Anxious-depressive Pathology in the Structure of Adaptation Disorders (Clinics, Diagnosis, Therapy)

Authors

  • Nataliia Maruta Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine
  • Viktoriia Fedchenko Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine

DOI:

https://doi.org/10.30841/2307-5112.5-6.2020.224988

Keywords:

adaptation disorders, anxiety-depressive symptoms, antidepressant therapy, Giacintia (escitalopram)

Abstract

The objective: evaluation of the effectiveness of the drug Giacintia (escitalopram) – coated tablets, 10 mg in the treatment of patients with anxiety and depressive symptoms in the structure of adaptation disorders.

Materials and methods. The study involved 38 patients with adaptive disorders, mixed anxiety-depressive response to ICD-10 (F 43.22). All patients received Giacintia at a dose of 10 mg per day, due to the sufficient therapeutic effect of this dosage. A comprehensive approach was used, which included methods: clinical and psychopathological; psychodiagnostic, based on the scale «Questionnaire of severity of psychopathological symptoms» (Symptom Check List-90-Revised – SCL-90-R), hospital scale of anxiety and depression (HADS) and the scale of social adaptation Sheehan (SDS); methods of mathematical statistics.

Results. Peculiarities of patients’ clinical condition and its dynamics were assessed before treatment (day 1), during therapy (day 14), and after treatment (day 90). As a result of Giacintia therapy, a significant improvement in the mental state of patients was found. When studying the regression of psychopathological symptoms, the positive dynamics of depressive disorders in this category of persons was observed by the end of the second week of therapy, and on the part of anxious – up to 21 days of therapy. Examination of patients at the end of the 90-day course of Giacintia treatment revealed a significant reduction in all previously recorded symptoms of anxiety and depression compared with baseline (p<0.05). On the SCL-90-R scale, on day 14 of therapy, patients showed a significant decrease in obsessive-compulsive symptoms, signs of paranoia (suspicion), hostility (feelings of anger), depressive symptoms, and phobic anxiety. Subsequently, there was a significant decrease in existing psychopathological symptoms and a probable decrease in all scales on day 90 of therapy with the studied antidepressant (t≥2,3477). At the time of the final assessment, the indicator on the scale of depression decreased to 0,52 points, and on the scale of anxiety – to 0,56 points, which indicates a reduction in clinically = pronounced anxiety and depressive symptoms. According to the HADS scale at the initial assessment of clinical and psychopathological manifestations of anxiety and depression, clinically expressed symptoms of anxiety were registered in 71,05 % of individuals (mean score – 15,00±2,39 points), subclinical – in 28,95 % of individuals (mean score – 8,82±0,75 points). At the same time, clinically pronounced symptoms of depression were registered in 81,58 % of individuals (mean score – 15,23±2,33 points), subclinical – in 18,42 % of individuals (mean score – 8,43±0,53 points). A significant decrease in the percentage of clinically pronounced manifestations of depressive symptoms was registered on day 14 of therapy (57,89 % of individuals, p<0,05). At the time of the final HADS assessment, clinically significant symptoms of anxiety and depression were completely reduced in the study group and were represented only by subclinical manifestations in 13,16 % of patients and 11,43 % of patients, respectively.

Conclusions. The results of the study showed high efficacy and good tolerability of the drug Giacintia in the treatment of anxiety and depressive symptoms in the structure of adaptation disorders. Giacintia has not only a balanced pronounced thymoanaleptic effect, but also provides increased professional, social and family activity and improves the quality of life of patients in general. Especially important is the good tolerability of the drug confirmed by the study, the unstable transient nature of adverse events, their insignificant severity, which is a significant advantage in the formation of patients’ commitment to treatment and achieving a deeper and more lasting therapeutic effect. Thus, the use of Giacintia can successfully overcome adaptation disorders and prevent their transformation into chronic conditions.

Author Biographies

Nataliia Maruta, Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine

Nataliia O. Maruta,

Head of Department of Borderline Psychiatry

Viktoriia Fedchenko, Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine

Viktoriia Yu. Fedchenko,

Department of Borderline Psychiatry

References

Jounger M, Frasch K, Becker T. Adjustment disorders – nosological state and treatment options. Psychiat Prax 2008;35(5):219–25.

Александровский Ю.А. Состояния психической адаптации и невротические расстройства / Ю.А. Александровский. – М.: ГЭОТАР-Медиа, 2012. – 52 с.

Психологічні особливості віддалених наслідків стресогенних впливів: монограф.; за ред. М.С. Корольчука / М.С. Корольчук, В.М. Корольчук, С.М. Миронець [та ін.]. – К.: Київ. нац. торг.-екон. ун-т, 2014. – 276 с.

Grassi L et al. Psychosomatic characterization of adjustment disorders in the medical setting: some suggestion for DSM-V. J Affect Dis 2007;101(1–3):251–4.

Lung FM, Lee FE, Shu BC. The premorbid personality in military students with adjustment disorders. Military Psychol 2006;18(1):77–88.

Portzky G, Audenaert K, van Heeringen K. Adjustment disorders and the course of the suicidal process in adolescents. J Affect Dis 2005;87(2–3):265–70.

De Leo D, Pellegrini C, Serraioto L. Adjustment disorders and suicidality. Psychol Rep 1986;59:355–8.

Stosberg K. Sociological aspects of addictive behavior. Offentl Gesundheitswes 1980;42(Suppl. 1):3–7.

Международная классификация болезней (МКБ-10). Электронная версия. http://www.mkb10.ru

Kawa S, Giordano J. A brief historicity of the diagnostic and statistical manual of mental disorders: issues and implications for the future of psychiatric canon and practice. Philos Ethics Humanit Med 2012;13(7):2

Pierre JM. The borders of mental disorder in psychiatry and the DSM: past, present, and future. J Psychiat Pract 2010;16(6):375–86.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text Rev. Washington DC, 1994. Am Psychiatric Association Press 2000

Васильева А.В., Полторак С.В., Поляков А.Ю., Соломонова С.В. Лечение расстройств адаптации: применение препарата Афобазол в комплексной терапии. Справ. поликлин. врача. 2006;8:87–8.

Papakostas G.I. Managing partial response or nonresponse: switching, augmentation, and combination strategies for major depressive disorder J. Clin. Psychiatry. 2009. Vol. 70. Suppl. 6. P. 16–25.

Hameed U, Schwartz TL, Malhotra K et al. Antidepressant treatment in the primary care office: outcomes for adjustment disorders vs major depression. Ann Clin Psychiat 2005;17:77–81.

Owens MJ, Knight DL, Nemeroff CB. Second-generation SSRIs: human monoamine transporter binding profile of escitalopram and R-fluoxetine. Biol Psychiat 2001;50:345–50.

Марута Н.О., Жупанова Н.О. Клініко-психологічні особливості хворих на депресію з різним рівнем медикаментозного комплаєнсу (діагностика і корекція). Український вісник психоневрології. 2016. Том 24. випуск 1 (86). – С. 5–11.

Рахман Л.В. Концептуальні чинники розвитку та принципи лікування терапевтично резистентних депресій. Український вісник психоневрології. 2016. Том 24. випуск 1 (86). С. 104–110.

APA Practice Guideline on MDD. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf

APA Practice Guideline on Panic Disorder. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf

Hyttel J, Bingesw KP, Perregaard J, Sánchez C. The pharmacological effect of citalopram resides in the (S)-(+)-enantiomer. J Neural Transm [Gen Sect] 1992;88:157–60.

Baumann P, Zullino DF, Eap ChB. Enantiomer’s potential in psychopharmacology – a critical analysis with special emphasis on the antidepressant escitalopram. Eur Neuropsychopharmacol 2002;12:433–44.

Francois C, Toumi M, Aakhus MA, Hansen K. A pharmacoeconomic evaluation of escitalopram, a new selective serotonin reuptake inhibitor. Eur J Health Econom 2003;4:12–9.

Burke WJ, Kratochvil ChJ. Stereoisomers in Psychiatry: The Case of Escitalopram. Primary Care Companion. J Clin Psychiat 2002;4:20–4.

Stahl SM, Gergel I, Li D. Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiat 2003;64(11):1322–7.

Wade A, Lemming OM, Bang Hedegaard K. Escitalopram 10mg/day is effective and well tolerated in a placebo-controlled study in depression in primary care. Int Clin Psychopharmacol 2002;17:95–102.

Stahl SM, Nierenberg AA, Gorman JM. Evidence of early onset of antidepressant effect in randomised controlled trials. J Clin Psychiat 2001;62(suppl 4):17–23.

Davidson Jr, Bose A, Wang Q. Safety and efficacy of escitalopram in the longterm treatment of generalized anxiety disorder. J Clin Psychiat 2005;66(11):1441–6.

Практикум по психотравматическому стрессу / под ред. Н.В. Тарабриной. – СПб.: Питер, 2001. – С. 29–32.

Смулевич А.Б. Депрессии при соматических и психических заболеваниях. М.: Медицинское информационное агентство. 2003. – 209 с.

Leon A.C., Shear M.K., Portera L. et al. Assessing impairment in patients with panic disorder: the Sheehan Disability Scale. Soc Psychiatry. 1992. № 27. P. 78–82.

Published

2020-12-21

Issue

Section

Topical issues