Method for treatment of opium narcomania

FIELD: medicine, narcology.

SUBSTANCE: method involves alternating comatose therapy and electroshock therapy every other day. In day carrying out the comatose therapy eserine ointment is placed in conjunctival sacs to patient and in 30 min 2-2.5 mg scopolamine hydrobromide solution is administrated as its 0.5% solution. Then in 3-5 h of comatose state patient is recovered from coma and 15-30 mg of physostigmine, 6 g of pyracetam, 7.5 g of magnesium sulfate and 400 ml of sodium hypochlorite are administrated by intravenous drops. In each next séance of comatose therapy dose of scopolamine hydrobromide is increased by 0.5 mg and brought about to 5-6 mg. In day carrying out electroshock therapy 1 ml of 0.1% solution of atropine sulfate and 2 ml of cordiamine are administrated and preliminary narcosis is carried out by intravenous administration of 200-300 mg of sodium thiopental or 100 mg of ketamine with simultaneous administration of 3-4 ml 2% ditiline solution and electroshock therapy is carried out followed by artificial lungs ventilation. Method provides enhancing effectiveness of treatment and to prolong the remission period.

EFFECT: enhanced effectiveness of treatment.

3 ex

 

The invention relates to medicine, namely to addiction, and can be used for the treatment of drug dependence, as well as in psychiatry at delusional and hallucinatory-paranoid States, ideology-obsessivly disorders, resistance to pharmacotherapy.

There is a method of treatment of drug addiction and alcoholism (RF patent No. 2055602), which includes a number of stages, such as the removal of the patient from a state of abstinence, conduct rational psychotherapy, fixing the developed setup using electric shocks.

Also known is a method of treatment of drug addiction is the most effective currently, pharmacological tool methadone hydrochloride or its derivatives (Friedmann PS, Fleet NF, and other drug and alcohol abuse. /Lane. from English. Publisher Binom Nevsky Dialect, 1998. - P.194).

Methadone hydrochloride is a synthetic opiate agonist long-term exposure, is used to support patients with opioid dependence, orally in a total daily dose of 20-80 mg. Methadone significantly reduces the need for drug and blocks the euphoric effects of heroin. However, the way addiction treatment with methadone has a number of disadvantages. The preparation according to the chemical structure and pharmacological properties similar to morphine and it formed its own meta is about addiction. The drug is prohibited in Russia for use (Lawrence DL, Bennett PN. Clinical pharmacology. Vol.2. /Lane. from English., Medicine, 1993, p.4).

For the prototype accepted method of treatment of drug abuse by the patent RF 2129866, the essence of which is that injected atropine in a dose of from 100 to 800 mg, causing coma in which the patient is 4 hours. Mild coma produced by intramuscular injection of 1% solution of ezerin three consecutive injections of 10 mg every 15-20 minutes. This procedure is repeated at least 10-12 times.

The aim of the invention is the most effective treatment of drug addiction with the use of medication and electroconvulsive therapy.

The main feature of the proposed method is the combined use atropinokomatoznaya (ACT) and electroconvulsive therapy, and in the ACT of atropine sulfate is replaced by the scopolamine hydrobromide. Of scopolamine hydrobromide influence on peripheral holinoreaktivnye similar to atropine, but has a pronounced Central cholinergic effect, sedative effect, instead of exciting the atropine, antiemetic action. The most characteristic property of scopolamine is called amnesia.

The method is as follows. Atropinokomatoznaya and electroconvulsive treatment poocharoen the day after. Holding atropinokomatoznaya therapy is preceded by physical examination, counseling, therapist, ophthalmologist, otolaryngologist. First intravenous 2.5 mg of scopolamine hydrobromide in the form of a 0.5% solution. At each subsequent session, the dose of scopolamine hydrobromide increase of 0.5 mg, bringing the end of the course up to 5-6 mg During the procedure retained tendon reflexes, muscle tone decreases. Disappears corneal reflex, sometimes, in some cases, there may be tachycardia and small hyperthermia. The duration of coma, required to achieve a therapeutic effect, is from 3 to 5 hours. For edema coma use physostigmine (0.1% or 0.5% solution) in doses of 15-30 mg or galantamine (nivalin), 6 g / kg and 7.5 g of magnesium sulphate (intravenous drip), 400 ml of sodium hypochlorite (intravenous drip). The patient comes out of the coma gradually. The first 30 min after the onset of edema appear corneal reflex and reaction of the pupil to light, after that appear consciousness, motor responses, you may receive verbal contact.

Holding electroconvulsive therapy is preceded by the abolition of the drugs that increase seizure threshold (anticonvulsants, Central ward). The patient on an empty stomach is laid on the table on his back, if there is a removable dental PR thesis, they are removed, watches, chains, all metal objects are removed.

Premedication: 1 ml of 0.1% R-RA atropine sulfate and 2 ml of kordiamin intravenously. Anaesthesia induction: 200-300 mg of thiopental sodium or 100 mg of ketamine. To resolve generalized seizures intravenous use ditilin in the amount of 3-4 ml of 2% solution. To prevent biting of the tongue and lips is inserted into the duct, the skin in the area of application of the electrodes degreased with alcohol. Preparing the respirator and the suction apparatus, apparatus for electroconvulsive therapy (ECT). After the introduction ditilina and end fasciculations, superimposed electrodes in the temporal area on the middle line from the outer edge of the eye to the front ("frankfurtska horizontal"). Pads on the electrodes are pre-wetted with saline. Minimum voltage and exposure time of the electric current at the beginning of the ECT is respectively 80 and 0.5 C. In the absence of convulsive reactions increase the voltage by 10 V or the exposure time of 0.1 sec. Average dosage: 46-130 pulses. Up to a maximum of 260. Is artificial ventilation until recovery of spontaneous breathing. After the seizure develops amnesia, which itself is within an hour, the fit amazonetta forever.

The proposed method has several advantages over known. Atrophy is and sulfate has a strong stimulating effect and the patient, in tropenbos coma, shows psychomotor agitation ("restless coma"). To prevent agitation of the standard procedure ACT as sedation using drugs for anaesthesia (sodium oxybutyrate, Relanium, thiopental sodium and others) and neuroleptics (haloperidol, desertin, chlorpromazine). Drugs for anaesthesia is undesirable to use in patients with addiction, because they can cause dependence. Of scopolamine hydrobromide sedative effect and does not require the use of premedication. Antiemetic effect it reduces the risk of vomiting during the procedure. Amnesia characteristic of this drug enhances therapeutic effect of the procedure, increasing the effectiveness of the treatment. The combination of the same ACT with ECT leads to a decrease in the number of procedures atropinokomatoznaya therapy (5-7 on the year), increases the effectiveness of treatment and duration of remission.

Example 1.

The patient is in KG, 1978. Opium addiction, stay in the hospital for 47 days, comatose therapy 5 sessions: 2.5 to 8 ml/day after 5 sessions of ECT through the day.

1 day - 2.5 ml of 0.5% solution of scopolamine hydrobromide

day 2 EST

day 3 - 5 ml of 0.5% solution of scopolamine hydrobromide

day 4 EST

day 5 - 6 ml of 0.5% solution of scopolamine hydrobromide

day 6 EST

7 day - 7 ml of 0.5% solution scopolamin is and hydrobromide

day 8 EST

day 9 - 8 ml of 0.5% solution of scopolamine hydrobromide

day 10 EST

The period of remission 1 year 11 months.

Example 2.

Patient B s A., born in 1981. Opium addiction, duration of stay in the Department of 21 days, comatose therapy 4 session: 2,5-7 ml/4 sessions of ECT through the day.

1 day 2.5 ml of 0.5% solution of scopolamine hydrobromide

day 2 EST

day 3 - 5 ml of 0.5% solution of scopolamine hydrobromide

day 4 EST

day 5 - 6 ml of 0.5% solution of scopolamine hydrobromide

day 6 EST

7 day - 7 ml of 0.5% solution of scopolamine hydrobromide

day 8 EST

The period of remission 1 year 8 months.

Example 3.

The patient Had s O.Y, born in 1975 Opium addiction, duration of stay in the Department of 21 days, comatose therapy 7 sessions: 2,5 -10 ml/7 sessions of ECT.

1 day - 2.5 ml of 0.5% solution of scopolamine hydrobromide

day 2 EST

day 3 - 5 ml of 0.5% solution of scopolamine hydrobromide

day 4 EST

day 5 - 6 ml of 0.5% solution of scopolamine hydrobromide

day 7 EST

8 day - 7 ml of 0.5% solution of scopolamine hydrobromide

day 9 EST

day 10 - 8 ml of 0.5% solution of scopolamine hydrobromide

day 11 EST

day 12 - 9 ml of 0.5% solution of scopolamine hydrobromide

day 13 EST

day 14 - 10 ml of 0.5% solution of scopolamine hydrobromide

day 15 EST

The period of remission 1 year 4 months.

Method for the treatment of opium addiction, including the surrounding conducting comatose therapy, characterized in that comatose therapy alternate every other day with electroconvulsive, the day of the comatose therapy to the patient in the conjunctival eye bags lay azarinova ointment, after 30 min intravenous 2-2,5 mg of scopolamine hydrobromide in the form of a 0.5%aqueous solution, then after 3-5 h of a coma patient is gradually removed from the coma, with intravenous infusions of 15-30 mg of physostigmine, 6 g / kg, 7.5 g of magnesium sulfate, 400 ml of sodium hypochlorite, in each subsequent session comatose therapy, the dose of scopolamine hydrobromide increase of 0.5 mg and adjusted to 5-6 mg; on the day of the electroconvulsive therapy intravenously injected 1 ml of 0.1%solution of atropine sulfate and 2 ml of kordiamin, perform anaesthesia induction intravenous 200-300 mg sodium thiopental or 100 mg of ketamine and simultaneously 3-4 ml of 2%ditilina, exercise, electroconvulsive therapy, followed by artificial ventilation of the lungs.



 

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