Marianna A. Tumova

BACKGROUND: The advent of neuroleptics and antidepressant therapy marked a significant step forward in clinical psychiatry. Numerous experiments worldwide had been dedicated to a search for the potential neurobiological mechanisms underlying the potency of new psychopharmacological drugs. The first laboratory of psychopharmacology in the USSR was established in 1960 at the Leningrad Psychoneurological Institute. It was headed by Professor Izyaslav Petrovich Lapin. The foundational article by Lapin I.P. and Oksenkrug G.F. (The Lancet, 1969) continues to be cited 55 years after its publication, which determines the interest in the role of this research team in shaping temporal concepts of the pathogenesis of depression and the development of psychopharmacology. AIM: To analyze the contribution of Lapin I.P. and his research team to the development of experimental approaches for studying the mechanisms of depression. METHODS: We analyzed the articles and monographs authored by Professor Lapin I.P., both individually and in co-authorship, available in PubMed, Google Scholar, eLIBRARY.RU, and in the bibliographic collection of the V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology. RESULTS: This analysis highlights the significance of Lapin I.P. and his scientific team’s work in advancing our understanding of serotonin role in the mechanisms of depression and in the development of animal depression models. The scientific contribution of this team is an important milestone towards future research into the neurobiological mechanisms underlying depression, as well as the development of therapeutic approaches. CONCLUSION: Lapin’s scientific publications and the work of his team in the field of psychopharmacology have had a significant impact on the development of neuroscience and continue to be of unquestionable importance in advancing scientific practice more than 50 years later.

ЦЕЛЬ ИССЛЕДОВАНИЯ Выявление связей между психотропной лекарственной терапией (антипсихотические и антихолинергические препараты) и когнитивными функциями у больных шизофренией. МАТЕРИАЛ И МЕТОДЫ Обсервационное проспективное исследование проводилось на базе отделения биологической терапии психически больных НМИЦ ПН им. В.М. Бехтерева. В исследовании принял участие 41 пациент (22 мужчины и 19 женщин, средний возраст 30,12±8,24 года) с параноидной формой шизофрении (F20 соответственно критериям МКБ-10) на стабильной антипсихотической монотерапии или в комбинации с антихолинергическим препаратом (тригексифенидил). Оценка когнитивных функций проводилась с помощью шкалы краткой оценки когнитивных функций у пациентов с шизофренией (BACS), тяжесть психического состояния и выраженность экстрапирамидных нарушений измерялись с помощью шкалы оценки позитивных и негативных синдромов (PANSS) и шкалы Симпсона—Ангуса для оценки экстрапирамидных побочных эффектов (SAS). Все процедуры обследования проводились дважды на 2-й и 8-й неделях терапии. Пациенты были разделены на две группы по характеру получаемой антипсихотической терапии. Двенадцать пациентов (1-я группа) получали антипсихотики первого поколения (АПП), 29 (2-я группа) — антипсихотики второго поколения (АВП). РЕЗУЛЬТАТЫ У пациентов, получавших АВП, значимо снизился общий балл по шкале SAS на 8-й неделе терапии по сравнению с данными на 2-й неделе (V=192, p=0,033) и наблюдалось улучшение когнитивных функций (V=46, p=0,0003), в отличие от пациентов, получавших АПП. Изменения по отдельным тестам BACS также были только у пациентов 2-й группы по таким тестам, как «Порядок чисел» (V=51,5, p=0,007), «Двигательный тест» (V=75,5, p=0,007) и «Башня Лондона» (V=52, p=0,027). ЗАКЛЮЧЕНИЕ К 8-й неделе приема АВП улучшилась переносимость препарата, а также когнитивные показатели. Исследование подтверждает необходимость придерживаться принципа минимальной эффективной дозы антипсихотических препаратов для лечения шизофрении, профилактики когнитивных нарушений, а также отдавать предпочтение в выборе терапии АВП.

Background: increasing interest in visual disturbances in schizophrenia is connected with the fact that they are a potential biomarker for objectification of a mental condition. The nature of the relationship between visual disturbances and higher-level cognitive functions in schizophrenia remains understudied.The aim of the study was to investigate differences in visual information processing between individuals with paranoid schizophrenia and healthy individuals, and to analyze the relationship between visual system characteristics with clinical and cognitive factors.Patients and methods: thirty-three patients with the paranoid form of schizophrenia and 19 healthy subjects were included in the cross-sectional study. Cognitive impairment was assessed using a battery of BACS tests, and the severity of the mental state was assessed using the PANSS scale. Contrast sensitivity characteristics were measured by computer visocontrastometry.Results: the study found that the visual system of persons with schizophrenia is characterized by hypersensitivity in the high and midrange, but decreased sensitivity in the low-frequency range. Decreased sensitivity in the low-frequency range was associated with better cognitive functioning and less pronounced productive symptoms. Medium frequencies at the trend level correlated with the digit sequencing tests, assessing working memory, and verbal fluency, reflecting speed of information processing.Conclusions: our findings expand information on the character of the relationship between contrast sensitivity and cognitive function. The results of study will provide the basis for further research on the development of more effective non-medicinal methods to improve cognitive functioning.

Background: the heterogeneity of schizophrenia impedes our efforts to provide adequate treatment. One step toward optimizing treatment is to deepen our understanding of cognitive variety in this disorder. Perhaps due to this heterogeneity, although visual impairment is a frequent symptom of schizophrenia, many studies show inconsistent data. The aim of our study was to identify homogeneous groups of patients with schizophrenia based on susceptibility to the Ponzo illusion, cognitive impairment degree (BACS T-score) and severity of mental state during therapy (Total PANSS score) and to examine the relationship between clinical parameters and the value of the illusion. Patients and methods: a prospective six-week observational study included 30 patients with the paranoid form of schizophrenia in the second week of stable antipsychotic monotherapy, 11 of whom dropped out due to exclusion criteria. At the second and eighth weeks of treatment, patients were assessed for susceptibility to the Ponzo illusion, cognitive impairment using a battery of BACS tests, and severity of mental status during a semi-structured interview using the PANSS scale. Results: the cluster analysis identified 2 clusters of patients who differed in their susceptibility to the Ponzo illusion. Patients in the first cluster (n = 9) with a significantly higher score on negative PANSS symptoms and marked cognitive impairment in the second and eighth weeks of therapy were prone to overestimate the Ponzo illusion, while patients in the second cluster (n = 10) were less susceptible to the Ponzo illusion. Conclusions: this study allowed us to identify two clusters of patients differing in the severity of cognitive and visual impairments, the relationship of susceptibility to Ponzo illusion with such clinical indicators as negative and cognitive symptoms was demonstrated, which confirms the informative value of using the visual illusion methodology as a marker of mental state.

BACKGROUND: In addition to the neurological complications affecting people infected with COVID-19, cognitive impairment symptoms and symptoms of anxiety and depression remain a frequent cause of complaints. The specificity of cognitive impairment in patients with COVID-19 is still poorly understood. AIM: An exploratory study of factors that may be associated with cognitive decline during the COVID-19 pandemic. METHODS: The cross-sectional multicentre observational study was conducted in a polyclinic unit in Saint Petersburg and in the regions of the North-Western Federal Region. During the study, socio-demographic parameters and information about the somatic condition of patients who applied for primary health care was collected. Emotional and cognitive state were investigated using the Hospital Anxiety and Depression Scale (HADS) and Montreal Cognitive Assessment (MoCA). Mathematical and statistical data processing was carried out using SPSS and RStudio statistical programs. RESULTS: The study included 515 participants, 60% (n=310) of which were women. The sample was divided into those who did (28.5%, n=147) and did not (71.4%, n=368) complain of cognitive decline. Patients with complaints of cognitive decline were significantly older, had lower levels of education and higher levels of depression and anxiety according to HADS (p 0.05). Patients with complaints of cognitive decline underwent the MoCA test (24.3%, n=125). The median MoCA test scores were within the normal range (Median=27, Q1=25, Q3=28), and cognitive decline (MoCA less than 26 points) was detected in 40% (n=50) of patients with complaints of cognitive decline. No significant correlations were found between the MoCA scores and the levels of anxiety and depression according to the HADS (p 0.05). Patients with mild severity of the COVID-19 course were more successful with MoCA subtests than patients with moderate and severe courses. CONCLUSION: We found no linear association between objective cognitive deficit and the affective state of respondents. Patients subjective complaints about cognitive dysfunction were mostly caused by their emotional state than an objective decrease of their cognitive functions. Therefore, in case of subjective complaints on cognitive decline, it is necessary to assess not only the cognitive but also the affective state of the patient. The severity of the COVID-19 course affects the functions of the cognitive sphere, including attention, regulatory functions and speech fluency. Mild and moderate severity of the COVID-19 correlates with clinically determined depression. The absence of this relationship with the severe course of the disease is probably explained by the significant somatic decompensation of patients.

Summary. Mental disorders are clinically heterogeneous chronic diseases resulting from complex interactions between genotype variants and environmental factors. Epigenetic processes, such as DNA methylation and post-translational histone modification, determine the interpretation by the body at the cellular and tissue levels of various environmental factors. Given that epigenetic modifications are environmentally sensitive, stable and reversible, epigenetic research in psychiatry may be a promising approach to better understanding and treating mental illness. This review discusses the clinical opportunities and challenges posed by epigenetic research in psychiatry. Using individual examples, the main conclusions are drawn that confirm the role of adverse life events, alone or in combination with genetic risk, in the epigenetic programming of neuropsychiatric systems. Further epigenetic studies show encouraging results in the use of methylation changes as diagnostic markers of disease manifestations and provide predictive tools for assessing progression and response to treatment. The potential for the use of targeted epigenetic pharmacotherapy, combined with psychosocial methods, in the context of the personalized medicine of the future in psychiatry is discussed next. It concludes with a discussion of methodological limitations that can make it difficult to interpret epigenetic data in psychiatry. They mainly arise due to the heterogeneity of individuals, both at the level of the whole organism and at the level of tissues, and require new strategies to better assess the biological significance of epigenetic data and their translational use in psychiatry. Overall, we believe that epigenetics can provide new insights and a more comprehensive understanding of the etiology and pathogenesis of mental illness, and should ultimately improve the nosology, treatment and prevention of mental disorders.

Применение методов хирургического лечения пациентов с психическими расстройствами, как известно, имеет многовековую историю. Эта область медицины, получившая название психохирургия, включает оперативные воздействия в тех случаях, когда методы фармакологического и нефармакологического лечения оказываются неэффективными, т. е. так называемая терапия отчаяния. В обзоре, который является результатом совместного труда психиатров и нейрохирургов, описываются исторические этапы становления психохирургии, основные показания и противопоказания к хирургическому лечению, эффективность и возможные осложнения психохирургических вмешательств. Значительное внимание уделяется рассмотрению таких методов лечения, как цингулотомия, капсулотомия, субкаудатная трактотомия, лимбическая лейкотомия, глубокая стимуляция мозга (DBS) и стимуляция блуждающего нерва (VNS).Авторы, понимая неоднозначность содержащихся в обзоре результатов исследований и дискуссионных приводимых суждений, вместе с тем считают целесообразным рассмотреть диапазон возможностей применения современных методов психохирургии в лечении ряда состояний, имеющих проявления резистентности к иным видам лечения. Вместе с тем отмеченная дискуссионная форма делает более чем обоснованным, на наш взгляд, предложение о последующей полемике на страницах журнала как о показаниях для психохирургии и ее последствиях, так и о самой целесообразности применения хирургических вмешательств в психиатрической практике. The use of methods of surgical treatment of patients with mental disorders is known to have a long history. This area of medicine, called psychosurgery, includes the methods of surgical intervention used in cases where other methods of pharmacological and non-pharmacological treatment are ineffective, i.e. the so-called "despair therapy". The review, which is the result of joint work of psychiatrists and neurosurgeons, describes the historical stages of psychosurgery, the main indications and contraindications to surgical treatment, the effectiveness and possible complications of psychosurgical interventions. Significant attention is paid to the consideration of such treatment methods as cingulotomy, capsulotomy, subcaudate tractotomy, limbic leucotomy, deep brain stimulation (DBS), and vagus nerve stimulation (VNS).The authors, understanding the ambiguity of the results of certain studies and the controversial judgments presented in the review, however, consider it appropriate to discuss the possibility of using modern methods of psychosurgery in the treatment of a number of conditions that have manifestations of resistance to other types of treatment. However, the above discussion form makes it more than reasonable in our opinion to suggest a subsequent polemic on the pages of the journal about the possibilities of psychosurgery and about the very feasibility of its application in psychiatric practice.

To investigate whether visual processing abnormalities are the result of visual dysfunction involving cognitive impairment or independent abnormalities and to identify the relationship of visual impairments with cognitive functions and severity of psychopathological symptoms. We compared results of visual size perception and actions on objects (motor assessment) in patients with schizophrenia (n=37), including patients with non-resistant schizophrenia (n=19) and healthy individuals (n=20). Cognitive impairments were assessed with BACS. Severity of schizophrenia symptoms was assessed with PANSS. The error in the visual size perception test was smaller in healthy controls compared with non-resistant patients (pr= -0.84, pr=0.55, p<0.05). Changes in visual threshold in patients with schizophrenia are correlated with cognitive dysfunction and reflect dysfunction in the parvocellular system.