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Vol LIII, No 1 (2021)

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Tzar cloudy Ivan in thepsychiatric chambers

Mendelevich V.D.


The article describes a clinical case of patient P., 43 years old, a political activist who conducted extravagant performances in the image of the Tsar, who called for a return to monarchical rule and, in connection with this, was hospitalized involuntarily in a psychiatric hospital. A comparative analysis with the actions of Pyotr Pavlenky and Pavel Krysevich is carried out, the contribution of the psychopathological to the creative activity of representatives of contemporary art is estimated. The validity of the psychiatric diagnoses exposed to patient P., the recognition of his social danger and the validity of the appointment of compulsory inpatient treatment to him are evaluated. It is concluded that freak behavior, presenting itself through actionism, performances and dissent, needs a serious psychological and psychopathological analysis. Often, such dissent becomes a way of self-realization or provocation (trolling), but psychopathology is also capable of hiding behind it. It is stated that this should in no way diminish the social significance and the creative component of the performances and actions of people considered to be freaks. In addition, it is argued that actionism should not be perceived as a socially dangerous act, and there is no reason to imprison a person or send a patient to a psychiatric hospital for compulsory treatment for performances.

Neurology Bulletin. 2021;LIII(1):5-12
pages 5-12 views

Mind and brain: what is the connection? Clinical and philosophical aspects

Zobin M.L.


The analytical review touches on clinical, neurobiological and philosophical problems of the relationship between brain and mind. With regard to the needs of clinical practice, the ontological aspects of consciousness and free will are considered, and some theoretical models of behavioral psychopathology are analyzed. A conclusion is made about the priority in psychiatry of the neurobiological paradigm while maintaining interest in modern forms of interactionist and property dualism.

Neurology Bulletin. 2021;LIII(1):13-18
pages 13-18 views

Original study arcticles

The ability to recognize odors in patients suffering from the schizophrenia spectrum disorders and depressive disorders

Dmitrieva N.G., Shunenkov D.A., Enikolopov S.N.


The works’ purpose was to study connection between smell malfunction that reduces level of smell recognition (anosmia) and current emotional condition of patients who suffer from schizophrenia spectrum disorders and patients with depressive disorders.

Methods of research. Patients who suffer from schizophrenia spectrum disorders (F20, F21, F23, F25), depressive disorders (F32, F33), and healthy individuals were examined. Methods of evaluation of current emotional condition were Beck Depression Inventory and Snaith–Hamilton Pleasure Scale. To determine malfunction of smell function “Professional olfactometric set of odorous substances “RAMORA” was used.

Results. In patients with schizophrenia spectrum disorders, the level of smell recognition is significantly lower than in the group of patients suffering from depressive disorders and the group of healthy people. When comparing patients with depressive disorders with a group of healthy individuals, there is a slight decrease in the identification of odors, close to normal values. In patients with depressive disorders and patients with schizophrenia, an increase in the level of anhedonia and depression is detected in comparison with healthy subjects. The overall level of smell recognition is not related to the indicators of the current emotional state (depression and anhedonia) in both clinical groups. However, the relationships between the identification of individual odorants and the actual emotional state in the group of patients with schizophrenia spectrum disorders were revealed.

Conclusions. A decrease in the level of odor identification (anosmia) is observed in patients with schizophrenia spectrum. These disorders are not typical for patients with depressive disorders and people who do not suffer from mental illness. The obtained results require additional research. It can be assumed that the indicators of olfactory processes can be an additional diagnostic method of the emotional and personal sphere of patients with the schizophrenia spectrum disorders.

Neurology Bulletin. 2021;LIII(1):19-22
pages 19-22 views

Mental health of university teachers under pandemic conditions: risk factors and ways of coping with them

Ryabova T.V., Petrova R.G.


Aim. The study of mental health risk factors in teachers in higher education and ways of coping with them under pandemic conditions in the period of forced switching to remote mode of education.

Methods. Interdisciplinary psychological and sociological questionnaire-based survey of University teachers. A uniform feedback form contained the author’s sociological questions, and the questions defining the extent of neuropsychic tension. The collection of empiric material was performed using Google Forms; the qualitative and quantitative analysis of the teachers’ answers was carried out by statistical and interpretative methods.

Results. The mental health risks can include the increased workload, the tension caused by this fact, the strict control of the teacher’s work activities by the authorities. In 86.1% of the teachers, the tension in the period of remote work was accompanied with pains in various parts of the body, irritability, insomnia, and etc. A moderate neuropsychic tension was observed in 65% of teachers, and every forth of them (25.2%) experienced excessive, pronounced tension. In 20.6% of teachers, the stress and tension contributed to success and efficiency of the activities. The major part of teachers (70%) remained satisfied with their own performance capabilities.

Conclusion. It is necessary to develop and implement a health protection program focused on the increase of the efficiency of professional activity, the personality resources, and the formation of psychological practices of the teachers’ personality self-preservation, self-realization and self-education.

Neurology Bulletin. 2021;LIII(1):23-27
pages 23-27 views

The acute vestibular dysfunction in emergency neurology

Kazancev A.Y., Yakupov E.Z.


The aim of this study is to research the structure of acute vestibular disorders at the stage of the emergency room and to determine the frequency of occurrence of life-threatening conditions.

Material and methods. It was made the analysis of acute vestibular disorders at the stage of emergency room of the Neurology department of Clinical Hospital No. 7, City Clinical Hospital No. 18 and stroke center of Interregional Clinical Diagnostic Center in Kazan, Tatarstan Republic, Russian Federation, for the period 2016–2020. The diagnosis of vestibular disorders was established on the basis of clinical data. There were additional instrumental researches made in doubtful cases. Statistical data processing was made using Microsoft Excel 10.0 program.

Results. The study included 106 patients in total with reliably established pathology of the peripheral or central vestibular system. The peripheral or functional nature of vestibular disfunctions were identified in 84% patients. 57% patients had benign paroxysmal positional vertigo. 42% of these patients had repeated benign paroxysmal positional vertigo attack. Vestibular neuronitis and Ramsey Hunt syndrome were detected in 15% patients. Acute cerebrovascular origin was diagnosed in 10% patients (10 ischemic strokes and 1 transient ischemic attack). 1 patient had an Arnold–Chiari malformation with the development of occlusive hydrocephalus. So, 12 patients had a life-threatening cause of vestibular pathology, among them only 2 patients had isolated vestibular symptoms. Vestibular migraine was diagnosed in another 5% patients.

Conclusions. Life-threatening causes of vestibular pathology account for 11% of all cases. Focal neurological symptoms are the main “red flags” of systemic vertigo. Benign paroxysmal positional vertigo is detected in 57% of cases of vertigo in the emergency room.

Neurology Bulletin. 2021;LIII(1):28-33
pages 28-33 views

The role of gastrointestinal specific anxiety and alexithymia as predictors of the severity of irritable bowel syndrome in women

Melehin A.I.


Aim. To analyze the role of gastrointestinal specific anxiety and alexithymia in predicting the severity of the disease in 194 women with moderate to severe IBS with refractory course (average duration of the disease 38.4 months).

Methods of investigation. Gastrointestinal Symptom Rating Scale-IBS (GSRS-IBS), Irritable Bowel Syndrome Severity Scoring System (IBS-SSS), Visceral Sensitivity Index (VSI), TAS-20, HADS, and SF-12.

Results. It was shown that in women, the severity of irritable bowel syndrome and the risks of refractory course are closely related to high alexithymia and uncontrolled gastrointestinal specific anxiety, which are also related to each other. Patients with severe IBS significantly differ from patients with moderate symptomocoplex manifestations (pain, bloating, diarrheal manifestations), satisfaction with the quality of life, pronounced symptoms of depression, visceral sensitivity and alexithymia, which contributes to the formation of a number of therapeutic barriers. Regression analysis showed that the severity of IBS was equally predicted by presence of alexithymia and gastrointestinal specific anxiety in the patient.

Conclusions. Alexithymia, especially the difficulty of expressing negative emotions (for example, irritation, anger), describing feelings, desires to other people, was a stronger factor in women predicting the severity of IBS compared to gastrointestinal specific anxiety. The presented symptomatic picture of alexithymic manifestations in patients with IBS shows that violations of emotional awareness affect the pathogenesis, the spectrum of reinsurance and avoidance behavior.

Neurology Bulletin. 2021;LIII(1):34-40
pages 34-40 views


Psychotherapy, psychoanalysis and anthropology: how a psychiatrist becomes a sophist (commentary to Joseph Zislin, md, part 1)

Martynov I.A.


“How and why psychoanalysts become storytellers” is a two-part article by Joseph Zislin, MD published by the “Neurology Bulletin” in 2020. In this paper Dr. Zislin studies several quasi-psychoanalytical essays on famous fairy-tales, published by physicians and psychologists online. Surprisingly, it is from his own philological discussion of their texts which Dr. Zislin draws conclusions about therapeutic abilities of the authors, as well as about the relevance of psychoanalysis to clinical practice and social studies alike. The present text is a commentary to Dr. Zislin’s “How and why psychoanalysts become storytellers”. It studies the ways of gathering and presenting data exercised in the original paper, as well as the strategies of argumentation Dr. Zislin chooses. Although one cannot tell for sure whether the data presented were distorted on purpose or not, choosing the strategy of argumentation is always a more or less conscious decision. Some analytic tools of rhetoric allow one to demonstrate that Dr. Zislin uses argumentation unacceptable in academic writing — that of deceptive reasoning, logical fallacies and “sophisms”. The present commentary is to highlight a problematic issue: should a practicing physician adhere to rules and norms of other disciplines, once he goes beyond the strict academic field of clinical medicine?

Neurology Bulletin. 2021;LIII(1):41-47
pages 41-47 views

About permanent diagnostics in child psychiatry

Pashkovskiy V.E.


The article analyzes the problem of diagnosis in child psychiatry. It is shown that errors in it are largely associated with the features of development at the early stages of ontogenesis. The need to take into account in the diagnostic process the theoretical positions of P.P. Blonsky, L.S. Vygotsky, D.B. Elkonin about crises in childhood and adolescence and V.V. Kovalev about the levels of neuropsychic response are discussed. The article shows that early developmental arrhythmia affects the diagnosis of such a pathology as autism spectrum disorder. It is emphasized that the typical childhood clinical diffuseness of the disorder is underestimated. It is argued that the heterochrony of development in childhood strongly requires a transition from noso-centered to risk-centered diagnostics.

Neurology Bulletin. 2021;LIII(1):48-51
pages 48-51 views

Discussion questions about the therapy of nonchemical addictions

Egorov A.Y.


Today there are no international standards for the treatment of non-chemical (behavioral) addiction (NA). This is largely due to the vagueness of their existence as nosological units and, as a consequence, their place in international classifications. This article discusses the forms of NA that are or will be included in DSM-V and ICD-11. It has been shown that NA research has sparked discussions about the spectrum of addictive disorders, expands the multidisciplinary understanding of the etiology and pathogenesis of addictive disorders, and promotes the study of new forms and expansion of therapeutic approaches. The criticism of the addictive spectrum concept is analyzed. The modern approaches of non-drug and pharmacological therapy of different forms of NA are presented.

The following conclusions are drawn.

  1. The existence of NA is confirmed by the inclusion of a part of them in the International Classifications of Diseases.
  2. NA have high comorbidity with other mental disorders, in respect of which pharmacotherapy and psychotherapy are not in doubt.
  3. Taking into account the general neurobiological mechanisms of the formation of addictive disorders, the possible pharmacotherapy of non-chemical addictions, officially recognized in the ICD and DSM, should proceed from the currently available approaches to the therapy of substance use disorders.
  4. Treatment of non-chemical addictions that are not included in the International Classifications can only be carried out within the framework of therapy for confirmed comorbid mental disorders. In its absence, psychological correction seems to be possible.
  5. There is an obvious need to continue researching the problem of non-chemical addictions to expand new approaches to their therapy and psychological correction.
Neurology Bulletin. 2021;LIII(1):52-56
pages 52-56 views

Diagnosis in the one-dimensional psychiatry

Davtian E.N.


Based on the analysis of the semantic content of the word “diagnosis” in general medicine and psychiatry, the author comes to the conclusion that of all the functions of diagnosis (medical, social, economic and statistical), modern psychiatric diagnosis has only the last two ones — economic and statistical. The clinical (medical) component of the diagnosis disappears. The origins of this state of things are analyzed. The article substantiates the position that the statistical language of operational psychiatry is a kind of pidgin languages, which led to the one-dimensional psychiatry.

Neurology Bulletin. 2021;LIII(1):57-60
pages 57-60 views

Mental disorder as a natural cataclysm: boundaries of а psychopathological landscape

Davtian S.E.


The main obstacle to the development of a reliable taxonomy of mental disorders is an incorrectly formulated problem: natural classification requires discrete elements, while the clinical picture of diseases does not meet this requirement. An alternative project is proposed, the essence of which is to create a map of the psychopathological landscape based on discrete landscape-forming factors, by analogy with models successfully used in climatology.

Neurology Bulletin. 2021;LIII(1):61-64
pages 61-64 views

Treatment without diagnosisand diagnosis without treatment

Zislin I.M.


In this article we try to compare psychiatric and psychoanalytic approaches to diagnosis. It is shown that the psychiatric diagnosis is based upon the metonymic principle, while the psychoanalytic diagnosis is based entirely on the metaphor. This fundamentally different approach leads to the fact that, unlike psychiatry, there is no place for malingering in psychoanalysis.

Neurology Bulletin. 2021;LIII(1):65-68
pages 65-68 views

Uncomfortable treatment without diagnosis

Zorin N.A.


One explanation for breakdown of the traditional medical connection of diagnosis and treatment is presented. It is suggested that it was a natural process brought to life by the results of the development of genetics and the results of the application of clinical epidemiology (the theory of evidence-based medicine), which led to the beginning of the downfall of the nosological concept, so far de facto, and in the long term de jure. Medicine is painfully returning to a holistic view of a patient.

Neurology Bulletin. 2021;LIII(1):69-70
pages 69-70 views

Diagnosis of schizotypal disorder: reliability of categorial approach or validity of dimensional one?

Kotsiubinskii A.P., Isaenko Y.V.


The article examines the problem of modern classifications used in psychiatry (ICD, DSM) that are devoid of the fundamental scientific base and primarily serve the goals of statistics and epidemiological research. In this context researchers are increasingly interested in the relationship between the two diagnostic approaches: categorical and dimensional. It is noted that each of these approaches has its own advantages and disadvantages. In this context it is proposed to take into consideration while making a diagnosis of schizotypal disorder not only typological (categorical) attributes but also dementia characteristics of the patient’s mental status, which, in the holistic approach, should be compared with the psychological, social and functional diagnosis.

Neurology Bulletin. 2021;LIII(1):71-75
pages 71-75 views

Brief communications

Psychological well-being of outpatients with mental disorders during the COVID-19 pandemic — a brief survey results

Chumakov E.M., Azarova L.A., Limankin O.V.


Aim. The aim of the study was to assess the impact of the COVID-19 pandemic and the social restrictions associated with it on the psychological well-being of outpatients with mental disorders.

Methods. A total of 151 outpatients (60.9% female; mean age 34.4±12.9 years) who received treatment at psychiatric day hospitals in St. Petersburg during the first two weeks of May 2020 participated in the study.

Results. The majority of respondents (72.8%) indicated that they became more stressed during the COVID-19 pandemic, including one-third of patients (29.1%) indicating deterioration in family relationships. Two-thirds of patients (60.3%) indicated that the COVID-19 pandemic and the restrictions imposed in connection with it resulted in and increased anxiety and distress.

Conclusions. This study confirmed that outpatients with psychiatric disorders, as well as the general Russian population, experienced an increase in stress, anxiety, and distress during the COVID-19 pandemic. The results of the study underscore the importance of continuing to provide outpatient psychiatric care during epidemics or social upheaval, despite the imposition of social restrictions.

Neurology Bulletin. 2021;LIII(1):76-79
pages 76-79 views

Error-related negativity: neurocognitive transdiagnostic marker of anxiety disorders

Sagalakova O.A., Truevtsev D.V., Zhirnova O.V.


The article is devoted to the analysis of the prospects for research on neurocognitive mechanisms of anxiety disorders. In response to limitations and contradictions in the logic of the categorical method of classification of mental disorders, the popularity of the dimensional approach, in which the emphasis shifts to the assessment of the severity of symptoms. The National Institute of Mental Health has developed the promising approach based on the search for systemic neurobiological foundations of mental disorders. Based on the project RDoC (Research Domain Criteria) the search for trans-diagnostic mechanisms of mental disorders has been updated. The logic of RDoC echoes the position of Russian pathopsychology, in which the syndrome of mental activity disorders is considered in dynamics, the mechanisms of the functioning of the psyche are qualified as identical in norm and pathology. In the study of anxiety-related disorders, the obvious commonality of the spectrum of manifestations that acquire nosological clarification against the background of the escalation of the severity of symptoms and secondary compensatory processes has repeatedly been put forward in the center of research attention. The aim of the article is a theoretical and methodological analysis of the neurocognitive basis of the errors monitoring system, characteristic of normal and excessively expressed in anxiety disorders, including ERP component — error related negativity (ERN). As a result, it is shown that this neurocogitive marker, experimentally modeled in conflict tasks (e.g., Eriksen’s flanker task), is expected to be a probable transdiagnostic basis for anxiety-related disorders (social anxiety disorder, obsessive-compulsive disorder). The increase in the amplitude of ERN in internalization, uniting anxiety-depressive symptoms, is explained by individual differences in the readiness to detect error and sensitivity to incorrect decisions. At the moment, the study of ERN retains the “tempted” of simplified interpretations, the arbitrary establishment of direct causal connections between the neural basis and mental phenomena.

Neurology Bulletin. 2021;LIII(1):80-83
pages 80-83 views

Mental disadaptation correction of the family members of dangerous professions workers

Kivorkova A.Y., Soloviev A.G.


Aim. The aim of the paper was the substantiation the directions of correction the emotional state of the family environment of the family members of dangerous professions on the basis of biobehavioral therapy using biofeedback technology.

Methods. 47 women were examined (29.3±4.7 years) — wives of employees whose professional activities are related to solving professional problems in extreme conditions. The hardware and software complex “BOS-Pulse” with the “Pulse” module with game plots, “Multipsychometer” was used. According to the pulse recorded by the photoplethysmographic method, a spectral analysis of heart rate variability was carried out using a program for processing data from game biocontrol. The control of efficiency was carried out according to the functional parameters of the cardiovascular system and indicators of the color choice test.

Results. By the end of the training, all women had mastered the skill of increasing R–R-intervals. The value of the stress index of Baevsky’s regulatory systems during the course of biobehavioral therapy decreased from 73.2±17.8 to 56.8±25.4, the index of vegetative balance — from 132.7±29.2 to 84.5±45.2. According to the test of color choices, a pronounced deepening of positive tendencies in terms of psychological indicators was noted, which, in general, was expressed in a significant decrease in anxiety and fatigue with a simultaneous increase in working capacity and indicators of the vegetative coefficient.

Conclusions. Correctional trainings with the use of biocontrol technology led to an improvement in personal adaptive characteristics, the formation and consolidation of the conditioned reflex skill of self-regulation and a corrective behavioral stereotype that promotes activation of the body’s reserve capabilities. The effective behavioral strategies of self-regulation developed by women contributed to the training of productive techniques for counteracting stressors associated with the specifics of husband’s professional activities and, accordingly, with the family microclimate.

Neurology Bulletin. 2021;LIII(1):84-87
pages 84-87 views


Review of the book by V. E. Pashkovsky "10 lectures on autism" Moscow: medpress-inform. 2021; 136 p. [1]

Egorov A.Y.


The problem of autism spectrum disorders (ASD) and early childhood autism, in particular, has become one of the most discussed problems of child psychiatry in recent years. For example, a search for publications with the keywords "Autism Spectrum Disorder" in PubMed for 2019 offers 4523 results, and for 2010 — 1795 links. This is due to a number of reasons.

Neurology Bulletin. 2021;LIII(1):88-90
pages 88-90 views

Passion for autism (on the controversial and indisputable aspects of V.E. Pashkovsky monograph “10 lectures on autism”)

Mendelevich V.D.


The article analyzes the scientific foundations set out in the book by V.E. Pashkovsky “10 lectures on autism”. It is noted that the author expresses his own point of view on autism and does not agree with the position of the World Health Organization and the world psychiatric community on the diagnostic criteria and treatment strategies for autism spectrum disorders. If on the issue of the peculiarities of diagnostics, the author’s arguments can be recognized as admissible, since the diagnosis in modern psychiatry reflects the consensus of specialists, then some provisions of V.E. Pashkovsky on the topic of the validity of the use of antipsychotics (neuroleptics) for the treatment of patients with autism should be considered as undocumented and misleading specialists.

Neurology Bulletin. 2021;LIII(1):91-93
pages 91-93 views

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