Neurology, Neuropsychiatry, Psychosomatics

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Vol 13, No 5 (2021)
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4-13 396

The article evaluates recent perspectives about the role of oral anticoagulants in the secondary prevention of cardioembolic stroke. The timing of prescribing drugs for ischemic stroke and transient ischemic attack is discussed in accordance with current clinical guidelines and the results of clinical trials. The issues of prescribing oral anticoagulants in some problematic situations, such as the elderly and senile age, reperfusion therapy, presence of hemorrhagic transformation, combined atherosclerosis of major head and neck arteries, cerebral microangiopathy, history of intracerebral hemorrhage, cryptogenic stroke, and low patient compliance are considered. Finally, an anticoagulant therapy algorithm in the acute period of cardioembolic stroke is presented.

14-19 350

The review shows modern concepts on the role of antiplatelet therapy in the secondary prevention of cardiovascular diseases in patients after non-cardioembolic ischemic stroke or transient ischemic attack (TIA). We present an analytical characteristic of all antiplatelet agents that have been studied in randomized controlled trials worldwide. We demonstrate the advantages and disadvantages of each agent in monotherapy and in combination. New ideas about the rationality of the use of combined antiplatelet therapy with clopidogrel and acetylsalicylic acid in the first 24 hours and no more than 90 days in patients with minor ischemic stroke or TIA are discussed. The efficacy and safety of new antiplatelet agents are analyzed. The basic principles of choosing antiplatelet agents in patients after ischemic noncardioembolic stroke/TIA are outlined.


20-25 260

During the pandemic of the new coronavirus infection, there is increasing evidence of neurological complications associated with COVID-19. There is no doubt that stroke can be a major complication in patients with severe disease course.

Objective: to determine the safest and most effective anticoagulant for stroke prevention in patients with severe COVID-19.

Patients and methods. A prospective study enrolled 520 patients with severe COVID-19. We used the following criteria for severe COVID-19: SpO2 <92% on room air at sea level, PaO2 /FiO2 <300 mm Hg, respiratory rate >30 breaths/min, lung infiltrates >50% on computed tomography. The study included 509 patients, divided into three groups depending on the type of anticoagulant therapy: patients of the 1st group received 24–36 thousand IU of heparin, patients of the 2nd group – enoxaparin at a dose of 1 mg/kg per day, patients of the 3rd group – rivaroxaban at a dose of 20 mg/day. The duration of anticoagulant administration depended on the severity of the patient's condition, dynamics of laboratory parameters (D-dimer, fibrinogen, international normalized ratio, activated partial thromboplastin time, platelet count), and varied from 2 to 6 weeks. In addition, we studied the incidence of ischemic and hemorrhagic strokes and transient ischemic attacks during a 6-week follow-up period. The article also presents a clinical case of large artery thrombosis in a young patient with severe COVID-19 without stroke risk factors.

Results and discussion. Even against the background of active primary prevention, stroke incidence was 2.6% (0.6% for ischemic stroke, 1.4% for venous stroke, and 0.6% for hemorrhagic stroke). The highest stroke incidence was observed in the group of patients receiving heparin. In contrast, the prevention of thrombotic complications in patients receiving low-molecular-weight anticoagulants or rivaroxaban showed the best results with minimal morbidity and mortality in severe COVID-19.

Conclusion. Stroke can be a complication of COVID-19, and preventive anticoagulant therapy using low-molecular-weight heparin or a factor X inhibitor effectively prevents this complication.

26-33 162

Objective: to establish associations of awareness and attitude towards cardiovascular diseases (CVDs) prevention in people with sleep disorders in an open population of Novosibirsk aged 25–64 years.

Patients and methods. We carried out screening surveys of representative samples of the 25–64 years old population: in 2013–2016 – V screening (427 men, mean age– 34±0.4 years, response rate – 71%; 548 women, mean age– 35±0.4 years, response rate – 72%); in 2015–2018 – VI screening (275 men, mean age – 49±0.4 years, response rate – 72%; 390 women, mean age – 45±0.4 years, response rate – 75%) using the protocol of the WHO international program «MONICA-psychosocial». Jenkins sleep evaluation questionnaire was used to evaluate sleep disorders in the study population.

Results and discussion. Participants with sleep disorders believed that they were «not entirely healthy» (men – 65.5%, χ2 =57.825, df=8, p<0.001 and women – 69.6%, χ2 =96.883, df=4, p<0.001); had health related complaints (men – 78.2%, χ2 =24.179, df=2, p<0.001 and women – 85.2%, χ2 =55.144, df=2, p<0.001), and clearly did not care enough about their health (men – 32.7%, χ2 =29.31, df=4, p<0.001 and women – 34.1%, χ2 =28.116, df=4, p<0.001). Men with sleep disorders more often assumed that they were more likely to get a serious illness within the next 5–10 years (χ2 =12.976, df=4, p<0.01). Participants with sleep disorders were confident that modern medicine can prevent (men – 10.9%, χ2 =19.079, df=2, p<0.001 and women – 13.3%, χ2 =21.944, df=2, p<0.01) and successfully treat (men – 3.6%, χ2 =24.142, df=8, p<0.01 and women – 3.7%, χ2 =15.538, df=8, p<0.05) only some heart diseases. Men and women with sleep disorders are more likely to seek medical attention in case of severe pain or discomfort in the heart area, but do not seek medical advice if this pain or unpleasant sensation is mild (men – 63.6%, χ2 =14.867, df=6, p<0.05 and women – 60%, χ2 =17.872, df=6, p<0.01). Among the participants with sleep disorders men more often believe that the doctor «knows more than me» (36.4%), and women (48.1%) chose an answer: «I will not necessarily agree with the opinion of the doctor after a general examination, until a thorough evaluation has been carried out by specialists» (χ2 =5.917, df=2, p<0.05). Women with sleep disorders were more likely to continue to work if they did not feel very well (54.1%, χ2 =12.455, df=4, p<0.05) or their body temperature rose (37.8%, χ2 =12.937, df=4, p<0.05).

Conclusion. People with sleep disorders generally have a more negative attitude towards their health and are skeptical about the possibilities of modern medicine to prevent and treat CVDs, which is reflected in their attitude to work and preventive check-ups.

34-39 248

The majority of patients with alcohol dependence syndrome suffer from sleep disorders, particularly insomnia, associated with a number of critical clinical aspects, increased suicide risk, anxiety and depression. The authors of relevant publications indicate associations between polymorphic melatonin genes and melatonin metabolism and symptoms of sleep disorders. However, the literature review failed to reveal any studies on the role of genetic polymorphism of circadian rhythm regulators in sleep disorders in patients with alcohol dependence.

Objective: to determine the associations of polymorphic variants of genes HTR2A, MTNR1A, MTNR1B, CLOCK, DRD2 with sleep disorders risk in alcohol dependence syndrome.

Patients and methods. 307 patients with alcohol dependence syndrome were screened, including 61 women (21%) and 246 (79%) men (mean age – 41.92±7.9 years). The presence and severity of sleep disorders were assessed by the Insomnia Severity Index. In addition, 10 ml of venous blood sample was obtained from all participants. Genotyping of single nucleotide variants of HTR2A (rs6313), MTNR1A (rs34532313), MTNR1B (rs10830963), CLOCK (rs1801260), DRD2 (rs1800497) genes was performed using real-time polymerase chain reaction. Statistical analysis of the data was conducted using parametric and nonparametric methods.

Results and discussion. The carriage of the *G allele of the polymorphic variant of the MTNR1B (rs10830963) gene, and its genotypes are associated with a greater risk of insomnia than the carriage of *С/*С genotype. The carriage of the *С allele of the polymorphic variant of the CLOCK (rs1801260) gene, as well as the *С/*Т genotype, are associated with the presence of sleep disorders. No associations between polymorphic variants of the HTR2A (rs6313), DRD2 (rs1800497) genes and insomnia risk were detected in patients with alcohol dependence syndrome.

Conclusion. The found associations reveal prospects for future research on melatonin's role in the pathophysiology of sleep disorders in patients with alcohol dependence and pathogenetic therapy for insomnia.

40-47 231

Objective: to analyze clinical and follow-up indicators in patients with mental disorders and COVID-19 and to identify on their basis predictors of poor outcomes associated with mental state.

Patients and methods. We conducted a prospective study in a multidisciplinary hospital. The severity of coronavirus infection was determined according to the temporary guidelines. Data collection was carried out using a patient chart consisting of 109 variables. Predictors of poor outcomes were determined using predictive models (logit regression, Cox model). The study included 97 patients: 41 men (42.3%) and 56 (57.7%) women, mean age – 62.3±15.3 years. 26 patients died; 71 patients recovered.

Results and discussion. The death occurred on 11.5 day. The mental state of these patients was severe, with a predominance of delirium cases. With increasing age, the probability of non-lethal outcome decreases [hazard ratio (HR) 1.03; 95% confidence interval (CI) 1.00–1.06; p=0.037]. The risk of death increased by 1.03 (p=0.037) for each year of life. An improvement in the mental state of patients during psychotropic therapy is associated with an 11.11-fold decrease in the risk of poor outcome of coronavirus infection (HR 0.09; 95% CI 0.01–0.76; p=0.027). Delirium is a predictor of low patient survival, especially in prolonged hospitalizations (HR 4.55; 95% CI 1.66–12.48; p=0.003). The severity of coronavirus infection makes the greatest contribution to the poor outcome: the risk of death increases by 33.17 times (CR 33.17; 95% CI 4.01–274.65; p<0.001). The severity of the mental disorder had a greater impact on the risk of death compared with age, increasing it by 4.55 times (p=0.003).

Conclusion. We found significant differences between the groups of deceased and surviving patients with COVID-19 concerning the variables related to certain mental disorders, their severity and dynamics, and the severity of coronavirus infection. In addition, the age of the patients had a significant impact on the prognosis of COVID-19. The results reflect the special prognostic significance of delirium in the structure of mental disorders developing in patients with coronavirus infection.

48-55 312

The article reveals results of the first russian prospective observational study, aimed at evaluating of the clinical results early using injections of abobotulinumtoxinA (Abo-BTA, Dysport®) in patients with upper limb spasticity (ULS), which is one of disabling consequence traumatic's brain injuries (TBI). Currently, botulinum therapy is an integral part of the complex treatment of patients with chronic spasticity, has a high level of evidence (level IA), is included in clinical recommendations, national guidelines in a lot of countries around the world countries. The article analyzes results of studies conducted in the world in recent years, which confirm the effectiveness of Abo-BTA injections in the treatment of spasticity, which developing in early period after acute brain injury. Presented data of their own observations are allowed to authors conclude, that using of Abo-BTA injections in the complex rehabilitation of patients with ULS in the early recovery period of TBI demonstrates its good tolerability and a high safety profile, contributes to improving the effectiveness of treatment by reducing muscle tone and spasticity, increasing the volume of movements in joints. Therefore, Abo-BTA injections can be considered as a necessary addition to standard early rehabilitation programs. However, it is necessary to conduct further large-scale studies to more accurately determine the timing of the start of botulinum therapy, the doses of Abo-BTA, the most effective combinations of rehabilitation methods in the creating of individual programs.

56-61 185

Symptoms of peripheral nervous system (PNS) damage are common clinical manifestations of systemic amyloidosis. Peripheral amyloid neuropathy is characterized by a progressive course, leading to the disability of patients; however, the current possibilities of pathogenetic therapy make the early diagnosis of amyloid neuropathy particularly urgent.

Objective: to evaluate the informative value of laser confocal microscopy (LCM) of the cornea in diagnosing small fiber neuropathy of peripheral nerves in patients with systemic amyloidosis.

Patients and methods. The study included nine patients (three men and six women) with morphologically confirmed primary amyloidosis (ALamyloidosis) and 12 patients (three men and nine women) with hereditary transthyretin amyloidosis (TTR-amyloidosis) verified by genetic and morphological methods. At baseline, the mean age of patients with AL-amyloidosis was 60.6±10.7 years, with hereditary TTR-amyloidosis – 57.1±13.1 years. According to the history of the disease in AL-amyloidosis, the mean duration of clinical symptoms was 2.7±1.4 years, with TTR-amyloidosis – 5.5±3.6 years. 20 age- and sex-adjusted healthy volunteers were included in the control group. All patients underwent a clinical neurological examination with an assessment of the severity of neuropathy according to the Neuropathy Impairment Score (NIS); 21 patients with systemic amyloidosis and all volunteers of the control group underwent LCM of the corneal nerve fibers (CNF). The coefficients of anisotropy (КΔL) and orientation symmetry (Ksym) of the CNF were calculated to assess the severity of damage to the corneal nerves.

Results and discussion. Clinical neurological examination in patients with AL-amyloidosis revealed polyneuropathic syndrome (45%), tunnel syndrome (22%), their combination (22%), and autonomic dysfunction in the form of orthostatic hypotension and impaired motility of the gastrointestinal tract (GI tract; 56%). Symptoms in patients with TTR-amyloidosis were characterized by a combination of tunnel neuropathy and sensory-motor polyneuropathy (50%), distal symmetric polyneuropathy (42%). Frequent symptoms of PNS damage in systemic amyloidosis include autonomic neuropathy (56% – in AL-amyloidosis, 92% – in TTR-amyloidosis) presenting with orthostatic hypotension, impaired gastrointestinal motility, hypohidrosis, and dysuria. The mean NIS score, which characterizes the severity of somatic neuropathy, was significantly higher in patients with TTR-amyloidosis than AL-amyloidosis (p<0.02). LCM of the cornea showed disturbances in the course and structure of the corneal nerve fibers in all examined patients with systemic amyloidosis. The mean anisotropy coefficient values were lower in patients with systemic amyloidosis than in the control group. There were no significant differences in the AL- and TTR-amyloidosis groups. An inverse correlation of average strength between the values of the anisotropy coefficient and NIS was revealed (r=-0.6; p=0.04) in the group of patients with TTR-amyloidosis.

Conclusion. Clinical polymorphism of peripheral somatic and autonomic nervous systems lesions is typical for patients with systemic amyloidosis. LCM of the cornea is informative in the diagnosis of small fibers neuropathy of peripheral nerves in systemic amyloidosis; however, it cannot establish the nosology of neuropathy.

62-67 159

Patients with chronic non-specific low back pain (CNSLBP) often have sleep disturbances (insomnia), which negatively affects pain severity, mental state, activities of everyday living, and the overall quality of life. The prevalence of insomnia in patients with CNSLBP and the effectiveness of its therapy require further investigation.

Objective: to identify the prevalence of insomnia and the effectiveness of its treatment in CNSLBP.

Patients and methods. The study included 71 patients aged 18–75 years (mean age 55.09±13.0 years) with CNSLBP. A single sleep hygiene educational session was run in the standard treatment group (n=34; mean age – 51±14 years). Intervention in the extended therapy group (n=37; mean age – 59±12 years) included an educational program dedicated to sleep, which was an individual face-to-face course of 4–5 sessions over two weeks and a telephone survey after three months. We used the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) to assess sleep disturbances, a numerical rating scale (NRS) to assess pain, the International Physical Activity Questionnaire (IPAQ-SF), and the 12-item short form health survey (SF-12) to assess physical activity and quality of life. The survey was carried out three times (at the admission, after 7–10 and 80–90 days).

Results and discussion. In both groups of patients with CNSLBP, PSQI scores improved in a week and after 3 months compared with baseline (p<0.05). Sleep quality between 7th and 90th days significantly improved only in the extended therapy group (p=0.025). ISI scores significantly improved during inpatient treatment in both groups (p<0.05), but between 7th and 90th days significantly improved only in the extended therapy group (р=0.048). Back pain intensity according to NRS significantly decreased in a week and after 3 months, compared to baseline (р<0.0001). Significant increase in physical activity (p≤0.001), physical and mental components of quality of life (p<0.05) were found only in the extended therapy group.

Conclusion. Most patients with CNSLBP have insomnia, the treatment of which can improve sleep and help reduce pain.

68-75 196

Knowing the frequency of spasticity patterns in different muscles allows correcting the botulinum neurotoxin (BoNT) administration schemes and creating spasticity models that could predict the drug consumption and treatment cost.

Objective: to develop clinical spasticity models based on the frequencies of the spastic syndrome in the muscles of the extremities in post-stroke patients to optimize BoNT administration.

Patients and methods. We examined 129 patients of both sexes aged 61.2±8.0 years with post-stroke spasticity (mean time after the stroke – 4.6±2.2). Twenty-seven muscles were tested for spasticity: shoulder girdle (n=3), upper (n=9) and lower (n=15) extremities. We used the original manual testing methods (MTM) of spasticity and the Tardieu scale (TS).

Results and discussion. We observed the following frequencies of spasticity in the arm muscles: pectoralis major, brachioradialis, pronator teres, fl. carpi radialis, fl. digitorum profundus et superfacialis, fl. pollicis long. – over 70%, subscapularis – 61%, brachialis – 56.6%, biceps brachii – 35.8%. Frequencies of spasticity in the leg muscles were: semitendinosus, semimembranosus, fl. digitorum long. – 37.5%, gracilis – 21.4%, cap. med. gastrocnemius – 48%, tibialis post. – 39.2%, soleus – 19.6%, fl. halluces long. – 23%. There was no spasticity in the hip adductors; low spasticity incidence was seen in fl. digitorum brev. et fl. halluces brev. (<10%), tibialis ant., rectus femoris (<5%); biceps femoris, teres major, fl. carpi ulnaris, and cap. lat. gastrocnemius (<2%). Based on the frequency of identified spastic patterns, we created four models of patients with arm spasticity and five models – with leg spasticity with the calculation of the necessary doses of BoNT.

Conclusion. We propose several spasticity models, which allow calculating the treatment costs, considering the frequency of involvement of specific muscles in spasticity evaluation, and tracking the rehabilitation follow-up of the patient's transition from one clinical model to another.


76-82 178

The review analyzes the role of serotonergic, dopaminergic, noradrenergic, and glutamatergic systems and neuroendocrine mechanisms, neuropeptides, and inflammatory mediators in aggression manifestation. We discuss the inconsistency of modern concepts about the neurochemical nature of aggressive behavior and the urgency of determining biological markers of social danger. Finally, questions of psychopharmacotherapy of aggressive behavior are reviewed.

83-89 344

Fibromyalgia (FM) occurs in 5–12% of patients but is relatively rarely diagnosed, so most patients do not receive adequate treatment. The review analyses pharmacological and non-pharmacological methods of FM treatment. Data suggests that antidepressants (duloxetine, milnacipran, amitriptyline) and antiepileptics (pregabalin, gabapentin) are most effective. Among non-pharmacological methods, the effectiveness of cognitive-behavioral and mindfulness therapy, kinesiotherapy, and biofeedback has been shown. In the management of patients with FM, a combination of non-pharmacological methods and medications can reduce pain and improve the quality of life.

90-95 166

Cognitive impairment (CI) is one of the earliest and most frequent neurological disorders in patients with arterial hypertension. Arterial hypertension is a leading modifiable risk factor for stroke and cerebral microangiopathy, which underlies the development of non-stroke associated CI. Antihypertensive therapy plays an essential role in preventing the development and slowing the progression of CI by controlling blood pressure. The review discusses the use of memantine – a reversible inhibitor of NMDA receptors (akatinol memantine) – in vascular CI.

96-101 237

The disease caused by the SARS-CoV-2 virus is multi-organ and involves almost all organs and systems. Myalgias and arthralgias and, in particular, back pain are common symptoms of COVID-19 and can be observed both at the onset of the disease and in the postcovid period. The causes of muscle and joint damage include both systemic inflammation and direct viral injury. Traditionally, musculoskeletal pain is treated with non-steroidal anti-inflammatory drugs. However, using this drug class in patients with COVID-19 requires caution due to the presence of comorbid diseases and possible complications of viral infection. The review discusses clinical variants and pathophysiological mechanisms of joints and muscles damage in patients with COVID-19 and treatment tactics for patients with musculoskeletal pain.

102-108 182

Acute musculoskeletal pain (MSP) is one of the leading complaints at patients' admission. Acute MSP is usually localized in the lower back, neck, shoulder girdles, and shins. With an increase in the number of obese and hypodynamic people, the prevalence of MSP increases, especially lower back pain. Treatment of acute MSP in the back consists of informing the patient about a favorable prognosis of the disease, recommendations to maintain daily activity, primary and additional pharmacotherapy. Primary or main pharmacotherapy of acute MSP in the back includes non-steroidal anti-inflammatory drugs (NSAIDs). Adjunctive therapy is usually used in combination with NSAIDs and is aimed to increase the effectiveness of treatment and reduce the duration of NSAIDs use. As an additional therapy, muscle relaxants or B vitamins can be prescribed. The efficacy and safety of combination therapy of NSAIDs and high-dose complexes of B vitamins have been demonstrated in clinical trials involving patients with acute back pain.

109-115 263

The review examines the epidemiology and clinical manifestations of COVID-19 long-term neurological effects, main pathobiochemical mechanisms, and integrated circuits of redox status impairment in COVID-19, such as the decrease of adenosine triphosphate production, fatty acids levels, acylcarnitine, and amino acids, impairment of oxidative phosphorylation and glycolysis, hypometabolic state, redox imbalance with the increase of peroxides and superoxides, isoprostanes, the decrease of α-tocopherol, substances reacting with thiobarbituric acid, increased nitrosative stress with the increase of inducible synthase of nitric oxide, nitric oxide, peroxynitrite, and nitrate. Neuroprotective approaches aimed at suppressing excitotoxicity, oxidative stress, and neuroinflammation are presented. Recent data on the relationship between mechanisms of chondroitin sulfate and its derivatives (chondroitin sulfate glycoprotein disaccharide) neuroprotective effects and characteristics of their chemical structure are analyzed. The mechanism of action and neuroprotective effects of chondroitin sulfate and its derivatives in fatigue syndrome in patients with SARS-CoV2 infection are discussed (regulation of the PKC/PI3K/Akt activity, the increase of heme oxygenase-1 level, the decrease of reactive oxygen species). The position that chondroitin sulfate and its derivatives can become promising drugs to prevent the long-term neurological effects of COVID-19 is reasoned.

116-122 228

The worldwide prevalence of prediabetes is steadily increasing, with up to a third of patients already showing signs of diabetic neuropathy (DN). Prediabetes includes impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or a combination of both.

Recent diagnostic criteria of prediabetes according to Russian, European, and American clinical guidelines are presented. The review covers the most common forms of DN in patients with prediabetes (distal symmetric sensory polyneuropathy, painful DN, cardiovascular autonomic neuropathy) and their prevalence. Recommended methods of DN screening are discussed: diagnostic scales, sensory testing, nerve conduction study, autonomic testing, corneal confocal microscopy. The results of studies evaluating instrumental methods for diagnosing peripheral nervous system (PNS) dysfunction in prediabetes are discussed. Management tactics in patients with prediabetes and PNS dysfunction should include non-pharmacological and pharmacological interventions. Combining a low-calorie diet and regular physical activity can delay the development of diabetes mellitus and reduce the severity of neuropathic pain. In patients with painful DN, the first-line therapy includes pregabalin, gabapentin, and duloxetine. Since there is no current data on the effect of hypoglycemic therapy on the risks of development and/or progression of DN in patients with prediabetes, antioxidants are considered pathogenetic therapy. Alpha-lipoic acid (Berlition®) in the management of patients with prediabetes is discussed.


123-129 183

We present a case report of a middle-aged patient with a rare sinus venosus atrial septal defect (ASD) and ischemic stroke that developed due to paradoxical embolism. Occlusion of the anterior cerebral artery led to a stroke with cognitive impairment, acalculia, and apraxia. Diagnostic ultrasound features of this anomaly in suspected cases are discussed. In the presented case, verification of the stroke cause became possible due to the contrast-enhanced computed tomography of the heart. ASD detection made it possible to refer the patient to the surgical treatment necessary to prevent both recurrent cerebral accidents and the progression of pulmonary hypertension, and the prevention of the development of right ventricular heart failure.

130-133 338

Alcohol-induced psychotic disorder (AIPD) is a diagnosis in the ICD 10. Previous studies of AIPD do not appear to have reported the co-morbid presence of depressive disorder in either prevalence studies or treatment studies. Five cases are presented with a dual diagnosis of AIPD and depressive disorder. These cases were assessed using the Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression Severity score (CGI-S), Clinical Global Impression Improvement score (CGI-I), Drug Attitude Inventory 10 (DAI 10), Short Assessment Personality-Abbreviated Scale (SAPAS) and Modified Sainsbury Tool. Antidepressants and antipsychotics were chosen based on drug attitude scores from DAI 10. Cases demonstrate inpatient and outpatient treatment with good treatment outcomes after six months. Three cases demonstrate suicide risk. The majority did not have a personality disorder. These cases highlight the importance of treating a depressive disorder in AIPD and of tailored medication treatments for poor medication compliance.

134-139 214

The novel coronavirus 2019 (COVID-19) pandemic has affected not only the somatic health of people but also their mental health and the organization of mental health care. Self-isolation, quarantine, extensive media coverage of the situation, a large amount of inaccurate information, and conflicting recommendations – all this has led to an increase in admission of patients who have not previously had mental illness to psychiatrists. As a confirmation of the influence of the above factors on the population's mental health, we present a case report of a 25-year-old patient who first came to a psychiatric clinic due to the obsessive-compulsive disorder that developed due to the pandemic.


140-147 236

Neuromyelitis optica spectrum disorders (NMOSDs) are autoimmune inflammatory disorders accompanied by central nervous system damage, widespread immunemediated demyelination, and axonal damage, involving mainly the optic nerves, spinal cord, and area postrema. The diagnostic capabilities, administration and routing of patients, and therapeutic approaches to this disease need to be improved. During several expert councils held in 2019–2021 in different regions of the Russian Federation, we discussed multiple issues related to various aspects of medical care for patients with NMOSDs. As a result, the experts developed further steps necessary to improve the medical care to these patients: to write and publish clinical guidelines for the diagnosis and treatment of NMOSDs; to consider the possibility of optimizing the NMOSDs diagnostic program including the aquaporin-4 antibodies (AQP4-IgG) testing; to evaluate the implementation of a set of measures aimed at including the corresponding laboratory investigations into the system of state guarantees (together with the institutions of the Ministry of Health of Russia), if there is clinical and economic feasibility; to include the issues of timely NMOSDs evaluation in educational programs initiated by the scientific medical community, in order to raise awareness of primary care neurologists in relation to the clinical and neuroimaging signs of probable NMOSDs; to assess the possibility of introducing routing schemes for patients with NMOSDs at the regional level; to work out a decision on the collection of NMOSDs epidemiological and clinical data in the Russian Federation.

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