RU2302242C1 - Method for correcting the disorders of psychoemotional status in patients with celiac disease - Google Patents

Abstract

FIELD: medicine, gastroenterology.

SUBSTANCE: at the background of aglutenic diet and complex therapy including antisecretory, antibacterial and enzymatic preparations one should introduce biologically active additives "Normoflorin Lacto" per 20 ml twice daily and "Normoflorin Bifido" per 20 ml once daily for the period of 28-30 d. The innovation enables to efficiently correct psychoemotional status in such category of patients due to simplifying the method of therapy at excluding side effects associated with applying psychotropic preparations.

EFFECT: higher efficiency of correction.

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Description

The invention relates to medicine, namely to gastroenterology, and can be used in the treatment of patients with celiac disease for the correction of disorders of psychoemotional status.

Celiac disease is a chronic progressive disease characterized by diffuse atrophy of the mucous membrane of the small intestine, which develops as a result of intolerance to the gluten protein of cereals. The high incidence of celiac disease in the population is now associated with an increase in the gluten content in the grain as a result of selection for the cultivation of new varieties of cereal crops.

The classic clinical picture of celiac disease is characterized by malabsorption in the small intestine, which is manifested by steatorrhea, diarrhea, polyfecalia, hypoproteinemia and weight loss (in severe cases, to the extent of cachexia).

Pathogenetic therapy of celiac disease includes dietary treatment, which consists in strict adherence to the gluten-free diet and symptomatic treatment (A.S. Loginov, A.I. Parfenov. Intestinal diseases. M: Medicine, 2000. P. 40 .; A.S. Loginov , A.I. Parfyonov, Ekisenina N.I., and others // Gluten enteropathy. - M .: Medicine, 1998. 67 .; A.I. Parfyonov, L.M. Krums, S.G. Zhukova / /. Rehabilitation of patients with celiac enteropathy // Russian Journal of Gastroenterology, Hepatology, Coloproctology. - 1997. - T.7, No. 4. - P.59-63 .; Revnova M.O. Celiac disease // Russian Bulletin of Perinatologists and pediatrics. - 1998. - T.41, No. 2. - P.63-65; Revnova M.O. Celiac disease: Methodological recommendations. - St. Petersburg: Pediatric Medical Academy, 1998; Revnova M.O., Lyle X .B. Clinical aspects of celiac disease in children // Pediatrics. - 2000. - No. 5. - P.107-110. A lifetime diet with the complete exception of all products containing gluten of barley, oats, wheat, rye, remains the main treatment method, but does not lead to a complete cure and requires strong-willed efforts from the patient. The need to follow a diet, the fear of breaking it, the patient’s subjective assessment of himself as a chronic patient, a reassessment of the severity of the disease, a low assessment of the prospects lead to worsening symptoms of the disease and the development of changes in the psycho-emotional sphere.

The traditional treatment of disorders of the psychoemotional status in patients with celiac disease is the use of psychotherapy and psychotropic drugs: tranquilizers, antipsychotics, antidepressants (amitriptyline, coaxil, cipramil, betamax). (Veltishev D.Yu. Diverse Egonil // Russian Medical Journal. - 2001. - No. 25 (144). - S.1197-1201; F.I. Komarov, S.I. Rapoport, S.V. Ivanov, etc. Treatment with sulpiride in patients with irritable bowel syndrome // Clinical Medicine. - 2000. - T.78, No. 7. - 22-26; Simanenkov VI, Poroshina EG. Use of the antidepressant Trittiko in patients with IBS // Experimental and clinical gastroenterology. - 2000. - No. 1. - p.163; Reshetova TV // Psychopharmacology for a general practitioner. Guidelines for doctors. 2004. - p.59).

As a prototype for the achieved effect, we have chosen a method for correcting disorders of the psychoemotional status in patients with celiac disease using a psychotropic drug from the group of antidepressants of the betamax drug. (Reshetova T.V. // Psychopharmacology for a general practitioner. Guidelines for doctors. 2004. - p. 59).

The disadvantages of the currently existing methods for the correction of psychoemotional status disorders in patients with celiac disease, including the prototype method, include: the need for special training of medical personnel in the field of psychodiagnostics and psychopharmacocorrection, increased time spent on the selection of drugs and monitoring their use, availability a large number of side effects, such as sedation, the development of psychological dependence, tolerance, withdrawal syndrome, and others, including and some types of professional activities (drowsiness, tremor, impaired articulation, nausea, vomiting, sleep disturbance, dizziness, headache, fainting, respiratory discomfort). (A.T. Burbello, A.V. Shabrov, P.P. Denisenko // Modern medicines. Clinical and pharmacological reference book of a doctor. 2003. - p.862 St. Petersburg). The use of traditional psychotropic drugs in patients with celiac disease is often limited by the inability to predict the further course of the disease during their use. Due to the reaction of altered enterocytes to the components of capsules and tablets, not only symptoms of intestinal dyspepsia, but also extraintestinal manifestations of celiac disease, such as skin lesions and allergic manifestations, may be aggravated.

The task of the invention is to improve the correction of psychoemotional status in patients with celiac disease by simplifying the method of therapy and eliminating side effects associated with the use of psychotropic drugs.

The problem is solved by the appointment of a biologically active additive (BAA) "Normoflorin Lacto" 20 ml 2 times a day and "Normoflorin Bifido" 20 ml 1 time per day for 28-30 days against a gluten-free diet and complex treatment, including antisecretory, antibacterial and enzyme preparations.

Normoflorins L (Lacto) B (Bifido) are dietary supplements for food (TU 9229-002-18840410-05 Certificate of State Registration No. 77.99.23.3. U.11144.10.05 of 05.10.2005).

Normoflorins are designed to normalize the flora in acute and chronic diseases of the gastrointestinal tract with the phenomena of dysbiosis, are used for dysbiosis, lactase deficiency, as well as in the treatment of allergic diseases, have detoxification ability, and have an immunomodulating effect.

Normoflorins L (Lacto) B (Bifido) - a new generation of liquid complex synbiotic drugs manufactured by Bifilyuks LLC (Moscow). This drug is a liquid complex, which is the main link in biofitocorrection. In addition to microorganisms, it contains substances and compounds that stimulate the growth and reproduction of its own obligate microflora, and affects metabolic processes in the body. Liquid forms of normoflorins destroy, neutralize pathogenic microflora, stimulate the growth of normoflora and the production of secretory immunoglobulins, increase intestinal motility, and facilitate the rapid evacuation of pathogenic microbes and their toxins from the human body. Normoflorin-Bifido is prepared on the basis of strains of bifidobacteria B.bifidum, B.longum; Normoflorin-Lacto - strains of lactobacilli L.acidophilus, L.planfarum.

Liquid synbiotics Normoflorins have two active principles: active living cells of lactobacilli and bifidobacteria and a balanced composition of probiotic substances necessary for physiological processes, maintaining homeostasis of the body (vitamins: B1, B2, B3, B6, B12, H, PP, C, E; trace elements: Fe, Ca, K, Na, Zn, Mg, Cu; organic acids; essential and non-essential amino acids; glycoprotein complex, which is part of the bacterial cell wall; enzymes). All components are of natural origin, do not contain preservatives, dyes, taste adapters. Normoflorins are prepared on a milk hydrolyzate containing residual milk proteins. In the process of preparation of drugs, proteins are converted into oligopeptides, dipeptides and amino acids. In addition, they are low-lactose products containing from 0 to 3% lactose, so they are suitable for children and adults suffering from lactase deficiency.

The method is as follows.

Against the background of the gluten-free diet and complex treatment, including antisecretory drugs (omeprazole), antibacterial drugs (metronidazole), enzyme preparations (creon, mesim-forte), Normoflorin Lacto dietary supplement (BAA) is prescribed, 20 ml 2 times a day and "Normoflorin Bifido" 20 ml once a day for 28-30 days.

A significant distinguishing feature of the proposed method is the appointment of the biologically active additives "Normoflorin Lacto" 20 ml 2 times a day and "Normoflorin Bifido" 20 ml 1 time per day for 28-30 days to correct violations of the psychoemotional status in patients with celiac disease. The use of dietary supplements of Normoflorins in the present method will eliminate the side effects associated with the use of psychotropic drugs in the traditional treatment, as well as simplify the correction method.

The theoretical prerequisites for the development of this method was the discovery of the fact that microorganisms of the intestinal biocenosis are able to synthesize neurotransmitters and affect the psychoemotional characteristics of a person. From this it follows that the intestinal microflora, being the most numerous biocenosis of a macroorganism, can take part in the formation of the characterological characteristics of an individual. Thus, the assumption arose that it was possible to correct psychological disorders in the patient by improving the microflora of the gastrointestinal tract.

For the first time, we found that the use of the agent with the probiotic mechanism of action of Normoflorins positively affects the psychoemotional status of patients with celiac disease, improves overall health, mood, reduces levels of asthenic manifestations, neurotization, personal and reactive anxiety, and depression.

Method implementation examples

Example 1. Patient L., 43 years old, and / b No. 7483.

An examination prior to treatment revealed a neurotic level of 23; the level of depression on the Hamilton scale - 9.5; the level of personal anxiety on the Spielberger-Hanin scale is 49.8; the level of situational anxiety on the Spielberger-Hanin scale - 43.1; the level of asthenia on the subjective scale of assessment of asthenia (MFI) is 15.0. Surveyed L. received “Normoflorins Lacto” 20 ml 2 times a day and “Normoflorin Bifido” 20 ml 1 time per day for 28 days against the background of the gluten-free diet and complex treatment, including omeprazole, metronidazole, creon and mezim-forte 4 weeks after therapy with normoflorins, a significant positive dynamics of psychological research indicators was recorded: neurotic level - 9; depression level on the Hamilton scale - 6.8; level of personal anxiety on the Spilberger-Khanin scale - 45.8; level of situational anxiety STI on a scale of Spielberger-Hanin - 40.1, the level of fatigue of the subjective assessment of the scale of fatigue (MFI) - 6,1.

Example 2. Patient M., 31 years old, and / b No. 8239.

An examination prior to treatment revealed a neurotic level of 21.0; the level of depression on a scale on the Hamilton scale - 8.5; the level of personal anxiety on the Spielberger-Hanin scale is 47.8; the level of situational anxiety on the Spielberger-Hanin scale - 42.1; the level of asthenia on the subjective scale of assessment of asthenia (MFI) is 11.0. Surveyed L. received “Normoflorins Lacto” 20 ml 2 times a day and “Normoflorin Bifido” 20 ml 1 time per day for 30 days against the background of the gluten-free diet and complex treatment, including omeprazole, metronidazole, creon, mezim-forte 30 days after the treatment with normoflorins, a significant positive dynamics of psychological research indicators was recorded: the level of neurotization - 8.2; the level of depression on the Hamilton scale - 6.9; the level of personal anxiety on the Spilberger-Hanin scale - 46.1; the level of situational anxiety ty on the Spilberger-Hanin scale -40.8; asthenia level on the subjective asthenia rating scale (MFI) - 6.6.

Example 3. Patient K., 41 years old, and / b No. 593.

An examination prior to treatment revealed a level of neurotization - 22; the level of depression on the Hamilton scale - 10.5; the level of personal anxiety on the Spielberger-Hanin scale is 49.6; the level of situational anxiety on the Spielberger-Hanin scale - 43.5; the level of asthenia on the subjective scale of assessment of asthenia (MFI) is 15.2. Surveyed L. received “Normoflorins Lacto” 20 ml 2 times a day and “Normoflorin Bifido” 20 ml 1 time per day for 29 days against the background of the gluten-free diet and complex treatment, including omeprazole, metronidazole, creon and mezim-forte 29 days after normoflorin therapy, a significant positive dynamics of psychological research indicators was recorded: the level of neurotization - 8.5; the level of depression on the Hamilton scale - 6.8; the level of personal anxiety on the Spilberger-Khanin scale - 46.2; the level of situational anxiety spilberger-Hanin scale - 41.1; asthenia level on the subjective asthenia rating scale (MFI) - 5.4.

Example 4 (prototype method). Patient H., 42 years old, and / b No. 14730.

An examination prior to treatment revealed a level of neurotization - 23.1; the level of depression on the Hamilton scale - 10.5; the level of personal anxiety on the Spielberger-Hanin scale - 50.8; the level of situational anxiety on the Spielberger-Hanin scale - 48.1; the level of asthenia on the subjective scale of assessment of asthenia (MFI) is 15.0. Surveyed L. received Betamax antidepressant 100 mg per day, once in the evening for 28 days against a background of gluten-free diet and complex treatment, including omeprazole, metronidazole, creon, mesim-forte. 4 weeks after Betamax therapy, a significant positive dynamics of psychological research indicators was recorded: the level of neurotization - 8; the level of depression on the Hamilton scale - 5.4; the level of personal anxiety on the Spielberger-Hanin scale - 45.9; the level of situational anxiety on the Spielberger-Hanin scale - 38.1; the level of asthenia on the subjective scale of assessment of asthenia (MFI) - 6.1. The following side effects were identified during treatment: headache, dizziness, drowsiness, nausea, impaired coordination, sleep disturbance, orthostatic hypotension, and dry mouth.

Example 5 (prototype method). Patient A, 19 years old, and / b No. 405.

An examination prior to treatment revealed a neurotic level of -24.1; the level of depression on the Hamilton scale - 12.5; the level of personal anxiety on the Spielberger-Hanin scale - 54.8; the level of situational anxiety on the Spielberger-Hanin scale is 49.1; the level of asthenia on the subjective scale of assessment of asthenia (MFI) is 15.5. Surveyed L. received Betamax antidepressant 100 mg per day, once in the evening for 30 days against the background of the gluten-free diet and complex treatment, including omeprazole, metronidazole, creon and mesim-forte. 30 days after Betamax therapy, a significant positive dynamics of psychological research indicators was recorded: the level of neurotization - 7.2; the level of depression on the Hamilton scale - 7.4; the level of personal anxiety on the Spielberger-Hanin scale is 44.9; the level of situational anxiety on the Spielberger-Hanin scale is 40.1; the level of asthenia on the subjective scale of assessment of asthenia (MFI) is 8.1. The following side effects were identified during treatment: headache, dizziness, drowsiness, nausea, impaired coordination, sleep disturbance.

According to the claimed method and the prototype method, 50 people were examined, the ratio of men and women was 1: 1, the average age of the patients was 29 years.

Patients were divided by random sampling into two groups: the main group, which received Normoflorins L and B (30 people) as part of the complex therapy, and the comparison group, which received Betamax antidepressant (20 people). Both groups included patients with a comparable initial level of psychological disturbances to obtain more reliable results during therapy.

The study evaluated the level of neurotization (scale of the level of neurotization); Hamilton Depression Level level of personal anxiety on the Spielberger-Hanin scale; the level of situational anxiety on the Spielberger-Hanin scale; asthenia level according to the subjective asthenia rating scale (MFI) before and after treatment.

The main group.

In the study group, before treatment, 65% had a high level of neuroticism (19.8 ± 0.5), which indicated emotional excitability, anxiety, anxiety, fixation on somatic sensations, which forms a feeling of inferiority. Against the background of treatment with the use of Normoflorins, a decrease in the level of neurotization was noted in all patients (9.5 ± 1.4). Hamilton Depression Level - moderate degree of depression, depressive affect. During treatment with Normoflorins, indicators of the level of depression decreased from moderate to mild, in 19.5% - the absence of depression (table).

Before treatment, 80% of patients had a high level of personal and situational anxiety, which was evaluated on the Spilberger-Khanin scale. During therapy, indicators of levels of personal and situational anxiety decreased from a moderate to a mild degree of severity of changes (table).

The level of asthenia according to the subjective rating scale for asthenia (MFI 20). Prior to treatment, an increase in asthenia was observed in 100% of patients. With the use of Normoflorins, the indicators characterizing asthenia normalized (table).

Comparison group (prototype method)

In the comparison group before treatment, 67% of patients had a high level of personal and situational anxiety (20.8 ± 0.5), which indicated emotional excitability, anxiety, anxiety, fixation on somatic sensations, which forms a feeling of inferiority. Against the background of treatment with Betamax, a decrease in the level of neurotization was noted in all patients (9.1 ± 1.5). Hamilton Depression Level - moderate degree of depression, depressive affect. During the treatment of Betamax, the level of depression decreased from moderate to no depression (table).

Before treatment, 81% of patients had a high level of personal and situational anxiety, which was evaluated on the Spilberger-Khanin scale. During therapy, indicators of levels of personal and situational anxiety decreased from a moderate to a mild degree of severity of changes (table).

The level of asthenia was evaluated according to the subjective rating scale for asthenia (MFI 20). Before treatment, 98% of patients showed an increase in asthenia. With the use of Betamax, the indicators characterizing asthenia returned to normal (table).

The method simplifies treatment (Normoflorins can be prescribed without the help of a medical psychologist), is more physiological and pathogenetically justified.

The dynamics of indicators of psychoemotional status during treatment with a synbiotic Normoflorin (the claimed method) and Betamax (prototype method) Normoflorin Normoflorin Betamax Betamax Indicators Before treatment After Before treatment After Depression level 8.5 1.2 6.9 1.0 9.7 1.5 6.8 1.4 Level of personal anxiety 50.1 5.4 45.1 5.2 54.2 6.4 43.8 4.2 Reactive Anxiety Level 42.3 5.6 40.6 4.8 46.5 5.2 40.1 3.9 General asthenia 12.5 6.5 13.6 7.20 Physical asthenia 14.2 4.1 13.25 4.22 Activity reduction 12.10 5.1 11.8 4.2 Reduced motivation 10.8 3.2 10.74 3.21 Mental asthenia 11.05 9.2 11.51 8.63 Neurotic level 19.8 9.5 20.8 9.1

Claims (1)

A method for the correction of psychoemotional status disorders in patients with celiac disease, characterized in that the biologically active additives Normoflorin Lacto 20 ml 2 times a day and Normoflorin Bifido 20 ml 1 time per day for 28-30 days against the background of gluten diet and complex treatment, including antisecretory, antibacterial and enzyme preparations.