes it possible to qualify criteria for the potential stress related to social functioning among family members, colleagues, and peers. The authors rationalized and tested a formalized questionnaire of Social Frustration Level developed at Bekhterev National Medical Research Centre for Psychiatry and Neurology in 2004 for patients with social adjustment disorders. The experiment justified the criterion validity of the Social Frustration Level Questionnaire. The article describes the structure of social frustration regarding the key spheres of activity attributed to internal and external frustration. The pilot study involved 45 patients with adjustment disorders, who showed significant frustration related to health problems and socio-economic status accompanied with relative satisfaction with interpersonal relations, i.e., family, friends, colleagues, and strangers. The research relied on the method of clinical psychological interview, as well as the Questionnaire of Social Frustration Level and the Integrative Anxiety Test. Personal anxiety and actual anxiety experiences proved to correlate with social frustration. The internal social frustration prevailed over the external one. The Questionnaire of Social Frustration Level proved to be an efficient practical tool to be used in systematic medical psychodiagnostics research, programs of disorder prevention, and psychotherapy.

Residual Depressive Symptoms in Treatment-Resistant Bipolar Depression Following Short-Term Ketamine Administration.

Residual symptoms are frequently observed in a significant number of patients with depression, indicating an unmet need for effective management strategies to achieve functional recovery. This observational study aimed to evaluate the impact of ketamine infusions on depressive symptoms in patients with bipolar disorder who continued their baseline psychotropic and chronic somatic treatments. Datasets of the two consecutive real-world registries (NCT04226963 for 2019-2022; NCT05565352 from 2023 onward) for the tertiary reference center for psychiatry at the Medical University of Gdańsk (Poland) for the safety and tolerability of ketamine use in mood and anxiety disorders were retrospectively analyzed. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology Self-Report 30 (IDS-SR30). Residual symptoms were identified in patients who achieved a treatment response, defined as a 50% or greater reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to the seventh infusion. Overall, 14 out of 22 patients met the criteria for response. The most commonly persistent depressive symptoms included sad mood (85.7%), view of my future (78.6%), difficulty falling asleep, and leaden paralysis/physical energy (both 71.4%), with the most severe being difficulty falling asleep (64.3%) and sad mood (42.9%). This observational post hoc analysis indicates that the most frequently observed residual depressive symptoms were low mood, altered view of future, sleep disturbances, and low energy levels. This study should be treated with caution as causality does not apply, however, it reports on a real-world population of subjects with treatment-resistant bipolar depression. Establishing standardized definitions for residual symptoms could enhance the quality and comparability of future research in this area.

10-year outcome trajectories of people with mental illness and their families who receive services from multidisciplinary case management and outreach teams: protocol of a multisite longitudinal study

IntroductionIndividuals with mental illness and their families often undergo their recovery process in their communities. This study explored the long-term outcome trajectories of individuals and families who received case management...

Predictors of hemorrhagic transformation in patients of first ever acute ischemic stroke receiving recombinant tissue plasminogen activator (rTPA)

Abstract Background Hemorrhagic transformation (HT) represents a serious complication of acute ischemic stroke (AIS). Aim To detect predictive factors linked to HT among patients having a first-ever AIS who received recombinant tissue plasminogen activator (rTPA), for better preselection of patients eligible for thrombolytic therapy. Patients and methods This research took place at the Neuropsychiatry Department and Centre of Psychiatry, Neurology, and Neurosurgery, Tanta University Hospitals over 12 months. The total number of patients included was 460, with 115 who received rTPA and 345 who did not receive rTPA. All participants underwent a comprehensive medical history, clinical and neurological assessments, radiological evaluation (ASPECT score), cardiac investigation, and were followed-up for two weeks to detect any HT. Results Patients with HT represented 21.7% of all rTPA patients, with symptomatic intracranial hemorrhage representing 6.9%, while non-rTPA patients with HT represented 13.9% and symptomatic intracranial hemorrhage represented 4.3%. HT patients in the rTPA group had significantly higher rates of smoking, respiratory rate, and lower platelet count, low density lipoprotein and cholesterol levels, while HT patients in the non-rTPA group exhibited significantly higher blood pressure, random blood sugar, as well as lower ASPECT scores. Conclusion There was an association between HT and five predictors (higher smoking rate, higher respiratory rate, lower platelet count, and lower low density lipoprotein and cholesterol levels) in first ever acute ischemic stroke patients receiving rTPA. In patients who did not receive rTPA, HT was associated with lower ASPECT scores, higher blood pressure, and random blood sugar.

“V.M. Bekhterev Review of Psychiatry and Medical Psychology” — History of the First Psychiatric Journal in Russia

The article presents the historical facts oт the creation of the first psychiatric journal in Russia (1896). The organizer of the journal and its first editor-in-chief was V.M. Bekhterev. After his death in 1927, the journal was named after him. It had been published until its closure in 1930. For various reasons, some of which are discussed in the article, the journal has not been published for six decades. The organizational difficulties of registering printed materials that existed at that time are also described. Nevertheless, they were overcome, and in 1990 the USSR State Press Committee issued the Order «On the resumption of publication of the journal...». The journal received a Registration Certificate and was assigned to almost the highest group of central journals. All financing was assigned to the Leningrad branch of the publishing house «Medicine», and the journal was printed in the fabulous in modern reality figure of 20,000 copies per month.After the collapse of the USSR in 1991, this Order ceased to be valid, and the whole thing had to be started all over again. Nevertheless, the first issue of the journal was published in 1991. Its release has been expected not only in Russia, but also abroad. The first issue included a welcoming speech by the President of the World Psychiatric Association, Jorge Alberto Costa e Silva, which attracted even more attention towards the journal. In 1992, the American Psychiatric Association published an English-language digest of the journal in the United States. For some time the journal was also published in Paris (1998-2000) and in Moscow (2004-2011). Currently, the journal is published by its founder, the V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology in St. Petersburg and is one of the most renowned journals in the field of psychiatry and medical psychology in Russia.

Serotonin syndrome controversies: A need for consensus

Serotonin syndrome (SS) is a drug-induced clinical syndrome resulting from increased serotonergic activity in the central nervous system. Although more than seven decades have passed since the first description of SS, it is still an enigma in terms of terminology, clinical features, etiology, pathophysiology, diagnostic criteria, and therapeutic measures. The majority of SS cases have previously been reported by toxicology or psychiatry centers, particularly in people with mental illness. However, serotonergic medications are used for a variety of conditions other than mental illness. Serotonergic properties have been discovered in several new drugs, including over-the-counter medications. These days, cases are reported in non-toxicology centers, such as perioperative settings, neurology clinics, cardiology settings, gynecology settings, and pediatric clinics. Overdoses or poisonings of serotonergic agents constituted the majority of the cases observed in toxicology or psychiatry centers. Overdose or poisoning of serotonergic drugs is uncommon in other clinical settings. Patients may develop SS at therapeutic dosages. Moreover, these patients may continue to use serotonergic medications even if they develop mild to moderate SS due to several reasons. Thus, the clinical presentation (onset, severity, and clinical features) in such instances may not exactly match what toxicologists or psychiatrists observe in their respective settings. They produce considerable diversity in many aspects of SS. However, other experts discount these new developments in SS. Since SS is a potentially lethal illness, consensus is required on several concerns related to SS.

“Pre-Discharge Syndrome” in Gerontopsychiatric Practice: Clinical Manifestations and Risk Factors

Background: hospitalization of elderly patients is associated with social and psychological maladaptation, reduced levels of daily functioning, and development of hospitalism. Patients whose status suddenly worsened immediately prior to discharge from psychiatric hospital make up a group that is difficult for diagnostics and treatment and not sufficiently studied. The aim of the study was to analyze changes in patients’ status before planned discharge from hospital to identify clinical patterns of deterioration and factors associated with this adverse event. Patients and methods: study participants were selected from 181 consecutive patients of the Geriatric Psychiatry Department of V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology. The main study methods were history-taking and psychological assessment. Results: predischarge deterioration was observed in 81 patients (44.8%) and was represented by exacerbation of mental disorder in 60 cases (33.2%), development of new symptoms in 12 patients (6.6%), or decompensation of somatic disease in 9 cases (5.0%). The history of patients with predischarge worsening was characterized by longer prior hospitalizations. These patients were more heavily pretreated, and had higher rates of hospitalism and non-compliance. For patients with worsening or development of new symptoms of mental disorder median duration of mental disease was respectively 84 and 204 months. They were more prone to violation of compliance, of the prescribed treatment regime and doses. Somatic decompensation occurred in patients with median duration of mental disorder 36 months and was associated with latent refusal to take medicines. Conclusions: an increased risk of predischarge deterioration in geropsychiatric patients with a history of prolonged hospitalizations needs earlier rehabilitation, psychotherapy, and psychological support when planning hospital discharge.

Suicide attempts in schizophrenia – A large retrospective cohort study from a tertiary care psychiatry centre in India

The extent of variability in identified risk factors for suicide attempts (SA) in schizophrenia limits their generalization. This study aimed to identify the rates and associated correlates of SA in schizophrenia by reviewing a large cohort (n=500). Nearly one-fourth had a history of SA, which was independently associated with a family history of SA, more inpatient admissions, and better long-term treatment response. These findings highlight the complex interaction between biological factors influencing SA and illness determinants in schizophrenia. Furthermore, they reinforce the need for future research to unravel the association between suicide vulnerability and the pathophysiology of schizophrenia to attenuate morbidity and mortality associated with the same.

The Epidemic of Non-Suicidal Self-Harm in Adolescents and Young Adults in the Kyrgyz Republic

Introduction During the last two years, many young people and adolescents in the Kyrgyz Republic started to visit specialists due to Non-suicidal self-harm. A significant rise in the amount of such cases allowed specialists from the Republican Center of Psychiatry in Bishkek to think about an “epidemic “of self-harming behavior. Non-suicidal self-harm (NSSH) is defined as repeated, deliberate, direct injury to the body without suicidal intent that is not socially acceptable (Nixon et al., 2002) to reduce psychological discomfort in the absence of a conscious intention to take one’s life (ICD-10 codes X60-X84, and ICD-11 codes PB80-PD3Z).ObjectivesTo determine the causes of NSSH among adolescents and young adults who approached specialists in mental health sphere at Institute of Behavioral Health at the American University of Central Asia.MethodsOver two years, forty-five adolescents and young adults under twenty-five who had committed self-harm visited specialists from the Behavioral Health Institute at the American University of Central Asia.All the patients received either dialectical behavioral treatment or cognitive processing treatment, medication (paroxetine) was used in three cases.ResultsThirty patients were girls under twenty-one, and fifteen were boys and young male adults. The overwhelming majority (40 people) had self-inflicted cuts, two had imposed burns with matches and cigarettes, and one had used self-suffocation without a bond. Reasons for self-harm were the following: releasing internal tension and anxiety, getting some rest from intrusive thoughts, relieving the inner pain, and a desire to “feel as a whole person.” All the patients underlined that they did not want to attract attention from their family members; moreover, they tried to hide the consequences of self-harm. Teens and young adults (twelve patients) from Kyrgyz traditional families visited a consultant or psychiatrist after a long drive through conventional or religious healers. All of the patients knew that they were addicted to self-harm, wanted to stop a problematic behavior, and could not stop it on their own. Ten patients have been diagnosed with borderline personality disorder. Two of them also had eating disorders. Five patients had PTSD, and five had social phobia. The others had recognizable anxiety symptoms.ConclusionsThe enormous rise of non-suicidal self-harm is a phenomenon that needs further research. Those cases often resist treatment due to the “addictive” component in the pathogenesis.Disclosure of InterestNone Declared

The role of negative childhood experiences and internal stigma in the formation of motivation for the treatment of patients with mental disorders

Background: Motivation for treatment is an important component of patients' compliance to treatment of mental disorders, and its formation can be affected by different factors. The aim of the study: To analyze relationship between adverse childhood experiences, internal stigma and the intensity and structure of motivation to pharmaco-psychotherapy in patients with mental disorders. Materials and methods: The study involved 102 patients treated at the V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, the Kashchenko Hospital, and the City Psychiatric Hospital No. 6. The study used the Adverse Childhood Experience (ACE) questionnaire, the Internalized Stigma of Mental Illness (ISMI) questionnaire, and the Treatment Motivation Assessment Questionnaire (TIMQ). Statistical analysis was performed using the SPSS 26.0 software package. Results: According to the results of multiple regression analysis, patients with higher education determined the improvement of patients' motivation for treatment, increasing the probability of its high intensity by 5.92 times. The presence of each additional type of adverse experience in childhood also 1.4-fold increase the odds of intensive motivation of patients. Among individual variants of negative experience, emotional abuse was associated with a tenfold decrease in odds, while observing violence against a mother or stepmother in childhood was conversely associated with a fifteenfold increase in the odds of forming an intense motivation for treatment. Conclusion: Integrative role of adverse childhood experiences is important, but, unlike the internal stigma of mental disorder, it can be equally associated with both less adaptive motivational patterns during treatment. to both more and less adaptive motivational patterns in patients in the process of their treatment.

Association of COVID-19 preventive behavior and job-related stress with the sleep quality of healthcare workers one year into the COVID-19 outbreak: a Japanese cross-sectional survey

BackgroundThis study aimed to evaluate the association of COVID-19 preventive behavior and job-related stress with sleep quality among healthcare workers (HCWs). We conducted a cross-sectional survey using a questionnaire at the National Center of Neurology and Psychiatry, Tokyo, Japan.MethodsA total of 586 participants who completed the questionnaire were eligible for the study. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. We examined the level of engagement between poor sleep and COVID-19-related infection preventive behaviors, such as avoiding closed spaces, crowded places, and close contact (three Cs), a distance of at least one meter from others, wearing a face mask regularly, washing hands regularly, and working remotely, as well as job-related stress in the work environment, exposure to patients, potential risk of infection, fear of infecting others, need for social confinement, and financial instability. We conducted a hierarchical logistic regression analysis to examine the relationship between poor sleep and COVID-19 preventive behavior, job-related stress, and other covariates, including age, sex, and the Kessler Psychological Distress Scale (K6), which was used to measure non-specific psychological distress.ResultsPoor sleep was observed in 223 (38.1%) participants. Adherence to COVID-19 preventive measures was relatively high: 84.1% of participants answered “always” for wearing a face mask regularly and 83.4% for washing hands regularly. In the multivariate logistic regression analysis, stress in the work environment (odds ratio [OR] = 2.09, 95% confidence interval [CI], 1.37–3.20; p < 0.001), financial instability (OR = 1.73, 95% CI, 1.12–2.67; p < 0.05), and low adherence to working remotely (OR = 1.65, 95% CI, 1.06–2.57; p < 0.05) were independently and significantly associated with poor sleep after controlling for the covariates.ConclusionsOne year into the COVID-19 pandemic, the poor sleep rates of HCWs remained high. These results emphasize the need to protect HCWs from work environment stress and financial concerns.

Safety and Tolerability of Combining CGRP Monoclonal Antibodies with Gepants in Patients with Migraine: A Retrospective Study.

The introduction of clacitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) has revolutionized the treatment of migraines. In clinical practice gepants might be considered as a valid option to treat acute attacks in patients with migraine who are treated with mAbs. However, the safety and tolerability of such a combination is not well addressed in the real-world setting. We designed this study to evaluate the safety and tolerability of combining CGRP mAbs with gepants in the management of migraines. This was a retrospective, real-world, exploratory study. The participants included within the study were adult (≥ 18years) patients diagnosed with migraine. Screening for patients who were treated with at least one GCRP mAbs was done. Data was collected from one site, the American Center for Psychiatry and Neurology, Abu Dhabi UAE. A total of 516 patients taking CGRP mAbs were identified. Extracted data from patients' electronic medical records included patient demographics, migraine characteristics, prescribed treatments, and adverse events (AEs). The tolerability and safety of the combination therapy was evaluated on the basis of documented AEs. Among the identified 516 patients, 234 were administered gepants in addition to the CRGP mAb (215, rimegepant; 19, ubrogepant). Eleven of the 234 patients switched from rimegepant to urogepant as a result of lack of efficacy; one patient switched from urogepant to zolmitriptan because of the lack of insurance coverage of the former medication. Among all the patients included in this study, three AEs were documented. These AEs were generally mild and transient and hence did not lead to discontinuation of treatment. Moreover, 42 of the 234 (17.9%) patients were switched from one class of CGRP mAbs to another at least once while continuing treatment with the assigned gepants. The findings of this study demonstrate that combining CGRP mAbs with gepants is a safe and well-tolerated treatment approach for migraine. Future studies are warranted to further validate these findings and explore long-term outcomes.

Course and Outcome of Anorexia Nervosa in Adolescents from a Tertiary-level Mental Health Setting in India: A Retrospective Chart Review.

Anorexia nervosa is one of the least studied mental health conditions in the Indian setting. The objective of this study was to assess the course and outcome of anorexia nervosa in adolescents who had presented to a tertiary care child and adolescent psychiatry center over a period of 10 years. The present study is a retrospective chart review of adolescents (up to the age of 18 years) with a diagnosis of anorexia nervosa, coded as F50.0 or F50.1 according to ICD 10, from 1st April 2009 to 31st March 2019. Data were extracted from the case records using standardized abstraction forms and evaluated using descriptive and nonparametric statistics. The average age at presentation and the average age at onset were 14.1 years and 13.1 years, respectively. The male-to-female ratio of the sample who got admitted was 1:9. The average duration of hospital stay was about 30 days. The duration of in-patient care and weight gain were positively correlated, with severe to extremely ill adolescents improving even in less than one month of in-patient care. Seventy per cent of the admitted adolescents followed up. The functional outcome as measured by a 'return to school' improved in 57.1% of the sample. The present study highlights the collaborative multidisciplinary and individualized treatment approach employed for adolescents diagnosed with anorexia nervosa within an inpatient mental health facility in India. Adolescents who presented with more severe illness at the initial assessment, such as an early onset of symptoms and a low BMI, experienced substantial weight gain that exhibited a positive correlation with the length of their stay in the inpatient facility.

Validity of the Functional Classification of the Upper Extremities for Duchenne Muscular Dystrophy.

Some upper-limb function assessments can evaluate treatments in the non-ambulatory stage of Duchenne muscular dystrophy (DMD). The Functional Classification of the Upper Extremities (FCUE) was developed for DMD in Japan. The FCUE is easier to use than the Performance of Upper Limb (PUL) and is more detailed than the Brooke Upper Extremity Scale. This study aimed to determine the concurrent validity of FCUE with other methods of assessment for DMD. This retrospective study reviewed the medical records of 39 boys with DMD from the National Center of Neurology and Psychiatry to evaluate the concurrent validity of the FCUE and PUL using non-parametric Spearman rank correlation (ρ). We also determined the concurrent validity of the Brooke Upper Extremity Scale and PUL for comparison. The ρ value between the FCUE and PUL was -0.914 (P<0.001). The FCUE showed robust concurrent validity with the PUL. That correlation between the FCUE and Brooke Upper Extremity Scale gave a ρ value of -0.854 (P<0.001). The FCUE had a higher concurrent validity with the PUL than with the Brooke Upper Extremity Scale. The FCUE is considered a valid assessment tool of upper-limb function in boys with DMD. Selecting the best assessment method depends on the severity of the patient's condition and a balance between assessment accuracy and evaluation time.

Service intensity of community mental health outreach among people with untreated mental health problems in Japan: A retrospective cohort study.

This study aimed to clarify the association between treatment status (untreated or treated) at the start of community mental health outreach services and service intensity. This retrospective cohort study was conducted using the Tokorozawa City mental health outreach service users' data. Treatment status at the start of service (exposure variable) and the service intensity (outcome variables) were taken from clinical records. Poisson regression and linear regression analyses were conducted. The frequency of medical or social service use 12 months after service initiation was also calculated. This study was approved by the Research Ethics Committee at the National Center of Neurology and Psychiatry (No. A2020-081). Of 89 people, 37 (42%) were untreated. Family members in the untreated group were more likely to be targets or recipients of services than in the treated group (b = 0.707, p < 0.001, Bonferroni-adjusted p < 0.001). Compared to the treated group, the untreated group received fewer services themselves (b = -0.290, p = 0.005), and also fewer services by telephone (b = -0.252, p = 0.012); by contrast, they received more services at the health center (b = 0.478, p = 0.031) and for family support (b = 0.720, p = 0.024), but these significant differences disappeared after Bonferroni adjustment. At least 11% of people in the untreated group were hospitalized and 35% were outpatients 12 months after service initiation. Family involvement may be a key service component for untreated people. The service intensity with and without treatment may vary by service location.

The impact of aggressive behavior of patients on staff employed in psychiatric wards

Introduction: Aggression and violence in the workplace are phenomena that occur more and more often, especially towards the staff working in Psychiatric Wards. The effects of these behaviors may be disturbances in the sphere of professional, social and mental health of employees.Aim of the study: The aim of the study was to analyze the phenomenon of patient aggression, to determine the frequency of patients' aggressive behavior and to assess their impact on the staff.Material and methods: The study was conducted among the staff working in the Bielsko Psychiatry Centre. The study used the diagnostic survey method, the research tool that was used in the work was a self-questionnaire.Results: Aggression of patients was experienced by 100% of the respondents. The most common manifestations of verbal aggression are vulgar words and shouting, and physical hitting and jerking. Physicians have less contact with physical aggression than other personnel. Despite this, most staff do not intend to change their place of employment and try to solve and prevent dangerous situations and minimize aggression on the part of patients with their professional approach to the patient. After attacks of aggression, the staff most often turns to a colleague for help and does not use the help of a psychologist.Conclusions: The analysis of the obtained data showed that aggression on the part of patients is a frequent phenomenon in the work of psychiatric ward staff.

Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder: a randomized-controlled trial.

An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5-12years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED-but not HD-participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably 'easier to treat' than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, numberNL5324 ( https://www.onderzoekmetmensen.nl/en/trial/25997 ).

Method of differential diagnosis of mild cognitive impairment of various origins: cross sectional study

INTRODUCTION:The differential diagnosis of mild cognitive impairment (MCI), due to the high prevalence in the population and the rapid increase in incidence, is an urgent task. The most common causes leading to the development of cognitive impairment are Alzheimer’s disease (AD), cerebrovascular pathology, and their combination. AD usually manifests as an amnestic type of mild cognitive impairment (aMCI) at the pre-dementia stage. Subcortical vascular mild cognitive impairment (svMCI) is considered as the prodromal stage of subcortical vascular dementia. According to the results of pathomorphological studies, it was found that subfields of the hippocampal formation are selective vulnerability to AD, ischemia/hypoxia, and aging.Currently, using the FreeSurfer 6.0 software, it is possible to obtain quantitative indicators of the hippocampal formation subfieldsin vivo.The current trend in medicine is the development and implementation of new diagnostic solutions based on artificial intelligence and machine learning. One of the machine learning algorithms is binary logistic regression, which we used in the course of the study for the differential diagnosis of MCI of various origins.OBJECTIVE:To develop a method for the differential diagnosis of mil cognitive impairment of various origins.MATERIALS AND METHODS:The study included patients with the syndrome of mild cognitive impairment who were examined in the department of geriatric psychiatry of the V.M.Bekhterev National Medical Research Center for Psychiatry and Neurology, from which two groups were formed: group 1 — patients with aMCI, group 2 — patients with svMCI. Conditionally healthy volunteers, comparable in age, sex and level of education, made up the 3rdgroup (control). MRI examination was performed using a Excelart Vantage Atlas XGV magnetic resonance imaging system (Toshiba, Japan) with a magnetic field strength of 1.5 T, followed by MR morphometry of the subfields of the hippocampal formation.Statistics:Statistical analysis was carried out using data that was converted from a database in Microsoft Excel to the statistical package IBM SPSS 21. To develop a differential diagnosis method, based on the data obtained, the binary regression method and ROC analysis were used.RESULTS:Based on the obtained MR-morphometry data, a method was developed using the binary logistic regression equation. The value of p≥0.5 makes it possible to classify the patient to the aMCI group, and the value of p&lt;0.5 — to the svMCI. The sensitivity of the method is 90%, the specificity is 80%, and the accuracy is 85%.DISCUSSION:Using binary logistic regression, the selection of variants of sets of variables (quantitative indicators) was carried out, for which ROC curves were constructed. The selection criterion was the area under the ROC curve — the AUC criterion (Area Under the Curve). The largest area under the curve (AUC=0.824) in the differential diagnosis of aMCI from svMCI was determined for the combination of the volume of the left subiculum and the thickness of the right entorhinal cortex.Since patients in the aMCI group have a significantly lower number of vascular foci than in the svMCI group (p&lt;0.05), at the next stage, one more variable, the volume fraction, was added to the selected combination of two variables (volume of the left subiculum and thickness of the right entorhinal cortex) hypointense foci. When conducting an ROC analysis with a combination of three variables, an increase in AUC to 0.892 was noted. Further, using a combination of three variables and a binary logistic regression equation, a method for differential diagnosis of aMCI from svMCI was developed.CONCLUSION:The method of differential diagnosis based on binary logistic regression using MR morphometry data allows to distinguish patients with aMCI from patients with svMCI with high sensitivity and specificity.

Effectiveness of a Therapeutic Educational Oral Health Program for Persons with Schizophrenia: A Cluster Randomized Controlled Trial and Qualitative Approach.

The oral health of people with schizophrenia (PWS) is very poor, suggesting a need for oral health promotion programmes with a high level of evidence. The aim of the EBENE study (Clinicaltrials.gov: NCT02512367) was to develop and evaluate the effectiveness of a multidisciplinary therapeutic educational programme in oral health (TEPOH) for PWS. A multicentre cluster randomised controlled trial, with outpatient psychiatry centres as the unit of randomisation, was designed to compare the effectiveness of TEPOH (intervention group) versus standard care (control group). The trial was conducted in 26 outpatient psychiatry centres in France (14 in the intervention group, 12 in the control group). Eligible patients with a diagnosis of schizophrenia were enroled between 2016 and 2020 and followed for 6 months. The TEPOH group received a multicomponent intervention (comprising an introductory session, three educational sessions, and a debriefing session). The primary endpoint was the evaluation of periodontal disease as a community periodontal index (CPI) score ≥ 3 at Month 6. The trial was completed using a qualitative approach based on semi-structured interviews with caregivers conducted between July 2018 and December 2019. The trial was stopped early due to difficulties in recruiting patients. Overall, 81 patients (of 250 planned) were included, and 54 patients completed the trial: 40 in the TEPOH group and 14 in the control group. At baseline, the percentage of CPI ≥ 3 was 42.5% in the TEPOH group and 9.1% in the control group. At Month 6, the percentage of CPI ≥ 3 was 20% in the TEPOH group and 14.3% in the control group. The qualitative evaluation underlined that the professionals emphasised the "seriousness" and "assiduity" of the patients' participation in this programme and that the TEPOH reinforced carers' investment in oral hygiene. It also highlighted structural factors (lack of resources for professionals, lack of teeth in PWS, COVID-19 pandemic) that may have exacerbated the difficulties with enrolment and follow-up. The effectiveness of this TEPOH, developed for PWS as part of the EBENE study, has not been demonstrated. Certain aspects of the programme's content and implementation need to be reconsidered. In particular, an adapted subjective measurement scale should be developed.

Investigating Cognitive Control and Repetitive Thinking in Clinical Groups With Major Depressive Disorder and Generalized Anxiety Disorder

Objective: Some theories state that a deficiency in cognitive control makes people more vulnerable to the occurrence of repetitive negative thoughts. The present study is aimed to investigate the association between cognitive control and repetitive thinking in major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods: Thirty people with major depressive disorder and 30 people with generalized anxiety disorder were selected by purposive sampling method from counseling and psychiatry centers in Shiraz City. Then, the Stroop and Wisconsin tests were performed and the questionnaires on rumination, worry, depression, and anxiety were completed. The obtained results were analyzed by Pearson’s correlation coefficient and multivariate analysis of variance (MANOVA). Results: The results showed that there was a negative and significant relationship between cognitive control and rumination in the depression group and worry in the generalized anxiety group. The level of cognitive control, rumination, and worry was not significantly different in cases with major depressive disorder and generalized anxiety disorder. Conclusion: Based on the results of this study, reducing attention control is considered a risk factor for repetitive thinking, including rumination and worry. The lack of significant difference in cognitive control, rumination, and worry can indicate common unified transdiagnostic components in these disorders.