Method for differential diagnostics of depressive disorder and organic lesion of central nervous system in post-insult patients

FIELD: medicine, psychiatry, neurology.

SUBSTANCE: one should evaluate psychic state in patients and detect the quantity of eosinophils, basophils and rod neutrophils in peripheral blood. At eosinophils ranged 1.97-2.52%, basophils 0.12-0.14%, rod neutrophils 0.64-0.91% it is possible to diagnose depressive state. At eosinophils being below 1.32%, basophils from 0.03% and less, rod neutrophils from 1.27 and higher one should diagnose organic lesion of central nervous system.

EFFECT: higher accuracy of differential diagnostics.

10 dwg, 1 tbl

 

The invention relates to the field of medicine, psychiatry and neurology, specifically to methods of differential diagnosis of depressive disorders and organic lesions of the Central nervous system in post-stroke patients.

A known method of differential diagnosis of depressive and psychoorganic syndromes in post-stroke patients based on the clinical picture, which is the collection of anamnestic and clinical signs and the description of them in MCB (international classification) (8), according to which compliance F01-F01.9 regarded as vascular dementia; P-07 as organic personality disorder, F-06 as organic mental disorder, P-07.8 as right hemispheric organic affective disorder, F-07.9 as organic psychosyndrome. When determining gross impaired memory and mental activity, disorientate in time, space, appearance of confabulate, delusional hallucinatory syndrome, emotional disorders assess severe vascular dementia. However, these methods of treatment based on clinical symptoms and signs. Due to the lack of sufficiently accurate and reliable criteria for the differential diagnostic conclusions are possible with the broad involvement of information that characterize the disease. However, d is I the research questions of classification in psychiatry is becoming crucially important natural connections of clinical symptoms, the corresponding changes in various functional systems of the body and sufficiently reflective of the physiological and social factors. Thus the differential diagnosis is difficult in the differentiation of vascular dementia from dementia, depressive disorders dementia. Differential diagnostic criteria based on clinical symptoms, such as acute onset, the uneven course of the disease, acute psychotic episodes (in particular, night). The basis of this state lies atherosclerotic vascular process with secondary atrophy of the cerebral cortex. In the second case, only the treatment with antidepressants with good clinical effect may withdraw the diagnosis of dementia. Testing of patients from the group with organic lesions of the Central nervous system, and adequate assessment of psychopathological condition depends on the subjective factor (the knowledge of the doctor).

A new technical challenge - improving the accuracy and informative way.

The task to solve the new methods of differential diagnosis of depressive disorders and organic lesions of the Central nervous system in post-stroke patients, consisting in the assessment of mental status, according to the International classification of diseases 10th revision, when the eat additional in the peripheral blood to determine the number of eosinophils, basophils and band neutrophils and the number of eosinophils from 1.97 to 2.52, basophils of 0.12 to 0.14, band neutrophils from 0.64 to 0.91 diagnosed depressive disorder, and when the number of eosinophils less 1,32, basophils from 0.03 or less, stab neutrophils from 1.27 and above diagnosed with organic lesion of the Central nervous system.

The method is as follows. On admission the patient, in addition to the clinical neurological examination and assessment of the mental sphere, according to the International classification of diseases 10th revision (ICD-10) (8), also produce fence peripheral blood with subsequent counting of leukocytes, lymphocytes, eosinophils, basophils, band and segmented neutrophils and the number of eosinophils from 1.97 to 2.52, basophils of 0.12 to 0.14, band neutrophils from 0.64 to 0.91 diagnosed depressive disorder, and when the number of eosinophils less 1,32, basophils from 0.03 or less, stab neutrophils from 1.27 and above diagnosed with organic lesion of the Central nervous system.

These criteria were chosen based on the study of clinical material, observation of 421 patients, among whom there were 186 men and 235 women. The average age of 61.5 years. Patients were combined into 4 groups: control (C), depressive disorders (the P), with organic lesions of the Central nervous system vascular abnormalities in psychotic manifestations (P), a lethal group (L).

Control group (C) consisted of patients without psychopathological manifestations - 139 people (men and 66 women - 73). The average age was 57 years.

Patients with depressive disorders (D) was observed 195 people. The average age was 58,3 years. Depressive disorder was assessed in accordance with the ICD-10 criteria [4] and refined using a self-rating scale Beck depression [1]. Prevailed patients with mild and moderate depressive episode - 179 patients (105 women, men - 74).

Patients with organic lesions of the Central nervous system with psychotic symptoms was 37 people (20 women, 17 men). The average age in this group is 65.5 years. Prevailed patients with lesions of the right hemisphere 21.

Dead in the acute period of ischemic and hemorrhagic stroke was 50 people (25 women and men), they entered into a lethal group. The average age was 65 years.

Estimation of parameters of white blood cells was performed in accordance with the normative values in healthy humans [16].

Table 1 shows the average values of the white blood cells to the major groups of patients. To - control group, LDA - mild depressive episode, UDE - moderate depressive episode, TDE - heavy depot is essigny episode L - lethal group, P - organic lesion of the Central nervous system (CNS).

The study looked 4 groups: control (C), depressive disorders (D), the group with organic lesions of the Central nervous system with psychotic manifestations (P) and lethal group (L). Observations and some regularities average by group for selected indicators are presented in Fig. 1-6.

As shown in Fig. 1, there is a clear trend towards growth of cells in the row on the severity of the patients, starting with the control group (K) to lethal (L) group. For L-groups of leukocytes is higher than the group, more than 2 times. There is a significant difference between the groups.

As shown in Fig. 2 average values of segmented neutrophils in the L-group significantly (by 13%-15%) are distinguished from all others by this parameter. The rest of the group on average indistinguishable. Ie, this parameter can only be defined critical condition

Figure 3 shows a significant increase in mean values of lymphocytes in the L-group (more than 2 times) compared with the other groups. Group K, Q, P are indistinguishable among themselves.

Figure 4 shows the average content of basophils in the groups studied. Also there is a clear trend, and each group of well time is of ichim, Ph.D.. In this parameter it is possible to clearly judge the severity of the patient: there is a depressive disorder or organic lesion of the Central nervous system or critical condition.

Figure 5 the trend is clearly towards growth of band neutrophils depending on the severity, and quantity for L-group is greater than for K-groups, about 20 times.

Figure 6 presents the average values of eosinophils in groups. There is a significant trend; the indicator value for the D-group is higher than control, but a significant trend towards the reduction of this indicator with the growth of gravity exists.

Thus, the analysis of mean values of different groups of different blood parameters were allowed to identify some trends in the behavior characteristics depending on the severity of the condition.

In Fig. 7 shows the average values for different characteristics, standard deviations and confidence intervals at the 95% level of confidence.

Analysis of blood components, unfortunately, does not give additional information on the characteristics of the groups K, L and P, the confidence intervals are quite overlap. Well always stands out only group L, sometimes - P (Fig. 8).

In figures 9, 10 show the confidence intervals of the average values of eosinophils and lymphocytes. Well always allocated on the given parameters only what about the lethal group and the group with organic lesions of the Central nervous system (CNS).

Based on the analysis of the observation data, it was possible to draw the following conclusions:

1. The absolute content of cells is a good indicator that you can judge the state of post-stroke patients. Their number increases with the increasing severity of condition of patients with depressive disorder (6,51, confidence interval of 0.53 at 95% reliability) and organic lesions of the Central nervous system with psychotic symptoms (7,8, confidence interval of 1.45) compared with the control group (5,59, confidence interval 0,397).

2. Marked decrease of average values of basophilic neutrophils in the group of patients with depressive disorders (0,12, confidence interval of 0.11 at 95% reliability) and organic lesions of the Central nervous system with psychotic manifestations (0,029, confidence interval - 0,058) compared with the control group (0,39, the confidence interval is 0.17).

3. There is some increase in average values of eosinophilic neutrophils in patients with depressive disorders (2,23, confidence interval of 0.55 at the level of 95% reliability) compared with the control group (2,1, confidence interval 0,308).

4. There is a slight decrease in the mean values eosinophilic neutrophils in patients with organic lesions of the Central nervous system with psychotic manifestations (1,32, confidence interval of 0.83) compared with the control group (2,1, confidence interval - 0,308).

5. There was an increased mean values of band neutrophils in groups of patients with depressive disorders (0,75, confidence interval 0.33) and with organic lesions of the Central nervous system with psychotic manifestations (the 1.265, confidence interval 0,732) compared with the control group (0,33, confidence interval to 0.108).

6. Organic lesion of the Central nervous system with psychotic manifestations leads, apparently, to the "imbalance" of the blood parameters.

7. Thus, these criteria can be used for differential diagnosis of depressive disorders and organic lesions of the Central nervous system (CNS) in post-stroke patients, as well as to predict the course of a stroke.

From the literature it is known that it is necessary to differentiate the severity of depressive disorders, organic mental States with the aim of obtaining the most reliable information that affects the appointment of adequate therapy. Our research has shown that there is compliance with such opinion. To differentiate depressive disorders and organic lesion of the Central nervous system is necessary in the early stages, because the elimination or reduction of psychopathological manifestations creates the prerequisites for the restoration of social functioning boldog the Sabbath." [9]. The doctrine, Selye "about adaptation syndrome" had a great influence on different areas of knowledge [14]. Currently, the study of nature and applied aspects of the stress response stepped from laboratory experiments on animals to their wider study of representatives of various scientific disciplines in the Annex to the healthy and sick person [13]. Stroke is considered as a catastrophic reaction of the brain, the stress that has both physiological and psychological components. Adaptive responses are generated in the Central nervous system. Under the action of strong stimuli (stress reaction) in the Central nervous system develops drastic action, beyond changing the braking. The literature describes the types of adaptive responses, which are determined by the percentage of lymphocytes in the leukocyte formula and their correlation with segmented neutrophils [10], [7]. The rest of the formed elements of the white blood cells and the total number of leukocytes are just more signs of reactions. Remains firmly in position on the availability of all kinds of stress reactions of anxiety lymphopenia, eosinopenia, leukocytosis and neutrophilia. In the literature we did not find data on the types of adaptive responses in patients with depressive disorders and organic lesions of the Central nervous system (CNS) with zudilova origin.

The stress response is divided into two types: controlled and uncontrolled. In both cases, it affects the limbic system in the Central nervous system associated with neuroendocrine subsystem "hypothalamus - pituitary - adrenal cortex". When uncontrolled stress response due to violations of the interaction of neurotransmitters can develop mental illness [10]. The value of subjective workload plays an important role [12]. When viewed stress as part of the process "stress reaction" (AKP) first initial assessment, which reflects the event in its impact on self, then the valuation time associated with awareness of individual capabilities overcome with understanding of the situation. Following this, the process of coping (Coping). The AKP is characterized by constant feedback between a source of stress and multiphase cognitive and emotional evaluation of the load. It is important for the stability and integrity of the individual: if he manages to overcome the AKP on its own, there is controlled the AKP (Koz SR), otherwise uncontrolled RPS (ppur). For Koz SR body has methods of overcoming, which together with adaptive processes lead to the optimum efficiency of the reaction mechanism [10], [12]. Uncontrolled stress is linked, rather the willows, with a process that cannot be overcome by the body. According to Huether G. [11], when it comes labilization state, partial termination suboptimal behavioral mode. This process of destabilization is fraught with the risk of decompensation of the body, which is implemented in the form-induced stress disorders (psychosis, myocardial infarction, ischemic heart disease). In patients with stroke, complicated organic lesions of the Central nervous system with psychopathological symptoms, we can talk about uncontrolled stress. It is important to differentiate this condition from disorders affective sphere, senile psychosis. After acute disorders of cerebral circulation possible amnestic syndrome dementia with marked disorders of memory fixation amnesia, gross disorientation and confabulation, the development of lacunar (postapoplectic) dementia with korsakovogo syndrome. Possible development pseudoparallelism" dementia with carelessness, euphoric, talkative, disinhibition drives, the absence of a feeling of sickness, a sharp decline of criticism and judgment - at relatively lower severity of memory impairment and orientation. For psychotic state characterized by the presence of entanglement, disorientate, delirious excitement, anxiety, periodic activities the ski hallucinatory and delusional disorders [6]. Testing of patients from the group with organic lesions of the Central nervous system, and adequate assessment of psychopathological condition depends on the subjective factor (the knowledge of the doctor). In this regard, the detection of changes in the leukocyte formula blood is an additional objective criterion. Thus, the proposed method can more accurately assess the status of the patient due to identified criteria.

Deviations of the white blood cells in patients with organic lesions of the Central nervous system with psychotic manifestations occupy an intermediate position between the patients with depressive disorders and lethal group. These changes indicate the presence of inferiority, tension adaptive reactions. These data allow us to construct a rehabilitation program for the category of post-stroke patients with depressive disorder and organic lesion of the Central nervous system (CNS) with psychotic manifestations. The most important point is the appointment of antiplatelet agents or indirect anticoagulants, angioprotectors, antihypoxants for prevention of recurrent stroke and prevention of progression of mental disorders, as well as small doses of neuroleptics, tranquilizers in order to relieve the psychopathological symptoms. Party which m is the purpose of modern selective antidepressants for post-stroke patients with comorbid depressive disorders, as it is shown that depressive disorders increase the risk of strokes. In addition, conducting an assessment of the performance of white blood post-stroke patients in the dynamics, it is possible to predict the further course of the disease.

The list of references.

1. Beck A. Cognitive Therapy and emotional disorders. - New York. International University Press in 1976.

2. Bleuler E. Dementia praecox oder Gruppe der Schizophrenien. - In: Handbuch der Psychiatric/ Ed. G. Auschaffenburg. - Leipzig. - Wien, 1911. - 420 S.

3. Shumakov V.M., Gindikin VJ VA, Reshetova R.K. et al. // Disorders of the nervous system and mental activity with somatic diseases. M., 1979, s-409.

4. David O. Fibers, Valery Feigin, Robert Dbrown. Guide cerebrovascular disease // TRANS. English Professor Volvagia. M.: ZAO Publishing house BINOM, 1999. -672 C.

5. Troshin E, Gustov AV, Troshin O.V., 2000. Acute disorders of cerebral circulation. Ed ngma.- N.Novgorod, 2000. - 435 S.

6. Guide to psychiatry. Vol.2. Ed. by Acad. The Academy of medical Sciences of the USSR Avinasha. M., 1983. S.

7. Garkavi LH, Cucina E.B., Ukolova M.A. Adaptive response and resistance of organism. Publishing house of Rostov University, 1977. - 109 C.

8. International classification of diseases (10th revision) Classification of mental and behavioural disorders. / Lane. into English under the editorship of JUL of Nuller, HE Zirkin. Who Russia Saint-Petersburg "Overlaid" 1994. - 285 S.

9. Woven RA, Sverd is s PS Psychopathological and psychological preconditions of treatment tactics in endogenous psychoses / In the book. Pharmacological basis rehabilitation of mental patients Ed. by R. Savina, G.-E. Kuehne. M: " Medicine". -1989. P.63.

10. Heine X. the Biology of stress. // Biological medicine. - 2000 - №7. - P.7-12.

11. Huether G., et al. Psychische Belastung und neuronale Plastizitat. In: Kropiuning U., Stacher A (Hrsg.) Ganzheitsmdiain und Psychoneuroimmunologie. Wien: Vierter Wiener Dialog, Facultas 1997.

12. Heine H. Gesundheit - Krankheit - Stress. Biol. Med. 1997: 26 (5): 200-4.

13. Kamenetz D.A. neurotic disorders and psychotherapy. Moscow. "Helios ARV".- 2001.- 371 C.

14. Selye, Essays about adaptation syndrome. M., 1960.

15. Selye H. The evolution of the stress concept-stress and cardiovascular disease. London, New York: Oxford University Press, 1971.

16. ) A.N. What are the tests. A manual for physicians. Medical standards laboratory and functional indicators of a healthy person. Rostov n/a don: Phoenix, 2001. - 96 S.

78.7
Table 1

Average values of the white blood cells to the major groups of patients
The control (K)LDEUDETDELethal (L)Organic lesion of the Central nervous system (N)All
Segmented. neutron., %67.767.1770.669.768.769.5
Lymphocytes, %23.923.620.422.49.1322.021.3
Leukocytes ×109/l5.596.456.826.1112.57.857.01
Monocytes, %5.545.585.924.825.196.235.57
Basophils, %0.390.120.120.140.040.030.19
Stab neutrons., %0.330.640.830.916.261.271.28
Eosinophils, %2.102.521.911.970.911.321.89

The method of differential diagnosis of depressive disorders and organic lesions of the Central nervous system in post-stroke patients, consisting in the assessment of mental state, characterized in that it further in the peripheral blood to determine the number of eosinophils, basophils and band neutrophils and when Kolichestvennaya from 1.97 to 2.52%, basophils from 0.12 to 0.14%, stab neutrophils from 0.64 to 0.91% of diagnosed depressive disorder, and when the number of eosinophils less 1,32%, basophils from 0.03% or less, stab neutrophils from 1.27% and above diagnosed with organic lesion of the Central nervous system.



 

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