«Alliance of Psychology, Psychotherapy and Pharmacotherapy. Science and the real world in the treatment of mental disorders»

Resolution of the conference dedicated to the 90th anniversary of the birth of B.D. Karvasarsky.

Principles of care for adolescent girls with eating disorders and body disturbances disorders: lessons from the COVID-19 pandemic

The pandemic of the new coronavirus infection (COVID-19) has contributed to an increase in problems related to eating behavior and body image in the population. Various risk factors that have become relevant due to changes in the usual lifestyle have significantly affected the frequency of eating disorders in the adolescent population. This necessitated the adapting of new strategies for providing medical care in conditions of limited personal contact.The aim of the work is the methodological substantiation and systematization of modern approaches to the prevention and treatment of eating disorders, body image disorders and risk factors associated with them in adolescents in the conditions of the COVID-19 pandemic.Materials and methods. The methodological basis of the work is a comprehensive analysis of modern medical and social approaches and recommendations on the organization of assistance to adolescents with eating disorders and body image disorders, with a description of personal experience of using various interventions on an outpatient basis during the pandemic.Results: Prevention and treatment of eating disorders and body image disorders in adolescents during the pandemic should be aimed at specific risk factors those have proved to be the most relevant in connection with restrictive measures: involvement in body image-related social media content and active use of the media; reduction of physical activity with simultaneous increase in access to food; social isolation and reduction of social support; restriction of access to qualified care. The most reasonable approaches during the pandemic are the approaches focused on the family of a teenager using, if possible, remote forms of assistance.Conclusions: Currently, there are no norms and standards in the organization of assistance to adolescents with eating disorders and body image disorders in the pandemic context. However, the analysis of the implemented approaches aimed at various risk factors of these disorders will allow the use of the most effective preventive and therapeutic practices in the future.

The Post-COVID-19 cognitive impairment. A modern view of the problem, pathogenesis and treatment

COVID-19 infection is a significant and poorly understood problem of modern world medicine. As the virus spreads, data on the clinical picture of the disease and damage to the nervous system are accumulating. Symptoms such as fatigue, anxiety, depression, sleep disturbances and many other neurological and somatic symptoms are often recorded, persist for a long time even after the acute infectious stage of the disease has been stopped, and make it difficult for the patient to fully recover. These symptoms occur even with a mild disease and persist for many months. One of the most common and disabling symptoms of post-COVID syndrome is cognitive impairment, in the formation of which, in addition to the direct ability of the virus to penetrate the nervous system and pathology of the microvasculature, various pathological mechanisms are involved, including dysregulation of cholinergic transmission. A comprehensive approach is important in the treatment of cognitive impairment; it is advisable to use both medication and non-medication methods. The main approaches to the treatment of secondary cognitive disorders are based on the hypothesis of replenishing the defect in mediator systems, including those associated with the death of cholinergic neurons. With these abnormalities, it is advisable to replenish acetylcholine. Among the precursors of choline, choline alfoscerate occupies a special place due to its proven efficacy in the treatment of neurodegenerative diseases, as well as due to data on its multifactorial action. The article presents the actual literature data on the mechanisms of development and features of the clinical manifestations of post-COVID cognitive impairment, as well as materials of experimental and clinical studies of the drug choline alfoscerate (Gliatilin).

Dynamics of ideas about the concept of epileptic psychosis

Introduction: psychosis in epilepsy is more common than in the general population. The frequency of psychotic mental disorders varies from 0,5% to 10%. The article presents the dynamics of the development of the concept of epileptic psychosis, depending on the evolutionary approaches to the study of the problem of mental disorders in epilepsy. Materials and methods: the analysis of Russian—and English language articles in scientific databases on keywords from 1971 to 2011 was carried out. Results: the first systematic descriptions of mental disorders occurring in epilepsy date back to the 19th century. The contribution of foreign and domestic authors to the study of the problem is described. There are six main periods of the concept formation, including the definitions of the concept of epileptic psychosis, the dynamics of clinical manifestations, the role of the influence of biological, personal and social factors in the genesis and development of psychotic disorders in epilepsy. The following risk factors for the development of psychosis are considered: the form of epilepsy; age of onset of seizures, lateralization of the epileptic focus, gender, and drug therapy. Variants of classification approaches to the problem are presented. The article discusses the differences in the systematization of «endoform» syndromes, as well as the parallels between schizophrenia and psychoses in epilepsy. The dynamics of scientific views on the interest in the formation of epileptic psychoses in various parts of the brain: the temporal lobe (amygdala, hippocampus, paralimbic zones and parahippocampal bend), as well as GABA-ergic neurons of the upper tubercles of the quadriplegic, posterior hypothalamus and serotonergic neurons of the dorsal suture and noradrenergic neurons of the blue spot are reflected. The association of psychopathological manifestations with neurophysiological, biochemical, genetic and morphofunctional correlates is noted. The authors‘ interest in psychoses associated with the use of antiepileptic drugs is emphasized. Conclusion: despite all attempts to systematize these conditions, the factors that provoke the development of psychoses in patients with epilepsy, their structure and prognosis remain poorly predictable and require further in-depth study.

B. D. Karvasarsky and psychotherapy establishment as a distinct discipline, homo faber, to the 90-th anniversary since birth

The establishment of psychotherapy and clinical psychology in a Russia is a very complicated and contradictive process. B. D. Karvassarsky has played an essential, key role in the psychotherapy formation as a science and distinct discipline. The article describes the crucial points of this discipline development, presents the main key studies of this mental health field. The Leningrad-Saint-Petersburg psychotherapy school maid a serious impact in the modern Russian neurosology cornerstone issues, that allowed to consider the multidimensional aspects of this pathology. This publication emphasizes the recent research results in this field, makes a deep analysis of the target phenomena understanding in different approaches, other methods integration in personality oriented reconstructive psychotherapy, elaboration of the nosocentric target oriented psychotherapy algorithms and strategies, and also different psychotherapy interventions research.

On the differential diagnostic prospects of determining the profile of the lateral organization of the personality during assessment of the systematic alcohol abuse

The article is devoted to the question of the possible improvement of the psychological examination of persons previously examined in alcoholic intoxication (hereinafter—PEAI). The authors propose an original view on the definition of the target of «alcohol screening», the principles and methods of assessing psychological markers of the systematic substance abuse. Purpose of the study: to determine the differential diagnostic significance of identifying the profile of the lateral organization (hereinafter—PLO) when assessing of the systematic of alcohol abuse in those previously examined in a state of alcoholic intoxication. The researchers made an attempt to highlight the features of PLO of such a «risk group» as those previously examined in a state of alcoholic intoxication (based on data obtained during the study according to the typology of E.D. Khomskaya (with a combination of three types of asymmetries: manual, auditory-verbal and visual) of lateral preferences of 19 PEAI patients of the branch of the Moscow Research and Practical Center for Narcology). As a result, the tendency of those previously examined in the state of intoxication to the lack of a «leading ear» and «leading eye», significant differences in the distribution of the attribute «leading hand» among those previously examined in a state of alcoholic intoxication and in the population were revealed. Conclusion. According to the results of this study, it is difficult to assume the presence of a significant differential diagnostic significance of PLO detection during «alcohol screening» among those previously examined in a state of alcoholic intoxication. At the same time, it should be noted that taking into account lateral preferences can contribute to the improvement of preventive work programs in the narcological service, providing greater individualization of psychological support measures. Directly in the rehabilitation work with PEAI, it is advisable to actively apply social and psychological training (because of a significant part of the contingent among the main factors of relapse with a high degree of probability has social stressors). The creation of short-term (3-5 meetings) programs of group exercises of a preventive orientation, which have different targets depending on the «vulnerability factors» of the owners of certain lateral profiles, also seems justified.

Identification of alcohol use disorders among women in the Republic of Khakassia

The article presents results of a regional project to prevent and reduce the prevalence of alcohol consumption among women in the Republic of Khakassia (Eastern Siberia, Russian Federation). In addition to the main preventive goal of reducing alcohol consumption among groups of women covered by the project, there was an objective to conduct screening using the AUDIT test and provide motivational counseling in case of identifying alcohol-related problems. 691 women took part in screening, among them 202 at enterprises of the Republic of Khakassia, and 489 when seeking social/psychological support to the Khakass Republican Branch of the Russian Red Cross, as well as to local branches of the Red Cross in other cities of the Republic of Khakassia. Levels of risk related to alcohol use were identified, based on the results of the screening the studied groups of women. Depending on the risk level, three types of socio-psychological interventions were carried out: informing about harmful consequences of alcohol use and the need to maintain a healthy lifestyle; motivational counseling; motivating women for treatment of dependency.Majority of women who were screened at workplaces were more likely to use alcohol with low risk (78.2%), much smaller proportion of women had risky alcohol consumption (14.4%), alcohol consumption with harmful consequences (2.5%) or signs of alcohol dependency (2.0%). Among women who applied for social and psychological support to branches of the Russian Red Cross, prevalence of low-risk use was lower (43.4%), and risky alcohol use (31.3%), alcohol use with harmful consequences (10.6%) or signs of alcohol dependency (14.5%) were significantly higher.

Lithium content in the population of the Aktobe region of the Republic of Kazakhstan and the relationship with mental illness: a cross-sectional study

The article presents data on the study of the content of lithium in the hair of the adult population of the Aktobe region of the Republic of Kazakhstan and the relationship with mental illness. The aim of the study is to assess the content of lithium in the biosubstrates of the adult population and its relationship with the morbidity of the population of the Aktobe region.Materials and methods: A one-stage cross-sectional study was carried out on the territory of the Aktobe region of the Republic of Kazakhstan. The study included 340 residents aged 18-60 years permanently residing in the study area using the method of simple random sampling. The lithium content in hair was determined by inductively coupled plasma mass spectrometry on a NexION 300D spectrometer (PerkinElmer Inc., USA) equipped with an ESI SC-2 DX4 sampler (Elemental Scientific Inc., USA). The morbidity rates were studied according to the ICD-10 classes per 100 thousand population. To assess the relationship between the Li content in the hair and the morbidity rates, the Spearman rank correlation coefficient was calculated.Results: According to the results of the study, significant deviations from the reference values were observed for the lithium content in the Aktobe region. There is an excess of lithium for 80.59% (CI: 76.38; 84.79) of the subjects, the norm is 19.41% (CI: 15.21; 23.62). Excess lithium is more common in men than in women (χ2 =11.07 df=1; p=0.001). Considering the districts of the Aktobe region, the highest content of Li (Me (q25-q75)) was found in the Aitekebi district (0.084 (0.022 -0.134)) mcg/g, in the Kobda district 0.069 (0.060- 0.076) mcg/g, in the Mugalzhar district 0.046 (0.019-0.066) mcg/g, in the Oiyl district 0.044 (0.021-0.0762) mcg/g, in the Alga district 0.040 (0.024-0.090) mcg/g. Spearman’s correlation rank analysis showed a weak positive association of Li content with age (r=0.20, p =0.0001), no association with body mass index was found (r=0.10, p =0.06). The correlation analysis established a direct inverse average relationship between the content of Li and morbidity in the class of diseases “Mental disorders and behavioral disorders” (r=-0.62; p= 0.044).Conclusions: The high prevalence of excess lithium content in the hair of the population and its relationship with mental illness requires further research. The study of the bioelement status of the population can serve as an indicator of environmental pollution, and also aims at monitoring the ecological situation in the region.

Evaluation of alcohol consumption motivation: psychometric properties of the Alcohol Consumption Motivation Inventory by V.Yu. Zavyalov

The alcohol consumption motivation inventory (ACM) was developed by V.Yu. Zavyalov. Now it is a widespread psychometric tool in research and clinical practice for the evaluation of alcohol consumption motivation in Russian-speaking patients with alcohol use disorders. The aim of the study is to analyze the psychometric properties of the ACM inventory. Results show that the factor structure of the ACM inventory significantly differs from the one stated in the original. The results of the statistical analysis allowed three significant clusters. Cluster A was composed of the scales of the conditioned triad—traditional, submissive, and pseudo-cultural motives. This cluster also partially included hedonistic motives and self-harm motives. Cluster B was composed of scales of personal and pathological triads—withdrawal, ataractic and hyperactivational motives. Hedonistic motives and addictive motives were also partially included. Cluster B included self-harm motives and hangover (addictive) motives. According to the data obtained, the ACM inventory cannot measure an alcohol consumption motivation in the way of the original method. Future work on the modification of the ACM inventory should be based on the results obtained recently in neurophysiological and clinicalpsychopharmacological studies in the field of motivation for alcohol consumption, and includes the revision of the items of the questionnaire, a statistically substantiated gradation of levels for assessing the effectiveness of the motives for alcohol use, and the validation of the version of the ACM questionnaire in women sample.

The old new theory of modern Russian psychiatry: a biopsychosocial approach (institutional discourse)

The article is discussed («Review of psychiatry and medical psychology named after V.M. Bekhterev». 2020; 2: 3-15), which examines the biopsychosocial model as the theoretical basis (scientific, clinical, preventive, therapeutic) of modern psychiatry, in particular, the biological (genetic) domain.The purpose of the discourse: from the standpoint of philosophy and methodology of science, to determine the place of the biological domain (biomedical research) of the biopsychosocial (biopsychosocial—spiritual) (BPS) approach (theory) in Russian psychiatry, in particular, from the standpoint of the subject of psychiatry and its main section-clinical psychiatry.Based on methodology and philosophy, and based on anthropological and holistic approaches, the biological domain of the BPS model, which is based on clinical psychiatry as a practice and, accordingly, theory, is discussed through the subject of psychiatry as a science. The significance and role of the subject of psychiatry (pathology, disorders, abnormalities of mental activity) in the ICD-10 and the components of the biopsychosocial (model) approach are discussed. There are differences in the domains of the model and the difficulties of clinical diagnosis (multi-axis, functional, multidimensional) and, accordingly, the study of the etiopathogenesis of mental disorders, the "bias" of diagnosis and therapy. The article deals with the neurological component of the biological domain and the "expansion" of neurologists into psychiatry, which leads to hidden antipsychiatry. The author emphasizes the independence, contiguity and two-paradigm nature of psychiatry as a science (with its own unity of subject and its own method of research—clinical and psychopathological). In addition to the interdisciplinarity of clinical neuroscience, it is proposed to be multidisciplinary (for the sections of psychiatry), but the future belongs to the transdisciplinary research methodology.