RU2578819C1 - Method of treating depression - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used in neonatal practice also for treatment of border psychic disorders. Biologically active points of acupuncture channels F5, H1, F4, H6, F2 are subject to acupuncture effect. Simultaneously with acupuncture effect the suggestive exposure is made by direct directives for a specific task. Patients perform tasks for managing your body, deep-chest breathing abdominally, setting a good sleep, appetite, enjoyment of life, removal of grief and sadness. In the first day acupuncture by toning with stimulation by vibration acoustic puncture tuning fork is performed. Corporeal points of H6 right channel are used: LI4, LI11, TE8. Sound evoking at each needle. During suggestive action instructions are made for relaxation. In the second day acupuncture by braking corporeal points on the left is effected. Corporal points of channel F2 are used: LR3, LR4, SP6. During suggestive action instructions are made for warming feelings. In the third day acupuncture by braking corporeal points on the right is performed. Corporeal points of F5 channel are used: GB37, GB38, GB39. Thus at suggestive influence instructions aimed at the emergence of a feeling of heaviness are given. In the fourth day acupuncture is made by toning with stimulation by vibration acoustic puncture tuning fork of corporeal points on the left. Corporeal points of H1 channel are used: LU10, HT8, PC5. At this action sound evoking at each needle. Thus at suggestive influence instructions aimed at the emergence of a feeling of easiness are given. In the fifth day acupuncture by braking corporeal points on the right is effected. Corporeal points of F4 channel are used: BL40, ST36, GB39. Suggestive influence is performed by directives aimed at initiating a sense of flight - takeoff and descent.

EFFECT: method increases efficiency of treating depression, including psychopathic manifestations without use of drugs.

1 cl, 2 ex, 1 tbl, 1 dwg

Description

The invention relates to medicine, namely to restorative medicine, and can be used, inter alia, in neonatal practice for the treatment of borderline mental disorders, including for relieving the maternal factor load of postpartum depression nursing in a hospital, clinic, preventive medicine center in the dyad "mother -child".

The relevance is due to the widespread (80%) of such a borderline state as postpartum depression, which negatively affects the health and performance of not only the postpartum woman, but also her newborn baby, which determines the search for new effective non-drug methods of treatment for preserving breastfeeding.

Depression is considered one of the leading causes of disability worldwide. Women are twice as likely as men to suffer from depression. Among the different types of depression, postpartum depression is a borderline mental condition associated with the development of symptoms such as anhedonia, lethargy, fatigue, depressed mood, decreased or increased appetite, sleep disturbance, cognitive impairment after childbirth, which differs in time from other types of depression, such as seasonal affective disorder, premenstrual dysphoria.

Screening for depression, which involves questionnaires using tests containing questions aimed at identifying indicators specific to depression, is considered a necessary part of evaluating any patient with manifestations of depression. In this case, when detecting depression in clinical practice and scientific research, a range of screening methods is chosen that allows you to fully identify indicators characteristic of depression, namely:

- the severity of depression (meaninglessness of life, lack of energy, self-frustration, loss of interest in things that previously gave pleasure, lack of hope for the future, loss of joy of life most of the time);

- neurotization (burning sensation in various parts of the body, headaches, nightmares, timidity, a sense of piling up of difficulties that cannot be overcome, severe anxiety, anxiety, emotional stress, timidity, despondency);

- psychopathization (feeling of a lump in the throat, indifference, suspicion, deceitfulness, anger, abrupt treatment of others, a sense of strange smells, emotional limitation, distrust, alienation, a tendency to violence, harming a child or oneself);

- reactive anxiety (anxiety, a sense of threat, lack of internal satisfaction, self-confidence at the moment after childbirth);

- personal anxiety (spleen, lack of composure and composure, long experiences of disappointment, tearfulness, strong anxiety about one’s affairs and concerns, a steady tendency to perceive a wide range of situations as threatening, to react to such situations with anxiety in ordinary life before childbirth);

- disturbance of the vegetative balance (decreased appetite, drowsiness, lethargy, sweating, chills, dizziness, fainting, headaches or weight loss, dry mouth, thirst, palpitations, late falling asleep and early awakening, restless sleep, chills, fear, distraction, carelessness );

- impaired performance (rapid fatigue, normal work is very stressful, inability to care for the child, for himself, unwillingness to respond to the crying of the child, to keep things and the room in order).

To quantify the severity of postpartum depression, use the self-assessment test questionnaire P. Pisho (P. Pisho Epidemiology of Depression // Journal of Neuropathology and Psychiatry. - 1990. - T. 90. - No. 12. - P. 82-84.). The test consists of 13 questions, to which a woman answers “Yes” - 1 point, or “No” - 0 points. For example, the first question: "Life seems to me empty and meaningless now."

The levels of neurotization and psychopathization are controlled by the test of the questionnaire A.E. Lichko (Methods for determining the level of neurotization and psychopathization (UNP): method, recommendations / under the editorship of AE Lichko. - L., 1980. - 41 p.). The test consists of 90 questions. For example, one of the questions: “In various parts of the body I often feel a burning sensation, tingling, numbness, creeping creeps”; Yes - minus 4 points. No - plus 3 points. The second question: “All my life I strictly follow principles based on a sense of duty”; Yes - plus 1 point. No - minus 4 points. Odd statements are typical for neurotization, even - for psychopathy.

The levels of reactive and personal anxiety are monitored by the survey method according to Ch.D. Spielberger-Khanin (Medical Psychology: Workshop / compiled by A.V. Golenkov, I.E. Bulygin. - Cheboksary: Publishing House of Chuvash, Univ., 2002. - 100 pp.), Containing 40 questions. For example, the 1st question: “I am calm at the moment. No, this is not so - 1 point. Perhaps so - 2 points. True - 3 points. That's right - 4 points ”; Question 21: “I usually enjoy it. Almost never - 1 point. Sometimes - 2 points. Often - 3 points. Almost always - 4 points. "

Violations of the vegetative balance and working capacity are determined by the method of color selection of M. Lusher (Method of color choices. Modified color test of Lusher: method. Guide / compiled by L.N. Sobchik. - M., 1980. - 88 pp.). When choosing a color preference, the method reveals the threshold perception of the visual analyzer in points, which depends on the severity of the vagotonic or sympathotonic state of the autonomic balance. In order of preference, a woman chooses cards of various colors. For example, with a consistent choice of the autogenous norm: red, yellow, green, purple, blue, brown, gray, black, performance is estimated at 20.9 points.

Vegetative balance is also evaluated using the Luscher test. The calculation of the coefficients according to the method of G.A. Amineva, 1997 (Melnikov V.I., Leontiev V.G. Application of the modified Luscher test for the diagnosis of mental states of a person // Psychopedagogy in law enforcement agencies. - 2001. - No. 2. - P. 112-114.). So with a pronounced thirst for success, a desire for life, full of impressions, with an optimistic view of the future, a vegetative balance of 8.3 points is estimated.

The questionnaires contain statements regarding the health and nature of the woman. A score is assigned for each answer. Then summarize the total score of the component of depression. After conducting surveys and identifying the presence of depression, treatment is carried out, the effectiveness of which is also monitored by the survey method.

Medicaments for treating depression are known in which drugs are used at the first stage, including serotonin reuptake inhibitors, followed by other drugs, such as norepinephrine reuptake inhibitors, tricyclic antidepressants and monoamine oxidase inhibitors (di Scalea TL, Wisner KL Pharmacotherapy // Expert. Opin. Pharmacother. - 2009. - Vol. 10, No. 16. - P. 2593-2607.). At the same time, in the treatment of postpartum depression with medical methods, breast-feeding of a newborn baby is canceled.

Psychotherapeutic suggestive therapy is known as the primary and complementary therapy method.

So, the famous “Method N.P. Zakharova of psychotherapy of depressive states ”(Patent RU 2289435 C2, 12.20.2006.), Which provides indirect directive guidance, which is not desirable for a postpartum woman with a slowed state of thinking. The emotional decline that occurs in the process of following the instructions slows down intellectual abilities and reduces creative activity. However, in the treatment of postpartum depression, it must be borne in mind that puerperas with depression show a deficit of attention and executive functions with a decrease in fluency in speech and memory. Therefore, for direct treatment it is advisable to direct directive to perform a specific task to control your body, representing the starting point of psycho-emotional experiences, and not categorical concepts and mental creation of hierarchical scales, as provided for in the above method.

Known suggestive "A method for the treatment of borderline mental and additive disorders" N.P. Zakharova (Patent RU 2255770 C1, 07/10/2005.), Characterized by a long verbal overcoming of hidden resistance, lack of connection and the need to write down your thoughts.

A well-known suggestive method in combination with the use of antidepressants is the treatment of neurotic disorders by rational-emotional behavioral therapy by Albert Ellis (Ellis A., Dryden W. Practice of rational-emotional behavioral therapy / Transl. From English T. Saushkina. - 2nd ed. - St. Petersburg: Rech, 2002. - 362 pp. - ISBN 5-9268-0120-6.). However, the method is not effective enough in the rehabilitation of depressive conditions. Its disadvantage is that to obtain the effect of treatment, long periods of application of this method are necessary.

The well-known "Method for the treatment of depression nonpsychopathic level" N.T. Tkachenko (Patent RU 2327443 C1, 06/22/2008), in which, along with acupuncture, stimulating up to 15 points in one procedure, tranquilizers, antidepressants, homeopathic medicines with sedative and antidepressant effects are used. The disadvantage of this method for the treatment of postpartum depression is the fact that drugs are excreted in breast milk and enter the body of a newborn, causing a number of undesirable somatic and vegetative consequences, up to respiratory arrest. Therefore, the use of this method in the treatment of postpartum depression can lead to undesirable consequences.

It is known that under the influence of acupuncture the functional organization of neural networks of the cerebral cortex and subcortical formations changes (Liu B., Chen J., Wang J., Liu X., Duan X., Shang X., Long Y., Chen Z., Li X., Huang Y., He Y. Altered small-world efficiency of brain functional networks in acupuncture at ST36: a functional MRI study // PLoS One. - 2012. - Vol. 7, No. 6. - e. 39342. )

It is known to treat various diseases with the help of acupuncture, in which, to select acupuncture points, the condition of the channel-meridian system is assessed by measuring the electric skin resistance at 24 representative points of 12 channels located on the hands and feet on the right (d) and left (s), which allows to judge the state of the body . The channels of the lungs (P / H1), pericardium (MS / H2), heart (C / H3), small intestine (IG / H4), triple heater (TR / H5), large intestine (GI / H6), pancreas ( RP / F1), liver (F / F2), kidney (R / F3), bladder (V / F4), gall bladder (VB / F5), stomach (E / F6). The sum of the electrical conductivity readings after all measurements is divided by 24, and the obtained average indicator, expressed in microamperes, is transferred to a special unified tablet card, using the average indicator further, choosing acupuncture points of those channels for which the conductivity is most different from the physiological limit which is set using the average. Acupuncture points are affected by a braking or tonic method.

The criterion for the onset of the clinical effect along with subjective sensations is the compliance of all indicators with the boundaries of the physiological limit Tabeeva, D.M. Guidelines for acupuncture / D.M. Tabeeva. - M .: Medicine, 1980 .-- 560 p.

The closest in technical essence and the achieved effect is a method of treating depression revealed by tests of the level of neuropathization and psychopathization, Pisho, Spilberger-Khanin, Lusher, in which they study the electrical conductivity of the system, affect the acupuncture points of six acupuncture channels, identifying those of them, electrical conductivity to the greatest degree differs from the average value of the electrical conductivity of all channels, namely: H1 (97.4 ± 2.79 μA), H4 (96.9 ± 2.80 μA), F1 (89.2 ± 2.22 μA), F4 (88.4 ± 2.09 μA) and F5 (69.5 ± 2.30 μA), F6 (70.1 ± 1.89 μA), with medium Score it to all channels 82.7 ± 1.73 pA. After that, the acupuncture points of the identified channels are exposed (Filonenko A.V. Electrocutaneous conductance of puerperas and reflexology // Bulletin of regenerative medicine. - 2010. - No. 3 (37). - P. 49, tables 1, 4 column). During this treatment, the conductivity of the channels changed, including the average conductivity of all the channels. (Filonenko A.V. Electrocutaneous conduction of puerperas and reflexotherapy // Bulletin of regenerative medicine. - 2010. - No. 3 (37). - P. 49, table. 2, 4 column). As a result of treatment, all 36 puerperas improved their clinical symptoms somewhat. However, such a non-drug method, despite the fact that it has no contraindications for breastfeeding, is effective in puerperas only with a neurotic form of depression, and with psychopathy, as shown by its practical use, is not effective enough. In this case, after treatment in puerperas with manifestations of psychopathization, for example, low working capacity remains.

The claimed invention solves the problem of creating a method of treating depression, which without the use of medicinal antidepressant drugs can increase the effectiveness of the treatment of depression, including with manifestations of psychopathy, and is applicable for the treatment of postpartum depression while maintaining breastfeeding of the newborn.

The technical result of the proposed method is to increase the effectiveness of the treatment of depression, including with manifestations of psychopathy, without the use of drugs.

This technical result is achieved by the fact that in the treatment of depression, in which acupuncture is applied to the biologically active points of the acupuncture channels F5, H1, F4, ACCORDING TO THE INVENTION, they are applied to the biologically active points of the acupuncture channels H6, F2, simultaneously with acupuncture carry out a suggestive effect by directive directives to perform a specific task to control your body and deep abdominal-chest breathing, setting good sleep, appetite, joy of life, removal from sadness and sadness, moreover, on the first day acupuncture is performed using the toning method with a vibrating acoustic puncture with a tuning fork of corporal points of channel H6 on the right LI4, LI11, TE8, causing the sensation of sounding of each needle, and with suggestive action, on the second day, directives aimed at relaxation carry out acupuncture by braking corporal points on the left of the channel F2 LR3, LR4, SP6, and when prompted, carry out directives, aimed at creating a sensation of warmth, on the third day they carry out acupuncture by braking corporal points on the right of the channel F5 GB37, GB38, GB39, and with suggestive action they carry out directives aimed at creating a feeling of heaviness, on the fourth day they perform acupuncture by toning with stimulation by vibrational acoustic puncture tuning fork of corporate points on the left of the HI LU10, NT8, PC5 channel, causing the sensation of sounding of each needle, and with suggestive action, carry out directive instructions, aimed at creating a feeling of lightness, on the fifth day they carry out acupuncture by braking corporal points on the right of the channel F4 BL40, ST36, GB39, and suggestive action is carried out by directives aimed at initiating a sense of flight - takeoff and decline.

Exposure to selected acupuncture points in combination with suggestion increases the effectiveness of treatment. In this case, the points of the five channels mentioned above were empirically selected, based on the fact that in all puerperas with manifestations of psychopathization, it was the effect on the selected five channels in combination with the selected sequence of exposure and additional suggestive effect that the best treatment results were obtained. At the same time, it was noted that the conductivity indices of precisely the selected five channels differed to the greatest degree from the average conductivity index of all channels. Studies have shown that the imbalance of these channels is characteristic of postpartum depression of puerperas with psychopathy and low working capacity. Low values of H6 (54.5 ± 2.30 μA) and H1 (58.2 ± 1.87 μA) were revealed. High values of F2 (87.3 ± 1.76 μA), F5 (86.9 ± 2.42 μA) and F4 (87.1 ± 1.21 μA). The average conductivity of all channels is 74.8 ± 1.91 μA. When exposed to the selected points of these channels, in all patients with manifestations of psychopathization, the narrowing of the field of consciousness was manifested to the greatest extent, in which there was a decrease in anxiety, the appearance of drowsiness, which contributed to greater suggestion with suggestive exposure. Suggestion was carried out by direct directives in combination with ritual actions in the form of deep abdominal-chest breathing.

Directive suggestion with a deep breathing ritual was carried out simultaneously with acupuncture for a total duration of 5 days. The main element of speech suggestive influence is a conceptual metaphor with the implementation of an incentive function.

Deep breathing in combination with reflexology and suggestion deepens the state of trance, up to falling asleep. Helps to reduce the partial tension of carbon dioxide in the blood and constriction of the vessels of the brain. Provides a decrease in intracranial pressure, a change in the autonomic balance, eliminates hypoxia (Zilber A.P. Clinical physiology in anesthesiology and resuscitation. - M .: Medicine, 1984. - 480 p.). In this case, self-massage of the pelvic organs additionally occurs.

When abnormalities are detected (manifestations of depression with psychopathization, such as lack of joy in life, insomnia, depressed mood, etc.), the psycho-emotional state of the puerperan is initially tested and scored using known tests. Namely: to determine the severity of postpartum depression, a self-assessment test is used - a questionnaire by P. Pisho; levels of neurotization and psychopathization by questionnaire A.E. Face; the levels of reactive and personal anxiety are controlled by the survey method according to Ch.D. Spielberger-Hanina; disturbances of the vegetative balance and working capacity are determined by the method of color choice of M. Lusher.

Then, treatment of depression with manifestations of psychopathization is carried out as follows:

The patient is in a comfortable position.

1 procedure

In the first procedure, acupuncture is performed by the toning method (exposure time is 20 minutes) with stimulation of the acoustic channel with a tuning fork “Germany C 523.3” of channel H6 at the points on the right LI4, LI11, TE8 with mini needles by inspiration, causing the patient to feel the sound of each needle , and with suggestive exposure carry out directive (for example: “Relax your eyelids”, “Relax your lips”) instructions aimed at relaxation. Suggestive impact after the installation of needles, aimed at relaxation, is as follows. They give directive instructions: “Find the dark point on the ceiling and look at it without closing your eyes. As soon as you feel that your eyes are tired, close them. Focus on the center of the forehead. Imagine the feather of the Firebird, from which light is lowered to the eyes. Inspect them mentally. Relax your eyelids. Mentally inspect the nose. Feel the air passing as you inhale and exhale. The breath is slow and deep. Look at your lips. Relax them.

Relax your right hand. Shoulder. Forearm. Brush. First finger. Second. Third. Fourth. Fifth. Feel the goosebumps running around your hand. The breath is even and deep.

Relax your left hand. Shoulder. Forearm. Brush. First finger. Second. Third. Fourth. Fifth. Feel the goosebumps running around your hand. The breath is even and deep.

Relax your chest, abdomen, and back muscles. The breath is even and deep.

Relax your right foot. Hip. Shin. Stop it. First finger. Second. Third. Fourth. Fifth. Feel the goosebumps running in your foot. The breath is even and deep.

Relax your left foot. Hip. Shin. Stop it. First finger. Second. Third. Fourth. Fifth. Feel the goosebumps running in your foot. ” The breath is even and deep. ”

Attention is drawn to deep abdominal-chest breathing: “With each breath, confidence (energy, love, sympathy) flows into you. With each exhalation, sadness (spleen, melancholy, despondency, sadness) disappears. ”

Attitudes are given on a good dream, appetite, joy of life, removal from sadness and sadness, for example, with the following conceptual metaphors:

1) just as autumn dark foliage peacefully falls from trees, so dark anxieties fall from you;

2) as circles on the water diverge from a fallen stone, so your interests in life expand;

3) as the fog dissipates on a summer morning, so does the feeling of guilt;

4) as a rainbow rises serene after a thunderstorm, so your mood rises;

5) as the dirt is washed off after washing, so your sad thoughts are washed off;

“Our session is coming to an end. Now the needles will be removed. To remove the last needle, I will ask you to open your eyes. You will take a deep breath and exhale slowly. The feeling of joy of motherhood and peace will remain with you for the whole day. We managed, the last needle removed. Open your eyes. Tell us how you felt during the procedure. ”

If the puerperan falls asleep, the needles are removed without prompting awakening.

2 procedure

In the second procedure, acupuncture is performed by braking the corporal points of the F2 channel, namely, the points on the left LR3, LR4, SP6 for 40 minutes.

Suggestive impact is aimed at creating a sensation of warmth.

To do this, give directives in the form of conceptual metaphors, for example:

1) as a warm sea wave breaks on a rock, so your sadness breaks;

2) as a fragrant rose exudes its aroma, so you exude tenderness and warmth to your child;

3) as water drains after a warm rain, so fatigue drains from you;

4) as a bird soars in the height of a gentle sky, so you easily soar over your worries;

5) as a feeling of cleanliness comes after a summer rain, so a feeling of joy of life comes to you.

3 procedure

In the third procedure, acupuncture is performed by braking corporal points GB37, GB38, GB39 on the right of channel F5, and with suggestive action, directive instructions are carried out aimed at creating a feeling of heaviness.

To do this, give directives in the form of conceptual metaphors, which can be as follows:

1) as a cargo ship sinks into the abyss of water, so your suffering is drowning;

2) as a bonfire warms a traveler in the severity of the cold, so love for a child warms you;

3) how far the east is from the west, so the despondency and fear are far from you;

4) as a sprout of a snowdrop makes its way through frozen snow, so the power of patience and calmness breaks through you;

5) as the candle melts from the fire, so the heavy petrified insensibility melts into you.

4 procedure

In the fourth procedure, acupuncture is performed by the toning method with stimulation of vibrational acoustic puncture with a tuning fork of corporal points LU10, НТ8, PC5 on the left of channel H1, causing the feeling of sounding of each needle “Germany C 523.3”, and with suggestive action they carry out directives aimed at creating a feeling of lightness .

Guidelines for suggestive exposure contain conceptual metaphors, for example:

1) as a "goldfish" easily fulfills all desires, so you joyfully fulfill the desires of your child;

2) as the morning dawn easily disperses the darkness of night, so disbelief in one's strength disappears;

3) as a bird takes care of its chick, so you take care of your child;

4) as a fluff easily flies through the air, so you easily look after your child;

5) how freely the smoke of a bonfire is blown away by the wind, so your longing is blown away.

5 procedure

In the fifth procedure, acupuncture is performed by braking corporal points on the right BL40, ST36, GB39 of the F4 channel, and with suggestive action they carry out directives aimed at initiating a sense of flight - takeoff and decline.

Suggestive effects are carried out by directives, for example: “The deeper you breathe, the higher you go up. Each exhale lowers you, but you continue to soar in the air. "

In this case, conceptual metaphors can be used:

1) as the stars give their tenderness to the moon, so you give your love to a child;

2) as the flowers wither by autumn, so your indifference to the child fades;

3) as a spring exudes water in a stream, so you exude tenderness to the child;

4) just as an unexpected joy inspires you, so you inspire a child with your calmness.

Examples of implementation of the prototype (example 1) and the claimed method (example 2).

Example 1. Patient F., 23 years old, complains of insomnia, lack of appetite, depressed mood, fatigue, sense of worthlessness and sadness, distracted attention after childbirth, fear of harming the baby, tearfulness.

First pregnancy and childbirth. Obstetric and gynecological history is burdened. Moved colpitis. Early gestosis, threatened abortion. Stimulation of labor. The marriage is not registered. Financial problems and lack of work.

He is in a serious condition, feeling unwell. Restless sleep. Decreased appetite. Psychological testing by the above methods revealed a high level of depression according to Pisho - 4 points, neurotization - minus 14 points, psychopathy - minus 6 points, reactive anxiety - 30 points, personal anxiety - 52 points. Color choice: blue, green, gray, violet, yellow, brown, red, black. The vagotonic orientation of the vegetative balance is minus 2.1 points, with low efficiency - 14.7 points. Needs a calm environment. Fear of meeting failure. Extreme caution. Angry and annoyed. Depletion of vital energy. Stubbornly defends his point of view. Diagnosis: postpartum depression F.53.0.

The course in accordance with the prototype method. Improving well-being. The severity of depression decreased - 2 points. The level of neurotization decreased - minus 2 points, the same psychopathy - minus 6 points. Reduction of reactive anxiety - 23 points and personal anxiety - 42 points. Color choice: blue, yellow, violet, green, red, gray, brown, black. Preservation of the vegetative balance according to the vagotonic type - 1.5 points and low working capacity - 16.0 points.

Upon completion of treatment, no complaints. There was a feeling of lightness: "I fly!". Calm sleep, good appetite, mood elevation, a sense of need for the child, the ability to concentrate, lack of fear of harming the child. Strives for a tender relationship. Ready to help. However, the psychopathic component of depression remains - distrust of staff, harsh judgments, fears using sharp objects, low working capacity - quickly gets tired, has no strength to force himself to look after the child, although he knows what needs to be done, puts off what needs to be done now, is not located to any type of activity. Seeks to use every opportunity when it is possible not to obey any restrictions or prohibition.

Example 2. Patient X., 25 years old, during the week after childbirth complains of drowsiness, increased appetite, loss of energy, guilt, lack of joy in life, and indifference to the child. Annoying, categorical.

Second pregnancy, first birth. The pathological course of pregnancy and childbirth. Late gestosis. At birth, manual allowance, entwining the umbilical cord of a child’s neck. Risk factors for the development of postpartum depression were a lack of support by a partner, an unplanned pregnancy, and a lack of knowledge about caring for a child.

Objective testing showed a high level of psycho-emotional maladaptation. The severity of depression - 3 points, neurotization - minus 16 points, psychopathy - minus 5 points. Expressed reactive anxiety - 32 points and personal anxiety - 53 points. Color selection: brown, green, red, purple, blue, gray, yellow, black. The vagotonic regulation of the autonomic balance is 2.6 points, diffuse, low efficiency - 16.0 points. Strictly controls himself so as not to break under the weight of his difficulties. It needs more reliable conditions in which it would feel more secure. Unfulfilled hopes led to uncertainty and intense alertness. He doubts that the situation will be better in the future, and this negative attitude leads to the fact that he refuses reasonable compromises. Diagnosis: Postpartum depression F 53.0.

A course of treatment of the claimed method. Good condition and well-being. During psychological testing using the above methods, the absence of depression is 0 points, there is no neurotization - plus 3 points, psychologization is stopped - plus 4 points, does not show reactive anxiety - 13 points, personal anxiety is absent - 32 points. Color selection: yellow, red, green, purple, blue, brown, gray, black. The vegetative balance returned to normal - 8.3 points, an increase in working capacity to 20.9 points.

There are no complaints. Driven by their own desires and hopes. Trying to improve other people's self-image. Seeks to know life from all sides. There was a sense of joy in motherhood. Desire for caring for a child. Sociability, energy. There are no manifestations of psychopathization. Sympathicotonic reactivity of the vegetative balance. Able to concentrate. High efficiency. Depression is stopped.

The claimed method of treatment has been tested in the treatment of 32 women in childbirth who were admitted to the neonatal pathology department of the Cheboksary Children's Republican Clinical Hospital in the Cheboksary Republic, regarding the treatment of perinatal damage to the nervous system of their newborn children, and in postpartum depression. Age from 23 to 28 years. Extragenital inflammatory diseases (chronic pyelonephritis, tonsillitis, sinusitis) were associated with pregnancy. Gynecological and obstetric history is burdened in all women with infectious diseases of the reproductive system (colpitis, adnexitis, erosion of the cervix), the pathological course of pregnancy and childbirth. In 6 cases, early gestosis developed, in 10 - late, in 16 - a combination of manifestations of early and late gestosis of various severity. In 15 cases, a history of threatened abortion. Birth complications in the history of all women. 5 children were born operatively. Stimulation of labor in 15, manual benefit in 8, entwining the umbilical cord of the neck of a newborn in 4 women in labor

Statistical analysis was carried out in two stages by parametric, nonparametric and probabilistic methods. On the first: average, errors of the average and significance of differences in the parameters of the samples of depression indicators are determined, which are estimated depending on the normality of the distribution by Student's t-test, χ ² -Pearson with Yeats correction and Mann-Whitney U-test. The software package StatSoft Statistika 5.0 was used. On the second: for a comparative analysis of the two models, the quality of treatment is evaluated according to the prototype method and the claimed method. A ROC analysis (Receiver Operating Characteristic analysis) is carried out according to the method of Hanley JA, McNeil B.J., 1982 (Hanley JA, McNeil BJ The meaning and use of the area under a receiver operating characteristic (ROC) curve / / Radiology. - 1982. - No. 143 (1). - P. 29-36.) Using the statistical program VassarStats, the construction of ROC-curves, also called characteristic curves (curves of the dependence of the number of true positive, called sensitivity, on the number of true negative results, called specificity) and determining the reliability of the difference in the area under them.

The ROC curve shows the dependence of the number of correctly classified positive results on the number of incorrectly classified negative results.

The method of constructing the ROC curve is based on the gradation of the range of numerical values of the results of the study, by dividing them into 4 step intervals and taking into account the number of results in each.

For example, the range of performance results is in the range of 9 to 20 points inclusive. For the initial performance of the proposed method, the number of results in the range from 9 to 11 points - 12 results, from 12 to 14 points - 14, from 15 to 17 points - 5, from 18 to 20 points - 1. After treatment - 1.4, 7, 20 - respectively.

As a result, the program generates a set of cutoff threshold values and the corresponding specificity and sensitivity values:

0.0313-0.375;

0.1563-0.8125;

0.375-0.9688;

1.00-1.00.

For initial performance before treatment according to the prototype method, the number of results was observed in the range of values from 9 to 11 points - 11 results, from 12 to 14 points -15, from 15 to 17 points - 4, from 18 to 20 points - 2. After treatment - 9.17, 5.1, respectively.

As a result, a set of cutoff threshold values and the corresponding specificity and sensitivity values were obtained:

0.3438-0.2813;

0.8125-0.8125;

0.9385-0.9688;

1.00-1.00.

Then, according to the data obtained, the program builds the ROC curve (the values “1 minus specificity” are plotted on the abscissa axis, and the “Sensitivity” value is plotted on the ordinate axis).

For an “excellent” test obtained, the curve passes through the upper left corner of the graph, where the share of truly positive cases is 1.0 (100%), and, conversely, the lower the curve bend, the lower the quality of the test.

To obtain the numerical value of the clinical significance of the model, as well as to compare the two models, the AUC indicator (Area Under Curve) is used, which is calculated using the numerical trapezoidal method embedded in the program. Quality is judged by the expert scale of AUC values:

0.9-1.0 - excellent;

0.8-0.9 - very good;

0.7-0.8 - good;

0.6-0.7 - average;

0.5-0.6 - unsatisfactory.

The closer the parameter area under the characteristic curve to unity, the more true positive results and the more effective the model (Trukhacheva N.V. Mathematical statistics in biomedical research using the Statistica package. - M.: “GEOTAR-Media”, 2013. - 384 p.).

The analysis of the curves showed a significantly greater effectiveness of the combined use of the complex of acupuncture and suggestion in puerperas in comparison with treatment with reflexology alone. So, the area under the characteristic curves of the ability to work of puerperas by the claimed method and the prototype method are presented in the figure. The difference between the areas under curves A and B (-0.422 ± 0.0873) is significant, p = 0.0000, and 2 times more with the proposed method.

The following figure shows the area under the characteristic curve of the ability to work of puerperas by the prototype method (A) and the inventive method (B), p <0.05

The advantage of the method over other technologies is significantly more effective treatment of depression itself and psychopathy, increased efficiency, improved quality of life of the puerpera, the exclusion of medication, preservation of breastfeeding of the newborn.

The inventive method of a new set of methods for treating postpartum depression significantly increases the effectiveness of treatment, expressed in improved well-being, a decrease in the severity of depression (1.5 times), neurotic (1.2 times), psychopathic (3.1 times), anxiety ( reactive 2.1 times and personality 2.5 times), autonomic (2.6 times) manifestations and an increase in working capacity (7.2 times) in comparison with the prototype P. Pichot depression tests, levels of neurotization and psychopathization, anxiety Ch.D. Spielberger-Hanin, color choice M. Lusher. The effectiveness of the effect of the integrated use of acupuncture and suggestion (159.1%) exceeds the prototype method (69.3%) 2.2 times. The dynamics of the average values with an average error, the quality of the model of 32 patients who were treated in accordance with the claimed method and 32 patients using the prototype method is shown in the table, where * is the significance of the difference before and after treatment p <0.05; ** - the reliability of the difference of the proposed method and the prototype method after treatment p <0,05

From the table it follows that the claimed method of treatment more effectively relieves postpartum depression, psychopathic component, increases the efficiency of the puerpera and overall efficiency compared with the prototype. The quality of the models is significantly different from each other. The average AUC of the prototype 0.638 ± 0.0690 (average quality). The AUC quality of the claimed method is 1.3 times better - 0.847 ± 0.0495 (very good). The difference (-0.2088 ± 0.0852) is significant, p = 0.0071.

Clinical recovery by the claimed method was noted in 93.8% of patients, a significant improvement in 6.2% of puerperas, a significant improvement in the quality of life in 100.0% of women.

Claims (1)

A method of treating depression in which an acupuncture effect on the biologically active points of the acupuncture channels F5, H1, F4 is carried out, characterized in that it also affects the biologically active points of the acupuncture channels H6, F2, and at the same time as an acupuncture effect, a suggestive effect is carried out by direct directive instructions performing a specific task to control your body and deep abdominal-chest breathing, setting for a good sleep, appetite, joy of life, removal from sadness and sadness moreover, on the first day, acupuncture is performed by the toning method with a vibrating acoustic puncture stimulation by tuning fork of corporate points of the H6 channel on the right LI4, LI11, TE8, causing the sensation of sounding of each needle, and with suggestive action, directive instructions are given to relax, on the second day, acupuncture is performed by the method braking of corporal points on the left of the channel F2 LR3, LR4, SP6, and when there is a suggestive effect, they carry out directives aimed at creating a sensation of heat on the third day about there is acupuncture by braking the corporal points on the right of the channel F5 GB37, GB38, GB39, and with suggestive action they carry out directives aimed at creating a feeling of heaviness, on the fourth day they perform acupuncture by the method of toning with a vibrating acoustic puncture forks of corporate points on the left of the channel H1 LU10, HT8 , PC5, causing the sensation of the sound of each needle, and with suggestive exposure, carry out directives aimed at creating a feeling of lightness, on the fifth day there is acupuncture by the method of braking corporal points on the right of the channel F4 BL40, ST36, GB39, and suggestive action is carried out by directive instructions aimed at initiating a sense of flight - takeoff and decline.

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