Therapy Of Mental Disorders Research Articles

Performance of game sessions in VR vs standard 2D monitor environment. an EEG study.

Nowadays studies using Virtual Reality (VR) are gaining high popularity due to VR being a better approximation of the ecological environment for visual experiments than standard 2D display settings. VR technology has been already applied in medicine in the therapy of mental disorders, neurorehabilitation, and neurofeedback. However, its effectiveness compared to the standard 2D procedure is still not fully documented and limited information about the neurophysiological underpinnings of VR is provided. In this study, we tested participants' performance during several sessions of the computer game in two different environments, VR vs. 2D monitor display. Participants performed three 25 min gaming sessions of adapted Delay Match-To-Sample task during EEG recording. The results showed that the VR group outperformed the 2D display group in the first session and then maintained its performance level throughout the remaining two sessions while the 2D group increased performance in each session eventually leveling up in the last one. Also group differences in the EEG activity were most profound only in the first session. In this session, the VR group was characterized by stronger and more synchronized neuronal activity, especially in delta, theta, and gamma bands. The VR group was less impacted by visual arousals as indicated by the theta/beta2 ratio in parietal electrodes.

Electroconvulsive therapy in the Fourth Industrial Revolution (Review).

There are very few treatments in psychiatry, even in medicine, that have experienced longevity and effectiveness such as electroconvulsive therapy (ECT), despite the controversies and stigma that accompany it. The experience of the COVID-19 pandemic has highlighted the need to strengthen mental health systems in most countries, given that depression is one of the leading health problems and that there is an evident shortage of psychiatrists worldwide. The Fourth Industrial Revolution, has witnessed great progress in artificial intelligence (AI) technology, which opens up the possibility of its application both in the diagnosis and in the therapy of mental disorders. It is no exaggeration to suggest that tools such as AI, neuroimaging and blood tests will bring significant change to psychiatry in the coming years, but even so, treating severe mental disorders remains a challenge. The present review summarized the development of ECT over time, its application in clinical practice, neurobiological correlates and mechanisms of action and sheds light on the important place of ECT in the era of technological development, considering that ECT is still the most effective therapy for the treatment of severe mental disorders, especially depressive disorder.

Therapy of mental disorders in patients with hematological malignancies

To assess the possibilities of therapy with minimal effective doses (MED) of psychotropic drugs for mental disorders (MD) that manifest during the treatment of hematological malignancies (HM). A prospective study was conducted at the National Medical Research Center for Hematology of the Russian Ministry of Health (Moscow), which included 204 (39.4%) men and 314 (60.6%) women (518 patients in total), aged 17 to 83 years (median 45 years), with various HM, in which the manifestation of MD occurred during the treatment of the underlying disease. To minimize the side-effects of psychotropic drugs and given the relatively mild level of MD, psychopharmacotherapy of patients was carried out mainly at MED. The severity of MD, manifested in patients, was assessed by the illness severity scale of the Clinical Global Impression (CGI) scale, and the effectiveness of the treatment was assessed by the improvement scale (CGI-I). Mainly mild (188, 36%) and moderately pronounced (270, 52%) MD were noted in patients with HM during the treatment of the underlying disease. Severe psychopathological disorders (60, 12%) were observed much less often. Because of psychopharmacotherapy with MED, patients experienced a very significant (97, 19%) and significant improvement (354, 68%) of their mental state, less often the improvement was regarded as minimal (67, 13%). Therefore, almost all patients showed a stable relief of MD; in 87% (95% CI 84-90) of patients, this improvement was significant. The tactics of treatment MD that manifest in patients with HM with MED of psychotropic drugs turned out to be therapeutically effective according to the results of the assessment on CGI scales.

The endogenic neurosteroid system and its role in the pathogenesis and therapy of mental disorders

Introduction: Although neurosteroids have been relatively recently discovered, their significant role in the neurochemical processes and pathogenesis of a number of psychiatric and neurological disorders is now quite clear. First of all, it seems important to clarify the definition of the endogenous neurosteroids as a class of steroids, taking into account the variability of approaches to their description. Currently, neurosteroids include endogenous steroids synthesized in the central nervous system, gonads, or adrenal glands and interacting with GABAA, NMDA, and sigma-1 receptors.
 Neurosteroid biosynthesis: Biosynthesis of neurosteroids begins with rate-limiting reaction of TSPO binding cholesterol and transporting it into the mitochondria, where pregnenolone is synthesized following the cytochrome P450scc (CYP11A1) impact.
 Interaction with GABAА, NMDA and sigma-1 receptors: According to the experimental data, neurosteroids act as the most highly potent endogenous allosteric modulators of the GABA receptor; some types of neurosteroids (ALLO, DHEA, etc.) can produce a rapid anxiolytic and anticonvulsant effect. There is some experimental evidence for antipsychotic effects of some neurosteroids realized through NMDA receptors: intracerebral administration of ALLO to laboratory animals can prevent further appearance of motor agitation and other equivalents of psychosis after administration of high doses of amphetamines. It has also been proven in several studies on animal models that neurosteroids exhibit anxiolytic effects through sigma-1 receptors.
 Conclusion: The article describes the process of neurosteroidogenesis and the effect of neurosteroids on listed receptorsin accordance with already available scientific data. In addition, this paper describes the specific role of various neurosteroids in the development of mental illnesses, including anxiety disorders, depression, and schizophrenia
 Graphical Abstract

Peculiarities of the initial psychopathological manifestations after the transferred coronavirus disease COVID-19

IntroductionThe pathogenesis of mental disorders occurring during the coronavirus pandemic 2 (SARS-COV-2) includes biological and psychosocial factors. Psychopathological consequences associated with the coronavirus disease COVID-19 may occur in different groups of individuals, including patients with a history of COVID-19 and patients with psychiatric disorders preceding COVID-19.ObjectivesTo investigate the peculiarities of the initial psychopathological manifestations in patients with newly diagnosed mental disorders who suffered from COVID-19 and were exposed to the stressors of the SARS-CoV-2 pandemic.MethodsThe study involved 97 patients with newly diagnosed mental disorders who suffered from COVID-19 and were exposed to the stressors of the SARS-CoV-2 pandemic (F 32.0-32.2 – 34 patients, F 40-45 – 32 patients, F 06.3-06.6 – 31 patient). The average age of the examined group was 44.82 ± 5.64 years. Clinico-psychopathological, psychodiagnostic, statistical methods were used.ResultsIn the structure of initial psychopathological manifestations detected in patients, the following prevailed: with depressive episodes - weakness and fatigue / asthenia ((87.50 ± 5.94) %), low mood / depression ((71.88 ± 8.07) %) and sleep disturbances ((65.63 ± 8.53) %); with neurotic, stress-related and somatoform disorders – weakness and fatigue / asthenia ((72.73 ± 7.87) %), decreased concentration of attention, memory / cognitive disorders ((66.67 ± 8.33 ) %) and feeling of inner tension ((60.61 ± 8.64) %); with mental disorders of organic genesis – a feeling of internal tension ((75.00 ± 7.78) %), anxiety ((62.50 ± 8.70) %) and weakness and fatigue / asthenia ((59.38 ± 8 .82) %).In patients with depressive episodes, initial psychopathological manifestations in the form of asthenia, low mood, cognitive disorders, and sleep disorders were detected in a significantly greater number of cases compared to patients with mental disorders of organic genesis (р < 0,05). In the examined subjects of this subgroup, initial psychopathological manifestations in the form of a decrease in mood were recorded in a significantly greater number of cases compared to patients with neurotic, stress-related and somatoform disorders (р < 0,05). In patients with neurotic, stress-related and somatoform disorders, initial psychopathological manifestations in the form of anxiety, fears and obsessions were noted in a significantly smaller number of cases compared to those examined with mental disorders of organic genesis (р < 0,05).ConclusionsThe obtained data will make it possible to improve the effectiveness of diagnosis and therapy of mental disorders, the formation, course and clinical picture of which were affected by the coronavirus disease COVID-19.Disclosure of InterestNone Declared

Monitoring of the Antipsychotic Therapy Effectiveness

Background: there is seminal medicine direction in the diagnosis and therapy of mental disorders, namely personalized medicine. Its concept embodies an individual approach to treatment based on the genotype and phenotype of the patient. Objective: the presented paper deal with the main modern approaches to the individualization of psychopharmacotherapy: genotyping, determination of the level of biomarkers and therapeutic drug monitoring (TDM). Methods: databases of medical and biological publications (MEDLINE, PubMed); clinical observations. Results: examples of genetic tests that allow optimizing the therapy of mental illness are presented. The concept of biomarkers as diagnostic and therapeutic indicators in personalized medicine is considered. Other promising areas of scientific research are briefly described: metabolism, transporters, neurotransmitters (mediators), epigenetics. Population modeling of antibiotic pharmacokinetics also deserves attention. Specific examples of TDM content of antipsychotics are given. Conclusion: the reviewed research directions focused on the introduction of the principles of personalized and translational medicine into routine psychiatric practice.

Reviewing the role of gut microbiota in the pathogenesis of depression and exploring new therapeutic options.

The relationship between gut microbiota (GM) and mental health is one of the focuses of psychobiology research. In recent years, the microbial-gut-brain axis (MGBA) concept has gradually formed about this bidirectional communication between gut and brain. But how the GM is involved in regulating brain function and how they affect emotional disorders these mechanisms are tenuous and limited to animal research, and often controversial. Therefore, in this review, we attempt to summarize and categorize the latest advances in current research on the mechanisms of GM and depression to provide valid information for future diagnoses and therapy of mental disorders. Finally, we introduced some antidepressant regimens that can help restore gut dysbiosis, including classic antidepressants, Chinese materia medica (CMM), diet, and exogenous strains. These studies provide further insight into GM's role and potential pathways in emotion-related diseases, which holds essential possible clinical outcomes for people with depression or related psychiatric disorders. Future research should focus on clarifying the causal role of GM in disease and developing microbial targets, applying these findings to the prevention and treatment of depression.

Sports psychiatry: Discipline, areas of activity, collaboration, and training

Abstract. Introduction: Sports psychiatry, a field of psychiatry, is a young medical discipline. The aim of this study was to gauge opinions on the following: sports psychiatry as a specialized subdiscipline, its areas of activity among professionals, the desire for interdisciplinary and interprofessional cooperation, and the need for specific sports psychiatry training. Methods: An online survey was performed to assess the views on sports psychiatry of German-speaking professionals in Switzerland, Germany, and Austria in the field of sports psychiatry. Results: Data from 183 professionals were included in the analysis. Most participants classified sports psychiatry as a field of psychiatry (89%), followed by sports medicine (61%) and child and adolescent psychiatry (49%). Mental health and disorders in competitive and elite sport (94%), sport and exercise for the prevention of and as therapy for mental disorders (84%), and sport-specific mental health problems and disorders in popular sport (80%) were reported by all the participants as areas of activity within sports psychiatry. Most of the participants stated the importance of interdisciplinary and interprofessional collaboration with sports psychiatry’s areas of activity. While 84% of the participants emphasized the necessity for specific training in sports psychiatry, a different picture emerged as to whether such training should be independent or integrated with postgraduate training for psychiatric or sports medicine. Conclusion: The results provide insight into sports psychiatry and its areas of activity and should be used for, and integrated with, the further development of the field.

Sports psychiatry and psychotherapy

Sports psychiatry and psychotherapy is arelatively young field and is comprised of two key segments: the special features of the diagnostics and therapy of mental disorders in elite athletes and the use of exercise and sports in the development and treatment of mental disorders. Although all mental disorders can in principle also occur in (elite) athletes, there are additionally sport-specific mental disorders, such as anorexia athletica and other eating disorders, chronic traumatic encephalopathy, misuse of and dependency on performance-enhancing substances (doping) and muscle dysmorphia. Many high-quality clinical trials over the past two decades have been able to demonstrate atherapeutic efficacy of physical activity and sport in the treatment of various mental disorders. All clinicians active in psychiatry and psychotherapy should possess abasic knowledge of sports psychiatry.

Effectiveness of therapies for mental disorders: real clinical practice versus scientific evidence

The article provides information on particular issues of treatment of mental disorders. An analysis was made of the issues of therapeutic resistance and compliance among mental patients, which play an important role in possible discrepancies between the results of randomized placebo-controlled trials and the use of psychotropic drugs in routine clinical practice. The main aspects of clinical pharmacology are presented in an accessible form, which determine the complexity and at the same time professionalism in the practice of a psychiatrist. Grouped and deciphered are the factors that have a direct impact on the therapeutic response of the drug, including the primary pharmacological properties of the drug, nosological, general biological, social, subjective-psychological factors.

Review: Radio Electric Asymmetric Conveyer (REAC) as adjuvant therapy of mental disorder

Mental disorders are one of the health disorders that contribute to high rates of disability and mortality worldwide. The current therapeutic modalities used to treat mental disorders are medical and psychological approaches, but it becomes problematic in some conditions, such as drug-resistant mental disorders. Radio Electric Asymmetric Conveyer (REAC) technology can be used as an alternative to overcome this problem. This technology uses radio waves which are guaranteed to be non-invasive and do not cause side effects. This technology enables neuromodulation effects by maximizing cell polarity and optimizing endogenous bioelectric activity. Of course, the REAC's mechanism as a neuromodulator and being a non-invasive technology is safe to use. It allows REAC to be used as an adjuvant therapy to reduce symptoms of several mental disorders such as depression, anxiety, bipolar disorder, phobias, and stress.

Nonprecsion (Standard) Psychosocial Interventions for the Treatment of Mental Disorders

Advances in precision treatment promise to greatly improve the extent to which therapies for mental disorders are better matched to patient characteristics. At the same, we need to ensure that more readily disseminable and available nonprecison treatments are further developed as well. These treatments refer to standardized interventions that do not have to be individualized and are more readily available. Impetus for this call stems from the treatment gap, namely, the huge difference in the proportion of individuals who are in need of mental health services and who actually receive any form of treatment. The prevalence rates for mental disorders worldwide are high and in low-, middle-, and high-income countries and the vast majority of individuals in need of services receive none. To address the need, we need interventions that can reach large numbers of individuals and especially target those individuals least likely to receive services. Standardized treatments that can be widely applied may be in a better position at present to reach people in need who otherwise receive no care.

Association of Innate and Acquired Aerobic Capacity With Resilience in Healthy Adults: Protocol for a Randomized Controlled Trial of an 8-Week Web-Based Physical Exercise Intervention.

BackgroundPhysical activity alleviates chronic stress. The latest research suggests a relationship between resilience and physical fitness. Beneficial adaptations of the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, endocannabinoid system, and tryptophan pathway, which are induced by an active lifestyle, are considered to be conducive to resilience. However, detailed knowledge on the molecular link between the effects of acute and chronic physical exercise and improved resilience to stress in humans is missing. Moreover, the relationship between innate and acquired aerobic capacity and resilience is poorly understood.ObjectiveThe aim of this study is to implement a human exercise intervention trial addressing the following main hypotheses: a high innate aerobic capacity is associated with high resilience to stress, and web-based physical exercise training improves aerobic capacity of physically inactive adults, which is accompanied by improved resilience. In this setting, we will analyze the relationship between resilience parameters and innate and acquired aerobic capacity as well as circulating signaling molecules.MethodsA total of 70 healthy, physically inactive (<150 minutes/week of physical activity) adults (aged 18-45 years) will be randomly assigned to an intervention or control group. Participants in the intervention group will receive weekly training using progressive endurance and interval running adapted individually to their remotely supervised home training performance via web-based coach support. A standardized incremental treadmill exercise test will be performed before and after the intervention period of 8 weeks to determine the innate and acquired aerobic capacity (peak oxygen uptake). Before and after the intervention, psychological tests and questionnaires that characterize parameters implicated in resilience will be applied. Blood and saliva will be sampled for the analysis of cortisol, lactate, endocannabinoids, catecholamines, kynurenic acid, and further circulating signal transducers. Statistical analysis will provide comprehensive knowledge on the relationship between aerobic capacity and resilience, as well as the capacity of peripheral factors to mediate the promoting effects of exercise on resilience.ResultsThe study was registered in October 2019, and enrollment began in September 2019. Of the 161 participants who were initially screened via a telephone survey, 43 (26.7%) fulfilled the inclusion criteria and were included in the study. Among the 55% (17/31) of participants in the intervention group and 45% (14/31) of participants in the control group who completed the study, no serious adverse incidents were reported. Of 43 participants, 4 (9%) withdrew during the program (for individual reasons) and 8 (19%) have not yet participated in the program; moreover, further study recruitment was paused for an indeterminate amount of time because of the COVID-19 pandemic.ConclusionsOur study aims to further define the physiological characteristics of human resilience, and it may offer novel approaches for the prevention and therapy of mental disorders via an exercise prescription.International Registered Report Identifier (IRRID)DERR1-10.2196/29712

A Multimodal Neuroprosthetic Interface to Record, Modulate and Classify Electrophysiological Biomarkers Relevant to Neuropsychiatric Disorders.

Most mental disorders, such as addictive diseases or schizophrenia, are characterized by impaired cognitive function and behavior control originating from disturbances within prefrontal neural networks. Their often chronic reoccurring nature and the lack of efficient therapies necessitate the development of new treatment strategies. Brain-computer interfaces, equipped with multiple sensing and stimulation abilities, offer a new toolbox whose suitability for diagnosis and therapy of mental disorders has not yet been explored. This study, therefore, aimed to develop a biocompatible and multimodal neuroprosthesis to measure and modulate prefrontal neurophysiological features of neuropsychiatric symptoms. We used a 3D-printing technology to rapidly prototype customized bioelectronic implants through robot-controlled deposition of soft silicones and a conductive platinum ink. We implanted the device epidurally above the medial prefrontal cortex of rats and obtained auditory event-related brain potentials in treatment-naïve animals, after alcohol administration and following neuromodulation through implant-driven electrical brain stimulation and cortical delivery of the anti-relapse medication naltrexone. Towards smart neuroprosthetic interfaces, we furthermore developed machine learning algorithms to autonomously classify treatment effects within the neural recordings. The neuroprosthesis successfully captured neural activity patterns reflecting intact stimulus processing and alcohol-induced neural depression. Moreover, implant-driven electrical and pharmacological stimulation enabled successful enhancement of neural activity. A machine learning approach based on stepwise linear discriminant analysis was able to deal with sparsity in the data and distinguished treatments with high accuracy. Our work demonstrates the feasibility of multimodal bioelectronic systems to monitor, modulate and identify healthy and affected brain states with potential use in a personalized and optimized therapy of neuropsychiatric disorders.

Out of the night-time and into the day: Ketamine and MDMA as therapies for mental disorders

Ketamine and 3,4-methylenedioxymethamphetamine (MDMA) used to be in the news for all the wrong reasons. They were party drugs, used imprudently and reported as presenting dangers to the physical and mental well-being of users. Now we read about them as potential treatments for mental disorders. What has happened?

ИСПОЛЬЗОВАНИЕ ПСИХОБИОТИКОВ ДЛЯ ДИМИНУАЦИИ СТРЕССОГЕННЫХ ПОСЛЕДСТВИЙ COVID-19

Summary. The gut-brain interconnection becomes vulnerable in the pandemic stressful conditions, in which the normal psychobiotic action micro flora of the gastrointestinal tract suffers, which leads to a decrease in stress resistance and depression. The inclusion of microbial associations containing strains of psychobiotics, as well as some amino acids, in the diet will positively influence both the regulation of mental functions and intestinal bacteriocenosis in the context of a COVID-19 pandemic and / or post-pandemic. The level of tryptophan in blood plasma can serve asa biomarker in the process of choosing the optimal therapy for mental disorders in a pandemic conditions.

Diagnostics and Therapy 24/7? Artificial Intelligence as a Challenge and Opportunity in Psychiatry and Psychotherapy

The aim of the article is to enable a fundamental understanding of the potentials and requirements of Artificial Intelligence (AI) for psychiatrists in the present and for the development of future working environments. Psychiatrists will need to understand the function of AI-systems and personalized AI-assistants in therapy systems and as part of their patients' daily life. The article provides an overview of basic categories and fields of application of AI and machine learning in the diagnosis, prevention and therapy of mental disorders. AI-applications will shape the prevention, diagnosis and treatment as well as the basic etiological understanding of mental disorders. Notably, the treatment of mental disorders is significantly influenced by commercial product development and assistance systems outside the medical system, as the corresponding developments can exploit large data pools with significantly lower restrictions. Psychiatrists should now seize the opportunity to actively shape the implementation of AI-systems as otherwise key competences could be transferred to a primary field outside the medical system to the detriment of the patient and the therapist.

Current Practices of Electroconvulsive Therapy in Mental Disorders: A Systematic Review and Meta-Analysis of Short and Long-Term Cognitive Effects.

Electroconvulsive therapy (ECT) remains one of the most effective treatments for major depressive disorder, but uncertainties persist regarding the cognitive tests to include in ECT follow-up. The current study is a systematic review and meta-analysis of the most frequent cognitive side effects after ECT. We also discuss the most common cognitive tests in ECT follow-up. We searched studies published from 2000 to 2017 in English and French language in Pubmed, EBM Reviews, EMBASE, and PsycINFO. Standardized cognitive tests were separated into 11 cognitive domains. Comparisons between cognitive measures included pre-ECT baseline with post-ECT measures at 3 times: PO1, immediately post-ECT (within 24 hours after last ECT); PO2, short term (1-28 days); and PO3, long term (more than 1 month). A total of 91 studies were included, with an aggregated sample of 3762 individuals. We found no significant changes in global cognition with Mini-Mental State Examination at PO1. Hedges g revealed small to medium effect sizes at PO2, with individuals presenting a decrease in autobiographical memory, verbal fluency, and verbal memory. Verbal fluency problems showed an inverse correlation with age, with younger adults showing greater deficits. At PO3, there is an improvement on almost all cognitive domains, including verbal fluency and verbal memory. There is a lack of standardization in the choice of cognitive tests and optimal cognitive timing. The Mini-Mental State Examination is the most common screening test used in ECT, but its clinical utility is extremely limited to track post-ECT cognitive changes. Cognitive assessment for ECT purposes should include autobiographical memory, verbal fluency, and verbal memory.

AT1 -R is involved in the development of long-lasting, region-dependent and oxidative stress-independent astrocyte morphological alterations induced by Ketamine.

Astrocytes play an essential role in the genesis, maturation and regulation of the neurovascular unit. Multiple evidence support that astrocyte reactivity has a close relationship to neurovascular unit dysfunction, oxidative stress and inflammation, providing a suitable scenario for the development of mental disorders. Ketamine has been proposed as a single-use antidepressant treatment in major depression, and its antidepressant effects have been associated with anti-inflammatory properties. However, Ketamine long-lasting effects over the neurovascular unit components remain unclear. Angiotensin II AT1 receptor (AT1 -R) blockers have anti-inflammatory, antioxidant and neuroprotective effects. The present work aims to distinguish the acute and long-term Ketamine effects over astrocytes response extended to other neurovascular unit components, and the involvement of AT1 -R, in prefrontal cortex and ventral tegmental area. Male Wistar rats were administered with AT1 -R antagonist Candesartan/Vehicle (days 1-10) and Ketamine/Saline (days 6-10). After 14days drug-free, at basal conditions or after Ketamine Challenge, the brains were processed for oxidative stress analysis, cresyl violet staining and immunohistochemistry for glial, neuronal activation and vascular markers. Repeated Ketamine administration induced long-lasting region-dependent astrocyte reactivity and morphological alterations, and neuroadaptative changes observed as exacerbated oxidative stress and neuronal activation, prevented by the AT1 -R blockade. Ketamine Challenge decreased microglial and astrocyte reactivity and augmented cellular apoptosis, independently of previous treatment. Overall, AT1 -R is involved in the development of neuroadaptative changes induced by repeated Ketamine administration but does not interfere with the acute effects supporting the potential use of AT1 -R blockers as a Ketamine complementary therapy in mental disorders.

Использование метода калорической вестибулярной стимуляции в терапии психических расстройств

Использование метода калорической вестибулярной стимуляции в терапии психических расстройств