RU2366359C1 - Method of suicide risk estimate in patients with depressive disorders - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, specifically to psychiatry. After electroencephalography and coherent analysis of background electroencephalography (EEG 1), there are evaluated two average coherence factors (ACF) within 0 to 30 Hz between anteriofrontal-frontal and anteriofrontal-mesotemporal cortical areas of the right hemisphere. These values are averaged, and electroencephalography (EEG 2) is recorded once more while a number of geometrical figures is shown to the patients under test. The negative differences of the averaged coherence factors EEG 2 and EEG 1, increased suicide risk is determined. ^ EFFECT: method extends range of suicide risk diagnostic means and allows improve accuracy and objectivity of estimation thereof in patients suffering from depressive disorders. ^ 3 ex

Description

The invention relates to medicine, namely to psychiatry.

A known method for assessing suicidal risk in patients with depressive disorders by conducting clinical and electroencephalographic (EEG) studies, followed by spectral analysis of the frequency ranges of EEG, including delta and theta alpha and beta rhythms. (Zenkov L.R. Non-paroxysmal epileptic disorders. A manual for doctors / M .: MEDpress-inform, 2007. - p. 165).

The disadvantage of this method is the low accuracy of diagnosis of suicidal risk in patients with depressive disorders.

The technical result of the proposed solution is to expand the arsenal of new objective methods and increase the accuracy of objective assessment of suicidal risk in patients with depressive disorders with the aim of timely therapeutic correction and early prevention of suicidal behavior.

This result is achieved by the fact that a coherent analysis of the background electroencephalogram (EEG 1) is carried out, two average coherence coefficients (CSC) are determined in the range from 0 to 30 Hz between the anterior temporal-frontal and anterior temporal-temporal cortical zones of the right hemisphere, average these indicators, repeat the recording electroencephalograms (EEG 2) against the background of the subject representing geometric figures and with negative values of the difference between the averaged KSK EEG 2 and EEG 1 assess the increased suicidal risk.

It does not follow from the prior art that the negative values of the difference between the averaged coefficients of EEG coherence against the background of the subjects representing geometric shapes and background EEG can serve as an indicator of increased suicidal risk in patients with depressive disorders.

The method is as follows.

Patients suffering from depressive disorders undergo an EEG study according to the standard method (Clinical Encephalography. M .: Medicine, 1973, 340 p.), Two average coherence coefficients (CSC) are determined in the range from 0 to 30 Hz between the anterior temporal-frontal and anterior temporal with the middle temporal cortical zones of the right hemisphere, average these indicators, repeat the recording of the electroencephalogram (EEG 2) against the background of the pragmatic uncertainty of the experiment when the subjects represent geometric figures and with negative values x the difference between the average XK EEG and EEG 1 2 evaluated the increased risk of suicide.

Example 1. Patient G., born in 1987, was under the supervision of the Department of acute mental disorders of the Moscow city hospital No. 4 named after P. B. Gannushkina, from September 15, 2006 to November 25, 2006, medical history No. 6102. Diagnosis: Recurrent depressive disorder, the current episode of moderate severity with somatic symptoms in an anxious-evading hysterical person.

From the anamnesis it is known that heredity of mental illness is not burdened. Premorbid in character, dependent, anxious, with an increased sense of duty, vulnerable, demonstrative, there were always few friends, because I was afraid not to find understanding among peers. From childhood, mood swings for a short time. The first depressed depressing and anxious depression 2 years ago was treated twice at the Federal State Institution “Moscow Research Institute of Psychiatry” of the Federal Agency for Healthcare and Social Development, while the therapy was accompanied by unstable improvements without reaching complete remission. In the neuropsychiatric dispensary was observed irregularly, supportive therapy was taken at her discretion. On the day of admission, she was preparing to make a suicidal attempt by self-poisoning, discovered by her mother with a handful of pills in her hands. Hospitalized in the Moscow City Hospital No. 4 named after P. B. Gannushkina. At admission: complains of severe anguish, anxiety with vitality behind the sternum, somato-vegetative disorders, daily rhythm, agitated, asks for help. She claims that she does not want to live, she regrets that her mother interfered with her plans.

An EEG study (EEG 1) was conducted with subsequent coherent analysis in the range from 0 to 30 Hz between the anterior temporal-frontal cortical zones of the right hemisphere, KSK = 0.758 was obtained, between the anterior temporal-temporal cortical zones of the right hemisphere, KSC = 0.751 was obtained. The average coherence indicator for these cortical zones was: (0.758 + 0.751) / 2 = 0.754.

Repeated holding of an electroencephalogram (EEG 2) against the background of the subject's presentation of geometric figures with subsequent coherent analysis in the range from 0 to 30 Hz between the anterior temporal-frontal cortical zones of the right hemisphere, obtained KSK = 0.739, between the anterior temporal-temporal cortical zones of the right hemisphere, obtained KSK = 0.723. The average coherence indicator for these cortical zones was: (0.739 + 0.723) / 2 = 0.732.

The difference between the averaged coherence coefficients of EEG 2 and EEG 1 was 0.732-0.754 = -0.022.

The negative value of the difference coincides with the presence of an increased suicidal risk in the patient.

Example 2. Patient D., born in 1987, was under the supervision of the Department of acute mental disorders in the Moscow city hospital No. 4 named after P. B. Gannushkina from 09/09/2007 to 02/23/2007, medical history No. 473. Diagnosis: Recurrent depressive disorder, the current episode of moderate severity with somatic symptoms in a person accentuated by psychasthenic type.

Heredity burdened: paternal grandfather suffered from alcoholism. From peers in physical and intellectual development did not lag behind. The psychastenic is pretentious in nature, touchy, vulnerable, "close to tears."

Last year, amid overwork from studying and a chronic psycho-traumatic situation - a breakdown in relations with a young man, I began to experience a depressed mood with a sense of hopelessness, inexplicable anxiety, decreased working capacity, it was difficult to concentrate on the implementation of educational tasks, as a result of which I had to take academic leave. At home for the whole day I did not do household work, I spent a lot of time in bed. She complained to her parents about her lowered mood, was irritable with them, often cried, said that “sad thoughts entered her head,” but she did not make suicidal attempts. Twice I turned to a psychotherapist for help, but no significant improvement was noted. It was hospitalized in the Moscow city hospital No. 4 named after P. B. Gannushkina. Upon admission: fixed on its condition. Complains of a bad mood, joylessness, a sense of hopelessness, anxiety, increased tearfulness, dry mucous membranes, loss of appetite, heaviness in the soul, and she feels worse in the morning.

An EEG study (EEG 1) was conducted with subsequent coherent analysis in the range from 0 to 30 Hz between the anterior temporal-frontal cortical zones of the right hemisphere, KSK = 0.741 was obtained, and between the anterior temporal-temporal cortical zones of the right hemisphere, KSK = 0.734 was obtained. The average coherence indicator for these cortical zones was: (0.741 + 0.734) 72 = 0.738.

Repeated recording of the electroencephalogram (EEG 2) against the background of pragmatic uncertainty of the experiment when the subjects presented geometric figures with subsequent coherent analysis in the range from 0 to 30 Hz between the anterior temporal-frontal cortical zones of the right hemisphere obtained KSK = 0.818, between the anterior temporal-temporal cortical zones of the right hemisphere obtained KSK = 0.753. The average coherence indicator for these cortical zones was: (0.818 + 0.753) / 2 = 0.786.

The difference between the averaged coherence coefficients of EEG 2 and EEG 1 was 0.786-0.738 = + 0.048.

A positive difference in KSK indicates the absence of suicidal risk. Follow-up 1 year: suicidal thoughts and attempts were not noted.

Example 3. A practically healthy subject K., aged 27, who had never applied for help to medical institutions of a psychiatric profile, had no complaints about her mental health and was socially adapted.

An EEG study (EEG 1) was carried out, followed by coherent analysis in the range from 0 to 30 Hz between the anterior temporal-frontal cortical zones of the right hemisphere and KSK = 0.781 was obtained; between the anterior temporal-temporal cortical zones of the right hemisphere, KSK = 0.783 was obtained. The average coherence indicator for these cortical zones was: (0.781 + 0.783) 72 = 0.782.

Repeated holding of an electroencephalogram (EEG 2) against the background of the subject's presentation of geometric figures with subsequent coherent analysis in the range from 0 to 30 Hz between the anterior temporal-frontal cortical zones of the right hemisphere, obtained KSK = 0.724, between the anterior temporal-temporal cortical zones of the right hemisphere KSK = 0.908. The average coherence indicator for these cortical zones was: (0.724 + 0.908) / 2 = 0.816.

The difference between the averaged coherence coefficients of EEG 2 and EEG 1 was 0.816-0.782 = + 0.034.

A positive difference in QC indicates the absence of suicidal risk.

In this way, a study of 118 patients with depressive disorders was carried out, of which 54 with a history of suicidal attempts. The coincidence of the results of clinical and EEG studies took place in 98 cases (of them in 47 with a history of suicidal attempts), that is, in 83.1% of all examined patients (p <0.05).

The proposed method has advantages over the known ones, which include expanding the arsenal of methods for objective diagnosis, increasing the accuracy of assessing the risk of suicidal attempts in depressed patients, which is of particular importance for the choice of therapeutic tactics for the prevention of suicides.

Claims (1)

A method for assessing suicidal risk in patients with depressive disorders by conducting clinical and electroencephalographic studies, characterized in that they conduct a coherent analysis of the background electroencephalogram (EEG 1), determine two coefficients of average coherence (CSC) in the range from 0 to 30 Hz between the anterior temporal frontal and anterior temporal with the middle temporal cortical zones of the right hemisphere, average these indicators, repeat the recording of the electroencephalogram (EEG 2) against the background of the subject's presentation of geometric figures and with negative values of the difference between the averaged KSK EEG 2 and EEG 1 assess the increased suicidal risk.