Psychosocial target for cognitive-saving therapy in the modern patient
СтатьиProceedings of the
19th International Conference of the
Association of Psychology and Psychiatry for Adults and Children
May 13-16, 2014 - Athens (Greece)
Editors
J. Kouros, T. Sidiropoulou, P. Moutevelis
A.P.P.A.C. 2014
Reshetova T.V.1, Reshetov A.V.2
1 Ph.D., professor North-Western State Medical University named after I.I. Mechnicov, St. Petersburg, Russia.
2 Master of Sociology of the St. Petersburg State University. Abstract
Anxiety, asthenia, cognitive functions and quality of life were investigated in the course of therapy in patients with irritable bowel syndrome (IBS). The patients with IBS receiving Tenoten+ in addition to basic therapy vs. the group of patients receiving basic therapy only, showed significant reduction in: anxiety, mental asthenia, pain syndrome without negative effect on cognitive function; quality of life improved (increased working capacity).
Keywords: cognitive dysfunction, asthenia, anxiety, quality of life, cognitive-saving therapy.
The modern patient lives in conditions of social instability. This results in growing incidence of anxiety disorders and psychosomatic diseases. Modern patients expect that the treatment would bring cure from the underlying disease while maintaining or improving quality of their life. And if previously the patients taking sedative drugs had to tolerate their adverse effects (somnolence, torpidity), today they are able to meet their expectations: anxiolytics allowing to maintain quality of life in terms of anxiolytic therapy have been developed. They allow to continue using PC actively, to lead active sexual life, be an attentive driver and efficient manager. The modern patient wishes to work: he is interested in outpatient, not a hospital treatment. Along with typical manifestations of anxiety and common complaints, modern patients experience mental problems (cognitive dysfunction). Improved cognitive function after anxiolytic therapy is critical, therefore cognitive-saving therapy is currently very important.
The purpose of this study was to demonstrate improved cognitive functions and quality of life secondary to cognitive-saving anxiolytic therapy with Tenoten in patients with irritable bowel syndrome.
Materials and methods
A prospective randomized comparative study enrolled 128 patients with verified irritable bowel syndrome (IBS). Scoring based on the relevance of clinical, laboratory endoscopic, cyto-histological investigations allowed to reveal exacerbations of the disease, its severity and evaluate treatment-related changes. All specific pathological changes were assessed in the course of therapy. Mental status of the patients and control patients was examined based on psychological anamnesis, methods of clinical observation and experimental and psychological investigation using test methods. Spielberger-Hanin trait anxiety scale verified anxiety level (1). MFI-20 scale identified various signs of asthenia: physical (weakness, fatigue), mental (reduced attention concentration, memory, i.e. moderate cognitive dysfunction), reduced activity and motivation level (2). Value > 12 scores on any parameters is deemed pathological. Quality of life scale by Kurihara M. et al. (3) assessed its criteria: working capacity, social adjustment; general health.
Study design
54 patients received basic somatic IBS therapy only: regulation stool, spasmolytics, probiotics, prebiotics; 66 IBS patients received Tenoten 1 tablet 4 times per day for 4 weeks in addition to basic therapy. The patients were examined twice: at baseline and 4 weeks later. The control group comprised 28 healthy subjects.
Anxiolytic Tenoten modifies functional activity of endogenous protein S100. This protein S100 is a molecular target for normalization of function of gamma-aminobutyric acid (GABA) - one of the principal neurotransmitters. S100 protein plays a key role in regulation of energy and plastic metabolism in central nervous system. By modifying functional activity of S100 protein in case of its damage, tenoten acts GABAmimetically, thus ensuring anxiolytic effect (4). Its clinical effect is evidenced by reduced manifestations of behavioural anxiety, autonomic dysfunction, improved adaptation (5), i.e. increased activity of stress-limiting systems.
Results and discussion
48.7% patients with IBS did not have any morphological abnormal substrate in their gut, i.e. these with functional disorders only. Tenoten target in this case is dysregulation of intestinal activity. 64.7% patients associated their exacerbation with psychogenies and stresses (6). Significant changes in the most important parameters: reduced anxiety, improved cognitive functions secondary to reduced mental asthenia, improved quality of life and working capacity are presented in Table 1.
Table 1. Changes in anxiety, mental asthenia and quality of life in patients receiving/not receiving Tenoten.
| Groups of IBS patients n=128 | Trait anxiety | Quality of life (working capacity) | Мental asthenia | |||
| before | after | before | after | before | after | |
| Basic therapy only no Tenoten. n=54 | 54.86±0.93 | 53.57±0.88 | 3.45+0.24 | 3.49+0.22 | 14.4+1.9 | 13.7+1.4 |
| Basic therapy + Tenoten n=66 | 58.89+0.98 | 49.61+0.96* | 3.49±0.22 | 4.15±0.25* | 14.1±1.7 | 9.8±0.25* |
The results showed that the improvement in the intestine after an adequate basic therapy in patients with IBS does not lead to an automatic reduction of psychopathological manifestations. Trait anxiety in IBS patients after therapy with Tenoten+ was significantly lower vs. IBS patients receiving basic therapy only. Basic therapy did not result in significant reduction of anxiety, and activity, motivation, physical and mental asthenia parameters did not show positive changes. The results of this study are provided in Figure 1.
*p <0,05
Figure 1. Changes in asthenia in patients receiving basic therapy only (no Tenoten).
Tenoten+ therapy in IBS patients did not increase mental asthenia (cognitive dysfunction) did not exert sedative effect. On the contrary, the patients receiving Tenoten+, reduced anxiety, decreased asthenia (6): reduced mental asthenia in patients receiving Tenoten+ was significantly higher vs. IBS patients receiving basic therapy only. The results of asthenia examination in patients receiving Tenoten+ are presented in Figure 2.
*p <0,05
Figure 2: Changes in asthenia in IBS patients receiving basic therapy and Tenoten+.
Parameters of general, physical and mental asthenia of IBS patients after Tenoten+ treatment course reached normal values. In addition to basic therapy, IBS patients receiving Tenoten+ vs. patients receiving basic therapy only, had significant reduction in pain syndrome (6). Reduction in pain syndrome in IBS patients receiving Tenoten+ is associated with the specific effect of anxiolytic on emotional component of pain, since the higher anxiety, the stronger is the pain (6). Correlation coefficient of pain threshold with anxiety (-0.76). The target for Tenoten in this case is anxiety which indirectly impairs intestinal motility. After Tenoten+ therapy IBS patients demonstrated significant improvement in quality of life parameters: working capacity from 3.49+0.22 score to 4.15+0.25 score. After therapy with Tenoten+ the patients evaluated their improvement in working capacity significantly higher vs. those receiving basic therapy only. General health self-assessment after Tenoten+ course also increased significantly from 3.58+0.21 scores to 4.02+0.27* scores. Basic therapy only in IBS patients did not show significant improvement in these parameters. Therefore, Tenoten inclusion into complex therapy of IBS patients allows to affect the following targets: anxiety, mental asthenia, cognitive dysfunction.
65% of all hospitalized patients with colonic diseases suffer from concomitant asthenic syndrome (6). Currently, there are medications, having cognitive-saving effect (7). This study demonstrated that addition of anxiolytic Tenoten into therapeutic process of IBS patients significantly improved working capacity, reduced anxiety and increased attention concentration. They are important factors for the modern patients. Saving ability to work effectively, despite the anxiolytic therapy, even in the course of this therapy, it is an important resource for the patient's motiva tion and increased compliance.
Conclusions
- Prevalence of asthenic syndrome requires cognitive-saving therapy to maintain quality of life.
- Anxiolytic Tenoten exerts verified cognitive-saving effect: it reduces anxiety and cognitive dysfunction greatly; improves quality of life and increases working capacity significantly.
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