Ефективність медикаментозної корекції непсихотичних психічних порушень у дітей, батьки яких хворіють на параноїдну форму шизофренії

Abstract

В статті досліджено ефективність фармакотерапії психічних порушень непсихотичного регістру у дітей, які виховувалися в сім’ях, де один з батьків хворів на параноїдну форму шизофренії. Загалом обстежено 168 дітей, з яких у 108 (64,28%) виявили психічні порушення непсихотичного регістру, які потребували медикаментозної терапії: фобічні тривожні розлади (F93.1; 25,00%), тікозні розлади (F95; 15,74%), змішані розлади поведінки й емоцій у вигляді депресивного синдрому (F92.0; 14,81%), енурез неорганічного ґенезу (F98.0; 12,96%), обсесивно-компульсивні розлади (F42; 10,19%), порушення поведінки у вигляді несоціалізованого розладу (F91.1; 9,26%), специфічні (ізольовані) фобії (F40.2; 7,41%) та розлади харчування (F50; 4,63%). Для лікування переважно застосовувалися антидепресанти, антипсихотичні засоби та ноотропи. Виявлено досить високу ефективність (поліпшення спостерігалося у 74 дітей — 68,52%) фармакологічного лікування непсихотичних психічних порушень у дітей, які виховуються в сім’ях, де один з батьків хворіє на параноїдну форму шизофренії; В статье исследована эффективность фармакотерапии психических нарушений непсихотического регистра у детей, которые воспитывались в семьях, где один из родителей страдал параноидной формой шизофрении. В общем обследовано 168 детей, из которых в 108 (64,28%) обнаружили психические нарушения непсихотического регистра, которые требовали медикаментозной терапии: фобические тревожные расстройства (F93.1; 25,00%), тикозные расстройства (F95; 15,74%), смешанные расстройства поведения и эмоций в виде депрессивного синдрома (F92.0; 14,81%), энурез неорганического генеза (F98.0; 12,96%), обсессивно-компульсивное расстройство (F42; 10,19%), нарушения поведения в виде несоциализированного расстройства (F91.1; 9,26%), специфические (изолированные) фобии (F40.2; 7,41%) и расстройства питания (F50; 4,63%). Для лечения преимущественно применялись антидепрессанты, антипсихотические средства и ноотропы. Выявлено достаточно высокую эффективность (улучшение наблюдалось у 74 детей — 68,52%) фармакологического лечения непсихотических психических нарушений у детей, воспитывающихся в семьях, где один из родителей страдает параноидной формой шизофрении; In the article, the authors investigated the effectiveness of pharmacotherapy of mental disorders of the non-psychotic register in children from the families where one of the parents suffered from a paranoid form of schizophrenia. In total, 168 children were examined. Mental disorders of the non-psychotic register that required drug therapy were characteristic of only 108 (64,28%) children. These were: phobic anxiety disorders (F93.1) - 27 (25,00%) patients, tic disorders (F95) - 17 (15,74%), mixed behavioral disorders and emotions in the form of depressive syndrome (F92.0) - 16 (14,81%) children, enuresis of inorganic genesis (F98.0) - 14 (12,96%), obsessive-compulsive disorders (F42) - 11 (10,19%), behavior disorders in the form of non-socialized disorder (F91.1) -10 (9,26%), specific (isolated) phobias (F40.2) - 8 (7.41%), eating disorders (F50) - in 5 (4,63%) patients. The effectiveness of psychopharmacotherapy was quite high, in 74 (68,52%) children with various neurotic disorders. The authors observed either the complete disappearance of neurotic symptoms, or a significant improvement in the state of mental health of the child. For the treatment of anxiety disorders, including phobias, drugs of the benzodiazepine class, antidepressants and nootropics have been used. Sertraline in a dose of 25-50 mg a day was the drug of choice, especially in the presence of depressive symptoms in the clinical picture. Also, the authors also used phenibut at a dose of 100 or 250 mg three times a day, depending on the age of the child, to reduce the level of anxiety. As a result of the treatment, we noted a complete normalization of the condition or a significant improvement in 21 children (77,77%) of anxious phobic disorders and in 6 (75,00%) children with a clinical picture of an isolated phobia. Treatment of tic disorders was quite effective. The authors used antipsychotic drugs of a new generation, in particular risperidone (0,5-2 mg a day), starting with small doses with a gradual increase. Reduction of symptoms or a significant decrease in the frequency of disorders was observed in 15 (88,24%) children. Fluoxetine was used in doses of 5 to 20 mg a day for mixed behavioral and emotional disorders with predominantly depressive symptoms. The authors observed a complete disappearance of symptoms or a significant improvement in the condition in 9 (56,25%) children, a partial improvement in the condition in 6 (37,50%) children. The therapeutic effect was not achieved only in 1 child (6,25%). For the treatment of enuresis, sibutin was used at a dose of 2,5-5 mg twice a day. Tricyclic antidepressants have also been effective. We prescribed clomipramine at a dose of 25-75 mg a day. As a result of the use of antidepressants, 8 (57,14%) children showed normalization or significant improvement of the condition. But the number of cases of ineffective therapy was also high, 4 (28,57%). The effectiveness of tricyclic antidepressants was relatively high in the treatment of obsessive-compulsive disorders. Clomipramine (50-100 mg a day) clearly improved the symptoms in 6 (54,54%) children, mostly with obsessive movements. Psychopharmacotherapy showed complete inefficiency in only 1 patient (9.10%). Neuroleptic drugs (thioridazine 10-25 mg 2-3 times a day), nootropic drugs (phenibut) were the drugs of choice for treating behavioral disorders; The authors also used combinations of nootropic drugs with benzodiazepine tranquilizers. During treatment, complete reduction of symptoms was observed in only half (50,00%) of children. It should be noted that the effectiveness of pharmacological therapy was low in the other half (50,00%) of children. For the treatment of eating disorders, the authors prescribed sertraline and sulpiride in anorexia nervosa, and fluoxetine in minimal doses in bulimia nervosa. 8 (80,00%) patients demonstrated normalization of the mental state or its significant improvement. Thus, by participating in the specifics of prescribing drugs in childhood, the pharmacological treatment of non-psychotic mental disorders in children from the families where one of the parents suffers from paranoid schizophrenia is characterized by high efficiency (improvement was observed in 74 children — (68,52%) and is an important component of multimodal treatment of mental health problems in such families.