 Subjects -> PSYCHOLOGY (Total: 983 journals)
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- Optimization of migraine attacks relief
Authors: Tabeeva G.R; Amelin A.V, Akhmadeeva L.R, Danilov A.B, Doronina O.B, Koreshkina M.I, Latysheva N.V, Mendelevich E.G, Sarvilina I.V, Sergeev A.V, Skorobogatykh K.V, Filatova E.G.
Abstract: On December 24, 2022, in Moscow an interdisciplinary Council of Headache Experts, held under the auspice of the interregional public organization “Russian Society for the Study of Headache”, discussed the key problems of effective treatment of a migraine attack and the possibilities of a specific drug Kaporiza® (rizatriptan). Despite the development of strategies for the relief of migraine attacks and the effectiveness of triptans as first-line therapy, the choice of a specific drug in accordance with the individual clinical profile of the patient is difficult due to the existence of drugs in various forms (standard tablets, oral dispersible forms, injections, nasal sprays, rectal suppositories). Rizatriptan in the form of an orally dispersible tablet (ODT) has a number of advantages: high bioavailability, fast onset of action, and ease of use. Therefore, Kaporiza® (rizatriptan ODT) may be recommended as a priority therapy for all migraine patients who prefer the dispersible tablet form and who experience symptoms of nausea and vomiting, as well as for patients who have experience of poor efficacy and/or poor tolerability of other triptans. The Expert Council recommends to include rizatriptan ODT in the next edition of the clinical guidelines for the diagnosis and treatment of migraine as a first-line agent with Level A evidence.
PubDate: Mon, 01 May 2023 00:00:00 +030
- New pharmaconutraceutical Chondroguard®TRIO for the prevention of
musculoskeletal diseases and nutritional support for patients with
osteoarthritis and nonspecific back pain: an assessment of clinical
options. Resolution of the Multidisciplinary Expert Council
Authors: Danilov A.B; Lila A.M, Majidova Y.N, Gromova O.A, Tkacheva O.N, Sarvilina I.V, Kochish A.Y, Nazarenko A.G, Zagorodniy N.V, Minasov T.B, Alekseeva L.I, Taskina E.A, Kotovskaya Y.V, Dudinskaya E.N, Rozanov A.V, Solovieva E.Y, Shavlovskaya O.A, Sharov M.N, Kamchatnov P.R, Rachin A.P, Barantsevich E.R, Iskra D.A, Yakupov E.Z, Devlikamova F.I, Barulin A.E, Nesterova M.V, Sakovets T.G, Barinov A.N, Dolgova I.N, Zabolotskikh N.V, Zonova E.V, Shchepankevich L.A, Parfenov V.A, Dzhurabekova A.T, Khakimova S.Z.
Abstract: In recent decades, there has been an increase in the prevalence and medical and social burden of osteoarthritis (OA) and nonspecific back pain in all countries of the world. The First Multidisciplinary Bilateral Russia-Uzbekistan Expert Council presented innovations in the prognosing, personalized prevention and adjuvant therapy of degenerative-dystrophic diseases of the joints and spine, the evidence base for the effectiveness and safety of the use of drugs that modify the course of OA (Disease-modifying osteoarthritis drugs, DMOADs): chondroitin sulfate, glucosamine sulfate, undenatured type II collagen for adjuvant pharmaconutraceutical support – prevention and adjuvant therapy (treatment) of OA and nonspecific lumbosacral pain.
The expert counsil resolution presents an optimized algorithm for the management, prevention and adjuvant therapy of OA and non-specific back pain, maintaining the function of healthy joints after intense physical activity with the inclusion of the drug Chondroguard solution for intra-articular and intramuscular administration (INN – chondroitin sulfate) and a new pharmaconutraceutical from the DMOADs group – TRIO trademark Chondroguard® (Chondroguard®TRIO).
PubDate: Mon, 01 May 2023 00:00:00 +030
- Clinical course and diagnosis of cerebral vein and sinus thrombosis
associated with COVID-19 in young and middle-aged patients
Authors: Klocheva E.G; Goldobin V.V, Olimova F.Z.
Abstract: Cerebral venous thrombosis (CVT) is a form of cerebrovascular disorders that is difficult to recognize, it is potentially a life threatening condition and requires timely anticoagulant therapy. In the era of the COVID-19 pandemic, there is a steady increase in CVT (4.2% vs. 0.5–1%). At the same time, mortality in patients with CVT on the background of COVID-19 significantly exceeds the mortality in patients with CVT without COVID-19 (45.5% vs. 15%).
Objective: to study the clinical course of CVT, to determine the diagnostic value of radiological methods and the significance of genetic risk factors for thrombosis in the development of CVT in young and middle-aged patients against the background of COVID-19.
Material and methods. Seven patients were examined: six women (five of them of reproductive age) and one man, aged 26 to 57 years (mean age 37 years). The main clinical and neurological manifestations of CVT, the results of laboratory examination, neuroimaging, and the data of molecular genetic analysis of risk factors for thrombosis were analyzed.
Results. The course of COVID-19 was severe in one case, and moderate in the rest of cases. The interval between the onset of COVID-19 symptoms and the development of CVT ranged from 7 to 25 days. In three cases CVT had an acute course and was accompanied by the development of a stroke (in two cases, hemorrhagic stroke was noted, in one case, multifocal ischemic stroke), in other cases, a subacute course of CVT was noted. Genetic risk factors for thrombosis were identified in all patients.
Conclusion. The diagnosis of CVT in the era of the COVID-19 pandemic is particularly difficult, since the most common symptom of CVT – headache (90%) – can be regarded as a manifestation of COVID-19. At the same time, timely diagnosis of CVT and immediate initiation of anticoagulant therapy are associated with a relatively favorable prognosis.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Quality of life of patients with rheumatoid arthritis and comorbid
fibromyalgia
Authors: Melikova N.A; Filatova E.S, Filatova E.G, Lila A.M.
Abstract: Objective: to evaluate the impact of comorbid fibromyalgia (FM) on the quality of life (QoL) of patients with rheumatoid arthritis (RA).
Material and methods. The study involved 90 patients with confirmed RA who complained of chronic pain. All patients underwent general clinical and laboratory examination. FM was diagnosed according to the 2016 ACR criteria. The questionnaires assessed the presence and severity of fatigue (FSS), anxiety and depression (HADS), sleep disorders (PSQI), cognitive impairment (DSST), symptoms of central sensitization (CSI) and the neuropathic component of pain (DN4, PD). The severity of pain syndrome (PS) was assessed by 10-cm VAS at rest. QoL was assessed using the EQ-5D questionnaire.
Results. In the main (FM+) and control (FM-) groups, the average severity of PS according to VAS at rest was 7 and 4 cm (p<0.001), the average score on the CSI questionnaire was 50 and 38.5 (p<0.001), and according to the PD questionnaire – 17 and 11 (p<0.001), respectively. Analysis of the severity of comorbid disorders revealed significant differences between the groups in terms of such parameters as fatigue (p=0.003), anxiety (p=0.001), sleep quality (p<0.001) and cognitive impairment (p=0.021). The QoL of patients (according to EQ-5D) in the main group was significantly lower (0.52 vs. 0.59; p=0.003). Significant correlations were found between the QoL index according to EQ-5D and VAS, FSS and PD values in both groups, CSI, DN4, HADS-T parameters and the number of painful joints – only in the main group.
Conclusion. Concomitant FM significantly reduces the QoL of patients with RA. The main factors affecting QoL in patients with RA and comorbid FM were the intensity and neuropathic phenotype of PS, increased fatigue and anxiety. Patients with FM are also significantly more likely to have sleep and cognitive impairments.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Prediction of cerebral ischemia during carotid stenting depending on the
intensity of the preoperative ultrasound signal from the plaque
Authors: Tanashyan M.M; Medvedev R.B, Anufriev P.L, Gemdzhian E.G, Shchipakin V.L, Koshcheev A.Y, Krotenkova M.V.
Abstract: Carotid stenting is an effective method for improving cerebral perfusion; risk assessment of cerebral embolism associated with this intervention remains a hot research topic.
Objective: to identify predictors of cerebral embolism associated with carotid angioplasty with stenting (CAS).
Material and methods. A prospective exploratory research included 46 patients (age from 44 to 81 years, median 65 years) with atherosclerotic stenosis of the internal carotid artery, who underwent CAS and were treated at the Scientific Center of Neurology (Moscow). The study did not include patients with restenosis, stroke with severe disability, contraindications for antiplatelet therapy, statins, and MRI examination. All patients underwent preoperative ultrasonographic (US) examination and postoperative histological examination of particles in carotid stent embolic protection devices. The state of the brain was assessed before and 24 hours after CAS using diffusion-weighted MRI. To identify predictors of the development of cerebral embolism, the clinical characteristics of patients, together with ultrasonographic and morphological data, were examined in a multivariate statistical analysis.
Results. Preoperative US signal from an atherosclerotic plaque of high (estimated above 35 dB) intensity was associated with dense matter (in a protective device) of the "fibrosis with calcification" and "calcification" type and with a high probability (80%; 95% confidence interval 71–85% ) predicted intraoperative embolization of cerebral vessels with the acute ischemic lesions (AIL) formation. In a low (not higher than 35 dB) intensity of the preoperative ultrasound signal, the probability of AIL formation was statistically significantly lower (50%).
Conclusion. There is a direct correlation between the intensity of the ultrasound signal and the density of the substance in the protective device. A high intensity of the preoperative ultrasound signal (estimated above 35 dB) is an unfavorable predictor of AIL, associated with CAS (with a probability of about 80%).
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Readiness potential as a neurophysiological marker of functional movement
disorders
Authors: Tolmacheva V.A; Dudnik E.N, Shishorin R.M, Petelin D.S, Bezrukov V.E, Gamirova A.N, Dolgopolova Y.V, Volel B.A.
Abstract: Functional movement disorders (FMD) are widespread and have a significant negative impact on the quality of life of patients. The pathogenesis is not completely clear, but currently there is ongoing research on searching for biological markers using methods such as functional magnetic resonance imaging and electroencephalography (EEG).
Objective: detection of the features of the amplitude-frequency characteristics of the readiness potential (RP) formed during FMD.
Material and methods. We examined 22 patients with a clinically diagnosed FMD and 22 healthy volunteers (all participants were right-handed). Both patients and the control group underwent an EEG in Erickson's Flanker paradigm with registration of the RP. RP was recorded in the projection area of the precentral gyrus (electrodes C3/C4/C5/C6 in the standard 10–20 overlay scheme).
Results. Comparative analysis of RP parameters showed the presence of significant frequency-amplitude differences between the main group and the control group in the right hemisphere in the absence of significant differences in the left hemisphere. At the same time, significant differences were demonstrated between the FMR group and the control group both in terms of the latent period (time to the onset of RP): 33.66±23.69 ms versus 276.28±176.1 ms (p<0.05), and its amplitude: -0.85±0.294 μV versus -0.35±0.26 μV (p<0.05).
Conclusion. The results of the present study suggest that neurophysiological parameters such as RP can be considered as a potential diagnostic marker to improve the diagnosis of FMR.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Rapidly progressive dementia with early onset associated with the I143T
mutation in the PSEN1 gene: a clinical case in a family from Russia
Authors: Shpilyukova Y.A; Protopopova A.O, Abramycheva N.Y, Fedotova E.Y, Illarioshkin S.N.
Abstract: Rapidly progressive dementias are a rare group of cognitive disorders that primarily require the exclusion of a large number of potentially reversible causes. Prion diseases are frequent in this group of disorders. Some hereditary forms of Alzheimer's disease can also be aggressive, with onset at a young age and autosomal dominant inheritance in the family. The article presents the first case report of a patient with a verified Ile143Thr mutation in the PSEN1 gene in a Russian family with a phenotype similar to the hereditary form of Creutzfeldt–Jakob disease. The specific features of the disease, diagnostic methods, and possible pathogenesis of the development are discussed.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Cognitive disorders in amyotrophic lateral sclerosis
Authors: Kutlubaev M.A; Areprintceva D.K, Pervushina E.V, Brylev L.V.
Abstract: Cognitive disorders (CD) are observed in more than half of patients with amyotrophic lateral sclerosis (ALS), but rarely reach the degree of dementia. Currently, a classification of ALS has been proposed depending on the presence of cognitive and/or behavioral disorders. CD in ALS can be represented by speech fluency disorders, various aphasic disorders, disorders of regulatory functions, social cognitive functions, and verbal memory. The most diagnostically sensitive are special scales, such as the Edinburgh Cognitive and Behavioral Impairment Screening Scale for ALS. CD in ALS have a negative impact on the outcome of the disease and the quality of life of patients and their families. This issue requires further study.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Headache and epilepsy: prevalence and clinical variants
Authors: Osipova V.V; Artemenko A.R, Shmidt D.A, Antipenko E.A.
Abstract: Headache, which is often present in patients with epilepsy, can occur outside of epileptic seizures as well as have a temporary connection with them – occur immediately before, during or after an attack. Clinical types of headache in epilepsy are considered in the International Classification of Headache, but not in the classification of epileptic seizures and types of epilepsy. Meanwhile, the presence of concomitant headache and its clinical phenotype should be taken into account when choosing treatment tactics in patients with epilepsy.
The article presents data on the prevalence of different types of headache in patients with epilepsy and a modern classification of cephalalgia depending on the temporal relationship with an epileptic attack. Diagnostic criteria for four clinical variants of cephalgia are given: interictal, preictal, ictal and postictal. The comorbid relationship between epilepsy and migraine is considered in more detail, including the pathophysiological mechanisms underlying the combination of these paroxysmal conditions.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Depression in patients with cerebral microangiopathy
Authors: Bogolepova A.N.
Abstract: Cerebral microangiopathy (CMA) is one of the significant causes of depression in the elderly. Close associations of the risk of developing depression with white matter hyperintensity, the presence of lacunar infarcts, and other markers of vascular disease are shown. The available data suggest that various vascular mechanisms, in particular, involvement of small vessels of the brain, generalized microvascular and endothelial dysfunction, metabolic risk factors, – are risk factors for the development of depression. Pathogenetic mechanisms include cerebral hypoperfusion and immune dysregulation. Depression is also a common complication of coronavirus infection, occurring both in the acute and postCOVID periods. The same mechanisms as in vascular depression are involved in the pathogenesis of the development of post-COVID depressive disorders.
Given the complexity of the mechanisms of development of depressive disorders in patients with CMA, the presence of severe comorbid vascular pathology, antidepressants with an optimal ratio of efficacy and safety should be preferred. Agomelatine (Valdoxan) is one of such drugs.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Management of patients with chronic cerebrovascular disease
Authors: Starchina Y.A; Kosivtsova O.V, Sokolov E.A.
Abstract: Cerebrovascular disease is one of the most common pathologies in the practice of a neurologist. Vascular cognitive impairment is the earliest and most objective sign of cerebrovascular pathology. The correction of vascular risk factors – antihypertensive, antiplatelet, lipid-lowering therapy, have the leading role in the treatment of patients with cerebrovascular diseases. It is necessary to pay special attention to non-drug methods of therapy, such as quitting smoking and alcohol abuse, regular physical activity. The possibilities of using dipyridamole for symptomatic and pathogenetic therapy are discussed.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Diagnosis and therapy of obsessive-compulsive spectrum disorders in
general medical and neurological practice
Authors: Petelin D.S; Gamirova A.N, Sorokina O.Y, Troshina D.V, Semin S.A, Boltueva M.S, Volel B.A.
Abstract: Obsessive-compulsive spectrum disorders are widely represented in the population and often encountered in clinical practice, but they are not well diagnosed and many patients do not receive proper treatment. This review discusses the prevalence of obsessive-compulsive spectrum disorders, their negative impact on the level of functioning of patients, comorbidity with other mental disorders, diagnosis and differential diagnosis. The emphasis is put on changes in approaches to the diagnosis of obsessive-compulsive disorders that will occur after the introduction of the International Classification of Diseases of the 11th revision (ICD-11). Approaches to the treatment of obsessive-compulsive spectrum disorders are discussed in accordance with the principles of evidence-based medicine, and the use of selective serotonin reuptake inhibitors and cognitive behavioral therapy as first-line therapy is justified.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Vascular cognitive impairment: issues of diagnosis and treatment
Authors: Lokshina A.B; Grishina D.A, Zakharov V.V.
Abstract: Vascular brain diseases are one of the leading causes of death and disability in developed countries. Along with acute disturbance of cerebral circulation, chronic cerebrovascular diseases, which manifest as vascular cognitive impairment (VCI), are of great medical and social importance. VCIs include a wide range of cognitive impairments (CI) ranging from subjective CI to vascular and mixed dementia. The article discusses pathogenetic and clinical variants, approaches to the diagnosis of VCIs, and provides their modern classification. The features of CI, typical for chronic cerebrovascular insufficiency, are described, such as a slowdown in the rate of mental activity and disorders of frontal executive functions in combination with behavioral and emotional disorders. The issues of treatment of VCI are discussed, which should be comprehensive and include correction of the underlying vascular disease, non-drug (regular physical activity, smoking cessation, cognitive training) and drug treatments aimed at improving cognitive functions. The possibilities of modern neuroprotective and symptomatic therapy of CI, including the use of Cellex®, are shown.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Efficacy and safety of aceclofenac in musculoskeletal diseases
Authors: Isaikina M.A; Isaikin A.I, Akhmedzhanova L.T.
Abstract: Musculoskeletal system pathology is one of the main causes of morbidity and disability worldwide. Inflammation plays the leading role in the genesis of these diseases. Pain is the most important factor leading to a critical decrease in the quality of life and limitation of daily activities. Most current international guidelines for the treatment of acute and chronic low back and neck pain, osteoarthritis, rheumatoid arthritis and other diseases recommend oral non-steroidal anti-inflammatory drugs as first-line therapy. The article presents data from the latest domestic and international studies, including the results of the largest SOS study, which demonstrated the high efficacy and safety of aceclofenac (Aertal) in acute and chronic neck and back pain.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Antioxidant therapy in the complex treatment of patients with ischemic
stroke in the acute and recovery period
Authors: Belova Y.A; Kotov S.V.
Abstract: Improvement of therapy of patients with ischemic stroke (IS) remains a relevant problem, despite the widespread use of drug and mechanical revascularization methods during recent years. One of the pathogenetic mechanisms of IS is oxidative stress as one of the components of brain tissue damage in the acute period and a factor that prevents the processes of repair and neuroplasticity in the recovery period. This is the rationale for the use of antioxidant drugs in the acute and recovery periods of stroke. Data from clinical studies on the use of antioxidants in the treatment of patients with IS are presented.
We describe the use of the domestic drug dimephosphone (dimethyloxobutylphosphonyl dimethylate), a synthetic non-anticholinesterase organophosphorus compound, which has a wide range of effects: antioxidant, antacidotic, vasodilating, membrane stabilizing, anti-inflammatory, etc. Data are given on the use of dimephosphone in the acute period of IS in patients with no indications for thrombolytic therapy, there was a decrease in neurological deficit and a decrease in disability. The positive results of the use of dimephosphone in the recovery period of IS and in chronic cerebrovascular insufficiency are described. The data of our own study on the use of dimephosphone in the complex therapy of cognitive rehabilitation of patients in the recovery period of IS are presented. A statistically significant recovery of cognitive functions was registered according to the Montreal Cognitive Scale (MoCA), and an increase in the MoCA score by 2 points or more in 59.6% of patients. An improvement in executive functions, an increase in the flexibility of cognitive control of cognitive processes, and the predominance of verbal thinking over sensory-perceptual were noted.
PubDate: Sun, 30 Apr 2023 00:00:00 +030
- Possibilities of multimodal neuroprotection in patients with chronic
cerebral ischemia on the background of arterial hypertension and
atherosclerosis
Authors: Gribacheva I.A; Popova T.F, Petrova E.V, Zvonkova A.V.
Abstract: hronic cerebrovascular pathology is manifested by a combination of cognitive, emotional and autonomic disorders. Correct and timely assessment and accurate diagnosis of emotional and autonomic disorders and their timely correction are important, among other things, for slowing down the progression of cognitive deficits.
Objective: to study the efficacy and safety of Mexidol administered intravenously by drip infusion (500 mg 1 time per day) for 14 days, followed by oral administration of the drug Mexidol FORTE 250 at a dose of 250 mg 3 times a day for 60 days in middle-aged patients with chronic cerebral ischemia (CCI) on the background of arterial hypertension and atherosclerosis.
Material and methods. The open observational program included 60 patients aged 45 to 59 years with CCI, confirmed by the results of a neuropsychological and neuroimaging examination. Patients received Mexidol first intravenously (14 days), and then orally in pills – Mexidol FORTE 250 (60 days). Patients underwent neuropsychological testing, assessment of the level of reactive and personal anxiety (Spielberger–Khanin scale), of vegetative disfunction (A.M. Wayne's autonomic response scale modified by V.L. Golubev), of the severity of general, mental and physical asthenia (MFI-20) and quality of life (MOS SF-36 questionnaire).
Results. The results of the treatment made it possible to establish relief of asthenic syndrome and vegetative dysfunction on the background of Mexidol use. The differences were statistically significant both when comparing with the baseline and with the comparison group (p<0.05). The use of Mexidol was accompanied by a decrease in the severity of complaints and subjective symptoms. The combination of positive effects led to an increase in indicators of quality of life (p<0.05). The treatment was well tolerated.
Conclusion. Patients with CCI have significant emotional, vegetative and asthenic disorders. The use of Mexidol can reduce the severity of these disorders, which gives reason to recommend it for the treatment of such patients.
PubDate: Sat, 29 Apr 2023 00:00:00 +030
- Withdrawal of valproic acid during pregnancy in women with epilepsy
Authors: Navumava H.I; Vlasov P.N, Prusakova A.I, Usoltseva A.A, Shnayder N.A, Dmitrenko D.V.
Abstract: Objective: to analyze the course of epilepsy in women after withdrawal of valproic acid (VA) during pregnancy.
Material and methods. The study was conducted in the Center of paroxysmal conditions of Vitebsk Regional Clinical Diagnostic Center. The study included 58 women with epilepsy who gave birth in 2018–2020; a prospective analysis was also done using the Russian Register of Pregnancy and Epilepsy (RRPE) data. The study group included 112 women with epilepsy who were taking VA at the time of conception. In 16.1% of cases (n=18 out of 112) VA was discontinued in the first trimester (withdrawal group), in 83.9% of cases (n=94) VA therapy was continued. We analyzed the frequency of epileptic seizures depending on the use of VA during pregnancy for each trimester and for the entire pregnancy as a whole.
Results. According to the Vitebsk Regional Clinical Diagnostic Center, 32 out of 58 (55.2%) patients took VA, all of them had generalized tonicclonic seizures in the structure of epileptic seizures. Seven of 32 patients (21.8%) received VA at a dose of <700 mg/day; 10 (31.3%) – 700–1000 mg/day, 15 (46.9%) – 1000–1500 mg/day. VA was canceled in two cases, in one of them a tonic-clonic seizure developed. According to the RRPE data, in 9 out of 65 (13.8%) cases VA was discontinued in the first trimester (withdrawal group), in 55 out of 65 (84.6%) cases the therapy with VA was continued, and in one case - the drug was changed. The number of women with epilepsy taking VA during pregnancy has decreased from 38.9% (275 out of 707) in 2017 to 24.9% (112 out of 450) by January 2023. According to the RRPE, the majority of patients continued VA therapy during gestation if pregnancy occurred while taking this antiepileptic drug. A high fraction of prescribing VA in patients with focal epilepsy was registered – 58.9% (66 out of 112) with continuation of VA therapy during pregnancy in 61.7% of cases. Among patients with generalized form of epilepsy, VA drugs were taken by 36.6% (41 out of 112). The majority of patients (35.1%; 33 of 94) continued to take VA throughout the entire gestation. About half of the patients took VA at a dose of >700 mg/day in the first trimester and throughout gestation. There were no statistically significant differences in the frequency of tonic-clonic and other types of epileptic seizures during pregnancy in patients who canceled VA and continued therapy, according to RRPE.
Conclusion. Further prospective and controlled studies with large sample sizes are needed to determine the most effective and safe strategy for VA withdrawal.
PubDate: Sat, 29 Apr 2023 00:00:00 +030
- The use of antidepressants in neurological practice
Authors: Parfenov V.A.
Abstract: Antidepressants are widely used in neurological practice, and their use in stroke, Alzheimer's disease, depression with cognitive impairment, Parkinson's disease, multiple sclerosis, chronic back pain and chronic migraine is discussed. Antidepressants are used in the presence of severe depressive symptoms, which are observed in 20–30% of neurological patients. The effect of antidepressants is higher in case of combination with recurrent depression. Presence of episodes of depression before the development of a neurological disease, history of effectiveness of antidepressants, hereditary burden of affective disorders, characteristic daily dynamics of symptoms with typical impaired sleep architecture indicate the likelihood of a combined affective disorder. Final establishment of a psychiatric diagnosis is possible with a consultation of a neurological patient by a psychiatrist, but in clinical practice this is realistic only in a small number of patients. The most commonly used antidepressants are selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants in low or medium doses, the duration of their administration is usually at least 3-6 months. In neurological diseases, the effectiveness of only some drugs has been noted, many antidepressants have not been studied in neurological diseases, but this does not exclude their effectiveness. When prescribing antidepressants, it is necessary to take into account possible drug interactions and avoid those combinations that may cause adverse reactions. It is advisable to use antidepressants in complex therapy in combination with an educational program, cognitive behavioral therapy and kinesiotherapy. Many questions regarding the efficacy and safety of treatment, the choice of the optimal antidepressant, its dosage and duration of use require further study.
PubDate: Fri, 21 Apr 2023 00:00:00 +030
- Patient with non-cardioembolic ischemic stroke or high-risk transient
ischemic attack. Part 1. Diagnosis
Authors: Kulesh A.A; Yanishevsky S.N, Demin D.A, Syromyatnikova L.I, Vinogradov O.I.
Abstract: Non-cardioembolic stroke and transient ischemic attack (TIA) are heterogeneous conditions, some variants of which are associated with a high short-term and long-term risk of cardiovascular events. The article presents clinical portraits of patients in high and very high risk groups: 1) patients with extracranial atherosclerosis and severe stenosis/subocclusion/occlusion or CT signs of atherosclerotic plaque instability; 2) all patients with intracranial atherosclerosis, especially those with symptoms of hemodynamic compromise or multiple infarcts; 3) all patients with mobile/ulcerative atheroma of the aortic arch. For the timely identification of these subtypes, it is necessary to use clinical and radiological clues with necessary diagnostic search. In addition, the following patients with TIA may be at high or very high risk: those with an ABCD2 score of ≥4 points or an ABCD3-I score of ≥8 points; with TIA in the vertebrobasilar basin, "crescendo" or "limb shaking" type, orthostatic TIA, as well as patients with warning capsular and bridge syndromes. Assigning a patient to one of the considered categories requires the immediate administration of enhanced secondary prevention, which will be discussed in the second part of this article.
PubDate: Fri, 21 Apr 2023 00:00:00 +030
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