[Psychological, psychiatric and neurological aspects of COVID-19]. / Psikhologicheskie, psikhiatricheskie i nevrologicheskie aspekty COVID-19.

OBJECTIVE: To analyze neurological, psychological and psychiatric aspects of COVID-19, as well as to study the current state of the problem. MATERIAL AND METHODS: The study included 103 patients with COVID-19. The main research method was clinical/psychopathological. To study the impact of activities related to the care of patients with COVID-19 in a hospital setting, the medical and psychological state of 197 hospital workers involved in the treatment of patients with COVID-19 was assessed. The level of anxiety distress was assessed with the Psychological Stress Scale (PSM-25), distress indicators corresponded to values of more than 100 points. The severity of anxiety and depressive symptoms was assessed using the Hospital Anxiety and Depression Scale (HADS). RESULTS: When considering psychopathological disorders in the context of COVID-19, it is necessary to distinguish between two main groups of disorders: mental disorders during the pandemic, and mental disorders directly caused by the causative agent SARS-CoV-2. The analysis of psychological and psychiatric aspects in various periods of the initial stage of COVID-19 showed that each of them was characterized by specific features depending on the nature of the influence of different pathogenic factors. In the structure of nosogenic mental disorders in patients with COVID-19 (103 patients), the following clinical forms were identified: acute reaction to stress (9.7%), anxiety-phobic disorders (41.7%), depressive symptoms (28.1%), hyponosognosic nosogenic reactions (20.5%). At the same time, the majority of the patients had manifestations of somatogenic asthenia (93.2%). A comparative analysis of neurological and psychological/psychiatric aspects of COVID-19 showed that the main mechanisms of the impact of highly contagious coronaviruses, including the SARS-CoV-2, on the central nervous system are: cerebral thrombosis and cerebral thromboembolism, damage to the neurovascular unit, neurodegeneration, including that induced by cytokines, and immune-mediated demyelinating nerve damage. CONCLUSION: Neurological and psychological/psychiatric aspects of COVID-19 should be taken into account both at the stage of disease treatment and in the post-infection period due to the pronounced neurotropism of SARS-CoV-2 and its effect on the neurovascular unit. Along with helping patients, an important aspect is the preservation of the mental health of medical personnel working in hospitals for infectious diseases, due to special working conditions and a high level of professional stress.

[Some psychiatric and neurological aspects of the asymptomatic and mild course of COVID-19]. / Nekotorye psikhiatricheskie i nevrologicheskie aspekty bessimptomnogo i legkogo techeniya COVID-19.

OBJECTIVE: To study neurological and mental disorders associated with the inapparent and mild course of COVID-19. MATERIAL AND METHODS: The study included 50 patients (mean age 35.2±11.4 years) admitted to a psychiatric hospital due to depressive spectrum disorders. Patients were divided into two groups: patients (n=16) who had IgG antibodies to SARS-CoV-2 (main group) and patients (n=34) without a history of COVID-19 (comparison group). RESULTS AND CONCLUSION: Patients of the main group showed a difference in the structure of asthenic disorders compared with the comparison group. Also, there was a significant predominance of the severity of asthenic symptoms and anxiety in the structure of psychopathological disorders in depressive spectrum disorders. The viral intoxication contributes to the formation of a kind of asthenic «soil¼ (with characteristic manifestations). In the future, in the case of the development of any stress-associated disorder, more pronounced psychopathological disorders are noted compared with patients of the comparison group. The authors describe a variant of the course of COVID-19, in which the development of ischemic stroke was the first clinical manifestation of the disease. These disorders are based on the pronounced neurotropic effect of SARS-CoV-2 and its effect on the neurovascular unit.

[Possibilities of using Mexidol in the complex therapy of mental disorders]. / Vozmozhnosti primeneniya Meksidola v kompleksnoi terapii psikhicheskikh rasstroistv.

A review of the current literature on the possible use of mexidol (ethylmethylhydroxypyridine succinate) in the treatment of mental (including addictive) disorders is conducted. The possibility of its use to reduce negative psychopathological symptoms, neurocognitive deficit, manifestations of the antipsychotic syndrome (including its extrapyramidal disorders) in antipsychotic treatment of patients with schizophrenia spectrum disorders and insomnia disorders in the complex therapy of borderline mental disorders has been shown. The potential of mexidol in the treatment of addictive pathology, as well as the effects of intoxication caused by alcohol and other psychoactive (including narcotic) substances, deserves special attention.

[Characteristics of postoperative cerebral dysfunction depending on the type and position of the implanted prosthetic heart valve]. / Osobennosti posleoperatsionnoi mozgovoi disfunktsii v zavisimosti ot tipa i pozitsii implantiruemogo proteza klapana serdtsa.

AIM: To study the prevalence and structure of postoperative cerebral dysfunction depending on the type and position of the implanted prosthetic heart valve in patients who underwent surgery for the acquired heart valve disease. MATERIAL AND METHODS: The study included 115 patients (70 men and 45 women; 64 [56; 72] years old), who underwent elective replacement or repair surgery for the acquired heart valve disease. RESULTS AND CONCLUSION: The postoperative cerebral dysfunction was diagnosed in 40.9% patients, including replacement in the aortic position (45.5%), in the mitral position (55%), in several positions (20%). Replacement surgery was accompanied by three clinical types of postoperative cerebral dysfunction and repair surgery - by deferred cognitive impairment only. Postoperative cerebral dysfunction after the replacement in the mitral position was more common (odds ratio 4.47, 95% confidence interval 1.21-18.35, p=0.041), including its acute clinical types - perioperative stroke and symptomatic delirium of the early postoperative period (p=0.029), compared to that after the repair heart valve surgery. After the replacement in the aortic position, acute clinical types of postoperative cerebral dysfunction were more common (p=0.036). After the replacement with biological prosthesis, symptomatic delirium of the early postoperative period was more common (p=0.047). The occurrence of the deferred cognitive impairment didn't depend on the type and position of the implanted prosthetic heart valve.

[Postoperative cerebral dysfunction]. / Posleoperatsionnaia mozgovaia disfunktsiia.

AIM: To study the structure, risk factors and methods of prevention of postoperative brain dysfunction on the example of coronary artery bypass surgery with cardiopulmonary bypass. MATERIAL AND METHODS: The study included 77 patients who undergone elective coronary artery bypass surgery at the beating heart (22 patients) or with cardiopulmonary bypass (55 patients, including 24 patients, who received cerebroprotective treatment with cytoflavin in the preoperative period). All patients underwent dynamic (pre- and postoperative) neurological, neuropsychological, instrumental examinations. RESULTS: The postoperative cerebral dysfunction was diagnosed in 34 (44,2%) patients. The frequency of the clinical types of postoperative cerebral dysfunction significantly differed: perioperative stroke - 3 (3,9%) cases, symptomatic delirium of the early postoperative period - 11 (14,3%) cases, delayed cognitive impairment - 28 (36,4%) cases. The risk factors of postoperative cerebral dysfunction after the coronary artery bypass surgery with cardiopulmonary bypass were identified. Preventive preoperative use of the neuroprotective drug cytoflavin reduces the severity of delayed cognitive impairment after the coronary artery bypass surgery with cardiopulmonary bypass and has a good safety profile. CONCLUSION: An analysis of the literature data and the results of our own studies show that postoperative cerebral dysfunction is the nosological entity with various etiological factors, pathogenetic mechanisms and the characteristic clinical types, which has an effect on the outcome of surgical treatment.

[Comorbide somatic pathology in servicemen with neurotic disorders].

Prevalence and structure of comorbidity a somatic pathology in military men with neurotic disorders was studied. It was established that 40,4% of surveyed noted concomitant somatic pathology, the structure of which was dominated by gastro-intestinal tract (26,8%), and pathology of the cardiovascular system (21,6%). It is shown that concomitant somatic pathology provided aggravating effect on clinic neurotic disorders in serviceman, making it difficult to diagnose mental disorders. The greatest risk concomitant a somatic pathology was marked in patients with depressive and somatoform disorders. Indicates the need for specialized standards of care for persons with comorbid mental and somatic disorders.

[Mental disorders in young serviceman with cardiological emergencies].

Investigated 82 young servicemen with cardiological emergencies (acute cardiac syndrome, hypertension events, rhythm pace disturbance). Divided three periods of mental disorders: acute, subacute and long-term effects. Found that in 95.1% of patients after emergencies developed state of mental maladaptation of varying degree. In further 47.1% of cases of mental disorders place in the form of psychogenic and somatogenically caused disorders of prenosological level. Among clinically executed forms predominated depressive disorder spectrum (nozogennye reaction and state). In the remote period prevailed somatoform dysfunction and manifestations of personality pathology. Shows the clinical and psychopathological features of these disorders and their effects on military service.

[Mental disorders at hypertensive illness at military men of young age (analysis of a condition of a problem)].

The review of the modern literature on the mental disorders arising at hypertensive illness at military men of young age is spent. The basic clinical forms of the mental pathology arising at different stages of hypertensive illness are investigated. Neuroendocrinological, neuromediatorical, neurophysiological, immunological and behavioural mechanisms of infringements of anxiety, depressive disorders and an arterial hypertensia at persons of young age are shown, them reciprocal mutual relations, influence on a current and the forecast of main illness.

[Pathomorphism of neurotic disorders among military servicemen].

There were analyzed changes in popularity, structure and clinical peculiarities of neurotic disorders among military servicemen for the period 1986-2006. There were used epidemiological, clinical-archival and clinical-psypathological methods. It was established, that that internosological pathomorphosis of neurosis came out in reduction of their rates in general structure of psychological pathology. Internosological pathomorphosis has found reflection in narrowing of syndromes spectrum and its drift from hypochondriac to anxiety and depressive pole. Dynamic pathomorphosis consisted of less favorable indices of course and outcomes of these disturbances in 1992-1999, and also in reduction of the period of the period from the beginning of illness to hospitalization to a specialized department.