Vol LIII, No 2 (2021)

In the article, the problem of self-harm behavior is considered in a comparative aspect — from the standpoint of hierarchical, traditional for psychiatry, and innovative network analysis. The rationale for highlighting non-suicidal behavior as an independent diagnosis is discussed. It is concluded that the analysis of the problem of self-harm behavior demonstrates the presence of many unresolved issues — from defining the boundaries of “normative” (based on youth style preferences) and psychopathological self-harm to finding correlations between suicidal and parasuicidal behavior. An innovative network analysis of psychopathology in the evaluation of this phenomenon needs further substantiation.

Many psychiatric disorders, including depression, bipolar disorder, schizophrenia, and alcohol use disorder, are characterized by an increased suicidal risk. Successful treatment of mental disorders with the use of antidepressants, antipsychotics, and mood stabilizers can reduce the risk of associated suicidality: suicidal thoughts, suicide attempts, and completed suicides. Clozapine and lithium have an outstanding ability to reduce the probability of suicide, and their common property, which determines (along with other pharmacological effects) their antisuicidal potential, is the reduction of impulsivity and aggression. In addition to significant antisuicidal activity, clozapine and lithium are characterized by both an advantage in overall clinical efficacy over other drugs of their classes, and significant risk of side effects, as well as complications of therapy.

The burden of depression is increasing worldwide, caregivers are seen as a psychologically vulnerable group, and the social burden of non-psychotic depression remains unexplored.

The aim of the study was to examine the clinical and functional characteristics of non-psychotic depression and the burden of family members of patients most involved in the interaction with patients. The study objectives included analysis of quality of life and co-occurring behavior of patients’ relatives as characteristics of their psychosocial adaptation.

Methods. We used clinical and scales assessment of depression level, quality of life, subjective distress level, and coping behavior features.

Results. Nonpsychotic depression was detected approximately half a year after the onset of symptoms, and in more than 40% of cases — not by psychiatrists, self-treatment was typical. Impairments in social functioning in non-psychotic depression patients affected more in the areas of socially useful activities and social relationships, predominantly in non-working patients. 62.96% of patients rated relationships with loved ones as good, and 82.6% rated support from relatives in connection with the illness as adequate. In 60.87% of cases, there were psycho-traumatic microsocial factors. Spouses (45.5%) prevailed among supportive relatives, of whom 60% were employed, and limitation of labor activity due to the relative’s illness was not characteristic, and material losses were insignificant. Supportive relatives more often than their sick relatives assessed the relationship with the sick as good (81.8%). In about 91% of cases, the attitude toward the mental illness of the relative was adequate, which exceeds the subjective assessment of patients with non-psychotic depression. The close relatives of the patients had decreased quality of life, which was mediated by severity of depression, higher than average level of distress related to mental disorder of the loved one (64,5±9,34 VAS scores). The structure of coping in supportive relatives is characterized on the whole by prevalence of constructive and relatively constructive coping-strategies, the most problematic being the emotional sphere of coping behavior.

Conclusion. Even mild to moderate non-psychotic depression is associated with the presence of social burden of illness, covering not only the patients themselves, but also their family members, which necessitates psychologically corrective work with supportive relatives.

Aim. Study of clinical and psychopathological characteristics in women with sexual dysfunctions and mental disorders of the psychotic level.

Material and methods. Clinical-psychopathological and sexological methods were used in the work. The results were processed using the licensed program Statistica 10.0 for Windows. At the first stage, 134 women (mean age 43.1±15.3 years) were examined who had inpatient treatment in the department for persons with non-psychotic mental disorders. At the second stage, the study involved 89 women (mean age 35.2±12.2 years), who were diagnosed with sexual dysfunctions.

Results. Clinical and psychopathological indicators were studied, clinical, psychopathological and sexological analysis of sexual dysfunctions in women with non-psychotic mental disorders was carried out, taking into account the diagnostic criteria of the International Classification of Diseases-10. Three groups of patients were identified: (1) a group of women with sexual dysfunctions caused by non-psychotic mental disorders; (2) a group of patients in whom non-psychotic mental disorders were formed against the background of primary sexual pathology; (3) a group of patients in whom non-psychotic mental disorders accompany sexual dysfunctions.

Conclusions. Sexual disorders in the studied groups are characterized by the predominance of libido disorder in the first group and the second group, as well as the predominance of dyspareunia in the third. There were no significant differences in the duration of sexual dysfunctions in the groups, which must be taken into account when choosing therapeutic and rehabilitation measures.

Aim. To study the coping behavior of persons in a pre-trial detention facility in order to identify groups at risk of psychological maladjustment.

Methods. The survey method and the Heim’s methodology for diagnosing of the coping strategies were used.

Results. It was found that non-adaptive and relatively adaptive behavioral and cognitive coping strategies prevail over adaptive ones in all the comparison groups. In all groups, the greatest number of maladaptive coping was found in the emotional sphere. The presence of adaptive cognitive coping is associated with a negative attitude to one’s offense, maladaptability of behavioral coping is associated with aggression, and emotional coping is associated with the use of psychoactive substances. The adaptability of behavioral strategies is associated with the presence of “experience” of the institutional confinement. It is established that newly arrived prisoners are at risk of psychological maladjustment, and prisoners who are held in common prison’s rooms have high indices of coping adaptability.

Conclusions. The surveyed comparison groups differ in the targets of psychological correction. The risk groups for developing mental maladjustment are newly arrived prisoners.

Psychoanalysis has met highly emotional resistance since its very “inception” in the late 19th century. A year never passes without somebody proclaiming the death of psychoanalysis. Despite such tendency, psychoanalysis is far from its decline. It is gathering new endorsers rapidly and is enhancing its positions in new geographical and cultural contexts. This article explores the possible origins of such resistance in the Russian mental health field. The author suggests that it is caused first and foremost by disciplinary discrepancies one may observe by studying the discrepancies between medical and psychoanalytical semiotics as a foundational method of the disciplines. Such view allows to explicate some problematic issues and conflicts in the Russian mental healthcare community, as well as to suggest what holds it back from obtaining significant public influence.

The article is devoted to the actual problem of subjective cognitive impairment, in particular, diagnostic methods, as well as hidden and obvious factors affecting its development. Due to the lack of effective treatment, today special attention is paid to pre-demental cognitive disorders.

Aim. Analysis of available literature data on subjective cognitive impairment.

Material and methods. Various sources were considered during conducting a literature review on the selected topic. The search depth was more than 15 years. Russian and foreign sources were studied on Internet platforms such as Web of science, UpToDate, PubMed, CyberLeninka, Medscape for selection of literature.

Results. According to the studied data, the prevalence of subjective cognitive impairment is quite high in the population, but diagnosis remains difficult due to the lack of susceptible and unified tests. International diagnostic criteria for subjective cognitive impairment are described. The article also presents modern ideas about the obvious and hidden factors that affect the course and prognosis of this state. The possibility of early diagnosis, as one of the most urgent tasks, as well as the methodology of neurocognitive testing are discussed.

Conclusion. Subjective cognitive impairment is becoming an increasingly urgent problem every year. In this regard, doctors of various specialties need to focus attention with minimal suspicion of pathology, since at this stage the changes are potentially reversible. There are both explicit and implicit factors that lead to subjective cognitive impairment. Among the hidden factors, the article discusses multitasking, impaired social interaction, gadget addiction, affective disorders, sleep disorders, pain, and COVID-19. For the most effective detection of subjective cognitive disorders, it is necessary to have unified sets of susceptible tests, which are currently under development.

The purpose of this research is to present virtual reality technology as one of the modern and novel option for pain syndromes treatment. Low back pain is one of the most frequent reasons for seeking medical help. According to the literature 90% of people experience back pain at least once in their life and 10% of them have a chronic course of pain. There may be many reasons for this: inadequate pain treatment, poor compliance with treatment, drug resistance, self-treatment, use of alternative medicine, etc. Pain that bothers a person for a long time significantly reduces the quality of life, affects cognitive functions and emotional state, and leads to a distorted perception of oneself body. Patients with pain contribute significantly to the financial losses of society in the form of lost wages and productivity. Low back pain is recognized worldwide as the most significant condition in relation to the number of years lived with disability. When patients are insensitive to treatment or its effectiveness is low, doctors resort to the use of non-pharmacological approaches. One of the modern and new options is the use of virtual reality. This technology allows the patient to distract himself from his pain and thus be out of the fear of movement. Studying and applying new non-pharmacological pain management methods may allow patients to reduce their medication use and increase compliance with treatment, as well as help to reduce the number of people with chronic pain.

Purpose of the work. The article is devoted to the first experience of epidural stimulation in the Khanty-Mansiysk Autonomous Okrug at the budgetary institution “Surgut Clinical Trauma Hospital”. Clinical examples are presented for two main indications for the application of this technique (disease of the operated spine, a consequence of spinal cord injury in combination with chronic neuropathic pain syndrome).

Research methods. An assessment of the intensity of pain syndrome was given according to a visual analogue scale, the “Pain Detect” questionnaire; indicators of anxiety, depression on the HADS scale; quality of life according to the Oswestry questionnaire for a follow-up period of 6-12 months in patients with chronic epidural stimulation.

Results. A positive assessment of the action during test neurostimulation was 63.3% (38 patients). Of the established permanent systems, a good result was achieved and persisted for 12 months or more in 96% (24 patients). It was necessary to change the stimulation parameters in 13% (3 patients). Revision of permanent systems was performed in 20% (5 patients), due to the progression of the degenerative-dystrophic process of the spine, damage and migration of system elements.

Conclusions. Chronic epidural spinal cord stimulation has established itself as a personalized, highly effective, minimally invasive and safe method of treating chronic neuropathic pain syndromes. Multicomponent corrective action is of scientific interest and requires further study.

Personal impressions of some oral presentations at the XVII congress of Russian psychiatrists are given. It is indicated a conservative trend for a number of reports, focused on “scientific sovereignty” and the conservation of the traditions. The point of view is supported that the form of discussion may be more important than its content.

9 апреля 2021 г. исполнилось 60 лет российскому психиатру и наркологу, исследователю деятельности мозга, доктору медицинских наук, профессору Алексею Юрьевичу Егорову — заведующему лабораторией нейрофизиологии и патологии поведения, профессору кафедры психиатрии и наркологии ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, профессору кафедры психиатрии и наркологии Санкт-Петербургского государственного университета.