TRAUMATIC EVENTS AND MENTAL DISEASES: THE ROLE OF CERTAIN NEUROTRANSMITTERS, METALLOENZYMES AND HORMONES

OBJECTIVE: Aim: To study the role of certain neurotransmitters (brain-derived neurotrophic factor (BDNF), 5-hydroxytryptamine (5-HT)), metalloenzymes (matrix met-alloproteinase-9) (MMP-9) and hormones (ghrelin) in the pathogenesis of mental disorders associated with stress under the impact of traumatic events. PATIENTS AND METHODS: Materials and methods: We conducted a systematic search of major electronic medical databases published before October 1, 2022. Such keywords as (post-traumatic stress disorder OR PTSD), (Brain-derived neurotrophic factor OR BDNF), (matrix metalloproteinase-9 OR MMP-9), (serotonin OR 5-HT), ghrelin, melatonin identified relevant studies. All articles were reviewed, including original studies, systematic reviews and meta-analyses. CONCLUSION: Conclusions: Unfortunately, the imbalance of neurotransmitter systems of the brain remains not fully understood under such a condition at this stage of world science development. Their role remains unclear both during the immediate exposure to the stress factor and in the remote period. Therefore, under¬standing the mechanisms underlying the systemic consequences of PTSD is crucial for the development of prediction models and timely rational therapy.

PECULIARITIES OF DYNAMICS OF INDICATORS OF PROTEINS OXIDATIVE MODIFICATION AND MATRIX METALLOPROTEINASE-9 ACTIVITY IN PATIENTS WITH PARANOID SCHIZOPHRENIA DEPENDING ON THE DISEASE DURATION.

OBJECTIVE: The aim: The objective of the research was to study the indicators of oxidative modification of proteins (OMP) and the activity of matrix metalloproteinase-9 (MMP-9) in patients with paranoid schizophrenia depending on the disease duration. PATIENTS AND METHODS: Materials and methods: 320 patients were included in the examination. 20 patients were with "Primary psychotic episode" (Comparison Group) and 300 patients were diagnosed with "Paranoid schizophrenia" (Experimental Group): 60 of them have suffered from this disease for a duration from 3 to 5 years (Subgroup I ); 60 patients have suffered for a period from 6 to 10 years (Subgroup II); 60 individuals - from 11 to 15 years (Subgroup III); 60 patients have suffered for a duration from 16 to 20 years (Subgroup IV); 60 patients - from 21 years and longer (Subgroup V). RESULTS: Results: The presented data showed that the levels of OMP indicators in Subgroup I constituted 0.826±0.046 conventional units at a wavelength of 356 nm; 0.864±0.051 conventional units at a wavelength of 370 nm; 0.444±0.019 conventional units at a wavelength of 430 nm; 0.176±0.007 conventional units at a wavelength of 530 nm, which is 1.99; 1.6; 1.13 and 1.43 times higher than in the Comparison Group. The content of OMP products was higher by 2.24; 1.74; 1.17, and 1.43 times in Subgroup II, respectively, by 2.4; 1.80; 1.36 and 1.46 times in Subgroup III, respectively; by 2.5; 1.9; 1.4; 1.6 times in Subgroup IV, respectively; by 2.5; 2.02; 1.54; 1.7 times in Subgroup V, respectively. The conducted correlation analysis indicated a direct correlation between OMP indicators and the disease duration. The concentration of MMP-9 in the patients of the Comparison Group was equal to 892.84±87.80 pg/ml, which was 11.2% less compared to the Experimental Subgroup I, where this indicator was 992.84±67.50 pg/ml. MMP-9 constituted 1092.53±47.20 pg/ml on average in the patients of Subgroup II, which was 22.36% higher than in the Comparison Group. This indicator was 1702.84±37.60 pg/ml in Subgroup III, which was 90.7% higher than in the Comparison Group. It constituted 1492.84±47.29 pg/ml in Subgroup IV, which was 67.2% higher than in the Comparison Group; and 2037.21±57.80 pg/ ml in Subgroup V, which was more than two times higher than in the Comparison Group (p<0.05). The conducted correlation analysis showed a direct relation between MMP-9 expression and the increase in OMP indicators. This relation was more significant between MMP-9 and OMP products of a neutral nature. The correlation strength between MMP-9 and OMP products of a basic nature was somewhat less significant. CONCLUSION: Conclusions: According to the results of the conducted analysis, the examined patients had the signs of decompensation of reactive-adaptive biomolecular mechanisms which activated radical reactions with the subsequent accumulation of oxidation products.

FEATURES OF SOCIAL DYSFUNCTION, ASSESSMENT OF LEVELS OF SOCIAL FRUSTRATION AND SATISFACTION WITH THE QUALITY OF MEDICAL CARE IN PATIENTS WITH SCHIZOPHRENIA ON THE BACKGROUND OF SOMATIC COMORBIDITY.

OBJECTIVE: The aim: To study the features of social dysfunction, assess the levels of social frustration and satisfaction with the quality of medical care in patients with schizophrenia on the background of somatic comorbidity. PATIENTS AND METHODS: Materials and methods: The study included 105 patients (55 women - 52.38% and 50 men - 47.61%) with a verified diagnosis of schizophrenia (F20.0-F20.3). The psychopathological condition of patients was assessed according to the "Positive and Negative Syndrome Scale" (PANSS). A special psychodiagnostic technique by L. I. Wasserman in the modification of V.V. Boiko was used to assess the level of social frustration. Peculiarities of social dysfunction were assessed based on the "Personal and Social Performance scale" (PSP). "The Health Resource Use Questionnaire" was used to obtain the information about the coverage of this patient with primary or specialized somatic care during the last three months. General and systematic examination of the patient was also performed, physical methods of diagnosis (palpation, percussion, auscultation) were applied, body mass index was calculated. Consultations of specialists, instrumental (ECG, ultrasound, Echo-CS, etc.) and laboratory diagnostic methods were prescribed depending on the detection or suspicion of concomitant somatic pathology. RESULTS: Results: The results showed significant social isolation of the respondents, their contacts were limited to communication with relatives and friends. This was confirmed by the data of social functioning on the PSP scale, according to which the most pronounced violations in the examined patients were found in the areas of "personal and social relationships", "socially useful activities, including work and study". It should be noted that the higher the rates of social dysfunction, the stronger the level of frustration (p<0.05). In particular, the low level of satisfaction with the field of medical services due to its inaccessibility, according to respondents, attracts attention. According to the relatives, the main reason for this restriction was the patients' lack of awareness of their condition, neglect and indifference. CONCLUSION: Conclusions: Further attention is required to develop strategies to improve comorbid treatment in the patients with schizophrenia regardless of whether this situation is the result of negative attitude of health professionals towards patients with mental illness, or the result of the patients' ignorance of their physical condition, or other factors.

MANIFESTATIONS OF EXCESSIVE DAYTIME SLEEPINESS AND GHRELIN LEVEL IN CASE OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE.

OBJECTIVE: The aim of the study was to discover the interrelation between the severity of gastroesophageal reflux disease (GERD) symptoms, acid exposure time (AET), excessive daytime sleepiness (EDS) and the level of active blood plasma ghrelin in the patients with undifferentiated connective tissue disease (UCTD). PATIENTS AND METHODS: Materials and methods: The study included 120 patients with GERD. All the patients were divided in two groups: Group I - GERD was not accompanied by the signs of connective tissue disease (n=45) and Group II - GERD developed on the background of UCTD syndrome (n=75). Daily transnasal pH monitoring was performed to determine the nature of pathological refluxes. EDS was detected by The Epworth Sleepiness Scale. Active ghrelin in blood plasma samples was determined by ELISA. RESULTS: Results: 80% of the patients of Group II and 35.48% of Group I suffered from EDS (p<0.05). The mean daily AET index was 5.48±0.4% in Group II and 6±0.2% in Group I, in the night hours mostly when patients were in the upright position. This phenomenon contributed to a deterioration of sleep quality and the appearance of EDS and was supported by a connection between AET and EDS (r=+0.827 for Group I and r=+0.768 for Group II). The mean De Meester index was higher in the patients of Group II (23.01±2.24 in Group I vs 31.08±2.4 in Group II; p<0.05). CONCLUSION: Conclusions: GERD manifestations are strongly related to the level to AET and intensity of EDS. The EDS symptoms depend on circulating ghrelin level.

PECULIARITIES OF BRAIN-DERIVED NEUROTROPHIC FACTOR AND MATRIX METALLOPROTEINASE-9 EXPRESSION DYNAMICS IN PATIENTS WITH PARANOID SCHIZOPHRENIA DEPENDING ON THE DURATION OF THE DISEASE.

OBJECTIVE: The aim: To study the expression of brain-derived neurotrophic factor (BDNF) and matrix metalloproteinase-9 (MMP-9) in the blood serum of patients with paranoid schizophrenia and to trace the features of their dynamics depending on the duration of the disease and analyse the correlation between BDNF, MMP-9 serum levels and symptoms severity by using the Positive and Negative Syndrome Scale (PANSS). PATIENTS AND METHODS: Materials and methods: The study included 120 patients, namely 20 patients with paranoid schizophrenia diagnosed less than 3 years ago (Сomparison Group) and 100 patients with a diagnosis of paranoid schizophrenia (Study Group): 20 of them have been suffering from this disease from 3 to 5 years (Subgroup I); 10 patients - from 5 to 10 years (Subgroup II); 10 patients - from 10 to 15 years (Subgroup III); 10 patients - from 15 to 20 years (Subgroup IV); 10 patients - from 25 years and more (Subgroup V). The groups did not differ with respect to age or gender. The content of BDNF and MMP-9 in blood serum was determined by enzyme-linked immunosorbent assay. RESULTS: Results: BDNF concentration averaged 28.327 ± 5.32 pg/ml in the patients of Group I; 25.40 ± 2.31 pg/ml in Group II; 24.32 ± 3.1 pg/ml in Group III; 23.8 ± 1.32 pg/ml in Group IV; 21.39 ± 0.97 pg/ml in Group V; 9.36 ± 4.38 pg/ml in Group VI. The expression of MMP-9 in the experimental groups constituted: 942.84 ± 87.80 pg/ml, 1042.84 ± 87.80 pg/ml, 1142.53 ± 77.20 pg/ml, 1752.84 ± 77.80 pg/ml, 1542.84 ± 37.70 pg/ml, 2042.74 ± 47.80 pg/ml, respectively. Decreased BDNF negatively correlated with MMP-9 expression (r=0.46; p<0.05). CONCLUSION: Conclusions: The development of paranoid schizophrenia was manifested by an imbalance in BDNF level and MMP-9 expression which could affect neurogenesis, synapticplasticity, ability to learn and remember, therefore, they could be considered as diagnostic markers of the pathology. With the increase in the duration of the studied pathology, BDNF parameters decreased and MMP-9 expression increased. A negative correlation between them was noted.

THE BONE-BRAIN AXIS? BIOPSYCHOSOCIAL ASPECTS OF ORTHOPEDICS AND A MENTAL WELLBEING ACTION PLAN IN MUSCULOSKELETAL CARE.

OBJECTIVE: The aim: To review the biopsychosocial aspects of psychiatric comorbidity in patients with musculoskeletal conditions and recommend a relevant mental health action plan. PATIENTS AND METHODS: Materials and methods: Keywords (orthopedics, psychiatry, mental health) were used to list down and analyze the literature in PubMed and Google Scholar. All types of articles, including original research, systematic reviews, and meta-analyses, along with gray literature dating back to 2000. We excluded studies reporting a significant conflict of interest and findings dispersed through popular media instead of peer-reviewed journals. CONCLUSION: Conclusions: The biopsychosocial aspects of the "bone - brain axis" need to be better addressed by means of a pragmatic approach involving all concerned parties and acknowledging the challenges and limitations along the way.