Neurology, Neuropsychiatry, Psychosomatics

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Vol 3, No 2 (2011)


4-8 659
Arterial rigidity (AR) is an independent cardiovascular risk factor. The strategy for primary and secondary prevention of cerebrovascular diseases involves correction of risk factors, modification of lifestyle, and the use of antihypertensive and antithrombotic agents and statins. AR whose correction is associated with a better cardiovascular prognosis is considered to be a particular therapeutic target. Positive changes in blood supply to tissues in increased AR may be also achieved with the use of drugs improving blood rheological properties.
8-16 1215
Cognitive disorders (CDs) are diagnosed in most patients within the first months after stroke. Moreover, the prevalence of poststroke dementia, the most severe type of CDs, is 7-40% in relation to patient age and prior stroke severity. The major risk factors of poststroke CDs are elderly age, recurrent stroke, low education level, pronounced leukoareosis, and/or hippocampal atrophy, as evidenced by magnetic resonance imaging (MRI), and left-hemisphere stroke. Prestroke CDs is an important predictor of poststroke dementia that is commonly detected retrospectively during the directed interview of relatives. This fact suggests that stroke is not the only cause of CDs, but frequently decompensates or engages a physician's attention to already existing CDs. Three clinical and pathogenetic types of poststroke CDs may be identified. These include sequels of strategic infarction crucial for cognitive functions; poststroke vascular CSs associated with reinfarctions and/or leukoareosis; and mixed (vascular and degenerative) CDs caused by a decompensated latent degenerative process. Approaches to managing poststroke CDs are the same as those in CDs as a whole. The study of the preventive effect of neuroprotective agents against the development of poststroke CDs and dementia in the rehabilitative period of stroke is promising.
17-24 540
Based on the data available in the literature and the results of his studies, the author analyzes one of the most important parts of the problem in the efficiency of treatment for schizophrenia, namely the quality of therapeutic collaboration (compliance) of patients and a physician. The paper gives data on the spread of low-quality therapeutic collaboration and discusses its reasons and impact on the efficiency of the therapeutic process. The efficiency of current psychopharmacotherapeutic methods aimed at optimizing the therapeutic collaboration is evaluated.
25-33 1317
Autonomic neuropathy (AN) is a disabling and life-threatening complication of diabetes mellitus and a number of other diseases. The timely diagnosis of this condition and early initiation of its therapy make it possible to prolong life and to improve its quality. The quantitative autonomic testing procedure permits one not only to diagnose AN and to detect the degree of autonomic nerve fiber lesion, but also to trace a trend in autonomic disorders during treatment, i.e. to evaluate the efficiency of therapy for cardiovascular AN.
34-41 782
Musculoskeletal pain associated with nonspecific changes in the vertebral structures and paravertebral muscles is the most common type of back pain. There is an association between back pain and education level, low physical activity, smoking intensity, and the frequency of bending and weight lifting during work; hereditary predisposition is also important. On examining a patient, it is important to rule out pain caused by a serious problem: severe somatic diseases, vertebral damages of specific etiology (injuries, neoplasms, infectious and inflammatory processes), compression damages, and psychogenic diseases. Adjacent joint diseases frequently imitate verterogenic pain. In back pain, there are most commonly three major clinical syndromes: vertebral, myogenic, and radicular. Neurological and orthopedic examinations are one of the most informative diagnostic techniques for musculoskeletal pain. Most patients with musculoskeletal pain do not need neuroimaging. Psychological factors are of great importance in the chronization of pain. Among non-drug treatments, early patient activation, walking, and swimming play a vital part; a fixing belt may be used in the acute phase. Adequate manual therapy is highly effective. Medical therapy includes nonsteroidal anti-inflammatory drugs in combination with myorelaxants, as well as therapeutic blocks. Psychotherapeutic procedures, therapeutic exercises, and antidepressants are used to treat chronic pain.


42-46 749
Clinical and psychological features were studied in patients with central pain syndrome (CPS) in multiple sclerosis (MS). There was a variety of the clinical manifestations of CPS. An association of pain with the form, degree, and type of the disease was evaluated. The patients with CPS in MS were found to have psychological features (the high level of catastrophization, somatization, and psychoticism) and to use nonadaptive pain elimination strategies that can make a significant contribution to the development of CPS. The given data allow one to consider CPS in MS in the biopsychosocial model.
46-49 569

Objective: to study the frequency of thrombohemorrhagic events and the specific features of hemostatic parameters in neonatal infants whose mother have received antiepileptic agents (AEA) during pregnancy.

Subjects and methods. One hundred and eighty-seven newborn infants were followed up. There was an absolute preponderance of valproic acid and carbamazepine among the drugs taken by the pregnant women. Hemostatic parameters were examined in the umbilical cord blood of 16 fullterm neonates. A control group consisted of 11 full-term neonatal infants of non-epileptic mothers who had received no AEA during pregnancy.
The clinical follow-up showed no thrombohemorrhagic events in all 187 cases. A hemostatic study revealed a proportional reduction in the levels of procoagulants and physiological anticoagulants and an increase in the content of von Willebrand factor in Groups 1 and 2 (a control group). Overall, the hemostatic parameters in Groups 1 and 2 of the newborns did not significantly differ from those in healthy full-term neonates.

50-56 734

Objective: to evaluate the efficacy, tolerability, and safety of citalopram (pram, «Lannacher Heilmittel, Austria) used to treat depressive disorders in adult patients with symptomatic or cryptogenic (presumptively symptomatic) focal epilepsy.

Subjects and methods. One hundred and twenty-one patients with symptomatic or cryptogenic (presumptively symptomatic) focal epilepsy were examined; 24 patients were found to have varying symptoms of depression. The Hospital Anxiety and Depression Scale (HADS) was used as a screening test for the symptoms of depression and anxiety. Citalopram was given orally for the treatment of depressive disorder. The Hamilton Depression Rating Scale (HDRS) was used to evaluate the efficiency of the performed therapy and to estimate the time course of changes in parameters. Quality of life was estimated by the special QOLIE-31 questionnaire. The duration of the follow-up was 12 weeks.

Results. The study enrolled 24 patients (14 women and 10 men). Their mean age was 47.5±7.6 years; the duration of epilepsy was 9.71±3.15 years. The first visit showed a pronounced preponderance of the symptoms of anxiety according to the HADS: the mean scores for anxiety and depression were 13.38±2.15 and 11.19±3.28, respectively. After citalopram therapy, the mean scores for anxiety and depression decreased to 6.19±2.60 and 7.58±1.86, respectively. During the first visit, the mean Hamilton depression score was 21.73±3.19 and that was 14.60±2.19 and 11.18±2.33 after 30 days and 12 weeks of citaloprom therapy, respectively. Analysis of the time course of changes in quality of life indicators during citalopram therapy, by applying the QOLIE-31 scale, revealed a significant increase in their total scores 2 and 3 months following the treatment with unchanged antiepileptic therapy. There was an inverse correlation between the total QOLIE-31 score for quality of life and the degree of depression rated by HDRS (r=-0.94, p<0.05) prior to and 12 weeks after citalopram therapy ((r=-0.92, p<0.05). No increases in the number of episodes were found in any of the patients.

Conclusions. By using the selective serotonin reuptake inhibitor citalopram, the patients with focal epilepsy showed a regression in the symptoms of depression and anxiety and an improvement in the quality of life. At the same time none patient was found to have any increases in the number of attacks. The side effects of the therapy were few and short-time and required no drug discontinuation.

56-60 576
Depressive disorders were detected in 48 (63.2%) of 76 patients (70 women and 6 men) with essential hypertension complicated by diastolic heart failure. The quality of life and the degree of chronic heart failure and depressive disorders were estimated at the inclusion of the patients into the study and then 3 months after therapy with the antidepressant pyrazidole. Moderate depressive disorders reduced exercise tolerance. The degree of depressive disorders was found to be directly related to worse quality of life. During combination psychotropic and basic treatment, there were improvements in the characteristics of physical and mental status and in quality of life in the patients.
60-65 527
The paper considers the issues of psychotherapy (PT) in patients showing a response to severe stress and adaptive disorders. The patients treated at the N.V. Sklifosovsky Research Institute of Emergency Care for burn injury and concomitant injury resulting from emergencies and road traffic accidents were examined. Psychopathological disorders were comparatively analyzed in the groups of patients depending on the genesis of psychological trauma. The authors consider the specific features of the clinical picture and propose a PT algorithm for these patients.



73-80 651
The possibility of regenerating interest in medical psychosomatics is associated with the revision of its goals and objectives. The major types of psychosomatic ratios, which determine how a mental disorder and a somatic disease affect each other (provoke an exacerbation, aggravate their course, and predetermine the development of a clinical type), are formulated. The paper shows that there may be psychic symptoms within somatic diseases and the latter within mental disorders. It gives clinical examples and recommendations to optimize psychosomatic care.


81-85 739
The paper gives the data of studies of the efficacy of choline alphoscerate in neurological care. It analyzes the possibilities of using cereton (choline alphoscerate) made in Russia to treat cerebrovascular diseases and cognitive disorders of different genesis.
85-88 934
Depression remains a serious problem despite the continuous stream of researches on the problems of affective disorders and the emergence of new antidepressants. About 80% of inpatients with depression and 70% of outpatients with this condition complain of sleep disorders. There are presently a few available hypotheses of the onset of depressive disorders. Prominent among them are neurotransmitter dysfunction hypotheses and chronobiological concepts (the presence of altered circadian rhythms mediated by melatonin). There is currently a wide range of drugs that are able to affect melatonin metabolism, amongst which there is agomelatine and fluvoxamine.


89-93 580
Nonsteroidal anti-inflammatory drugs (NSAIDs), the long-term administration of which is associated with a risk for complications, gastrointestinal tract (GIT) ones in particular, are extensively used to treat chronic pain in the back and limbs. The paper reviews the data available in the literature on adverse reactions occurring with the use of NSAIDs, discusses the issues of pharmacoeconomics in the administration of various NSAIDs. The use of the selective cyclooxygenase-2 inhibitor meloxicam (Movalis) is noted to cause fewer GIT adverse reactions than that of standard NSAIDs, the cost of treatment for GIT complications reduces.
94-99 556
Primary osteoporosis (OP) can be successfully diagnosed with the complex use of clinical, laboratory, and X-ray studies. In terms of the population characteristics of the sizes and shapes of vertebral bodies, X-ray morphometry of the vertebral column occupies a special place in a set of radiodiagnostic methods. X-ray morphometry is required to diagnose the most pronounced deformative osteoporotic changes in the spine and to determine the time course of changes in vertebral bodies. The use of X-ray morphometric study to examine other parts of the skeleton, including the proximal femur, has become an important stage in its development for the diagnosis of OP. That of X-ray morphometry for the concurrence of osteopenia and OP with other dystrophic changes in the vertebral column primarily with chondrosis and osteochondrosis is of value. The accumulated diagnostic experience allows X-ray morphometry to be considered to be an effective current diagnostic study of the spine.


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