Neurology Bulletin

Armed attacks with numerous victims committed in educational institutions of various levels, mainly (but not always) with the use of firearms, have received the generic name “school shooting”, and attackers are most often called “school shooters”. The United States is the leader in the prevalence of mass murders in educational institutions, although these tragic incidents also occur in other countries, and their number shows a tendency to constantly increase. Since any murder is an abnormal phenomenon, the question of the mental health of school shooters naturally arises. Research shows that not all assailants show symptoms of mental disorders; the most common cause of armed attacks is bullying and the desire to take revenge on offenders for cruel humiliation. In cases where a mental disorder is still diagnosed, not all students, as well as their family members, agree to receive psychiatric care. The prevention of armed attacks must be carried out by the efforts of school counsellors and school psychologists with the possible involvement of psychiatrists, although the potential of psychiatric care in the prevention of school murders, according to the authors of the article, is quite limited.

BACKGROUND: The rationale for the concept of psychotic and psychotic-like experiences, delusions and auditory hallucinations, on the basis of which the Psychotic Experiences Questionnaire was developed.

AIM: The purpose of this study is to present the results of testing and validating of a questionnaire that assesses the severity of psychotic experiences. The study aims to determine the content of the experience at different phases of manifestation, including the phase of psychotic-like experiences, as well as metacognitive appraisals of the experience and its relationship to social anxiety.

MATERIAL AND METHODS: The sample of 122 respondents includes non-clinical and two clinical groups — with symptoms of the affective spectrum and with symptoms of the psychotic spectrum. To assess the convergent validity of the Questionnaire, the Russian-language Symptom Check List-90-Revised was used. Metacognitive appraisals of psychotic experience and the overall severity of social anxiety (“Social Anxiety and Social Anxiety Disorder Questionnaire”) were measured.

RESULTS: The structure of the Questionnaire obtained by cluster analysis was verified by confirmatory factor analysis, and optimal agreement between theoretical and empirical models was demonstrated (CFI=0.998; TLI=0.998; SRMR=0.102; RMSEA=0.02; RMSEA p-value=0.986). Three scales and corresponding subscales (six categories) defining the phases of unfolding of psychotic experience were identified. The high reliability and item consistency of the Questionnaire was determined using Cronbach's alpha coefficient. Convergent validity was assessed using Pearson correlation analysis of the questionnaire scales with the SCL scales — psychoticism, paranoid ideation and obsessive-compulsive symptoms; reliable and adequate statistical relationships were obtained. The role of social anxiety and metacognitive appraisals of psychotic experiences in their actualisation and maintenance is shown. The conceptualisation of thought the emergence of intrusions, “voices” as a dialogical embodiment of the internalised experience of social defeat in re-expanded inner speech is presented.

CONCLUSION: The results of approbation and validation of the questionnaire are presented, and the relationships of the psychotic experiences component with its metacognitive appraisals and social anxiety are described. The concept of psychotic experiences is considered a continuum in which disruptions in the usual controllability of mental processes vary range from mild (objectification of thinking) — to moderate (disturbance of self-perception, intrusive phenomena, including “voices”) — to severe (disturbance of the sense of agency, including command “voices”).

The article presents the clinical case of 10-year-old Karim, whose behavior and mental status changed after a traffic accident in which the boy was hit by a car (without loss of consciousness and without traumatic brain injury). In addition to various motor paroxysms (convulsions) that did not meet the criteria for epileptic symptoms, the clinical picture included wave-like psychopathological symptoms and inappropriate behavior. The clinical picture could not be clearly attributed to the manifestation of dissociative disorders or post-traumatic stress disorder. Within two months after the accident, the clinical picture worsened — the "light intervals" during which Karim was completely adequate and critical became less frequent. Neurologists rejected the organic (epileptic) basis of the paroxysmal states. Examination and treatment by psychiatrists did not lead to stabilization of the mental state. In the opinion of the authors, the clinical case belongs to a rare polysyndromic variant of the dissociative subtype of PTSD, not described in the scientific literature, in which a mixture of various psychopathological symptoms was found - dissociative motor paroxysms, Ganser's syndrome, astasia-abasia, onirism, and flashbacks.

Frontotemporal dementia is a heterogeneous pathology with various clinical, histological, and genetic variants. The behavioral variant of frontotemporal dementia (bvFTD) in some cases presents differential diagnostic difficulties when distinguishing from primary mental disorders. The article provides an observation of patient K., who was observed at the initial stage of the disease with a diagnosis of schizophrenia. The comparison of psychopathological and behavioral symptoms with the presence of a family history of amyotrophic lateral sclerosis (ALS) served as a turning point to a different interpretation of the pathology and recognition and confirmation of the “definite diagnosis” — bvFTD.

The first part of the review challenges the diagnostic concept of anti-NMDA receptor encephalitis (ANMDARE). The second part focuses on analyzing current therapeutic approaches. It is demonstrated that the use of antipsychotics or immunosuppressants poses the risk of severe complications, potentially leading to fatal outcomes, in the near or distant future. Comparing clinical and neurobiological effects associated with antibodies to the GluN1 subunit of the glutamate N-methyl-D-aspartate receptors (NMDAR1-AB) and the administration of subanesthetic doses of the non-competitive NMDA receptor antagonist Ketamine highly suggests a neuroprotective, health-promoting role of NMDAR1-AB, which should not be suppressed but rather potentiated. Benzodiazepines and electroconvulsive therapy (ECT) remain the treatment of choice for acute polymorphic hyperkinetic psychoses.

The article is a critical analysis of the diagnostic search carried out on the basis of an assessment of Sasha Shch’s mental state. From the authors’ point of view, the boy has a functional language disorder within the framework of residual encephalopathy with mental atony. The article is of a debatable nature and is of interest to specialists.