RU2077322C1 - Method of prognosis of endogenic psychosis psychopharmacotherapy efficacy - Google Patents

Abstract

FIELD: medicine, psychiatry. SUBSTANCE: method involves administration of neuroleptic of prolonged action, for example, clopixol-depot at dose 600 mg or piportil L4 at dose 300 mg. Positive therapeutic effect of psychopharmacotherapy is prognosticated at improvement of psychic state for 3-5 days after drug administration. EFFECT: increased precision, broadened field of prognosis using.

Description

 The invention relates to medicine, namely to psychiatry, and can be used in the treatment of patients with endogenous psychoses.

 A known method for predicting the effectiveness of psychopharmacotherapy by intramuscular administration of a single test dose of psychotropic drugs - haloperidol or triftazine, followed by a clinical study of the patient's mental state. (In the "Journal of Neuropathology and Psychiatry named after S. S. Korsakov", 1984, v. 84, issue 3, p. 391-406.).

 The disadvantages of this method is the lack of accuracy of prediction (up to 40%), its narrow specificity (specifically for the test drug), limitation of the scope of use) mainly, hallucinatory-paranoid syndrome in the framework of paranoid schizophrenia).

 The aim of the present invention is to improve the accuracy of the forecast, expanding the scope of use (nosological, syndromic, psychopharmacological).

 This goal is achieved by the fact that the patient is administered antipsychotic drugs of prolonged action, for example, clopixol-depot at a dose of 600 mg or piportil L4 at a dose of 300 mg and with the improvement of the mental state within 3-5 days after administration, a positive effect of psychopharmacotherapy is predicted.

 The method is as follows.

 A patient with endogenous psychosis undergoes a therapeutic and neurological examination and in the absence of somatic contraindications (severe heart damage, active tuberculosis, acute febrile conditions) and organic diseases of the central nervous system, 300 mg piportil L4 or 600 mg clopixol-depot are administered intramuscularly once. After 3-5 days, the patient’s mental state is examined and, with its improvement, the positive effect of psychopharmacotherapy is predicted.

 What does not follow from the known level is the fact that a therapeutic reaction to a single administration of one of the long-acting antipsychotic drugs with a specific chemical structure (thioxanthenes or pipothiazines) can be extrapolated to the effectiveness of antipsychotics and other chemical structures, which allows to expand the scope of this method ( nosological, syndromic, psychopharmacological).

 Example 1

 Patient B., born in 1968 and / b N 1418.

 Received July 5, 90.

 Diagnosis: schizophrenia paroxysmal, paranoid, hallucinatory-paranoid syndrome. Mentally ill since 1983, when her mood suddenly decreased, it began to seem that people around her did not treat her, condemned her, and wanted to harm her. She was hospitalized in a psychiatric hospital, where she was treated with psychotropic drugs - antipsychotics and antidepressants. Subsequently, she was hospitalized twice more in connection with various delusions, auditory hallucinations, inappropriate behavior. The duration of the last two attacks was 90 and 120 days. Before this hospitalization, the patient's condition worsened again, auditory hallucinations, delusions of attitude, persecution, expressed fear and anxiety, tension and insomnia appeared, mood decreased significantly, behavior became inadequate, and correction could not be made. In connection with the considerable duration of the two previous attacks of schizophrenia, it was necessary to determine the therapeutic prognosis of psychopharmacotherapy in a patient with this acute condition.

 After a clinical and laboratory examination, the patient was prescribed clopixol-depot at a dose of 600 mg intramuscularly. After 3 days in her condition, a distinct positive dynamics was observed, which persisted for another two months with a series of subsequent injections of clopixol-depot at a dose of 400 mg once every 10 days. Side effects were minimal when taking cyclodol daily at a dose of 6 mg.

 In connection with a clear stabilization of the mental state, the patient was discharged under the supervision of a local psychiatrist, continued outpatient administration of maintenance doses of psychotropic drugs, and for 2 years her condition remained satisfactory.

 Example 2

 Patient K., born in 1961 and / b N 4896.

 Diagnosis: schizophrenia paroxysmal paranoid, hallucinatory-paranoid syndrome.

 Mentally ill since 1980, when, after severe emotional stress, he began to perceive verbal pseudo-hallucinations of a threatening nature, expressed crazy ideas about relationships, the prosecution of poisoning. He was hospitalized in a psychiatric hospital, where he stayed for 4 months, received traditional treatment with psychotropic drugs - antipsychotics and antidepressants. Subsequently, he was hospitalized 6 more times in connection with delusions, auditory hallucinations, and inappropriate behavior. The duration of the last two attacks was 120 and 160 days. Before this hospitalization, the patient's condition worsened again - auditory hallucinations, delusions of attitude, persecution, poisoning, expressed fear and anxiety, tension and insomnia appeared, mood decreased significantly, behavior became inadequate, and correction could not be corrected. The traditional treatment with haloperidol intramuscularly at a dose of 30 mg per day for 20 days was ineffective, despite the addition of 200 mg of amitriptyline and 75 mg of tizercin in the next 10 days.

 After a clinical and laboratory examination, to determine the effectiveness of further psychopharmacotherapy and in the absence of therapeutic changes, piportil L4 was prescribed at a dose of 300 mg intramuscularly. The patient's condition after 5 days remained unchanged. No side effects.

 Subsequently, the ongoing therapy with other antipsychotics (majeptil, trisedil, azaleptin) at maximum therapeutic doses for 30 days did not give significant results. The patient was given a course of electroconvulsive therapy, during which a significant improvement in his mental state was achieved.

 Thus, the trial administration of one of the antipsychotics of the prolonged action of piportil L4 made it possible to predict the absence of a therapeutic effect from psychopharmacotherapy, which was confirmed by the absence of positive results from subsequent PFT. A single intramuscular injection of the neuroleptic prolongation of clopixol-depot at a dose of 600 mg (dose of piportil L4-300 mg) made it possible to predict the positive effect of PFT, which was also subsequently confirmed (example 1).

 This method predicts the therapeutic effect in 80 patients with acute and protracted attacks of paranoid and recurrent schizophrenia with hallucinatory-paranoid, paranoid, depressive-paranoid, manic-delusional, paraphrenic, obsessive-phobic, depressive-depersonalization and other. As a result of the application of our proposed method, the coincidence of the predicted and real effect of PFT was observed in 72 patients (90% of cases).

 The application of our proposed method has advantages over the known ones, which include saving psychotropic drugs, increasing the accuracy of the prognosis, expanding the scope of use for the contingent of patients with endogenous psychoses, both according to the type of course of the endogenous process (paranoid continuous and paroxysmal, recurrent), type, psychosis (acute, subacute, protracted, chronic), and by the nature of the leading symptom complex (positive, negative, mixed).

Claims (1)

1 A method for predicting the effectiveness of psychopharmacotherapy of endogenous psychoses, including intramuscular administration of a single test dose of a psychotropic drug followed by a clinical study of the mental state, characterized in that, as a psychotropic drug, antioxidants of prolonged action of thioxanthenes, for example clopixol-depot at a dose of 600 mg, or pipotiazines, are administered for example, piportil L <Mv> 4 <D> at a dose of 300 mg, and if the mental state improves within 3 to 5 days, therapeutically predicted The effectiveness of the method of psychopharmacotherapy in the treatment of endogenous psychoses.