RU2238034C2 - Method for predicting remission duration in alcohol addicted patients at the remission development period - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves patient condition is evaluated during the first three months of soberness period. Clinical course of disease, personality deviations in premorbid period, constitution and personality pattern, variations of intoxication nature, therapeutic remissions duration in the past, spontaneous remission events, pathological alcohol attraction manifestation frequency, pathological alcohol attraction pattern, its manifestation intensity degree like depression, dysphoria, internal stress, psychopathic-type disorders, psycho-organic disorders, asthenia, disease criticism, soberness suggestion; psychotropic preparation therapy, intensity of emotional, vegetative, ideational and behavioral components of pathological alcohol attraction. Each factor is evaluated from a table using prognostic coefficient. Sum of coefficients associated to the whole set of symptoms being equal to or greater than +9, the treatment is considered to be efficient and high probability of remission is predicted. The sum being equal to or less than -9, the treatment is considered to be inefficient. The sum being between -9 and +9, prognosis is considered to be unclear.

EFFECT: high accuracy of prediction.

1 tbl

Description

The invention relates to medicine, namely to narcology, to methods for predicting the duration of remission, allowing to predict the likelihood of relapse in patients with alcohol dependence during the formation of remission.

An urgent need of modern medicine and, in particular, narcology is the possibility of objective prediction of the outcome of the therapy, the duration of therapeutic remissions and the likelihood of relapse. For a practical doctor, the need for informative, reliably prognostic criteria that would allow to predict the results of therapy became apparent.

Prediction of the results of rehabilitation treatment, or rather, the duration of the patient maintaining absolute sobriety after a course of anti-alcohol therapy, can be considered as a fragment of a more comprehensive task of choosing the optimal tactics of treatment and rehabilitation measures at all stages of the formation of therapeutic remission. To solve this problem, a significant role can be played by the allocation of a set of prognostically significant characteristics of the patient's condition during the formation of remission and the measurement of the "information weight" of such characteristics using mathematical procedures. The importance of the task is emphasized by the fact that in existing studies the prognostic value of certain signs is considered in isolation. Clinical evaluation of the initial stage of the formation of remission seems to be especially significant for prognostic constructions, since it is crucial for the development of optimal therapeutic tactics.

Closest to our proposed method is a method for predicting the duration of remission, which consists in assessing the patient’s condition, including determining the presence and evaluation of the following symptoms: criticism of the disease, sobriety, severity of the affective component of the pathological attraction to alcohol according to the N.V. Cherednichenko and B scale .B. Altshuler ("International Medical Journal", 1998, v.4, No. 3, pp. 104-105 [1]). In the known method there are a number of statistical and dynamic criteria for predicting the duration of alcoholic remission. However, in the known method, the approach to forecasting is carried out only from the perspective of the clinical experience of the doctor. At the same time, there is no assessment of the effectiveness of forecasting by determining the complex of the most informative prognostic factors identified using the Kullback statistical information measure from a large array of -350 attributes and using the Bayes predictive decision rule.

The reliability and effectiveness of forecasting is largely determined by the analysis of information, including the understanding of the data and the selection of the most important of them. The doctor has to use 2 groups of information: obtained during a direct examination of the patient (the results of the examination, psychological tests, biochemical and other studies) and indirect information (the description of the disease according to the patient), which contain a lot of inaccuracies, and sometimes inaccurate data. Objective data can also be varied, the interpretation of which allows a certain amount of subjectivity.

Thus, the need for this development is associated with difficulties that narcologists have when choosing tactics for constructing treatment and rehabilitation programs. Often, these difficulties are caused by the ever-increasing burden on practical doctors and narcologists of dispensaries and hospitals.

The technical task of the present invention is to improve the accuracy of predicting the duration of remission in patients with alcohol dependence.

The stated technical problem is achieved by the fact that in the method for predicting the duration of remission in patients with alcohol dependence in the period of remission, which consists in assessing the patient’s condition, including an analysis of the following symptoms: criticism of the disease, attitude toward sobriety, the severity of the affective component of the pathological attraction to alcohol (PVA ) according to the scale of N.V. Cherednichenko - V. B. Altshuler, according to the invention, the patient's condition is assessed during the first 3 months of sobriety in the establishment of remission, tively determine if the patient 23 below each of these prognostic factors: the type of the disease; personal deviations in premorbid; constitutional-personal type; change in the nature of intoxication; duration of therapeutic remissions in the past; spontaneous remissions in the past; incidence of PVA; nature of PVA; severity of depression; dysphoria; internal stress; psychopathic disorders; psycho-organic disorders; asthenia; criticism of the disease; sobriety; the nature of personality changes in remission; sensitizing therapy; therapy with psychotropic drugs; the severity of the emotional, vegetative, ideative and behavioral components of PVA syndrome according to the modified N.V. Cherednichenko - V. B. Altshuler scale, each of the factors being evaluated using a prognostic coefficient selected from several proposed options for the values of this coefficient, and a clinical assessment is carried out using a table that includes 23 prognostic factors, which assess the condition of the patient, taking into account their prognostic value, indicating prognostic coefficient of appropriate gradations of the severity of each factor, and a prognostic decision is made provided that when summing the prognostic factors the threshold value is ± 9, with a value of +9, the prognosis is good, the probability of remission is high, treatment is effective, with a value of -9 the prognosis is poor, treatment is ineffective, it is necessary to strengthen the observation and if necessary, take emergency measures, and with values (+9) - (- 9) the forecast is unclear, further observation is necessary.

For the computational forecasting of the duration of remissions, a prognostic card for remission in alcoholism was used, including 350 signs that fix the clinical, personal and socio-psychological characteristics of the patient, the treatment and rehabilitation measures taken and their results. The traits studied were scored and digitally encoded. Prognostic factors were obtained on the basis of a follow-up study of 217 patients with alcohol dependence.

The patient’s life history was analyzed: features of early development, upbringing, relationships in the parent family, relationships with each of the parents, with peers, previous and accompanying addictive diseases, premorbid personality traits (constitutional personality type), marital status, reasons for divorce ( if it took place), degree of satisfaction with marital status, relationship between spouses, attitude towards children, nature of work, attitude towards work and etc. The history of the disease was studied: prescription, the rate of formation, the severity of the main symptoms (for a quantitative assessment of the severity of PVA, a modified scale of N.V. Cherednichenko and V. B. Altshuler (given in the appendix to the invention), the types of treatment in the past, the duration of therapeutic and spontaneous remissions were used , causes of relapses. The treatment carried out was analyzed - various treatment and rehabilitation measures and the patient’s attitude to various types of pharmacotherapy and psychotherapy. During the study, the clinical assessment of the patients' condition was supplemented by psychological tests - the Spilberger-Hanin reactive anxiety scale and the Luscher color test (measurement of the total deviation from the autologous Valneffer norm). pulsometry with the calculation of the voltage index (IN) of regulatory systems. Due to the dynamic observation of patients in remission, in many cases - contacts and psychotherapeutic work with relatives, reliable follow-up information was obtained.

In accordance with follow-up data and information on the duration of remission, patients in the training sample of 144 people were divided into 2 groups: the first (79 people) with remissions of more than 1 year and the second (65 people) with remissions of less than 1 year. These groups were compared according to 310 characteristics to identify statistically significant differences in frequencies and average values (for quantitative signs) using the Fisher and Student t-tests. The predictive value of the signs was determined using the Kullback information measure. To build prognostic rules, one of the methods of the theory of pattern recognition, the Bayes rule, was used. Of the large array of signs, 23 of the most prognostically significant ones were identified on the basis of the Kullback information measure. At the same time, the possibility of their analysis in the conditions of “express diagnostics” with minimal material and technical equipment was also taken into account; on this basis, the indicators of variational pulsometry were excluded from the final prognostic table.

Each of 23 signs was evaluated by its diagnostic (prognostic) value based on statistical characteristics (Kullback measure, diagnostic coefficient) (see T.V. Gurvits, B.V. Iovlev, I.M.Tonkonogih "Table computational methods in diagnosis strokes and predicting their outcomes. "L .: Medicine, 1976, pp. 41-47 [2]). The diagnostic (prognostic) coefficient is obtained on the basis of a statistical analysis of the frequencies of symptoms in the training sample and is a 10-logarithm of the likelihood ratio of the frequencies with which symptoms occur in one and the other diagnostic classes.

In a tabular diagnosis, it is recommended to summarize the coefficients of all 23 signs found in the patient and compare the received amount with a threshold of ± 9. The forecasting procedure comes down to summing up all prognostic coefficients taking into account the sign (plus or minus) and comparing the resulting amount with the threshold value (± 9).

If the sum of the prognostic coefficients of all the signs is equal to or exceeds the threshold of +9, the prognosis is favorable with a high probability of the establishment and stabilization of remission. If this amount is equal to or less than the threshold of -9, then a high probability of a resumption of alcohol consumption, a relapse of the disease is predicted, which requires urgent measures to prevent it in the form of increased monitoring of the patient and intensification of treatment. If the sum of all prognostic coefficients of the signs of the scale is within the interval (-9) - (+9), then the prognosis is considered to be uncertain, which requires continued active therapeutic efforts to form and consolidate the attitude to sobriety, the biological correction of psycho-vegetative disorders of the syndrome of attraction to alcohol, dynamic observation of the patient.

On the training group of 143 people, the results of the decisive rule are as follows: the correctness of the computational forecast is confirmed in 70.6% of cases; in 18.2% - the forecast is uncertain; in 11.2%, the forecast is erroneous.

The effectiveness of the developed decision rule was also tested and confirmed in the control group of patients numbering 73 people with the results: the correctness of the computational forecast was confirmed in 70.4% of cases; in 12.7% - the forecast is uncertain; in 16.9% - the forecast is erroneous.

The proposed prognostic rules have no analogues in clinical narcology, as they allow for a comprehensive assessment of the patient’s status, taking into account the quantitative “prognostic weight” of 23 of the most informative indicators selected from preliminary statistical procedures from a large array (350) of signs.

Material and technical support of the method for calculating the duration of remission of a patient with alcohol dependence: a modified scale by N.V. Cherednichenko and V. B. Altshuler for a quantitative assessment of the severity of PVA (Appendix 1); prognostic scale for assessing the duration of remission based on the condition of the patient with alcohol addiction at the stage of formation of remission (in the first 1-3 months after cessation of alcohol use).

The practical use of the method for predicting the duration of remission in patients with alcohol dependence in the period of formation of remission is illustrated by clinical examples.

CLINICAL EXAMPLES

Example 1

P-EV SERGEY ANATOLIEVICH born in 1954.

Heredity is burdened by alcoholism: the maternal grandfather died of alcoholic cirrhosis. Father suffered from alcoholism. Early development - without features. Parents divorced when the boy was 2 years old; at the age of 9, a stepfather appeared in the family with whom a "good" relationship developed. In his youth he was fond of sports - rowing. He studied mediocre at school. Past diseases: rare colds. Higher education (LETI), in recent years he has been engaged in business, is a private entrepreneur. Married again. The first marriage was at the age of 31-34 years old, has a daughter from her first marriage, does not support relations with her. Since 1995 - in the second marriage. Wife - chief accountant in the same company where the husband works. The patient lives together with his wife and mother, the relationship between which is very complex, periodically conflict. Marital relations are unstable, inharmonious. It seems premorbid accentuated hysterical personality with features of egocentrism, some pretentiousness, a high need for attention, recognition.

Medical history

Occasional alcohol consumption - from 16 years old, systematic alcoholization - from 18 years old. AAS has been formed since the age of 25 in the form of somato-vegetative disorders, low mood, irritability. It was alcoholized in the form of pseudo bouts for 4-5 days with breaks of up to a month, tolerance of 1.0 l of vodka. There were no psychoses, convulsive attacks. Changes in the nature of intoxication were not noted. There were no spontaneous remissions. He turned to a narcologist for the first time in 1983 - he was treated in a narcological dispensary under the influence of his mother with remission for about a month. In 1985, coding was performed according to the Savchenko method without remission. He was treated according to the method of Shichko with remission of 4 months. In recent years, herbal medicine has been carried out with an unstable positive effect. Relapses usually occurred both against the background of emotional disorders, the actualization of craving for alcohol, and subjective psycho-physical well-being due to a change in attitude to sobriety. For several months, the patient visited the group "AA"; believes that, thanks to the influence of the community, he is better aware of his alcohol problems. The patient also noted the effect of "psychological relief", improvement of mental state when visiting group "AA". In September - October 2000 he was treated in Dep. 5 Institute. Ankylosing spondylitis.

Diagnosis: Alcohol addiction. Moderately progressive course. Pseudoblastic form.

Survey data :: an. blood: hemog - 136 g / l; er-4.2 · 10 ¹² / l; col.pok - 0.97; lake - 6.2 · 10 ⁹ / l; fell - 6; seg - 40; eos - 3; lymph - 37; mon - 12; ESR - 18 mm / hour; ACT - 0.040 μmol / s.l; ALT - 0.204 μmol / s.l; bilirubin commonly - 10.5 μmol / l; glucose - 5.0 mmol / l. An. blood on Hbs - antigen - not detected. An. urine is normal. An. to AIDS, Wassermann reaction - negative. An. for diphtheria, intestines. column - neg. ECG: a variant of the norm.

During hospitalization, the patient received treatment: finlepsin - 400 mg per day; glutamic acid - 0.75 per day; piracetam; Vit. C, B1, B6, nicotinic acid; Esperal 250 mg daily in the morning per os.

After discharge, the patient abstained from drinking alcohol for 11 months. During the period of remission, he received supportive individual psychotherapy, visited the attending physician after discharge during the first 3 months - 1 time per month, then -1 time in 3 months. Supportive treatment with finlepsin was carried out - 200 mg per day in combination with St. John's wort - gelarium. Picamilon, cinnarizine, ginkgo biloba were also prescribed as courses. During the first 3 months of remission, episodic manifestations of PVA of an obsessive nature, increased fatigue, and mild irritability persisted. Then the condition improved, the manifestations of PVA and asthenic disorders were reduced. Relapse occurred in July 2001 - in hot weather, against the backdrop of a pronounced thirst, "I wanted to drink beer ...". The secondary attraction to alcohol was immediately updated. The patient drank alcohol for 3 days. At this time, the narcological department of the institute was closed due to the vacation of employees. The next binge was repeated a month later - he drank alcohol for 3 days after a stressful situation - a car accident, serious damage to the car, frustration due to the need for expensive repairs. He sought medical help on his own. In connection with working circumstances, the patient asked not to hospitalize him in the clinic. It was decided to conduct treatment on an outpatient basis with a decision on the need for hospitalization, depending on the dynamics of the condition.

At the beginning of treatment, a decreased mood was noted - the patient looked sad, was upset by the breakdown that occurred, and felt guilty. Concerned about the situation at work, anxiety about the state of health, work and home circumstances. The patient complained of increased fatigue, some memory impairment, hardly restrained irritability, and the often arising desire to “drink” a persistent obsessive character, which he had to deal with. Attraction to alcohol is especially manifested with fatigue, feelings of hunger, thirst, in stressful, as well as provocative situations. The patient is critical of his illness, realizes the need for a complete rejection of alcohol, treats with confidence, expresses willingness and desire to be seriously treated, take all prescribed medications, and go to psychotherapeutic talks with a doctor. The wife accompanying the patient shows a desire to participate and help in the treatment of her husband.

Treatment: methadoxyl (5.0 ml intramuscularly N 5), tiapridal (300 mg per day), finlepsin (300 mg per day), proproten (1 tablet 5 times a day for the first 3 days, then 1 ton per day ), pyrroxan (45 mg per day). After 2 weeks, the drug colme was added - 12 cal. once a day.

As a result of treatment, the mood improved, there were no signs of a decrease in mood, manifestations of a craving for alcohol became less and less pronounced. There was enough confidence in their own abilities to cope with the craving for alcohol, ease in communicating with drinking acquaintances, while maintaining the desire to avoid provocative situations, if possible. Increased fatigue persists, manifested during exertion, irritability, noted with fatigue, emotional stress. The patient expresses a convincing attitude toward a complete rejection of alcohol; he is determined to continue taking the drug (colma), which is sensitizing to alcohol, the normotimics of finlepsin, and nootropics.

The decision was made - relapse is unlikely, the treatment is effective, there is no need for hospitalization. It is recommended that outpatient follow-up and treatment be continued, taking drugs - finlepsin 200 mg / day, phenibut - 50 mg / day.

Example 2

M-SERGEY YURIEVICH Born in 1960.

Heredity is burdened by a mother’s mental illness (schizophrenia), which is registered in the IPA, has been repeatedly treated in a hospital. Father abused alcohol, died of stomach cancer at the age of 63. Early development without features. He was brought up by the youngest of two children in hypoprotection. He spent most of the time on the street, loved collective games. The home environment in childhood and school years was complicated by the drunkenness of his father. He studied at school mediocre, did not show special interests in any school subjects. He graduated from 8 classes of school and vocational school, specializing in car mechanics. He served in the army without disciplinary action. Married since 21, has two children. He lives with his mother, wife and children. Marital relations are complicated by the patient's drunkenness, but during periods of abstinence from drinking alcohol, they quickly improve. The home environment is also complicated by the mother’s mental illness, periodic deterioration of her condition, and a constant hostile attitude towards her daughter-in-law. Spouses evaluate their marriage as “strong enough”; there were no situations on the verge of a divorce. The patient works as a car mechanic; he is not satisfied with his real job due to low pay and heavy workloads. Denies any hobbies, "work and housework take up all the time." Past diseases - rare colds, pneumonia. Premorbidly seems to be a person without a pathology of character - quite sociable, prone to rivalry, leadership.

Medical history.

Occasional alcohol consumption - from the age of 17 with a rapid transition to a systematic drinking regimen. From the age of 18 he drank alcohol almost daily in small doses in companies, traditional, hedonistic motives dominated. From the age of 21, a loss of the protective emetic reflex and situational-quantitative control were noted. AAS has been formed since the age of 25 in the form of somatovegetative and neurological disorders: increase in blood pressure to 190/100 mm Hg, tremor of the fingers, sensitivity disorders (numbness of the left half of the body was noted). Alcoholized in the form of pseudo bouts lasting 1-2 weeks with sobriety breaks of about 2 weeks, tolerance of 1 liter of vodka. In the last 5 years, a decrease in tolerance to 0.5 l of vodka, amnestic forms of intoxication were noted. In a state of intoxication, no manifestations of increased irritability were noted. In 2000, he refrained from drinking alcohol for 7 months after the troubles associated with drinking. Over the past year, there has been an increase in the manifestations of AAS, decreased performance, and passivity. Ataraktic, hedonistic motives for drinking alcohol dominated - to reduce internal stress, anxiety and anxiety, increase strength and energy, achieve pleasant relaxation, pleasure. He applied for medical help for the first time.

He entered the department in a state of acute alcohol withdrawal after a 5-day binge. The patient complained of headaches, general weakness, difficulty falling asleep due to restless thoughts, a pronounced attraction to alcohol, and forgetfulness. There was increased anxiety, tension, an almost constant attraction to alcohol of an obsessive nature, intensifying in the evening (persistent memories, vivid and strongly attracting ideas about drinking with elements of internal struggle, counteraction), tremor of fingers, hyperhidrosis. The criticism of the disease was partial - the patient admitted that he was sick, but classified only part of the disorders and problems as painful, justifying drunkenness with various provocative moments. The attitude to sobriety seemed formal - when declaring the need to lead a sober life, there was no serious deliberation of the problem and understanding of its role in solving it.

Somato-neurological status: Tremor of the fingers. A slight stagger in the Romberg pose. Tendon and periosteal reflexes are symmetrical. Pathological reflexes are not detected. Facial skin is hyperemic. In the lungs, vesicular breathing. Heart sounds are rhythmic. Pulse 92 beats. in minutes The abdomen is soft, painless on palpation. The liver is not enlarged. Dynamics of blood pressure 150 / 100-140 / 100-140 / 90-125 / 85 mm Hg

Survey data: an. blood clinic: hemog - 140 g / l; er-4.7 · 10 ¹² / l; col.pop - 0.89; lake -14.3 · 10 ⁹ / l; fallen 10; Seg - 53; eos - 3; lymph - 26; mon - 8; ESR - 6 mm / hour. An. blood dynamics: ACT - 0.085 - 0.085 μmol / s.l; ALT - 0.284 - 0.104 μmol / s.l; bilirubin - 20.1 - 14.8; glucose - 4.8 - 5.0 mmol / l. An. blood on Hbs - antigen - not detected. An. urine: protein - 0; glucose - 0; white blood cells - single in sight; salts - oxalates in a small amount. An. to AIDS, Wassermann reaction - negative. An. for diphtheria, intestines. column - neg. ECG: a variant of the norm.

EEG: Diffuse changes in the bioelectrical activity of the brain, indicating the instability of the functional state of neurons in the cerebral cortex and the presence of irritation throughout the convex surface. Local changes in the type of irritation in the deep brain structures of the right hemisphere in the projection of the frontal and temporal regions, manifested during functional load (hyperventilation) with paroxysmal-like changes in activity involving the brain stem pathology at the mesodiencephalic level.

Diagnosis: Alcohol addiction. Severely progressive course.

Pseudoblastic form.

Complication: Alcoholic hepatosis.

Treatment: during the period of acute withdrawal - intravenous administration of magnesium sulfate 25% - 10; potassium chloride 4% - 10; Vit. In 65% - 3.0; Mildronate - 5.0; phenazepam 0.1% - 2.0; chlorpromazine 2.5% - 2.0 IM at night. Subsequently, treatment was carried out: sonapax - 0.075 per day; Trichopolum - 0.75 per day .; glutamic acid - 0.75; pyroxan - 0.09 per day; Vit. B12, B1, mildronate, glycine.

Against the background of treatment, manifestations of anxiety and internal tension were somewhat reduced, but episodic attraction to alcohol of an obsessive nature, dreams of alcohol content remained; asthenic disorders - headaches, fatigue, difficulty falling asleep; vegetative disturbances in the form of hand tremor, episodic tachycardia (92-96 beats per minute), sad mood, cloudy appearance, slight irritability. But when discussing alcoholic issues, emotional and facial expressions, redness of the skin of the face were observed.

Total score +3. The forecast seems uncertain. Decision made: extension of inpatient treatment is necessary, correction in therapy in order to overcome the therapeutic resistance of PVA syndrome.

An immunological study was conducted on the sensitization of immunocytes to brain antigens with the result: protein S-100 - 0.65 IA / norm 0.7 - 1.33 /; membranous antigen 0.77; basic myelin protein - 0.63; galactocerebrosides - 0.85.

In connection with the violation of the immune response to the S-100 protein and the main myelin protein, treatment with the following preparations is prescribed: proproten - 100: 1 tab. in a day; antioxidant complex - lipovitam-beta - 3 tab. in a day. Sonapax - canceled with a gradual decrease in dose. Assigned prodep - 40 mg in the morning; finlepsin - 300 mg / day; Cavinton - 3 tab. in a day; Esperal 0.5 per day.

Against the background of treatment with the indicated drugs, the mood improved, anxiety and internal tension, manifestations of craving for alcohol (only observed in provocative situations) were reduced, and sleep was normalized. The patient with greater self-confidence and optimism assessed the prospects for the future, expressed a convincing attitude to sobriety.

Total score: + 24. The forecast in terms of likelihood of maintaining sobriety is positive. A decision was made on discharge with recommendations for maintenance treatment: prodep - 20 mg / day; proprotin 1 tablet / day; lipovitam-beta - 3 tab. in a day.

A method for predicting the duration of remission in patients with alcohol dependence was developed and tested at the Research Psychoneurological Institute. V.M. Ankylosing spondylitis. The proposed method improves the accuracy of predicting the duration of remission in patients with alcohol dependence at the stage of formation of remission

Annex 1

QUANTITATIVE ASSESSMENT OF THE STRUCTURE AND DYNAMICS OF PATHOLOGICAL ATTRACTION TO ALCOHOL (PVA) IN PATIENTS WITH ALCOHOL DEPENDENCE

(modified version)

Assessment Glossary developed by N.V. Cherednichenko and V.B. Altshuler (1992), somewhat modified by employees of the Institute. V.M. Ankylosing spondylitis, used for dynamic monitoring of patients with alcohol dependence in remission

Quantification of the affective component

(absence of emotional disorders 0 points)

1 Subdepressive condition

a) Cloudy appearance, sad mood, reticence ... 1 point

b) Slowness. Fixation on life's hardships, own failures, resentment. Ranimost ... 2 points

c) Depression, complaints of bad mood, reduced self-esteem, pessimism ... 3 points

2 Alarm

a) Concern over various specific issues ... 1 point

b) Gloomy forebodings, frightening uncertainty of the future, self-doubt ... 2 points

c) The intense expectation of an impending breakdown. Feeling helpless. He finds no place, restless, restless, annoying ... 3 points

3. Emotional lability

a) Tears and clouding only when discussing issues unpleasant for the patient, mood swings are insignificant and short-lived ... 1 point

b) Excitement and tears throughout the conversation and some time after it ... 2 points

c) Touchiness, moodiness, tearfulness all day long ... 3 points

4 Dysphoria

a) Discontent, grouchy, gloomy, gloomy mood ... 1 point

b) Tension, irritability, a feeling of internal discomfort, a feeling of depression ... 2 points

c) Depression, tension, explosiveness, aggressiveness ... 3 points

5 Euphoria

a) Feeling of complacency, complacency ... 1 point

b) A joking tone in communication, lightness of judgment, ease of perception of life and your problems ... 2 points

c) Carelessness, distraction, arrogance, unjustified optimism ... 3 points

6. Apathy

a) "Automatic", "mechanical" performance of their affairs, duties, attitude to them as a necessary necessity. Passivity, lack of initiative ... 1 point

b) Complaints of boredom, monotony of life. Avoids communication, any activity due to lack of interest ... 2 points

c) Indifference to the environment, to oneself. The statement that “nothing interests, nothing wants. Unwillingness to do anything. The desire to stay in bed. He ceases to monitor himself, becomes sloppy ... 3 points

Note 1

A feature of affective disorders in alcohol dependence is their combined nature - a combination of various affective radicals, emotional ambivalence and lability. In clinical practice, with exacerbation of PVA, it is often necessary to deal with mixed conditions, including anxiety, subdepression, irritability (sometimes against the background of euphoria), apathy. Therefore, in our study, a scoring of emotional disorders corresponds to the maximum degree of severity of any dominant radical in the indicated spectrum and varies from 0 (absence of emotional disorders) to 3 points (maximum severity).

Quantification of the vegetative component of PVA syndrome

(lack of vegetative manifestations of PVA ... 0 points)

1. Mimic reactions

a) The revival of mimic reactions, emotional revitalization when discussing alcohol topics ... 1 point

b) Eye gloss, blanching or redness of the face when discussing alcohol topics ... 2 points

c) Hypersalivation, the occurrence of swallowing movements when discussing alcohol topics ... 3 points

2. Alcoholic dreams, sleep disturbances

a) A calm statement of a dream with an alcoholic theme, there may be difficulties in reproducing it ... 1 point

b) A vivid alcoholic dream that leaves a strong impression. The revival of facial expressions when reproducing the content of sleep ... 1 point

c) Superficial sleep, frequent awakenings. Bright, exciting alcoholic dreams ... 3 points

3 change in appetite

a) Instability of appetite ... 1 point

b) Persistent decrease or increase in appetite ... 2 points

c) Anorexia, bulimia. Thirst ... 3 points

Note 2

The vegetative component of PVA syndrome is associated with emotional disorders, since these areas have a close affinity. The scoring of autonomic disorders corresponds to the maximum degree of severity of any of the manifestations presented in the scale and varies from 0 (absence of vegetative disorders) to 3 points (maximum severity).

Quantification of the ideator component of PVA syndrome

(lack of ideative manifestations of PVA ... 0 points)

a) Occasionally appearing thoughts (memories) about alcohol ... 1 point

b) Frequent returns to thoughts of alcohol ... 2 points

c) Constant reflections on alcohol. Super value attitude to alcohol ... 3 points

Note 3

In our study, with a qualified assessment of the ideator component of PVA, we primarily evaluated the symptoms reflecting a direct relationship to alcohol (only this indicator was included in the integral score of the severity of the ideator component of PVA). Given that the attitude to the disease and treatment is determined, it is determined not only by attraction to alcohol, but also by the characteristics of the personal processing of various volumes and levels of information, the action of psychological defense mechanisms, and the symptoms reflecting the attitude to the disease and treatment were evaluated separately.

Quantification of the behavioral component of PVA syndrome

(lack of behavioral manifestations of PVA ... 0 points)

a) Savoring alcohol topics in conversations. Hyperactivity and troubles in trying to distract from thoughts about alcohol. Incompetence, forgetfulness, injustice, ardor, ostentatious pathos in condemning drunkenness ... 1 point

b) Fussiness, distraction, slow comprehension of issues, difficulty switching to other topics, instability and inconsistency in business, dissatisfaction with the regime of separation. Changing the circle of communication (communication with patients not configured for treatment) ... 2 points

c) Hostility, opposition to persons imposing sobriety. "Experiments" with alcohol, handling complaints of craving for alcohol. The desire to write out immediately ... 3 points

Claims (1)

A method for predicting remission in patients with alcohol dependence in the period of remission, which includes assessing the patient’s condition, characterized in that the patient’s condition is assessed during the first 3 months of sobriety, and the type of the course of the disease, personality deviations in premorbid, and constitutional-personality type are determined. a change in the nature of intoxication, the duration of therapeutic remissions in the past, spontaneous remissions in the past, the frequency of manifestations of a pathological attraction to alcohol (PVA), the nature of PVA, the severity of depression, dysphoria, internal tension, psychopathic disorders, psycho-organic disorders, asthenia, criticism of the disease, sobriety; the nature of personality changes in remission; sensitizing therapy; therapy with psychotropic drugs; the severity of the emotional, vegetative, ideative and behavioral components of PVA, each factor is evaluated using a prognostic coefficient according to the table and with the sum of the coefficients of all the signs that is equal to or exceeds +9, treatment is determined to be effective and a high probability of remission is predicted, with an amount equal to or less than -9 , treatment is estimated to be ineffective, and with values of (+9) - (-9), the prognosis is not clear.