[Serotonin-norepinephrine reuptake inhibitors in psychiatry and neurology]. / Ingibitory obratnogo zakhvata serotonina i noradrenalina v psikhiatrii i nevrologii.

Antidepressants are one of the most important classes of psychotropic drugs and they are widely used in clinical practice, mainly in psychiatry and neurology. The main indications for the use of antidepressants are depression and anxiety disorders. First-line antidepressants are selective serotonin reuptake inhibitors, as well as serotonin-norepinephrine reuptake inhibitors which due to their dual pharmacological action have an additional effect on pain syndromes that determines their use in the treatment of neuropathic pain and fibromyalgia. A special place among the serotonin-norepinephrine reuptake inhibitors has duloxetine, which is characterized by proven efficacy in the treatment of depression, anxiety disorders, as well as isolated and comorbid pain. The optimal balance of efficacy and tolerability determines the possibility of safe use of duloxetine in patients with severe neurological disorders.

[Systematics and treatment of anxiety disorders]. / Sistematika i lechenie trevozhnykh rasstroistv.

Anxiety disorders are the most common type of mental disorders and include such core forms as generalized anxiety disorder, panic disorder, agoraphobia, specific phobias, and social anxiety disorder. Anxiety disorders contribute significantly to the global burden of disease, and the diagnosis and treatment of these disorders is of great social and economic importance. Current approaches to the treatment of anxiety disorders involve the use of cognitive behavioral therapy, antidepressants, benzodiazepines, antipsychotics, few anticonvulsants, and some other medications.

[Anxiety in neurological practice]. / Trevoga v nevrologicheskoi praktike.

Anxiety and related disorders are the most common type of mental disorders in both the general population and the neurological clinic. A current typology of anxiety disorders includes panic disorder, agoraphobia, simple (specific) phobias, social anxiety disorder, and generalized anxiety disorder. Anxiety disorders often accompany diseases of the nervous system, worsen their course and impede treatment, and the degree of anxiety usually corresponds to the severity of neurological symptoms. Anxiety may precede brain diseases, but the answer to the question of whether it contributes to these diseases or predicts them or can be an early manifestation of these diseases requires further studies. Modern approaches to the treatment of anxiety involve the use of benzodiazepines, antidepressants, some mood stabilizers, antipsychotics, as well as psychological interventions.

[Antipsychotics: treatment of schizophrenia and other therapeutic options]. / Antipsikhotiki: lechenie shizofrenii i drugie terapevticheskie vozmozhnosti.

Antipsychotics are used in the treatment of schizophrenia and other psychoses, as well as bipolar disorder, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and specific types of personality disorders. Due to better tolerability, as well as some advantages of the pharmacological profile, the second-generation antipsychotics are preferred in clinical practice. A special place among antipsychotics is taken by sulpiride, which shows the ability to improve the condition of patients with different types of mental disorders as well as with internal diseases.

[Challenges of the use of antipsychotics in children and adolescents]. / K probleme primeneniia antipsikhotikov v detskoi i podrostkovoi psikhiatrii.

The more frequent prescription of antipsychotics with high proportion of off label use, in particular for children and adolescents, is seen in many countries, including European Union, United States and Russian Federation. In accordance to current clinical guidelines, second-generation antipsychotics are preferred in clinical practice due to the higher tolerability compared to the first-generation antipsychotics. However, second-generation antipsychotics in children and adolescents, especially in continuous use, are associated with cardiac abnormalities and metabolic disorders, including hyperglycemia, and the risk of type 2 diabetes, weight gain and obesity, an increase in prolactin synthesis and hyperlipidemia. The adverse effects of antipsychotics in children and adolescents determine the need for more balanced approaches to their use, careful monitoring of the safety of treatment and the development of measures to prevent and correct side-effects of these drugs.

[Stroke and depression]. / Insul't i depressiia.

Depression is a frequent complication of stroke and occurs in approximately one in three surviving patients. Depression worsens the course of post-stroke neurological disorders, enhances the physical helplessness of patients, further reduces their quality of life, significantly decreases the effectiveness of therapeutic and rehabilitation measures and increases the risk of death. Antidepressants eliminate or relieve depressive symptoms, mitigate neurological disorders, improve cognitive functions and the general condition of patients, increase the effectiveness of treatment and rehabilitation, diminish the risk of recurrent stroke and decrease mortality. Selective serotonin reuptake inhibitors are the first line antidepressants for post-stroke patients; there is evidence of the effectiveness of other modern antidepressants, as well as tricyclic drugs. Unresolved aspects of this problem that require further well-designed controlled studies include tolerability of antidepressants by patients of late age, the choice of optimal drugs and the duration of therapy.

[Typical and atypical antipsychotics: how significant are the differences?] / Tipichnye i atipichnye antipsikhotiki: naskol'ko sushchestvenny razlichiia?

A number of frequently discussed issues of clinical psychiatry include comparing the advantages and disadvantages of typical and atypical antipsychotics. It is believed that atypical antipsychotics are less likely to cause extrapyramidal disorders and have a more significant effect on the negative symptoms of schizophrenia compared to typical drugs. However, many randomized controlled and cohort studies, as well as systematic reviews and meta-analyses carried out on their basis, allow questioning the superiority of second-generation antipsychotics over their predecessors, in particular in terms of tolerability. Current scientific evidence provides sufficient evidence for the clinical use of chlorpromazine and other traditional antipsychotics, along with more recent medicines.

[Treatment of anxiety disorders in alcohol abusers]. / Lechenie trevozhnykh rasstroistv u patsientov, zloupotrebliaiushchikh alkogolem.

The tendency to anxiety is a characteristic feature of alcohol abusers, and anxiety can be a symptom of alcohol withdrawal as well as comorbid disorder. The frequent comorbidity of alcohol use disorders and anxiety is due to a number of reasons including general hereditary predisposition, mutual conditioning and similar pathogenesis. Pharmacological therapy of anxiety disorders in alcohol-dependent patients is carried out on the basis of general principles of anxiety treatment and involves the use of benzodiazepines, antidepressants and, in some cases, antipsychotics as second-line medicines.

[Antidepressants: the goals and possibilities of therapy]. / Antidepressanty: tseli i vozmozhnosti terapii.

Antidepressants are among the most commonly prescribed drugs due to their effectivenes in treating depression and anxiety disorders. One of the reasons for early discontinuation of taking antidepressants are side-effects. Agomelatine is a relatively novel antidepressant with high efficacy and good tolerance. Clinical effects of agomelatine include a reduction in symptoms of depression, anti-anxiety and hypnotic effects, as well as the rapid elimination of anhedonia, which determines high adherence to therapy, restoration of normal social functioning, and complete remission of disease.

[Serotonin neurotrasmission and treatment options for depression]. / Neirotransmissiia serotonina i vozmozhnosti lecheniia depressii.

The efficacy of modern antidepressants is largely related to their ability to enhance neurotransmission of serotonin. The medicines with serotonergic properties include trazodone, which is intermediate between tricyclic antidepressants with their powerful antidepressive effect and selective serotonin reuptake inhibitors, as first-line agents in the treatment of depression and anxiety disorders. The value of trazodone for clinical practice is determined by the effective elimination of the symptoms of major depressive disorder in combination with good tolerability, including in elderly patients. Among the advantages of trazodone is the absence of such undesirable effects as sexual dysfunction and weight gain. Trazodone has significant hypnotic and anxiolytic properties, which gives it special meaning in the treatment of depression, combined with insomnia and anxiety. It is emphasized that the beneficial effect of trazodone on sleep should not prevent its main use as a drug for treating major depressive disorder regardless of whether depression is accompanied by insomnia or not.

[Prevention and treatment of hepatic encephalopathy]. / Profilaktika i lechenie pechenochnoi éntsefalopatii.

Hepatic encephalopathy is a common neuropsychiatric complication of serious liver diseases and serves as a marker for worsening of their course and increasing the risk of death. The principal pathogenesis factors of hepatic encephalopathy is the excessive formation of ammonia and its accumulation by astrocytes. A key role in the prevention and treatment of hepatic encephalopathy is played by drugs that prevent hyperammonemia and promote the removal of ammonia from the body, namely lactulose, rifaximin and L-ornithine-L-aspartate. L-ornithine-L-aspartate has proven clinical effectiveness in the treatment of hepatic encephalopathy, prevents the transformation of minimal hepatic encephalopathy into overt forms, increases the tolerability of psychotropic drugs used in the treatment of alcohol dependence, and improves cognitive functions.

[Traumatic brain injury: neurologic and psychiatric aspects]. / Travmaticheskoe povrezhdenie mozga: nevrologicheskie i psikhopatologicheskie aspekty.

Traumatic brain injury is among the leading social-medical problems that causes preventable deaths, health deterioration and disability in young individuals. It is manifested by neurologic and psychiatric disorders, firstly by neurocognitive impairment. Therapeutic interventions in traumatic brain injury include correction of cerebral disorders in the acute phase of trauma, treatment of neurocognitive impairment and symptomatic treatment of mental disorders. The efficacy of treatment of neurocognitive deficits associated with brain injury is still unsatisfactory, which determines the need to find new medicines and therapeutic approaches.

[Substance abuse: a relationship with childhood traumas]. / Zloupotreblenie psikhoaktivnymi veshchestvami: sviaz' s travmami detskogo vozrasta.

Childhood maltreatment contributes to poor mental and physical health and besides, in some cases, not only in early age but also throughout the life of the individual. Adverse effects of childhood trauma, along with depression, anxiety and other mental disorders, include predisposition to substance abuse. A reduction of child abuse may decrease the prevalence of mental disorders, including addictive disorders, and improve mental health.

[Panic disorder: clinical phenomena and treatment options]. / Panicheskoe rasstroistvo: klinicheskie fenomeny i vozmozhnosti terapii.

Panic disorder is a common mental disease with high psychiatric comorbidity. It is considered that a combination of genetic predisposition and a special psychic vulnerability plays a key role in the occurrence of panic disorder. Clinically proven efficacy in the treatment of panic disorder have benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitors; antidepressants from other pharmaceutical groups are also used. Selective serotonin reuptake inhibitors are the first line medicines in the treatment of panic disorder. Atypical antipsychotics may be used for the therapy augmentation in addition to first line drugs. Psychotherapy is used along with medications, and a combination of pharmacotherapy and cognitive behavioral therapy is the best method of treatment.

[Anxiety associated with substance abuse]. / Trevoga, svyazannaya so zloupotrebleniem psikhoaktivnymi veshchestvami.

Substance abuse and anxiety is a common comorbid dyad and an example of so-called dual diagnosis in psychiatry. Comorbidity of anxiety and addictive disorders may be due to interdependence of these states as well as common predisposing factors and pathogenic mechanisms. There are various medicines in the treatment of anxiety associated with substance abuse, including benzodiazepines, calcium channel modulators, non-benzodiazepine anxiolytics, antidepressants and antipsychotics. One of the best approaches to the treatment of chronic anxiety disorders in drug treatment clinic is a long course of treatment with antidepressants, primarily with selective serotonin reuptake inhibitors as first line preparations. Such medications as pregabalin, buspirone, etifoxine and alimemazine are also of interest for the treatment of dual diagnosis patients.

[Alcohol use disorders: current approaches to diagnosis and treatment].

Alcohol abuse and alcoholism are the leading causes of disability, health worsening and increased mortality. Diagnosis of alcohol use disorders is based on the formal criteria of ICD-10 and DSM-V. Sobriety-oriented therapy has extremely low efficiency. The difficulties of therapy are compounded by the fact that less than 10% patients with alcohol use disorder participate in treatment programs. Serious expectations in addressing unsatisfactory efficiency of alcoholism treatment are associated with WHO reducing alcohol consumption strategy. Nalmefene is the first and still only drug registered as a medicine for reducing alcohol use. Recent studies show that the decrease of alcohol consumption using nalmefene creates opportunities for significant lessening of alcohol-related morbidity, injuries and deaths.