[Management of patients with insomnia and polymorbidity. A draft of the clinical guidelines]. / Vedenie patsientov s insomniei pri polimorbidnoi patologii. Proekt klinicheskikh rekomendatsii. Obshcherossiiskaya obshchestvennaya organizatsiya «Rossiiskoe obshchestvo somnologov¼.

Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other diseases and conditions, such as arterial hypertension, type 2 diabetes mellitus, pain syndromes, anxiety and depressive disorders, etc. A separate problem is drug-induced insomnia, when patients develop symptoms due to other diseases treatments. Insomnia has a negative effect on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and decreased quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so clinical guidelines draft for the evaluation and treatment of insomnia in multimorbid patients is proposed. Diagnostic methods are reviewed and recommendations are given for the treatment of acute and chronic insomnia and features of the treatment of insomnia in multimorbid patients. A clinical algorithm has been proposed to determine treatment tactics in multimorbid patients.

[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.

[Clinical aspects of the use of imidazopyridine derivatives in the treatment of sleep disorders associated with post-COVID syndrome]. / Klinicheskie aspekty primeneniya preparatov gruppy imidazopiridinov v terapii narushenii sna, assotsiirovannykh s postkovidnym sindromom.

In 2019, a pandemic caused by the SARS-CoV-2 virus began. The fight against COVID-19 required the introduction of a number of restrictive measures, in particular the introduction of quarantine for the population and isolation of the sick, which, along with the direct effect of the virus on the nervous system, led to a significant spread of sleep disorders. In this regard, questions have become relevant about the choice of drugs for the correction of sleep disorders, about which sleeping pills will be safe in conditions of acute illness and during the recovery period after COVID-19. The article discusses the prevalence and therapy of insomnia in patients with acute COVID-19 and in patients with postcovid syndrome. The pharmacological effects and safety of zolpidem, a non-benzodiazepine short-acting hypnotic drug belonging to the class of imidazopyridines, which is used in short courses for both acute and transient insomnia and chronic insomnia, are described. The data on the ability of zolpidem to improve memory after a night's sleep are given. The possibility of its use in acute COVID-19 and postcovid syndrome is being evaluated.

[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.

[Astenic disorders within the framework of post-covid syndrome]. / Astenicheskie rasstroistva v ramkakh postkovidnogo sindroma.

The direct neurotropic and neurotoxic effect of the SARS-CoV-2 virus on the central nervous system, as well as the stressful effect of various factors of the COVID-19 pandemic, contribute to the development of the so-called post-COVID syndrome. The clinical picture of the syndrome includes asthenic, anxiety-asthenic, and depressive manifestations. When prescribing psychopharmacotherapy to patients who have undergone COVID-19, it is recommended to assess the potential benefits and risks in the aspect of using drugs not only with therapeutic antiasthenic and anxiolytic properties, but with minimally expressed undesirable effects and adverse drug interactions.

[Dizziness and anxiety disorders in the elderly]. / Golovokruzhenie i trevozhnye rasstroistva u lits pozhilogo vozrasta.

Perhaps each dizzy patient feels anxiety. Varying emotional disorders are particularly common in elderly patients with dizziness. The causes of the frequent concurrence of dizziness and mental disorders (anxiety and depression) are diverse. Amongst these there are two chief conditions: 1) vestibular vertigo may cause anxiety to a greater extent than many other symptoms; 2) anxiety and depression are themselves frequently manifested by the sensations resembling vestibular ones that patients are inclined to call dizziness. On the contrary, anxiety may appear in some cases as the sensations resembling dizziness. Besides the latter, the patient may present a lot of complaints, which serves as a manifestation of psychoautonomic syndrome (the basis for which is anxiety and depression). At the same time, the term 'phobic postural instability' is proposed to describe psychogenic disorders, in which dizziness becomes virtually the only chief complaint. The treatment of dizziness and anxiety disorders in the elderly encompasses a few areas: vestibular rehabilitation, drug therapy, and psychotherapy. The paper describes the possibilities of using anvifen as a pathogenetically sound treatment in patients with anxiety disorders, as anvifen is a GABA-ergic medication.

[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.

[Effect of motor cortex excitability on the course of symptomatic focal epilepsy].

We studied 31 patients with symptomatic focal epilepsy (SFE). Mean age of patients was 31.3 years. Twelve patients were first diagnosed with epilepsy, three of them started treatment; 22 patients received antiepileptic therapy. Thresholds of motor cortex excitability (MCE) in patients with SFE were significantly lower than in healthy people. Thresholds of MCE were lower in patients without treatment compared to controls (p < 0.004). Significant differences between thresholds of MCE in patients with- and without treatment were found. The threshold of MCE was higher in treated patients (p < 0.01). The frequency of seizures was twice higher (10.8 +/- 6.0 seizures per year) in the group with lower MCE thresholds (<40%) compared to that in the group with normal thresholds (5.16 +/- 4.6 seizures per year, p < 0.03). The thresholds were decreased in patients with SFE with the following signs of epileptic activity: the secondary generalization during a seizure, the elevation of seizure frequency in a year prior to the study, EEG epiphenomena, the response to hyperventilation during the EEG recording.

Evoked motor response thresholds during transcranial magnetic stimulation in patients with symptomatic partial epilepsy.

Transcranial magnetic stimulation (TMS) occupies a leading position among noninvasive neurophysiological methods used for evaluating the balance of processes of cortical inhibition and excitation. The aim of the present work was to assess motor cortical excitability in symptomatic partial epilepsy using TMS in relation to the effects of antiepileptic treatment. A total of 31 patients were studied. A decrease in the motor response threshold was seen in a group consisting of untreated patients, with changes in cortical excitability during seizures. Treated patients showed no difference as compared with healthy subjects. The shorter the interval between a seizure and TMS, the smaller the evoked motor response threshold. The low threshold seen in patients with symptomatic partial epilepsy showed a significant correlation with clinical signs of neuromuscular excitability. The data obtained here provide evidence of changes in the functional state of the cortex and, thus, the motor response threshold, in patients with epilepsy.

[Novel functional stress test (stochastic) and perspectives of its application]. / Novaia funktsional'naia nagruzochnaia (stokhasticheskaia) proba i perspektivy ee primeneniia.

AIM: To assess advantages of a stochastic functional stress test during which workloads change according to law of random numbers. METHOD: Results of stochastic tests and standard stress tests with stepwise increments of workloads were compared in 45 healthy subjects and 90 patients with ischemic heart disease (45 with angina pectoris, 45 after myocardial infarction). RESULTS: Compared with standard tests stochastic test was characterized by shorter times of achievement of ischemic threshold and higher double product. Sensitivity and specificity of stochastic test were significantly better than those of standard stress test. The difference between results of two tests can be explained by increased information content of the stochastic test.

[The role of emotional pressure in the development of the early forms of chronic cerebrovascular insufficiency]. / Rol' émotsional'nogo napriazheniia v razvitii nachal'nykh form khronicheskoi tserebrovasculiarnoi nedostatochnosti.

The paper presents a comparative analysis of the results of biochemical, neuropsychological and neurophysiological examination of initial chronic cerebrovascular insufficiency in patients without significant psycho-emotional tension (the 1-st group--37 individuals) and with significant emotional tension (the 2-nd group--44 persons). Statistically significant differences between the groups concerned both cerebral hemodynamic parameters and EEG data. On the basis of the results obtained several possible pathogenetic variations of chronic cerebral circulatory insufficiency are suggested on the domination of either primary damages of the structures of the brain and its vessels or the secondary disorder of energetic metabolism and cerebral blood circulation. That, in turn, may be conditioned both by supertension of cerebral systems in chronic stress, and by somatic disturbances. More precise definition of the main pathogenetic factors of initial chronic cerebrovascular insufficiency may be useful for improving efficiency of rehabilitation in these patients.

Production and characterization of monoclonal anti-idiotypic antibodies to muramylpeptide.

Hybridomas producing monoclonal anti-idiotypic antibodies (anti-id MAbs) to N-acetylglucosaminyl-beta 1-4-N-acetylmuramyl-alanyl-D-isoglutamine (GMDP) were developed. Three clones of hybridomas demonstrated the properties characteristic for the Ab2 beta type of anti-id antibody: they bound to Fab-fragments of high-affinity MAb to GMDP; dose-dependent inhibition of this binding by GMDP was observed; immunization of mice with these MAbs resulted in production of GMDP-specific antibodies. When these antibodies were used to stain blots from SDS-PAGE of macrophage lysate, the same receptor proteins were specifically stained as upon staining with 125I-labelled GMDP derivative.