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Vol LIV, No 3 (2022)

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ICD-11 (psychiatric section): who diagnoses better treats better?

Mendelevich V.D.


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.

Neurology Bulletin. 2022;LIV(3):5-10
pages 5-10 views

Original study arcticles

Gender characteristics of schizophrenia remission

Serazetdinova V.S., Petrova N.N., Serazetdinova L.G., Gluskina L.Y.


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.

Neurology Bulletin. 2022;LIV(3):11-20
pages 11-20 views

Impairment of social cognitive functions in the patients with acute ischemic stroke

Ozerova A.I., Kutlubaev M.A.


BACKGROUND. Cognitive impairment is common after a stroke. However, the condition of social cognitive functions, in particular theory of mind, in this group of patients has been studied insufficiently.

AIM. To study the frequency and predictors of the development of the social cognitive disorders based on theory of mind impairment in patients with acute ischemic stroke.

MATERIAL AND METHODS. Theory of mind impairment was assessed using “Reading the Mind in the Eyes” test in the acute period of ischemic stroke. National Institutes of Health Stroke scale was used to assess the severity of neurological deficit, modified Rankin scale — the degree of disability, Delirium Severity Rating Scale — the symptoms of delirium, Buss Perry aggressiveness scale — severity of aggressive behavior, Montreal Cognitive Assessment Scale — cognitive deficit. The severity of cortical atrophy was evaluated by computed tomography of the brain. The study included 86 patients, 53 males and 33 females. The average age of patients was 64 years. Statistical analysis was performed using the IBM SPSS Statistics 21 software package. Nonparametric statistics methods were used. Binary data were compared using the chi-square parameter, categorical data were compared using the Mann–Whitney test.

RESULTS. Seventy percent of patients suffered from the impairment of social cognitive functions. Independent predictors of the impairment of theory of mind according to linear regression analysis were cognitive dysfunction according to the Montreal Cognitive Assessment Scale (p=0.0001) and the severity of cortical atrophy on computed tomography of the brain (p=0.001).

CONCLUSION. Social cognitive impairment is registered in a substantial number of patients in acute period of stroke; its predictors include general cognitive impairment and cortical atrophy of the brain.

Neurology Bulletin. 2022;LIV(3):21-26
pages 21-26 views

Cognitive and behavioral changes in amyotrophic lateral sclerosis

Areprintseva D.K., Kutlubaev M.A.


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.

Neurology Bulletin. 2022;LIV(3):27-32
pages 27-32 views

Structural and bioenergetic changes in muscle tissue in idiopathic muscular dystonia

Bushueva O.O., Antipenko E.A., Pchelin P.V., Mukhina I.V., Lobanov I.A.


BACKGROUND. Muscular dystonia is a syndrome with localization of the pathological process in the central nervous system and the formation of local muscle hypertonicity. It is relevant to study changes in the muscles involved in hyperkinesis in dystonia as one of the possible symptoms of the disease.

AIM. To identify structural and bioenergetic changes in muscles in patients with idiopathic muscular dystonia.

MATERIAL AND METHODS. 10 patients were examined with a diagnosis of idiopathic segmental and generalized dystonia, including cervical dystonia syndrome. The control group included 5 conditionally healthy individuals. All patients received injections of botulinum toxin type A with a TWSTRS and Tsui efficacy score before injection and 3 weeks after injection. Structural changes in the muscles were assessed by magnetic resonance imaging (MRI) (1.5 Tl). To assess bioenergetic changes, the parameters of mitochondrial respiration were studied, including basal respiration during oxidation of substrates (pyruvate and pyruvate-malate), respiration during oxidative phosphorylation with various participation of respiratory chain complexes, electron transport chain capacity (ETC), ATP-associated respiration in a trapezius muscle biopsy.

RESULTS. Bioenergetic changes in muscle tissue were revealed in the form of a decrease in the indices of initial respiration, basal respiration with the participation of the I complex (KI) ETC in the process of oxidation of pyruvate and pyruvate-malate substrates, oxidative phosphorylation with the participation of KI. Structural changes of muscle tissue in the form of asymmetric hypertrophy and partial fat replacement of the involved muscles are demonstrated. The presence of fat replacement reduced the difference on the TWSTRS scale before botulinum therapy and 3 weeks after injection.

CONCLUSIONS. Patients with dystonia have bioenergetic changes in muscle tissue in the form of a defect in the work of the KI respiratory chain, but these changes do not affect the effectiveness of botulinum therapy. Structural changes in the form of partial fat replacement of muscle tissue reduce the effectiveness of botulinum therapy.

Neurology Bulletin. 2022;LIV(3):33-41
pages 33-41 views


The anticipatory concept of neurosis and cognitive behavioral model: prospects for integration

Granitsa A.S.


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.

Neurology Bulletin. 2022;LIV(3):42-50
pages 42-50 views

Some theoretical models of addictive disorder are used for behavioral transformation

Zobin M.L.


Existential, neurobiological and cognitive models of addictive behavior are considered as a theoretical basis for transformational therapy of addictive disorders. The NMDA receptor antagonist ketamine, which has neurotrophic, modulatory and psychedelic effects, demonstrates the universal properties of a transforming agent for any of the presented concepts of addictive behavior. Since persistent mental and behavioral changes essentially are psychobiological changes, the substrate that determines the effectiveness of the intervention is synaptic plasticity and neural network remodeling.

Neurology Bulletin. 2022;LIV(3):51-61
pages 51-61 views

Social intelligence in the context of the development of subjective cognitive impairment

Yakupov E.Z., Bakanova A.S., Zhamieva R.A.


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.

Neurology Bulletin. 2022;LIV(3):62-70
pages 62-70 views

Cognitive-behavioral approach to the treatment of night eating syndrome

Melehin A.I.


The article presents an analysis of a widespread disorder in recent years — the syndrome of night eating (SLEEP). The trajectory of the behavioral pattern of patients with this disorder is described. The criteria for distinguishing eating disorders in sleep (somnambulistic eating) are shown from the night food syndrome. The biological, psychological and social factors influencing and supporting the night eating syndrome are differentiated. Based on the biobehavioral model of A. Stankard’s night food syndrome, the psychological model of the relationship between the attachment style and night food syndrome L. Wilkinson and the Cognitive Behavioral Model (CBT) of SLEEP K. Allison substantiates the relevance of the use of psychotherapeutic strategies in the framework of complex treatment with the use of psychopharmacotherapy and light therapy. The structural components, effectiveness, and limitations of the protocol of cognitive behavioral therapy for K. Allison’s night eating syndrome are detailed. It is shown that the connection of a psychodynamic or interpersonal psychotherapeutic model to CBT allows us to focus on the role of significant other people for the mental organization of the patient, their lack or loss in the development of psychological inflexibility and linking mental distress with deficiency in the processes of emotional self-regulation.

Neurology Bulletin. 2022;LIV(3):71-83
pages 71-83 views


On some aspects of psychiatric diagnosis

Voskresensky B.A., Begmatov R.I.


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”.

Neurology Bulletin. 2022;LIV(3):84-91
pages 84-91 views

ICD-11 (psychiatric section): from regress in diagnosis to progress in therapy?

Snedkov E.V.


The article is devoted to the analysis of the correlation of approaches to diagnostics and therapy in the classification of mental and behavioral disorders (ICD-11), described in the article by V.D. Mendelevich. The author questions the validity of the antinosological principle of the new classification and ignoring a comprehensive study of the anamnesis of life and disease, the patient’s inner world, and the contextual connections of mental phenomena.

Neurology Bulletin. 2022;LIV(3):92-95
pages 92-95 views

ICD-11: Routine diagnostic tool without the splendor of classical psychopathology of the past

Sivolap Y.P., Portnova A.A.


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.

Neurology Bulletin. 2022;LIV(3):96-101
pages 96-101 views

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