RU2350331C1 - Method of treatment of neurosis of obsessional conditions - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely to psychiatry, and can be used at treatment of patients with a neurosis of obsessional conditions. For this purpose within 20 days pharmacotherapy is performed, including Diazepamum introduction, Mexidol and Tymogene. Thus Tymogene is administered intramusculary in a dose of 0.1-0.125 mg once in two days in amount of 10 injections. Simultaneously with pharmacotherapy within the first 15 days hyperbaric oxygenation is performed.

EFFECT: method provides appreciable reduction of the undesirable effects arising owing to administration of benzodiazepine anxiolytics, namely muscle relaxing activity, and also prevents possibility of medicinal dependence to the given group of preparations.

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Description

The invention relates to medicine, namely to psychiatry, and can be used in the treatment of patients with a neurosis of obsessive states - this is a psychogenic disease that develops in individuals with an anxious-suspicious radical and is characterized by the appearance of various kinds of obsessions - obsessive thoughts, movements (tics), doubt, memory, account.

A known method for the treatment of neurosis of obsessive conditions, including conducting within 20 days of a therapeutic effect, including the introduction of a benzodiazepine anxiolytic, in particular diazepam, mexidol, thymogen. In this case, simultaneously with pharmacotherapy, for the first 15 days, hyperbaric oxygenation is carried out with an excess pressure of 0.8-1 atmospheres at a compression and decompression rate of 0.1 atmospheres per minute, an isopression period of 40 minutes, 1 time per day (Podsevatky V.G. Research the effectiveness of hyperbaric oxygenation and its combinations with drugs possessing stress-protective properties under experimental stress and in patients with neurosis. Dissertation of the doctor of medical sciences, Kazan, 2000, pp. 94-96, 150, 161, 223).

The clinical use of this group of drugs is limited by the occurrence of mental dependence, addiction, the development of sedative, hypnotic effects, and a decrease in psychophysical activity.

The technical result is to reduce unwanted effects, namely muscle relaxant activity and drug dependence in traditional treatment.

The essence is that in the method of treating neurosis of obsessive states, which consists in conducting pharmacotherapy for 20 days, including the administration of diazepam, mexidol and thymogen, at the same time hyperbaric oxygenation is carried out during the first 15 days, thymogen is administered intramuscularly at a dose of 0.1 -0.125 mg once every two days in the amount of 10 injections.

The method is as follows. From the first day of treatment, patients are prescribed intramuscularly diazepam as a benzodiazepine anxiolytic at a dose of 15-20 mg per day for 10 days. Then, with the same dose of diazepam, Mexidol is administered to patients: intravenously in a daily dose of 200-250 mg for the first 10 days, then at a dose of 100-125 mg for the next 10 days, thymogen at a dose of 0.1-0.125 mg intramuscularly 1 every 2 days, 10 injections. Simultaneously with pharmacotherapy, for the first 15 days of treatment, patients undergo hyperbaric oxygenation (HBO) in single chamber BLKS-3-01 (NPF "LAD", Russia) with an excess pressure of 0.8-1 atmosphere, with a compression and decompression rate of 0.1 atmospheres per minute, the period of isopression is 40 minutes. HBO sessions are carried out 1 time per day.

Clinical example. Patient N., 31 years old (medical history No. 1978), was admitted to the Mordovian Republican Psychiatric Hospital in the Saransk city district on June 17, 2006, under the direction of a psychiatrist with a diagnosis of neurosis of obsessive states. In the anamnesis: the disease arose in an anxious-suspicious person after a traumatic situation significant for the patient. The patient began to notice the appearance of obsessive thoughts about her worthlessness, bankruptcy, obsessive fears for the fate of her relatives; there was an obsessive desire to raise bright objects on the sidewalk (candy wrappers, cigarette boxes). During walks around the city there was an unmotivated desire to count all the objects encountered on the way (poles, windows, trees). At the same time, an independent desire to get rid of obsessive thoughts, accounts that the patient recognizes as alien and unpleasant, were unsuccessful. A similar clinic was observed for 2 months, it became difficult for the patient to do the usual housework, groundless fears for the fate of her relatives led to the fact that she stopped attending work and constantly controlled her loved ones.

Mental state at admission. Outwardly neat. Oriented correctly in all forms. Somewhat tense. Fixed on a traumatic situation. Emotionally labile. He actively asks for help in getting rid of obsessive thoughts, fears, counts. At the same time, he is afraid to go to the hospital, expressing fears that without her, something could happen to relatives. Notes sleep disturbance, loss of appetite until complete loss.

On examination. General blood test from 06/17/2006: hemoglobin 125 g / l, ESR - 10 mm / h, the total number of leukocytes - 7.1 × 10 ⁹ / l, eosinophils - 3, stab neutrophils - 6, segmented neutrophils - 59, lymphocytes - 30, monocytes - 2. General urine analysis - without pathology.

Immunogram from 06/17/2006: T-lymphocytes 64%, B-lymphocytes 6%, class M immunoglobulins 62 mg%, class G immunoglobulins 1115 mg%, class A immunoglobulins 103 mg%, neutrophil phagocytosis activity 39%, T-helper cells 34%, T-suppressors 3%, circulating immune complexes large 5 c.u., circulating immune complexes medium 27 c.u., circulating immune complexes small 118 c.u., neutrophil adhesion 8%, HCT test 1%, neutrophil activation index 0.05 cu, load index 5.7 cu, immunoregulatory index 11. Conclusion: Immunopathological condition. Hypoimmunoglobulinemia of class A, weakening of the functional activity of neutrophils, inhibition of oxygen-dependent neutrophil systems, an imbalance of T-subpopulations, an increase in circulating immune complexes of medium and low molecular weight, a decrease in the functioning of the immune system.

Hormonal status from 06/17/2006: thyroid-stimulating hormone 0.15 μMU / ml, T ₄ free 8.48 pmol / L, no antibodies to thyroglobulin were detected, cortisol 281.27 nmol / L.

Diagnosed with neurosis of obsessive states.

Prescribed treatment:

Sol. Diazepami 0.5% - 2 ml (10 mg).

D.S. Intramuscularly, 2 ml 2 times a day (daily dose of 20 mg) - 10 days.

Against the background of the treatment, the patient began to note muscle weakness, with her words her arms and legs became cottony, drowsiness, fatigue, detachment, and signs of drug dependence appeared - the patient required an increase in the dose and frequency of administration of diazepam.

In this connection, in addition to diazepam administered in the same dose, they added:

1. Sol. Mexidoli 5% - 2 ml (100 mg).

D.S. Intravenously, 2 ml dropwise per 400 ml of an isotonic 0.9% sodium chloride solution 2 times a day - 10 days (daily dose of 200 mg), then 2 ml once a day for another 10 days (daily dose of 100 mg).

2. Sol. Thymogeni 0.01% - 1 ml (0.1 mg).

D.S. Intramuscularly, 1 ml once every 2 days, 10 injections.

3. Hyperbaric oxygenation (HBO) with an overpressure of 0.8-1 atmosphere, at a compression and decompression rate of 0.1 atmospheres per minute, the isopression period is 40 minutes, 1 time per day for 15 days.

Positive dynamics was observed from the 3rd day of therapy, when a subjective improvement was noted in the form of normalization of the general mood background, improvement of appetite, and sleep restoration. By the 5-7th day of therapy, the obsessive count disappeared. On the 10-14th day of therapy, the frequency of occurrences of obsessive thoughts and fears became less frequent. After 20 days of treatment, a complete reduction in psychopathological symptoms was noted.

On examination. Complete blood count from 07/09/2006: hemoglobin 125 g / l, ESR - 4 mm / h, the total number of leukocytes - 6.2 × 10 ⁹ / l, eosinophils - 4, stab neutrophils - 1, segmented neutrophils - 57, lymphocytes - 35, monocytes - 3. General urine analysis - without pathology.

Immunogram from 06/14/2006: T-lymphocytes 72%, B-lymphocytes 8%, class M immunoglobulins 76 mg%, class G immunoglobulins 1100 mg%, class A immunoglobulins 125 mg%, neutrophil phagocytosis activity 64%, T-helper cells 55%, T-suppressors 14%, circulating immune complexes large 0 cu, circulating immune complexes medium 10 cu, circulating immune complexes small 16 cu, neutrophil adhesion 46%, HCT test 9%, neutrophil activation index 0.25 cu, load index 2.1 cu, immunoregulatory index 3.9.

Conclusion Compared to the immunogram of June 25, 2006, positive dynamics are observed: the functional activity of neutrophils has been restored, oxygen-dependent neutrophil systems have been activated, circulating immune complexes have decreased, and the system indicators - the load index and immunoregulatory index are normal. Class A hypoimmunoglobulinemia persists despite a tendency to normalize this indicator.

Hormonal status. Thyroid stimulating hormone 2.17 μIU / ml, T ₄ free 18.4 pmol / L, no antibodies to thyroglobulin were detected, cortisol 300.34 nmol / L.

07/10/06, the patient was discharged.

Mental state at discharge. Outwardly neat. Oriented correctly in all forms. Consistent, logical thinking. The general background of the mood is even. Discharged with recovery. The obsessions were completely reduced.

The effect of the treatment is positive. Consultation recommended after 3 months.

10/12/2006, when examining psychopathological disorders were not detected. The resumption of obsessions within 3 months was not observed.

Thus, in this clinical example, due to the use of thymogen in the claimed doses and under certain conditions, it is possible to achieve optimal neuroimmune dysfunction in case of compulsive neurosis, which in combination with mexidol and hyperbaric oxygenation is accompanied by a decrease in the frequency of development of the muscle relaxant effect of benzodiapine anxiolytics and drug dependence on them.

Claims (1)

A method for the treatment of neurosis of obsessive states, which consists in conducting pharmacotherapy for 20 days, including the administration of diazepam, mexidol and thymogen, simultaneously with which hyperbaric oxygenation is carried out during the first 15 days, characterized in that the thymogen is administered intramuscularly at a dose of 0.1-0.125 mg once every two days in the amount of 10 injections.