Neurology Bulletin

This article presents a diagnostically ambiguous clinical case of a patient, Yakov, who had been classified as disabled since childhood due to a diagnosis of childhood-onset schizophrenia with an oligophrenic-like defect. Since the age of 3 years, he has been repeatedly hospitalized in psychiatric facilities and received antipsychotic therapy. However, during a specialized psychiatric assessment at the age of 23 years, the diagnosis of schizophrenia was not confirmed, as the observed psychopathological symptoms did not align with the diagnostic criteria. The initial diagnosis of childhood schizophrenia had been based on a misinterpretation of behavioral disturbances and symptoms of emotional-volitional deficit: from early childhood, the patient exhibited low sociability, social withdrawal, lack of initiative, emotional flatness, and a tendency toward unusual behaviors, along with developmental delays in cognition and speech. Later, his intellectual and speech delays eventually resolved, but behavioral peculiarities, communication difficulties, infantilism, and a tendency to fantasize and live in an imagined reality persisted. No clear signs of positive psychotic symptoms were observed. At the time of assessment at the age of 23 years, communicative difficulties, autistic traits, and speech disorders characteristic of autism spectrum disorder remained predominant, which led to a revised diagnosis of autism spectrum disorder instead of schizophrenia. Attention is drawn to the fact that the symptoms observed in the patient—previously regarded as delusional, hallucinatory, or indicative of disorganized and incoherent thinking—could be interpreted as quasipsychotic, associated with impaired cognitive information processing rather than true psychosis. The published data were analyzed, and the attention of colleagues was drawn to the issue of overdiagnosis of schizophrenia and disregarding the possibility of similar symptoms related to autism spectrum disorders.

BACKGROUND: Despite the increasing prevalence of non-suicidal self-injury among adolescents—particularly girls—its clinical, social, and predictive factors, as well as psychological features, remain insufficiently studied.

AIM: The work aimed to analyze clinical, social, behavioral, and psychological factors associated with non-suicidal self-injury.

METHODS: A total of 186 adolescent girls hospitalized in a specialized psychiatric facility with confirmed episodes of non-suicidal self-injury were assessed as part of a two-year observational study (September 1, 2022–September 1, 2024). Sociodemographic characteristics (age, place of residence, parenting style), clinical variables (diagnoses according to the 10th revision of the International Classification of Diseases, psychiatric history), and behavioral indicators (location and frequency of episodes) were evaluated. Psychological parameters were assessed using the Maria Kovacs Depression Inventory, Raven Progressive Matrices, the Suicide Risk Assessment Scale, and the Individual Typological Questionnaire.

RESULTS: The first episode of non-suicidal self-injury most frequently occurred at ages 13–14 (38.2%). A high level of depression (median score: 64) was associated with interpersonal difficulties and low self-esteem. Behavioral aspects included predominant localization of injuries on the forearms (81.18%) and a tendency to commit episodes at home (83.9%). Suicide risk was identified in 25.8% of participants, and a significant proportion of adolescents demonstrated emotional dysregulation.

CONCLUSION: Non-suicidal self-injury in adolescent girls is associated with a wide range of social, behavioral, and psychological factors. A differentiated approach to assessment and prevention that considers family and emotional aspects is essential for improving treatment and prevention outcomes.

BACKGROUND: Alcohol withdrawal syndrome (AWS) is a condition that develops as a result of an abrupt reduction or cessation of ethanol intake. The severity of AWS depends on numerous factors, one of which is the extent of ethanol consumption and alcohol tolerance. Alcohol tolerance, especially when it is increased, is one of the key diagnostic criteria of alcohol dependence.

AIM: The work aimed to analyze the relationship between severity of AWS and maximum daily alcohol tolerance.

METHODS: A continuous screening of patients with alcohol dependence syndrome who were undergoing inpatient treatment at a specialized addiction facility was conducted on days 7–14 of their hospital stay (post-withdrawal period). Inclusion, non-inclusion, and exclusion criteria were established for the selection of participants. All patients were diagnosed with middle stage alcohol dependence syndrome. At the time of inclusion in the study, none of the participants had AWS. To assess the severity of AWS, the CIWA-Ar scale was used.

RESULTS: The study included 399 participants diagnosed with F10.2 (alcohol dependence), of whom 83 (21%) were females and 316 (79%) were males. The mean age of the patients was 41.52 ± 8.42 years. During hospital stay, 108 (27%) patients had an AWS-associated convulsive seizure, while 291 (73%) had no convulsive seizures. Statistical analysis revealed a significant relationship between daily alcohol tolerance and the severity of individual alcohol withdrawal symptoms. It was also found that patients with convulsive seizures after alcohol withdrawal had higher daily alcohol tolerance. A threshold value of daily alcohol tolerance of 3.59 g/kg of body weight predictive of the development of AWS-associated convulsive seizures was calculated.

CONCLUSION: The study found that the severity of AWS was positively correlated with the maximum daily alcohol tolerance. When daily alcohol tolerance is more than 3.5 g/kg of body weight, patients should be considered at risk for developing AWS-associated convulsive seizures.

This article analyses the diagnostic criteria for borderline personality disorder as defined in the 5th edition of Diagnostic and Statistical Manual of Mental Disorders and the 11th revision of International Classification of Diseases. The combination of categorical and dimensional diagnostic models improves its validity, which meets the needs of clinical practice. At the same time, the heterogeneity and persistent conceptual ambiguity of borderline personality disorder are emphasized. The phenomenology of comorbidity between borderline and addictive disorders is considered as overlapping symptoms that exacerbate overall clinical presentation. Challenges in diagnosing borderline personality disorder are noted when constitutional symptoms are masked by the consequences of psychoactive substance use. The article offers a brief overview of current approaches to the treatment of borderline personality disorder, highlighting the potential of ketamine therapy. The results of our own retrospective open study of 18 patients with dual (borderline personality disorder + alcohol/cocaine use disorder) and triple (borderline personality disorder + alcohol/cocaine use disorder + depression) diagnosis who received ketamine treatment are discussed. Patients received three ketamine infusions over one week (0.5–0.75 mg/kg over 40 minutes), followed by a booster session one month later. Preliminary results of treatment are discussed, which are quite comparable with the effectiveness of specialized psychotherapy. These findings suggest that ketamine therapy may offer a novel perspective on the traditionally pessimistic therapeutic outlook for borderline personality disorder.

Currently, the number of middle-aged and elderly patients with multiple sclerosis (MS) is increasing. The incidence of late-onset multiple sclerosis (LOMS), defined as disease onset after the age of 50, is also growing. Given that MS has always been considered a disease of young adults, its course and transformation in the context of aging, as well as its associations with aging processes, necessitate investigation. Diagnostic and treatment approaches require re-evaluation to find the most effective and safe options for elderly patients with MS. This article analyzes available data on the course, diagnosis, and treatment of MS in patients aged over 50. It has been shown that MS activity decreases with age, which can possibly be attributed to age-related changes in the immune system. At the same time, there is an increase in comorbidities associated with age and MS, as well as with a transition of the disease from an inflammatory to a neurodegenerative phenotype. The efficacy of pharmacologic interventions tend to decrease, or they become unsafe due to the risk of serious side effects. However, there is a growing body of evidence worldwide on the safety and efficacy of long-term use of disease-modifying drugs in elderly patients with MS.

Cognitive and metacognitive processes, along with dissociative symptoms, play a significant role in the development of suicidal behavior in the context of traumatic experiences and posttraumatic stress disorder. This article reviews theoretical models that conceptualize the transition from suicidal ideation to actions, emphasizing the mechanisms and mediating variables underlying this progression. The discussed models include the interpersonal theory of suicide, the three-step theory, the integrated motivational–volitional model, the perfectionism-based model of suicide risk, the fluid vulnerability theory, the integrated pain-brain evolutionary model, the dual-system model of suicidality, the stage-based theory of antivital behavior, and a dynamic model of antivital and suicidal behavior taking into account the roles of negative social emotions and resilience factors, strength model of self-regulation, the mindsponge-based model of suicide risk simulation, the network analysis model, the cry of pain model, the narrative model of suicidal crisis, the dual-process conceptualization of suicidality, the theory of repetitive negative thinking, suicidal rumination, and others. The cognitive model of trauma memory processing and encoding, along with the model of trauma-induced dissociation and the emergence of hallucinations, helps explain the increasing intrusiveness and uncontrollability of trauma-related experiences. These phenomena are marked by alienation from one’s own physical and psychological suffering and emotional detachment from others. Such mechanisms provide insight into the transition from suicidal ideation to actions as a nonlinear and dynamic process in the development of suicidal behavior.