[Multi-center open comparative randomized study of efficacy and safety of Akatinol Memantine 20 mg (single-doses) vs Akatinol Memantine 10 mg (double-doses) in patients with vascular dementia]. / Mnogotsentrovoe otkrytoe sravnitel'noe randomizirovannoe issledovanie effektivnosti i bezopasnosti primeneniya preparata Akatinol Memantin, 20 mg (odnokratnyi priem) v sravnenii s preparatom Akatinol Memantin, 10 mg (dvukratnyi priem) u patsientov s sosudistoi dementsiei.

OBJECTIVE: Evaluation of the efficacy and safety of the drug Acatinol Memantine, 20 mg (once daily) in comparison with the drug Acatinol Memantine, 10 mg (twice daily) in patients with moderate to moderate severe vascular dementia. MATERIAL AND METHODS: The study included 130 patients aged 50-85 years of both sexes with instrumentally and clinically confirmed vascular dementia. The patients were randomized into 2 groups. Group I consisted of 65 patients receiving Akatinol Memantine, 20 mg once daily, group II - 65 patients receiving Akatinol Memantine, 10 mg twice daily for 24 weeks. Clinical, parametric and statistical research methods were used. The Alzheimer's disease assessment scale, the cognitive subscale (ADAS-cog), the short mental Status Assessment Scale (MMSE) and the general clinical impression scale for patients condition and illness severity (CGI-C and CGI-S) and the Hamilton Depression Rating scale (HAM-D) were used. Adverse events were collected and analyzed. RESULTS: At week 24, both groups showed statistically significant positive change in ADAS-cog total score: in group I the total score was 27.2±8.76 points (absolute difference from baseline 3.5 points; p<0.01), and in group II - 26.1±7.86 points (absolute difference from baseline 2.5 points; p<0.01) with no statistically significant differences between groups. Evaluation of secondary efficacy criteria (change in ADAS-cog total score at week 12 and MMSE at weeks 4, 12, and 24) also revealed statistically significant benefit in both groups compared to baseline with no significant differences between groups. Statistically significant improvement was noticed on CGI-S and CGI-C scales in both groups. Akatinol Memantine was safe and well tolerated in both groups. CONCLUSION: The study showed no lesser efficacy and safety of Akatinol Memantine, 20 mg (once daily) compared to Akatinol Memantine, 10 mg (twice daily) in patients with moderate and moderately severe vascular dementia.

[Organic mental disorders with comorbid alcoholism in the elderly]. / Organicheskie psikhicheskie rasstroistva u lits pozhilogo vozrasta, komorbidnye s alkogolizmom.

Elderly people are particularly vulnerable to comorbid disorders. The age-related weakness, cognitive decline, and criticism create favorable conditions for the formation of traumatic situations and is often accompanied by an increase in alcohol consumption, which in some cases leads to the formation of mental and physical dependence. Alcohol abuse leads to exacerbation of somatic disorders, the frequency of which increases with age. Alcoholism in the elderly leads to the accelerated development of organic mental disorders of varying severity. In turn, organic mental disorders lead to aggravation and complication of alcoholism. The formed comorbid disorder makes it difficult to diagnose and provide therapeutic and preventive measures.

[Slow-wave sleep and the possibilities of modern insomnia therapy]. / Medlennovolnovoi son i vozmozhnosti sovremennoi terapii insomnii.

Effective therapy of insomnia, especially chronic insomnia, is one of the most pressing neuropsychiatric problems. Unfortunately, at present in the Russian Federation, as in most other countries of the world, there are no officially approved drugs for long-term treatment of insomnia. In this regard, the use of medical sedation agents that do not have restrictions on the duration of use is of considerable interest. This review considers drugs of various psychopharmacological classes, one way or another used in practice for the correction of sleep disorders, especially in patients with underlying comorbid pathology.

[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.

[Optimization of treatment of depression with administration of ethylmethylhydroxypyridine succinate (Mexicor)]. / Optimizatsiya lecheniya depressii naznacheniem etilmetilgidroksipiridina suktsinata (Meksikor).

OBJECTIVE: To investigate the therapeutic efficacy and tolerability of Mexicor as an adjuvant in the treatment of depression with SSRI antidepressants. MATERIAL AND METHODS: The study included 100 patients, aged 18-50 years, with verified depression of mild (n=32) or moderate (n=68) severity. Patients (n=50) of the main group, along with basic antidepressant therapy with SSRIs, received Mexicor at a dose of 600 mg/day, in the comparison group (n=50) - only SSRIs. Clinical-psychopathological, psychometric, using the HDRS-21 scale, CGI, HADS, fluency test of speech responses and the Stroop test, statistical research methods were used. RESULTS: The reduction of depressive symptoms on the HDRS-21 scale, starting from the fourth week, was statistically significantly superior to that in the comparison group (p<0.001), the reduction in the severity of the condition on the CGI scale in the main group was also significantly greater than in the comparison group (17.3% and 9.6% respectively, p<0.05). A significant improvement in speech fluency was found in the main group (p<0.05). Adverse events in the main group were significantly less common (p<0.001). CONCLUSION: Administration of Mexicor together with SSRIs leads to improved efficacy and tolerability of antidepressant therapy, and in the future, Mexicor may be recommended as an adjuvant in SSRI therapy for depression.

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.

[Roadmap for ecosystem-based approach for patients with Alzheimer disease in Russia: current needs, barriers, and possible solutions (resolution of the scientific and practical experts meeting)]. / Dorozhnaya karta po okazaniyu pomoshchi patsientu s bolezn'yu Al'tsgeimera v Rossii v formate ekosistemy: tekushchie potrebnosti, bar'ery i vozmozhnye resheniya (rezolyutsiya nauchno-prakticheskoi vstrechi ekspertov).

The care of a patient with Alzheimer's disease (AD) is considered from the perspective of an ecosystem, that is, a systemic approach describing effective partnership, collaboration and research aimed at creating value, involving all participants in the AD patient journey. The effectiveness of this ecosystem is only possible with the involvement of all stakeholders in its development, including patients, healthcare professionals at all levels, government agencies, private companies, and patient organizations. The unmet health care and information needs of patients with AD are a consequence of barriers in the AD ecosystem. Key barriers for the patient include low awareness and stigmatization of the disease in society, lack of quality epidemiological data, difficulties in timely diagnosis, lack of prevention programs, unpreparedness of most physicians to conduct AD patient rehabilitation, and other factors. Based on the analysis of the ecosystem of AD and the patient pathway, 10 main directions (strategies) necessary for the formation of the ecosystem were identified: conducting research in the diagnosis and epidemiology of AD, creating and implementing a cognitive health program, forming a legal framework, raising public awareness, optimizing patient routing for timely diagnosis, organizing a network of memory clinics/laboratories, creating a register of patients with dementia, developing digital solutions and supporting social projects.

[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.

[Efficacy and tolerability of contemporary antidepressants: results of network meta-analyses and Russian experience]. / Éffektivnost' i perenosimost' sovremennykh antidepressantov: rezul'taty setevykh metaanalizov i rossiiskii opyt.

The objective of this review is to compare results of network metaanalyses of the efficacy and tolerability of different antidepressants for treatment of unipolar depression in adults. An analysis of different criteria of antidepressant efficacy and tolerability showed the benefits of agomelatine. Results of using this drug in national clinical practice and multicenter studies of depression of different nosology with heterogeneous psychopathological symptoms support this notion.

[Treatment of depression with cognitive impairment]. / Opyt primeneniia val'doksana pri depressiiakh, protekaiushchikh s kognitivnymi narusheniiami.

AIM: To investigate the efficacy and tolerability of monotherapy with agomelatine (valdoxan) in depressive patients with marked cognitive impairment. MATERIAL AND METHODS: Thirty-five patients (women 77.1%) were recruited to participate in the study. Mean age of patients was 48.9±3.5 years. The following scales and cognitive tests were used: HAM-21, CGI, HADS, MMSE, the Stroop task, the Rey test, RAVLT. Effective therapeutic doses of valdoxan were 25mg per day in 77.1% of patients, 50 mg per day beginning from week 2 in 22.9%. Cognitive impairment was found in astheno-apathic depression (51.4%), anxiety-hypochondriacal depression (28.6%), anhedonic depression (5.7%). RESULTS: The results showed that 74.3% of patients were responders and 51.4% were in remission. The dynamic of cognitive impairment demonstrated the positive effect of treatment with agomelatine (valdoxan). Beneficial safety profile of valdoxan was confirmed. CONCLUSION: Valdoxan is the effective and relatively safe antidepressant; it can be recommended for treatment of depression with cognitive impairment in therapeutic doses for at least 6 weeks.

[Agomelatine (valdoxan) in treatment of endogenous depression in day patient department]. / Terapiya agomelatinom (val'doksan) endogennykh depressii v usloviyakh dnevnogo statsionara.

AIM: Naturalistic psychopharmacological study of efficacy and tolerability of agomelatine (valdoxan) in treatment of endogenous depressions (in the framework of schizophrenia, schizoaffective and bipolar disorder) in day patient department. MATERIAL AND METHODS: Study sample consisted of 37 patient (59.4% female, mean age 41.6±3.7 years). RESULTS AND CONCLUSION: CDS total score significantly reduced after 8 weeks of treatment 44.9% compared to baseline (р<0.001); HAM-D total score decreased on 51.3% compared to baseline (р<0.001). The proportion of responders at the 8th week of treatment was 54.1%. Agomelatine (valdoxan) had favorable safety profile. Follow-up study (up to 24 months) showed stable antidepressive effect and good tolerability profile of agomelatine (valdoxan). There was no withdrawal syndrome after treatment discontinuation.

[The differences in the estimation of depression severity by psychiatrists and patients during the combined treatment with agomelatine (a multicenter study "EMOTSIA")]. / Razlichiya v otsenke tyazhesti depressii vrachami i patsientami v protsesse kombinirovannoi terapii agomelatinom (mul'titsentrovoe issledovanie «EMOTsIYa¼).

AIM: To compare the prognosis of depression severity estimated by the physician and by the patient based on the treatment outcome. MATERIAL AND METHODS: One hundred and seven patients with depression were examined. Mental status was assessed with HАМ-D, SHAPS, CGI-S, CGI-I, PGI-S, PGI-I and VAS. A data analysis was performed. RESULTS: There were differences in the estimation of depression severity by psychiatrists and patients. Moreover, the scores on HАМ-D and CGI-S were not consistent when assessed by psychiatrists. As the severity of depression decreased and patient's state improved during the treatment with agomelatine (valdoxan), the assessments of the changes by the psychiatrist and the patient became similar. CONCLUSION: Agomelatine (valdoxan) is effective and tolerable in the treatment of depression of any severity. The differences between the psychiatrist's and patient's estimation of the depression severity at baseline using different psychometric scales can level the prognostic value of treatment outcome.

[Optimization of the treatment of anxiety disorders with selank].

AIM: To compare the efficacy and tolerability of monotherapy with phenazepam to complex treatment with the peptide preparation selank and phenazepam in patients with anxiety disorders. MATERIAL AND METHODS: Authors explored the anxiolytic effect and tolerability of monotherapy with phenazepam (30 patients) and complex treatment with selank and phenazepam (40 patients) in anxiety-phobic, hypochondriac and somatoform disorders (ICD-10 items F40.2-9, F41.1-9, F45.0-2). Therapeutic effect was assessed clinically and with HDRS, CGI and Spilberger scales. Tolerability was evaluated using the UKU scale. Stroop test and verbal fluency test were used. Quality of life was assessed with the SF-36. RESULTS: The positive effect of phenazepam was achieved earlier in the optimization of treatment with selank on HDRS. The combined treatment decreased the level of undesirable side-effects of phenazepam (attention and memory impairment, asthenia, sedation, increase in sleep duration, sexual disturbances, emotional indifference and orthostatism) during the course of treatment and after the tranquilizer withdrawal. Taken together, the therapeutic efficacy and reduction of side-effects had a positive impact on the quality-of-life of the patients treated with selank as add-on to phenazepam. CONCLUSION: The results extend therapeutic possibilities of treatment of anxietyspectrum disorders with the combination of benzodiazepine tranquilizers and selank.

[Augmented antipsychotic therapy with pantogam active in patients with schizophrenia].

OBJECTIVE: to study the efficacy of the GABA-ergic drug pantogam active (D-, L-gopantenic acid) in patients with schizophrenia treated with typical neuroleptics and to assess the rate of treatment response and tolerability of the drug. MATERIAL AND METHODS: A sample consisted of 70 patients with schizophrenia stratified into main (n=35) and control (n=35) groups. All patients received one of typical antipsychotics (haloperidol, zuclopenthixol, promazine or perphenazine). Patients of the main group received in addition pantogam active in dose of 1200-1800 mg daily. The maximum allowed dose of 1800 mg daily was used in 62.9% of the patients. RESULTS AND CONCLUSION: The long-term combined therapy with the addition of D-, L-gopantenic acid (pantogam activ) allowed to achieve clinical improvement earlier (on 8th week in the main group versus 16th week in the control group). The frequency and severity of secondary negative symptoms associated with antipsychotic therapy were decreased as well. The high efficacy and tolerability of the combined therapy allow to improve quality of life in patients with schizophrenia and their compliance to treatment as well as to reduce costs of medical care.

[Possibilities of ultrasonic investigations in differentiation of a small-foci impairment of thyroid gland].

The results of ultrasound investigation of microcarcinomas and nontumoral foci of thyroid gland up to 10 mm in diameter and malignant foci over 10 mm are presented. Ultrasound signs are depicted, in accordance to which a potentially malignant thyroid gland foci are delineated, what demands a morphological (cytological) verification conduction.

[New possibilities of pharmacotherapy in cardiovascular patients with mental disorders].

OBJECTIVE: To study the efficacy and tolerability of the drugs pantogam active and phenotropil in mild neurotic, somatoform, stress-induced and depressive disorders developed in patients with cardiovascular diseases. MATERIAL AND METHODS: The effect of pantogam active was assessed in an open study. The main group of patients (n=35) treated with phenotropil during 12 weeks was compared to the comparison group (n=35). Patient's status was evaluated using psychometric (CGI, HDRS etc) and adverse effect scales. RESULTS AND СONCLUSION: Statistically significant results demonstrated the advantages of pantogam active has advantage on a number of values. The treatment effect of pantogam active gradually increased while the effect (in particular anxiolytic one) of phenotropil decreased after 4-8 weeks of treatment. The tolerability of both drugs was satisfactory.

[A comparison of the anxiolytic effect and tolerability of selank and phenazepam in the treatment of anxiety disorders].

Objective. To study the efficacy and tolerability of the new anxyolytic peptide selank in comparison with phenazepam. Material and methods. A comparative study of the anxiolytic effect and tolerability of selank and phenazepam was carried out in 60 patients with phobic-anxiety- and somatoform disorders (F40.2-9, F41.1-9, F45.0-1 by ICD-10) were examined. Results Pronounced anxiolytic and mild nootropic effects of selank were demonstrated. The anxiolytic effect lasted for a week after last receiving the peptide. Selank had a positive impact on the quality of life of the patients. Conclusion. The data obtained in the study extend therapeutic possibilities in the treatment of anxiety disorders.