RU2523671C1 - Diagnostic technique for alexithymia in patients with chronic obstructive pulmonary disease complicated with chronic cor pulmonale - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used for diagnosing alexithymia in patients with chronic obstructive pulmonary disease (COPD) complicated with chronic cor pulmonale. That is ensured by evaluating clinical-anamnestic data, determining respiratory function, blood gas, and a patient's pulmonary hemodynamic status. An alexithymia value is calculated by the certain formula and used to state the presence or absence of alexithymia in the patient, or the presence of psychopathological borderline cases.

EFFECT: diagnosing alexithymia without using the known alexithymia scale leading to the higher clinical and preventive effectiveness and improved disease prognosis in the COPD patients.

2 ex

Description

The invention relates to medicine, namely to internal medicine, in particular to pulmonology, and can be used to diagnose alexithymia (AT) in patients with chronic obstructive pulmonary disease (COPD) complicated by chronic pulmonary heart (CHL), with the aim of a differentiated approach to the choice of treatment preventive measures [2, 4].

It is known that alexithymia in the case of its secondary origin against the background of chronic somatic pathology decreases the patients' adherence to treatment, quality of life and prognosis of the disease [1, 3]. In this connection, the problem of comorbidity of COPD and psychopathological disorders becomes extremely important [5, 6].

Diagnosis of alexithymia is carried out using the Toronto alexithymic scale (TAS), proposed by G. Taylor (1985) and adapted at the Psychoneurological Institute. V.M. Ankylosing spondylitis in 1987 [7]. The method consists in interpreting the answers obtained as a result of an individual questionnaire survey of patients. The presence of alexithymia or its absence is determined by the sum of the points scored. Patients who scored 74 points or more are considered as alexithymic individuals, less than 62 points are non-alexithymic, values in the range of 63-73 points are regarded as intermediate (borderline).

The known method has the following disadvantages:

1. For the diagnosis of alexithymia using the Toronto alexithymic scale, psychological examination skills are required.

2. For questioning patients, additional material costs are required, since special questionnaires are required.

3. It takes time for the patient to fill out the scale and his predisposition to testing.

4. It takes time for the doctor who conducts testing and interprets the results, especially this is difficult in an outpatient setting. The objective of the invention is to identify the psychosomatic characteristics - alexithymia to increase the effectiveness of therapeutic measures and improve the prognosis of the disease in patients with COPD.

The essence of the invention lies in the fact that a method for the diagnosis of alexithymia in patients with COPD complicated by HLS includes determining the duration of the disease (DZ) from the moment of diagnosis of COPD, smoking index (IR), partial pressure of oxygen of arterialized blood (pO ₂ ), forced expiratory volume for second (FEV _{1 of the} end-diastolic volume of the right ventricle (BWC RV) and the solution of the regression equation:

AT (points) = 106.5-0.04 × IR (pack / year) + 0.05 × BWW RV (ml) -0.76 × pO ₂ (mmHg) + 0.15 × FEV ₁ (% due) + 0.16 × DZ (years),

where AT is alexithymia, whose numerical value of 74 or more points allows diagnosing alexithymia, less than 62 points - the absence of alexithymia, indicators in the range of 63-73 points are considered borderline, indicating personal disintegration and an increase in psycho-emotional stress.

The method is as follows:

1. According to the results of the clinical and medical history examination, the duration of the disease (DZ) from the moment of diagnosis of COPD and the smoking index (IR) are determined.

2. The partial pressure of oxygen of arterialized blood (pO ₂ ) is determined.

3. The forced expiratory volume per second is determined (OFB ₁ ).

4. The end-diastolic volume of the right ventricle (BWC of the pancreas) is determined using data from an echodoplerocardiographic study, which is an obligatory standard for examining patients with COPD with HLS.

5. The obtained data is substituted into the regression equation:

AT (points) = 106.5-0.04 × IR (pack / year) + 0.05 × BWW RV (ml) -0.76 × pO ₂ (mmHg) + 0.15 × FEV ₁ (% due) + DZ (years),

where AT is alexithymia, whose numerical value of 74 or more points allows diagnosing alexithymia, less than 62 points - the absence of alexithymia, indicators in the range of 63-73 points are considered borderline, indicating personal disintegration and an increase in psycho-emotional stress.

Previously, in 107 patients with chronic obstructive pulmonary disease (COPD), a correlation analysis was performed using the statistical package STATISTICA (data analysis software system), version 6.1 (StatSoft, Inc., 2001, http: www. Statsoft.com) between the following variables: smoking index, disease duration, pO ₂ , FEV _1, BWW of the pancreas. The highest correlation coefficient was 0.63, while r≥0.80 excludes the possibility of using variables in the equation, since it indicates their high correlation. Fisher's criterion is F (5.95) = 30.15 (p <0.0001), the standard error of the model estimation was 4.83, the residuals of the difference between the observation results and the predicted values had a normal distribution. The coefficient of multiple determination (R ² ) was 0.78 (78.0%), which confirms the reliability of the forecast model.

After solving the regression equation, the obtained scores evaluate the presence, absence of alexithymia, or the borderline state.

Example 1. Patient S., born in 1963, No. of medical history 5674, by profession a turner. He entered the pulmonology department with complaints of cough with sputum of a mucopurulent character, shortness of breath of a mixed nature, an increase in body temperature to 37.4 ° C, associated with hypothermia. Considers herself ill since 2003 (9 years the duration of the disease), when he became bothered by a constant cough with a small amount of sputum mucosa. The appearance of these complaints was associated with smoking. He went to the clinic, was examined, diagnosed with COPD, given recommendations to stop smoking, and was prescribed treatment with the Spiriva inhaler.

Since 2003, compliance with the recommendations has been incomplete, has not given up smoking, has been treated sporadically, the first visit to a pulmonologist in the past time was November 2008, when after hypothermia I began to notice shortness of breath of a mixed nature with minimal physical exertion, cough with a lot of mucopurulent sputum, increase in body temperature to 37.8 ° C. Smokes for 16 years at 17-16 cigarettes per day, smoking index (IR) = 14 pack / year. The clinic conducted a clinical and instrumental examination, diagnosed with COPD. HLS, stage of compensation. Currently, she is registered with a pulmonologist, uses a “berodual” inhaler as needed.

Clinical diagnosis: COPD, moderate course, mixed type, acute stage. Emphysema, diffuse pneumosclerosis. HLS in the stage of compensation. Respiratory failure (DN) II degree.

Upon admission to the hospital, the patient's condition is moderate. Tense, closed. The skin is clean, acrocyanosis. With percussion over the lungs, a boxy sound, with auscultation, hard breathing, scattered dry rales are heard. BH 22 per minute. The boundaries of the heart are within normal limits. Heart sounds are rhythmic, muffled. Heart rate - 93 per minute. Emphasis II tone on the pulmonary artery. Blood pressure 120 and 85 mm Hg The abdomen is soft, painless. The liver is not enlarged, according to Kurlov: 9 × 8 × 7 cm. Clinical blood test: er - 5.1 × 10 ¹² / l, HB - 153 g / l, leu - 9.2 × 10%, p / y - 2%, segmented - 69%, eosinophils - 1%, lymphocytes - 23%, monocytes - 5%, ESR - 23 mm / h.

Biochemical analysis of blood: fibrinogen - 5.7 g / l, CRP - 5.8 mg / l, total cholesterol - 4.7 mmol / l, total protein - 74 g / l.

ECG: Sinus rhythm, heart rate of 91 per minute, the electrical axis is vertical, increased load on the right heart, incomplete blockade of the right leg of the bundle of His.

Chest x-ray: increased pulmonary field transparency, diffuse pneumosclerosis.

Spirography: VC - 71%, MVL - 63%, FEV ₁ - 57.8%, MOS ₂₅ - 48.9%, MOS ₅₀ - 47.2%, MOS ₇₅ - 46.8% of the proper values. Conclusion: violation of the ventilation function of the lungs of the II degree, mainly obstructive type. The gas composition of arterialized blood: pO ₂ - 69.7 mm Hg, pCO ₂ - 40 mm Hg, pH 7.43.

Fibrobronchoscopy: diffuse bilateral endobronchitis, degree of inflammation II degree.

Echocardiography: TPSPZH - 6 mm. KDO RV - 132.5 ml, KTO RV - 60.8 ml, UI RV - 38.2 ml / m ² , SI RV - 3.05 l / min / m ² . FV RV - 50.2%, E RV - 0.42 m / s, A RV - 0.39 m / s, E / A - 1.14, SDLA - 35.5 mm Hg, EF LV 63 % Conclusion: moderate dilatation of the right ventricle with impaired systolic and diastolic functions. Pulmonary hypertension.

We solve the regression equation:

AT (points) = 106.5-0.04 × 14 (pack / year) + 0.05 × 132.5 (ml) -0.76 × 69.7 (mmHg) + 0.15 × 57.8 (% due) + 0.16 × 9 (years) = 69.7

A result of 69.7 points indicates the absence of alexithymia in this patient, but since alexithymia values in the range of 63-73 points are considered borderline, therefore, dynamic monitoring of the patient’s psychological status is necessary in this case, a psychiatrist consultation is recommended, due to the increase in psychoemotional stress.

Upon admission to the hospital and conducting a psychological examination in patient S., born in 1963, Alexithymia was not revealed by TAS results - 72 points.

Example 2. Patient B., born in 1955, No. of case history 6734, by profession a locksmith. He was admitted to the pulmonology department complaining of a cough with difficult to separate sputum of a purulent nature, shortness of breath with difficulty exhaling with slight physical exertion and at rest, fever up to 37.8 ° C, swelling in the legs, heaviness in the right hypochondrium, headaches, obsessive experiences, decreased mood, memory, performance, sleep disturbances in the form of disturbing dreams and frequent awakenings, weakness. Smokes 24 years at 15 cigarettes per day, IR = 18 pack / year. Complaints and medical history were collected mainly from the words of close relatives (wife and daughter).

Considers herself sick since 1998 (14 years of illness), when in the morning he began to be bothered by a persistent cough with a small amount of sputum mucosa. He addressed these complaints to the clinic, was examined, diagnosed with COPD, mild course, chronic nicotine intoxication. Recommendations for smoking cessation and the use of inhalers were given by a pulmonologist, but the patient did not follow them.

Shortness of breath appeared later, in 2003, at first worried with significant physical exertion, then with moderate, and therefore went to the clinic in December 2003, where a comprehensive clinical and instrumental examination was performed. The conclusion of the pulmonologist on December 16, 2003 (extract from the outpatient card): COPD. HLS, stage of compensation. Emphysema, diffuse pneumosclerosis. DN II degree. Since 2003, the patient has frequent exacerbations of COPD up to 3 times a year. Currently, she is registered with a pulmonologist, with an exacerbation of bronchopulmonary infection, she undergoes inpatient treatment in the pulmonology department. He did not give up smoking, smokes 15-16 cigarettes per day. The inhaler “Berodual” is used as needed, “Seretide - multidisk” and “Spiriva” - occasionally, violating the treatment regimen recommended by the pulmonologist.

Clinical diagnosis: COPD, mixed type, severe course, acute stage. Emphysema, diffuse pneumosclerosis. HLS in the stage of decompensation. DN III degree. CHF II B. FC III.

Consulted by a neurologist upon admission: II degree dyscirculatory encephalopathy.

When examined by a psychiatrist, subdepressive symptoms of a neurotic level and alexithymia were diagnosed.

Upon admission to the hospital, the patient's condition is serious. Amimicity and lethargy are noted. Speech production is sluggish and monotonous. Memory, thinking are lowered, answers questions poorly and monosyllables. On examination, indifferent, inert, indifferent. Contact with the patient is difficult, relatives are actively involved in questioning the patient.

Orthopnea position. Diffuse cyanosis of the skin, swelling of the cervical veins, swelling on the lower extremities. The chest is emphysematous. With percussion over the lungs, a boxy sound, with auscultation, weakened breathing, scattered dry rales are heard, in the lower sections moist finely bubbling rales. BH 24 per minute. The borders of the heart are extended to the right by 2 cm. The heart sounds are rhythmic, muffled, the emphasis is II tone on the pulmonary artery, heart rate - 96 per minute. Blood pressure 125 and 80 mm Hg The abdomen is soft, painless. The liver protrudes 4 cm from the edge of the costal arch, Kurlov dimensions: 13 × 11 × 9 cm.

Clinical blood test: er - 5.5 × 10 ¹² / l, HB - 159 g / l, leu - 11.2 × 10 ⁹ / l, stab - 2%, segmented - 68%, eosinophils - 2%, lymphocytes - 26%, monocytes - 2%, ESR - 21 mm / h.

Blood biochemical analysis: fibrinogen - 5.7 g / l, CRP - 5.9 mg / l, total cholesterol - 5.1 mmol / l, total protein - 75 g / l, bilirubin 19.5-4.7-14 8 μmol / L.

ECG: Sinus tachycardia, heart rate of 97 per minute, the electrical axis is vertical, signs of hypertrophy of the right atrium and right ventricle. Diffuse changes in the myocardium.

Chest X-ray: diffuse pneumosclerosis, pulmonary emphysema. Spirography: VC - 49%, MVL - 35%, FEV ₁ - 39.8%. MOS ₂₅ - 18%, MOS ₅₀ - 24%, MOS ₇₅ - 12% to the proper values. Conclusion: violation of the ventilation function of the lungs of the III degree in a mixed type, mainly in obstructive. The gas composition of arterialized blood: pO ₂ - 51.9 mm Hg, pCO ₂ - 56.3 mm Hg, _P H - 7.34. Fibrobronchoscopy: diffuse bilateral endobronchitis, degree of inflammation II degree.

Echocardiography: TPSC - 5 mm, BWC RV - 139 ml, KSO RV - 83.6 ml, UI RV - 31.7 ml / m ² , SI RV - 2.86 l / min / m ² , EF RV - 43% . E RV - 0.44 m / s, A RV - 0.41 m / s, E / A - 1.07, SDLA - 48 mm Hg, LVEF - 59%. Conclusion: Pulmonary hypertension, pancreatic hypertrophy, increased BWC of the pancreas, CSR of the pancreas, decreased UI of the pancreas, SI RV, and PV RV

We solve the regression equation:

AT (points) = 106.5-0.04 × 18 (pack / year) + 0.05 × 139 (ml) -0.76 × 51.9 (mmHg) + 0.15 × 39, 8 (% due) + 0.16 × 14 (years) = 81.4

The result of 81.4 points indicates the presence of alexithymia in this patient and the need to include measures to correct psycho-emotional disorders in order to increase adherence to therapy.

Upon admission to the hospital and conducting a psychological examination in a patient B., born in 1955, Alexithymia was revealed by TAS results - 84 points.

The technical result of the use of the invention is:

1. Reliable diagnosis of the presence of alexithymia or the borderline state of this psychological feature in patients with COPD complicated by HLS to select management and treatment tactics for patients with psycho-emotional disorders in order to increase adherence to therapy in this category of patients.

2. The possibility of using the method for detecting alexithymia by practitioners of public health without psychological examination skills.

List of references

1. Nikolaeva V.V. On the psychological nature of alexithymia // Psychology of corporeality and psychosomatics. - 2007. - http://www.gestaltlife.ru/publications/13/1.

2. Kvasnikova Yu.V. et al. Comorbid psychopathological disorders in patients with chronic obstructive pulmonary disease // Far Eastern Medical Journal. - 2011. - No. 4. - S.21-23.

3. Solozhenkin V.V., Guzova E.S. Alexithymia (adaptation approach) and the psychotherapeutic correction model // Social and Clinical Psychiatry. - 1998. - No. 2. - S.18-24.

4. Fedosenko S.V., Kirillova N.A. The effect of treatment of severe chronic obstructive pulmonary disease with tiotropium bromide on comorbid somatogenic anxiety-depressive disorders // Bulletin of Siberian Medicine. - 2011.V.10. No. 1. - S. 92-96.

5. Shprakh V.V., Sayutina S.B., Romazina T.A., Mikhalevich I.M. Prediction of the development of cognitive impairment in patients with combined atherosclerosis of cerebral and coronary arteries // Siberian Medical Journal. - 2011. - No. 6. - S. 57-59.

6. Shprakh V.V., Suvorova I.A. New diagnostic technology and prediction of the development of vascular dementia in patients with moderate cognitive impairment // New Medical Technologies. - 2011. - No. 8. - C.3-11.

7. Taylor G.J. Alexithimia: Concept, measurement and implications for treatment // Am. Psychiat. - 1984. - V.141. No. 6. - P.725-732.

Claims (1)

A method for the diagnosis of alexithymia in patients with chronic obstructive pulmonary disease (COPD) complicated by chronic pulmonary heart (HLS), including determining the smoking index (IR), end-diastolic volume of the right ventricle (BWC of the pancreas), partial pressure of oxygen of arterialized blood (pO ₂ ), forced expiratory volume per second (FEV ₁ ), the duration of the disease (DZ) since the diagnosis of COPD and the solution of the regression equation by the formula:
AT (points) = 106.5-0.04 × IR (pack / year) + 0.05 × BWW RV (ml) -0.76 × pO ₂ (mmHg) + 0.15 × FEV ₁ (% due) + 0.16 × DZ (years),
where AT is alexithymia, whose numerical value of 74 or more points allows diagnosing alexithymia, less than 62 points - the absence of alexithymia, indicators in the range of 63-73 points are considered borderline, indicating personal disintegration and an increase in psycho-emotional stress.