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Relapsing-remitting multiple sclerosis is diagnosed in approximately 85 % of patients in the form of disorders of functional organism systems and remissions. The disease activity is determined by the frequency of exacerbations and disability progress rate. With this purpose we analyzed the findings of 9-year observation of 145 patients. The degree of neurological signs was assessed using EDSS. The patients were investigated using neuroimaging methods (MRI, MRS). Main correlations between clinical and neuroimaging features were shown. Increased lactate level in demyelination foci correlated strongly with exacerbation frequency. The number of T1 foci at the disease onset is an unfavorable prognostic sign. The size of the foci, reduction of NAA/Cr, Cho/Cr indices are prognostically significant for determining the terms of exacerbation development using Kaplan-Meyer method.

Parkinson's disease and essential tremor are the diseases in clinical picture of which tremor occurs most frequently. The diagnosis for prescription of correct treatment is sometimes difficult in clinical practice despite the availability of existing clinical criteria for essential tremor and recommendations for its treatment. The aim of the study was to determine the differential diagnostic markers of Parkinson's disease and essential tremor with the definition of the safest effective treatment strategy with application of Propranolol or Topiramate. Using clinical scale for the diagnosis of the disease, essential tremor was diagnosed in 42 patients and Parkinson's disease in 18 patients. Detailed characteristics of tremor and other clinical signs of the diseases were given. In the group of patients (24 patients) with essential tremor who were administered Propranolol in a dose of 120-240 mg/day, tremor decreased significantly in 75 % of cases, but with the dose titration after 5 days - 8 months side-effects (hypotension, bradycardia) appeared in 82 % of cases. Two men refused from the use of the drug due to possible side-effects described in the drug leaflets (impotence). The 16 patients were invited to go to a group of patients who were administered Topiramate in a dose of 25-125 mg (total 34 patients). At the beginning of treatment attention disorders and lethargy were observed in 18 % of cases; 4 (11 %) patients refused from the treatment, considering the discomfort of constant drug use was greater than that of the tremor. The older the patients were, the lower dose was required for positive effect. 6-12 months after the treatment beginning a positive effect of Propranolol without side-effects was observed in 33 %, and with Topiramate it was in 85 % of cases. Thus, the efficacy of both drugs is evident, but Tpiramate in a dose of 25-100 mg is more effective and safer.

The study involved 107 patients with an established diagnosis of ischemic stroke aged 34-59 (mean age 47.2±2.6 years). All participants underwent clinical and neurological examination, laboratory, and instrumental studies (MRI and MR-AG of the brain). This allowed to make a group of 77 (72 %) patients aged 34-44 (mean age 36.1±1.7 years) with anomalies of intracerebral (ICAr) and precerebral arteries (PCAr). The data were processed statistically. Among internal carotid artery anomalies full back trifurcation of the right and left internal carotid artery, front trifurcation of the right internal carotid artery, hypoplasia of the right posterior cerebral artery and bilateral hypoplasia of the posterior cerebral artery, aplasia of the posterior communicating artery and the left anterior cerebral artery, hypoplasia of the anterior communicating artery and anterior communicating artery aplasia were determined. The examination of the PCAr found their anomaly in 83.1 % of patients: pathological tortuosity of the internal carotid artery (S-shaped, loop-like, C-shaped), hypoplastic vertebral artery, aplasia of the right vertebral artery. Combination of ICAr and PCAr anomalies was detected in 45.5 % of patients. According to brain MRI in young patients, who suffered ischemic stroke, with abnormalities of cerebral arteries, structural changes in the brain were clarified. Hypoplasia of the right posterior cerebral artery, aplasia of the posterior communicating, left anterior cerebral and anterior communicating artery and pathological S-shaped tortuosity of internal carotid artery, hypoplasia of vertebral artery influence the disease severity.

Despite the routine use of neuroimaging in modern clinical practice, the rate of acute ischemic cerebrovascular accidents mimicry ranges from 10 to 50 %. The rate and nosological structure of pathological conditions that mimic transient ischemic attacks and ischemic strokes was investigated, as well as the key clinical signs distinguishing these conditions from the real cerebrovascular accidents. Clinical mimicry of transient ischemic attacks was recorded in 25.3 % cases and imitators of ischemic stroke in 8.0 % cases. Transient ischemic attacks clinical mimicry occurred predominantly due to lipothymia (16.8 %) and peripheral vestibular system disorders (22.2 %). The most common stroke-like conditions were vestibular neuronitis (14.1 %), conversion disorder (11.9 %) and brain tumors (10.2 %). Common features that distinguish stroke-like conditions from real transient ischemic attacks and strokes were younger age, significantly lower rate of co-morbid cerebrovascular risk factors (coronary artery disease, diabetes mellitus, arterial hypertension), high rate of non-specific complaints on admission (loss of consciousness, headache), high probability of absence of focal neurological signs, as well as a significant probability of cognitive impairments. Thus, the knowledge of transient ischemic attacks and stroke mimicry is quite important in the clinical diagnosis of suspected transient ischemic attacks and ischemic stroke, and may be useful for prompt diagnosis.

Cerebrovascular disorders are a very important medical-social problems frequently caused by diabetes. Progression and bad prognosis of cerebrovascular disorders in patients with type 2 diabetes mellitus are determined by endothelial dysfunction, which results from negative influences of hyperglycemia, protein glycolization, development of oxidative stress. The purpose of investigation was to detect the relationships between hemodynamic and metabolic disorders in patients with type 2 diabetes mellitus and diabetic encephalopathy. The study involved 87 patients with type 2 diabetes mellitus and stage 2 diabetic encephalopathy. Glycolyzed hemoglobin ranged from 7.2 % to 8.8 %. The examination included neurological, hemodynamic, biochemical and statistical. Decreased blood flow velocity in the aa. carotis int. by 32.9 %, aa. cerebri med. by 35.2 %, aa. vertebralis by 45.1 %, a. basilaris by 32.1 % and 1.8 and 1.75 times, respectively, increased pulsatility index and circulatory resistance index compared to the controls were revealed. Five times increased pool of damaged circulating endothelial cells and level of endothelin-1 increased in 1.9 times were observed. The correlation analysis confirmed the pathogenetic vasoconstrictor effect of endothelin-1 on the cerebral vessels and the link between the violation of carbohydrate metabolism and endothelial cell damage in patients with stage 2 diabetic encephalopathy. Thus, diabetic encephalopathy in patients with type 2 diabetes mellitus is the result of combined effect of metabolic and hemodynamic factors, among which an important role is played by endothelial dysfunction, which is a strategically important therapeutic target in the treatment and prevention of cerebrovascular complications of diabetes.

The main scientific data on extrapyramidal disorders are reported. Classification of subcortical structures damage and characteristic of each of them are given. Hyperkinetic syndrome is one of the most widespread forms of subcortical structures affection. A lot of research have been undertaken to study the factors leading to such disorders in the young age. Musculodystonic syndrome is one of specific conditions, which appears separately. However the combination of hyperkinetic and musculodystonic syndrome has not been investigated in detail. A case with involvement of the subcortical nuclei is described. A young patient presented with severe craniocerebral injury, complicated with fracture of the right tempoparietal bone, epidural hematoma, contusion of the brain and subarachnoid hemorrhage. All aspects of investigations of this patient such as clinical, paraclinical, biochemical, instrumental were carried out. The diagnosis of generalized musculodystonic and hyperkinetic syndromes was made on the basis of theoretical computations and numerous objective data.

Clinical features of ischemic stroke in patients with polymorphism 5G/4G gene inhibitor of plasminogen activator 1. The aim of this study was to characterize neurological disorders in patients with ischemic stroke and polymorphism of 5G/4G PAI-1 gene, an important regulator of the fibrinolytic system. This clinical neurological and genetic study involved 113 patients (mean age 73.6±8.9 years) with acute ischemic stroke. Genotyping was performed using PCR-thermocycler "Eppendorf". Statistical analysis was performed using SPSS 17.0 and included one-way ANOVA and Pearson χ². When compared genotype frequencies of polymorphism 5G/4G PAI-1 gene in patients with ischemic stroke with the controls significant differences were not found. Fatal stroke in the first 14 days of the disease was reported in 17 (15 %) patients without significant differences between the groups (p = 0.12). The most favorable type of ischemic stroke course was reported in patients with genotype 5G/5G PAI-1 gene, they showed more complete recovery of neurological functions and on the 14th day of the stroke 34.8 % demonstrated complete resolution of neurological disorders and further 56.5 % showed mild neurological deficiency. Our findings demonstrate that polymorphism of 5G/4G PAI-1 gene is associated with clinical features of ischemic stroke. Patients with abnormal homozygous 4G/4G PAI-1 gene have more pronounced neurological deficiency during the first 14 days of the stroke, with a high mortality rate (21.3 %) and insufficient recovery of the neurological function by the end of the second week of ischemic stroke.

Microprolactinoma is the most common functioning pituitary adenoma. In the chain of pathogenic events developing during microprolactinoma functioning hyperprolactinemia is a key element. Hyperprolactinemia triggers a number of neuroendocrine changes, which clinically manifest by menstrual and, subsequently, reproductive functions; pathological changes in the breast with development of galactorrhea; endocrine disorders in the form of androgeny of andrenal origin, thyroid disorders, hyperinsulinemia, osteoporosis, ocular changes. Undeservedly little attention has been paid to neurological and psychoaffective disorders, which, according to our observations, occur under the described syndrome in more than a half of cases. Pathogenetic aspects of development of these disorders are not clear. We analyzed 52 cases of pituitary microprolactinomas in female patients of reproductive age. Clinical performance of neurological manifestations in this group of patients, depending on the extent of the defect was also analyzed. It was shown that the described complex of disorders was often obligate for female patients of reproductive age with pituitary microprolactinomas and it can present without references to concomitant gynecological signs, which require an interview in order to determine ovarian menstrual cycle disorders as a clinical criterion of hormonal state disorder in female patients of the group. This can ensure early diagnosis and timely initiation of pathogenetic therapy, which largely reduces these symptoms.

Complex clinical and laboratory investigation of 102 patients was done during the early recovery period of ischemic stroke using clinical neurological and laboratory (determination of lipid profile, blood plasma homocysteine), neuroimaging (MRI) studies and statistical methods. Early recovery period of the disease was noted to correlate with neurological deficiency, persistent violations of lipid spectrum, increased concentration and hyperhomocysteinemia, which supports and enhances dyslipoproteinemia. Great deviations in the investigated laboratory parameters were found in atherothrombotic and cardioembolic ischemic stroke subtypes. Therefore, complex therapy of post-stroke neurological disorders included lipolytic therapy combined with vitamin complex Milgamma administered orally for 20 days along with traditional one. The analysis of the results of treatment demonstrated a positive dynamics in the state in the form of leveling neurological status and normalization of the laboratory parameters. In conclusion, the patients in the early recovery period of ischemic stroke are recommended to control blood lipid levels and plasma homocysteine to predict disease outcome and administer an adequate therapy.

At present the number of patients with Parkinson's disease amounts 6 million. The prevalence of Parkinson's disease increases after the age of 50 and reaches its highest frequency at the age of 70-79 years. The methods of diagnosis include in-depth clinical assessment, pharmacological load, electroneuromyography, accelerometer, neuroimaging. The author evaluated the main indicators of electroneuromyography in patients with different forms of Parkinson's disease. The study involved 30 patients with akinetic-rigid and tremor form of Parkinson's disease. The control group consisted of patients with vascular parkinsonism. Analysis of the parameters in patients with tremor and rigid form of the disease did not demonstrate significant differences in the findings of superficial and stimulating electroneuromyography. Oscillation frequency decreased when coordination tests were performed in groups of patients with tremor form of the disease. In patients with rigid form dystonic phenomenon characteristic of early parkinsonism with tremor component was registered. This can be used with diagnostic purposes at early stages of the disease. Electroneuromyography can be used to monitor and assess the effectiveness of therapy for Parkinson's disease.

Brain injury occupies a leading place among different types of injuries and accounts for 25-30 % of disability. Approximately 60-90 % patients have mental disorders and cognitive dysfunction and deficiency as the result of brain injury. One of the consequences is brain posttraumatic cystic formations. The purpose of the work was to identify cognitive dysfunction syndrome features in patients with brain posttraumatic cystic formations observed in remote period of brain injury on the basis of the complex analysis of epidemiological and morphological characteristics of posttraumatic cystic formations of the brain. The study involved 315 patients. The diagnosis was based on the analysis of case histories, neurological status, computed tomography and magnetic resonance imaging of the brain, neuropsychological tests (Mini-mental state examination, MMSE; Frontal assessment battery, FAB). Cognitive dysfunction syndrome of different severity was revealed in 216 (68.6 %) patients. Of the patients with solitary posttraumatic cystic formations (n = 244), 164 (67.2 %) patients had cognitive disorders, in the group with multiple brain cystic formations (n = 71), 52 (73.2 %) patients had cognitive disorders. More often cognitive disorders developed after severe and moderate brain contusion, and were presented in a significant number of observations by the mild and moderate cognitive disorders, the degree of cognitive dysfunction correlated with the degree of severity of previous brain injury. There were no patients with cognitive disorders after concussion and compression of the brain. Disorders of cognitive functions occurred in a different sizes and localization of the brain posttraumatic cystic formations occurring even at small (up to 1.5 cm in diameter) posttraumatic cystic formations. It was revealed that the degree of cognitive deficiency increased with enlargement of posttraumatic cystic changes. The frontal, temporal localization of posttraumatic brain cystic formations and mixed localization are important for formation of cognitive dysfunction syndrome.

One of the major problems of modern neuroscience is the issue of the effectiveness of treatment of acute pain syndrome caused by discogenic radiculopathy. At radiculopathy pain can last for several weeks or even months and in severe cases years. At prolonged pain syndrome depressive disorders can occur 3-4 times more frequently than in traditional cases. This reduces the patient's life span and leads to viability loss. The question about effectiveness of psychotherapeutic methods at acute pain syndrome caused by discogenic lumbosacral radiculopathy has not been studied and discussed. Relaxation treatment can be one of psychotherapeutic method in order to treat acute pain syndrome. The aim of this investigation was to compare the traditional treatment (non-steroid anti-inflammatory drugs, neuromuscular relaxants, vitamins) and complex therapy (traditional treatment) and psychotherapeutic method of relaxation treatment. The study involved 49 patients (20 men and 29 women) aged 28-55 with acute pain syndrome associated with compression of L5 or S1 against a background of intervertebral disk protrusion. Pain questionnaire by Mac-Gill, visual analogue scale, Spielberger-Hanin test, Schober test, Tomaier test, depression scale by Beck, Rolland - Morris questionnaires were used to determine the problems caused by acute pain syndrome. The patients were divided into two groups. The controls consisted of 26 patients who obtained traditional treatment while 23 patients were administered relaxation treatment. The treatment course lasted for 14 days. The patients were performed complex examination on day 1 and 14 of the observation. The analysis of the treatment results demonstrated that the use of psychotherapy more effectively reduced clinical signs of the disease, decreased the pain intensity, the level of state and trait anxiety, depression level, which improved the level of vital activity of the patients by 51.3±4.6 %.

Timely diagnosis and treatment of rectal cancer is urgent due to a steady growth in the number of the disease cases. Increase of the number of sphincter-preserving surgery (52-87 % cases) is a typical tendency of the modern surgery for colorectal cancer. Among post-operative complications a significant place is occupied by purulent ones responsible for 12-67 % of cases. These complications are the most common cause of death in early post-operative period. High incidence of purulent complications stimulates search for the causes as well as their prevention and treatment. The analysis of the treatment outcome of 124 patients with rectal cancer demonstrated that a series of diagnostic measures allows to make a correct diagnosis within a short period of time. The complex of measures included laboratory diagnosis of intoxication parameters, urinalysis, x-ray (plain radiography of the abdominal cavity). X-ray contrast investigation of the rectum was performed to exclude anastomosis failure after transabdominal resection and abdominoanal resection, fistulography was performed to reveal fistulas of the rectum after abdominoanal surgery, the number of fistulas. Ultrasouography and CT of the abdominal cavity and small pelvis were used to reveal anastomosis failure, exclude intraabdominal and retroabdominal abscesses, phlegmons of the small pelvis, and retroperitoneal space as well as when peritonitis was suspected. The program of monitoring with the use of the methods of early diagnosis of post-operative complications allowed 2-fold reduction of the diagnostic period from the moment of the complication development to the onset of therapy, which promoted reduction of general mortality from 18.2 to 8.2 %.

Significant hemorrhage together with blood transfusion increase postoperative morbidity and mortality after hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. Investigation into less traumatic method of vascular occlusion during liver resection is an urgent problem of hepatic surgery due to a high level of complications such as liver failure. The purpose of this work was to determine the optimal model of vascular clamping. Experimental and clinical research was done. Forty white giant rabbits were divided randomly into 4 groups (n = 10 in each). Different models of vascular exclusion were compared. The research showed that vascular occlusion with ischemic preconditioning in the mode 5/10/15 was the most delicate technique. Clinical investigation involved 152 patients who underwent liver resection within the period of 2008-2013. An algorithm of application of afferent liver vascular exclusion, which improved the results of surgical treatment of patients with focal pathologies mainly due to the reduction of intraoperative blood loss (from 902 ml to 478 ml) and minimize the manifestations of ischemia-reperfusion syndrome was suggested. This decreased postoperative complications (from 32.7 % to 21.6 %) and mortality rate (from 5.8 % to 1.96 %).

The aim of our study was to improve the results of treatment of patients with decompensated forms of chronic venous insufficiency by applying differentiated pathogenetically based surgical tactics. Within the period of 2009-2013 102 patients with decompensated forms of chronic venous insufficiency were operated. Presence of trophic disorders of soft tissue tibia of varying severity (CVI C4-6 class CEAP) and insufficient perforating veins of the calf were common. All patients underwent combined surgery including elimination of perforation failure, various modifications of the operation on the superficial veins eliminating vertical reflux. Depending on the method of filling the low horizontal venovenous shunt the patients were randomly divided into two groups. The study group comprised 52 (51 %) patients who underwent subfascial dissection of incompetent perforated veins through a minimal access. The comparison group included 50 (49 %) patients who underwent endoscopic dissection of incompetent perforating veins. The use of pathogenetically differentiated surgical tactics in decompensated forms of chronic venous insufficiency allowed to increase the effectiveness of treatment, to achieve good and satisfactory results in 80.5 % of cases.

The literature data and the original epidemiological studies demonstrated that the greatest percentage of nonunions which were reoperated was observed after plate and intramedullary osteosynthesis (20.5-26 % depending on the segment). Malunions were observed in 46-68 % of patients. It testifies that the quality of fixation constructions and the method of its setting cannot provide a high efficiency of treatment. The success of the treatment depends on the ability of the structure created by the surgeon to create the conditions for natural formation of regenerate. Fibrin carries out mechanical function (resistance to blood pressure) and it can transfer power influence to the cell membrane. The effect of mechanical action of external and internal tensions can explain the vectors direction of collagen and bone structure. Fibrin-blood clot possesses elastic features and it is located in the closed space, surrounded by nonextesible tissues. At such conditions fibrin-blood clot is under deformations and internal tensions initiated by functional load. Thus, previously to the appearance of internal tension inside of the clot due to external loading its deformation must occur. External loading exceeds in several times those ones appointed by osteosynthesis theoreticians. We consider that linear fragment displacements by 2-10 % from the initial level at plate ostheosynthesis cannot cause effective level of internal tensions. These are the conditions limiting structural self-organization of the callus and leading to a high level of nonunions. The data obtained during the experimental and clinical investigations show that at functional method of diaphysar fracture treatment with apparatus of external fixation the level of fragments displacement several times exceeds the 10 %-limit. We also observe very low percentage of nonunions at external fixation 3.1-6.8 %. The obtained findings allow to formulate the theory of primary fibrin tension with adaptive positional cells activation of interfragments regenerate. It assumes another principles of diaphysar fracture treatment different from apparatus osteosynthesis.

The question of optimal treatment of posttraumatic deformities of the cervical spine is disputable. Both conservative and surgical treatment is recommended by different authors. Based on the results of examination and treatment of patients as well as the findings of instrumental diagnosis, new scheme of surgical treatment of posttraumatic deformities of the cervical spine was proposed. The study involved 70 patients. The type of primary damage was revealed and subtyping according to Allen was performed. The controls included 47 patients in whom treatment strategy was determined only on the basis of clinical and radiological survey findings, excluding additional instrumental examination. The main group consisted of 23 patients in whom treatment strategy was determined based on the nature of the primary damage, clinical data and additional Doppler ultrasound investigation and electromyography. These groups had no significant statistical differences in gender, age, nature of primary damage, the amount of deformation and the timing of its existence. Clinical evaluation of treatment results was performed using known techniques in accordance with the criteria of Odom. Effectiveness of the proposed method was confirmed by the results of treatment of patients of the main group (excellent results in 78.6 % and satisfactory in 21.4 %).

Genital pathology manifested by hemorrhagic syndrome in children and adolescents is the most common and difficult problem of contemporary gynecology. This group of patients includes those with puberty uterine bleeding which often have secondary post-hemorrhagic anemia significantly reducing their quality of life and requiring timely adequate therapy. The aim of the study was to improve the diagnosis of puberty uterine bleeding against a background of anemia for further selection and application of complex conservative therapy. The study involved 128 girls aged 11-18 with puberty uterine bleeding. The complex investigation included clinical, gynecological examination, ultrasound, analysis of pathomorphologic picture of endometrium, hormonal profile. The study demonstrated that 75 % of girls had extragenital pathology, 76.5 % secondary iron deficiency anemia, 79.7 % hormonal disorders. Histological examination of the endometrium and ultrasound data established the presence of endometrial hyperplasia in 62.3 % of patients. Conservative therapy of puberty uterine bleeding included a complex dietary supplement Indol-F®, which resulted in acceleration of hemostasis, high efficiency of treatment of endometrial hyperplasia and reduction of recurrence of puberty uterine bleeding in patients as well as reduced the treatment time and was not accompanied by side effects and complications.

The purpose of the study was to determine the level of sex steroids in the blood serum and contents the breast cysts in patients with the diffuse form of fibrocystic mastopathy with the prevalence of cystic component; to develop tactics of treatment for this pathology. The study involved 69 patients with fibrocystic mastopathy and 48 healthy women aged 23-65. Depending on the age and menstrual function main group of patients was divided into the following subgroups: 1a - 20 women with preserved menstrual cycle aged 23-35, 1b - 28 patients with preserved menstrual cycle aged 36-45, 1c - 21 perimenopausal or menopausal patients over 46. Serum hormone levels (prolactin, progesterone, estradiol, cortisol, thyroid-stimulating hormone), estradiol to progesterone ratio were determined in all patients. In single-walled cysts over 10 mm in diameter puncture with evacuation of the contents was performed. Concentration of progesterone and estradiol was assessed in the cystic contents. No significant hormonal changes were revealed in subgroup 1a, more pronounced changes were present in the hormonal status of subgroup 1b and no significant difference in the content of hormones were found in subgroup 1c. Absence of marked changes in the content of hormones in the blood serum in subgroup 1c confirms that at this age metabolic abnormalities leading to cystic breast tissue degeneration play more important role. The patients with macrocystic changes in the breast tissue demonstrated marked accumulation of estradiol in the cystic content (645.58±298.53 ng/ml) with absence of absolute hyperestrogeny. The identified changes in the level of estradiol in breast cystic content confirm the information about local metabolic disturbances in the breast tissue in proliferative processes.

To study the clinical sexopathological characteristics of sexuality formation in women and its influence on development of sexual and marital deadaptation in the depressions of various origins, 399 families were examined. The women were diagnosed depressive disorder of various origins (affective, including bipolar, recurrent), neurotic depression (neurasthenia, reaction to severe stress, mixed anxiety and depressive reaction). The comprehensive examination of women with depressive disorders included clinical, clinical psychopathology, psychodiagnostic, special sexual research, clinical and statistical analysis. The results of systemic structural analysis according to the criteria of sexual health showed that disorders of sexual function in women had their specific pathogenetic features and clinical manifestations, which were closely related to the duration of the disease and the type of sexual constitution. Pathogenic effects of depressive disorders on sexual function should be considered in the diagnosis and correction of sexual dysfunction and psychological adaptation of sexual deadaptation in married couples.

Anxiety and phobic disorders are nonpsychotic disorders often associated with long-term, difficultly emotionally experienced psychoemotional stress. Anxiety and phobic disorders include phobic, panic, generalized anxiety, mixed anxiety and depressive, obsesive-compulsive disorders. The factors contributing to development of anxiety and phobic disorders include burdened by mental illness (primarily neurotic and depressive disorders) heredity; the presence of organic predisposition in the form of prenatal, intrapartum (birth asphyxia) and postnatal (head injury, CNS, acute and chronic intoxication) of brain damage; personality traits (anxious-hypochondriac, anankastic features); a history of neurotic and depressive disorders; psycho-emotional stress in the period preceding the disease. Clinical characteristics of various disorders are common but often with varying degrees of severity may occur simultaneously (combined), or at different stages of the disease, acquiring clinically distinct or subsyndromal forms. A combination of various distinct syndromes reaching degree of independent disorders suggest comorbidity disorders. The main directions in the treatment of anxiety disorders at the present stage are a combination of pharmacotherapy and psychotherapy.