[Influence of cytoflavin on symptoms of asthenia, emotional disorders and autonomic regulation in patients with organic asthenic disorder].

The present observational study addressed effects of cytoflavine on symptoms of asthenia and emotional and autonomic regulation in patients with organic emotional-labile (asthenic) disorder (F06.6). Fifty one females and 49 males (mean age 36.8±11.0 years) were included into the study during their in-patient treatment in Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department. All patients received standard antidepressant and vascular therapy, were consulted by psychologists or psychotherapists, visited physiotherapeutic procedures, massage and medical physical training. In addition, 50 patients received cytoflavin two tablets twice per day. At the psychiatric re-assessment before discharge both cytoflavin and control groups showed similar significant reduction of asthenia symptoms. At the same time, patients with cognitive deficits showed significantly larger improvement of cognitive functions after cytoflavin treatment in comparison with cognitively deficient patients after only standard therapy. Improvement of depressive symptoms was significantly larger in cytoflavin group in comparison with controls as well. These data are consistent with previous studies which showed cytoflavin to be effective as a treatment for patients with cognitive deficits and organic depression.

[Investigation of the effects of cytoflavin on symptoms of depression and autonomic dysfunction in patients with organic depressive disorder].

The present observational study addressed effects of cytoflavin as an adjunctive nootropic therapy in patients with organic depressive disorder (F06.36). 54 female and 46 male in-patients were included into the study. All patients received standard antidepressant therapy (controls) and 48 patients additionally received 2 pills of cytoflavin twice per day. Age, gender distribution, education and severity of depression were equal in cytoflavin and control groups. The follow-up assessment at discharge showed a significantly more pronounced decline in the severity of depression symptoms in patients receiving cytoflavin in comparison with the controls. Importantly, the effect of cytoflavin on the depression symptoms was prominent only in females. Moreover, women receiving cytoflavin demonstrated the more pronounced normalization of autonomic regulation in comparison with control women. The present results allow to recommend cytoflavin in dose 4 pills daily as an adjunctive therapy in female patients with organic depressive disorder.

[Steroid-induced myopathy].

Physiological effects of glucocorticoids include the inhibition of protein synthesis and the increase in catabolic processes in muscles. Consequently, a long-term intake of steroids in high doses causes myopathy. Myopathic effects of glucocorticoids are observed during systemic as well as inhallatory use. Most frequently, steroid myopathy manifests as the weakness and hypotrophy of lower limbs muscles, weakness of respiratory muscles, dysphonia. Prevention and treatment of steroid myopathy include limitation of indications for long-term usage of glucocorticoids, alternating regimens of treatment, adequate physical activity. The current data demonstrate the efficacy of vitamin D and amino acids mixtures in the prevention and treatment of steroid myopathy.

[Changes of spectral EEG parameters in normals at two week follow-up].

Computer EEG is commonly used in longitudinal clinical studies though physiological changes of electrical brain activity during repeated EEG recordings are poorly known. Resting eyes-closed EEG was recorded twice in two weeks in 14 healthy subjects (13 women, aged 25-69 years). At follow-up, the significant decrease of alpha and theta-2 power, along with changes of alpha-1 and alpha-2 mean frequencies in the right hemisphere, was observed. In addition, the increase of delta-2, theta and beta power was prominent in the left temporal region in the combination with slowing of delta-1 mean frequency in the left hemisphere and theta-2 frequency in the temporal regions. The present results reveal that physiological changes of brain electrical activity at repeated recordings are prominent and this fact should be correctly treated during longitudinal clinical studies using EEG.

[Microemboli as a cause of postoperative deliria and cognitive disorders in surgical practice].

Analysis of contemporary clinical and experimental studies evidences that intraoperative microemboli considerably contribute to the development of postoperative deliria and cognitive disorders. A number of studies have shown that left temporal and occipital structures are especially vulnerable to intraoperative ischemia. It is important that neurological cases of ischemia of the former brain regions are frequently characterized by transient psychoses and hypomnesia. Approaches to preventing intraoperative microembolism and associated neurological complications need further research.

[Brain bioelectrical activities in heroin addicts during early abstinence period]. / Bioélektricheskaia aktivnist' mozga u bol'nykh geroinovoi narkomaniei v rannie sroki abstinentsii.

Standard 19-channel EEG registration was performed in 30 heroin addicts (mean age 21.7 +/- 2.8 years, daily heroin abusing duration--12.2 +/- 8.0 months, heroin dose per day--0.42 +/- 0.29 g, abstinence duration--12.3 +/- 8.1 days). Qualitative EEG changes, being observed in more than 70% of the cases, included low voltage of background activity with depression of alpha rhythm and increase in beta activity; large amount of low amplitude waves in central regions; low reactivity to stimulation. The patients with daily heroin doses more than 0.5 g demonstrated slowing of alpha rhythm in comparison to those with lower doses (8.9 +/- 0.8 Hz vs 10.3 +/- 2.0 Hz, p < 0.05). In follow-up study, obvious or even complete normalization of the EEG was observed in most of the cases during the first months of abstinence.

[Neurological disturbances in heroin addicts in acute withdrawal and early post-abstinence periods]. / Nevrologicheskie narusheniia u bol'nykh geroinovoi narkomaniei pri ostroi abstinentsii i v rannem postabstinentnom periode.

Neurological examination was performed in 79 heroin addicts (mean age 24.4 +/- 6.3 years; heroin abusing duration 16.6 +/- 12.4 months; heroin dose per day 0.48 +/- 0.42 grams). During the first week after withdrawal, "physical dependency" symptoms, mild hypomimia and hypokinesia, low muscle tone, low tendon reflexes and facilitated nociceptive reflexes were observed in more than 70% of the patients. Non-specific microneurological signs as nystagm, limited convergence, tremor and dynamic ataxia etc, were found in more than 35% of the cases. Previously reported meningeal irritation or polyneuropathy symptoms were not determined in the patients population. Most of the symptoms disappeared after 10 days of abstinence as the follow-up examination of the 34 patients revealed. Mild hypomimia and hypokinesia persisted along with characteristic psychopathological changes. The most abundant neurological disturbances were observed in patients abusing heroin for more than 6 months in dosages more than 0.4 grams per day. Heroin withdrawal symptoms include reversible decrease in muscle tone and tendon reflexes as well as facilitation of nociceptive reflexes and reversible non-specific neurological microsigns. Heroin encephalopathy is characterized by ventral striatum insufficiency signs.

[Premorbid psychological status in heroin abusers: impact of treatment compliance]. / Vliianie premorbidnogo psikhologicheskogo statusa zloupotrebliaiushchikh geroinom lits na ikh otnoshenie k lecheniiu.

UNLABELLED: Heroin abusers who performed two "prefrontal" psychological tests (WCST and Delayed Alternation test--DIAT) with unusual amount of perseverative responses, reached i.v. doses of 0.5-1.0 g of heroin per day during the first year of heroin intake and continued out-patient treatment after discharge from hospital. Patients with "ideal" performance on two tests injected 0.1-0.3 g of heroin per day during the first year of heroin intake and stopped treatment after discharge, sometimes returned for treatment after several months of remission because of relapse. The latter patient group had lower verbal intelligence in comparison with education-matched normal controls. Percent of normal controls who made unusually many perseverative responses on WCST was the same as in the patient group (chi 2 = 5.5, p = 0.24). CONCLUSIONS: a) Performance of WCST and partially DAT can characterise of premorbid psychological status in heroin abusers; b) premorbid dysfunction of prefrontal cortex that mediates perseverative responses to WCST and DAT may contribute to drug abusing severity; c) low verbal intelligence may poorly influence treatment compliance in heroin abusers.

[Neuropsychological deficit in chronic heroin abusers]. / Neiropsikhologicheskii defitsit pri khronicheskoi narkotizatsii geroinom.

Neurological consequences of chronic heroin exposure are poorly known. 38 male patients with current heroin abuse or dependence were examined in withdrawal period that lasted more than 10 days, and were compared with 19 healthy controls. Wisconsin Card Sorting Test (WCST), "Delayed Alternation" Test (DAT), "Tower of London" Test (TLT), Russian version of WAIS (1995) were used. Patients were medicated and medication status was evaluated by psychomotor speed level. Patients with the duration of daily heroin abuse more than 1.5 years performed significantly less effectively TLT solutions as compared with the healthy controls (after Bonferroni correction, p = 0001). Patients with shorter duration of daily heroin abuse had a trend to perform TLT solutions poorer as compared to healthy controls and better than group with longer duration (after Bonferroni correction, p = 0.07 and 0.08). Three groups did not differ by WCST and DAT significantly, and general intelligence was in normal range in three groups. Multiple regression analysis confirmed significant influence of daily heroin abuse duration on TLT performance efficiency in our population (beta = -0.426, p < 0.05) without effect of age, education, IQ, dosage of heroin per day, withdrawal duration and current medication status (psychomotor speed level). Perseverative responses on DAT were significantly related to daily heroin dosages before treatment (beta = 0.405, p < 0.05) and negatively correlated with the withdrawal duration. These data give grounds to suppose, that chronic heroin exposure impairs planning functions of prefrontal cortex (TLT), that can be explained by cumulative neuronal damages of prefrontal cortex and VTA dopamine neurons. That was demonstrated in experimental and morphological studies of opiate addicts who died after opiate overdose. Large doses of heroin can induce more extensive functional impairment with possible involvement of orbit frontal cortex. The latter deficit may be partially reversible during short-term withdrawal.