Method for carrying out combined reduction of depressive syndromes of subpsychotic level and endogenous genesis in day care hospital

FIELD: medicine.

SUBSTANCE: method involves administering typical tricyclic antidepressants combined with selective reverse serotonin capture inhibitors. Anxious version of subpsychotic level depressive syndrome of endogenous genesis being treated, intravenous drop-by-drop infusion of 2.-4.0 ml of 1% amitriptiline solution per 200 ml of physiologic saline is applied in 12-14 procedures combined with selective reverse serotonin capture inhibitor given per os, Zoloft is per os administered as the inhibitor at a dose of 50-100 mg. Then, supporting Zoloft therapy is applied at a dose of 100 mg during 3 months. Atypic version of depressive syndrome of subpsychotic level and endogenous genesis is treated with intravenous drop-by-drop infusion of 1.25% Melipramine solution at a dose of 2.0-4.0 ml per 200 ml of power supply source in 12-14 infusions combined with a reverse serotonin capture inhibitor. Paxyl is taken at a peroral dose of 40-60 mg as the inhibitor. Then, supporting Paxyl therapy is applied at a dose of 40-60 mg during 3 months.

EFFECT: enhanced effectiveness of treatment; reduced risk of complications; accelerated depressive syndrome relief.

 

The invention relates to medicine, namely to the edge of psychiatry.

There are ways to relieve depressive syndromes supplications level of endogenous origin: initial dose amitriptyline or melipramin must be at least 75 mg, the rate of increase of the dose should be 25-50 mg per day, the average therapeutic dose of amitriptyline is 250-300 mg per day, the recommended oral amitriptyline or melipramin (Gyaurskiy. The treatment of the mentally ill, 1981, page 343).

However, in the method of treatment Gaarochka is used, first, oral administration of antidepressants, which contributes to delays in the flow of the depressive phase, leads to the formation of therapeutic resistance, and secondly, using large doses that leads to serious side effects, reducing the “quality of life” patients.

Closest to the technical nature of the treatment of depressive syndromes supplications level of endogenous origin proposed Ulollak. In moderate and severe endogenous depression Genesis treatment starting with a/drip in large doses of tricyclic antidepressants (75-100 mg), increasing the dose over 3-4 days up to 200-250 mg In some cases, the daily dose tricyclic antidepressants may be increased up to 400-450 mg (Y. Muller. Affective psychoses, 1988, pp. 103-104).

However, in the method of treatment Uller also used large suboxides doses of tricyclic antidepressants, which leads to patients of a large number of side effects, reducing the “quality of life” of the patient. In addition, the method of treatment Uller calculated only for the patient, which limits the application of pharmacotherapy, increasing the risk of development of hospitalism” sick.

The task fast relief of depressive syndromes supplications level of endogenous origin in the daytime, except side effects.

The method consists in the/in a drip tricyclic antidepressants in combination with oral administration of selective inhibitors of serotonin reuptake, in/in drip 2,0-4,0 ml of 1% solution of amitriptyline in 200.0 ml of physiological solution No. 12-14, combined with oral administration of zoloft (sertraline) at a dose of 50-100 mg for anxiety version of the depressive syndrome supplications level of endogenous origin (ICD-10: recurrent depressive disorder, current episode severe degree), and within 3 months of zoloft (sertraline) at the dose of 100 mg on strategic support pathogenetic therapy; and/drops the ohms introduction 2,0-4,0 ml of 1, 25% solution of melipramin in 200.0 ml of physiological solution No. 12-14 when apathetic version of the depressive syndrome supplications level of endogenous origin, combined with oral administration of paxil (paroxetine) at a dose of 40-60 mg with taking paxil (paroxetine) at a dose of 40 mg for 3 months at the strategic support of pathogenetic therapy.

The method is as follows.

The treatment is performed in a day case or Cabinet of intensive therapy in the clinic. The patient lies on a bed, and he is intravenous drip infusion monetaryeconomics composition. When a disturbing version of the depressive syndrome supplications level of endogenous origin is/drip 2.0 ml of 1% solution of amitriptyline in 200.0 ml of physiological solution, which is combined with oral administration of zoloft (sertraline) at a dose of 50-100 mg depending on the severity of the condition after 2-3 days of treatment, the dose of amitriptyline increased to 4.0 ml. of All is 12-14 in/infusions. Strategic support pathogenetic therapy is prescribed zoloft (sertraline) at the dose of 100 mg for 3 months. When apathetic version of the depressive syndrome supplications level of endogenous origin is/drip 2.0 ml of 1.25% solution of melipramin in 2000 ml of physiological solution, that combined with oral administration of paxil (paroxetine) at a dose of 40-60 mg depending on the severity of the condition after 2-3 days of treatment, the dose of melipramin increases to 4.0 ml. of All is 12-14 in/infusions. Strategic support pathogenetic therapy is prescribed paxil (paroxetine) at a dose of 40 mg for 3 months. The duration of intravenous infusion of 1.5-2 hours, every 30 minutes is the control of blood pressure, pulse. After infusion the recommended rest for 30-40 minutes.

Examples:

1. Patient N. 38 years. Delivered to the treatment of relatives with complaints of severe anxiety (especially in the morning), sleep disturbance (pre-, intra-, postsomnic disorder), lack of appetite (lost 2 months to 8 kg), violation of the menstrual cycle in the form of delays, low mood, lack of strength, desires to do anything, thoughts of guilt before the relatives of the blame for the “non-existent” sins, fragmentary critical attitude to his condition. On the basis of complaints, anamnesis, psychopathological and pathopsychological survey was diagnosed according to ICD-10 and traditions of the domestic clinical psychiatry: depressive syndrome supplications level of endogenous origin, alarm option (ICD-10: the recurrent depressive disorders is eusto, the current episode severe degree). Was applied intravenous drip 4,0 ml to 1% solution of amitriptyline in combination with oral intake of zoloft (sertraline) 100 mg, course of 14 treatments. 3-4 day decreased anxiety, improved mood, at the end of treatment was stopped alarm, normalized vital function, improved mood, desactualizado depressive experiences, appeared critical attitude towards their disease. After the course the patient was transferred to the strategic support of pathogenetic therapy zoloft dose of 100 mg, the course of 3 months.

2. Patient S. 49 years. Delivered for treatment at the insistence of relatives, because he thinks that he has no help” and categorically refuses admission to a psychiatric hospital. Upon receipt of a complaint on depression, apathy, lack of strength, desires to do anything”, low mood, sleep disturbance, appetite (lost for 1.5 months to 12 kg), thoughts about the “futility of life”, “guilt”, a recurring suicidal thoughts. On the basis of complaints, anamnesis, psychopathological and pathopsychological survey was diagnosed with a depressive syndrome supplications level of endogenous origin, apathetic option. Was applied vnutricinovialnoe introduction to 4.0 ml of a 1.25% solution of melipramin in combination with oral administration of paxil (paroxetine) at a dose of 40 mg course of 14 treatments. 3-4 day increased mood for 10-12 days noted a surge of strength, energy, had a desire to live, work, normal vital functions, improved mood, desactualizado depressive experiences, appeared critical attitude towards their disease. After the course the patient was transferred to the strategic support of pathogenetic therapy paxil dose of 40 mg, the course of 3 months.

3. Patient D. 36, Delivered to the treatment with complaints of anxiety (especially in the morning), low mood, sleep disturbance (pre - intrasonics disorder), lack of appetite, lack of strength, desires, fatigue. Tears in his eyes, pantomimic depressed, lonely. According to relatives, most of the time at home he is actually doing nothing, staying in bed, with no one talking, refuses treatment in a psychiatric hospital. On the basis of complaints, anamnesis, psychopathological and pathopsychological survey was diagnosed with a depressive syndrome supplications level of endogenous origin, alarm option. Were treated according to the method Uller: was/drip injection of large doses of tricyclic antidepressants (75-100 mg), dose was increased over 3-4 days to 200-250 mg maintenance therapy has been recommended dose of 300 mg After treatment SOS is the right improved: normal vital functions, improved mood; stoped anxiety, however, during the entire course of treatment and further receiving maintenance therapy with amitriptyline at a dose of 300 mg, the patient had filed numerous complaints about the “dryness” in the mouth, asthenia and myorelaxation, constipation, vision problems, difficulty urinating. After discharge from hospital the patient was unable to perform usual work was drowsy, lethargic, had complained of sexual problems. When using this method there side effects typical of tricyclic antidepressants, which affects the quality of life of the patient and this method is adequate only for stationary conditions.

Thus, the use of the proposed method facilitates rapid relief of depressive syndromes supplications level of endogenous origin in the daytime; the combination of tricyclic antidepressants with selective inhibitors of serotonin reuptake leads to minimal side effects, which significantly improves the quality of life of patients by further use of selective inhibitors of reuptake of serotonin as a strategic support pathogenetic therapy.

The method of combined relief of depressive syndromes supplication the level of endogenous origin in the daytime includes intravenous drip tricyclic antidepressants, characterized in that the introduction of tricyclic antidepressants combined with oral administration of selective inhibitors of serotonin reuptake, while in the treatment of anxiety variant of depressive syndrome supplications level of endogenous origin injected intravenously 2,0-4,0 ml of 1% solution of amitriptyline in 200 ml of physiological solution number 12-14 infusion in combination with oral administration of an inhibitor of serotonin reuptake, which orally administered zoloft dose of 50-100 mg followed by maintenance therapy zoloft dose of 100 mg for three months; and when atypical variant of depressive syndrome supplications level of endogenous origin injected intravenously 2,0-4,0 ml of a 1.25% solution of melipramin in 200 ml of physiological solution number 12-14 infusion in combination with oral administration of an inhibitor of serotonin reuptake, which orally administered paxil dose of 40-60 mg followed by maintenance therapy with paxil dose of 40 mg for three months.



 

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