Pharmacogenetics of antidepressants (from history to the present)

Pharmacogenetics is a relatively new scientific discipline, which is currently the main tool in personalized medicine. The aim of research in this area is to identify significant genetic markers for the introduction of their accounting in routine clinical practice. Generalization of data on the patient’s phenotype should be the key to predicting the pharmacokinetics and pharmacodynamics of the drug in the body. A personalized approach based on pharmacogenetic research data in psychiatry is extremely relevant due to the high social and budgetary costs of treating mental disorders around the world. Currently, there are data on the pharmacogenetics of most modern antidepressants, however, conducting such studies in patients with depressive disorders in most cases is impossible for implementation in routine clinical practice due to the impossibility of conducting the test in the laboratory of medical organizations and the lack of specialists competent in the clinical interpretation of the results of pharmacogenetic testing.

Application of computer stabilometric technologies with biofeedback in patients with lumbosacral pain

Introduction. Low back pain is one of the most common sufferings of modern humans. In developed countries, such manifestations are a serious medical and economic problem. Lumbosacral pain in many cases is caused by the occurrence of somatic dysfunction of the bones of the pelvis and sacrum. The main methods of treatment are prescribing drug therapy and non-drug treatment. Today, osteopathic techniques are highly effective for the diagnosis and correction of somatic dysfunctions of the pelvic region. Such treatment in patients with pain in the lower back helps to reduce pain and restore the functional state of patients. Equally important are computer technologies with biofeedback (BFB) with the possibility of effective correction of proprioceptive innervation and muscle-tonic syndromes. The stabilometric platform allows you to register the parameters of the static-dynamic function of support and balance maintenance. The resulting changes in the position of the sacrum and pelvic bones create a distortion of proprioceptive somatosensory afferentation, postural tonic reflexes of the axial skeleton and limbs are blocked, the sequence of activation of the motor units of the locomotor apparatus is disrupted, the mechanisms for maintaining support and walking change. The aim — to study the effectiveness of using a stabiloplatform with biofeedback in the diagnostic mode of coordinating and static-dynamic disorders in patients with somatic dysfunctions of the pelvic and sacral bones in a training mode in combination with osteopathic correction for pain in the lumbosacral region. Materials and methods. In a prospective controlled study in patients with lumbosacral pain with somatic dysfunctions of the pelvic bones, the results of treatment were analyzed in 66 patients aged 23–56 years. Diagnosis of dysfunctions of the iliac bones was carried out according to the generally accepted rules of osteopathic examination — osteopathic examination and determination of the position of bone landmarks. The observed patients were divided into groups and subgroups depending on the type of dysfunction. The main group consisted of patients with clinical and osteopathic signs of somatic dysfunctions of the pubic bone and ilium. The patients were followed up for 14 days. The observation and treatment program included: osteopathic correction of diagnosed somatic dysfunction and stabilometric examination (3 control points) with a training regimen (3 sessions). Stabilometric testing was carried out at the stage of diagnosis and selection of patients for inclusion in the study. Re-examination was carried out 14 days after the moment of treatment. The clinical effect was compared with the results of stabilometric tests. In addition, the intensity of the pain syndrome and the severity of muscle-tonic reactions were analyzed. According to the results of the test regime, the stability in the «eyes open» and «eyes closed» modes was assessed. Results. A decrease in the intensity of pain is achieved, normalization of the balance in axial parameters with an improvement in the function of coordination of movements is noted. The Romberg coefficient decreases most significantly in somatic dysfunctions of the iliac bones in the position of anterior rotation without a significant difference in lateralization: on the right, a decrease from 570 ± 12% to 295 ± 23% and on the left from 550 ± 22 to 260 ± 25% (p <0.05). Conclusion. In the event of somatic dysfunctions of the pelvic bones with lumbosacralgia, the combined use of osteopathic correction and physiotherapy exercises on a stabiloplatform in a training mode with biofeedback has a significant effect. The training regimen promotes pain regression in acute and chronic pain. The best results have been achieved in patients with dysfunction in the anterior rotation of the ilium. Stabilometric testing in the diagnostic mode allows you to obtain objective data on the nature of imbalance and imbalance. The training regime ensures the achievement of a therapeutic result in 3 sessions and can be used in inpatient and outpatient conditions of medical institutions.

Lateral ventricular stenting as a method of preventing trapped temporal horn following resection of lateral ventricular trigone tumor. Case report and review of literature

Resection of lateral ventricular trigone tumor can lead the development of specific complication like a trapped temporal horn. Secretion of cerebrospinal fluid from the choroid plexus in closed space leads to progressive enlargement of the temporal horn. The enlargement of the temporal horn leads to lateral transtentorial herniation with brain steam compression, which manifested by disorders of consciousness, hemiparesis, memory impairment and loss of visual fields. The proposed stenting technique allows to prevent the development of extended temporal horn and excludes the requirement its treatment in the long-term period. Over the past year, intraoperative stenting have been performed in five cases. In the long-term period none of the patients have had trapped temporal horn. There was no case of stent dysfunction.The article presents a clinical case of ventricular stenting following resection of lateral ventricular trigone tumor.

Depression in patients in a somatic hospital

The aim of this work was to assess the prevalence and risk factors for depression in patients in a somatic hospital in the city of Izhevsk. The study group (94 adult patients) was compiled by the method of continuous sampling. The Russian version of M. I. N. I. 5.0.0 interview, Depression Scale were used for the diagnosis of depression. The prevalence of current depressive disorders was 19,1 %. Depression was more often diagnosed in patients with chronic somatic diseases (47,0 %), women (45 %), widowed or divorced patients (63,6 %), patients with psychological problems in the family (100 %). In patients with acute somatic illness, the current depressive episode correlated with the influence of psychological factors. In 64,2 % of patients with chronic somatic diseases with an identified depressive episode at the time of examination depression had a previous history. None of the patients with identified depression sought medical help or received antidepressant therapy.

Impact of coronavirus infection on children and adolescents with mental disorders

The article presents the results of the study of changes in the frequency of hospitalizations and the nosological composition of diagnoses of children and adolescents hospitalized in the Regional Clinical Psychiatric Hospital of Hagia Sophia during the period of self-isolation from March to May 2020, compared to the same period in 2019. The clinical cases that demonstrate the development of a new-onset psychotic disorder under the influence of stress factors provoked by the COVID-19 pandemic are presented. English version of the article on pp. 730-735 is available at URL: https://panor.ru/articles/impact-of-coronavirus-infection-on-children-and-adolescents-with-mental-disorders/70278.html

Correlation of cognitive disorders and catecholamine excretion in anorexia nervosa

The article presents the analysis of correlation and dynamics of clinical and psychophysiological characteristics of the long-term effects of long-lasting abstinence from food on the example of 500 women with anorexia nervosa (AN), who applied for help to the Department of Psychiatry and Medical Psychology, FSAEI HE Peoples’ Friendship University of Russia in 1989-2017. The adverse effects of prolonged abstinence from food are shown; the indicators of catecholamine excretion (dopamine, adrenaline, norepinephrine), encephalography data, mental performance and memory of those examined at various stages of AN weight loss and gain were studied. The difference in the excretion of catecholamines in AN and psychogenic vomiting, which can be used for differential diagnosis, was demonstrated.

A comparative analysis of the intellectual–mental disorders in patients with brain gliomas and meningiomas after surgical treatment

We performed study of 61 patients with brain glioma and meningioma. The diagnosis of the studied patients was based on clinical and laboratory data, data of radiation and instrumental methods of research. The analysis of patientsquality of life was carried out in the preoperative and early, late postoperative periods. The patient age ranged from 25 to 65 years; the median age was 56,5 year. We used the intelligence tests (Amthauer test (for persons under 60 years), Raven test); memory tests (10 word memorization test, Wechsler memory scale). Results. Regression of mnestic disorders after surgery was found in both groups. Three months after surgery — mnestic disorders were observed in 96.7 % of subjects with glioma, and in 64.5 % — of meningioma. After 3–6 months, the number of patients with high intelligence in both groups increased (from 32.3 % to 45.2 % — in patients with glioma and from 30 % to 40 % among meningioma patients). Conclusion. On examination of intelligence and memory before and resection brain glioma and meningioma, it was found that surgical intervention leads to regression of intellectual and memory impairments. English version of the article on pp. 651-659 is available at URL: https://panor.ru/articles/sravnitelnyy-analiz-intellektualno-mnesticheskikh-narusheniy-u-bolnykh-s-gliomami-i-meningiomami-golovnogo-mozga-posle-operativnogo-lecheniya/70264.html

Sodium fluorescein and indocyanine green in neuro-oncology and surgery of brain arteriovenous malformations. Review

In this article we generalized results of sodium fluorescein and indocyanine green usage in removing of brain tumors and arteriovenous malformations. Basic principles of fluorescence, it’s sensitivity and specificity are thoroughly described. Drug’s dosages, their ways and exposition of administration are indicated. Special attention is payed at fluorophores’ use in removing of various brain lesions.Concerning fluorescence with indocyanine we reviewed «second window» effect, expanding its usage in neurooncology. In conclusion we described other perspective methods of fluorescence that are being actively researched but have not been implemented in clinical practice yet.

Personalized approach to the administration of haloperidol in patients with acute alcoholic hallucinatie (literature review)

To date, it is known that haloperidol is used to treat productive psychopathological symptoms in acute alcoholic hallucinosis, but its use is associated with a high risk of developing undesirable drug reactions (NLR). A number of isoenzymes of the cytochrome P-450 family take part in the metabolism of haloperidol. The biotransformation of haloperidol occurs with the participation of the CYP2D6 isoenzyme encoded by the gene of the same name. The CYP2D6 gene is highly polymorphic, and this polymorphism can lead to a change in the activity of the encoded isoenzyme. Changes in the rate of biotransformation of haloperidol may affect the profile of its effectiveness and safety. This review is aimed at analyzing the information accumulated in the literature on the role of genetic factors in the formation of an individual response to haloperidol therapy in patients with acute alcoholic hallucinosis.

Anti-NMDA receptor encephalitis in the practice of a psychiatrist on the example of a clinical case

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune disease of the central nervous system (CNS) with prominent neurologic and psychiatric features at disease onset. Anti-NMDAR encephalitis can occur in all ages. The disorder predominantly affects children and young adults, occurs with or without tumour association, and can relapse. The presence of a tumour (usually an ovarian teratoma) is dependent on age, sex, and ethnicity, being more frequent in women older than 18 years. Primarily presents in the form of mental disorders, seizures, and involuntary movement, and is often accompanied by sleep disorders and prominent speech difficulties. Anti-NMDAR encephalitis in children may present differently than in adults. Children are more likely to have abnormal movements (chorea, incoordination) early in the disease course and also may have atypical motor symptoms such as ataxia or hemiparesis. Children more often have seizures than adults. The classic symptoms of psychosis seen in adults are less common, but behavioral regression is frequently noted. The proper diagnosis and management of autoimmune encephalitis requires a multidisciplinary treatment approach. Ancillary testing with MRI, EEG, lumbar puncture and immunological assessment of cerebrospinal fluid and serum may further support a diagnosis of encephalitis and potentially suggest particular causes. Early immune-modulatory treatment can alleviate the severity of the disease and improve the cure rate. Further study of anti-NMDAR antibody and its related encephalitis would give essential clues for the research of schizophrenia, catatonia, and atypical psychosis.