RU2703723C1 - Method of correction of anxiety-depressive disorders in patients with systemic connective tissue diseases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to therapy, and concerns correction of anxiety-depressive disorders in patients with systemic connective tissue diseases. For this purpose, in addition to the traditional therapy of systemic connective tissue diseases, paroxetine is orally administered in an initial dose of 10 mg a day, followed by increasing dose to 20–30 mg a day. Duration of course is 3 months.

EFFECT: such mode of drug administration provides higher clinical effectiveness in the main disease combined with reducing depressive symptoms, including by increasing adherence to treatment.

1 cl, 2 ex

Description

Application area

The invention relates to medicine, namely to internal medicine and can be used in psychiatry in the treatment of anxiety-depressive disorders.

Analogs

Known methods for the treatment of anxiety-depressive disorders with the use of antidepressants: patent 2288712 (RU). According to this method, traditional therapy for myocardial infarction is carried out and pyrazidol is additionally prescribed orally at a dose of 25 mg 2 times a day for 21 days in combination with eglonil 1 ml (50 mg) 1 time per day intramuscularly for 10 days.

Criticism of analogues

When using pyrazidol in combination with eglonil, pronounced side effects are observed. In addition, there is no pronounced clinical effect.

Prototype

As a prototype, we have chosen a method for the treatment of anxiety-depressive disorders and autonomic imbalance in patients with acute myocardial infarction according to patent 2288712 (RU). According to this method, traditional therapy for myocardial infarction is carried out and pyrazidol is additionally prescribed orally at a dose of 25 mg 2 times a day for 21 days in combination with eglonil 1 ml (50 mg) 1 time per day intramuscularly for 10 days.

Criticism of the prototype.

When using pyrazidol in combination with eglonil, pronounced side effects are observed. In addition, there is no pronounced clinical effect.

The aim of the invention is to increase the effectiveness of the treatment of patients with systemic diseases of the connective tissue.

A study of the psycho-emotional status is carried out using the Beck scale, which is a questionnaire that includes 21 categories of symptoms and complaints. Each category consists of 4-5 statements corresponding to the specific manifestations / symptoms of depression. These statements are ranked as the specific contribution of the symptom to the overall severity of depression increases. The obtained points were interpreted as follows: 10-15 points - mild depression; 16-19 points - moderate depression; 20-29 points - severe depression; > 30 points - severe depression. In addition, the Spielberg-Khanin scale was used, which is an informative way of self-assessment of the level of anxiety at the moment (reactive anxiety, as a state) and personal anxiety (as a stable characteristic of a person). The reactive anxiety scale consists of 20 judgments, and personal anxiety - of 40 judgments, for each of which there are 4 answer options, each of which is assigned a specific score (1 point - no, this is not so; 2 points - perhaps so; 3 points - true; 4 points - absolutely true). The patient was offered to read each of the above judgments and cross out the figure in the corresponding column on the right, depending on how he was feeling. The scores obtained were interpreted as follows: <30 - low anxiety; 31-45 - moderate anxiety; > 46 - high anxiety.

The data obtained using the above studies are necessary for the correction of anxiety-depressive disorders.

Indications for the correction of anxiety and depressive disorders are the identification of moderate depression (16-19 points); severe depression (20-29 points); severe depression (more than 30 points). And also anxiety of moderate (31-45 points) and high (over 46 points) degrees. To carry out the correction, traditional therapy of systemic diseases of the connective tissue is carried out and an additionally selective oral serotonin reuptake inhibitor (SSRI) paroxetine is prescribed, starting from 10 mg / day with a single dose, with a dosage increase to 20-30 mg / day after a week.

The novelty of the proposed method lies in the fact that this drug was not used in the correction of anxiety-depressive disorders in patients with systemic diseases of the connective tissue.

Example 1

Patient A., 47 years old.

Clinical diagnosis:

Rheumatoid arthritis, polyarthritis, activity - 1 tbsp; R stage - II, NPS - I tbsp. November 22, 2016 she was admitted to the rheumatology department of the Republican Clinical Hospital with complaints of joint pain: shoulder, elbow, and wrist. Severe pain in the small joints of the hands, knees. A clear morning stiffness for more than 3 hours, limitation of range of motion in the knee joints, small joints of the hands and feet, a feeling of numbness and chilliness in the limbs.

Medical history. The patient considers himself about 21 years old, the disease began for no apparent reason, gradually, from morning pain in small joints, as well as swelling in them. For what was not examined and not treated. For the first time she was sent for examination and treatment in 2000 to the rheumatology department, where she was diagnosed with rheumatoid arthritis, polyarthritis. They prescribed therapy (NSAIDs, sulfasalazine, delagil) with effect. The treatment was carried out regularly, noted the effect. She was admitted to the hospital for a follow-up examination.

Upon receipt of the general condition of moderate severity. Patient with proper physique, low nutrition. The skin is clean, normal color and moisture. The shape of the chest is correct, symmetrical, the respiratory rate is 20 per minute. With percussion of the lungs, a clear pulmonary sound. With auscultation - vesicular breathing, no wheezing. The pulse is rhythmic, symmetrical, satisfactory filling and tension, heart rate of 80 per min. HELL 110/70 mm Hg Borders of the heart: right - 0.5 cm outward from the right edge of the sternum, upper - lower edge of the third rib, left - 0.5 cm to the left of the mid-clavicular line. Heart sounds saved. The tongue is wet, clean. The abdomen is regular in shape, soft and painless on palpation. Liver on the edge of the costal arch. The spleen is not palpable. No swelling.

Musculoskeletal system: pain is noted with the active movement of the elbow, wrist joints of both hands. There is a limitation of the range of motion in the elbow and radiocarpal joints. Flexion, extension at an angle of 20 gr. swelling, thickening of the proximal interphalangeal joints of the II-III fingers of both hands, atrophy of the m / bone muscles, a compression syndrome of the hands is positive. Pain, restriction of movement in the plastophalangeal joints of the feet, ulnar deviation of the feet. Pain, restriction of movement in the ankle joints, due to which the gait is changed, walks in small steps, is lame. Psychological testing was carried out using the Beck Depression Scale, Ch.D. Spielberger, as modified by Yu.L. Hanina (level of personal and reactive anxiety). The results obtained indicate that patient A. has a high level of depression, as well as reactive (RT) and personality (RT) anxiety upon admission to the hospital.

Data of additional research methods at admission. Complete blood count from 11/23/2016: hemoglobin 120 g / l, red blood cells 4.41 × 10 / l, color index 0.9, white blood cells 7.7 × 10 / l. Leukocyte formula: stab neutrophils - 4%, segmented - 57%, eosinophils 1%, monocytes 4%, lymphocytes 26%. The erythrocyte sedimentation rate (ESR) is 11 mm / h.

Biochemical blood test from 11/23/2016: glucose 4.1 mmol / l, urea 6.4 mmol / l, creatinine -79 mmol / l, amylase 7.0 mg (spruce), aspartate aminotransferase 36 nmol (spruce), alanine aminotransferase 42 nmol (eat) C-reactive protein 2.9.

Urine analysis dated 11/23/2016: the color of the urine is straw yellow, transparent, the reaction is acidic, the specific gravity is 1021, protein traces, leukocytes units. in sight.

Ecg: no pathology.

R-gram of the hands: ulnar deviation of the hands, o / articular powder. C / slits moderately narrowed.

R-gram of feet: deviation, subluxations of b / fingers of both feet, o / articular porosis.

Symmetric leaf-shaped enlightenment in the epiphyses of the proximal phalanges.

Treatment was prescribed: Movalis 7.5 mg 2 times a day after meals, with an exacerbation of the process, fibrogastroscopy. Methotrexate 15 mg - 1 time per week (Monday) + 2 liters of fluid on this day under the control of OAK, ALT, ACT. Folic acid at 1 TB 3 times a day, on Tuesday, Wednesday, Thursday. After taking methotrexate. Calcemide at 1 TB-2 times a day - for a long time. Omez 1 capsule 2 times a day when taking NSAIDs and GCS.

Paroxetine 10 mg 1 time per day with a dosage increase of 10 mg per week, up to 30 mg per day.

During treatment, by the end of the first week, a decrease in anxiety was noted, the patient returned to normal sleep, and appetite improved. By the end of the second week there was a positive trend with a decrease in depressive disorder, the patient noted an increase in mental and physical performance, a change in pessimistic outlook on the prospects for their own health and performance. After a full course of treatment (90 days), anxiety, depression decreased and the quality of life improved. No side effects were observed during the therapy.

Example 2

Patient S., 52 years old.

Clinical diagnosis:

Rheumatoid arthritis, polyarthritis, activity-II Art., R stage-II, NPS - II art.

06/12/2016, she was admitted to the rheumatology department of the Republican Clinical Hospital with complaints of joint pain: interflank joints of 2-5 fingers, wrist joints. Severe pain in the knee joints, a crunch in them. She notes morning stiffness for more than 3 hours, limitation of range of motion in small joints of the hands, the hand with difficulty compresses into a fist. Feeling of numbness and chilliness of the hands. Medical history. The patient considers himself since 2007, when after hypothermia (bathed in the river), severe pain and swelling of small joints appeared. Then there were pains in the radiopaque joints, then in the small joints of the hands, the restriction of movements in them. Previously examined and treated at the place of residence. Received therapy with NSAIDs, SPVP with effect. He was admitted to the hospital due to worsening condition, for follow-up examination and selection of therapy.

Upon receipt of the general condition of moderate severity. The patient has the correct physique, normal nutrition. The skin is clean, normal color and moisture. The shape of the chest is correct, symmetrical, the respiratory rate is 18 per minute. With percussion of the lungs, a clear pulmonary sound. With auscultation - vesicular breathing, no wheezing. The pulse is rhythmic, symmetrical, satisfactory filling and tension, heart rate of 80 per min. HELL 115/75 mm Hg Borders of the heart: right - 0.5 cm outward from the right edge of the sternum, upper - lower edge of the third rib, left - along the mid-clavicular line. Heart sounds saved. The tongue is wet, clean. The abdomen is regular in shape, soft and painless on palpation. Liver on the edge of the costal arch. The spleen is not palpable. No swelling.

Musculoskeletal system: there is a moderate restriction of movements in the elbow, wrist joints of both hands. Flexion and extension are painful in the radiopaque joints. Swelling in the metacarpophalangeal joints of both hands of 2-3-4 fingers, pain, restriction of movement in the proximal interphalangeal joints of both hands of the 2nd to 3rd fingers, the hand does not compress into a fist, amyotrophy of interosseous muscles, a tendency to ulnar deviation of the hands. Pain, restriction of movement in the knee and ankle joints of both legs.

Psychological testing was carried out using the Beck Depression Scale, Ch.D. Spielberger, in the modification of Yu.L. Khanin (level of personal and reactive anxiety). The results obtained indicate that patient A. has a high level of depression, as well as reactive (RT) and personality (RT) anxiety upon admission to the hospital.

Data of additional research methods at admission. General blood test from 06/13/2016: hemoglobin 110 g / l, red blood cells 4.12 × 10 / l, color index 0.9, white blood cells 6.8x10 / l. Leukocyte formula: 70% segmented, eosinophils 1%, monocytes 8%, lymphocytes 18%. The erythrocyte sedimentation rate (ESR) is 40 mm / h. Biochemical blood test dated 06/13/2016: glucose 4.4 mmol / l, urea 8.4 mmol / l, creatinine 82 mmol / l, amylase 15 mg (spruce), aspartate aminotransferase 25 nmol (spruce), alanine aminotransferase 15 nmol (spruce ), C-reactive protein - 33.

Urine analysis from 06/13/2016: the color of the urine is straw yellow, transparent, the reaction is acidic, the specific gravity is 1018, the protein is not up to date, the leukocytes are units. in sight.

ECG: without pathology.

R-gram of the brushes with the coverage of the radiopaque joints: the porous diffuse, s / fissures of the interphalangeal joints narrowed, rheumatoid semmetric osteitis, thickening of the soft tissues of the o / articular region.

R-gram of feet: deviation, diffuse porosity, joint spaces narrowed, symmetrical leaf-shaped enlightenment in the epiphyses of the proximal phalanges. Treatment was prescribed: Movalis 15 mg 1 time per day after meals, with an exacerbation of the process, fibrogastroscopy. Methylprednisolone 8 mg per day, in the morning during breakfast for 2 months, then gradually (by 1/4 tablet 1 time in 7-10 days), reduce the dosage until the drug is completely discontinued. Methotrexate 10 mg in the morning and 5 mg in the evening - 1 time per week (Monday) + 2 liters of fluid on this day under the control of OAK, ALT, ACT. Folic acid at 1 TB 3 times a day, on Tuesday, Wednesday, Thursday. After taking methotrexate. Calcemide 1 TB-2 times a day, for a long time.

Paroxetine 10 mg 1 time per day with a dosage increase of 10 mg per week, up to 30 mg per day.

During treatment, a decrease in anxiety was noted by the second week, the patient returned to normal sleep, and appetite improved. By the end of the second week there was a positive trend with a decrease in depressive disorder, the patient noted an increase in mental and physical performance. After a full course of treatment (90 days), anxiety, depression decreased and the quality of life improved. No side effects were observed during the therapy.

Repeated psychological testing, laboratory and instrumental studies were carried out after 10 days and 3 months from the start of therapy. The results of the observation showed that in the process of treatment there is a decrease in personal, reactive anxiety and depression, and the quality of life of patients A. and C. increases. There were no significant and significant changes during routine laboratory studies during therapy. As a result, a statistically significant decrease in the average level of anxiety (from 55 ± 4.5 to 35 ± 4.2 points) and depression (from 63 ± 6.3 to 44 ± 5.1 points) was noted.

Thus, the use of paroxetine in the complex treatment of systemic diseases of the connective tissue made it possible to reduce the level of anxiety and depression in a shorter time. This is accompanied by an improvement in mood, normalization of sleep, increased efficiency and quality of life of the patient.

Features of the invention, distinctive from the prototype

According to the prototype, a combination of pyrizidol and eglonil preparations is used.

The proposed method uses the drug paraxetine.

A positive result from the use of the proposed method

The proposed method improves the clinical condition of patients with systemic diseases of the connective tissue (TSFST), complicated by anxiety-depressive disorders due to a decrease in depressive symptoms, and as a result of increased adherence to treatment. In addition, it was shown that the administration of paroxetine led to an improvement in the course of TSZST and quality of life (QOL) in the examined patients. Nielsen O.A., Morsing I., Peterson J.S. et al. Paroxetine and imipramine treatment of depressive patients in a controlled multicentre study with plasma amino acid measurements. // Acta Psychiatr. Scand. - 1991. - Vol. 84. - P. 233-241] with the appointment of paroxetine, an earlier onset of effect was noted (sometimes already by the 2nd week of therapy).

The source of information

patent 2288712 (RU) is a prototype.

Claims (1)

A method for the treatment of anxiety-depressive disorders in patients with systemic diseases of the connective tissue, including the traditional treatment of systemic diseases of the connective tissue, characterized in that it is additionally prescribed orally paroxetine, starting from 10 mg / day with a single dose, with an increase in dosage to 20-30 mg / a day in a week for 3 months.