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9MEDICAL SCIENCES
THE USE OF NOOTROPICS FOR PSYCHO-EMOTIONAL DISORDERS IN CHILDREN WITH
FUNCTIONAL DYSPEPSIA.
DrokhH.
PhD-student, Shupyk National Medical Academy of Postgraduate Education
Abstract
Functional dyspepsia is a functional gastrointestinal disorder accompanied by pain in the upper abdomen and also not an integral part of this pathology are psycho-emotional disorders. The search for an effective treatment for this pathology is quite relevant, which is why this study is devoted.
Keywords: functional dyspepsia, cognitive functions, psycho-emotional disorders, treatment.
Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders (FGID) in the practice of pediatric gastroenterologist, pediatrician, general practitioner, manifested by persistent or recurrent epigastric pain and a feeling of rapid satiety and satiety [5,8].
According to Roman criterion IV, this pathology is a disorders of the axis of "gut-brain" interaction that occurs as a result of stress and psychological factors [15]. Most authors believe that psychological factors significantly affect the physiology of the gastrointestinal tract, modulate clinical symptoms [1,5,7]. Most studies in this area note a wide range of psycho-emotional disorders in this category of patients and recommend treatment not only for symptoms of abdominal pain, but also for psycho-emotional correction [13,14,15].
In view of this, the issue of FD treatment is still debatable, as there is currently no convincing evidence in favor of one or another type of psychocorrection [5,8,9]. It is the search for effective correction of psycho-emotional disorders in patients with PD and this study is presented.
The aim. To determine efficacy of the use of nootropics for the correction of psycho-emotional disorders in children with functional dyspepsia.
Materials and methods. The study was conducted at the Kyiv City Clinical Hospital during 20162017. The number of subjects was 93 children aged 612 years (39 boys and 54 girls), who sought help with complaints that according to Roman criteria III and IV corresponded to the diagnosis functional dyspepsia. The study was conducted in accordance with the requirements of the Helsen Convention and was approved by the Committee on Bioethics of the Shupyk National Medical Academy of Postgraduate Education. All participants and their parents signed a voluntary informed consent to participate. All children underwent a set of diagnostic procedures according to the Unified Clinical Protocol of Medical Care for Children with PD (Order № 59 of the Ministry of Health of Ukraine from 29.01.2013) [10]: general clinical examination, FGDS, determination of H. pylori antigen in feces, ultrasound to rule out concomitant pathology.
To determine psychological disorders in children, a questionnaire was conducted according to the method of "Children's Questionnaire of Neuroses" by VV Sednev, which consists of 6 scales: depression, asthenia, anxiety, autonomic disorders, behavioral disorders, sleep disorders. The number of points in each area is
from 0 to 20. The number of points from 0 to 10 was estimated, according to this method is considered normal, 11-15 points - as an average level of manifestations, 16-20 points - a high level of clinical manifestations [6,11]. Max Luscher's color test was also performed to characterize the child's psychological portrait [12].
The "Memory for Numbers" and "RAM" methods were used to evaluate memory. Determination of the level of attention was determined using the proofreading test of B. Bourdon and the method of Munstenberg [7,14].
To study the effectiveness of nootropic drugs in the correction of psychological disorders, patients were divided as follows: Group I consisted of 25 children who, together with protocol treatment of PD for the correction of emotional disorders received phenibut at a dose of 100 mg 3 times a day for 1 month, group II patients (25 children) received calcium gopantenate for the correction of psychological disorders according to the scheme: 125 mg 3 times a day for 1 week, 250 mg 3 times a day for 45 days and 125 mg 3 times a day for 1 week. Group III patients (23 children) received comprehensive treatment with organic salts of magnesium and vitamin B6 for 1 month at a dose of 250 mg 3 times a day, group IV patients were a control group (20 people) and received only symptomatic treatment without correction of psychoemotional disorders.
The clinical dynamics of manifestations during treatment was assessed before treatment and after 1 month. During the last visit, the child was psychologically tested and examined.Statistical processing of the obtained data was performed with the calculation of parametric and non-parametric criteria using standardized tools Microsoft Excel 2010 and the application package Statistica 10.0. The data obtained in the article are presented in the form of relative values and their errors (M ± m), absolute values from which the relative values are calculated, in the format n / N, where n is the number of cases and N is the size of the corresponding group. The difference in probability was taken as p<0.05
Resalts. Children of all groups were comparable in sex, age and clinical course of functional dyspepsia. In all study groups, girls were dominated by 58.1% (54/93), the average age of the examined patients was 9.9±1.7 years. Epigastric pain syndrome was found in 40.9% (38/93) of patients, postprandial distress syndrome is 59.1% (55/93) (Table 1).
Table 1
Qualitative characteristics of patients in comparison groups
Indicators I group (Phenibut) n = 25 II group (Ca hopante-nate) n = 25 III group (Mg and B6 complex) n = 23 IV group Control n = 20 P
Age, year (M/m) 8,9±0,9 9,23±1,02 10,04±0,89 8,75±1,23 0,345
Sex (M/F) 11/14 10/15 8/15 10/10 0,134
FD (EPS/PDS) 10/15 12/13 9/14 7/13 0,234
According to the survey conducted with the help of the "Children's Neurosis Questionnaire", a high level of depression was noted by 83.9±3.4% (78/93) of patients, anxiety - 89.3 ± 2.3% (83/93), asthenia -82.8±1.8% (77/93), dysfunction at school - 78.5±3.2% (73/93), autonomic disorders - 73.1±2.4% (75/80) of patients
Low levels of attention and memory were found in all patients when determining cognitive function. Low level of selective attention (Munsterberg method) was noted by 69.9% (65/93) of patients, productivity and stability of attention (Bourdon Test) by 80.7% (75/93), working memory (RAM) by 87.1% (81/93), short-term memory (Memory for numbers) by 74.2% (69/93).
Children with functional dyspepsia were prone to choose dark complementary colors during the Luscher color test. Thus, a significant level of depression was found by 86.1% (80/93) of patients, anxiety by81.7% (76/93), emotional instability by 72.1% (67/93) and physical exhaustion by 88.2% (88/93).
1 month after treatment, children of all groups noted a significant improvement in their psycho-emotional state according to a questionnaire from the children's neurosis questionnaire. Thus, children in the phenibut and calcium hopantenate groups showed a significant improvement in all areas compared with the control group (pk-w=0.036) and (pk-w=0.042), respectively. Also, patients of group I had statistically better indicators according to this questionnaire in comparison with the group taking the mineral-vitamin complex (pk-w=0.035). In contrast to patients in group II, because the difference between children in group III was detected only by indicators of asthenia, depression and dysfunction at school (pk-w=0.047).(Table 2).
Control testing revealed a significant improvement in cognitive function in children of all groups. Although groups 1 and 3 showed a statistically significant improvement in attention and memory relative to baseline (pw=0.025) and (pw=0.042), respectively, and control group (pk-w=0.037) and (pk-w=0.05), respectively, the level of cognitive function in children from group 2 was statistically better (pk-w=0.003) (Table 2).
Table 2
Characteristics of psychoemotional indicators and cognitive function after treatment
Indicators I group (Phenibut) n = 25 II group (Ca hopantenate) n = 25 III group (Mg and B6 complex) n = 23 IV group Control n = 20 P
Asthenia, point(M±m) 6,1±0,7 7,4±1,2 10,1±2,1 12,3±1,1 pk-w=0,043
Depression, point (M±m) 6,5±1,1 6,5±2,2 8,3±1,1 11,6±1,7 pk-w=0,021
Anxiety, point (M±m) 5,5±2,1 7,8±2,2 7,2±2,3 12,5±2,4 pk-w=0,013
Sleep desorders, point (M±m) 6,2±2,4 8,5±3,2 7,7±2,3 10,4±2,1 pk-w=0,045
Autonomic disorders, point (M±m) 5,2±3,1 7,4±2,7 8,7±3,4 12,7±3,1 pk-w=0,042
Dysfunction at school, point (M±m) 6,7±3,2 5,1±2,2 9,3±3,1 11,2±2,3 pk-w=0,031
«RAM», point (M±m) 18,8±0,5 20,8±1,2 16,1±0,3 11,3±1,4 pk-w=0,037
«Memory for numbers», point (M±m) 8,2±0,9 9,2±1,1 7,5±0,8 5,8±0,5 pk-w=0,027
«Munsterberg method», point (M±m) 17,9±1,1 18,2±0,2 13,8±0,6 9,8±1,2 pk-w=0,03
Bourdon Test, point (M±m) 8,3±0,7 9,5±1,2 7,9±0,9 6,3±0,9 pk-w=0,047
Lusher color test indicators also had significant changes during treatment and in general the palette of selected colors changed to brighter, children choose
mostly blue, green and yellow, which indicates the absence of psycho-emotional disorders. thus, children in groups 1 and 2 showed significant improvement (
Fig.1)
7 6 5 4 3 2 1 0
4,6
5
5,5
5,8
2,3
1,2,3
2,5
8
4,5
Anxiety
2,324 Depression
22,3
2,5
53,5
1, 21, 2,3
Physical exhaustion
Phenibut ■ Ca hopant. ■ Mg. Comp.
Emotional instability
Control
Figure 1. The Lusher color test. 1 - statistically significant difference between groups 1 and 2, 2 - statistically significant difference between groups 1 and 3, 3 - statistically significant difference between groups 1 and 4, 4 - statistically significant difference between groups 2 and 3, 5 - statistically significant difference between groups 2 and 4, 6 - statistically significant difference between groups 3 and 4.
Conclusions.
Children with functional dyspepsia have a significant level of psycho-emotional and cognitive disorders, which is associated with the body's response to stress. Inclusion in the complex treatment of functional dyspepsia in children with nootropic drugs, significantly improves the psycho-emotional state of patients, promotes rapid recovery. The study of the effectiveness of this group of drugs can be further used to develop new algorithms for the treatment and prevention of this pathology.
The authors declare that they have no conflicts of interest.
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