Method for prediction of atypical antipsychotic drug treatment rates in shizophrenics

FIELD: medicine.

SUBSTANCE: clinical investigation is supplemented with simultaneously testing monoamine oxidase (MAO) activity in thrombocytes in nmole of benzaldehyde per 1 mg of protein an hour and semicarbazide-dependent amine oxidase (CAO) activity in blood serum in nmole of benzaldehyde per one ml of blood serum an hour. The blood serum CAO to thrombocyte MAO activity relation is calculated. If the value exceeds 0.6, a positive result of atypical antipsychotic drug treatment in schizophrenia is predicted.

EFFECT: more precise and objective prediction, reduced length of treatment in schizophrenics.

2 ex

 

The problem of predicting the effectiveness of pharmacotherapy (CFT) before treatment is relevant in connection with a large selection of expensive psychotropic drugs and the individual response of patients.

There is a method of predicting the effectiveness of CFT by clinical studies on therapy after 3-6 weeks after beginning treatment (Ph.D GY, Neduva A.A. Treatment of mental patients. - M.: Medicine, 1988, p.8-25).

The disadvantage of this method is the duration of the study 3-6 weeks, as well as the subjective evaluation of the patient depending on the practitioner.

There is a method of predicting the effectiveness of treatment residual schizophrenia by clinical and biological research - determining the concentration of neurosteroid dehydroepiandrosterone, cortisol and rate of apoptosis of neutrophils (RU patent No. 2319155 C2, 10.03.2008). The disadvantage of this method is time consuming, expensive research.

The technical result of the proposed solutions is empowering predicting treatment of atypical antipsychotics schizophrenia patients, the reduction treatment, saving medicines, reduction of treatment time.

This result is achieved by the fact that in addition to the clinical study to determine simultaneously the activity is monoaminoxidase (MAO) in platelets of 1 nmol of benzaldehyde per mg protein per hour and semicarbazides oxidase (CAO) in the serum of 1 nmol of benzaldehyde/ml of serum per hour, calculate the ratio of activity of CAO to the activity of MAO and with the value of more than 0.6 predict a positive outcome of schizophrenia atypical antipsychotics.

The method is as follows.

Patients with schizophrenia before treatment in addition to the clinical study to determine simultaneously the activity of monoamine oxidase in platelets in nmol benzaldehyde 1 mg protein per hour according to the method described in the article Ontologies, Taskswitching Method of determining monoaminoxidase activity of platelets, Zh. "Laboratory work", 1985, No. 5, p.289-291 and activity semicarbazides oxidase in serum at a concentration of benzaldehyde in 1 ml per hour according to the method described in the article Ahisaariego Colorimetric method for determining the activity of monoamine oxidase in serum // Ukr. "Laboratory work", 1976, No. 3, s-153. Calculate the ratio of activity semicarbazides oxidase in serum activity of monoamine oxidase in platelets and when the value of the ratio more than 0.6 predict a positive outcome of therapy atypical antipsychotics schizophrenia patients.

Assessment of mental status is carried out by the PANSS (Kay, S.R., Fiszbein a, Opler LA The positive and negative syndrome scale (PANSS) for schizophrenia // Schizophr Bull. 1987. Vol 13, No. 2. P.261-276.

Example 1.

Patient M., case History No. 105. The tread is in the clinic UHF IRI psychiatry University, 19.01.2007 Diagnosis: paranoid Schizophrenia. The observation period less than one year. (ICD-10: F 20.0). Mentally ill for 2 years. During the previous two years had two supplications attack paranoid structures permitted without treatment within 3-4 months. Six months before the present admission gradually began to grow paranoid symptoms in the form of the ideas of the impact of mental automatisms, pseudohallucinations, brad relations. Describes the symptoms gradually increased in connection with what was referred for treatment in the clinic of the Institute. Before therapy is defined activity in serum CAO (10 nmol benzaldehyde in 1 ml per hour) and MAO activity (13,8 nmol benzaldehyde for 1 mg of protein per hour) in platelets, the value of which amounted to 0.7. Was conducted therapy atypical neuroleptic risperidone at a dose of 4 mg per day. Already during the first weeks of therapy had improvement of psychopathological symptoms. The patient was discharged with improvement. PANSS when entering 78 points, while the extract 60 points.

Thus, the ratio of CAO to MAO than 0.6 is a predictor of positive therapeutic prognosis in patient with schizophrenia in the treatment of atypical neuroleptic.

Example 2.

Patient N., Case history No. 1280. Was admitted to the hospital UHF IRI psychiatry University 09.10.2007, Di is the prognosis Schizophrenia paranoid. The observation period less than one year (ICD-10: F 20.0). The disease made its debut 3 years prior to referral to a psychiatrist. Psychopathological symptoms were determined hallucinatory version of Kandinsky syndrome-clérambault. PANSS when entering 83 points. Before therapy is defined activity in serum CAO (15.0 nmol benzaldehyde in 1 ml per hour) and MAO activity (9.0 nmol benzaldehyde for 1 mg of protein per hour) in platelets, the value of which amounted to 1.7 (15,0/9,0). In the treatment of atypical neuroleptic olanzapine noted positive dynamics in the form of the disappearance of hallucinatory product flows thoughts, streamlined the behavior that has an impact on social functioning. Issued in remission. PANSS - 53.

Thus, the ratio of CAO to MAO than 0.6 is a predictor of positive therapeutic prognosis in a patient with schizophrenia in the treatment of atypical neuroleptic.

The proposed method is applied 36 patients with schizophrenia. The coincidence of the clinical and biochemical parameters in 73,3% of patients (p<0,001).

This method has advantages compared with the known, consisting in the reduction of treatment time, increase accuracy, objectivity diagnosis and saving drugs.

A method for predicting the effectiveness of treatment atipic the diversified antipsychotics schizophrenia by clinical and biological research, characterized in that in addition to the clinical study to determine simultaneously the activity of monoamine oxidase (MAO) in platelets in nmol of benzaldehyde per 1 mg of protein per hour, and the activity semicarbazides oxidase (CAO) in the serum at the concentration of benzaldehyde per ml of serum per hour, calculate the ratio of the activity of CAO in the serum to the activity of platelet MAO, and when the value of more than 0.6 predict a positive outcome in the treatment of schizophrenia with atypical neuroleptics.



 

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