Dynamics of Psychosocial, Psychopathological and Neuropsychological Characteristics in Clean-up Workers of the Consequences of Chernobyl Disaster: Results of 30-years Study

Study Objective: To assess the possibilities of social adaptation in persistent psychopathological, including cognitive impairments. Study Design: Longitudinal study.

Materials and Methods. A 30-year observation, treatment and rehabilitation of clean-up workers of accident at the Chernobyl nuclear power plant, who underwent an in-wide clinical, psychopathological and neuropsychological examination at the Moscow Research Institute of Psychiatry, was carried out. 373 people were selected for the study. A dynamic psychopathological and neuropsychological assessment of their condition is given, as well as a description of their social status and adaptive capabilities. In the neuropsychological section of the study, the results of systematic cognitive training were evaluated. The neuropsychological test battery included methods for assessing memory, attention, and thinking.

Study Results. The subjects had modally non-specific memory impairments, in particular due to insufficient fixation of mnestic traces, limited ability to analyze and rethink information in the process of memorization, a decrease in the overall level of activity, exhaustion of voluntary attention, general mental fatigue and stress in the process of mental activity, learning difficulties new skills. However, the quantitative characteristics of cognitive functions did not change from hospitalization to hospitalization, which means that there was no progressive cognitive decline in the cohort. Psychocorrectional measures consisted in conducting cognitive training that stimulates the development of cognitions and the disclosure of unused cognitive resources. The level of somatic and mental well-being of Chernobyl disaster consequences participants correlates with that of patients with organic, cerebrovascular diseases and differs statistically significantly from the indicators of healthy individuals, the same relationships were noted when assessing microsocial support and the level and nature of self-perception. The results of the assessment of social functioning showed a fairly stable social adaptation of former clean-up workers and positive personality attitudes.

Conclusion. Systematic medical and rehabilitation care, the formation of therapeutic partnerships based on the preserved personal qualities of patients made it possible to significantly compensate for psychopathological disorders, slow down cognitive decline and ensure fairly stable social adaptation.

1. Schrimpf L.A., Aggarwal A., Lauriello J. Psychosis. Continuum (Minneap. Minn). 2018; 24(3, Behavioral Neurology and Psychiatry): 845–860. DOI: 10.1212/CON.0000000000000602

2. Khokhlov L.K., Khokhlov A.L. Exogenous organic psychopathology: neurosis-like states, acute, prolonged symptomatic psychoses, psychoorganic syndromes. Therapy of cognitive disorders: monograph. Yaroslavl; 2019. 413 p. (in Russian).

3. Kachaeva M.A., Kharitonova N.K., Shishkina O.A. Temporary mental disorders (exceptional conditions) in forensic psychiatric practice. History and stages of development of the problem. Forensic psychiatry. Actual problems. 2021; (18): 89–106. (in Russian)

4. Klimenko T.V., Igonin A.L., Kulagina N.E., Olifirenko N.Yu. Forensic psychiatric assessment of acute alcohol intoxication with an atypical clinical picture: Guidelines. Moscow; 2004. 24 p. (in Russian)

5. Kinkulkina M.A., Vinnikova M.A., Severtsev V.V. Psychotic disorders associated with the use of synthetic cathinones: a review of the literature. Narcology. 2021; (7): 52–60. (in Russian). DOI: 10.25557/1682-8313.2021.07.52-60

6. Beckmann D., Lowman K.L., Nargiso J. et al. Substance-induced Psychosis in Youth. Child Adolesc. Psychiatr. Clin. N. Am. 2020; 29(1): 131–143. DOI: 10.1016/j.chc.2019.08.006

7. Weinstein A.M., Rosca P., Fattore L., London E.D. Synthetic cathinone and cannabinoid designer drugs pose a major risk for public health. Front. Psychiatry. 2017; 8: 156. DOI: 10.3389/fpsyt.2017.00156

8. Vdovin A.S. Сlinical variants of psychosis associated with the use of synthetic cannabinoids. Narcology. 2022; 21(8): 49–55. (in Russian). DOI: 10.25557/1682-8313.2022.08.49-55

9. Afanasyeva N.A., Berezovskaya M.A., Korobitsina T.V. et al. Clinical and dynamic features of intoxication psychoses caused by the use of modern synthetic psychoactive substances. Siberian Herald of Psychiatry and Addiction Psychiatry. 2017; 3: 78–83 (in Russian). DOI: 10.26617/1810-3111-2017-3(96)-78-83

10. Liu Y., Hao B., Shi Y. et al. Violent offences of methamphetamine users and dilemmas of forensic psychiatric assessment. Forensic Sci. Res. 2017; 2(1): 11–17. DOI: 10.1080/20961790.2017.1287155

11. Srisurapanont M., Lamyai W., Pono K. et al. Cognitive impairment in methamphetamine users with recent psychosis: A cross-sectional study in Thailand. Drug Alcohol Depend. 2020; 210: 107961. DOI: 10.1016/j.drugalcdep.2020.107961

12. Klimenko T.V. Forensic psychiatric and complex judicial narcological and psychiatric examination of alcohol abusers in criminal proceedings. In: Alcoholism: A guide for physicians. Moscow; 2011; 721–750. (in Russian)

13. Igonin A.L., Kekelidze Z.I., Klimenko T.V. Oftaev I.V. Clinical, legal and expert assessment of various conditions caused by the use of psychoactive substances (taking into account the latest changes in Russian legislation). Moscow; 2015. 172 p. (in Russian)

14. Morozov G.V., Ivanets N.N. On the differential diagnosis of various forms of alcoholic psychoses. In: Problems of alcoholism. Clinic, pathogenesis and treatment of alcoholic diseases: Collection of scientific papers. Issue. 4. Moscow; 1974: 5–10. (in Russian)

15. Vvedensky I.N. On the sanity of alcoholics. In: Forensic Psychiatric Expertise, Its Practice and Tasks. Moscow; 1935: 102– 118. (in Russian)

16. Kachaev A.K. To the clinic and differential diagnosis of complex forms of simple intoxication. Forensic psychiatric examination. Questions of alcoholism (Collection of scientific papers No. 32). Moscow; 1979: 3–11. (in Russian)

17. Alekseeva G.Yu., Dubovets N.V., Kerova T.N., Solodyankina T.V. Forensic psychiatric assessment of alcoholic psychoses. Omsk Psychiatric Journal. 2014; 2(2): 35–40. (in Russian)

18. Kondratiev F.V., Gerasimova S.M., Razumovskaya S.P. Analysis of combinations of drug addictions and borderline states (forensic psychiatric aspect). Combined mental disorders of various origins in forensic psychiatric practice: Collection of scientific papers. Moscow; 1991: 46–54. (in Russian)

19. Bourget D. Forensic considerations of substance-induced psychosis. J. Am. Acad. Psychiatry Law. 2013; 41(2): 168–173.

20. Mellsop G., Choi W.K., Every-Palmer S. et al. Drug driven psychoses and legal responsibility or insanity in six Western Pacific nations. Int. J. Law Psychiatry. 2016; 47: 68–73. DOI: 10.1016/j.ijlp.2016.02.037

21. Appelbaum P.S. Settled insanity: substance use meets the insanity defense. Psychiatr. Serv. 2022; 73(1): 105–107. DOI: 10.1176/appi.ps.2021005180000