Treatment of stress-related mental disorders of the neurotic level

EDUCATIONAL-SCIENTIFIC MEDICAL CENTER

OF THE ADMINISTRATIVE DIRECTORATE
OF THE PRESIDENT OF RUSSIAN FEDERATION

CLINICAL SANATORIUM "BARVIKHA"
OF THE ADMINISTRATIVE DIRECTORATE
OF THE PRESIDENT OF THE RUSSIAN FEDERATION

CLINICAL HOSPITAL №1
OF THE ADMINISTRATIVE DIRECTORATE
OF THE PRESIDENT OF THE RUSSIAN FEDERATION
LLC "AKELA-N"

The use of medical xenon in the treatment of stress-related mental disorders of the neurotic level

The proposed method and the practical recommendations for treating patients with borderline mental disorders described below are based on observations of more than 200 patients which have been treated at the bases of "Clinical Sanatorium "Barvikha" of the Administrative Directorate of the President of the Russian Federation and "Clinical Hospital No. 1" (Volynskaya)" of the Administrative Directorate of the President of the Russian Federation.

In order to reliably assess the effectiveness of the proposed method, a documented clinical study involving 60 patients aged 30-42 years with duration of neurotic disorders from 3 months to 2 years was conducted. The examined patients were employees of power structures, military personnel, professional athletes of extreme sports, civil aviation pilots who had anxiety disorders of mild to moderate severity, including panic attacks, and asthenic syndrome.

To analyze the effectiveness of the applied therapy standard questionnaire questionnaires (GBB, BDI, HDRS) and indicators of the bioelectrical activity of the cerebral hemispheres were used before and after treatment.

The Giessen Questionnaire (GBB) has been designed to identify the subjective picture of the physical suffering of patients and consists of a list of 57 complaints (general well-being, vegetative disorders, dysfunction of internal organs, etc.). For detailed qualification of the state of anxiety and monitoring of its dynamics, the Hamilton clinical scale (HDRS) was used. For the qualitative and quantitative assessment of depression, the Beck Depression Inventory (BDI) was used.

The results of the study. Sessions of xenon therapy were subjectively tolerated well by all patients. After inhalation, they noted an anesthetic effect, a feeling of lightness, calm; in some cases a state of euphoria was detected. There was no recorded case of deterioration of hemodynamic, respiration or gas exchange in these patients.

Fig. 2. The results of the questionnaire scales before and after treatment

After treatment there was a significant decrease in scores at average for the experimental group on the GBB scale by 66%, on the HDRS scale by 70%, and on BDI scale by 55% compared with pre-treatment values; in control group decrease in the scores on the GBB, HDRS and BDI scales was by an average of 35%, 26%, and 30%, respectively.

Xenon in the treatment of depressive states

Depressive disorders are characterized by a pathologically low mood (hypothymia) with a negative, pessimistic assessment of oneself, one's position in the surrounding reality and one's future. Depression aggravates the subjective response to the clinical manifestations of the disease, adversely affecting the ability to cope with somatic disease due to apathy, reduced motivation and worsened cognitive functions. Affective disorders significantly worsen compliance, cause a rejection of recommended medicinal prescriptions, physical exercises and other rehabilitation methods.

Positive dynamics of somatovegetative symptomatology was noted in all patients during the first sessions of xenon therapy. Vegetative disorders were gradually reduced after 7-8 inhalations of xenon, and after 9-10 procedures patients felt well.

The symptoms of asthenic-depressive disorders (fatigue, irritability, low mood, decreased performance, etc.) were more resistant to therapy. Reduction of depressive symptoms was somewhat slower than in patients with anxiety disorders.

When analyzing the spectral power and coherence of the background EEG, as well as the reactivity of the EEG and of a number of autonomic indices (including heart rate, blood pressure) to indifferent and emotionally significant stimuli in patients with a predominance of melancholy and asthenic manifestations in the clinical picture of depression, signs of increased tone of the parasympathetic system were detected. During xenon inhalations, the parasympathetic system is also activated; as a result, the patient feels even greater weakness, dizziness, nausea after xenon inhalation.

Together with the reduction of asthenic disorders, the depth of affective disorders decreased. After 8-9 inhalations of xenon, a clear decrease in these disorders was revealed: the subjects became emotionally more animated, made plans for the future, their pessimistic mood decreased, and an increase in physical performance was noted.

The proposed analysis of the condition of patients with non-psychotic mental disorders has shown that the inclusion of xenon in the therapeutic complex leads to the faster reduction of depressive and astheno-depressive symptoms.

After the first inhalation, patients experience mild euphoria, a burst of energy, a more stable emotional state. The next 3-4 inhalations lead to a significant decrease in the level of anxiety, an increase in physical performance. The background of mood is normalized after 9-10 inhalations. Sleep disturbances accompanying these types of depression are reduced closer to 7-10 inhalations.

At the end of the course, patients with depression demonstrated a positive perception of the present and the future; anxiety and depression decreased, and sleep improved. Mild dysthymia persisted for 1-2 hours after waking up. At the same time, during the day, patients noted an increase in working capacity, absence of anxiety or tension, normalization of pulse and blood pressure; headaches disappeared.

After two weeks of treatment, a significant decrease in somatic complaints, anxiety and severity of the depressive state compared with the start of the study were detected in patients of both groups, but a much more pronounced reduction was observed in the experimental group.

Practical recommendations. In the treatment of depressive states, xenon inhalation should be combined with antidepressant therapy, nootropic drugs and antioxidants. The most common antidepressants used for anxiety depressions are SSRIs or heterocyclics.

Because of a possible reaction to an antidepressant in the form of nausea, loss of appetite, drowsiness, dizziness, weakness that occurs when using the first doses of the drug it is recommended to use xenon inhalation from 5-6 days from the start of drug therapy.

The first inhalation is carried out at xenon concentrations of 18-24%. In women, the concentration of xenon during the first inhalation is usually 15-18%. The duration of the first inhalation is 7-15 minutes. In severe depressions it's desirable to carry out xenon inhalation after 7-10 days of antidepressant therapy.

In reactive depressions associated with acute psychotrauma xenon inhalations are performed on the day of the first contact with a patient seeking medical care; xenon inhalations are well combined with antidepressants, tranquilizers, and nootropic drugs. Inhalations are held for 20-30 minutes, at xenon concentration of 24-30%, 1-2 times a day.

Xenon in the treatment of anxiety and anxiety - phobic disorders

Severe anxiety is common for all clinical variants of anxiety disorders. Fear (anxiety-phobic disorders) and anxiety are often caused by being confined in a small space (claustrophobia), or being on public transport; sometimes fear can be produced simply by thinking about these unpleasant situations. Generalized anxiety disorders are characterized by a feeling of nervousness, trembling in the body, muscle tension, tachycardia, sweating, dizziness, and feeling of discomfort.

In patients with panic attacks the use of xenon inhalation in combination with antidepressants, benzodiazepine tranquilizers, and nootropic drugs leads to a significant reduction or even complete reduction of the alarming symptoms. After completion of inhalations, restrictive behavior and anxiety about waiting an attack disappears, emotional background becomes normal.

Practical recommendations. Given the high level of anxiety and the psychological type of this category of patients (anxiously-suspicious personality type), the mask should not be fixed on the patient's face during the first inhalation. The patient is encouraged to keep the mask on his own during the first and subsequent inhalations, until he wishes to fix it on his face with a mask holder.

The recommended concentration of xenon is 18-20% for the first few inhalations, and then the dosage of xenon can be increased up to 23-25% and 28-30% in males. For this category of patients it is recommended to use xenon inhalations daily, with duration of 20-30 minutes, in the amount of 10 sessions.

Xenon in asthenic syndrome

Asthenic syndrome is a condition manifested by increased fatigue and exhaustion, weakening or full loss of the ability to complete prolonged physical or mental activities. Asthenic syndrome can be the result of prolonged emotional or intellectual overstrains, as well as of many mental disorders. It has been suggested that asthenia occurs as a result of depletion of nerve elements due to excessive energy consumption, malnutrition, impaired intracellular metabolism, and intoxication of internal or external origin.

The results of the study showed the effectiveness of the inclusion of xenon inhalation in the treatment of asthenic syndrome. The reduction of neurotic symptoms begins with the 2nd procedure, the feeling of internal tension and anxiety disappear, and sleep improves. Headaches and dizziness are significantly reduced in frequency and intensity, starting from the 4th or 5th inhalation.

Practical recommendations. In asthenic syndrome xenon inhalations are combined with nootropic drugs, vitamin therapy. Since xenon reduces anxiety and a sense of internal tension, relaxes the muscles, the prescription of tranquilizers is not always needed. The minimum recommended number of xenon inhalations is 5. In asthenic syndrome, xenon inhalations are carried out in concentrations of 18-25%, the recommended number of sessions is from 5 to 10.

Conclusion

The conducted study indicates a high therapeutic efficacy, safety and prospects for the use of XeMed® in the complex treatment of depressive, anxiety-phobic, or panic disorders and asthenic conditions. When using xenon as part of complex therapeutic programs, reduction of main psychopathological and somatovegetative disorders occurs more efficiently and in less time.

The inclusion of the course of inhalation procedures of therapeutic doses of xenon in the system of therapeutic, rehabilitation and preventive measures contributes to the rapid and effective relief of mental disorders, the reduction of pathological reactions to the disease and the creation of motivation for adequate behavior.