No 19 (2012)

The article describes the features of development, course, diagnosis and treatment of depression in a clinic of occupational diseases. The types of depression that may occur in occupational diseases (somatic, neurotic, psychogenic, somatoform depression) are discussed.

The article discusses algorithm for diagnosis of headache, designed for physicians of different specialties. In the diagnosis of headache, premium effort consists in definition of primary or secondary headaches. This strategy is implemented through a search for "red flags" that may indicate the secondary nature of the headache. If “red flags" are found, additional examinations are required, and their range is individual for each patient. For primary headaches, diagnosis should follow the diagnostic criteria outlined in the International Headaches Classification, 2003. If the clinical picture does not fit to any type of primary headache, i.e., in the presence of atypical features, search for secondary headache is required.

Psychovegetative syndrome (PVS) is a common problem faced by the general practitioners. PVS is defined as functional disorder of the nervous system, characterized by the disturbances of the general condition and well-being, resulting in decreased quality of life, and manifested by nonorganic dysfunction of various organs and systems. In most cases, the PVS is caused by anxiety or anxiety-depressive disorders within neurotic or stress-related disorders, less often - by the endogenous diseases. In the pharmacological treatment, psychotropic therapy has priority, given predominantly psychogenic origin of PVS. But not all PVS patients are ready to begin therapy with psychotropic drugs. In this case, other groups of drugs are also effective in PVS, for example metabolic agents, in particular, glycine.

The article presents the data on the main types of the course of psoriatic arthritis (PA), and discusses common approaches to the treatment of this disease. The place of methotrexate (MTX) in the treatment of psoriasis and PA is considered. The main indications for the administration of disease-modifying anti-rheumatic drugs for the treatment of the MT are malignant form of the PA, aggressive type of the disease, generalized joint disease, high laboratory activity, exudative, pustular or erithrodermic psoriasis, pronounced trophic disorders, persistent diffuse glomerulonephritis, low efficiency and poor tolerance of NSAIDs and glucocorticoids. The use of MTX for several months or even years (“involuntarily long-term use") allows monitoring the activity of PA and course of its major syndromes, reducing the progression of the disease, contributing to the preservation of working capacity of patients and improving their quality of life. The safety of use of MTX is discussed in detail.

Melatonine is natural direct and indirect antioxidant that contributes to maintaining mitochondrial functions, has a good safety profile, non-toxic for human, and easy penetrates blood - brain barrier. Experimental studies confirm the efficacy of use of melatonin for the treatment of cerebral infarction: in rodents with experimental arterial occlusion, melatonin increases cerebral reperfusion, reduces cerebral edema, enhances neuroplasticity, and alters immune status. In this regard, the features of the use of melatonin in acute and subacute stages of cerebral infarction require further investigations.

Currently, the use of antioxidants, taking into account their ability for specific correction of energy metabolism in brain, particularly under the conditions of ischemia and hypoxia is one of the most promising methods for nonspecific therapy of cerebral stroke and chronic cerebrovascular diseases. Broad therapeutic potential was observed in α-lipoic acid (Thiogamma) that affects energy metabolism and reduction of oxidative stress, and this effect is pathogenetic rationale for use of Thiogamma in patients with cerebral ischemia. Now, early treatment with antioxidants is considered as real, pathogenetically relevant method for the correction of cerebral metabolism in cerebral ischemia.

Depression and dementia are two most common psychiatric syndromes in elderly patients, which often accompany each other, engaging in complex interaction. On the one hand, depression debuting in the elderly often is prodromal phenomenon, emerging in the early stages of vascular or degenerative diseases of the brain and leading to dementia. On the other hand, dementia manifesting at an early age can be considered as a risk factor for the further development of depression. The influence of depression may be mediated by cortisol hypersecretion, activating neuroinflammatory processes in the brain, associated with the deposition of amyloid in the brain, as well as insufficient production of trophic factors. Frequent combination of cognitive and affective symptoms requires regular neuropsychological screening of patients with depression, and clinical suspicion of signs of depression in patients with dementia. In clinical practice, an error diagnosis of depression in patients with developing dementia is more common than a mistaken diagnosis of dementia in patients with depression. As a first-line treatment for depression in patients with dementia, selective serotonin reuptake inhibitors are recommended. In patients with dementia, antidepressant with a cholinesterase inhibitor or memantine, and in some cases, with atypical antipsychotic or mood stabilizing agents are the most effective combinations.