RU2227031C2 - Method for treatment of narcomania - Google Patents

Abstract

FIELD: medicine, narcology. SUBSTANCE: atropine-comatose therapy is alternated in one other day with electroshock therapy. In day carrying out atropine-comatose therapy a patient is given 5 mg haloperidol, 2 g of sodium oxybutyrate, 25 g of tisercin and eserine ointment is put into conjunctival cavity of eyes. In 30 min 50-75 mg of atropine sulfate is administrated by intravenous route as 1% solution. Then in 3-5 h of comatose state 15-30 mg of physostigmine, 6 g of piracetam, 7.5 g of magnesium sulfate, 400 ml of sodium hypochlorite are administrated by intravenous route by drops and patient is recovered from coma gradually. For the each next seance of atropine-comatose therapy the dose atropine sulfate is increased by 10 mg and brought about to 70-150 mg or 90-170 mg. In day of carrying out the electroshock therapy 1 ml of 0.1% atropine sulfate solution and 2 ml of cordiaminum are administrated by intravenous route. The initial narcosis is carried out by intravenous administration of 200-300 ml of sodium thiopental or 100 mg of ketamine with simultaneous administration of 3-4 ml of 2% dithylinum, electroshock therapy is carried out followed by artificial lung ventilation. EFFECT: enhanced effectiveness of treatment. 3 ex

Description

The invention relates to medicine, namely to narcology, and can be used to treat drug addiction.

Drug addiction treatment is aimed at overcoming withdrawal symptoms - a syndrome of mental and physical disorders that develop after a sharp cessation of drug use or pharmacological blocking of its action, as well as overcoming psychological dependence, which includes an unstoppable craving for drugs, agitation, anxiety, and depression. However, physiological mechanisms also underlie psychological dependence.

Known methods for the treatment of drug addiction are: “A drug for treating patients with opium addiction and a method for their treatment” (RF patent No. 2147879), “Means for stopping opium withdrawal syndrome” (RF patent No. 2131245), “Method for stopping opium withdrawal symptoms” (RF patent 2135172 ), ("A method for the treatment of opium addiction" (patent application No. 97101216/14)). But the proposed methods have several disadvantages. For example, the use of naltrexone adversely affects the psycho-emotional state of the patient, as it completely neutralizes traces of the drug in the blood. The drug lupeptin is effective for relieving signs of withdrawal, and the use of sedatives, analgesics and painkillers, such as pentamine, analgin, diphenhydramine and relanium, only briefly improves the patient's condition.

Also known is the "Method for the treatment of drug addiction and alcoholism" (RF patent No. 2055602), which includes a number of stages, such as removing a patient from abstinence, conducting rational psychotherapy, fixing the device by using electric current.

There is also a method of treating drug addiction, the currently most effective pharmacological agent of methadone hydrochloride or its derivatives (Friedman L.S., Flemit N.F. et al. Narcology, trans. From English. Publishing house Bin Nevsky Dialect, 1998. -c .l94).

Methadone hydrochloride is a synthetic long-acting opiate agonist, used with the support of patients with opioid dependence, orally in a daily total dose of 20-80 mg. Methadone significantly reduces the need for a drug and blocks the euphoric effects of heroin. However, the methadone treatment method for addiction has several disadvantages. According to the chemical structure and pharmacological properties, the drug is close to morphine and its own methadone dependence is formed. The drug in Russia is banned for use. (Lawrence D.L., Benitt P.N. Clinical Pharmacology, vol. 2, trans. From English, - Medicine, 1993, p. 4).

The prototype adopted the method of treatment of drug addiction according to the patent of the Russian Federation 2129866, the essence of which is that atropine is administered in a dose of 100 to 800 mg, which causes a coma in which the patient is in 4 hours. The coma is stopped by intramuscular injection of 1% eserin solution in three consecutive injections of 10 mg with an interval of 15-20 minutes. This procedure is repeated at least 10-12 times.

Unlike analogues, the proposed method for the treatment of drug addiction has an advantage. It has a pronounced antidepressant effect, since the dosage of antidepressants is significantly reduced in comparison with the known methods, and also significantly potentiates the effects of drug psychopharmacotherapy and non-drug psychocorrection methods, which leads to a decrease in the number of atropinomatous therapy procedures and increases the effectiveness of treatment and the duration of remissions.

The aim of the invention is the most effective treatment for drug addiction with the use of drug therapy and reflex effects of electric shock.

An essential distinguishing feature of the proposed method is the combined use of atropinomatous and electroconvulsive therapy. The method is as follows. Atropinomatous and electroconvulsive therapy is carried out alternately every other day. Atropinomatous therapy is preceded by a somatic examination, including general and biochemical (bilirubin, transaminase) blood and urine tests, chest x-ray, electrocardiography. Consultations of the therapist, ophthalmologist, otolaryngologist are required. Individual sensitivity to the action of atropine is checked by administering 0.5 ml of a 0.1% solution of atropine sulfate (increased sensitivity to atropine is manifested by tachycardia, a feeling of intoxication). On the day of treatment in the morning on an empty stomach, the patient is injected with 5 mg of haloperidol, 2 g of sodium oxybutyrate, 25 mg of tizercin intravenously 30 minutes before the injection of atropine sulfate solution to prevent nausea and vomiting. In the conjunctival sacs of both eyes, to reduce the effect of atropine, an eserin ointment is laid, and the mucous membranes of the mouth and nose are lubricated with vaseline. First, 50-75 mg of atropine sulfate is administered intravenously as a 1% solution. At each subsequent session, the dose of atropine sulfate is increased by 10 mg, bringing to the end of the course to an average of 70-150 mg or a maximum of 90-170 mg of a coma dose. During the procedure, tendon reflexes persist, muscle tone decreases. The corneal reflex disappears, sometimes, in some cases, tachycardia and slight hyperthermia can be observed. The duration of the coma, necessary to achieve a therapeutic effect, is from 3 to 5 hours. To stop coma, physostigmine (0.1% or 0.5% solution) is used in doses of 15-30 mg or galantamine (nivalin), 6 g of piracetam and 7.5 g of magnesium sulfate (intravenous drip), 400 ml of sodium hypochlorite (intravenously drip). The patient comes out of a coma gradually. The first 30 minutes after the start of stopping, a corneal reflex and the pupil’s reaction to light appear, followed by consciousness, motor reactions, and speech contact.

Conducting electroconvulsive therapy is preceded by the abolition of drugs that increase the convulsive threshold (anticonvulsants, central relaxants). A patient on an empty stomach is laid on a table on his back, if there are removable dentures, they are removed, watches, chains, all metal objects are removed.

Premedication: 1 ml of 0.1% atropine sulfate and 2 ml of cordiamine intravenously. Induction anesthesia: 200-399 mg of thiopental sodium or 100 mg of ketamine. To eliminate generalized seizures, ditilin is used intravenously in an amount of 3-4 ml of a 2% solution. To prevent biting the tongue and lips, an air duct is inserted, the skin in the area where the electrodes are applied is degreased with alcohol. A respirator and an electric suction device, an apparatus for electroconvulsive therapy (ECT) are being prepared. After the introduction of dithylin and the end of fasciculations, electrodes are applied to the temporal regions in the middle of the line from the outer edge of the eye to the tragus (the "Frankfurt horizontal"). The gaskets on the electrodes are pre-wetted with saline. The minimum voltage and exposure of the electric current at the beginning of ECT is 80 V and 0.5 s, respectively. In the absence of a convulsive reaction, increase the voltage by 10 V or the exposure by 0.1 s. Average dosage: 46-130 pulses. Maximum up to 260. Artificial ventilation of the lungs is carried out until spontaneous respiration is restored. After a seizure, amnesia develops, which disappears on its own within an hour, the seizure itself is amnesized forever.

Example 1

Patient S. in K.G., born in 1975. Opium addiction, hospital stay of 27 days, coma therapy 5 sessions: 2.5 - 8 ml iv every other day 5 ECT sessions every other day.

1 day - 2.5 ml of 1% atropine sulfate; 2 day - ECT; 3 day - 5 ml of 1% atropine sulfate; 4 day - ECT; 5 day - 6 ml of 1% atropine sulfate; 6 day - ECT; 7 day - 7 ml of 1% atropine sulfate; 8 day - ECT; 9 day - 8 ml of 1% atropine sulfate; 10 day - ect. The term of remission is 1 year 8 months.

Example 2

Patient B. A.A., born in 1975. Opium addiction, length of stay in the department is 18 days, coma therapy 4 sessions: 2.5-7 ml iv, 4 ECT sessions every other day.

1 day 2.5 ml - 1% atropine sulfate; 2 day - ECT; 3 day - 5 ml of 1% atropine sulfate; 4 day - ECT; 5 day - 6 ml of 1% atropine sulfate; 6 day - ECT; 7 day - 7 ml of 1% atropine sulfate; 8 day - ect. The term of remission is 1 year 5 months.

Example 3

Patient Z. in O.YU., born in 1974 Opium addiction, length of stay in the department - 23 days, coma therapy 7 sessions: 2.5 - 10 ml iv, 7 ECT sessions.

1 day - 2.5 ml of 1% atropine sulfate; 2 day - ECT; 3 day - 5 ml of 1% atropine sulfate; 4 day - ECT; 5 day - 6 ml of 1% atropine sulfate; 7 day - ECT; 8 day - 7 ml of 1% atropine sulfate; 9 day - ECT; 10 day - 8 ml of 1% atropine sulfate; 11 day - ECT; 12 day - 9 ml of 1% atropine; 13 day - ECT; Day 14 - 10 ml of 1% atropine sulfate; 15 day - ect. Remission term 1 year 4 months.

Claims (1)

A method for the treatment of drug addiction, including atropinomatous therapy, characterized in that atropinomatous therapy is alternated every other day with electroconvulsive; on the day of atropinomatous therapy, the patient is injected with 5 mg of haloperidol, 2 g of sodium oxybutyrate, 25 g of tisercin, and an eserin ointment is placed in the conjunctival sacs of the eyes, after 30 minutes 50-75 mg of atropine sulfate is administered intravenously in the form of a 1% solution, then after 3-5 h coma intravenously, drip injected 15-30 mg of physostigmine, 6 g of piracetam, 7.5 g of magnesium sulfate, 400 ml of sodium hypochlorite and gradually remove the patient from a coma; at the same time, in each subsequent session of atropinomatous therapy, the dose of atropine is increased by 10 mg and adjusted to 70-150 mg or 90-170 mg; on the day of electroconvulsive therapy, 1 ml of a 0.1% solution of atropine sulfate and 2 ml of cordiamine are intravenously administered, anesthetic anesthesia is carried out by intravenous administration of 200-300 mg of thiopental sodium or 100 mg of ketamine and at the same time 3-4 ml of 2% dithilin, electroconvulsive therapy is carried out after which they carry out artificial ventilation of the lungs.