RU2723226C1 - Method of correction of anxiety-depressive state in patients of neurological profile in chronic pathology of digestive system organs - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to neurology, and concerns correction of anxious-depressive state in patients of neurological profile in chronic pathology of digestive system. That is ensured by a complex treatment involving administration of preparation Spytomin 10 mg 2 times a day or Cipralex 10 mg once a day for three months, as well as Hepatosan 2 capsules twice a day, for 30 days and Enterosan 1 capsule 3 times day for 40 days.EFFECT: such complex therapy provides effective treatment of anxious-depressive manifestations in patients with exacerbation of chronic pathology of digestive organs, including by reducing content of catecholamines in blood, combined with positive dynamics of symptoms from the digestive system.1 cl, 2 ex

Description

The invention relates to medicine, namely to neurology and allows for the correction of anxiety and depression in patients with exacerbation of chronic pathology of the digestive system.

Currently, borderline mental disorders are one of the leading medical and social problems of modern society, the total share of which in general medical practice is approaching 50%. Disorders of the anxiety-depressive spectrum have become widespread among mental diseases. The clinical and subclinical state of anxiety and depression are recorded in 20-80% of cases. In clinical practice, it is rather difficult to distinguish one condition from another, therefore they are considered as a manifestation of one disorder - mixed anxiety-depressive syndrome (TDS) (Malkina-Pykh I.G. Psychosomatics: Handbook of a Practical Psychologist. M .: Publisher Eksmo, 2005. 992) with.)

Anxiety-depressive disorder refers to a group of neuroses, which are characterized by a wide variety of clinical manifestations and the absence of changes in personality identity. The main clinical symptom that determines the presence of anxiety-depressive syndrome is a constant feeling of vague anxiety without objective reasons. The danger of this condition is that it turns out to be a vicious circle: a sense of anxiety stimulates the production of adrenaline, which in itself stimulates the emotional state.

According to the combined data of the World Health Organization (WHO), from 38% to 42% of all patients visiting somatic doctors' offices belong to the group of psychosomatics (Topolyaysky V.D., Strukovskaya M.V. Psychosomatic disorders. M: Medicine, 1986. 384 s).

According to literature data, 22% of people with complaints of a psychosomatic nature occupy up to 50% of the doctor’s working time in the general medical network. These patients have been observed for years by specialists of various clinical profiles specializing in internal pathology and, as a rule, the accompanying therapy does not give them a tangible therapeutic effect (S. Lyubavskaya. Pharmacological correction of anxiety-depressive disorders in railway workers with exacerbation of chronic pancreatitis. Abstract for competition Candidate of Medical Sciences, Voronezh, - 2017).

In the international classification of diseases ICD-10, psychosomatic disorders are classified as psychological factors affecting the somatic state. The close connection of emotions and the gastrointestinal tract (GIT), which is figuratively called the “sounding organ of emotions”, has been known for a long time, since, indeed, the first emotions of a person and an animal were associated with the pleasure of eating. According to various authors, digestive diseases of a psychogenic nature are recorded in 30-70% of patients admitted to inpatient treatment at the gastroenterological department (Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F., Spiller RC Functional bowel disorders. In : Drossman DA, Corazziari E., Delvaux M. et al., Editors. Rome III: The Functional Gastrointestinal Disorders. 3 rd edition. McLean, Va, USA: Degnon Associates. 2006. P. 487-555.).

In diseases of the digestive system, secondary psychopathological manifestations, according to a number of authors, are absent only in 10.3% of patients. The clinical picture is determined by the peculiarities of gastroenterological symptoms, prone to perennial, torpid course with a tendency to involve the entire digestive system in the pathological process. In these patients, for example, the following syndromes can be distinguished:

- gastralgia without connection with food intake, a mandatory connection with emotional factors and fatigue, is distinguished by its imagery and distinct objectivity;

- psychogenic nausea and vomiting;

- lump in the throat (globus hystericus);

- dysgeusia - a neurogenic taste disorder, manifested by food-independent and organic-free sensation of bitterness in the mouth;

- psychogenic diarrhea - imperative urges to defecate can occur in the most inappropriate situation with the development of a state of anxious expectation of a recurrence of these phenomena ("bear disease", "diarrhea-alarm clock");

- constipation with a neurogenic component - increased concern for the act of defecation and the occurrence of anxiety in case of delay, fixation of attention on the frequency, quantity and quality of their bowel movements.

The extreme diversity and the multiplicity of functional disorders of the digestive system make it difficult to timely and correctly recognize the disease. Some patients have been “treated” by gastroenterologists for years without receiving significant relief. Only when psychoemotional disorders are taken into account does hope for a successful outcome appear. The full normalization of the patient’s well-being and mood in the process of a strictly individual approach to psychopharmacotherapy allows to finally solve the treatment problem.

At the same time, a rather high prevalence of liver pathology - non-alcoholic fatty disease in people of working age is relevant. Non-alcoholic fatty liver disease (a synonym for “fatty hepatosis”) is characterized by a change in parenchyma tissue due to the filling of liver cells with fat, which develops due to a violation of the structure of hepatocyte membranes, slowdown and metabolic and oxidative processes inside liver cells.

In 50-75% of patients, symptoms of general fatigue, decreased performance, malaise, weakness, heaviness in the right hypochondrium may appear. Digestive disorders, increased gas formation occur. Often fatty hepatosis corresponds to gallbladder disease, chronic cholecystitis. Recently, studies conducted by microbiologists indicate that the severity of fatty hepatosis may be due to a special type of intestinal microflora. Therefore, with this pathology of the liver, one should keep in mind such a bacterial factor.

Anxiety-depressive syndrome in somatic patients, including patients with chronic pathology of the digestive system, namely, the gastrointestinal tract and liver, have a significant impact on the main pathogenetic links and mechanisms of the formation of somatic pathology associated with impaired functioning of the GABAergic, serotonergic, noradrenalinergic systems of the brain. Thus, a decrease in the activity of the GABAergic system contributes to the emergence of gastrointestinal panic attacks with the appearance of a feeling of discomfort in the epigastric region, nausea, and urges to defecate. Serotonin deficiency leads to impaired motility of the gastrointestinal tract, increases the threshold of pain sensitivity. With insufficient production of norepinephrine, enzyme secretion increases, resulting in the formation of dystrophic changes in peripheral and nerve tissues (Lyubavskaya S.S. Pharmacological correction of anxiety-depressive disorders in railway workers with exacerbation of chronic pancreatitis. Abstract for the degree of candidate of medical sciences, Voronezh, - 2017 )

Diagnosis of a psychoemotional disorder in the framework of a somatic disease is largely based on the correct collection and analysis of patient complaints, medical history and medical history. A clinical interview with a potentially anxious or depressed patient is a rather complicated process that requires a certain amount of patience and skill from the doctor.

Pharmacological correction of concomitant pathology is quite complicated, especially in people whose type of activity requires stress and concentration, which is associated with the possibility of a negative effect of drugs on the state of professionally important psychophysiological functions.

Studies conducted indicating a combination of anxiety-depressive disorders and chronic intestinal, liver pathologies are relatively few. However, the addition of the anxiety-depressive syndrome to somatic pathology significantly worsens the general condition and quality of life of patients, prevents the formation of long-term and complete remissions, and also reduces the effectiveness of the treatment and negatively affects professional activity.

A prerequisite for the development of this method was the observation and treatment of patients with signs of anxiety and depressive disorders of mild to moderate severity, which were identified using specialized scales and questionnaires - hospital scale GSTD (anxiety / depression) on the background of chronic pathology of the gastrointestinal tract and fatty hepatosis of the liver.

Of course, the search for new approaches to the treatment of TDS in combination with chronic pathology of the digestive system involves the use of drugs that affect the pathogenesis of pathological conditions, which are highly effective against the symptoms of the disease and have a favorable safety profile, taking into account the state of the digestive system.

In this regard, the objective of the present invention is to develop a method for improving the treatment of psychosomatic manifestations in patients with a neurological profile with fatty hepatosis complicated by intestinal dysbiosis and impaired motor-evacuation function.

The problem is solved by the proposed method for the correction of anxiety and depression in patients with a neurological profile in chronic pathology of the digestive system, including the appointment of the drug "Spitomin" 10 mg 2 times a day or "Cipralex" 10 mg 1 time per day for three months, and “Hepatosan” 2 capsules twice a day for 30 days and “Enterosan” 1 capsule 3 times a day for 40 days.

To assess the severity of gastroenterological complaints, tests were performed on AMD (detection of micronutrient deficiency) and CSN (detection of deficiency of neurotransmitters: dopamine, norepinephrine, serotonin) with the determination of the intensity of dyspeptic disorders (bitterness in the mouth, nausea, diarrhea or constipation), and an ultrasound examination ( Ultrasound) of the liver with the determination of the size, contours, echogenicity and structure of the organ parenchyma. The level of functioning of the liver and intestines was evaluated including the biochemical parameters of liver samples and microbiological indicators of the activity of the small intestinal microflora according to Osipov. The effect of complex therapy on the patient’s body was evaluated by the dynamics of the blood levels of catecholamines and serotonin.

All patients (n = 38 people) who showed signs of anxiety-depressive disorders were prescribed psychotropic therapy (antidepressant or anxiolytic), as well as 2 capsules twice a day for 30 days to correct Hepatosan liver function; to restore the evacuation-motor function and intestinal microbiota "Enterosan" 1 capsule 3 times a day for 40 days. Positive clinical experience with the use of the biological product “Hepatosan” is proposed in patent No. 2306943 “A method for the treatment of hypercholesterolemic conditions in patients with cholelithiasis by the use of the drug“ Hepatosan ”, accelerating the oxidation of cholesterol in the liver, and“ Enterosan ”in patent No. 2637628“ Method for the correction of psychosomatic manifestations ” in patients with irritable bowel syndrome. "

Depending on the treatment with psychotropic drugs, the patients were divided into two groups, in which "Hepatosan" and "Enterosan" had the same mode of use. The first group consisted of 23 patients who were prescribed "Spitomin" 10 mg twice a day. The course of therapy was 3 months.

Patients of the second group in the amount of 15 people received "Cipralex" in a daily dose of 10 mg once a day. The course of therapy is three months.

The testing of the claimed method was carried out on the basis of

“HEALTH AND BEAUTY PROFESSIONALS-HHP Corpse”, Limited Liability Company

The method illustrates the following examples.

Example 1

Patient I.E., 50 years old.

Clinical diagnosis: Generalized anxiety disorder. Astheno-depressive syndrome. GERD. Irritable bowel syndrome. Fatty hepatosis.

Complaints of sleep disturbance, anxiety, tearfulness, decreased mood background, heartburn, bloating. The patient is observed for a long time by a gastroenterologist, periodically takes courses of choleretic and enzymatic preparations, symbiotics.

Neurological status: in a clear mind, contact, oriented in time, space and self, the mood background is reduced, emotionally labile. There are no meningeal symptoms. FMN: without features. Muscle strength 5 points. C / f and periosteal reflexes of medium vivacity, d = s. There are no sensitive violations. Coordination tests are satisfactory. In the Romberg position, slight instability.

Test results before treatment:

GShTD: T-14 / D-15

AMD - 59 / CSN - 45

Data from laboratory research methods before treatment: Plasma catecholamines: Adrenaline - 59 pg / ml (0-110); Norepinephrine - 317 pt / ml (70-750); Dopamine - 41 pt / ml (0-87); Plasma serotonin - 45 ng / ml (50-220), Hepatic tests: ALT - 7.80 units / l (7.00-35.00); ACT -18, 00 u / l (13.00-35.00); bilirubin, etc. - 14.00 μmol / ml (0.0-8.6); Bilirubin commonly. - 17.00 μmol / L (5.00-21.00); Alkaline phosphatase - 41.00 u / l (42.00-98.00), total cholesterol. - 6.09 mmol / L (0-5.30), LDL - 3.93 mmol / L (0-3.30), HDL - 1.80 mmol / L (0.90-1.90), triglycerides - 0.79 mmol / l (0.00-1.70)

Gas mass chromatography spectrometry (blood test for intestinal microbiota according to Osipov): the analysis shows an increase in the total bacterial load, an increase in the number of bifidobacteria and lactobacilli, actinomycetes, an imbalance in the group of clostridia, an increase in fungi due to micromycetes (sitosterol), and increased rates of herpes simplex.

Ultrasound of the abdominal cavity: U3-picture of fatty hepatosis, diffuse changes in the pancreas.

Scheme of complex treatment. Cipralex 10 mg was prescribed once a day for three months and Hepatosan 2 capsules 2 times a day 15-20 minutes before meals for 30 days. "Enterosan" 1 capsule 3 times a day for 40 days.

Test results after treatment:

GShTD: T-7 / D -8

AMD - 21 / ДДНС -18

Data from laboratory research methods before treatment:

Plasma catecholamines: Adrenaline - 67 pg / ml (0-110); Norepinephrine - 421 pg / ml (70-750); Dopamine - 52 pg / ml (0-87); Plasma serotonin - 64 ng / ml (50-220),

Hepatic tests: ALT - 12.50 units / l (7.00-35.00); ACT - 23.00 u / l (13.00-35.00); bilirubin, etc. - 7.00 μmol / ml (0.0-8.6); Bilirubin commonly. - 19.00 μmol / L (5.00-21.00); Alkaline phosphatase - 41.00 u / l (42.00-98.00), total cholesterol. - 4.93 mmol / L (0-5.30), LDL - 3.31 mmol / L (0-3.30), HDL - 1.74 mmol / L (0.90-1.90), triglycerides - 0.65 mmol / L (0.00-1.70)

Gas mass chromatography spectrometry (blood test for intestinal microbiota according to Osipov): a repeated study shows positive dynamics, a significant improvement in dysbiotic disorders: normalization of the level of micromycetes and herpes simplex, a decrease in the severity of the imbalance in the group of clostridia.

Upon repeated admission, the patient is in a good mood, notes a significant decrease in bloating and gas formation, normalization of stool. According to the results of testing for anxiety and depression - positive dynamics, normalization of biochemical parameters and the level of blood catecholamines.

Example 2

Patient K, 49 years old.

Clinical diagnosis. Generalized Anxiety Disorder. Astheno-neurotic syndrome. Headaches of tension. Irritable bowel syndrome. Fatty hepatosis.

The patient complains of increased irritability, anxiety, mood swings, constant headaches. The patient notes bloating and flatulence, a tendency to constipation.

Neurological status: in a clear mind, contact, oriented in time, space and self, emotionally labile, fixated on his complaints. There are no meningeal symptoms. FMN: without features. Muscle strength 5 points. C / f and periosteal reflexes of medium vivacity, d = s. There are no sensitive violations. Coordination tests are satisfactory. In the Romberg position is stable.

Test results before treatment:

GShTD: T-17 / D-13

VMD - 51 / CSN -54

Data from laboratory research methods before treatment:

Plasma catecholamines: Adrenaline - 37 pg / ml (0-110); Norepinephrine - 636 pg / ml (70-750); Dopamine - 42.1 pg / ml (0-87); Plasma serotonin - 52 ng / ml (50-220), Hepatic tests: ALT - 37.60 units / l (7.00-35.00); ACT - 33.00 u / l (13.00-35.00); bilirubin, etc. - 8.00 μmol / ml (0.0-8.6); Bilirubin commonly. - 20.10 μmol / L (5.00-21.00); Alkaline phosphatase - 53.00 u / l (42.00-98.00), total cholesterol. - 4.59 mmol / L (0-5.30), LDL - 2.91 mmol / L (0-3.30), HDL - 1.43 mmol / L (0.90-1.90), triglycerides - 0.5 mmol / l (0.00-1.70)

Gas mass chromatography spectrometry (blood test for intestinal microbiota according to Osipov): the analysis shows an increase in the total bacterial load, an increase in the number of bifidobacteria and lactobacilli, actinomycetes, eubacteria and clostridia, an increase in fungi due to micromycetes (campesterol).

Ultrasound of the abdominal cavity: ultrasound picture of fatty liver, suspension in the gallbladder.

Scheme of complex treatment. Prescribed "Spitomin" 10 mg 2 times a day for three months and "Hepatosan" 2 capsules 2 times a day for 15-20 minutes before meals for 30 days. "Enterosan" 1 capsule 3 times a day for 40 days. The patient was also prescribed an individual elimination diet, herbal antifungal drugs.

Test results after treatment:

GShTD: T-10 / D-9

VMD-17 / DNS-21

Data from laboratory research methods before treatment:

Plasma catecholamines: Adrenaline - 35 pg / ml (0-110); Norepinephrine - 378 pg / ml (70-750); Dopamine - 21.9 pg / ml (0-87); Plasma serotonin - 81 ng / ml (50-220),

Hepatic tests: ALT - 19.70 u / l (7.00-35.00); ACT - 27.00 u / l (13.00-35.00); bilirubin, etc. - 4.00 μmol / ml (0.0-8.6); Bilirubin commonly. - 13.00 μmol / L (5.00-21.00); Alkaline phosphatase - 54.00 u / l (42.00-98.00), total cholesterol. - 4.21 mmol / L (0-5.30), LDL - 2.84 mmol / L (0-3.30), HDL - 1.64 mmol / L (0.90-1.90), triglycerides - 0.55 mmol / L (0.00-1.70)

Gas mass chromatography spectrometry (blood test for intestinal microbiota according to Osipov): with a second study, normalization of the level of micromycetes, lacto- and bifidobacteria, a decrease in clostridia and eubacteria are observed.

With repeated admission, the patient is calm, the emotional background is even, headaches do not bother, and the stool improves. There is an improvement in the results of the hospital anxiety and depression scale.

Thus, the proposed complex therapy makes it possible to increase the effectiveness of the treatment of anxiety-depressive manifestations in patients with exacerbation of the chronic pathology of the digestive system, which is manifested by the positive dynamics of clinical symptoms, as well as the normalization of biochemical parameters, including the content of catecholamines in the blood, which leads to higher quality life in patients and does not affect their professional activities.

Claims (1)

A method for the correction of anxiety and depression in patients with a neurological profile in case of chronic pathology of the digestive system, characterized in that they prescribe the drug "Spitomin" 10 mg 2 times a day or "Cipralex" 10 mg 1 time per day for three months, "Hepatosan" 2 capsules twice a day, for 30 days, and Enterosan 1 capsule 3 times a day, for 40 days.