RU2419383C1 - Method of diagnosing affective disorders in patients with ihd by data of encephalographic examination - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to functional diagnostics. Electroencephalographic examination is carried out and in case if synchronised alpha activity with frequency 8-12 Hz with high indices of power in all regions of brain, with maximum in occipital region is detected, prevailing of anxiety component in structure of afferent disorder is diagnosed. In case if maximal power of alpha activity is detected in frontal regions of brain in frequency range 8-12 Hz, prevailing of depressive component in structure of afferent disorder is diagnosed. In case if dominating alpha-rhythm with frequency 10-11 Hz is detected in parietooccipital regions and rhythm with frequency 7-8 Hz is registered in frontal-central and temporal regions, combination of anxiety and depressive components in affective disorder is diagnosed. ^ EFFECT: method extends arsenal of means for diagnosing affective disorders in patients with IHD. ^ 4 dwg, 2 ex

Description

The invention relates to medicine, namely to internal medicine, and can be used for quick and objective differential diagnosis of affective disorders in patients with coronary heart disease.

A.B.Smulevich in the monograph Depression in General Medical Practice (M .: Bereg. - 2000. - 160 p., P. 73-78) considers a method for diagnosing affective disorders in patients with somatic pathology, based on an analysis of the characteristics of the patient's complaints reflecting the symptom complexes of pathological affect. The author draws attention to the peculiarities of somatic complaints of patients with coronary heart disease in the presence of affective disorders: prolonged pain in the region of the heart, which differs from classical anginal pain due to the circumstances of occurrence (lack of connection with physical activity) and relief (nitrate inefficiency) in patients with coronary artery disease, rare cases accompanied by characteristic "ischemic" dynamics of the ECG.

However, the clinical picture of anxiety and depression includes a number of somatovegetative symptom complexes characteristic of both affective pathology and cardiovascular diseases (pallor and dry skin, sleep disturbances, dizziness, tachy- and bradycardia, increase or decrease in blood pressure, chest pain , dyspnea), which practically make it impossible to correctly determine the contribution of affective symptoms to the structure of the disease.

A number of authors, including Vasyuk Yu.A., Dovzhenko T.V. ("Diagnosis and treatment of depression in diseases of the cardiovascular system." M., 2006, 58 p., P.15-16), as well as A.B.Smulevich ("Depression in somatic and mental diseases", M. : Medical News Agency. - 2003. - 432 p., P. 328-350), they offer scales for diagnosing affective disorders that allow subjective (questionnaires, questionnaires or self-report scales filled out by the patient) and relatively objective methods (clinical rating scales) filled in by an expert observer) s appearance and rank them by severity. Each of these tools has its own limitations.

The use of relatively objective scales requires the participation of a qualified psychiatrist, which is almost impossible, given the high (according to various estimates from 31 to 78%) prevalence of affective disorders in patients with coronary heart disease, and therefore the need for quick and accurate diagnosis and treatment of such patients by cardiologists and general practitioners.

Tyschenko I.A. in the dissertation for the degree of candidate of medical sciences “Features of the course of the post-infarction period in elderly patients with chronic heart failure depending on the severity of affective disorders and their medical correction” (2008, 199 p., p. 159, 197) suggests using the Hospital anxiety scale and Depression (HADS) for screening affective disorders in patients with coronary heart disease. The scale is easy to apply and interpret the results. It is filled up by the patient. Interpretation of the results does not require special training in psychiatry.

But the scale is applicable only for screening of affective disorders and does not allow assessing the degree and depth of psychopathological disorders. The use of several subjective scales, reflecting the severity of separately disturbing and depressive symptoms to assess the degree and structure of affective disorders, is not only laborious and requires a sufficient amount of time to fill out, but also suggests the possible occurrence of filling artifacts, which further casts doubt on the reliability of the diagnosis.

The purpose of the invention is the development of a method for the rapid and objective diagnosis of affective disorders in patients with coronary heart disease.

In order to achieve a result of an objective assessment of the degree and depth of affective disorders, as well as the predominance of a component in the structure of psychopathological disorders, a patient with coronary artery disease undergoes a standard 10/20 electroencephalographic study at the MBN 20 electroencephalographic complex (Moscow). Assessment of the bioelectric activity of the brain is carried out visually, by methods of coherent analysis and spectral power analysis, which are performed by the standard computer program of the MBN 20 complex.

In the presence of affective disorders, the presence of an expansion of the alpha-rhythm representation zone has been established: in contrast to the normal representation of the alpha rhythm in the electroencephalogram leads, reflecting the potentials of the parieto-occipital areas: P3-A1, P4-A2, O1-Al, O2-A2. In the presence of affective disorders, the alpha rhythm is visualized in other leads: Fp1-Al, Fp2-A2, F3-A1, F4-A2, C3-A1, C4-A2, F7-A1, F8-A2, T3-A1, T4 -A2, T5-A1, T6-A2.

With the predominance of the anxiety component in the structure of affective disorders, the synchronized alpha activity of a high frequency of 8-12 Hz is noted on the electroencephalogram, while the alpha spectrum has a wide alpha peak with high power indices in all leads, with a maximum in the occipital O1-A1, O2- A2.

With the predominance of the depressive component in the structure of affective disorders in the power spectrogram, alpha activity occurs with the maximum projection zone in the anterior sections Fp1-Al, Fp2-A2, F3-A1, F4-A2, F7-A1, F8-A2.

In the case of affective disorders of a mixed nature, combining both the anxious and depressive components, we noted the presence of a two-modal alpha rhythm: in the parietal-occipital regions P3-A1, P4-A2, O1-A1, O2-A2 with a frequency of 10-11 Hz and in the fronto-central and temporal sections F3-A1, F4-A2, C3-A1, C4-A2, T3-A1, T4-A2, T5-A1, T6-A2 with a frequency of 7-8 Hz.

The proposed method for the diagnosis of affective disorders is easily feasible and reproducible, since for its use it is only necessary to conduct a standard 10/20 electroencephalographic study on an electroencephalographic complex, for example, MBN 20 (Moscow). The method was tested on 10 patients with coronary artery disease. The results are offered as illustrative clinical examples.

Clinical example 1.

Patient M-on E.I., 56 years old. Ischemic heart disease. Stable angina pectoris. FC II. NK 0-1. Disease experience 2 years.

Complaints: about pressing pains behind the sternum with moderate physical exertion (walking up to 300 m at an average pace), after psycho-emotional stress, accompanied by a feeling of fear, stopping at rest or within 2-5 minutes after taking nitroglycerin; sleep disturbances: difficulty falling asleep, frequent night awakenings; high anxiety, concerns about the aggravation of the condition; headaches, dizziness, irritability.

Objectively: Normostenik. Normal skin color, wet. NPV = 16 per minute. Pulse 68 per minute, satisfactory qualities. ADd = 135/85 mmHg ADs = 130/80 mmHg In the lungs - vesicular breathing. Heart sounds are rhythmic, sonorous. The abdomen is soft, painless. No swelling.

Constantly takes Thrombo-Ass 100 mg / day., Concor 5 mg / day., Liprimar 10 mg / day., Preductal MB 70 mg / day. Nitro-spray - on request.

General blood analysis. Hemoglobin 132 g / l, red blood cells 4.0 × 10 / l, CP 0.97, leukocytes 6.2 × 10 / l, stab 2%, segmented 66%, lymphocytes 24%, monocytes 7%, eosinophils 1%, ESR 10 mm / h - without pathology.

Blood chemistry. Total protein 68 g / l, blood glucose 4.8 g / l, urea 5.7 g / l, creatinine 0.065 mmol / l, blood α-amylase 5.0 mg, ALAT 138.00 nmol / s, ASAT 90, 00 nmol / s, free bilirubin 16.0 μmol, direct bilirubin - 0, total cholesterol 5.9 mmol / l, alpha-LP 1.0 mmol / l, beta-LP 4.4 mmol / l, atherogenic coefficient 4, 9 triglycerides 1.150 mmol / l - hypercholisterinemia, increased atherogenic coefficient.

General urine analysis. Straw yellow, transparent, relative density 1019, protein 0.033, flat epithelium 0-1 in the field of view, white blood cells 0-1 in the field of view, erythrocytes - 0.

ECG: heart rate of 67 per minute. Sinus rhythm, correct. The normal position of the EOS.

Holter ECG. Sinus rhythm. Single supraventricular extrasystoles. Submaximal heart rate achieved. Ischemic ST changes in heart rate corresponding to FC II.

Echo-KG: PV 58% Slight left ventricular hypertrophy with a slight disturbance in its relaxation, compaction of the walls of the ascending aorta.

The results of a psychometric study initially:

The hospital anxiety and depression scale - HADS: on the anxiety scale - 12 points, which corresponds to clinically expressed anxiety, on the depression scale - 8 points - subclinical depression.

Questionnaire for assessing the severity of Spilberger-Hanin's anxiety: situational anxiety - 51 - high anxiety, personal anxiety - 39 - moderate anxiety.

Questionnaire of the Center for Epidemiological Research to assess the severity of depression - CES-D-: 18 - mild depression.

Thus, this patient was diagnosed with an affective disorder with a pronounced anxiety component (Fig. 1).

In addition to the basic treatment of coronary artery disease, a selective anxiolytic, an anti-anxiety drug, Afobazole, was added at a dosage of 10 mg 3 times a day for 28 days.

The results of a psychometric study at the point of 28 days - after the use of anxiolytic:

Hospital scale of anxiety and depression - HADS: on the anxiety scale - 5 points - normal, on the depression scale - 6 points - normal.

Questionnaire for assessing the severity of Spilberger-Hanin's anxiety: situational anxiety - 29 points - low anxiety, personal anxiety - 32 points - low anxiety.

Questionnaire of the Center for Epidemiological Research to assess the severity of depression - CES-D: 17 points - normal.

Thus, in this patient after the use of anxiolytic there is no affective disorder (figure 2).

Clinical example 2.

Patient J. E.V., 57 years old. Ischemic heart disease. Stable angina pectoris. FC II. Arterial hypertension II, the risk of MTR 3. NK 1-2. Disease experience 3 years.

Complaints: about pressing pains behind the sternum with moderate physical exertion (walking up to 300 m at an average pace), after psycho-emotional stress, stopping at rest or within 2-5 minutes after taking nitroglycerin; insomnia, difficulty falling asleep, frequent night awakenings; headaches, dizziness, fatigue, weakness, irritability.

Objectively: Normostenik. Normal skin color, wet. NPV = 17 per minute. Pulse 58 in a minute, satisfactory qualities. ADd = 140/80 mm Hg ADs = 140/80 mmHg In the lungs - vesicular breathing. Heart sounds are rhythmic, sonorous. The abdomen is soft, painless. No swelling.

Constantly takes Thrombo-Ass 100 mg / day., Equator 1 tablet / day., Liprimar 10 mg / day., Preductal MB 70 mg / day., Nitromint - on demand.

General blood analysis. Hemoglobin 121 g / L, red blood cells 4.2 × 10 / L, CP 0.98, white blood cells 5.7 × 10 / L, stab 2%, segmented 64%, lymphocytes 26%, monocytes 8%, eosinophils 1%, ESR 12 mm / h - without pathology.

Blood chemistry. Total protein 68 g / l, blood glucose 3.9 g / l, urea 5.2 g / l, creatinine 0.067 mmol / l, blood α-amylase 4.3 mg, ALAT 128.00 nmol / s, ACAT 78, 00 nmol / s, free bilirubin 14.0 μmol, direct bilirubin - 0, total cholesterol 7.5 mmol / l - hypercholesterolemia.

General urine analysis. Straw yellow, transparent, relative density 1019, protein 0.033, flat epithelium 0-1 in the field of view, white blood cells 0-1 in the field of view, erythrocytes - 0.

ECG: heart rate of 58 per minute. Sinus rhythm, correct. The normal position of the EOS.

Holter ECG. Sinus rhythm. Supraventricular extrasystoles in a non-pathological amount. Ischemic ST changes in heart rate corresponding to FC II.

Echo-KG: PV 58%. Slight LV myocardial hypertrophy with a slight disturbance in its relaxation, slight dilatation of the LP.

The results of a psychometric study initially:

The hospital anxiety and depression scale - HADS: on the anxiety scale - 11 points - clinically expressed anxiety, on the depression scale - 12 points - clinically pronounced depression.

Questionnaire for assessing the severity of anxiety Spilberger-Hanin: situational anxiety - 35 points - moderate anxiety, personal anxiety - 34 points - moderate anxiety.

Questionnaire of the Center for Epidemiological Research to assess the severity of depression - CES-D: 28 points - moderate depression.

Thus, in this patient is diagnosed with mixed affective disorder with severe anxiety and depressive components (figure 3).

In addition to the basic therapy of coronary heart disease, the antidepressant Pyrazidol, which has both antidepressant and anxiolytic activity, was prescribed in a dosage of 50 mg 2 times a day for 28 days.

The results of a psychometric study at 28 days after the use of pyrazidol:

Hospital scale of anxiety and depression - HADS: on the anxiety scale - 6 points - normal, on the depression scale - 5 points - normal.

Questionnaire for assessing the severity of anxiety Spilberger-Hanin: situational anxiety - 28 points - low anxiety, personal anxiety - 26 points - low anxiety.

Questionnaire of the Center for Epidemiological Research to assess the severity of depression - CES-D: 16 points - normal.

Thus, in this patient after the use of anxiolytic there is no affective disorder (figure 4).

Thus, our proposed method for the differential diagnosis of affective disorders in patients with coronary artery disease consists in using the data of an electroencephalographic study conducted according to the standard 10/20 method on an electroencephalographic complex, for example, MBN 20, namely, analysis of the distribution of alpha activity. This examination allows you to objectively assess the severity and depth of mental disorders in patients with coronary artery disease, the predominance of a component in the structure of affective disorders, significantly saves the time needed to diagnose affective disorders associated with coronary artery disease, which will significantly increase the effectiveness of the treatment of patients with coronary artery disease and comorbid affective disorders.

Description to figures

Figure 1: Encephalogram patient M-EI, 56 years old with a diagnosis of CHD. Stable angina pectoris. FC II. NK 0-1. Disease experience 2 years - initially. Synchronized alpha activity of a high frequency of 8-12 Hz, a common alpha peak with high power in all leads, with a maximum in the occipital O1-A1, O2-A2, was recorded.

Figure 2. Encephalogram of the patient M-on E.I., 56 years old with a diagnosis of IHD. Stable angina pectoris. FC II. NK 0-1. Disease experience 2 years - at the point of 28 days - after the use of selective anxiolytic. Normal representation of alpha rhythm is recorded.

Figure 3. Encephalogram Patient J. E.V., 57 years old with a diagnosis of CHD. Stable angina pectoris. FC II. Arterial hypertension II, the risk of MTR 3. NK 1-2. Disease experience 3 years - initially. Two peaks of alpha activity were recorded: a peak of 8–10 Hz in the occipital region dominates and a peak of 7.5–8.5 Hz subdominates with a predominance in the anterior-central leads.

Figure 4. Encephalogram Patient J. E.V., 57 years old with a diagnosis of CHD. Stable angina pectoris. FC II. Arterial hypertension II, the risk of MTR 3. NK 1-2. Disease experience 3 years - at the point of 28 days - after the use of an antidepressant with anxiolytic activity. Normal representation of alpha rhythm is recorded.

Claims (1)

A method for diagnosing affective disorders in patients with coronary heart disease, characterized in that an electroencephalographic study is performed and when synchronized alpha activity is detected with a frequency of 8-12 Hz with high power indices in all areas of the brain, with a maximum in the occipital regions, the prevalence of afferent disorder in the structure is diagnosed disturbing component; when detecting the maximum power of alpha activity in the frontal areas of the brain in the frequency range of 8-12 Hz, the prevalence of the depressive component in the structure of the afferent disorder is diagnosed; when a dominant alpha rhythm with a frequency of 10-11 Hz in the parietal-occipital regions is detected and a rhythm with a frequency of 7-8 Hz in the fronto-central and temporal regions is detected, a combination of anxious and depressive components in an affective disorder is diagnosed.

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