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Sultanov Shokrukh Habibullaevich, PhD., in Medicine, department of psychiatry and psychotherapy Tashkent Institute of Postgraduate Medical Education, E-mail: [email protected]
COMPARATIVE CLINICAL STUDY OF HIV-INFECTED PATIENTS WITH HEROIN ADDICTION
Abstract: Psychopathological disorders in the withdrawal period of heroin addiction in HIV-infected patients are more severe than in non-infected patients. Heroin addicts with HIV infection are premature failures and relapses in post-abstinent period due to the difficult for correction of affective disorders.
Keywords: heroin addiction, HIV infection, withdrawal syndrome, affective disorders, relapse, remission.
Mental adaptation with the advent of tools that enable you to extend the life of HIV-infected patients has become a pressing issue [4, 887-891]. On average, 32% of HIV-infected patients have different psychopathological disorders [3, 968-973], including affective disorders.
Study and search of new approaches to the treatment of HIV-infected patients with heroin addiction is a problem of study of post-abstinent period to improve quality of life [1, 86-90; 2, 9-15].
The aim of the study was to identify clinical features in HIV-infected patients with heroin addiction in post-abstinent period.
Material and methods: 52 patients with heroin addiction (according to the criteria of ICD-10 - F. 11.3) were examined at the age from 25 to 40 years. All patients were divided into 2 groups. The main group is 35 heroin addicts with HIV infection and the comparison group is 17 patients with heroin addiction without HIV. The main methods of investigation were clinical-psychopatholog-ical, statistical. Clinical features of the disease in the 2 groups were assessed on scales of the dynamics of psychopathological disorders, common clinical impression (CGI), a modified rating scale of side effects UKU (UKU Side-Effect Rating Scale). Also conducted a quantitative assessment of relapses. Patients of two groups were homogeneous for age, sex and social security. The average age of patients in the main group amounted to 27.0 ± ± 4.4 years, in a comparative - 26.0 ± 3.1.
For statistical processing of material was used statistical analysis and information delivery SAS (Statistical Analysis System).
Results and discussion: The majority ofpatients in both groups had a high proportion of the social consequences of addictions: 80% in main and 83% in comparative groups, respectively. Personality changes according to the type of abuse was identified in 73.3% of patients of the main and 76% in the comparative group. In 67% of cases in main and 53% of patients in the comparative group had chronic somatic diseases that are caused by injecting drug use.
In hospital withdrawal syndrome proceeded with characteristic somatic vegetative, algic and psychopathological disorders. Thus in both groups the most frequently observed psychopathological disorders such as subdepressive, anxiety, dysphoria, irritability and explosive behavior. Only 8.7% patients of the main group the clinical picture of withdrawal symptoms to the forefront were algic disorders, while in the comparative group this form of abstinence syndrome were found significantly more often in 59.3% of patients. Withdrawal disorders with a prevalence of vegetative disorders were detected in single cases in both groups (Table 1).
From the first day ofpatient admission to the clinic, in the presence of clinical signs of the withdrawal syndrome was conducted therapy in accordance with the standards of treatment. Assessment of the pathological craving for the drug in dynamics is an important indicator ofthe effectiveness of therapy. The syndrome ofpathological craving for drugs is inextricably linked to concomitant affective behavioral disorders. Not all symptoms included in the structure of pathological attraction to drugs used thus reducing the same. Dysphoria, emotional lability, sleep
COMPARATIVE CLINICAL STUDY OF HIV-INFECTED PATIENTS WITH HEROIN ADDICTION
disorders and behavioral disorders decreased significantly without HIV infection significant improvement is noted sooner in the group without HIV infection. So, emotional with 10 to 14-th, and in the group with HIV infection from
16-18-day therapy. It should be noted that a significant clinical effect in the treatment group without HIV infection was observed already to 7-10-th day of its application. This relief of symptoms of abstinence syndrome greatly facilitated psychotherapeutic contact with patients and the treatment process as a whole.
and severity of withdrawal syndrome
lability, sleep disturbances in the group without HIV infection tended to the relief already after 4 days of treatment, whereas in the group with HIV infection these parameters were changed no earlier than 14-20 days of therapy. Impact of treatment on affective symptoms (low mood) were identified in both groups, however, in the group
Table 1. - Clinical manifestations
The characteristic opioid withdrawal syndrome The group without HIV n = 17 The group with HIV n = 35
Ebs. % Ebs. %
With the prevalence of vegetative disorders 1 5.9 2 5.8
With the prevalence of pain disorders 10 59.3* 3 8.7
With the prevalence of psychopathological disorders 6 34.4 30 85.5*
Total 17 100 35 100
*significantly compared to control group (p < 0,05)
In patients with HIV infection after 2-3 weeks of HIV infection "a big improvement" identified slightly
therapy on the background of the side effects (symptoms of neuroleptic syndrome - stiffness, restlessness, recurring anxiety) increased inactivity, apathy, lack of interest in surroundings, decreased activity. Whereas patients without HIV infection were more open, available for communication and psychotherapy, they are distinguished by high mobility, sociability, social activity, involvement in the life of the department.
The therapeutic efficacy of treatment in post-abstinent period and at the stage of forming remission was confirmed on a scale of overall clinical impressions. All patients without HIV infection, within 3 weeks the condition improved. While in 80% of cases the improvement was evaluated as "big", whereas in the group with
less often. In patients without HIV infection in 8% of cases there was a "very big" improvement. In the group of patients with HIV infection it was not such dynamics.
All the study (30 days) were 26 (86.7%) of patients without HIV and 23 (76.7%) of patients with HIV infection. In both groups there were patients who refused further treatment, was eliminated from the program early, despite active psychofarmakotherapy and psychotherapy. Refuse treatment was associated with aggravation of the attraction to drugs. 1 (5.9%) patients without HIV and 3 (8.6%) with HIV infection had left the program by the 20th day of the study. After 3 months the number of relapses in the main group consisted of 25 patients (71.4%) and in the comparative group - 9 patients (52.9%).
Table 2. - Comparative timing of relapses in patients
The timing of recurrence The group with HIV n = 35 The group without HIV n = 17
Ebs. % Ebs. %
After 20 days 3 8.6 1 5.9
After 1 month 5 14.3 3 17.6
After 2 months 6 17.1 2 11.8
After 3 months 11 31.4 3 17.6
Total 25 71.4* 9 52.9
*significantly compared to control group (p < 0,05)
In general, in patients without HIV infection at all stages marked low severity of extrapyramidal side effects. Significantly less frequent than in patients without
HIV infection met such undesirable phenomena as impaired concentration, weakness, drowsiness, impaired memory, anxiety, internal stress. All side effects in
patients without HIV infection compared to those in the group with HIV infection were mild, rapidly stopped by lowering the daily dose of the drug and, as a rule, did not require the appointment of corrective therapy. Patients with HIV infection took any discomfort in the body for signs of the manifestation of the disease and seriously responded to the survey, considering it proof of its occurrence. In these cases, was aggravated by the depressive and anxious feelings.
Conclusions
Thus, 85.5% of the heroin patients with HIV infection in the clinical picture ofwithdrawal symptoms to the forefront were psychopathological disorders, whereas in the comparative group, this form of withdrawal symptoms were found in only 34.4% of patients. In patients with heroin addiction with HIV infection in post-abstinent condition is the larger number of relapses than in patients without HIV infection.
References:
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