Vol LI, No 4 (2019)

Frontiers papers
Understanding the cultural context: experiences of auditory vocal hallucinations among patients from different language groups
Graber M.G., Kuzmina S. ., Irkabaeva A.B., Mason D.P., Luhrmann T.M.
Abstract

Schizophrenia affects approximately one in one hundred individuals. Treatment is rarely simple, and the exact biological mechanism is unknown. However, we are beginning to understand that schizophrenia does not manifest in isolation; rather, its manifestation and severity can be impacted by cultural context. Previous work by Luhrmann and colleagues found individuals diagnosed with schizophrenia from the United States, India, and Ghana who experience auditory vocal hallucinations — hearing voices — differently. American individuals often reported voices that gave violent commands; Indian and Ghanaian individuals reported more positive relationships with their voices. The present project extends this research and investigates whether patients diagnosed with schizophrenia in Russia demonstrate similar symptoms or thought processes about their disorder as participants from previously studied countries. This research has yet to be conducted in Russia, and provides an important perspective on the manifestation of a devastating disorder. Furthermore, understanding how Russian culture affects the symptoms of schizophrenia could inform development of culturally appropriate interventions in Russia, with potential to generalize globally. This review aims to explore the existing literature and provide a theoretical basis for the present investigation.

Neurology Bulletin. 2019;LI(4):5-9
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After psychotherapy
Trutneva D.R., Mendelevich V.D.
Abstract

The article analyzes the problem of long-term psychotherapy from the point of view of the criteria of expediency and effectiveness. Options for termination and continuation of psychotherapy by clients/patients and their consequences are considered. The question is raised about the need to develop a strategy for moving from face-to-face psychotherapy to methods of supporting self-regulation, in particular using mobile applications. Data on the demand and effectiveness of these approaches are provided. As a supportive psychotherapy, the possibility of using the Master Kit technique, designed for the independent work of a person with his/her beliefs, settings, emotional states (fears, offense), unknown qualities, self-esteem, is assessed. It is concluded that the development of a strategy of supporting digital self-regulation is promising.

Neurology Bulletin. 2019;LI(4):10-16
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Original studies
The effect of atypical antipsychotics on hormonal and biochemical parameters in patients with schizophrenia
Mednova I.A., Boiko A.S., Kornetova E.G., Ivanova S.A.
Abstract

Objective of this research is to study the effect of atypical antipsychotics on hormonal and biochemical parameters in patients with schizophrenia.

Materials and methods. A comprehensive clinical, psychopathological and laboratory examination of 96 patients with schizophrenia (F20 according to ICD-10) who were hospitalized in the Department of Endogenous Disorders of the Scientific Research Institute of Mental Health of the Tomsk Scientific Research Center and received second-generation antipsychotics, was carried out. The Positive and Negative Syndromes (PANSS) scale (in the adapted Russian version of SCI-PANSS) was filled for a psychometric assessment of the severity and dynamics of schizophrenia symptoms in all patients upon admission to hospital and at discharge after 4 weeks. The laboratory study included determination of the concentration of total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL), glucose, insulin and cortisol in blood serum with the calculation of lipoproteins with low (LDL) and very low (VLDL) density, atherogenic index (IA) ) and insulin resistance (HOMA-IR). Statistical data processing was performed using the standard application package SPSS Statistic (V. 17.) for Windows. Differences were considered statistically significant at p ≤0.05.

Results. The pronounced effect of four-week treatment with atypical antipsychotics on the metabolism of glucose [glucose (p <0.001) and HOMA-IR (p=0.036)] was established. A statistically significant increase in TC (p=0.005), TG (p <0.001), VLDL (p <0.001), IA (p <0.001) and TG/HDL (p <0.001) after four weeks of treatment with atypical antipsychotics. No statistically significant changes in hormone levels were established.

Conclusions. The results demonstrate the pronounced effect of a four-week treatment with atypical antipsychotics on glucose metabolism, a change in glucose level and insulin resistance index. A typical atherogenic change in the serum lipid spectrum is shown. These indicators are laboratory markers of the risk of cardiovascular disease and diabetes, and therefore careful monitoring of metabolic disorders in patients with schizophrenia is necessary.

Neurology Bulletin. 2019;LI(4):17-20
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Gelotophobia, gelotophilia and katagelasticism in female patients with non-psychotic mental disorders
Shunenkov D.A., Khudyakov A.V., Ivanova E.M.
Abstract

The research objective was to study the features of attitude to humor and laughter (gelotophobia, gelotophilia and katagelasticism) in female patients with non-psychotic mental disorders.

Methods. The study included 85 female patients with non-psychotic mental disorders. They were examined using PhoPhiKat-30 questionnaire.

Results. Amount of patients with gelotophobia in this group exceeds its prevalence in a sample of mentally healthy individuals, but is lowest compared to data from other clinical studies. In most of patients the normative values of gelotophilia and katagelasticism were determined, but some of patients had its lower values. Positive correlations of fear of being laughed at with gelotophilia and katagelasticism were found, and a link between katagelasticism and gelotophilia was found. A positive link between gelotophobia and the number of hospitalizations in a psychiatric hospital has been identified. In addition, gelotophobia is more pronounced in those with secondary education and widowed.

Conclusions. Gelotophobia among individuals with non-psychotic disorders reflects their “borderline” character between the norm and pathology. Katagelasticism and gelotophilia in mental disorders are rather declining. Gelotophobia has nosological specificity and can be a diagnostically important indicator reflecting not only disorders, but also the preservation of the emotional and personal sphere of patients.

Neurology Bulletin. 2019;LI(4):21-24
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Alexithymia in patients after the first cerebral stroke
Savina M.A.
Abstract

Alexithymia is considered to be a frequent complication of stroke that is not studied in Russian population.

Aim. To determine frequency of alexithymia in patients with first-ever stroke and particularly in patients with affective disorders.

Methods. 40 patients (mean age 63.1±12.0 years, 40% female) involved in prospective cohort study were assessed by 26-point Toronto Alexithymia Scale. Scores more than 62 were considered as borderline level of alexithymia, more than 74 as obvious alexithymia.

Results. Borderline alexithymia was found in 13 patients (32.5% of sample), obvious alexithymia — in 20 patients (50%). Patients with alexithymia were more frequently male and didn`t differ by age, educational level, stroke severity, lesion volume and location, cognitive dysfunction severity, comorbid somatic pathology. Alexithymia was more frequent in patient with pre-stroke and post-stroke depression but was not associated with generalized anxiety disorder.

Conclusions. Alexithymia frequently accompanies post-stroke depression. High alexithymia score in patients with pre-stroke depression may indicate that Toronto Alexithymia Scale gives false-positive results in gerontological patients with depressive disorders.

Neurology Bulletin. 2019;LI(4):25-28
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Russian adaptation of the internalized stigma of the mental state (self-stigmatization) scale ISMI-9
Vorontsova V.S., Shunenkov D.A., Ivanova E.M., Pichugina I.M., Enikolopov S.N.
Abstract

Aim. The research objective was to provide a Russian adaptation of the ISMI-9.

Methods. The study included 103 patients: with brain injuries (n=30); endogenous affective disorders (n=30); with mental disorders of neurotic level (n=43). After a preliminary clinical interview the patients were to complete the questionnaires: to assess their level of self-stigmatization (ISMI-9), gelotophobia (the fear of being laughed at) (PhoPhiKat-30), the predominant type of the attitude to the disease (TOBOL).

Results. The Russian version of the ISMI-9 revealed good psychometric properties in terms of reliability of the scale, unifactorial structure and correlations of all the items with the scale. Associations of self-stigmatization with the types of attitudes to the diseases and gelotophobia (the fear of being laughed at), revealed in the study, confirmed validity of the scale. Thus, in the group of patients with brain injuries, it was positively associated with hypochondriac type of attitude to the disease, paranoid, neurasthenic, melancholic, apathetic and sensitive, and it was negatively associated with anosognosic type of attitude to the disease. In the group of patients with endogenous affective disorders, self-stigmatization correlated positively with hypochondriac, neurasthenic, egocentric, paranoid, dysphoric types of attitude to the disease, as well as with gelotophobia. In the group of patients with mental disorders of neurotic level, self-stigmatization was positively associated with anxious, neurasthenic, melancholic, apathetic, sensitive, dysphoric types of attitude to the disease, and it was negatively associated with anosognosic type. There was also a positive correlation with gelotophobia.

Conclusions. The results of the study testify in favor of good psychometric properties of the Russian version of the Internalized Stigma of Mental State scale, its reliability and validity. The questionnaire may be recommended for use in scientific research, as well as in practice of psychodiagnostics and psychological counseling.

Neurology Bulletin. 2019;LI(4):29-33
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Features of voluntary self-regulation and locus of control in patients with diabetes mellitus type 2 with different options of its current
Koshanskaya A.G.
Abstract

Purpose. To study the severity of volitional self-regulation and the level of subjective control in patients with type II diabetes mellitus (DM) with various variants of its course.

Methods. Methodology “The study of volitional self-regulation” (A.V. Zverkov and E.V. Eidman) and the diagnosis “Level of subjective control” (E.F. Bazhin, E.A. Golynkina, L.M. Etkind). The data obtained were processed using the statistical program SPPS 20.

Results. The study showed that in most patients with type II diabetes, a decrease in the level of subjective control of the person over significant events was revealed, especially with type II diabetes insulin. The low level of development of volitional self-regulation with instability of intentions, emotional lability and impulsiveness can be associated with problems in organizing the life of patients with type II diabetes, the inability to build relationships with other people and adequately respond to certain situations, which reflects the appearance of maladaptive forms of behavior. The main characteristics of a low level of volitional self-regulation were significantly positively correlated with the decompensated course of type II diabetes and the external locus of control in relation to health and illness. This category of patients perceives their health to a great extent to be dependent on external influences, accidents and practically do not make their own efforts to restore it, which can lead to eating disorders, taking sugar-lowering drugs and worse diabetes compensation. This suggests that patients with type II diabetes with external localization of control preferred to deny personal responsibility and had a low level of self-regulation and insufficient cognitive assessment.

Conclusion. External localization of control with a low level of volitional self-regulation, perseverance and self-control have an effect on the course of type II diabetes, especially in patients with insulin-treated diabetes , leading them to a decompensated course of the disease and an increase in diabetic complications.

Neurology Bulletin. 2019;LI(4):34-38
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Premorbid personal features as a risk factor of bipolar disorder development
Osipova N.N., Dmitrieva E.V., Turanskij M.M., Bardenshtejn L.M.
Abstract

Aim. Study of the relationship between premorbid personality traits and the tendency to affective bipolar spectrum pathology at the prenosological stage.

Methods. The study involved 129 healthy respondents, the mean age (M=18.27±0.12) years. There were used psychodiagnostic and screening methods: diagnostic scale of bipolar spectrum disorders (Bipolar Spectrum Diagnostic Scale), R. Pies; Mood Disorder Questionnaire (MDQ); Hypomania Checklist (HCL-32); Abbreviated Multifactor Personality Survey (MMPI); Zung Self-Rating Depression Scale.

Results. The results of the MMPI study of students’ personality revealed features that corresponded to the degree of severity of the types of character accentuations, did not reach the degree of pathological values with statistically significant prevalence of values on the scale of “Ma” (hypomania) over all other scales and a decrease in values on the scale of “Pd” (psychopathy). The relationship between bipolar tendencies and personality types was found in respondents of hypomaniacal, hypochondrial, hysteroidal types among girls and paranoia type in boys.

Conclusion. Diagnosis of premorbid personality traits in combination with screening for affective pathology will allow the identification

Neurology Bulletin. 2019;LI(4):39-41
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Systematization of interaction areas of psychiatrists and medical psychologists of the Ministry of Internal Affairs
Sidorenko V.A., Ichetovkina E.G., Soloviev A.G.
Abstract

Aim. For the purpose to systematize the directions of interaction of psychiatrists, medical and social psychologists in the system of the Ministry of Internal Affairs of Russia.
Methods. The analysis of organizational approaches of intradepartmental interaction is carried out during the examination of candidates for service and employees of Internal Affairs Bodies (IAB) during the psychiatric examination by the military medical commission, medical and psychological support.
Results. It is shown that a comprehensive approach to prevention of mental health disorders of police officers with the participation of psychiatrists, clinical and social psychologists is the only effective method of work, that allows for quality systematic monitoring of mental health of employees, helps to reduce the incidence of mental and psychosomatic disorders, dismissal of police officers, improves the social climate
Conclusion. The complex of measures for intradepartmental interaction of specialists in the field of mental health contributes for preservation of mental well-being of employees, their personal professional and functional reliability and reduces image losses.
Keywords: mental health protection, employees of Internal Affairs Bodies, intradepartmental interaction, Mental health centers.

Neurology Bulletin. 2019;LI(4):42-45
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Stigmatization of persons with mental disorders by therapeutic doctors, as an obstacle to obtaining general medical care
Churnosova O.I., Ruzhenkov V.A., Ruzhenkova V.V.
Abstract

Somatic diseases are widespread in people with mental disorders (DM). At the same time, there is a lack of integration of somatic and psychiatric medical care, and stigmatization and discrimination lead to neglecting their needs in the treatment of somatic pathology.

This study aimed to develop recommendations for destigmatizing people with mental disorders by doctors of the general medical treatment network.

Methods. A sample of 217 general practitioners was examined using medical, sociological and psychometric methods: 36 (16.6%) males and 181 (83.4%) females aged 25–73 (45.1±12.7) years with 1–48 (19.5±12.6) years of working experience.

Results. It has been established that therapeutic doctors have both a reassessment of their own competence in the field of psychiatry and archaic ideas about the genesis of mental disorders: fifth part does not admit their biological nature, and one in ten believes that people with mental disorders are “contactors with aliens”. The distance between therapeutic doctors and people with mental disorders was verified: less than 2% of therapeutic doctors accept them as work colleagues, more than half only as “citizens of their country”, and one in ten would generally prefer not to see persons with mental disorders in country. This point of view is more inherent in males. The vast majorities (81.6%) of therapeutic doctors do not allow their children to be friends with people with mental disorders and would prohibit them from giving birth and raising their own children, as well as marriage. A third part of therapeutic doctors consider that it is undesirable to treat persons with mental disorders together with the mentally healthy, and insist on creating separate clinics for them or treatment in psychiatric hospitals.

Conclusions. In order to destigmatize persons with mental disorders, it is advisable to introduce lectures and practical exercises in psychiatry at certified continuing education courses and therapeutic practice in a psychiatric clinic. For a long-term perspective, it is necessary to develop a destigmatization program for students of medical universities and its implementation in the program of the psychiatry course.

Neurology Bulletin. 2019;LI(4):46-51
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Treatment commitment as a factor of effective including additional reality program to rehabilitation of stroke patients
Kotelnikova A.V., Nikishin I.I., Turova E.A., Savostikova E.N., Rogachkova E.I.
Abstract

Aim. The current paper presents analysis of adherence to treatment in the effectiveness of rehabilitation measures using the Visual Medicine program in patients with the consequences of stroke.

Methods. The sample consisted of 70 patients with acute stroke. Assessment of the functional state of patients after a stroke was carried out using the Rankin scale. Adherence to treatment was studied using the psycho-diagnostic questionnaire “Level of Compliance”. The state of higher mental functions (HMF) of patients before and after undergoing a course of rehabilitation was assessed using functional neuropsychological tests, assessed by four parameters (rate, accuracy, differentiation, and coordination). In the course of rehabilitation, the software and hardware complex Visual Medicine was used. Statistical processing was performed in the Statistical 10.0 software package.

Results. As a result of the study, a positive dynamics of the restoration of kinesthetic, spatial praxis was revealed. Patients of the experimental group demonstrated more accurate reproduction of the posture of the hands according to the tactile and visual pattern, improved right-left orientation, more efficient implementation of the motor program. It has been reliably established that frequency of occurrence of indicators of social compliance in groups with a different amount of shift in the state of HMF in subjects who underwent rehabilitation using the Visual Medicine program allows us to state that a score of 27 points is the section boundary in relation to the level of shift: upon reaching the dynamics of the recovery of HPF are significantly lower. The results obtained indicate that the higher level of compliance, shows the higher level of the efficiency of restoration of fine motor functions using the program.

Conclusions. Exercises with the program “Visual Medicine” personify the rehabilitation process, which improves the efficiency of restoration of fine motor functions of post-stroke patients. High effectiveness of these exercises achieved due to the high level of social compliance of patients, manifested in a friendly position, the desire to psychologically rely on the doctor, to earn his approval. Conducting a preventive diagnosis of adherence allows optimizing the rehabilitation route of patients during their hospital presence.

Neurology Bulletin. 2019;LI(4):52-58
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Review papers
Stroke in dialysis patients
Khrulev A.E., Monashova E.A., Shestakova N.A., Paramonova Y.A., Grigorieva V.N.
Abstract

Cerebrovascular disorders are the most frequent and urgent complications of chronic kidney disease, especially, in the dialysis period.

The purpose is to provide an analytical review of current (2011 and later) publications containing a comprehensive analysis of stroke data in dialysis patients.

Methods. A critical analysis of the literature data with a generalization of the currently available results of the original studies on the stroke in dialysis patients.

Results. The risk of stroke increases many times in hemodialysis patients with end-stage chronic kidney disease. According to different publications, the risk of hemorrhagic stroke increases 4–6 times, and ischemic stroke — 2–3 times, compared with the general population. Dialysis patients are under the higher risk of mortality after the stroke. The presence of atrial fibrillation in a dialysis patient is prognostically unfavorable and increases the frequency of stroke by 2.5 times, mortality by 2 times, compared to dialysis patients without atrial fibrillation.

Conclusions. There is lack of studies on the use of warfarin in comparison with aspirin or new oral anticoagulants to conclude on the benefits of one or another way of management in dialysis patients with atrial fibrillation. Apparently, the use of warfarin is not justified in dialysis patients. Thrombolytic therapy is not indicated to a dialysis patient with acute period of ischemic stroke. The use of prolonged renal replacement therapy is preferable in the patients with acute stroke and acute renal failure. It is suggested to carry out hemodialysis without anticoagulation or (if necessary) with the use of fractionated heparins in case of increased risks of bleeding.

Neurology Bulletin. 2019;LI(4):59-65
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Gilles De La Tourette syndrome. Clinical diagnostic and therapeutic features
Sofronov A.G., Zaytsev D.E., Zaytsev I.D., Titov N.A.
Abstract

The article presents and analyzes current views on the classification, pathogenesis, diagnostic and treatment of Gilles de la Tourette syndrome. The age and gender features of the course of Tourette syndrome (TS) and comorbid disorders are described. In many psychiatrists’ opinion one of the most important courses is the study of psychiatric comorbidities in TS, which do not allow timely diagnosing of TS. Several authors propose to conceptualize certain comorbid disorders as independent ones that do not have common pathogenesis chains with TS. The least studied comorbid disorders in TS include epilepsy, although antiepileptic drugs can be effective in treating patients with TS. In consideration of the difficulty of TS diagnosing in the presence of psychiatric comorbidities, number of authors comes to the conclusion that patients have to get treatment of identified psychiatric disorder. However, according to the results of other authors’ clinical observations, there is evidence of aggravation of the course of both TS and comorbid disorder with the described therapeutic tactic. Genetics and instrumental research methods also do not reveal univocal diagnostics criteria. The authors of the article conclude that questions of diagnostics and treatment of Gilles de la Tourette syndrome are still unsolved

Neurology Bulletin. 2019;LI(4):66-72
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Discussions
Market drift of medicine and paramedical crafts (on the example of psychoanalysis)
Zorin N.A.
Abstract

This work is a “literary response” to the publication by D. Trutneva and V. Mendelevich “Psychotherapy without a psychotherapist” within the overall subject “Apologies of the industrial model of medicine” which was raised by the author at the symposium “Stаtus praesens of psychiatry” in St. Petersburg on 29–30 November 2019. The body of the text is made up of two literary essays written way back in 1994. The essays have proven to be visionary in terms of the evolution of paramedical studies, to which I believe psychoanalysis belongs.

Neurology Bulletin. 2019;LI(4):73-75
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Наблюдения из практики
Non-pathological phenomena of thinking disorders in plagiarized texts of students and listeners studying psychology and methods of their correction
Uzlov N.D.
Abstract

The article is devoted to the problem of plagiarism as one of the most common forms of academic dishonesty. An attempt is made to use the conceptual apparatus of clinical pathopsychology to analyze the mental processes of students learning psychology distantly and resorting to plagiarism. Phenomena resembling disorders of thinking such as slippage and disposition to futile judgement are described. Adherence to plagiarism is considered in the context of the concept of “clip thinking”. Measures of counteraction to plagiarism, and also available ways of overcoming plagiarism-slippage and plagiarism with disposition to futile judgement in the conditions of use of traditional approach in distance learning of students are considered.

Neurology Bulletin. 2019;LI(4):76-82
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Clinical case of early diagnosis of inflammatory form of cerebral amyloid angiopathy
Klocheva E.G., Goldobin V.V., Tertyshnaya N.M., Osipova M.
Abstract

There was presented a clinical case of early recognition of inflammatory form of cerebral amyloid angiopathy in patient with severe diffuse headache, slightly responding to analgetics, and focal signs of pyramidal and cerebellar involvement. Clinical and radiological data were sufficient to make diagnosis of probable inflammatory form of cerebral amyloid angiopathy. Pulse-therapy with methylprednisolone was performed, followed by clinical and MRI data improvement. After 4 month relapse the cephalgia took place again due to viral infection. Pulse-therapy with corticosteroids was repeated with clinical improvement.

 

Neurology Bulletin. 2019;LI(4):83-87
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Spirituality as an indicator of mental health-related quality of life
Vitko Y.S., Lebedeva A.A.
Abstract

The problem of new existential states that psychologists or psychiatrists are facing in their practice in relation to accelerating changes in human existence is discussed. The classifications of mental illnesses are replenished with new nosological units and treatment recommendations, because of a changing world. The definition of health as the absence of disease becomes untenable due to its inability to shed light on the nature of the pathologies. An understanding health in terms of psychological well-being is the most perspective nowadays. Various authors recognize spirituality as one of the integral components of human well-being. Researchers attribute to spirituality the function, which has moderating effects (reduced or leveled) of stressors and adverse life circumstances on human well-being. The work poses the problem of spiritual health as the possibility of mastering spiritual experience and its integration into a personality worldview. Substantiated that spirituality is recognized as a special field of quality of life research, and spiritual health and psychological well-being have heuristic potential in the context of psychiatry.

Neurology Bulletin. 2019;LI(4):88-91
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Recommendation for practitioners
Assessment of the pharmacotherapy influence on mental state deterioration in acute endogenous psychosis
Veraksa A.E., Egorov A.Y.
Abstract

Due to the diagnostic difficulties and the lack of clinical recommendations for treatment, assistance in acute endogenous psychoses (atypical, cycloid psychoses) is a hard task in psychiatric practice. The abundance of different therapeutic approaches has not yet been systematically investigated. The data obtained suggest that benzodiazepine monotherapy is the most effective and safe method, while other pharmacological combinations have significant drawbacks and can provoke deterioration of the mental state and the resumption of psychosis. Risk factors for the recurrence of psychosis include the use of antipsychotics in high doses, the combination of several antipsychotics and the addition of cholinolytic drugs to therapy.

Neurology Bulletin. 2019;LI(4):92-94
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Features of psychological support of schizophrenic patients on compulsory treatment: basic principles and objectives
Penyavskaya A.V.
Abstract

The work is devoted to the description of the basic principles and tasks of psychological support of patients with schizophrenia on compulsory treatment. Such principles include: the principle of stages and continuity, the principle of differentiation, the principle of integrativity and the principle of consistency. The tasks of psychological support of patients with schizophrenia who committed a socially dangerous act are correlated with the stages of compulsory treatment in a psychiatric hospital and the psychological characteristics of patients.

Neurology Bulletin. 2019;LI(4):95-97
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Subjective health in the field of psychology and psychiatry
Lebedeva A.A., Kostenko V.Y.
Abstract

Subjective health is a self-assessment of human condition and measure of health — has proven itself in research as a predictor of mortality and objective health. This indicator is most widely used by a variety of disciplines in the context quality of life and health studies. Along with this, the comprehension of this construct is still complicated and disputed. In psychiatry, the subjective understanding of health is reduced to ideas about development and course of mental illness. There is evidence of a culturally specific understanding of health by representatives of different nationalities. The article raises the problem of the influence of psychiatric diagnosis on self-assessment of health as a whole.

Neurology Bulletin. 2019;LI(4):98-101
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