Vol LIII, No 1 (2021)

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.

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.

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.

“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?

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.

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.

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.

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.

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.

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.