Vol LII, No 3 (2020)

The article analyzes the problem of scientific groundlessness, inexpediency and unethical use of instrumental paraclinical methods for diagnosing mental and behavioral disorders. An opinion is expressed about the discrepancy between instrumental diagnostics and the criteria set out in international classifications. The use of polygraph examination, profiling and eye tracking in forensic psychiatric expert practice is criticized. It is concluded that in the context of a subjective interpretation of the results obtained and the absence of evidence of correlations between the clinical syndrome and psychophysiological parameters, the conclusion about the presence of psychopathological disorders based on the proposed methods should be recognized as dangerous for the fate of patients and discrediting psychiatric diagnostics.

Norm and illness, stages of illness, forms of illness differ from each other in qualitative, and not quantitative characteristics. Psychometric tools are unable to capture the gestalt of the clinical picture and determine the qualitative changes taking place in it. The article argues for the pseudoscientific basis and unreliability of quantitative measurements of intelligence, personality, statics and dynamics of mental illness.

Aim. Identify the adaptive level of stigma and describe its characteristics.

Methods. Adapted for the cardiology clinic questionnaire of N. Sartorius, symptomatic questionnaire SCL-90-R (Simptom Check List-90-Revised), Schutz’s Interpersonal relations questionnaire (1958), Tobol test method of the type of attitude to disease and treatment, and the Personal differential questionnaire. The data obtained were processed using the statistical program SPPS 20.

Results. The study determined the optimal degree of stigmatization, which performed a positive role in relation to the state of health, helping patients to adequately assess the severity of the pathology, identify themselves with the disease and realize the necessary measure of their own responsibility in the treatment process (from 48 to 60). Clinical and social factors of optimal degree of stigmatization and successful rehabilitation of cardiology clinic patients are identified (resources): the patient’s higher education and the family’s tendency to low-protecting position potentially contribute to the treatment and rehabilitation of cardiology clinic patients with moderate severity of their somatic condition. Clinical and social factors (anti-resources) that prevent the formation of an optimal degree of stigmatization and successful rehabilitation of patients are identified: the operative type of treatment, the overprotective position of the family, which is not justified by a real need, and the low level of education. It is established that the absence of pronounced pathocharacterological features and difficulties in interpersonal interaction of patients with an average level of stigmatization is an argument for determining this level of stigmatization as a resource. According to the results of the study the tasks for the medical psychologist of the cardiology clinic are set:

1) diagnostic, which consists in determining the level of stigmatization, analyzing the ratio of the degree of stigmatization and the degree of severity of cardiovascular pathology, studying individual resources and anti-resources (attitude to the disease and treatment, pathocharacterological features and interpersonal features);

2) psychocorrective, which consists in forming an adequate position in relation to the disease and treatment of patients and their families, restoring intra-family ties, changing inadequate responses to the disease, creating realistic attitudes to treatment in patients and their family members.

Conclusion. The average degree of stigmatization is formed in patients in the absence of a pronounced personal and interpersonal problems, allowing them to receive social support in the conditions of restrictions imposed by the disease, and adapt to it. The average level of stigmatization in this case acts as an additional psychological resource for patients.

The aim of this study is to analyze the occurrence of depressive and anxiety disorders in patients with COVID-19 and to study the relationship of these disorders with organic damage to the central nervous system.

Material and methods. An analysis of occurrence of depressive and anxiety disorders in patients with COVID-19 was carried out at the infectious hospital of the KBGMU for the period June-August 2020. Depression and anxiety were identified using the Hospital Anxiety and Depression Scale (HADS) and compared with the MRI data of the brain. Statistical data processing was carried out using Microsoft Excel 7.0.

Results. According to the analysis, out of 76 patients with COVID-19, depressive disorders were observed in 36 (46.3%) patients, anxiety disorders — subclinical anxiety in 16 (21.05%), clinical anxiety — in 19 (25%). The absence of depressive disorders was observed in 40 (52.63%), the absence of anxiety — in 41 (53.94%). By gender differentiation of patients, depressive disorders in men — 20 (46.5%), women — 16 (48.48%). Anxiety disorders: subclinical anxiety in men — 11 (25.5%), women — 5 (15.15 %), clinical anxiety in men — 7 (16.2%), women — 12 (36.36%). The average age of patients at the time of the study was 45.7 years. When conducting MRI of brain, organic lesions were detected in 12 (16%) people, in 64 (84%) at the time of the study, organic lesions were not detected. When collecting a follow-up in 31 patients, depressive disorders were noted in 8 (25.8%), subclinical anxiety — 2 (6.45%), clinical anxiety — 2 (6.45%), no anxiety — 27 (87.09%), no depression — 23 (74.19%). No organic lesions were found at the time of MRI of brain.

Conclusion. When studying the occurrence of depressive and anxious states and their organic substrates, we found that there is no clear relationship between them and rather have a functional character.

Multiple sclerosis is a chronic disabling disease of the central nervous system, afflicting mainly young people. The efforts of investigators around the world are aimed at creating highly effective disease-modifying therapies that have a favorable safety and tolerance profile. The review briefly lists the disease-modifying therapies currently registered in the Russian Federation. Information is provided on the international clinical trial phases II and III of disease-modifying therapies, international nonproprietary products and/or active substance molecules, intended mechanisms of action and indicators of their effectiveness and safety. The article describes disease-modifying therapies that have been approved by the FDA and that may be available for Russian neurologists in the near future for the treatment of multiple sclerosis. The treatment possibilities of drugs used in Russia for other indications than multiple sclerosis are discussed.

The scientific review reveals the relevance of the problem of persistent disability in patients with mental disorders as one of the most important indicators of public health. It has been shown that organic pathology plays an important role in increasing of incidence of disability due to mental disorders in people of working age. In addition, the clinical and epidemiological data of recent years, confirming the large scatter of disability rates across regions and the poorly understood clinical factors that determine disability in organic mental disorders, are presented. The need for further study of predictors of health deterioration as well as risk factors for persistent disability in order to solve the problems of preventing disability and to develop personalized programs of medical and social rehabilitation is discussed.

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).

The goal of this study is to discover and describe the clinical qualities of higher cortical functions in a young Moyamoya patient with acute brain ischemia. We assessed the recovery of higher cortical functions for the period from March 2019 to January 2020. This paper presents the individual patient’s medical history and the neuropsychological evaluation conducted during the patient’s rehabilitation in January 2020.

The authors give their own clinical observation of a patient with a headache. Headache is one of the most common complaints and a diagnostic search requires a multidisciplinary approach. It is important for any specialist to answer the question with what headache he is dealing with. Is this a primary headache as a leading symptom of damage to the nervous system, or is it a secondary headache that has arisen against the background of somatic disease, as one of the manifestations of the symptoms of the disease? The next question is the choice of a diagnostic algorithm to determine the cause of the headache, and each specialist has his own one. The pediatrician primarily eliminates the secondary headache associated with an acute process or exacerbation of a chronic disease, and studies inflammatory markers. The neurologist is rather aimed at eliminating the primary headache, and the research algorithm is designed to search for an organic disease from the nervous system. In the presented clinical observation, a wide range of high-tech studies was carried out, which did not allow to determine the final diagnosis in this case.