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Vol LV, No 4 (2023)

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Editorial

Psychopathological analysis of the phenomenon of abstruseness (case of Sasha Shch.)

Mendelevich V.D., Nesterina M.K., Konovalova V.N., Khvostantseva Y.R.

Abstract

This article analyses the phenomenon of “abstruseness” from a psychological and psychiatric perspective. It presents differential diagnostic criteria and describes the features of the manifestation of abstruseness in the examined person, using the example of a clinical case of ten-year-old Sasha Shch. The conclusion is drawn that abstruseness can present itself both as a personal quality and as a psychopathological symptom attributed to the schizophrenic spectrum of mental disorders.

Neurology Bulletin. 2023;LV(4):5-17
pages 5-17 views

Opioid crisis in the USA and Canada: how and why did this happen?

Sivolap Y.P.

Abstract

In the last few decades, there has been an epidemic increase in opioid use disorder and fatal opioid overdose in the United States and Canada, which allows us to state the presence of an opioid crisis. The opioid epidemic is believed to have begun due to a significantly low threshold for prescribing narcotic analgesics to treat chronic pain. This subsequent tightening of medical opioid dispensation led to the resurgence of the unlawful drug market, which included heroin and fentanyl. The review article provides data from a special commission established with the supporting of Stanford University and The Lancet Journal to understand and overcome the opioid crisis in North America, as well as analyzes other literary sources.

Neurology Bulletin. 2023;LV(4):18-24
pages 18-24 views

Original study arcticles

Risk factors for early-onset and late-onset fatigue after a stroke

Savina M.A., Ponevezhskaya E.V., Petrova E.A., Koltsova E.A.

Abstract

BACKGROUND. Post-stroke fatigue is a predictor of adverse outcomes such as high mortality, worse functional outcome and daily living dependence. It is a heterogeneous syndrome that changes over time, as demonstrated by studies.

AIM. The aim of the study was to assess dynamic changes of risk factors related to post-stroke fatigue during a year after first-ever stroke.

MATERIALS AND METHODS. This study formed a section of a prospective observational study involving of a cohort of 348 patients experiencing their first-ever stroke (53.2% male, 46.8% of female, with a mean age of 66±12 years). During the acute stroke period, 75 patients completed the Fatigue Severity Scale (FSS). Additionally, 19 patients completed the FSS at both 3 and 6 months after their stroke, while 33 patients did so at 12 months post-stroke. The neurological (NIHSS, Rankin) and psychiatric (HDRS, HARS) evaluation scores, pain scores measured with visual analogue scales, cognitive test results (MMSE, TMT-B) taken at the same time point, and locus control testing were compared with these findings. Spearman coefficient was utilized. The relationship between fatigue and depression (DSM-IV), stroke location, and patients’ demographic characteristics were tested with a χ2-test to avoid partiality.

RESULTS. Fatigue following a stroke during the acute stage showed an association with pain, depression, anxiety scores and complaints about cognitive dysfunction prior to the stroke. In contrast, late-onset fatigue (12 months post-stroke) demonstrated a link with medical locus of control and more severe neurological deficit.

CONCLUSION. Post-stroke fatigue manifests as a heterogeneous syndrome, characterized by changes in risk factors over time. Due to its complexity, accurate assessment necessitates the use of modern technologies, such as EMA and digital phenotyping.

Neurology Bulletin. 2023;LV(4):25-34
pages 25-34 views

Case reports

Dissociation, “OCD IN REVERSE” and unfulfilled schizophrenia. Case of Alsu B.

Mendelevich V.D., Katok A.A., Beybalaeva T.Z., Kapralov A.A., Abakarov R.R.

Abstract

The article describes a rare clinical case of severe histrionic personality disorder featuring manifestations of an atypical obsessive-compulsive disorder (“obsessive-compulsive disorder in reverse”), which led to an erroneous diagnosis of schizophrenia and classification of the patient as disabled. Over an eight-year period of psychiatric observation, the girl was given many different diagnoses in leading Russian and foreign clinics — from somatoform, hypochondriac and obsessive-compulsive disorder to schizophreniform disorder, bipolar affective disorder and paranoid schizophrenia with an emotional and volitional defect. The article substantiates the diagnosis of histrionic personality disorder and the incorrectness of other diagnoses. The article also provides a brief review of the literature regarding the comorbidity of dissociative and obsessive-compulsive disorders.

Neurology Bulletin. 2023;LV(4):35-49
pages 35-49 views

Brief communications

Deviant behavior in adolescents: the role of non-suicidal self-harm, depression and the desire to find new sensations

Antokhina R.I., Antokhin E.Y., Nemtseva E.K.

Abstract

BACKGROUND. Although previous studies have shown that deviant predisposition is an important risk factor for non-suicidal self-harming behavior, the reasons for this relationship are unclear.

AIM. The purpose of the study is to identify the features of deviant behavior, the level of depression and the desire to search for new sensations in adolescents with non-suicidal self-harming behavior.

MATERIALS AND METHODS. At the first stage, 154 adolescents with a history of self-harming behavior were examined. At the second stage, using the Colombian Scale of Severity of suicidal Intentions, 149 adolescents with only non-suicidal self-harming behavior were selected from the entire sample (31.50% of them boys and 68.50% of girls, the average age was 16.35 years; SD=1.15). The study excluded 5 adolescents who had self-harmed for suicidal purposes. Columbia Scale of severity of suicidal intentions, Razuvaeva Suicide Risk Questionnaire, Bass–Perry Aggression Level Questionnaire, Diagnostic questionnaire to identify the propensity to various forms of deviant behavior for students of general education institutions, A. Beck’s depression questionnaire, Diagnosis of the needs of new sensations by M. Zuckerman, methods of descriptive statistics, r-Spearman correlation analysis.

RESULTS. Persons prone to aggressive behavior in general are more likely to show inconsistency, demonstrativeness, poorly developed time perspective and uniqueness. Teenagers who have a poor idea of the future (a weak time perspective) are characterized by a high level of general aggressiveness, hostility, physical aggression, as well as a desire to search for sensations. Adolescents with depressive syndrome with feelings of insolvency, helplessness, are prone to deviant behavior in general, and to the search for new sensations.

CONCLUSION. The correlation analysis revealed statistically significant correlations of aggression, autoaggression, deviant behavior, desire for sensation seeking and depression in adolescents. The results of our study provide the basis for an intervention aimed at preventing and reducing adolescent NSSP and deviant behavior in general.

Neurology Bulletin. 2023;LV(4):50-55
pages 50-55 views

Discussions

On the natural incompleteness of terms, euphemisms and psychiatric nomenclature

Davtian E.N.

Abstract

The article examines the classification of terms denoting psychopathological phenomena in diagnostic criteria of the operational ICD from the perspectives of epistemology and general terminology. The conclusion is that the terms featured in the diagnostic criteria are not scientific terminology, but rather nomenclature lists. Using the example of substituting traditional psychiatric terminology with euphemisms, this study demonstrates the manipulative impact of classifications on the consciousness of both professionals and society as a whole, resulting in the “psychologization” of psychiatry. The psychiatric symptom was found to be a diminished semiotic system, reduced to the simplistic idea of “object — label”. The diagnostic work of the physician has lost its meaning.

Neurology Bulletin. 2023;LV(4):56-65
pages 56-65 views

Is anti-NMDA receptor encephalitis real? I. Diagnostic challenges

Snedkov E.V., Volchek I.A., Lemeshev I.V.

Abstract

After conducting a thorough analysis of clinical, neurophysiological, neuroimmunological, neurobiological, and neuropathological research findings, the authors of the review question on the validity of the anti-NMDA receptor encephalitis concept. The review highlights the significance of studying sanogenetic mechanisms in medicine and warns against hasty interpretations of neurobiological data without clinical knowledge.

Neurology Bulletin. 2023;LV(4):66-78
pages 66-78 views

Anti-NMDA receptor encephalitis as a reversible cause of acute psychoses: Diagnostic possibilities. (Comment on the article by E.V. Snedkov "Is anti-NMDA receptor encephalitis real? I. Diagnostic challenges")

Vasenina E.E., Levin O.S.

Abstract

Encephalitis with antibodies to NMDA receptors is a form of autoimmune encephalitis that most often debuts as an acute psychosis. Considering its curability and reversibility, encephalitis with antibodies to NMDA receptors must be included into differential diagnostic list for all the patients suffering first psychotic episode. However, to diagnose it, it is necessary to follow a step-by-step algorithm considering both clinical and instrumental and laboratory data. Confirming anti-NMDA-receptor encephalitis based solely on increased blood antibodies level often leads to false-positive diagnostics and errors in treatment of such patients. In this article, we discuss diagnostic features of encephalitis with antibodies to NMDA receptors, as well as other forms of autoimmune encephalitis that can initially manifest as acute psychoses.

Neurology Bulletin. 2023;LV(4):79-88
pages 79-88 views

Are the new diagnoses needed in psychiatry, or is it enough for us to remember valentin magnan’s bouffée délirante? (To the article by E.V. Snedkov and co-authors ‘Is anti-NMDA receptor encephalitis real?’)

Sivolap Y.P., Portnova A.A.

Abstract

New clinical observations and new scientific data lead to the identification of new diseases. Anti-NMDA receptor encephalitis, which mainly develops in young women due to ovarian teratoma and other suspected etiological factors, manifested by numerous neurological and psychiatric symptoms that give an acute condition resembling primary mental disorders, and accompanied by the appearance of antibodies to NMDA receptors, is one example of this kind. Some experts are questioning whether anti-NMDA receptor encephalitis should be considered a separate neuropsychiatric disorder. This article analyses a recent publication by one of the groups opposing the new diagnosis.

Neurology Bulletin. 2023;LV(4):89-95
pages 89-95 views


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