Vol 4, No 4 (2023)

RESEARCHES

Serum Interleukin-6 in Schizophrenia: Associations with Clinical and Sociodemographic Characteristics

Zhilyaeva T.V., Rukavishnikov G.V., Manakova E.A., Mazo G.E.

Abstract

BACKGROUND: Recently a significant part of schizophrenia studies have been focused on the role of cytokines, especially interleukin-6 (IL-6). Some authors have suggested a pathogenetic role for IL-6 in schizophrenia and concluded that therapy that centers on suppressing IL-6 activity may prove beneficial for certain categories of patients with the disorder. However, many questions about whether the changes in IL-6 levels in schizophrenia are primary, related to symptoms or caused by therapy, are concomitant metabolic disorders, are related to smoking or other secondary factors remain unanswered.

AIM: To assess the level of serum IL-6 in patients with schizophrenia in comparison with healthy controls, as well as to study its association with clinical and socio-demographic characteristics.

METHODS: Some 125 patients with schizophrenia and 95 healthy volunteers were examined. The evaluation of IL-6 was performed by enzyme immunoassay. All patients were assessed using standardized psychometric instruments. Information from patient medical records on the course of the disease and treatment was analyzed.

RESULTS: The level of IL-6 was significantly higher in the patients than in the healthy volunteers (z=2.58; p=0.0099), but among men the difference between the patients and volunteers was not significant. Statistically significant correlations were found between the level of serum IL-6 and the severity of the cognitive impairment of patients: (auditory [ρ=–0.31; p=0.00063] and working memory [ρ=−0.25; p=0.0065], hand-eye coordination [ρ=−0.29; p=0.0011], verbal fluency [ρ=−0.28; p=0.0019] and problem-solving capacity [ρ=−0.22; p=0.013]), total severity of schizophrenia symptoms (PANSS, ρ=0.22; p=0.016), PANSS positive subscale (ρ=0.18; p=0.048), and the age of manifestation (ρ=0.20; p=0.025) and disease duration (ρ=0.18; p=0.043). The level of IL-6 was the lowest in patients treated with third-generation antipsychotics, and the highest in those treated with first-generation antipsychotics (H=6.36; p=0.042). Moreover, in hospital patients, the level of IL-6 was significantly higher than in outpatients and inpatients hospitals (H=18.59; p=0.0001).

CONCLUSION: The study confirmed that there are associations between the serum IL-6 level and schizophrenia, the age of the patient, duration of the disease and how late in one's life cycle it began manifesting itself, as well as a number of clinical characteristics. Considering that IL-6 is associated with a wide range of symptoms that are loosely controlled by antipsychotics, this biochemical marker needs to be studied to look into how closely its level tracks with an unfavorable course of schizophrenia. That would require further prospective studies.

Consortium Psychiatricum. 2023;4(4):5-16
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Efficacy and Safety Profiles of Antipsychotic Drugs as Viewed by Psychiatrists: A Comparative Analysis of Cariprazine and Risperidone

Gvozdeckii A.N., Dobrovolskaya A.E., Prokopovich G.A., Sofronov A.H.

Abstract

BACKGROUND: Physicians hold the belief that the treatment outcomes and the treatment strategy they eventually adopt is largely determined by the differences in medications. Despite numerous studies focusing on the decision-making processes of psychiatrists, including the choice of antipsychotics when prescribing pharmacotherapy, the impact of therapeutic drug profiling on physicians’ decision-making remains poorly comprehended.

AIM: The aim of this study is to assess the quantitative differences in perceptions of antipsychotics by psychiatrists using cariprazine and risperidone as examples.

METHODS: A total of 79 psychiatrists were interviewed anonymously in St. Petersburg, Russia. The physicians documented the clinical advantages they perceived drugs to possess relative to one another, following a predetermined principle: A >B, A=B, A < B (2-AC protocol). The comparison is based on eleven parameters that assess the effectiveness and safety of cariprazine or risperidone. It has been hypothesized that the pattern of responses (qualitative difference) and the degree of preference for each drug (quantitative difference) may not align with the data in the original meta-analyses.

RESULTS: The perception parameter exhibited a greater difference than anticipated (δ — 0.889), while the threshold for differentiating between the drugs was lower (τ — 1.001). The response pattern only aligned with theory by 44.37%. The dispersion of responses was associated with the length of work experience.

CONCLUSION: The perceived difference between the drugs significantly deviates from the theoretical data, both in terms of strength of perception and pattern (quantitative and qualitative differences).

Consortium Psychiatricum. 2023;4(4):17-27
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The Effects of Cognitive Impulsivity on the Duration of Remission in Alcohol-Dependent Patients

Galkin S.A.

Abstract

BACKGROUND: Cognitive impulsivity manifesting in impaired inhibitory control and decision-making impulsivity is observed both in alcohol-dependent and substance-dependent individuals and may affect the ability to maintain long-term (persistent) remission.

AIM: To evaluate the effects of cognitive parameters of impulsivity on the duration of remission in alcohol-dependent patients.

METHODS: The study included 83 patients with alcohol dependence and 51 mentally healthy study subjects as the control group. The distribution of patients by duration of remission was based on the DSM-5 criteria. Patients were divided into two groups according to the duration of their most recent remission: patients with early remission (n=48) and patients with sustained remission (n=35). Impulsivity was assessed using the Go/No-Go task, which included a response inhibition component (inhibitory control). Choice impulsivity was assessed using two cognitive tests that encompass its separate components: decision-making under risk (Cambridge Gambling Task, CGT), and decision making under uncertainty (Iowa Gambling Task, IGT).

RESULTS: The study groups (patients and the controls) differed significantly in all domains of impulsivity: decision making under risk [GT: decision making quality (H(2, N=134)=30.233, p <0.001) and decision-making time (H(2, N=134)=18.433, p <0.001)] and decision making under uncertainty [IGT: selecting cards from “losing” decks (H(2, N=134)=9.291, p=0.009)]. The group of patients with sustained alcohol remission was characterized by longer decision times in CGT compared to the group of patients with early remission (z=2.398, p=0.049). Decision quality in CGT (z=0.673, p=0.999) and IGT scores (z=1.202, p=0.687) were not statistically significantly different between the groups of patients with sustained and early remission from alcohol dependence. The assessment of impulsive actions showed that the study groups were significantly different in terms of their ability to suppress their dominant behavioral response when performing the GNG task [false presses when seeing the “No-Go” signal (H(2, N=134)=28.851, p <0.001)]. The group of patients in sustained remission from alcohol dependence was characterized by better suppression of the behavioral response to the “No-Go” signal relative to the patients in early remission [H(2, N=134)=2.743, p=0.044)]. The regression analysis showed that the decision-making quality (t=2.507, р=0.049) and decision-making time (t=3.237, р=0.031) and the number of false presses when seeing the “No-Go” signal in the GNC task had a statistically significant impact on the duration of remission (t=3.091, р=0.043).

CONCLUSION: The results of this study indicate that impaired decision-making processes and the ability to inhibit the dominant behavioral response have a significant impact on the ability of alcohol-dependent patients to maintain long-term remission.

Consortium Psychiatricum. 2023;4(4):29-38
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CASE REPORTS

The Use of Umbilical Cord Blood Nucleated Cells in the Treatment of Regressive Autism: A Case Report

Morozova Y.V., Smirnov V.N., Makarov I.V., Emelina D.A.

Abstract

BACKGROUND: Interest in the issue of childhood autism has surged in the recent decades. At the same time, despite the significant progress achieved in understanding the etiological and pathogenetic aspects of the condition, effective ways to treat it have continued to elude us. Stem cell therapy appears to hold great promise in the treatment and rehabilitation of patients with both neurological diseases (cerebral palsy, hydrocephalus) and mental disorders (autism, schizophrenia).

METHODS: This article presents a case report describing the use of nucleated cord blood cells in a patient with regressive autism and resistance to standard therapies. The child’s condition was assessed before treatment and 6 and 12 months after.

RESULTS: Clinical observation, psychometric, and instrumental diagnostic methods led to a significant improvement in the child’s condition in the form of perception development, reduction of somatosensory disorders, normalization of emotional status, and a development of social and communication skills.

CONCLUSION: We assume that the result obtained may be associated with the normalization of the immunological status of our patient thanks to the cord blood cells therapy and consider it necessary to conduct further studies into the effectiveness of the method, taking the pathogenic mechanisms of autism into account.

Consortium Psychiatricum. 2023;4(4):39-47
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The Interdisciplinary Diagnostics of Autism Spectrum Disorder Using DC:0-5TM: A Case Report

Skoblo G.V., Trushkina S.V.

Abstract

BACKGROUND: The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5TM) is widely used in many Western countries. For Russian specialists, such classification represents a relatively new tool for the comprehensive diagnosis of mental disorders in children from birth to the five-year-old threshold. The purpose for presenting this case study report is to showcase the practical application of the DC:0-5TM.

AIM: This study aims to illustrate the diagnostic process according to the DC:0-5TM criteria using the example of a specific clinical case report involving the collaborative efforts of two specialists: a child psychiatrist and a clinical child psychologist.

METHODS: DC:0-5TM consists of five axes. The main axis focuses on clinical diagnosis criteria for mental disorders, considering their age specificity. The remaining four axes allow one to take into account and specify data related to biological, social, and psychological factors, which play a crucial role in understanding the causes and characteristics of a mental disorder in a child.

RESULTS: In the examined case, an analysis of symptoms by means of the Clinical Disorders axis revealed that they were consistent with the diagnostic criteria for autism spectrum disorder. The use of the remaining axes supplemented the clinical diagnosis with specific details about the adverse physical health factors in the child, a high cumulative stress burden, significant developmental delays in the emotional, speech, and social dimensions, as well as dysfunction in the mother-child dyad. Since the parents declined medication for their son, this information proved crucial in developing a support program for both the child and the family.

CONCLUSION: The comprehensive diagnostic approach using the DC:0-5TM axes proved highly effective, not only in psychiatric diagnosis but also in establishing goals and objectives for subsequent intervention. Its application in psychiatric, clinical psychology, and corrective educational practices has the potential to make support for children in their early years a more personalized and family-oriented undertaking.

Consortium Psychiatricum. 2023;4(4):49-56
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Recurrent Psychotic Episodes Induced by Synthetic Cathinones in a Monozygotic Twin with Drug Addiction: A Case Report

Severtsev V.V., Budanova A.A.

Abstract

We have described a clinical case of psychotic disorder induced by synthetic cathinones in one drug-addicted monozygotic twin. This clinical case is unique, because it offers the opportunity to observe many features of the singularity of the dependence syndrome in twin brothers: drug choice; motivation to use drugs; and the development of multiple, long-lasting psychoses in one of the brothers. We pursued a twelve-month follow-up of this case. The case substantiates the paucity of a fundamental understanding of mental disorders and highlights the importance of further research into the clinical features of drug-induced psychoses, especially those induced by novel psychoactive substances such as synthetic cathinones.

Consortium Psychiatricum. 2023;4(4):58-65
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Endoxifen in Treatment of Individuals with Borderline Personality Disorder with Predominant Impulsivity: A Case Series

Banerjee D., Ray R.

Abstract

Endoxifen, a protein kinase C inhibitor, has been approved for use in manic episodes in India. One of the symptom traits that it predominantly targets is impulsivity. Impulsivity can also be a symptom dimension of other mental health conditions, one of which is Borderline Personality Disorder (BPD). Management of BPD is challenging, with limited pharmacological options that are symptom-directed and psychotherapy sessions that are fraught with early dropouts and lack of compliance. Impulsive behaviors represent a major reason for seeking help in BPD, especially with regard to non-suicidal self-injury, substance abuse, high-risk sexual behavior, aggression, etc. Here, we present a case series comprising five individuals with a diagnosis of BPD whose treatment regimens were changed and endoxifen added at a dose of 8 mg once daily. Clinical improvement was monitored using the Borderline Evaluation of Severity Over Time (BEST). All the subjects improved in the impulsivity domains as well as with regard to attention deficits, mood fluctuations, and overall functioning. Endoxifen is thus potential promising in terms of the management of BPD, but needs more extensive study to fully substantiate its clinical benefits.

Consortium Psychiatricum. 2023;4(4):66-73
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OPINIONS

Biological Reductionism as an Obstacle to the Advancement of the Biopsychosocial Concept of Mental Disorders

Kotsyubinsky A.P., Kotsyubinsky D.A.

Abstract

The substantial progress in neurobiological technologies has narrowed the horizons of many psychiatrists, ultimately leading them to focus exclusively on biomedical research, primarily aimed at studying the biological basis of mental illnesses. This has led to an unjustified dominance of the biomedical paradigm in understanding the nature of mental disorders, while virtually ignoring the study of other components of the disease related to the psychosocial maladjustment of patients. This trend, largely associated with advancements in neuroscience employing neuroimaging techniques to study the brain’s activity as a biophysical object, has contributed to the development of such innovative field as evidence-based medicine. The methods of evidence-based medicine are seen as adequate in terms of determining the effectiveness of therapy for predominantly biologically determined components of mental illness (including the selection of medications) and only partially for psychological interventions. However, it seems that the predominant use of evidence-based medicine principles is insufficient for a holistic diagnostic approach, which includes a multilevel (diversified) representation of the criteria of effectiveness for pharmacological and psychological interventions. In this regard, it is promising to establish a scientifically and clinically productive combination of, on the one hand, the evidence-based concept of effectiveness assessments based on high-quality randomized scientific studies, and on the other, expert opinions of highly qualified scientific specialists, as well as practicing physicians with their personal professional experience in individualized therapy. This makes it reasonable to develop a personality-oriented personalized psychiatry, based on a biopsychosocial understanding of the nature of mental disorders, their holistic assessment, and the development of comprehensive therapeutic measures.

Consortium Psychiatricum. 2023;4(4):75-84
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