Plasma levels of neurotrophic factors are not associated with the severity of depression

Depression is one of the most common mental illnesses. Impaired neurogenesis is observed in depression. Studying the concentration of biochemical indicators in the blood that may be involved in the pathogenesis of depression, looking for associations with the severity of depressive symptoms can be useful as an objective diagnosis of the disease and predicting the severity of the pathology. We determined plasma concentrations of the monoamine neurotransmitters serotonin and dopamine, and neurotrophic factors involved in neurogenesis (BDNF, CDNF and neuropeptide Y) in depressed patients and healthy volunteers with the same socio-demographic parameters using enzyme immunoassay and mass spectrometry. All study participants were administered the Hamilton Depression Scale (HAMD), the Generalized Anxiety Disorder Questionnaire (GAD-7), and the Center for Epidemiological Studies (CES-D). The cumulative scores on the three scales examined were significantly higher in depressed patients than in controls. The concentration of serotonin, dopamine, BDNF, CDNF, and neuropeptide Y in plasma did not differ between the subject groups and was not associated with the scores on the scales. Positive correlations were found between the content of neuropeptide Y and serotonin, BDNF and CDNF in blood plasma. Thus, although these markers are related to the pathophysiology of depression, they do not correlate with the severity of symptomatology and possibly in plasma cannot reflect processes occurring in the brain.

Diagnosing and treating depression and anxiety in patients with cardiovascular disorders and diabetes mellitus in primary healthcare: is training of physicians enough for improvement?

INTRODUCTION. Common mental disorders - anxiety and depression - are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation. OBJECTIVE. To explore whether the rates of referrals to psychiatrist and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in the primary healthcare facility after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist). METHODS. Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n = 400). The educational programme for PCPhs on diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS 7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n = 178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment, according to the screening criteria used in the study for anxiety and depression for both samples. RESULTS. The proportions of patients with borderline abnormal and abnormal HADS scores ( 7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS 7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases it was indicated in compliance with the screening criteria. In Sample 2, among patients with HADS 7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS 7 met a psychiatrist through PCPh referral. CONCLUSIONS. Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.

Acceptance and Commitment Therapy for Patients with a First Psychotic Episode

ABSTRACT The search for the most effective methods of therapy for mental disorders is a priority for modern psychiatry. An approach to the early diagnostics and rehabilitation of patients experiencing a psychotic episode for the first time is proposed in the present article. The proposed approach is based on the combination of drug therapy and, acceptance and commitmenttherapy (ACT) characterized by the development of the patient's psychological flexibility, rather than controlling the disease symptoms. The article describes the main processes of the ACT model: acceptance, cognitive defusion, contact with the present moment, understanding of the inner world, awareness of significant values and the regulation of purposeful behaviour for the implementation of these values. Recommendations for different stages of treatment were also developed by specialists of the First Psychotic Episode Clinic at the Mental-health clinic No.1 named after N.A. Alexeev. The psychological rehabilitation of patients with the use of ACT in the case of psychotic disorders with both negative and productive symptoms was elaborated. The application of acceptance and commitment therapy in the early diagnostics and treatment of patients with a first psychotic episode results in fewer readmissions and improved psychosocial functioning in both inpatient and outpatient care.

Community-based psychiatry services in Sri Lanka: A new model in the making

Sri Lanka is a lower middle-income small island nation in the Indian Ocean with a multi-ethnic population of 22 million. The healthcare system of the country is well-established and fairly advanced, the delivery of which is free to the consumer. The health indicators of the country are impressive compared to regional figures. Psychiatric care in Sri Lanka saw a rapid development over the last four decades as the care model transformed from an asylum-based one, established during the British colonial times, to a district-wise hospital-based care delivery model. Gradually, the teams that provided inpatient and outpatient services at the hospitals started to also provide community-based care. The newly added community based services include outreach clinics, residential intermediate rehabilitation centres, home based care, community resource/support centres and telephone help lines. There is no or little separate funding for community-based care services. The teams that deliver community services are funded, mostly indirectly, by the state health authorities. This is so as these community teams are essentially the same psychiatry teams that are based at the hospitals, which are funded and run by the state health authorities. This lack of separation of the community and hospital teams without separate and dedicated funding is an impediment to service development, which needs to be addressed. Paradoxically, it conforms an advantage by making care delivery from the hospital to the community continuous, as it is the same team that provides both hospital- and community-based care. In addition to the essential mental health care provision in the community with this basic infrastructure, each community service has improvised and adapted utilization of other resources available to them, formally as well as informally, to compensate their financial and human resource limitations. These other resources are the community officials and the community services of the non-health sectors of the government, mainly of the civil administration. Though sustainability maybe questionable when services involve informal resources from the non-health sectors, it has so far proven useful and effective, in a resource-poor environment, as it brings the community and various sectors together to facilitate services to support their own community.

Stigma and Quality of Life among People Diagnosed with Mental Disorders

INTRODUCTION: The anti-psychiatric movements that emerged in the early 1960s led to the appearance of stigma in psychiatry. The misunderstanding of the concept of mental disorder, the negative way in which associated hospitalization was perceived, the inclination to treat patients through psychological therapies, and the criticism of pharmacological treatment led to the discrediting of psychiatry. AIM: The current paper aims to review the available literature regarding the impact of stigma on the quality of life of people diagnosed with mental disorders. MATERIALS AND METHODS: A narrative review of relevant literature published between 1999 and 2021 was conducted. The authors analysed studies found on PubMed and the Web of Science electronic databases. The search terms combined two overlapping areas with keywords such as "stigma" and "mental disorders". A descriptive analysis was employed to synthesize the obtained data. RESULTS: Stigma continues to be an important challenge to the management of health conditions in people with mental disorders. A lack of comprehension may give the impression that all psychiatric patients are aggressive and are unable to function adequately. Such stigmatizing beliefs and habits have proven to be very difficult to change. CONCLUSIONS: Due to the stigmatization and repulsive attitudes in society, patients are reluctant to be linked to any form of mental disorder or to be seen as having any contact with mental health professionals. This undermines the beneficial effects of treatment, resulting in a poor quality of life and diminished socio-occupational functioning.

Effectiveness of the Outpatients Services in Georgia

Georgia has made a commendable effort to reform mental health care recently. The 'Concept on Mental Health Care' adopted by the Government and two strategic plans for 20142020 and 2021-2031, which aimed to develop comprehensive evidence-based, culturally appropriate, and human rights-oriented mental health care, have promoted deinstitutionalization and development of community mental health services. Since 2018 new standards of care for mental health ambulatories and mobile teams have been imposed and implemented in the state program and funded accordingly. The initiation of new standards for ambulatories and mobile teams increased access and coverage of mental health care across the country. However still, further effort is needed to achieve a comprehensive treatment in mental health care services.

Community Mental Health Services in Greece: development, challenges and future directions

The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental healthcare since at least the 80s, the main recent Greek effort has been Psychargos, a programme which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various different services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is on-going. Future goals should be to improve the current framework of care, improve access to care by establishing fit-for-purpose community mental health services across the country, enhance multidisciplinary collaboration and patient involvement, integrate community mental health care with physical and social care services, and to ensure that service development is driven by need. Crucially, such aims demand the adoption of a culture of clinical governance and a consistent shift from traditional therapeutic care to person-centered psychiatry and preventive psychiatry.

Grant support as an option for private sector solutions and systemic issues in the work of NPOs

This article examines the existing practice of participation by non-profit organizations (NPOs) in solving social policy problems, both in the West and in Russia, and makes a comparative analysis of Russian and foreign experience in this area. A separate section of the work is devoted to the study of the grant support system of NPIs in Russia. Systemic and private problems have been identified. Conclusions are drawn about imperfections of the emerging system of interaction between the State and NCBs, including in the area of project financing; and also about the need to create conditions for the replication of successful pilot projects of individual NCBs on the territory of the whole of Russia.

Clinical Features of First-episode Psychoses During the COVID-19 Pandemic

INTRODUCTION: The pandemic of the new coronavirus infection has become one of the most significant global social shocks in the past decade. It influenced the lifestyle of many people, including those with mental disorders. AIM: To compare the psychopathological structure of psychotic states in young patients (up to 40 years old) with first-episode psychosis before the COVID-19 pandemic and during the COVID-19 pandemic. METHODS: The research was conducted at the First psychotic episode clinic of the Mental-health clinic No. 1 n.a. N.A. Alexeev, Moscow, Russia. In total, 66 patients were enrolled, who met the inclusion criteria: first-in-life admission to a mental healthcare unit that occurred during the spring of 2019 (control group) or spring 2020 (experimental group), diagnosis on admission that belonged to the group Acute and transient psychotic disorders (F23.XX) of ICD-10. Patients with a disability or concurrent somatic or neurologic conditions were excluded from the study. Assessment of clinical and psychopathological characteristics with the allocation of the leading syndrome within the psychotic state, psychometric assessment according to the PANSS scale was carried out, the above indicators were compared between the experimental and control group. RESULTS: We observed statistically insignificant increase in the rates of affective and catatonic subtypes of psychoses, a decrease in the rate of the delusional subtype of paranoid syndrome. PANSS scores differed significantly for different clinical subtypes of psychoses, although the differences between the experimental and control groups showed no statistical significance. Additionally, in spring 2020, a considerable decrease in the total number of hospitalizations was revealed. CONCLUSIONS: The differences in the clinical and psychopathological structure of psychotic states revealed during the COVID-19 pandemic were statistically insignificant. Additional results of the study may indicate a decrease in the availability of mental healthcare for patients with psychoses, which requires further investigation.

Comprehensive Clinical and Social Research at the Moscow Research Institute of Psychiatry: Translation into Clinical Practice

The article is devoted to the work of the Moscow Research Institute of Psychiatry to improve psychiatric care for patients with psychotic disorders. An important feature of this work was an integrated approach, in which the clinical picture of the disease was assessed in close connection with the patient's personal and psychological characteristics, social conditions of his life, therapeutic opportunities, rehabilitation potential and organizational structure of care. The article reflects the results of many years of work of the department of outpatient psychiatry and the organization of psychiatric care under the guidance of Professor I.Ya. Gurovich. The results of scientific research carried out by the staff of the institute in a traditional humanistic manner are presented. The translational nature of the research is emphasized by its inextricable link with clinical and social approaches. As a result of many years of work, a concept was developed to provide assistance to various groups of patients, starting with the first manifestations of the disease and ending with cases of long-term chronic disorders with a pronounced level of social maladaptation. As a result, a whole spectrum of new organizational forms of psychiatric care was proposed, such as departments (clinics) of the first psychotic episode, medical rehabilitation departments, assertive community treatment departments, designed for the most difficult patients. These organizational forms were fixed in the regulatory documents of the Ministry of Health and Social Development of the Russian Federation. To date, the above departments have been established in psychiatric institutions in many regions of the Russian Federation. Further development of this area is associated with neurobiological research to identify complex biomarkers of psychotic spectrum disorders. Thus, the research carried out at the present time preserves the tradition of an integrated clinical and social approach to the study of mental disorders. It is shown that an important advantage of this approach is their translational nature.