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Neurology, Neuropsychiatry, Psychosomatics

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Scientific and practical reviewed journal

Since 2009 the “Nevrologiya, Neiropsikhiatriya, Psikhosomatika" (Neurology, Neuropsychiatry, Psychosomatics) journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of neurology. The Journal is aimed to provide a forum to discuss etiology and pathogenesis, clinical features, modern diagnostic and treatment approaches to neurology, psychiatrics and its complications, as well as associated conditions.

The journal is intended for a wide range of neurologists, psychiatrists, neuropsychologists, and specialists of related occupations.

Articles from all specialized medical institutions of the Russian Federation and neighboring countries and materials prepared by Western partners are submitted to the journal.

Among editorial board members of the journal there are 24 Russian and foreign doctors of medical sciences and 3 candidates of medical sciences.

Federal Supervision Agency for Information Technologies and Communications registration ПИ № ФС77-35419 from 20.02.2009.

 

 

Current issue

Vol 14, No 5 (2022)
View or download the full issue PDF (Russian)

LECTURES 

4-12 67
Abstract

We describe the history of studying of the problem of tyramine syndrome during the treatment with antidepressants, irreversible non-selective monoamine oxidase inhibitors. Data on clinical observations are presented. Early hypotheses of pathogenesis are considered. The period of discovery of the relationship between increased blood pressure and the use of foods containing tyramine is outlined. The transformation of terminology is demonstrated. The events associated with the restriction of the use of therapy are characterized. The formation of the opinion about the exaggeration of the risk of developing tyramine syndrome is analyzed. Data on the involvement in the discussion of the problem of tyramine syndrome of society as a whole are given. 

ORIGINAL INVESTIGATIONS 

13-21 55
Abstract

Genetic polymorphisms associated with impaired one-carbon metabolism (1-CM) can be a risk factor not only for somatic and neurological diseases, but also for affective disorders (AD).

Objective: to compare the frequency of genetic polymorphisms MTHFR, MTR, MTRR associated with 1-CM disorders among patients with AD, their blood relatives and healthy individuals.

Patients and methods. This cross-sectional study of the frequency of genetic polymorphisms (MTHFR, MTR, MTRR) associated with 1-CM included patients with AD (n=24), their blood relatives (n=40), as well as a group of healthy individuals (n=35). All study participants underwent a structured diagnostic interview, as well as genetic analysis using real-time polymerase chain reaction.

Results and discussion. Patients with AD were statistically more likely to carry the minor allele C of the 1298A>C polymorphism of the MTHFR gene and the minor allele G of the 2756A>G polymorphism of the MTR gene compared to the group of healthy individuals. The minor allele T of the 677C>T polymorphism of the MTHFR gene was associated with longer depressive episodes, as well as with the presence of concomitant cardiovascular diseases in blood relatives of patients with AD.

Conclusion. Genetic polymorphisms associated with 1-CM may contribute to familial aggregation of AD and somatic diseases. Further highquality family studies using molecular genetic methods are needed.

22-27 37
Abstract

Objective: to study the association of the G-174C (rs1800795) polymorphism of the IL-6 gene with depression in an open population of 25–44 year old in Novosibirsk.

Patients and methods. In 2013–2016 years we examined 403 men (mean age – 34±0.4 years, response – 71%) and 531 women (mean age – 35±0.4 years, response – 72%) from an open population of 25–44 year old residents of the Oktyabrsky district, Novosibirsk, the sample was representative. Depression was assessed using the MONICA-MOPSY psychosocial questionnaire. Genotyping of the studied gene polymorphisms was carried out in the Laboratory of Molecular Genetic Research of Scientific Research Institute for Therapy and Preventive Medicine, Federal Research Center Institute of Cytology and Genetics, Russian Academy of Sciences, Novosibirsk.

Results and discussion. A severe level of depression occurred in 12.8% of the population, among men – in 8.9%, among women – in 15.8%; and moderate level – in 24.5% of the population (among men – 21.3%, among women – 26.9%). The most common in the population was the heterozygous C/G genotype (45.1%), the G/G genotype was observed in 34.6% of the population and, finally, C/C in 20.3% of participants. The most common allele of the IL-6 gene of the G-174C polymorphism (rs1800795) was the G allele in 57.5% of the population, and the C allele in only 42.5%. Among carriers of the G/G genotype of the IL-6 gene, a moderate (39.7%) or severe level of depression (37.3%) prevailed, while there was no depression in the carriers of the C/C genotype of the IL-6 gene (24.2%; χ2 = 10.962; df=4; p=0.027). Carrying the C/G genotype of the IL-6 gene increased the chance of developing a severe level of depression by almost 2.9–3.3 times in comparison with the carriage of the C/C genotype. Among carriers of the G/G genotype of the IL-6 gene, a severe level of depression was 3.3 times more common than in carriers of the C/C genotype. Individuals carrying the G allele of the IL-6 gene were 1.6 times more likely to experience a severe level of depression than those carrying the C allele.

Conclusion. The data obtained suggest that the carriage of the G allele of the G-174C polymorphism (rs1800795) of the IL-6 gene may be associated with a severe level of depression. 

28-35 34
Abstract

Temporal lobe epilepsy (TE) is the most common form of focal epilepsy in adults with a high rate of drug-resistant course. In the Russian Federation studies of the contribution of the carriage of single nucleotide variants of genes (SNGs) encoding proteins of neuroinflammation and neurodegeneration to the development of TE have not been previously carried out.

Objective: to study the association of SNGs rs16944 and rs1143634 of the IL-1β gene, rs1800629 of the TNFA gene, rs6265 of the BDNF gene, rs3780645 of the NTRK-2 gene with the risk of development, clinical and neuroimaging features of TE.

Patients and methods. The study included 166 patients with TE and 203 healthy volunteers living in the Siberian Federal District. The study included clinical, neurophysiological, neuroradiological, and laboratory work-up. Investigation of the carriage of SNGs rs16944 (-511T/C) and rs1143634 (+3954C/T) of the IL-1β gene, rs1800629 (G-308A) of the TNFA gene, rs6265 (G/A) of the BDNF gene, rs3780645 (C/T) and rs2289656 (C/T) of the NTRK-2 gene was carried out by real-time polymerase chain reaction. Results and discussion. The prognostically unfavorable role of carriage of the A allele and the GA rs1800629 genotype of the TNFA gene in the development of TE, the GA rs6265 genotype of the BDNF gene in the development of TE with hippocampal sclerosis was established. Carrying the genotype AA rs1800629 of the TNFA gene in patients with TE reduces the risk of polytherapy with antiepileptic drugs.

Conclusion. The study of neuroinflammation and neurodegeneration processes is important both from a physiological point of view and from the point of view of searching for the TE development markers, which make it possible to predict and evaluate the rate of disease progression, help to determine the tactics of treatment, and evaluate its effectiveness. In this regard, at present, the identification of potential genetic markers remains a task of high priority. 

36-42 73
Abstract

The COVID-19 pandemic is causing a heavy increase in the incidence of development/exacerbation of mental disorders in healthcare workers. The relevance and importance of early detection of predisposition to the development of mental disorders is increasing not only among practicing physicians, but also among clinical residents and students of medical universities.

Objective: to assess the emotional state in different groups of medical workers and medical students.

Patients and methods. The study involved 110 doctors of both sexes, including 64 (68.2%) women and 46 (41.8%) men aged 26–40 years who took upgrade training courses at the RUDN University departments; 108 residents of the second year of study aged 24–26, of which 67 (62.1%) women and 41 (37.9%) men, and 43 students of the 1st year of RUDN University aged 17–19, of which 29 (67.4%) women and 14 (32.6%) men. The study was conducted in February–May 2021. The research methods included questionnaires and psychometric assessment of the condition of the subjects and statistical data processing.

Results and discussion. We documented a high frequency of signs of psychopathological disorders such as anxiety (44.5%), depression (23.6%), asthenia (86.4%) and eating behavior disorders (up to 68.2%) among practicing physicians of various specialties and students (residents and students) during pandemic.

Conclusion. The stressful impact of the pandemic on the work and training of medical professionals leads to a deterioration in their mental health. 

43-48 139
Abstract

About 20% of patients with depression are diagnosed with alcohol dependence, and alcohol dependent individuals are at a higher risk of developing depression. A number of authors point to the relationship of CLOCK gene activity with both affective disorders and alcohol use/dependence disorders; in particular, variations in the CLOCK gene at the evidence level link to depression and stress.

Objective: to establish clinical and genetic associations of the CLOCK circadian rhythm gene and depressive disorders during the period of abstinence in patients with alcohol dependence syndrome.

Patients and methods. From June 2019 to December 2022, 402 patients (mean age 42.47±7.5 years) were examined, who underwent outpatient follow-up at a narcological dispensary not earlier than 1 month after and not later than 2 months after discharge from the hospital. All patients were diagnosed with middle-stage alcohol dependence syndrome, early remission phase. Depending on the presence of an episode of depression at the time of the examination, the main group (patients with a depressive disorder; n=128) and a comparison group (patients without a depressive disorder; n=274) were formed. Clinical interviews and psychometric study using the Montgomery–Asberg Depression Scale, were conducted for all the subjects. All subjects provided 10 ml venous blood samples for molecular, genetic and biochemical studies.

Results and discussion. Correlations were found between the carriage of the TT genotype of the CLOCK gene in patients with alcohol dependence and concomitant clinical depression. Carrying the TT genotype of the CLOCK gene is presumably associated with the predominance of the following symptoms of depression, which demonstrated statistically significant differences: loss of appetite, impaired concentration, apathy, as well as with a higher overall score on the MADRS depression scale. The established association between the CLOCK gene and depression in people with alcohol dependence can be considered as a vulnerability factor in relation to the development of depression in patients with the underlying disease – alcohol dependence syndrome.

Conclusion. The CLOCK gene is associated with the development of depression in patients suffering from alcohol dependence. Carriers of the TT genotype of the CLOCK gene (rs1801260) to a greater extent than carriers of other genotypes are characterized by the development of comorbid depression, as well as the predominance of such clinical symptoms as loss of appetite, impaired concentration, apathy, and a higher overall score on the MADRS depression scale. 

49-54 68
Abstract

Objective: non-interventional study ELBRUS (Etoricoxib in the Treatment of Back Pain) was conducted to investigate the efficacy and safety of daily administration of Rixia® (Etoricoxib) 60 mg per day in patients with chronic non-specific low back pain (CNSLBP).

Patients and methods. The study included 50 patients (31 women and 19 men, mean age 54.3±16.8 years) with CNSLBP. Educational conversation, cognitive therapy, regular therapeutic exercises, identification and treatment of comorbidities were conducted. Patients received etoricoxib 60 mg once daily. Pain intensity was assessed on a 10-point numerical rating scale (NRS), pain-related disability was assessed on the Oswestry Scale (ODS), and emotional state was assessed on the Hospital Anxiety and Depression Scale (HADS).

Results and discussion. The causes of CNSLBP were: in 5 (10%) patients – sacroiliac joint involvement, in 14 (28%) – lower lumbar facet joints involvement, in 3 (6%) – myofascial pain, the remaining 28 (56%) patients had a combination of several reasons. As a result of complex treatment, the intensity of pain at rest decreased on average from 4.0±2.5 to 1.4±1.3 points, while moving – from 6.6±1.9 to 2.8±1.8 points, at night – from 2.7±2 to 0.7±0.9 points according to the NRS, disability – from 39±18.9 to 19.9±14.6% according to the ODS, the severity of anxiety – from 6.5±3.9 to 3.3±2.4 points and depression from 5.0±3.7 to 3.1±2.9 points according to HADS (p<0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib. Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted. Keywords: chronic nonspecific low back pain, non-steroidal anti-inflammatory drugs, etoricoxib, Rixia®>˂0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib.

Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted. 

55-59 180
Abstract

Objective: dissociative disorders usually have a poor prognosis. Childhood trauma is one of the most important predisposing factors for it. This study aimed to investigate the relationship between dissociative experiences with childhood abuse, in nursing and midwifery students of Rafsanjan University Medical Science.

Patients and methods. This cross-sectional study was carried out in nursing and midwifery students of Rafsanjan University of Medical Sciences. The students were asked to complete Dissociative Experience (DES) and Traumatic Life Events Questionnaires. Descriptive statistics, independent t-test, ANOVA, chi-square test and pearson correlation coefficient were used for statistical analysis.

Results and discussion. The prevalence of moderate and severe dissociative experiences among the participated students was about 38%. Nearly 50% of the students reported to have moderate to severe childhood injuries. Significantly higher dissociative experiences scores were observed in men compare with women (P=0.015). Moderate correlations were detected between subscales of childhood traumatic life events questionnaire and dissociative experiences score (P<0.05). Conclusion. The prevalence of dissociative experiences among the studied students was moderately high which revealed the necessity and importance of psychological counseling among health professional students. A positive correlation was detected between dissociative disorders and traumatic events. Therefore, in order to reduce the chance of dissociative disorder, childhood psychological counseling is necessary in children who have had traumatic events. Keywords: dissociative disorders, adult survivors of child adverse events, nursing, midwifery>˂ 0.05).

Conclusion. The prevalence of dissociative experiences among the studied students was moderately high which revealed the necessity and importance of psychological counseling among health professional students. A positive correlation was detected between dissociative disorders and traumatic events. Therefore, in order to reduce the chance of dissociative disorder, childhood psychological counseling is necessary in children who have had traumatic events. 

EXPERIMENTAL STUDIES 

60-68 47
Abstract

It is well known that a complex of nervous and hormonal signals during stress stimulates adrenal glands to secrete adrenaline, norepinephrine and cortisol. Much less attention has been paid to the roles of intermediate signaling proteins mediating the effects of “stress hormones”, neurotransmitters, and other signaling molecules. This paper presents the results of a systematization of studies of glycogen synthase kinases GSK-3α and GSK-3β, whose excessive activity aggravates the course of chronic stress, has a negative effect on neuronal survival and adaptation processes. Lithium ions are a natural inhibitor of the excessive activity of both GSK-3, which partly determines the normothymic and antidepressant effects of lithium drugs. Taking lithium salts based on organic anions is the safest and most effective way to replenish lithium deficiency in the body. The prospects for the use of lithium ascorbate to increase the body's adaptive reserves are considered. 

REVIEWS 

69-76 62
Abstract

Irreversible neurological deficit and disability in neuromyelitis optica spectrum disorders (NOSD) are formed as a result of exacerbations, which are often life-threatening. Timely diagnosis and treatment of exacerbations is a key task in the management of this category of patients. A unified structured approach to the diagnosis and treatment of NOSD exacerbations has not been developed. The purpose of this article is to analyze the scientific literature data on this issue in order to optimize the diagnostics and treatment of NOSD exacerbations in everyday clinical practice. 

77-82 58
Abstract

To reduce the risk of developing adverse events (AEs) and increase the adherence of elderly patients to treatment, it is recommended to limit maximally the total number of prescribed drugs (DR), using one drug for the treatment of two or more pathologies if possible. The drugs that meet the criteria for use in elderly patients and / or patients with comorbidity include the original Russian drug Mexidol® (ethylmethylhydroxypyridine succinate), which has a multimodal mechanism of action and has multiple pharmacological effects. In order to study the safety of Mexidol in comparison with placebo in different age groups of patients with chronic cerebral ischemia, a post hoc analysis of the international multicenter, randomized, double-blind, placebo-controlled MEMO study with an adaptive design was carried out, which assessed the efficacy and safety of sequential therapy with Mexidol®, a solution for intravenous and intramuscular injection, 50 mg/ml (NPK PHARMASOFT, Russia) and Mexidol® FORTE 250 film-coated tablets, 250 mg (NPK PHARMASOFT, Russia) in patients with chronic cerebral ischemia. The study involved 318 patients aged from 40 to 90 years.

Comparable safety and tolerability of Mexidol was demonstrated in middle-aged and elderly people with chronic cerebral ischemia, including patients over 75 years of age. 

83-89 71
Abstract

The article highlights the problem of dysphagia, which is often present in patients with Alzheimer's disease (AD), as a rule, at advanced stages of the disease and significantly complicates the management of this group of patients. Issues of age-related physiologic swallowing changes are considered. Mechanisms of dysphagia development in the elderly and in AD patients are discussed. It is noted that in AD areas of the cerebral cortex, involved in the act of normal swallowing are affected. The most dangerous complication of dysphagia is aspiration, which increases the risk of pneumonia and death. It is noted that dysphagia in patients with AD leads to weight loss and increased dependence on nutrition. Weight loss increases the risk of opportunistic infections in patients with AD. In the case of dysphagia symptoms development, pill administration causes great problems. In this scenario, the solution is the use of dispersible or liquid forms of drugs. We describe a clinical case of severe AD in which a dispersible form of memantine, Memoritab, was used. The complications associated with dysphagia in patients with AD highlight the importance of early detection and treatment of this symptom. Understanding the specific pathological processes of the underlying disease that contribute to the development of dysphagia is necessary in order to adapt the treatment of patients in a timely fashion. 

90-95 77
Abstract

Chronic low back pain (CLBP) is the most common chronic pain syndrome that causes deterioration of the quality of life and disability. Anxiety and depressive disorders are significantly more common in patients with CLBP. The negative impact of CLBP on cognitive abilities and sleep was revealed. Treatment of patients with CLBP should be started with non-pharmacological methods, including an educational program, kinesiotherapy, and cognitive behavioral therapy. Antidepressants are prescribed for CLBP to reduce the severity of associated anxiety and depressive disorders, improve sleep and relieve pain. The efficacy and safety of sertraline (Serenatа) in CLBP, its additional neurochemical mechanisms of action due to its effect on dopamine reuptake, interaction with sigma receptors, low incidence of side effects, and high adherence of patients to therapy are discussed. 

96-102 63
Abstract

Depression is one of the most common mental disorders in neurological practice. Among other symptoms of depression, a symptom complex represented by apathy, anhedonia, and cognitive impairment plays an important role. This review presents the clinical characteristics of the symptoms described above and discusses modern neurochemical and neuroimaging concepts of their pathogenesis. The problem of pathogenetically substantiated therapy of depression with a predominance of apathy, anhedonia and cognitive impairment is discussed. Fundamental and clinical arguments are presented in favor of the high efficacy of vortioxetine in depression with a predominance of apathy, anhedonia, and cognitive impairment. 

103-108 110
Abstract

The article discusses the clinical manifestations, pathomorphology, pathogenesis and various treatment methods of cervical radiculopathy (CR). Article points out diagnostic difficulties arising from the frequent discrepancy between clinical and neuroimaging data. The issues of choice of conservative and surgical treatment are discussed, based on the analysis of data from recent systematic reviews.

In the absence of focal neurological symptoms, radicular compression is unlikely. The natural course of CR is favorable. Rehabilitation programs are used as the first line of treatment, including a combination of education, exercise, manual therapy, psychological and pharmacological methods. Drug therapy for CR starts with non-steroidal anti-inflammatory drugs administration; to achieve the effect quickly, it is possible to use aceclofenac (Aertal) in the form of a powder for suspension. 

EXPERT CONSENSUS 

109-116 62
Abstract

This consensus reviewed the main current issues of clinical application and integration into everyday practice of a new targeted preventive therapy for migraine using monoclonal antibodies (mAbs) to the calcitonin gene related peptide (CGRP) ligand or receptor. These recommendations are based on current scientific and clinical studies and an analysis of the results of several years of clinical use. The main purpose of the consensus is to assist practitioners in prescribing effective prophylactic treatment of migraine using anti-CGRP mAbs and to improve care for patients with various forms of the disease. 

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