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The influence of the drug atarax on cognitive function in the treatment of anxiety disorder
AE Bobrov, MA Kulygin, MA Belyanchikova, MV Rzheznikov, OA Gladyshev Research Center for Mental Health of RAMS, Moscow
Research and clinical experience indicate that many patients with anxiety disorder, there are also specific cognitive violations that may be of Pathogenetic significance. Correction of these violations is an important condition protivoretsidivnoy treatment of anxiety [1-3]. One of the promising drugs that may be used for this purpose is atarax (gidroksizin). These drugs known as atypical tranquilizer that is different from the mechanism of central action of benzodiazepines, and does not have side effects such as drug addiction and the phenomenon of "return." This allows you to safely use it for a long time. The spectrum of anxiolytic activity atarax also differs from that of the benzodiazepines. The highest anxiolytic activity of this drug is registered with generalized anxiety disorder, adjustment disorders, and some variants somatoformnyh states. Of particular interest to atarax due to the fact that, according to preliminary data, it has beneficial effects on cognitive processes. However, the nature and structure of cognitive effects of this drug, as well as their relationship to the anxiolytic effect is largely unclear. The purpose of this study was to explore differential effects of the drug atarax on cognitive functions (attention, memory and associative processes, the ability to perceive reality and assessment) in patients with generalized anxiety, somatoformnymi disorders and reactions disadaptation. Materials and methods Treatment atarax done outpatient. Patients followed for 6 weeks. And during the first 4 weeks they received atarax, but in the last 2 weeks were without medication. The full course of therapy has passed 50 patients aged from 26 to 62 years (average 47.1 years). Of these, 43 - female, 7 - men. In accordance with the criteria of ICD-10 of 30 patients as the principal at the time of the survey was presented diagnosis of generalized anxiety disorder. At the same time in 9 patients were diagnosed with generalized anxiety in the remission or recurrent bipolar affective disorder. In 11 patients the state was seen as a disorder of adaptation, and at 9 - as somatoformnoe disorder. A survey conducted every 2 weeks on a single scheme. For the objective therapeutic advances using the following psychometric methods: a general clinical impression scale (OKV), Hamilton Scale for anxiety (GT), the scale of Ferrero for alarm (FT), the sample on flicker fusion frequency test (KCHSM) test for placement of the numbers (RF ), the test for Memorizing ten words (ZDS), methods "icon" (MP), as well as test repertory grids (RG). Description of the methodology is given in the appendix. Statistical processing of the material produced with the help of one of dispersion analysis for nonparametric data by Friedman (Friedman ANOVA) test and the nonparametric Mann - Whitney on the reliability of differences between unrelated samples (Mann - Whitney U test). The results of the research results of the treatment on a scale OKV depending on the clinical diagnosis are presented below. From these data suggest that the greatest improvement was recorded in the adjustment disorders (82% of patients with this diagnosis), while the lowest - if somatoformnyh disorders (67% of patients with this diagnosis). In addition to the overall therapeutic efficacy was evaluated as a specific anxiolytic activity atarax. To do this, apply the criteria 50% reduction of the total score on the scale of GT by the end of the 4 th week of therapy. In general, such a reduction was noted in 28 (56%) patients. And the greatest effect was registered with generalized anxiety disorder (in 73% of all patients with this diagnosis). Expression anxiolytic effect in patients with adjustment disorders and somatoformnymi conditions was significantly lower. Based on the criterion of 50% reduction of symptoms of TD are sick, the last course of therapy, were divided into two subgroups: responderov (28) and non-responderov (22). In light of these data carried out an analysis of all results obtained during this study. The study of the dynamics of the therapeutic state of patients on a scale of FT showed a significant decline in the overall score, as well as a significant reduction in the amount of points on subshkalam of this scale. It reached a maximum value at the 4 th phase of the study group as a whole and in the subgroup of non-responderov. At the same time, in the subgroup responderov greatest reduction of symptoms observed in the 3rd phase. You can also enter into the differential impact of atarax in the various components of anxiety. For the group as a whole the greatest therapeutic advances in the 3rd phase of the study were recorded on subshkalam subjective and the level of wakefulness (61 and 59% respectively). When comparing the same effects on subgroups is found that responderov unlike non-responderov the greatest changes occurred subshkalam subjective relations, somatic status and cognitive functions. Moreover, statistically significant differences on a scale of cognitive function were recorded not only on the 3rd, but on the 1 st phase of the study. As can be seen from the table. 2, after the cessation of active therapy condition responderov usually somewhat deteriorated, especially on scales of wakefulness and subjective relationships. At the same time in a group of non-responderov paradoxically noted improvement. The study of the dynamics on the background therapy KCHSM atarax shows that the mean value of this indicator during the therapy to the 3rd phase of the study significantly increased to 28.6 Hz and remain at that level, despite the repeal of the drug. In the subgroup responderov this tendency has been expressed most clearly, whereas in the subgroup of non-significant increase responderov KCHSM was not. On the contrary, the 2 nd sub-group had a tendency to a decrease of this indicator at the 2 nd phase of therapy. In a test RF were as follows. First of all, against the backdrop of atarax therapy showed statistically significant reduction in time spent by patients on a task (p <0,002). This decline was a reliable and responderov subgroup (p <0,003), while non-responderov observed only trends not reaching the level of statistical significance (p <0,096). At the same time in all phases of the study revealed significant difference in length between the performance of the sample responderami and non-responderami. More than slow the implementation of RF non-responderami is especially noticeable in the third phase (p <0,002) studies. In many ways, similar results were obtained when examining the number of errors in the sample to RF. That figure has fallen significantly against the backdrop of the reception atarax as the whole group (p <0,003), and in the subgroup responderov (p <0,017). At the 4 th phase of the study after the end of the introduction of atarax errors again increased slightly. At the same time, non-responderov it behaved in a different way. First, the decrease in the number of errors in the RF is not reached statistical accuracy, and secondly, there has been such a parallelism between the appointment and termination of drug therapy. In examining the ability of patients to store and play back verbal material using techniques ZDS was found that when playing a short number of correct answers on the background of atarax significantly increased from 1 st to the 3rd phase of the study, and at the 4 th again declined. This effect is clearly seen in the subgroup responderov (p <0,001) and virtually absent in non-responderov. Statistically significant difference in this parameter between subgroups appearing in the third phase of the study in contrast, the number of correctly reproduced words in the delayed anamnesis as the entire group of patients receiving atarax, and in subgroups responderov and non-responderov not significantly changed. No significant differences in the number of correct answers among subgroups also did not show any. Along with the study of reproduction in the course of this work was carried out a study of mediated memory using IP. This has revealed the dependence of several parameters of the mode designation atarax. One of these parameters was the propensity of patients to produce more coherent associations in response to the presentation stimulnyh words and phrases. This finds expression in drawing more than one object (multiple pictures). The described trend is consistently evident only in the subgroup responderov, which reached its peak in the 3rd phase of the study and then declined. Moreover, this parameter between the subgroups at the 3 rd and 4 th phases of the study showed statistically significant differences. With respect to the subgroup of non-responderov, the change of a plurality of images has been taking place here. However, these changes accounted for a maximum of 2 nd phase, then the rate declined only by 4-th stage, after the abolition of atarax almost back to its original level. ANOVA on Friedman (p) <0,14525 <0,00854 <0,02857 atarax On the background was not detected significant changes in playing memorable phrases, as well as part of their definitions. However, the subgroup of non-responderov significantly improved reproduction of store sites (p <0,020), with maximum improvement came at the 2 nd phase of the study. After the abolition of atarax is the rate sharply decreased in both groups, so that for the whole group, this decline became statistically significant (p <0,029). In carrying out this section of the study also noted a statistically significant for the group as a whole (p <0,012) and a subgroup responderov (p <0,050) lowering the level of generalization to the 2 nd phase of the study. However, at the 3rd stage, he almost entirely rebuilt, and subsequently is not affected when you cancel the product. Moreover, it is not found and no differences between subgroups of patients. The rate of association to the adequacy of the incentives offered in the course of treatment is not undergoing significant change, but after the abolition of atarax in the 4-th stage of the group as a whole (p <0,001) and in the subgroup responderov (p <0,002) significantly increased. This led to what is called, which is initially in the sub responderov was somewhat higher (p <0,068), by the end of the study significantly exceeded the corresponding rate for non-responderov (p <0,050). Close picture is observed in terms of "I" statements. In the course of therapy atarax this figure has not changed. However, after its abolition in patients showed statistically significant increase in the number of "I"-statements (p <0,048), which was especially evident in the subgroup responderov (p <0,039). The final section of the study was associated with the PP technique. Analysis of results revealed the accurate assessment of change of contrast, which reflects the internal contradictions of installations subject. This parameter decreased significantly only in the subgroup responderov (p <0,031), with the largest reduction occurred in the 3rd phase. At the same phase on the index between subgroups of patients were reported statistically significant difference (p <0,05). With the help of RG also found a statistically reliable reduction of conjugacy ratings in the subgroup of non-responderov. This figure has declined significantly in the 2 nd phase of therapy (p <0,025), but then again gradually increased. Only after the abolition of atarax conjugacy ratings in the subgroup of non-responderov drops (p <0,012). Interestingly, the estimates of the conjugacy responderov on the background of atarax has not changed, and after its abolition have tended to increase (p <0,059). Discussion of the results should be particularly noted that the study confirmed the clinical effectiveness of atarax in the therapy of generalized anxiety disorders and adjustment disorders somatoformnyh. For example, on a scale OKV significant therapeutic results achieved in his appointment in 74% of cases, but there was most effective in the treatment of adjustment disorders (82%). It is also important that the sudden cessation of therapy atarax not to cancel events and observed expressed therapeutic aftereffect. This is confirmed by improvement in performance on a scale of FT at the 4 th phase of the study and is consistent with previous results [4]. Interestingly, at the expense of improvements initiated by the cancellation of atarax, noted improvement in the subgroup of patients from non-responderov. It is worth noting that the clinical effectiveness of the drug significantly exceeded its anxiolytic activity. This was especially evident in the problems of adaptation and somatoformnyh disorder, where 50% reduction in the amount of points on the scale of GT was noted only at 46 and 11% of patients respectively. Similar discrepancies between the assessment of the effects of atarax Scales OKV and GT were observed in the performance of our previous study [1]. From this the conclusion of the irreducibility of therapeutic effects atarax to anxiolytic action. Apparently, a significant role in improving the condition of patients played by the influence of this drug on the cognitive domain. This is confirmed in a statistically reliable increase the KCHSM. This indicator, describing the temporary summatsiyu in the visual analyzer and the mobility of nervous processes, usually applied to assess the attention and level of wakefulness [5]. Interestingly, the increase KCHSM most clearly seen in the subgroup responderov. This leads to the conclusion of its relationship with anxiolytic activity. Meanwhile, most anksiolitikov KCHSM decreases due to inhibition of activating brain systems [6-8]. The observed effect atarax is atypical for this class of drugs that may be due to other mechanisms of its pharmacological action. In particular, it is possible that the anxiolytic activity of atarax is a result of improved under his influence the dynamic properties of the central nervous system such as the ability to shift. The study found the impact of optimizing the drug in the mind and thinking. This is evidenced by the fact that against the background of the reception atarax decrease the overall execution time of the sample to RF and the number of errors committed, and in the subgroup responderov these changes were most pronounced and significant. It should also be noted that among the subgroups responderov and non-responderov before treatment and in the course have been consistently significant difference in time spent on the implementation of the sample. This indicates the presence of significant cognitive-style differences between subgroups, and may be used to predict the effects of atarax. In the study revealed that under the influence of the drug occurs improved reproduction techniques for ZDS. It is important to note that the effect is detected only in the subgroup responderov. This indicates the conjugacy anxiolytic effect atarax with improved short-term memory, and it is another difference from typical of tranquilizers, which usually worsen short-term memory [9, 10]. The results obtained with the help of MP, said the complexity of the changes under the effect of indirect atarax store and playback. In particular, the increased rate of a plurality of figures indicates the enrichment of imagery associations that arise in patients due to pressure stimuli. It should be emphasized that this effect, as well as improve the short-term memory, is revealed on a background therapy mainly from responderov. In contrast, the change in a number of other IP parameters was not related to the anxiolytic effect of atarax. This includes improving play facilities store, which was especially evident in the subgroup of non-responderov, but also occurs in both groups but more marked in responderov transient lowering of the level of generalization. In the same category of effects and changes should be recorded after the abolition of atarax, although they prevailed in the subgroup responderov. These advances are expressed in raising the adequacy of association and increase the subjective perception of activity, apparently associated with ulterior therapeutic drug persisted for several weeks.