RU2726396C1 - Method of psychoemotional correction in patients with gilbert's syndrome - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to neurology, and can be used for correction of psychoemotional manifestations in patients with Gilbert's syndrome. That is ensured by administering "Cipralex" 10 mg once a day for three months or "Atarax" 25 mg 1 tablet 2-3 times a day for two months and "Hepatosan" 2 capsules 3 times day 15–20 minutes before meals for 60 days with dietetic nutrition.EFFECT: method enables eliminating the main pathological symptoms in unconjugated bilirubinemia by potentiating the effect of the preparations while improving the somatic status of the patients and reducing the length of treatment.1 cl, 6 ex

Description

The invention relates to medicine, namely to neurology, and allows for the correction of anxiety and depressive states in patients with Gilbert's syndrome.

Recent studies have made it possible to expand the understanding of the pathogenesis of depressive anxiety disorders by introducing the concept of neurobiological mechanisms of development, which made it possible to identify additional targets in a number of pharmacological effects.

The neurotoxic effects of indirect bilirubin on the brain have long been known. It turns out that the gene responsible for the metabolism of bilirubin is next to the gene that causes the patient to have extrapyramidal disorders, which can manifest in some patients with hand tremors.

Bilirubin is a toxic metabolite, and therefore bilirubin encephalopathy can indeed develop when benign hyperbilirubenemia is diagnosed. One of the most common variants of functional hyperbilirubinemia is Gilbert's syndrome.

Currently, Gilbert's syndrome is a heterogeneous, relatively common condition that leads to chronic, often familial, unconjugated hymerbilirubinemia. Diseases are caused by a violation of the metabolic processes of bilirubin and its subsequent excretion in the bile. Traditionally, Gilbert's syndrome is considered an autosomal recessive pathology, and in the light of new studies, a violation of bilirubin metabolism is also detected in heterozygous gene carriers.

Bilirubin is toxic to both the nervous system and many other tissues. Its metabolism is associated with a complex of biochemical processes in the body. The gem-core of hemoglobin and some other enzyme systems of the body forms bilirubin during metabolism. Its retention in serum is an indicator of liver dysfunction.

During the day in the process of metabolism, gem is formed from 200 to 450 mg. bilirubin. The breakdown of hemoglobin is the source of 80% of bilirubin.

In the blood, bilirubin is present in unconjugated form and is tightly bound to albumin. In the body, under the action of the microsomal enzyme UDPGT (uridine diphosphate-glucuronyl transferase), bilirubin is converted into a polar water-soluble substance during conjugation, which is then secreted into the intestinal lumen with bile. UDFGT is a group of enzymes located in the endoplasmic reticulum of hepatocytes. It is involved in the metabolism of a large number of substances: hormones (steroid hormones, thyroid hormones), catecholamines, endogenous metabolites (bile acids, bilirubin), drugs and their metabolites, as well as toxins, including carcinogens. The transformation of molecules in the first phase of biotransformation increases their polarity and decreases the ability to dissolve in lipids, which makes them less toxic.

This effect is further enhanced due to the addition of endogenous substances (glucuronic acid, acetate, glutathione, etc.) to the metabolic products formed during phase 1. Like the phase 1 enzymes of xenobiotic matebolism, phase 2 enzymes have substrate specificity and are involved in the transformation of a large group of chemicals. There are two subtypes of UDFGT: UDFGT1 and UDFGT2. UGT1A1 is responsible for the conjugation of bilirubin, it is its defect that leads to the appearance of hyperbilirubinemia.

The main clinical symptom is jaundice, which is characterized by a yellow color of the skin, sclera and mucous membranes as a result of their staining with bilirubin with an increase in its level in the blood. Some patients may experience asthenovegetative disorders, which are characterized by increased fatigue, weakness, and sleep disturbance. These phenomena, caused by the neurotoxic effect that bilirubin has on the brain, are associated with inhibition of metabolic processes and impairment of the synthetic function of cells in a number of brain structures. They are linked to the appearance of "bilirubin" encephalopathy.

In such patients, an increase in bilirubin due to an indirect fraction may be detected during examination. With ultrasound in 11% of cases, minor hepatomegaly may be detected due to the right lobe. Moreover, in the study of the motor function of the gallbladder, its dysfunction is often determined.

Currently, methods of treating hyperbilirubininemia with drugs that have the ability to increase the enzymatic activity of hepatosomes, enhance the formation of glucuronides, which ensure the excretion of endogenous and exogenous metabolites from the body, increasing the secretion of bile, are being actively developed.

In patients with Gilbert's syndrome, in about 30% of cases, essential tremor of varying severity is detected. This phenomenon, apparently, is due to the fact that chronic hyperbilirubinemia is a factor leading to the manifestation of the latter (Shulyatiev I.S. "Gilbert's syndrome: clinic, diagnostics, functional state of the liver", Abstract of the dissertation for the degree of candidate of medical sciences, Moscow, 2006).

Of course, Gilbert's syndrome always refers to an autosomal recessive mode of inheritance. However, in our study, heterozygous (n = 6n = 7) patients were identified who had a clinical picture of this disease, despite the fact that their clinical manifestations were much less pronounced than in homozygous (n = 7n = 7) carriers. Based on the literature (Fermander Salazar SM "Distibution of the A (AT) 7TAA genotype associated with Gilbert syndrome in the Spanish population. Med. Clin (Bare), 2000 Oct 28, 115 (14): 540-1) at risk may include up to 40% of the world's population. Probably, the development of the disease in these patients requires the presence of other mutations in the enzyme systems of cytochrome P-450, which are involved in detoxification. Based on this, we can talk about the heterogeneity of Gilbert's syndrome. The presence of a mutation is a predisposing factor, however, a complex of factors is required for the development of the disease. Depending on their presence, a certain variant of the course of the disease may develop. Therefore, upon finding a gene defect in a patient, it is necessary to assess the state of other organs and systems, in particular, the liver, gastrointestinal tract, etc.

The closest technical solution is a method of treating patients with Gilbert's pigmentary hepatosis (SU, AC No. 1836949 A1 dated 08.30.93), including the appointment of sodium nucleinate, benzonal and convaflavin.

The objective of the present invention is to improve the efficiency of treatment of neurological patients with psychoemotional disorders against the background of Gilbert's syndrome.

The task, namely, a method of correcting psychosomatic manifestations in patients with Gilbert's syndrome, is achieved by prescribing Cipralex 10 mg once a day for three months or Atarax 25 mg 1 tablet 2-3 times a day for two months and "Hepatosan" 2 capsules 3 times a day 15-20 minutes before meals for 60 days on the background of dietary nutrition.

The proposed combination of drugs, when administered together, provides a potentiated effect and eliminates the main pathological symptoms in unconjugated hyperbilirubinemia in patients with a gene defect (UDFGT1).

For the first time, a comprehensive assessment of the potential of psycho-pharmacotherapeutic drugs along with agents normalizing the metabolic activity of liver hepatocytes associated with bilirubin biotransformation was carried out, based on a combined analysis of indicators of mental status and the level of neurotransmitters, regardless of the clinical variant of the disease.

To assess the effect of pharmacotherapy on the dynamics of mental status, the state of functional activity of the liver and clinical and laboratory manifestations of the disease, two groups of patients with a total number of 23 people were identified, in which, according to psychodiagnostic tests, the level of depressive and (or) anxiety disorders went beyond the range of reference values for used techniques. The control group included 17 patients who received psychocorrective therapy. The main group of patients received complex treatment, including a biological product that affects the functioning of the liver (“Hepatosan” was prescribed 2 capsules 3 times a day 10-15 minutes before meals for 60 days).

The study of mental status in patients was carried out using a quantifiable hospital scale of anxiety and depression (according to A.S. Zigmond and R.P. Snaith). Neuroendocrine changes were studied by the level of serotonin and catecholamines in blood plasma: adrenaline, norepinephrine and dopamine.

When testing patients, a time frame was clearly defined, sufficient to answer all questions that reliably confirm the pronounced symptoms of anxiety and depression.

As a result of the studies, it was found that patients with Gilbert's syndrome showed a high and moderate general level of neuroticity. Moreover, all patients had mental disorders of varying severity. On the hospital scale of anxiety and depression, the average values were: T-11 / D-14 (clinically pronounced anxiety and depression).

In a comparative analysis of the dynamics of the clinical manifestations of anxiety and depressive disorders in patients with Gilbert's syndrome, it was found that the appointment of the biological product "Hepatosan" to psychocorrective therapy can significantly reduce the time of correction of the psychoemotional state in comparison with the control group, and also improve the somatic status of patients.

Clinical trials were carried out on the basis of "PROFESSIONALS OF HEALTH AND BEAUTY-HP BP Group", Limited Liability Company.

The method is illustrated by the following examples:

Example 1.

Patient A, 59 years old

Clinical diagnosis: Essential tremor. Gilbert's syndrome. Astheno-depressive syndrome. Metabolic syndrome.

When applying, he complained of tremor of the hands, yellowness of the skin, decreased mood background, occasional discomfort in the right hypochondrium, bloating of the intestines, stool disorders (constipation, loose stools).

Neurological status: clear consciousness, contact, oriented in time, space and self, the face is hypomimic. Speech is a little blurry. Visually - pronounced yellowness of the face, hysteria of the sclera. There are no meningeal symptoms. FMN: no peculiarities. Muscle strength 5 points. Slight rigidity of the trunk and arms. C / f and periosteal reflexes of medium liveliness, d = s. There are no sensitive violations. Performs coordination tests satisfactorily. Tremor of the fingers is noted. Stable in the Romberg position. Notes a decrease in concentration and memory.

Test results before treatment:

Hospital scale of anxiety and depression (hereinafter GSHTD): T-11 / D-14.

Microfood Deficiency Test (MTD) and Neurotransmitter Deficiency (DNT) Test: 40 and 57.

Data of laboratory research methods before treatment:

Plasma catecholamines: Epinephrine - 67 pg / ml (0-110); Norepinephrine - 307 pg / ml (70-750); Dopamine - 51 pg / ml (0-87); Plasma serotonin - 48 ng / ml (50-220).

Liver tests: ALT - 54.70 units / l (7.00-35.00); ACT - 42.40 units / l (13.00-35.00); bilirubin ex. - 9.10 μmol / ml (0.0-8.60); bilirubin total - 26, 50 μmol / l (5.00-21.00); ALP - 67.00 units / l (42.00-98.00).

Complex treatment scheme:

Prescribe "Cipralex" 10 mg once a day for three months and "Hepatosan" 2 capsules 3 times a day 15-20 minutes before meals for 60 days

Data of laboratory research methods after treatment:

Plasma catecholamines: Epinephrine - 50 pg / ml (0-110); Norepinephrine - 218 pg / ml (70-750); Dopamine - 57 pg / ml (0-87); Plasma serotonin - 61 ng / ml (50-220).

Liver tests: ALT - 27.40 units / l (7.00-35.00); ACT - 24, 90 units / l (13.00-35.00); bilirubin ex. - 6.20 μmol / ml (0.0-8.60); bilirubin total - 20.00 μmol / l (5.00-21.00); ALP - 71.00 units / l (42.00-98.00).

Test results after treatment:

GShTD: T-9 / D - 10

MPD - 22 / DNT - 30

Against the background of the therapy, the patient noted a significant improvement in his general condition. The tremor became less pronounced, the mood improved, complaints of discomfort and bloating in the abdomen were significantly reduced, the yellowness of the face and hysteria were not observed. According to the results of repeated testing, a positive trend is noted. According to laboratory studies, there is a decrease in the levels of direct and total bilirubin, an increase in the level of serotonin.

Example 2.

Patient B, 27 years old

Clinical diagnosis: Generalized anxiety disorder. Astheno-neurotic syndrome. Gilbert's syndrome. Dorsopathy, osteochondrosis of the spine.

When applying, he complained of increased anxiety, irritability, fear, emotional lability, decreased libido, abdominal discomfort after eating, lower back pain radiating to the right leg, pulling pain in the groin.

Neurological status: In clear consciousness, contact, oriented in time, space and self. Emotionally labile, a little agitated. On examination, there is some icterus of the sclera. There are no meningeal symptoms. FMN: no peculiarities. Muscle strength 5 points. Muscle tone is not changed. C / f and periosteal reflexes are revived, d = s. No sensitive disorders were found. Performs coordination tests correctly. Stable in the Romberg position.

Test results before treatment:

GShTD: T - 19 / D-13

MPD - 47 / DNT - 52

Data of laboratory research methods before treatment:

Plasma catecholamines: Epinephrine - 114 pg / ml (0-110); Norepinephrine - 753 pg / ml (70-750); Dopamine - 84 pg / ml (0-87); Plasma serotonin - 44 ng / ml (50-220).

Liver tests: ALT - 52.00 units / l (7.00-35.00); ACT - 34.30 U / L (13.00-35.00); bilirubin ex. - 10.30 μmol / ml (0.0-8.60); bilirubin total - 32.90 μmol / l (5.00-21.00); ALP - 78.00 units / l (42.00-98.00).

Genetic research: diagnosis of Gilbert's syndrome - n = 7n = 7

Complex treatment scheme:

Prescribe "Atarax" 25 mg 3 times a day for three months and "Hepatosan" 2 capsules 3 times a day 15-20 minutes before meals for 60 days. Complex therapy was also prescribed to relieve low back pain.

Data of laboratory research methods after treatment:

Plasma catecholamines: Epinephrine - 78 pg / ml (0-110); Norepinephrine - 332 pg / ml (70-750); Dopamine - 54 pg / ml (0-87); Plasma serotonin - 56 ng / ml (50-220).

Liver tests: ALT - 27.00 units / l (7.00-35.00); ACT - 29.80 U / L (13.00-35.00); bilirubin ex. - 7.00 μmol / ml (0.0-8.60); bilirubin total - 19.60 μmol / l (5.00-21.00); ALP - 69.00 units / l (42.00-98.00).

Test results after treatment:

GShTD: T - 10 / D - 7

MPD - 19 / DNT - 24

On a second visit, she notes a significant improvement in her condition. The mood background has stabilized, but some irritability remains. The feeling of discomfort in the abdomen does not bother. Pain syndrome does not bother. According to laboratory research and testing results, there is a positive trend.

Example 3.

Patient B, 22 years old

Clinical diagnosis: Generalized anxiety disorder. Astheno-depressive syndrome. Gilbert's syndrome.

At the first visit, complaints of decreased mood background, apathy, chronic fatigue, sleep disturbances; on acne on the face, stool disorders - a tendency to constipation, bloating and discomfort in the abdomen, to a sharp increase in body weight.

Neurological status: in clear consciousness, contact, oriented in time, space and self, the background of mood is lowered, anxious. There are no meningeal symptoms. FMN: no peculiarities. Muscle strength 5 points. C / f and periosteal reflexes of medium liveliness, d = s. There are no sensitive violations. Performs coordination tests satisfactorily. She is stable in the Romberg position.

Test results before treatment:

GShTD: T-17 / D - 14

MPD - 27 / DNT - 39

Data of laboratory research methods before treatment:

Plasma catecholamines: Epinephrine - 93 pg / ml (0-110); Norepinephrine - 418 pg / ml (70-750); Dopamine - 56 pg / ml (0-87); Plasma serotonin - 47 ng / ml (50-220).

Liver tests: ALT - 36.00 units / l (7.00-35.00); ACT - 20.10 U / L (13.00-35.00); bilirubin ex. - 8.9 μmol / ml (0.0-8.6); Bilirubin total - 25.80 μmol / l (5.00-21.00); ALP - 22.00 units / l (42.00-98.00).

Genetic research: diagnosis of Gilbert's syndrome - n = 7n = 7

Complex treatment scheme:

Prescribed "Cipralex" 10 mg once a day for three months and "Hepatosan" 2 capsules 3 times a day 15-20 minutes before meals for 60 days.

Data of laboratory research methods after treatment:

Plasma catecholamines: Plasma catecholamines: Epinephrine - 69 pg / ml (0-110); Norepinephrine - 299 pg / ml (70-750); Dopamine - 52 pg / ml (0-87); Plasma serotonin - 65 ng / ml (50-220).

Liver tests: ALT - 20.00 units / l (7.00-35.00); ACT - 24.40 U / L (13.00-35.00); bilirubin ex. - 4.6 μmol / ml (0.0-8.6); bilirubin total - 12.30 μmol / l (5.00-21.00); ALP - 24.00 units / l (42.00-98.00).

Test results after treatment:

GShTD: T-10 / D - 9

MPD - 19 / DNT - 22

At the second consultation, the patient notes that the background of the mood has improved significantly, tearfulness and irritability have decreased. The stool has returned to normal, bloating is less bothersome, but some abdominal discomfort remains. Weight decreased by 1.5 kg. There is a positive trend in the results of testing for anxiety and depression, as well as the normalization of biochemical parameters and the level of blood catecholamines.

Example 4.

Patient G, 59 years old

Clinical diagnosis: Generalized anxiety disorder. Astheno-neurotic syndrome. Gilbert's syndrome.

Complaints at the initial consultation about sleep disturbances, shallow sleep, increased irritability, tearfulness, decreased mood background, dissatisfaction with oneself, internal tension, apathy, a feeling of heaviness in the abdomen, a tendency to constipation, periodically numbness of the fingers and feelings of chilliness in the hands, headaches.

Neurological status: in clear consciousness, contact, oriented in time, space and self, emotionally labile. The pronounced icterus of the sclera, yellowness of the face are visually determined. There are no meningeal symptoms. FMN: no peculiarities. Muscle strength is preserved. C / f and periosteal reflexes are evenly revitalized. No sensitive disorders were found. Performs coordination tests correctly. She is stable in the Romberg position.

Test results before treatment:

GShTD: T - 17 / D-15

MPD - 41 / DNT - 55

Data of laboratory research methods before treatment:

Plasma catecholamines: Plasma catecholamines: Epinephrine - 126 pg / ml (0-110); Norepinephrine - 783 pg / ml (70-750); Dopamine - 40 pg / ml (0-87); Plasma serotonin - 47 ng / ml (50-220).

Liver tests: ALT - 29.90 units / l (7.00-35.00); ACT - 25.40 U / L (13.00-35.00); bilirubin pr. - 8.7 μmol / l (0.0-8.6), total bilirubin. - 27.10 μmol / l (5.00-21.00); ALP - 59.00 units / l (42.00-98.00).

Genetic research: diagnosis of Gilbert's syndrome - n = 7n = 7

Complex treatment scheme:

Prescribed "Atarax" 25 mg 3 times a day for three months and "Hepatosan" 2 capsules 3 times a day 15-20 minutes before meals for 60 days.

Data of laboratory research methods after treatment:

Plasma catecholamines: Plasma catecholamines: Epinephrine - 104 pg / ml (0-110); Norepinephrine - 713 pg / ml (70-750); Dopamine - 37 pg / ml (0-87); Plasma serotonin - 55 ng / ml (50-220).

Liver tests: ALT - 28.60 units / l (7.00-35.00); ACT - 24.10 U / L (13.00-35.00); bilirubin pr. - 5.1 μmol / l (0.0-8.6), total bilirubin. - 13.10 μmol / l (5.00-21.00); ALP - 55.00 units / l (42.00-98.00).

Test results after treatment:

GShTD: T - 12 / D-9

MPD - 20 / DNT - 29

At the second consultation, the patient notes a significant positive dynamics against the background of the treatment: complexion and sclera normalized, mood improved, tearfulness decreased, stools normalized, and began to perceive information more calmly. She began to fall asleep faster, practically does not wake up at night. However, there remains a feeling of inner tension and a feeling of dissatisfaction with oneself. There is a positive dynamics of laboratory parameters and a decrease in the severity of anxiety and depression according to the results of repeated testing.

Example 5.

Patient D, 26 years old

Clinical diagnosis: Essential tremor. Gilbert's syndrome. Astheno-depressive syndrome. Irritable Bowel Syndrome.

When applying, he complained of tremor of the hands and facial muscles, more pronounced in the morning, in a state of hunger, after coffee, tea, in stressful situations. Discomfort, abdominal pain, especially after bread, fatty, fried; tendency to frequent stools, increased gas production. Notes apathy, decreased mood, lethargy, decreased motivation, concentration. Gilbert's syndrome (n = 7n = 7) was diagnosed at the age of 14 years.

Neurological status: in clear consciousness, contact, oriented in time, space and self. Visually, the face has a slight icteric color, the sclera are icteric. There are no meningeal symptoms. FMN: no peculiarities. Muscle strength is preserved. C / f and periosteal reflexes of medium liveliness, D = S. No sensitive disorders were found. Performs coordination tests correctly. Small-sweeping tremor of the hands, D = S, not a pronounced tremor of the extended tongue. Stable in the Romberg position.

Test results before treatment:

GShTD: T - 13 / D-10

MPD - 34 / DNT - 41

Data of laboratory research methods before treatment:

Plasma catecholamines: Epinephrine - 105 pg / ml (0-110); Norepinephrine - 730 pg / ml (70-750); Dopamine - 62 pg / ml (0-87); Plasma serotonin - 51 ng / ml (50-220).

Liver tests: ALT - 32.80 units / l (7.00-35.00); ACT - 35.50 U / L (13.00-35.00); bilirubin pr. - 9.20 μmol / l (0.0-8.60), total bilirubin. - 28.90 μmol / l (5.00-21.00); ALP - 65.00 units / l (42.00-98.00).

Complex treatment scheme:

"Cipralex" 10 mg once a day for three months and "Hepatosan" 2 capsules 3 times a day 15-20 minutes before meals for 60 days.

Data of laboratory research methods after treatment:

Plasma catecholamines: Epinephrine - 76 pg / ml (0-110); Norepinephrine - 401 pg / ml (70-750); Dopamine - 57 pg / ml (0-87); Plasma serotonin - 58 ng / ml (50-220)

Liver tests: ALT - 21.70 units / l (7.00-35.00); ACT - 19.70 units / l (13.00-35.00); bilirubin pr. - 4.90 μmol / l (0.0-8.60), total bilirubin. - 18.20 μmol / l (5.00-21.00); ALP - 76.00 units / l (42.00-98.00).

Test results after treatment:

GShTD: T - 6 / D-7

MPD - 17 / DNT - 19

On repeated admission, he notes a significant positive dynamics, a surge of strength. The tremor of the hands worries periodically - against the background of excitement, overwork. She notes that the yellowness of the face is gone, pains and discomfort in the abdomen bother much less often. The drugs were well tolerated without the development of adverse reactions. He adhered to dietary recommendations with minor violations.

Example 6.

Patient B, 49 years old

Clinical diagnosis: Migraine. Cervicocranialgia. Muscular-tonic syndrome. Astheno-depressive syndrome. Gilbert's syndrome.

At the first visit, complaints of headaches in the temples of a pulsating character. Headaches can last up to three days and are relieved by taking triptans for 12 hours. The patient is also worried about constipation. Confirmed diagnosis of Gilbert's disease.

Neurological status: in clear consciousness, contact, oriented in time, space and self, the background of mood is lowered, anxious. There are no meningeal symptoms. FMN: no peculiarities. Muscle strength 5 points. C / f and periosteal reflexes of medium liveliness, d = s. There are no sensitive violations. Performs coordination tests satisfactorily. She is stable in the Romberg position. On palpation, tension and soreness of the muscles of the neck-collar region.

Test results before treatment:

GShTD: T-13 / D - 14

MPD - 42 / DNT - 37

Data of laboratory research methods before treatment:

Plasma catecholamines: Adrenaline - 37 pg / ml (0-110); Norepinephrine - 458 pg / ml (70-750); Dopamine - 42.1 pg / ml (0-87); Plasma serotonin - 51 ng / ml (50-220).

Liver tests: ALT - 18.9, 00 units / l (7.00-35.00); ACT - 32.5 units / l (13.00-35.00); bilirubin ex. - 9.8 μmol / ml (0.0-8.6); Bilirubin total - 28.9 μmol / l (5.00-21.00); ALP - 22.00 units / l (42.00-98.00).

Complex treatment scheme:

Prescribed "Cipralex" 10 mg once a day for three months and "Hepatosan" 2 capsules 3 times a day 15-20 minutes before meals for 60 days.

Data of laboratory research methods after treatment:

Plasma catecholamines: Plasma catecholamines: Epinephrine - 81 pg / ml (0-110); Norepinephrine - 205 pg / ml (70-750); Dopamine - 58 pg / ml (0-87); Plasma serotonin - 71 ng / ml (50-220)

Liver tests: ALT - 12.6, 00 units / l (7.00-35.00); ACT - 22.9 units / l (13.00-35.00); bilirubin ex. - 7.8 μmol / ml (0.0-8.6); Bilirubin total - 20.1 μmol / l (5.00-21.00); ALP - 22.00 units / l (42.00-98.00).

Test results after treatment:

GShTD: T-8 / D - 7

MPD - 21 / DNT - 18

Upon repeated consultation, she notes an improvement in well-being, a significant decrease in the intensity and frequency of headaches, and an improvement in the background mood. The chair returned to normal. According to the patient, that in the first two weeks there was some deterioration, a decreased background of mood and general weakness, then she felt a sharp improvement, a surge of strength.

It should be noted that the entire course of treatment was carried out against the background of dietary nutrition based on lean soups, vegetable oil, porridge on the water, fruits and vegetables after heat treatment, as well as with the inclusion of lean meats and fish.

The proposed combination therapy ensures the elimination of bilirubin in a more physiological way.

Thus, thanks to the proposed method of complex treatment of patients with anxiety and depressive disorders against the background of Gilbert's syndrome, a positive effect was obtained, reflecting a high therapeutic efficacy, accompanied by the correction of anxiety and depressive conditions, including due to the normalization of metabolic processes in the liver and leading to a reduction in the time treatment.

Claims (1)

A method of correcting psychosomatic manifestations in patients with Gilbert's syndrome, characterized by the fact that Cipralex is prescribed 10 mg once a day for three months or Atarax 25 mg, 1 tablet 2-3 times a day for two months and "Hepatosan" 2 capsules 3 times a day 15-20 minutes before meals for 60 days on the background of dietary nutrition.