Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-107-117
O. Glavnova, N. Vorokhobina, L. Velikanova, M. Yarmolinskaya, E. Malevanaya, E. Strelnikova, K. A. Balandina
Objective: to study the steroid metabolomics in women with normal body weight and various PCOS phenotypes by gas chromatography-mass spectrometry (GC-MS). Materials and methods: forty-eight(48)women with PCOS aged 25±0,3 yearswith a BMI less than 25 kg/m2 were examined. The control group (CG) consisted of twenty-five (25) healthy women aged 26±0,6 years with a BMI of 23 (21-24) kg/m2. Immunoassays were used to determine the levels of hormones in serum. Urinary steroid profiles (USP) were studied by GC-MS method. Statistical data processing was performed using the software system STATISTICA for WINDOWS (ver. 10). Results: the article provides an analysis of the metabolism of androgens, glucocorticoids and progestogens in women with different phenotypes of polycystic ovary syndromeaccording to gas chromatography-mass spectrometry. Summary: the urinary excretion of androstenedione metabolites was increased in PCOS patients with androgen excess and anovulation (A and B phenotypes), dehydroepiandrosterone metabolites - in PCOS patients with androgen excess (A, B and C phenotypes). PCOS women with phenotype C showed raised urinary excretion of 11-oxo-pregnanetriol, pregnanetriol and 17-hydroxypregnanolone, a decrease in the ratios of the sum of tetrahydro derivatives of cortisol and cortisone to these progestogens, as well as determination of tetrahydro-21-deoxycorticol and nonclassical 5-ene-pregnenes according to GC-MS data. In fact, it indicated to deficiency of the 21-hydroxylase enzyme in these patients. It was found PCOS patients with androgen excess (A, B and C phenotypes) had the signs of insufficient 3β-hydroxysteroid dehydrogenase activity. PCOS women with phenotype A were revealed deficiency of 11β-hydroxysteroid dehydrogenase (type 1).
目的:采用气相色谱-质谱联用技术(GC-MS)研究正常体重、不同PCOS表型女性的类固醇代谢组学。材料与方法:48例年龄25±0.3岁，体重指数小于25 kg/m2的PCOS女性。对照组(CG) 25名健康女性，年龄26±0.6岁，BMI为23 (21-24)kg/m2。免疫测定法测定血清中激素水平。采用气相色谱-质谱法研究尿液类固醇谱。统计数据处理采用统计软件系统STATISTICA for WINDOWS。10)。结果:采用气相色谱-质谱联用技术分析了多囊卵巢综合征不同表型女性雄激素、糖皮质激素和孕激素的代谢变化。总结:雄激素过量和无排卵的PCOS患者(A和B表型)尿中雄烯二酮代谢物排泄增加，雄激素过量的PCOS患者(A、B和C表型)尿中脱氢表雄酮代谢物排泄增加。根据GC-MS数据，表型为C的PCOS女性尿中11-氧孕三醇、孕三醇和17-羟基孕酮的排泄量增加，皮质醇和可的松的四氢衍生物与这些孕激素的总和比例降低，以及四氢-21-脱氧皮质醇和非经典5-烯孕酮的测定。事实上，这表明这些患者缺乏21-羟化酶。发现雄激素过量(A、B、C型)的PCOS患者存在3β-羟基类固醇脱氢酶活性不足的体征。表型为A型的PCOS女性表现为缺乏11β-羟基类固醇脱氢酶(1型)。
{"title":"Gas chromatography-mass spectrometry based steroid metabolomics in women with different phenotypes of polycystic ovarian syndrome and normal body weight","authors":"O. Glavnova, N. Vorokhobina, L. Velikanova, M. Yarmolinskaya, E. Malevanaya, E. Strelnikova, K. A. Balandina","doi":"10.21886/2219-8075-2022-13-3-107-117","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-107-117","url":null,"abstract":"Objective: to study the steroid metabolomics in women with normal body weight and various PCOS phenotypes by gas chromatography-mass spectrometry (GC-MS). Materials and methods: forty-eight(48)women with PCOS aged 25±0,3 yearswith a BMI less than 25 kg/m2 were examined. The control group (CG) consisted of twenty-five (25) healthy women aged 26±0,6 years with a BMI of 23 (21-24) kg/m2. Immunoassays were used to determine the levels of hormones in serum. Urinary steroid profiles (USP) were studied by GC-MS method. Statistical data processing was performed using the software system STATISTICA for WINDOWS (ver. 10). Results: the article provides an analysis of the metabolism of androgens, glucocorticoids and progestogens in women with different phenotypes of polycystic ovary syndromeaccording to gas chromatography-mass spectrometry. Summary: the urinary excretion of androstenedione metabolites was increased in PCOS patients with androgen excess and anovulation (A and B phenotypes), dehydroepiandrosterone metabolites - in PCOS patients with androgen excess (A, B and C phenotypes). PCOS women with phenotype C showed raised urinary excretion of 11-oxo-pregnanetriol, pregnanetriol and 17-hydroxypregnanolone, a decrease in the ratios of the sum of tetrahydro derivatives of cortisol and cortisone to these progestogens, as well as determination of tetrahydro-21-deoxycorticol and nonclassical 5-ene-pregnenes according to GC-MS data. In fact, it indicated to deficiency of the 21-hydroxylase enzyme in these patients. It was found PCOS patients with androgen excess (A, B and C phenotypes) had the signs of insufficient 3β-hydroxysteroid dehydrogenase activity. PCOS women with phenotype A were revealed deficiency of 11β-hydroxysteroid dehydrogenase (type 1).","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76313736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-161-172
V. Tskhay, A. A. Bakunina
Currently, the medical community has accumulated significant experience in the use of endovascular methods in obstetric practice to achieve hemostasis and prevent massive hemorrhage, including in patients with placenta accreta spectrum (PAS) disorders. Objective — to evaluate the effectiveness of various methods of uterine devascularization in reducing blood loss during caesarean section in patients with PAS. In this review, we analyzed relevant literature and assessed the quality of clinical trials based on a systematic search in the Embase, PubMed, Web of Science, and Cochrane Library databases. The review presents an overview of modern methods of uterine devascularization aimed at reducing intraoperative blood loss in patients with PAS. A comparative analysis of the effectiveness of such methods of uterine devascularization as temporary balloon occlusion of the internal iliac arteries, common iliac arteries, abdominal aorta, as well as arterial compression using distal hemostasis was carried out. We evaluated effectiveness of the methods by such indicators as the mean amount of blood loss and the frequency of hysterectomy. The most effective methods of hemostasis in patients with PAS are temporary balloon occlusion of the abdominal aorta and the method of distal hemostasis. At the same time, there is still no ideal method for uterine devascularization in PAS, and clinical research in this direction should be continued.
目前，医学界在产科实践中使用血管内方法实现止血和预防大出血方面积累了丰富的经验，包括在患有胎盘增生谱(PAS)疾病的患者中。目的:评价各种子宫断流术对减少PAS患者剖宫产术中出血量的效果。在这篇综述中，我们分析了相关文献，并基于Embase、PubMed、Web of Science和Cochrane Library数据库的系统检索评估了临床试验的质量。本文综述了旨在减少PAS患者术中出血量的现代子宫断流术方法。对比分析暂时性球囊闭塞髂内动脉、髂总动脉、腹主动脉及远端止血压迫动脉等宫内断流术的效果。我们通过平均失血量和子宫切除次数等指标来评价方法的有效性。PAS患者最有效的止血方法是暂时性球囊阻断腹主动脉和远端止血法。同时，PAS中仍没有理想的子宫断流方法，应继续在此方向进行临床研究。
{"title":"Comparative analysis of the effectiveness of different methods of surgical hemostasis in patients with placenta accreta spectrum disorders","authors":"V. Tskhay, A. A. Bakunina","doi":"10.21886/2219-8075-2022-13-3-161-172","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-161-172","url":null,"abstract":"Currently, the medical community has accumulated significant experience in the use of endovascular methods in obstetric practice to achieve hemostasis and prevent massive hemorrhage, including in patients with placenta accreta spectrum (PAS) disorders. Objective — to evaluate the effectiveness of various methods of uterine devascularization in reducing blood loss during caesarean section in patients with PAS. In this review, we analyzed relevant literature and assessed the quality of clinical trials based on a systematic search in the Embase, PubMed, Web of Science, and Cochrane Library databases. The review presents an overview of modern methods of uterine devascularization aimed at reducing intraoperative blood loss in patients with PAS. A comparative analysis of the effectiveness of such methods of uterine devascularization as temporary balloon occlusion of the internal iliac arteries, common iliac arteries, abdominal aorta, as well as arterial compression using distal hemostasis was carried out. We evaluated effectiveness of the methods by such indicators as the mean amount of blood loss and the frequency of hysterectomy. The most effective methods of hemostasis in patients with PAS are temporary balloon occlusion of the abdominal aorta and the method of distal hemostasis. At the same time, there is still no ideal method for uterine devascularization in PAS, and clinical research in this direction should be continued.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83654930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-93-106
I. Dzherieva, N. Volkova, I. Davidenko, I. Reshetnikov, S. Brovkina, S. M. Avakova, Y. Tishchenko
Glucocorticoids (GC) are one of the most common drugs in the practice of doctors of various specialties because of their therapeutic effects. The increased number of usage is related to the current SARS-CoV-2 virus pandemic. However, GC therapy has serious obstacles caused by side effects, including those leading to fatal outcomes. Side effects include: glucose and lipid metabolism impairments, weight gain, sleep disorders, thromboembolism, atherosclerosis, osteoporosis, myopathy, etc. The described processes cause a direct increase in the risk of developing cardiovascular diseases (CVD) even with short-term therapy and low doses of GC, which affects the further life, prognosis and outcomes of the underlying disease. This review describes in detail the pathogenetic mechanisms and the mutual influence of the side effects of GC, their contribution to the subsequent occurrence of CVD and focuses on the danger of irrational use of GC therapy.
{"title":"Glucocorticoid therapy is a risk factor for cardiovascular diseases","authors":"I. Dzherieva, N. Volkova, I. Davidenko, I. Reshetnikov, S. Brovkina, S. M. Avakova, Y. Tishchenko","doi":"10.21886/2219-8075-2022-13-3-93-106","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-93-106","url":null,"abstract":"Glucocorticoids (GC) are one of the most common drugs in the practice of doctors of various specialties because of their therapeutic effects. The increased number of usage is related to the current SARS-CoV-2 virus pandemic. However, GC therapy has serious obstacles caused by side effects, including those leading to fatal outcomes. Side effects include: glucose and lipid metabolism impairments, weight gain, sleep disorders, thromboembolism, atherosclerosis, osteoporosis, myopathy, etc. The described processes cause a direct increase in the risk of developing cardiovascular diseases (CVD) even with short-term therapy and low doses of GC, which affects the further life, prognosis and outcomes of the underlying disease. This review describes in detail the pathogenetic mechanisms and the mutual influence of the side effects of GC, their contribution to the subsequent occurrence of CVD and focuses on the danger of irrational use of GC therapy.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78228171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-7-12
K. S. Vinogradova
Objective — to study and analyze the current trends among Western scientists and mental health professionals regarding issues of gender identity; to study the data of foreign and domestic studies concerning the problems of gender incongruence, gender dysphoria and their comorbidity with mental disorders, personality disorders, especially with schizophrenia and autism spectrum disorders; to identify promising areas of scientific research in this direction. Source search in electronic databases was carried out mainly for the past 5 years among foreign and russian publications, including Web of science, Researchgate.net, Google Scholar, Elibrary, Cyberleninka systems, using phrases such as gender identity disorder, gender identity disorder comorbidity, gender identity disorder schizophrenia, gender identity disorder autism, gender nonconformity, mentalization personality disorder. The article presents the data of modern publications and studies, showing, on the one hand, the tendency of Western experts to depathologize gender incongruence, promote gender transition, on the other hand, an active study of the relationship between this phenomenon with autism and schizophrenia spectrum disorders, personality disorders. According to the presented studies, the influence of mentalization features on the presence of mental disorders and gender incongruence is revealed.
目的——研究和分析西方科学家和心理健康专业人员关于性别认同问题的当前趋势;研究国内外关于性别不一致、性别不安及其与精神障碍、人格障碍，特别是与精神分裂症、自闭症谱系障碍共病的研究资料;确定这方面有前景的科学研究领域。本文主要对近5年来国内外出版物的电子数据库进行检索，检索对象包括Web of science、Researchgate.net、谷歌Scholar、library、Cyberleninka等系统，检索词包括性别认同障碍、性别认同障碍共病、性别认同障碍精神分裂症、性别认同障碍自闭症、性别不一致、心智化人格障碍等。文章列举了现代出版物和研究的数据，一方面表明西方专家倾向于将性别不一致去病态化，促进性别转换，另一方面，积极研究这一现象与自闭症、精神分裂症谱系障碍、人格障碍之间的关系。根据这些研究，揭示了心理化特征对精神障碍和性别不一致存在的影响。
{"title":"Gender nonconformity as a problem of mentalization","authors":"K. S. Vinogradova","doi":"10.21886/2219-8075-2022-13-3-7-12","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-7-12","url":null,"abstract":"Objective — to study and analyze the current trends among Western scientists and mental health professionals regarding issues of gender identity; to study the data of foreign and domestic studies concerning the problems of gender incongruence, gender dysphoria and their comorbidity with mental disorders, personality disorders, especially with schizophrenia and autism spectrum disorders; to identify promising areas of scientific research in this direction. Source search in electronic databases was carried out mainly for the past 5 years among foreign and russian publications, including Web of science, Researchgate.net, Google Scholar, Elibrary, Cyberleninka systems, using phrases such as gender identity disorder, gender identity disorder comorbidity, gender identity disorder schizophrenia, gender identity disorder autism, gender nonconformity, mentalization personality disorder. The article presents the data of modern publications and studies, showing, on the one hand, the tendency of Western experts to depathologize gender incongruence, promote gender transition, on the other hand, an active study of the relationship between this phenomenon with autism and schizophrenia spectrum disorders, personality disorders. According to the presented studies, the influence of mentalization features on the presence of mental disorders and gender incongruence is revealed.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82256301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-67-74
A. I. Kovalev, O. Bukhanovskaya, A. Dyachenko, M. Temirova
The article presents the current state of the problem of patients with gender dysphoria. The heterogeneity of clinical groups within which this phenomenon occurs is shown. It is indicated that a thorough clinical and paraclinical examination is necessary for the correct choice of further therapeutic and diagnostic tactics. As an example, a clinical case of a 14-year-old patient who applied to a medical center due to dissatisfaction with her sexual identity, as well as problems of increasing social maladaptation, in the form of self-harm and suicidal behavior is given. During the examination, the patient was diagnosed with schizotypal disorder in which optional symptoms developed in the form of gender dysphoria due to the presence of symptoms of dysmorphic mania in combination with affective manifestations. Correctly chosen therapeutic tactics led to stabilization of the patient's condition and complete relief of symptoms of gender dysphoria.
{"title":"Clinical case of gender dysphoria in a patient with a procedural disease","authors":"A. I. Kovalev, O. Bukhanovskaya, A. Dyachenko, M. Temirova","doi":"10.21886/2219-8075-2022-13-3-67-74","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-67-74","url":null,"abstract":"The article presents the current state of the problem of patients with gender dysphoria. The heterogeneity of clinical groups within which this phenomenon occurs is shown. It is indicated that a thorough clinical and paraclinical examination is necessary for the correct choice of further therapeutic and diagnostic tactics. As an example, a clinical case of a 14-year-old patient who applied to a medical center due to dissatisfaction with her sexual identity, as well as problems of increasing social maladaptation, in the form of self-harm and suicidal behavior is given. During the examination, the patient was diagnosed with schizotypal disorder in which optional symptoms developed in the form of gender dysphoria due to the presence of symptoms of dysmorphic mania in combination with affective manifestations. Correctly chosen therapeutic tactics led to stabilization of the patient's condition and complete relief of symptoms of gender dysphoria.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88314176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-32-35
G. Vvedensky
Objective: a psychopathological analysis of the ideas of sex change and a description of the state of the sexual sphere in patients with schizotypal disorder. Materials and methods: we examined 38 patients who applied with a request to change their passport sex and were diagnosed with schizotypal disorder, 27 of them were women, 9 were men. Methods: clinical-psychopathological, sexological. To assess the sexual sphere and identify the motivation for changing sex and plans for the future a specially designed questionnaire was used. Results: variants of the ideas of gender reassignment were identified: obsessive, fixed, dominant, overvalued, delusional, their features specific to schizotypal disorder were described. For each variant, varying degrees of severity of violations of criticality and features of sexual behavior are described. An analysis of the characteristics of the sexual sphere of the studied groups showed the predominance of delays in psychosexual development and the associated deactualization of this sphere. In order to characterize the ability to adequately assess one's state, it is necessary to assess criticality as a variant of capacity, the issue of its methodology needs to be developed. Conclusions: the selected options differ in the degree of violation of criticality, which should be taken into account when deciding whether to change the passport gender.
{"title":"Phenomenology of ideas of gender change in patients with schizotypic disorder","authors":"G. Vvedensky","doi":"10.21886/2219-8075-2022-13-3-32-35","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-32-35","url":null,"abstract":"Objective: a psychopathological analysis of the ideas of sex change and a description of the state of the sexual sphere in patients with schizotypal disorder. Materials and methods: we examined 38 patients who applied with a request to change their passport sex and were diagnosed with schizotypal disorder, 27 of them were women, 9 were men. Methods: clinical-psychopathological, sexological. To assess the sexual sphere and identify the motivation for changing sex and plans for the future a specially designed questionnaire was used. Results: variants of the ideas of gender reassignment were identified: obsessive, fixed, dominant, overvalued, delusional, their features specific to schizotypal disorder were described. For each variant, varying degrees of severity of violations of criticality and features of sexual behavior are described. An analysis of the characteristics of the sexual sphere of the studied groups showed the predominance of delays in psychosexual development and the associated deactualization of this sphere. In order to characterize the ability to adequately assess one's state, it is necessary to assess criticality as a variant of capacity, the issue of its methodology needs to be developed. Conclusions: the selected options differ in the degree of violation of criticality, which should be taken into account when deciding whether to change the passport gender.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84197179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-13-20
A. Perekhov, M. N. Kryuchkova
Today, psychiatric care for people with transgender people in the Russian Federation is difficult due to non-compliance with ethical principles in the work of the psychiatric service. The article deals with the unresolved ethical conflict regarding gender reassignment procedures between proponents of "not allowed, forbidden" with the attitude of psychiatrists to issue permission for sex reassignment only to "real" transsexuals, and supporters of the opposite liberal attitude towards issuing permission. for gender reassignment procedures for almost all applicants. Our article discusses ethical issues to help transgender people. The ethical principles of autonomy, harmlessness and beneficence in this article are intended to help transgender people. The authors ethically write about adding and not adding a transgender diagnosis to the International Classification of Diseases. This article raises concerns about the benefits and harms, the principle of respect for autonomy and the principle of beneficence, in order to provide good quality ethical care for transgender people. The authors discuss the problem of the ethical attitude of a psychiatrist to the mental health of transgender subjects. The authors discuss the ethical problem of the psychiatrist's attitude to the mental health of transgender subjects, medicalization and medical paternalism with the help of transgender people. This article raises considerations about the ethical role of the psychiatrist in gender reassignment procedures for subjects with varying degrees of mental health. The authors propose an algorithm for providing psychiatric care to persons who have undergone gender reassignment, which includes an in-depth examination by psychiatrists, psychologists, sexologists and a collegial conclusion on the state of mental health of a transgender person in the triad: mentally healthy or "have mental disorders", "borderline" or "mental psychotic disorders".
{"title":"Psychiatric ethical issues of transgender people","authors":"A. Perekhov, M. N. Kryuchkova","doi":"10.21886/2219-8075-2022-13-3-13-20","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-13-20","url":null,"abstract":"Today, psychiatric care for people with transgender people in the Russian Federation is difficult due to non-compliance with ethical principles in the work of the psychiatric service. The article deals with the unresolved ethical conflict regarding gender reassignment procedures between proponents of \"not allowed, forbidden\" with the attitude of psychiatrists to issue permission for sex reassignment only to \"real\" transsexuals, and supporters of the opposite liberal attitude towards issuing permission. for gender reassignment procedures for almost all applicants. Our article discusses ethical issues to help transgender people. The ethical principles of autonomy, harmlessness and beneficence in this article are intended to help transgender people. The authors ethically write about adding and not adding a transgender diagnosis to the International Classification of Diseases. This article raises concerns about the benefits and harms, the principle of respect for autonomy and the principle of beneficence, in order to provide good quality ethical care for transgender people. The authors discuss the problem of the ethical attitude of a psychiatrist to the mental health of transgender subjects. The authors discuss the ethical problem of the psychiatrist's attitude to the mental health of transgender subjects, medicalization and medical paternalism with the help of transgender people. This article raises considerations about the ethical role of the psychiatrist in gender reassignment procedures for subjects with varying degrees of mental health. The authors propose an algorithm for providing psychiatric care to persons who have undergone gender reassignment, which includes an in-depth examination by psychiatrists, psychologists, sexologists and a collegial conclusion on the state of mental health of a transgender person in the triad: mentally healthy or \"have mental disorders\", \"borderline\" or \"mental psychotic disorders\".","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80897323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-137-147
N. Esakova, A. Lebedenko, A. Pampura
Anaphylaxis is a severe, life-threatening, systemic hypersensitivity reaction that develops rapidly and can lead to death. The diagnosis of anaphylaxis continues to be primarily clinical. Therefore, a large number of studies are initiated annually aimed at a deeper study of the mechanisms of the development of this disease and the search for its biomarkers, which could become an important tool to facilitate the verification of diagnosis, prevention and risk assessment of repeated episodes of anaphylaxis, stratification of the severity of its course, the risk of life-threatening episodes of systemic reactions, and be important in the development of new therapeutic strategies. This review provides information on the currently available data on potential biomarkers of anaphylaxis.
{"title":"Biomarkers of anaphylaxis","authors":"N. Esakova, A. Lebedenko, A. Pampura","doi":"10.21886/2219-8075-2022-13-3-137-147","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-137-147","url":null,"abstract":"Anaphylaxis is a severe, life-threatening, systemic hypersensitivity reaction that develops rapidly and can lead to death. The diagnosis of anaphylaxis continues to be primarily clinical. Therefore, a large number of studies are initiated annually aimed at a deeper study of the mechanisms of the development of this disease and the search for its biomarkers, which could become an important tool to facilitate the verification of diagnosis, prevention and risk assessment of repeated episodes of anaphylaxis, stratification of the severity of its course, the risk of life-threatening episodes of systemic reactions, and be important in the development of new therapeutic strategies. This review provides information on the currently available data on potential biomarkers of anaphylaxis.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"904 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77489742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-75-82
V. Soldatkin
The change in the position of transsexualism in the new ICD classification, the hot debate about the psychopathological structure of this phenomenon and its relation to other mental disorders determine the relevance of considering the following clinical case.A detailed clinical description demonstrates the possibility of combining two initially independent disorders - transsexualism and schizophrenia - which gave a bright individual color to the clinical picture and caused difficulties both in the medical and legal aspects of patient care.At the age of 25, a patient with clinical signs of transsexualism developed acute paraphrenia psychosis. Without medical assistance, according to the mechanisms of sanogenesis, the severity of the condition decreased, but the psychotic state was not recovered. Features of the onset and dynamics of psychosis typical for the continuous type of paranoid schizophrenia (acuteness of development and absence of signs of syndromotaxis) allow us to attribute it to episodic with progressive or stable deficit paranoid schizophrenia variant. It is noteworthy that after the onset of psychosis, the stereotype of the development of birth-assigned gender rejection syndrome did not undergo significant changes: the formation of crossdressing, inverse psychosexual identity and inverse gender identity were finally completed; mimicry reactions became bright, self-destructive tendencies began to appear more and more clearly, and the patient applied for permission to change gender.In the described clinical situation, the primary task is to overcome the acute schizophrenia psychosis. After solving this problem, the secondary prevention and rehabilitation program development becomes more important. Formally, the patient does not have the right to change sex, since she suffers from schizophrenia, which is a contraindication for sex transformation. In the state of psychosis, the patient essentially loses her civil procedural capacity. Informally, the question remains relevant.
{"title":"A clinical review: schizophrenia, transsexualism or their combination?","authors":"V. Soldatkin","doi":"10.21886/2219-8075-2022-13-3-75-82","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-75-82","url":null,"abstract":"The change in the position of transsexualism in the new ICD classification, the hot debate about the psychopathological structure of this phenomenon and its relation to other mental disorders determine the relevance of considering the following clinical case.A detailed clinical description demonstrates the possibility of combining two initially independent disorders - transsexualism and schizophrenia - which gave a bright individual color to the clinical picture and caused difficulties both in the medical and legal aspects of patient care.At the age of 25, a patient with clinical signs of transsexualism developed acute paraphrenia psychosis. Without medical assistance, according to the mechanisms of sanogenesis, the severity of the condition decreased, but the psychotic state was not recovered. Features of the onset and dynamics of psychosis typical for the continuous type of paranoid schizophrenia (acuteness of development and absence of signs of syndromotaxis) allow us to attribute it to episodic with progressive or stable deficit paranoid schizophrenia variant. It is noteworthy that after the onset of psychosis, the stereotype of the development of birth-assigned gender rejection syndrome did not undergo significant changes: the formation of crossdressing, inverse psychosexual identity and inverse gender identity were finally completed; mimicry reactions became bright, self-destructive tendencies began to appear more and more clearly, and the patient applied for permission to change gender.In the described clinical situation, the primary task is to overcome the acute schizophrenia psychosis. After solving this problem, the secondary prevention and rehabilitation program development becomes more important. Formally, the patient does not have the right to change sex, since she suffers from schizophrenia, which is a contraindication for sex transformation. In the state of psychosis, the patient essentially loses her civil procedural capacity. Informally, the question remains relevant.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90240690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-11DOI: 10.21886/2219-8075-2022-13-3-21-31
M. Yagubov, E. A. Starostina, N. V. Dobaeva, M. A. Ichmelyan
Recently, the issues of violations of gender identity are becoming more relevant and discussed, the number of patients with a request for a sex change is increasing. The complexity of this issue requires clinicians to be competent in helping transgender people, as they sometimes face many obstacles in the way of receiving care in medical institutions: the lack of specialists in the regions, a clear algorithm for helping transgender people, discrimination, stigmatization, and financial difficulties. At the same time, there are more and more foreign studies devoted to "detransition", i.e. "reverse" gender reassignment, which may indicate existing problems in the diagnosis of these conditions and methods of providing medical care to patients with gender identity disorders. The most difficult issues when working with patients experiencing gender dysphoria, in addition to identifying the true causes of gender identity disorders, are the preservation of fertility after gender-affirmative interventions, possible regrets after operations, and the provision of medical care to minors. Changes in the classification of gender disorders, including the exclusion of transsexualism from the class of mental disorders, creates the basis for discussions about the clinical, psychopathological and phenomenological features of these conditions. The scientific review provides information on the clinical and psychological aspects of gender identity disorders, as well as on therapeutic interventions for individuals with this pathology, using a multidisciplinary approach. Certain stages of the provision of medical and social assistance are described to reduce risks and more successful, professional assistance to persons with a gender incongruence.
{"title":"Gender Incongruence: clinical, psychological and therapeutic aspects","authors":"M. Yagubov, E. A. Starostina, N. V. Dobaeva, M. A. Ichmelyan","doi":"10.21886/2219-8075-2022-13-3-21-31","DOIUrl":"https://doi.org/10.21886/2219-8075-2022-13-3-21-31","url":null,"abstract":"Recently, the issues of violations of gender identity are becoming more relevant and discussed, the number of patients with a request for a sex change is increasing. The complexity of this issue requires clinicians to be competent in helping transgender people, as they sometimes face many obstacles in the way of receiving care in medical institutions: the lack of specialists in the regions, a clear algorithm for helping transgender people, discrimination, stigmatization, and financial difficulties. At the same time, there are more and more foreign studies devoted to \"detransition\", i.e. \"reverse\" gender reassignment, which may indicate existing problems in the diagnosis of these conditions and methods of providing medical care to patients with gender identity disorders. The most difficult issues when working with patients experiencing gender dysphoria, in addition to identifying the true causes of gender identity disorders, are the preservation of fertility after gender-affirmative interventions, possible regrets after operations, and the provision of medical care to minors. Changes in the classification of gender disorders, including the exclusion of transsexualism from the class of mental disorders, creates the basis for discussions about the clinical, psychopathological and phenomenological features of these conditions. The scientific review provides information on the clinical and psychological aspects of gender identity disorders, as well as on therapeutic interventions for individuals with this pathology, using a multidisciplinary approach. Certain stages of the provision of medical and social assistance are described to reduce risks and more successful, professional assistance to persons with a gender incongruence.","PeriodicalId":18314,"journal":{"name":"Medical Herald of the South of Russia","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81648550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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