Management of a Female Patient with Irritable Bowel Syndrome and Somatoform Disorder

Aim: to demonstrate the management of a patient with somatization disorder and irritable bowel syndrome.Key points. A 41-yo female patient was admitted with complains of spastic lower abdomen pain, hard stool once every 1–2 days under laxative treatment (macrogol), bloating, anxiety, waiting for confirmation of a life threatening illness, internal stress, difficulty in falling asleep, shallow sleep. Has a long history of disease, characterized by the appearance of a variety of somatic symptoms (headache, tachycardia, joint pain, stool disorders, abdominal pain, etc.) during periods of emotional tension, lack of data suggesting organic disease. No abnormal changes were detected in examination at the clinic (complete blood count, serum chemistry tests, urinalysis or fecal tests, hydrogen and methane breath tests with lactulose, abdominal ultrasound, esophagogastroduodenoscopy, colonoscopy). With the prior agreement of patient, she was consulted by a psychiatrist and diagnosed with somatization disorder and mild anxiety disorder. On discharge from hospital recommended cognitive-behavioral therapy, continue taking macrogol, as well as treatment with Kolofort. After 3 months of complex treatment, there was a significant decrease in the severity of both the symptoms of irritable bowel syndrome and anxiety disorder.Conclusion. For patients whose complaints meet the diagnostic criteria for IBS, a two-stage differential diagnosis may be justified: at the first stage, differentiation of IBS and organic diseases of the gastrointestinal tract is carried out; at the second stage - IBS and somatization disorder. Kolofort can be the drug of choice both in patients with IBS and the pharmacological part of therapy in patients with somatization disorder

DOUBLE-BLIND PLACEBO-CONTROLLED RANDOMIZED EFFICACY AND SAFETY TRIAL OF ADD-ON TREATMENT OF DIMEBON PLUS RISPERIDONE IN SCHIZOPHRENIC PATIENTS DURING TRANSITION FROM ACUTE PSYCHOTIC EPISODE TO REMISSION

Background: There is evidence that blockade of 5-HT 6 receptors can improve cognitive dysfunction in schizophrenic patients. A number of antagonists of 5-HT6 receptors are in development as cognitive enhancers. One of the agents with relatively strong 5-HT6 activity is dimebon. We tested the hypothesis that this 5-HT6 antagonist administered in the early stage of stabilization after an acute episode can improve both neurocognitive and clinical symptoms in schizophrenia. A phase II study of dimebon as add-on to risperidone therapy was conducted. Subjects and methods: 56 male subjects with paranoid schizophrenia were included in the study. All the patients demonstrated therapeutic response to risperidone as treatment of the acute psychotic episode. After 4 weeks of stability patients were randomized into two groups with placebo or dimebon add-on treatment in a 1 to 1 ratio for 8 weeks. PANSS, CGI-S, CSDS and NSA-16 were used as clinical measures of symptom severity. Different aspects of memory, psycho-motor coordination and executive functioning were assessed with a battery of cognitive tests. Clinical and cognitive assessment was performed twice: after a patient was randomized and 2 months later. Results: Severity of negative symptoms (by NSA-16) were significantly lower in the dimebon group then in the placebo group (p=0.036). Patients in the dimebon group demonstrated improvement in more cognitive dimensions than patients in the placebo group, including working memory, attention, psycho-motor coordination and planning. Conclusion: Dimebon as add-on therapy to antipsychotic treatment in the period of stabilization after an acute episode can improve some aspects of clinical and cognitive status in schizophrenic patients

The Effectiveness of Add-on Treatment with Nutraceutical

Aim: evaluation of the effectiveness of the nutraceutical “Standard Zdorovia: Gastro” (“SZ Gastro”) in the treatment of patients with irritable bowel syndrome (IBS).Materials and methods. 52 patients (62 % women) diagnosed with IBS and IBS in combination with functional dyspepsia (FD) were included in the study and divided into two groups. Both groups received basic therapy according to the guidelines. The experimental group received as add-on the nutraceutical “SZ Gastro” (containing a standardized amount of menthol, gingerol and D-limonene); patients in the control group — placebo. The duration of the study was 30 days. The severity of somatic symptoms was assessed with the 7×7 questionnaire. Emotional state was assessed with the Four Dimensional Distress, Depression, Anxiety, and Somatization Questionnaire (4DSQ).Results. Patients of the experimental and control groups did not differ from each other either in terms of demographics, basic treatment, or in the severity of symptoms at the beginning of the study.The effectiveness of the treatment in the patients, who received add-on “SZ Gastro” was significantly higher than in the patients of the control group: in the control group the percentage of improvement of somatic symptoms was 22.35 %, in the experimental group it amounted to 49.18 % (χ2 = 15.9; p = 0.0001). The percentage of patients with significant decrease of emotional disturbances was also higher in the experimental group: distress (χ2 = 18.7; p = 0.0000), anxiety (χ2 = 6.9; p = 0.0097) and somatization (χ2 = 14.99; p = 0.0001). No significant side effects were registered in any of the groups.Conclusions. Add-on of nutraceutical “SZ Gastro” to basic treatment is safe and significantly increases effectiveness of the therapy in the patients with IBS and IBS in combination with PD

Efficacy of a Relaxation Scenario in Virtual Reality for the Comorbid Symptoms of Anxiety and Asthenia in a General Hospital Setting: A Pilot Comparative Randomized Open-Label Study

BACKGROUND: Patients in general hospitals often display concomitant signs of mental maladjustment: low mood, anxiety, apathy, asthenia, all of which can have a negative impact on the course of the underlying disease and the recovery process. One of the non-pharmacological approaches that has gained wider acceptance in medical practice in recent years is the use of procedures based on virtual reality. AIM: Assess the efficacy of the new domestic, virtual reality application Flow as relates to symptoms of anxiety and asthenia in patients undergoing inpatient treatment. METHODS: The study was open-label and had a comparison group; the patients were assigned to the experimental or control group using a randomization table. The patients were assessed using the Spielberger State Anxiety Inventory; the Fatigue Symptom Rating Scale; the Well-being, Activity, Mood questionnaire; the Depression Anxiety Stress Scale; and the Clinical Global Impression Scale. Physical parameters were measured before and after each virtual reality session. The obtained data were statistically processed. RESULTS: The study involved 60 patients. In 40 patients, the treatment program included a course of five daily relaxation sessions in virtual reality; the control group consisted of 20 patients, who were treated in accordance with the usual practice of the institution. The addition of virtual reality sessions to the standard treatment course yielded significant advantage in terms of affective symptoms reduction in patients both after a single session and as a result of undergoing the full course, and several days after its completion. The patients in the experimental group also showed a significant decrease in blood pressure after the sessions, and this was most pronounced in individuals who initially had elevated and high blood pressure. CONCLUSION: The use of relaxation program courses in the virtual reality application Flow is an effective and promising means of non-pharmacological care for non-psychiatric inpatients showing symptoms of anxiety, apathy, depressive mood, as well as hypertension

Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants

Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants

Functional Comparison of Innate Immune Signaling Pathways in Primates

Humans respond differently than other primates to a large number of infections. Differences in susceptibility to infectious agents between humans and other primates are probably due to inter-species differences in immune response to infection. Consistent with that notion, genes involved in immunity-related processes are strongly enriched among recent targets of positive selection in primates, suggesting that immune responses evolve rapidly, yet providing only indirect evidence for possible inter-species functional differences. To directly compare immune responses among primates, we stimulated primary monocytes from humans, chimpanzees, and rhesus macaques with lipopolysaccharide (LPS) and studied the ensuing time-course regulatory responses. We find that, while the universal Toll-like receptor response is mostly conserved across primates, the regulatory response associated with viral infections is often lineage-specific, probably reflecting rapid host–virus mutual adaptation cycles. Additionally, human-specific immune responses are enriched for genes involved in apoptosis, as well as for genes associated with cancer and with susceptibility to infectious diseases or immune-related disorders. Finally, we find that chimpanzee-specific immune signaling pathways are enriched for HIV–interacting genes. Put together, our observations lend strong support to the notion that lineage-specific immune responses may help explain known inter-species differences in susceptibility to infectious diseases

Nutraceuticals and Pharmaceuticals

Aim. To provide a definition and classification of nutraceutical products and to show their significane in modern integrative medicine.Background. Nutraceuticals are foodstuffs and their components, which have a positive effect on human health, including preventive maintenance and treatment of diseases. Nutraceuticals include healthy and functional foods, as well as biologically active food additives (BAFA). Healthy foods are nutritional foodstuffs without any artificial modification. These include organic, whole, and natural foods. Alongside a high nutritional value, functional food products have a positive effect on the human body due to functional food ingredients. BAFAs are food additives that contains one or several food ingredients (vitamins, mineral substances, plant components, amino acids and others). Specialists express conflicting viewpoints concerning nutraceuticals. Some nutraceuticals, such as probiotics, have confirmed their effectiveness in clinical trials, while the beneficial properties of others require further elucidation.Conclusions. The application of nutraceuticals, as well as their combined use with pharmaceuticals, in accordance with recommendations by scientific professional associations formulated on the basis of valid research studies can lead to an improvement in the quality of the life and longevity of the population. This position forms a basis for the development of integrative medicine — a contemporary approach to the treatment of diseases

DOUBLE-BLIND PLACEBO-CONTROLLED RANDOMIZED EFFICACY AND SAFETY TRIAL OF ADD-ON TREATMENT OF DIMEBON PLUS RISPERIDONE IN SCHIZOPHRENIC PATIENTS DURING TRANSITION FROM ACUTE PSYCHOTIC EPISODE TO REMISSION

Background: There is evidence that blockade of 5-HT 6 receptors can improve cognitive dysfunction in schizophrenic patients. A number of antagonists of 5-HT6 receptors are in development as cognitive enhancers. One of the agents with relatively strong 5-HT6 activity is dimebon. We tested the hypothesis that this 5-HT6 antagonist administered in the early stage of stabilization after an acute episode can improve both neurocognitive and clinical symptoms in schizophrenia. A phase II study of dimebon as add-on to risperidone therapy was conducted. Subjects and methods: 56 male subjects with paranoid schizophrenia were included in the study. All the patients demonstrated therapeutic response to risperidone as treatment of the acute psychotic episode. After 4 weeks of stability patients were randomized into two groups with placebo or dimebon add-on treatment in a 1 to 1 ratio for 8 weeks. PANSS, CGI-S, CSDS and NSA-16 were used as clinical measures of symptom severity. Different aspects of memory, psycho-motor coordination and executive functioning were assessed with a battery of cognitive tests. Clinical and cognitive assessment was performed twice: after a patient was randomized and 2 months later. Results: Severity of negative symptoms (by NSA-16) were significantly lower in the dimebon group then in the placebo group (p=0.036). Patients in the dimebon group demonstrated improvement in more cognitive dimensions than patients in the placebo group, including working memory, attention, psycho-motor coordination and planning. Conclusion: Dimebon as add-on therapy to antipsychotic treatment in the period of stabilization after an acute episode can improve some aspects of clinical and cognitive status in schizophrenic patients