RU2270001C1 - Method for correcting psychoautonomic disorders and dysfunctions of cardiochronotropic regulation in patients with psoriasis combined with chronic opisthorchiasis in residual period - Google Patents

Abstract

FIELD: medicine, dermatovenerology.

SUBSTANCE: about 6-12 mo after carrying out dehelminthization and during in-patient stage of psoriasis in case of anxiety-depressive syndrome one should prescribe coaxial per 12.5 mg twice daily for 30 d. Simultaneously, it is necessary to conduct three courses of acupuncture reflexotherapy for 7 d/each course. Five auricular points should be affected: AT 13, 34, 51, 55, 11 symmetrically from both sides at a 5-d-long interval. Before each course of acupuncture reflexotherapy it is necessary to perform a single impact upon the following corporal points: 20 VJ, 6 MC, 36 E, 6 RP, JI 4. The innovation suggested prolongs remission duration.

EFFECT: higher efficiency of correction.

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Description

The invention relates to the field of medicine, dermatovenerology and relates to methods for the correction of psychovegetative disorders and cardiac chronotropic regulation disorders in patients with psoriasis in combination with chronic opisthorchiasis in the residual period.

There is a method of treating psychosomatic disorders in patients with psoriasis, which consists in prescribing combined treatment with antidepressants in combination with one of the methods of electrical stimulation in the form of effects on the brain [1]. Thus, the author uses small doses of melipramine (75 mg per day) in combination with steam polarization therapy sessions.

However, the method proposed by the author is difficult for the patient psychologically, does not work with the anxiety-depressive syndrome, which is often found in patients with psoriasis in combination with chronic opisthorchiasis in the residual period.

A new technical result - increasing the effectiveness of treatment of psoriasis patients by reducing the number of complications and prolonging the period of remission, is achieved by using a new method for the correction of psychovegetative disorders in psoriasis patients in combination with chronic opisthorchiasis in the residual period, which consists in the appointment of a psychotropic drug in combination with a simultaneous effect on the nervous system the patient, and 6-12 months after deworming and in the stationary stage of psoriasis in the presence of anxiety -depressive syndrome appoint coaxil 12.5 mg 2 times a day for 30 days and at the same time conduct three courses of acupuncture for 7 days each at 5 auricular points (AT 13, 34, 51, 55, 100) symmetrically on both sides with a break of 5 days, and before each course of acupuncture, they produce a single exposure to corporal points (20VJ, 6MS, 36E, 6RP, JI4).

The method is as follows.

6-12 months after deworming in the case of exacerbation of psoriasis, the patient receives the following treatment of psoriasis on an outpatient basis: detoxification therapy (30% sodium thiosulfate solution 10 ml IV), antihistamine therapy (1 tablet traxyl once a day 7- 10 days), vitamin therapy (Centrum multivitamins, 1 capsule once a day for 30 days), sedatives (sibazon 1 tablet at night for 20 days). Outwardly: indifferent ointments and creams.

The patient also undergoes a general clinical examination (general blood test, general urinalysis, biochemical blood test), duodenal sounding or enzyme immunoassay for the diagnosis of opisthorchiasis, ultrasound examination, questionnaire: level of anxiety at the time of the study (reactive anxiety as a state at a certain moment) and personal anxiety ( as a stable human characteristic) was determined by the method of Ch.D. Spilberger in the modification of Yu.L. Khanin [2]; MMPI technique modified by F.B.Berezin et al. allowed to evaluate the characteristics of personality and the actual mental state of the studied [3]. For screening diagnostics and quantitative assessment of the severity of SVD, a questionnaire method was developed, developed and recommended for use by the All-Union Center for Vegetative Pathology [4]. The study of the autonomic regulation of the circulatory system, as well as the determination of the state of adaptability of the body, was carried out using the method of cardiointervalography (CIT), based on a mathematical analysis of heart rhythm. The methodology for performing cardiointervalography consisted in recording 100 cardiointervals after 15 minutes of resting in a prone position [5]. Investigated vegetative tone [4].

In the presence of anxiety-depressive syndrome, the patient is prescribed acupuncture for 5 days at 5 auricular points (AT 13, 34, 51, 55, 100) symmetrically on both sides. For microneedles to work, periodically massage the dots. The needles are sealed with adhesive tape. Before each course of auricular acupuncture, a single exposure to corporal points is performed (20VJ, 6MS, 36E, 6RP, JI4).

To obtain the clinical effect, at least 3 similar seven-day courses are carried out with a break of 5 days. At the same time, the patient receives coaxil 12.5 mg 2 times a day for 30 days.

Coaxil (tianeptine) is a new tricyclic antidepressant. It has a timoleptic and anxiolytic effect, improves sleep structure. They are used for depressive states of various etiologies: neurotic and reactive in nature, anxiety-depressive states (including somatic diseases) [6].

The proposed treatment regimen, doses of drugs, the sequence and mode of their use are selected on the basis of clinical observations of 11 patients.

The combination of acupuncture with drug therapy can reduce the dose of the drug, which is important for this category of patients. The acupuncture reflexology scheme has also been optimized; the minimum number of points has been taken to obtain a stable clinical effect, which is expressed in a decrease in the symptoms of anxiety and depression in this category of patients. The use of these points allows for vegetotropic and cardiochronotropic effects. The duration of the treatment course with microneedles of 7 days is necessary and sufficient for this category of patients. When conducting a course of less than 7 days, the effectiveness of treatment decreases, and lengthening the course of more than 7 days leads to side effects undesirable for patients with psoriasis. Conducting three courses with microneedles is necessary and sufficient for patients with psoriasis in combination with chronic opisthorchiasis to obtain a stable effect. Conducting a smaller number of courses reduces the effectiveness of treatment, and conducting a larger number of courses leads to undesirable side effects. A single exposure to corporal points before each course of acupuncture (20VJ, 6MS, 36E, 6RP, JI4) has an additional tonic effect. When choosing the points of acupuncture (auricular microigloreflexotherapy and corporal acupuncture) were guided by the recommendations given in the manuals Tabeyeva DM, 1982 [7], Hoang Bao Tiaou and La Quang Niep, 1988 [8], Stoyanovsky D.N., 1987 [9 ]. A break between the courses of acupuncture to assess the effectiveness of treatment at 5 days is necessary and sufficient for monitoring patients. A break of less than five days is not sufficient to assess the clinical effect, and more than 5 days is undesirable, as it can lead to a decrease in the effectiveness of treatment and the occurrence of undesirable side effects. The dose of coaxil 12.5 mg 2 times a day was selected based on the interpretation of clinical material. A dose of coaxil less than 12.5 mg 2 times a day is not effective, and a dose of more than 12.5 mg 2 times a day causes excessive drowsiness, which is undesirable for outpatient treatment of patients.

An example implementation of the method on the patient.

Patient T.A., 30 years old, went to the doctor of dermatologist OKVD with a diagnosis of Psoriasis, teardrop-plaque, progressive stage, common, autumn-winter.

He had psoriasis in the history for about 15 years, 8 months ago an effective treatment of chronic opisthorchiasis was carried out (deworming was carried out with the Populin drug (a positive decision to grant a patent for application No. 2002117852 dated 02.07.2002)).

However, the patient complains of a feeling of fear, anxiety, self-doubt and the outcome of the disease, apathy, sweating, palpitations, a feeling of heat, weakness, heaviness in the right hypochondrium, soreness in the left hypochondrium, nausea, bitterness in the mouth, impaired bowel movement in the form of diarrhea .

The last exacerbation of psoriasis appeared a month ago, after emotional and mental stress.

The patient was prescribed the following treatment of psoriasis according to the traditional scheme:

detoxification therapy (sodium thiosulfate 30% in 10 ml No. 10), antihistamines (traksil about 1 tablet 1 time per day for 10 days), vitamins (aevit 1 capsule 3 times a day for 30 days), sedatives (Novopassit 1 tablespoon) spoon 3 times a day for 20 days Outwardly: Unna cream.

An outpatient general clinical examination was performed: a general blood test, a general urinalysis, a biochemical blood test, an ultrasound scan, duodenal sounding, and a study of psycho-vegetative status.

In the general analysis of blood and urine without changes. A biochemical blood test is normal.

According to bile microscopy, no opisthorchis eggs were found. According to ultrasound data, the liver is not enlarged, the contour is smooth, the edge is sharp, the bile ducts are dense, with moderate amplification of echo signals, signs of chronic cholecystitis, cholangitis are detected. The gallbladder volume was significantly increased and amounted to 78 cm ³ (with a norm of 40-60 cm ³ ).

The examination revealed that the patient had a severity level of SVD - 29 points, an index of autonomic equilibrium - 121 conventional units, personal anxiety 49 points, reactive anxiety - 50 points, the likelihood of prevailing parasympathetic manifestations was 69%, the level of anxiety, depression in the second and the ninth MMPI scales - 67 and 59 T-points, respectively, quality of life - 2.9 points, voltage index - 98 conventional units

Objectively: normosthenic physique. On the skin in the area of the scalp, elbows, knees, torso, the papules are pink-brown in color, merging into plaques, covered with silver-white scales, which are easily removed by scraping. The psoriatic triad is positive (the phenomenon of stearin stain, the phenomenon of psoriatic film, the phenomenon of pinpoint bleeding). The tongue is coated with white plaque. In the lungs and heart without pathology. The abdomen is soft, with palpation in the right and left hypochondria is moderately painful. Positive symptoms are Keri and Murphy.

Thus, the patient was diagnosed with Chronic non-calculous cholecystitis in the stage of moderate exacerbation. The residual period of chronic opisthorchiasis. Anxiety-depressive syndrome. Concomitant diagnosis: Psoriasis, teardrop-plaque, stationary stage, common, autumn-winter.

The patient decided to conduct a treatment course with microneedles according to the proposed method at 5 auricular points (AT 13, 34, 51, 55, 100) symmetrically on both sides for 7 days. Moreover, before each course of microigloreflexotherapy, they once exerted an effect on the corporal points (20VJ, 6MS, 36E, 6RP, JI4). To obtain a stable clinical effect, three similar courses were conducted with an interruption of 5 days. At the same time, the patient received coaxil 12.5 mg 2 times a day for 30 days.

In between courses, based on observations of the patient, a conclusion was drawn about the positive dynamics in the process of treatment.

After the treatment, the patient felt improvement. No complaints. According to ultrasound, the gallbladder volume was 56 cm ³ , which is the norm. So, the severity of SVD is 21 points, the index of autonomic equilibrium is 143 conventional units, personal anxiety is 39 points, reactive anxiety is 41 points, the likelihood of parasympathetic manifestations is prevailing is 61%, the level of anxiety, depression is 56 on the second and ninth scales MMPI and 53 T-points, the voltage index is 118 srvc. The skin process was in a regression stage.

Thus, 11 patients with psoriasis were treated after the effective deworming of chronic opisthorchiasis. Patients tolerated the treatment well, there were no side effects on this technique, the remission period increased to 1.5 years.

The results of the study are presented in the table.

As can be seen from the table, as a result of the treatment, the probability indicators of the prevalence of parasympathetic manifestations, the severity of SVD, personal and reactive anxiety, the second MMPI scale significantly decreased, and the indicators of quality of life, vegetative equilibrium index, and stress index significantly increased. In 5 patients, a decrease in the indicators of the ninth MMPI scale was noted, however, in the whole group, reliability was not obtained.

Thus, the proposed treatment regimen allows to achieve the desired positive effect, namely, to increase the effectiveness of treatment for patients with psoriasis, reduce the number of side effects caused by psychotropic drugs, and obtain a more pronounced and lasting therapeutic effect.

Table
Psychovegetative status before treatment and after treatment in the study group Indicators Before treatment (n = 11) After treatment (n = 11) Healthy (n = 20) The severity of SVD (points) 40.1 ± 0.76 33.65 ± 1.67 * 12.70 ± 0.08 The probability of prevalence of parasympathetic manifestations (%) 71.92 ± 1.83 64.11 ± 1.91 *** 49.32 ± 1.62 Index of vegetative equilibrium (conventional units) 125.2 ± 9.7 148.3 ± 11.7 * 200.1 ± 10.7 Personal anxiety (points) 50.2 ± 1.24 43.44 ± 1.07 *** 36.77 ± 1.27 Reactive anxiety (points) 50.1 ± 0.91 41.47 ± 1.41 *** 35.35 ± 1.27 Second MMPI scale (T-points) 68.8 ± 1.51 59.51 ± 1.79 *** 47.2 ± 1.2 Ninth MMPI scale (points) 57.09 ± 1.35 55.3 ± 1.07 53.3 ± 1.09 Voltage Index (arb) 102.7 ± 4.82 118.9 ± 3.91 * 124.1 ± 9.5 Quality of life (points) 3.45 ± 0.21 4.13 ± 0.16 * 0.26 ± 0.02 Note: the significance of the differences before and after treatment (* - p <0.05; ** - p <0.01; *** - p <0.001).

Bibliography

1. Bukreev V.I. Relief of psoriatic skin lesions in case of larvated depression // Journal of Neurology and Psychiatry. S.S. Korsakova. - No. 2. - T. 97. - 1997. - S. 49-50.

2. Khanin Yu.L. A brief guide to the use of the reactive and personal anxiety scale of Ch.D. Spilberger. - L .: LNIITEK, 1976 .-- 5 p.

3. Berezin FB, Miroshnikov MP, Rozhanets R.V. Methodology of multilateral personality research (in clinical medicine and psychohygiene). - M .: Medicine, 1976. - 176 p.

4. Vegetative disorders: clinic, treatment, diagnosis // Ed. A.M. Wayne. - M.: Medical News Agency, 1998. - 752 p.

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6. Mashkovsky M.D. Medicines - M .: New wave, 2001. - Volume 1. - P.107.

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Claims (1)

A method for the correction of psycho-vegetative disorders in patients with psoriasis in combination with chronic opisthorchiasis in the residual period, which consists in the appointment of 6-12 months after deworming and in the stationary stage of psoriasis in the presence of anxiety-depressive psychotropic drug syndrome in combination with three courses of acupuncture with effects on auricular point AT 55, characterized in that coaxil receive 12.5 mg 2 times a day for 30 days, and each of the three courses of acupuncture is carried out in within 7 days, additionally affect 4 auricular points АТ13, АТ34, АТ51, AT100 symmetrically on both sides with a 5-day interval, and before each course of acupuncture, they conduct a single exposure on corporal points 20VJ, 6MS, 36E, 6RP, 4JI.