RU2254571C1 - Method for differential diagnostics of depressive disorder and organic lesion of central nervous system in post-insult patients - Google Patents

Abstract

FIELD: medicine, psychiatry, neurology.

SUBSTANCE: one should evaluate psychic state in patients and detect the quantity of eosinophils, basophils and rod neutrophils in peripheral blood. At eosinophils ranged 1.97-2.52%, basophils 0.12-0.14%, rod neutrophils 0.64-0.91% it is possible to diagnose depressive state. At eosinophils being below 1.32%, basophils from 0.03% and less, rod neutrophils from 1.27 and higher one should diagnose organic lesion of central nervous system.

EFFECT: higher accuracy of differential diagnostics.

10 dwg, 1 tbl

Description

The invention relates to the field of medicine, psychiatry and neurology, specifically to methods for differential diagnosis of depressive disorder and organic damage to the central nervous system in post-stroke patients.

A known method for the differential diagnosis of depressive and psycho-organic syndromes in post-stroke patients, based on the clinical picture, which consists in collecting anamnestic and clinical signs and describing them in ICD10 (international classification) (8), according to which compliance F01-F01.9 is regarded as vascular dementia ; P-07 as an organic personality disorder, F-06 as an organic mental disorder, P-07.8 as a hemispheric organic affective disorder, F-07.9 as an organic psychosyndrome. If a gross violation of memory and mental activity, disorientation in time, space, the appearance of confabulations, delusional-hallucinatory syndrome, emotional disorders are detected, the severe course of vascular dementia is assessed. However, these methods are based on the treatment of clinical symptoms and signs. Due to the lack of sufficiently reliable and reliable criteria, differential diagnostic conclusions are possible with the wide involvement of information characterizing the course of the disease. However, in order to study classification issues in psychiatry, the logical connections of clinical symptoms corresponding to changes in various functional systems of the body and adequately reflecting neurophysiological and social factors are crucial. Thus, the differential diagnosis is difficult to distinguish between vascular dementia from senile dementia, depressive disorders from dementia. Differential diagnostic criteria are based on clinical signs, such as acute onset of the disease, uneven course of the disease, acute psychotic episodes (in particular, nightly). The basis of this condition is an atherosclerotic vascular process with secondary atrophy of the cerebral cortex. In the second case, only treatment with antidepressants with a good clinical effect can remove the diagnosis of dementia. Testing of patients from the group with organic damage to the central nervous system is impossible, and an adequate assessment of the psychopathological condition depends largely on the subjective factor (the knowledge of the doctor).

A new technical problem is to increase the accuracy and information content of the method.

The problem is solved by new methods of differential diagnosis of depressive disorder and organic lesions of the central nervous system in post-stroke patients, consisting in assessing the mental state, according to the International Classification of Diseases of the 10th revision, and in addition, the number of eosinophils, basophils and stab neutrophils in the peripheral blood and the number eosinophils from 1.97 to 2.52, basophils 0.12 to 0.14, stab neutrophils from 0.64 to 0.91 diagnose depressive disorder, and when the number of eosinophils is less than 1.32, basophils from 0.03 or less, stab neutrophils from 1.27 and higher, an organic lesion of the central nervous system is diagnosed.

The method is as follows. At the patient’s admission, in addition to clinical neurological examination and assessment of the state of the mental sphere, according to the International Classification of Diseases 10 revision (ICD-10) (8), peripheral blood is also taken, followed by the count of leukocytes, lymphocytes, eosinophils, basophils, stab and segmented neutrophils and with the number of eosinophils from 1.97 to 2.52, basophils 0.12 to 0.14, stab neutrophils from 0.64 to 0.91, depressive disorder is diagnosed, and with the number of eosinophils less than 1.32, basophils from 0.03 and me her, stab neutrophils from 1.27 and above are diagnosed with an organic lesion of the central nervous system.

These criteria were selected based on the study of clinical material, observation of 421 patients, among whom there were 186 men and 235 women. The average age is 61.5 years. Patients were combined in 4 groups: control (K), with depressive disorders (DR), with organic lesions of the central nervous system of vascular origin with psychotic manifestations (P), lethal group (L).

The control group (K) consisted of patients without psychopathological manifestations - 139 people (men - 66, women - 73). The average age is 57 years.

Patients with depressive disorders (D) were observed 195 people. The average age was 58.3 years. Depressive disorders were evaluated in accordance with the ICD-10 criteria [4] and specified using the Beck Depression Self-Assessment Scale [1]. Patients with a mild and moderate depressive episode predominated - 179 patients (women - 105, men - 74).

There were 37 patients with organic damage to the central nervous system with psychotic manifestations (20 women, 17 men). The average age in this group is 65.5 years. Patients with damage to the right hemisphere prevailed - 21 people.

There were 50 people who died in the acute period from ischemic and hemorrhagic stroke (25 women and men each); they entered the lethal group. The average age was 65 years.

Assessment of white blood parameters was carried out in accordance with the normative indicators of a healthy person [16].

Table 1 shows the average values of the indicators of white blood for the main groups of patients. K - control group, LDE - mild depressive episode, UDE - mild depressive episode, TDE - severe depressive episode, L - lethal group, P - organic damage to the central nervous system (CNS).

The study analyzed 4 groups: control (K), with depressive disorders (D), a group with an organic lesion of the central nervous system with psychotic manifestations (P) and a lethal group (L). Observations and some patterns of average values for groups for individual indicators are presented in FIG. 1-6.

As shown in FIG. 1, there is a clear tendency for leukocyte growth in a series according to the severity of patients, starting from the control group (K) and ending with the lethal (L) group. For the L-group, the content of leukocytes is higher than in the K-group, more than 2 times. There is a fairly significant difference between the groups.

As shown in FIG. 2, the average values of segmented neutrophils in the L group significantly (by 13% -15%) differ from all others in this parameter. The remaining groups are indistinguishable by average value. That is, only an extremely serious condition can be determined by this parameter

Figure 3 shows a significant increase in the average values of lymphocytes in the L-group (more than 2 times) compared with other groups. Groups K, D, P are indistinguishable among themselves.

Figure 4 shows the average content of basophils in the studied groups. There is also a clear trend, and each group is clearly distinguishable. By this parameter, one can clearly judge the severity of the patient: there is a depressive disorder or organic damage to the central nervous system or an extremely serious condition.

Figure 5 shows a clear trend for the growth of stab neutrophils depending on the severity, and their number for the L-group is more than for the K-group, about 20 times.

Figure 6 presents the average values of eosinophils in groups. There is a significant trend; the value of the indicator for the D-group is higher than that of the control, but there is a significant tendency to decrease this indicator with increasing severity.

Thus, the analysis of average values for various groups of different blood indices revealed some trends in the behavior of characteristics depending on the severity of the condition.

In FIG. 7 shows the average values for groups of different characteristics, standard deviations and confidence intervals at the level of 95% confidence.

The analysis of blood components, unfortunately, does not provide additional information regarding the characteristics of groups K, D and P, confidence intervals overlap quite strongly. Well, only the group A is always distinguished, sometimes the group P (Fig. 8).

Figures 9, 10 show confidence intervals of the mean values of eosinophils and lymphocytes. Only the lethal group and the group with an organic lesion of the central nervous system (CNS) are always well distinguished by these parameters.

Based on the analysis of observational data, the following conclusions could be drawn:

1. The absolute content of leukocytes is a good indicator by which one can judge the state of post-stroke patients. Their number increases with increasing severity of the condition of patients: with depressive disorder (6.51, confidence interval - 0.53 at the level of 95% reliability) and organic damage to the central nervous system with psychotic manifestations (7.8, confidence interval - 1.45) compared with a control group (5.59, confidence interval 0.397).

2. There is a decrease in the average values of basophilic neutrophils in the group of patients with depressive disorders (0.12, confidence interval - 0.11 at the level of 95% reliability) and organic damage to the central nervous system with psychotic manifestations (0.029, confidence interval - 0.058) compared with the control group (0.39, confidence interval 0.17).

3. There is a slight increase in the average values of eosinophilic neutrophils in patients with depressive disorders (2.23, a confidence interval of 0.55 at a 95% reliability level) compared with the control group (2.1, a confidence interval of 0.308).

4. There is a slight decrease in the average values of eosinophilic neutrophils in patients with organic damage to the central nervous system with psychotic manifestations (1.32, confidence interval 0.583) compared with the control group (2.1, confidence interval 0.308).

5. An increase in the average values of stab neutrophils was revealed in groups of patients with depressive disorders (0.75, confidence interval 0.33) and with organic damage to the central nervous system with psychotic manifestations (1.265, confidence interval 0.732) compared with the control group (0, 33, the confidence interval is 0.108).

6. Organic damage to the central nervous system with psychotic manifestations leads, apparently, to the "imbalance" of blood parameters.

7. Thus, the obtained criteria can be used for the differential diagnosis of depressive disorders and organic lesions of the central nervous system (CNS) in post-stroke patients, as well as for predicting the course of stroke.

From literary sources it is known that it is necessary to differentiate the severity of depressive disorders, psycho-organic conditions in order to obtain the most reliable information, which affects the appointment of adequate therapy. Our studies have shown that there is agreement with this opinion. Differentiate depressive disorders and organic damage to the central nervous system is necessary in the early stages, because "The elimination or reduction of psychopathological manifestations creates the prerequisites for the restoration of the social functioning of the patient" [9]. G. Selye’s teaching “on adaptive syndrome” had a great influence on various fields of knowledge [14]. At present, the study of the nature and applied aspects of the stress response has moved from laboratory experiments on animals to their wide research by representatives of various scientific disciplines as applied to a healthy and sick person [13]. A stroke is considered as a catastrophic reaction of the brain, stress, which has both physiological and psychological components. Adaptation reactions form in the central nervous system. Under the action of strong stimuli (stress reaction), a sharp excitation develops in the central nervous system, followed by transcendent inhibition. The literature describes the types of adaptive reactions, which are determined by the percentage of lymphocytes in the leukocyte formula and their ratio with segmented neutrophils [10], [7]. The remaining white blood cells and the total number of leukocytes are only additional signs of reactions. The position on the presence of an anxiety reaction with lymphopenia, eosinopenia, leukocytosis and neutrophilia remains unshakable. In the literature, we did not find data on the types of adaptive reactions in patients with depressive disorders and organic lesions of the central nervous system (CNS) of vascular origin.

The stress response is divided into two types: controlled and uncontrolled. In both cases, it affects the limbic system in the central nervous system, associated with the neuroendocrine subsystem "hypothalamus - pituitary - adrenal cortex." With an uncontrolled stress response, mental illness can develop due to impaired interaction of neurotransmitters [10]. Moreover, the value of subjective load plays a crucial role [12]. When considering stress as part of the stress response process (RPS), first an initial assessment takes place, which reflects the event in its impact on one's own personality, then an assessment over time associated with the recognition of individual overcoming opportunities with understanding of the situation. Following this is the process of overcoming (Coping). PSR is characterized by a constant feedback between the source of stress and the multiphase cognitive and emotional load assessment. This is important for the stability and integrity of the individual: if he manages to overcome the RPS on his own, there is a controlled RPS (kPSR), otherwise, an uncontrolled RPS (nPSR). For qPSR, the body has methods of overcoming that, together with adaptation processes, lead to optimal reaction mechanism efficiency [10], [12]. Uncontrolled stress is, in contrast, associated with a process that cannot be overcome by the body's own forces. According to Huether G. [11], at the same time, the state becomes labile, and the non-optimal behavioral mode is partially terminated. This process of destabilization is fraught with the danger of decompensation of the body, which is realized in the form of stress-induced diseases (psychosis, myocardial infarction, coronary heart disease). In patients who have had a stroke, complicated by organic damage to the central nervous system with psychopathological symptoms, we can talk about uncontrolled stress. It is important to differentiate this condition from an affective disorder, senile psychosis. After acute cerebrovascular accident, amnestic dementia syndrome with severe impaired memory such as fixative amnesia, severe disorientation and confabulation, the development of lacunar (postapoplectic) dementia with Korsakov-like syndrome is possible. Perhaps the development of "pseudo-paralytic" dementia with carelessness, euphoria, talkativeness, disinhibition of drives, lack of a sense of illness, a sharp decrease in criticism and level of judgment - with a relatively less pronounced memory impairment and orientation. The psychotic state is characterized by the presence of confusion, disorientation, delirious arousal, anxiety, periodic hallucinatory and delusional disorders [6]. Testing of patients from the group with organic damage to the central nervous system is impossible, and an adequate assessment of the psychopathological condition depends largely on the subjective factor (the knowledge of the doctor). In this regard, the identification of changes in the white blood cell count is an objective additional criterion. Thus, the proposed method allows you to most accurately assess the status of the patient due to the identified criteria.

Deviations of the parameters of white blood in patients with organic damage to the central nervous system with psychotic manifestations occupy an intermediate position between patients with depressive disorders and the lethal group. These changes indicate the presence of inferiority, the intensity of adaptive reactions. These data allow us to build rehabilitation programs for the category of post-stroke patients with depressive disorder and organic damage to the central nervous system (CNS) with psychotic manifestations. The most important point is the appointment of antiplatelet agents or indirect anticoagulants, angioprotectors, antihypoxants to prevent repeated strokes and prevent the progression of mental disorders, as well as small doses of antipsychotics, tranquilizers in order to stop psychopathological symptoms. Mandatory is the appointment of modern selective antidepressants to post-stroke patients with comorbid depressive disorders, as it has been shown that depressive disorders increase the risk of stroke. In addition, by assessing the white blood indices of post-stroke patients in dynamics, it is possible to predict the further course of the disease.

List of references.

1. Beck A. Cognitive Therapy and emotional disorders. - New York. - International University Press - 1976.

2. Bleuler E. Dementia praecox oder Gruppe der Schizophrenien. - In: Handbuch der Psychiatric / Ed. G. Auschaffenburg. - Leipzig. - Wien, 1911. - 420 S.

3. Shumakov V.M., Gindikin V.Ya., Ryashitova R.K. et al. // Violations of the nervous system and mental activity in somatic diseases. M., 1979, p. 406-409.

4. David O. Vibers, Valery Feigin, Robert D. Brown. Guide to cerebrovascular disease // Per. from English prof. V.L. Feigina. M .: CJSC Publishing House BINOM, 1999. -672 p.

5. Troshin VD, Gustov AV, Troshin OV, 2000. Acute cerebrovascular accident. Publishing house of the NGMA.- N.Novgorod, 2000 .-- 435 p.

6. Guide to psychiatry. T.2. / Ed. Acad. Academy of Medical Sciences of the USSR A.V. Snezhnevsky. M., 1983. S. 508.

7. Garkavi L.Kh., Kvakina E.B., Ukolova M.A. Adaptive reactions and body resistance. Publishing House of Rostov University, 1977 .-- 109 p.

8. International Classification of Diseases (10th revision) Classification of mental and behavioral disorders. / Per. into Russian edited by Yu.L. Nuller, S.Yu. Tsirkina. WHO Russia St. Petersburg Overlay 1994. - 285 p.

9. Vovin R.Ya., Sverdlov L.S. Psychopathological and psychological prerequisites for the choice of therapeutic tactics for endogenous psychoses / In the book. Pharmacotherapeutic basis for the rehabilitation of mental patients, ed. R.Ya. Vovina, G.-E. Kuehne. M .: "Medicine". -1989. S.63.

10. Heine X. Biology of stress. // Biological medicine. - 2000 - No. 7. - S.7-12.

11. Huether G., et al. Psychische Belastung und neuronale Plastizitat. In: Kropiuning U., Stacher A (Hrsg.) Ganzheitsmdiain und Psychoneuroimmunologie. Wien: Vierter Wiener Dialog, Facultas 1997.

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15. Selye H. The evolution of the stress concept-stress and cardiovascular disease. London, New York: Oxford University Press 1971.

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Table 1
Average values of white blood parameters for the main groups of patients Control (K) LDE UDE TDE Lethal (L) Organic damage to the central nervous system (P) Everything Segmented Eater. neutr.% 67.7 67.17 70.6 69.7 78.7 68.7 69.5 Lymphocytes,% 23.9 23.6 20.4 22.4 9.13 22.0 21.3 White blood cells × 10 ⁹ / L 5.59 6.45 6.82 6.11 12.5 7.85 7.01 Monocytes,% 5.54 5.58 5.92 4.82 5.19 6.23 5.57 Basophils,% 0.39 0.12 0.12 0.14 0.04 0.03 0.19 Band neutron.,% 0.33 0.64 0.83 0.91 6.26 1.27 1.28 Eosinophils,% 2.10 2.52 1.91 1.97 0.91 1.32 1.89

Claims (1)

A method for the differential diagnosis of depressive disorder and organic damage to the central nervous system in post-stroke patients, which consists in assessing the mental state, characterized in that the number of eosinophils, basophils and stab neutrophils is determined in the peripheral blood and with the number of eosinophils from 1.97 to 2.52% , basophils from 0.12 to 0.14%, stab neutrophils from 0.64 to 0.91% are diagnosed with depressive disorder, and when the number of eosinophils is less than 1.32%, basophils from 0.03% or less, fell of neutrophil neutrophils from 1.27% and above diagnose organic damage to the central nervous system.

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