Method for treating the cases of drug addiction
SUBSTANCE: method involves talking to patient and parents for setting diagnosis. Detoxication, prohibitory and rehabilitative therapy is carried out in hospital. Basic therapy is administered with Clophellinum, Hemineurine, Tizercine, Galoperidol, Loperamide before beginning detoxication. Ultra-rapid opioid detoxication is carried out and vitamin and cardioprotector therapy is applied for 1-2 days after it is finished. Comatose atropine therapy and electric convulsion therapy are alternated every other day at the prohibitory therapy stage. Total number of procedures is equal to 5-6. Ozone therapy is applied every day at the same stage in 80 mg/l mode at a rate of 0.1 l/min. Premedication is carried out before electric convulsion therapy with 0.5 ml of 0.1% atropine sulfate solution, 2 ml of 2% Ditiline solution, 10-15 ml of 20% sodium oxybarbiturate solution. Transcrtanial electric stimulation is carried out at rehabilitation stage. Electric convulsion therapy is carried out once per two-week period during the whole period. Ozone therapy is carried out on the background of anti-depressant introduction twice per 10-14 days.
EFFECT: wide range of functional applications.
The invention relates to medicine, namely addiction, and can be used in the treatment of drug dependency.
In recent years the problem of drug addiction among young people and people of working age is one of the most important for Russian society. The average life expectancy of this population is rapidly decreasing due to the toxic effects of drugs on the brain and other internal organs (liver, kidneys, gastrointestinal tract and other), and due to complications, mainly infections and psychosomatic. The rapid spread of drug addiction in Russia is evidence of the poor performance of medical programs that would interrupt drugs, which stimulates the search for effective ways of correcting acute withdrawal syndrome (OSA). In ICD-10 there are no terms "alcoholism", "addiction", "substance abuse". In one series set psychoactive substances, the use of which is traditionally widespread, i.e. alcohol and tobacco, substances that are widely used in everyday life and control over their misuse is almost impossible (volatile solvents) and drugs that are subject to strict control, i.e. opiates, cocaine, and so what. Violations that meet the criteria for separate syndromes, should be clearly associated with taking drugs.
Thus, this category includes cases of toxic psychosis caused by use of psychoactive substances.
All the actual drug syndromology placed in:
- drugs (toxic) intoxication,
- syndrome of altered reactivity;
syndrome psychological dependence,
syndrome of physical dependence,
toxic effects of substance abuse.
In accordance with this currently, use of drugs aimed at stopping the actual drug symptoms:
acute intoxication (drugs);
- mental craving for the drug;
- relief of withdrawal state, the treatment of physical dependence;
- treatment effects of intoxication.
Thus, all therapeutic measures used by addiction can be divided into groups depending on the purpose of their application.
In the treatment of mental and behavioural disorders associated with the use of opiates, have to deal mainly with the treatment of acute intoxication (frequent overdose), relief of opiate withdrawal syndrome, treatment of the syndrome is based, personality and behavioral disorders closely associated with dependence syndrome, correction of the effects of intoxication (primarily due to impurities in narcotic drugs and infectious complications of injecting drug use). Seldom psychotic disturbances associated with the use of opiates, expressed intellectual disability reduction, convulsive syndrome. Cognitive impairment that can occur in opium addicts, due to either severe asthenic phenomena, or encephalopathy caused by intoxication by impurities in drug consumption or concomitant use of other psychoactive substances. Seizures can occur only in case of overdose of some synthetic opioids, such as tramadol.
An important principle of treatment of persons with mental disorders caused by psychoactive substance use, is its stages.
Stage I - detoxification (detoxification and/or mild withdrawal syndrome).
Stage II - correction somatoneurological, mental disorders and primary anti-relapse therapy.
Stage III - supporting, anti-relapse therapy.
It should be noted that currently there is a wide Arsenal of non-pharmacological treatments (different is the option of acupuncture, laser therapy, intravenous laser blood irradiation, ultraviolet blood irradiation, hyperbaric oxygenation, surface controlled craniocerebral hypothermia, exposure to pulses of electric current, sorption methods of treatment: small and large hemosorption, enterosorption and others), which are used at all stages of treatment of drug dependence.
Uncomplicated opium intoxication usually does not require medical treatment. Important at this stage psychotherapeutic work with patients and obtaining their consent to treatment. In severe intoxication, the threat of breathing and other vital functions is injected intravenously (if necessary, again in 20 minutes) naloxone hydrochloride and 0.4 mg. Assigned respiratory analeptics, medications, providing a stabilizing effect on cardiovascular activity, nonspecific means of detoxification. Detoxification is not a treatment process in the full sense of the word, this is only temporary, auxiliary step on the long road of addiction treatment. After detoxification and without passing through the stage prohibitive therapy, the addict 99% doomed to imminent failure and further anesthesia.
Opiate withdrawal syndrome is heavy and requires a balanced medical approach to its relief. With the temporary integrated circuit edema with the use of psychopharmacological agents (intravenous drip amitriptyline, carbamazepine, diazepam, compulsive craving for the drug use of antipsychotic drugs), vegetotherapy drugs, antispasmodics (papaverine, platifillin, no-Spa), analgesics (aspirin, Ketorolac, diclofenac, reopirin, short-tramadol). Long-term drug therapy sleep. Substitution therapy with use of narcotic analgesics and their gradual abolition (abroad detoxification methadone, we use buprenorphine, tramadol). Correctly selected psychotropic drugs (desertin, sonapaks, Eglon, chlorprothixene, Klopicksola, amitriptyline, diazepam, carbamazepine) and a means for anaesthesia (sodium oxybutyrate, thiopental sodium), which has psychoactive properties, contribute to the reduction of psychopathological symptoms withdrawal States, reduce the degree of affective voltage, suppress craving for the drug. For the correction of psychopathic symptoms allowable careful use of antipsychotics - haloperidol, neuleptil. When reducing emotional tension decrease somatovegetative symptoms of the abstinence syndrome. Important is the change of attitude towards the withdrawal syndrome, reduction of fear of manifestations of a withdrawal state. Many psychotropic drugs, having expressed vegetotherapy dei is a journey, significantly reduce somatovegetative symptoms of the abstinence syndrome. Effective combined use of neuroleptics (tizertsin), antidepressants with sedatives action (amitriptyline), tranquilizers (diazepam; nitrazepam) and of anesthetic (sodium oxybutyrate, thiopental sodium). In General, this model of treatment quickly (5-8 days) and painlessly allows to overcome the withdrawal state, but the early use of psychotherapeutic methods of treatment is to create preconditions for the further stages of treatment (Kuzminov, VN, Abrosimov, AS drug Addiction and drug abuse: pharmacotherapy of substance abuse // Medicines in narcopsychopharmacology. Ed. Vasapollo and Eva. - Kharkov: Prapor, 2002. - S-107).
In recent years, widespread method ultrafast opioid detoxification (UBOD) or rapid opioid detoxification (Rapid opioid detoxification). Distinctive features of this approach are early adaptation to opioid-antagonists (naloxone and naltrexone), use of clonidine in combination with means for reingestion anesthesia and a short time (1-3 days) almost complete reduction somatovegetative of withdrawal syndrome. Antagonists of opioid receptors (naloxone, naltrexone) designate the first day of active therapy. A sharp increase in abstinence (precipitiously withdrawal syndrome), caused by the blockade of opiate receptors antagonists, is extremely painful subjective and objective condition, manifested by hemodynamic (primarily change in heart rate, to a lesser extent the HELL), and possibly respiratory function (tachypnea), acute autonomic dysfunction (rash, sudden chills, alteration of intestinal peristalsis, and so on). Recommended due to the severity of the condition and the threat of cardiovascular and respiratory decompensation carrying out these methods of detoxification in terms of ICUS (intensive care or ream. hall), with the possibility for the need for mechanical ventilation (mechanical ventilation. In fact, the provision of health care is an anesthetic monitoring. In parallel with the opiate receptor blockers prescribed clonidine, sedatives.
Described is a method of treatment of opiate withdrawal syndrome, according to which the initial detoxification included 4-7 daily rate of use of analgesics, tranquilizers, sedative-hypnotics and neuroprotective drugs. After the disappearance of the acute withdrawal syndrome (pain in muscles and joints, sweating and possibleway, diarrhea, sneezing, etc) was administered activated dimefest (AD) intravenously at day the first dose of 30-60 mg/kg over 2-4 weeks. This therapy was repeated with an interval of 1.5-2 months for 1-1,5 years. The results showed that HELL eliminates weakness and insomnia, reduces the severity of mental distress syndrome, suppresses urge for the drug in heroin addicts (Century, Malyshev //a New method for the treatment of opiate withdrawal syndrome (OSA), 2002).
Describes how rapid opioid detoxification with the use of mechanical ventilation. Drug coverage method was carried out using the following pharmacological triad: antagonists of opioid receptors - naloxone and naltrexone; Central α2- adrenomimetic clonidine (clonidine); means for reingestion anesthesia - midazolam (dormicum, flormidal) and propofol (Diprivan); less frequently used short-acting barbiturates - thiopental sodium and methohexital (brietal).
Naloxone was injected fractionally in a daily dose of 2-16 mg, naltrexone was administered in a daily dose of 100-250 mg with subsequent reduction to 50 mg Daily dose of clonidine was of 0.15 to 0.75 mg. Means of anaesthesia was administered in the mode monitored sedation using intravenous dosing with the following ranges daily dose: midazolam - 30-90 mg, propofol - 8-32 mg, sodium thiopental - 300-2000 mg, methohexital up to 500-1000 mg.
The severity of the PVN were estimated in the range (0 to 4 points) in accordance with the self-reporting ill is x (Sivolap P. // On therapeutic possibilities of rapid opioid detoxification.- Anesthesiology and resuscitation. - 2002.- N 6.- P.55-58).
There is a method of treatment of opium-marvinney addiction by A.S. USSR №1670840 (1989). The treatment is carried out by medical therapy, which irrigate mucous membrane of the mouth 2% solution of papaverine hydrochloride in a dose of 1-4 ml 2-3 times a day for 7-10 days.
There is a method of treatment of alcohol, nicotine and drug dependence on RF patent No. 2034576 (1995), according to which by means of a multi psychotherapy, supported by reflexology, create a positive setting for the rejection of alcohol, nicotine, drugs, altering the metabolism in the body of the patient.
There is a method of psychotherapeutic influence on the human body by RF patent No. 2070821(1996). For the treatment of selected contingent-oriented release from sustained negative attitudes, inspire the perception of external interfering factors to achieve peace. Provide suggestive impact. Then encode developed a reflex irritation of reflexogenic zones. While choosing the ratio of the minimum and maximum values of time intervals between impacts, the ratio of the minimum and maximum values of the squares of reflexogenic zones is the magnitude of the impact, causing the patient pain. Then irritate the exit point greater occipital nerve exposure with parameters similar to irritation of the above reflexogenic zones.
The method of treatment of drug and alcohol abuse RF Patent №2055602 (1996). The method allows to increase the efficiency of treatment of patients with drug addiction, substance abuse and alcoholism in the second stage of their treatment, after detoxifying, a tonic and stimulant therapy in combination with the exception of narcotic substances, as well as to eliminate the occurrence of psychological and physical dependency. To do this, as pityogenes (stress) exposure uses an electric current with parameters that cause the development of unilateral convulsive seizure.
The described method of treatment for drug dependence RF patent No. 2079309 (1997). Treatment for drug dependence patient used in this method includes a preliminary interview, a period of abstinence of drugs, group and individual psychotherapy. In the first stage of group psychotherapy verbal using the techniques of rational and emotional stress psychotherapy convince the patient of the possibility of cure and increase motivation for treatment by forming the patient's story about an awareness of the pathological information programme on the use of narcotic drugs, and achieve awareness of the patient necessary and possible destruction of the specified pathological programs. In the second stage of group psychotherapy enter the patient into a state of autologous dive and carry out verbal suggestive effect with repeated recitation of formulas suggestions and highlighting key words formulas suggestion voice and sharp sound kick. At the stage of individual psychotherapy enter the patient into a state of autologous dive and set him bioenergy thermal contact, then enter the patient into a trance by the unexpected sharp capture of the patient's head with the imposition of the fingers on the eyebrows and covering the rest of the fingers of the patient's head at the level of the temples and the subsequent hard shaking of the patient's head with the simultaneous recitation of the formula of suggestion. After a pause of 3-5, resume hard shaking of the patient's head with greater amplitude and at the same time pronouncing the term liberation from addiction.
There is a method of treatment for drug dependency on the RF patent №2165270 (2001). Exclude drug cropped withdrawal syndrome using anesthesia, which is performed by inhalation of a mixture of oxygen with inert gas xenon at a ratio of(50:50)-(30:70) within 1-5 min 1-7 times per day and within 5-7 days. At the same time, use drugs, and subsequently perform physical therapy procedures and conduct psychotherapy sessions.
The described method of treatment for drug and alcohol dependence according to the patent of Russian Federation №2205665 (2003), according to which the impact on the patient's exercise at the same time: pulse current voltage of from 0.1 to 204, the pulse width of 0.15 to 0.75 MS, the frequency of their repetition from 15030 to 2000400 Hz with electrodes placed on the forehead, light pulses with a duration of 8-12 MS, lying in the wavelength range of the visible part of the spectrum of the audio signals from infrasound to 15 kHz intensity from the hearing threshold up to 80 dB. Suggestion influence conduct at the end of the session on the background of relaxing melodies. When this exercise suggestion to install on abstinence from alcohol and drugs that cause psychological dependence. Session duration 40 min, the number of sessions from 1 to 10.
The described method of treatment of alcohol and drug dependence, the application for the patent of the Russian Federation No. 2001129622 (2003). The method involves substitution: instead of alcohol-and drug - artificial euphoria, which automatically occurs in situations that provoke to receive alcohol or take drugs, artificial euphoria, a temporary escape from reality without breaking to the rdinatio movements and spatial orientation, accompanied by muscle relaxation and the emergence of inner warmth and comfort, the condition is characterized by an inner peace, a sense of peace and self-sufficiency, without aggression, even if she had a place in history, does not arise naturally intoxication with all the ensuing consequences, feelings of joy, happiness, carefree, innocence are purely subjective value as an associative not supported and do not have a physical basis in the gustatory and tactile senses, the existing conditional reflex in relation to alcohol or narcotic drugs, with no real reinforcement, over time, fade out, while retaining a sense of happiness or euphoria not anatomically associated with pathological dominant, mental (psychological and emotional) dependence is compensated by a state of altered consciousness that are influenced by endorphins with morphine-like effect, isolated from the binding in the state of hypnosis (trance), the effect produced on the mind as a result of alcohol or drug addiction, with factors that may cause the alcohol or take drugs, fixed arc allows you to save (if necessary) property communicab is lnasty as a fact, confirming the absence of alienation and inferiority of the new state, it is likely, and this is proof that the traditional encoding, which only prohibits alcohol and drugs, giving nothing in return, provokes the substitution of alcohol drugs, and the abolition of the drug in some cases they are replaced by alcohol, in both cases the substitution is due to the fact that there is the need of the organism in a state of euphoria, that it is possible to compensate for the artificially created euphoria, in parallel with the complete abolition of alcoholic beverages or narcotic drugs.
The disadvantages of these methods:
1) Partial blockade and competitive binding to opiate receptors in the absence of installation on the discontinuation of psychoactive substances in order to achieve euphoria is the cause of the overdose of opiates and by palearctica.
2) weaknesses substitution therapy are: the duration of detoxification, the tendency to the formation of opioid dependence-substituents and their frequent non-medical use. There are two extremes in the use of opioid analgesics.
3) In most patients after ultrafast opioid detoxification /OBOD/ are pronounced affective disorders in the form of trevo and, irritability, districtsee state (often as a manifestation of acute craving for drugs), overvalued concerns associated with the anticipation of a new wave of withdrawal symptoms, aggravation behavior.
4) it Should be noted abortifacient effect on the condition of cancellation of any stressful methods of treatment: ECT - electroconvulsive therapy, atropine-comatose, insulinomimetic therapy and pharmacological delirium. The risk from medical interventions (this is evidenced by the fact anesthesiology and reanimation cover of the procedures) often exceeds the risk and severity of the condition, about which they are held.
5) complications of pharmacotherapy can be divided into specific associated with neurotropic activity. It is neurological and psychiatric complications of pharmacotherapy, serotonin syndrome. The second group (non-specific complications) is toxic and allergic reactions.
Our proposed method of treatment for drug dependency does not have these disadvantages.
The objective of the invention is to develop affordable and effective method of treatment, which will reduce the number of relapses and to increase the duration of remission.
The problem is solved in that the claimed method includes several what about the stages, such as the diagnostic interview with the patient and parents; detoxification in hospital; prohibitive therapy and rehabilitation program, while the second stage is carried out by carrying out ultra-fast opioid detoxification, before which the prescribed basic therapy (clonidine 0.15 mg - 3 tabs., heminevrin - 3 caps., tizertsin - 1 tab., haloperidol - 0,05, loperamide - 3 caps.), and after ultrafast opioid detoxification consistently 1-2 days carry out patient infusion therapy, then at the third stage, tropidoclonion and electroconvulsive therapy, in front of which are premedication R-RA of 0.1% atropine sulfate 0.5 ml, aq 2% ditilina - 2.0 ml, aq 20% sodium oxybutyrate 10-15 ml, followed by ozone therapy, and tropidoclonion and electroconvulsive therapy alternate: day tropidoclonion, the next day, electroconvulsive therapy /only 5-6 procedures for course/and ozone therapy in mode 80 mg/l, at a speed of 0.1 l/min spend every day, on the fourth stage, the impact on patient electroconvulsive therapy and ozone therapy 2 times in 10-14 days on the background of antidepressants.
The method allows to extend the Arsenal of methods of drug dependence treatment and increase treatment effectiveness. Express detoxification in our technique allows the juice is atiti duration edema somatovegetative manifestations of withdrawal States in opium addiction. Due to electroconvulsive and tropidoclonion therapy improves: background mood, prevents the emergence of compulsive craving for the drug. Ozone therapy gives immunomodulatory effect, which improves overall physical condition and well-being, and, consequently, improvement of mood.
Thus, the combination of ect and tropidoclonion therapy and ozone therapy can significantly prolong remission and improve social adaptation of patients with drug dependence, can significantly reduce the dose of anti-depressants (which is beneficial economically). Thus, the goal of therapy is the discontinuation of other opioids (especially heroin) and reduction of mental manifestations drug addiction.
Detailed description of the method and an example of its specific implementation.
To reduce the risk of procedure, UBOD you need to meet the following conditions:
1) the Procedure of UBOD must hold qualified (certified) anesthesiologist in the conditions corresponding to the resuscitation ward intensive care unit.
2) Appoint the procedure UBOD psychiatrist, after consultation with the anesthesiologist.
3) the Patient must be examined before the procedure according to the list of minimal examination of the patient.
4) Method of anesthesia required up to the wives to be endotracheal anesthesia.
5) Requires close monitoring of the vital functions and the standard Arsenal of medicines, anaesthetics and intensive care practice (HR, BP, ECG and ST-segment saturation method polarimetrie, respiratory rate, minute ventilation, tidal volume, peak airway pressure, the inhaled oxygen concentration, temperature gradient, hourly diuresis, the products of the degradation of heroin). The beginning of the treatment is determined by individual clinical picture after diagnostic interviews with the patient and his / her parents or relatives. The patient is taken by the receipt of consent to treatment. The average time interval after the last dose of narcotic drug and the beginning of relief of withdrawal syndrome under anesthesia is 6-12 hours. The method of choice may be the preparation of the patient clophelinum (clonidine) at a daily dose of 0.09 mg controlled blood pressure (90/60 mm RT. Art.) and benzodiazepine.
Further, the drug dependence treatment is carried out in three major stages. Detoxification is the removal of withdrawal" is a modern method - a method of ultra-fast opiate detox, which means the release of the body from opiates: under General anesthesia injected antagonist opiate - naloxone or naltrexone. The peculiar thing about this is Yoda in our clinic is before the procedure UBOD necessarily give the "basic therapy" (clonidine 0.15 mg - 3 tabs., heminevrin 3 caps., tizertsin 1 tab., haloperidol of 0.05, loperamide 3 caps.), that smooths the autonomic storm in the process of UBUD. The scheme of General anesthesia during UBOD:
1. Premedication: antihistamines, atropine at a standard dosage.
2. Anaesthesia induction.
a) hypnotic: thiopental sodium 5-7 mg/kg, or methoxyacetyl 2-4 mg/kg, or midazolam 2-4 mg/kg (30 mg), or propofol 2-4 mg/kg;
b) local (surface) anesthesia vocal cords - lidocaine (dispenser 10% - 2 doses);
C) recurarization - antidepressivi relaxant in subanalyses dose;
d) diplegia - succinylcholine 2-3 mg/kg;
d) tracheal intubation, inflating the cuff;
e) inserting nasogastric tubes;
W) catheterization of the urinary bladder.
3. Maintenance of anesthesia:
a) timental sodium, methoxyacetyl, midazolam, propofol - bolus or by continuous infusion (dose selected individually);
b) maintaining diplegia - antidepolyarizuyuschy relaxant in conventional dosage (Arduan, pavulon);
C) mechanical ventilation (a mixture of oxygen with air).
4. Extubate is carried out according to standard indications.
a) naloxone/0.4 mg, 0.8 mg, 1.6 mg, 3.2 mg, 6.4 mg every 15 minutes during the first the Asa after intubation (total dose of naloxone of 12.4 mg), then drip 0.4-0.8 mg/h for 24 hours in the first day (thus, the beginning of the infusion of naloxone begins during anaesthesia and lasts in the near postdetoxification period);
b) the naltrexone oral dose of 50 mg is injected through 24 hours after the start of UBOD after infusion of naloxone. Time UBOD and General anesthesia is 6-8 hours. The criterion for the end of UBOD is a regression of the symptoms of the abstinence syndrome: normalization of blood pressure and pulse, decrease of discharge by nasogastric probe, temperature reduction, reduction of slezootdelenia, reduction of diarrhea. The advantage of UBOD is that the peak of development of withdrawal syndrome occurs during rapid detoxification, when the patient is under General anesthesia and does not feel withdrawal symptoms. Nonspecific, deep Central nervous system inhibition facilitates the relief of withdrawal symptoms. Reliability detoxification due to the use of large doses of antagonists of opioid receptors, which allows to displace heroin during the procedure itself. The use of naltrexone prevents the reverse link with heroin opioid receptor, providing a long siege, and the consequence taking opiates does not cause euphoria. Safety procedures due to the recent under endotracheal anesthesia and the use of VSP the service of drugs, aimed at limiting and eliminating withdrawal symptoms.
In the near postdetoxification period symptomatic therapy aimed at eliminating vegetative withdrawal simptomokomplekse - clonidine, benzodiazepine, neuroleptics.
After UBOD 1-2 days carry out patient infusion therapy drugs that promote rapid recovery of good health (vitamins, cardioprotector etc). Then proceed to the next step in the treatment of medication psycho-correction - prohibitive therapy that contains a combination of procedures "poderosa in memory of the patient a feeling of drug parish and buzz. This atropinisation (ACT) and electroconvulsive therapy (ECT). These alternate procedures: day tropidoclonion /only 5-6 procedures for course/ is carried out according to the standard technique described in the "Guide to addiction", edited by Ivanets I.A., 2001, the day - electroconvulsive therapy: the "elikon 01" (in accordance with the "guidelines for use", 1998). Working together in resale psychiatrist-a psychiatrist and anesthesiologist. Before ECT are premedication drug mixture containing:-p 0.1% atropine sulfate 0.5 ml, aq 2% ditilina - 2.0 ml, aq 20% sodium oxybutyrate - 10-15 ml.
Necessarily introduce oral duct. During the process the URS is the patient in anaesthesia on comfortable beds, monitored vital functions using a special monitor. The number of treatments at the rate of 5 or more. ES-therapy is a non-drug method and allows from 2 to 5 times to reduce the number of drugs, including analgesics, intravenous fluids, antibiotics, immunomodulators, anti-depressants, some hormonal drugs, and often completely abandon them. At this stage, every day after the ACT, and after ECT is held in the afternoon ozone therapy. The most commonly used mode of 80 mg/l at a speed of 0.1 l/min Duration - 30 minutes, the number of procedures at the stage of medical psychotherapy to 8.
For ozonetherapy you can use the device AOT-NSC-01-C (A-16)" for the production of ozone-oxygen mixture with low and medium concentration of ozone from oxygen (Basic principles and tactics of ozone therapy // Manual for doctors.-Moscow.-2000). Systemic ozone therapy ozonation of blood of the patient, intravenous injection of ozonized solutions) has a strong detoxification effect. The mechanism of action of medical ozone following: improvement of the activity of the detoxification enzyme systems of the liver and kidneys, improve blood circulation, increase the phagocytic activity of the cells (binding, Perera who refuse or remove toxins, foreign antigens and so on).
The last stage of rehabilitation. To improve the quality and elongation phases of remission - abstinence from drug - in this step is also used ECT, which improves the background mood, prevents compulsive craving for the drug; is carried out during the period of rehabilitation before the year is not less than 1 time in 2 weeks. Ozone therapy gives immunomodulatory effect, which is confirmed by immunogram (taken 1 every three months), and improves the General physical condition of health, and therefore, together with antidepressants and background mood. Now in the clinic as antidepressants used blocker reuptake serotonin - Fevarin. Ozone therapy in the third phase of rehabilitation is conducted 2 times in 10-14 days. At the stage of rehabilitation is also used transcranial electrostimulation. Transcranial electrostimulation as a physiotherapeutic method is used in addiction with alcohol and drugs to stimulate the production of endorphins (pleasure hormones) in the Central nervous system at the stage of psycho-correction at the time of hospital stay. This is achieved by the effect on the skin of the head of a weak electrical impulses special characteristics with use of special equipment, such as machine Transair 01", which is intended for transcranially of electrical stimulation and provides a bipolar pulse current up to 5 mA. Thus, it is possible to obtain stable and reproducible selective activation of protective (endorphin) mechanisms of the brain using non-invasive electrical effects. Clinical example.
Patient-to, 27 years old, was admitted to the hospital 14.07.2002, case History No. 374. The diagnosis of drug dependence.
When a diagnostic interview with the parents and the son revealed the history and attitude to help get rid of the addiction of drugs. The last five years it produces itself in the/with the introduction of heroin in the veins of the lower extremities.
Anamnesis. Born from the genera I, I pregnancy, delivered with a double umbilical cord entanglement in the blue asphyxia, with a weight of 3550,0 length - 52 see Grew and developed ahead. In childhood he suffered measles, mumps. The school is easy to 9th grade. Since grade 9 (14.5 years) parents drew attention to the fact that my son has decreased academic performance, appeared indifference to learning. Along with this, they began to notice some lack of coordination of movements (son swaying when standing). In addition, he noted an increased appetite and a strong sense of hunger. Sometimes it seemed to them that the son of a drunk, but the smell of alcohol is not felt. There was also a very long sleep. After high school (17 years old) neither work nor study the patient was not. Parents a year before completing his studies in the school is obnaruzhili on the lower limbs traces of injections and were convinced, that the son is using drugs.
With 13 years began to smoke marijuana, mixing with tobacco, chewed leaves of the hemp plant. Against this background, felt carefree, fun, colorful hallucinations. But soon to achieve the same effect, it was necessary to smoke more and more. Friends suggested to try intravenous heroin. After that I could no longer do without the appropriate dose. Secret from parents. He himself attempted to quit the use of this drug, but to no avail.
Complaints about fatigue, pain in the right hypochondrium, frequent nausea and vomiting in the morning, joint pain, frequent urination, thirst. Notes that often builds some plans, but realize they can't because of extreme fatigue or spells. Notes erectile dysfunction, which have intensified over the last 3 months.
Objectively: the patient is of average height, thin, visible mucous membranes pale, dry. On the lower extremities and on the rear side in the region of the elbow bend of the left limbs are the scars of injections administered. Body with a bluish tinge. Eyes darting, look timid, slow movement. The upper extremities are cold. HELL 100/60, pulse 100 beats per 1 minute of the Liver is under Ribera 2 cm, palpation is painful. M of Pasternack positive on both sides. Tendon reflexes red eye reduction the us. Answers questions primitive as worried about fear.
The treatment of drug dependence according to the claimed method. Stationary phase ended on the 18th day. Further during the year the patient received outpatient ECT and antidepressant therapy Fevarin, then moved on to a correction in the group of narcotics anonymous, maintaining sobriety.
The positive effect from the use of our method: increasing the efficiency of treatment of patients with drug dependency in the second stage of their treatment, the elimination of the manifestations of psychological and physical dependence. Reducing complications and improving therapeutic efficacy of treatment.
The claimed method was treated 347 patients with drug dependency.
Comparative effectiveness of remedial measures was assessed by the duration of the reduction of the main withdrawal manifestations; the severity of residual manifestations of opiate withdrawal syndrome (OSA) on the 15th day of abstinence from drug use; severity of psychopathological disorders on day 7 of abstinence; the intensity of the PVN on day 7 of abstinence.
In the assessment of patients following methods were used: clinical kataliticheskoe observation, standardized self-reports of patients pathopsychological study using questionnaire MMR (in which odificatio FB Berezina et al., 1994). Monitoring of patients within 12-18 months revealed no recurrence in 290 patients, 7 patients changed the place of residence and the observation was interrupted, and the remaining patients received non-pharmacological and supporting anti-relapse therapy in the outpatient setting. Thus, the claimed method has shown its high efficiency, which in the proposed version does not depend on sex, age, duration of drug addiction, the daily dose. We have not identified the vital complications and deaths associated with the proposed methodology. The degree of anesthetic risk corresponds to that in the General practice anaesthetics.
Unlike other methods of treatment of mild withdrawal syndrome is reached much faster, longer remission and relapse less often. The advantages of the proposed method.
1. Rapid elimination of opiates.
2. Painless mild "drug withdrawal".
3. Beginning therapy prolonged opioid antagonist is naltrexone from the first day of hospitalization.
4. Reducing the length of hospitalization.
The inventive method of treatment for drug dependency is tested on a sufficient volume of clinical material has demonstrated its safety and efficacy and can be widely used in drug law the tick.
Method for the treatment of opioid dependence, including the steps: a diagnostic interview with the patient and parents, detoxification hospital, prohibitive and rehabilitation therapy, wherein before the step of detoxification, the patient is given the basic treatment, including clonidine, heminevrin, tizertsin, haloperidol, loperamide, conduct, performance, display, opioid detoxification, after which within 1-2 days of exercise therapy in vitamins and cardioprotection on stage prohibitive therapy alternate every other day tropidoclonion and electroconvulsive (EX) therapy, just spend 5-6 procedures, at this stage, daily ozone therapy in mode 80 mg/l at rate of 0.1 l/min, because the FORMER therapy are premedical 0.5 ml of 0.1%solution of atropine sulfate, 2.0 ml of 2%solution ditilina, 10-15 ml of 20%aqueous solution of sodium oxybutyrate, at the stage of rehabilitation underwent transcranial electrical stimulation during the entire period of once in two weeks spend ECT and twice in 10-14 days - ozone therapy on the background of the introduction of antidepressants.
FIELD: medicine, pharmacy.
SUBSTANCE: invention relates to medicine preparations that are used for treatment of opiomania or opiate dependence being especially heroin dependence. Diamorphine and/or one of pharmaceutically acceptable salts addition of acid are used as active substance. Also, invention relates to a method for treatment of opiate dependence. Invention provides the more long release of an active substance that is not decomposed and not loss activity in storing.
EFFECT: enhanced effectiveness of preparation, valuable medicinal properties.
12 cl, 1 tbl, 2 dwg, 3 ex
SUBSTANCE: method involves injecting membrane-associated antigen vaccine from destroyed tumor cells. Biopsy tumor cells taken from patient are used as raw vaccine material. Vaccine is produced by irradiating cell suspension with pulsating electric field having succession frequency and rectangular pulse duration equal to 35-50 Hz and 5-7 ms, respectively, specific current amplitude being equal to 300-500 mcA during 30-40 min in microelements presence. The injection is carried out by subcutaneously implanting incubator-carriers manufactured from porous titanium nickelide having vaccine deposited into the pores.
EFFECT: enhanced effectiveness of oncologic disease treatment.
SUBSTANCE: the present innovation deals with treating ischemic insult, especially at rehabilitation of patients at its acute phase. Along with medicinal therapy it is necessary to fulfill nervous-muscular electrostimulation (NES) of paretic extensors of fingers and wrist followed by evaluation of motor function. NES of paretic extensors of fingers and wrist should be started from the moment of establishing the fact of ischemic insult to be continued during 3-4 wk. Duration of 1 seance lasts for about 20-30 min twice daily. Impulses should be supplied every 4 sec at 2-sec-long duration. The innovation increases the quality of motor and functional reconstruction in post-insult patients due to changing the terms for the onset of NES technique towards its decreasing.
EFFECT: higher efficiency of reconstruction.
1 ex, 1 tbl
SUBSTANCE: method involves applying fractured bone fragments reposition at the first stage and implanting metal electrodes at the second stage into the osteolysis zone. Beck wires with dielectric coating are used as the electrodes. The wires are introduced transcutaneously in parallel to femur neck axis and mounted on epiphyseal germination zone with their working ends penetrating not less than 3 mm deep. Then, flexible electrodes are subcutaneously implanted in hip joint projection zone. Electric stimulator is connected to the skin ends of the electrodes. Pulsating current of negative polarity is supplied to intraosseous electrodes, whereas the flexible electrodes receive current of negative polarity from 5 to 10 mcA, frequency of 1 Hz and voltage of 8.8 V. Total duration and cross-section of rectangular pulses is not longer than 200 mcs. Pulsating electric current acts the whole day to achieve full closure of the germination zone.
EFFECT: enhanced effectiveness of treatment; prevented adverse side effects.
SUBSTANCE: method involves applying drug therapy under ischemic lesion focus state control with magnetic resonance tomography (MRT) being used. Bioenergetic evaluation of focus state, its size and cerebral blood circulation condition are evaluated in dynamics. Therapy without drugs is concurrently applied for observing ischemic lesion focus at the end of acute period using MRT-mode with suppressed signal from free liquid surface. The MRT observation is started at the first two days from the ischemic stroke beginning.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: the present innovation deals with treating and rehabilitating patients after insult cases. Electrostimulation should be carried out due to transcranial impact with direct and impulse current with frontal-mastoidal disposition of electrodes, current power being about 2-3 mA, impulse current frequency being 77 Hz, duration being 3.5 msec. Simultaneously, one should affect peripheral nerves of paralyzed and healthy limbs with direct current of 60-90 Hz frequency and voltage up to 70 V. Moreover, at paralyzed limb polarity should be altered every 10-15 min. Therapy should be fulfilled by courses consisted of about 7-10 seances, each being of about 1.2-1.5 h. The innovation enables to increase hemodynamics and enhance cerebral circulation.
EFFECT: higher efficiency of therapy.
1 cl, 2 ex
FIELD: medicine; neurology.
SUBSTANCE: right and left forehead, cervical and temporal areas of brain are subject to simultaneous trans-cranial influence of amplitude-frequency-modulated magnetic field during 3 minutes and to amplitude-frequency-modulated electric waves onto mammiform appendices with modulation frequency of 3 Hz and current up to 100 mcA during 20 minutes. Then carotid and vertebral arteries are subject from the left and from the right to low-intensity IR-radiation laser with modulation frequency up to 3 Hz, depth of modulation up to 50%, power up to 50 J, wavelength of 960 nm from the right and from the left during 5 minutes. Then vision analyzer is subject to influence of amplitude-frequency-modulated low-intensity IR waves with modulation frequency up to 3 Hz, depth of modulation up to 50%, 850 nanometer's wavelength and with power up to 2 mW/cm2 during 30 minutes. Course of treatment consists of 15 procedures.
EFFECT: stronger metabolic processes in brain tissue; improved parameters of arterial and venous blood current, rheologic properties of blood; restored cortical neuro-dynamics.
SUBSTANCE: the present innovation deals with treating patients with the lesion of spinal cord of uninflammatory character. Electrostimulation should be carried out in three stages: at the first stage due to applying electrodes: anode-needle-electrode should be introduced into inter-spinous space along the middle line being below the site of lesion, and cutaneous electrode-cathode should be located in frontal-parietal area, in projection of motor and promotor cerebral areas. At the second stage, electrostimulation should be conducted by applying electrodes: cathode-needle-electrode by introducing into inter-spinous space along the middle line being above the site of lesion, and cutaneous electrode-anode should be located in projection of a nerve bundle under stimulation. At the third stage electrostimulation should be carried out by changing the polarity of electrodes and applying: electrodes anode-needle-electrode to be kept in inter-spinous space along the middle line being above the site of lesion, and cutaneous electrode-cathode should be located above affected muscles or in areas of affected sensitivity. The innovation enables to accelerate the reconstruction of the functions of spinal cord at its keeping.
EFFECT: higher efficiency of reconstruction.
FIELD: medicine, veterinary science.
SUBSTANCE: it is necessary to affect biologically active points (BAP) with current of 15-30 mcA, frequency of 8 Hz. The ratio of the duration of impulses of positive and negative current polarities corresponds to 1:1. The impact lasts for 2 min once daily. In case of femur fracture one should affect BAP 108 and 109, and in case of shin bones fracture - BAP 115 and 116. Therapy course lasts for 7 d. The method shortens terms of therapy due to applying the current of the above-mentioned parameters.
EFFECT: higher efficiency of stimulation.
1 dwg, 2 ex, 1 tbl
FIELD: medicine, veterinary science.
SUBSTANCE: it is necessary to introduce bioferon intramuscularly at the dosage of 1 ml/40 kg body weight for 5 d. Additionally, it is necessary to affect symmetric biological active points (BAP) of hepatic and splenic meridians Liv2, Liv3, Liv14, SP6, SP9, SP10. One should affect with alternating current of 10-15 mcA, duration being 60 sec for 5 d. One should measure BAP electroconductivity at positive and negative polarities to compare them. If positive polarity value dominates it is necessary to affect BAP with positive potential and if negative polarity dominates one should affect BAP with negative potential. Impact lasts till the difference in electroconductivity values escapes and then one should diagnose recovery in animals. The innovation decreases labor capacity and time expenses for therapy implementation.
EFFECT: higher efficiency of therapy.
2 ex, 2 tbl
SUBSTANCE: method involves applying low intensity magnetic field and infra-low electric waves treatment. Indifferent electrode is placed in trigeminal ganglion projection and active electrodes on upper eye-socket edge in the area of foramen supraorbitale, on lower eye-socket edge in foramen infraorbitale zone and on the lower mandible end in foramen mentale zone. The procedures are applied during 15 days.
EFFECT: enhanced effectiveness in suppressing determinant excitation foci in frontal cortex; stopped pain pulses propagation into the frontal cortex.
FIELD: medicine, ophthalmology, pharmacy.
SUBSTANCE: invention relates to irrigation solution used in ophthalmology. Irrigation solution used in ophthalmology surgery operations comprises sodium chloride, sodium hydrogen phosphate and sodium dihydrogen phosphate, L-carnosine, glycoseaminoglycans and water wherein glycoseaminoglycans are represented by as a solution of keratan sulfate and chondroitin sulfate sodium salts taken in the definite ratio of components. Invention provides preparing the balanced saline solution for irrigation and anti-exudative effect in using. Invention can be used for washing out lens masses in cataract extraction and filling chamber eye space in different ophthalmic surgery operations.
EFFECT: valuable medicinal properties of solution.