Vol LII, No 1 (2020)

The article analyzes the problem of widespread misuse of therapy for mental disorders. The role of paradigmatic changes in psychiatric classifications and the introduction of a spectral approach in the formation of new psychopharmacotherapeutic strategies is evaluated. New concepts are distinguished: “psychopharmacotherapy of healthy people”, “diagnostic and therapeutic relativism”. It is argued that the emergence in the psychiatric field of the topic “psychopharmacotherapy of healthy people” is more likely to be a natural than an accidental phenomenon. It is concluded that innovations are initiated by both patients and psychiatrists. It is assumed that the appointment of mentally healthy psychotropic drugs for their desired use is possible in the presence of public and medical consensus. For the expert community, this issue poses new legal and deontological challenges. If consensus is reached, clear criteria should have been developed — what groups of psychopharmacothrapy can be used off-label and under what specific prenosological mental conditions. It is argued that psychiatry should follow the requests of clients, and not against innovations dictated by a change in human psychology.

Aim. To study representation and distribution of comorbidities, their relationship with clinical presentation and severity of Gilles de la Tourette syndrome, with age of onset of motor and vocal tics.

Methods. Were examined 58 children (44 boys, 14 girls) at the age of 11.07±0.52 years (4–18 years old) with observation period from 1 to 10 years with diagnosis of Gilles de la Tourette syndrome. All patients were examined by child psychiatrist, neurologist, child psychologist to clarify diagnosis and psychopathological comorbidities. Comorbidities were determined by clinical-psychopathological method and by standardized scales.

Results. In the course of the research there were identified the main comorbid disorders, their representation, prevalence and relationship with tic disorder. The results of the study allow us to conceptualize separately comorbid disorders and complex tic-like symptoms. According to the study, comorbid disorders tend to develop on their own, while a number of specific features tend to manifest themselves, increasing representation during the course of development of the main tic disorder.

Conclusion. Such specific features as self-injurious behaviors, non-obscene, socially inappropriate behaviors, coprophenomena, echophenomena; and paliphenomend are proposed to be called complex tic-like symptoms. In our opinion, we should differentiate and separately classify complex tic-like symptoms from mental comorbidities, that have their own development regardless of the course of tics in Gilles de la Tourette syndrome.

Excessive health anxiety is frequent post-stroke psychopathological syndrome that remains understudied.

Aim. Quantitative assessment of health anxiety by Whiteley Index as well as it`s relation to psychiatric and somatic disorders.

Methods. This study is a part of prospective observational study of patients with first-ever stroke. 53 patients (mean age 60.2±11.8 years, 37% female) were assessed by Whiteley Index: 35 patients in 14 day of stroke, 32 — at 6. Month of post-stroke period, 14 — in both time-points. Borderline health anxiety was diagnosed in patients with score 32–44, excessive health anxiety — with score more than 44.

Results. Patients were divided into 5 groups: with low health anxiety (n=19), with borderline health anxiety (n=14), with high health anxiety (n=15), with lowering score (n=3) and with increasing score (n=3). Increased health anxiety was associated with bigger stroke volume, executive dysfunction, with larger number of habitual anxiety reactions and anxiety-related motor, ideational and vegetative symptoms as well as with uncontrollable hypertension in post-stroke period. Excessive health anxiety didn`t relate to increased frequency of generalized anxiety disorder and fear of stroke recurrence.

Conclusion. Although increased health anxiety is understandable psychological reaction to stroke, it has some pathological correlates: with increased habitual anxiety and vegetative lability, bigger lesion volume and executive dysfunction.

The aim of the work is a systematic analysis of the problem of the effectiveness of interaction between specialists of polyprofessional teams during psychosocial rehabilitation interventions. Formation of procedures and algorithms for processing the results of processing expert information to assess the weight and consistency of decisions based on the method of analysis of hierarchies.

The material for this work was a set of Russian and foreign scientific publications devoted to use and processing of the expert data presented in different scales: categorical, rank, scales of relations.

Methods of data analysis: rank methods, methods of system data analysis and, in particular, algorithms of the analytic hierarchy process.

Results. It is shown that the issues of interdisciplinary interactions of team members, and the procedures for assessing the weight and consistency of decisions made by team members, are naturally represented by the appropriate hierarchies, the analysis of which is carried out by means of the method of hierarchy analysis.

Summary. The fundamental difference between the estimates obtained by means of the hierarchy analysis method and the rank estimates is due to the fact that numerical estimates of the weight and consistency of decisions are formed, which depend on the qualification of employees, the patient’s condition and the characteristics of the environment.

Aim. The article discusses the results of a psychological study of the development of mental functions in children with convulsive paroxysms in the anamnesis. In order to identify common patterns of mental dysontogenesis in children with cerebral organic pathology, the data obtained are compared with the results of other studies.

Methods. As experimental research methods, methods of neuropsychological diagnosis of higher mental functions in children were used (Tsvetkova, 2002), the diagnostic complex “Forecast and prevention of learning problems at school” (Yasyukova, 2002). Statistical analysis was performed using the SPSS statistical analysis software.

Results. The results of the study showed that the early onset of seizures in children is combined with impaired auditory perception, short-term speech memory, visual linear thinking and motor awkwardness. The prolonged presence of convulsive paroxysms in the history of a preschool child is associated with the pathology of the development of kinesthetic praxis, as well as speech functions and forms of thinking associated with speech. A significant number of seizures in the history of the disease has a more destructive and total effect on the brain of the child in comparison with the age of onset and the duration of the disease. The data obtained are similar to the results of psychological studies of children with other cerebral organic pathology. Consequently, pathological cerebral processes and conditions of various nature can lead to similar disorders in the development of mental functions, presumably those that are at the time the pathological factor begins in the sensitive period of development. This allows using the concept of “levels of neurocognitive response” in a situation of organic damage to the brain of a child.

Conclusion. The picture of the mental development disorder of children with convulsive paroxysms in the anamnesis is mediated by the age of onset, the duration and massiveness of the disease. Children with various diseases of the central nervous system, presumably, have common patterns of mental dysontogenesis.

Aim. Assessment of the health consequences of substance use in the form of lost years of healthy life in the world in comparison with Russia. An additional task was to determine the economic losses from alcohol, tobacco and drugs in the Russian Federation.

Methods. We used indicators of mortality, morbidity, prevalence, and years of life lost, taking into account the DALY disability from tobacco, alcohol, opiates, cannabis, and other drugs (ICD10: I42.6, K70.03, Z72.0, F10-19). Indicators of harmful health effects from PS were presented from 1990 to 2017. Variables were standardized by age and sex. An economic assessment of the impact of tobacco, alcohol, and drugs denominated in rubles was applied.

Results. Total economic losses from psychoactive substances, expressed in rubles, amounted to from 887.4 billion to 8.5 trillion rubles in Russia in 2017. The greatest harmful effects on health from psychoactive substances in Russia and the world are caused by tobacco, with alcohol in the second place. The damage from smoking in Russia in years of lost life including disability DALY amounted to 8.6 million in 2017 Alcohol consumption and its consequences in Russia caused 1.85 million DALYs of harm to health, alcoholic cirrhosis and other liver diseases-643 thousand DALYs.

Conclusion. Alcohol and nicotine cause maximum harm to the health and economy of Russia, and in conditions of limited resources, the main efforts should be directed at preventing the consequences of alcoholism and tobacco smoking.

The deficit of vitamins in patients receiving the long-term hemodialysis is discussed in the modern literature. Vitamin deficiency in a dialysis patient can be explained by the peculiarity of the diet recommendations, the need to take a number of medications, impaired absorption of vitamins in the digestive tract, poor appetite, uremic anorexia, depression, limited ability to buy and cook food, as well as losses of vitamins during the procedure of program hemodialysis. An analytical review of current (2011 and later) publications containing a comprehensive analysis of data on the status of water-soluble vitamins and its role in the development of neurological disorders in dialysis patients is provided. There is a high risk of deficiency of various water soluble vitamins and neurological disorders, such as vitamin B₁ deficiency and thiamine deficiency encephalopathy and polyneuropathy, vitamin B₆ deficiency and pyridoxine deficiency polyneuropathy, folic acid metabolism disorders, as well as vitamin B₁₂ and the development of hyperhomocysteinemia, cognitive and depressive disorders, strokes, restless legs syndrome and dialysis polyneuropathy among the patients with end-stage chronic kidney disease and program hemodialysis. Vitamin C deficiency and the development of severe asthenic syndrome with insomnia and depression are described in dialysis patients. It seems necessary to revise the traditional nutritional approaches to the dialysis patients based on the analysis of the literature. Special attention is paid to the possible addition of such water-soluble vitamins as B₁, B₆, B₉, B₁₂ and C. Timely diagnosis of vitamin deficiency conditions and neurological disorders in patients on program hemodialysis, the development of methods for their correction and their introduction into clinical practice would improve the life expectancy and quality of life of dialysis patients.

In this paper, I wish to look at the approach of psychoanalysts to folklore texts. The evaluation of psychoanalytic interpretations of two Russian fairy tales shows that psychoanalysts, not knowing the methods of anthropology and folklore, freely and mistakenly construed the text material. Such a free interpretation is based on the confidence of analysts that the psychoanalytic method itself can provide a correct key to understanding any text. According to our opinion, such erroneous interpretations lead to the discrediting of psychoanalysis and may ultimately lead to fatal errors in psychotherapy.

The problem of the psyche and consciousness has been the most mysterious one for a few thousand years and is still unresolved. It has been almost forgotten that Aristotle considered human psyche a structure that is not bound to the body. This idea did not persist, though. It was Hippocrates who ruined it and declared a different concept, which prevailed for many centuries, that the brain is a repository of all mental processes. Even such a genius as Rene Descartes took Hippocrates’s idea for granted and spent many months in attempts to find memory and emotions in gyrus and ventricles of the brain. This path — the search of material structures of the psyche — was followed by I.M. Sechenov, I.P. Pavlov and many others. Later, many other mistaken ideas were born, declared new and revolutionary ones and died prematurely. However, not only ideas died, but also patients, who were treated by methods developed on the basis of these hypotheses. The author formulates the idea of the brain as the biological interface and proves a non-material theory of the psyche, which is a discovery that requires a change in basic paradigms of human sciences.

The paper presents a critical analysis of the main traditional and modern directions of General psychopathology of the problem. The terminological aspects of psychopathological analysis are discussed. The semantic content of the main units of General psychopathology is considered.

Two clinical cases of adolescents with self-harming behavior in the framework of personal and affective disorders are presented.

Aim. Identification of the relationship between suicidal risk and features of the text written by patients with endogenous mental diseases.

Methods. The study involved 58 people-patients with endogenous mental diseases who were being treated at the MHRC clinic. All patients were asked to write an essay on the topic “I, others, the world”. To analyze the semantic and syntactic structure of utterances, the method of relational-situational analysis and the method of frequency lexical analysis using the PLATIn analyzer were used. All patients completed the following methods: (1) SCL-90-R symptomatic questionnaire (Symptom Check List-90-Revised); (2) the Iowa game problem — the expectation-result model of Expectancy-valence is used, which introduces parameters for probabilistic modeling of decision-making: “attention to win-loss”, “learning-forgetting”, “impulsivity–determinism”; (3) The Barratt impulsivity scale [10]; (4) the five-factor personality questionnaire, the Bass–Perry questionnaire.

Results. The results of the Spearman correlation analysis showed statistically significant correlations between the severity of suicide risk (from the SCL-90 questionnaire) and the parameters of texts obtained using computer analysis, with the parameters of the Expectation-valence model of the Iowa game problem, the Barratt impulsivity scale, the Bass–Perry questionnaire, and emotionality in the five-factor personality questionnaire.

Conclusions. There were found the features of the text that are associated with increased suicide risk: increased use of past tense verbs in texts; higher productivity — increase in the number of sentences and words in the text while reducing the length of the words and decrease of the number of infinitives; the increase in the coefficient of Trager; reduced vocabulary positive rational assessment and mental activities; increase vocabulary of asthenic negative emotions. The analysis of the relationship between suicidal risk and personal characteristics revealed characteristics similar to those shown in the texts: a high level of hostility, increased emotionality, increased impulsivity and a pronounced momentary effect.