The study of cognitive impairment in bipolar disorder (BD) combined with anxiety-phobic disorders, as the most common comorbid pathology, is a new, little-studied and relevant direction for further research on BD, promising for clarifying the neurobiological mechanisms of the disease and improving the quality of the diagnostic process. By searching for combinations of the keywords «bipolar disorder», «anxiety disorders», «cognitive impairment», «cognitive dysfunction», «meta-analysis» and «review» in the databases «PubMed» and «Google Scholar», meta-analyses, analytical, review and original relevant research articles were identified. A generalization of the information accumulated in the literature indicates a) the presence in BD of both phase-dependent and persistent cognitive impairments that also occur during the period of euthymia, b) different structure and severity of neurocognitive disorders in cases of «pure» BD and anxiety-phobic disorders, c) the unique structure of cognitive impairment in BD with comorbid anxiety-phobic disorders, which incorporates the features of neurocognitive impairments that are characteristic of both disorders and have the greatest severity compared to them. The results of this review are of interest for planning further empirical studies of this topic on the Russian patient population.
Изучение когнитивных нарушений при биполярном аффективном расстройстве (БАР), сочетанным с тревожно-фобическими расстройствами как наиболее распространенной коморбидной патологией, является новым, малоизученным и актуальным направлением дальнейших исследований БАР, перспективным для прояснения нейрокогнитивных механизмов заболевания и улучшения качества диагностического процесса. Посредством поиска по сочетаниям ключевых слов «bipolar disorder», «anxiety disorders», «cognitive impairment», «cognitive dysfunction», «meta-analysis» и «review» в базах данных PubMed и Google Scholar были выделены метааналитические, обзорные и отдельные соответствующие теме исследовательские статьи. Обобщение накопленных в литературе сведений указывает на: наличие при БАР как зависящих от фазы, так и стойких когнитивных нарушений, имеющих место и в период эутимии; разную структуру и выраженность нейрокогнитивных нарушений в случаях «чистого» БАР и тревожно-фобических расстройств; уникальную структуру когнитивных нарушений при БАР с коморбидными тревожно-фобическими расстройствами, вбирающую в себя особенности нейрокогнитивных нарушений, свойственных обоим расстройствам, и имеющую наибольшую выраженность по сравнению с ними. Полученные в настоящем обзоре результаты представляют интерес для планирования дальнейших эмпирических исследований данной темы на российской популяции пациентов.

To analyze the stages of development of the problem, identify the evolution of views and the main directions of current research in the field of bipolar affective disorder, which occurs with psychopharmacotherapy-induced manic phases, the search for publications by keywords «pharmaco-induced mania»\", «bipolar affective disorder» was carried out in the PubMed/MEDLINE, Russian Citation index and other sources from the mid-19th century to the present. The issue of adequate treatment of bipolar depression became relevant back in the 20th century; numerous observations indicated the presence of associated risks when using antidepressants in patients with bipolar affective disorder, namely, the likelihood of affect inversion and aggravation of the course of the disease (accelerated cyclicity, continuum). In recent years, due to the expansion of research capabilities and the introduction of biological psychiatry, works have appeared that consider this problem from both clinical and pharmacodynamic, genetic and neurophysiological aspects, which opens up the prospect of developing advanced methods of personalized medicine for the diagnosis and treatment of bipolar disorder, taking into account the need to minimize iatrogenic effects.
Для анализа этапов становления проблемы, выявления эволюции взглядов и основных направлений актуальных исследований в области биполярного аффективного расстройства (БАР), протекающего с индуцированными психофармакотерапией маниакальными фазами, по ключевым словам «фармакоиндуцированная мания», «биполярное аффективное расстройство» проведен поиск публикаций в базах PubMed/MEDLINE, РИНЦ и других источниках с середины XIX века по настоящее время. Вопрос адекватной терапии биполярных депрессий получил свою актуальность еще в XX веке, многочисленные наблюдения свидетельствовали о наличии сопряженных рисков при применении антидепрессантов у пациентов с БАР: вероятности инверсии аффекта и усугублении течения заболевания (ускорение цикличности, континуальное течение). В последние годы благодаря расширению исследовательских возможностей и внедрению биологической психиатрии появились работы, рассматривающие данную проблему со стороны как клинических, так и фармакодинамических, генетических и нейрофизиологических особенностей, что открывает перед нами перспективу разработки передовых методов персонализированной медицины для диагностики и лечения БАР, учитывающих необходимость минимизации ятрогенного воздействия.

Valproic acid (VPA), or sodium valproate, is a frequently prescribed medication for many psychiatric conditions, notably for the management of bipolar affective disorder. While its common side effects are well known and thoroughly documented in medical literature, the occurrence of cataracts as a side effect is exceedingly rare. There is evidence of cataract formation with long-term use of VPA in a few studies. Recognizing this potential adverse effect is crucial. It is important to recommend that patients undergo regular eye examinations if they experience any visual disturbances or as a preventative measure to ensure effective management. This case report examines the unusual occurrence of cataract development associated with valproate use.

BACKGROUND: Self-stigma remains one of the most vexing issues in psychiatry. It complicates the treatment and social functioning of patients with endogenous psychiatric disorders. Identifying the specific features of self-stigma depending on the type and duration of the endogenous mental illness can help solve this problem.
OBJECTIVE: The aim of this study was to establish the level and specific features of self-stigma in patients with various types of chronic endogenous psychiatric disorders at different disease stages and to establish the correlation between the level of self-stigma and the attitude of the patient to his/her disease and treatment.
METHODS: Clinical psychopathology assessment, psychometric scales and questionnaires: \"Positive and Negative Syndrome Scale\" (PANSS), \"Questionnaire for Self-Stigma Assessment in Mentally Ill Patients\", and Russian versions of the \"Insight Scale for Psychosis\" (ISP), and \"Drug Attitude Inventory\" (DAI-10). The cross-sectional study included 86 patients with endogenous mental illnesses (bipolar affective disorder and schizophrenia spectrum disorders.
RESULTS: The analysis of the results of the \"Questionnaire for Self-Stigma Assessment in Mentally Ill Patients\" showed that at the initial disease stages the highest level of self-stigma is observed in patients with bipolar affective disorder (M±σ=1.22±0.73; Me [Q1; Q3]=1.10 [0.83; 1.60]), while the lowest level was observed in patients with schizophrenia spectrum disorders (M±σ=0.86±0.53; Me [Q1; Q3]=0.77 [0.31; 1.25]). Patients with schizophrenia and schizoaffective disorder and a disease duration more than five years participating in a long-term comprehensive psychosocial rehabilitation program also demonstrated high rates of self-stigma (M±σ=1.20±0.57, Me [Q1; Q3]=1.26 [0.89; 1.47]). The study groups showed differences in terms of the structure of components of self-stigma and their severity; significant correlations were uncovered between the self-stigma parameters and the attitude of patients to their disease and therapy.
CONCLUSIONS: The results of this study contribute to a better understanding of the specific features of self-stigma in patients with various endogenous disorders at different stages of the disease. These data can be used as part of a comprehensive psychosocial treatment program for this patient cohort, as well as for future research.
UNASSIGNED: Самостигматизация остается одной из актуальных проблем современной психиатрии, которая затрудняет лечение и социальное функционирование пациентов с эндогенными психическими расстройствами. Решению этой проблемы может способствовать определение особенностей и специфики самостигматизации в зависимости от формы и длительности эндогенного психического расстройства.
UNASSIGNED: Установить уровень и особенности самостигматизации у пациентов с различными формами эндогенных хронических психических расстройств на разных этапах болезни и выявить связь выраженности самостигматизации с отношением к своему заболеванию и лечению.
UNASSIGNED: Клинико - психопатологический, психометрические шкалы и опросники (« Опросник для оценки феномена самостигматизации психически больных », « Шкала позитивных и негативных симптомов — «Positive and Negative Syndrome Scale» (PANSS), русскоязычные версии опросников « Осознание болезни » — «Insight Scale for Psychosis» (ISP), « Отношение к лекарственным препаратам » — «Drug attitude inventory» (DAI-10). Проведено кроссекционное исследование 86 пациентов с эндогенными психическими заболеваниями (биполярное аффективное расстройство и расстройства шизофренического спектра).
UNASSIGNED: С помощью « Опросника для оценки феномена самостигматизации психически больных » установлено, что на начальном этапе заболевания наибольший уровень самостигматизации характерен для пациентов с биполярным аффективным расстройством (M±σ=1,22±0,73; Me [Q1; Q3]=1,10 [0,83; 1,60]), наиболее низкий выявлен у пациентов с расстройствами шизофренического спектра (M±σ=0,86±0,53; Me [Q1; Q3]= 0,77 [0,31; 1,25]). Пациенты с шизофренией и шизоаффективным расстройством и длительностью заболевания более 5 лет, участвующие в долгосрочной комплексной программе психосоциальной реабилитации, также продемонстрировали высокие показатели самостигматизации (M±σ=1,20±0,57, Me [Q1; Q3]= 1,26 [0,89; 1,47]). В изученных группах обнаружены различия в структуре компонентов самостигматизации пациентов и их выраженности и получены достоверные корреляционные связи между показателями самостигматизации, отношением пациентов к имеющемуся психическому расстройству и получаемому лечению.
UNASSIGNED: Результаты проведенного исследования уточняют и расширяют имеющиеся знания об особенностях самостигматизации у пациентов с различными эндогенными расстройствами на разных этапах заболевания. Полученные данные могут послужить основой для дальнейших исследований, а также для использования в комплексном психосоциальном лечении таких пациентов.

BACKGROUND: To examine if the COVID-19 pandemic was associated with a differential effect longitudinally in relation to its psychological and functional impact on patients with bipolar disorder and Emotionally Unstable Personality Disorder (EUPD).
METHODS: Semi-structured interviews were conducted with 29 individuals attending the Galway-Roscommon Mental Health Services with an ICD-10 diagnosis of either bipolar disorder (n = 18) or EUPD (n = 11). The impact of the COVID-19 pandemic was assessed in relation to anxiety and mood symptoms, social and occupational functioning, and quality of life utilising psychometric instruments and Likert scale data, with qualitative data assessing participants\' subjective experiences.
RESULTS: Individuals with EUPD exhibited significant anxiety and depressive symptoms and increased hopelessness compared to individuals with bipolar disorder. Repeated measures data demonstrated no significant change in symptomatology for either the EUPD or bipolar disorder group over time, but demonstrated an improvement in social (t = 4.40, p < 0.001) and occupational functioning (t = 3.65, p = 0.03), and in quality of life (t = 4.03, p < 0.001) for both participant groups. Themes attained from qualitative data included the positive impact of the discontinuation of COVID-19 mandated restrictions (n = 19), and difficulties experienced secondary to reductions in the provision of mental health services during the COVID-19 pandemic (n = 17).
CONCLUSIONS: Individuals with EUPD demonstrated increased symptomatology over a two-year period compared to those with bipolar disorder. The importance of face-to-face mental health supports for this cohort are indicated, particularly if future pandemics impact the delivery of mental health services.

The review discusses aspects of the use of atypical antipsychotics in the treatment of depression in affective disorders and schizophrenia using the model of aripiprazole, a partial agonist of dopamine receptors. According to numerous studies, aripiprazole is the drug of choice for augmentative therapy of major depressive disorder, as well as for relieving and long-term maintenance monotherapy and combination therapy of various affective episodes of bipolar affective disorder and depression in schizophrenia.
В обзоре обсуждены вопросы применения атипичных антипсихотиков при терапии депрессий в рамках аффективных расстройств и шизофрении на модели арипипразола — частичного агониста дофаминовых рецепторов. По данным многочисленных исследований, арипипразол является препаратом выбора для аугментирующей терапии большого депрессивного расстройства, а также для купирующей и долгосрочной поддерживающей монотерапии и комбинированной терапии различных аффективных эпизодов биполярного аффективного расстройства и депрессий при шизофрении.

OBJECTIVE: To determine the clinical picture of bipolar affective disorders (BD) in children and adolescents hospitalized at the Clinical Ward of Developmental Age Psychiatry and Psychotherapy (DAPP) in Sosnowiec, Poland.
METHODS: Documentation analysis of 288 BD patients below 18 years of age. Detailed clinical and demographic data were collected and symptoms present during hospitalization were assessed.
RESULTS: The mean age of illness onset was 13.6 ± 1.7 years. A total of 86.5% of the studied individuals received a first diagnosis different from BD/mania, and the average time until the proper diagnosis was 16.9 months. In 45.5% the first episode was depression with varied severity, in 29.2% a mixed episode and in 25.3% mania/hypomania. In 48.6% comorbid disorders were present. The most frequent reason for hospitalization was a mixed episode (47.6%). Among the symptoms, irritability was observed in over 80% of patients with mania or mixed episodes, but also in 60% of patients with depression. Suicidal thoughts were experienced by almost all the depression patients, 84.7% in the mixed episode and also 52.6% in mania/hypomania episode. Anxiety was mostly present in depression (40.7%) and mixed episode (22.6%), while moodcongruent delusions in depression and mania (around 20% of cases). Aggressive behaviours were manifested in around half of patients with mania and a mixed episode.
CONCLUSIONS: In the studied population of children and adolescents, BD usually started with a depression episode accompanied by a high rate of comorbid disorders and in most cases there was an original misdiagnosis. Study results also point to a significant frequency of some pathological symptoms in this population.

Bipolar affective disorder refers to a category of mood disorders characterized clinically by the presence of both manic or hypomanic episodes and depressive episodes. Lithium stands out as the primary pharmacological intervention for managing bipolar affective disorder. However, its therapeutic dosage closely approaches toxic levels. Toxic symptoms appear when the blood lithium concentration surpasses 1.4 mmol/L, typically giving rise to gastrointestinal and central nervous system reactions. Cardiac toxicity is rare but serious in cases of lithium poisoning. The study reports a case of a patient with bipolar affective disorder who reached a blood lithium concentration of 6.08 mmol/L after the patient took lithium carbonate sustained-release tablets beyond the prescribed dosage daily and concurrently using other mood stabilizers. This resulted in symptoms such as arrhythmia, shock, impaired consciousness, and coarse tremors. Following symptomatic supportive treatment, including blood dialysis, the patient\'s physical symptoms gradually improved. It is necessary for clinicians to strengthen the prevention and recognition of lithium poisoning.
双相情感障碍是指临床上既有躁狂或轻躁狂发作，又有抑郁发作的一类心境障碍。锂盐是治疗双相情感障碍的一线药物，但其治疗剂量与中毒剂量较接近，当血锂浓度超过1.4 mmol/L时即可产生中毒症状，通常包括胃肠道反应和中枢神经系统症状等。心脏毒性在锂中毒相关病例中较为少见，但后果极为严重。本研究报道1例双相情感障碍患者，在每日超医嘱剂量服用碳酸锂缓释片，同时联用其他心境稳定剂后，血锂浓度达到6.08 mmol/L，并出现心律失常、休克、意识障碍、粗大震颤等症状，在经过血液透析等对症支持治疗后，患者躯体症状逐渐缓解。临床医生有必要加强对锂中毒的预防和识别。.

Mental illnesses are one of the biggest contributors to the global disease burden. Despite the increased recognition, diagnosis and ongoing research of mental health disorders, the etiology and underlying molecular mechanisms of these disorders are yet to be fully elucidated. Moreover, despite many treatment options available, a large subset of the psychiatric patient population is nonresponsive to standard medications and therapies. There has not been a comprehensive study to date examining the burden and impact of treatable genetic disorders (TGDs) that can present with neuropsychiatric features in psychiatric patient populations. In this study, we test the hypothesis that TGDs that present with psychiatric symptoms are more prevalent within psychiatric patient populations compared to the general population by performing targeted next-generation sequencing of 129 genes associated with 108 TGDs in a cohort of 2301 psychiatric patients. In total, 48 putative affected and 180 putative carriers for TGDs were identified, with known or likely pathogenic variants in 79 genes. Despite screening for only 108 genetic disorders, this study showed a two-fold (2.09%) enrichment for genetic disorders within the psychiatric population relative to the estimated 1% cumulative prevalence of all single gene disorders globally. This strongly suggests that the prevalence of these, and most likely all, genetic diseases is greatly underestimated in psychiatric populations. Increasing awareness and ensuring accurate diagnosis of TGDs will open new avenues to targeted treatment for a subset of psychiatric patients.

A large number of people who have had COVID-19 have developed mental symptoms and mood disorders. Anxiety and depression prevail among affective pathology. Evidence is accumulating that the Sars-CoV-2 virus can induce mania or hypomania in people with no personal psychopathological history. Some clinical, anamnestic and paraclinical patterns of new-onset mania and hypomania have been found. In cases of severe manic symptoms, it is possible to quickly assume the occurrence of bipolar affective disorder. The predominance of depressive and anxiety syndromes in the long-term disease and the presence of vivid vegetative symptoms can mask brief and syndromally incomplete episodes of hypomania, which distorts the understanding of the disease as a bipolar disorder. This article presents such a clinical case of the occurrence of bipolar affective disorder in a patient who had COVID-19 with an asymptomatic course. Approaches to rational diagnosis and treatment are discussed.
У большого числа людей, перенесших COVID-19, развились симптомы психических расстройств. Среди аффективной патологии преобладают тревожные и депрессивные расстройства. Накапливаются данные, что вирус SARS-CoV-2 может индуцировать возникновение мании или гипомании у людей с отсутствием психопатологического анамнеза. Обнаружены некоторые клинико-анамнестические и параклинические закономерности впервые возникших постковидных маний и гипоманий. В случаях выраженной маниакальной симптоматики можно достаточно быстро предположить наличие биполярного аффективного расстройства. Преобладание в длиннике болезни депрессивных и тревожных синдромов и наличие ярких вегетативных симптомов могут маскировать короткие и синдромально незавершенные эпизоды гипомании, что затрудняет диагностику состояния как биполярного расстройства. В статье представлен клинический случай развития биполярного аффективного расстройства у пациента, перенесшего COVID-19 с бессимптомным течением. Обсуждены подходы к рациональной диагностике и терапии.