Журнал «Медицина неотложных состояний» 5(52) 2013

Introduction. Clinic of the opiate withdrawal syndrome (ОWS) has characteristic features, widely described in the literature. In its structure the main place is occupied by the pain, vegetative, emotional, sleep, psychopathic, hypochondriac  and other disorders.

Particularly acute patients experiencing a kind of painful pain, located in the muscles, bones, joints, skin and other parts of the body. Some of the authors  define  these feelings  as senestopathical, but the overwhelming majority of experts did not share this point of view. The pain is accompanied by the characteristic of vegetative disorders (chills, sweating, nasal catarrh, hypersalivation, nausea, etc.), and sleep disorders. Due to constant pain, vegetative disorders, and consequences of the distressing for any patient painful insomnia arises naturally expressed psychopathological response, the painting of which on the background of emotional lability usually predominate depressive-hypochondriac  or dysphorical symptoms. The notable fact is that the attention of the vast majority of doctors, clinicians at this stage is paid to psychogenic component of the ОWS. This is partly explained by the fact that the treatment of the ОWS  mainly engaged and involved doctors with basic mental health training, which focus on they know the symptoms. Symptoms of these pretty much look like the real picture of the disease, and it is very often in clinical practice leads to domination of the so-called psychopharmacological  model in the treatment of opiate withdrawal  syndrome. Method of execution of this model well enough tested in different variations, but its pathogenetic interpretation  causes a serious criticism of many of the authors.

In effect marked the reasons for the current treatment of opiate withdrawal syndrome is often based on the search of a balance between the therapeutic effect appointed by the sick funds and the appearance of symptoms, which are the complications of drug therapy, and the complications of drug therapy in this case, the doctor is often consciously, that is not always justified from the moral point of view and not always positively in terms of short-term forecast of the state of the patient. In this situation, much more acceptable is attempts so pick up the complex treatment of the patient, that in the process of therapy, individual manifestations of the OWS were expressed minimally or not expressed in general, and the side effect of used products would be reduced to a minimum.

In the opinion of the authors of the article, OWS at the first stage of the process can be regarded as an acute condition, integral components of which are pain syndrome, vegetative syndrome (mainly vagotonical) and the syndrome of sleep disorders, that is agripnical  syndrome. The main goal of the proposed work was the estimation of the role of atropine as acting  anticholinergic remedy  in the treatment of OWS in order to minimize the manifestations of vegetative component of this syndrome.

It is also necessary to pay attention to the fact that the practical doctor in the process of treatment of OWS deprived of the criteria for the objective assessment of the condition of the patient. In order to fill this gap we were previously developed two control-diagnostic scales, ОWS1 and ОWS2.

Material and methods of research. In the framework of the conducted research the main attention was paid to the dynamics of vegetative disorders, for cupping which patients was appointed atropine sulphate in the form of subcutaneous and intramuscular injection of 0.1% solution of 1 ml three times a day during the first five days of their stay in the hospital.

The study included 95 patients with opiate addiction men who were in the hospital, who were randomly assigned to two groups: the first group (65 people) patients treated with the purpose of stopping of vegetative symptoms of OWS by atropine; the second group (30 people) - patients who received traditional treatment of the classical psychopharmacological  model, as it is defined  G. Malyshev and O. Korlyugov, i.e., in the form of a combination of neuroleptics and tranquilizers.

All of the sick people suffered from opioid addiction 2-nd stage and had formed OWS of varying degrees of severity. The patients of both groups are used opioids in injection form. In the first group the duration of the disease was from 3 to 18 years, an average of 6.7±3.4 years. The average age of the patients of this group accounted for 24.2±5.1 years. In the control group the duration of the disease ranged from 3 to 17 years old, on average, a 6.8±3.3 years. The average age of the patients of this group was 24,0±5.2 years. In other words the main and control groups were matched by age, sex and common term drug use.

All patients were admitted to the hospital or being under the influence of drugs or at the stage of early clinical manifestations of the OWS. For the evaluation of the initial state of the patient as well as to assess the effectiveness of the treatment, during the first five days of stay in the hospital, we have used the specially designed scale ОАС1 and ОАС2 (OWS1 andOWS2).

Patients of the main group in the period of development of the SLA were appointed by the injection of 0.1% solution of atropine sulphate in a dose of 1 ml three times per day. In addition to atropine patients of the main group in the course of complex treatment received  pain relievers  and somnolent  drugs, which in the interests of research  have no pronounced effect on the autonomic nervous system.

Patients of the control group received the following treatment: fluanxol - 5 mg two times a day, truxal 50 mg once a day, clozapine 25 mg at night, sonmyl - 2 tablets at night, gidazepam - 40 mg three times a day, aminazin - 50 mg per night, vitamin B1 5% - 2.0 V / m, vitamin B6, 5% - 2.0 V / m, ascorbic acid 10% - 2.0 V / m, piracetam 20% - 5.0 Vm.

After the relief of withdrawal symptoms  of patients in both groups with the purpose of correction of psychopathological and somatoneurological afterwithdrawal  disorders prescribed therapy, including: antidepressants (amitriptyline, paroxetine), antipsychotics (truxal, aminazin, fluanxol), tranquilizers (gidazepam), nootropa, hepatoprotectors, vitamin therapy, widely used physiotherapeutic methods of treatment.

The research results and their discussion. The clinical picture of the OWS was presented pain syndrome (muscle, joint, bone pain), sleep disorders and vegetative disorders in the form of violations of the intestine, nasal catarrh  and a slobber, the dynamics of vegetative disorders under the influence of the proposed treatment and was the subject of our study.  In addition, the account of mental complications arising in the process of course and treatment of OWS.

The condition of patients was estimated at entry to treatment, and then daily in the morning, prior to the therapeutic measures, within 5 days from the time of admission to the hospital.

Received in the course of treatment results are reflected in the summary indicators of the dynamics of vegetative, consolidated  neurological and consolidated psychopathological manifestations in the structure of the OWS. The degree of severity of the individual vegetative symptoms, namely, the violation of the functions of the intestine, salivation and rhinorea were estimated us individually according to the criteria scale ОАС1 (OWS1). Since the investigation of the dynamics of the pain and agripnical  syndromes in the treatment of OWS is not the aim of this study, they are not reflected in the results of this work, however, the total indicators of the scale ОАС1, also submitted the work can afford to objectively evaluate the динамку status of patients in both groups. Indicators of the scale ОАС2 (OWS2) provide the opportunity to evaluate the progress of the treatment process.

Under the influence of atropine noted significant reduction of symptoms of a disorder of the bowel, the excess in salivating and rhinorea.

By using the classic psychopharmacological  model of treatment of OWS autonomic symptoms in the structure of disease as it existed in themselves and aborted in the process of the natural course of the pathological process on the fifth-sixth (sometimes - on the fourth) day of stay of the patient in the hospital,  the use of atropine in similar conditions in patients of the main group allowed to significantly alleviate the suffering of patients during abstinence from the first days of treatment.

Total score points on a scale ОАС2 shown in the results of the work, testifies to the practical absence of serious psychopathological complications in the main group of patients and the fairly expressed the number of these complications in the control group.

Conclusions. Assessment of the results of treatment with atropine sulfate, namely its influence on the pathological area of autonomic symptoms in the treatment of opiate withdrawal syndrome in comparison with the therapy with the use of classical psychopharmacological  model has shown the high effectiveness of the offered treatment in comparison with the traditional therapy. It should be noted that the atropine was used in therapeutic doses, to avoid complications, characteristic of action of this drug when it is used in the methods, similar to those of the central cholinolithical blockade.

Monitoring of the results of treatment in both groups of patients was carried out on a specially designed scales that on the one hand  objects  and confirms the authenticity of the results of research, and on the other hand demonstrates the information content of both scales and prospects of their use them in the work of a practical physician.