In the modern world, there is a rapid advance in the design and clinical introduction of a huge number of drugs that are able to cure a patient or to improve his/her health status on the one hand and to cause significant harm to his/her health on the other. Polypragmasy is the desire to enhance the efficiency of treatment and to help the patient recover from all developed diseases inevitably leads to the use of a large number of medications. At the present time, polypragmasy as a result of iatrogenia is a serious public health problem, as it is clinically manifested by a reduction in the effectiveness of pharmacotherapy, by the development of severe adverse drug reactions, and by a considerable increase in healthcare expenditures. The reason for the simultaneous prescription of multiple drugs may be comorbidity (multimorbidity), the availability of drugs, as well as clinical guidelines, manuals of professional medical associations, treatment standards that contain recommendations for using combination therapy with more than 5 drugs for only one disease in some cases, the efficiency of which corresponds to a high level of evidence. Currently, the fight against polypragmasy is one of the important tasks in rendering medical care to elderly and senile patients since it is a major risk factor of adverse drug reactions in this category of people. To minimize polypragmasy in elderly patients, it is necessary to use current methods for analyzing each prescription of a drug (the index of rational drug prescribing; an anticholinergic burden scale) and those for optimizing pharmacotherapy with the use of restrictive lists (Beers criteria, STOPP/START criteria) that will be able to reduce the number of errors in the administration of drugs and to maximize the efficiency and safety of pharmacotherapy.

IntroductionOpsoclonus myoclonus syndrome (OMS) in childhood still remains unexplored from the perspective of clinical psychology.Objectives and aimsThe research was aimed at defining types of psychological development in the group of children with OMS. The study included 18 children between ages 2 years 4 months and 9 years with OMS (8 boys, 10 girls).MethodsThe following methods were used: analysis of patient's development and medical record, psychological interview with parents, neurological state assessment and pathopsychological assessment.ResultsPatients were divided into three groups according to cognitive development level:– group with normal intelligence level (n = 4);– group with developmental delay (n = 11);– group with intellectual disability in different forms (n = 3).Several children in group 1 (n = 3) and in group 2 (n = 4) expressed neurotic behavior with increased levels of anxiety and fear of trying unusual actions during psychological assessment. Children with delay in psychoverbal development (n = 7) and with developmental delay (n = 1) expressed psychopathy-like states with verbal aggression and had difficulties controlling their emotions. In some cases (n = 2), the psychological state of the patient was defined as borderline state with emotional instability, especially in mother–child interaction.ConclusionPsychological features of children with OMS indicate heterogeneity of their development types that implies different prognosis and developmental dynamics for each type. The results point out the necessity of detailed psychological examination aimed at correlation of psychological help to children with OMS and their families with their psychological state.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Opsoclonus-myoclonus syndrome (OMS) is a rare and often relapsing neurologic illness with onset in early childhood. Patients with OMS have longitudinal mental development disturbances and features of emotional and behavioral state. Interruption of the normative mental development is determined by movement disorders (primary defect), which establish new conditions for child's life for a long time. Case study of the child with OMS and the discussion of movement disorders in the structure of the different mental processes types in this disease are presented. Movement disorders (primary defect) and their effects (secondary and other defects) affecting mental development are discussed (based on the levels of movements coordination concept by N.A. Bernstein). The research detects mistmatch between levels of movements coordination (intactness of higher levels and disturbance of lower levels), which important for prospective analysis of the mental disorders mechanisms in children with OMS.

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