PSYCHOTHERAPEUTICAL FEATURES OF PERSONS WITH MULTIPLE SCLEROSIS AND HEPATOCEREBRAL DEGENERATION.

Physiological process of aging causes a slight deterioration in memorization, learning, and the speed of cognitive processes. There is often a big gap between established standards, norms that work for mass and individual cases, for which standards are no more than guidelines, not prescriptions and dementia could be caused by many factors, the most important of which are degenerative, vascular, and toxic. Multiple sclerosis (MS) is the commonest non-traumatic disabling disease to affect young adults. Wilson's disease (WD) is an uncommon hereditary disorder caused by a deficiency in the ATP7B transporter. All of the above realized in the aim of our work: performing comprehensive clinical and laboratory examination of patients with multiple sclerosis and patients with Wilson's disease in order to study the problem of neurodegenerative diseases and their prevention. MATERIALS AND METHODS: The "Mini Mental Status Exam" scale was used for the screening assessment of the state of cognitive functions and the study of the level of intellectual productivity of patients. To determine the verbal memory, the method: "memorizing 10 words" was used, and the Derogatis SCl-90-P method was used to study the personality and emotional sphere. Psychodiagnostic examination was performed for 111 patients with MS and 33 patients with WD. RESULTS: Сognitive disorders were found in less than half of the patients (44.9%) in young patients with multiple sclerosis, whereas in the older age group, almost all patients (91.2%) had various cognitive disorders. Violation of verbal memory, of varying degrees of severity, was found in 69.1% of patients with multiple sclerosis. More than half of the patients with Wilson's disease (66.7%) had impaired productivity of cognitive functions of various degrees of severity. Identified violations were noted in 27.3% of patients (10 patients), among them 7 were aged 40 years or older and had not received pathogenetic treatment for a long time. Violations of mental functions of various nature and severity were found in 78.8% patients with Wilson's disease. They are characterized by dynamic and voluntary-regulatory thinking disorders, such as exhaustion of mental capacity (88.0%), a decrease in its speed characteristics (39.4%) and general productivity, as well as inertia (48.5%), impulsiveness (27.3%) of mental processes. Decrease in criticality of thinking was noted in 33.3% of patients. CONCLUSIONS: The structures that take participation in cognitive functions of the brain are always involved (sooner or later) in the pathogenetic process in patients with multiple sclerosis and hepatocerebral degeneration, that leads to the development of their defects. Therefore, for the treatment of these patients, a comprehensive, pathogenetically justified and personal fixed therapy is necessary. The development of palliative therapy, which will prevent the transformation of cognitive disorders into dementia, may become a prospect for further research.

PSYCHOLOGICAL FEATURES OF THE REHABILITATION OF PERSONS IN POST-COVID-19 CONDITION.

The global medical problem has become the COVID-19 pandemic since 2019, which represents one of the most difficult medical realities. One of the crucial medical hypotheses is the effect of SARS-Cov-2 infection on mental health that requires creation of effective psychological and psychiatric management of such patients. In connection with described above, we set the task of our research to develop and test a complex of psychological interventions in the system of psychosocial rehabilitation of patients with cognitive disorders against the background of the endured SARS-Cov-2 infection. The material of the study was the data obtained after passing the GAD-7 test for level of anxiety detection. The persons were divided into two groups with patients who have a history of severe acute respiratory syndrome of coronavirus 2 (SARS-CoV-2) and non-suffered with coronavirus. At the end of the course of psychological rehabilitation, the GAD-7 test was repeated. It was established that people who have endured COVID-19 have a significantly higher level of anxiety during examining the initial level of anxiety by performing the GAD-7 test. So, if most of the examined had a minimal level of anxiety (68%) in the control group, then after COVID-19 the majority of patients had a moderate level of anxiety (64%), and 6% even had a high level of anxiety. A month after the initial testing, the group of patients (after COVID-19) who had not undergone psychological rehabilitation was still predominantly in the zone of moderate level of anxiety (54%). Going through psychological rehabilitation had positive consequences and the majority of patients moved into the minimal level of anxiety zone (58%). Majority of persons who endured COVID-19 suffer moderate level of anxiety with GAD-7 test 10.12±0.43 (6.92±0.33 for non-suffered). Psychological rehabilitation could reduce it to 7.24±0.36. The data obtained in the course of the work testify to the effectiveness of conducting a complex of psychotherapeutic interventions using cognitive training, cognitive-behavioral psychotherapy in the system of psychosocial rehabilitation of patients with cognitive disorders against the background of COVID-19 with reducing level of anxiety. Results provide critical information on the efficacy of psychological rehabilitation for persons who experience persistent cognitive deficits after COVID-19.

PHARMACOLOGY OF POST-TRAUMATIC STRESS DISORDER.

The aim of this study was to evaluate current approaches to the pharmacotherapy of posttraumatic stress disorder. An information search was carried out in the databases PubMed, Ovid, EMBASE by keywords: "posttraumatic stress disorder", "treatment", and "medications". Search depth 2012-2022 years. From the general data (4877 articles) there were selected 14 articles with the highest degree of relevance. A content analysis of selected articles was carried out with the formation of recommendations for the use of pharmacotherapy in posttraumatic stress disorder. Currently, there are no unified approaches to the pharmacotherapy of posttraumatic stress disorder. Antidepressants (SSRI SNRIs) are primarily considered as first-line drugs, but only sertraline, paroxetine, and fluoxetine are approved by the FDA. But these drugs have a fairly wide range of side effects, including suicidal thoughts. The use of benzodiazepines should be limited as they increase the risk of developing posttraumatic stress disorder. Vortioxetine becomes a very promising option. The most significant benefits of vortioxetine are the significant positive effects of vortioxetine on attention, memory, and executive function. There is some evidence for the use of alpha-1 adrenoceptor antagonists and alpha-2 adrenoceptor agonists in therapy. In insomnia the use of prazosin and trazodone is recommended. Pharmacotherapy of posttraumatic stress disorder requires administration of medications with multimodal action. Currently, there are no unified approaches to the pharmacotherapy of posttraumatic stress disorder. Further randomized clinical trials are necessary for developing effective treatment of posttraumatic stress disorder.

THE INFLUENCE OF IMMUNODEFICIENCY ON THE LEVEL OF CD34-POSITIVE CELLS IN THE CERVIX.

There are many studies on changes in cervix, however, there are no data about property of cervical tissue to keep potential for regeneration under influence of immunodeficiency, which is very important since it allows escaping severe irreversible changes in tissue. CD34 stem cells are one of significant indicator for property of tissual regeneration. So, the purpose of our study was to identify amount of CD34 stem cells in the cervix under influence of immunodeficiency of infectious and non-infectious origin. Sectional material of reproductive women was studied. All subjects were divided into 3 groups: women who were diagnosed with HIV infection; women who have identified anamnestic and postmortem signs of alcohol abuse; group of comparison. After routine testing and immunohistochemical (IHC) staining to CD34, morphometric measure was performed. We evaluate presence activities of stromal cells for detection of connection and relationship between expression of CD34 and the thickness of the cervical epithelium, relative volumes of condyloma, cervical dysplasia severity, degree of infiltration of the mucosal lamina propria by immunocompetent cells. The obtained digital data were statistically processed. Morphological investigation revealed changes of thickness of the cervical stratified squamous nonkeratinized epithelium up to 714.23±59.21 x 10-6 m in group of HIVinfected women. Relative volumes of condylomas were 44 increased in both investigated groups with presence of pointed, flat and inverted types. Both low- and high-grade squamous intraepithelial lesions were detected more often in investigated goups. Assessment of the degree of infiltration of the mucosal lamina propria by immunocompetent cells was changed unevenly with reducing in HIV-group and increasing in alcohol group. Results of ICH reaction CD34 realized in cytoplasmic staining with membranous accentuation in all cases of control group with strong, but reduced level in investigated groups. Most close connection was observed for cervical dysplasia severity and CD34 expression. HIV infection and alcohol abuse have pronounced pathological effects with cervical changes. The expression of CD34 is present in 96% of women with immunodeficiency mainly with strong reaction. It is statistically likely that it does not depend on such morphological indicators as thickness of the cervical epithelium, relative volumes of condyloma, degree of infiltration of the mucosal lamina propria by immunocompetent cells. The expression of CD34 has statistically close negative connection with cervical dysplasia severity (r=-0,81) and can be used for detection of early potential of tissual transformation in women with immunodeficiency.