[Management of patients with insomnia and polymorbidity: expert consensus]. / Vedenie patsientov s insomniei pri polimorbidnoi patologii: konsensus ekspertov.

Sleep disorders are becoming increasingly important due to the high comorbidity with other diseases and a significant impact on the patient's quality of life. Insomnia is the most common sleep disorder both in the general population and in patients with multimorbid pathology. Its prevalence in the general population is 6-15%, while in patients with somatic diseases it increases up to 20-40% and can reach 90% in patients with comorbid mental disorders. Another problem is the development of drug-induced insomnia. Insomnia has negative impact on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and a worse quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so it is extremely important to identify and correct these disorders in the early stages, therefore recommendations for the diagnosis of insomnia in polymorbid patients are proposed. Modern methods of treating acute and chronic insomnia and features of insomnia treatment in polymorbid patients are also discussed.

[Hypersomnia in mental disorders]. / Gipersomniya pri psikhicheskikh rasstroistvakh.

Hypersomnia is a group of diseases that share the main symptom - excessive daytime sleepiness, not caused by disturbances in nocturnal sleep or circadian rhythms. Excessive daytime sleepiness is present in 15.6% of adults in the world, a Russian study showed a prevalence of 39.2%. It is associated with a wide range of comorbidities, including obesity and mental disorders, on the other hand, the presence of hypersomnia increases the likelihood of mental illness. People with hypersomnia are more likely to take medications, have a decreased quality of life, spend more health care resources, and more often receive social benefits. The heritability is estimated to be about 40% for sleep duration and 17% for excessive daytime sleepiness. Hypersomnia in mental disorders is secondary. It most often occurs in patients with depression or bipolar disorder. To assess the severity of daytime sleepiness, self-observation and objective methods, including the multiple sleep latency test, actigraphy, polysomnography, are used. In the differential diagnosis of hypersomnia in psychiatric disorders, it is necessary to make a differential diagnosis with hypersomnia caused by taking medications or other substances and insufficient sleep syndrome. The etiology of prolonged sleep in psychiatric disorders is complex, and includes biological and psychological causes. The relationship between self-reported hypersomnia and sleep actually obtained is still unclear. Results of daily polysomnography show a significant increase in time in bed during the day and night (clinophilia). Therapy of hypersomniac syndromes should be done taking into account the etiology of the disease. In cases of secondary nature, the main efforts should be directed to the treatment of the underlying mental disorder causing somnolence.

Sleep Disorders in Post-COVID Syndrome: A Psychiatric or Neurological Problem?

The coronavirus pandemic that began in 2019 continues. COVID-19 adversely affects human health not only in the acute, but also in the long-term period of the disease: in a large percentage of cases, health is not fully restored after long periods, requires medical intervention, and is often difficult to correct. Researchers noted during the first wave of the pandemic in 2020 that about 10-20% of patients did not fully recover by three weeks from disease onset and the possible duration of the recovery period remains insufficiently clear, as do the reasons for differences in course during this period. Prolonged recovery after viral infection is not a feature exclusive to COVID-19, which does not facilitate the management of patients with post-COVID syndrome (PCS). The mental health impact of COVID-19 is significant, with at least 30% of recovered patients likely to have symptoms of anxiety and/or depression after the acute phase has passed. Since the onset of COVID-19, there has been an increase in sleep disorders by 42%, with every third COVID-19 survivor reporting sleep complaints. In PCS, this condition is referred to as coronasomnia. The success of therapy for this condition depends on identifying and correcting patients' mental disorders, as anxiety and depression are often accompanied by sleep disorders this results in a bidirectional interaction between mental disorders and sleep quality. This article presents data on the anti-anxiety drugs Noofen and Adaptol, which help to correct the manifestations of PCS with sleep disorders.

[The second stage of rehabilitation of post-infectious myelopathy after a new coronavirus infection]. / Vtoroi etap reabilitatsii postinfektsionnoi mielopatii posle perenesennoi novoi koronavirusnoi infektsii.

After suffering a new coronavirus infection (COVID-19), patients develop damage to various organs and systems, including the central nervous system. One of the rare and little-described complications is spinal cord injury. PURPOSE OF THE STUDY: Description of a clinical case of post-infectious myelopathy in a young patient after a new coronavirus infection. MATERIAL AND METHODS: Patient L., 28 years old, was admitted for rehabilitation treatment at the Regional Medical and Rehabilitation Center with a diagnosis of post-infectious myelopathy, acute period, lower central paraplegia. The patient underwent a comprehensive clinical and instrumental monitoring, including an assessment of the anamnesis, complaints, physical condition, and neurological status. The dynamics of the patient's condition was assessed using the rehabilitation routing scale, as well as the Rivermead mobility index, functional categories of walking, the Hauser walking index, the Berg balance scale, and the Frenchay hand test. RESULTS: After completion of the rehabilitation course, the patient showed positive dynamics in the form of an increase in exercise tolerance up to 40 minutes; increase in strength and volume of active movements in the lower extremities. Positive dynamics was revealed on all scales assessed. CONCLUSION: Due to the fact that the number of complications of COVID-19 is growing, it is necessary to inform doctors about the possibility of such a complication as myelopathy in order to timely diagnosis and effective treatment, which will reduce the incidence associated with spinal cord dysfunction.

[Sleep disorders in post-COVID syndrome - a problem of psychiatry or neurology?] / Rasstroistva sna pri postkovidnom sindrome ­ problema psikhiatrii ili nevrologii?

The pandemic of coronavirus infection, which has begun in 2019, has not ended to this day. COVID-19 adversely affects human health not only in the acute period of the disease, but also in the long-run: in a large percentage of cases, recovery takes very long, patients require and often have problems returning to their baseline. During the first wave of the pandemic in 2020, researchers noted that about 10-20% of patients didn't fully recover three weeks after the onset of the disease. It is still not clear how long the recovery period can last, and what are the reasons of different time course of the recovery. Long-term recovery after a viral infection is a non-unique feature of COVID-19, which does not facilitate the management of patients with post-COVID syndrome. The impact on mental health after COVID-19 is significant, and at least 30% of those, who have been ill, may have symptoms of anxiety and/or depression after the acute phase of the disease. Since the emergence of the SARS-CoV-2 virus, there has been an increase in somnological disorders by 42%, while every third COVID-19 patient reports altered sleep patterns. In post-COVID-19 syndrome, this condition is referred to as Coronasomnia (COVID-somnia). The success of therapy of this condition depends on reporting and treating mental disorders in patients, as anxiety and depression are often accompanied by sleep disorders, that is, there is a bidirectional influence of mental disorders on the quality of sleep. The article provides data on two anti-anxiety drugs (noofen and adaptol) that help to treat the manifestations of post-COVID syndrome accompanied by sleep disorders.

[COVID-19 and stress-related disorders]. / Kovid-19 i stress-svyazannye rasstroistva.

Since the WHO declared the COVID-19 outbreak a pandemic, the most actual problem has been a change in the lifestyle of the population of Russia and the rest of the world. Fear of illness, self-isolation/quarantine, and decreased quality of life have dramatically increased the level of stress-related disorders in the population. The main mental disorders arising from stress refer to anxiety disorders (post-traumatic stress disorder (PTSD), panic disorder, agoraphobia, social phobia, generalized anxiety disorder), obsessive-compulsive disorder, depressions of varying severity and conversion reactions. The symptoms and early warning signs of stress-related disorders may be chronic or episodic. Stress-related disorders are corrected with psychotropic therapy, which aims to restore the balance of neurotransmitters. Current first choice agents for the treatment of both pathological anxiety and depression are selective serotonin reuptake inhibitors (SSRIs). During the pandemic, the SSRI fluvoxamine is of special interest. Its mechanisms of action are recognized as potentially useful for treating COVID-19 infection. Two studies confirming the efficacy and safety of fluvoxamine in the treatment of coronavirus infection are described.

[Social, demographic and clinical characteristics of female patients with schizophrenia and HIV]. / Sotsial'no-demograficheskie i klinicheskie osobennosti VICh-infitsirovannykh zhenshchin, bol'nykh shizofreniei.

OBJECTIVE: To evaluate social, demographic and clinical characteristics of women with schizophrenia and HIV. MATERIAL AND METHODS: Medical histories of patients who were in inpatient treatment during 2017 were retrospectively studied. A total of 174 medical histories were analyzed, but the final analysis included 40 HIV-infected patients (main groups) and 48 patients without HIV infection (comparison group). These groups included patients with a diagnosis of schizophrenia or acute polymorphic psychotic disorder. All patients with HIV infection were examined by a specialist and an immunological analysis was performed. Correlation analysis was performed between quantitative clinical indicators (duration of illness, number of hospitalizations, the number and duration of remissions, etc.) and immunological parameters. RESULTS AND CONCLUSION: Patients with schizophrenia and HIV infection are more often hospitalized and stay in the hospital longer than patients with schizophrenia without HIV infection, which may in part be determined by the social problems of this cohort of patients. There is a relationship between individual indicators of the immune status of the patients, the duration and some features of the course of mental illness. Regular treatment of HIV infection correlates with a lower frequency of hospitalizations in a psychiatric hospital due to an exacerbation of the mental state.

[A regional experience of the optimization of neurological care for the rural population]. / Regional'nyi opyt optimizatsii nevrologicheskoi pomoshchi sel'skomu naseleniiu.

At present, the problem of disparity of healthcare, including neurological care, in urban and rural settings is highly relevant. Medical care after acute stroke or other chronic disabling diseases (epilepsy, Parkinson's disease) in rural settings is quite challenging due to the lack of access to specialized medical treatment facilities, low level of resources in medical and obstetric centers, low quality of healthcare, personnel turnover in rural healthcare and insufficient coverage of population with outpatient follow-up services. The most promising optimization approaches, which proved to be effective both abroad and in the Russian Federation, including Tyumen district, are the development of multidisciplinary mobile teams and telemedicine. Introduction of these approaches provides an increased access of rural population to specialized medical care, which leads to improvement in overall population health status.

[Algorithm for the diagnosis, treatment, and prevention of stress (for general practitioners)].

By inducing physical and mental disorders, human stresses are known to lead to long-term serious consequences and frequent use of more medical resources. Owing to long-term clinical trials, a management algorithm based on the principles of personalized medicine has been elaborated to minimize the consequences of stress, to activate natural adaptation mechanisms and to enhance stress resistance.

[Sleep disorders in epilepsy].

The review of the literature on sleep disorders in epilepsy over the last two decades is presented. Paroxysmal phenomena of epileptic origin, nonepileptic paroxysms, antiepileptic drugs, polypragmasia and comorbid depression may affect sleep in epilepsy.Shortening of sleep time may cause seizures, hallucinations and depression because sleep plays an important role in the regulation of excitatory and inhibitory processes in the brain both in healthy people and in patients with epilepsy. According to the literature data, drugs (short treatment courses of hypnotics) or nonpharmacological methods should be used for treatment insomnia inpatients with epilepsy.

[Magnesium in the treatment and prevention of cerebrovascular disease].

To date, the amount of evidences for the role of magnesium in determining the energy potential of the cells increases, which is critical in the pathogenesis of stroke, as well as in the survival and recovery of brain cells. Energy donor in cellular processes is adenosine triphosphate (ATP) as a complex of Mg2+- ATP [1]. In acute and chronic cerebral ischemia deficit Mg2+ is the basis of hypoxia cells, which leads to their subsequent death. [2]. Severe deficiency of selenium, when there is an issue of life and death of the patient, requires a massive correction of magnesium homeostasis. It is an integral component of intensive care in neurology, cardiology, obstetrics. However, in daily practice neurologist frequently has patients with chronic cerebrovascular disease, accompanied by magnesium deficiency. This proves necessitate of the use of magnesium containing drugs with neuroprotective and neurotrophic properties in the treatment and prevention of cerebrovascular disease.

[Transcranial magnetic stimulation in chronic tension-type headache].

In the treatment of 30 patients with chronic tension-type headache have included transcranial magnetic stimulation apparatus "TAMAS". The course of treatment was 5 procedures. We evaluated the severity of pain on a visual analogue scale (VAS), the portability procedures, the possible local and general side effects. We compared performance before and after therapy. Showed a reduction in headache intensity on a scale of VAS, improved general well-being.

[The role of dysfunction of the autonomic nervous system in idiopathic overactive urinary bladder in women].

A complex urological and neurological examination of female patients with idiopathic overactive bladder (IOAB) has detected clinical signs and neurophysiological correlates of vegetative dysfunction in the form of disturbed sympatho-parasympathic interrelations, failure of segmental and compensatory enhancement of suprasegmental mechanisms of regulation of lower urinary tract activity. The treatment with selective inhibitors of serotonin re-entry reduced severity ofpsychovegetative syndrome and symptoms of the lower urinary tract. This confirms an essential role of the autonomic nervous system in pathogenetic mechanisms of IOAB development and gives grounds for recommending selective inhibitors of serotonin re-entry for combined treatment of IOAB patients.

[Autonomic imbalance in patients with metabolic syndrome: role in the development of hyperfiltration--an early marker of renal lesions].

AIM: to study the impact of the autonomic nervous system on the development of renal lesion in patients with metabolic syndrome (MS). SUBJECTS AND METHODS: One hundred and nine patients (45 females and 54 males) aged 29 to 72 years who had MS were examined. Glomerular filtration rate (GFR) was estimated using the Cockroft-Gault formula, by correcting the obtained result on the body surface. According to the level of GFR, the patients were divided into 3 groups: 1) 30 MS patients with hyperfiltration (GFR > 110 ml/min/1.73 m2); 2) 55 patients with normal GFR (110-60 ml/min/1.73 m2); 3) 24patients with lower GFR ( < 60 ml/min/1.73 m2). All the patients underwent physical examination; autonomic tonus was examined by 24-hour cardiac rhythm variability (CRV) study using the Holter monitoring system, by applying the time analysis. The presence of autonomic dystonia syndrome (ADS) and its degree were determined by a questionnaire to detect autonomic nervous system (ANS) dysfunction. RESULTS: Each of 3 groups was found to have signs of autonomic imbalance with a preponderance of sympathetic activity with decreased parasympathetic activity, these impairments being more pronounced in Group 1. The obtained regulation reflects the entire decrease in autonomic actions on the cardiovascular system in patients with MS and suggests the maximum hyperactivation of the sympathetic ANS in early-stage renal lesion--hyperfiltration CONCLUSION: When the first signs of renal lesion (hyperfiltration) occur in patients with MS, there is significant hypersympaticotonia that promotes the progression of target organs, including the kidneys.

[Nonspecific pains and depression in neurology].

Nonspecific pains (NP) are considered as general symptoms in different pathologies. They occurred in most patients with depression. A data analysis using a program "PARUS" allowed to specify clinical characteristics related to depression. It has been found that the clinically significant depressive state amplified the pains characteristic of somatic and neurological pathology. Therefore, treatment of such patients must be complex and include a therapy of somatic disease and antidepressants. A choice of the latter is depended on its thymoanaleptic and, in case of NP, antinociceptive activity.

[A study of mydocalm efficiency in the treatment of chronic headache of tension].

Mydocalm was used for the treatment of 31 patients, mean age 45 +/- 4 years, with chronic headache of tension in a dosage of 150 mg 3 times per day during 4 weeks. Twenty-six patients have completed the therapy course. Before- and after treatment, neurological status, dynamics of psychoautonomic disorders, an extent of anxiety and depression, quality of sleep, quality of life, pain syndrome measured by a number of tests, were assessed, along with electromyography and examination of nociceptive reflex. Subjective evaluation of the drug efficacy was taken into account as well. A marked positive effect of mydocalm was observed in 70% of patients, moderate effect--in 30%. A predictor of mydocalm efficacy was severity of muscle tonic syndrome.