Основания и практика применения нейропсихологической диагностики в контексте судебно-психиатрической экспертизы

Обоснование: когнитивные нарушения являются коморбидными при большинстве психических расстройств и могут быть важны при оценке способности субъекта осознавать и контролировать свои действия в юридически значимых ситуациях. Цель: анализ нейробиологических коррелят и когнитивных нарушений у лиц, страдающих психическими расстройствами, такими как пограничное расстройство личности и шизофрения в контексте судебно-психиатрической экспертизы. Материалы и методы: по ключевым словам: «когнитивные нарушения при шизофрении», «когнитивные нарушения при органических расстройствах личности», «когнитивные нарушения при расстройстве личности» «шизофрения, МРТ», «органическое расстройство личности, МРТ», «расстройство личности, фМРТ» «судебная нейропсихология», «шизофрения и противоправные действия», «органические расстройства личности и противоправные действия», «расстройства личности и противоправные действия» проведен поиск и анализ научных публикаций за последние пять лет в PubMed, Scopus и РИНЦ. Заключение: при шизофрении выявляются отклонения в работе лобных, височных отделов, которые характеризуются когнитивными нарушениями управляющих функций, внимания, слухоречевой памяти, психомоторной, непоследовательным поведением и дефицитом волевых усилий. При пограничном расстройстве личности наблюдаются снижение объема передней поясной извилины, гиппокампа, миндалины и префронтальной коры, дисфункциональное взаимодействие лимбической и префронтальной областей, проявляющееся трудностями идентификации эмоций и импульсивностью. У лиц, перенесших ЧМТ с сопутствующими вторичными расстройствами личности, отмечаются диффузные поражения головного могза, распространяющиеся на лобные, височные и теменные области, с большим акцентом на дисфункцию структур лимбико-ретикулярного комплекса, с когнитивными нарушениями: снижение скорости мышления, устойчивости внимания, управляющих функций слухоречевой памяти, зрительно-пространственной памяти, зрительно-моторной координации, а также снижение контроля торможения импульсов. Лица с психическими расстройствами, совершившие противоправные действия, часто обнаруживают дефицитарность лобных отделов и сопутствующие нарушения управляющих компонентов психической деятельности, особенно когнитивной гибкости и планирования. Нейропсихологические методы исследования когнитивных функций могут быть использованы для получения дополнительной информации при судебно-психиатрической экспертизе.

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