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Vol LIII, No 2 (2021)

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Frontiers papers

Self-harm behavior: hierarchical and network analysis

Mendelevich V.D.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):5-9
pages 5-9 views

Application of the cognitive-behavioral approach in psychotherapy for self-harming behavior

Granitsa A.S.

Abstract

This review article discusses research and practical guidelines on the use of the cognitive behavioral approach in psychotherapy for self-harming behavior. Self-harm is an acute problem of modern psychiatry, psychotherapy and clinical psychology, affecting mainly young people. A significant part of the research on assistance is devoted to cognitive behavioral therapy and related areas. Given the complexity of the phenomenon of self-harm, the first part of the article considers the theoretical models that underlie the applied hikes. This was followed by a review of studies on various areas of psychotherapy for self-harming behavior. The main techniques and basic principles of cognitive-behavioral psychotherapy were considered, and illustrative practical examples were given. It is concluded that the quality of evidence is currently insufficient, but the methods of the cognitive-behavioral approach are recognized as “well-established” and “promising” for helping patients in this group.

Neurology Bulletin. 2021;LIII(2):10-17
pages 10-17 views

The clean and dirty ways to reduce suicidality

Sivolap Y.P., Portnova A.A.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):18-25
pages 18-25 views

Original studies

Non-psychotic depression and the social burden of illness

Petrova N.N., Shatil M.M.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):26-33
pages 26-33 views

Psycho-emotional characteristics of persons addicted to synthetic drugs, depending on the timing of drugs cessation

Patrikeeva O.N., Solovieva I.G., Retser R.A., Larin A.V., Vinokurova S.E., Kormilina O.M.

Abstract

The research aim was to study the characteristics of psychoemotional response in persons with dependence on synthetic drugs (synthetic cathinones and synthetic cannabinoids) at different stages of abstinence from consumption of psychoactive substances.

Methods. Clinical and pathopsychological examination of 127 patients with dependence on synthetic drugs was carried out. All patients are male. Of these, 83 people with a period of abstinence from 3 to 6 months and 44 people with a period of abstinence from 6 to 18 months. The control group consisted of 55 healthy men. We used a clinical interview, the Hospital Anxiety and Depression Scale, the A. Bass and A. Darki questionnaire for diagnosing the parameters of aggression, the STAXI questionnaire of the property-state and expression of anger, the Toronto Alexithymia Scale, the Life Style Index of Kellerman–Plutchek.

Results. It was found that patients with dependence on synthetic drugs have a significantly higher level of anxiety, aggression, more pronounced manifestations of alexithymia in comparison with healthy patients, regardless of the duration of remission. It was revealed that in persons with abstinence from drug use for more than six months, on the one hand, the ability to control the manifestation of anger increases significantly, on the other hand, depressive manifestations intensify and suicidal risk increases in comparison with addicts with a shorter period of abstinence.

Conclusion. Emotional disturbances in addicted to synthetic drugs (cathinones and cannabinoids) are persistent and persist even during periods of prolonged abstinence.

Neurology Bulletin. 2021;LIII(2):34-41
pages 34-41 views

Clinical and psychopathological characteristics of sexual dysfunctions and non-psychotic mental disorders in women

Martusenko A.V., Boyko E.O., Zaitseva O.G.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):42-45
pages 42-45 views

The effectiveness of short-term cognitive behavioral therapy in the complex treatment of idiopathic restless legs syndrome with chronic insomnia

Melekhin A.I.

Abstract

Aim. To investigate the effectiveness of the short-term protocol of cognitive behavioral therapy RELEGS M. Hornyak et al. in complex treatment to improve the quality of sleep, reduce the symptoms of depression, anxiety, suicidal thoughts in patients with primary SBN comorbid with chronic insomnia.

Methods. Study participants: 68 patients with primary restless legs syndrome with comorbid chronic insomnia. Women — 56 (average age 52.1±10.3 years), men — 12 (average age 50.3±9.4 years). The severity of restless legs syndrome is moderate to severe. The average age of the onset of the disease is 18–48 years, the duration of the course of the disease is on average 14–15 years. Taking various medications for the management of SBN for an average of 4–5 years. Study design: a randomized controlled trial, after screening — 26 patients were assigned to the main group, underwent combined treatment, took a prolonged form of Pramipexole (Mirapex-PD, 1.5 mg.) and underwent the RELEGS CBT protocol (Restless Legs Skills program, Hornyak, Grossmann, 2018), which integrates the cognitive behavioral insomnia protocol (Morin, 2007) and Mindfulness-Based Stress therapy (Mindfulness-Based Stress Reduction, Bablas, 2016). The control group consisted of 24 people who received only general recommendations on sleep hygiene once. Both groups were treated with dopaminergic agonists under the supervision of a neurologist. Research methods: IRLS, ISI, DBAS-16, sleep diary analysis, actigraphy, BDI, SBQ-R, BAI.

Results. The use of the CBT protocol in combination therapy with prolonged-acting dopaminergic agonists in patients with primary restless leg syndrome (mild and moderate severity) with comorbid chronic insomnia, in contrast to simple one-time general recommendations on sleep hygiene, is more effective for reducing dysfunctional behaviors, the spectrum of reinsurance and avoidance behavior both in relation to sleep and symptoms of restless legs. In patients with primary restless legs syndrome who underwent CBT, greater mental well-being was observed, which was expressed in a decrease in the severity of symptoms of insomnia, anxiety, and suicidal behavior after completion and persisted after 3 months of follow-up.

Conclusion. As part of a personalized comprehensive approach, along with a drug-based approach and general recommendations for sleep hygiene, the use of short-term CBT (4 sessions, 60 minutes each) can significantly improve mental well-being, improve the quality of sleep of patients with restless legs syndrome with comorbid chronic insomnia.

Neurology Bulletin. 2021;LIII(2):46-56
pages 46-56 views

Features of coping behavior at prisoners in a pre-trial detention center

Petrova N.N., Kurapova E.Y., Khomenko A.E.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):57-63
pages 57-63 views

Discussions

Psychoanalysis: from clinical medicine to clinical anthropology

Martynov I.A.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):64-70
pages 64-70 views

Recommendation for practitioners

Subjective cognitive impairment —more questions than answers

Yakupov E.Z., Zhamieva R.A.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):71-80
pages 71-80 views

Ocular myasthenia gravis — clinical diagnosis and treatment

Khafizova I.F., Galiavieva A.R.

Abstract

The ocular myasthenia gravis has a variable clinical presentation and imitates many diseases with ocular region damaged. The diagnosis of ocular myasthenia gravis is complicated due to low sensitivity of the diagnostic approaches. The article introduces the features of the examination of patients with the ocular myasthenia gravis. The article describes the study methodology and interpretation of Simpson, Gorelick, Cogan`s lid twitch sign, rest and sleep tests, ice test. The article considered features of the treatment of the disease in order to achieve remission and prevent the generalization of the process. Timely diagnosis and optimal choice of treatment strategy can significantly change the quality of patient’s life and influence the subsequent prognosis of the disease.

Neurology Bulletin. 2021;LIII(2):81-87
pages 81-87 views

Virtual reality — new possibilities in the treatment of pain

Trepalina T.S., Yakupov E.Z.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):88-93
pages 88-93 views

Наблюдения из практики

First experience with chronic epidural spinal cord stimulation in Khanty-Mansi autonomous okrug — clinical observations

Bondarenko O.A., Gavrilov G.V., Padurets V.A., Kasich R.V.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):94-100
pages 94-100 views

Письмо в редакцию

Quick notes of the XVII congress of psychiatrists of Russia (impressions from the work of several sectional meetings)

Zobin M.L.

Abstract

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.

Neurology Bulletin. 2021;LIII(2):101-103
pages 101-103 views

Anniversary

Alexei Yurievich Egorov. For the 60th anniversary of his birth

Abstract

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.

Neurology Bulletin. 2021;LIII(2):104-104
pages 104-104 views

Professor Yury Pavlovich Sivolap — the disappearing type of the russian intellectual (for the 60th anniversary).

Abstract

30 марта 2021 г. исполнилось 60 лет известному российскому психиатру, доктору медицинских наук, профессору кафедры психиатрии и наркологии Первого Московского государственного медицинского университета им. И.М. Сеченова Юрию Павловичу Сиволапу.

Neurology Bulletin. 2021;LIII(2):105-106
pages 105-106 views

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