Vol LV, No 1 (2023)

The article is devoted to the analysis of the causes of overdiagnosis and misdiagnosis of schizophrenia from the standpoint of cognitive distortions in the process of cognition of clinical reality. Using the diagnosis of “sluggish schizophrenia” as an example, it is concluded that overdiagnosis is based on the false consensus effect, which in psychiatry reflects the diagnostician’s solidarity with the position of the scientific school to which he belongs, and with the inability to resist the pressure of authorities. A clinical example of an erroneous diagnosis is given. In conclusion, it is stated that the overdiagnosis of schizophrenia and the unjustified prescription of antipsychotic therapy to patients leads to the discrediting of psychiatry and the stigmatization of the mentally ill. This trend should be reconsidered and the diagnosis of schizophrenia should be made solely on the basis of obvious, and not indirect, clinical phenomena.

BACKGROUND. There are many studies in the literature suggesting that cognitive impairment is more pronounced in patients with myasthenia gravis compared with healthy people, but there is no explanation of the reasons and mechanisms. However, the reverse character — the influence of intellectual-mnestic disorders on the course of myasthenia gravis — has not been studied enough.

AIM. To compare clinical, anamnestiс, laboratory and instrumental data in patients with myasthenia gravis according to the presence or absence of cognitive impairment.

MATERIAL AND METHODS. 61 patients with a confirmed diagnosis of myasthenia gravis were divided into 2 groups according to the Montreal cognitive test. Patients scoring 25 or less were assigned to the first group, those scoring 26 points or more to the second group.

A comparative assessment was made according to the myasthenia gravis impairment index, age of onset, duration of the disease, duration of hospitalization, severity of myasthenia gravis according to clinical scales, body mass index, electroneuromyography data, levels of antibodies to the acetylcholine receptor and skeletal muscles, and daily doses of the drugs received.

RESULTS. In the 1st group, there was a significantly higher score on the Generalised Disorders subscale of the Myasthenia Gravis Impairment Index; the severity of Quantitative myasthenia gravis score was significantly higher in the 1st group than in the 2nd both for the total score and for the Musculoskeletal Lesions subscale. On average, 49 mg more pyridostigmine bromide was required in the first group, while the average body mass index was significantly lower in the first group.

CONCLUSION. The presence of a cognitive deficit in patients with myasthenia gravis may worsen the clinical picture of the disease, which should be taken into account by clinicians, especially in elderly patients, who are at increased risk of developing cognitive disorders.

AIM. To discuss the historical traditions, modern approaches and experimental research data of the alienation syndrome, including the phenomena of mental automatism, depersonalization, “voices”; to comprehend the correlation between the phenomena of alienation and dissociation.

RESULTS AND CONCLUSIONS. Data from classical pathopsychological experiments which investigating the psychological structure of the alienation syndrome are analyzed. In the pathopsychological school of B.V. Zeigarnik aspects of the examination situation, including mental tension and presence of errors perceptible to the examinee, were studied as moderators of the dynamics of the Kandinsky–Clerambault syndrome. The role of social evaluation factor as a significant source of strengthening or weakening of symptoms was shown. Manifestations of alienation are often perceived as negative influences exerting power over the individual, controlling, humiliating, insulting or “interfering” with performance. Auditory hallucinations are not so much an auditory event, a perceptual defect, as a psychosocial dialogic phenomenon embodying internalized, often negative, patterns of social interaction. Contemporary psychotherapies for auditory hallucinations include an understanding of the role of metacognitive strategies, social emotions, negative content, and patterns of “voice”: interaction.

After spinal cord injury pathological changes in the lesion site and adjacent segments are described in detail. Data are accumulating on the tissue response in the areas of the spinal cord and even the brain distant from the epicentre of spinal cord injury. The concept of plasticity and post-traumatic responses in remote lumbar regions, which contain a specific circuits of interneurons known as the central pattern generator, is particularly important for the recovery of motor function. Among the factors influencing the plasticity of neuronal connections and regenerative potential in the area remote from the lesion epicentre, myeloid infiltration, microglial reactivity, neuroinflammation, and molecular rearrangements of the extracellular matrix are only beginning to be systematically studied. After thoracic spinal cord injury rapid responses develop in the lumbar cord that are characteristic of disintegration of the axons of the descending tracts. These shifts are accompanied by glial reactivity, synapse elimination, imbalance between excitation and inhibition, and disruption of connections in neural networks. This severity of these remote changes depends on the type and severity of the injury, which determines the different involvement and degree of destruction of the descending motor pathways. The review presents an analysis of experimental data on the responses and reorganization of the neural network in the lumbar spinal cord after injury in the proximal regions. The lesional biomarkers are of particular interest as a possible cause of pathological changes in distant areas. These molecules are released from dying cells at the epicenter of injury, appear in the cerebrospinal fluid, and acting as injury-associated molecular patterns and alarmins, can exert a neurotoxic effect in areas remote from the epicenter of injury.

The article presents the case of twenty-year-old Artem L., whose clinical picture of the disease was dominated by an overvalued hobby in the form of pathological hoarding. The case was analyzed from the standpoint of highlighting a new diagnosis — hording — in international psychiatric classifications. Differential diagnosis of hording with schizotypal and obsessive-compulsive disorder, as well as with autism spectrum disorders was carried out. It is concluded that the emergence of a new diagnosis of hoarding requires the formation of new algorithms of diagnostic thinking in psychiatrists and the rejection of interpretations of paradoxical, seemingly pretentious behavior as belonging to the circle of schizophrenic disorders.