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Vol LIII, No 4 (2021)

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Catatonic schizophrenia: historical error of psychiatric taxonomy?

Sivolap Y.P., Portnova A.A.


Numerous clinical observations and studies of recent decades allow us to question the existence of a catatonic form of schizophrenia or, in any case, the legitimacy of the unconditional attribution of all cases of catatonia to schizophrenia. Antipsychotics used in the treatment of schizophrenia are often ineffective in patients with catatonia, can worsen its manifestations and increase the risk of malignant neuroleptic syndrome. The first-line drugs in the treatment of catatonia are lorazepam and other benzodiazepines, and electroconvulsive therapy is used in case of their ineffectiveness. The concept of the independence of catatonia as a separate neuropsychiatric disease requiring the special therapeutic approaches that do not coincide with traditional treatment of schizophrenia deserves attention.

Neurology Bulletin. 2021;LIII(4):5-10
pages 5-10 views

Original study arcticles

Decision-making process and negative childhood experience in adolescents with autoagression

Antokhina R.I., Vasilieva A.V.


BACKGROUND. Analysis of the literature indicates the need for a detailed study of the features of the decision-making process, adverse experiences in childhood, the severity of depression in adolescents with truly suicidal and non-suicidal self-injurious behavior.

AIM. To determine the level of depression, unfavorable childhood experience, the characteristics of the process of forming preferences, the choice of executive actions and the assessment of results in conditions of uncertainty in adolescents with suicidal attempts and non-suicidal self-injurious behavior.

MATERIAL AND METHODS. From September 2019 to May 2020, clinical and experimental psychological methods (semi-structured interview, A. Beck Depression Scale, Columbian Suicidal Intentions Severity Scale, Adverse Childhood Experience Questionnaire, Iowa Gambling Task) examined adolescents from14 to 17 years: 30 persons with suicidal self-harm (mean age 16.1 years, 26 girls, 4 boys) and 32 persons with non-suicidal self-harm (mean age 16.3 years, 26 girls, 6 boys). Statistical processing was carried out using the Kolmogorov–Smirnov and Liliefors tests, the Leuven test, the Mann–Whitney U-test, and the two-sided Fisher test.

RESULTS. All examined patients showed manifestations of depression of different levels. In the group with suicidal attempts, the manifestations of depression were significantly more pronounced, and they also had significantly more adverse childhood experience factors. The decision-making process is more effective in individuals with non-suicidal self-injurious behavior than in the group with suicidal auto-aggression (although the difference does not reach statistical significance).

CONCLUSIONS. Thus, we have determined the level of depression, unfavorable childhood experience, peculiarities of the process of formation of preferences, choice of executive actions and assessment of results in conditions of uncertainty in adolescents with suicidal attempts and non-suicidal self-injurious behavior.

Neurology Bulletin. 2021;LIII(4):11-22
pages 11-22 views

Features of the manifestation of psychopathological symptoms in patients with somatoform disorders

Bychenko I.V., Dokukina T.V.


BACKGROUND. The relevance of studying psychopathological symptoms in patients with somatoform disorders is due to the current situation around the study of the mechanisms of development and course of this pathology.

AIM. To study the features of the manifestation of psychopathological symptoms in patients with somatoform disorders for subsequent consideration in conducting of therapeutic and diagnostic measures.

MATERIAL AND METHODS. The study involved 125 respondents who were divided into a main group [patients diagnosed with somatoform disorder (F45)] and a control group (potentially healthy people). To study psychopathological symptoms, the SCL-90-r questionnaire was used — a questionnaire on the severity of psychopathological symptoms in the adaptation of N.V. Tarabrina. The study of social factors was carried out using the developed author’s questionnaire to identify social factors. The diagnosis was verified in accordance with the research criteria of the International Classification of Diseases of the 10th revision.

RESULTS. The results obtained indicate statistically significant differences in the manifestations of psychopathological symptoms in patients with somatoform disorders and healthy people. In the main group above, psychopathological symptoms are expressed according to the scales “Somatization” U=307.500; Z=–7.32; p <0.001; “Interpersonal sensitivity” U=809; Z=–4.64; p=0.000003; “Depression” U=557; Z=–5.98; p <0.001; “Anxiety” U=413; Z=–6.78; p <0.001; “Phobia-phobic anxiety” U=573.500; Z=–6.16; p <0.001 compared to control group. The presence of traumatic situations at school, income dissatisfaction, parenting style in the family, marital status, psychological violence at work, etc. affect the severity of psychopathological symptoms in patients with somatoform disorders (p <0.05).

CONCLUSION. Patients with somatoform disorders have high manifestations of psychopathological symptoms that occur under the influence of social factors, compared with healthy people.

Neurology Bulletin. 2021;LIII(4):23-29
pages 23-29 views

Clinical and neuroimmunologic characteristics of late onset of schizophrenia and schizophrenia-like psychoses

Pochueva V.V., Kolychalov I.V., Androsova L.V.


BACKGROUND. After dementia and depression, schizophrenia-like psychoses with very late onset is the largest diagnostic group among late onset mental diseases. Last studies have shown the clinical heterogeneity of these psychoses.

AIM. Determine the clinical forms of late-onset psychoses, their corresponding immunological correlates and their diagnostic significance.

MATERIAL AND METHODS. 25 patients with late onset psychoses, mean age 64.8±6.0 years, age of onset of the disease 69.8±7.99 years were examined. The control group consisted of 14 people (9 women, 5 men) without mental disorders, mean age 64.8±6.0 years. Clinical and psychopathological examination was carried out, and assessment using psychometric scales (PANSS, HAMD, MoCA, MMSE). Immunological parameters were assessed: leukocyte elastase, α1-proteinase inhibitor, their ratio — proteinase inhibitor index, levels of autoantibodies to neuroantigens — protein S100b and basic myelin protein. Cluster analysis, as well as the t-criteria, Kruskal–Wallis, U Manna–Withney methods were used as the main approach to statistical data processing

RESULTS. Three groups of patients were identified — a group with acute polymorphic psychotic symptoms, characterized by the severity of the pathological process, heterogeneous psychotic symptoms, pronounced cognitive decline, lack of significant dynamics in the treatment process; a group of patients with a predominance of “involutional color” of psychosis, characterized by a continuous course with incomplete remission and little response to therapy; group of affective-delusional psychoses with paroxysmal course, low severity of cognitive impairment, good response to therapy.

CONCLUSION. The clinical heterogeneity of the group of late manifesting psychoses was determined, the immunological features inherent in each group, their prognostic significance were highlighted.

Neurology Bulletin. 2021;LIII(4):30-39
pages 30-39 views

The use of antioxidant medicine as an adjunctive therapy in late-onset schizophrenia spectrum disorders

Savushkina O.K., Boksha I.S., Sheshenin V.S., Tereshkina E.B., Prokhorova T.A., Pochueva V.V., Vorobyeva E.A., Burbaeva G.S.


BACKGROUND. Imbalance in the activity of neurotransmitter systems, mitochondrial impairment, and oxidative stress are potential neurobiological factors in the schizophrenia development.

AIM. To test the hypothesis about the possibility of a subgroup selection from patients with late-onset schizophrenia spectrum disorders, for which the use of ethylmethylhydroxypyridine succinate as an adjunctive to antipsychotic therapy would be the most effective in relation to symptoms that are relatively more pronounced in patients of this subgroup.

MATERIAL AND METHODS. 43 patients (women and men) aged 45–78 years with late-onset (after 40 years) schizophrenia spectrum disorders were examined using clinical psychopathological, psychometric, biochemical and statistical research methods. Enzymatic activities of cytochrome C-oxidase, glutamate dehydrogenase, glutathione reductase and glutathione-S-transferase were assessed in blood cells twice (on a patient admission to the hospital and after a 28-day treatment course).

RESULTS. Criteria for a patient assignment to the subgroup for ethylmethylhydroxypyridine succinate prescription were: more prominent side effects of pharmacotherapy, predominance of anxiety-hypochondriac symptoms and a lesser severity of psychosis. Before the treatment starting, the subgroup to which ethylmethylhydroxypyridine succinate was prescribed significantly differed in the activity of platelet glutamate dehydrogenase (p=0.031), glutathione-S-transferase (p=0.005), and erythrocyte glutathione reductase (p=0.045). As a result of the treatment course, the severity of symptoms by which the patients receiving ethylmethylhydroxypyridine succinate significantly differed before the starting the treatment, became undistinguished from those in the rest examined patients. After the treatment course, no significant differences in enzymatic activities were found in patients treated with ethylmethylhydroxypyridine succinate from those in other patients.

CONCLUSION. This study confirmed the clinical validity of using a medicine with antioxidant properties as an adjunctive therapy to the main treatment in the selected subgroup of patients.

Neurology Bulletin. 2021;LIII(4):40-50
pages 40-50 views


Cervical dystonia with dystonic tremor: a modern view of the problem

Buriak I.V., Zakharov D.V., Mikhailov V.A., Bogacheva V.A., Zakharova O.P.


One of the important areas of modern neurology is movement disorders, due to their negative impact on the daily activity and quality of life of patients. Dystonia is the third most common extrapyramidal disease. Often, dystonia is accompanied by trembling hyperkinesis, however, known data on dystonic tremor are scattered and not systematized, and its fixation causes difficulties due to the lack of clear tremorographic characteristics. Many issues of prevalence, pathophysiology, differential diagnosis with other types of tremor, as well as the effectiveness of therapy also remain insufficiently studied. This review focuses on the literature on dystonic tremor.

Neurology Bulletin. 2021;LIII(4):51-60
pages 51-60 views

Case reports

COVID-19 and the manifestation of psychosis: clinical cases

Petrova N.N., Manyushina V.M.


The emergence and global spread of the new coronavirus COVID-19 has placed a significant mental health burden on communities around the world. Many of the mental manifestations of COVID-19 are the result of psychological stressors such as fear of illness and death, prolonged social isolation, insecurity and fear of the future. However, there is growing evidence that the virus itself can cause psychosis in infected people. The potential of the virus to induce psychosis is of particular interest. Much remains to be seen about the biological mechanisms, presentation, treatment and long-term results of psychotic illnesses associated with COVID-19.

METHODS. This article examines cases of manifestation of psychosis against the background of a new coronavirus infection. The features of the development of psychosis, course, response to therapy are analyzed. The analysis of foreign scientific literature on psychoses associated with COVID-19 is carried out.

RESULTS. According to the results of the analysis of clinical cases, acute psychoproductive symptomatology, pronounced anxiety and insomnia were described. A positive response to therapy with second-generation antipsychotics with good tolerance in usual therapeutic dosages was observed in 100% of cases. Achieving a therapeutic response required a change of antipsychotics.

Neurology Bulletin. 2021;LIII(4):61-69
pages 61-69 views

Наблюдения из практики

Analysis of expert practice on the issues of determining the place of residence of a child

Kharitonenkova E.Y., Masyakin A.V.


In order to study the quantitative and qualitative features of complex psychological and psychiatric examinations on family disputes about the upbringing of children, the conclusions of the commission of experts of the Central Clinical Psychiatric Hospital of the Ministry of Health of the Moscow Region, conducted from 2016 to 2020, were analyzed. The clinical and psychopathological features of the subexperts are determined, as well as a number of problems associated with conducting such examinations: objective complexity, a large range of expert questions, ambiguity in the interpretation of the main expert concepts.

Neurology Bulletin. 2021;LIII(4):70-77
pages 70-77 views


Modern pathopsychology and psychopathology at the stage of revision of the mental disorders classification: understanding the logic of interaction, problems and development prospects

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


AIM. Analyze the problems and prospects of the development of modern pathopsychology in the era of a new revision of the classifications of mental disorders, overcoming the categorical approach and achieving progress in the treatment and psychotherapy of psychotic disorders. The most important role of psychological theory and psychological experiment based on it in determining the patterns of mental activity disorders is comprehended, the problem of typicity and specificity of individual symptoms of mental disorders to a particular mental disorder, the role of psychological mechanisms and conditions for the occurrence of psychopathological symptoms is considered. In the conditions of modern progress in medicine and psychotherapy, pathopsychology needs an incentive to actively rethink the rich experimental experience and further development. An obstacle on this path is the historical narrowing of the professional framework of the pathopsychologist to the level of “nosological service” (Bratus B.S.), overdiagnosis of individual nosological headings to the detriment of others.

CONCLUSIONS. In the context of the progress made in the treatment and psychotherapy of mental disorders, and against the background of current changes in the classifications of mental disorders, the problems and trajectories of the development of modern pathopsychology are identified. The importance of methodological renovation in understanding the basic provisions and problematic niches of pathopsychology, rethinking experimental experience and implementing modern experiments in compliance with the rules of scientific research, correlation with modern scientific knowledge, as well as the importance of reflection on the professional tasks of a pathopsychologist is shown. The inclusion of psychological intervention in the active arsenal of tasks of a pathopsychologist can transform his professional activity.

Neurology Bulletin. 2021;LIII(4):78-86
pages 78-86 views

Historical Article

History of asexuality as medico-biological phenomenon and identity

Romanov R.V.


The study presents the history of asexuality — a sequence of epochs conditioned by the control, regulation of non-normative practices and gender order. The author examines asexuality in the context of pathologization and normalization, which resemble the history of homo- and bisexuality. The result of the pathologization of asexuality was the construction of identity as a basis that deprives doctors of the right to pathologize it.

Neurology Bulletin. 2021;LIII(4):87-91
pages 87-91 views

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