Method for carrying out combined reduction of schizo-affective syndromes of psychotic and subpsychotic level in day care hospital

FIELD: medicine.

SUBSTANCE: method involves administering typical neuroleptics according to titration scheme and tricyclic antidepressants. Neuroleptics are applied according to titration scheme in the morning and tricyclic antidepressants are introduced as intravenous drop-by-drop infusion in the evening in combination with per os application of atypic neuroleptic risperidon. After having given 12-14 intravenous infusions, strategic supporting risperidon psychopharmacotherapy in combination with tricyclic antidepressants during 4-6 months.

EFFECT: enhanced effectiveness in overcoming pharmacological resistance; accelerated schizo-affective syndrome relief.

 

The invention relates to medicine, namely to clinical psychiatry.

Principles of treatment of schizoaffective States in recent years have been most thoroughly developed Antaranews (1995) and Powrotem (1998) (From “Guide to psychiatry”./Edited Asthana, 1999). In the case of schizoaffective psychosis with relatively shallow nature of delusional disorders by type of delirium perception and phase dynamics of the disease is most justified concomitant use of antidepressants and neuroleptics. For relief of acute psychotic States uses a combination of tricyclic antidepressants and phenothiazine neuroleptics series. Tricyclic antidepressants (amitriptyline, melipramin, anafranil) are recommended in moderate doses (150-200 mg per day). The dosage of neuroleptics and their combination depends on the degree of completion of delusional disorders in the framework of delirium perception. When unexpanded state by type of crazy mood dosage of stelazine may not exceed 10 mg per day of chlorpromazine 50-75 mg These drugs can be administered in combination with Relanium (in moderate doses). When the more extensive forms of delusional disorders (delirium staging and brad symbolic values) require higher doses of neuroleptics. Daily dose of stelazine when these forms can be taken is obtained up to 15-20 mg, chlorpromazine - up to 100-150 mg

However, in this method of treatment is used, first, the reception of classical neuroleptics with severe neuroleptic side effect, making it difficult for psychotic state, leads to the formation of pharmacogenet negative symptoms, and secondly, using large doses that leads to severe side effects, reducing the “quality of life” patients.

Another method for the treatment of schizoaffective States proposed Ulollak (Uller “Affective psychoses”, 1988, str -213). Treatment starting with daily doses of leponex from 200 to 800 mg, more 400-600 mg for less severe and rapid development schizoaffective attack the appointment of fenazepam at a dose of 3-6 mg (20% solution).

However, this method of treatment is used atypical neuroleptic clozapine, for which a high risk of development of such dangerous complications such as agranulocytosis, which requires control of the blood treatment method Uller calculated only for the patient, because involves oral medication, which limits the possibility of acute pharmacotherapy.

Closest to the technical nature of the way the relief of acute psychotic States proposed in the application “titration methods in the modification RA the barn., Ahistoric. 1989 (“the Pharmacological basis of rehabilitation of the mentally ill./Edited Ryabogin, Gesture, 1989). The essence of the method consists in the following: first, insert a small test dose of the drug to determine whether the patient has hypersensitivity to it. If not observed, begins injecting drugs in a small dosage (haloperidol, triftazin or maratel 5-10 mg, melipramin 25-50 mg intramuscularly). For the patient's condition is monitored and within 1/2 hour, the outcome of which addressed the issue of the expediency of the further administration of the drug and determining the dose. Re-introduction is carried out in the case, if the previous injection has not had a therapeutic effect. The main criteria based on which the conclusion is made about the necessity or otherwise, to continue the introduction, is the degree of reduction of psychopathological symptoms in the sphere of affect motility and activity, as well as the severity of sedation. The emergence of severe side somatotropic or neurotropic action serves as a signal to suspend the introduction of psychotropic drugs. Antiparkinsonian offsets are entered only when a distinct occurrence of extrapyramidal side effects.

Method proposed by the authors of psychopharmaca therapy involves intramuscular injection of classical antipsychotic drugs, having pronounced side effects, contributing to the formation of negative drug disease variability. This technique involves only monotherapy psychotic state and not rely on the possibility of combined pharmacotherapy.

The task fast relief of schizoaffective disorder psychotic syndromes and supplications level of endogenous origin depressive-paranoid variant in the daytime with overcoming drug resistance.

The essence of the method lies in the fact that patients with schizoaffective condition, psychosis and supplications level of endogenous origin in the first half of the day is intramuscular haloperidol in a dose of 5-10 mg titration scheme (3-4 titration in the average daily dosage 115-130 mg), to the relief of manifestations of psychomotor excitation, intense affect the appearance of a pronounced degree of sedation in the second half of the day is intravenous infusion of 2.0 to 6.0 ml of 1% solution of amitriptyline in 200.0 ml of physiological solution No. 12-14, from the first day of pharmacotherapy patient orally takes atypical neuroleptic risperidone (Rispolept) at a dose of 4-6 mg per day as a strategic support pathogenetic therapy is prescribed risperidone (ri is Palat) at a dose of 4-6 mg in combination with amitriptyline dosage 75-125 mg per day, a duration of at least 4-6 months.

The method is as follows. Treatment in a day hospital or separation of the first episode. The patient lies on a bed and he is intramuscular antipsychotics - haloperidol at a dose of 5 mg, and then dynamically monitoring the patient's condition, the re-introduction of the drug through 1/2 hour when signs of fading psychotropic effects of the drug and the lack of side effects. The criterion of necessity or otherwise, to re-titrate is the degree of reduction of productive psychopathological symptoms. When depressive-Bregovo version schizoaffective syndrome is titration haloperidol 5-10 mg per injection, depending on individual tolerance. The titration is carried out in the first half of the day. The second half of the day is spent in/drip 2.0 ml of 1% solution of amitriptyline in 200.0 ml of physiological solution, which is combined with oral administration of risperidone (Rispolept) at a dose of 4-6 mg due To the severity of psychopathological symptoms the titration is carried out through the day, at least 2-3 courses per week average dose 115-130 mg of haloperidol per day, the dose of amitriptyline increased to 40-60 mg (4,0-6,0 ml). Just held 12-14 in/infusions Period of time between the last injection of haloperidol and the start of the intravenous infusion of amitriptyline is 4.5-5 hours, 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, if necessary, use symptomatic treatment (kordiamin, caffeine and others).

Examples

1. Patient S., 38 years. In premorbid with symptoms of schizo-cyclonic personality traits. Delivered to the treatment of relatives with a pronounced state of agitation, anxiety, fear, depressive state, accompanied by ideas of self-blame, self-abasement, delusional ideas of his own guilt, ideas of persecution, delusional orientation, false recognitions, the syndrome of “double negative”, abortifacient auditory hallucinations, there is a decrease of the critical attitude to his condition. On the basis of complaints, anamnesis, psychopathological and pathopsychological survey was diagnosed with Acute schizoaffective condition, depressive-paranoid syndrome of endogenous origin. Was applied intramuscular titration haloperidol in a dose of 5 mg increase after the 4th injection up to 10 mg daily dose of haloperidol was 110 mg, in the second half of the day intravenous drip of 6.0 ml of 1% solution of amitriptyline, morning and evening, assigned to risperidone (Rispolept in the dose of 4 mg per day. In% the CE course pharmacotherapy were stopped agitation fully degenerate affect anxiety, fear, desactualizado paranoid experiences, criticism appeared to her condition, normal vital functions, recovered positively unstable background mood. After the course the patient was transferred to the strategic support of pathogenetic therapy Rispolept in a dose of 4 mg / day and amitriptyline at a dose of 75 mg per day.

2. Patient P., 37 years. With signs of schizoid personality traits in premorbid delivered for treatment at the insistence of relatives, marked anxiety, fear, expressed delusional ideas of persecution, dramatizations, believes that he and his family in danger on the street notice how the surrounding sympathetic look at him, hints, trying to play in front of him “play”, where he acts as the protagonist, the suppressed mood, periodically starts crying, asking him “did lethal injection, and then, on the contrary, with tears in her eyes tragic voice asks, to the doctors stopped his torment, because he thinks that he has no help”, closed, away from interpersonal contacts, categorically refuses admission to a psychiatric hospital. Relatives say the state has evolved over 1.5 weeks the ü - the patient was withdrawn, anxious, suspicious, tearful, within 3 days of not sleeping. On the basis of complaints, anamnesis, psychopathological and pathopsychological survey was diagnosed with Schizoaffective disorder, sustainedly option, affective - paranoid syndrome. Was applied intramuscular haloperidol in titration scheme 5 mg every 30 minutes for 2 injections in the future intramuscular haloperidol with the same interval in the dosage of 10 mg daily tetrazona dose was 130 mg, in the second half of the day intravenous drip of 4.0 ml of 1% solution of amitriptyline, oral assigned Rispolept in the dose of 4 mg per day. During therapy conducted 3 course “titration” the haloperidol in the average daily dosage of 120 mg, 14 courses of intravenous infusions of amitriptyline dose Rispolept increased to 6 mg per day. In the process of pharmacotherapy in the scheme were stopped affective disorders, paranoid feelings have become fragmented and abortifacient in nature, the connection broke delusional ideas with personality, significantly improved mood, normal vital functions, appeared unstable criticism to their condition, social planning your life, relationships became more real. After 7-8 days of PS is goticheskoe state was stopped. After the course the patient was transferred to the strategic support of pathogenetic therapy Rispolept in dosage 6 mg per day, amitriptyline 75 mg per day.

3. Patient D., 45, Delivered to the treatment with complaints of anxiety, fears, thoughts that work against it are planning a conspiracy that the apartment is “envious colleagues have established a listening device,” at work in the morning on her Desk “put the items in a particular sequence to hint that it will be fired and go to jail to make room for someone, reduced mood, constantly feel despair, “the impossibility of its existence”, tearful, argues that feels like a changed attitude of the husband, who “believe in gossip, spreading the work about its moral character”. According to the relatives, during the week of almost no sleep, appetite drastically reduced, not out of the apartment, stopped going to work, categorically refuses treatment in a psychiatric hospital. On the basis of complaints, anamnesis, psychopathological and pathopsychological survey was diagnosed with Schizoaffective disorder, depressive-paranoid syndrome supplications level of endogenous origin. Were treated according to the method developed Antaranews (199) and Powrotem (1998): stelazine in the dosage of 10 mg per day, chlorpromazine intramuscular injection of 50 to 75 mg / day, intravenous drip infusion of 1% solution amitriptyline 4,0 ml After the treatment condition improved: normal vital functions, desactualizado paranoid experiences, faded but not disappeared manifestations of anxiety, fear, better mood wore unstable character, appeared formal and partial critique of the state. However, during the entire course of treatment and further receiving maintenance therapy with amitriptyline at a dose of 100 mg per day, triftazinom 10 mg per day, the patient was filed numerous complaints about the “dryness” in the mouth, constipation, visual disturbances, difficulty with urination. After discharge from hospital the patient was unable to perform usual work, complained of “restlessness, tremor of hands, the feeling of “tightness”. Using this method, experiencing side effects, characteristic of typical neuroleptics and tricyclic antidepressants, which affects the quality of life of the patient and this method is only possible in a hospital.

Thus, the proposed methodology facilitates rapid relief affective paranoid syndromes within schizoaffective disorder psychotic and supplications level of endogenous origin with PR is the overcoming therapeutic resistance in the day hospital. The combination of tricyclic antidepressants with atypical antipsychotics leads to faster and better relief of psychosis, allows to minimize side somatotropic and neurotropic effect, significantly improves the quality of life of patients in terms of strategic support pathogenetic pharmacotherapy, which corresponds to the modern requirements of social psychiatry.

The method combined edema schizoaffective psychotic syndromes and supplications level in the daytime, including the introduction of typical neuroleptics on titration scheme and tricyclic antidepressants, characterized in that the neuroleptics on tetrazinni the scheme is administered in the morning and in the afternoon intravenous drip tricyclic antidepressants combined with oral administration of atypical neuroleptic risperidone; after conducting 12-14 intravenous infusion move on to strategic support psychopharmakotherapie risperidone in combination with tricyclic antidepressants within 4-6 months.



 

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