The objective of the study is to present a description of the first domestic clinical observation of the painful dropped head syndrome in a patient with myasthenia gravis (MG).

Materials and Methods. Clinical, laboratory and instrumental data were analyzed over the course of MG symptoms with late onset in combination with thymoma, manifesting with pain and weakness in the neck extensors.

Results. The characteristic and unique features of diagnostics and treatment of MG developed in a 59-year-old patient associated with antecollis and significant pain syndrome, initially considered as manifestations of osteochondrosis, are observed in comparison with the literature data. The information on the occurrence, demographic origin, association with the type of receptor targets, thymus pathology and reversibility of these disorders in MG is systematized, and the importance of addressing the concepts of pain in MG is emphasized. The positive effect of ipidacrine in the symptomatic treatment of MG in a patient with marked cholinergic manifestations induced by conventional anticholinergic agents (AA) therapy is confirmed.

Conclusions. MG can cause axial muscle impairment leading to the phenomenon of “dropped head” and the development of pain syndrome atypical for the classical course of the disease. Pathogenetic treatment of seropositive MG in most cases leads to the elimination of its clinical manifestations, including pain. In some cases, the use of the reversible AA ipidacrine is an additional advantage in the therapy of such conditions, taking into account its concomitant proven efficacy as an adjuvant analgesic.

Migraine is the most frequent and costly type of headache. The analysis of the «cost of the disease» implies an assessment of direct and indirect costs expressed in monetary units. Drastic changes have recently occurred in approaches to the treatment of the disease, in connection with which there are large differences in the structure of the economic burden «yesterday and today». «Yesterday» knowledge about the pathophysiology of migraine was insufficient and various nonspecific agents were used to treat the disease, the antimigrenous effect of which was manifested as an additional one. The relatively low prices of these ineffective drugs for relieving attacks and preventing migraines were accompanied by high indirect costs due to temporary disability of patients, frequent time off from work, decreased labor productivity, family troubles, etc. Therefore, «yesterday»: the indirect costs associated with migraine therapy outweighed the direct costs. «Today» the cost of drugs for the prevention and pathogenetic agents for the relief of migraine attacks has become significantly higher and their costs are the main part of the costs of migraine therapy, However, the effectiveness of new pathogenetic agents for the treatment of migraines helps to reduce indirect costs and improve the quality of life. Awareness of the change in the ratio of direct and indirect costs, as well as the causes of this phenomenon, will increase patient compliance, correctly allocate costs and ultimately save personal and public financial resources.

The article is devoted to the combined use of psychological relaxation and transcutaneous electrical stimulation in post-stress disorders in persons of hazardous professions.

Materials and methods. There were 90 men with a high level of stress aged 40 to 55 years, whose clinical picture was distinguished by the interweaving of neuropsychiatric and cardiovascular disorders. The assessment of the mental status of patients was supplemented by the results of testing; the reserve capabilities of the body were assessed based on a test of dosed physical activity. Electro- and echocardiography were used to analyze cardiovascular activity. The patients were divided into three treatment groups, in which, in addition to the previously prescribed drug treatment in a third of cases, respiratory relaxation training and percutaneous neurostimulation were used. In the first two groups, these methods were used separately, in the 3rd group – in combination.

Research results. Initially, the features of neuropsychic and somatic manifestations in the observed contingent were specified. At the same time, in most of the observations, neurotic manifestations prevailed, combined with somatic disorders, mainly in the form of arterial hypertension and angina pectoris. In the course of assessing the results of treatment, the proposed complex was significantly more effective than the compared groups in terms of improving indicators of mental status and cardiovascular activity. The catamnesis analysis confirmed the stability of the results achieved even in the case of combined exposure.

Conclusion. The therapeutic complex of psychorelaxation and hardware equipment provides the effectiveness and therapeutic reliability of the effect due to the addition of several therapeutic mechanisms, and the work itself opens up prospects for optimizing corrective programs for the pathology under study.

Objective. To study the quality of life and adaptation of elderly men and women with chronic cerebral ischemia.

Materials and methods. The study included 65 patients (31 men and 34 women, mean age 81.6±1.1 years) diagnosed withchronic cerebral ischemia. The assessment of quality of life carried out by using the Russian version of the general questionnaire “SF-36 HEALTH STATUS SURVEY”. The level of asthenia studied using the MFI-20 questionnaire. Levels of anxiety and depression were determined using the HADS scale. Adaptive reactions studied in the leukocyte blood count by calculating the percentage of lymphocytes and segmented neutrophils.

Results. The patients rated their quality of life low in all areas, including the areas of physical capabilities, psychological well-being and social activity. A high prevalence and varying degrees of severity of asthenia, anxiety and depressive disorders revealed in all patients, more pronounced in women. The formation of homeostatic blood reactions was observed, indicating a decrease in the level of adaptation.

Objective. To study the influence of clinical indicators of myasthenia gravis severity to the quality of life of men and women with generalized myasthenia gravis.

Materials and methods. The study included 41 patients aged 60.4±16.4 years with generalized myasthenia gravis: 31 (76 %) women and 10 (24 %) men. Clinical manifestations of myasthenia gravis were assessed with quantitative myasthenia gravis score, myasthenia gravis-specific activities of daily living scale and short form of specialized quality of life questionnaire. Forced vital respiratory capacity was measured in all patients with subsequent additional data calculation.

Results. We revealed significant improvement of examined data during hospitalization in both males and females, but in females, significant improvement was established in all quantitative myasthenia gravis score subscales. In men worse affection of swallowing muscles and severe pain phenomena were revealed. Correlations of physical functioning parameter with total quantitative myasthenia gravis score and with score characterizing the strength of limb muscles were revealed in studying group.

Conclusion. Clinical manifestations and course of myasthenia gravis have the peculiarities n men and women. Quality of life disorder in studying patients correlated with severity of clinical manifestations, mainly with limb weakness.

Diabetes mellitus (DM) is a serious medical and social problem of our time due to its high prevalence, lethality, early onset of disability and increasing morbidity. In children and adolescents, type 1 diabetes (DM1), characterized by absolute insulin deficiency due to autoimmune or idiopathic lesions of pancreatic β-cells, is registered more often. Every year, the total number of patients with DM1 under 18 years of age in the Russian Federation increases by several tens of thousands of people. DM is accompanied by various complications and one of the most frequent is diabetic polyneuropathy (DP), which occurs in half of children with DM1 more than 3 years. The progressive course of DP leads to the development of serious consequences affecting the quality of life and prognosis of patients. At the same time, at present, many aspects of this complication are insufficiently studied or have contradictory data, which justifies the expediency of systematization of materials on the pathogenesis of DP, effective methods of diagnostics and treatment of the disease in childhood.

The aim of the work was to analyze modern scientific publications devoted to the study of DP in children, based on the search of literature sources in PubMed, CyberLeninka and RINC databases. A total of 58 bibliographic publications were reviewed, including contemporary resources from the period 2019–2023.

Objective. The aim of this study was to determine the psychopathological symptoms associated with self-harming behavior in order to develop preventive measures.

Materials and Methods. We included individuals aged 18 to 35. The main group consisted of individuals with a history of self-harming behavior, while the control group included individuals without any history of self-harming behavior. All participants completed a structured interview and the following questionnaires: SCL-90-R, the questionnaire of propensity to deviant behavior, and the «Coping Behavior Methods» questionnaire. We assessed the severity of psychopathological symptoms, motivation, and other characteristics of self-harming behavior.

Results. A total of 77 participants were included, divided into the main (n=39) and control (n=38) groups. Correlations were identified between the main characteristics of self-harming behavior. According to the SCL-90-R questionnaire, individuals with a history of self-harming behavior had higher scores in somatization, obsessions, sensitivity, depression, anxiety, hostility, phobic anxiety, paranoia, and psychoticism (p<0.01). The «avoidance» coping strategy was more prevalent in the main group (p<0.05). According to the questionnaire of propensity to deviant behavior, individuals in the main group had higher scores in overcoming rules, aggression and violence, volitional control, and addictive, self-destructive, and delinquent behavior (p<0.05). There were correlations between the regularity of self-harming behavior and the use of multiple types of self-harming behavior (r=0.497; p<0.01), pursuit of internal goals (r=0.333; p<0.05), occurrence of positive emotions after self-harm (r=0.352; p<0.05), increasing desire to stop this behavior (r=0.359; p<0.05), and difficulty achieving remission (r= –0.553; p<0.01). Experiencing negative emotions after an act of self-harm was negatively associated with the use of multiple types of self-harming behavior (r= –0.412; p<0.01) and addictive behavior (r= –0.408; p<0.05).

Conclusion. Adolescents and young adults with a history of self-harming behavior differ significantly from their peers in the presence of concomitant psychopathological symptoms. The regularity of self-harming behavior is associated with the use of multiple types of self-harming behavior and difficulty achieving remission. Our findings have clinical significance and may be incorporated into the development of preventive measures.

Introduction. Ischemic stroke in patients under 50 years of age is not uncommon. The prevalence of stroke in young people increases due to the increase in risk factors. Early detection of risk factors and optimization of primary and secondary preventive therapy are mandatory to reduce the burden of stroke in young people and preserve potential years of life.

Objective. To identify and evaluate the main risk factors and clinical and laboratory parameters in men aged 31–40 and 41–50 years with atherothrombotic stroke.

Material and methods. Before the development of the COVID-19 pandemic, 60 patients were examined (mean age 43.3±3.8 years). All patients underwent neuroimaging of the brain, ultrasound examination of the main vessels of the head, echocardiography, ECG, and laboratory analysis of blood serum.

Results. Among all patients, there were 10 patients aged 31–40 years (mean age 37.4±2.6 years) and 50 patients aged 41–50 years (mean age 44.5±2.8 years). All patients had atherosclerotic lesions of the main arteries of the head, with stenosis of more than 70 % only in patients aged 41–50 years. Among patients aged 31–40 years and 41–50 years, the most common risk factors were arterial hypertension (90 and 72 %), smoking (70 and 72 %), dyslipidemia (66.7 and 60 %), and regular alcohol consumption (30 and 36 %). The study showed statistically significant correlations of the main vascular risk factors with serum lipid metabolism indices, hemostasis and endothelial dysfunction markers.

Conclusions. The study showed the frequency of occurrence of the main risk factors in patients with atherothrombotic stroke aged 31–40 and 41–50 years, as well as the role of lipid metabolism disorders, hemostasis disorders and endothelial dysfunction in their development.

Аim. Generalization and systematization of ideas about the pathophysiological mechanisms of asthenic syndrome development against the background of COVID-19.

Materials and methods. The work analyzed scientific articles and monographs devoted to the etiopathogenesis of post-COVID asthenic syndrome (PCAS). The search was carried out by the keywords «COVID-19», «post-COVID syndrome», «psychoneurological disorders», «asthenic syndrome» using the PubMed, Medline, eLibrary.ru databases.

Results and discussion. The ideas about the clinical structure of PCAS are systematized, the mechanisms of penetration of the SARS-CoV-2 virus into the nervous system are presented, modern views on the molecular mechanisms of the development of neurological symptoms in COVID-19 convalescents are highlighted. The key pathogenetic links of PCAS are described, including immune deviations associated with cytokine imbalance, oxidative and nitrosative stress reactions with subsequent activation of anaerobic metabolic pathways in brain and muscle tissues; neurometabolic changes accompanied by dysfunction of the serotonergic, dopaminergic, noradrenergic and GABAergic systems.

Conclusion. Analysis of world literature data, as well as our own clinical experience, allows us to conclude that psychoneurological disorders associated with COVID-19 infection are multifaceted and complex and are accompanied by highly variable symptoms. At the same time, the existing fragmentary knowledge regarding the pathomechanisms of psychoneurological disorders against the background of COVID-19 dictates an urgent need to continue further research in this area.

The purpose of the study. To conduct a comparative assessment of the effectiveness of various sanatorium treatment programs for patients with respiratory disorders in postcovid syndrome.

Material and methods. The study involved 112 people with impaired respiratory system functions who were referred for sanatorium treatment 2–3 months after suffering a new coronavirus infection COVID-19. Of these, 74 are women and 38 are men. The programs used: physical therapy, halotherapy, inhalation of nitric oxide, electrostatic massage.

Results. The use of an extended program of sanatorium treatment with the inclusion of inhalations of nitric oxide and electrostatic massage in patients with respiratory disorders with postcovid syndrome contributes to a significant reduction in the number and severity of complaints in this category of patients.

Conclusion. The inclusion of nitric oxide inhalations and electrostatic massage in the programs of sanatorium treatment in patients with respiratory disorders with postcovid syndrome increases the effectiveness of rehabilitation treatment after acute infectious disease.

The problem of the occurrence of persistent olfactory dysfunction (OD) associated with Novel Coronavirus infection (COVID-19) has now become relevant, however, a regulated standard of therapy has not been developed. According to the literature, about 60 % of patients report the presence of olfactory disorders that persist for several months or more after recovery from COVID-19. However, no more than 5 % seek medical help for olfactory disorders, which indicates the importance of the problem and the need for treatment in a polyclinic setting. Currently, two main areas of treatment for quantitative and qualitative disorders of the sense of smell are used – drug and non-drug therapy. The article proposes a systematization option based on existing treatment methods with an assessment of their effectiveness. The method of performing olfactory training is described, and the results of treatment of persistent OD are presented.

The article presents the results of a scientific study aimed at determining the effectiveness of the drug Vortioxetine (Brintellix) in the treatment of affective spectrum disorders in patients with alcohol dependence in a drug treatment hospital, since the drug is promising for widespread use in the drug therapy of a number of mental disorders and in the future could be included in the standard of medical care in the field of psychiatry-addictology. It is known that anhedonia is one of the mental disorders in withdrawal syndrome, which provokes relapses of an addictive disorder and negatively affects the duration and quality of remissions of patients with an addiction profile. At the same time, the study of antidepressant therapy in the treatment of alcohol dependence remains relevant, since poor tolerance, side effects, and deterioration of the patient's general condition may affect adherence to drug therapy. In the present study, anhedonia was assessed on the Snaith-Hamilton SHAPS scale, anxiety-depressive manifestations using the HADS hospital anxiety and depression scale and quality of life according to the SF-36 questionnaire during 24 weeks of follow-up.

The result of drug therapy with Vortioxetine was the relief of affective disorders in alcohol dependence, which contributed to the improvement of overall subjective well-being, the degree of satisfaction with the quality of life and a decrease in anxiety-depressive tendencies and anhedonia. In addition, minimal and minor adverse reactions when taking Vortioxetine affected the increased adherence of the examined patients to medical prescriptions and recommendations.

Conclusions. The use of Vortioxetine in the treatment of affective disorders among patients suffering from alcohol dependence provides new opportunities to help people suffering from alcohol addiction. Vortioxetine can be recommended both at the stage of inpatient care and outpatient treatment, since when it was taken, stable positive dynamics of antidepressant, anti-anxiety and antiangedonic effects were recorded.