Neurology Bulletin

The article discusses the problems of interaction between psychotherapy and such a direction of philosophy as phenomenology. The basic principles of the phenomenological method are considered in the context of their application in psychotherapy. The author sees the main problems in the isolation of related fields of humanistic knowledge from each other, in the continuing commitment of Russian psychotherapy to an exclusively natural-scientific positivist concept of health and illness, and in the dominance of biologically oriented approaches. This is reflected both in the interpretation of the phenomenological method in domestic psychiatry, and in the use of phenomenology in various psychotherapeutic fields. The solution to this problem may be a deeper acquaintance of specialists with the philosophical foundations and methodological principles of the phenomenological method, interdisciplinary dialogue, expansion of the humanitarian component of professional training, which corresponds to the objectives of the further development of domestic psychotherapy.

BACKGROUND: Treatment of depression in men with testosterone deficiency is particularly challenging because of the overlap between the symptoms of depression itself and those associated with testosterone deficiency, which requires the development of additional diagnostic and therapeutic approaches.

AIM: To enhance the effectiveness of comprehensive treatment of depression in men with testosterone deficiency.

MATERIALS AND METHODS: The study involved 140 male participants (aged 18–65 years) diagnosed with depressive episodes and recurrent depressive disorder according to the International Classification of Diseases, 10th revision. Patients were divided into the main group (testosterone levels below 12.1 nmol/l) and the control group (normal testosterone levels). The main group (n=90) was further divided into three therapeutic subgroups of 30 patients each: receiving sertraline monotherapy, testosterone monotherapy, and combined sertraline and testosterone treatment. The control group included men with depression and normal testosterone levels (n=50), who received sertraline only.

RESULTS: Depression in men in the context of testosterone deficiency has distinct clinical features, both phenomenologically and syndromally. The severity of the depressive syndrome in men with testosterone deficiency is lower (17.0 [16.0; 18.75] points on the HDRS scale) than in patients with normal testosterone levels (19.0 [18.0; 22.0] points on the HDRS scale), and the depressive episode tends to occur later in life (47.0 [42.0; 55.0] years) compared to those with normal levels of testosterone (29.5 [24.25; 40.0] years) and is less likely to be recurrent than in those with normal testosterone levels (29.5 [24.25; 40.0] years). The study of the efficacy and safety of depression therapy in the context of testosterone deficiency shows that a combined approach to the treatment of depression in men with testosterone deficiency has both advantages (considering the specifics of patients by normalizing testosterone levels and erectile function) and disadvantages (relatively higher risk of adverse events) compared to sertraline monotherapy.

CONCLUSION: The identified characteristics of the course and treatment of depression in the context of reduced testosterone levels allowed for the development of a more effective therapeutic and diagnostic algorithm.

BACKGROUND: The study of various characteristics of mentally ill persons suffering from mental disorders that influence the possibility of committing a repeated socially dangerous act. This has been one of the most urgent tasks of forensic psychiatry in recent years. The identification of such factors will significantly improve the secondary prevention of crime among the mentally ill.

AIM: The purpose of the study — a comparative analysis of clinical and social characteristics in patients with mental retardation and organic psychological disorders (hereinafter referred to as DIS) who have repeatedly committed socially dangerous acts (hereafter referred to as DIS) and the identification of factors specific to patients with mental retardation that contribute to the commission of repeated DIS. Design: comparative study.

MATERIALS AND METHODS: The comparative study included 65 patients diagnosed with mild and moderate mental retardation (who made up the main group A) and 45 patients with organic mental disorders (who made up the comparative group B) had repeatedly committed socially dangerous acts (OOD), who had been recognised as insane and who had undergone two or more periods of court-ordered compulsory medical treatment (hereafter referred to as MMMT) of various types. The study was carried out both in the form of a personal questionnaire and through a retrospective study of the patients' medical records. Correlation and comparative analysis were the main research methods used in the thesis.

RESULTS: A number of clinical and social characteristics such as: hereditary burden of exogenous diseases (r +0.58, p_i <0.05); single lifestyle (r +0.33, p_i <0.05); urban place of residence (r +0.21, p_i <0.05) increase the risk of repeated OOD, and are specific predictors for patients with mental retardation. A number of characteristics had a negative impact on the possibility of repeated OOD and negative correlations: the absence of any hereditary burden (r –0.44, p_i <0.05), the presence of severe endogenous heredity (r –0.35, p_i <0.05), living in rural areas (r –0.21, p_i <0.05), concomitant alcohol dependence (r –0.29, p_i <0.05).

CONCLUSION: The data obtained will form the basis for the development of practical recommendations for secondary forensic psychiatric prevention, specifically for this nosological group, as well as methods for predicting and preventing recurrent DIS.

Umbilical cord blood has evolved from being considered a mere cellular/tissue waste product after childbirth to a valuable biological material with a wide regenerative potential. Today, hematopoietic cord blood stem cells are used in the same way as bone marrow and mobilised peripheral blood as part of the standard medical treatment for haemoblastoses and hereditary blood diseases. There is an increasing amount of experimental data showing possibility of umbilical cord blood cell fractions using for treatment of non-hematological diseases and, in particular, diseases of the central nervous system. One of the key challenges in cell therapy for central nervous system diseases is the choice of cellular material for neurotransplantation. This is particularly relevant for ischemic and traumatic injuries, as well as neurodegenerative diseases. Stem or mature somatic cells prepared for neurotransplantation should have predictable and reproducible characteristics thataccording therapeutic purposes, exactly: trophic and/or neuroprotective action to increase neurons viability in damaged area; axon growth stimulation and myelination; cell matrix restoration or predictable differentiation direction to replace amount of lost brain or spinal cord cells. The fact that umbilical cord blood contains not only hematopoietic, but also various non-hematopoietic stem cells with a wide regenerative potential has become the basis for active use of these cells for neurotransplantation. The proposed review provides historical information about umbilical cord blood introduction into practical medicine, its cellular composition and clinical applications of stem cells various types for children central nervous system diseases treatment, such as ischemic encephalopathy, stroke, cerebral hemorrhage, cerebral palsy, autism, and in adults — for stroke treatment, spinal cord injury and neurodegenerative diseases.

The paper examines the impact of combat stress on human personality, with a particular focus on identity disintegration. This is considered to be the most significant impact of combat stress, accompanied by the loss of values that generally make up a framework for assessing and interpreting current events. The conventional psychological treatments for personality reconstruction, which appeal to cognitive, emotional, motivational and volitional processes that make up the structure of the psyche, are found to be ineffective in cases where stress exceeds the average psychological resources of a person. Coping with extreme impacts assumes going beyond the familiar life experience accompanied by the reference to the spiritual level resources, among which religiosity is traditional for the mentality. This paper reviews the relationship between religion and psychotherapy, with a focus on the psychotherapeutic factors of religion aimed at combatants’ identity reconstruction.

Despite the capabilities and availability of modern diagnostic methods, due to the low alertness of doctors, a number of cerebrovascular disorders are diagnosed late, which can lead to serious consequences, illness leading to disability and death in patients of working age.

A clinical case of a young patient with recurrent cerebral venous thrombosis and reversible cerebral vasoconstriction syndrome is presented.