Mental Health. 2026; Volume 21. Issue 5

Introduction. Schizophrenia is accompanied by impaired social adaptation and cognitive deficits, often leading to the «revolving door» phenomenon — repeated hospitalizations (three or more per year). Executive function impairments reduce treatment adherence and the ability to recognize early signs of relapse. Cognitive remediation is considered a way to improve neurocognitive indicators and functional outcomes.

Aim: to assess the effect of cognitive remediation on the risk of rehospitalization in patients with schizophrenia who meet the criteria for the «revolving door» phenomenon.

Methods. A prospective study included 272 patients with schizophrenia meeting the criteria for the «revolving door» phenomenon. The intervention group (n=137) completed a course of at least 20 cognitive remediation sessions using the Wisconsin Card Sorting Test to train cognitive flexibility. The control group (n=135) received standard therapy. Effectiveness was assessed over 12 months using Cox regression and cost-offset analysis (bed-day cost set at 20 USD).

Results. During the year, 47.4% of patients in the intervention group and 63.7% in the control group were rehospitalized. The absolute risk reduction (ARR) was 16.3%, and the relative risk reduction (RRR) was 25.5%. The hazard ratio (HR) was 0.60 (p = 0.002), indicating a 40% reduction in the risk of hospitalization. Savings per patient, depending on the duration of hospitalization (14–60 days), ranged from 45.5 to 195.1 USD. The break-even threshold for the program with a 30-day hospitalization was determined at 97.6 USD per patient.

Discussion. The effect of remediation is realized through the improvement of executive functions, which increases treatment adherence and planning skills. The reduction in hospitalization frequency directly translates into decreased budgetary expenditures. The intervention is most effective in high-risk groups, where even a moderate reduction in relative risk yields significant economic and clinical results. Study limitations include accounting only for the first rehospitalization and the lack of individual data on the actual length of stay.

Conclusion. Cognitive remediation significantly reduces the risk of rehospitalization in patients with the «revolving door» phenomenon. The method possesses significant economic potential, allowing for the optimization of mental health service resources by reducing the need for inpatient treatment.

Keywords: schizophrenia, revolving door phenomenon, cognitive remediation, executive functions, rehospitalization, clinical and economic analysis

Introduction. Self-stigma is a serious barrier to high-quality remission and social integration of individuals with mental disorders. Internalized stigma not only reduces self-esteem and treatment adherence but also acts as an independent factor in reducing quality of life, often regardless of the severity of clinical symptoms. Understanding the social and psychological determinants that contribute to the internalization of negative stereotypes is a pressing task for the development of effective psychosocial rehabilitation programs.

Objective: to identify the structure of subjective and objective life parameters influencing self-stigmatization in psychiatric care recipients; To measure the influence of individual parameters on patients’ self-stigma.

Methods. The study is based on the results of a sociological survey. The sample consisted of patients receiving treatment in psychiatric institutions (inpatient and outpatient). The primary instruments used were the WHO Quality of Life (WHOQOL) questionnaire (BREF), adapted and validated for Russia by the Bekhterev Institute, as well as a proprietary methodology developed by researchers at the Center for Sociological Research at the Russian Presidential Academy of National Economy and Public Administration (RANEPA) (St. Petersburg). Statistical analysis of the data was conducted using correlation, regression, and discriminant analysis to determine the significance of the influence of various factors on the stigmatization process.

Results. The study confirmed the multifactorial nature of self-stigma. Low levels of social support and low self-esteem were found to be key predictors of high internalized stigma. Regression analysis revealed that satisfaction with oneself and therapy are significant factors reducing self-stigma.

Conclusion. The analysis demonstrates that self-stigma is a dynamic process closely linked to the social environment and the subjective perception of illness. Medication alone is insufficient to reduce self-stigma; comprehensive measures are necessary, including cognitive processing of stigmatizing experiences and the development of social advocacy skills. Rehabilitation programs should focus on strengthening the patient’s personal identity and increasing their satisfaction with key aspects of life, such as external representation and social activity.

Keywords: self-stigma, mental disorders, social factors, quality of life, social support, identity, rehabilitation

Introduction. The high prevalence of depressive reactions among medical students necessitates the search for internal vulnerability factors and the development of effective psychoprophylaxis programs.

Objective. To identify key targets for psychoprophylaxis based on an empirical analysis of self-concept, perfectionism, and attributional style in students with varying severity of depressive symptoms, and to develop a psychological support program.

Methods. The study involved 66 1st–3rd year students of Kursk State Medical University. The Beck Depression Inventory (BDI-II), the «Who Am I?» test (M. Kuhn, T. McPartland, modified by V.V. Lazurna), the Attributional Style Questionnaire (ASQ) by M. Seligman, and the Multidimensional Perfectionism Scale (MPS) by P. Hewitt and G. Flett were used. Statistical analysis included the Mann–Whitney U test and Spearman’s rank correlation.

Results. Based on BDI-II scores, the sample was divided into a conditionally normative group (n=22) and a risk group (n=44). The risk group showed significantly lower self-esteem, a pronounced discrepancy between the «Real Self» and the «Ideal Self», a predominance of socially prescribed perfectionism, and a pessimistic attributional style (p<0.01). Strong positive correlations were found between the level of depression and all forms of perfectionism (r=0.92–0.98), as well as a negative correlation with self-esteem (r=–0.94).

Conclusion. The key targets for psychoprophylaxis are harmonizing the self-image, correcting the pessimistic attributional style, reducing socially prescribed perfectionism, and improving self-esteem. The proposed psychological support program can be integrated into the work of the university psychological service.

Keywords: depressive reactions, self-concept, perfectionism, attributional style, self-perception, real self, ideal self

Background. Mental disorders are multifactorial conditions shaped by biological, psychological, and social influences. Despite growing evidence on the impact of social conditions, their systematic integration into clinical assessment remains insufficiently developed.

Aim: to summarize current concepts of the biopsychosocial model of mental disorders and to analyze the role of social determinants in their development, course, and outcomes.

Methods. A narrative literature review was conducted. Sources were identified through searches in PubMed, Google Scholar, and eLibrary using keywords related to the biopsychosocial model, social determinants of mental health, and risk factors for mental disorders.

Results. The biopsychosocial model conceptualizes mental disorders as the result of interactions among biological vulnerability, psychological characteristics, and social conditions. Evidence indicates that family environment, social support, working conditions, urban environment, gender-related factors, and large-scale stressors may function as modifiable risk or protective factors. Consideration of social determinants improves clinical assessment and supports more effective treatment and rehabilitation planning.

Conclusion. The biopsychosocial approach represents a conceptual framework for understanding mental disorders. Incorporating social determinants into clinical evaluation is an important component of comprehensive psychiatric care and may enhance diagnostic and therapeutic strategies.

Keywords: Biopsychosocial model, mental disorders, social determinants of health, mental health, risk factors, social support, review

Introduction. An effective system of psychosocial rehabilitation can reduce the socio-economic problems caused by mental disorders. In order to identify the most effective solutions in the field of relevant legal instruments, it seems advisable to study the existing experience of legal regulation in the BRICS states, taking as examples the models applied in China and the UAE.

Methods. The study employs systemic, comparative legal, and formal legal analysis.

Results. The research identified the main programmatic-strategic and regulatory instruments that contribute to the creation, functioning and improvement of the psychosocial rehabilitation system in the BRICS states under consideration, ensuring an interdepartmental integrative approach to solving the tasks at hand and combining the efforts of the state and society in this field.

Conclusion. The most effective organizational and legal developments in the field of psychosocial rehabilitation applied in the BRICS states under consideration can be used in improving the relevant sphere in the Russian Federation.

Keywords: psychosocial rehabilitation, mental health, mental disorders, China, UAE, community-based rehabilitation, social adaptation, supported employment

The article presents the development and evaluation of a specialized medical and psychological support program for inpatients with schizophrenia spectrum disorders. The comparative study included 117 patients with an illness duration of 6–10 years and 4–6 previous hospitalizations: 66 patients formed the intervention group and 51 the comparison group. Clinical improvement was comparable in both groups and appeared to be primarily associated with psychopharmacotherapy. At the same time, the specialized program produced more pronounced positive changes in illness perceptions, symptom coping skills, adherence to treatment and psychosocial rehabilitation, and reduction of self-stigma. The effect on social avoidance and distress was less marked, supporting the need for continued rehabilitation after discharge.

Keywords: schizophrenia spectrum disorders, psychosocial rehabilitation, inpatient care, adherence, self-stigma, psychoeducation

The article reviews foreign studies on psychosocial rehabilitation in patients with depressive disorder after stroke. Post-stroke depression is shown to significantly complicate recovery, worsen functional outcomes, and reduce quality of life, which makes early diagnosis and comprehensive support essential. The paper considers the main components of rehabilitation, including neurological and psychiatric assessment, psychodiagnostics, antidepressant therapy, cognitive behavioral therapy, social support, and innovative approaches such as virtual reality and electroencephalography combined with machine learning algorithms. The author concludes that effective rehabilitation of patients with post-stroke depression is possible only within a multidisciplinary framework aimed not only at reducing depressive symptoms, but also at improving psychological adaptation and social recovery.

Keywords: post-stroke depression, psychosocial rehabilitation, stroke, cognitive behavioral therapy, social support, multidisciplinary approach

The article reviews current studies on the use of music therapy in combating stress conditions. Based on a content analysis of 12 empirical publications, music therapy is shown to reduce stress, anxiety, emotional tension, and physiological stress markers, including cortisol levels and heart rate. Different intervention formats are considered, including live and prerecorded music, receptive music therapy, and combinations with progressive muscle relaxation, virtual reality, aromatherapy, and sports games. Music therapy is reported to improve emotional well-being, promote a sense of safety and comfort, and may be regarded as an effective non-pharmacological method of psychoprophylaxis and psychological correction for stress-related conditions in various groups of patients and professionals.

Keywords: music therapy, stress conditions, anxiety, emotional well-being, psychosocial support, non-pharmacological care

The article presents an analysis of the possibilities of the narrative resource method of working with biography in the context of psychosocial rehabilitation for combatants and their family members. The relevance of this work is driven by an acute shortage of professional personnel (psychologists, psychotherapists) alongside a high need for assistance. The results of a prospective randomized comparative study are presented, demonstrating its effectiveness in reducing anxiety, depression, and asthenia, as well as in triggering mechanisms of post-traumatic growth through the actualization of personal resources. The method of working with biography, unlike the known medical history-taking, transforms the diagnostic process into a therapeutic one. Two application directions are demonstrated: an algorithm for a psychotherapist or psychologist, and an adapted protocol for a non-specialist (a family member) in a home setting.

Keywords: psychosocial rehabilitation, biography work, resource method, combatants and family members, grief experience

The article examines the role of clinical psychology technologies in optimizing decision-making in psychosocial therapy for individuals with mental illness. Particular attention is paid to patient motivation as a key determinant of the effectiveness of psychosocial interventions, especially in group-based formats. Based on an analysis of Russian and international studies, the author shows that formal managerial decisions that ignore clinical-psychological mechanisms of group dynamics may reduce therapeutic effectiveness. The paper substantiates the importance of motivational influences of role models, vicarious learning, feedback, and the therapeutic environment. It also emphasizes the value of joint training for researchers, practicing clinicians, and clinical managers in heterogeneous groups to support more grounded clinical decisions and improve the quality of psychiatric care.

Keywords: clinical psychology, psychosocial therapy, patient motivation, group dynamics, clinical decision-making, psychiatric care

The article presents the results of an empirical evaluation of a social-psychological training program designed to prepare legally incompetent individuals with mental disorders living in neuropsychiatric residential institutions for restoration of legal capacity. The study included 56 participants: 30 in the intervention group and 26 in the control group. The 10-week program was shown to produce a statistically significant reduction in the need for outside assistance and an increase in motivation for independent living. Higher educational level was associated with greater independence, whereas longer institutional residence was linked to lower motivation for autonomy. The practical value of the program is supported by successful court decisions restoring limited legal capacity in some training participants.

Keywords: psychosocial rehabilitation, restoration of legal capacity, mental disorders, social-psychological training, independence, neuropsychiatric residential institution

The article examines the structure and main directions of psychosocial rehabilitation for patients with epilepsy in contemporary conditions. The study included 317 patients aged 18 to 65 years, whose clinical, social, and psychological indicators were analyzed. The key components of rehabilitation were psychological support, educational programs, social and vocational rehabilitation, family work, and cognitive rehabilitation. The most pronounced emotional needs were reduction of anxiety, the need for calmness, and external protection. Psychotherapeutic support was shown to reduce anxiety, improve adaptive capacities, and enhance emotional stability; maladaptive states were relieved in 86% of the participants. The author concludes that comprehensive rehabilitation is important for improving clinical and social outcomes and maintaining quality of life in patients with epilepsy.

Keywords: epilepsy, psychosocial rehabilitation, psychological support, cognitive rehabilitation, quality of life, anxiety

This study assesses the psychological well-being of students at a pedagogical university and explores the specifics of psychological support for students with symptoms of mental disorders. The prevalence of psychological distress symptoms in the sample is demonstrated. The results reveal the prevalence of neurotic (anxiety-depressive, phobic) states among other manifestations of student psychological distress. The main targets of psychological work with students with neurotic mental disorders are identified. The data obtained are used to develop preventive programs and recommendations for improving students’ psychological well-being.

Keywords: psychological well-being, student, psychological support, anxiety-depressive symptoms

The article examines the impact of digital literacy on adherence to a remote monitoring program in patients with schizophrenia during early rehabilitation after a first psychotic episode. This single-center prospective cohort study included 84 patients in remission who were divided into groups with high and low digital competence according to a modified eHEALS questionnaire. A higher level of digital literacy was associated with greater regularity in completing tasks in a mobile application and with improved subjective treatment adherence. Digital literacy remained an independent predictor of compliance with remote monitoring after adjustment for demographic and clinical factors. The findings emphasize the need for targeted patient preparation for the effective use of digital rehabilitation tools.

Keywords: schizophrenia, digital literacy, remote monitoring, early rehabilitation, treatment adherence, first psychotic episode