V. Mendelevich, Gazinur A. Sitdikov, Radzhab R. Abakarov
The article presents the clinical case of 10-year-old Karim, whose behavior and mental status changed after a traffic accident in which the boy was hit by a car (without loss of consciousness and without traumatic brain injury). In addition to various motor paroxysms (convulsions) that did not meet the criteria for epileptic symptoms, the clinical picture included wave-like psychopathological symptoms and inappropriate behavior. The clinical picture could not be clearly attributed to the manifestation of dissociative disorders or post-traumatic stress disorder. Within two months after the accident, the clinical picture worsened — the "light intervals" during which Karim was completely adequate and critical became less frequent. Neurologists rejected the organic (epileptic) basis of the paroxysmal states. Examination and treatment by psychiatrists did not lead to stabilization of the mental state. In the opinion of the authors, the clinical case belongs to a rare polysyndromic variant of the dissociative subtype of PTSD, not described in the scientific literature, in which a mixture of various psychopathological symptoms was found - dissociative motor paroxysms, Ganser's syndrome, astasia-abasia, onirism, and flashbacks.
{"title":"Clinical mixed dissociative and post-traumatic stress disorders in a 10-year-old boy after a traffic accident","authors":"V. Mendelevich, Gazinur A. Sitdikov, Radzhab R. Abakarov","doi":"10.17816/nb625486","DOIUrl":"https://doi.org/10.17816/nb625486","url":null,"abstract":"The article presents the clinical case of 10-year-old Karim, whose behavior and mental status changed after a traffic accident in which the boy was hit by a car (without loss of consciousness and without traumatic brain injury). In addition to various motor paroxysms (convulsions) that did not meet the criteria for epileptic symptoms, the clinical picture included wave-like psychopathological symptoms and inappropriate behavior. The clinical picture could not be clearly attributed to the manifestation of dissociative disorders or post-traumatic stress disorder. Within two months after the accident, the clinical picture worsened — the \"light intervals\" during which Karim was completely adequate and critical became less frequent. Neurologists rejected the organic (epileptic) basis of the paroxysmal states. Examination and treatment by psychiatrists did not lead to stabilization of the mental state. In the opinion of the authors, the clinical case belongs to a rare polysyndromic variant of the dissociative subtype of PTSD, not described in the scientific literature, in which a mixture of various psychopathological symptoms was found - dissociative motor paroxysms, Ganser's syndrome, astasia-abasia, onirism, and flashbacks.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140362552","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}
The article is a critical analysis of the diagnostic search carried out on the basis of an assessment of Sasha Shch’s mental state. From the authors’ point of view, the boy has a functional language disorder within the framework of residual encephalopathy with mental atony. The article is of a debatable nature and is of interest to specialists.
{"title":"Why invent the bicycle?","authors":"V. E. Pashkovskiy","doi":"10.17816/nb625495","DOIUrl":"https://doi.org/10.17816/nb625495","url":null,"abstract":"The article is a critical analysis of the diagnostic search carried out on the basis of an assessment of Sasha Shch’s mental state. From the authors’ point of view, the boy has a functional language disorder within the framework of residual encephalopathy with mental atony. The article is of a debatable nature and is of interest to specialists.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"33 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140363513","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}
Frontotemporal dementia is a heterogeneous pathology with various clinical, histological, and genetic variants. The behavioral variant of frontotemporal dementia (bvFTD) in some cases presents differential diagnostic difficulties when distinguishing from primary mental disorders. The article provides an observation of patient K., who was observed at the initial stage of the disease with a diagnosis of schizophrenia. The comparison of psychopathological and behavioral symptoms with the presence of a family history of amyotrophic lateral sclerosis (ALS) served as a turning point to a different interpretation of the pathology and recognition and confirmation of the “definite diagnosis” — bvFTD.
{"title":"Clinical spectrum of frontotemporal dementia: schizophrenia-like symptoms and amyotrophic lateral sclerosis (family case study)","authors":"E. Mendelevich","doi":"10.17816/nb625675","DOIUrl":"https://doi.org/10.17816/nb625675","url":null,"abstract":"Frontotemporal dementia is a heterogeneous pathology with various clinical, histological, and genetic variants. The behavioral variant of frontotemporal dementia (bvFTD) in some cases presents differential diagnostic difficulties when distinguishing from primary mental disorders. The article provides an observation of patient K., who was observed at the initial stage of the disease with a diagnosis of schizophrenia. The comparison of psychopathological and behavioral symptoms with the presence of a family history of amyotrophic lateral sclerosis (ALS) served as a turning point to a different interpretation of the pathology and recognition and confirmation of the “definite diagnosis” — bvFTD.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"10 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140364371","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}
The article describes a unique combination of anorexia nervosa in 15-year-old dizygotic twin sisters, Masha and Dasha, which developed synchronously and proceeded with a similar clinical picture. Within six months from the time they jointly made the decision to change their eating habits and follow a special diet, each of the sisters lost more than 25% of her body weight. However, they each still had an obsessive fear of gaining weight, preoccupation with appearance, dissatisfaction with their figures and volumes of various body parts, and also periodically disrupted their menstrual cycles. The mechanism of the development of eating disorders in each of them was analyzed and it was concluded that the principle of fierce competition between them turned out to be fundamental. The twin sisters constantly compared the results of weight loss, making sure that the other did not achieve better results. This was accompanied by emotional reactions such as resentment, irritation, complacency or gloating. It is concluded that the clinical case of “tandem anorexia” in dizygotic twin sisters Masha and Dasha allows us to confirm the fact that the formation of “pair psychopathology” (in this case, eating disorder) may be associated not so much with genetic factors, but with psychological mechanisms and should be taken into account when choosing a treatment strategy.
{"title":"“Tandem anorexia” in dizygotic twin sisters Masha and Dasha","authors":"V. Mendelevich, Maria K. Nesterina","doi":"10.17816/nb625487","DOIUrl":"https://doi.org/10.17816/nb625487","url":null,"abstract":"The article describes a unique combination of anorexia nervosa in 15-year-old dizygotic twin sisters, Masha and Dasha, which developed synchronously and proceeded with a similar clinical picture. Within six months from the time they jointly made the decision to change their eating habits and follow a special diet, each of the sisters lost more than 25% of her body weight. However, they each still had an obsessive fear of gaining weight, preoccupation with appearance, dissatisfaction with their figures and volumes of various body parts, and also periodically disrupted their menstrual cycles. The mechanism of the development of eating disorders in each of them was analyzed and it was concluded that the principle of fierce competition between them turned out to be fundamental. The twin sisters constantly compared the results of weight loss, making sure that the other did not achieve better results. This was accompanied by emotional reactions such as resentment, irritation, complacency or gloating. It is concluded that the clinical case of “tandem anorexia” in dizygotic twin sisters Masha and Dasha allows us to confirm the fact that the formation of “pair psychopathology” (in this case, eating disorder) may be associated not so much with genetic factors, but with psychological mechanisms and should be taken into account when choosing a treatment strategy.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"28 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140364592","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}
Armed attacks with numerous victims committed in educational institutions of various levels, mainly (but not always) with the use of firearms, have received the generic name “school shooting”, and attackers are most often called “school shooters”. The United States is the leader in the prevalence of mass murders in educational institutions, although these tragic incidents also occur in other countries, and their number shows a tendency to constantly increase. Since any murder is an abnormal phenomenon, the question of the mental health of school shooters naturally arises. Research shows that not all assailants show symptoms of mental disorders; the most common cause of armed attacks is bullying and the desire to take revenge on offenders for cruel humiliation. In cases where a mental disorder is still diagnosed, not all students, as well as their family members, agree to receive psychiatric care. The prevention of armed attacks must be carried out by the efforts of school counsellors and school psychologists with the possible involvement of psychiatrists, although the potential of psychiatric care in the prevention of school murders, according to the authors of the article, is quite limited.
{"title":"School shooting: are psychiatrists capable of preventing tragedies?","authors":"A. Portnova, Y. Sivolap","doi":"10.17816/nb626772","DOIUrl":"https://doi.org/10.17816/nb626772","url":null,"abstract":"Armed attacks with numerous victims committed in educational institutions of various levels, mainly (but not always) with the use of firearms, have received the generic name “school shooting”, and attackers are most often called “school shooters”. The United States is the leader in the prevalence of mass murders in educational institutions, although these tragic incidents also occur in other countries, and their number shows a tendency to constantly increase. Since any murder is an abnormal phenomenon, the question of the mental health of school shooters naturally arises. Research shows that not all assailants show symptoms of mental disorders; the most common cause of armed attacks is bullying and the desire to take revenge on offenders for cruel humiliation. In cases where a mental disorder is still diagnosed, not all students, as well as their family members, agree to receive psychiatric care. The prevention of armed attacks must be carried out by the efforts of school counsellors and school psychologists with the possible involvement of psychiatrists, although the potential of psychiatric care in the prevention of school murders, according to the authors of the article, is quite limited.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"54 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140361508","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}
A narrative review of research studies discusses the clinical features, differential diagnosis, and treatment of anti-NMDA receptor encephalitis. Special attention is given to the controversial aspects of the etiology and pathogenesis of this disorder. The need for further research into on the role of antibodies to NMDA receptors in the development of psychiatric disorders is emphasized.
{"title":"Does new knowledge allow to improve the diagnosis of mental disorders: the problem of anti-NMDA receptor encephalitis?","authors":"Alexander B. Shmukler","doi":"10.17816/nb625638","DOIUrl":"https://doi.org/10.17816/nb625638","url":null,"abstract":"A narrative review of research studies discusses the clinical features, differential diagnosis, and treatment of anti-NMDA receptor encephalitis. Special attention is given to the controversial aspects of the etiology and pathogenesis of this disorder. The need for further research into on the role of antibodies to NMDA receptors in the development of psychiatric disorders is emphasized.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"42 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140363460","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}
The article cites the case of Dmitry A., who was detained by the police on the street on suspicion of using cannabinoids and sent for a medical examination for intoxication, which he refused. The judge found Dmitry guilty and ordered him to be examined at a drug treatment clinic. Based on the results of an inpatient examination, despite the absence of mental disorders, somatic consequences of episodic cannabinoid use and the absence of pathological changes according to laboratory tests, he was diagnosed with "harmful use of cannabinoids". Dmitry was placed under preventive observation. During the court-ordered forensic psychiatric examination at the Serbsky Center (Moscow), the drug diagnosis was not confirmed. However, the expert opinion was ignored at the court hearing. The author analyzes the frequency and validity of the diagnosis of "harmful use of psychoactive substances" and concludes that the case of Dmitry A. may become a precedent.
{"title":"A casuistic case of ignoring an expert opinion by the court conclusions about the absence of drug use disorder diagnosis","authors":"Владимир D. Mendelevich","doi":"10.17816/nb623306","DOIUrl":"https://doi.org/10.17816/nb623306","url":null,"abstract":"The article cites the case of Dmitry A., who was detained by the police on the street on suspicion of using cannabinoids and sent for a medical examination for intoxication, which he refused. The judge found Dmitry guilty and ordered him to be examined at a drug treatment clinic. Based on the results of an inpatient examination, despite the absence of mental disorders, somatic consequences of episodic cannabinoid use and the absence of pathological changes according to laboratory tests, he was diagnosed with \"harmful use of cannabinoids\". Dmitry was placed under preventive observation. During the court-ordered forensic psychiatric examination at the Serbsky Center (Moscow), the drug diagnosis was not confirmed. However, the expert opinion was ignored at the court hearing. The author analyzes the frequency and validity of the diagnosis of \"harmful use of psychoactive substances\" and concludes that the case of Dmitry A. may become a precedent.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"33 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140361593","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}
BACKGROUND: The rationale for the concept of psychotic and psychotic-like experiences, delusions and auditory hallucinations, on the basis of which the Psychotic Experiences Questionnaire was developed. AIM: The purpose of this study is to present the results of testing and validating of a questionnaire that assesses the severity of psychotic experiences. The study aims to determine the content of the experience at different phases of manifestation, including the phase of psychotic-like experiences, as well as metacognitive appraisals of the experience and its relationship to social anxiety. MATERIAL AND METHODS: The sample of 122 respondents includes non-clinical and two clinical groups — with symptoms of the affective spectrum and with symptoms of the psychotic spectrum. To assess the convergent validity of the Questionnaire, the Russian-language Symptom Check List-90-Revised was used. Metacognitive appraisals of psychotic experience and the overall severity of social anxiety (“Social Anxiety and Social Anxiety Disorder Questionnaire”) were measured. RESULTS: The structure of the Questionnaire obtained by cluster analysis was verified by confirmatory factor analysis, and optimal agreement between theoretical and empirical models was demonstrated (CFI=0.998; TLI=0.998; SRMR=0.102; RMSEA=0.02; RMSEA p-value=0.986). Three scales and corresponding subscales (six categories) defining the phases of unfolding of psychotic experience were identified. The high reliability and item consistency of the Questionnaire was determined using Cronbach's alpha coefficient. Convergent validity was assessed using Pearson correlation analysis of the questionnaire scales with the SCL scales — psychoticism, paranoid ideation and obsessive-compulsive symptoms; reliable and adequate statistical relationships were obtained. The role of social anxiety and metacognitive appraisals of psychotic experiences in their actualisation and maintenance is shown. The conceptualisation of thought the emergence of intrusions, “voices” as a dialogical embodiment of the internalised experience of social defeat in re-expanded inner speech is presented. CONCLUSION: The results of approbation and validation of the questionnaire are presented, and the relationships of the psychotic experiences component with its metacognitive appraisals and social anxiety are described. The concept of psychotic experiences is considered a continuum in which disruptions in the usual controllability of mental processes vary range from mild (objectification of thinking) — to moderate (disturbance of self-perception, intrusive phenomena, including “voices”) — to severe (disturbance of the sense of agency, including command “voices”).
{"title":"Psychotic Experiences Questionnaire. Part 1","authors":"O. Sagalakova, D. V. Truevtsev, O. Zhirnova","doi":"10.17816/nb623959","DOIUrl":"https://doi.org/10.17816/nb623959","url":null,"abstract":"BACKGROUND: The rationale for the concept of psychotic and psychotic-like experiences, delusions and auditory hallucinations, on the basis of which the Psychotic Experiences Questionnaire was developed. \u0000AIM: The purpose of this study is to present the results of testing and validating of a questionnaire that assesses the severity of psychotic experiences. The study aims to determine the content of the experience at different phases of manifestation, including the phase of psychotic-like experiences, as well as metacognitive appraisals of the experience and its relationship to social anxiety. \u0000MATERIAL AND METHODS: The sample of 122 respondents includes non-clinical and two clinical groups — with symptoms of the affective spectrum and with symptoms of the psychotic spectrum. To assess the convergent validity of the Questionnaire, the Russian-language Symptom Check List-90-Revised was used. Metacognitive appraisals of psychotic experience and the overall severity of social anxiety (“Social Anxiety and Social Anxiety Disorder Questionnaire”) were measured. \u0000RESULTS: The structure of the Questionnaire obtained by cluster analysis was verified by confirmatory factor analysis, and optimal agreement between theoretical and empirical models was demonstrated (CFI=0.998; TLI=0.998; SRMR=0.102; RMSEA=0.02; RMSEA p-value=0.986). Three scales and corresponding subscales (six categories) defining the phases of unfolding of psychotic experience were identified. The high reliability and item consistency of the Questionnaire was determined using Cronbach's alpha coefficient. Convergent validity was assessed using Pearson correlation analysis of the questionnaire scales with the SCL scales — psychoticism, paranoid ideation and obsessive-compulsive symptoms; reliable and adequate statistical relationships were obtained. The role of social anxiety and metacognitive appraisals of psychotic experiences in their actualisation and maintenance is shown. The conceptualisation of thought the emergence of intrusions, “voices” as a dialogical embodiment of the internalised experience of social defeat in re-expanded inner speech is presented. \u0000CONCLUSION: The results of approbation and validation of the questionnaire are presented, and the relationships of the psychotic experiences component with its metacognitive appraisals and social anxiety are described. The concept of psychotic experiences is considered a continuum in which disruptions in the usual controllability of mental processes vary range from mild (objectification of thinking) — to moderate (disturbance of self-perception, intrusive phenomena, including “voices”) — to severe (disturbance of the sense of agency, including command “voices”).","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"53 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140361776","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}
E. Y. Antokhin, N. Neznanov, A. V. Vasileva, V. Budza, Tatyana A. Boldireva, Yaroslav S. Kozlov
BACKGROUND: Clinical diagnosis of depression in schizophrenia is difficult because of the dimensional overlap of a number of affective symptoms with negative manifestations of schizophrenia spectrum disorders. In the very first attack of schizophrenia, when the negative symptom complex is not yet clear enough, the difficulties of differential diagnosis become even more relevant, especially when depression occurs in the post-attack stage during the formation of remission and the manifestation of postpsychotic depression. AIM: To establish a diagnostic approach based on a combination of clinical-psychopathological and psychometric methods for the assessment of postpsychotic depression in patients with a first episode of schizophrenia. MATERIAL AND METHODS: We are examined 1112 patients who had suffered a first psychotic episode. Аfter introducing inclusion/exclusion criteria, two groups were formed in the final design: 243 patients with postpsychotic depression (PPD) and 119 patients without depression in partial remission. Clinical-psychopathological, psychometric (PANSS, CDSS, SCL-90-R scales), and statistical (descriptive, non-parametric statistics — significance level p 0.05) methods were used. RESULTS: Based on the concept of positive-negative affectivity, three types of PPD have been identified: with signs of positive affectivity — anxious, sensitive-psychasthenic, depersonalisation-hypochondriacal and melancholic-anergic subtypes; with signs of negative affectivity anhedonic, dysthymic-apathetic and dysphoric subtypes; formed due to psychopathological manifestations of the non-affective register — obsessive-ruminative, agoraphobic, paranoid-symbolic subtypes. Patients who were diagnosed with PPD with positive affectivity after an attack were predominat (p 0.05): 46.91% of the total number of depressed patients. PPD formed due to non-affective spectrum disorders is accompanied by the strongest subjective severity of suffering in patients, compared to patients diagnosed with PPD with positive affectivity. Subjectively, the easiest for patients is PPD with negative affectivity, which, however, does not mean that it can be considered as favourable from the standpoint of therapy and rehabilitation. CONCLUSION: PPD is detected in a significant number of patients with a first psychotic episode, even after excluding the group with pharmacogenic depression, both due to subjective complaints, nosogenic depressive experiences, and as a result of a psychometric assessment of the patients’ condition. The concept of “dissociated post-attack depression” is substantiated.
{"title":"Clinical subtypes of postpsychotic depression in the first episode of schizophrenia: results of a cross-sectional observational study","authors":"E. Y. Antokhin, N. Neznanov, A. V. Vasileva, V. Budza, Tatyana A. Boldireva, Yaroslav S. Kozlov","doi":"10.17816/nb626328","DOIUrl":"https://doi.org/10.17816/nb626328","url":null,"abstract":"BACKGROUND: Clinical diagnosis of depression in schizophrenia is difficult because of the dimensional overlap of a number of affective symptoms with negative manifestations of schizophrenia spectrum disorders. In the very first attack of schizophrenia, when the negative symptom complex is not yet clear enough, the difficulties of differential diagnosis become even more relevant, especially when depression occurs in the post-attack stage during the formation of remission and the manifestation of postpsychotic depression. \u0000AIM: To establish a diagnostic approach based on a combination of clinical-psychopathological and psychometric methods for the assessment of postpsychotic depression in patients with a first episode of schizophrenia. \u0000MATERIAL AND METHODS: We are examined 1112 patients who had suffered a first psychotic episode. Аfter introducing inclusion/exclusion criteria, two groups were formed in the final design: 243 patients with postpsychotic depression (PPD) and 119 patients without depression in partial remission. Clinical-psychopathological, psychometric (PANSS, CDSS, SCL-90-R scales), and statistical (descriptive, non-parametric statistics — significance level p 0.05) methods were used. \u0000RESULTS: Based on the concept of positive-negative affectivity, three types of PPD have been identified: with signs of positive affectivity — anxious, sensitive-psychasthenic, depersonalisation-hypochondriacal and melancholic-anergic subtypes; with signs of negative affectivity anhedonic, dysthymic-apathetic and dysphoric subtypes; formed due to psychopathological manifestations of the non-affective register — obsessive-ruminative, agoraphobic, paranoid-symbolic subtypes. Patients who were diagnosed with PPD with positive affectivity after an attack were predominat (p 0.05): 46.91% of the total number of depressed patients. PPD formed due to non-affective spectrum disorders is accompanied by the strongest subjective severity of suffering in patients, compared to patients diagnosed with PPD with positive affectivity. Subjectively, the easiest for patients is PPD with negative affectivity, which, however, does not mean that it can be considered as favourable from the standpoint of therapy and rehabilitation. \u0000CONCLUSION: PPD is detected in a significant number of patients with a first psychotic episode, even after excluding the group with pharmacogenic depression, both due to subjective complaints, nosogenic depressive experiences, and as a result of a psychometric assessment of the patients’ condition. The concept of “dissociated post-attack depression” is substantiated.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"31 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140364257","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}
V. Mendelevich, A. A. Katok, T. Z. Beybalaeva, Andrey A. Kapralov, Radzhab R. Abakarov
The article describes a rare clinical case of severe histrionic personality disorder featuring manifestations of an atypical obsessive-compulsive disorder (“obsessive-compulsive disorder in reverse”), which led to an erroneous diagnosis of schizophrenia and classification of the patient as disabled. Over an eight-year period of psychiatric observation, the girl was given many different diagnoses in leading Russian and foreign clinics — from somatoform, hypochondriac and obsessive-compulsive disorder to schizophreniform disorder, bipolar affective disorder and paranoid schizophrenia with an emotional and volitional defect. The article substantiates the diagnosis of histrionic personality disorder and the incorrectness of other diagnoses. The article also provides a brief review of the literature regarding the comorbidity of dissociative and obsessive-compulsive disorders.
{"title":"Dissociation, “OCD IN REVERSE” and unfulfilled schizophrenia. Case of Alsu B.","authors":"V. Mendelevich, A. A. Katok, T. Z. Beybalaeva, Andrey A. Kapralov, Radzhab R. Abakarov","doi":"10.17816/nb624043","DOIUrl":"https://doi.org/10.17816/nb624043","url":null,"abstract":"The article describes a rare clinical case of severe histrionic personality disorder featuring manifestations of an atypical obsessive-compulsive disorder (“obsessive-compulsive disorder in reverse”), which led to an erroneous diagnosis of schizophrenia and classification of the patient as disabled. Over an eight-year period of psychiatric observation, the girl was given many different diagnoses in leading Russian and foreign clinics — from somatoform, hypochondriac and obsessive-compulsive disorder to schizophreniform disorder, bipolar affective disorder and paranoid schizophrenia with an emotional and volitional defect. The article substantiates the diagnosis of histrionic personality disorder and the incorrectness of other diagnoses. The article also provides a brief review of the literature regarding the comorbidity of dissociative and obsessive-compulsive disorders.","PeriodicalId":436189,"journal":{"name":"Neurology Bulletin","volume":"7 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139529840","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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