Vol LIV, No 3 (2022)

The article analyzes the reasons for the opposition of a significant number of Russian psychiatrists to the introduction of a new international classification of mental and behavioral disorders (ICD-11). An opinion is expressed that the increase in the effectiveness of therapy from ICD-9 to ICD-10 in world psychiatry is associated not so much with the transition to syndromic (anosological) assessment of clinical phenomena, but because of the widespread use of modern psychopharmacological drugs and the introduction of evidence-based medicine principles, which in domestic psychiatry are also criticized. It is argued that two important aspects of psychiatry — diagnosis and therapy — are practically independent of each other, and the entire dispute about rejection or acceptance of the new classification (ICD-11) has nothing to do with the effectiveness of therapy.

BACKGROUND. Currently, it is relevant to study the gender characteristics of the incidence of schizophrenia, the age of onset, the features of the clinical picture and course of the disease, the response to treatment and the tolerability of antipsychotic drugs in patients.

AIM. The aim of the study was to study the clinical and functional characteristics of remission, depending on the gender of patients with schizophrenia.

MATERIAL AND METHODS. 61 outpatient patients with paranoid schizophrenia (28 men and 33 women) were examined at the stage of remission of the disease. Clinical and scale assessment was carried out using the PANSS, PSP, CGI-S, DAI scales.

RESULTS. There were more married women than men. Restriction of professional activity and social contacts was more often observed in male patients. Among patients without disabilities and patients with the 3rd disability group, female persons prevailed, while among patients with the 2nd disability group — men. It was shown that the age of onset of the disease was significantly less in men than in women. The indicator of the severity of the disease on the CGI-S scale during remission corresponded to moderate severity in men and mild severity in women (p <0.05). The severity of residual productive and, especially, negative symptoms is greater in male patients. The level of social and everyday functioning according to PSP is higher for women than for men. Noticeable disorders prevailed in patients of both sexes, however, they were observed more often among men, while women more often than male patients had minor difficulties in certain areas of functioning. The most pronounced differences were found in the degree of impaired functioning in the behavioral sphere. The paranoid type of remission unfavorable with respect to social functioning was more often observed in men. For women, the thymopathic type of remission turned out to be the most favorable from the point of view of compliance and social functioning. Antipsychotics of the first generation were more often prescribed for the paranoid type of remission in both men and women, while therapy with antipsychotics of the second generation was associated with the most favorable remission options for both men (apathetic type) and women (thymopathic type), which correlated with a higher level of social functioning. In general, the level of social functioning was higher when prescribing second-generation antipsychotics, regardless of the gender of patients with schizophrenia.

CONCLUSION. The hypothesis about the best outcome of the disease in the framework of personal and social recovery in women has been confirmed.

BACKGROUND. Amyotrophic lateral sclerosis (ALS) is not limited only to motor impairment, and can also manifest with cognitive and behavioral disorders. Currently these presentations of ALS are unrecognized. Hence the research of ALS variants with cognitive and behavioral impairments is necessary.

AIM. To study the frequency and clinical characteristics of ALS variants with cognitive and behavioral impairments.

MATERIAL AND METHODS. The patients were recruited in 2020–2021. All patients with definite and possible ALS according to El Escorial criteria were included. The Edinburgh Cognitive and Behavioral ALS Screen (ECAS) was used to assess cognitive and behavioral changes. 44 patients, 26 males and 18 females, aged 39 to 77 years (median of age 61 years, interquartile range 53.5–74.5). Statistical analysis was performed using IBM SPSS Statistics 21. Continuous data were analyzed using the Mann–Whitney test, categorical data was analyzed by exact Fisher criteria. A p-value less than 0.05 was statistically significant.

RESULTS. In 43.2% of patients cognitive and/or behavioral changes were observed. The majority of patients (approximately 20%) suffered from a variant of ALS with cognitive impairment, which was mostly presented with executive and social cognitive dysfunction. ALS with behavioral impairment was observed at 9% of patients, which mostly presented with apathy and disinhibition. A combination of cognitive and behavioral impairment was registered in 7% of patients. In another 7% of patients severity of cognitive and behavioral impairment reached a degree of dementia and corresponded to frontotemporal degeneration.

CONCLUSION. This cognitive and behavioral impairment is observed in a substantial number of patients with ALS and mostly presented with moderate executive and social cognitive dysfunction, as well as apathy and less often — disinhibition.

The article deals with the theoretical intersections of V.D. Mendelevich’s anticipatory concept of neurosis and models developed within the framework of the cognitive behavioral direction of psychotherapy. The fundamental similarity of approaches is shown, which allows integrating both theoretical and practical aspects of these concepts. Using examples of clinical cases, the possibility of joint integrative conceptualization is demonstrated, taking into account the ideas inherent in both approaches. This work can serve as a basis for further research on the development of psychocorrective and psychotherapeutic interventions.

BACKGROUND. The presented literature review reveals the topic of subjective cognitive impairment in the context of social intelligence disorders as one of the most important components of cognitive functions.

AIM. Analysis of existing literature data on subjective cognitive impairments and assessment of social intelligence.

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, Medscape, eLIBRARY for selection of literature.

RESULTS. The paper compares the types of cognitive disorders and the main differences between the group of subjective disorders and other pronounced forms of cognitive disorders. The key differences include the impossibility of making a diagnosis based on the results of neuropsychological testing, the absence of a clinically pronounced syndrome and difficulties in performing everyday tasks. The connection of social intelligence with factors adversely affecting the state of health is considered, and a generalizing characteristic of social intelligence as a separate cognitive function is presented.

CONCLUSION. The low detectability of subjective cognitive impairments is associated with ignorance of their severity on the part of both the doctor and the patient. There is a problem of adequate methods for assessing subjective cognitive impairment using neuropsychological testing, including determining the level of social intelligence. The most accurate method of assessing social intelligence is the Guilford test.

At present, the concepts of psychical disease and disorder are compared. The concept of disease is preferred. Psychiatric diagnosis and its aspects are considered for the position of the biopsychosocial (trichotomy) model, the second term is preferred, the concept of a soul is concretized. The medical aspect is pathological experiences, the social one is the demetaphorization of the disease, the destigmatization of the patient, the psychological one is the impact on “the healthy among the sick”, the philosophical one is “divine madness is teleological”.

The psychiatric section of ICD-11 is the subject of criticism both in the world and in the Russian psychiatric community. Russian psychiatrists find such shortcomings in the ICD-11 as excessive simplicity of presentation, lack of in-depth psychopathology, unjustified removal of gender dysphoria from the list of mental, behavioral and neurodevelopmental disorders. The authors of this article tend to consider the noted features of the new version of the ICD as advantages rather than disadvantages, and regard it far from ideal and in many ways inferior to the DSM-5, but quite suitable for the psychiatric practice diagnostic tool.