Asthenic States Research Articles

Features of depressive disorders in patients with multiple sclerosis and their medical correction

Patients with multiple sclerosis (MS) often have comorbid symptoms that reduce their quality of life; these include a high prevalence of depression, anxiety, cognitive impairment, and increased fatigue. Although these problems manifest themselves in a wide range, clinicians do not always succeed in differentiating them due to their disguise by underlying disease. The detection of depressive disorders, as well as pharmacological treatment, is an important area of therapeutic intervention. Currently, there are no clinical recommendations regulating the treatment of affective disorders in MS patients, which makes it difficult to select therapy and affects the rehabilitation potential of the patient. The purpose of this study was to investigate the manifestations of depressive disorders in patients with multiple sclerosis, as well as the choice of drug correction. Patients and methods: The study involved 113 patients with a clinically confirmed diagnosis of multiple sclerosis receiving DMTs (disease modifying therapies). The age of the patients at the time of examination ranged from 15 to 60 years (mean age 39.7±10.91). Among those examined, 77% (87 patients) were women, and 23% (26 patients) were men. Taking into account the course of the disease, the MS patients were distributed as follows: 80.5% (91 patients) had a remitting course, and 19.5% (22 patients) had a secondary progressive course. The disability indicator varied in the patients with RMS (2.89±0.16 points) and the patients (5.0±0.24 points). The A. Beck’s scale, the asthenic state scale (ASS), and the point scale for assessing the condition were used. Results and discussion: The study presents two groups of patients: with multiple sclerosis (study group), 113 participants with depressive disorders, and a group of 70 participants with depressive disorders (comparison group). The study revealed that the level of depressive disorders in the MS patients was mainly represented by mild and moderate depression, while in the comparison group moderate and severe depressive disorders were more common. Indicators of depressive manifestations in the patients in the comparison group were also higher. In almost equal proportions, the patients of the compared groups experienced: "a sense of punishment", "indecision", "loss of performance", a feeling of "increased fatigue", "decreased appetite or loss of appetite", and a feeling of being "engulfed by bodily sensations", according to the Beck questionnaire. These experiences varied and depended on the severity of depressive disorder. When selecting therapy, the neurological status of the patients as well as clinical symptoms of depression, which were combined into clinical symptomatic forms, were taken into account. Drugs that could enhance neurological disorders were excluded. The drugs from the SSRI and SNRI groups were mostly selected. Using a score assessment of the condition before and after the prescription, the MS patients evaluated the effect of the received therapy, where statistically significant differences were obtained for the following drugs: escitalopram p<0.001, sertraline, fluvoxamine, and agomelatine p<0.01, and paroxetine slightly lower than p<0.05. Conclusion: Multiple sclerosis is not only a concern for neurologists, but also psychiatrists, since anxiety and depression occur in every second patient. Timely diagnosis of depressive disorders, as well as the synthesis of knowledge in the field of the development of multiple sclerosis taking into account neurological symptoms, will help clinicians prescribe pharmacotherapy in a timely manner, thereby improving the rehabilitation potential and quality of life of MS patients.

Asthenia in young patients and possibilities for its correction

To investigate the effect of using the drug Brainmax on various manifestations of asthenic syndrome. 30 patients, average age 29 years (20-44 years) took part in the study. The duration of treatment was 15 days. Subjective indicators on the asthenic state scale, hospital anxiety and depression scale, daytime sleepiness scale, as well as objective indicators of the corrective test were analysed. It was found that after treating patients with Brainmax, the severity of asthenic syndrome, anxiety, and depression significantly decreased, the quality of sleep increased, and the results of the correction test improved. The drug Brainmax can be recommended for the correction of asthenic syndrome in patients with functional diseases of the nervous system.

Long-term consequences of COVID-19 in patients with functional bowel disorders, rehabilitation prospective of microbiocenosis-oriented therapy

To analyze long-term consequences of the new coronavirus infection and rehabilitation prospective of microbiocenosis-oriented therapy in patients with functional bowel disorders. The study enrolled 100 consecutive patients with various types of functional bowel disorders with recurrence of symptoms after the new coronavirus infection. The severity of abdominal pain was evaluated in points, and bowel movement disorders were assessed using the Bristol stool scale. A questionnaire was used as part of an in-depth clinical examination for COVID-19 survivors to identify the clinical symptoms typical for the post-COVID syndrome. The Hospital Anxiety and Depression Scale was used to identify and assess the severity of depression and anxiety, and the Asthenic State Scale was used to diagnose the asthenia. All patients in the study subjectively linked the recurrence of bowel disorders with the new coronavirus infection. The most common bowel disorder was irritable bowel syndrome with diarrhea. A distinctive feature of exacerbations of intestinal symptoms in the post-COVID period is their association with depression/anxiety and asthenic states. The addition of Zakofalk® metaprebiotic to the treatment regimen was associated with significant regression of abdominal pain and normalization of bowel movement, an improvement of asthenia, anxiety, and depression. The addition of Zakofalk® to treatment regimens for exacerbations of functional bowel disorders after the new coronavirus infection significantly improves the effectiveness of therapy.

Психогігієнічна оцінка особливостей емоційного вигорання, астенічного і депресивного станів та агресивності студентів за умов дистанційного (on-line) навчання

The aim of the work was to perform a psychohygienic assessment the characteristics of the spread of emotional burnout’s features, asthenic and depressive states and aggression of students in the conditions of the use of remote (on-line) organization of educational activities. Materials and methods: The research was conducted on the basis of National Pyrohov Memorial Medical University. A complex of highly informative hygienic, medical-sociological and psychodiagnostic methods and the methods of statistical analysis was used. Results: When considering the leading characteristics of emotional burnout, first of all, it was necessary to pay attention to a significant increase in the level of expression of resistance phase indicators (р<0.05-0.01), characteristic of the organization of the educational process according to the auditorium format, against the background of completely stable expression indicators of the specified phase (p>0.05), characteristic of the organization of the educational process according to the remote format. In the course of research aimed at determining the correlates of the asthenic state, it was established that under the conditions of using the remote form of education, either a decrease in the degree of their expression was observed (young women), or the indicators stabilized at the initial level (young men). When determining the characteristics of changes in the leading correlates of depression, it was noticed that under the conditions of using the remote format of the organization of the educational process, either a significant decrease in the degree of their expression was observed (young women), or the indicators stabilized at the initial level (young men) too. During the analysis of indicators of aggressive personality manifestations, it should be noted that under the conditions of remote education, statistically significant changes were observed in the characteristics of physical aggression (p<0.05) and negativism (p<0.05). Conclusions: In the course the research the psychohygienic assessment of the personality traits of students in the conditions of application of a remote form of organization of educational activity was carried out. It is established that in the case of use on-line learning there is a significant increase in the degree of expression of the phase of tension of emotional burnout, the stable course of the processes of formation of asthenic and depressive states, a decrease in the level of physical aggression on the background of a pronounced increase in the degree of negativism in the structure of aggressive manifestations.

Metabiotic based on metabolites of <i>Bacillus subtilis</i> for correction of gastrointestinal symptoms in patients with post-COVID syndrome

Purpose of the study. To evaluate the efficacy and safety of using a metabiotic preparation, which includes biologically active metabolites of the culture fluid of the probiotic bacterium Bacillus subtilis (B. subtilis) and fructooligosaccharides, for the correction of gastrointestinal symptoms in patients with post-COVID syndrome.Materials and methods of the study. The study included 40 outpatients with post-COVID syndrome aged 18 to 60 years (mean age 38.25–8.70 years), who, after undergoing COVID-19, were disturbed by gastrointestinal complaints and asthenia. Patients were randomized into 2 groups. Group 1 (n = 20) consisted of patients who received metabiotic capsules in the regimen of 1 capsule 2 times a day for 28 days; group 2 (n = 20) – patients who did not receive additional support. The observation period was 28 days. The severity of gastroenterological symptoms was assessed using the GSRS (Gastrointestinal Symptom Rating Scale) quality of life questionnaire, and asthenia was assessed using the Asthenic Condition Scale (ASS) by L.D. Malkova. Patients of group 1 (n = 10) additionally underwent a study of feces to quantify the composition of the microbiota of the colon by real-time polymerase chain reaction (PCR), test Kolonoflor-16.Research results. According to the results of assessing the quality of life in patients with post-COVID syndrome using the GSRS questionnaire, the main gastrointestinal complaints included: diarrhea, abdominal pain and dyspepsia; the severity in points was 14.1 points, 7.9 points, and 15.2 points, respectively, which corresponded to moderate manifestations of symptoms. Against the background of taking a metabiotic in patients of group 1, there was a statistically significant decrease in gastrointestinal complaints on the scale of the total measurement of symptoms (p < 0.0001), on the scales of abdominal pain syndrome (p < 0.0170), dyspeptic syndrome (p < 0.0001) and diarrheal syndrome (p < 0.0001). In patients of group 2 on the 28th day of the study, there was no significant change in symptoms. When assessing asthenia after taking metabotics, patients of the 1st group showed positive dynamics, the severity of asthenia before treatment was 51.5 ± 7.9 points, after treatment – 43.3 ± 5.9 points (p < 0.0500), in patients of group 2 there was no significant decrease in asthenic state indicators when assessed at the beginning and at the end of the observation period. On the 28th day, in patients of group 1 the representation of Lactobacillus spp. statistically significantly increased, normalization in the spectrum of Escherichia coli representation was noted, and the representation of UPM decreased. In the examined group, attention is drawn to the complete absence of Akkermansia muciniphila DNA in the feces of patients with post-COVID syndrome and the restoration of the representation of this bacterium after taking a metabiotic in 60 % of patients.Conclusions. In patients with post-COVID syndrome, the structure of gastrointestinal complaints is dominated by manifestations of abdominal pain, dyspeptic and diarrheal syndromes, and there are phenomena of colon dysbacteriosis, expressed in a decrease in the representation of obligate microflora and an increase in TMR. The use of metabolic tyranny in patients with post-COVID syndrome for 28 days in a regimen of 1 capsule 2 times a day is effective and safe.

The Use of Non-Drug Therapy Methods in the Complex Treatment of Asthenic Syndrome in Persons Exposed to Emergency Radiation

Background: eccording to numerous medical observations, asthenic syndrome (AS) in persons exposed to emergency radiation is one of the early manifestations of disorders of the central nervous system. The combination of standard drug therapy with non-drug therapy in its treatment to increase the effectiveness of therapeutic measures is very relevant. The objective of the research is to study the effectiveness of non-drug therapy (a combination of Beta training and breathing exercises) in the complex treatment of AS in persons exposed to emergency radiation. Patients and methods: а retrospective analysis of the treatment was carried out. The study involved 80 people born from 1950 to 1957, residing in the coastal villages of the Techa River, who were diagnosed with AS. Participants of the study were divided into two groups comparable in different parameters. In the main group, in addition to standard drug treatment, Beta training was conducted in combination with breathing exercises, in the control group (40 people) standard medical treatment was carried out. To assess the effectiveness of intervention the following methods were used: clinical and psychological methods (Asthenic state scale, MFI-20, simple visual and motor reaction) and statistical processing of materials. Results and conclusion: according to the results of repeated diagnostics in the main group, there is a tendency to improve performance indicators, a statistically significant increase of persons with «low asthenia» (p = 0.039), a low overall score (decrease in asthenic manifestations) according to the MFI-20 method (p = 0.036) compared with the control group, whereas there are statistically significantly more subjects with a high overall score according to the MFI-20 method (p = 0.036). According to the results of Beta training in the main group, there is a statistically significant increase in the power index of the user range (UR) of the beta rhythm (16-20 Hz) at the start of the first and last session (p = 0.002) and the finish of the first and last one (p < 0.001). Conclusion: The use of an integrated approach in the treatment of AS in persons exposed to emergency radiation increases the overall effectiveness of therapeutic measures.

Эффективность и безопасность применения препарата Ренобрейн® СМ у пациентов с хронической ишемией головного мозга

Aim: to study the efficacy and safety of bovine cerebral cortex polypeptides (BCCP) in patients with chronic cerebral ischemia (CCI). Patients and Methods: an open multicenter randomized prospective comparative clinical trial was conducted with the participation of 40 patients with CCI (ICD-10: 167.8) aged 55 to 75 years, having risk factors for cerebrovascular pathology (hypertension, obesity, dyslipidemia or atherosclerosis) and vascular brain damage (according to the data of MRI, the STRIVE v1 protocol). After randomization, main group (n=20) received standard therapy for the underlying disease and Renobrain® СМ 10 mg/day, intramuscularly, for 10 days. Control group (n=20) received only standard therapy of the underlying disease. Clinical and neurological examination was performed using international questionnaires to assess cognitive and functional disorders before and after the therapy course in 30–32 days (Schulte and DSST tests, asthenic state and life quality SF-36 scales). Results: the BCCP, in addition to standard therapy in patients with CCI contributed to a statistically significant (p<0.05) improvement in cognitive functions (volume; refocusing rate; concentration and vigilance; working memory; information processing speed; executive, neurodynamic and regulatory functions), increased exercise tolerance, reduced mental fatigue and improving the life quality. The positive changes that occurred during treatment in the main group were probably related to the GABAergic effect, relationship normalization of the excitatory and inhibitory amino acids and mediators in the central nervous system, which leaded to functional restoration of neuronal cerebral systems. Conclusion: BCCP use in the complex therapy of patients with CCI is pathogenetically justified. Given its neurotrophic effect along with a high safety profile, repeated courses of such a drug and its wider use in patients with vascular brain damage can be recommended. KEYWORDS: chronic cerebral ischemia, cerebrovascular diseases, cognitive disorder, asthenia, bovine cerebral cortex polypeptides. FOR CITATION: Ekusheva E.V., Voitenkov V.B. Efficacy and safety of Renobrain® СМ in patients with chronic cerebral ischemia. Russian Medical Inquiry. 2023;7(10):666–671 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-9.

Постковидный синдром у пациентов с ревматическими заболеваниями

Aim: to study the incidence and duration of postcovid manifestations in patients with rheumatic diseases (RD), as well as the RD course patterns in the postcovid period. Patients and Methods: 271 patients (mean age 56 [46; 65] years) were included in the study: with a diagnosis of rheumatoid arthritis (RA) — 186 (68.6%) patients, with ankylosing spondylitis (SpA) — 46 (16.9%), with psoriatic arthritis — 38 (14%) patients who had previously suffered COVID-19. The presence of postcovid syndrome (PCS) was determined 3, 6, 9 or 12 months after acute COVID-19. An in-depth medical check- up questionnaire for citizens who have experienced COVID-19 was used to identify the clinical symptoms of PCS. The article presents the results of the following scales: the Hospital Anxiety and Depression Scale (HADS) was used to identify and evaluate the severity of depression and anxiety, the Hamilton Depression Rating Scale (HAM-D) — to evaluate depression, the Asthenic State Scale (ASS) — to diagnose asthenic condition, and the Mini Mental State Examination (MMSE) — to study the severity of cognitive disorder. RD course progression was assessed 3, 6, 9 and 12 months after the experienced COVID-19. Results: 75.3% of patients with RD had complaints characteristic of PCS, which could persist up to 12 months after undergoing COVID-19. 3 months after the COVID-19, during case follow-up and filling out the in-depth medical examination questionnaire, it was noticed that patients most commonly complained of increased joint pain (80.2% of patients), dyspnea, and reduced exercise tolerance (50.6% of patients). The second most common complaint was asthenovegetative manifestations. Given the analyze of RD activity in patients before, during and after the COVID-19 after 3, 6, 9 and 12 months, it was found that the maximum number of patients with RD exacerbation was 3 months after the COVID-19. It was also found that moderate and severe RD activity before COVID-19 had a direct effect on the incidence of increased joint pain 3 and 6 months after COVID-19. Patients with RD were significantly more likely to complain of reduced exercise tolerance, fatigue and muscle pain 3 and 6 months after COVID-19 versus patients with SpA. Anxiety-depressive disorders, cognitive impairments, and asthenic manifestations in the setting of PCS were registered more commonly in female patients for 6 months after undergoing COVID-19 than in male patients. Conclusion: complaints characteristic of PCS were revealed in most of the patients with RD, persisting up to a year after the COVID-19: arthralgia and asthenic manifestations (fatigue, faintness) were most common in the respondents. Moderate and severe RD activity before the COVID-19 caused increased joint pain 3 and 6 months after the recovery from COVID-19. 3 months after the experienced COVID-19, patients with RD had more complaints characteristic of PCS and an increase RD activity itself. The gender patterns during the PCS course in patients with RD were also revealed. KEYWORDS: new coronavirus infection, rheumatic diseases, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, postcovid syndrome, in-depth health check-up, musculoskeletal manifestations, anxiety, depression, cognitive impairment, asthenia. FOR CITATION: Mukhamadieva V.N., Shamsutdinova N.G., Abdrakipov R.Z., Mukhina R.G., Abdulganieva D.I. Postcovid syndrome in patients with rheumatic diseases. Russian Medical Inquiry. 2023;7(7):452–459 (in Russ.). DOI: 10.32364/2587-6821-2023-7-7-8.

Легітимність влади: чинники детермінації у повоєнній Україні

In the center of the article is an analysis of the transformation of Ukrainians and our civil society during the first year of the full-scale Russian-Ukrainian war, conducted by the author with the aim of determining the possible limits of the format of the post-war normalization of the defects of Ukrainian democracy. Among the defects is the functioning of power, which gains the influence due to the electoral procedures of electoral democracies, but does not receive final legitimation due to the lack or even absence of public trust. The political product of the crisis of legitimacy of power in transit Ukrainian democracy is a weak state with dual institutions and an asthenic state of Ukrainian society with a dual national identity. The full-scale Russian-Ukrainian war created unique grounds (for the first time in 30 years after the renewal of Ukrainian independence) for the localization of the influence of the crisis of the legitimacy of power on the Ukrainian political system. The value evolution of Ukrainians, the active formation of national and civil identities, the unification of society, the formation of high level of trust of Ukrainians to the authorities, and the acquisition of new experiences by civil society – all these factors give hope for the formation and implementation of conventional instruments for overcoming crises and, accordingly, for the active promotion of Ukrainian democracy towards consolidation. The author notes that the qualitative construction of anti-crisis policies for the nearest future requires avoiding voluntarism when assessing the modernization potential of society, which determines the reforming potential of civil society. An objective look at modern Ukrainians forces us to recognize the fact that we have preserved a certain value dichotomy, certainly in much smaller sizes than on the eve of February 24, 2022. The axiological specificity of modern Ukrainians will also determine the post-war opportunities of civil society. Therefore, civil society will be active in the areas of supporting reforms, resuming all democratic procedures and processes after the end of hostilities, and actively formation of a new culture of discourse within the country. Advocacy of liberal democracy requires the participation of an exogenous actor.

Выявление аффективных нарушений в период установления диагноза «рассеянный склероз»

Aim: To study emotional disorders and response to stress in patients with multiple sclerosis (MS) at the diagnostic stage. Design: Comparative prospective study. Materials and methods. We examined 30 MS patients who were not taking any disease-modifying drugs. The age of patients was 34 ± 9 years; Kurtzke Expanded Disability Status Scale: 1.7 ± 1.3 points. Beck Self-Rating Depression Inventory and V. M. Bekhterev Self-Rating Depression Inventory, State-Trait Anxiety Inventory, Asthenic State Scale, Psychological Diagnostics of Coping Mechanisms, Coping Strategies questionnaire, were used. Results. MS patients were divided into groups depending on the presence/absence of symptoms of depression (n = 18 and n = 12). The patients with depression had statistically higher (р < 0.05) number of asthenic manifestations and anxiety disorders, emotional releases with fixation on negative events. In order to reduce stress, patients chose to avoid the problem. Conclusion. Identified emotional disorders aggravate the overall condition of MS patients, reduce stress tolerance and ability to social adaptation; they lead to more complex symptoms and possible disease progression. Keywords: multiple sclerosis, depression, anxiety, copin mechanisms, ways of coping with stress.

Biomarkers of neuroinflammation in patients with chronic cerebral ischemia during the therapy with vinpocetine (study INFLAMARK)

To evaluate the effect of vinpocetine therapy on clinical manifestations of chronic cerebral ischemia (CCI) and the blood concentrations of neuroinflammation markers (S100B, IL-1β). The study included 30 patients (mean age 61.6 [56.9; 67.9] years) with CCI that received vinpocetine (30 mg/day) for 3 months. Brain changes according to magnetic resonance imaging data were assessed using the STRIVE protocol. We analyzed the dynamics of changes in the clinical questionnaires: Montreal Cognitive Assessment Scale (MoCA), Hospital Anxiety and Depression Scale (HADS), Asthenic State Scale (ASS), Epworth Sleepiness Scale (ESS), general impressions of treatment (Global Rating of Change Scale, GRC). In 3 months after vinpocetine therapy there was a significant improvement in cognitive status (MoCA: 25.1±2.1 vs 26.6±1.4 p<0.05), emotional state (HADS: 8.4±1.4 vs 7.1±1.8 (p<0.05)), daytime sleep parameters (ESS 8.4±2.1 vs 6.2±2.3 p<0.05) and reduction in asthenia (ASS: 72.2±18.1 vs 52.3±9.3, p<0.05). A significantly larger proportion of patients assessed the improvement from therapy as «moderate» and «pronounced» (GRC, n=22, 73.3%). Concentrations of S100B and IL-1β decreased significantly by the time therapy was completed. The overall severity of cerebrovascular changes according to MRI was significantly associated with blood levels of S100β, but not IL-1β: β=0.504, p=0.026, 95% CI 0.149-0.901, mainly due to periventricular changes in white matter (β=0.562, p=0.035, 95% CI (-0.024-0.820). Blood levels of S100β correlated with MoCA test results (r=0.6795), and IL-1β correlated with ESS scores (r=0. 6657). The use of vinpocetine can significantly reduce the severity of cognitive and affective disorders, asthenia, normalize the circadian rhythm of sleep, suppress the expression S100β and IL-1β in patients with CCI. One of the vinpocetine's mechanisms of action may be the inhibition of neuroinflammation.

Choline preparations in the treatment of asthenic states: modernity and perspectives (A Clinical Case Presentation)

In this article, we want to present the reader with an interesting clinical case from authors’ practice, which, in our opinion, clearly demonstrates the efficacy and safety of using Gliatilin (choline alfoscerate) as a part of combination therapy in a 19-year-old man with so-called «long COVID syndrome», manifesting itself predominantly as mix of symptoms of asthenia, depression, anxiety, sleep and cognitive difficulties. This patient, for his ideological reasons and beliefs, refused taking antidepressants, anxiolytics, as well as any other psychotropic drugs. At the same time, the patient asked for help in choosing «a treatment, which will consist of only natural ingredients».

Features of treatment of chronic brain ischemia in young patients with arterial hypertension

Actuality: Increasing the frequency of hypertension among the young population is a socially significant problem. The insidiousness of hypertension in young people is that it has the character of a disease with few symptoms. Since hypertension plays one of the main roles in the pathogenesis of chronic disorders of cerebral blood circulation, including both arterial and venous systems, the search for pathogenetically determined medicinal approaches to the elimination of cerebrovascular disorders, especially at a young age, continues. The purpose of the study: to study the effectiveness, tolerability and safety of the combination of Flego and Cognitium in young patients with chronic cerebral ischemia (CMI) on the background of hypertension. Methods: clinical-neurological, psychodiagnostic (asthenic state scale (ASS), anxiety scores according to the Spielberger-Hanin scale and Beck depression scale, Montreal scale of cognitive function assessment (MoCA)), ultrasound examination, general scale of clinical impression, statistical. Results: 52 patients (28 men and 24 women) at a young age with AMI on the background of hypertension were examined. The median age of the examined patients was (37.7 ± 4.6) years; among them, 23 patients suffered from hypertension of the 1st century. and 29 patients with hypertension of the second stage. Patients were randomly divided into two groups - the first - 23 (44.2%) patients (received only hypotensive drugs), the second - 29 (55.8%) patients (in addition to the standard hypotensive therapy received a combination of Phlego and Cognitium). Dynamic monitoring of patients after 2 months of treatment did not show significant changes in the distribution structure of objective clinical and neurological symptoms. However, positive dynamics of indicators of cognitive functions and the psychoemotional state of the subjects were observed, as well as a statistically significant decrease in the blood flow rate in the direct sinus at the end of the 2-month course using the combination of Phlego and Cognitium (decreased from 36.27±2.84 cm/s to 25.65±1.47 cm/s.). Conclusions: The introduction of the combination of Phlego and Cognitium into the treatment of young patients with arterial hypertension and chronic brain ischemia had a positive effect on the subjective state, on indicators of asthenia, emotional and cognitive state of the patients. A significant positive effect was noted in the dynamics of venous blood flow indicators (speed of blood flow in the direct sinus). Such treatment was well tolerated by patients, had few side effects and was combined with other drugs

Neurological and neuropsychological characteristics of postconcussion syndrome following blast mild traumatic brain injury

A common complication of blast mild traumatic brain injury (mTBI) is postconcussion syndrome (PCS), the diagnostic criteria of which are based on the patient's subjective complaints. Creation of reliable tools for clinical signs of blast mild TBI objectification is of great priority. Objective: using a comprehensive neurological and neuropsychological examination to determine the characteristics of clinical signs of blast mild TBI in the long-term period to assess the correlation with the data of neurophysiological and radiological studies. Materials and methods. The study involved 115 male participants of hostilities in the East of Ukraine (main group) with a diagnosis of " PCS after previous blast mTBI " and 30 healthy individuals (control group). Patients were in the long-term period of injury (from 6 months to 3 years). After collecting complaints and medical history data, the neurological status and the state of cognitive functions were examined. The latter were studied using the questionnaire "Cicerone". Neuropsychological testing according to the Montreal Cognitive Assessment score (MoCA) was carried out. The Hospital Anxiety and Depression Scale (HADS) was also used, and to objectify asthenic disorders - the Asthenic State Scale (ASS). Results. Assessment of the severity of cognitive impairment using the questionnaire "Cicerone" allowed identifying three clinical variants of PCS: 1) with cognitive impairment in combination with affective disorders (44,3 ± 9,1) % of patients), 2) with a predominance of affective disorders (23,5 ± 7,7) % of patients), 3) moderate and mild disorders of the cognitive and affective spectrum in combination with moderate autonomic disorders ((32,2 ± 8,5) % of patients). In 43,5% of cases, according to the MoCA scale, a decrease in cognitive impairment was found for memorization (memory), attention, delayed recall, total score. According to the HADS scale, the distribution of patients was as follows: clinically significant anxiety was noted in (9,6%) patients, depression - in (11,3%) patients, combination of clinically significant anxiety with depression - in (5,2%) patients, subclinical symptoms of anxiety of various severity - in (55,7%) patients. The phenomena of asthenia due to fatigue with mood swings, loss of the ability to concentrate for a long time on mental and physical tasks occurred in all patients with PCS. Factors with a probably higher risk of cognitive impairment were identified: 1) complaints of extreme fatigue and headache, 2) neurological signs in the form of pyramidal insufficiency, brisk tendon reflexes, 3) anxiety level according to the HADS scale. They can be considered as predictors of detection of cognitive deficit in patients with PCS as a result of blast mild TBI. Conclusions. Comprehensive neurological and neuropsychological examination is an effective tool for diagnosing cognitive changes in PCS as a result of blast mild TBI.

Dynamics of neurocognitive indicators against the background of neuroprotective therapy of vertebrobasilar insufficiency with cerebral venous discirculation symptoms

The aim of the study was to assess the effect of Cytoflavin on the severity of neurocognitive parameters in patients with chronic cerebral ischemia, as well as vertebrobasilar insufficiency with symptoms of cerebral venous circulation. The study involved 60 patients who were divided into two groups. Cytoflavin was prescribed in the treatment group: once per day in the morning, slow intravenous drip of 10.0 ml per 200 ml of 0.9% sodium chloride solution, the duration of the infusion averaged 40–60 minutes for a course of 10 days with the transition to a tablet form — 2 tablets twice per day for 30 days against the background of standard basic therapy (acetylsalicylic acid and antihypertensive drugs). Patients in the comparison group received only basic therapy. The rating scales for headache (visual analogue scale) and asthenia (asthenic state scale) were used to assess the neurological status in addition to the standard clinical and labo ratory examination. It was revealed that the main clinical and neurological manifestations in patients with symptoms of cerebral venous discirculation are headaches (48 (80%) patients) and dizziness (53 (88.3%) patients). The incidence of dizziness increased with the progression of chronic cerebral ischemia, for example, at stage I dizziness occurred in 57% of cases, at stage II — in 78%, and at stage III — in 100%. When conducting a study of the headache severity dynamics on the VAS scale, a decrease in the intensity of headaches by 1.7 times (5.68±0.62 to 3.23±0.56 points, p[1]0.5) was noted in patients who received Cytoflavin, while only a slight decrease in the intensity of pain was noted in patients of the comparison group. In addition, the inclusion of the drug in the therapy regimens for patients with this pathology showed a significant decrease in the frequency of complaints, including specific «venous» complaints, the severity of cephalgic syndrome, as well as asthenic and autonomic disorders, which had a positive effect on the patients’ quality of life. The results obtained make it possible to recommend the inclusion of the drug in the therapy regimens for patients with symptoms of cerebral venous dysfunction.

DISORDERS OF ADAPTATION OF COMBATANTS AND THEIR MEDICAL AND PSYCHOLOGICAL REHABILITATION AT THE SANATORIUM STAGE OF TREATMENT

The aim of the study was on the basis of the study of clinical manifestations and mechanisms of the formation of disorders of psychological adaptation among the combatants, to develop the principles and program of their medical and psychological rehabilitation. Materials and methods: The study was attended by 153 people at the sanatorium and resort stage of treatment, of which 98 people were combatants and 55 people were civilians. The study used a set of methods aimed at the study of emotional disorders (HDRS, BDI, Spielberger Scale, “Asthenic state scale”), individual psychological features (Multilevel personal questionnaire “Adaptability,” Test questionnaire G. Shmishek, K. Leonhard), features of psychosocial functioning (Mississippian scale of PTSD-military version) and quality of life (WHOQOL-BREF). Results: At the stage of sanatorium treatment of combatants is important readaptation to peaceful living conditions. A clinical and psychological analysis of combatants showed that the presence of experienced state of subjective distress and emotional disorder leads to a decrease in the productivity of adaptation to a stressful event. The stress factor disrupted the integrity of the micro-social network of combatants and their system of social support and social values, with the prevailing sense of inability to overcome problems and build plans. A detailed analysis of the nature of depressive and anxiety manifestations was carried out, which allowed to determine the predictors of the violation of adaptation in combatants. Thus, on the basis of the study of clinical manifestations and mechanisms of the formation of disorders of psychological adaptation among the participants of hostilities, the principles of their medical and psychological rehabilitation at the sanatorium and resort stage of treatment are developed. Conclusions: The peculiarities of stress response in combatants as a component of personal potential play a role in the formation of predictors of psychological adaptation disorders among combatants. Psychological intervention at the tertiary stage of rehabilitation (sanatorium-resort) should be targeted, taking into account individual-psychological characteristics (preventors) and psychosocial factors (predictors)

Постковидный синдром у пациентов с воспалительными заболеваниями кишечника

Aim: to assess the presence and course of postcovid syndrome in patients with inflammatory bowel diseases (IBD), as well as to study the IBD course in the postcovid period. Patients and Methods: 125 patients with Crohn’s disease (CD) and ulcerative colitis (UC) in the postcovid period were sequentially included in the study. Assessment of the postcovid syndrome was conducted 3, 6, 9 or 12 months after acute period of COVID-19. A questionnaire included in an in-depth medical check-up for citizens who have experienced COVID-19 was used to identify the clinical symptoms of postcovid syndrome. The article presents the results of the following scales: Hospital Anxiety and Depression Scale (HADS) — to identify and evaluate the severity of depression and anxiety, Hamilton Depression Rating Scale (HAM-D) — to evaluate depression, Asthenic State Scale (ASS) — to diagnose asthenic condition, Mini Mental State Examination (MMSE) — to study the severity of cognitive disorder. The nature of the IBD course and the change in therapy were also evaluated. Results: 81 (64.8%) patients were diagnosed with CD, and 44 (35.2%) — with UC. The mean age of patients was 41.8±14.5 years, of which 68 (54.4%) were male, 57 (45.6%) — female. When filling up the questionnaire of the in-depth medical check-up 3 months after COVID-19, 47.8% of patients most commonly noted fatigue, and/or muscle pain, and/or headaches, and/or dysautonomia, and/or cognitive disorder, while 34.7% of patients — dyspnea, reduced exercise tolerance and/or chronic cough, and joint pain. Thus, postcovid manifestations occurred in approx. 47.8% of patients with IBD. An increase of complaints frequency, characteristic of postcovid syndrome, was noted by the 6th month after COVID-19. By the 9th and 12th month, the frequency of complaints decreased. When analyzing complaints related to asthenia, cognitive disorder, anxiety and depression, there was a tendency to the maximum number of disorders 6 months after COVID-19. Studying the activity in patients with IBD before, during and after COVID-19 (after 3, 6, 9 or 12 months), it was noted that the largest number of patients with acute IBD was 6 months after COVID-19. Conclusions: 47% of patients with IBD had complaints characteristic of postcovid syndrome, which persisted up to 12 months after COVID-19. Asthenia was the most common. Several complaints were increasing by the 6th month. IBD exacerbation rate reached its maximum value also by the 6th month after COVID-19. KEYWORDS: inflammatory bowel diseases, ulcerative colitis, Crohn’s disease, new coronavirus infection, COVID-19, postcovid syndrome, anxiety, depression, cognitive disorder, asthenia. FOR CITATION: Kupkenova L.M., Shamsutdinova N.G., Odintsova A.Kh. et al. Postcovid syndrome in patients with inflammatory bowel diseases. Russian Medical Inquiry. 2022;6(5):227–231 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-227-231.

Динамика психоэмоциональных характеристик и качества жизни у пациентов с ишемической болезнью сердца после коронарного шунтирования

Background. The study of psychoemotional characteristics and quality of life (QOL) in patients with CHD undergoing coronary artery bypass grafting (CABG) at different stages of treatment is crucial for enriching information about the characteristics of the psychological responses to illness and for the comprehensive analysis of the psychological aspects of recovery after CABG. The study was carried out at the Almazov National Medical Research Centre (St. Petersburg, Russia). The study sample comprised 65 patients with CHD preparing for CABG. Methods. Asthenic State Scale, Integrative Anxiety Test, The Symptom Checklist-90-R (SCL-90-R), and 36-Item Short Form Survey (SF-36). Results show that in the early postoperative periood, asthenia tends to intensify. State anxiety and its components decrease during the rehabilitation period after CABG. Both before and after CABG, patients have increased rates of psychopathological symptoms. A week after CABG, depressive and somatization symptoms intensify. 3 months after CABG, psychopathological symptoms tend to decrease, however, many indicators remain above the norm. Conclusion. The analysis of the QOL dynamics revealed the influence of the surgery on all QOL components. Psychological interventions for patients with CHD undergoing the CABG are necessary at all stages of the treatment and rehabilitation process.

DEPRESSION IN CANCER PATIENTS DURING COVID-19 PANDEMIC.

More than 100 million confirmed accidents and more than 2 million deaths - this is the summary of СOVID-19 in mid-2021 when the whole world is experiencing the worst twilight of the pandemic. At the same time, the WHO European Regional Office considers this period to be the tipping point of the pandemic, linking it to the beginning of mass vaccination and the accumulated experience in the diagnosis and treatment of COVID-19 and its consequences, Despite the emergence of new mutations of the virus, the presence of prolonged forms of the disease (long-COVID, or post-COVID syndrome) (World Health Organization. Statement by Dr. Hans Henri P. Kluge, WHO Regional Director for Europe. Copenhagen, 7 January 2021). Apart from psychotic disorders of infectious origin in СOVID-19 (mental confusion, psychomotor agitation, delirious, hallucinatory, beacon-like, and affective disorders), non-productive changes in consciousness may develop, post-traumatic stress disorder (PTSD), non-psychotic asthenic states, depression, hypochondriacally disorders, sleep disorders, autonomic manifestations, cognitive deficit disorder, secondary encephalopathy, organ disorders (Kumar S., et al., 2021; Einvik G, et al., 2021). The prevalence of infectious psychosis has a pronounced tendency to decrease, while non-psychotic and cognitive deficit disorders after COVID-19 occur more frequently (Hampshire A., et al., 2020). At this time, the rate of depression and anxiety disorders due to the influence of coronavirus infection is significantly higher than in previous years (McCracken L.M., et al., 2020; Kujawa A., et al., 2020). Among the predictors of their development under pandemic conditions are COVID-19 symptoms, history of somatic disorders, oncological diseases, interim measures, and financial losses. A major stressor effect of the COVID-19 pandemic can provokenosocomial depression in COVID-19 postinfectious cancer patients, a complication in the course of postinfectious depression, and an exacerbation of depression in patients with an infectious disorder in their medical history (Petelin D.S, 2018; Dorozhenok I.Yu., 2021). Depression invariably attracts the attention of physicians. The main reasons for this are its widespread and widespread manifestations and variants of disorder that affect a significant number of people of different stature, age, social groups, and cultures. Women suffer from depression more often than men. According to the World Health Organization, more than 350 million people in the world suffer from depression (World Health Organization.Depression., 2018). The prevalence of depression in cancer is significantly higher than in the general population and, according to physicians, ranges from 33 to 42% (Otroshchenko N. P., et al., 2019). Symptoms of depression are diagnosed in every fourth oncologic patient and occur more frequently in the later stages of the disease. Unfortunately, these patients do not often come into the psychiatrist's field of vision, because, considering the specifics of the disease, they are under the care of oncologists, and they turn to psychiatrists only in cases of major depression or suicidal attempts. High rates of depression (23%) are diagnosed with the most common forms of gynecologic cancer, cervical cancer, and uterine cancer (Arnaboldy P., et al., 2016; Bulletin of the National Cancer Registry N 20 - Cancer in Ukraine, 2017-2018; Petelin D.S., 2018; Otroshchenko N. P., et al., 2019). Comorbidity of oncologic diseases and coronavirus disease causes the risk of serious complications of these viral infections and requires the development and implementation of medical, social, and other protection measures for cancer patients, as well as for patients who have had cancer or other diseases and diseases that impair the function of the immune system (Tian, Y., et al., 2021). Therefore, the relevance of the study of post-covid depression (Hampshire A., et al., 2020; Kumar S., et al., 2021), including in patients with cancer (Tian, Y., et al, 2021), is due to the significant number of cervical and uterine cancerpatients, comorbidity, lack of early effective diagnosis, psychological and psychiatric support, late call for help, the tendency to chronicity, and risk of self-harm (Arnaboldy P., et al., 2016; Petelin D.S., 2018; Otroshchenko N. P., et al., 2019).

Clinical and psychopathological features of course and correction of depressive disorders in patients with brain tumors, prevention and rehabilitation

The article studys the psychological characteristics in patients with brain tumors of different localization which allows to reduce the diagnostic period and, as a result, minimize the time of early detection and the consequences of the surgical treatment of this pathology, and to cause a positive effect on preventing the development of psychopathological disorders at the hospital stage. Analysis of the clinical manifestations of depressive disorders of the subclinical level revealed their polymorphism: depression was accompanied by various variants of asthenic (prevalence of dyssomnias, psychalgia, adynamia and anxiety component) and anxiety (prevalence of senestopathies, hypochondria, phobia) states. The revealed symptom complexes of psychopathological and pathopsychological characteristics of the patient's condition were the clinical justification for the choice of methods of psychotherapeutic correction. Adjuvant psycho­logical therapy, individual rational and family psychotherapy were used as the basic method of psycho­therapeutic influence. Pharmacological correction included: anxiolytics, antidepressants, atypical mild antipsychotics in low doses. The results of the SCL-90-R test demonstrate the effectiveness of the comprehensive treatment aimed at preventing and reducing the manifestations of psychopathological symptoms. Comparison of the mean values of the SCL-90-R test revealed significant differences in such indicators as somatization (p&lt;0.05), depressiveness (p&lt;0.01), anxiety (p&lt;0.05); high statistical significance is noted in the “index of symptom severity” integral indicator (p&lt;0.01). Obtained results of psychological and psychiatric research became the basis for the development of differential diagnostic criteria for the diagnosis and prevention of the development of mental disorders.