Background. Suicides are predicted to drop in the acute phase of any crisis that poses a threat to the entire population, though data on this are inconsistent. A pandemic is the most severe global crisis one can imagine. There is an urgent need to identify objective trends in suicide rates across countries and populations in a real-time manner in order to be better informed regarding prospects and adaptation of preventive strategies. Objectives. To evaluate suicidal behaviour in a metropolis immediately after the introduction of severe containment measures due to the pandemic. Methods. Cases of completed suicides in St. Petersburg were obtained from the local city Bureau of Forensic Medical Examinations for the period 1 January 2016 to 31 July 2020. Data were accurately collected and monthly frequencies per 100,000 of the population in April-May 2020 (introduction of the most severe stay at home measures) were compared with corresponding data from 2016-2019. Confidence intervals were calculated according to Wilson. Results. Suicide frequencies in the population of St. Petersburg in April 2020 did not go up, in contrast, they were 30.3% lower than the average for the previous four years. The decrease in April was more pronounced in males than in females (36.3% and12.4%, respectively). When looking at age groups it was found that the biggest drop in suicides was in older males ( 55 years). In this group, suicide indices were 58.5% lower than average for the previous four years. However, in females, there was a 50% rise in suicides in June, while in young males (15-34 years) there was an 87.9% rise in May. Total number of suicides for the first half of 2020 was very close to the average seen in previous years. None of the registered changes were statistically significant. Conclusions. The analysis is preliminary and does not account for possible seasonality, however, we consider that the reduction in completed suicides immediately after crisis exposure deserves attention. It supports views that in the acute phase of the crisis, suicidal behaviour may decline, which may be quickly replaced by a rise. Such a rise in females and younger males points on possible risk groups and requires a response from society. More studies are needed to have a clearer picture of suicide dynamics in Russia during the different waves of the pandemic, and prevention should be prioritized regardless of the tendencies.

This paper examines the psychological aspects of adaptive-compensatory psychological mechanisms in patients with paranoid schizophrenia before and after social skills training. The features of self-regulation of behavior, the level of subjective control, life orientations and subjective perception of psychological characteristics of time are studied. The effects of social skills training were compared with a control group of patients who received only isolated drug therapy with psychotropic drugs. Positive dynamics was noted in both studied samples.The patients who took part in the study improved their ability to control impulses, increased behavioral flexibility, awareness of their contribution to the current situation and rational acceptance of responsibility for what is happening. Life goals also took shape better, the sense of manageability of life and satisfaction with it increased. The present has become perceived by patients with paranoid schizophrenia as more structured, saturated and predictable, and the past as realistic and tangible, which has a positive effect, including on the emotional background of patients. The effects of the training were clearly manifested when compared with a group of patients receiving only drug therapy. With combined treatment (social skills training and psychopharmacotherapy), patients begin to perceive the past more realistically, assess their actions and activity level more soberly, integration, awareness and structuring of past experience increases. This will allow patients with paranoid schizophrenia to facilitate the planning of their behavior in the future, as well as to increase the adequacy of the formation of cause-and-effect relationships and perception of what is happening, which has a beneficial effect on the ability to adapt to life in society and compensate for existing violations.

BACKGROUND: Hundreds of studies are dedicated to the negative effects of glaucoma therapy on the ocular surface. At the same time, the state of the eye surface after successful hypotensive surgery, which resulted in the cessation or significant reduction of medical therapy, has not been studied. AIM: To identify ocular surface changes after glaucoma surgery. MATERIALS AND METHODS: The study group consisted of 475 consecutively enrolled patients who were operated during 20162020 in Saint Petersburg Multidisciplinary City Hospital No. 2 for primary open-angle unstable glaucoma, and then observed for 6 to 24 months. Trabeculectomy (TE) was used as the first hypotensive procedure (418 patients), as re-operation TE (25 patients) or Ahmed valve implantation (32 patients) were chosen. Using statistical methods, the dynamics of symptoms (OSDI) and signs [tear film break-up time (TBUT) and reflex tear production defined by Schirmer I test] depending on outcome (complete or partial success and total failure) were analyzed. RESULTS: The cessation of the pharmacological load due to the complete success of the surgery was accompanied by pronounced (two-fold) and long (for at least two years) decrease of OSDI scores. The obliged, even partial, return to instillations by patients, who were included into the subgroup of partial success, within six months, transformed the achieved differences into insignificant ones. TBUT at complete and partial success significantly increased at all end-points of the study, significantly differing from the similar indicator in the subgroup total failure. The results of the Schirmer I test against the background of complete success of the operation showed a statistically significant increase, compared to the baseline , delayed for six months, throughout the whole further follow-up period. Patients entering the partial success subgroup in 24 months after surgery, also showed a significant increase in tear secretion. The failure of glaucoma surgery was accompanied by a brief and insignificant improvement in all scores. CONCLUSIONS: The hypotensive surgery, which lead to complete success, was accompanied by a significant improvement of the ocular surface state. Restart of local therapy reduces achieved results. Failure of surgical treatment is associated with minimal fluctuations of the studied parameters.

INTRODUCTION: The differential diagnosis of mild cognitive impairment (MCI), due to the high prevalence in the population and the rapid increase in incidence, is an urgent task. The most common causes leading to the development of cognitive impairment are Alzheimer’s disease (AD), cerebrovascular pathology, and their combination. AD usually manifests as an amnestic type of mild cognitive impairment (aMCI) at the pre-dementia stage. Subcortical vascular mild cognitive impairment (svMCI) is considered as the prodromal stage of subcortical vascular dementia. According to the results of pathomorphological studies, it was found that subfields of the hippocampal formation are selective vulnerability to AD, ischemia/hypoxia, and aging.Currently, using the FreeSurfer 6.0 software, it is possible to obtain quantitative indicators of the hippocampal formation subfields in vivo.The current trend in medicine is the development and implementation of new diagnostic solutions based on artificial intelligence and machine learning. One of the machine learning algorithms is binary logistic regression, which we used in the course of the study for the differential diagnosis of MCI of various origins.OBJECTIVE: To develop a method for the differential diagnosis of mil cognitive impairment of various origins.MATERIALS AND METHODS: The study included patients with the syndrome of mild cognitive impairment who were examined in the department of geriatric psychiatry of the V.M.Bekhterev National Medical Research Center for Psychiatry and Neurology, from which two groups were formed: group 1 — patients with aMCI, group 2 — patients with svMCI. Conditionally healthy volunteers, comparable in age, sex and level of education, made up the 3rd group (control). MRI examination was performed using a Excelart Vantage Atlas XGV magnetic resonance imaging system (Toshiba, Japan) with a magnetic field strength of 1.5 T, followed by MR morphometry of the subfields of the hippocampal formation.Statistics: Statistical analysis was carried out using data that was converted from a database in Microsoft Excel to the statistical package IBM SPSS 21. To develop a differential diagnosis method, based on the data obtained, the binary regression method and ROC analysis were used.RESULTS: Based on the obtained MR-morphometry data, a method was developed using the binary logistic regression equation. The value of p≥0.5 makes it possible to classify the patient to the aMCI group, and the value of p<0.5 — to the svMCI. The sensitivity of the method is 90%, the specificity is 80%, and the accuracy is 85%.DISCUSSION: Using binary logistic regression, the selection of variants of sets of variables (quantitative indicators) was carried out, for which ROC curves were constructed. The selection criterion was the area under the ROC curve — the AUC criterion (Area Under the Curve). The largest area under the curve (AUC=0.824) in the differential diagnosis of aMCI from svMCI was determined for the combination of the volume of the left subiculum and the thickness of the right entorhinal cortex.Since patients in the aMCI group have a significantly lower number of vascular foci than in the svMCI group (p<0.05), at the next stage, one more variable, the volume fraction, was added to the selected combination of two variables (volume of the left subiculum and thickness of the right entorhinal cortex) hypointense foci. When conducting an ROC analysis with a combination of three variables, an increase in AUC to 0.892 was noted. Further, using a combination of three variables and a binary logistic regression equation, a method for differential diagnosis of aMCI from svMCI was developed.CONCLUSION: The method of differential diagnosis based on binary logistic regression using MR morphometry data allows to distinguish patients with aMCI from patients with svMCI with high sensitivity and specificity.

The aim of the study was to investigate the structure of delirium in elderly patients with different outcomes of coronavirus infection.Materials and Methods. The study was carried out on the basis of Hospital for War Veterans, St. Petersburg. The study involved  30 patients: 13 male and 17 female (median age (Med) 70.5, interquartile range (IQR) 62-83) with clinical diagnosis: "New coronavirus infection COVID-19 (PCR+), F05.86 other delirium in association with other viral and bacterial neuroinfections. Peculiarities of delirium manifestations were studied using Delirium Rating Scale-Revised-98 (DRS-R-98). Current physical condition was monitored using The National Early Warning Score (NEWS2) for COVID-19.Results: All patients had moderate to severe disorders of the wake-sleep cycle on the DRS-R-98 scale. In addition, perceptual and long-term memory impairments were common. A significant correlation (p<0.05) was found between the severity of the physical condition and disorders of the sleep-wake cycle, lability of affect, formal thought disorders, motor agitation, and disorientation. In addition, there were significant correlations (p<0.05) between delirium symptoms and physical status scores on the NEWS2 scale. In lethal patients, more pronounced disturbances were recorded on sleep-wake indicators (Med.3.0, IQR 2.0-3.0 vs Med.2.0, IQR 2.0-3.0, p=0.0327) and motor agitation (Med.2.0, IQR 1.0-2.5 vs Med.1.0, IQR 0.0-2.0, p=0.441). A logit regression model showed that the variables "respiratory rate," "heart rate," and the final NEWS2 score could be considered predictors of disease outcome.Conclusion. Delirium, one of the most frequent manifestations of acute brain dysfunction, is a serious complication of COID-19 in hospitalized patients and a strong predictor of adverse outcome of coronavirus infection in older patients.