In the modern world, the role of the attending physician is large and ambiguous. The attending physician is a specialist who is not only responsible for the diagnosis, treatment and monitoring of the patient, but is also a key link between the patient and the healthcare system, providing an individual approach to each patient and coordinating the work of other specialists. The article discusses the concepts of "doctor", "attending physician", tasks, functions and assigned responsibilities, correlates with the concepts of "consultant physician" and "doctor on duty". To date, the concept of "attending physician" in primary health care, where the patient is examined simultaneously by specialists of completely different profiles, does not disclose any of the current regulatory legal acts. Today, taking into account the increasing specialization of medical care, changes in the model of interaction with patients, the introduction of new forms of organization of medical care, there is a need to change the paradigm, improve this concept, clarify the role of the "attending physician" depending on the form, type and conditions of medical care.

Background. Migraine is a common disease that affects about 1 billion people worldwide. Factors affecting the limbic system play a major role in the migraine chronification. Dysfunction of the limbic system underlies many non-painful symptoms of migraine. Also there is an association between severe migraine and depression. Conditions such as misophonia and trypophobia are clinical markers indicating the development of limbic sensitization that accompanied chronic migraine. Aim. The impact of limbic sensitization on the efficacy of fremanezumab therapy and depression in migraine patients. Methods. A total of 80 patients with the established diagnosis of migraine and depression took part in the study. Fremanezumab 225 mg was administered monthly for 6 months. Сlinical interviewing and filling of Hamilton Depression Rating Scale, Central Sensitization Inventory, Trypophobia Questionnaire, and Misophonia Questionnaire were performed every month. Results. A significant decrease in the headache frequency, depression, central sensitization, misophonia and trypophobia is observed with the steady increase of effect by month 3 of therapy and the effect persistence by month 6 of therapy is reported in patients with chronic migraine and depression. A significant decrease in the depression scores based on the Hamilton depression rating Scale is observed at 2, 3, and 6 months of treatment compared with baseline. There was a correlation between baseline misophonia and trypophobia scores and headache frequency, depression scores, and central sensitization scores. High baseline levels of misophonia and trypophobia were negative predictors of treatment efficacy. Conclusion. Limbic system-mediated symptoms and comorbidities contribute to migraine chronification and affect patient quality of life, treatment satisfaction, and behavioral patterns. Screening for comorbidities is recommended for all patients with migraine.

Future thinking deficits (FTD) may to a great extent explain the main issue of alcohol dependence (AD), and namely, one’s failure to stop drinking, even in spite of the serious negative consequences for health and life. Treatment and rehabilitation aim at changing the actual future of people with AD by improving their mental and physical health, quality and duration of life, expanding and improving social activity. Meanwhile, working with mental future thinking may also have a marked relapse-prevention effect. The article outlines the clinical picture of typical FTD in alcohol-dependent patients, provides simple and ecological methods for diagnosing and analyzing FTD that can be used in addiction treatment, by doctors, psychotherapists, or medical psychologists. The presented methods allow to structure psychosocial interventions in the medium term, and to identify significant targets in individual and group psychotherapy, psychological counseling, and psychoeducation that will strengthen therapeutic alliance and create a benevolent therapeutic space during medical rehabilitation.

Aim. To evaluate the efficacy and safety of using the complex herbal preparation Mabell Cycle in the treatment of stress-dependent menstrual disorders. Materials and methods. Prospective, open-label, non-interventional study was conducted with 80 patients aged 18–31 years (mean age 24.41±2.95 years) with stress-dependent menstrual disorders. The participants were ratio into two groups: the main group (n=40) received Mabelle Cycle (active ingredients: Trifolium pratense (red clover) extract, Vitex agnus-castus extract, Angelica sinensis root extract, Griffonia simplicifolia extract, D,L-phenylalanine, iron) at a dose of 2 tablets daily for 3 months, while the control group (n=40) received non-drug therapy (consultation with a psychologist, physiotherapy) following the same regimen. The duration of therapy was 3 months. Efficacy was assessed by menstrual cycle restoration, dynamics of premenstrual syndrome symptoms, and MEDI-Q questionnaire indicators. Safety assessent was based on the incidence of adverse reactions. Study design: prospective, open-label, non-interventional. Results. The Mabell Cycle group showed progressive restoration of the menstrual cycle: 22.5%, 50.0%, and 62.5% of patients over three months of therapy compared to 7.5%, 17.5%, and 27.5% in the control group, respectively. Statistically significant differences were detected from the second month of therapy (p=0.008). The Mabell Cycle group showed significant reduction in mood lability (from 45.0% to 7.5%, p=0.015), mastalgia (from 40.0% to 10.0%, p=0.008), complete resolution of depressive symptoms (p<0.001), and improvement in five out of six evaluated psycho-emotional parameters versus three in the control group. The total MEDI-Q score in the Mabell Cycle group decreased from 58.00 to 33.00 (p=0.001), achieving significant intergroup differences by the end of the study (p=0.001). Conclusion. The multitarget phytocomplex Mabell Сycle demonstrates high efficacy and safety in restoring the menstrual cycle in stress-dependent disorders. The use of a phytocomplex for 3 months provides significant improvement in cycle regularity, reduction in the severity of psycho-emotional and somatic symptoms, and enhancement of patients' quality of life. The results obtained allow recommending the phytocomplex Mabell Cycle for inclusion in clinical protocols for managing patients with stress-dependent menstrual disorders.

The article presents the results of a study aimed at determining the degree of physical and mental development of children with autism spectrum disorder. The aim of the study was to diagnose the indicators of somatic development, mental and physical health and the features of existing disorders in children of this nasal group as a basis for the development of methodological and practical recommendations on the organization and content of the educational and training process with children with autism spectrum disorders. The obtained diagnostic results opened the possibility to transform the existing adaptive gymnastics programs for children with autism spectrum disorder in order to improve physical conditions, social integration and quality of life.

Insomnia disorders are a common problem among patients with type 2 diabetes mellitus, which can negatively affect their overall health and disease management. This paper discusses the basic principles of insomnia treatment in this group of patients, including cognitive behavioral therapy, pharmacotherapy, and non-medicinal methods. Special attention is paid to the clinical features of insomnia in the context of diabetes, such as the effect of hypoglycemia and chronic stress on sleep quality. Lifestyle correction approaches are also being considered, such as dietary recommendations and physical activity that can help improve sleep. The need for an integrated approach to the treatment of insomnia disorders is emphasized, with an emphasis on individualizing therapy depending on the clinical characteristics and needs of the patient.

Asthenia/asthenic syndrome is present in the clinical picture of a large number of diseases and conditions, and, accordingly, the causes of asthenia are diverse. Acute respiratory viral infections are widespread diseases, poorly controlled infections, and are characterized by moderate, constant growth. Asthenia/asthenic syndrome after acute respiratory viral infection (post-viral asthenia) occupies a leading place in the structure of post-infectious asthenia and remains relevant in real clinical practice. In most patients, asthenic syndrome develops 10–14 days after recovery, and can persist for several months to six months. Due to the diverse clinical symptoms of post-viral asthenia, patients need complex therapy. The review examines one of its leading components – the use of vitamin and mineral complexes (nutraceuticals). The use of nutraceuticals in acute respiratory viral infections is experiencing a "second youth" due to new data accumulated during the pandemic of the new coronavirus infection (COVID-19). The review examines the possible impact of deficiency of trace elements selenium and zinc, vitamins A, E and C on various aspects of the course of acute respiratory viral infections: non-specific prevention, treatment and rehabilitation. The analysis of domestic and foreign literature indicates the benefits of including nutraceuticals in the complex therapy of asthenia/asthenic syndrome or chronic fatigue syndrome after acute respiratory viral infections (post-viral asthenia). In real clinical practice, it is advisable to supplement the recommendations of experts on the diagnosis of postinfectious asthenia by determining the levels of selenium and zinc and vitamins A, C, E in patients with asthenic syndrome and, with a reduced level of these components, consider prescribing vitamin and mineral complexes in order to eliminate the deficiency of essential micronutrients. The presence in the arsenal of a practitioner of the Selzink® vitamin and mineral complex at the outpatient stage of medical care will increase the effectiveness of rehabilitation of patients after acute respiratory viral infections in the presence of post-viral asthenia.

The article describes a casuistic case of 67-year-old Oksana, the mother of patient Mikhail, who was under dynamic observation in a psychoneurological dispensary and was hospitalized several times. During another attempt to hospitalize him due to his deteriorating condition, the ambulance team was refused involuntary hospitalization by the doctor in the admissions department. The patient's mother showed a strong emotional reaction to this, threatened the psychiatrist on duty, and was hospitalized as a result. Oksana, who had never sought psychiatric help before, had no complaints about her mental health, and who was not considered mentally ill by anyone around her, ended up in the emergency room of a psychiatric hospital by chance. She was accompanying her mentally ill son to the hospital. She might not have been there, since she was not obliged to accompany the patient. Considering the fact that her son Mikhail had been behaving inappropriately at home for a long time, had spoken of hallucinations, had committed risky acts, and there was a danger that he would commit suicide and/or set fire to the apartment, the mother made efforts to have him hospitalized and treated in a psychiatric hospital. It is concluded that the described isolated case reflects a trend in determining the grounds for involuntary hospitalization, characterized by ignoring the basic provisions of Article 29 of the Law on Psychiatric Care and Guarantees of Citizens' Rights in its Provision, and, in particular, the need to detect and confirm a severe, rather than any, mental disorder.

Acute stroke is the most common cause of seizures and epilepsy in elderly people. Post-stroke epilepsy (PSE) develops in approximately 2–11% of patients who have experienced a stroke, according to various estimates. The article discusses modern aspects of the pathogenesis of PSE, including neurotransmitter imbalance, hormonal dysregulation, blood-brain barrier damage, changes in neural networks, oxidative stress, glial proliferation, and genetic mechanisms. The main prediction methods and possibilities of pharmacotherapy for PSE are also discussed in detail. Despite significant advances in understanding the pathogenesis and treatment of PSE, many questions remain unanswered. There are several promising directions for further research on PSE. The development and refinement of biomarkers of epileptogenesis will allow us to predict which patients may experience seizures after a stroke. This knowledge will also be useful for conducting research on epilepsy therapy. It is extremely important to investigate the impact, tolerability, and interactions of AEDs in patients who have suffered a stroke. It is also necessary to study the interaction of AEDs with oral anticoagulants. Finally, more accurate biomarkers of ongoing epileptic activity are needed to determine which patients may benefit from stopping AEDs. This will optimize treatment and improve the quality of life of patients after a stroke.

Background. The biggest risk factor for Alzheimer's disease (AD) is aging, contributing to impaired clearance of tau and amyloid-beta proteins, microglial senescence, endoplasmic reticulum stress, lipid dysregulation, and excitotoxicity. Objective. This review investigates how aging speeds up the pathophysiology of AD and evaluates emerging geroscience-based interventions targeting biological aging mechanisms to delay or prevent cognitive decline. Methods. A narrative review of the literature from 2015 to 2025 was conducted, integrating longitudinal studies, meta-analyses, and preclinical models that examine the aging-AD interface. The MEDLINE, Embase, Cochrane, Google Scholar, and PubMed databases were searched using specifically related keywords, such as ageing, AD, AD pathology, anti-aging strategies, and AD therapies. Results. From the initial search, more than 150 studies were excluded, and only 100 studies were selected for this review. After revision also duplicated 30 studies were removed. Ultimately, the review comprised seventy studies. Most of these studies discussed aging-related mechanisms – glymphatic dysfunction, APOE ε4-associated lipid transport impairment, BDNF depletion, and glutamate excitotoxicity, and anti-ageing strategies such as lifestyle interventions (e.g., physical activity, sleep optimization, cognitive engagement) and medical and biological therapies for AD. Conclusion. Targeting aging mechanisms offers a paradigm shift in AD prevention and treatment; however, multidisciplinary collaboration is essential to translate geroscience into clinical practice. The integration of lifestyle and pharmacological strategies may yield synergistic neuroprotective benefits. Future research should focus on integrated, multimodal interventions that combine lifestyle modification with pharmacological and biological therapies. Tailored approaches–based on genetic risk profiles (e.g., APOE status), comorbidities, and individual aging trajectories–may optimize clinical outcomes. To evaluate the long-term safety and effectiveness of innovative treatments like senolytics, epigenetic modulators, and stem cell-based therapies in older populations, extensive, longitudinal clinical trials are also required. Developments in biological age biomarkers, machine learning, and systems biology have the potential to improve risk assessment and therapy customization.