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Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)最新文献

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Clinical and statistical analysis of factors affecting compliance in schizophrenia patients 精神分裂症患者依从性影响因素的临床与统计分析
V. V. Ruzhenkova, I. S. Khamskaya, K. Retyunskiy, U. Moskvitina, O.V. Zhigulina, O. Novikova
Patients with schizophrenia have an increased risk of non-compliance with medical therapy, which, as a rule, leads to exacerbation or relapse of the disease, repeated hospitalization, and impaired social adaptation. The aim of the study was to analyze clinical and organizational factors that affect the compliance of schizophrenia patients. We examined 157 patients with a diagnosis of schizophrenia aged 23 to 52 (38.5±8.1) years. The study was carried out a week before discharge from the hospital. Clinical-psychopathological, clinical-dynamic, psychometric, and statistical research methods were used. It was found that only 11.4% of males and 20.7% of females were fully compliant. Taking medications under the relatives’ control was observed in a third of men and half of women. The probability (chance) of compliance overestimation by the attending physician using the clinical method is 1.8 times higher than when using the corresponding questionnaires. The higher the criticism of the disease was, the higher was patients’ compliance after discharge. The following risk factors for non-compliance in patients with schizophrenia have been identified: male gender; history of alcohol abuse; early discharge of patients from the hospital with clinically expressed anxiety, depression, and a sense of hopelessness; complete absence or insufficient explanation to the patient of the principle and procedure for taking supporting therapy; prescribing many oral or expensive drugs. Thus, compliance in schizophrenia patients is a dynamic formation, which is formed under the influence of a whole complex of individual, personal, social, environmental, and clinical factors, which should be taken into account when forming therapeutic tactics.
精神分裂症患者不遵守药物治疗的风险增加,这通常会导致疾病加重或复发、反复住院和社会适应受损。本研究的目的是分析影响精神分裂症患者依从性的临床和组织因素。我们研究了157例23 ~ 52岁(38.5±8.1)岁的精神分裂症患者。这项研究是在出院前一周进行的。采用临床-精神病理学、临床-动态、心理测量学和统计学研究方法。调查发现,只有11.4%的男性和20.7%的女性完全遵守规定。三分之一的男性和一半的女性在亲属的控制下服用药物。主治医师使用临床方法对依从性高估的概率(机会)是使用相应问卷调查时的1.8倍。对疾病的批评越高,患者出院后的依从性越高。精神分裂症患者不遵医嘱的危险因素如下:男性;酗酒史;临床表现为焦虑、抑郁和绝望感的患者提前出院;完全不向患者说明辅助治疗的原则和程序或说明不充分的;开很多口服或昂贵的药。因此,精神分裂症患者的依从性是一个动态的形成,是在个体、个人、社会、环境和临床等综合因素的影响下形成的,在制定治疗策略时应考虑到这些因素。
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引用次数: 0
Results of transsphenoidal endoscopic removal of ACTH-secreting pituitary adenomas 经蝶窦内镜切除垂体促肾上腺皮质激素腺瘤的结果
K. V. Tikhonov, V. Cherebillo
The article presents the results of surgical treatment of patients who underwent endoscopic transsphenoidal adenomectomy for ACTH-secreting pituitary adenomas in the Neurosurgical Department of the Pavlov First Saint Petersburg State Medical University from 2015 to 2022. The analysis of patients was carried out according to the following criteria: clinical manifestations of the disease, the nature of tumor growth according to the MRI study, positive results of surgical treatment, postoperative complications. Effective treatment of ACTH-secreting pituitary adenomas is necessary as this tumor is associated with the development of Itsenko-Cushing's disease, and in the absence of adequate and timely treatment and in case of preservation of hypercorticism, the 5‑year mortality of these patients exceeds that of general population, reaching 50%.
本文介绍了2015年至2022年在圣彼得堡巴甫洛夫第一医科大学神经外科行经蝶窦腺瘤切除术治疗垂体acth腺瘤患者的手术治疗结果。根据以下标准对患者进行分析:疾病的临床表现,根据MRI研究肿瘤生长的性质,手术治疗阳性结果,术后并发症。垂体acth分泌腺瘤的有效治疗是必要的,因为这种肿瘤与Itsenko-Cushing病的发展有关,如果没有适当和及时的治疗,并且在保留高皮质的情况下,这些患者的5年死亡率超过一般人群,达到50%。
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引用次数: 0
Meningitis after spinal injury surgery 脊髓损伤手术后的脑膜炎
А. V. Botov, P. Shnyakin, I. J. Gasymly
Postoperative meningitis is quite rare in the practice of a spine surgeon and, as a rule, is associated with unintentional damage to the dura mater or necessary durotomy. According to a number of researchers, emergency interventions, severe spinal cord injury, prolonged preoperative stay in intensive care, diabetes mellitus, obesity, smoking, and age over 65 are risk factors for the development of postoperative meningitis in spinal injury surgery. The development of postoperative meningitis lengthens the time of hospitalization, requires prolonged antibacterial therapy, and significantly deteriorates the outcome of surgical treatment, which determines the relevance and significance of studying this issue. The article presents our own experience of 12 cases of patients with meningitis after spinal injury surgery, which accounted for 0.6 % of all interventions.
术后脑膜炎在脊柱外科医生的实践中是相当罕见的,通常与硬脑膜的意外损伤或必要的硬脑膜切开有关。许多研究者认为,紧急干预、严重脊髓损伤、术前重症监护时间延长、糖尿病、肥胖、吸烟和年龄超过65岁是脊髓损伤手术后发生脑膜炎的危险因素。术后脑膜炎的发生延长了住院时间,需要长时间的抗菌治疗,明显恶化了手术治疗的效果,这决定了研究这一问题的相关性和意义。本文介绍了我们对12例脊髓损伤手术后发生脑膜炎的经验,占所有干预措施的0.6%。
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引用次数: 0
Parkinson’s disease and multiple sclerosis (a complex clinical case) 帕金森病和多发性硬化症(一个复杂的临床病例)
А. А. Kumakhov
This article presents a clinical case of the development of Parkinson's disease and multiple sclerosis in a 60‑year old patient. The most important anamnestic data, the results of laboratory and instrumental studies, and various approaches to treatment are described. Several visiting consultations and boards of doctors were held to reach a final verdict. However,many specialists may still have some disagreements about the diagnosis, which makes this clinical case especially interesting.
这篇文章提出了一个临床病例发展帕金森氏病和多发性硬化症在一个60岁的病人。最重要的记忆数据,实验室和仪器研究的结果,以及各种治疗方法的描述。举行了几次会诊和医生委员会以达成最终裁决。然而,许多专家可能仍然对诊断有一些分歧,这使得这个临床病例特别有趣。
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引用次数: 0
Obsessive-compulsive disorder induced by psychostimulants, synthetic cathinones, or cocaine: a systematic review 由精神兴奋剂、合成卡西酮或可卡因引起的强迫症:一项系统回顾
I. Fedotov, B. Y. Volodin, V. Novikov, E. V. Leonov, D. Shustov
The aim of the article is to conduct a systematic review of the literature in order to summarize the available data on the frequency of occurrence, clinical features, predictors of prognosis, and effective approaches to the treatment of obsessive-compulsive and related disorders associated with influence of cocaine (code 6C45.72 according to ICD-11), psychostimulants (6C46.73), and synthetic cathinones (6C47.72). The analysis of scientific publications in the eLibrary, CNKI, PubMed, and Scopus databases was performed with keyword search. In accordance with the PRISMA recommendations, 12 articles were selected and included in the analysis. No articles with data on synthetic cathinones have been found. It has been found that the misuse of amphetamine increases the risk of OCD by about 3 times, methamphetamine — by 4 times, cocaine — by 2.5 times. In the presence of additional comorbidity, this risk increases even more: in HIV infection — by 13 times, in the presence of induced psychoses in the anamnesis — by 12 times. The initial presence of OCD also increases the risk of developing addictions. Such mutual influence may be associated with the overlap of these disorders at genetic level (the relative contribution of these factors is estimated at 56–68 %), at neural circuits level (a decrease in the connectivity of the orbitofrontal cortex and in D2‑dopamine activity in the striatum are characteristic of both disorders), and at a behavioral level (both disorders are characterized by a decrease in cognitive flexibility in the model of probabilistic reversal learning). Comorbidity of OCD and addictions deteriorates the social functioning of patients, but increases the duration of remissions. To improve the effectiveness of the treatment of such conditions, combined treatment, aimed at both OCD and addiction, is required. The clinical picture of OCD induced by the use of the studied group of substances may differ in the greater severity of obsessions of contrast contents and compulsive counting. Socio-demographic predictors of the risk of its occurrence were not found.
本文的目的是对文献进行系统回顾,以总结与可卡因(ICD-11代码6C45.72)、精神兴奋剂(6C46.73)和合成卡西酮(6C47.72)影响相关的强迫症及相关疾病的发生频率、临床特征、预后预测因素和有效治疗方法等方面的现有数据。通过关键词搜索对图书馆、中国知网、PubMed和Scopus数据库中的科学出版物进行分析。根据PRISMA的建议,选择了12篇文章并将其纳入分析。没有发现含有合成卡西酮数据的文章。研究发现,滥用安非他明会使患强迫症的风险增加约3倍,甲基苯丙胺增加4倍,可卡因增加2.5倍。在存在其他合并症的情况下,这一风险增加得更多:在感染艾滋病毒的情况下,这一风险增加了13倍,在健忘症中存在诱发性精神病的情况下,这一风险增加了12倍。最初出现的强迫症也会增加发展成成瘾的风险。这种相互影响可能与这些疾病在遗传水平上的重叠有关(这些因素的相对贡献估计为56% - 68%),在神经回路水平上(眶额叶皮层连通性下降和纹状体中D2 -多巴胺活性下降是这两种疾病的特征),以及在行为水平上(这两种疾病的特征是在概率反转学习模型中认知灵活性下降)。强迫症和成瘾的合并症恶化了患者的社会功能,但增加了缓解的持续时间。为了提高治疗这种情况的有效性,需要针对强迫症和成瘾的联合治疗。使用所研究的物质引起的强迫症的临床表现可能在对比内容和强迫计数的更严重程度上有所不同。未发现其发生风险的社会人口学预测因子。
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引用次数: 0
Dysmorphophobic disorders in patients with anorexia nervosa and bulimia nervosa 神经性厌食症和神经性贪食症患者的畸形恐惧症
E. Okonishnikova, A. Bryukhin
Anorexia nervosa (AN) and bulimia nervosa (BN) are manifested by cognitive, emotional and behavioral symptoms that disrupt the process of eating. They manifest in childhood, adolescence with a conscious restriction in food, and sometimes with a complete rejection of it, in order to correct imaginary fullness or sharply overestimated increased body weight. The psychopathological basis of AN and BN is the syndrome of dysmorphophobia or dysmorphomania, which is accompanied by a depressed mood, careful masking of both their experiences and body features, the desire to correct an imaginary defect in any way. The aim of the study was research pathological dissatisfaction with one»s own appearance and to evaluate the diagnostic capabilities of questionnaires to determine the degree of dissatisfaction with one»s own body and their impact on the affective state and quality of life of patients. Methods used in the study: clinical and psychopathological with anamnestic information from patients and their relatives and catamnestic observation data and psychometric. A study of 130 female patients with AN and BN aged 13 to 44 years showed the presence of symptoms characteristic of dysmorphophobic disorders in an absolutely overwhelming number of patients either in anamnesis or in the current mental state, as well as the degree of its influence on the affective state and quality of life. Dysmorphophobic disorders are axial in typical eating disorders — anorexia nervosa and bulimia nervosa. The absence of obvious dysmorphophobic or dysmorphomanic symptoms makes it possible to distinguish atypical variants from typical cases of AN and BN, as well as to identify other eating disorders and eating behavior, followed by the use of individual forms of therapy. The study indicates the prevalence, severity, persistence of dysmorphophobic symptoms and its role in the manifestation, dynamics and outcomes in typical variants of eating disorders.
神经性厌食症(AN)和神经性贪食症(BN)表现为认知、情绪和行为症状,破坏进食过程。他们出现在童年,青少年的有意识的限制食物,有时与一个完整的拒绝,为了正确的虚构的丰满或大幅高估了增加体重。AN和BN的精神病理学基础是畸形恐惧症或畸形狂躁综合征,伴有抑郁情绪,小心地掩盖他们的经历和身体特征,渴望以任何方式纠正想象中的缺陷。这项研究的目的是研究病理不满自己»年代外观和评估问卷调查确定的诊断功能的程度不满自己»年代的身体和对情感的影响国家和患者的生活质量。本研究采用的方法:临床和精神病理资料结合患者及其亲属的记忆资料和动态观察资料及心理测量。研究的130名女性患者和BN 13至44岁显示dysmorphophobic紊乱的症状特征的存在绝对压倒性数量的病人在记忆或目前的心理状态,以及对情感状态的影响程度和生活质量。畸形恐惧症是典型的饮食失调-神经性厌食症和神经性贪食症的轴心。由于没有明显的畸形恐惧症或畸形症状,因此有可能将非典型变异与典型的AN和BN病例区分开来,并确定其他饮食失调和饮食行为,然后使用个别形式的治疗。该研究表明了畸形恐惧症症状的患病率、严重程度、持久性及其在典型饮食失调变体的表现、动态和结果中的作用。
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引用次数: 0
Common pathogenetic mechanisms in affective disorders and multiple sclerosis: role of interleukin imbalance in the progression of comorbid pathology 情感性障碍和多发性硬化症的共同发病机制:白细胞介素失衡在共病病理进展中的作用
S. Kiryukhina, D. V. Samarina, N. Kolmykova, D. Labunskiy
Relevance. Among many comorbid pathologies, it is of considerable interest to study and compare the pathogenetic mechanisms of neurological and mental disorders that combine the clinical manifestations of multiple sclerosis (MS) and affective disorders. The high MS prevalence, economic and social significance of the disease, heterogeneity of clinical symptoms, an unfavorable progressive course, as well as the frequent combination of this pathology with various forms of hypothymic disorders determine the relevance of studying the common pathogenetic mechanisms for the development of this comorbid pathology, which is necessary for the development of effective and safe preventive medical activities. The purpose of the review is to determine the common immunopathological mechanisms of affective disorders and multiple sclerosis, to analyze the role of cytokine status imbalance in the mutual increase in the severity of clinical symptoms in comorbid pathology, and to identify prognostic markers of disease progression. Materials and methods. On the basis of electronic Russian and foreign databases for the period 2017–2022, a theoretical analysis of the pathophysiological mechanisms of autoimmune CNS damage in MS and affective disorders was carried out. In order to search for literary sources, the following resources were used: https://elibrary.ru/, https://www.ncbi.nlm.nih.gov/pubmed/, https://cyberleninka.ru/. 10 Russian and 25 foreign sources were cited. Results. The mechanisms of development of mental affective disorders and multiple sclerosis have common pathogenetic features and are characterized by a violation of pro-inflammatory cytokine reactions and autoimmune nature of changes in the structures of the central nervous system (CNS). The similarity of immunological disorders underlying the pathogenesis of various forms of multiple sclerosis and affective disorders is of undoubted interest in terms of developing common approaches to the prevention and treatment of detectable interleukin status imbalance in neurological and mental diseases. Conclusion. Identification of mutually reinforcing changes in interleukin status and determination of the features of the course of immune imbalance in multiple sclerosis and hypothymic disorders in various pathologies of the mental sphere are necessary for a deeper understanding of neuroimmune interactions.
的相关性。在众多共病病理中,研究和比较结合多发性硬化症(MS)和情感性障碍临床表现的神经和精神障碍的发病机制具有相当大的意义。MS的高患病率、疾病的经济和社会意义、临床症状的异质性、不利的进展过程,以及该病理与各种形式的低胸腺功能障碍的频繁合并,决定了研究该共病病理发展的共同发病机制的相关性,这是开展有效和安全的预防性医疗活动所必需的。本综述的目的是确定情感性障碍和多发性硬化症的共同免疫病理机制,分析共病病理中细胞因子状态失衡在临床症状严重程度相互增加中的作用,并确定疾病进展的预后标志物。材料和方法。在2017-2022年俄罗斯和国外电子数据库的基础上,对MS和情感性障碍中自身免疫性中枢神经系统损伤的病理生理机制进行了理论分析。为了搜索文献来源,使用了以下资源:https://elibrary.ru/, https://www.ncbi.nlm.nih.gov/pubmed/, https://cyberleninka.ru/。引用了10名俄罗斯人和25名外国消息来源。结果。精神情感性障碍和多发性硬化症的发展机制具有共同的病理特征,其特点是促炎细胞因子反应的破坏和中枢神经系统(CNS)结构变化的自身免疫性质。各种形式的多发性硬化症和情感性疾病的发病机制背后的免疫学障碍的相似性,在开发预防和治疗神经和精神疾病中可检测到的白细胞介素状态失衡的共同方法方面,无疑是令人感兴趣的。结论。识别相互加强的白细胞介素状态的变化,确定多发性硬化症和各种精神领域病理的胸腺功能低下疾病的免疫失衡过程的特征,对于更深入地理解神经免疫相互作用是必要的。
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引用次数: 0
Modern approaches to treatment of depressive disorders in cardiological patients 心脏病患者抑郁障碍的现代治疗方法
N. V. Filippova, Y. Barylnik, T. Bogdanova, A. A. Shchelchkova, E. S. Mozgacheva
The prevalence of depressive disorders in modern society is quite high, which is an important medical and social issue throughout the world. The role of psychosocial factors in the development of cardiovascular diseases, as well as the high comorbidity of cardiac pathology and depression in recent decades, are beyond doubt. Therapy for depressive disorders in cardiac patients should combine efficacy and safety, as well as ensure patient adherence to therapy. Despite the rather large number and wide availability of antidepressants, including those that are relatively safe in relation to the treatment of depression in cardiovascular pathology, there is a need to search for new depressive disorders treatment options that are even safer and more effective, especially in patients with various comorbid pathologies and concomitant therapy.
抑郁症在现代社会的患病率相当高,这是一个重要的医学和社会问题,在全世界。心理社会因素在心血管疾病发展中的作用,以及近几十年来心脏病理和抑郁症的高合并症,是毋庸置疑的。心脏病患者抑郁症的治疗应结合疗效和安全性,并确保患者坚持治疗。尽管抗抑郁药的数量和可用性相当大,包括那些相对安全的治疗心血管病理抑郁症的药物,但仍需要寻找更安全、更有效的新的抑郁症治疗方案,特别是在各种共病病理和伴随治疗的患者中。
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引用次数: 0
The features of clinical manifestations of acute stroke associated with COVID-19 新冠肺炎合并急性脑卒中的临床表现特点
N. Nozdryukhina, E. N. Kabaeva, K. Tushova, G. Chmutin
The most severe course of COVID-19 is observed in patients with vascular comorbidity (more than 3 cardiovascular diseases). At the same time, a large number of complications from various organs and systems are recorded in this group of patients, with acute stroke being one of the most severe. Stroke in patients with COVID-19 is characterized by a severe clinical course, with a high rate of deaths and poor rehabilitation prognosis in the early and late recovery period. The cohort combined retrospective-prospective study included 80 patients. All subjects were divided into groups: 1) patients with stroke and COVID-19; 2) stroke patients without COVID-19; 3) COVID-19 patients without stroke. All patients underwent complex clinical and laboratory monitoring, including general and biochemical blood tests, assessment of hemostasis and the level of pro-inflammatory cytokines, and MSCT of the brain and lungs. As a result of the study, it was found that patients with stroke and COVID-19 have a more severe course of the disease with a high incidence of multiple organ dysfunction syndrome (MODS) and deaths at the hospital stage.
伴有血管合并症(3种以上心血管疾病)的患者病程最为严重。同时,这组患者出现了大量来自各个器官和系统的并发症,其中急性脑卒中是最严重的并发症之一。COVID-19患者卒中临床病程严重,病死率高,康复早期和后期康复预后差。该队列回顾性-前瞻性联合研究纳入了80例患者。所有受试者分为两组:1)卒中合并COVID-19患者;2)无COVID-19的脑卒中患者;3)无卒中的COVID-19患者。所有患者都进行了复杂的临床和实验室监测,包括一般和生化血液检查,止血和促炎细胞因子水平评估,以及脑和肺的MSCT。研究结果发现,卒中合并COVID-19患者病程更严重,多器官功能障碍综合征(MODS)和住院期死亡发生率较高。
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引用次数: 0
Locus of control as a fundamental factor in a favorable emotional state and motivation for success 控制点是良好情绪状态和成功动机的基本因素
S. Barylnik
The aim of the work was to study the influence of the locus of control on students’ emotional state and motivation to achieve success. Methods: The study involved 127 students (66 girls and 61 boys) of the 1st year of study at the Medical and Pediatric Faculties of the Saratov State Medical University named after V. I. Razumovsky. The following research methods were used: the questionnaire on the level of subjective control (LSC), T. Ehlers’ questionnaire for studying the motivation to achieve success, test questionnaire «Determining the level of self-esteem» by S. V. Kovalev, and the diagnosing methodology for self-assessment of mental states according to H. Eysenck. Results: The indicator «General Internality Scale» (Questionnaire on the level of subjective control) positively correlates with the indicator «Motivation» by T. Ehlers’ method (0.61) and negatively — with «Self-assessment» of the test-questionnaire by S. V. Kovalev (–0.96), as well as with the indicators of H. Eysenck's methodology: «Aggressiveness» (–0.96), «Anxiety» (–0.97), «Frustration» (–0.90), and «Rigidity» (–0.88). The data obtained confirm the presence of a strong relationship between the studied parameters. Indeed, internality determines the behavior of the individual, being a kind of internal control mechanism for the successful achievement of goals.
本研究的目的是研究控制源对学生情绪状态和成功动机的影响。方法:该研究涉及以V. I. Razumovsky命名的萨拉托夫国立医科大学医学和儿科学院一年级的127名学生(66名女孩和61名男孩)。研究方法包括:主观控制水平问卷(LSC)、T. Ehlers研究成功动机的问卷、S. V. Kovalev的“确定自尊水平”测试问卷和H. Eysenck的心理状态自我评估诊断方法。结果:指标“一般内在性量表”(主观控制水平的问卷)与T. Ehlers方法的指标“动机”呈正相关(0.61),与S. V. Kovalev测试问卷的“自我评估”呈负相关(- 0.96),与H. Eysenck方法的指标“攻击性”(- 0.96)、“焦虑”(- 0.97)、“挫折”(- 0.90)、“刚性”(- 0.88)呈负相关。获得的数据证实了所研究的参数之间存在很强的关系。的确,内在性决定着个体的行为,是一种目标成功实现的内部控制机制。
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引用次数: 0
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Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)
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