Study Objective: To evaluate the characteristics of patients with medication-overuse headache (MOH) for their further treatment.

Study Design: Prospective study.

Materials and Methods. Within 12 months, 120 patients (12 men and 108 women, mean age of men — 46.3 ± 3.54 years, of women — 41.3 ± 9.5 years) with primary headache and MOH were followed up. Participants were divided into two groups depending on the diagnosis: group I (n = 44) — patients with chronic forms of primary headache without MOH, group II (n = 76) — patients with chronic forms of primary headache and MOH. The patients filled out special questionnaires for their characterization.

Study Results. The study compared groups according to the frequency of taking various types of analgesic drugs. Patients with MOH took pain medications: non-steroidal anti-inflammatory drugs — 15 (19.7%), triptans — 38 (50%), combined drugs — 23 (30.3%); 46 patients chose analgesic drug/s based on the speed of effect, and the preferred characteristics of the drugs were the availability (n = 25) and complete relieve pain (n = 19). The most of participants chose pain medications based on a doctor's recommendation; 44 (57.9%) of MOH patients tried to cancel them on their own, but failed. In people with MOH, the most common behavioral strategies were: taking painkillers to prevent headaches due to fear of pain (34.2%); refusal to discontinue the drug due to fear of increased pain even in the presence of side effects (22.4%); frequent practice of escalating the amount and dose of symptomatic agents in conditions of catastrophic pain (21.1%). The characteristics of our patients and their emotional and behavioral features showed that a more detailed study of these characteristics and features is necessary to develop a further treatment plan.

Conclusion. When treating patients with MOH show that a complex approach to a comprehensive analysis of the state of physical and emotional health is needed. The characteristics of our patients once again prove the importance of a dialogue between a doctor and a patient to improve the effectiveness of treatment. A significant role in preventive methods implemented through educational programs are important for improving the quality of their lives.

Study Objective: To study the characteristics and compliance of patients with bilious headache.

Study Design: Observational сomparative clinical trial.

Materials and Methods. We reviewed medical records of 184 patients treated for bilious headaches. The mean age was 42 ± 12 years old. Diagnosis of 82 (44.6%) patients combined bilious headache and drug-induced headaches (DIH). We examined the past history of bilious headaches, frequency of visits to the doctor, life-long use of medications to kill bilious headache, and preventive therapy. Also, we reviewed the factors impacting DIH development depending on prevalence of bilious headaches, comorbidities and medications used. 6 months after discharge from the hospital, participants took a survey on the efficiency of preventive management. We compared patients with and without DIH. Compliance of patients who started drug prevention was assessed using Morisky–Green questionnaire.

Study Results. 125 (67.9%) patients had chronic bilious headache, while in 59 (32.1%) patients, bilious headaches were episodic. Patients with chronic bilious headaches included 66 (52.8%) persons with DIH and 59 (47.2%) did not have any bilious headaches, while among patients with episodic bilious headache the figures were 16 (27.1%) and 43 (72.9%), respectively. In chronic bilious headache group, the frequency of DIH was statistically higher (p = 0.001). The correlation analysis of the relation between the duration of the history of bilious headaches and past drug therapy did not demonstrate any significant correlation between the amount of drugs used (grouped by the active ingredient) and course of disease (ρ = 0.115, p = 0.12); however, when drugs are counted on their trade names, there is a statistically significant correlation (ρ = 0.149, p = 0.048). Also, statistically significant correlation is seen when reviewing the duration of disease depending on the presence of DIH (p = 0.001): a longer past history of bilious headaches is associated with DIH development. 22 out of 184 patients (12%) did not start prescribed therapy. According to Morisky–Green questionnaire results, 137 (84.6%) patients were highly compliant, 21 (13%) were inadequately compliant, and 4 (2.5%) were not compliant at all. Most highly compliant were patients on antidepressants (p = 0.024). Patients with combined chronic bilious headache and DIH were also more compliant with preventive therapy (p = 0.045); patients without DIH mentioned beneficial effect from the therapy more often (p = 0.047).

Conclusion. A majority of patients were compliant with the therapy. We found out that 142 (78%) patients were familiar with preventive therapy; however, there was no statistically significant difference in compliance between such patients and naive subjects. Patients taking antidepressants and those without DIH are most compliant; they mentioned the beneficial effect of the preventive therapy more often, and this is a result not only of good compliance, but also of initially less severe disease.

Study Objective: To study the clinical features of pain syndrome (PS) in demyelinating diseases (DS) with spinal cord damage on the example of patients with multiple sclerosis (MS) or spectrum of neuroopticomyelitis disoders (NMOSD).

Study Design: Cross-sectional study.

Materials and Methods. 30 patients with demyelinating diseases and spinal cord injury were examined. All patients were divided into two groups: with PS (n = 20, of which patients with MS — 10, with NMOSD — 10) and without it (n = 10, of which patients with MS — 7, with NMOSD — 3). All participants underwent standard interviewing, assessment of neurological status, pain intensity on a 10-point visual analog scale (VAS), the degree of general disability on the Expanded Disability Status Scale, and also filled out questionnaires on the presence of neuropathic PS (DN4), Beck's anxiety and depression, quality of life Short Form 36-item health survey.

Study Results. The duration of PS was on average 23.5 ± 1.3 days in patients with MS and 46.6 ± 2.4 days in patients with NMOSD (p = 0.000014). There was no statistically significant difference in the intensity of PS according to VAS between the study groups. When analyzing the scores on the SF-36 quality of life scale, a statistically significant difference was revealed in mental health indicators (with PS — 30.1 ± 2.6, without PS — 50.77 ± 3.39 points, p = 0.000182), social activity (with PS — 30.35 ± 10.37, without PS — 77.33 ± 6.5 points, p = 0.00145), role functioning associated with physical factors (with PS — 27.5 ± 3.31, without PS — 44.22 ± 5.55 points, p = 0.0019842), role functioning associated with emotional factors (with PS — 27.6 ± 11.38, without PS — 70.67 ± 14.74 points, p = 0.001649), as well as in the intensity of PS (with PS — 38.80 ± 7.27, without PS — 73.56 ± 6.56 points, p = 0.001571). According to the Beck scale of anxiety and depression, depression was significantly more common in patients with PS (p = 0.002).

Conclusion. Neuropathic pain in NMOSD is more intense and prolonged, and the characteristics of pain do not depend on age, gender and duration of the disease. In patients with PS, the indicators of the mental component of health, social and role functioning are reduced. Statistically significant differences in these indicators between patients with MS and NMOSD were not revealed.

Study Objective: To study the features of neuroimaging indicators (magnetic resonance imaging (MRI) of the brain and magnetic resonance spectroscopy of the mediobasal temporal lobes) in patients with mesial temporal epilepsy (TLE).

Study Design: A retrospective study.

Materials and Methods. Brain MRI was analyzed in 166 patients with mesial TLE, and the results of MR spectroscopy of the mediobasal parts of the temporal lobes in 32 of them were additionally analyzed. There were 69 men (42%), 97 women (58%). The median age was 35 [29; 46] years. The age of onset of TLE is 19 [13; 30.5] years. The median duration of the disease is 11 [9; 20] years. Taking into account the peculiarities of neuroimaging for the analysis of metabolic changes, patients with TLE were divided into three groups: 1st — patients with TLE and hippocampal sclerosis (62 (37.3%) people); 2nd — patients without structural changes, according to MRI of the brain (MR-negative) (40 (24%) people); 3rd — patients with other structural changes of the brain (64 (38.7%) people, excluded from subsequent analysis due to heterogeneity of neuroradiological data). All patients underwent MRI of the brain with a magnetic field power of 1.5 Tesla in T1, T2, FLAIR, DWI and SWI modes. MR spectroscopy of the mediobasal parts of the temporal lobes was carried out with the study of the main metabolites: N-acetylaspartate, choline, creatine, lactate, glutamate-glutamine complex, myonositol. Only qualitative indicators characterizing a decrease or increase in the level of the metabolite, as well as the side of the lesion, were evaluated.

Study Results. In patients with TLE and hippocampal sclerosis, focal neurological symptoms (p = 0.019) and interictal regional epileptiform activity (p = 0.002) were statistically significantly more often recorded, they were more likely to receive polytherapy with antiepileptic drugs (p = 0.022) than MR-negative patients. In 93.7% of patients with mesial temporal epilepsy, regardless of the etiology of the disease, one-/two-sided changes in the levels of N-acetylaspartate and other major metabolites were registered, according to MR spectroscopy of the mediobasal temporal lobes.

Conclusion. MR spectroscopy of the mediobasal temporal lobes is a sensitive method for diagnosing metabolic disorders in patients with TLE.

Study Objective: To determine the independent role of the carriage of SNVs genes IL-1β, TNF, BDNF, NTRK-2, clinical, biochemical parameters in predicting the course of mesial temporal lobe epilepsy using statistical modeling methods.

Study Design: Prospective study.

Materials and Methods. 166 patients with mesial temporal lobe epilepsy were examined. The diagnosis of temporal lobe epilepsy was determined on the basis of clinical and anamnestic data, electroencephalography data, and neuroimaging data. Based on the molecular genetic analysis of the SNVs genes IL-1β, TNF, BDNF, NTRK-2, the study of the concentration of BDNF, NTRK-2, IL-1β, TNFα in blood plasma by enzyme immunoassay, neuroimaging data and clinical anamnestic data, a prognosis of the course was carried out mesial temporal lobe epilepsy using logistic regression analysis and classification trees.

Study Results. The method of multiple logistic regression analysis revealed that the combined effect of hippocampal sclerosis and carriage of the A allele rs6265 of the BDNF gene leads to an uncompensated course of temporal lobe epilepsy. The accuracy was 80.3%, sensitivity — 66.7%, 95% CI: 46.0%; 83.5%, specificity — 91.4%, 95% CI: 76.9%; 98.2%. Using the CHAID algorithm, a classification tree was generated, allowing to assign patients with temporal lobe epilepsy to the group of compensated or uncompensated course of the disease. The accuracy of the model was 80.3%, sensitivity — 75.0%, 95% CI: 66.9%; 82.0%, specificity — 87.8%, 95% CI: 79.6%; 93.5%.

Conclusion. Prognostically significant clinical characteristics of patients with VE, features of changes in the concentrations of circulating proinflammatory and neurotrophic factors, the carriage of single-nucleotide variants of the genes encoding them to predict the nature of the course of VE were identified which allows in practice to apply a personalized approach to the patient, especially in demand in the case of chronic disease.

Objective of the Review: To discuss the efficiency and safety of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with low back pain (LBP), also during COVID-19 pandemic.

Key Points. Musculoskeletal pain syndromes, including LBP, are common; they affect the quality of patients’ life and result in huge medical bills. In a lot of post-COVID-19 patients, LBP appears for the first time or gets worse. Challenges in the management of such patients are caused by involvement of multiple organs and body systems, the need in taking numerous medications at once, which increases the risk of drug interaction. This overview describes the efficiency and safety of nimesulide in patients with low back pain. The use of NSAIDs in patients with COVID-19 is discussed. Beneficial effects and possible risks of nimesulide are analysed.

Conclusion. Management of patients with LBP during the COVID-19 pandemic requires thorough selection of an optimal therapy taking into account comorbidities and a high risk of drug-drug interactions. Nimesulide is a potent medication with a favourable safety and tolerability profile. It is advisable to use nimesulide in the management of patients with low back pain, including COVID-19 survivors. Safety of the therapy can be ensured by thorough drug selection taking into account comorbidities and risks of complications.

Study Objective: To identify the impact from the pneumonia-complicated COVID-19 coronavirus infection over patients’ cognitive functions.

Study design: Perspective study.

Materials and Methods. We examined 32 patients with COVID from the study group on days 2–3, 8–10 in inpatient settings, after 2 months of hospitalisation vs 30 healthy controls. Cognitive functions were evaluated using the following neuropsychologic tests: Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), Frontal Assessment Battery (FAB), The Clock-drawing Test (CDT). Signs of anxiety and depression were screened using the Hospital Anxiety and Depression Scale (HADS).

Study Results. During the acute and recovery periods, patients from the study group demonstrated statistically significant cognitive disorders as per MMSE, MoCA, FAB vs controls (p < 0.001). On days 2–3 and 8–10 in inpatient settings, MMSE was 22 [22; 29] and 22 [19.2; 23.7] points; MoCA — 26 [21; 28] and 21 [18; 23] points, FAB — 13 [10; 18] and 10 [8; 12] points; in 2 months after hospitalisation, MMSE was 29 [26.8; 30] points (р = 0.008 vs days 2–3 and 8–10), MoCA — 25 [22; 27] points (р = 0.03 vs days 8–10), FAB — 16 [14.5; 17] points (р = 0.004 and р = 0.02). The condition of cognitive functions measured during the acute period of the disease worsened even more by days 8–10 of hospitalisation and tended to normalise in 2 months. As per HADS, there were no abnormal findings; therefore, the patients were neither anxious, nor depressed, and the median was 8 points. СDT values were normal as well, both in acute period and during recovery.

Conclusion. The coronavirus infection impacts the cognitive status. For cognitive dysfunctions, neuroprotectives and non-drug cognitive rehabilitation can be recommended. Cognitive dysfunctions are quite an expected independent syndrome, the course of which is not directly associated with somatic recovery.

Study Objective: To assess the efficacy of adding hyperbaric oxygenation (HBO) in Oxysys 4500 oxygen cabinet to a set of rehabilitative measures in healthcare professionals with emotional burnout syndrome (EBS).

Study Design: Open-label prospective randomized comparative cohort study.

Materials and Methods. We have examined 79 healthcare professionals who experienced stress during the COVID-19 pandemic. We have studied changes in the psychoemotional state of subjects during rehabilitation that included HBO procedures in Oxysys 4500.

We used Beck’s depression test, State-Trait Anxiety Inventory, and methods for professional burnout diagnostics developed by C. Maslach and S. Jackson.

Study Results. EBS and psychoemotional consequences of the stress were observed in two-thirds of respondents, predominantly in young persons, and were more often (р ≤ 0,05) recorded in subjects who did not have COVID-19. The contribution of the stress and state anxiety in the formation of EBS symptoms allows making them a target for psychoemotional stabilisation and elimination of consequences of the occupational stress. Addition of HBO sessions to the therapy resulted in reduction in depression and reduced state anxiety.

Conclusion. The high efficacy of HBO addition to rehabilitation of healthcare professionals with EBS has been demonstrated.

Study Objective: To study the incidence and the structure of the postoperative cerebral dysfunction after open and endovascular aortic valve replacement surgery, and to identify the risk factors and the methods of prevention of postoperative cerebral dysfunction after the open aortic valve replacement surgery.

Study Design: Prospective cohort study.

Materials and Methods. The study involved 114 patients (92 men and 22 women) aged 67 [58; 76] years, who undergone elective aortic valve replacement surgery. All patients were divided into three groups: “open surgery” (n = 82), “cerebroprotection” (n = 16) and “X-ray surgery” (n = 16). In the “open surgery” and “cerebroprotection” groups, patients undergo open aortic valve replacement surgery with cardiopulmonary bypass, in the “X-ray surgery” group transcatheter aortic valve implantation is performed. In the “cerebroprotection” group patients additionally received the 1.5% solution of meglumine sodium succinate in the early postoperative period.

Study Results. The postoperative cerebral dysfunction was diagnosed in 41.2% of patients, the incidence of the postoperative cerebral dysfunction did not differ in the study groups. In the group “cerebroprotection” there was a shorter duration of symptomatic delirium of the early postoperative period (p = 0.0441) compared with the group “open surgery”. We identified 18 risk factors for postoperative cerebral dysfunction and its clinical types and two cerebroprotective factors — a body mass index more than 25 kg/m² and the use of the meglumine sodium succinate in the early postoperative period.

Conclusion. Aortic valve replacement surgery is characterized by the high incidence of the postoperative cerebral dysfunction, further improvement of the methods of the perioperative cerebroprotection is required.

Study Objective: To track the dynamics of an organic personality disorder for 5 years after call-up.

Study Design: Longitudinal study.

Materials and Methods. The study had two stages. Stage one was the analysis of information on conscripts who were undergoing a medical examination and were condemned as unserviceable or partially suitable for conscription. We examined 52 conscripts with an organic personality disorder with the mean age of 19.02 ± 1.01 years old. We assessed their mental status, mental disorder intensity, and degree of social adaptation; also, an experimental psychological questionnaire for anamnestic study of conscripts and Conscript Questionnaire were completed. Stage two was a clinical and follow-up (for 5 years) examination of patients. A factorial analysis of results was performed in 2, 3, 4, 5 years after the first examination. Six subjects withdrew from stage two because their place of residence changed or because they did not want to further participate in the study.

Study Results. The clinical presentation of the disorder was more complicated in more than 60% cases. The factorial analysis revealed the most stable rigid link, i. e., a combination of clinical symptoms to be targeted by the therapy in order to more drastically unravel the stable pathological system of disorder manifestations. The rigid link of the system passes all first factors in examinations conducted and characterises the highest proportion of cases vs. total variance: inclination to impulsive response with poor control over behaviour, uptown tastes, decreased social adaptation and close symptoms in the form of unstable inner emotional well-being or impaired affective volitional regulation. At year four of the study, a flexible link appears: addictions, e. g., alcohol and substance abuse, and unskilled labour. At year five, further aggravation of psychopathy-like state was observed. We have identified the flexible links of the system, which can be manipulated in order to attempt to gradually negate the stable pathological condition; the quality of manipulations is worse since elimination of one relation between symptoms brings about another one, but with a lower number of observations vs total variance.

Conclusion. This study highlights the need in further observation, a more drastic interference (therapeutic, psychocorrective, social and rehabilitative) with conscripts who were condemned as unserviceable or partially suitable for conscription, in order to avoid a complicated mental pathology.

Study Objective: To study the clinical and criminological factors in patients with schizophrenia and organic mental disorders (OMDs) recorded before the first socially dangerous act (SDA), and to analyse various features taking into account follow-up of these patients and repeated SDA prevention.

Study Design: Comparative study.

Materials and Methods. The study included 86 schizophrenia patients (study group A) and 45 patients with OMDs (study group B) who committed repeated SDAs, were found insane and were forced to undergo various court-appointed therapies for 2 and more times. In this study, we used the clinical psychopathologic method with due account to psychopathology and clinical statistic method as the main methods.

Study Results. 49 (57%) and 23 (51.1%) patients in group A and group B, respectively, were not held criminally liable before; thus, 37 (43%) patients in group A and 22 (48.9%) patients in group B had criminal records. In group A, 26 (30.2%) patients were held criminally liable once, whereas in group B — 9 (20%); 11 (12.8%) and 13 (28.9%) patients, respectively, had multiple criminal records. Patients with schizophrenia committed more crimes against life — 13.5% in past medical history to 30.2% in case of a repeated SDA; the number of crimes against property remained relatively stable (from 59.4% in past medical history to 54.7% in case of a repeated SDA). Drug-related crimes became more numerous: an increase from 2.7 to 11.7%. In patients with OMDs, the number of crimes against property dropped from 86.4% in past medical history to 51.1% in case of a repeated SDA, whereas the number of crimes against life rose (from 4.5% in past medical history and up to 35.6% in case of a repeated SDA). At the same time, the incidence of drug-related crimes grew insignificantly (from 9.1% to 11.1%).

Conclusion. It was found out that patients in these nosological categories have specific criminal behaviours affecting their illegal activities, features of SDA relapses, and changes in the criminal behaviour structure over the course of disease. The obtained data make it possible to study the characteristics of criminal behaviours of mentally handicapped individuals and will help develop recommendations for prevention and forecast of crimes committed by mentally ill persons.

Objective of the Review: To analyze and systematize the results of the studies of heart rate variability in schizophrenia and schizoaffective disorder.

Key points. Most studies demonstrate a reduction in total heart rate variability and a decrease in parasympathetic tone and reactivity in patients with schizophrenia and schizoaffective disorder, including in response to a cognitive or stress load. And also the baroreflex sensitivity decrease was revealed. Autonomic cardiac dysregulation detected in unmedicated patients with schizophrenia, as well as in healthy first-line relatives. The extent of these changes correlates with the severity of productive, negative and affective symptoms, as well as with the presence of metabolic syndrome. Autonomic cardiac dysregulation is much more pronounced in psychotic states. Antipsychotics with anticholinergic and/or α₁ -adrenolytic activity can exacerbate these changes. Reductions in total heart rate variability and vagal activity are detected not only in schizophrenia, but also in other mental and somatic disorders, in the pathogenesis of which distress is involved.

Conclusion. The possibility of using heart rate variability indicators as additional criteria for assessing the severity of psychosis, predicting the effectiveness of therapy, as well as for early stratification of cardiovascular risks requires further study in scientific research.

Study Objective: To study the role of the psychoeducational program in coping with self-stigmatization in patients with somatoform disorders.

Study Design: Observational emperical comparative clinical trial with two randomized groups with provisional and final examination.

Materials and Methods. The study enrolled patients aged 20 to 45 years old who were hospitalised for a somatoform disorder for the first time. The study group comprised 60 patients, who attended a psychoeducational program in addition to psychopharmacological treatment. Controls were 60 patients treated only with medications. Patients’ status was evaluated using clinical, psychological and psychognostic methods.

Study Results. After completion of the therapy, the difference in the degree of self-stigmatization and the level of knowledge about the mental disorder in the groups was statistically significant (p < 0.001). When groups were compared on a somatization scale, a statistically significant trend towards differences was noticed (0.05 ≤ p < 0.1).

Conclusion. The psychoeducational program facilitates coping with ‘avoiding the psychiatrist’ behaviour, thus reducing the risk of disease chronization and helping prevent irreversible personality changes.