No 93 (2025)
Psychiatry and narcology
Long-Term Dynamics and Structure of Mental Disorders in Various Categories of Military Personnel of the Russian Ministry of Defense
Abstract
Objective. To evaluate the long-term dynamics of medical and statistical indicators of mental illness in various categories of military personnel of the Russian Ministry of Defense in order to optimize psychoprophylactic measures.
Methodology. The primary medico-statistical indicators of mental morbidity among various categories of military personnel were examined, utilizing data from medical reports in Form 3/ MED spanning 19 years (2003–2021) and open-source publications. The analyzed indicators were correlated with Chapter V “Mental and behavioral disorders” of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Morbidity rates were calculated per 10,000 military personnel (10–4). Mean multi-year and mean annual indicators (M ± m) were determined, and their development was assessed using dynamic series analysis and by calculating a second-order polynomial trend.
Results and analysis. The average long-term indicator of primary morbidity of the cohort of military personnel of the Russian Ministry of Defence with mental disorders was 70.7 · 10–4, with the proportion of cases among officers being 10.7 %, among contract sergeants and warrant officers –
9.3 %, among female military personnel – 2.9 %, and among conscripted military personnel – 77.1%. Hospitalization rates were 61.8 · 10–4 with a proportion of 10.6, 8.6, 2.0, and 78.8 % respectively; days of sick leave were 1839 · 10–4 with a proportion of 7.4, 6.5, 1.7, and 84.4 % respectively; discharge rates were 42.6 · 10–4 with a proportion of 3.9, 4.9, 0.4, and 90.8 % respectively. There is a decrease in the indicators in the studied types of morbidity in all categories of military personnel, with the exception of conscripted military personnel, who have an increase in the analyzed data and, compared with other categories of military personnel, statistically significantly higher levels of morbidity.
Conclusion. An analysis of the long-term dynamics of medical and statistical indicators of mental illness in various categories of military personnel has shown that more than 80 % of mental disorders were reported in conscripted military personnel, usually due to underestimation of the mental health status of the conscripted contingent by military medical commissions of military commissariats. Accordingly, improving the quality of the selection of conscripts for military service (“barrier functions”) and psychoprophylactic measures during the period of conscription training in military training centers will significantly reduce the development of mental adaptation disorders and, thereby, improve the quality of mental health of this category of military personnel.
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Modern Approaches to the Objectification of Depressive Disorders among Military Personnel (Literature Review)
Abstract
Introduction. Depressive spectrum disorders (DSD) occupies a leading position in the structure of mental disorders among military personnel of many countries. However, there are still no clear and unambiguous criteria for diagnosing depressive disorder. The primary method for diagnosing depressive disorders is the clinical-psychopathological approach, whose subjectivity often leads to diagnostic errors, justifying the need to search for objective markers of DSD.
Objective. Based on the analysis of scientific studies dedicated to the challenges of diagnosing depressive disorders, this study aims to identify promising directions for the objectification of this pathology and the development of diagnostic methodologies suitable for use in medicalpsychological support at various stages of military service.
Methodology. an analysis of more than 50 scientific papers containing scientifically substantiated data on the diagnosis of depressive disorders was conducted. The search was carried out using search engines such as PubMed and eLIBRARY, by keywords.
Results and analysis. Genetic factors play an important role in the development of depressive disorders, but the formation of the last is due to a complex of genetic factors. Neuroimaging and biochemical markers, despite their high cost, mainly allow for the identification of group-level differences rather than individual diagnoses. Psychophysiological correlates allow to assess the cerebral basis of DSD only indirectly. Information technology and artificial intelligence cannot fully replace traditional methods of clinical and pathological diagnostics. At the same time, the RDoC project is a new approach to the objectification of mental disorders. RDoC studies mental disorders at different levels, which allows for more accurate diagnostics and determining therapy goals, and among included in RDoC methods the most promising is behavioral or neurocognitive tasks.
Conclusion. The use of high-tech diagnostic methods due to the above disadvantages is of little use for mass examinations in military service. The most promising approach to the objectification of RDS is the use of neuropsychological tests.
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Medical psychology
Assessment of the Psychological State of Patients in the Process of Pain Treatment
Abstract
Relevance. Pain is one of the major medical and socio-economic problems in the world. Since the problem of pain remains relevant, it is necessary to pay close attention to the study of risk factors for the occurrence of combat syndrome, among which psychosocial factors play a significant role, such as stress, depression, anxiety and other factors.
Intention. The purpose of the study is to assess the characteristics of the psychological state of patients in the process of complex treatment of pain syndrome.
Materials and methods. A study was conducted to evaluate the levels of anxiety, depression, and stress in patients reporting prolonged pain sensations. All study participants underwent a neurological examination using standard methods, and testing was performed using a visual analogue scale (VAS).
The study group included patients (n = 220), men and women, aged from 23 to 63 years, with diagnosed pain in the cervical and thoracic spine.
Inclusion criteria: documented adult patients aged 18 to 65 years with complaints of pain present at the time of the study, who had their levels of anxiety, stress and depression assessed using the Distress, Depression, Anxiety and Somatization Questionnaire, and their relationship with chronic pain.
Exclusions included respondents under the age of 18 years, patients over 65 years of age, as well as patients suffering from cancer pain syndromes and pain syndromes of a psychogenic nature, the occurrence of which is due to the presence of a psychological conflict, and not damage to somatic or visceral organs or structures of the somatosensory nervous system.
Statistical analysis included a comparative assessment of the Spearman rank correlation test, the G-sign test.
Results. The results obtained indicate a high level of anxiety and depression in patients complaining of pain. The anxiety levels of such patients range from elevated to high levels. A statistically significant (p ≤ 0.01) correlation between the level of pain determined using VAS and indicators of anxiety, depression and stress in patients was shown.
The cervical dorsopathy therapy carried out included drug therapy in combination with the use of a rehabilitation complex of physiotherapeutic and psychotherapeutic influences.
A comparison of indicators of anxiety, depression and stress levels before and after application of the treatment method using the Sign G test confirms the presence of a statistically significant (p ≤ 0.01) difference in the values of anxiety, depression and stress before and after treatment, which proves the effectiveness of the therapy.
Conclusion. The study confirms the effectiveness of a treatment approach that integrates psychotherapeutic interventions (including autogenic training by J. Schultz and applied relaxation therapy based on E. Jacobson’s method, adapted by Lars-Göran Öst) alongside pharmacological and physiotherapeutic treatment in addressing the psychological distress (anxiety, depression, and stress) associated with pain syndrome. These conclusions are supported by the results of using the mathematical-statistical G-Sign test, confirming the presence of a statistically significant difference (p ≤ 0.01) between indicators of anxiety, depression and stress before and after treatment. Indicators of psychological state in all patients complaining of pain showed increased values (moderately increased and high values). Accordingly, it is necessary, regardless of the form and history of the disease, to include methods of psychological influence in the treatment and rehabilitation program for patients with acute pain.
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Relationship Between Anxiety and Treatment Adherence in Patients with Hypertension
Abstract
Relevance. The problem of hypertension is caused by the high prevalence of the disease, disability and mortality from cardiovascular complications. Increasing the level of treatment adherence is a complex and multicomponent process, since it is necessary to improve the treatment process of patients taking into account their personal characteristics and psychological status.
Intention – to assess the relationship between anxiety and treatment adherence in patients with hypertension stage 2 and 3 (HT), to develop practical recommendations.
Materials and methods. The study involved 300 patients with stage 2 and 3 hypertension (mean age 45 ± 7.4). At the time of the study, the patients were undergoing inpatient treatment at the private healthcare institution “Medical and Sanitary Unit” and were under the supervision of cardiologists and therapists (Astrakhan, Russia). The study used survey methods, in particular, psychodiagnostic techniques: KOP-25 “Quantitative Assessment of Treatment Adherence Questionnaire” (N.A. Nikolaev, Yu.P. Skirdenko), Spielberger-Khanin Anxiety Scale (Charles Spielberger, Russian adaptation by Yu.L. Khanin). Empirical data were recorded using the Google Forms Internet service. The parameters of descriptive statistics, the linear correlation coefficient and the Spearman rank correlation coefficient were calculated (SPSS Statistics 21.0 program).
Results. The study revealed a low level of overall treatment adherence in patients, which means low involvement in following doctor’s recommendations regarding medication, diet, and other lifestyle changes. Hypertensive patients showed high levels of situational and personal anxiety. The correlation analysis revealed an inverse relationship between treatment adherence and situational anxiety, which must be taken into account when monitoring the effectiveness of antihypertensive treatment.
Conclusion. The obtained results substantiate the necessity of forming positive commitment to a healthy lifestyle and treatment in patients with hypertension. Psychocorrectional measures should be aimed at optimizing the psychoemotional state and reducing anxiety in patients. Among the factors that play a negative role in increasing the degree of commitment to treatment, the following should be highlighted: attending health schools; informing relatives (with the patient’s consent); encouraging the use of non-drug therapy; psychocorrectional measures aimed at changing the patient’s lifestyle.
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Analysis of Predictors of Smoking and Alcohol Abuse Among Pregnant Women
Abstract
Relevance. Smoking and alcohol consumption are widely prevalent among pregnant women and negatively impact both pregnancy progression and outcomes. Compared with demographic and psychosocial characteristics, the onset of pregnancy is the strongest predictor of cessation of nicotine products and alcoholic beverages for most women; however, some women continue to use them.
Intention. The aim is to study the predictors affecting smoking and alcohol abuse among pregnant women by conducting correlation and factor analysis.
Methodology. The study included 204 pregnant women who were patients at the perinatal centre in the Nizhny Novgorod region. Psychometric methods were used: the Kessler Psychological Distress Scale K-10; the Impact of Event Scale IES-R; the AUDIT-C screening test; the ASSIST screening test; and the TLFB method for retrospective assessment of daily use of psychoactive substances. Data analysis was performed using multivariate factor analysis in groups of pregnant women with different risk levels for smoking and alcohol consumption (factorisation by principal component method, rotation method – Varimax).
Results. Correlation analysis identified several associations between nicotine and alcohol use and socio-demographic, psycho-emotional, and clinical-psychological risk factors, which were subsequently included in the factor analysis. The results of the factor analysis showed that among non-smoking pregnant women (Group 1), six factors were identified that influence the risk of developing nicotine (tobacco) dependence (total variance explained was 72.9 %): the factor of psychoemotional state; the factor of small social group (family composition and income distribution); the factor of psychosocial predictors of alcohol dependence; the factor of large social group (age and occupational qualification); the factor of marital status; the factor of urbanization. For pregnant smokers (Group 2), four factors were identified (total variance explained was 70.0%): also the factor of psycho-emotional state; the factor of small social group (family composition, income distribution and demographic characteristics); the factor of psychosocial predictors of alcohol dependence; and the factor of social status. Factor analysis in the group of non-drinking women (Group 3) and in the group of women who abuse alcohol (Group 4) identified six risk factors (total variance explained was 72.3 % for women in Group 3 and 80.2 % for women in Group 4). For women in Group 3 the identified factors were: psycho-emotional state factor; small social group risk factor (family composition and income distribution); psychosocial predictors of alcohol dependence risk factor;
socio-demographic factor; urbanization factor; social status factor. For women in Group 4, the identified factors were: the factor of psycho-emotional state; the risk factor of small social group (family composition); the risk factor of psychosocial predictors of alcohol dependence; the sociodemographic factor; the factor of socio-economic status; the factor of urbanization; and the factor of occupational status.
Conclusion. The conducted factor analysis of smoking and alcohol abuse predictors among pregnant women in the four studied groups demonstrated that psycho-emotional state plays the most significant role in these behaviors. The results emphasize the need to enhance preventive measures for both women who abstain from substance use during pregnancy and those who engage in addictive behaviors, as the combined influence of identified risk factors can both trigger and exacerbate such behaviors.
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Screening Testing of Medical University Students to Detect Obsessive-Compulsive Disorder
Abstract
Relevance. Obsessive-compulsive disorder is a fairly common problem among the population. There is still no single point of view on the etiology of obsessive thoughts and actions. Consequently, people of different genders and ages, mental and physical labor, and different socio-economic status may be susceptible to this disorder. Great importance in the development of obsessions and compulsions is given to the prolonged effect of distress, traumatic situations. Hence, the issue of studying the severity of obsessive-compulsive disorder in medical students who face high mental stress, constant distress, lack of time to rest and sleep is interesting.
The aim is to determine the severity of symptoms of obsessive–compulsive disorder in medical university students through screening testing.
Methodology. An observational descriptive one-stage study was conducted with the participation of 90 5th-year students of the Perm State Medical University named after Academician E.A. Wagner, Perm. The respondents were divided into 2 groups based on gender. The first group consisted of 52 women (57.78 %), with an average age of 22.87 ± 1.16 years. The second group consisted of 38 men (42.22 %), with an average age of 23.21 ± 1.21 years. Psychodiagnostic assessment of symptoms of obsessive-compulsive disorder was determined using clinical questionnaires: Maudsley Scale of obsessive-compulsive symptoms, MOCI (Russian-language adaptation: D.S. Karpov, M.A. Karpova, S.P. Popova, A.B. Kholmogorova, 2022), Questionnaire of obsessive-compulsive symptoms, OCI-R (Russian-language adaptation: psytests.org, 2024. URL: https://psytests.org.ru/diag/ocir.html (date of request: 08/20/2024). The absolute values are calculated in the form of the arithmetic mean (M) and the standard deviation (SD). Statistical processing was carried out using StatSoft Statistica 12.6 software, a two-sample Student T-test was used due to the fact that the data distribution does not differ from normal. The differences were considered statistically significant at p < 0.05.
Results and Discussion. As a result of the data obtained, it was found that according to the Maudsley Scale of obsessive-compulsive symptoms, no symptoms of the above-mentioned disorder were detected in men during the psychodiagnostic study (10.79 ± 4.67 points), while in women the presence of obsessive-compulsive manifestations was confirmed by a high indicator (11.67 ± 4.41 points), however, the difference is statistically unreliable (p = 0.284). Therefore, it cannot be argued that mental disorder has a definite correlation with the gender of students. According to the data from the Obsessive-Compulsive Symptoms Questionnaire, men also showed no obsessivecompulsive symptoms (9.29 ± 6.75 points), while women had the most pronounced symptoms of the disorder (13.60 ± 8.11 points), which was statistically confirmed (p = 0.009). In addition, female students with obsessive-compulsive disorder are most characterized by symptoms such as washing (3.63 ± 2.58 points) and arranging (4.13 ± 3.17 points).
Conclusion. It is impossible to say with certainty that obsessive-compulsive disorder is directly related to a person’s gender, however, the data obtained indicate that psychodiagnostic signs of mental disorder are much more common in female students and its symptoms are most pronounced in their gender group. This is probably due to the psychological and individual typological characteristics of female representatives, who are characterized by emotional lability, lower stress tolerance, current problem orientation, and an increased need for emotional stimuli. Women are characterized by symptoms of ordering and washing, while men are characterized by obsessions.
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Organization of Rehabilitation for Military Personnel, Disabled People and Their Families in Foreign Countries: Psychological, Medical and Social Help
Abstract
Relevance. With the ongoing emergence of armed conflicts worldwide, the issue of military personnel rehabilitation remains highly relevant. This article provides an overview of the methods of habilitation and rehabilitation of military veterans and their families in Western Europe, North America and Australia as well as the governmental and non-governmental institutions involved in recovery and readaptation. The paper discusses possible ways of providing psychotherapeutic and social assistance to military personnel and their families, options for conducting psychoeducational programs for them, creating information resources, as well as systems of sanatorium treatment and socio-economic assistance.
The aim of this article is to critically assess the experience of Western European, North American, and Australian countries in the habilitation and rehabilitation of military personnel.
The data for the analysis include some regulatory acts of Western Europe, North America and Australia, Internet resources of specialized organizations and structures, sites with psychoeducational information, scientific articles devoted to the problem of rehabilitation of military personnel.
Results. It has been established that at the moment, the medical and social assistance programs implemented in the above-mentioned countries are being updated and changing the vector of development. Preference is given not to classical psychopharmacological methods of treatment and rehabilitation, but to psychotherapeutic and social-adaptive approaches. Significant attention is paid to the formation of unpaid programs for obtaining the necessary surgical, drug and sanatorium treatment, as well as providing subsidized assistance in receiving paid treatment. Assistance offered in solving employment problems, and facilitating the return of military personnel to productive civilian life. Psychoeducational programs are conducted not only for military personnel, but also for their relatives; information resources are designed to prevent various psychological complications and psychopathological conditions. Modern trends include fundamental importance of supporting the family of a veteran, supervision in the event of his death, protecting the mental health of family members and children.
Conclusions. The key principles for enhancing the effectiveness of the medico-social and professional rehabilitation and habilitation system have been identified. The study concludes that a multifaceted approach to the medico-social rehabilitation of military personnel is essential, along with the operation of organizations capable of addressing habilitation and rehabilitation based on individual characteristics while offering military personnel and their families a broad range of opportunities for continuing a fulfilling life.
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Features of Recognizing Other Person’s Cognitive Errors among Patients with Schizophrenia During the Perception of Communicative Situations
Abstract
Relevance. Social cognition impairments in patients with schizophrenia complicate their interactions with others, adversely impacting daily functioning and the progression of the disease. Investigating these impairments is crucial for developing effective strategies for diagnosis, rehabilitation, and psychological intervention to improve patients’ quality of life.
Intention. To investigate the impairments in cognitive information processing in patients with schizophrenia while performing tasks focused on recognizing cognitive errors of characters in communicative situations.
Methodology. The study included 40 patients with paranoid schizophrenia (experimental group) and 60 healthy participants (control group). Participants’ eye-movement parameters during video perception and verbal interpretations of the clips during retelling to the experimenter were analyzed. Data analysis was performed using ANOVA and Student’s t-test.
Results. Patients with schizophrenia exhibited impairments in recognizing cognitive errors of characters in videos of social situations. These impairments were associated with difficulties in identifying task-relevant objects and events; monitoring characters’ perceptions; and comparing their own cognitive activity with that of the observed characters. Additionally, patients with schizophrenia used vague linguistic expressions to describe characters and struggled to identify features necessary for their unambiguous recognition by their interlocutors. These impairments were significantly more frequent in patients with severe deficit symptoms compared to healthy individuals and patients with mild deficits.
Conclusion. The findings underscore the importance of implementing psychocorrection programs at the early stages of the disorder. Interventions should focus on training patients in effective linguistic encoding of objects and developing skills for detailed analysis of communicative situations through the use of open-ended questions.
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Консилиум
Comorbidity of Somatoform Disorders and Cardiologic Pathology: a Clinical Observation
Abstract
Relevance. Currently there is a problem of insufficiently studied interrelationships of psychiatric disorders characterized by somatoform dysfunctions of the cardiovascular system and cardiologic diseases. The aspects of mutual pathoplastic influence between mental and somatic processes remain underexplored. Consequently, there is ongoing debate regarding whether somatoform and cardiological diagnostic definitions are mutually exclusive or, in some cases, may present as pathogenetically interrelated comorbidity. This issue significantly affects the treatment strategy for such conditions.
Intention: To demonstrate the development of somatoform disorder (SFD) of the cardiovascular system in a patient during the convalescent period of acute myocardial infarction (AMI) beyond the scope of traditional clinical concepts (using the case of patient E.), as well as to objectify the unexpected relationship between truly somatic and psychosomatic diseases.
Methodology. The study utilized clinical-archival, dimensional, and clinical-catamnestic research methods.
Results and their analysis. Following AMI, various complications may arise, including those affecting mental health. One of the consequences is the emergence of neurotic-spectrum mental disorders, particularly somatoform disorders.
Conclusion. This clinical case demonstrates that persistent neurotic-spectrum mental disorders may develop after acute myocardial infarction, leading to patient maladaptation and requiring psycho-pharmacotherapeutic intervention. Interdisciplinary collaboration between cardiologists and psychotherapeutic specialists improves prognosis.
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