RU2221486C1 - Method for evaluating efficiency of combined pharmaco- and psychotherapy in patients with neuropsychic disorders - Google Patents

Abstract

FIELD: medicine, medicinal psychology and psychiatry. SUBSTANCE: one should carry out psychological testing both before and after treatment. Four-point evaluation is carried out for the following definitions: patient's position in public life, work, emotional state of rest, family, children, health, conditions in a district where patient lives, living conditions, prosperity, nutrition, sexual life, spiritual requirements, contacts with friends, entertainments, relaxation time. At points values' increase by 12.9 points after carrying out pharmaco- and psychotherapy one should consider the treatment to be an efficient one. The present innovation enables to objectivize the value of therapy conducted. EFFECT: higher efficiency of evaluation. 1 dwg, 1 ex, 5 tbl

Description

 The invention relates to medicine, specifically to medical psychology and psychiatry, and relates to methods for evaluating the effectiveness of combined pharmacotherapy and psychotherapy of patients with neuropsychiatric disorders.

 Combined pharmacotherapy and psychotherapy have become the dominant approach in the treatment of psychiatric disorders. I.Treves in his study notes a huge increase in psychopharmacological knowledge in the last decade of the 20th century, and new drugs have less toxicity, low side effects and can be used for such disorders that have traditionally been treated by psychotherapists. L.Alexandrovich (1) analyzes literature data that consider these two streams as opposing, giving a theoretical justification (the concept of an intermediate object). But the author himself, based on clinical experience, notes the inadequacy of this course. V.Krasnov (2) postulates that psychotherapy and pharmacotherapy are characterized by a minimum of interpenetration. Perhaps these contradictions did not exist if we could separate and objectively evaluate the effects of psycho- and pharmacotherapy. Of particular difficulty are questions of evaluating the effectiveness of the psychotherapeutic process (3, 4).

 A known method (3, 4) for evaluating the effectiveness of pharmacotherapy and psychotherapy using the Hamilton anxiety scale. But this scale does not apply to the social dynamics of the patient, which, according to J. Mezzich (6), forms the basis for the adaptation of patients with mental disorders.

 However, the method described as a prototype has insufficient effectiveness in evaluating the treatment of patients with neuropsychiatric disorders, since it is primarily focused on determining the effectiveness of the pharmacological process and there is no assessment of the patient's social adaptation.

 The objective of the invention is to eliminate the disadvantages of the prototype, namely the objectification of increasing the effectiveness of the evaluation of pharmacotherapy and psychotherapy of patients with neuropsychiatric disorders by simultaneously assessing the effectiveness of pharmacotherapy and social adaptation of the patient.

 The task is achieved by conducting psychotherapeutic testing before and after treatment and scoring, and the assessment is carried out according to a four-point system according to the following definitions: position in society, work, life, peace of mind, family, children, health, conditions in the area of residence, living conditions, material wealth, food, spiritual needs, chatting with friends, entertainment. And with an increase in the score after pharmacotherapy and psychotherapy by 12.9% of the treatment, it is estimated as effective.

 The essence of the method lies in the fact that they use the "Rose of the quality of life" according to I. A. Gundarov (Table 5). Patients subjectively determine in digital categories (1 - not satisfied, 2 - moderate, 3 - satisfied, 4 - in full accordance with the desired) the following definitions: position in society, work, peace of mind, family, children, health, conditions in the area of residence , housing, material wealth, food, sexual life, spiritual needs, chatting with friends, entertainment and relaxation. The obtained data were processed statistically using Student's criterion.

 We examined 25 patients with neurotic disorders associated with stress (F 4), the treatment effectiveness of which was evaluated by the proposed method.

 The results are shown in tables 1, 2.

 As can be seen from table 1, pharmacotherapy led to a statistically significant increase in the parameters of peace of mind, health, and spiritual needs. Psychotherapy led to the strengthening of positions according to the criteria: life, friends, entertainment, peace of mind, health, spiritual needs. Therefore, pharmacotherapy has a positive effect on the patient’s condition, psychotherapy strengthens his position in microsocium, while at the same time increasing the quality of life according to the criteria that are restored after pharmacotherapy.

 To assess the effectiveness of the therapeutic process (Table 2), we evaluated the percentage of quality of life indicators. The dynamics is estimated by calculating the average percentage after pharmacotherapy and psychotherapy. The calculation was carried out as follows: 4 points were taken for 100% (i.e., the maximum indicator on the scale of quality of life). For each category, the average percentage was calculated and a comparison was made of the change in percentages by their difference before therapy, after pharmacotherapy and after psychotherapy. After pharmacotherapy, the average indicators of quality of life increased by 3.8%, after psychotherapy - by 9.1%.

 From the above it is seen how much psychotherapy enhances the effectiveness of treatment.

 Thus, the use of the proposed method allows us to evaluate not only the improvement in the clinical condition of patients, but also to see the degree of social adaptation in the microsocial group and to objectify the data of the therapeutic process. These characteristics are extremely important for the multiaxial diagnosis (J. Mezzich, 1996) and rehabilitation measures in each case.

 We have developed a scale for the effectiveness of the therapeutic process. The basis was the group averages (3.8% after pharmacotherapy, 9.1% after psychotherapy and 12.9% combined therapy). We qualified these reference points as “good” indicators, 0 as the absence of dynamics and, naturally, intermediate values between them were designated as moderate. By analogy, indicators superior to the average values were found to be excellent and excellent (the mirror projection of the points is "moderate" and without effect) (Table 3).

 For a better understanding of the essence of the method, we offer the following specific example.

 Shakiryanova Albina Andreevna, 46 years old. I entered the department of borderline states for the first time with complaints of weakness, persistent headaches, chills of tremor with headaches against the background of increased blood pressure with a feeling of numbness of the left half of the body, pain in the cervical spine, difficulty in pronouncing words (I sometimes want say, but I can’t - my lips do not move as if).

 Over the past 5 months in my head constantly “all sounds are scrolling, words beyond my will”, there was a fear of sharp objects, a fear of going crazy.

 Over the past year, lost 20 kg in weight. During this year, she was in a state of constant psycho-emotional stress, stress due to her daughter's serious illness.

 He lives in the countryside, in his house with her husband and 20-year-old daughter. The son is married, lives separately, has no children and, according to the conclusion of the doctors, is barren, and therefore his family is on the verge of a divorce.

 It is possible that the daughter will not have children after the gynecological operation, which is painfully experienced by the patient.

 Health conditions have been declining over the past 5 months, when her daughter’s life was in danger.

 Diagnosis: phobic anxiety disorder (F 40).

 Upon admission, the patient was examined on a Hamilton anxiety scale. The anxiety level was 18 points (anxiety mood - 3 points; stress - 2 points; insomnia - 3 points; decrease in intellectual productivity - 2 points; muscle somatic symptoms of anxiety - 2 points; cardiovascular symptoms - 2 points; neurovegetative symptoms - 2 points and anxious behavior - 2 points). Studies of the quality of living made up the following picture (see drawing): according to positions, living conditions, spiritual needs, position in society, family, material well-being, the patient presented a subjective assessment of 3 points; at 2 points she evaluated entertainment, recreation, work and housing; the basis for mental disharmony was the position, rated at 1 point - life, peace of mind, children, health, nutrition.

 During pharmacotherapy for two weeks (cassadan 250 mcg 3 times a day), the patient's condition improved, anxiety symptoms on the Hamilton anxiety scale decreased to 7 points (anxiety mood - 1 point; stress - 1 point; decrease in intellectual productivity - 1 point; muscle somatic symptoms of anxiety - 1 point; cardiovascular symptoms - 1 point; neurovegetative symptoms - 1 point and anxiety behavior - 1 point).

 The quality of life after pharmacotherapy increased in the following categories: life, peace of mind, health, the patient was evaluated at 2 points, and nutrition at 3 points.

 After a two-week drug treatment, an integrative personality-oriented psychotherapy was carried out (4 individual and 6 group sessions), where conscious and unconscious mechanisms of the formation of a subjective clinical picture of the disease, which leads to an incorrect assessment of the patient's condition, were discussed.

 Used suggestive psychotherapy aimed at regulating the psychophysiological processes of the body. Subsequently, the use of elements of cognitive-behavioral psychotherapy contributed to the adaptation, a more optimistic perception of the quality of life in general, as evidenced by the projective psychological test - the "rose of quality of life" (see drawing), where the patient reflects the dynamics of perception of her life in biological, social and spiritual aspects.

 This is confirmed clinically - sleep and appetite improved, headaches decreased, diencephalic paroxysms occurred less frequently, and the speech process was somewhat relieved.

 As a result of psychotherapy, obsession, unpleasant sensations in the body and in the head disappeared, self-confidence appeared, and attitudes to health strengthened. On the Hamilton anxiety scale, an anxiety level of 3 points was revealed (anxiety mood - 1 point; neurovegetative symptoms - 1 point; behavior during a conversation - 1 point). In the process of psychotherapeutic work, contacts with friends expanded, and real plans for employment appeared. On the "rose of the quality of life" this improvement manifested itself in the form of an increase in the scales: "peace of mind", "health", "entertainment and relaxation", "work", "life".

 Thus, if we characterize the condition of the patient upon admission, then in addition to the clinical subjective description, a quantitative determination of the condition is possible: 18 points on the Hamilton scale, and the quality of life is 51.7% (Table 4).

 The subjectivity of this test does not detract from the effectiveness of the treatment, and its visibility and understandability allows you to "take a detached view" of all your problems and life difficulties. This method allowed us to evaluate the significant reverse development of clinical manifestations in the formation of social activity, the ability to overcome situations that previously provoked anxiety. It is possible to accurately assess the level of social adaptation: the patient’s standard of living increases by 9% after pharmacotherapy; the patient’s standard of living increases by 8.9% after psychotherapy. The total therapeutic effect is 17.9%. Using our proposed scales, we can evaluate this case as an excellent result due to pharmacotherapy (> 7.6% on the scale of the effectiveness of pharmacotherapy), moderate results of psychotherapy (> 4.55% on the scale of psychotherapy) and good results of the effectiveness of combined pharmacotherapy and psychotherapy ( > 12.9% on the scale of the combined therapeutic effect). This patient should be advised to work through the existing problem and psychological restructuring of their own personality.

Literature
1. JM Aleksandrowicz. Are psychotherapy and psychopharmacology contradictory? Item. P.17.

 2. V.Krasnov. Psychopharmacotherapy and psychotherapy: contradiction and limit of interaction. Item. P.43.

 3. B.D. Karvasarsky. Psychotherapeutic Encyclopedia. St. Petersburg, 1998, 743 p.

 4. V. Ya.Semke. Psychotherapy of borderline conditions: old and new problems. Siberian Bulletin of Psychiatry and Addiction. 2, 1996, p. 37-39.

 5. I. Treves, S. Fenning, N. Horesn. The integration of psychotherapy and psychopharmacology in different setting. In: World psychiatric association thematic conference: The synthesis between psychopharmacology and psychotherapy. Jerusalem, Israel, November 16-21, 1997. Abstract, p. 7.

 6. J. Mezzich. ICD-10 an Quality of Mental Health Care / X World Congress of psychiatry. Madrid, August 23-28, 1996. Abstracts. Volume 1, p. 91.

 7. V. Ya. Semke, I.E. Kupriyanova, M.M. Aksenov. Cassadan in the treatment of borderline neuropsychiatric disorders with severe symptoms of anxiety. On Sat : Actual questions of borderline addictive states, Tomsk-Barnaul, 1998, pp. 97-99.

 8. V. Ya. Semke, I.E. Kupriyanova, V. B. Trusov. Combined psycho- and pharmacotherapy of patients with borderline neuropsychiatric disorders (for example, cassadan). Modern technology of psychiatric service, Tomsk, 1997, p.69.

Claims (1)

A method for evaluating the effectiveness of combined pharmacotherapy and psychotherapy for patients with neuropsychiatric disorders, including psychotherapeutic testing before and after treatment and scoring, characterized in that the assessment is carried out on a 4-point system according to the following definitions: position in society, work, life, peace of mind, family, children, health, conditions in the area of residence, living conditions, material well-being, food, spiritual needs, chatting with friends, entertainment, and increasing the value of points after the fa pharmacotherapy and psychotherapy at 12.9 points, the treatment is rated as effective.

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