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 15, No 1 (2023)
View or download the full issue PDF (Russian)


4-17 168

In the pharmacotherapy of depressive disorders, the problem of the predictors of a therapeutic response remains relevant, they may be important in determining treatment tactics.
Objective: to determine the predictive power of the Cloninger Temperament and Character Inventory (TCI) in evaluating the results of antidepressant pharmacotherapy in patients with depression (major depressive disorder).
Material and methods. PubMed and Google Scholar were searched for articles published between 1990 and November 2021. Only English-language prospective studies, that examined the relationship between pre-treatment TCI personality scores and antidepressant pharmacotherapy efficacy were selected.
Results. A total of 18 studies were found (Ntot=3122). The most commonly cited statistically significant predictors of therapy effectiveness were: harm avoidance (HA) in 11 studies (Ntot=2413), reward dependence in 6 (Ntot=1941), cooperativeness (CO) in 6 (Ntot=1259). In only two studies (Ntot=234), personality parameters were not associated with treatment efficacy. In 10 studies (Ntot=1065) baseline values of personality characteristics were indicated, which made it possible to include them in the meta-analysis. HA (z=4.06; p<0.0001; I2 =49%) and CO (z=2.71; p=0.007; I2 =66%) were associated – in a statistically significant way – with the likelihood of achieving a response to antidepressant pharmacotherapy.
Conclusion. Personality dimensions from the TCI questionnaire are predictors of the effectiveness of antidepressant pharmacotherapy

18-27 116

The most important component of the treatment effectiveness is the adherence of patients to the recommendations of the attending physician, which can affect the course and prognosis of the disease. The problem of adherence in cerebrovascular disease (CVD), depending on the clinical picture of the disease and comorbid diseases, is currently poorly studied.
Objective: to assess the degree of adherence to treatment in patients with the main diagnosis of CVD and to determine the factors influencing it.
Material and methods. 161 patients with cerebrovascular pathology aged 58–70 years (mean age 64 years) were examined. The assessment of somatic and neurological status, neuropsychological examination, assessment of adherence to therapy using standardized national questionnaires: the Russian Scale of Quantitative Assessment Adherence to Treatment (QAA-25) and the Domestic Therapy Adherence Questionnaire (DTAQ), laboratory studies were performed. The influence of cognitive impairments (CI), background and comorbidities, as well as drug therapy in the framework of the prevention of cardiovascular diseases were evaluated.
Results. In patients with CVD, according to the results of the QAA-25 questionnaire, adherence to medical support was 33.4 [26.3; 57.5] %, drug therapy – 44.4 [29.7; 59.0] %, the lifestyle modifications – 31 [26; 55] %, overall adherence to treatment – 31 [26; 56] %. The proportion of patients with low adherence according to the DTAQ test reached 19.9%. In patients with a low adherence, the result on the Montreal Cognitive Assessment Test (MoCA) was 21 points, in patients with very high adherence – 26 points. An increase in the total number of prescribed basic drugs was accompanied by a decrease in adherence according to the results of DTAQ (p=0.041) and QAA-25 (p<0.05) tests. The worst indicators of adherence were noted in CI and the presence of such factors as arterial hypertension (AH), an increase in waist circumference, the severity of carbohydrate metabolism disorders, especially the combination of AH and type 2 diabetes mellitus (DM).
Conclusion. The conducted study demonstrated insufficient adherence to treatment in patients with chronic CVD. Adherence deterioration factors are CI, an increase in the number of drugs administered, comorbid diseases, of which the combination of AH and type 2 DM is of the greatest importance.

28-35 119

In patients with chronic migraine (CM), the illness perception includes three main aspects: cognitive (thoughts, beliefs, attitude towards pain), emotional (mood) and behavioral (pain coping strategies). The patient’s perception affects the course of CM, the prognosis and personality of the patient, so its assessment, understanding and correction underlie a multidisciplinary approach to treatment.
Objective: to evaluate the cognitive, emotional and behavioral characteristics of patients with CM.
Material and methods. The study included 200 patients with CM (63 men and 137 women), mean age 33.1±7.1 years. All patients were interviewed and tested to assess their clinical, cognitive, emotional and behavioral characteristics.
Results. High levels of indicators such as catastrophizing of symptoms (84%), autonomic sensations (89%), intolerance to bodily sensations (71%), overestimation of the severity of symptoms (91%), and bodily weakness (68%) were revealed. All patients had misconceptions about the causes of headache, the majority (80%, n=160) had misconceived negative ideas about the prognosis. Almost all patients had high situational (95%, n=190) and personal (90%, n=180) anxiety, depressive symptoms of varying severity (95%, n=190). Non-adaptive pain coping strategies prevailed: avoidance coping style (87%, n=174); emotion-oriented coping (76%, n=152). In a group of 20 patients significant (p<0.05) associations were found between catastrophizing of symptoms, autonomic sensations, overestimating the severity of symptoms, anxiety and depression, and coping strategies.
Conclusion. In most patients with CM, the illness perception includes negative and misconceived ideas about headache, clinically expressed symptoms of anxiety and depression, and maladaptive coping strategies. Significant relationships were found between cognitive, emotional, and behavioral characteristics, which emphasizes the validity and positive perspective of using the cognitive-behavioral model of pain in CM treatment.

36-42 118

The study of glioneuronal apoptosis and neuroinflammation is extremely important for understanding the causes of epilepsy. Currently, the focus is on neuronal apoptosis and certain aspects of neuroinflammation, while glial apoptosis remains poorly understood.
Objective: to evaluate neuronal and glial apoptosis in conjunction with neuroinflammation in the area of the epileptic focus in patients with focal drug-resistant epilepsy (DRE).
Material and methods. Biopsy specimens of the cortex and white matter of the temporal lobe of the brain from 30 patients with focal DRE due to focal cortical dysplasia were studied. We evaluated pathological changes and structural signs of apoptosis, levels of apoptotic and pro-inflam-matory factors such as caspase-3, caspase-9, FAS, FAS ligand (FAS-L), tumor necrosis factor α (TNFα), p53, nuclear factor κB (NF-κB). Histological methods, transmission electron microscopy (TEM), immunohistochemical study (IHC), and Western blot (WB) were used. The comparison group consisted of 21 people without epilepsy and brain involvement.
Results. In DRE patients IHC revealed the expression of active caspase-3 in single neurons (20% of cases) and in gliocytes of the cerebral cortex and white matter (100% of cases). TEM revealed ultrastructural signs of apoptosis in all cases in neurons and oligodendrocytes. The WB of the epileptic focus showed an increased expression of the apoptotic factors caspase-9, FAS, p53 and pro-inflammatory factors TNFα, NF-κB.
Conclusion. The results obtained indicate the presence of associated apoptosis and neuroinflammation processes of in DRE. Glial apoptosis is actively involved in epileptogenesis. The main part of apoptotic glia is oligodendrocytes, which explains the well-known phenomenon of myelin damage in epilepsy. Along with neuronal apoptosis, oligodendrocyte apoptosis together with neuroinflammation forms a self-sustaining pathological focus, which contributes to the progression of the disease and the occurrence of relapses.

43-49 63

Objective: to study the associations between polymorphic variants of the 5-HTTLPR SNP rs25531 A>G gene and sleep disorders in the open population of the able-bodied population aged 25–44 years in Novosibirsk.
Material and methods. A representative sample of the population aged 25–44 years in Novosibirsk was surveyed in 2013–2016 (403 men, mean age – 34±0.4 years, response – 71%; 531 women, mean age – 35±0.4 years, response – 72%). The general examination, included in the WHO MONICA-psychosocial (MOPSY) program was carried out according to standard methods. Sleep disturbance was assessed using the Jenkins scale. Three hundred forty nine (349) people who underwent genotyping were selected from the total sample using the method of random numbers generation.
Results. In the studied population aged 25–44 years, 42.8% of respondents gave a negative assessment of their sleep, 39.7% of men and 45.3% of women had sleep disorders (χ2 =11.397; df=4; p<0.05). In 19.6% of men and 21.5% of women, sleep duration was 6 hours per day, 5.7% of men and 4.5% of women reported 5 hours of sleep per day (χ2 =2.269; df=5; p>0.05).
The most common genotype of the 5-HTTLPR SNP rs25531 A>G gene was SLA (43.3%), LALA (26.4%) was on the second place, SS (17.8%) was on the third place, less represented genotypes in our population were LALG (6.9%), SLG (4.4%), LGLG (1.4%) genotypes.
Among individuals with the SLA genotype more common was 5–6 hour sleep (55.3%) (χ2 =4.121; df=1; p<0.05) and 8–10 hour sleep (63.5%) (OR=4.863; 95% CI 1.625–14.555; χ2 =7.625; df=1; p<0.01), among LALA carriers – 8–10 hour sleep (58.5%) (χ2 =4.862; df=1; p< 0.05), compared with carriers of the LALG genotype, among whom 7-hour sleep was more common (73.7%).
Conclusion. The effect of the 5-HTTLPR SNP rs25531 A>G gene on serotonin neurotransmission contributes significantly to the etiology of sleep disorders.

50-56 95

High prevalence of borderline personality disorder, high comorbidity with other psychiatric disorders, impulsive reactions necessitate psychological interventions on this group of patients.
Objective: this study aimed to indicate the effect of dialectical behavior therapy individually and along with family therapy on borderline personality symptoms.
Materials and methods. Eight patients were selected based on diagnostic and statistical manual of mental disorders (DSM-5), borderline personality disorder severity Index (BPDSI) and semi-structural interview (SCID-II). They divided into two groups: individual intervention and individual intervention with family education. All received Soler-based dialectical behavioral skills training (3-months) in 13 sessions of 120 minutes. In four stages, beginning of sessions, the median of treatment, end of the treatment, and three months after treatment, BPDSI questionnaire were filled and family of the second group completed McMaster questionnaire.
Results. The findings of Friedman test show the effectiveness of dialectic-behavioral skills training based on Soler model as a short-term model alone and along with family education in reducing the symptoms of borderline personality disorder. Wilcoxon test indicate the effectiveness of this method in reducing the symptoms in post-test. Three months follow-up indicates the stability of the results with a 95% confidence level. U Mann-Whitney indicates no significant difference between two groups.
Conclusion. Dialectical-behavior skills training based on the Soler model is effective in reducing the symptoms of borderline personality disorder and improving family function. It is recommended as a short term method to control the symptoms of borderline personality disorder and improvement the performance and communication among family members.

57-64 94

Objective: to study the effectiveness of a combination of non-drug methods in the treatment of non-dementia cognitive impairment of vascular etiology.
Material and methods. The study involved 60 patients with moderate cognitive impairment of vascular etiology. The patients were divided into two groups: group 1 (n=30, mean age 63.7±8.8 years) received a combination of non-drug methods in the form of cognitive training, physical activity and meal planning for 1 month; patients of the 2nd group (n=30, mean age 64.2±10.7 years) were once informed about the advisability of a healthy diet and maintenance of mental and physical activity. Neuropsychological testing was done at the inclusion stage of the study, immediately after 1 month course of treatment, 6 months and a year after the start of the study. There were no significant differences between the groups in terms of cognitive functions at baseline.
Results. After a month of treatment, in the 1st group the results of neuropsychological testing significantly (p<0.05) improved compared to the first visit: Montreal Cognitive Function Assessment Scale (MoCA-test) – from 22.5±2.4 to 23.7±2.8, Trail making test part A – from 56.9±20.1, up to 49.3±21.7; Trail making test part B – from 116.8±47.8 to 93.5±36.3; the Digit Symbol Substitution test (DSST) scores increased from 26.6±9.0 to 28.8±9.0. Categorical and literal fluency increased from 14.9±4.1 to 16.5±4.6 and from 10.0±1.7 to 11.6±1.9, respectively. In the 2nd group, 1 month after the start of the study, there were no significant differences from the baseline in neuropsychological tests. Differences between the groups at the second visit were statistically significant (p<0.05) according to the MoCA test, Trail making tests (parts A, B), DSST, and association tests. Significant differences between groups persisted during the first 6 months, but disappeared after 12 months of follow-up.
Conclusion. Multimodal non-drug therapy in patients with moderate cognitive impairment of vascular etiology improves the main cognitive parameters.

65-70 81

A common tool for detecting mild cognitive impairment (MCI) is the Montreal Cognitive Assessment (MoCA). An extension of the standard MoCA testing – MoCA-Memory Index Score (MoCA-MIS; Memory Index, MI) – allows a deeper study of the mechanisms of MCI formation. We consider the drug Prospecta as an effective measure to prevent the progression of MCI.
Objective: to study the efficacy and safety of Prospecta in the treatment of MCI in patients with cerebrovascular disease (CVD) in real clinical practice.
Material and methods. The observational program PRIORITET included 192 patients of both sexes aged 40 to 74 years inclusive (mean age 63.6±8.8 years) with MCI and CVD, they were prescribed Prospecta, two tablets twice a day during 24 weeks. The presence of MCI was confirmed by testing on the MoCA scale; MI was assessed additionally`. At the end of treatment, the condition of patients was assessed using the Overall Clinical Impression Scale and the safety of the therapy.
Results. The change in the mean score on the MoCA scale after 24 weeks of therapy with Prospecta was 5.3 (p<0.0001). The proportion of patients who responded positively to treatment with Prospecta and after 24 weeks of treatment restored their cognitive functions to normal (MoCA >26 points), reached 48.9%. Additionally, patients were divided into groups depending on the results of testing on the MoCA scale and MI. During therapy with Prospecta, the number of patients in the MIS <7 and MoCA <20 group decreased by 19 times, in the MIS <7 or MoCA <20 group – by 4.8 times. There were 16 adverse events, 75% of which were mild. In 62.5% of adverse events, there was no connection with taking Prospecta.
Conclusion. Prospecta is an effective and safe treatment for patients with MCI and CVD.


71-76 178

Labyrinthine infarction is a rare variant of vertebrobasilar stroke. The disease requires differentiation from other causes of acute cochleovestibular deficiency, in particular, with viral labyrinthitis, which presents serious clinical difficulties. The article describes a clinical case of labyrinthine infarction in a patient with multiple cardiovascular risk factors. The diagnosis was made possible by the use of magnetic resonance imaging with delayed contrast enhancement. Modern data on clinical and instrumental diagnosis of the disease are presented.

77-82 62

In the occurrence of idiopathic infertility, psychological factors and mechanisms of transformation of the mental into the somatic play an important role. The psychotherapeutic view of the problem of idiopathic infertility consists in recognizing the fact that at a particular moment of life a person is in a state of intrapsychic or interpersonal conflict, which at an unconscious level blocks the possibility of having a child. Women with idiopathic infertility compared with fertile women are characterized by a more pronounced manifestation of such unconscious mechanisms in the implementation of their reproductive function. The reproductive function is blocked by the central nervous system, as a result of which ovarian dysfunction with the formation of cysts, ovulation disorders, lack of hormone production by the corpus luteum, spasm of the fallopian tubes, increased production of antisperm antibodies can be observed.
The article presents three clinical observations that describe different variants of intrapersonal conflicts that led to infertility through their somatization. The ways of overcoming infertility with the help of psychotherapy through the awareness of psychological obstacles are shown.


83-89 200

Cognitive impairments (CI) are among the most common types of neurological disorders that occur in the practice of both neurologists and doctors of other specialties. The article discusses the modern principles of CI classification according to severity, their clinical signs, diagnostic criteria, and the most important approaches to managing patients with dementia and non-dementia CI. A review of current publications on the treatment of mild CI syndrome (MIS) and dementia was carried out, it was shown that the treatment should be comprehensive and include nondrug methods (regular physical activity, cognitive training), correction of all vascular risk factors, as well as drug treatment aimed at improvement of cognitive functions. At the same time, the strategy for choosing drug therapy for CI is determined by the degree of their severity. The importance of early detection of CI is due to the fact that timely diagnosis of these disorders expands the potential for secondary prevention and therapeutic intervention, which can delay or even prevent the onset of professional and social maladjustment due to the development of dementia. The possibilities of modern neuroprotective and symptomatic therapy of CI, the place of akatinol memantine in the treatment of CI syndrome and dementia are shown. Modern data on the use of this drug in various nosological variants of diseases with MCI syndrome and dementia of varying severity are presented.

90-96 110

Parkinson's disease (PD) is a neurodegenerative disease characterized by the progressive death of dopaminergic neurons in the substantia nigra of the brain and the deposition of α-synuclein in the form of Lewy bodies in other parts of the brain. Characteristic manifestations of this disease, along with motor symptoms, are the gastrointestinal tract disorders, accompanied by a change in the cellular composition of the intestinal biocenosis. This made it possible to propose the so-called "intestinal" theory of the PD origin. According to this theory, degenerative changes begin in the nervous apparatus of the large intestine, and then spread to the brain. Changes in the intestinal microbiota composition can contribute to the development of the neurodegenerative process through neural, immune, endocrine mechanisms, as well as through biologically active substances.

97-102 102

The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Issues of diagnostics and therapy of patients with CI and their high mortality during the period of coronavirus infection are discussed. A wide prevalence of patients with mild CI (MCI), an important role of neuropsychological research in establishing CI, and frequent diagnosis of CI only at the stage of dementia were noted. In our country, CI is poorly diagnosed, the most common cause of CI in the elderly – Alzheimer's disease (AD) – is rarely established, patients are observed for a long time with a diagnosis of cerebrovascular disease (CVD). Some non-drug and drug methods can reduce the manifestations of CI, improve the quality of life of both the patients themselves and those around them. In severe CI, socio-psychological methods, stimulating patients to feasible household and social, physical and mental activity, and avoiding prolonged hospitalization are of primary importance. In addition to lifestyle changes, much attention in CI is given to the prevention of stroke, the treatment of arterial hypertension and diabetes mellitus. At the stage of dementia, cholinomimetic drugs (acetylcholinesterase inhibitors, donepezil, rivastigmine, galantamine) and the glutamate receptor blocker memantine are used. The use of choline alfoscerate in CI and the results of the multicenter, placebo-controlled ASCOMALVA study are discussed, in which, in patients with AD and CVD, the addition of choline alfoscerate to donepezil reduced the severity of CI, manifestations of depression, anxiety, and apathy. A new oral form of choline alfoscerate (Cerpechol) is reported that may improve patient compliance and be used in patients with swallowing disorders.

103-109 62

Meniere's disease (MD) is a chronic disease characterized by spontaneous recurrent attacks of vestibular vertigo, hearing loss, tinnitus, ear congestion, and other symptoms. Patients with acutely developed vestibular vertigo in most cases seek medical help from a neurologist. MD is characterized by the presence of endolymphatic hydrops, but there is no clear correlation between the severity of hydrops and the severity of clinical manifestations. The clinical presentation of MD is variable, with some patients having progressive auditory symptoms with occasional vertigo attacks, while others may have frequent vertigo attacks with minimal auditory symptoms. Diagnosis is based on a comprehensive assessment of the clinical picture, otoneurological examination, audiometry data, electrocochleography, vestibular evoked myogenic potentials; in complex cases, MRI of the inner ear with contrast enhancement is performed (currently, this method is not widely used in clinical practice) and MRI of the head to exclude intracranial pathology. Treatment of patients is aimed at relieving acute attacks of dizziness, informing the patient about the disease, prescribing a low-salt diet, betahistine or Arlevert administration to prevent attacks; in rare cases of ineffectiveness of conservative therapy, intratympanic administration of gentamicin or surgical methods of treatment are possible. The use of Arlevert in MD is discussed.


110-118 65

Modern fundamental and clinical studies show that chondroprotector molecules (chondroitin sulfate – CS; glucosamine sulfate – GS) can be useful in the treatment of neuroinflammation and so-called "inflammageing" – chronic, low-grade systemic inflammation that stimulates the development of neurodegeneration, atherosclerosis, ischemia, osteoarthritis and other pathologies. The role of CS and GS in the central nervous system are evident in the context of the concepts of the tetrapartite synapse and perineuronal nets (PNNs). Molecular mechanisms of action of CS and GS on neuroinflammation include: 1) interaction with the CD44 receptor, leading to inhibition of the pro-inflammatory factor NFκB, antiatherosclerotic and anticoagulant effects; 2) direct contribution to the formation of the PNNs, which support the division and differentiation of neurons; 3) inhibition of Toll-like receptors; 4) antioxidant and neuroprotective properties through activation of the PKC/PI3K/Akt signaling pathway; 5) inhibition of matrix metalloproteinases. These molecular effects determine the neuroprotective properties of CS/GS in ischemia, neurodegeneration, and pain syndromes associated with neuroinflammation.


119-122 57

Comments were provided on the article on the management of patients with neuromyelitis optica spectrum diseases (NMOSD), published in the journal "Neurology, Neuropsychiatry, Psychosomatics" No. 6 for 2022. The main comments relate to the management of patients with NMOSD who do not have antibodies to aquaporin-4 (AQP4-Ab), and methods for detecting these antibodies.


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