[Pandemic COVID-19 and mental disorders international experience and therapeutic approaches]

Assessment of the psycho-emotional state of patients after COVID-19-associated pneumonia in relationship with laboratory indicators

The aim. To study peculiarities and association of psychological and laboratory indicators in patients with cardiovascular diseases (CVD) who underwent COVID-19 to clarify the factors affecting the possibility of developing delayed psychological and cardiovascular adverse events.

Methods. The study enrolled 350 patients with COVID-19. Group 1 consisted of 92 patients without CVD, Group 2 – of 258 patients with CVD. Indicators of laboratory and psychological parameters were assessed according to the data of psychological questionnaire using GAD-7 (General Anxiety Disorder-7), PHQ-9 (Patient Health Questionnaire-9), PSS (Perceived Stress Scale) screening scales and SF-36. Parameters of complete blood count and biochemical blood tests were measured during hospitalization and three months after discharge from the monohospital.

Results. After three months, in the general group of patients, signs of anxiety and depression were detected in more than 30 % of the examined patients, signs of stress – in 10.4 %. In the group with CVD, psycho-emotional disorders were identified in 1/4 of the patients, and severe stress – in 8 % of those included in the study. In addition, it was registered that the indicators of erythrocyte sedimentation rate, fibrinogen, high-sensitivity C-reactive protein (CRP), homocysteine and IL-6 remained at a higher level in the second group.

Correlation analysis showed that the psychological component of health is interconnected with the level of neutrophils (p = 0.044) and fibrinogen (p = 0.050); the physical component of health is correlated with the level of erythrocytes (p = 0.030), hemoglobin (p = 0.015), CRP (p = 0.002), creatine phosphokinase (p = 0.036) and glucose (p = 0.017). Regression analysis revealed that in patients with CVD three months after hospitalization, an increased glucose index contributes to deterioration, and increased hematocrit and mean hemoglobin concentration improve the quality of life of patients.

Conclusion. Laboratory markers that maintain the duration of a prolonged vascular reaction, violation of the rheological and metabolic properties of blood, determine the nature of the development of both psychological and cardiovascular complications.

[Natural therapeutic factors in medical rehabilitation of patients with post-COVID syndrome]

The feasibility of using therapeutic physical factors in post-COVID syndrome is due to their sanogenetic effects that ensure the restoration of impaired bodily functions, which serves as the basis for their use at various stages of medical rehabilitation of this category of patients.

OBJECTIVE

To develop a new medical technology for the 3^rd outpatient stage of medical rehabilitation of the patients with post-COVID syndrome using natural therapeutic factors of Nalchik resort.

MATERIAL AND METHODS

There has been carried out a controlled study in compliance with the principles of randomization to develop an outpatient medical rehabilitation program including 168 patients with post-COVID syndrome. All the patients were divided into four groups: the control group (n=40) was prescribed pharmacotherapy and physical therapy in the hall in accordance with federal clinical recommendations; comparison group 1 (n=43) had drinking mineral water in addition; comparison group 2 (n=43) received physical therapy on the route of Nalchik resort terrainkur in addition to the treatment in comparison group 1; the main group (n=42) included a group psychotherapy on the Terrainkur route in addition to the treatment in comparison group 2.

RESULTS

The results of the comparative analysis showed the feasibility of the developed outpatient medical rehabilitation program for the patients suffering from post-COVID syndrome: the overall effectiveness of rehabilitation measures increased compared to other follow-up groups by 10-15% due to the improvement of external breathing function (p<0.05), cognitive status (p<0.01), increased exercise tolerance (p<0.01), physical recovery (p<0.01) and mental health (p<0.01).

CONCLUSION

The summation and integration of sanogenetic effects of physical factors, psychocorrective techniques, and pharmacotherapy provide a significant improvement in the physical and mental status of the patients with post-COVID syndrome.

[Post-traumatic stress disorder in the focus of international research: from soldier heart to ICD-11]

The article presents the evolution of the post-traumatic stress disorder (PTSD) definition from various war syndromes to PTSD definition as a sovereign disorder and complex PTSD appearance in ICD-11 as distinct diagnosis. It is focused on the epidemiology, gender issues, clinical features and differential diagnostic PTSD aspects. It is considered elaboration of the new international clinical guidelines for the anxiety disorders including PTSD, the new pharmaceutical and psychotherapeutic treatment algorithms for PTSD based on the evidence based research data is presented. Additionally as an illustration case vignette is described.