Chronic fatigue is among the manifestations of focal brain lesions. It is most often encountered in multiple sclerosis (MS) and patients with the sequelae of traumatic, inflammatory, and vascular brain damage (encephalopathies). The aim of the present work was to study the mechanisms of formation of this syndrome in 50 patients with focal brain lesions of different origins (in the inactive stage) and to assess the possibility of correcting it using the combined agent Fezam (2 capsules t.i.d. for one month), which contains piracetam and cinarrizine. In patients with encephalopathies, chronic fatigue syndrome was directly associated with the severity of depression. Patients with MS showed changes in the value-sense sphere. Neuropsychological testing showed that the psychological and personality components played a greater role in the origins of chronic fatigue in patients with encephalopathies than in those with MS. Fezam significantly decreased the severity of chronic fatigue, particularly in patients with MS; in the second group (non-MS patients) this was accompanied by a decrease in the severity of depression. Mild side effects (in six patients--12%) consisted generally of sleep disturbances. These results indicate that Fezam should be used in the treatment of chronic fatigue in patients with focal brain lesions; in encephalopathies it should be combined with psychoactive agents.

Objective: to study the effectiveness of art therapy methods in the complex treatment of neuropsychological disorders and quality of life improvement in patients with relapsing-remitting and secondary-progressive multiple sclerosis (MS).Patients and methods. A group of 42 patients (5 men and 37 women, mean age 32.9 years, mean EDSS severity 3.8 points) with MS underwent outpatient continuous active art therapy cycle. The mean group training cycle duration was six months. The comparison group included 15 age- and sex-adjusted individuals without neurological disorders. Tests on various drawing topics were carried out before and after a three-month therapy course. We used Hospital Anxiety and Depression Scale (HADS) to assess the severity of anxiety and depression and the SF-36 scale to evaluate the quality of life (QoL).Results and discussion. Before the art therapy start, light blue, yellow, pink, blue, and green colors prevailed in the drawings. There was no predominance of any color depending on MS severity or course. The green color predominated in this test in the control group, and the light blue color was significantly less represented. The art therapy course did not lead to a significant change in the severity of MS according to the Expanded Disability Status Scale (EDSS). After the art therapy course, the color scheme of the drawings was mainly represented by red, light blue, green, yellow, and blue colors. In addition, a red-orange color appeared in the drawings, which was completely absent before the course. Positive trends were noted according to HADS: a decrease in anxiety by 23% and depression by 19%. The physical component of QoL assessed by the SF-36 scale did not change substantially, but the psychological component significantly improved by 11%.Conclusion. The predominance of light blue color observed in MS is associated with damage to the nervous and musculoskeletal systems, and blue color – with psychological problems and depression. However, after a course of art therapy for MS, red, red-orange, yellow, and green colors representation increased significantly, which indicates an increase in positive attitude, a decrease in the level of depression, and an improvement in QoL.

The article provides a review of the scientific literature devoted to postcoid conditions. The concept of postcovid syndrome, its structure, and epidemiology are disclosed. The article contains the results of 2 meetings of experts (psychiatrists, psychotherapists, neurologists) from different regions of Russia who had experience in providing care to persons with postkovid syndrome. Particular attention is paid to postcovid depression, its clinical characteristics, and the experience of therapy. It was noted that the severity of the post-coV syndrome did not depend on the severity of the infectious disease suffered. The leading variants of depressive syndromes observed in SARS-CoV-2 patients were: astheno-depressive, apato-depressive and anxious-depressive syndromes. Anhedonia, anxiety, cognitive disorders, insomnia, and hypochondria occupied a significant place in the structure of postcovid mental disorders. It is emphasized that persons with postcovid syndrome, as a rule, initially found themselves in the field of vision of internists, therefore, their training in the diagnosis of postcovid mental disorders is relevant. Clinical experience has demonstrated the feasibility of antidepressant therapy for postcovid depression and the high efficacy and safety, including the risk of drug interactions, of using vortioxetine, including prescribing the drug to the elderly and the somatically impaired. The article is illustrated with clinical examples.

The article contains a comprehensive analysis of the summary epidemiological data obtained during the observational study to assess the effect of therapy with Ipigrix® on the dynamics of motor and sensory functions, as well as the severity of pain in outpatient patients with various diseases of the peripheral nervous system: mononeuropathy, polyneuropathy and polyradiculopathy of various origins.