The article presents an overview of scientific publications devoted to the study of the problem of anxiety disorders. The authors present various views on the neurobiological mechanisms of the pathogenesis of these disorders, consider the main somatic, neurological and cognitive disorders characteristic of anxiety disorders. Also considered are modern approaches to the pharmacological treatment of anxiety disorders and the main methods of psychotherapeutic correction used in their treatment.

Objective. The aim of the study was to evaluate the effectiveness of the drug Mildronate in the complex therapy of patients with a new coronavirus infection COVID-19 in the acute period and the background of cerebrovascular disease.

Material and methods. The material for the study was the medical records of 210 patients (140 women and 70 men) who had COVID-19 coronavirus infection against the background of cerebrovascular pathology in the period from 04.10.2020 to 12.31.2021. 120 patients (75 women and 45 men) received the drug Mildronate as part of complex therapy, 90 patients (55 women 35 men) made up the control group, received complex treatment without the use of the drug Mildronate. Patients in both groups were comparable in age, the average age was 76.5 years (from 50 to 93 years). Groups according to nosological forms were distributed as follows: in the main group – ischemic stroke of various localization – 70 patients (48 women and 22 men), chronic cerebrovascular insufficiency of varying severity – 50 patients (27 women and 23 men); in the control group – ischemic stroke of various localization was in 50 patients (36 women and 14 men), chronic cerebrovascular insufficiency – 40 patients (19 women and 21 men). To correct chronic hypoxia, the drug Mildronate was chosen, which is a blocker of fatty acid oxidation, has a multicomponent effect, stabilizes microcirculation under conditions of ischemia and hypoxia. Also, Mildronate is one of the universal cytoprotectors with a pronounced neuro-, cardio- and angioprotective effect, which goes well with drugs of other pharmacological groups.

Results. The drug Mildronate is a blocker of fatty acid oxidation, has a multicomponent effect, stabilizes microcirculation in conditions of ischemia and hypoxia. According to the observations, it can be noted that the neurological status during mildronate therapy has a more significant regression trend with good rehabilitation potential – 56.0% of patients can serve themselves independently, while patients in the control group reached a level of 9 points only in 51.0% of cases. A significant neurological defect remained in the main group in 6.2% of patients, in the control group this figure was 8.8%.

Aim. To study the emotional and personal characteristics of patients with benign paroxysmal positional vertigo (BPPV) and their impact on the development of functional dizziness (FD).

Materials and methods. 93 patients with BPPV were examined. Patients were twice examined (immediately after BPPV treatment and 1 month follow up) with scales: dizziness (DHI), depression (PHQ-9), anxiety (GAD-7), somatic symptoms scale (PHQ-15), Holmes – Rahe Stress Inventory, Leonhard – Schmishek personality accentuation test, Anxiety Sensitivity Index, and Agoraphobic Cognitions Scale.

Results. Seventeen (18%) patients had FD1 month after BPPV treatment (FD+ group), 76 patients had no dizziness (FD– group). Immediately after BPPV treatment patients FD+ group had more hight results of DHI (57 [49; 68] vs 49 [33; 61], p = 0.035), GAD-7 (13 [7; 15] vs 4 [2; 7]), p < 0.001) and PHQ-9 (9 [6; 13] vs 5 [3; 11], p = 0.025). One month after BPPV treatment, the level of depression in the FD+ group was higher (4.5 [4; 11] vs 3 [1; 6], p = 0.049), but the level of anxiety decreased and became comparable with the FD– group (p = 0.2). In the FD+ group had found higher rates of anxious personal accentuation (15 [12; 18] vs 12 [9; 15]; p = 0.020), anxious sensitivity (55.5 [43; 68.5] vs 36.5 [22.5; 53.5]; p = 0.010), as well as agoraphobia (11 [9; 18] vs 6 [2; 9], p = 0.003). The level of psychosocial stress did not differ between the groups.

Conclusion. Anxiety-depressive reaction is common in patients with BPPV. Anxiety and depression decrease after successful treatment with repositioning maneuvers. High levels of anxiety and depression, personal anxiety and anxiety sensitivity may be predictors of the development of functional dizziness.

Introduction. Movement disorders are one of the most common complaints of patients with cerebral palsy. The attending physician needs to evaluate the motor activity of patients after treatment. The Functional Mobility Scale (FMS) is a clinically feasible tool to quantify changes after SEMLS in children with cerebral palsy.

Purpose of the study. To evaluate the effect of simultaneous multilevel operations in combination with early rehabilitation treatment on the functional mobility of children with cerebral palsy in comparison with standard surgery.

Materials and methods. The criterion for inclusion in the study was age at the time of examination less than 18 years, spastic cerebral palsy, surgical treatment due to orthopedic complications of cerebral palsy in two groups: after SEMLS and standard surgery. All subjects were assessed motor activity on the FMS scale.

Results. The analysis performed showed no statistically significant changes in the assessment of functional mobility at a distance of 5 meters after surgical treatment in both study groups (p = 0.143; p = 0.083). A statistically significant improvement in functional mobility according to the FMS scale was found in children after simultaneous multilevel operations at distances of 50 and 500 meters (p = 0.025; p < 0.001). No statistically significant changes were noted after standard operating procedures were carried out at distances of 50 and 500 meters (p = 0,063; p = 0,058).

Conclusion. In children with cerebral palsy after simultaneous multilevel operations in combination with a complex of rehabilitation measures, the level of functional mobility improves. The use of the functional mobility scale allows the attending physician to objectify the dynamics of the motor function of patients with cerebral palsy after surgical treatment.

Objective. To perform a pharmacological analysis of treatment received by patients with schizophrenia spectrum disorders and to elaborate the principles of combination therapy with antipsychotics and antidepressants based on pharmacodynamics and pharmacokinetics.

Materials and methods. The study included 311 inpatients with schizophrenia spectrum disorders admitted to the V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology for the management of treatment resistance. A comprehensive pharmacological analysis was performed including a retrospective evaluation of the quality of patients’ treatment (based on their medical records) and a comparison of the neurochemical activity of the drugs in order to determine the rationality of combined use of antipsychotics and antidepressants. Statistical analysis included descriptive statistics and frequency analysis.

Results. An analysis of treatment data for 311 patients has demonstrated that given the significant frequency of combined administration of antipsychotics and antidepressants (29.3%), the choice of drugs was based on clinical judgment, without considering the pharmacological effects of the drugs being used. A comparison of pharmacodynamics has allowed to arrange antipsychotics and antidepressants according to their binding affinities to neurochemical targets. A methodological approach to evaluating the compatibility of combined drugs based on their neurochemical activity and affinity to specific receptors has been argued. The principles of combination therapy with antipsychotics antidepressants have been elaborated.

Conclusion. Combined use of an antipsychotic and an antidepressant without considering their ‘neurochemical compatibility’ regarding postsynaptic targets may decrease efficacy and potentiate adverse effects. In combination therapy with an antipsychotic and an antidepressant, drugs should be started one at a time taking into account their pharmacokinetics in order to avoid the possibility of competitive neurochemical effects prior to establishing a specific drug homeostasis. The development of rational strategies for combination therapy should be based on the assessment of pharmacodynamics and pharmacokinetics of the drugs.

The objective. To evaluate the effectiveness of the 5P-model for the prevention of acute cerebral ischemia in Dagestan women.

Materials and methods. The prospective study included 35 women permanently residing in Dagestan. The mean age was 66.46 ± 10.9 years. Each participant of the study was individually interviewed and examined clinically, neurologically, an additional examination included: complete blood test, biochemical blood test, coagulation test, molecular genetic study for 11 candidate gene mutations significant for the occurrence of ischemic stroke, electrocardiography, neuroimaging.

Results. By analyzing the results of the study, individual background conditions that predispose to the occurrence of ischemic stroke were established. The results of the examination were explained to each participant, there were given the recommendations on lifestyle modification, a diet was prescribed and the necessary therapy was selected. In the process of dynamic observation for 4 years the observed group had no episodes of acute cerebrovascular accident.

Conclusions. The study confirms the effectiveness of the use of the 5P-model for the prevention of acute cerebral ischemia in women Dagestan and declare a positive experience of its application.

Labyrinth of the inner ear consists of two parts: semicircular canals and vestibulum. Vestibular disorders predominantly associated with vertigo – the feeling of moving of the surrounding objects and oscillopsia. However, vertigo is a result of the damage of ampullar receptors in semicircular canals and their connections with vestibular nuclei in brainstem. At the same time the dysfunction of otoliths system is much more mysterious and unpredictable. Elaboration of new methods of objective assessment of vestibular system provides a wonderful opportunity of the analysis of different components of the peripheral vestibular system including saccular and utricular parts. As a result of such analysis, it was demonstrated that otolithic dysfunction is a common consequence of the most frequent vestibular disorders like Meniere’s disease, benign paroxysmal positional vertigo and vestibular neuritis. It is not clear yet what is the clinical presentation of otolithic dysfunction and how otolithic dysfunction influence the prognosis of common vestibular disorders. It is unknown whether isolated otolithic dysfunction exists, for example in patients with unspecific disequilibrium or dizziness.

In the presented clinical observation in early age patients with thrombophilia, bacterial endocarditis, mechanical compression of the iliac vessels of large uterine fibroids, the detection of recurrence of ischemic stroke. The article discusses the diagnostic requirements for the verification of these pathologies.