Neurology, Neuropsychiatry, Psychosomatics

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Vol 4, No 4 (2012)


14-17 457
The article considers the epidemiological features of psychosomatic and depressive disorders in the European population for the last 10 years. It assesses risk factors for depressive disorders, such as age, gender, alcohol intemperance, smoking, marital status, intellectual or physical work, stressful situations, chronic somatic diseases, body mass index.
18-24 1018
Sleep disorders are closely associated with both nervous system diseases and mental disorders; however, such patients prefer to seek just neurological advice. Insomnia is the most common complaint in routine clinical practice. It is characterized by different impairments in sleep and daytime awakening. Obstructive sleep apnea syndrome is less common, but more clinically important because of its negative impact on the cardiovascular and nervous systems. The common neurological disorders are restless legs syndrome and REM sleep behavior disorder, as well as narcolepsy, the major manifestations of which are impaired nocturnal sleep and daytime awakening.
24-33 395
The paper describes the most important periods in the history of the design of antipsychotics. It analyses whether the current principles in the classification of neuroleptics are appropriate. There is evidence that different classifications are of importance for the individual choice of a therapy option for mental disorders.
34-38 1312
The paper shows that it is urgent to study stroke in young patients aged 15—45 years. In accordance with the TOAST classification, the author presents the major pathogenetic subtypes of ischemic stroke (IS): atherothromboembolic, cardioembolic, lacunar, that of other known and unknown etiology. The clinical picture and diagnostic principles of IS at young age are considered. Particular emphasis is laid on therapy for IS. It is pointed out that the leading therapy option in these patients is thrombolysis; intravenous recombinant tissue plasminogen activator is more frequently used; oral anticoagulants and antiplatelet agents are certain to prescribe.
39-44 491
The impact of -5T/C polymorphism in the GP1BA gene on the risk of ischemic stroke (IS) was studied in patients younger than 50 years of age. Ninety-two patients (73 men and 19 women; mean age 42.6+6.7years) with atherothrombotic, lacunar, and cryptogenic IS were examined on days 1—21 after its development. All the patients underwent brain magnetic resonance imaging or computed tomography, brachiocephalic artery duplex scanning, echocardiography, and laboratory studies (antiphospholipid antibodies, coagulogram and platelet aggregation, homocysteine, clinical and biochemical blood analyses, rheumatic tests, determination of -5T/C polymorphism in the GP1BA gene). An increased risk for IS was found in the young males versus the controls (healthy individuals; p = 0.03; OR 2.7; CI 1.14; 6.47). This association was not found in the women. Analysis of pathogenetic types ascertained that the lacunar IS men with CC and CT genotypes had a higher risk for stroke than the healthy individuals (p = 0.04, OR 3.5, CI 1.1; 10.9). In other subtypes of stroke, there was no association with this polymorphism. A group of patients with IS caused by thrombosis of the great arteries of the brain. In this group, the patients had CC and CT genotypes significantly more frequently than the controls (p = 0.003; OR 6.7; CI 2.0; 21.8), as well as C allele (p = 0.0008; OR 5.1; CI 1.97; 13.3). The -5T/C polymorphism in the GP1BA gene was associated with the development of IS in young males. The -5C allele and -5T/C and -5C/C genotypes are increased risk factors for lacunar and arterial thrombosis-induced IS in men.
44-47 420
To study a range of coordination disorders in Chiari malformation type 1 (CM1), a clinical examination and magnetic resonance imaging (MRI) were made in 73 patients (52 women and 21 men) aged 17 to 71 years with this disorder. Special tests were used to identify cerebellar and vestibular disorders. Vertigo was noted in 76.7% of the patients with CM1. The special tests revealed impaired coordination in the majority (93.1%) of the patients. Babinsky’s asynergy was the most common (52% of the patients) symptom of coordination disorders. The findings confirmed the high rate of coordination disorders in CM1 and the informative value of supplementary studies of cerebellar and vestibular functions along with routine evaluation of the neurological status.
48-53 411
Objective: to refine the pattern of clinical manifestations of epileptic autonomic auras (EAA) and to reveal clinical, electroencephalographic, and neuroimaging ratios. Patients and methods. Eighteen patients (8, 41% men and 10, 59% women) aged 9 to 27years (mean 18±5years) were examined. The examination encompassed analysis of history data, clinical and neurological studies, long-term video-assisted electroencephalographic monitoring, and magnetic resonance imaging (MRI) of the brain. Results. In most patients (n = 12, 67%), the symptoms of EAA corresponded to the criteria for abdominal one. In the other patients, the clinical manifestations resembled autonomic paroxysms as attacks of panic. Interictal pathological changes on an electroencephalogram (EEG) were present in the frontal, temporal, and frontotemporal regions in 4 (22%), 6 (33%), and 7 (39%) patients, respectively, as well as in both the left and right hemispheres without significant differences. Pathological EEG changes were not found in one case. MRI detected that 13 (72%) patients had structural changes that were potentially eliptogenic. Conclusion. The clinical symptoms of EAA give information on the site of a primary pathological focus. It is necessary to differentiate EAA from non-epileptic paroxysmal states. The autonomic phenomena of epileptic genesis help study the functional organizations of the autonomic nervous system.
53-58 392
Systemic (intravenous) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is a proved effective treatment modality in a certain group of patients with ischemic stroke (IS) in the first 4.5 hours after the onset of neurological symptoms. The main mechanism for improving functional outcomes in patients treated with intravenous thrombolysis is reperfusion of an ischemic brain portion. The results of intravenous thrombolytic therapy are shown in 60 IS patients (18 women and 42 men; mean age 61 years). Different mechanisms of reperfusion during systemic thrombolysis, which are not confined to thrombus- or embolus-occluded artery recanalization, but are a portrait of the systemic effect of the thrombolytic drug and include collateral blood flow activation, gradual recanalization, etc.
58-61 456
The paper presents the results of a study of risk factors for ischemic stroke (IS) in the rural versus urban population of the Stavropol Territory. The rural dwellers have been found to have a higher rate of alcohol abuse, atherogenic diet, unawareness of arterial hypertension and, accordingly, its treatment and atrial fibrillation. How to improve the prevention of IS in the rural area is discussed.
62-66 487
The paper based on the study 114 (61 men and 53 women) persons with schizophrenia and organic mental disorders who have committed socially dangerous acts and under compulsory treatment in psychiatric hospitals of general and specialized types were identified nozo-and gender-specific predictors of socially committed unsafe acts and features of transformation syndromes when performing repeated socially dangerous Dane. These features are additional criteria for the appointment and the abolition of forced treatment of this group of individuals and allow the development of differentiated treatment and rehabilitation, with the nosology and sex of the patient.
67-70 430
An abundance of drugs to prevent and treat vitamin B 1 deficiency-induced neurological diseases has been today registered on the Russian pharmaceutical market. The most used agents are vitamin B 1 preparations, the therapeutic efficiency of which has been proven in many trials. It is noted that it is urgent to develop and introduce into practice the lipophilic formulations of water-soluble vitamins, which will make vitamin therapy more effective.
71-76 808
The paper gives data available in the literature on the use of citicoline in an experimental model of ischemic stroke (IS) and in randomized multicenter placebo-controlled trials. It analyzes the results of the ICTUS trial in which 2298 patients with IS who received randomly citicoline or placebo for 24 hours after the onset of symptoms (I000 mg intravenously every I2 hours during the first 3 days, then orally as one 500-mg tablet every 12 hours during 6 weeks). The results of the trial confirmed the safety of citicoline used in IS, but failed to show its significant advantage over placebo in reducing the degree of disability (global improvement) 90 days later. However, to pool the results of the ICTUS trial with those of other randomized multicenter placebo-controlled studies demonstrates a significant decrease in the degree of disability in IS patients treated with citicoline.
76-83 491
When managing patients with locomotor pathology, serious attention is paid to symptomatic therapy aimed at eliminating the unpleasant manifestations of the disease. At the same time, rational analgesia is of the greatest importance. If acute pain should be arrested, parenteral or tableted formulations of fast-acting analgesics are used for days. Longer analgesic therapy especially for clinically relevant inflammation is based on the use of nonsteroidal anti-inflammatory drugs (NSAID) having analgesic and anti-inflammatory effectiveness and good tolerance. The level of analgesia may be increased, by combining NSAID with tramadol and paracetamol. When clinical muscular spasm is implicated in the pathogenesis of chronic pain, it is expedient to prescribe myorelaxants that have an analgesic potential and are able to potentiate the analgesic effect of NSAID.
84-88 754
The paper reviews the data available in the literature on the prevalence, pathogenesis, diagnosis, treatment, and prevention of poststroke depression. Depression develops in nearly one in every three patients, who have experienced stroke, and can negatively affect the rehabilitation process. The role of psychological factors, genetic predisposition, brain lesion location, monoamine deficiency in the pathogenesis of depression is considered. Poststroke depression is frequently diagnosed although it is detected using simple studies (Beck depression inventory, Hamilton rating scale). Psychotherapy is effective in preventing poststroke depression; the efficacy of antidepressants is actively being investigated. When depression develops, there is a positive result of treatment with antidepressants; a combination of psychotherapy and antidepressants produces even a more pronounced effect. The long-term (6-month or more) use of tricyclic antidepressants and selective serotonin reuptake inhibitors is noted to have a positive effect; there are data on the high efficacy and good tolerability of escitalopram in poststroke depression. It is stressed that the prevention and treatment of depression may substantially improve the rehabilitation process and quality of life.
88-91 517
The paper discusses therapy for chronic cerebral circulatory disorders (CCD), which encompasses the use of antihypertensive medications, antiaggregants (for brain great artery atherosclerosis, arterial hypertension), indirect anticoagulants (for atrial fibrillation), statins. It details the results of clinical trials showing the efficacy of cavinton in treating chronic CCD. Based on the data available in the literature and their experience, the authors substantiate the expediency of using cavinton in chronic CCD.

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)