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Vol LIV, No 2 (2022)
Editorial
Psychotic symptoms for non-psychotic disorders: errors of diagnosis or a new reality?
Abstract
The article is devoted to the analysis of current trends in the field of clinical psychiatry. Using the example of borderline personality disorder, in which verbal hallucinations are observed, the problem of qualifying psychotic symptoms in non-psychotic disorders is discussed. The question is raised that such phenomena can be considered either as diagnostic errors or as a “new psychiatric reality”.
5-12
Original study arcticles
Life-time anxiety disorders in patients with late-onset psychosis
Abstract
BACKGROUND. Anxiety disorders are frequently observed in patients with schizophrenia. Meanwhile lifetime frequency of these disorders in late-onset schizophrenia remains unknown.
AIM. The aim of the study was to investigate frequency of anxiety disorders in patients with late-onset psychosis.
MATERIAL AND METHODS. 85 patients with late-manifesting psychoses (after 40 years) aged 45 to 86 years (average age 66.5=9.5 years) were examined. Patients with late schizophrenia (n=42), late schizoaffective disorder (n=12), late chronic delusional disorder (n=15), organic schizoform psychosis (n=8), recurrent depression with psychotic symptoms (n=8) underwent psychiatric examination (PANSS, HDRS-17, MMSE, MoCA) and standard interviews. The diagnosis was carried out according to the criteria of the International Classification of Diseases of the 10th revision. The control group included 24 people over 45 years old without signs of mental disorders (average age 57.6±8.8 years). Statistical analysis included nonparametric criteria.
RESULTS. Results. Patients with late schizophrenia were distinguished by certain premorbid features in the form of an increased frequency of social phobia, more animal phobias and multiple polysymptomatic habitual anxiety reactions. Patients with late schizoaffective disorder were characterized by a tendency to hypochondriac fears and multiple polysymptomatic habitual anxiety reactions. Patients with late delusional disorder were characterized by an increased frequency of animal phobias. Patients with late mental depression are characterized by the presence of multiple undeveloped anxiety reactions and hypochondriac fears. Patients with endomorphic organic psychoses were distinguished by a low frequency of hypochondriacal fears in the anamnesis.
CONCLUSION. High frequency of anxiety disorders in patients with late-onset schizophrenia was detected. This data could improve diagnostics of late-onset psychosis.
13-22
Specificity and dynamics of psychological adaptation during the COVID-19 pandemic
Abstract
BACKGROUND. The relevance is due to the negative consequences caused by the COVID-19 pandemic for individuals and for society as a whole, covering almost all aspects of life at the macro and individual levels, and the lack of detailed studies of the psychological state of the population.
AIM. Study of the specifics and dynamics of psychological adaptation in subjects during the COVID-19 pandemic.
MATERIAL AND METHODS. Method of studying personality accentuations of K. Leonhard (modified by S. Shmishek); diagnostics of the state of aggression (Bass-Darkey questionnaire), multilevel personality questionnaire “Adaptiveness” by A.G. Maklakov and S.V. Chermyanin, test-questionnaire “Health, activity, mood”, clinical questionnaire for the detection and evaluation of neurotic conditions (Yakhin K.K., Mendelevich D.M.). Statistical analysis of the data was performed using Spearman’s rank correlation coefficient, Student’s t-test for independent samples, and Student’s t-test for dependent samples. The study involved 51 people — 16% are men and 84% are women, who were selected by a random continuous method, whose average age is 21.3±1.87 years. The study was carried out in 2 stages. The first stage: the end of April 2020 — 21 days after the start of voluntary self-isolation; second stage: end of September — beginning of November 2020.
RESULTS. The subjects were found to have such character accentuations as exaltation — 94%, hyperthymism — 88%, emotivity — 86%, low level of personal adaptive potential (2.1±1.43), neurotic depression prevailed — 43%, obsessive-phobic disorders — 33%, conversion disorders — 27%. The expression of aggression was carried out mainly through verbal aggression (6.35±2.43), guilt (5.59±1.72) and irritation (5.37±1.92).
CONCLUSION. The subjects have a low level of personal adaptive potential, which increased with the end of self-isolation, accompanied by a gradual acceptance of what is happening, stabilization of the growth in the number of sick and dead, news about the development of measures to combat the spread of the virus, methods of treatment and prevention.
23-32
Cognitive dysfunction, pain and affective disorders in patients with Chiari malformation type 1 in the context of reciprocal relationships
Abstract
BACKGROUND. Chiari malformation type 1 (CM1) is a multicomponent pathology. The CM1 symptom complex has a variable structure within the limits of cerebrospinal fluid, cerebellar, brainstem and spinal disorders. A new component is cognitive dysfunction. Various hypotheses of its formation are discussed. Along with the independent role of CM1 in the development of cognitive dysfunction, great importance is attached to pain and affective disorders.
AIM. To identify the features of cognitive status in patients with CM1 and to assess the relationship with pain and affective disorders.
MATERIAL AND METHODS. The study included 110 adult patients with CM1 aged 25.61±6.9 years. The control group consisted of 50 people aged 26.36±5.0 years. The assessment of neuroimaging parameters was carried out on an MR tomograph with an induction of a magnetic field of 1.5 T. MMSE, MoCA, and the Trail Making Test were used to assess cognitive status. The pain syndrome was assessed using the SF-MPQ-2-RU questionnaire and the visual analogue scale, assessment of affective disorders — HADS and DASS-21.
RESULTS. Patients with CM1 had significantly lower cognitive indicators. Deficits are found in the domains of executive functioning, visual-spatial skills, attention, delayed recall and speech. The association of cognitive decline and pathognomonic headache for CM1 may indicate the presence of common pathogenic mechanisms. The decisive importance probably belongs to cerebellar dysregulation — dysfunction of the universal process of cerebellar transformation. It is assumed that emotional disorders collectively affect the structure of cognitive status, not being the main link in pathogenesis.
CONCLUSIONS. Patients with CM1 show significant cognitive decline. Cerebellar dysregulation may be a common mechanism underlying cognitive dysfunction and pathognomonic for CM1 headache. Emotional disorders collectively affect the structure of cognitive status, not being the main link in pathogenesis.
33-43
Reviews
Efficacy of hypnotherapy in the treatment of irritable bowel syndrome. A systematic review with meta-analysis
Abstract
BACKGROUND. Hypnotherapy is one of the treatments for irritable bowel syndrome (IBS).
AIM. Meta-analysis was to evaluate the effectiveness of its use and to identify the most optimal conditions for its implementation.
MATERIALS AND METHODS. We analyzed Scientific medical databases PubMed, EMBASE, eLibrary for the period from 2005 to 2022. Studies performed on adult samples of patients with a confirmed diagnosis of IBS on the basis of Rome II–IV with a control group were selected. Included studies were analyzed for risks of bias and publication bias. Clinical efficacy was assessed by comparing data on gastrointestinal symptoms reduction and psychological condition. A subgroup analysis was used to compare the effectiveness of group and individual hypnotherapy, as well as the number of sessions conducted.
RESULTS. Nine studies (867 patients) were included in the final meta-analysis. Hypnotherapy was significantly more effective in reducing gastrointestinal symptoms in patients with IBS compared to controls (SMD=0.25 [95% CI 0.02–0.49], I2=53%, p=0.03), with positive effects persisting up to one year (SMD=0.34 [95% CI 0.07–0.60], p=0.01). Hypnotherapy resulted in an equalization of the psychological distress (MD=1.09 [95% CI from –1.27 to 3.44], p=0.37), but the results were not significant. Group hypnotherapy (SMD=0.35 [95% CI 0.01–0.70], p=0.05) and higher amount of hypnotherapy sessions during treatment (SMD=0.35 [95% CI 0.14–0.57], p=0.001) were more effective.
CONCLUSION. Based on the results of this systematic review, it is fair to assume that the most effective use of hypnotherapy in patients with IBS, including those with therapy-resistant forms, is more than 7 sessions of group hypnotherapy more than once a week with a minimum session time of 45 minutes.
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Antiamyloid therapy of Alzheimer’s disease: origins, current state and prospects of development
Abstract
Over the past historical period, views on Alzheimer’s disease therapy have undergone significant changes. This was facilitated by new research in the framework of studying the mechanisms of its development. Currently, the “amyloid hypothesis” remains prevalent, the central link of which is the accumulation of insoluble beta-amyloid protein, which provokes a subsequent cascade of pathochemical reactions leading to the formation of dementia. The presence of reliable evidence of a significant contribution of β-amyloid in the processes of neurodegeneration contributed to the development of therapeutic strategies aimed at leveling its pathological influence. In this regard, attempts are being made to develop antibodies to β-amyloid, to create β-secretase and γ-secretase inhibitors, α-secretase stimulants, as well as the synthesis of drugs capable of blocking zinc- and copper-induced formation of toxic forms of oligomers and aggregation of β-amyloid. The greatest success was achieved with the introduction of monoclonal antibodies to the protein β-amyloid. It is in this direction that the greatest efforts of scientists are focused on creating a new effective treatment for Alzheimer’s disease.
56-68
Clinical Practice Guidelines
A review of instruments of experimental psychological diagnostics of gender dysphoria and gender incongruence in the context of transition to ICD-11
Abstract
In 2024, Russia will change over to the 11th version of the International Classification of Diseases (ICD-11) where the diagnosis “transsexualism” will be replaced by “gender incongruence”. At present, clinical practice guidelines rooted in evidence-based medicine are being developed. This means that validated instruments of experimental psychological diagnostics should be used. In the present review, we identify ten instruments used in international practice. After discussing their strengths and weaknesses we can recommend four instruments for diagnosing gender dysphoria and gender incongruence: Transgender Congruence Scale, Trans Collaborations Clinical Check-In (TC3), Gender Congruence and Life Satisfaction Scale, and Utrecht Gender Dysphoria Scale — Gender Spectrum (UDGS-GS). Six instruments are recommended for prescribing psychotherapy aimed to help the patients accept their gender identity and build resilience: Transgender Congruence Scale, Gender Identity Reflection and Rumination Scale, Gender Preoccupation and Stability Questionnaire, Trans Collaborations Clinical Check-In (TC3), Gender Congruence and Life Satisfaction Scale, and Transgender Identity Survey. At the same time, we do not recommend two widely used instruments — Utrecht Gender Dysphoria Scale (classical version) and Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults — due to their inapplicability to gender non-binary individuals and those in the process of gender transition. In the article we also discuss issues related to differential diagnostics in the context of ICD-11, as well as peculiarities of using diagnostic scales with gender non-binary individuals, intersex people and detransitioners.
69-84
Case reports
Demyelinating disease in a patient with cerebral venous thrombosis and covid-19 clinical manifestations
Abstract
Actually, verifying neurological disorders associated with COVID-19 make clinicians ask several questions: the manifestation of neurological pathology is due to COVID-19, or there is a combination of several CNS pathologies with COVID-19. We report a clinical case of a 57-year-old female patient with demyelinating disease of the central nervous system, cerebral venous thrombosis associated with clinically transferred COVID-19. Differential diagnosis was performed with multiple sclerosis, acute multiple encephalomyelitis, opticomyelitis, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, sarcoidosis, antiphospholipid syndrome, mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) and thrombosis veins of the large hemispheres. Probable pathogenetic variants of demyelination development and possible connection with cerebral venous thrombosis and COVID-19 are highlighted.
85-95
Was it a malingering of a mental disorder? Clinical case of self-disclosure of the patient and its interpretation
Abstract
A clinical case of Stanislav G., 18 years old, an IT-specialist, who underwent therapy in a psychiatric hospital in connection with a schizotypal disorder diagnosed in him, is described. After a month, the patient admitted that he was feigning a mental disorder, because he could not receive effective treatment for the vegetative symptoms of hypothyroidism diagnosed in him, and began an intensive search for the psychopathological causes of his own illness. He believed that he had some signs of schizotypal disorder, but they were not enough to make an official diagnosis and receive the desired psychopharmacotherapy. For persuasiveness, he studied on the Internet the anamnesis of patients and decided to simulate “elements of reasoning, emasculation of associations and a distorted perception of the interlocutor’s words, flattening of affect”. On re-examination after claiming the sham, it was concluded that he did not have the listed symptoms and that there was no scientific evidence to support any psychiatric diagnosis. Doubts in the analysis were only caused by the patient’s motivation to simulate psychopathology in the absence of traditional grounds for malingering (criminal prosecution, military service), and excessive intellectualization of health problems and a specific style of thinking that did not go beyond the norm. The article discusses the question of whether the patient had symptoms of schizotypal disorder and, if so, whether they could completely stop in a short period of time. The article provides substantiations for the conclusion about the detection of feigning behavior in the patient, and provides data on the differential diagnosis between the malingering of a healthy person and pseudo-simulation in schizotypal disorder, as well as observations on the specifics of the mental activity of persons with schizoid personality disorder and Asperger’s syndrome — diagnoses assumed in the examined.
96-104
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор). Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 75562 от 12 апреля 2019 года.