RU2138818C1 - Method of prognosis of effectiveness of endogenic psychosis psychopharmacotherapy - Google Patents

Abstract

FIELD: medicine, psychiatry. SUBSTANCE: method involves clinical-biochemical studies and additional determination of level of total and effective concentration of serum blood albumin before and after 7 days after onset of psychopharmacotherapy. Positive result of psychopharmacotherapy of endogenic psychosis is prognosticated at decrease of the level of these indices by 10%, not less, as compared with the parent values. EFFECT: increased precision of diagnosis and treatment time. 2 ex

Description

 The invention relates to medicine, namely to psychiatry.

 A known method for predicting the effectiveness of psychopharmacotherapy (PFT) through a clinical study of the initial mental state of the patient and its dynamics in the PFT process for 4-5 weeks (Avrutsky G.Ya., Neduva A.A. Treatment of mentally ill patients. - M .: Medicine, 1988 p. 8-25).

 The disadvantages of this method is the low accuracy of clinical diagnostics in connection with the subjective assessment of a doctor, lengthening the duration of treatment, useless use of drugs, the presence of side effects and complications in a number of patients during trial therapy.

 A known method for predicting the effectiveness of treatment of depression with tricyclic antidepressants (ed. St. SU N 1755195, G 01 N 33/48) by conducting clinical and biochemical studies of the activity of monoamine oxidase (MAO) of blood platelets.

 The disadvantages of this method are its narrow specificity (specifically to tricyclic antidepressants), limitation of the scope of use, the inability to use it in the treatment of antipsychotic drugs - the main therapy for endogenous psychoses, in particular schizophrenia.

 The technical result of the invention is to eliminate the above drawbacks, increase accuracy and reduce the time frame for predicting PFT endogenous psychoses, expanding the scope of use (nosological, syndromic, psychopharmacological).

 This technical result is achieved by the fact that, in addition to the clinical study, the level of total (OKA) and effective concentration of albumin (ECA) in serum is determined before and 7 days after the start of PFT, and with a decrease in the level of these indicators by at least 10% compared to baseline predict a positive effect of PFT endogenous psychoses.

 It does not follow explicitly from the prior art that the decrease in OKA and ECA levels before and 7 days after the start of PFT can serve as a prognostic criterion for PFT of endogenous psychoses.

 The method is as follows. Patients with endogenous psychoses after a clinical study determine the level of serum levels of OCA and ECA before and 7 days after the start of PFT according to the procedure (Gryzunov Yu.A., Miller Yu.I., Dobretsov G.E., Pestova AB, Fluorescence a method for determining the mass concentration of albumin in blood serum // Clinical laboratory diagnostics. 1994, N 5, S. 27-31). With a decrease in the levels of OKA and ECA of at least 10%, a positive effect of PFT of endogenous psychoses is predicted.

 Example 1. Patient M., born in 1967. Disabled person 2 groups. Was admitted to the hospital 05/11/95, with a diagnosis of schizophrenia paranoid, continuously flowing. Hallucinatory-paranoid syndrome. Aggravation against the background of a defect. The condition of the patient upon admission was characterized by verbal pseudo-hallucinosis, a syndrome of mental automatism in the ideator and motor spheres, ideas of persecution, exposure. The expressed negative symptoms attracted attention. 05.16.95, the blood serum was studied for the content of OKA and ECA. The level of OCA was 68.2 g / l, the level of ECA was 35.8 g / l. The patient was started with adequate psychopharmacotherapy (haloperidol up to 40 mg / s., Amitriptyline up to 150 mg / s., Piportil L 4 200 mg once every 2 weeks, correctors). May 23, 1998 (after 7 days) a second blood test was taken. The level of OKA was 45.3 g / l, ECA - 18.9 g / l. By the end of the month, the patient's condition improved. Delusional experiences were deactivated, pseudo-hallucinatory phenomena significantly decreased. The patient was discharged. According to the follow-up data (1.5 g), the patient is on outpatient treatment, regularly takes maintenance therapy, is engaged in homework, she has not been hospitalized in psychiatric hospitals.

 Thus, a decrease in the levels of OKA and ECA by more than 10% (respectively, OKA - 34%, ECA - 47%) 7 days after the start of PFT compared with the initial coincides with a positive result of PFT.

 Example 2. Patient S., born in 1965, was admitted to the clinic 03/26/95, with a diagnosis of schizophrenia, paranoid, continuously flowing. Hallucinatory-paranoid syndrome. Upon receipt of the core syndrome was verbal pseudo-hallucinosis. Delusional disorders were hallucinatory in nature, their plot was related to the content of "voices" such as hallucinatory delusions of persecution, the developed Kandinsky-Clerambo syndrome was noted. April 3, 1995, blood serum was studied for the content of OCA and ECA. The level of OCA was 28.7 g / l, the level of ECA was 22.3 g / l. Psychopharmacological therapy was started on the patient (haloperidol up to 60 mg / s., Triftazine up to 60 mg / s., Amitriptyline up to 200 mg / s., Piportil L 4 200 mg in 10 days, correctors). 04/10/95, (after 7 days) was taken a second blood test. The level of OKA was 27.6 g / l, ECA - 21.3 g / l. Despite conducting quite active PFT, verbal pseudogallucinosis, Kandinsky-Clerambo syndrome did not undergo any noticeable reduction. Delusions were constantly present in his reasoning in the complete absence of criticism. The patient was discharged to continue treatment in a psychiatric hospital at the place of residence due to lack of effect. According to follow-up data (1.5 g), he is constantly on active antipsychotic therapy, the course of the disease has become protracted, remissionless, socially maladaptive.

 Thus, a decrease in the levels of OKA and ECA by 4 and 5%, respectively, 7 days after the start of PFT compared with the initial (less than 10%) coincided with a negative result of PFT.

 The specified method was applied to 19 patients with endogenous psychoses. In 83% of cases, the predicted and real results of treatment coincide (with a decrease in OKA and ECA by at least 10% 7 days after the start of PFT).

 This method has advantages over the known ones, which include increasing accuracy, reducing the forecast time, expanding the scope of use, as well as saving drugs.

Claims (1)

 A method for predicting the effectiveness of psychopharmacotherapy of endogenous psychoses by means of clinical and biochemical studies, characterized in that in addition to the clinical study, the level of indicators of the total and effective concentration of albumin in blood serum is determined before and 7 days after the start of psychopharmacotherapy and with a decrease in the level of these indicators at least 10% in comparison with the initial ones, a positive result of psychopharmacotherapy of endogenous psychoses is predicted.