Vestibular pathology of various origins, in addition to dizziness and imbalance, can lead to metavestibular disorders, which manifest themselves as spatial disorientation and navigation disorders and often remain unrecognised, but can hinder the recovery of such patients and reduce their quality of life.

Vestibular rehabilitation is currently undergoing active development. It has been well studied and has proven effective in peripheral vestibulopathy. However, in cases of central vestibular dysfunction and metavestibular disorders, its results are not yet clear-cut and require further research.

It is known that the vestibular system is involved not only in maintaining balance, but also in cognitive functions, primarily in the implementation of visual-spatial functions. In this regard, patients with vestibular disorders may experience problems with concentration when solving various cognitive tasks, and conversely, the presence of cognitive impairments may exacerbate existing vestibular dysfunction. Vestibular rehabilitation promotes vestibular compensation through neuroplasticity, which improves statokinetic control and spatial orientation. This process consists of three components: recovery, habituation, and adaptation. In addition to physical exercises, it is advisable to include cognitive training in the vestibular rehabilitation programme, as this combination has a more pronounced positive effect on recovery. To increase the effectiveness of vestibular rehabilitation, it is reasonable to add betahistine dihydrochloride, which has been shown to be effective in numerous placebo-controlled studies, to the complex therapy as a drug capable of accelerating vestibular compensation.

In addition to using standard scales and questionnaires, it is currently proposed to objectify the effect of vestibular rehabilitation based on the study of saccadic response patterns and the assessment of grey matter volume in specific areas of the brain, measured using structural neuroimaging.

Further study of the mechanisms linking vestibular disorders with cognitive function will contribute to improving the effectiveness of rehabilitation for patients with various vestibular pathologies.

Myasthenia gravis (MG) is one of the most common autoimmune diseases of the nervous system. Medical and social analysis of the patient population structure and assessment of their quality of life (QoL) as one of the criteria for the effectiveness of treatment are of great importance for evaluating the condition of patients and the directions of development of specialised care.

Objective: to analyse the quality of life of patients diagnosed with MG.

Material and methods. The study involved 662 patients with MG from 26 regions of Russia. A specially designed medical and social questionnaire and the SF-36 questionnaire were used.

Results. In Russia, women and middle-aged and elderly people predominate among MG patients. MG is characterised by a relatively favourable course (less than half of patients have any form of disability). Almost two-thirds of patients have other chronic diseases. About 90% of MG patients receive drug therapy, but almost half of patients have problems obtaining their prescribed medication. In addition to a significant decrease in physical activity, there is also a decrease in the mental state of patients associated with various physical disorders, as well as fear of the future (fear of symptom recurrence, risk of being left without support and unable to perform daily tasks, the need for lifelong treatment). Among the symptoms of MG that affect the emotional state of patients, weakness and rapid fatigue are in first place, followed by bulbar dysfunction. The role functioning of patients with MG depends to a greater extent on their physical condition and to a lesser extent on their emotional state. Those receiving regular drug therapy had significantly better indicators than those who were not treated. The SF-36 scale assessment confirmed that physical condition and physical functioning, which influence the psychological components of QoL assessment, are crucial for QoL in MG.

Conclusion. A significant decrease in QoL indicators was noted in MG, primarily in the physical component and, secondarily, in psychological health. All this points to the need for early initiation of highly effective pathogenetic therapy, in particular with modern C5-complement inhibitors.

Objective: to investigate changes in quantitative susceptibility mapping (QSM) of magnetic resonance imaging (MRI) of the brain in patients with Alzheimer's disease (AD) and to compare the results with those of a morphometric study and the state of cognitive functions.

Material and methods. The study included 11 patients with AD (five women and six men; mean age 75.3±9.4 years; MoCA score 11.2±3.9) and 12 volunteers without cognitive impairment (eight women and four men; mean age 72.7±8.9 years; MoCA score 26.7±0.9). QSM MRI was performed on a Signa PET/MR 3.0 T tomograph using a 32-channel coil. In both hemispheres, the regions studied included the amygdala, caudate nucleus, putamen, hippocampus, globus pallidus, thalamus, frontal, temporal, parietal and occipital lobes, and posterior cingulate gyrus. For each region, volume (voxels), QSM (ppm), and QSM/volume ratio were calculated.

Results. In patients with AD, QSM and QSM/volume values were higher and volume was lower than in the control group in most areas. The left temporal lobe cortex (volume, QSM and QSM/volume – SE ≥93.7, SP ≥90.4, AUC ≥0.921; p<0.0001), the hippocampus (volume and QSM/volume – SE ≥91.9, SP ≥89.1, AUC ≥0.939; p<0.0001) and the amygdala (volume – SE ≥88.4, SP ≥91.6, AUC ≥0.902; p<0.0001) of both hemispheres had the highest sensitivity and specificity. In the hippocampi and amygdalae, the QSM/volume ratio had greater sensitivity and specificity than QSM (ΔAUC ≥0.277±0.105, z≥2.636; p≤0.0084). There was a correlation between the total MoCA score and the volume of the amygdala, hippocampus, and temporal lobe cortex of the left hemisphere (r≥0.429; p≤0.0026). In addition, there was a relationship between the total MoCA score and QSM in the caudate nuclei and putamen of both hemispheres, in the left temporal lobe (r≥-0.429; p≤0.019) and QSM/volume in the caudate nuclei and hippocampi of both hemispheres, in the putamen and temporal lobe of the left hemisphere (r≥-0.415; p≤0.014).

Conclusion. This study demonstrated a correlation between QSM, the QSM/volume ratio, morphometric parameters, and the total MoCA score in AD. The QSM/volume ratio has greater sensitivity and specificity than QSM in distinguishing between the AD group and the control group.

Objective: to study the role of the human gut microbiome in the mechanisms of multiple sclerosis (MS) development and in the formation of response to immunomodulatory therapy.

Material and methods. The study included 100 people – 80 patients with MS, 65 of whom had relapsing-remitting MS (RRMS) and 15 had primary-progressive MS (PPMS), all before being prescribed glucocorticoid therapy, as well as 20 healthy people of the same age. The gut microbiome was studied using 16S rRNA gene analysis. The influence of gender, duration and severity of MS, therapy received, the presence of a risk factor for MS exacerbation (smoking), and the presence of a predisposing factor in the genotype (DR2(15) haplotype) were assessed.

Results. For MS, regardless of gender, disease duration, type of course, treatment received, and other clinical and demographic characteristics, there is generally an increase in the content of rare forms of bacteria of the Verrucomicrobia type and related classes, orders, and families, as well as a decrease in the level of butyrate-producing bacteria of the genus Roseburia, which has an anti-inflammatory effect. The microbiome of male MS patients is more enriched with microorganisms, as in women in the control group, which can be regarded as one of the compensatory anti-inflammatory mechanisms that reduce the spread of MS in men. In cases of short-term MS, the gut microbiome was dominated by bacteria of the classes Erysipelotrichia, Verrucomicrobiae and Deltaproteobacteria, with the latter two being characteristic of all types of MS, indicating their role in the formation of a predisposition to MS; As the duration of MS increased, the content of bacteria of the genus Phascolarctobacterium increased, while the decrease in the level of bacteria of the genus Roseburia and OTU_825 (Roseburia_intestinalis), typical for MS, did not depend on the duration of MS. As the severity of MS increased on the EDSS scale, a predominance of rare forms of the class Verrucomicrobiae, family Verrucomicrobiaceae, was noted. In severe patients with EDSS ≥4.5 points, a predominance of bacteria of the class unc_Bacteroidetes was noted. In PPMS, as a more unfavourable type of MS course, the levels of bacteria of the Desulfovibrionaceae fam- ily, Akkermansia genus and OTU_30 (Akkermansia_muciniphila) were significantly increased (both compared to PPMS and compared to the control), and the level of OTU_825 (Roseburia_intestinalis) are significantly increased (compared to both PPMS and the control group), while the level of OTU_825 (Roseburia_intestinalis) is even lower than in typical relapsing MS, indicating a more unfavourable course of MS with a predominance of the neurodegenerative process.

During exacerbation of PPMS, a statistically significant increase in the presence of Proteobacteria and other classes, families and genera of bacteria associated with inflammation, indicating the involvement of the microbiome not only in the formation of predisposition, but also in a short-term increase in the activity of autoimmune inflammation, leading to an exacerbation of the pathological process in brain tissue.

Many differences between the gut microbiome of MS patients and that of the control group were most significant in the group of smokers. An increase in the presence of Verrucomicrobiaceae bacteria in the gut microbiome in MS was most noticeable in carriers of the HLA-DRB1-2(15) genetic marker, which increases the risk of developing MS.

High-dose IFN therapy may alter the composition of the gut microbiome, possibly due to the growth of anti-inflammatory microbiome, partic- ularly Holdemanella and Megasphaera, as well as butyrate-producing bacteria OTU_33 (unc_Lachnospiraceae).

Conclusion. The gut microbiome plays an important role in shaping the course and response to treatment in MS.

A significant trend in modern medicine is heterogeneous cognitive impairment (CI). The extremely pressing issue of cerebro-metabolic health and CI, especially against the backdrop of type 2 diabetes mellitus (DM2), is currently the focus of neurology.

Objective: to evaluate CI, as well as the associated brain status and metabolic characteristics in patients with various manifestations of cerebrovascular disease (CVD) against the background of type 2 diabetes mellitus.

Material and methods. Patients with CVD (n=151) were divided into groups depending on the presence or absence of DM2. The first group (n=69; age – 63.0 [58.0; 69.0] years) consisted of patients with CVD combined with DM2. The second group consisted of 82 patients with isolated CVD (age – 62.5 [57.0; 68.0] years). Clinical and neurological examinations, neuropsychological testing, laboratory tests (including assessment of metabolic parameters and calculation of the triglyceride-glucose index – TyG index) and magnetic resonance imaging (MRI) of the brain were performed.

Results. The worst cognitive function (CF) assessment results were recorded in patients with CVS and DM2: Montreal Cognitive Assessment (MoCA) score – 25 [23; 26] points versus 27 [25; 28] points (p<0.001), on the Addenbrooke's Cognitive Examination Scale III (ACE-III)– 87 [80; 89] points versus 90 [84; 94] points (p=0.002). During MRI, more significant changes in the form of white matter hyperintensity (WMH) on the Fazekas scale and other neuroimaging patterns were also noted in patients with DM2: Fazekas III brain damage in 23.2% of patients, Fazekas II in 36.2%, Fazekas II–III – in 59.4% (in patients without DM2 – 7.3; 19.5; 26.8% of observations, respectively; p<0,001). In patients with WMH, the presence of DM2 is associated with a decrease in CF: MoCA – 24 [22; 26] points versus 27 [25; 28] points (p=0.013); ACE-III – 87 [80; 89] points versus 92 [84; 95] points (p=0.012). The severity of CI is correlated with the level of TyG index. Combined cerebro-metabolic status (WMH and TyG index ≥4.825) in patients with CVD was accompanied by more severe CI, with 79.2% of individuals having MoCA <26.

Conclusion. The combination of CVD and type 2 diabetes mellitus is characterised by an unfavourable cerebro-metabolic status in the form of significant damage to brain tissue and changes in carbohydrate/lipid metabolism parameters (glucose lipotoxicity) and is associated with more pronounced CI.

Predicting the outcome of ischaemic stroke (IS) is a complex task, as mortality and disability depend on many factors, including age, gender, type and severity of stroke, and comorbidities. Survival rates also vary between countries depending on genetic characteristics and differences in the organisation of healthcare systems.

Objective: to search for predictors of one-year survival after IS in a sample of patients from the Perm region.

Material and methods. The study included 254 patients who had suffered an IS. Seventy-five parameters obtained during routine clinical examination were analysed, including information on the subtype and severity of the stroke, the size and location of the lesion, neurological disorders, comorbidities, and other factors. Relevant features were selected using the WEKA programme, and the selected features were used in a predictive model based on logistic regression.

Results. The following factors have been identified as significant predictors of annual survival in patients who have undergone IS (the sign of the coefficient reflects the relative contribution of the factor to the model and its positive or negative effect): age (-0.02), degree of neurological deficit on the NIHSS scale at discharge (-0.06), haemoglobin level (0.01), infarction in the anterior choroidal artery basin (0.74), recurrent stroke within the following year (-0.02) and cardioembolic stroke subtype (-0.32). The accuracy of the logistic model was 84% with 10-fold cross-validation.

Conclusion. In the model predicting one-year survival after IS, other factors have been identified in addition to age, which is usually associated with a less favourable prognosis. Further multicentre studies are needed to confirm the reliability of the proposed model.

Objective: to establish associations between the level of sleep disturbances (SD) and cognitive decline (CD; patterns of memory, attention, and executive functions) in individuals aged 25–44 years.

Material and methods. In 2013–2016, a survey of a random representative sample of individuals aged 25–44 was conducted in one of the districts of Novosibirsk under the World Health Organisation's MOPSY (MONICA-psychosocial) programme. The level of SD and the state of cognitive functions (CF) were assessed in 713 people (325 men and 388 women; average age – 36.17±5.99 years) according to the criteria of the World Health Organisation's MOPSY (MONICA-psychosocial) programme. Standardised tests were used to assess CF.

Results. In a random representative sample of individuals aged 25–44, the prevalence of sleep disorders was higher among women than men (46.4% versus 40.1%, respectively). At the same time, the subjective assessment of sleep by respondents was as follows: 'satisfactory' – 35.6% and 35.5%, “poor” – 10.3% and 4.3%, 'very poor' – 0.5% and 0.3% in women and men, respectively (χ²=10.482; df=4; p<0.033). It was found that when sleep was poor, men were able to name only 7.5476±1.20973 words during direct word recall in the 10-word memorization test of A.R. Luria, with satisfactory sleep – 7.5948±1.17612 words, and with good and very good sleep, they named 7.9956±0.84677 and 7.9923±0.94697 words, respectively (χ²=10.114; df=5; p=0.039). It was found that with poor sleep, men were able to view only 251.64±82.822 letters of the proofreading test in 1 minute, with satisfactory sleep – 288.36±73.961 letters. The best results for this indicator were achieved by men without SD, who were able to view 303.91±70.292 letters in 1 minute in the case of good sleep and 319.7±61.577 letters in the case of very good sleep (χ²=19.012; df=5; p=0.001). Women with sleep disturbances were able to recall 8.63±1.125 words during delayed reproduction of 10 words after an interfering task, while those with satisfactory sleep recalled 8.38±1.347 words. The best results in this test were achieved by women without SD, who were able to recall 8.76±1.387 words after good sleep and 8.69±1.398 words after very good sleep (χ²=12.264; df=5; p=0.015).

Conclusion. A population study has established an association between sleep disturbances and cognitive decline (memory, attention and executive functions patterns) in individuals aged 25–44.

In older and senile age, the prevalence of night-time sleep disturbances increases significantly (up to 30–48%), which is associated with both physiological changes in sleep and medical and behavioural factors.

Objective: to identify clinical and social factors contributing to sleep disorders in older people and establish their relationship with internal organ diseases

Materials and methods. The study included 1,002 patients aged 60–90 who underwent a comprehensive geriatric examination, screening for sleep disorders (Pittsburgh Sleep Quality Index) and depression (Geriatric Depression Scale), as well as a neuropsychological examination. An analysis of clinical and social factors and an analysis of associations with somatic diseases were performed, and sleep disorder phenotypes were identified by data clustering (UMAP + K-means).

Results. A decrease in sleep efficiency with age (p<0.001) was identified, while sleep duration remained unchanged within the age range studied. Presomnic disturbances (prevalence – 9.6%) were associated with female gender, lower income, education and physical activity level, intrasomnic disturbances (prevalence – 12.3%) were associated with cardiovascular diseases, body mass index, having a partner, introversion, and taking walks. Common predictors for both falling asleep and staying asleep were pain syndrome, depression, and geriatric syndromes of asthenia and sarcopenia. Cluster analysis identified five phenotypes that differed not only in their sleep disturbance patterns but also in their clinical and social characteristics, subjective attitudes toward sleep, and ageing profiles with varying risks of developing geriatric syndromes.

Conclusion. Clear clinical and social correlates have been identified in elderly patients: presomnic disturbances are associated with female gender and socio-economic factors, while intrasomnic disturbances are predominantly associated with somatic pathology. Of particular importance is the identification of five discrete phenotypes of sleep disorders, each characterised by a unique combination of clinical parameters, ageing pro- file, and risk of geriatric syndromes.

Perceived stress is a complex of cognitive and emotional reactions that reflect both the level of distress caused by a stressor and the ability to cope with it. Recently, there has been growing interest in its connection with cognitive functions (CF).

Objective: to investigate the relationship between perceived stress and reduced CF, and to assess their impact on mortality in the population aged 55 and older.

Material and methods. This study was conducted as part of the epidemiological study ‘Stress, Aging, and Health.’ The study included 1,876 participants aged 55 years and older. A decrease in CF was recorded when assessed using the Mini-mental State Examination scale <25 points. High levels of perceived stress were defined as values corresponding to the fifth quintile on the Cohen scale for men and women (≥21 and ≥24 points, respectively). During the entire observation period (median – 13 years), 948 study participants died.

Results. Decreased CF was more common in men, individuals without higher education, and patients with a history of cardiovascular disease. The level of perceived stress was significantly higher in the group of individuals with cognitive impairment (19.9±5.8 vs 17.0±5.8 points; p=0.001). Multivariate analysis data showed a significant association between cognitive dysfunction and high stress (OR=2.33; 95% CI 1.75–3.11). Moreover, the simultaneous presence of reduced CF and high stress increased the risk of death by 1.74 times (95% CI 1.37–2.20) compared to those in whom these pathologies were not detected.

Conclusion. The associations between high levels of perceived stress and reduced CF, as well as their combined adverse effect on mortality in individuals aged 55 and older, indicate the need to develop a comprehensive approach that includes regular screening of cognitive functions and assessment of psycho-emotional status in this age group.

The pathogenesis of multiple sclerosis is multifaceted and not fully investigated, but it is now clear that each patient has their own ratio of inflammation and neurodegeneration severity. Given the available evidence base, understanding of the pathogenesis underlying secondary progression, and accumulated clinical experience, it is important not only to make a timely diagnosis and prescribe adequate therapy, but also to monitor for continued progression in order to revise treatment with the aim of preventing patient disability. This publication describes a clinical case of a patient with secondary progressive multiple sclerosis (SPMS) who received therapy with an anti- CD20 monoclonal antibody infusion. The patient showed complete suppression of activity and no exacerbations, but despite this, there was a gradual progression on the EDSS scale from 4.5 to 6.0 points over 3 years of therapy. In this regard, the patient was transferred to therapy with siponimod, against which a decrease to 5.5 points was noted within a few months. At the time of publication, this indicator has remained stable for 3 years, indicating that the main goal of therapy for SPMS – preventing secondary progression – has been achieved.

Therefore, when treating patients with SPMS and ongoing secondary progression, even with complete suppression of activity and no exacerbations, including against the background of infusion therapy with anti-CD20 monoclonal antibody drugs, it is necessary to consider switching to siponimod therapy.

Currently, more than 200 different symptoms and signs classified as "post-COVID syndrome" (PCS) have been described, including fatigue, shortness of breath, and muscle or joint pain. There are known cases of peripheral nervous system damage associated with COVID-19, such as Guillain–Barre syndrome, Parsonage–Turner syndrome, critical condition polyneuropathy, and others. The SARS-CoV-2 virus can damage not only the nervous system but also muscle tissue, as evidenced by reports of rhabdomyolysis and myositis in patients with COVID-19. Manifestations of peripheral nervous system and muscle pathology that arose during the acute phase of the disease may be observed for several months as part of PCS. However, if any symptoms persist for more than a year after COVID-19, alternative diagnostic options to PCS should be considered, since there is no information on the persistence of SARS-CoV-2 in the human body for more than 4 months or the chronic course of COVID-19. Various independent nosologies, including hereditary neuropathy and myasthenia, may be hidden under the 'mask' of the PCS diagnosis. COVID-19, as a severe acute infectious disease, may act as a trigger for the onset or progression of these diseases; coincidental comorbidity is also possible. A case report of patients with hereditary neuropathy and myasthenia, presenting under the “mask” of PCS, is presented. A thorough analysis of clinical, genealogical, and neurophysiological data, combined with the results of whole-genome sequencing, allowed for the diagnosis of distal hereditary motor neuropathy associated with a mutation in the GARS1 gene (7p14.3) (type V), with an autosomal domi- nant inheritance pattern (familial case), clinically manifesting as peripheral distal tetraparesis with mild gait impairment. Information collected in a timely manner in accordance with diagnostic criteria ensured successful surgical intervention for thymolipoma in patients with generalized myasthenia, seronegative, thymus-dependent, involving the oropharyngeal and axial muscles, without disruption of swallowing or breathing. Early detection of conditions masquerading as PCS allowed for adequate treatment, preventing progression and severe outcomes.

Optimising the management of patients with chronic neck pain (NP) is one of the pressing issues in modern medicine. We present a case study of a 38-year-old patient with chronic musculoskeletal NP and shoulder pain, increased anxiety, and severe limitation of movement in the cervical spine, which arose against a background of prolonged static loads, whiplash injury, and previous episodes of NP. The patient had suffered from NP for 5 years, with no effect from conservative treatment methods or surgical treatment (decompression surgery with stabilisation) at the cervical level. A comprehensive approach was used in the patient's treatment, combining educational discussions, kinesiotherapy, and optimal pharmacotherapy. Previously, the patient had not been prescribed therapeutic exercises, nor had he been given recommendations on ergonomics, lifestyle, and physical activity. Against the background of complex therapy, including the formation of correct ideas about the causes and factors supporting pain, lifestyle correction, training in the rules of ergonomics in combination with individual therapeutic exercises and pharmacotherapy with Dexalgin, a gradual decrease in pain and improvement in functional activity were observed. The use of Dexalgin made it possible to quickly reduce pain and increase adherence to therapeutic exercises. As a result of comprehensive treatment, after 3 months, pain intensity decreased from 6 to 2 points on a numerical rating scale, the Neck Disability Index decreased from 72 to 12%, and the severity of anxiety disorders on the Beck Anxiety Inventory decreased from 34 to 12 points. Issues related to the optimisation of management of patients with chronic musculoskeletal pain are discussed.

Diagnostic errors in examinination of patients with complaints of dizziness lead to ineffective treatment, chronicity of the process and a decrease in the quality of life of patients. A description of a patient with vestibular neuronitis which presents with typical symptoms such as acute systemic dizziness, nausea, vomiting, and imbalance with with preserved hearing is presented. The patient was misdiagnosed with chronic cerebrovascular disease and vestibuloatactic syndrome, without any otoneurological testing being performed. The importance of conducting an otoneurological examination in all patients with complaints of systemic dizziness is highlighted. The efficacy of complex treatment, including vestibular gymnastics with the use of an Arlewert, is demonstrated. The pathogenesis, manifestations, diagnosis, and treatment of vestibular neuronitis are discussed, as well as issues of optimizing care for patients with vestibular vertigo. The need to follow international clinical guidelines for examining patients with vertigo is emphasized to avoid inappropriate treatment decisions and improve long-term treatment outcomes.

Functional dizziness (FD) is defined as persistent postural perceptual dizziness and is the most common cause of chronic non-rotatory dizziness. In routine clinical practice, there are difficulties and errors in both the diagnosis and treatment of patients with FD. This article presents clinical observations of patients with FD and discusses manifestations, approaches to diagnosis and therapy in outpatient practice. Management of patients with FD should be based on effective communication between the physician and the patient using psychotherapy methods, the creation of an individual treatment strategy that includes vestibular exercises, rehabilitation, and the use of evidence-based pharmacotherapy, with justification of the pathogenetic mechanisms of the leading role of the serotonergic system in neurotransmitter imbalance. Based on the evidence presented in the scientific literature and clinical experience, it is considered appropriate to prescribe Vespireit® to all groups of patients with FD to reduce symptoms of dizziness and instability, restore a sense of balance, and reduce anxiety and vegetative symptoms.

Post-traumatic stress disorder (PTSD) is currently the focus of attention among specialists. Practitioners point to the need for thorough differ- ential diagnosis; to confirm the diagnosis, it is necessary not only to have a history of stressful exposure, but also to meet the necessary diagnostic criteria. Current real-world studies are focused on accumulating large databases of clinical cases for evaluation using machine learning and other innovative methods, as well as creating algorithms for personalized therapy. The article presents two clinical cases of PTSD associated with the death of loved ones. The first case describes the symptoms of re-experiencing associated with the loss of a spouse in a special military operation, identifies triggers that provoke the development of intrusions, and describes symptoms of psychophysiological arousal and avoidance of contact with traumatic stimuli. The process of joint decision-making with the patient on the choice of therapy in the presence of a history of negative experience with antidepressants is presented in detail. The second case is devoted to the development of PTSD due to the fact that the patient was a direct witness to the unexpected death of the important one. A detailed description of the symptoms of re-experiencing is provided, and a low level of social support, which is a significant risk factor for the development of PTSD, is highlighted. The fragmentary nature of mem ories of the traumatic event is demonstrated. Additionally, symptoms of psychophysiological arousal and avoidance are presented. In both cases, data on the dynamics of the condition during subsequent visits are provided. An algorithm for discussing the appropriate therapy with the patient is presented. In real clinical practice, the model of joint decision-making, when therapy is selected taking into account the patient's opinion, helps to significantly increase adherence to treatment.