Study Objective: To assess the efficiency of transcranial direct current stimulation (tDCS) as a component of rehabilitation measures in ischemic stroke patients with motor and speech disturbances.

Study Design: prospective study.

Materials and Methods. We tested 77 patients in the early rehabilitation period after ischemic stroke using Montreal Cognitive Assessment, Hospital Anxiety and Depression Scale, Wassermann Scale, Dysarthria Assessment Scale, Locus of Control Recovery Assessment Scale, Medical Research Committee Scale, Franchay Scale.

Study Results. Distal muscle strength in paralytic upper extremity improved in patients who were treated with motor zone tDCS (p < 0.05). Franchay Scale results during rehabilitation demonstrated improvements in all study groups (p < 0.05). “Attention” sub-scale results in Montreal Cognitive Assessment, Hospital Anxiety and Depression Scale, and Locus of Control Recovery Assessment Scale were statistically higher in patients who were treated with speech zone tDCS.

Conclusion. Use of tDCS in stroke patients improves cognitive functions in naming objects, speech functions, and patients’ motivation to rehabilitation grows, positively impacting their quality of life. Use of tDCS in motor zones facilitates motor function improvement and enhances dexterity of stroke patients. When electrodes were used in speech zones, anxiety and depression reduced, while attention improved.

Study Objective: To identify the frequency of the types of visual agnosia (VA), their association with one another and with other neuropsychologic disorders in patients with acute hemispheric non-lacunar ischemic stroke (IS).

Study Design: retrospective study.

Materials and Methods. We followed up 104 patients with acute IS (mean age: 66.7 ± 9.4 years old), who underwent neurological, neuropsychologic, neuroimaging and ophthalmological examination.

Study Results. VA was diagnosed in 52% of patients; in the majority of cases, the condition was diagnosed on the basis of deep neuropsychologic tests only, and it was asymptomatic. VA structure was dominated by unilateral visual neglect (21%), apraxia (20%) and object VA (18%).

Object VA was the most frequent clinical sign (8 (42%) out of 19 patients). Spatial VA (including neglect and apraxia) correlated with the rate of regulatory dysfunction and short-term visual memory impairment; object VA — with regulatory dysfunction; facial VA — only with a decrease in short-term visual memory. The cluster analysis allowed identifying relatively homogeneous groups of patients: 1) no VA; 2) impaired spacial gnosis; 3) with impaired objects and facial gnosis.

Conclusion. VA is diagnosed in a half of patients with acute hemispheric non-lacunar IS and is mostly asymptomatic. Spatial VA is predominant. Spacial, object and facial VA have statistically significant association with frontal lobe dysfunction; spacial and facial — with short-term visual memory impairments. Two most common combinations of various VA types in acute IS were identified — visual and spacial disorders and impaired object and face recognition.

Study Objective: The aim of the study was to evaluate the patterns of medical overuse headache (MOH), the effectiveness of therapy, and to compare 2 subgroups of patients with chronic migraine, medical overuse of symptomatic analgesics: with MOH and without MOH.

Study Design: prospective cohort study.

Materials and Methods. The study included 20 patients aged 18 to 75 years with an established diagnosis of chronic migraine medical overuse of symptomatic analgesics. We’re planning to apply a headache diary, several scales about various characteristics of headaches, the psychological state of patients, scales on lifestyle and quality of life, somatic pathology.

Study Results. All patients were recommended to cancel the “guilty” analgesic and limit the use of the drug with analgesic action from another group. For prophylaxis, metoprolol was used in 6 (30%) cases, topiramate — in 2 (10%) cases, amitriptyline — in 30%, venlafaxine in 30%. After 3 months from the start of therapy, patients noted the greatest reduction in the frequency and intensity of headache when taking amitriptyline at a dose of up to 50 mg, venlafaxine at a dose of up to 150 mg. At the time of withdrawal, “rebound” symptoms and withdrawal syndrome developed in 14 (70%) people. Detoxification therapy (dexamethasone 4–8 mg per 200 ml of saline and magnesia 10% 25 ml N10) was carried out in 12 (60%) patients. Over 3 months of follow-up, the occurrence of a headache attack decreased by 2 points on the intensity scale, duration — by an average of 6 hours, the number of days with a headache increased by an average of 3.4 days, the number of days with the use of pathogens per month — by 12.6 days.

Conclusion. It is necessary to raise the awareness of therapists, neurologists about the causes, patterns, methods of treatment of МОН, as well as about the risk factors for its recurrence. Patient compliance can be improved by telephone interviews, face-to-face consultations 1–3 months after the start of preventive therapy. With the correct use of the prophylactic drug and following the recommendations to limit the overuse of symptomatic analgesics, after 3 months the patient's quality of life improves, the headache decreases in frequency and intensity, and cognitive functions improve.

The purpose of the review: to present a clinical case of a patient with late-diagnosed persistent postural perceptual dizziness (PPPD).

Key points. Modern criteria, features of diagnosis and methods of treatment of PPPD, medical history and course of diagnostic search are presented. The specialists did not find data for organic pathology of the brain and inner ear and established only a preliminary diagnosis, recommending further examination. The authors focused on the search for anxiety-depressive disorders and a detailed medical history. So, during the survey, a specialized questionnaire was used to identify anxiety associated with dizziness, and a very high level was shown. It was also found out that there was an acute episode of systemic dizziness in the anamnesis. PPPD was diagnosed. The patient was recommended psychotherapy. Appointed to receive selective serotonin reuptake inhibitors, perform vestibular exercises with a gradual increase in vestibular load. Three months later, a positive trend was noted.

Conclusion. This clinical case demonstrates the importance of an in-depth analysis of the medical history in patients with dizziness and attention to the neuropsychological profile.

Objective of the Review: To analyse and systematise knowledge in the problems with autoimmune epilepsy diagnostics.

Main part. Clinical phenotypes of immune-mediated epilepsy depend on various types of antibodies. However, autoimmune epilepsy is diagnosed also in patients who are followed up for chronic refractory unexplained epilepsy, especially in initial epileptic status and late onset epilepsy without structural changes on brain imaging. Brain imaging changes may not be observed, especially in early disease. Very often a diagnostic challenge in autoimmune epilepsy is the difference between epileptic seizures and behavioural symptoms and the mental changes caused by involvement of limbic brain structures. An important role in detection of seizures and differential diagnosis is played by video-EEG-monitoring, which allows identifying the true number of seizures, epileptiform activity between seizures, behavioural changes not related to paroxysmal activity of cortical neurons. Any specific EEG signs for differentiation between various types of autoimmune epilepsy have not been found yet. Still, EEG can provide patterns that are unique for certain forms of autoimmune encephalitis.

Conclusion. Video-EEG-monitoring significantly contributes to autoimmune epilepsy diagnostics, and some changes can be used as markers of disease severity. It is very important, especially in patients with impairment of consciousness, where identification of the clinical status and response to therapy is challenging.

Objective of the Review: To discuss the efficiency of using various robot-aided rehabilitation devices in order to improve the upper extremity functions in patients with cerebral pathologies.

Key Points. The medical devices market is abundant in various robot-aided devices for patient rehabilitation. Currently, the issue of combining various rehabilitation techniques is still open; scientific researches are ongoing which aim at analysing the problem of gain of motion.

Conclusion. The variability of technical solutions and results of the use of rehabilitation techniques requires further deep analysis of factors determining the efficiency of their use, and development of personified approaches to the management.

Study Objective: To assess the possibilities of sanatorium-and-spa treatment in patients with neurotic, stress-associated and somatoform disorders taking into account the modern idea of their pathogenesis.

Main part. According to various sources, at least 30% of patients who come to outpatient clinics have neurotic and/or somatoform disorders. Given the complex pathogenesis of these conditions, the rate of exacerbations and relapses, such patients should undergo a long-term comprehensive therapy aimed at elimination of etiological and pathogenic factors, together with the development of adequate adaptive reactions, including psychogenic reactions, increased physical and mental performance, and healthy lifestyle habits. The potential to reach the goal increases considerably with the use of sanatorium-and-spa treatment, the main methods of which include climatotherapy, hydrobalneotherapy, reflexotherapy, physical factors, biofeedback techniques, mental therapy, and exercise therapy.

Conclusion. The efficiency of the comprehensive treatment of neurotic, stress-related and somatoform disorders using natural and artificial therapeutic factors is 60%. The knowledge of non-drug treatments of such conditions is essential not only for medical staff in sanatoria and spas, but also for outpatient medical professionals, since they are the primary referring individuals.

Study Objective: To assess the possibilities of social adaptation in persistent psychopathological, including cognitive impairments. Study Design: Longitudinal study.

Materials and Methods. A 30-year observation, treatment and rehabilitation of clean-up workers of accident at the Chernobyl nuclear power plant, who underwent an in-wide clinical, psychopathological and neuropsychological examination at the Moscow Research Institute of Psychiatry, was carried out. 373 people were selected for the study. A dynamic psychopathological and neuropsychological assessment of their condition is given, as well as a description of their social status and adaptive capabilities. In the neuropsychological section of the study, the results of systematic cognitive training were evaluated. The neuropsychological test battery included methods for assessing memory, attention, and thinking.

Study Results. The subjects had modally non-specific memory impairments, in particular due to insufficient fixation of mnestic traces, limited ability to analyze and rethink information in the process of memorization, a decrease in the overall level of activity, exhaustion of voluntary attention, general mental fatigue and stress in the process of mental activity, learning difficulties new skills. However, the quantitative characteristics of cognitive functions did not change from hospitalization to hospitalization, which means that there was no progressive cognitive decline in the cohort. Psychocorrectional measures consisted in conducting cognitive training that stimulates the development of cognitions and the disclosure of unused cognitive resources. The level of somatic and mental well-being of Chernobyl disaster consequences participants correlates with that of patients with organic, cerebrovascular diseases and differs statistically significantly from the indicators of healthy individuals, the same relationships were noted when assessing microsocial support and the level and nature of self-perception. The results of the assessment of social functioning showed a fairly stable social adaptation of former clean-up workers and positive personality attitudes.

Conclusion. Systematic medical and rehabilitation care, the formation of therapeutic partnerships based on the preserved personal qualities of patients made it possible to significantly compensate for psychopathological disorders, slow down cognitive decline and ensure fairly stable social adaptation.

Objective of the Review: To summarise the references related to the forensic psychiatry aspects of exogenous organic psychotic disorders.

Key Points. The majority of acute exogenous organic psychotic disorders during a wrongdoing are more or less associated with the use of psychoactive substances (PAS). This literature overview discusses typical forensic psychotic conditions appearing in acute intoxication with PAS (short-term psychotic disorders, abnormal alcoholic intoxication, abnormal forms of alcoholic intoxication, PAS-induced psychosis) and psychosis associated with withdrawal. Key challenges in the diagnosis of these conditions, changes in approaches to their forensic psychiatric assessment and the modern idea of legally relevant skills of wrongdoers who committed an illegal act during an exogenous psychosis, are analysed here.

Conclusion. The matter of acute exogenous psychoses which is a relevant issue for forensic and psychiatric examination, is discussed insufficiently in recent literature sources. Further studies are needed, and approaches to a forensic and psychiatric examination of legally relevant skills of wrongdoers should be developed.

Objective of the Review: To collect and analyse the available Russian and foreign literature sources in borderline personality disorder.

Key Points. The review is dedicated to the borderline personality disorder, which is partially relevant due to a high rate of self-injurious and psychiatric co-morbidities. The data on morbidity, milestones in the development of the notion of the borderline personality disorder, and diagnostic criteria in ICD-11 and DSM-5 are presented. Clinical signs of a borderline personality disorder are characterised, and approaches to the differential diagnosis of schizophrenic and affective disorders are discussed.

Conclusion. A review of literature sources demonstrated a higher theoretical and practical importance of the borderline personality disorder.

Study Objective: To investigate the prognostic and therapeutically significant characteristics in neurophysiological reactivity of male and female patients with bipolar depression.

Study Design: comparative controlled non-randomized clinical experimental study.

Materials and Methods. 53 patients (26 men and 27 women) with bipolar depression were examined before the start of their psychopharmacotherapy. They were aged from 21 to 59 years. There were no significant differences between men and women on the Hamilton Depression and Anxiety Scale. The groups of healthy volunteers included 23 men and 29 women of the corresponding age. The participants sorted the photos, 80 of which were images of angry/aggressive people or animals, and 80 had neutral expressions. Simple figures (keys) were displayed 2 seconds before the pictures, their connection with the photographs was not explained. A 128-channel electroencephalogram was recorded and the brain responses elicited by the keys were analyzed. Differences (p < 0.05) between neutral and emotional conditions were defined as emotional modulation (EM).

Study Results. EM differences in male and female patients were more pronounced than in the control groups. In women with bipolar depression, EM was consistently located in the posterior areas of the cortex from 100 ms to the end of the analysis period. The EM for the P100 component was missing, and the EM topography for P200 was closer to normal than in men. The EM of components N170 and P380 in patients differed depending on their sex and differed from EM of healthy controls of the same sex.

Conclusions. The EM of the brain activity in patients with bipolar depression differs from the EM of healthy people. The differences depend on the gender of the patient and affect several components of the evoked brain activity. This suggests that it is important to take into account the gender of the subjects when studying affective disorders in patients.

Study Objective: to clarify the role of neurophysiological mechanisms in the pathogenesis of suicidal behavior in young depressed patients with a history of suicidal attempts.

Study Design: open study.

Materials and methods. The study included 35 female patients aged 16-25 years. Relationships between pre-treatment quantitative clinical scores (according to the HDRS-17 scale) and values of the absolute spectral power of the background resting EEG in narrow frequency subbands were analyzed.

Study Results. Significant negative correlations (p < 0.05) between the EEG parameters and the sum of depression cluster scores of the HDRS-17 scale indicate reduced activation of the frontal-anterotemporal cortex areas of both hemispheres (according to the values of the alpha2 EEG sub-band (9–11 Hz) spectral power in F7, F3, F4 and F8 leads), and especially, of the left anterior temporal region (according to the values of the EEG beta2 sub-band (20–30 Hz) spectral power in F7 lead). In addition, these patients are characterized by a somewhat reduced functional state of the central temporal-parietal zones of the right hemisphere in the form of significant positive correlations (p < 0.05–0.01) of the slow-wave delta (2–4 Hz), theta1 (4–6 Hz) and theta2 (6–8 Hz) EEG activity spectral power values in F4, C4, T4 and P4 leads with the sum of anxiety cluster scores of the HDRS-17 scale.

Conclusion. The results obtained make it possible to clarify the neurophysiological mechanisms of the pathogenesis of suicidal behavior in young depressive patients.

Objective of the Review: to analyze one of the most popular L. Tolstoy’s works “Anna Karenina” by showing that it illustrates classic and contemporary theories of suicide, starting from the sociological study of suicide by E. Durkheim.

Key Points. The novel depicts four episodes of suicidal behavior: ego-dystonic thoughts (Lewin), suicide attempt (Vronsky), completed suicide (Anna) and volunteer fighters (Vronsky and other men going to war). The article draws parallels with four types of suicide according to E. Durkheim: anomic, egoistic, fatalistic and altruistic. Besides, the paper points out changes in worldviews of the main characters that happen after their mortality was made salient, which corresponds to Terror Management Theory in social psychology and works of cultural anthropologist E. Becker. In the end, we look at Anna’s presuicidal state from the point of view of Narrative Crisis Model of Suicide by I. Galynker.

Conclusion. Thus, the novel “Anna Karenina” can help specialists in studying various theories of suicidal behavior, as L. Tolstoy carefully depicted the phenomenology of suicidal feelings and mechanisms of psychological defense from the fears of death, even before suicidology was established as a science.