[Cognitive impairment in children with organic asthenic disorder]. / Kognitivnye narusheniya u detei s organicheskim astenicheskim rasstroistvom.

OBJECTIVE: To study cognitive impairment and neurophysiological characteristics in children with organic asthenia, as well as the effectiveness of the drug Cogitum in the treatment of this pathology. MATERIAL AND METHODS: The main study group included 40 children aged 8 to 10 years with a diagnosis of «Organic asthenic disorder¼ (F06.6). The control group consisted of 30 children aged 8 to 10 years without manifestations of asthenia. The following research methods were used in the work: the asthenic state scale (ASS) by L.D. Malkova to assess the severity of asthenic syndrome, the S. Lee «SCT¼ (sluggish cognitive tempo) scale to assess manifestations of low cognitive tempo, the «Random Access Memory¼ method to quantify working memory, the TOVA (The Test of Variables of Attention) computer test to quantify assessment of attention disorders and impulsivity level, electroencephalogram (routine and spectral analysis) (p<0.05). For the treatment of patients from the study group, the drug Cogitum was used at a dose of 10 ml of a drinking solution per day for 30 days. RESULTS: In was shown that children from the study group were characterized by a decrease in working memory (7.8±2.9 vs 14.9±5.4), a statistically significant increase in SCT scores (p<0.05), a significantly greater degree of inattention and impulsivity with a tendency to an increase in the number of errors in the second half of the TOVA test (p<0.05). Comparative analysis of EEG relative power data showed a statistically significant increase in the power of waves in the alpha and theta ranges in the fronto-central leads of both hemispheres in the group of children with organic asthenic disorder (p<0.05). When re-evaluating the condition of children after treatment, a statistically significant decrease in the manifestations of asthenia on the ASS scale was recorded in 77.5% of cases. At the same time, there was a significant improvement in attention, memory, and indicators characterizing a low cognitive pace. The results of an electroencephalographic study after a course of treatment showed a decrease in the relative power of the EEG in the theta and alpha ranges in the anterior sections of the cerebral cortex (p<0.05), which indicates an increase in the level of activation of neocortical structures. CONCLUSION: Thus, the use of the drug Cogitum for the treatment of organic asthenic disorder leads not only to a decrease in asthenia and cognitive impairment, but also to an improvement in the functional state of the brain.

[Cognitive disorders in burnout syndrome]. / Kognitivnye narusheniya pri sindrome emotsional'nogo vygoraniya.

OBJECTIVE: To study the impairment of cognitive functions in patients with different stages of the burnout syndrome (BS). MATERIAL AND METHODS: 78 patients aged 25-45 years (average age 36.9±9.5 years) were examined, which at the BS stage were divided into two subgroups: Residence (51.3%, n=40) and Exhaustion (48.7%, n=38). The control group consisted of 106 practically healthy (average age 36.3±7.2 years) The following methods were used: Russian-language version of the MBI questionnaire, questionnaire to diagnose the level of emotional burnout by V.V. Boyko, questionnaire CFQ, method «Learning 10 words¼ by A.R. Luria, registration of cognitive evoked potentials (EP) in the psychophysiological visual test VCPT. RESULTS: Subjective symptoms of memory loss were in 47 patients (60.3% of the total number of patients with EBS): 17 patients (42.5%) from the subgroup Resistance and 30 patients (78.9%) from the subgroup Exhaustion. The quantitative evaluation of the subjective symptoms in the CFQ test showed a reliable increase in all patient groups (p<0.05) and especially in the subgroup Exhaustion. There was statistically reliable decrease of the P200 component in subgroup Resistence and control group in the alloys Cz (p<0.001) and Fz (p<0.001), as well as statistically reliable reduction of the P300 component in the indicated leads (Cz (p<0.001) and Pz (p<0.001)) in patients in the subgroup Resistance. Most BS patients had cognitive complaints that were more common at the Exhaustion stage. At the same time, objective cognitive impairments were detected only in patients at the stage of Exhaustion. Only the long-term memory is affected. Psychophysiological research has shown a decrease in the level of attention in both subgroups, which demonstrated an increased impairment of mental processes. CONCLUSION: Cognitive impairment in patients with BS manifests in various forms of attention, memory impairment, and performance degradation in the resistance and exhaustion phases, and can result from high asthenization.

[Clinical and psychological manifestations of emotional burnout in mothers of children with neuropsychiatric diseases (on a model of ADHD)]. / Kliniko-psikhologicheskie proyavleniya emotsional'nogo vygoraniya u materei detei s psikhonevrologicheskimi zabolevaniyami (na modeli SDVG).

OBJECTIVE: To evaluate the therapeutic efficacy of Pantogam aktiv in the treatment of clinical manifestations of burnout in mothers of children with ADHD. MATERIAL AND METHODS: Under observation were 108 mothers of children with attention deficit hyperactivity disorder (ADHD) aged 25 to 50 years, who had symptoms of burnout in the clinical picture during the initial visit. The following research methods were used in the work: clinical history taking, neurological examination, S. Maslach questionnaire for assessing the burnout manifestations, subjective asthenia rating scale (MFI-20) with five subscales, digital fatigue rating scale (10-point variant), quantitative assessment of autonomic changes (questionnaire A.M. Wein), Spielberger-Khanin Scale for assessing emotional disorders, psychophysiological study of cognitive functions: test of attention variables TOVA (the Test of Variables of Attention). For the treatment of patients, the drug Pantogam Active was used in capsules of 300 mg, at a daily dose of 900 mg (2 capsules in the morning and 1 capsule in the afternoon) for 8 weeks. RESULTS: A re-examination after a course of treatment showed improvement in 68.5% of patients. After treatment, there was a significant decrease in the severity of such indicators of burnout as emotional exhaustion and depersonalization, a significant decrease in the average values according to the A.M. Wayne, a decrease in reactive anxiety, a statistically significant improvement in attention and a decrease in impulsivity (p<0.05). CONCLUSION: Thus, the results of the study indicate that the use of Pantogam active in the treatment of clinical manifestations of parental burnout is characterized by high efficiency. After treatment, there is a significant decrease in fatigue, asthenia, anxiety, and total indicators characterizing burnout. The data obtained make it possible to recommend the use of Pantogam aktiv in the treatment of clinical manifestations of parents burnout in children with neurological diseases.

[Emotional and behavioral dysregulation in children with attention deficit hyperactivity disorder]. / Narusheniya emotsional'noi i povedencheskoi regulyatsii u detei s sindromom defitsita vnimaniya s giperaktivnost'yu.

OBJECTIVE: To study disorders of emotional regulation in different types of attention deficit hyperactivity disorder (ADHD) in children. MATERIAL AND METHODS: 58 children suffering from ADHD, aged 12 to 15 years were divided into 2 subgroups (38 children with a combined form of ADHD and 20 children with ADHD with a predominance of inattention). The control group consisted of 30 children without manifestations of neuropsychiatric disorders. The following research methods were used in the work: the SNAP-IY scale to assess the severity of the disease; the Strengths and Difficulties Questionnaire (SCT), a form for parents to assess emotional and behavioral impairments; Spielberger's self-assessment test in the processing of Khanin to assess the level of anxiety; spectral analysis of the EEG with the construction of graphical power spectra and registration of evoked potentials (EP) with the performance of an attention test in the Go/No-Go paradigm. RESULTS: The results of the study showed the presence of emotional and behavioral disorders in children with ADHD, more pronounced in the combined form of the disease. Complaints of emotional lability, tearfulness, irritability were noted in 53 children with ADHD in the study group (61.6%). At the same time, these complaints were registered in 39 children from the first group (72.2%) and 14 children from the second group (43.8%). The level of inattention was approximately the same (3.21±0.64 and 3.43±0.56, respectively), while the level of hyperactivity and impulsivity in adolescents from the first group was significantly higher (3.18±0.54, p<0.01). Indicators of the SCT scale, as a total indicator (3.4±1.6, p<0.01), and on the scales of «behavior problems¼ (7.4±1.6, p<0.01), «emotional problems¼ (8.0±1.6, p<0.01), «problems with peers¼ (7.6±1.3, p<0.01), «prosocial behavior¼ (3.4±1.6, p<0.01) were significantly higher in the subgroup of children from the first group. The performed statistical analysis of the test data for attention in the Go/No-Go paradigm revealed significant differences (p<0.01) in the number of omissions of significant pairs of stimuli between healthy children and a subgroup with ADHD with a predominance of inattention, between healthy children and a subgroup with combined form ADHD. When comparing evoked EEG synchronization in the theta range under Go conditions, we found a significant decrease in this parameter in the range of 200-400 ms in the subgroup of children with ADHD with a predominance of inattention and in the subgroup of ADHD with a combined form; under No-Go conditions, a significant decrease in the magnitude of evoked EEG synchronization was revealed in a subgroup of children with combined form ADHD. CONCLUSION: In general, the results of this study allow us to conclude that impaired cognitive control has a large impact on the development of emotional disorders in children with ADHD.

[Clinical features of asthenia in the context of adjustment disorders]. / Klinicheskie osobennosti astenii v ramkakh rasstroistv adaptatsii.

OBJECTIVE: To study asthenic symptoms in patients with adjustment disorders and to assess the efficacy of cytoflavin in their treatment. MATERIAL AND METHODS: The study included 100 patients, aged 20 to 43 years, with a diagnosis of adjustment disorder. Clinical, neurophysiological and parametric methods were used. An asthenic state scale, the Multidimensional Fatigue Inventory (MFI-20), a digital rating scale (a 10-point variant) and the Headache Impact Test (HIT-6), the Psychological Stress Measure (PSM-25), the Cognitive Emotion Regulation Questionnaire, the Test of Variables of Attention (TOVA) were administered. Cytoflavin was used in a dose of 2 tab. 2 times a day for 25 days for the treatment of patients from the study group. RESULTS: In the study group, 48.0% of patients had a pronounced degree of asthenia, and 52% had a moderate one. The clinical improvement was achieved in 73.0%. In the subgroup with moderate asthenia, the improvement was recorded in 88.5% of cases, in the subgroup of patients with severe asthenia in 56.3% of patients. There was a significant decrease in the severity of indicators on the scales of general asthenia, decreased activity and mental asthenia; a significant decrease in the integral indicator of mental tension, a significant improvement in the indicator of attention, a decrease in the frequency and intensity of headache. The improvement in the functional state of the brain in the form of a decrease in the power of the alpha rhythm in the anterior cerebral cortex was shown. CONCLUSION: The results of the study allow us to conclude that the use of cytoflavin is effective in the treatment of adjustment disorders.

[Executive functions disorders in children with dyslexia]. / Narusheniya upravlyayushchikh funktsii u detei s disleksiei.

OBJECTIVE: To study the severity of disorders of executive functions in children with dyslexia and to assess the effectiveness of treatment of this pathology with cortexin. MATERIAL AND METHODS: The main study group included 60 children, aged 8-11 years, with a specific reading disorder (F.81.0). Reading skills were assessed using methods of T.A. Fotekova, T.V. Akhutina. Diagnostic examination included neurological examination with dyspraxia test, electroencephalography with visual and quantitative analysis. To objectify the severity of memory impairments, the «Working memory¼ technique was used. Attention and impulsivity disorders were quantified using SNAP-IY and the Test of Variables of Attention (TOVA). The control group consisted of 60 children of the same age without symptoms of dyslexia. Cortexin was used to treat 30 patients from the study group, 30 patients received encephabol. A control study to analyze the effectiveness of the therapy was carried out one month after the end of therapy. RESULTS AND CONCLUSION: Children with dyslexia are characterized by a higher level of inattention and impulsivity, as well as significantly lower indicators of working memory compared to children from the control group. The decrease in attention and working memory as well as an increased level of impulsivity are manifestations of impaired executive functions in children with dyslexia. The results of the control study after treatment showed a significant increase in reading skills in both groups. In addition, there was an improvement in indicators of attention and working memory. However, the effectiveness of treatment with cortexin was slightly higher compared to encephabol (improvement was noted in 73.3% and 60.0%of patients, respectively). According to a comparative analysis of EEG results, after a course of treatment with cortexin, children with dyslexia have significant neurophysiological changes that indicate the activation of the brain regulatory systems.

[Dyslexia as a multideficit disorder]. / Disleksiya kak mnogofaktornoe rasstroistvo.

The article provides a review of research on dyslexia. Various views on the role of genetic and environmental factors in the etiology and pathogenesis of this disorder are examined. The results of neurophysiological and neuropsychological studies are presented, indicating a disturbance of some higher mental functions in dyslexia. The main neurocognitive deficits observed in dyslexia are considered: a disturbance of certain parameters of attention and working memory, a decrease in the speed of information processing, and insufficient automation of new skills. Based on the data presented, dyslexia appears to be a multifactorial and multideficit disorder.

[Disturbances of executive functions in children with emotional and behavioral dysregulation]. / Narusheniya upravlyayushchikh funktsii u detei s emotsional'noi i povedencheskoi disregulyatsiei.

OBJECTIVE: To study a role of executive functions in the development of organic emotionally labile (asthenic) disorder (OELD) and oppositional defiant disorder (ODD). MATERIAL AND METHODS: The study included 66 patients, aged 6 to 8 years, including 36 children with OELD and 30 children with ODD. Fatigue was assessed by parents on a 10-point digital rating scale. SNAP-IV questionnaire for evaluation of severity of behavioral disorders, the "Strengths and Difficulties Questionnaire" for assessment of emotional and behavioral disorders, the anxiety test of P. Temple, M. Dorkey and V. Amen, A.R. Luria test for auditory-speech memory and the Test of Variables of Attention (TOVA) were used. RESULTS AND CONCLUSION: A significantly greater severity of cognitive and emotional impairment in the group of children with OELD is identified. The data suggest that if the insufficiency of functions regulating the activation of behavior and impaired cognitive control of behavior is important in the pathogenesis of OELD, then behavioral self-regulation disorders associated with emotional reinforcement play a leading role in children with ODD.

[Cognitive disturbances in children with chronic tics and their treatment]. / Kognitivnye narusheniia u detei s khronicheskimi tikami i ikh lechenie.

AIM: To clarify the severity of cognitive disturbances in children with chronic tics and to evaluate the efficacy of cortexin as part of complex therapy in the treatment of this pathology. MATERIAL AND METHODS: The main study group included 50 children, aged 6-8 years, with chronic motor tics. Twenty patients of these group received phenibut and 30 patients received cortexin in addition to phenibut. The comparison group consisted of 30 children with transient tics, aged 6-8 years, the control group consisted of 40 children of the same age without tics and other neuropsychiatric disorders. Clinical assessment of tick manifestations and their frequency was performed using the Tourette Syndrome Global Scale (TSGS), neurological examination, electroencephalography. Severity of asthenic and cognitive disorders was evaluated using the Subjective Asthenia Scale (MFI-20), the memorization technique by A.R. Luria and the TOVA test. RESULTS AND CONCLUSION: Children with chronic tics show signs of asthenia, they are characterized by a higher level of inattention and significantly lower levels of long-term memory compared to children from the comparison group and the control group. The level of impulsivity in children with chronic tics is significantly higher than in the control group but significantly lower than in children in the comparison group. A comparative analysis of EEG data in children with chronic tics reveals the following significant differences from the control and comparison groups: a higher amplitude and higher values of the peak frequency of the alpha-rhythm in the posterior regions of both hemispheres, a significant increase in the alpha-range of the frontal temporal leads of both hemispheres. Complex therapy with the addition of cortexin significantly improves treatment efficacy: improvement is noted in 60,0% of patients in monotherapy and in 83.3% of patients in complex therapy.

[Impairments of cognitive control in patients with somatoform disorders and their treatment]. / Narusheniia kognitivnogo kontrolia u patsientov s somatoformnymi rasstroistvami i ikh lechenie.

AIM: To study impairments of cognitive control in patients with somatoform disorders (SD) and to evaluate the efficacy of recognan in the treatment of this pathology. MATERIAL AND METHODS: Forty-six patients with SD, aged from 18 to 45 years, were studied. A clinical history, neurological examination, and assessment of autonomic disorders were collected from all patients. For the objectification of the severity of asthenic and emotional disorders, the Subjective Scale of Asthenia (MFI-20), the Hamilton Anxiety Scale (HARS), the Cognitive Emotion Regulation Questionnaire (CERQ were used. A quantitative assessment of impaired attention and impulsivity was performed using the psychophysiological test TOVA. Patients were treated with recognan (citicoline). The control group consisted of 30 healthy people aged from 18 to 45 years. RESULTS AND CONCLUSION: Patients with SD had specific characteristics of the cognitive sphere, most pronounced in the form of attention disorders. The psychological study showed the higher level of anxiety. In addition, patients with SD were characterized by the low levels of emotional intelligence and cognitive control of emotions compared with the control group. The results of the follow-up study after treatment suggest the high efficacy of recognan in the treatment of SD (improvement was noted in 67.4% of patients). A significant decrease in the severity of autonomic disorders and in indicators characterizing asthenia was established after the treatment.

[Clinical manifestations of burnout]. / Klinicheskie proiavleniia sindroma émotsional'nogo vygoraniia.

AIM: To study clinical manifestations of burnout. MATERIAL AND METHODS: The study included 131 patients (38 men and 93 women) aged from 25 to 45 years. The control group consisted of 106 age-matched healthy people. Evaluation of the manifestations of burnout was carried out using the Boyko's questionnaire. For the objectification of the severity of asthenic disorders, the Subjective Scale of Asthenia (MFI-20) consisting of five subscales was used. Trait and state anxiety was assessed by Spilberger-Khanin test. The 10 word memory task was used to assess auditory memory. RESULTS AND CONCLUSION: The authors singled out several dominant syndromes in the structure of burnout: asthenic, psychovegetative, cephalic, anxious/phobic and mild cognitive impairment syndrome. Asthenic syndrome occurred most frequently in patients with burnout.

[Effect of tiotropium bromide on exercise tolerance in patients with chronic obstructive pulmonary disease].

This open prospective randomized parallel-group comparative study included 43 patients with moderate or severe chronic obstructive pulmonary disease (COPD). The patients of active working age were referred to the disability groups II-III based on the average forced expiratory volume in 1 second (1.70+/0.43 1 or 49.1+/-10.7% the normal value) and received an eight-week course of pulmonary rehabilitation. During the study, the patients were given tiotropium bromide (TB) for 14 weeks to assess its effect on the tolerance of physical activity. A combination of TB with pulmonary rehabilitation was shown to improve tolerance evaluated by whole-body rheography (WBR) in a 6 minute step-test and the standard functional test. Also, this treatment resulted in the clinically significant alleviation of dyspnea and permitted to decrease the intake of salbutamol (used "as required") compared with pulmonary rehabilitation alone. It is concluded that combination of TB and pulmonary rehabilitation provides an effective tool for the treatment of patients with COPD. The whole-body rheographic technique can be used to evaluate the functional state of the patients and the efficiency of their rehabilitation.

[Combination of thiotropium bromide with almitrine and pulmonary rehabilitation in the treatment of patients with chronic obstructive pulmonary disease].

AIM: To elucidate efficacy of a combination almitrine+thiotropium bromide (TB)+pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) of stage II-III complicated with chronic respiratory failure (CRF). MATERIAL AND METHODS: Efficacy of therapy was compared in two groups of patients: group 1 (n = 22) received TB in a dose 18 mcg/day for one year, almitrine in a dose 10 mg/kg/day for 3 months, an 8 week course of PR, group 2 (n = 17) received TB and PR. The treatment efficacy was determined by spirometric parameters of external respiration function, blood gases, dyspnea indices, exercise tolerance assessed by 6-min walk test, quality of life (St. George Hospital Respiratory Questionnaire). RESULTS: Group 1 patients walked longer distance after a course of PR and 1 year later (by 90.5 +/- 25.4 and 44.5 +/- 10.2 m, respectively, p < 0.05), had reduced desaturation measured by pulsoxym-etry at the end of 6-min walk test, increased PaO2 in baseline under 70 mmHg (by 5.8 +/- 1.2 mmHg, p > 0.05), decreased exacerbation rate per 1 patient a year (by 25%). CONCLUSION: Combination treatment with TB, almitrine and PR is indicated for COPD patients with moderate hypoxemia.

[Use of epidural analgesia for the arresting of pronounced lumbar pains]. / Primenenie épidural'noi anal'gezii dlia kupirovaniia vyrazhennykh bolei v poiasnitse.

A combination of local anesthetics (2% lydokaine solution, 2 mg/kg; 0.5% bupivakaine solution, 0.4 mg/kg or 0.75% ropivakaine solution, 0.55 mg/kg), promedol (20 mg) and corticosteroids (125 mg hydrocortisone or 80 mg kenalog) was epidurally administered in 78 patients to arrest the pronounced root pain syndrome of the lumbar-sacral localization provoked by intervertebral disk hernias. The most prolonged analgesic effect was registered in groups, whose patients received bupivakaine or ropivakaine, which prevented the onset of pain before the antiinflammatory effect of corticosteroids started. The patient must be informed well in advance about the possibility of a momentary relapse of pains and about the intensification (at the same time moment) of pharmacotherapy prescribed by neuropathologist.

[The results of the dynamic observation of bronchial hyperreactivity in risk-group subjects and in bronchial asthma patients. Some corrective procedures]. / Rezul'taty dinamicheskogo nabliudeniia za giperreaktivnost'iu bronkhov u lits grupp riska i bol'nykh bronkhial'noi astmoi, nekotorye sposoby ee korrektsii.

The following bronchial provocation tests were carried out: 310 with acetylcholine, 216 with submaximal physical exercise, 246 with cold air inhalation, and 103 with aspirin in healthy subjects, relatives of bronchial asthma patients, in patients with preasthma and asthma in a stage of exacerbation abatement or remission. Based on the data obtained the authors show nonspecific hyperreactivity of the bronchi in healthy relatives of bronchial asthma patients, heterogeneity and a high incidence of responses to acetylcholine, cold air and physical exercise, augmentation of the reaction intensity to different stimuli in all asthma patients. The follow-up of bronchial hyperreactivity discovered its progression in the absence of the treatment and the lowering of its intensity as a result of the treatment with calcium antagonists, magnesium sulfate, punctate massage, sublaminal physical exercise, ultraviolet radiation of autologous blood, specific desensitization with aspirin.

[The therapeutic potentials of magnesium sulfate in bronchial asthma]. / Terapevticheskie vozmozhnosti sul'fata magniia pri bronkhial'noi astme.

Twelve patients with preasthma (PA) and 27 bronchial asthma (BA) patients were examined for the effect of magnesium sulphate aerosol on bronchial sensitivity and reactivity to acetylcholine (ACC) and graded physical exercise (GPE) as well as on bronchial patency recorded by general plethysmography and pneumotachography. Inhalation of the drug was established to exert no bronchodilatory action but reduced, as compared with placebo, nonspecific hyperreactivity of the bronchial tree and blocked the ACC induced increment of histamine in the exhaled air condensate. The data obtained allow bronchial smooth muscles and mast cells to be regarded as targets for magnesium sulphate. The drug properties discovered may serve a prerequisite for its use in the combined treatment of BA patients and those with PA.