ABSTRACT

Somatovegetative disorders (SVR) represent a significant clinical problem characterized by a variety of symptoms and difficulty in diagnosis in general medical practice. This article is devoted to a detailed analysis of modern approaches to the diagnosis and therapy of SVR, focusing on the optimization of patient management in primary care. The paper considers key aspects of differential diagnosis of SVR, including the exclusion of organic pathology and identification of comorbid anxiety disorders. The importance of a comprehensive approach is emphasized, including assessment of the patient's somatic and mental status, as well as the use of validated scales and questionnaires to quantify the severity of symptoms.
Special attention is paid to the pharmacotherapy of SVR, in particular, first-line drugs used for the treatment of anxiety disorders. The efficacy and safety of different groups of drugs, including selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSRIs) and anxiolytics, are analyzed. In the context of pharmacotherapy of SVR the feasibility of etifoxine (Anxilera) is considered in detail. The mechanisms of action of the drug, its efficacy in the treatment of anxiety and vegetative symptoms, as well as its safety profile in comparison with other anxiolytics are discussed. The data of clinical studies confirming the efficacy and tolerability of etifoxine in the treatment of SVR are presented. In conclusion, the article presents an algorithm of SVR therapy for general practitioners, which includes the stages of choosing the optimal pharmacotherapy taking into account the evaluation of treatment efficacy. The necessity of an integrative approach combining pharmacotherapy with psychotherapeutic methods and lifestyle modification is emphasized. The algorithm is designed to optimize the management of patients with SVR in primary care and improve their quality of life.

KEYWORDS: anxiety, anxiolytics, somatovegetative disorders, diagnostic algorithm, etifoxine

For citation: Rachin A.P., Charnukha T.N., Madjidova E.N., Turuspekova S.T., Turgumbaev D.D., Nurguzhayev E.S., Djurabekova A.T., Novikova L.B., Chutko L.S., Ekusheva E.V., Barulin A.E., Kurushina O.V., Karpov S.M., Butko D.Y., Sharov M.N., Shcheglova L.V., Parsamyan R.R., Rachin S.A., Prokofieva Y.S. Somatovegetative Disorders in General Practice: an Algorithm for General Practitioners. A Review. Comorbidity Neurology. 2025; 2 (1): 62-73. https://doi.org/10.62505/3034-185x-2025-2-1-62-73

*For correspondence: Andrei Rachin, Dr. Sci. (Med.), Professor, National Association of Experts in Comorbid Neurology, Moscow, Russia, e-mail: 7851377@gmail.com.

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ADDITIONAL INFORMATION

Andrei P. Rachin, Dr. Sci. (Med.), Professor, President of the National Association of Experts in Comorbid Neurology, Moscow, Russia. E-mail: 7851377@gmail.com. ORCID: https://orcid.org/0000-0003-4266-0050

Tatyana N. Charnukha, Dr. Sci. (Med.), Associate Professor, Deputy Director of Scientific Department, Republican Research and Clinical Center of Neurology and Neurosurgery, Chief Neurologist of the Ministry of Health of the Republic of Belarus, Minsk, Republic of Belarus. E-mail: tatkachern@yandex.ru. ORCID:  https://orcid.org/0000-0002-2072-2903

Ekutkhon N. Madjidova, Dr. Sci. (Med.), Professor, Chief Neurologist of the Ministry of Health of the Republic of Uzbekistan, Head of the Department of Neurology, Pediatric Neurology and Medical Genetics, Tashkent Pediatric Medical Institute, Tashkent, Republic of Uzbekistan. E-mail: madjidova1@yandex.ru. ORCID: https://orcid.org/0000-0002-2464-0315

Saule T. Turuspekova, Dr. Sci. (Med.), Professor, Chief Neurologist of the Ministry of Health of the Republic of Kazakhstan, Head of the Department of Nervous Diseases, S.D. Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan. E-mail: doctorsaule@mail.ru. ORCID: https://orcid.org/0000-0002-4593-3053

Dzhamalbek Dz. Turgumbaev, Dr. Sci. (Med.), docent, Head of the Department of Emergency Neurology at the National Hospital under the Ministry of Health of the Kyrgyz Republic, Chief freelance neurologist of the Kyrgyz Republic, Bishkek, Kyrgyz Republic, E-mail: t.jamal@mail.ru. ORCID: https://orcid.org/0000-0003-1247-6543

Erkin S. Nurguzhayev, Dr. Sci. (Med.), Professor, Professor of the Department of Nervous Diseases of the Kazakh National Medical University named after S.D. Asfendiyarov, President of Public Association ‘Association of Neurologists’ of the Republic of Kazakhstan, Almaty, Republic of Kazakhstan. E-mail: erkinnurgujaev@mail. ORCID: https://orcid.org/0000-0001-8110-9013

Aziza T. Djurabekova, Dr. Sci. (Med.), Professor, Head of the Department of Neurology, Samarkand State Medical University, Samarkand, Republic of Uzbekistan. E-mail: Nevrologiya.km@mail.ru. ORCID: https://orcid.org/0000-0001-6397-9576

Lilia B. Novikova, Dr. Sci. (Med.), Professor, Head of the Department of Neurology, Institute of Further Professional Education, Bashkir State Medical University,, Honored Doctor of the Russian Federation and the Republic of Bashkortostan, Ufa, Russia. Е-mail: novicova@inbox.ru. ORCID: https://orcid.org/0000-0001-8469-1635.

Leonid S. Chutko, Dr. Sci. (Med.), Professor, Head of the Centre for Behavioural Neuroscience, Head of the Laboratory for the Correction of Mental Development and Adaptation, N.P. Bekhtereva Human Brain Institute of the Russian Academy of Sciences, Saint. Petersburg, Russia. Е-mail: chutko5@mail.ru. ORCID: https://orcid.org/0000-0002-1065-9859

Evgenia V. Ekusheva, Dr. Sci. (Med.), Professor, Head of the Department of Nervous Diseases and Neurorehabilitation of Postgraduate Education, Academy of the Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Federal Medical Biological Agency, Moscow, Russia; Senior Researcher, Problems of Aging Laboratory, Belgorod State University, Belgorod, Russia. E-mail: ekushevaev@mail.ru. ORCID: https://orcid.org/0000-0002-3638-6094

Olga V. Kurushina, Dr. Sci. (Med.), Associate Professor, Head of Neurology, Neurosurgery, Medical Genetics Department, Volgograd State Medical University, Volgograd, Russia. E-mail: ovkurushina@mail.ru. ORCID: https://orcid.org/0000-0003-4364-0123

Aleksandr E. Barulin, Dr. Sci. (Med.), Associate Professor, Head of Neurology, Psychiatry, Manual Medicine, Medical Rehabilitation Department, Volgograd State Medical University, Volgograd, Russia. E-mail: barulin23@mail.ru. ORCID: https://orcid.org/0000-0001-7264-3580.

Sergey M. Karpov, Dr. Sci. (Med.), Professor, Head of the Department of Neurology, Neurosurgery and Medical Genetics Stavropol State Medical University, Stavropol, Russia. E-mail: karpov25@rambler.ru. ORCID: https://orcid.org/0000-0003-1472-6024 

Dmitriy Yu. Butko, Dr. Sci. (Med.), Professor, Head of Medical Rehabilitation and Sport Medicine Department, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia. E-mail: prof.butko@mail.ru. ORCID: https://orcid.org/0000-0001-6284-0943

Mikhail N. Sharov, Dr. Sci. (Med.), Professor, Department of Therapy, Clinical Pharmacology and Emergency Medicine, Moscow, Russia. E-mail: 6112286@mail.ru. ORCID: https://orcid.org/0000-0001-9634-346X

Larisa V. Shcheglova, Dr. Sci. (Med.),, Professor, Honoured Doctor of the Russian Federation, Head of the Department of Family Medicine, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia. E-mail: shcheglovalar@mail.ru. ORCID: https://orcid.org/0000-0002-1059-4610

Ruzanna R. Parsamyan, Ph.D., Associate Professor of the Department of Neurology named after. K.N. Tretyakova, Senior Researcher at the Department of Basic Research in Neurocardiology, Research Institute of Cardiology, Saratov State Medical University, Head of Clinic Pain, Saratov, Russia. E-mail: kvl.prr@mail.ru. ORCID: https://orcid.org/0000-0002-6509-5958

Sergey A. Rachin, Executive Director, National Association of Experts in Comorbid Neurology, Moscow, Russia. E-mail: Rachin.sergei@gmail.com. ORCID: https://orcid.org/0000-0001-9771-4621

Yulia S. Prokofieva, Postgraduate Student of the Department of Nervous Diseases, Faculty of Dentistry, Russian University of Medicine, Moscow, Russia. E-mail: pryulek@yandex.ru. ORCID: https://orcid.org/0000-0003-4454-7174

Author contributions. All authors confirm the compliance of their authorship, according to international ICMJE criteria (all authors made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). Rachin S.A., Prokofieva Yu.S., Parsamyan R.R. – searched for suitable literature; Rachin A.P., Charnukha T.N., Madjidova E.N., Turuspekova S.T., Turgumbaev D.D., Nurguzhayev E.S., Djurabekova A.T., Novikova L.B., Chutko L.S., Ekusheva E.V., Barulin A.E., Kurushina O.V., Karpov S.M., Butko D.Y., Sharov M.N., Shcheglova LV – correcting the text in accordance with the basic requirements.

Funding. This study was supported by any external sources of funding.

Disclosure. Rachin A.P. – editor-in-chief of the journal «Comorbidity Neurology». Sharov M.N., Butko D.Y., Nurguzhayev E.S., Novikova L.B. – Members of the editorial council of the journal «Comorbidity Neurology». Other authors declare no apparent or potential conflicts of interest related to the publication of this article. Madjidova E.N., Charnukha T.N., Turuspekova S.T., Djurabekova A.T., Chutko L.S., Ekusheva E.V., Kurushina O.V., Karpov S.M., Barulin A.E. – members of the editorial board of the journal «Comorbidity Neurology». Other authors declare apparent or potential conflicts of interest related to the publication of this article.

The content is available under the Creative Commons Attribution 4.0 License.

©2025. Andrei P. Rachin, Tatyana N. Charnukha, Ekutkhon N. Madjidova et al.