Abstracts of №2, 2014
The myth of schizophrenia as a progressive brain disease
R.B. Zipursky, T.J. Reilly, R.M.Murray (Hamilton, Canada; London, Great Britain)
Schizophrenia has historically been considered to be a deteriorating disease, a view reinforced by recent MRI findings of progressive brain tissue loss over the early years of illness. On the other hand, the notion that recovery from schizophrenia is possible is increasingly embraced by consumer and family groups. This review critically examines the evidence from longitudinal studies of 1) clinical outcomes, 2) MRI brain volumes, 3) cognitive functioning. First, the evidence shows that although approximately 25% of people with schizophrenia have a poor long-term outcome, few of these show the incremental loss of function that is characteristic of neurodegenerative illnesses. Second, MRI studies demonstrate subtle developmental abnormalities at first onset of psychosis and then further decreases in brain tissue volumes; however, these latter decreases are explicable by the effects of antipsychotic medication, substance abuse, and other secondary factors. Third, while patients do show cognitive deficits compared with controls, cognitive functioning does not appear to deteriorate over time. The majority of people with schizophrenia have the potential to achieve long-term remission and functional recovery. The fact that some experience deterioration in functioning over time may reflect poor access, or adherence, to treatment, the effects of concurrent conditions, and social and financial impoverishment. Mental health professionals need to join with patients and their families in understanding that schizophrenia is not a malignant disease that inevitably deteriorates over time but rather one from which most people can achieve a substantial degree of recovery.
Key words: MRI, cognition, outcome, prognosis, remission, recovery.
On some aspects of diagnostics of children’s autism
B.V.Voronkov, L.P.Rubina (Sankt-Petersburg)
The article presents the sources and reasons of inadequate diagnostic of children’s autism. The effect of the introduction of "autistic spectrum" concept into professional routine has been discussed. The quality of diagnostic criteria of child autism and hypothesis of development disability in this disease are criticized and measures for more restrained diagnostics of children’s autism are suggested.
Keywords: children’s autism, autistic spectrum, phantom of the form.
The mechanism of conversion-dissociative disorders in patients in general psychiatric wards of a mental hospital
154 people, who had conversion-dissociative disorders, were inspected. Mechanism of hysterical symptoms differed depending on character of psychotraumatic situation. Psychotraumatic situation was rated as objectively or subjectively significant. In the first case, the appearance of the conversion-dissociative disorder preceded absolutely painful psychogenic event, in the second case hysterical symptoms had manipulative function, or arose as parapsyhonozognoziya.
Keywords: Conversion-dissociative disorder, hysteria, conversion, dissociation, psychogenic disorders
Epidemiology of mental illness in the European countries and their impact on society. Features of the psychiatric care structure on the example of Germany
V.A.Kazhin (Bad Durkheim, Germany)
The article provides an overview of the prevalence of mental illness in the European countries, their importance, economic and human losses. It also gives statistical data on the specific incidence of mental illness and the financing of health systems and shows the growth in the population of disability and economic costs of treating neuropsychiatric diseases on the example of Germany. The article discloses a structure of mental health care in the Federal Republic of Germany and its main components.
Keywords: epidemiology of mental illness, mental health care structure, the cost of treatment of neuropsychiatric diseases, health care financing
Provision of information constituting a medical secret on request of the inquiry, investigation bodies and trial
Yu. N. Argunova
The author describes the rules of delivery on information, constituting medical confidentiality, by medical organization to the inquiry, investigation bodies and trial in criminal and civil proceedings, as well as in proceedings on administrative violations. The author focuses on the widespread violations of the law by law enforcement agencies. Practice of the courts has been analyzed. The contradictions in the legislation has been stressed.
Keywords: medical secret, competence of the inquiry, investigation bodies and trial
From an expert’s dossier
Psychiatrists and fighter for the truth has become a patient of his own department
The article describes ethical casus representing the apotheosis of paternalism on the part of physicians and overvalued preoccupation by protection of patients’ rights in a completely peaceful colleagues.
Keywords: ethical incident, paternalism, fighter for the truth
Answers of Chief editor to Dr.Nemtsov’s questions regarding scientometric approach
Scientometric data on psychiatry without scientific comments in Russian conditions are only misleading. These are sociometric and not actually scientific indicators.
Keywords: scientometrics, science of science, citation index, impact-factor
Doctor as a wounded Aesculapius
B. A. Voskresensky
The problem of emergence of reflexive self-consciousness, involving mythological, cultural and historical facts, is discussed. The tragedy of phenomena is emphasized, as long as it has knowledge about human finiteness — its mortality. Therefore, in some sense, doctor’s activity – fight against a death – is doomed to failure. Tragic collisions of this scenario are pointed out – both public and coming out through personal destinies of psychiatrists. A concept of «psychiatrist’s cross» is introduced into practice. It is summarized that a Christian mission of a doctor is to die for another.
Key words: self-consciousness, reflection, death, psychiatrist’s cross
Dr. Clerambault, his life and scientific ideas
The article presents historical study of life and scientific ideas of French psychiatrist Gaëtan Gatian de Clérambault (1872-1934), his work in St. Anna hospital, his travels, the ablepsia and suicide at the end of his life. The author observes Clerambault’s conceptions concerning women fetishism, erotomanic disorders, syndrome of mental automatism and the presence of his ideas in contemporary psychiatry; psychological and psychoanalytical schools.
Keywords: fetishism, erotomanie, paranoia, stalking behavior, syndrome of mental automatism