Репозиторий Университета

Background: There is currently a wide therapeutic arsenal for migraine patients, without a single first-line preventive drug and we choose the different available alternatives taking into account comorbidities, national guidelines, previous treatments and personal experiences. Our objective was to evaluate the differences in the use of migraine treatments between neurologists from different countries. Methods: This is a multi-centre observational study carried out by neurologists from specialized headache units in seven countries, retrospective with consecutive inclusion of all patients presenting with a migraine diagnosis, over a period of three months. Results: A total of 734 patients were recruited but only 600 were considered in the analysis in order to homogenize the patient cohorts from countries: 200 Spain (ES), 100 Italy (IT), 85 Russia (RUS), 80 Germany (DE), 60 Portugal (PT), 45 Poland (PL) and 30 Australia (AU). 85.4 % of patients were women with a mean age of 42.6 ± 11.8 years. Considering previous and current preventive treatment, the order of use was: antidepressants (69.3 %), antiepileptic drugs (54.7 %), beta-blockers and antihypertensive drugs (49.7 %), OnabotulinumtoxinA (44.0 %) and others (36.2 %). Statistically significant differences were found between all pharmacological classes: antidepressants were commonly used in all countries, with the exception of Poland (AU: 76.7 %, IT: 71.0 %, DE: 60.0 %, PL: 31.1 %, PT: 71.7 %, RUS: 70.6 %, ES: 78.5 %; p < 0.0001); antiepileptic drugs were more frequently prescribed in Portugal, Australia and Spain (AU: 73.3 %, IT: 40.0 %, DE: 37.5 %, PL: 48.9 %, PT: 85.0 %, RUS: 29.4 % and ES: 69.0 %; p < 0.0001); beta-blockers and antihypertensive drugs were frequently used in all countries except Italy (AU: 60.0 %, IT: 14.0 %, DE: 53.8 %, PL: 48.9 %, PT: 68.3 %, RUS: 49.4 % and ES: 59.0 %; p < 0.0001); BTX-A were predominately used in Spain, Italy and Australia (AU:56.7 %, IT:58.0 %, DE:20.0 %, PL: 42.2 %, PT: 26.7 %, RUS: 24.7 % and ES: 58.5 %; p < 0.0001) and others were most frequently used in Poland (AU: 0.0 %, IT: 19.0 %, DE: 42.5 %, PL: 95.6 %, PT: 31.7 %, RUS: 3.5 % and ES: 49.5 %; p < 0.0001). If only patients without comorbidities are considered (200/600), statistically differences between countries persist in all preventive treatments. Conclusions: There is heterogeneity in the choice of preventive treatment between different countries. Prospective comparative studies of the different oral and subcutaneous alternatives would help to create a global therapeutic algorithm that would guarantee the best option for our patients.

The tendency to anxiety is a characteristic feature of alcohol abusers, and anxiety can be a symptom of alcohol withdrawal as well as comorbid disorder. The frequent comorbidity of alcohol use disorders and anxiety is due to a number of reasons including general hereditary predisposition, mutual conditioning and similar pathogenesis. Pharmacological therapy of anxiety disorders in alcohol-dependent patients is carried out on the basis of general principles of anxiety treatment and involves the use of benzodiazepines, antidepressants and, in some cases, antipsychotics as second-line medicines.

© 2018, Media Sphera Publishing Group. All rights reserved. Antidepressants are among the most commonly prescribed drugs due to their effectivenes in treating depression and anxiety disorders. One of the reasons for early discontinuation of taking antidepressants are side-effects. Agomelatine is a relatively novel antidepressant with high efficacy and good tolerance. Clinical effects of agomelatine include a reduction in symptoms of depression, anti-anxiety and hypnotic effects, as well as the rapid elimination of anhedonia, which determines high adherence to therapy, restoration of normal social functioning, and complete remission of disease.

© 2018, Media Sphera Publishing Group. All rights reserved.  Objective. To assess the prognostic significance of biological rhythms in depression on the example of the individual chronotype. Material and methods. One hundred patients (women 68%), aged 18—77 years, mean age 48±16, were examined before and after 8 weeks of treatment. The Morningness-Eveningness Questionnaire (MEQ) was used. Treatment response (a decrease of 50% in total MADRS scores to the 8 th week of treatment) and dynamics of depression severity (dMADRS; R) were assessed. Results and conclusion. Evening chronotype was found to be associated with poor prognosis. TCAs and SSRIs were more effective in eveningness, other antidepressants—in morningness. MEQ changes during and after treatment may reflect the resynchronizing activity of antidepressants.

© N.N. IVANETS E.N. EFREMOVA, 2018. Objective. To explore psychopathological features of affective disorders in the structure of schizotypal disorder. Material and methods. The study included 102 patients with schizotypal disorder, aged from 18 to 60 years. Assessment was done using clinical/ psychopathological method and psychometric scales — Calgary depression scale in patients with schizophrenia (CDSS), General Clinical Impression scale (CGI), Yang’s mania scale (YMRS). Results and conclusion. Affective disorders are noted in the majority of inpatients with schizotypal disorder. They are represented by depressive disorders of variable severity, and mixed depressive states. A group of patients with schizotypal disorder was identified in whom the symptoms of the affective disorder constituted the main clinical picture of the disease, whereas concomitant neurosis-like disorders were formed solely during the exacerbation of depression, correlated with its severity and reduced on antidepressant therapy along with depressive symptoms. Observed reversibility of productive disorders allowed us to consider the dynamic of these states as similar to the atypical affective phase, and the natural course of the disorder as close to the paroxysmal type in the form of distinct depressive phases. In patients with persistent neurosis-like disorders, affective disorders accompanied axial symptoms of the disease and made a large impact on the structure of the exacerbation of the endogenous process. A reduction of depressive symptoms in these patients was accompanied by a decrease in the intensity of axial symptoms of the disease, however the complete reduction of axial symptoms and remission was not observed.

© 2018, Media Sphera Publishing Group. All Rights Reserved. Objective. To develop therapeutic programs for treatment of depression with panic attacks on the basis of their clinical and psychopathological features. Material and methods. A total of 100 in-and outpatients, aged from 18 to 60 years, with depression of mild and moderate severity with panic attacks were studied. The investigation was carried out using clinical, psychopathological and psychometric (the Atypical Depression Diagnostic Scale (ADDS), the Montgomery—Asberg Depression Rating Scales (MADRS), and the Sheehan Anxiety Rating Scale (ShARS)) methods. The patients were assessed on admission, on the 1st, 2nd, 4th and 8th weeks with subsequent processing and defining standard indicators. Three therapeutic groups were formed: the 1st group received therapy combining an antidepressant and a tranquilizer; the 2nd group an antidepressant, a tranquilizer and a mood stabilizer; and the 3rd group an antidepressant, a tranquilizer and an antipsychotic agent. The time course of expression of the signs of depression, anxiety and frequency of panic attacks was analyzed. Results. The highest efficacy in the form of reduced signs of depression and anxiety was observed in the 3rd group on the 1st week of therapy. No significant differences in reduction of depression and anxiety were found between the 1st and 2nd groups. In the 1st therapeutic group, there was an increase in the frequency of panic attacks together with the reduction in their expression and decrease in the severity of depression as compared to the 2nd and 3rd groups. At the same time the 3rd therapeutic group was characterized by a maximally expressed decrease in the frequency of panic attacks already on the 1st week of therapy. Conclusion. The study has shown that the use of antipsychotic drugs in addition to therapy with antidepressants and tranquilizers is the most effective way to stop depression.

© 2018 Ima-Press Publishing House. All Rights Reserved. Based on the data available in the literature, the author has first systematized in detail the main stages of the design and clinical introduction of serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants. Theoretical prerequisites for their emergence are described. The evaluation of the efficiency of depression therapy with drugs of this group in clinical trials and post-marketing studies is analyzed in the historical context. The reasons for temporary restrictions on their wide use are considered. There are data on the design of novel representatives of SNRI antidepressants.

© 2018 Izdatel'stvo Meditsina. All rights reserved. NMDA receptor modulators are a new class of antidepressants with rapid onset of action and lasting antidepressant effect. These drugs increase BDNF level in CNS and adult hippocampal neurogenesis, which events are in common for both NMDA receptor modulators and classical antidepressants. However, unlike classical antidepressants, drugs of this new group produce no direct influence on the monoaminergic system, but regulate the neuroplasticity in the prefrontal cortex and hippocampus via modulation of the glutamatergic neurotransmission. Clinical tests of ketamine and rapastinel confirmed the rapid onset of action and the continuation of stable antidepressant effect (upon single administration per 7 days) for both usual and treatment-resistant forms of depression.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. The antidepressant-like effect of fluoxetine (20 mg/kg i.p.) has been assessed using the forced swimming test (FST) in IRC (CD-1) mice exposed or not to a pretest session of different duration (5 or 20 min). The influence of the mitochondrial translocator protein (TSPO) activity on the antidepressant-like effect of fluoxetine (20 mg/kg i.p.) in the FST was also studied. The antidepressant-like effect of fluoxetine was observed only in mice subjected to a 5-min pretest session 24 h before the FST. The TSPO antagonist PK11195 [1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinolinecarboxamide; 1 or 3 mg/kg i.p.] inhibited the antidepressant activity of fluoxetine in the FST. In the present study, fluoxetine or PK11195 was administered for a short duration. We suppose that the functional activity of TSPO may depend on a pretest session and that using this procedure is necessary to detect antidepressant activity of fluoxetine-like drugs.