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Dear colleagues, sends you his article that the results of research on the thesis "anxiety disorders in patients with metabolic syndrome X". I apologize for my imperfect English. We want to hear your feedback about the information provided, including how to diagnosis and treatment. Igor Lazebnyk, alienist e-mail: [email protected], [email protected] Skype: lazebnyk17 Address: 04210 Kyiv, etc. Heroes of Stalingrad, d. 13A, Apt. 243 Phone: Mobile +380955307293 Features of diagnosis and treatment of anxiety disorders Igor Lazebnyk Ukrainian Research Institute for Social and Forensic Psychiatry and Addiction Keywords: psychosomatic disorders, anxiety disorders, metabolic X syndrome, cardiovascular disease Introduction. Found that recurrent anxiety disorders in 20% of women and 8% in men and usually lasts six months or more. Nearly 70-90% of patients with somatic diseases, attending physician, experiencing anxiety. However, the somatic complaints often hides the main problem that often leads physicians to prescribe unnecessary testing and treatment [1-5]. Pathological condition with anxiety disorder characterized by a sense of danger and is accompanied by somatic symptoms (which are connected with the autonomic nervous system hyperactivity): a sense of tremor, back pain, headache, tension - hypertonus soft muscles, feeling of lack of air caused by pathological hyperventilation; increased fatigue, skin pallor or hyperemia, tachycardia, and sinus arrhythmia, sweating, cold extremities; dispeptia disorders connected with violation of the central regulation of gastro - intestinal tract; kserostomia often mistakenly believe that the result of medication side effects; polakiuria; paresthesia; violations in swallowing . Psychological symptoms of anxiety manifested a sense of danger, reduced capacity for attention, too up to the wary suspiciousness, sleep disorders, lower libido, a sense of "someone in the throat. But mostly all of these symptoms are usually treated patients as a manifestation of "some very dangerous bodily disease" due to a very high level aleksytymia. It is well known that normal stress response, mostly disturbing, its structure is a state of adaptation in response to the action of stress factor and as a limited time, and on its severity. This more pronounced and / or longer anxiety, often qualitatively not unlike normal reactions, leading to social and psychological disadaptation worsen prognosis of somatic diseases and therefore require careful psychopathologic diagnosis to assign adequate therapy. First of all anxiety disorders lead to violations of the treatment, consultation and avoidance reactions increased number of medicines taken. These factors undoubtedly affect the deterioration in the therapeutic prognosis - increasing frequency of exacerbations and hospitalizations of patients. Furthermore, the influence of anxiety on the deterioration of quality of life of patients than the negative effect of serious somatic symptoms. Undoubtedly also significant negative social and economic consequences. Study the economic costs to the anxiety disorders that appear in primary practice showed that the costs if expressed alarm at two times higher than in the absence anxiety disorders. Mostly those with high costs in general medical network, the cost of psychiatric treatment. Doctors general and specialized medical practices are more often viewed as a normal alarm response disadaptation effect of somatic disease, anxiety disorders or somatic manifestations of the disease masks, why anxiety disorder detected them very rarely. Many researchers explain the appearance of many symptoms of anxiety and some components of metabolic syndrome X of hypertension, abdominal obesity, type 2 diabetes mellitus, atherosclerotic changes in the presence of hyperventilation syndrome, which can objectify by analysis of partial pressure of blood gases (particularly crucial to reduce the partial pressure carbon dioxide) during the exacerbation of symptoms [6-13]. Chronic hyperventilation is accompanied by profound metabolic changes that occur in the gas alkalosis and metabolic acidosis. Change the fundamental constants of homeostasis causes vegetative-visceral and polysystem clinical disorders: cardiovascular, gastrointestinal, urinary, numerous violations of the central and peripheral nervous system, muscles. There vessel and extended vazoconstryctia. Gas alkalosis increases Combinationality oksihemoglobin to erythrocytes (rally oxyhemoglobin dissociation curve to the left - Verigo-Bohr effect), which enhances hypoxia of organs and tissues. It appears paradoxical situation - at excess oxygen in the blood the body is suffering from hypoxia. Thus, according to the literature, we found that hyperventilation test can detect signs of hyperventilation syndrome and anxiety disguised as fact in patients with alarming disorders for ICD-10 and in patients with psychosomatic disorders [6,8,9,12,13 ]. There is great diversity of forms and methods of hyperventilation tests (test of Troisier-Bonsdorf, Rosset’s test, tests performed at the EEG and ECG studies), but they have not standardized, time-consuming and requires much time, requiring hardware, or do not meet goals and conditions of the study patients with mental and psychosomatic disorders [6]. Based on the idea that hyperventilation, anxiety disorders and metabolic syndrome X linked clinically we decided along with clinical psychopathology, social-psychological, psycho-diagnostic research methods anxiety disorders in patients with metabolic syndrome X apply hyperventilation test. The appearance of certain psychic and somatic signs of metabolic syndrome X on the stage of formation may constitute pathology status, stress due to compensatory functional reserves of the body. Stage adaptation of psychosomatic stress in the form of negative total dynamic psychopathological phenomena may serve as a basis for early diagnosis of anxiety disorder that prevents further development of the group of psychosomatic diseases type 2 diabetes mellitus, hypertension, ischemic heart disease and possibly others. Based on these data will be developed recommendations for general practitioners, cardiologists, endocrinologists regarding the use of the most effective methods of early diagnosis, prevention, treatment and rehabilitation of patients with anxiety disorders with metabolic syndrome X. The study was to determine the clinical and psychopathological features of anxiety disorders in patients with the Ministry of Agriculture to increase the efficiency of medical care for this category of patients by further improving the quality of diagnosis, treatment and rehabilitation. Material and methods. Object of study were anxiety disorders in 183 patients aged 19 to 72 years who were in inpatient treatment at the National Research Center Institute of Cardiology. MD Strazhesko Academy of Medical Sciences of Ukraine and in specialized hospital departments and hospital number 1 number 2 tablespoons. Kyiv. Studied patients with clinical symptoms consistent with anxiety disorders Diagnostic criteria ICD-10 rubrics. To determine the clinical features of anxiety disorders patients were divided into 2 groups according to nosological belonging somatic disease. In the first group included patients with metabolic syndrome X (97 persons - the main group), in second - patients without metabolic syndrome X (86 persons - control group). Patients were examined with reactive anxiety scale Spilberg-Hanin, scoring the quality of life (the author A. Chaban, 2008.) Toronto aleksytymia scale hyperventilation test (in Rosset modifications. Chaban OS, OO Khaustova , Lazebnyk IV, filed an application for patent № u 2010 04106 dated 04/08/2010). We have proposed the following hyperventilation test methods - two-time the next load: 10 quick, forced, deep breaths, exhale of breath holding following the tenth full, deep until inhalation the desire to breathe (like the test of Schtange). The aim wos of reveal hidden anxiety symptoms and disorders associated visceral-vegetative symptoms, which save analysis further diagnostic purposes. According to our observations, usually symptoms appeared for 8-10 breaths and the first 15-25 seconds breath (anxiety, panic, feelings of suffocation, dizziness, etc.).. For ease of use in diagnosis, we divided the symptoms that arise during hyperventilation sample into two groups: And - Mental symptoms: • Anxiety • anxiety • stimulation (excitement) • Derealisation • Depersonalisation • Fears: death, loss of self-distraction • Reduced attention • Deteriorating playback memory • Narrowing of consciousness • Tearfulness II - symptoms of Somatic: • heart and cardiovascular system - dizziness, fainting, palpitations, headaches or feeling compression of the heart • upper gastrointestinal tract - dry mouth, or hypersalivation, breach of swallowing, a sense of who in the throat, nausea, vomiting, pain or heaviness in the stomach, burp, hiccup, aerofahia, • the lower gastrointestinal tract - stomach growl, tenesmus, flatulence, pain or heaviness in the stomach, bloated • Respiratory system - hysterical coughing, choking sensation, complications, failure of any breathing, breathing with aspiration • digestive system - polakiuria, pain or discomfort in the perineum, the region Sich bladder, prostate • other organs and systems - muscle cramps, muscle aches, hypertonicity in the limbs, feeling of tightness, a sense of twisting, rheumatic in muscles and joints, skin burning sensation, hyperhidrosis, tremor, jerk, sweating, feeling of weakness, feeling hot or cold in different parts of the body, generalized tetanus Test is considered positive if any mental symptoms, especially those like anxiety and fears. If psychological symptoms (mainly anxiety and fears) are not shown, sample is negative and somatic symptoms are analyzed to diagnose other disorders, somatoform mainly when they repeat the main organ symptoms. The study and discussion. Volume pilot study did not allow a full statistical data processing, but helped to identify some trends in clinical and psychopathological features of anxiety disorders in patients with metabolic syndrome X. The average age of the examined control group was 44.6 years, a group of metabolic syndrome X - 46.3 years (p ≤ 0,01). In the examined groups dominated by women: in their control group consisted of 48 persons (55.8%) in group of patients with metabolic syndrome X 57 people (58.8%). In the control group, men were represented by 38 persons (44.2%) in group of patients with metabolic syndrome X - 40 persons (41.2%). Duration of disease in the control group amounted to 4.3 years while in patients with metabolic syndrome X - 13.7 years. Clinical manifestations of anxiety disorders in patients with metabolic syndrome X is less diverse, represented mostly hidden somatic pathology of panic disorder and organic anxiety disorder. In the group with metabolic syndrome X of mental disorders were represented Panic Disorder - 52 (53.6%), generalized anxiety disorders - 17 persons (17.6%), post-traumatic stress disorder - 1 person (1%), organic anxiety disorder, 27 people (27.8%). In the control group were presented mental disorders, anxiety disorders phobia - 1 person (1.1%), panic disorder - 3 (3.4%), generalized anxiety disorders - 22 people (25.7%), mixed anxiety and depressive Disorder - 19 people (22.1%), other mixed anxiety disorders - 23 people (26.8%), mixed obsessions thoughts and actions - 2 (2.3%), post-traumatic stress disorder - 1 person (1, 1%), disorders of adaptation - 9 persons (10.6%), organic anxiety disorder - 6 persons (6.9%). Patients with metabolic syndrome X showed higher level of alexithymia - 78 points by leveling with the control group - 70.5 points (p <0,01). What indicates anxiety secretiveness heat of passion with metabolic syndrome X somatic sensations. On a scale Spilberg-Hanin reactive anxiety level in the control group amounted to 41.6 points in the group of patients with metabolic syndrome X - 44.2 points, the level of personal anxiety in the control group amounted to 16.1 points in the group of patients with metabolic syndrome X - 48.2 points. This may indicate that in patients with metabolic syndrome X in the genesis of anxiety disorders, higher level expressions than the general population, as higher personal factors play a role, whether as a result of the persistence of disease following somatization relevant personal changes. On a scale assessing the quality of life level in the control group amounted to 14.21 points in patients with metabolic syndrome X - 12.94 points. In a hyperventilation test in patients with metabolic syndrome X along with somatic signs hyperoksyhenatia (which had a very wide range and intensity) panic attacks occurred in 83.5% patients in the general population, they occur in 10.5%, somatic signs were less less pronounced and differed spectrum manifestations. So among the main group of patients presented symptoms of psychological anxiety - 97 people (100%), concern - 97 people (100%), excitement - 68 persons (70.1%), derealisation - 55 persons (56.7%), depersonalisation - 56 persons (57.7%), insurance - 81 people (83.5%), decrease in attention span - 90 persons (92.8%), memory impairment - 74 people (76.4%), narrowing consciousness - 17 persons (17.5%), tearfulness - 28 persons (28.9%). Among control group patients presented symptoms of mental anxiety - 77 persons (89.5%), concern - 74 people (86%), excitement - 23 people (26.7%), derealisation - 5 persons (5.8%) depersonalisation - 6 persons (6.9%), insurance - 9 people (10 ,%%), decline in attention - 53 people (56.6%), memory impairment - 32 people (37%), narrowing of consciousness - 8 persons (9.3%), tearfulness - 13 persons (15.1%). Somatic symptoms among a core group of patients presented with symptoms of the heart and cardiovascular system - 92 people (94.8%) of the upper gastrointestinal tract - 75 persons (77.3%) from the lower gastrointestinal tract - 70 (72.1%) from the respiratory system - 61 person (62.9%) from the digestive system - 48 people (49.5%) from other organs and systems - 97 people (100%). In the control group, somatic symptoms were represented by symptoms of heart and cardiovascular system - 52 people (60.4%) of the upper gastrointestinal tract - 46 persons (53.5%) from the lower gastrointestinal tract - 22 people (25.6%) of the respiratory system - 17 people (19.7%) of the digestive system - 14 people (16.2%) from other organs and systems - 53 people (61.6%). Most patients who held hyperventilation test noted improvement of their health (85 persons - 87,6% with metabolic syndrome X and 64 - 74.4% control group), lower levels of stress and anxiety related somatic symptoms compared with their condition to of hyperventilation test. Usually improvement advancing through 5-15 minutes after hyperventilation test. What apparently was caused by conditioned reflex increase in resistance and hyperoxyhenation- hipocapnia associated with the development of anxiety. We recommend patients to perform breathing exercises, such as hyperventilation test performed them twice a day (morning and evening) to patients with panic disorder recommended dwarf similar attack breathing exercises. After 2 weeks - a month, they noted a significant weakening or disappearance of psychic and vegetative-visceral manifestations during their hyperventilation test. Patients noted improvement of their health, those who were in panic disorder, panic attacks filmed development of performance tests such as hyperventilation (for reviews is exceeded by many times the effectiveness of breathing in a paper bag), anxiety attacks on their personal feeling was less pronounced. Example 1. Patient S., 43 years old. Diagnosis: Hypertension II art. Obesity II-III. The metabolic syndrome X. sick 9. Complaints of irritability, conflicts at work, sleep disorders, feelings broken, fatigue, anxiety, life pessimism. Antihypertensive drugs received from time to time. Diets do not made over the past 5 years weight gain of 4-5 kg per year. Patients with anxiety disorder did not felt anxiety and fears linked with hypertensive crises. At the inspection came on the recommendation of the therapist. At the inspection kept confident, but somewhat tense. Denies the presence of anxiety. But fixed on painful symptoms. Mood equal. Focus is reduced. Easy runs in study. In time of the hyperventilation test felt concern panic attack, anxiety, fear and stop the heart, trembling, excitement, feeling of nausea, tachycardia, palpitations, feeling of fading heart, limb numbness, dizziness. After the hyperventilation test was feeling much better than before the study, said that realized, always within 10-12 years, felt anxiety, but could not understand her, and panic attacks linked to hypertensive crises, although aggravation of anxiety and fears warned raising blood pressure. Established diagnosis: panic disorder (F 41.00). Upon further daily breathing exercises performed in the background 20 days reported that easily performs well hyperventilation tried without discomfort, anxiety attacks and warned the implementation of respiratory exercises such as hyperventilation test. Example 2. Patient M., 1938. Diagnosis: Hypertension I-II cent. Obesity I cent. Ill five years. Complaints for tearfulness, anxiety, irritability, and home conflicts, reduce disability, sleep disturbance, fatigue, lower vitality. BP = 170/95. From time to time taken, “Corvalol”, hypotensive drugs, but the effect is felt. In the interview easily change the emotional state of smiles to the summation. Scattered. Fixed on their somatic state, feeling weak, diffident. Productivity due to unstable mental processes fatigabiliti. Presents the nature of somatic complaints, symptoms of mental nature denies. During the test (during breath-holding) felt anxiety, tearfulness, dizziness, stiff neck, extremities, lips, pain in left arm and left half of the chest, palpitations, headache, feeling someone's throat, unclear vision and blur in the eyes . After the sample recalled that similar but less pronounced feeling appeared 18 years ago after the wedding, which were connected with family difficulties. Diagnosed: Mixed anxious and depressive disorder [F41.2]. The most effective test proved to phobia anxiety-disorder [F40.0], panic disorder [F41.0], posttraumatic stress disorder [F43.1], adaptation disorder [F43.2], organic anxiety disorder [F06.4]. Number of patients who were diagnose this way was 183 patients. All cases were seen high diagnostic efficiency, which can detect hidden anxiety and related viscero-vegetative symptoms. The method is simple, quick to perform, requires no additional equipment. Conclusions. Based on the pilot study found a trend of accumulation among patients with metabolic syndrome X usually panic disorders, escaped somatic manifestations, a higher level of latent anxiety, high somatysation of anxiety disorders because of their longer duration, more pronounced signs of change hyperventilation syndrome compared with patients in the general population. In our opinion, the use of comprehensive psychological and psychiatric diagnosis, early psychotherapeutic treatment using breathing exercises for hyperventilation, cognitive-behavior, hypno-suggestive and conditioned reflex psychotherapy should not only increase the speed and quality of recovery, but also contribute to subjective patient satisfaction treatment and quality of life. Thus, the results of further research will allow general practitioners to improve efficiency of care appropriate category of patients. Summary: A pilot study anxiety disorders in patients with metabolic syndrome X. These data suggest a higher level of anxiety, panic disorders share growth (escaped somatic pathology), more pronounced vegetal-related changes and the growth of visceral manifestations of hyperventilation syndrome in patients with anxiety compared to the total population. Installed high efficiency hyperventilation test in diagnosis of latent anxiety disorder. Noted the positive impact of exercise hyperventilation followed by breath holding in the treatment of anxiety. Further studies will enable general practitioners to improve efficiency of care appropriate category of patients. Literature:
Шановні колеги, надсилаю Вам свою статтю, в якій викладені результати досліджень за темою дисертації «Тривожні розлади у пацієнтів з метаболічним синдромом Х». Прошу вибачення за мій недосконалий англійський. Хотілося би почути Ваш відгук про надану інформацію, зокрема про спосіб діагностики та лікування. Лазебник Ігор Васильович, лікар-психотерапевт, аспірант Українського науково-дослідного інституту соціальної і судової психіатрії та наркології. e-mail: [email protected], [email protected] адреса: 04210, м. Київ, пр. Героїв Сталінграда, д. 13А, кв. 243 телефон: мобільний +380955307293 домашній +380444185727 З повагою, Лазебник І. |
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