Vol LI, No 4 (2019)

Schizophrenia affects approximately one in one hundred individuals. Treatment is rarely simple, and the exact biological mechanism is unknown. However, we are beginning to understand that schizophrenia does not manifest in isolation; rather, its manifestation and severity can be impacted by cultural context. Previous work by Luhrmann and colleagues found individuals diagnosed with schizophrenia from the United States, India, and Ghana who experience auditory vocal hallucinations — hearing voices — differently. American individuals often reported voices that gave violent commands; Indian and Ghanaian individuals reported more positive relationships with their voices. The present project extends this research and investigates whether patients diagnosed with schizophrenia in Russia demonstrate similar symptoms or thought processes about their disorder as participants from previously studied countries. This research has yet to be conducted in Russia, and provides an important perspective on the manifestation of a devastating disorder. Furthermore, understanding how Russian culture affects the symptoms of schizophrenia could inform development of culturally appropriate interventions in Russia, with potential to generalize globally. This review aims to explore the existing literature and provide a theoretical basis for the present investigation.

Objective of this research is to study the effect of atypical antipsychotics on hormonal and biochemical parameters in patients with schizophrenia.

Materials and methods. A comprehensive clinical, psychopathological and laboratory examination of 96 patients with schizophrenia (F20 according to ICD-10) who were hospitalized in the Department of Endogenous Disorders of the Scientific Research Institute of Mental Health of the Tomsk Scientific Research Center and received second-generation antipsychotics, was carried out. The Positive and Negative Syndromes (PANSS) scale (in the adapted Russian version of SCI-PANSS) was filled for a psychometric assessment of the severity and dynamics of schizophrenia symptoms in all patients upon admission to hospital and at discharge after 4 weeks. The laboratory study included determination of the concentration of total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL), glucose, insulin and cortisol in blood serum with the calculation of lipoproteins with low (LDL) and very low (VLDL) density, atherogenic index (IA) ) and insulin resistance (HOMA-IR). Statistical data processing was performed using the standard application package SPSS Statistic (V. 17.) for Windows. Differences were considered statistically significant at p ≤0.05.

Results. The pronounced effect of four-week treatment with atypical antipsychotics on the metabolism of glucose [glucose (p <0.001) and HOMA-IR (p=0.036)] was established. A statistically significant increase in TC (p=0.005), TG (p <0.001), VLDL (p <0.001), IA (p <0.001) and TG/HDL (p <0.001) after four weeks of treatment with atypical antipsychotics. No statistically significant changes in hormone levels were established.

Conclusions. The results demonstrate the pronounced effect of a four-week treatment with atypical antipsychotics on glucose metabolism, a change in glucose level and insulin resistance index. A typical atherogenic change in the serum lipid spectrum is shown. These indicators are laboratory markers of the risk of cardiovascular disease and diabetes, and therefore careful monitoring of metabolic disorders in patients with schizophrenia is necessary.

Alexithymia is considered to be a frequent complication of stroke that is not studied in Russian population.

Aim. To determine frequency of alexithymia in patients with first-ever stroke and particularly in patients with affective disorders.

Methods. 40 patients (mean age 63.1±12.0 years, 40% female) involved in prospective cohort study were assessed by 26-point Toronto Alexithymia Scale. Scores more than 62 were considered as borderline level of alexithymia, more than 74 as obvious alexithymia.

Results. Borderline alexithymia was found in 13 patients (32.5% of sample), obvious alexithymia — in 20 patients (50%). Patients with alexithymia were more frequently male and didn`t differ by age, educational level, stroke severity, lesion volume and location, cognitive dysfunction severity, comorbid somatic pathology. Alexithymia was more frequent in patient with pre-stroke and post-stroke depression but was not associated with generalized anxiety disorder.

Conclusions. Alexithymia frequently accompanies post-stroke depression. High alexithymia score in patients with pre-stroke depression may indicate that Toronto Alexithymia Scale gives false-positive results in gerontological patients with depressive disorders.

Purpose. To study the severity of volitional self-regulation and the level of subjective control in patients with type II diabetes mellitus (DM) with various variants of its course.

Methods. Methodology “The study of volitional self-regulation” (A.V. Zverkov and E.V. Eidman) and the diagnosis “Level of subjective control” (E.F. Bazhin, E.A. Golynkina, L.M. Etkind). The data obtained were processed using the statistical program SPPS 20.

Results. The study showed that in most patients with type II diabetes, a decrease in the level of subjective control of the person over significant events was revealed, especially with type II diabetes insulin. The low level of development of volitional self-regulation with instability of intentions, emotional lability and impulsiveness can be associated with problems in organizing the life of patients with type II diabetes, the inability to build relationships with other people and adequately respond to certain situations, which reflects the appearance of maladaptive forms of behavior. The main characteristics of a low level of volitional self-regulation were significantly positively correlated with the decompensated course of type II diabetes and the external locus of control in relation to health and illness. This category of patients perceives their health to a great extent to be dependent on external influences, accidents and practically do not make their own efforts to restore it, which can lead to eating disorders, taking sugar-lowering drugs and worse diabetes compensation. This suggests that patients with type II diabetes with external localization of control preferred to deny personal responsibility and had a low level of self-regulation and insufficient cognitive assessment.

Conclusion. External localization of control with a low level of volitional self-regulation, perseverance and self-control have an effect on the course of type II diabetes, especially in patients with insulin-treated diabetes , leading them to a decompensated course of the disease and an increase in diabetic complications.

Aim. For the purpose to systematize the directions of interaction of psychiatrists, medical and social psychologists in the system of the Ministry of Internal Affairs of Russia.
Methods. The analysis of organizational approaches of intradepartmental interaction is carried out during the examination of candidates for service and employees of Internal Affairs Bodies (IAB) during the psychiatric examination by the military medical commission, medical and psychological support.
Results. It is shown that a comprehensive approach to prevention of mental health disorders of police officers with the participation of psychiatrists, clinical and social psychologists is the only effective method of work, that allows for quality systematic monitoring of mental health of employees, helps to reduce the incidence of mental and psychosomatic disorders, dismissal of police officers, improves the social climate
Conclusion. The complex of measures for intradepartmental interaction of specialists in the field of mental health contributes for preservation of mental well-being of employees, their personal professional and functional reliability and reduces image losses.
Keywords: mental health protection, employees of Internal Affairs Bodies, intradepartmental interaction, Mental health centers.

Aim. The current paper presents analysis of adherence to treatment in the effectiveness of rehabilitation measures using the Visual Medicine program in patients with the consequences of stroke.

Methods. The sample consisted of 70 patients with acute stroke. Assessment of the functional state of patients after a stroke was carried out using the Rankin scale. Adherence to treatment was studied using the psycho-diagnostic questionnaire “Level of Compliance”. The state of higher mental functions (HMF) of patients before and after undergoing a course of rehabilitation was assessed using functional neuropsychological tests, assessed by four parameters (rate, accuracy, differentiation, and coordination). In the course of rehabilitation, the software and hardware complex Visual Medicine was used. Statistical processing was performed in the Statistical 10.0 software package.

Results. As a result of the study, a positive dynamics of the restoration of kinesthetic, spatial praxis was revealed. Patients of the experimental group demonstrated more accurate reproduction of the posture of the hands according to the tactile and visual pattern, improved right-left orientation, more efficient implementation of the motor program. It has been reliably established that frequency of occurrence of indicators of social compliance in groups with a different amount of shift in the state of HMF in subjects who underwent rehabilitation using the Visual Medicine program allows us to state that a score of 27 points is the section boundary in relation to the level of shift: upon reaching the dynamics of the recovery of HPF are significantly lower. The results obtained indicate that the higher level of compliance, shows the higher level of the efficiency of restoration of fine motor functions using the program.

Conclusions. Exercises with the program “Visual Medicine” personify the rehabilitation process, which improves the efficiency of restoration of fine motor functions of post-stroke patients. High effectiveness of these exercises achieved due to the high level of social compliance of patients, manifested in a friendly position, the desire to psychologically rely on the doctor, to earn his approval. Conducting a preventive diagnosis of adherence allows optimizing the rehabilitation route of patients during their hospital presence.

Cerebrovascular disorders are the most frequent and urgent complications of chronic kidney disease, especially, in the dialysis period.

The purpose is to provide an analytical review of current (2011 and later) publications containing a comprehensive analysis of stroke data in dialysis patients.

Methods. A critical analysis of the literature data with a generalization of the currently available results of the original studies on the stroke in dialysis patients.

Results. The risk of stroke increases many times in hemodialysis patients with end-stage chronic kidney disease. According to different publications, the risk of hemorrhagic stroke increases 4–6 times, and ischemic stroke — 2–3 times, compared with the general population. Dialysis patients are under the higher risk of mortality after the stroke. The presence of atrial fibrillation in a dialysis patient is prognostically unfavorable and increases the frequency of stroke by 2.5 times, mortality by 2 times, compared to dialysis patients without atrial fibrillation.

Conclusions. There is lack of studies on the use of warfarin in comparison with aspirin or new oral anticoagulants to conclude on the benefits of one or another way of management in dialysis patients with atrial fibrillation. Apparently, the use of warfarin is not justified in dialysis patients. Thrombolytic therapy is not indicated to a dialysis patient with acute period of ischemic stroke. The use of prolonged renal replacement therapy is preferable in the patients with acute stroke and acute renal failure. It is suggested to carry out hemodialysis without anticoagulation or (if necessary) with the use of fractionated heparins in case of increased risks of bleeding.

This work is a “literary response” to the publication by D. Trutneva and V. Mendelevich “Psychotherapy without a psychotherapist” within the overall subject “Apologies of the industrial model of medicine” which was raised by the author at the symposium “Stаtus praesens of psychiatry” in St. Petersburg on 29–30 November 2019. The body of the text is made up of two literary essays written way back in 1994. The essays have proven to be visionary in terms of the evolution of paramedical studies, to which I believe psychoanalysis belongs.

The article is devoted to the problem of plagiarism as one of the most common forms of academic dishonesty. An attempt is made to use the conceptual apparatus of clinical pathopsychology to analyze the mental processes of students learning psychology distantly and resorting to plagiarism. Phenomena resembling disorders of thinking such as slippage and disposition to futile judgement are described. Adherence to plagiarism is considered in the context of the concept of “clip thinking”. Measures of counteraction to plagiarism, and also available ways of overcoming plagiarism-slippage and plagiarism with disposition to futile judgement in the conditions of use of traditional approach in distance learning of students are considered.

The problem of new existential states that psychologists or psychiatrists are facing in their practice in relation to accelerating changes in human existence is discussed. The classifications of mental illnesses are replenished with new nosological units and treatment recommendations, because of a changing world. The definition of health as the absence of disease becomes untenable due to its inability to shed light on the nature of the pathologies. An understanding health in terms of psychological well-being is the most perspective nowadays. Various authors recognize spirituality as one of the integral components of human well-being. Researchers attribute to spirituality the function, which has moderating effects (reduced or leveled) of stressors and adverse life circumstances on human well-being. The work poses the problem of spiritual health as the possibility of mastering spiritual experience and its integration into a personality worldview. Substantiated that spirituality is recognized as a special field of quality of life research, and spiritual health and psychological well-being have heuristic potential in the context of psychiatry.

Due to the diagnostic difficulties and the lack of clinical recommendations for treatment, assistance in acute endogenous psychoses (atypical, cycloid psychoses) is a hard task in psychiatric practice. The abundance of different therapeutic approaches has not yet been systematically investigated. The data obtained suggest that benzodiazepine monotherapy is the most effective and safe method, while other pharmacological combinations have significant drawbacks and can provoke deterioration of the mental state and the resumption of psychosis. Risk factors for the recurrence of psychosis include the use of antipsychotics in high doses, the combination of several antipsychotics and the addition of cholinolytic drugs to therapy.

Subjective health is a self-assessment of human condition and measure of health — has proven itself in research as a predictor of mortality and objective health. This indicator is most widely used by a variety of disciplines in the context quality of life and health studies. Along with this, the comprehension of this construct is still complicated and disputed. In psychiatry, the subjective understanding of health is reduced to ideas about development and course of mental illness. There is evidence of a culturally specific understanding of health by representatives of different nationalities. The article raises the problem of the influence of psychiatric diagnosis on self-assessment of health as a whole.