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Vol LII, No 2 (2020)

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Frontiers papers
Non-binary gender identity and transgendence beyond psychiatric discourse
Mendelevich V.D.
Abstract

An analysis of the problem of non-binary gender identity and transgender shows that the professional position of psychiatrists and psychologists is often based on “selfish gender” when subjectivity begins to be seen in psychiatric diagnostics due to a rigid binary gender setting. Modern research proves the existence of gender diversity and a spectrum of gender identity. All this allows us to state that the phenomenon of so-called gender identity disorders goes beyond the psychopathological context. The psychiatrists’ use of the binary approach does not correspond to rapidly changing public ideas about the norm and pathology of human behavior.

Neurology Bulletin. 2020;LII(2):5-11
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Philosophy of psychiatry: quarter of a century in discussions
Vlasova O.A.
Abstract

The papers presents the discussion field of a young branch of the philosophy of science — the philosophy of psychiatry. As an interdisciplinary platform in the dialogue of sciences, schools and individual professionals, it unites psychiatrists and philosophers, psychologists and social workers in discussing on crucial issues. The paper analyses a multiple field of discussion of the philosophy of psychiatry, separating two stages of its brief development: the stage of institutionalization and fixing of problems (1995‒2005) and the stage of expansion (2005 — present). Modern discussions are studied on the most important thematic blocks: (1) the methodology of human research; (2) the philosophical basis of psychiatric classification; (3) psychiatric ethics. The work presents the first complete and specialized review of discussions of the philosophy of psychiatry in Russian.

Neurology Bulletin. 2020;LII(2):12-19
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Problems of psychopathologic systematics: alternative approaches and clinical practice requests
Zobin М.L., Ustinova N.V.
Abstract

The reliability and validity of traditional classifications give rise to justifiable criticism because of the conventionality of the boundaries between norm and pathology, fuzzy delimitation of disorders and their frequent co-occurrence, heterogeneity and clinical instability of symptoms within the diagnostic categories. There is little evidence that the majority of mental disorders are discrete entities. Discontent with the expert consensus classifications have led to attempts at a new quantitative and empirical systematization of psychopathology. Two alternative projects have been proposed: Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP). The aim of the paper is to clarify the conceptual framework of RDoC and HiTOP, discuss their advantages and disadvantages in terms of the prospects for use in clinical practice.

Neurology Bulletin. 2020;LII(2):20-28
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Psychiatric knowledge in Russia: domestic traditions or scientific facts?
Sivolap Y.P., Portnova A.A.
Abstract

Russian and world psychiatry are characterized by significant differences: the first can be called as “the psychiatry of domestic traditions”, and the second one as “the psychiatry of scientific facts”. Russian psychiatry is marked by emphatic devotion to national theoretical schools, an appeal in scientific discussions to the authority of famous psychiatrists of the past, a tendency to speculative psychopathological constructions, the use of archaic psychiatric terms with unclear content, insufficient attention to the principles of evidence-based medicine, or even outright disregard for these principles. The natural consequences of Russian psychiatry’s traditionalism are the arbitrariness of psychiatric diagnosis and the frequent use of medicines and treatment methods without proper evidence of their effectiveness and safety.

Neurology Bulletin. 2020;LII(2):29-32
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Original studies
Clinical and functional characteristics of remission and rehabilitation of patients with schizophrenia
Petrova N.N., Lugovskaia L.V.
Abstract

The aim of this study was to evaluate real social functioning of patients in remission of paranoid schizophrenia in the dynamics of treatment and rehabilitation measures.

Methods. Patients of the medical rehabilitation department were included in the transverse clinical and population study. Clinical scale evaluation was used, including PANSS, PSP.

Results. It was shown that patients with schizophrenia included in the program of therapeutic and rehabilitative measures, met clinical and functional criteria of remission. Negative symptomatology prevailed in the clinical picture and was more present in male patients. Individual negative symptoms were associated with the effectiveness of rehabilitation. Despite the generally comparable level of social functioning in patients of different sexes, functioning in different spheres is mediated by the gender factor. Factors associated with the social functioning of patients include employment, experience of own family and independent living. As a result of treatment and rehabilitation measures, there is a tendency to decrease the severity of positive and negative symptoms, a reliable decrease in the severity of depressive symptoms and an increase in the level of social functioning of patients.

Conclusions. The clinical and functional characteristics of schizophrenia remission are gender-specific. Differentiated assessment of patients’ social functioning should include professional and microsocial adaptation. The criteria for evaluation of the effectiveness of treatment and rehabilitation measures in remission of schizophrenia include reduction of the severity of residual symptoms and increase in the level of social functioning of patients.

Neurology Bulletin. 2020;LII(2):33-39
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Clinical structure of psychoses, associated with use of modern synthetic psychoactive substances
Usov G.M., Rakitin S.A.
Abstract

Psychoses associated with use of modern synthetic psychoactive substances (PAS) have significant differences in clinical features for making accurate diagnosis. These features play important role in correct diagnosis of psychoses, associated with synthetic cannabis (spice), synthetic stimulants (bath salts), and synthetic GABA-agonists (butyrates) still badly investigated.

The aim of this study was to reveal main symptoms and syndromes of psychoses associated with modern synthetic PAS.

Methods: clinical and psychopathological, laboratory, statistical.

Results. We examined 154 patients with psychoses associated with modern synthetic PAS: 53 users of synthetic cannabinoids (spices), 54 users of synthetic psychostimulants (cathinones, metcathinones, “bath salts”), and 47 users of synthetic GABA-agonists (butyrolactone).

Conclusion.  Differences in psychotic symptoms in different groups are described.

Neurology Bulletin. 2020;LII(2):40-45
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Awareness of russian doctors about autism spectrum disorders (results of sociological research)
Мukharyamova L.M., Saveljeva J.V., Mendelevich V.D.
Abstract

Aim. Identification of awareness in doctors of different specialties (pediatricians, child psychiatrists, neurologists) on a wide range of issues of diagnosis, etiology, therapy of children with ASD.

Methods. There was a survey conducted on the author’s questionnaire. It was answered by 400 doctors working in the large, medium, and small cities and towns in 35 subjects of the Russian Federation, representing all Federal districts. In the sample there were pediatricians (53%), psychiatrists (24.2%), neurologists (14.7%), 8.2% did not specify a specialty. 89.2% of respondents are women and 10.2% are men.

Results. 70% of doctors believe that the number of children with ASD has increased dramatically in recent years. A fifth of respondents found it difficult to answer, 10% said that the number remained the same. The distribution of responses to the question by the profile of specialists indicates the relationship of variables. Neuropathologists and psychiatrists more often chose the answer option “increased sharply” (χ2=32.528, p <0.01). The distribution of different specialists’ opinions on the factors that cause changes in the number of children with ASD in society did not have statistically significant differences. About 40% of pediatricians, neurologists, psychiatrists, and other doctors chose the factors “improvement of quality in diagnostic procedures” and “increasing availability of medical care”; about a third noted — “reducing child mortality and, as a result, increasing diversity”, about a quarter chose “an environmental impact”, “changing the rules of medical statistics”. It is alarming that when asked about the impact of vaccinations on the occurrence of autism, only 46.9% indicated that this is a myth, about 2.8% indicated that autism is a reaction to vaccination, the majority of respondents (50.3%) chose the option that there is not enough data in medicine to confirm or disprove this position.

Conclusions. The results of the study allow us to conclude that it is necessary to increase the awareness of doctors about the current state of research on the problem of ASD. Educational programs are needed taking into account not only medical data but also approaches developed in the social Sciences.

Neurology Bulletin. 2020;LII(2):46-51
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Influence of oxygen therapy methods in comprehensive treatment on cognitive functions at correction of alcohol withdrawal syndrome
Kopytov D.A., Bychenko I.V., Kopytov A.V.
Abstract

Aim. Based on the application of methods of normoxic therapeutic compression and hyperbaric oxygenation in combination with pharmacotherapy for the relief of cognitive impairment in alcohol withdrawal syndrome (AWS), to evaluate the effectiveness of their use to optimize the treatment process.

Methods. 160 patients with AWS were examined: 62 people underwent hyperbaric oxygenation and 56 normoxic therapeutic compression sessions along with symptomatic pharmacotherapy, 42 with drugs in accordance with medical care protocols. To assess the severity of the manifestations of AWS, the CIWA-A scale was used. Diagnosis and clinical verification of the diagnosis of alcohol dependence was carried out in accordance with the research criteria of the ICD-10 and AUDIT. To study cognitive impairment, the Schulte table technique was used.

Results. The use of the method of normoxic therapeutic compression in the complex treatment of AWS increases the “mental performance” after the first day of therapy by 4.6 times, after the third day of therapy, 3.18 times, after the seventh day of therapy, 3.25 times, compared with drugs.

Conclusion. Oxygen therapy methods in combination with pharmacotherapy should be used when stopping cognitive impairment in alcohol withdrawal syndrome, which will increase the effectiveness of treatment and avoid possible cognitive impairment in pharmacotherapy.

Neurology Bulletin. 2020;LII(2):52-58
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The relation between perceived level of the instrumental support’s exchange and the patterns of internet using in men with mental disorders
Boyko O.M.
Abstract

Relevance of this work is determined by the fact that the exchange of the instrumental social support plays an important role in the prevention of lowering the level of the social adaptation in people with mental illness.

Aim of this work is to study the relative different types of internet using and amount of instrumental support in people with mental illness.

Material and methods. 84 men between 16 and 32 years were interviewed through the questionnaires COPE, California social networks inventory, questionnaire to the pictures of the social networks, semi-structured questionnaire for internet-using research.

Results. (1) Absence of social networks (sites) usage for contacting with people can reduce intensity of exchange of instrumental social support. (2) The lack of usage internet for contact with old friends has a negative impact on the exchange quality of instrumental social support. It can contribute to a trained helplessness. (3) Informational internet using can reduce a frequency of use of coping strategy - “recourse to instrumental support”, which can be related to a stronger sense of empowerment. (4)  Entertaining use of Internet technologies can reduce a number of ineffective requests for practical help.

Conclusion. Therefore, using of internet technologies is related to perception of own system of exchange of instrumental social support as more effective. It must be considered in programs of social rehabilitation for people with mental illness.

Neurology Bulletin. 2020;LII(2):59-62
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Reseach of the association of suicidal behavior and sleep disorders in persons with alcohol addiction
Efremov I.S., Asadullin A.R., Nasyrova R.F., Akhmetova E.A., Yuldashev V.L.
Abstract

The purpose of the work is to determine the associations of sleep disorders and subjective perception of sleep quality with suicidal behavior and depressive manifestations in individuals with alcohol dependence.

The following methods were used — a method of clinical interviewing, a psychodiagnostic method and the method of processing statistical data. We examined 128 patients with chronic alcohol dependence (100 men and 28 women) aged 18 to 55 years, the average age was 41.66±8.09 (median 41). There were used the following psychodiagnostic scales: Columbia–Suicide Severity Rating Scale (Posner K. et al., 2007); Montgomery–Asberg Depression Rating Scale (MADRS, Montgomery S.A., Asberg M., 1979); The Pittsburgh Sleep Quality Index (PSQI, Buysse D.J. et al., 1989); Insomnia Severity Index (ISI, Morin S. et al., 2011). Statistical methods: Shapiro–Wilk test, Mann–Whitney U-test, Spearman’s Rank correlation, Kruskal–Wallis test, Pearson’s chi-squared test.

Results. No correlation was found between the intensity of suicidal thoughts and sleep disturbances and sleep quality. People with suicidal ideation of insomnia have more pronounced insomnia. Associations were identified in the form of a direct correlation between sleep disorders and subjective sleep quality and the severity of depressive experiences.

Conclusions. It can be assumed that if there are any suicidal ideas regardless of the severity of these, insomnia is more pronounced. It may become an early criterion for diagnosing suicidal risk in the future. Sleep disturbances are associated with depressive symptoms and occur even when the clinical criteria for depressive disorder cannot be confirmed. Findings suggest the presence of more complex relationships of the described phenomena, which is planned to be studied in further clinical studies.

Neurology Bulletin. 2020;LII(2):63-66
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Relationship of background electroencephalogram with cognitive impairment in patients with alcohol dependence
Galkin S.A., Peshkovskaya A.G., Roshchina O.V., Belokrylov I.I., Bokhan N.A.
Abstract

A significant number of studies have focused on the neurophysiological basis of cognitive dysfunction among individuals with neurological and psychiatric disorders, including alcoholism. However, the neural correlates of cognitive deficits in alcohol dependence are still not clear enough.

The purpose of the study: to identify the relationship of background electroencephalogram indicators with cognitive disorders in patients with alcohol dependence.

Material and methods. 107 patients with alcohol dependence aged 30 to 60 years after detoxification were examined. The background electroencephalogram was recorded with closed eyes for 2 min. The values of the absolute spectral power of theta, alpha and beta rhythms were analyzed. The study of the level of Executive functioning was conducted using the Go/Nogo test. The level of spatially working memory was evaluated using the Corsi Block-Tapping test.

Results. Data analysis revealed statistically significant correlations between the spectral power of the alpha rhythm in the occipital cortex and the number of errors per inhibitory signal (Nogo) in the Go/Nogo problem (r=–0.287; p=0.025). There were also statistically significant correlations between the values of alpha-rhythm spectral power and working memory in the Corsi test in the parietal cortex (r=0.273; p=0.037), occipital cortex (r=0.316; p=0.015) and temporal cortex (r=0.359; p=0.005). There were no statistically significant correlations of beta and theta rhythms with the results of cognitive tests (p >0.05).

Conclusion. Thus, all of the above results indicate that the background EEG indicators, in particular the spectral power of alpha activity, can with a certain probability indicate violations of cognitive functioning (inhibitory control and working memory) in patients with alcohol dependence.

Neurology Bulletin. 2020;LII(2):67-71
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Discussions
How and why psychoanalysts become storytellers. Part 2
Zislin I.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(2):72-78
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Adversarial nature of the parties in the litigation, related to the assessment of mental health of participants
Mendelevich V.D.
Abstract

The article analyzes the problem of public distrust in the objectivity of the conclusions of forensic psychiatric examinations. It is stated that this is due to the lack of adversarial nature of the parties in real practice. It is concluded that the introduction of the principle of adversarial nature of the parties between an expert psychiatrist and a specialist psychiatrist can significantly increase the objectivity and reasonability of forensic psychiatric conclusions, reduce public distrust in them and increase the credibility of forensic psychiatry.

Neurology Bulletin. 2020;LII(2):79-82
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Psychiatry: a philosophy of cognitivism and/or clinical medicine (methodological discourse 1)
Nosachev G.N., Nosachev I.G.
Abstract

Based on the philosophy and methodology of science are discussed two provisions of article by Y.P. Sivolap and A.A. Portnova “Psychiatry: scholastic philosophy and clinical medicine?” the subject of psychiatry and “expansion” of neurologists in clinical psychiatry organic dementia. Differences between neurologists and psychiatrists in the concept of “dementia” are analyzed. Discussed proposed by E.V. Makushkin and L.E. Pischikovа “The Concept of understanding late age” for clinical gerontopsychiatry and all of the clinical neurosciences.

Neurology Bulletin. 2020;LII(2):83-88
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Recommendation for practitioners
Clinical diagnostics in psychiatry — empirical and theoretical levels of knowledge (on the example of analysis of a written text). Part 1
Davtian E.N., Davtian S.E., Uryson E.V.
Abstract

The paper shows correlation of empirical and theoretical levels of knowledge in psychiatry by analyzing a single text written by a patient. The patient’s text is analyzed three times. The first analysis performed by a linguist demonstrates how informative for a clinician can be an attentive attitude to the patient’s Word. The second analysis is a standard procedure for psychiatric phenomenological diagnostics. It is shown that the formulation of a clinical diagnosis from epistemological positions is equivalent to establishing a scientific fact (completion of empirical research): there is no theoretical modeling of pathological processes in psychiatry today; it all ends at the stage of recognizing the symptoms, without any attempt to understand them. The third analysis demonstrates the advantages in understanding pathological mechanisms provided by the explanatory model (interpretation of the text from the perspective of the bipersonal model of personality).

Neurology Bulletin. 2020;LII(2):89-96
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Psychotherapy, psychological education, medical education in the work of a particular child / adolescent psychiatrist
Shmakova O.P.
Abstract

In order to develop a comprehensive methodology for outpatient psychiatric care for children and adolescents that can improve the social adaptation of patients, we analyzed the data of long-term clinical catamnestic follow-up of a cohort of patients with various mental disorders in childhood and adolescence. The methods of psychotherapy, psycho-education and medical education suitable for outpatient care are discussed.

Neurology Bulletin. 2020;LII(2):97-101
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Наблюдения из практики
A clinical case of ischemic stroke in a young patient with thrombophilia
Minina J.D., Strelnikova I.A., Svetkina A.A., Kalinin V.A.
Abstract

A clinical observation is presented of a young patient with a rare form of homozygous mutation, which caused recurrent pulmonary embolism, ischemic stroke in the left middle cerebral artery basin. To determine the etiology of recurrent thrombosis, instrumental diagnostic methods were performed to exclude dissection of extra- and intracranial arteries, heart diseases, as well as laboratory methods to detect thrombophilia, antiphospholipid syndrome, connective tissue diseases, and the blood system. According to the results of the examination, the patient revealed a homozygous mutation of the plasminogen activator inhibitor PAI-1, which, in the absence of other factors, can be considered as a probable cause of recurrent thrombosis. During treatment, the patient’s condition improved, focal neurological symptoms partially regressed. As a secondary prophylaxis, the patient was prescribed lifelong administration of warfarin under the control of INR.

Neurology Bulletin. 2020;LII(2):102-104
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Obituary
Professor Maksum Fasakhovich Ismagilov (November 30, 1936 - July 3, 2020)
 
Abstract

On July 3, 2020, after a long illness, Maksum Fasakhovich Ismagilov died.

Neurology Bulletin. 2020;LII(2):105-106
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