Neurology Bulletin

The paper analyzes specific psychopathological symptoms of addictive pathology, particularly in heroin addiction. Based on neurobiological, epidemiological, and clinical evidence, the authors argue for the existence of a complex model that explains the phenomenology of addiction. Despite the suggested close relationship between addiction and other psychiatric conditions, psychiatric classifications have not yet been modified to clarify the comorbidity of addictive behaviors. Current psychiatric nosography is limited primarily to behavioral descriptions of addiction and does not consider other aspects of psychiatric expression, such as affective or cognitive attitudes. In the absence of core behavioral and psychopathological criteria, many psychopathological symptoms are classified as other categories, such as additional or associated disorders (forms of comorbidity). The high incidence of psychopathological symptoms in heroin addicts should not be underestimated.

BACKGROUND: Aspects related to the clinical differentiation of gender identity disorders in patients with schizophrenia remain insufficiently studied.

AIM: To examine the clinical and psychopathological characteristics of gender identity disorders in schizophrenia spectrum disorders in terms of their typology, dynamics, and treatment.

MATERIALS AND METHODS: The study included 35 patients aged 18–65 years diagnosed with schizophrenia or schizotypal disorder according to the ICD-10, who reported dissatisfaction with their biological gender. Clinical-psychopathological, clinical-catamnestic, and statistical research methods were used.

RESULTS: A typological differentiation of gender identity disorders was conducted, determined by the structure of mental disorders and the patterns of the endogenous process course. The studied conditions were classified into two types: in Type 1, gender identity disorders manifested within the framework of affective-delusional psychoses in episodic schizophrenia (n=13), while in Type 2, they were observed in schizotypal disorder (n=22). In Type 1, the manifestation of gender identity disorders predominantly (69.2% of cases) occurred between the ages of 21 and 24 years. As schizophrenia progressed, 38.5% of cases showed a complication of delusional themes, with the emergence of characteristic signs of Kandinsky–Clérambault syndrome. At the peak of depressive-delusional psychosis, patients "suddenly realized" that they "belonged to the opposite gender" and began to "recall" and exaggerate past events that allegedly confirmed their belief. The further dynamics of gender identity disorder unfolded in phases. As the affective-delusional psychosis resolved, ideas of gender transition faded. Over time, patients developed two stable symptom complexes — hypochondriacal or dissociative. In Type 2, gender identity disorders primarily occurred within the framework of schizotypal disorder. Their development was observed against the background of monopolar depressive disorders with features of "metaphysical intoxication." Further progression of Type 2 gender identity disorders was not distinctly linked to the dynamics of other psychopathological disorders, with gender transition ideas becoming overvalued or paranoid in nature.

CONCLUSION: The study identified clinical-dynamic types of gender identity disorders based on the structure of mental disorders and the patterns of the endogenous process course.

BACKGROUND: The degree to which patients acknowledge their condition in cases of synthetic cathinone dependence is a key factor influencing the success of therapeutic and preventive interventions. However, anosognosia, or the inability of individuals with substance addiction to fully recognize their condition, often hinders complete acknowledgment of the disease. This phenomenon represents a multidimensional construct which includes cognitive, emotional, and motivational-behavioral components. Denial of illness is one of the most critical aspects of anosognosia, alongside lack of awareness, failure to recognize symptoms, and emotional rejection of the disease.

AIM: To investigate the correlation between socio-demographic, clinical, and psychological parameters and the assessment results on the "Denial of Illness" subscale in patients with synthetic cathinone dependence, with the aim of developing more effective rehabilitation programs.

MATERIALS AND METHODS: The study included 70 male patients diagnosed with synthetic cathinone dependence, with a mean age of 30.44±6.32 years (ranging from 20 to 40 years). The following assessment methods were used: clinical and psychological methods (utilizing a specially developed structured registration form); experimental psychological methods, including Anosognosia in Addiction Questionnaire, Addiction Severity Index, Rehabilitation Potential Assessment Tool, Personality Differential Scale (Factor O), Freiburg Personality Inventory, and Family Environment Scale. Using correlation analysis, key socio-demographic, clinical, and psychological characteristics associated with denial of illness were identified.

RESULTS: The study identified key socio-demographic, clinical, and psychological correlates that contribute to increased denial of illness and incllude good family financial status, lack of relationships with parents, high addiction severity index and mental health issues, presence of hepatitis C, a history of a single overdose, low rehabilitation potential, high self-esteem, pronounced personality masculinity, and a subjectively perceived high level of control within the family system.

CONCLUSION: This study may be useful for developing more effective treatment strategies for synthetic cathinone dependence, taking into account various socio-demographic, clinical, and psychological characteristics of patients.

The article presents a clinical case of a 43-year-old patient, Jasmine, who sought psychiatric help due to "affects that interfere with life: dissociations, regressions, anhedonia, flashbacks, social phobia, asthenia, anxiety, and nightmares." The patient reported that she had consciously changed her place of residence and moved to a city "known for good psychiatrists" to receive qualified help. Over several years of "mental suffering," the patient thoroughly studied psychiatric literature, mastered scientific terminology, gained a deep understanding of the etiopathogenesis of mental disorders, and acquired knowledge of various psychotherapy and psychopharmacotherapy methods. The patient positioned herself as an expert in psychiatry. She independently identified dissociative symptoms (depersonalization, derealization, regression), and diagnosed herself with a dissociative disorder. It is concluded that modern psychiatry faces a new challenge in the objective diagnosis of mental and behavioral disorders — in particular, the widespread prevalence of self-diagnosis and the influence of patient expertise on this process. The issue of therapist trust in patient complaints is shifting from differentiating between genuine symptoms and malingering to assessing how "psychiatric literacy" impacts diagnosis.

This brief report presents a narrative literature review describing potential pathogenetic mechanisms underlying the transformation of drug-induced psychoses into chronic psychotic disorders of the schizophrenic spectrum. The central role of hyperdopaminergia in the development of productive psychotic symptoms is discussed, along with the possibility of dopamine D2 receptor sensitization resulting from prolonged use of stimulant drugs. Attention is drawn to the previously described phenomenon of reverse tolerance, the study of which at genetic, molecular, neurotransmitter, and clinical levels may offer a promising approach for clinical assessment of prognosis and prevention of schizophrenia in individuals with a history of substance use.

This review explores contemporary perspectives on the role of shame and guilt in the development of sexual dysfunctions and disharmonies in men and women. Particular attention is given to the relationship between excessive sexual shame and guilt and disturbances of psychosexual development, highlighting the factors contributing to their emergence. The review provides a detailed discussion of the differences between sexual shame and guilt, their associated behavioral patterns, and their impact on sexual function. Based on these distinctions, differentiated therapeutic approaches to sexual shame and guilt are presented, as well as specific psychotherapeutic techniques. The review is grounded in the analysis of original Russian and English-language articles as well as extensive clinical experience of the authors. References are primarily made to statistically reliable, randomized, and placebo-controlled studies conducted over the past 20 years, with some consideration of smaller-scale and unblinded studies. The analysis demonstrated a significant lack of knowledge on this topic. It is concluded that further development of specific psychotherapeutic programs is necessary to address sexual shame and guilt in patients with sexual dysfunction, marital and sexual disharmonies, and other relational issues. Additionally, there is a need for preventive programs to address excessive sexual shame and guilt during childhood and adolescence, emphasizing parental education on their role in sexual upbringing.

The prevalence of smoking among individuals with schizophrenia is higher than in those with other mental disorders and several times greater than in the general population. Moreover, the severity of tobacco dependence in patients with schizophrenia significantly exceeds that in individuals without serious psychiatric illnesses. Schizophrenia is associated with an increased susceptibility to cardiovascular and metabolic diseases, as well as a high rate of premature mortality due to both medical causes and suicide. Smoking significantly magnifies the issue, contributing to both poor physical health and increased mortality rates. The decrease in tobacco use observed in many regions of the world over recent decades has only minimally affected individuals with schizophrenia. Standard smoking reduction strategies and tobacco dependence treatments have proven ineffective or insufficiently effective for individuals with schizophrenia, which highlights the need for the development of new preventive measures and therapeutic interventions.

In recent years, there has been a significant surge of interest in psychedelic research. These studies encompass both neuroscience and their potential clinical applications. This phenomenon, often referred to as the "Psychedelic Renaissance", includes studies on compounds such as psilocybin, MDMA, DMT, and LSD used for the treatment of depression, post-traumatic stress disorder, anxiety, and obsessive-compulsive disorders. These substances offer a novel treatment paradigm due to their rapid therapeutic effect and their ability to induce long-term mental state changes, particularly when supported by appropriate psychotherapeutic interventions. At the same time, many studies that praise psychedelics remain methodologically weak, limiting integration of these compounds into medical practice.

This article provides a discussion of current perspectives on psychedelics and a critical review of existing scientific evidence. It explores the historical context of psychedelic use, including early research and the psychedelic therapy methodology with ketamine developed in Russia by Professor E.M. Krupitsky. Key challenges are discussed in detail, including the lack of adequate placebo controls and standardized dosing, small sample sizes, and the significant influence of contextual factors that may confound study outcomes. Based on this analysis, the author encourages Russian psychiatrists to critically assess the available data and develop a balanced approach to the use of psychedelics in therapy, considering the quality of the evidence base and the specifics of the Russian regulatory framework.