Vol XXVI, No 1-2 (1994)

Forensic psychiatry can be defined as a branch of medical science - psychiatry, whose task is to establish the mental state of a person in relation to certain legal norms and situations. Such a definition implies several main areas of activity of forensic psychiatrists and scientific research in this area. The inseparable connection between forensic psychiatry and general psychiatry, the impossibility of fruitful work of expert psychiatrists in isolation from the psychiatric clinic, without the use of an appropriate conceptual apparatus, without taking into account the development trends of diagnostics, therapy and organization, remains fundamental. Obviously, the specific tasks of forensic psychiatry at the present stage are directly related to the tasks of general psychiatry and a number of changing legal provisions, and complex integrative relations between psychiatry and law are necessary here.

From 1989 to 1992, X-ray computed tomography (CT) of the skull and brain was performed in 183 patients on the basis of the Medical Unit "Radiopribor" in Kazan. There were 71 children (30 boys, 41 girls), adult patients aged 20 to 69 years - 112 (45 men, 67 women).

In recent years, to explain the mechanisms of development of multiple sclerosis (MS), special attention has been paid to the study of defense systems and much less to other systems of homeostasis, in particular, the state of the autonomic nervous system (ANS). At the same time, it is she who plays the leading role in providing adaptation mechanisms. Available information about the role of the ANS in the mechanisms of development of MS is either scarce or contradictory.

In the clinical manifestations of ischiocrural syndromes, a significant role belongs to the triceps muscle of the lower leg, especially the soleus. What morphological and functional features of the soleus muscle can be displayed in the clinic of ischiocrural syndromes? In order to identify these features, we undertook a macromicroscopic study of 57 anatomical preparations.

The use of «ability to adaptation» index in neurology clinic proved to be adequate in the decision of basic tasks occuring in the process of treatment, rehabiltiation and prophylaxis of neurologic diseases. The characteristic of individual peculiarities of the disease, epidemiologic characteristic of the selection, treatment efficacy estimation, rehabilitation level, prognosis tasks, medicoworking examination, distribution by dispensary account groups and prophylactic measures efficacy estimation are among these tasks.

The conception of the adaptive functional dominant of central nervous system for the description of general regularities of the patho- and sanogenesis course in neurosurgicai patients is proposed. It is shown that the disease result and primary trend of rehabilitation depend on the developing adaptive dominant.

The comparative analysis of results of the treatment of two groups of patient after insult and with psychoemotional stress syndrome is performed. The traditional combined recovery therapy is performed in patients of the first group, the rehabilitation course — in the second groupwhere nonmedicamental methods of psychoemotional correction are used. It is shown that the introduction of the psychoemotional correction methods in the combined treatment provides a reduction of psychoemotional stress, significantly increases the treatment efficacy at the expense of optimization of the psychis aim of patients.

As many as 50 patients aged over 60 years suffering from chronic vascular cerebral deficiency with equilibrium disorders are examined. The neurological- ly sharply defined symptomocomplexes explaining the equilibrium disorders and having stabilographic correlators are revealed in 2/3 of the cases. The subclinical patterns of postural instability in patients with various diseases are found in 1/3 of the cases. The stabilographic tests are performed as well as with the use of biologically reverse communication, resulting in rehabilitation measure in definite forms of the equilibrium disorder.

The psychic functions are not fully recovered in neurosurgical patients in the rehabilitation process in postoperational and posttraumatic periods. The disorders of mnestic processes are more pronounced: shortterm (affect, aural, visual) memory, memorizing volume of verbal material, psychic rate. It is shown that the «Se- max» medicine is able to improve the processes of teaching, aural perception, to increase the volume of verbal and affect material, the volume of long-term and some kinds of short-term memory even with short-term treatment (5 days).

In conditions of the specialized rehabilitation center the combined treatment including the Peto’s conductive pedagogy method provides the satisfactory result in diplegic and spasticorigid forms and comparatively weak effect of the treatment in hyperkinetic form.

In children with schizophrenia the motor disorders are studied and their connection with psychic disfunctions in infancy is defined. As many as 112 children °I the early age are examined: one-sided burdening - is revealed in 80 of these, doublesided burdening — in 32 of these. The peculiarities of postural motor development and Various motor disfunctions are noted, which can be correlated with psychic endogenic disease in infancy or schizo- typical diathesis as a manifestation of sctizophrenic development and can be diagnosed in the first year of life. The early correction of motor development disorders directed to the normalization and stimulation of motility with an accent on the training of normal poses and motions, provides the maturation of not only motor but also psychic functions, stimulates the development of high integrative centers having an inhibiting effect on the truncal mechanisms activity.

The clinical observations confirming the possibility of the origin and course of the information disease in persons involved in intensive mental work are presented. In psychohygienic sénse the necessity to reveal the etiologic factors of the disease is well-founded. The complex of exercise therapy and sport game elements is indicated in the treatment and rehabilitation.

Based on the analysis of the clinical es- sense of osteochondrosis and concrete - illustration, an important principle of rehabilitation in the acute period of osteochondrosis — deautomatization of motility, permanent control-, formation of protective dynamic stereotypes by the physician — is postulated.

The various forms of the clinical manifestation of the disease, the peculiarities of the course of combined injury of spinal cord and brain are revealed in 302 newborns with vertebrospinal injury on the cervical level being observable. The early medical rehabilitation of patients begins from the birth and involves the performance of nondifferentiated and differentiated therapy allowing to reduce lethality and improVe the results of the treatment.

The experience of recovery and rehabilitation of patients with hereditary neuromuscular diseases (more than 1000 observations) is generalized. Their own methods of pathogenetic and correcting therapy as well as patented methods are described. Their therapeutic efficacy is estimated on evidence of clinical observations, biochemical and electrophysiologic examinations. The possibility to obtain the stable and relatively prolonged remissions and to bring the disease under control is shown.

The peculiarities of microcirculation and peripher hemodynamics in patients with Bekhterev’s disease depending on the form and clinical picture are analysed. The complexes of rehabilitation measures using laser radiation, alternating magnetic field, decimetric wave band therapy are developed. The statistically reliable efficacy of the treatment methods proposed is established. A good medical effect is possible only in regular prescription of the combined treatment using laser radiation, alternating magnetic field and extremely high frequencies, decimetric wave band therapy.

The mechanisms of change of the neuromuscular synapse function, in the process of denervation and reinnervation are investigated in éxperiments on skin and sternal muscles of frogs using electrophysiologic and morphologic methods. It is shown that denervational and reinnervational changes are concerned just as with pre- and so with postsynaptic membranes. Postsynaptic changes are connected with change of cholinoreceptors density and substitution of normal ones for cholinoreceptors typical of the denervational muscle, and presynaptic changes are defined by ion channels degradation in denervation followed by fitting them into thenerve ending membrane in reinnervation. The density of ion channels responsible for the formation and performance of action potential, the entry of calcium ions and mediator secretion is identical in the course of the regenerating nerve ending distinguishing it from the normal one. Calcium-activated potassium channels fit in the end reinnervation stages.