COVID-19-associated orthostatic hypotension syndrome: direct and indirect mechanisms of development

Background. The article presents an observation of the clinical case of orthostatic hypotension that developed after an infection caused by the SARS-CoV-2 virus. The issues of etiology, pathogenesis, diagnosis are outlined. The complexity of diagnosis at the stage of clinical observation is due to the comorbidity of possible mechanisms and the difficulty of determining the primary factor. Taking into account the study of variants of direct and indirect action of this 2019-nCoV, the description of the clinical observation of orthostatic hypotension supplements the data on the spectrum of manifestations of this disease. Aim. Analysis of the clinical case of the development of orthostatic hypotension in the post-acute period of COVID-19. Material. When conducting a literature review on the selected topic, various sources were considered. The search depth was over 7 years. For the recruitment of literature, Internet platforms UpToDate, PubMed, Medscape were used. Russian and foreign sources were studied. Methods. Anamnesis collection, objective research, specialized tests, laboratory and instrumental research methods, study of disease history, literature sources on orthostatic hypotension and the effect of COVID-19 on the autonomic nervous system. Results. The analysis of this case with the determination of the leading mechanism of orthostatic hypotension is extremely difficult. Probably, there is a combination of factors: direct and indirect effects on the nervous system at COVID-19. The direct effect is associated with the interaction of the virus with the angiotensin converting enzyme 2 receptors in the nervous system, which causes a significant increase in the concentration of bradykinin and the development of hypotension. An indirect effect is due to both increased thrombus formation with the development of PE, and autonomic dysfunction, within the framework of secondary polyneuropathy of fine fibers. Conclusion. It is likely that in the near future the number of such patients in the practice of doctors will increase, therefore, timely and correct diagnosis of these conditions, with their careful management, will be the fundamental postulates in the recovery of patients. Drawing attention to this topic will possibly expand our understanding of the spectrum of complications of COVID-19 and will greatly complement the information available today.

Survival and risk factors for premature mortality in patients with parkinson’s disease

Aim. To assess the survival rate and risk factors for premature mortality in patients with Parkinsons disease in Baku. Material and research methods. The observation was carried out retrospectively, information was collected on all patients (110 patients) in whom the diagnosis of Parkinsons disease was first established in 20092010. These patients are provided with drugs free of charge, which made it possible to provide them with diagnostic monitoring in polyclinics. During 20102019, 94 patients with a diagnosis of Parkinsons disease died. All medical death certificates were selected for analysis. The diagnoses in column a of these documents were accepted as direct causes of death, regardless of the presence or absence of a causal relationship of these diagnoses with Parkinsons disease. Therefore, the reported cases were interpreted not as death due to Parkinsons disease, but as the death of a patient diagnosed with Parkinsons disease. Results. Noteworthy is the prevalence of men (72.7%) and people without dementia (70.9%) among patients. Within 10 years, 85.5% of patients died from various causes. The immediate causes of death were acute cerebrovascular accidents (36.2%) and acute myocardial infarction (24.5%). The annual survival rate of the observed patients was high (94%; 95% confidence interval 51100%). The five-year survival rate is 76% (95% confidence interval 42100%). Conclusions. (1) The survival rate of patients with Parkinsons disease within 10 years after the onset of signs ranges from 0.94 to 0.41 (five-year survival rate is 0.76). (2) The immediate causes of mortality in patients with Parkinsons disease were cerebrovascular accidents (36.2%), myocardial infarction (24.5%), pulmonary embolism (11.7%), pneumonia (10.6%) and others (17%). (3) The effect of age of onset and signs of Parkinsons disease, gender, comorbidity and dementia on survival is statistically significant (p 0.05).

Onco-specific sleep disorders and fatigue: tactics of psychological test and cognitive behavioral therapy

Introduction. Sleep disorders are widespread throughout the entire period of treatment of an oncological patient from the moment of diagnosis, and in many patients persist after completion of treatment. The nature of cancer and its treatment expose patients to many potential provoking and/or supportive factors that are atypical for the general population. In addition, sleep disturbance rarely manifests as a separate symptom, but more often occurs together with such symptoms as fatigue, pain, depression and/or cognitive impairment. This complicates the assessment and often requires an individual treatment plan with a team approach. AIM. of the work is to acquaint mental health specialists, oncologists, chemotherapists with the specifics of the examination of cancer-specific insomnia and fatigue, the construction of team treatment tactics, the organization of psychotherapeutic care for cancer patients. Results. The article describes for the first time the specifics of onco-specific insomnia and fatigue. The general predisposing and supporting factors of insomnia characteristic of cancer patients are systematized. The relationship between onco-specific fatigue and sleep disorders is shown. The role of pro-inflammatory cytokines as a common neuroendocrine-immune mechanism underlying the behavioral symptoms of sleep disorders, fatigue, depression and cognitive dysfunction in people with cancer is noted. Due to the limitations of the pharmacological approach, the purpose, forms, modes and approaches of using cognitive behavioral therapy protocols to minimize insomnia and fatigue are described. Based on the data of our foreign colleagues, we have proposed an algorithm for assessing sleep disorders in a patient with an oncological profile. The effectiveness of the standard protocol of cognitive behavioral psychotherapy of insomnia (SCBT-I) in a patient of the oncological profile Lavini Fiorentino is described in detail and shown; as well as the short protocol of CBT of cancer-specific insomnia by Eric Zo et al.; remote protocol of mindfulness enhancement therapy to minimize onco-specific fatigue Z.by Fieke et al. Conclusions. CBT in the framework of complex treatment has a positive effect on the immune system, reducing inflammation mediated through the hypothalamic-pituitary-adrenal axis. Despite the accumulation of evidence confirming the effectiveness of this form of psychological assistance, its availability in Russia remains extremely limited and not fully appreciated.

The effect of brain neurotrophic factor gene polymorphism on the effectiveness of therapeutic and rehabilitation measures in patients with psychostimulant dependence

Justification. Along with the rising consumption of psychostimulants, the number of patients with dependence on psychostimulants is increasing all over the world and in Russia in particular. At the same time, the number of patients with dependence on drug combinations is increasing, most of which are psychostimulants. Aim. The aim of the work is to develop a personalized approach to the therapy of patients with dependence on psychostimulants, taking into account the polymorphism of the neurotrophic factor gene of the brain. Material and methods. 305 patients with dependence on psychostimulants, men and women from 18 to 50 years old, were studied. Depending on the drug used and their combinations, as well as the presence of comorbid psychiatric pathology, all patients were divided into 6 groups. Research methods: molecular-genetic, clinical-psychopathological, catamnestic, statistical (parametric and nonparametric methods using Statistica 10.0 programs of STAT Soft Inc., USA). The effect of polymorphism of the neurotrophic factor gene of the brain on the effectiveness of therapeutic and rehabilitation measures in patients in different groups was evaluated. Results. It was found that patients who use only psychostimulants and psychostimulants with cannabinoids, having a homozygous (GG) genotype of the neurotrophic factor gene of the brain, are longer in the rehabilitation program and have the longest remissions. Conclusion. Polymorphism of the neurotrophic factor gene of the brain affects the effectiveness of therapeutic and rehabilitation measures in patients with dependence on psychostimulants.

Understanding of anhedonia: from traditional to phenomenological analysis of the phenomena

The article is written in the form of a survey lecture highlighting the modern views of scientists on the phenomenon of anhedonia. A comparative analysis of the traditional psychiatric view of anhedonia with the phenomenological one is carried out. The specificity of anhedonia as a psychopathological symptom and as a psychological phenomenon is shown, as well as the features of the manifestation of anhedonia in neurological diseases. For practicing psychiatrists, the aspect of differentiation of anhedonia may be important, allowing one to choose the most adequate ways of correcting it between psychotherapeutic interventions, prescribing antidepressants with a proven anti-anhedonic effect or atypical antipsychotics.

Dear colleagues!

Kazan State Medical University, Russian Society of Psychiatrists (Tatarstan Branch), Union of Mental Health Protection, Institute for Mental Health Research are organizing in Kazan on December 1, 2021. Online conference "Psychiatric generations in search of consensus"

Psychosocial, clinical, and organizational perspectives of the risks of remote work for employees` mental health

The objective of the study was to analyze the modern data on the risks of remote work influence on the employees` mental health from psychosocial, clinical, and organizational perspectives. Methods. The analysis of literary sources, policy documents, publications in the mass media with an emphasis on the period from the beginning of the spread of the new coronavirus infection 2019-nCoV to the present. Results. The current state of the problem of the impact of remote work on the employees` mental health in Russia and in and in other countries during the global COVID-19 pandemic is analyzed. The causal relationships of medical, social, and organizational perspectives of labor activity are considered, and strategies for prevention of negative effects are studied. The widespread using of remote work all over the world is due to the need to limit the direct interpersonal contacts of citizens to contain the spread of infection. It is established that employees of organizations that perform labor functions remotely can be recognized as a type of risk group for mental, behavioral, and addictive disorders due to medical and social perspectives. The development of self-employment and the provision of services on the principles of freelancing may contribute to reducing the number of employees covered by preventive maintenance medical examinations and complicate the early detection of mental and somatic deviations in freelance workers. Conclusion. The result of the growing popularity of remote work is the spread of a hybrid work regime, which requires a comparative assessment of the medical and social risk factors of remote workers, amendments to several regulatory documents as well as the development of evidence based psychohygienic methodological recommendations for employers and early detection of employees with contraindications to remote work.

Social anxiety and eating disorders in medical students

Aim. Assessment of social anxiety and eating disorders prevalence in students of Voronezh State Medical University after N.N. Burdenko. Methods. The study was conducted in 20202021 among students of Voronezh State Medical University on the basis of the Voronezh Regional Psychoneurological Dispensary and the Lion-Med clinic. Were used printed and online versions of the Liebowitz Social Anxiety Scale and the Dutch Eating Disorders Questionnaire (DEBQ). It was carried out correlation analysis of data between the general statistical indicators of the sample (gender, age, year of education) and the data of the questionnaires for each question separately. The correlation coefficient for nonparametric scale types (Pearson correlation coefficient) was used in the analysis. Results. Overall, significant level of anxiety was in diagnosed 525 (45.09%) people. The average duration of anxiety symptoms was 1.5 years. High level of social anxiety was estimated in 14.57% (169 people), marked level was revealed in 5.28% (61 people), moderate level was diagnosed in 14.08% (163 people), low social anxiety level was diagnosed in 11.09% (132 people), 54.98% didnt have any features of social anxiety (641 people). Restrictive and emotional types of eating disorders correlate with the female gender and the older year of education (p 0.01). There were no significant correlations between the gender of the respondents and the year of education in relation to the external type of eating disorder. Conclusion. Attention is drawn, firstly, to the relatively high percentage of social anxiety among medical students, and secondly, to the presence of eating behaviors predisposing to eating disorders. Features of restrictive and emotional eating behavior correlate with the year of education (the older the course, the more often these types of eating patterns are revealed).

History of the kazan psychophysiological laboratory headed by V.M. Bekhterev (1885–1893)

Based on archival data and literary sources, the article presents the history of the Kazan psychophysiological laboratory of V.M. Bekhterev during the years of his work in Kazan (18851893). The circumstances of the creation of the psychophysiological laboratory, its locations (during the years of Bekhterevs work, it changed two rooms) and equipment are described. The main scientific directions of V.M. Bekhterev and his students during the Kazan period of activity, the history of their appointment to the positions of residents and assistants of the Department of Psychiatry are analysed. The reasons and history of creation of a psychophysiological laboratory at the clinical base of the University in the Kazan District Hospital are described.

Quantitative characteristics of the alpha-rhythm of the electroencephalogram in depressive disorders

The aim of research was to study the quantitative characteristics of the alpha rhythm in patients with depressive disorders. Material and methods. The study sample consisted of patients who were treated at the clinic of the Research Institute of Mental Health (department of affective states) Tomsk NIMC. A total of 84 patients (67 women, 17 men) aged 20 to 60 years with mood disorders in the framework of a depressive episode, recurrent depressive disorder and dysthymia were examined. An electroencephalogram was recorded at rest with closed and open eyes. The values of the absolute spectral power of the alpha rhythm, the parameters of the microstructure of the alpha spindle were analyzed and the reactivity index (the Berger effect) was calculated. Results. With open eyes, the spectral power of the alpha rhythm was statistically significantly higher in patients with depressive disorders in the Fp1 (p=0.041), F4 (p=0.042), F7 (p=0.046) and T4 (p=0.047) leads compared to the control. Also, in patients with depressive disorders, a predominantly low-amplitude alpha rhythm was recorded (53.6% vs. 26.7%, p=0.006). The degree of alpha-rhythm depression in the posterior temporal leads T5 (p=0.012) and T6 (p=0.006) was statistically significantly less pronounced in patients with depressive disorders compared to the control group of healthy individuals. Conclusion. The detected changes indirectly indicate a decrease in the oscillatory activity of brain processes in depressive disorders.