Stroke is the world’s 2^nd – 3^rd leading cause of death and mortality. The risk of stroke is much greater for survivors of stroke. Survivors of a transient ischemic attack (TIA) or ischemic stroke are at higher risk of recurrent stroke during the interval between a few days or weeks and several years after the first event. Risk factors for ischemic stroke include hypertension, diabetes, hyperlipidemia, etc. The highest rate of recurrent stroke is observed in large artery atherosclerosis (atherothrombotic stroke) and cardioembolic stroke, while a recurrent stroke most often relates to the same subtype. A lacunar stroke is noted to have a lower recurrence rate, and a recurrent stroke may have a subtype that is different from the first one. In a recurrent stroke, neurological damage is usually more severe and harder to deal with. Patients with recurrent stroke have a higher mortality rate compared with patients with the first stroke. Secondary prevention is crucial to reduce recurrent ischemic stroke rates. To identify CVD risk factors is the initial priority when focusing efforts on secondary prevention. Lifestyle modifications, including tobacco cessation, decreased alcohol use, and increased physical activity, are also important in the management of patients with a history of stroke or transient ischemic attack. Optimal pharmacotherapeutic preventive strategies should be tailored to the specific stroke subtype. Antiplatelet therapy is recommended to reduce the risk of recurrent ischemic stroke, and its choice should be based on treatment duration, safety, efficacy, the cost of the drug, and patient characteristics and preferences.

According to a WHO report, the number of patients with arterial hypertension in the world has increased from 650 million to 1.3 billion over a relatively short period of about 10 years. In neurological practice, fluctuations in blood pressure are associated with acute cerebrovascular accidents, chronic cerebral ischemia, cognitive impairment, and dementia. At the same time, low blood pressure also causes irreversible changes in the cerebral cortex, especially in elderly patients, and is associated with a risk of developing cardiovascular diseases and neurodegeneration, therefore, in foreign literature, fluctuations in blood pressure are considered a global neurological problem. The versatility of pathological changes in a number of risk factors for the development of hypertension requires early prescription of cerebroprotectors – drugs that affect all parts of the neurovascular unit. One of the modern treatment strategies is the use of polypills, which are a combination of 2 or 3 medicinal substances in one tablet. The polypill strategy is reflected in new treatment regimens for neurological diseases. Complexes of non-steroidal anti-inflammatory drugs with vitamins or muscle relaxants, several antioxidants, and two neuroprotectors have proven themselves to be effective. Fixed combinations are the basis for multifactorial cerebroprotection without increasing the pharmacological load, a way to increase compliance. The fixed combination of Picamilon + Ginkgo Biloba extract is an example of optimal synergism as pharmacodynamic (potentiation and summation of the vasoprotective and antioxidant effects of Picamilon on the one hand, enhancing the neurotransmitter effect of Ginkgo Biloba extract on the other) and pharmacokinetic (the complex does not require dose adjustment depending on the age of the patients, since the composition was selected according to long-term clinical trials in optimal dosages) action.

Dementia is one variant severe disorder’s higher cortical function and is currently considered as one most important cause a decrease in the quality household, social adaptation patients, and a violation their ability function in the world around them. It can be formed in a wide range disease, main which are neurodegenerative processes, in particular Alzheimer’s disease. In the diagnosis cognitive disorders, in addition to clinical and neuropsychological, as well as laboratory examination, modern methods computer neuroimaging plays an essential role. Same time, significant importance is attached research based on magnetic resonance, which has achieved great progress in recent years. Changes recorded by structural magnetic resonance imaging (MR tomography) often “lag behind” recorded clinical symptoms and are determined advanced disease. New MR methods have been proposed to verify early manifestations of neurodegenerative changes observed in the brain. These include, in particular, MR morphometry. It allows you to determine absolute values severity of atrophic changes, to establish their exact topical localization. Its use not only improves the possibilities of diagnosis pre-stage stages, but also improves quality of differential diagnosis various pathogenetic variants observed cognitive disorders. In addition, use special postprocessing data processing programs reduce the likelihood errors in interpretation received data. Currently, three options have been proposed for evaluating the results of MR morphometry, based on the analysis volume individual brain structures, thickness gray matter, as well as the spatial shape certain formations. Integrated use these options contributes highest quality MR morphometric examination of the brain during formation neurodegenerative process.

Age-related cognitive impairment is one of the top public health challenges nowadays. Vascular cognitive impairment (VCI) includes a broad spectrum of cognitive disorders, from clinically mild cognitive impairment, which is revealed only due to  cognitive testing, to moderate and severe ones reaching the level of dementia. Vascular cognitive impairment covers the full spectrum of neurological disorders caused by cerebrovascular diseases. The neuropathology of cognitive impairment in later life is often a mixture of vascular pathology, Alzheimer disease, and other neurodegenerative diseases, which overlap and heighten the risk of cognitive impairment. Cognitive impairment is defined by the presence of a progressive reduction in cognitive abilities, worsening both of memory and attention, which leads to increased dependence and social isolation. Cerebrovascular risk factors are common among older adults and are major contributors to the development of vascular cognitive impairment. The most common vascular risk factors include hypertension, high cholesterol levels, diabetes and smoking, which have high prevalence rates in the population. The main causes of vascular cognitive impairment are considered to be acute cerebrovascular accidents, silent (asymptomatic) infarctions and cerebral microbleeds combined with or without white matter (WM) structural integrity and density changes. Cerebral small vessel disease is one of the most topical due to its effect in terms of socioeconomic burden. The use of neuroimaging, in particular magnetic resonance imaging, greatly improves the ability to identify the contribution of vascular diseases to the development of vascular cognitive impairment. Currently, no specific treatments for vascular cognitive impairment exist, but standard stroke prevention measures are recommended. Multimodal interventions including vascular risk factors and lifestyle modifications is currently the most promising treatment and prevention strategy. Cholinergic precursors were among the first compounds used to treat cognitive impairment.

Introduction. Differential diagnosis of idiopathic and functional dystonia is often the cause of errors. The comparative severity of anxiety, depressive disorders and the level of somatization in idiopathic and functional dystonia has been poorly studied.

Aim. To comparatively analyze the severity of anxiety, depressive disorders and the level of somatization in patients with idiopathic and functional dystonia.

Materials and methods. The study included 178 patients with idiopathic dystonia, 32 patients – with functional dystonia, and the control group consisted of 50 people. The GAD-7 scale was used to assess the level of anxiety, PHQ-9 for depression, and SOMS for somatization. The EQ-5D scale was used to assess the quality of life.

Results. There was a predominance of women patients in all groups. Patients with functional dystonia were younger than patients with idiopathic dystonia, and most of them were unmarried and unemployed (p < 0.001). In separate groups of patients with idiopathic and functional dystonia, elevated levels of anxiety (9.0 and 8.0) and depression (8.0 and 16.5) were observed compared to the control group (p < 0.001), while the severity of anxiety between idiopathic and functional dystonia did not differ significantly, and the severity of depression in functional dystonia was significantly higher (p < 0.001) than in patients with idiopathic dystonia. The results of the SOMS survey revealed a relative difference between the group and the maximum values in patients with functional dystonia – 22.0 (19.8; 24.0). According to the European Quality of Life Questionnaire, patients with functional dystonia had the lowest quality of life – 20.0 (10.0; 30.0).

Conclusion. Patients with functional dystonia have a lower quality of life and higher levels of depression and somatization compared to patients with functional dystonia, as well as to the control group. These data can be additional criteria in the differential diagnosis of idiopathic and functional dystonia.

According to the diagnostic criteria for generalized anxiety disorder in ICD-10, the obligatory symptoms of anxiety are somatic (vegetative) manifestations, represented by a whole spectrum of disorders vital to the patient: cardiovascular, respiratory, neurological, gastrointestinal, urogenital, thermoregulatory, motor. Classic benzodiazepine drugs, such as phenazepam, alprazolam, and clonazepam, are quite effective in anxiolytic therapy. However, they have pronounced side effects, such as decreased reaction speed, drowsiness, weight gain, decreased libido, nervousness, headache, and others. With long-term use, side effects develop in more than 90% of patients. Side effects can significantly impair the patient’s quality of life and carry many hidden disorders of mental and somatic health. Etifoxine has a unique mechanism of action that includes allosteric effects on GABA(A) receptors and modulation of neurosteroid metabolism. It is effective in the treatment of anxiety disorders, reducing somatic and mental manifestations of anxiety. Etifoxine also has anti-inflammatory and neurotrophic effects. It does not cause dependence and withdrawal syndrome, does not affect psychomotor functions, and has high safety. Studies show that etifoxine can be recommended for widespread use in general medical practice as an effective and safe drug for daytime use to alleviate anxiety in various comorbid pathologies, especially in general neurological practice. It is a valuable tool for improving the quality of life of patients with anxiety disorders, especially when there are accompanying somatic manifestations of anxiety and comorbid neurological pathology.

Anxiety disorders are the most common group of mental disorders. The high prevalence of anxiety disorders and their negative impact on the functioning and quality of life of patients determines the need for timely diagnosis and therapy. The review presents data on the clinical manifestations of anxiety, as well as on the main forms of anxiety disorders according to current classifications of mental disorders. An analysis is conducted on the relationship between somatic and cognitive manifestations of anxiety, explaining the difficulties in diagnosing and treating patients with a predominance of somatic symptoms. Cognitive features specific to patients with anxiety disorders are described. Approaches to the diagnosis and differential diagnosis of anxiety disorders are provided, along with information on main psychometric scales. The importance of a clinical approach in diagnosing anxiety disorders is justified, and the role of para-clinical methods in establishing a diagnosis is described. According to recent consensus documents and clinical guidelines, the first-line therapies for anxiety disorders are cognitive-behavioral therapy and the use of selective serotonin reuptake inhibitors; the basics of both methods are described. Considering current research, both approaches have drawbacks, which necessitates the use of medication with an alternative mechanism of action. One such medication is the modern multimodal anxiolytic Aviandr, which has demonstrated high effectiveness and safety in treating patients with the most severe form of anxiety disorders – generalized anxiety disorder. The main points of the review are illustrated with a clinical example of the successful use of Aviandr in a patient with generalized anxiety disorder.

Introduction. Panic disorder (PD) are common problems in both primary and psychiatric specialty care. PD includes panic attacks (PA). PA are characterized by a sudden wave of fear or discomfort or a sense of losing control even when there is no clear danger or trigger. PD is frequently comorbid with sleep disorders, especially insomnia, сlosely interrelated etiopatogenically and worsen each other’s flow.

Aim. To evaluate the severity of the impact of sleep disturbances on the condition of patients with panic disorder and their dynamics during therapy.

Materials and methods. The study included 46 patients including 26 with a PD and sleep disturbances, assigned to the main group, and 20 healthy patients. The study design included clinical, anamnestic and psychometric methods (Sheehan scale, State-T rait Anxiety Inventory (STAI)) and sleep quality scales (Pittsburgh Sleep Quality Index (PSQI), Spiegel questionnaire). Participants in the main group received psychoeducation and drug correction of PD (without the use of sedatives). A few months later, patients in the main group were re-tested.

Results. The results of the study indicate an obvious dependence of manifestation of clinical manifestations of panic disorder (agoraphobia attachment) and emotional disorders on the degree of severity of accompanying insomnia. With PR treatment not focused on correcting sleep disorders, patients experienced not only statistically significant reductions in Shihan levels of anxiety and trait anxiety in the STAI, but also statistically significant improvements in sleep quality.

Conclusion. Dependence of manifestation of clinical manifestations of panic disorder and emotional disorders on degree of manifestation of accompanying insomnia is shown. A panic disorder correction aimed at reducing anxiety led to a significant improvement in sleep subjectivity and psychometric testing.

The topicality of issues of health maintenance and quality of life improvement in pre-, peri- and postmenopausal women is associated with the increasingly growing socio-public activity of women in today’s context. A number of studies have found a direct relationship between the onset of menopause and appearance of symptoms of autonomic dysfunction, shift of mood, various sleep disorders, decreased performance, including intellectual one, increased irritability and anxiety. The symptoms of autonomic dysfunction are the most difficult ones for a woman during this period. The most common symptoms of the period covering peri- and postmenopause are hot flashes, severe sweating, chills, heat palpitations in combination with increased anxiety. At the same time, hot flashes and other presentations of autonomic dysfunction do not always mean the onset of menopause and is not obstetrician-gynecologists’ responsibility alone. Therefore, complaints about hot flashes in pre-, peri- and postmenopausal women should not be the only course for the prescription of menopausal hormone therapy, but require a more detailed study of their cause. Previously it was shown that clinically significant components of the MPS symptom complex can be associated with other causes, both somatic and neuropsychiatric. Thus, the effects of psychosocial risk factors on perimenopausal women health include acute or chronic stress, chronic negative emotions, low social status, low or missing social support, general distress, loneliness, etc. These factors often cause the development of anxiety disorders, which are accompanied not only by psycho-emotional presentations, but also by autonomic symptoms. Therefore, the symptoms of autonomic dysfunction caused by anxiety disorders and menopausal syndrome largely overlap. This review presents the characteristics of vegetative and psycho-emotional disorders at each stage of female reproductive ageing. A tofisopam therapy option for vegetative and psychoemotional disorders in pre-, peri- and postmenopausal women is discussed.

Issues of diagnosis, effective treatment and prevention of chronic pain syndromes represent an urgent problem of modern medicine. About 80% of the population has experienced low back pain (LBP) at least once in their life; in 20% of patients acute LBP becomes chronic. Pain in the gluteal region with radiation to the leg can be caused by damage to various structures (joints, ligaments, deep muscles of the gluteal region, spinal roots), which are closely located and have similar innervation. The article presents a clinical case that illustrates the difficulties of diagnosing deep pain syndrome in the gluteal region in a young athlete. The condition, which was initially considered as myofascial pain syndrome of the piriformis muscle, upon detailed examination and observation turned out to be a rheumatological pathology (Bechterew’s disease). The article discusses the etiology, diagnostic criteria, differential diagnosis and treatment of piriformis muscle syndrome. There are currently no reliable diagnostic tests or validated diagnostic criteria to confirm the diagnosis, and therefore piriformis syndrome should be considered a diagnosis of exclusion. In clinical practice, there is both overdiagnosis of piriformis muscle syndrome with the widespread use of various invasive procedures, and ignorance of this syndrome. In most cases, secondary piriformis syndrome is observed and identification of the causative factor is decisive for the successful treatment of patients. Treatment of piriformis muscle syndrome should include the elimination of provoking factors, kinesiotherapy, NSAIDs, muscle relaxants, and, if indicated, therapeutic blockades, and for chronic pain syndrome, cognitive behavioral therapy and antidepressants. Nimesulide is a NSAID with proven effectiveness and a good safety profile, and therefore can be recommended for the treatment of both musculoskeletal pathologies and symptomatic treatment of rheumatological diseases.

The presented clinical case describes a patient with chronic musculoskeletal cervicobrachialgia and lumbosciatica, which are some of the most common neurological disorders. The authors identified the factors contributing to the onset and chronification of musculoskeletal pain: pain catastrophization, anxiety, kinesiophobia, physical inactivity, spending too much time in front of the computer, long-term static postures, comorbid diseases – chronic insomnia, episodic tension-type headache with pericranial tenderness. No therapeutic effect, pain reduction and returning to previous daily activity were earlier observed, the pain chronification factors were not assessed or corrected, no awareness conversations about the causes of the disease and prognosis were held, the patient was only offered pharmacotherapy as treatments, no therapeutic gymnastics was recommended, and no recommendations for ergonomics and motor activities for daily life were provided to the patient. A complex approach to the treatment, including awareness conversations, kinesiotherapy, kinesiotaping, Difendum (diclofenac potassium) therapy course were offered to the patient at the Sechenov University Clinic of Nervous Diseases. Kinesiotherapy is a modern, efficient yet proven method for treating chronic musculoskeletal pain. It includes therapeutic gymnastics, an exercise program for posture correction, recommendations for ergonomics and lifestyle. Difendum (diclofenac potassium) has become a drug of choice within the pharmacotherapy course. It is a non-steroidal anti-inflammatory drug that is widely used in Russian neurological practice and has a proven efficacy and safety profile in the treatment of musculoskeletal pain. It should be noted that Difendum was prescribed to the patient from the first days of treatment at the same time as he started to take a kinesiotherapy training course. The patient experienced a rapid pain relief while taking pharmaceutical therapy, which played an important role in supporting adherence to recommendations for increasing physical activities, ergonomics and therapeutic gymnastics. The complex treatment provided a relatively quick and efficient relief to the patient. After a 5-day course of treatment, he reported a decrease in pain syndrome and an increase in functional activities. After 3 months, the pain completely regressed, sleep and emotional state returned to normal, and daily activities improved. A 6-month follow-up examination showed a persistent therapeutic effect.

Introduction. Extraction of mandibular third molars is one of the most common oral surgical procedures.

Aim. To evaluate the efficacy of B Complex Preparation on pain and sensory problems related to inferior alveolar nerve damage after surgical removal of mandibular third molars.

Materials and methods. In the open-label comparative trial 86 patients aged 45 to 54 years with sensory disturbances, lasting 72 hours, after surgical removal of mandibular third molar were included. Pain intensity was assessed using a visual analogue scale (VAS). Quantitative sensory testing (QST) was performed with the computer-controlled Thermal Sensory Analyzer (TSA type II, Medoc Ltd., Ramat Yishai, Israel) with contact thermode (30 × 30 mm). Patients with inferior alveolar nerve damage were divided into 2 groups: the first group – 44 patients received the standart therapy in combination with B Complex Preparation for 30 days, in the second group 42 patients received the standart treatment.

Results. After a course of treatment in the first group (B Complex Preparation) was determined the relieving of numbness and pain in 90.9% of patients with inferior alveolar nerve damage. The pain intensity in VAS reduced from 6.3 ± 0.9 to 0.8 ± 0.2 points (p = 0.02) in the first group and from 6.1 ± 0.6 to 4.8 ± 0.4 points (p = 0.09) in the second group. Only in the first group there was a decrease of the warm sensation threshold during QST, which additionally confirms the positive therapeutic effect of B Complex Preparation.

Conclusion. Effectiveness of therapy with B Complex Preparation was noted in patients with algic manifistations and sensory disorders after the removal of the third molar.

In March 2020, oral cladribine was licensed in Russian Federation for the treatment of adult patients with highly active relapsing multiple sclerosis as defined by clinical or imaging features. Three years after the introduction into the Russian market, practical aspects in the use of cladribine tablets we evaluated, including data from real-world studies and the experience gained in the own routine clinical practice. Early initiation of cladribine therapy, use of cladribine in treatment naïve patients and patients with suboptimal response to previous disease-modifying therapy, use of cladribine as the treatment of choice in patients with suboptimal response to platform disease-modifying therapy and washout period while switching to cladribine from other disease-modifying therapy. During the discussion thirteen neurologists from federal and regional centers experienced in multiple sclerosis diagnosis and therapy were asked to answer several questions regarding the practical use of cladribine tables and come to consensus opinion. Consent was reached if at least 75% of the experts agreed on a particular statement. The experts agreed on the possibility to switch patients to cladribine from platform disease-modifying therapy in case of MRI activity or neutralizing antibodies in the absence of relapses activity to achieve better disease control, potential cladribine effects on progression independent of relapses, washout period reduction while switching from natalizumab to cladribine. Consensus opinion will help to manage practical questions regarding cladribine usage.

Multiple sclerosis is a chronic disease that leads to disability at the young, working age. Disease-modifying treatment are used to control multiple sclerosis. There are two models of therapy: escalation and induction. Recently, many experts have given preference to an induction approach to treatment, when highly effective drugs are prescribed as early as possible. One promising direction is parenteral anti- B cell therapy. The history of the development of this drug group begins with the successful use of Rituximab for the treatment of patients with multiple sclerosis. The results of the study were so impressive that this was the reason for prescribing this therapy off-lable in routine practice. And we are now noticing an increase in the number of patients on therapy with the Rituximab in European countries. Subsequently, the Ocrelizumab was developed, which became the first and only drug for the treatment of primary progressive multiple sclerosis. Divosilimab (Russian-made drug) was registered in 2023, which is also considered original due to the specific modified glycosylation scheme of the Fc-fragment. Having a sufficient selection of highly effective drugs, we must remember that in the pursuit of effectiveness we must not forget about the safety of the therapy. The issues of the possible use of an extended administration interval and reduction of the used dosage with long-term use of this type of therapy are discussed.

Introduction. Psoriatic arthritis (PsA) is a chronic systemic immune-mediated inflammatory disease of the musculoskeletal system, and is a complex inflammatory arthropathy with a heterogeneous spectrum of manifestations. Persistent inflammation can lead to joint destruction and disability, which can be prevented with early diagnosis and treatment. Despite the extensive therapeutic arsenal, disease control in a significant proportion of patients is suboptimal. It is of interest to evaluate the effectiveness of the janus kinase inhibitor (JAK kinase) tofacitinib in the treatment of psoriasis and PsA.

Aim. Evaluate the possibilities of using tofacitinib in the treatment of psoriasis and psoriatic arthritis.

Materials and methods. We searched for literature on this topic in the databases of the electronic scientific medical libraries PubMed, PubMed Central, Scopus, eLibrary.Ru (until February 29, 2024). Our review scientific article is based on previously conducted research and does not contain any studies involving animals or humans conducted by any of the authors of our article. Results. Randomized controlled trials have demonstrated the high efficacy of tofacitinib in the treatment of PsA. Tofacitinib is a modern effective drug for the treatment of psoriasis and PsA, with a good efficacy profile and an acceptable safety profile. Further long-term expanded research and clinical data will help expand the role of tofacitinib in the treatment of these diseases

Conclusion. The literature data indicate the high efficacy of tofacitinib in the treatment of psoriasis and psoriatic arthritis. The use of tofacitinib is promising in the treatment of patients with PsA, especially patients burdened with residual disease phenomena and pain.

Low-energy osteoporotic fractures in men, especially of the proximal femur, can cause disability and premature mortality. The authors bring to the discussion the relevance of early diagnosis and treatment of osteoporosis in men. The article presents two clinical cases of severe osteoporosis in men with a detailed analysis of the diagnostic algorithm in accordance with clinical guidelines and a discussion of the choice of zoledronic acid for the treatment of this category of patients. The first clinical case describes the case history of a patient (age 58 years) who underwent total hip replacement of the right hip joint for a low-energy fracture of the proximal femur. The specialist of the Osteoporosis Prevention and Treatment Cabinet identified risk factors contributing to the development of secondary osteoporosis (long history of smoking, alcohol abuse, comorbidities). X-ray osteodensitometry confirmed a decrease in bone mineral density in axial sections of the skeleton. Monitoring of these parameters one year after zoledronic acid infusion showed a 7.5% increase in bone mineral density in the lumbar vertebrae and a 2% increase in the femoral neck. It was decided to continue therapy with zoledronic acid for up to 6 years. The second case demonstrates the efficacy of antiresorptive therapy (zoledronic acid 5 mg/100 ml) in a 68-year-old patient with a severe form (compression fractures of two thoracic vertebral bodies) of primary osteoporosis with an aggravated family history. Observation of the patient for the next two years showed regression of pain, increase of bone mineral density, absence of new fractures, which confirmed the correct choice of zoledronic acid as a first line drug in the treatment of osteoporosis.

Introduction. The lack of available and effective laboratory markers makes predicting exacerbations and progression in systemic inflammatory diseases of connective tissue an intractable task for rheumatologists and primary care specialists who monitor patients. Hematological indices calculated from a complete blood count have demonstrated effectiveness in predicting the course of several diseases.

Aim. To determine the prognostic value of hematological indices of complete blood count (RDW, MPV, PLR, NLR, LMR, PMR,

PNR, SII) in predicting exacerbations and progression of systemic inflammatory diseases of connective tissue

Materials and methods. For a retrospective observational case-control study, patients with systemic lupus erythematosus (SLE) and ANCA-associated vasculitis (microscopic polyangiitis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis) were selected. Patients with an exacerbation or progression of the disease that occurred within 3–12 months were assigned to the main group, patients with stable disease were assigned to the control group.

Results. 60 patients were selected, of which 25 had an exacerbation or progression over the next 3–12 months, 35 had a stable course of the disease. The initial clinical and demographic characteristics of patients had no significant differences, including between the subgroups with ANCA-associated vasculitis (n = 35) and systemic lupus erythematosus (n = 25). Patients in the main group had a higher initial erythrocyte distribution width (p < 0.001). Statistically significant differences were observed between the groups in the baseline level of platelet-lymphocytic, neutrophil-lymphocytic, platelet-neutrophil ratios and the index of systemic inflammation, but in the subgroups of SLE and ANCA-associated vasculitis, the differences were divergent.

Conclusion. The red blood cell distribution width demonstrated a higher prognostic value in relation to exacerbations and progression of ANCA-associated vasculitis and SLE compared with ESR and C-reactive protein and appears to be the most universal among the studied markers of prognosis of systemic inflammatory diseases of connective tissue.

The article presents a clinical case of a patient with cardioneurosis, frequent episodic tension headaches involving the pericranial muscles, chronic musculoskeletal cervicalgia, thoracalgia, chronic insomnia and increased anxiety. The above disorders are listed among the most common reasons for seeking outpatient care from a neurologist. The majority of patients with these disorders are young people of working and reproductive age. For this reason, it is important to consider an effective, modern approach to the treatment of such patients in outpatient neurological settings. Treatment of this category of patients is quite a challenge that requires the expert knowledge, experience and attentive attitude of the doctor towards the patient. Difficulties in treating such patients are associated with the fact that they have misconceptions about their disease, catastrophic thinking about their symptoms, avoidance behaviours, unhealthy lifestyle and distress for a long time, increased emotional sensitivity to current events, and stressful events that preceded their disease. Despite the increased level of anxiety and the psychosomatic nature of the complaints, many patients refuse to consult a psychiatrist and take antidepressants in real neurological practice.  The Sechenov University Clinic of Nervous Diseases offered the patient a comprehensive approach to the treatment that comprises awareness conversations, recommendations on sleep hygiene and lifestyle, the short-term use of Valocordin, cognitive-behavioural therapy, relaxation and mindfulness, and kinesiotherapy. The detailed clinical conversations with the patient and examination data allowed to identify all factors that provoked and supported cardioneurosis, pain syndromes, insomnia that was caused by stressful events in the anamnesis, misconceptions about her condition and treatment methods, catastrophizing of symptoms, erroneous strategies for overcoming pain, anxiety and insomnia, physical inactivity, prolonged static load. The treatment process included therapeutic dealing with all of the listed factors. The complex treatment resulted in a decrease in patient’s pain and cardioneurotic symptoms, improvement of her sleep and emotional state, and returning to her previous active lifestyle.