Vol LII, No 1 (2020)

Frontiers papers
Psychopharmacotherapy of healthy people and the off-label problem in modern psychiatry
Mendelevich V.D., Pyrkova К.V.
Abstract

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.

Neurology Bulletin. 2020;LII(1):5-8
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Physicians who use substances: what does it look like and what to do about it?
Sivolap Y.P., Savchenkov V.A., Yanushkevich M.V., Pushin P.V.
Abstract

Substance use disorders in physicians is a serious problem of the medical community and public health. The prevalence of substance use disorders depends on gender, age and medical specialty. The substance abuse impairs physical and mental health of physicians and affects the quality of patient care. Treatment of chemically addicted physicians involves the use of conventional therapeutic approaches adopted in addiction medicine, but requires compliance with certain special principles.

Neurology Bulletin. 2020;LII(1):9-13
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Original studies
Relationship between representation and severity of Gilles de la Tourette syndrome and comorbidities
Sofronov A.G., Zaytsev D.E., Zaytsev I.D., Titov N.A.
Abstract

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.

Neurology Bulletin. 2020;LII(1):14-18
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The meanings of self-harm behavior: internet study results
Medvedeva T.I., Boyko O.M., Vorontsova O.Y., Kazmina O.Y., Enikolopov S.N.
Abstract

Self-harming is one of the most acute problems that mental health professionals face in their work. This explains the relevance of developing the most effective ways to work with it.

The aim of the work is a study of subjective meaning of self-harm behavior in the sample of internet users.

The methods. The materials for the study were the responses of 156 people above 18 years of age received during an online survey. The methods were the questions about subjective meaning of self-harm behavior. The data were processed by the method of calculation of a percentage each of meaning of self-harm behavior in the total sample.

The results show heterogeneity of meaning of self-harm behavior. 8.5% of the responses (meaning “an alternative to suicide”) demonstrate the actual suicidal risk. 25.4% of the responses (meaning “confirmation of reality of myself”, “stop panic attack, episode of anxiety, hysteric, obsession thoughts”, “filling inner emptiness”) show to psychopathological symptoms among respondents. 61.5% of the responses (meanings “relief of emotional pain”, “rest, sedation, stress reduction”, “cope with aggression, mental strain”) demonstrate low tolerance for emotional tension and negative feelings. 5.3% of the responses (meanings “revenge”, “raise awareness to themselves”) could be explained by poverty of the communicative skills. Etiology of some meanings is a need to be examined in each specific case

The findings indicate an importance of studying the subjective meaning of self-harm behavior. Its allow us to highlight several areas of work. (1) Psychiatric treatment of psychopathological symptoms. (2) Prevention of suicidal risk. (3) Training in emotional self-regulation skills. (4) Depending on the meaning of self-harm behavior, optimal psychotherapeutic approaches will vary.

 

Neurology Bulletin. 2020;LII(1):19-21
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Quantitative assessment of anxiety about their health in patients with first-ever stroke
Savina M.A.
Abstract

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.

 

Neurology Bulletin. 2020;LII(1):22-26
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Features and results of the diagnosis of disorders of social and emotional intelligence of patients with schizophrenia at an early stage of the disease
Bragin D.A.
Abstract

Aim. The aim of the paper was to study the specifics of diagnosing disorders of social and emotional intelligence of patients with schizophrenia at an early stage of the disease (mainly by projective methods) and to determine, thanks to the diagnosis, the targets of psychocorrectional effects.

Methods. 64 people were studied (40 men and 24 women, average age 28 years). The experimental group included patients with a verified diagnosis of schizophrenia (F20) at an early stage of the disease (33 people, 21 men and 12 women) aged 16 to 37 years (average age 29 years), the control group of a similar age and gender structure — mentally healthy persons (31 people, 19 men and 12 women, average age 28 years). As research methods the following tests were used: (1) Methodology “G. Rorschach’s Ink Spot Test” (The Rorschach Inkblot Test, 1921); (2) Test “Understanding the mental state of the eyes” — Reading the mind in the Eyes (Baron-Cohen et al., 2001) — a modified version of E.E. Rumyantseva (2016); (3) Test “Social Intelligence” by J. Guildford, M. Sulliven (adaptation by E.S. Mikhailova, 1996); (4) Methodology “Emotional Intelligence” by J. Mayer, P. Salovei and D. Caruso (MSCEIT V2.0, 2014); (5) Test of emotional intelligence of Lucin (EmIn); (6) Hall emotional intelligence test. Data Processing Methods: John Exner Integrative System (Exner, 1997, 2003).

Results. It was found that patients with schizophrenia, even at an early stage of the course of the disease, are worse at solving problems to assess the success of social functioning.

Conclusions. The most significant and reliable differences (reliable by the U-criterion, at p ≤0.001) are found when schizophrenic patients perform tasks related to the characteristics of perception and analysis not so much of the social stimuli themselves, as by their nuancing. The structure of violations of social functioning is also dominated by difficulties in predicting both their further actions and the interlocutor. Determined by the decrease in general social incompetence is the practically reduced possibility of using emotions and their manifestations in solving “social” problems.

Neurology Bulletin. 2020;LII(1):27-29
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Assessment of the weight and consistency of the interaction of specialists in the polyprofessional teams
Mitikhin V.G., Solokhina T.A.
Abstract

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.

Neurology Bulletin. 2020;LII(1):30-33
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Independent living skills and cognition in early-onset and late-onset of schizophrenia patients: a pilot study
Abdullina E.G., Savina M.A., Rupchev G.E., Morozova M.A., Pochueva V.V., Sheshenin V.S.
Abstract

Aim. To evaluate cognitive functions and independent living skills in patients with late-onset schizophrenia (LOS) compared to patients with early-onset schizophrenia (EOS).

Methods. The study included two clinical groups: 8 EOS patients (M=51.3±7.2; 7 males) and 8 LOS patients (M=67.8±9.9; 8 females), with comparable illness duration (22.6±9.1 and 19.9±11.9 respectively). Cognitive functions were assessed through the Brief Assessment of Cognition in Schizophrenia (BACS). The Autonomy Assessment Scale (AS) was used to measure independent living skills. The Mann–Whitney U-test was applied to determine differences between groups.

Results. LOS group performed significantly better on Digit Sequencing Task, Verbal Fluency and Tower Test of the BACS. Composite score on AS was also significantly better in LOS group along with better scores on AS`s subscales assessing primarily social skills.

Conclusion. LOS patients have milder cognitive dysfunction along with better independent living and social skills compared to AOS patients.

Neurology Bulletin. 2020;LII(1):34-37
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Levels of neurocognitive response in the situation of organic brain damage of a child as a clinical and psychological problem
Turovskaya N.G.
Abstract

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.

Neurology Bulletin. 2020;LII(1):38-42
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ROLE OF EMOTIONAL FACTORS IN FORMATION OF CARDIOVASCULAR PATHOLOGY (ON THE EXAMPLE OF THE MYOCARDIAL INFARCTION AND DIABETES OF THE 2ND TYPE)
Solovyova S.L., Koshanskaya A.G., Vlasova N.V.
Abstract

Aim. To investigate a role of emotional factors in formation of cardiovascular pathology (on the example of a myocardial infarction and diabetes of the 2nd type).

Methods. The symptomatic questionnaire of SCL-90-R (from English Symptom Check List-90-Revised), a scale of alarm of Beck, the test questionnaire of a depression, a scale of hopelessness of Beck, a test technique of type of the relation to a disease and treatment TOBOL. The obtained data are processed by means of the statistical SPPS 20 program.

Results. The research showed that emotional factors influencing development of cardiovascular pathology, advancing a demonstration of the disease. Women at a stage of formation of cardiovascular pathology have more expressiveness of symptoms of a distress with tendency to its strengthening, fixing on the somatic feelings, existence of easy and moderate disturbing and depressive symptomatology with reactions of irritability leading to the avoiding behavior and also fear of loss of independence with feeling of own inferiority in comparison with other people, “escape” in the disease. The professional demand is more important for men, unlike women, leading to concealment of relevant symptomatology, perhaps, unconscious. They are not inclined to fix the attention on painful feelings, cannot attach significance on them, explaining their disease with fatigue at work. All this leads to later request for medical care and serious consequences. In men with cardiovascular pathology in the moderated and expressed degree the disturbing and depressive symptomatology is expressed with a dysphoria, violations of night sleep, ergopathic or anozognostic type of the relation to a disease is shown. The disturbing depression of patients with cardiovascular pathology is supported by observance of the high therapeutic security, risk of development of the complications causing a feeling of loss of control over own life and future that promotes formation of living position for disabled. Knowledge of features of the emotional sphere of the patients with for the first time revealed SD of the 2nd type who had a myocardial infarction expands possibilities of correction of negative impact of emotional factors on formation and progressing of cardiovascular pathology.

Conclusions. Emotional factors such as alarm and depression influence formation of cardiovascular pathology and advance a demonstration of the disease. More often women are fixed on somatic complaints, and men with cardiovascular pathology cannot attach significance to somatic symptoms that leads to later request for medical care. Emotional factors should be considered as main “targets” of psychological intervention when developing programs of prevention along with the known somatic indicators that assumes need of interaction of experts of different clinical disciplines.

 

Neurology Bulletin. 2020;LII(1):43-48
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The burden attributable to substance use in the Russian Federation
Soshnikov S.S., Starodubov V.I., Khaltourina D.A., Vlassov V.V., Obuhova O.V., Idrisov B.T.
Abstract

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.

Neurology Bulletin. 2020;LII(1):49-54
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Review papers
Status of water-soluble vitamins and neurological disorders in dialysis patients
Khrulev A.E., Baykina A.N., Shiyanova N.A., Sirotkina A.Y., Salokhina O.Y., Grigorieva V.N.
Abstract

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.

Neurology Bulletin. 2020;LII(1):55-59
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Discussions
How and why psychoanalysts become storytellers
Zislin Y.M.
Abstract

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.

Neurology Bulletin. 2020;LII(1):60-67
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Perspectives of phenomenological approach in psychiatry: the problem of patient’s understanding
Kropocheva N.V., Lebedeva A.A.
Abstract

The problem of understanding of patients in modern psychiatry is discussed. Nowadays patient’s subjective experience is almost entirely excluded from psychiatric manuals that brings risk of ignoring holistic patient’s experience. This experience can be shared by psychiatrist only in context of mutual trust. The latter as an approach to communication requires certain theoretical background which differs from the current one in modern psychiatry. The phenomenological approach is seen as promising for evolution of psychiatry because this approach was made in the 20th century to descript pathological and everyday experience. We reveal importance of patient’s subjective experience to diagnostics and description of mental illnesses according to current literature in the field. We also suggest original research of need for understanding in Russian psychiatry professionals.

Neurology Bulletin. 2020;LII(1):68-71
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Modern ideas about the psyche: changing of the paradigm
Reshetnikov M.М.
Abstract

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.

Neurology Bulletin. 2020;LII(1):72-81
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Place of evidence-based medicine in the diagnosis of mental disorders
Poltavskaya E.G.
Abstract

The polemic article is a presentation of the author’s opinion regarding the role of evidence-based medicine in the formulation of a psychiatric diagnosis, in particular schizophrenia. The principles of “clinical approach” and “evidence-based medicine” in psychiatry are compared.

Neurology Bulletin. 2020;LII(1):82-85
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Recommendation for practitioners
Discussion issues of general psychopathology (traditional and innovative approaches)
Krylov V.I.
Abstract

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.

Neurology Bulletin. 2020;LII(1):86-91
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Наблюдения из практики
Body image and coping behavior in adolescents with self-damaging behavior (clinical cases)
Makarova O.S., Pyrkova K.V., Krasilnikova A.M., Nasibullina R.R.
Abstract

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

Neurology Bulletin. 2020;LII(1):92-96
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Brief communications
Suicidal risk and characteristics of text written by patients with endogenous mental disorders
Medvedeva T.I., Enikolopov S.N., Vorontsova O.Y.
Abstract

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.

Neurology Bulletin. 2020;LII(1):97-100
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