Coronavirus pandemia as a challenge to the mental health system

Background. Humanity is experiencing a collective mental trauma associated with the COVID 19 pandemic, which has immediate and delayed mental health consequences. The predicted is an increase in the number and severity of mental illness in the country, a decrease in the availability of medical and psychiatric care and social support for people with special needs. The pandemic is developing against the backdrop of the reform of specialized medical care, the reduction in funding for outpatient psychiatric services and psychiatric hospitals in the country. In addition, the SARS-CoV-2 coronavirus, causes COVID-19, along with the acute respiratory syndrome, can infect the brain, cause immune reactions, disrupt blood clotting, and small blood vessel thrombosis, further adversely affecting the brain functions and mental health of patients. Objective – to analyze the influence of the coronavirus disease pandemic on mental health, the course of mental and neurological disorders and the availability of psychiatric and general medical care for specialized patients, according to literature and the results of a survey of experts in mental health. Materials and methods. Using the information-analytical method, publications from MEDLINE, Embase, Pubmed, Web of Science and other open sources by keywords were selected and analyzed, and the results of a survey of doctors, heads of medical institutions and people representing patient and parent organizations were analyzed. acting in the interests of persons with mental disorders. Results and conclusions. The results indicate that the COVID-19 pandemic affects all aspects of the life of Ukrainian society, is accompanied by massive lesions of the respiratory, gastrointestinal, cardiovascular, nervous systems, mental disorders and is fraught with the development of a global crisis in the field of mental health. Multicenter studies of the effect of COVID-19 on the central and peripheral nervous systems, on the course of mental and neurological diseases in infected people, the study of the long-term psychological, psychological and neurological consequences of coronavirus disease, and the effect on the mental health of the entire population and vulnerable groups are needed. There is an urgent need for research to find out how to mitigate the psychological consequences of prolonged isolation in a pandemic, to develop tools for specific prevention in risk groups. It is necessary to develop mechanisms to increase the effectiveness of psychiatric care in a pandemic, mass social exclusion, demoralization of psychiatric and social support systems in the face of a high level of infection and a reduction in specialized services and medical workers. It is concluded that to solve this problem, integration between disciplines and sectors and new funding for research are needed.

Features of the relationship between severity of macrosocial maladaptation and anxiety-depressive symptoms in women with different genesis depressive disorders

Background. The leading position in the structure of the pathology of the psyche today is convincingly held by depressive disorders. In recent years, the number of publications showing a combination of the frequency of depression and psychosocial maladaptation, which acts both as a derivative in the clinic of depressive disorders and as an independent phenomenon that provokes and aggravates their course, has increased. Objective – to study the correlation of the structure and severity of the manifestations of macrosocial maladaptation and anxiety-depressive symptoms in women with depressive disorders of various genesis, in order to further determine the targeted points for differentiated psychosocial rehabilitation of this patient population. Materials and methods. 252 women with a diagnosis of depressive disorder were examined: 94 women with depressive disorder of psychogenic genesis (F43.21), 83 women with endogenous depression, (F32.0, F32.1, F32.2, F32.3, F33.0, F33. 1, F33.2, F33.3, F31.3, F31.4, F31.5) and 75 women with depressive disorder of organic genesis (F06.3). According to the results of assessing the degree of macrosocial maladaptation, two groups were distinguished: women without signs of maladaptation were assigned to the first group (n=48); the second group (n=204) consisted women with identified signs of maladaptation. We used such research methods: clinical-psychopathological, psychodiagnostic, statistical. Results. The regularities between the genesis of depression and the severity of signs of macrosocial maladaptation and anxiety are established and described. Macrosocial maladaptation of various severity occurs in the vast majority of patients with depression of any genesis. The severity and variability of pathological anxiety is the lowest in women with psychogenic depression with no or mild macrosocial disadaptation, and high in severe maladaptation, meanwhile in patients with endogenous depression the severity of anxiety is highest with mild maladaptation and low with severe macrosocial maladaptation. Conclusions. The severity of macrosocial maladaptation does not demonstrate a direct association with the severity of depressive phenomena and a clear comparability with the genesis of depressive disorder. Anxiety is less dependent on the genesis of depression, and is more determined by the degree of maladaptation. Received data should be taken into account when developing diagnostic, treatment and rehabilitation measures for women with depressive disorders.

Features of depressive and anxiety manifestations in the first episode of bipolar affective disorder

Background. The study of depression and anxiety in the first episode of BAR is important for the timely detection, treatment and prevention of poor diagnosis of the disease. Objective – the study of the features of depressive and anxiety symptoms of the first episode of bipolar affective disorder, taking into account the gender factor and the clinical type. Materials and methods. We have clinically examined 65 men and 88 women diagnosed with first episode (FE) of bipolar affective disorder (BAD). Results. In patients with depressive FE of BAD, all indicators, with the exception of the undifferentiated depression indicator, in men are slightly higher than in women: the overall indicator (respectively 22.55±3.61 points and 22.16±3.03 points); adynamic depression (17.41±2.62 points and 16.76±2.48 points); pervasive depression (9.75±3.13 points and 9.69±2.66 points); depression with fear (9.34±2.55 points and 9.51±2.27 points); undifferentiated depression (4.89±0.95 points and 5.01±1.22 points); in patients with the mixed variant are not significantly different: accordingly 15,83±2,64 points and 17,00±3,32 points; 11.00±1.67 points and 11.80±1.64 points; 6.67±1.63 points and 6.60±2.07 points; 7.33±1.21 points and 8.00±1.87 points; 3.67±1.03 points and 3.40±1.14 points; in patients with a manic type there are no signs of depression. The indicators of anxiety in men and women do not differ significantly: in the depressive variant, the total indicator was accordingly 21.41±7.01 points and 23.36±7.01 points; psychic anxiety – 13.25±3.86 points and 14.35±3.87 points; somatic anxiety – 8.16±4.05 points and 9.01±4.10 points; when mixed, accordingly, 20,00±4,52 points and 22,00±4,90 points; 13.33±3.27 points and 15.20±2.39 points; 6.67±3.27 points and 6.80±3.70 points; the manic variant showed no signs of anxiety. The mean Zung score for the depressed variant was 68.82±8.30 points and 65.97±8.41 points, accordingly, for the mixed one, 44.00±5.55 points and 50.40±5.32 points, accordingly, at a manic variant 2.13±1.64 points and 2.50±1.60 points. Conclusions. Differences in manifestations of depression and anxiety in the first episode of bipolar affective disorder are determined by the clinical option; the impact of gender on these manifestations is insignificant.

The effectiveness of complex therapy of suicidal behavior in schizophrenia

Background. The relevance and clinical and social need for this study is determined by the fact that to date, no comprehensive therapy and prevention of suicidal behavior (SB) has been developed in patients with schizophrenia from the area of the anti-terrorist operation (ATO). Objective – to analyze the features of positive and negative syndromes by using the PANSS scale before and after complex therapy in people with schizophrenia who in the past had suicidal behavior. Materials and methods. 266 people aged 22 to 50 years were selected with a diagnosis of schizophrenia, who in the past had suicidal behavior. 136 people with suicidal behavior in schizophrenia who were treated in 2014-2016 constituted the main group (МG). The control group (CG) constituted 130 people with suicidal behavior in schizophrenia who were examined in 2006-2013. Results. In order to improve care for patients with suicidal behavior in schizophrenia who have been living in the ATO zone, we proposed an algorithm for the treatment process, which included a comprehensive and phased provision of medical and social assistance. In addition to standard care using clinical protocols, we have introduced a comprehensive approach taking into account the gender characteristics of patients with schizophrenia with suicidal behavior. Integrated author’s therapy was carried out at the inpatient and outpatient stages. Treatment measures were aimed both at the patients with schizophrenia with suicidal behavior, and at their relatives. After the treatment, we analyzed dynamics of positive, negative and psychopathological syndromes according to the PANSS, compared the results obtained before and after therapy. It was found that the main number of results that have a significant difference in МG and CG, relates to general psychopathological symptoms, which were identified as markers. Conclusions. The highlighted markers of positive, negative and psychopathological syndromes, that reduce the quality of life and lead to impaired social functioning, underwent positive changes when introducing a model of comprehensive measures to help patients with suicidal behavior in schizophrenia.

Targets of medical-psychological assistance for medical university students with adaptation disorders

Background. In the course of work is to identify and develop a system of measures for psychotherapeutic correction on the basis of identification and comprehensive evaluation of clinical and psychological manifestations and mechanisms of formation of maladaptive states in medical students. Objective – to comprehensively study the mechanisms of formation of students’ maladaptation states and develop a system of their psychotherapeutic correction and psychoprophylactic support in a medical institution of higher education. Materials and methods. Complying with the principles of bioethics and deontology, 412 students of the 2-5 academic years of the Kharkiv National Medical University (KhNMU), of both sexes, at the age of 17-22 years, were examined. All the surveyed people were divided into three groups: Group 1 included 215 students-inhabitants of the Eastern Ukraine; Group 2 consisted of 87 students-residents of Luhansk and Donetsk regions, who entered the study at the KhNMU before the ATO; Group 3 consisted of 110 students-migrants from the ATO zone. Results. Students-migrants have a higher level of adaptation disorders, compared with the students of the first and second groups. It was established that the structure of adaptation disorders is represented by depressive, neurasthenic, anxious and dissociative syndrome complexes. Prognostically significant elements in the formation of adaptation disorders are excitability and imbalance, proneness to conflicts in relationships, disturbing confidence, disorganization of behavior, failure to self-regulation, inability to successfully overcome stressful situations, act in conditions of uncertainty, rigidity, and focusing on traumatic and negative feelings. According to the results of the pathopsychological examination, high levels of somatization, depression and anxiety by the SCL-90-R scale; the prevalence of severe depressive and anxiety episodes by the Hamilton scale; clinical manifestations by the hospital anxiety and depression scale were characteristic for the examined students with disorders of adaptation. Based on the data obtained, a system of medical and psychological support of the medical student during the study period was developed, which envisages the use of complex differentiated psychotherapeutic, psychoeducational and psychoprophylactic influences. Conclusions. Against the background of the psychotherapeutic correction, a positive dynamic of the psychological state was noted: rapid reduction of anxiety and depressive symptoms, reduction of the level of neuro-psychic tension, increase of students’ psychophysical activity, positive change of coping strategy.

The ways to overcome stress in student learning activity

Background. Stress is an integral part in the life of a contemporary man. The problem of stress is especially acute in the field of higher professional activity. Student learning activity has been always associated with a high level of stressful tension. In case of a long stress effect and when students do not have skills of its positive overcoming, stress can result in occurrence of psychosomatic diseases, non-psychosomatic psychic disorders (NPD), formation of educational neglect, disorders of personality and professional development of the personality, which stipulate the topicality of the given work. Objective – to examine the ways of overcoming stress among students depending on NPD available, gender and the course of education. Materials and methods. 1235 students of both genders were examined comprehensively including 852 students (68,99%) from the Higher State Educational Establishment of Ukraine “Bukovinian State Medical University” and 383 students (31,01%) from Yuriy Fedkovych Chernivtsi National University. An average age of those involved in the study was 20,15±0,05. The following methods were applied: clinical, psychodiagnostic and statistical. Results. The conducted study found that most often students used the following means to overcome stress: sleep – 70,35% and 71,24% in І and ІІ groups respectively; walking in the open air – 58,99% and 60,02%; tasty food – 58,04% and 52,51%; communication with friends – 56,78% and 57,41% (р≥0,05). A reliable majority of students with NPD during the first examination indicated that they used cigarettes as a means to get over stress (34,38%) against 13,18% of students without NPD, and alcohol (26,81% and 13,73% respectively) (р<0,05). Conclusions. Therefore, the conducted study did not find any reliable gender differences in the choice of means to get over stress. The number of smoking students increases with every next year getting its maximum at the 4th year of studies. It decreases a little at the 5th year which should be considered in planning of preventive and therapeutic measures. Our comprehensive treatment of students with NPD reduced the rate of smoking 2,09 times, from 33,80% to 16,19% (р<0,05), which is indicative of its high effect.

Comprehensive approach to therapy of adaptation disorders associated with computer addiction

Background. In modern conditions there is a quick increase in non-chemical addictions, primarily computer addiction. Unfortunately, patients with non-chemical addictions do not fall into the field of view of doctors at the early stages of the development of the disease. They seek specialized help when addiction becomes a chronic process; due to disability, and delinquent behavior, which contributes to a violation of social functioning and quality of life of the patient and his family. Objective – to develop and evaluate the effectiveness of a comprehensive program for the treatment of adaptation disorders associated with computer addiction, based on the study of clinical, psychopathological and pathopsychological patterns of their formation. Materials and methods. The study involved 117 patients with signs of computer addiction according to the results of AUDIT-like tests and with adaptation disorders. The main group consisted of 66 patients who took part in the complex therapy program using the methods of pharmacotherapy, psychotherapy and psycho-education; control group – 51 patients who received standard regulated therapy in a medical institution. We used such study methods: clinical-anamnestic; clinical-psychopathological, using AUDIT-like tests for a comprehensive assessment of addictive status, psychodiagnostic using a hospital scale of anxiety and depression, Hamilton anxiety rating scale, Hamilton depression rating scale, the questionnaire of neuro-psychic tension according to T. A. Niemchyn; statistical. Results. The clinical picture of computer addiction noted: compulsive surfing in a computer network (45.8±1.6% of the examined), computer games (22.3±1.2%), virtual communication (5.8±0.4%), gambling on-line (14.1±1.1%), passion for porn sites (1.2±0.1%). All examined patients received pharmacotherapy – antidepressants (SSRI) and anxiolytic drugs. and anxiolytic drugs. The psychotherapeutic complex included the use of rational psychotherapy, personality-oriented psychotherapy, existential psychotherapy, art therapy (painting technique). Psycho-educational work included the use of information modules, motivational trainings, the formation of communicative skills, problem-oriented discussions and teaching coping skills. Psychotherapeutic and psycho-educational work was aimed at determining the patient’s resource in overcoming computer addiction and its occurrence. Due to effects of the developed comprehensive program for the treatment of adaptation disorders associated with computer addiction, positive dynamics of the emotional status of patients were achieved, reduction of manifestations of anxiety and depression by HADS, reduction of manifestations of severe depressive and anxious episodes according to the Hamilton scales as well as reduce neuropsychic stress on a scale of T. A. Niemchyn were indicated. Conclusions. A comprehensive system for the treatment of adaptation disorders associated with computer addiction should include a combination of pharmacotherapy, psychotherapy and psycho-education. Positive dynamics of the emotional status of patients, the predominance of subclinical manifestations or the absence of anxiety and depression on the HADS scale; mild depressive and anxious episodes or their absence according to the HAM-D and HAM-A scales; reduction of neuropsychic stress on a scale of T. A. Niemchyn as well as stability of the therapeutic effect during a two-year follow-up study indicates the effectiveness of the developed comprehensive therapy program.

The role of melatonin in the pathogenesis and therapy of depressive disorders (literature review)

Background. Depression is one of the most common diseases worldwide. Despite the ongoing flow of research on affective disorders and the emergence of new antidepressants, depression remains a serious problem. Among the hypotheses of the occurrence of depressive disorders hypothesis associated with dysfunction of neurotransmitters and chronobiology concept (altered circadian rhythms that are implemented with the help of melatonin) occupy a leading place. The latter formed the basis of the melatonin theory of depression, the founder of which was A. Lewy. Objective – of this work was to review the literary sources that highlights the role of melatonin in the pathogenesis and therapy of depressive disorders. Materials and methods. Was analyzed publications from databases of Pubmed, Web of Science, Google Scholar with keywords – depression, melatonin, biorhythmology, agomelatine, desynchronosis. Results. According to the chronobiological concept of depression, the only cause of depressive disorders is the phase inconsistency of different circadian rhythms among themselves due to weakness in the work of their governing structures. In particular disorders of the central monoaminergic transmission is capable first and foremost negatively affect the role of lead retooling apparatus – suprachiasmatic nuclei of the hypothalamus, which leads to an acceleration of «progress» biological clocks and the formation of internal desynchronosis. Benefit chronobiological nature of the depressions suggest 3 basic facts: pronounced cyclicity in the clinical picture of the majority of depressive disorders and the availability of insomnia; the possibility of effective influence on the course of depression chronobiological methods (sleep deprivation, light therapy, therapy with «darkness»); the existence of many classes of antidepressants activity relative to circadian rhythms. A review of literature sources has shown that disorders of melatonin secretion is a characteristic feature of patients with depressive disorders. But the focus of this disturbance may be different: both downward and upward. This fact is due to the presence of biochemically different subgroups of depression. Antidepressant effect of melatonin today is quite controversial. The effect of another melatoninergic antidepressant, agomelatine, may be due to both the effect on melatonin receptors and antagonistic properties against serotonin 5-HT2C receptors. Conclusions. Each clinical case of depression is unique and requires careful evaluation to determine the quality of the therapeutic response to antidepressants. In this regard, there is a question of developing a differentiated approach to the treatment of various depressive disorders, in particular – a preliminary laboratory assessment of pineal function.

Features of the cognitive sphere in patients with a mixed episode of bipolar affective disorder

Background. Data of various meta-analyzes confirm that the majority of patients with bipolar affective disorder (BAD) have neurocognitive dysfunction, even during remission. According to the latest research, disturbed domains with moderate to pronounced changes are attention, verbal learning and memory, as well as executive functions, whereas premorbid intelligence may remain unchanged. The main body of research is devoted to the study of cognitive impairment in the first episode of BAD, in manic, depressive episodes and euthymia. At the same time, the features of cognitive dysfunction in mixed forms of biologically active substances remain insufficiently studied. Objective – to study the characteristics of the cognitive sphere in patients with a mixed episode of BAD. Materials and methods. With the help of battery tests (a test to memorize ten unrelated words; Rey-Osterreith Complex Figure Test; Verbal Fluency Test Digit Symbol Substitution Test; Trail making test), the cognitive functions of 25 patients with mixed episodes, 16 patients with manic episodes, and 15 patients with depressive episode of BAD. Results. Cognitive impairments were identified in all patients, regardless of the type of affective symptoms, in the form of a wide range of psychopathological phenomena, which are more pronounced in patients with a mixed episode BAD. The peculiarities of the phenomenological structure of cognitive impairment in patients with mixed phase BAD manifest themselves in the form of: a more pronounced deterioration of verbal memory, speed of information processing; more pronounced violations of spatial representations, impairment of visual memory, verbal associative performance and executive functions; reduction of attention and violations of its distribution. Conclusions. The findings suggest that the presence of depressive symptoms in the structure of mixed affect plays a dominant role in the formation of these disorders.

Comparative characteristic of manifestations of pathological anxiety in workers of the marine merchant and passenger fleets

Background. The activities of seafarers are extremely complex and at the same time risky professions; they put forward specific requirements for the crew of ships. Long seagoing are associated with the constant presence of crew members in a confined space, monotony of activity, a sharp narrowing of external social relations, an increased risk of emergency situations and etc. Scientific studies show the differentiation of the negative impact of occupational stress factors depending on the ranks of long-distance sailors. Objective – to study the specifics of manifestations of anxiety reaction of workers of the marine merchant and passenger fleets to determine the need to create specific systemic measures to protect mental health for this contingent. Materials and methods. During 2016–2019 we examined 120 workers of the Ukrainian navy. Of these, 90 were sailors, minders, and other merchant fleet workers, and 30 were passenger fleet workers. All examined were men, citizens of Ukraine. The study included the use of clinical, psychopathological, psychodiagnostic and statistical methods. Results. A significant part of the deck ratings (workers) of both merchant and passenger fleets has manifestations of a pathological anxiety reaction, mainly of medium-low intensity. Representatives of the working professions of the passenger navy are characterized by more intense manifestations of anxiety symptoms, the average severity of which approaches the upper limit of subclinical values, while among the representatives of the merchant fleet it approaches the upper limit of normative indicators. Conclusions. The data obtained should be taken into account when developing specific measures of psychotherapy and psychoprophylaxis for this contingent, which is the prospect of this study.