Опіоїдна залежність у жінок з коморбідною патологією щитоподібної залози

Abstract

RadchenkoT.M., Sosin I.K., Ovcharenko M.O., Mishyev V.D., Pinskiy L.L. Opioid dependence in women with comorbid pathology of the thyroid gland. In the book the theoretical generalization and a certain solution of important scientific and practical tasks of modern narcology, which is the study of clinicopathogenetic, pathosychological and immunological features of the course of opioid dependence in women with comorbid pathology of the thyroid gland. The study included 165 women aged 18 to 45 years (mean age of 31.5±1.6 years) who was the LP OD. It is established that 44.85% women with LP OD has comorbid thyroid pathology, namely AT&HT. The incidence of PAS in women with LP OD in the background of AT with HT is 63.5% and it is 2.14 times more than women with the LP OD and the lack of comorbid AT&HT (29,7%). Drug-addicted women regarde clinical signs of decompensate HT (weakness, depression, loss of cognitive function, lethargy, drowsiness, etc) as the beginning of withdrawal symptoms that encourages them to relapse of opioid use. In various stages of forming remission the intensity of the pathological attraction to opioids significantly increased from early up to late period of withdrawal symptoms with a gradual reduction at remission period. FWS is represented mainly by significant affective and autonomic disorders at lower the manifestations of ideator disorders. In the period of remission has been a substantial growth of ideator disorders component while maintaining the leading role of the affective disorders, simultaneously there has been a decrease of autonomic manifestations in the early period of withdrawal symptoms. At all stages of the formation of remission is present the highest intensity of all components of the pathological attraction to opioids among patients with OD the demonstrative and the lowest is in patients with hypomaniacal features. It has been determined the unfavorable dynamics of affective disorders in persons with epileptoid typological features and associative disorders in hypomaniacal persons, depending on the stages of forming remission (compared - 135 - with OD patients with other personality characteristics). In the group of women suffering of the LP OD with AT & HT pathopsychological disorders were more significant, as in early, late withdrawal periods, as in the period of remission by such characteristics as level of anxiety, level of neurotic depression and the level of asthenia in comparison with group of patients with OD without thyroid diseases, namely AT & HT. The severity of pathopsychological changes increases with the duration of opioid dependence and presence comorbide thyroid diseases – AT & HT. Endocrine, immune and metabolic status of women with the LP OD background comorbid AT & HT is characterized by a decrease in serum hormones T3, T4, IL-1β, ratio CD4+/CD8+, increased TSH, ATPO, ATG, the absolute number of leukocytes and lymphocytes, lymphocytes with phenotype CD3+, CD8+ and CD19+, CEC, γ-IFN, α-IFN, IL-6, IL-8, TNF-α, SKHL, IHL, square chemiluminogenic, DK, MDA, activity of catalase and SOD, with unchanged levels of lymphocytes with the phenotype CD4+ and CD16+. Endocrine and immune status in women with LP OD and the lack of comorbide AT & HT significant differences with the indicators of the group of healthy donors has not. The use of levothyroxine (50 to 150 micrograms daily) as the drug of hormone replacement therapy in the complex treatment of women with LP OD and comorbidly with thyroid disease (AT &HT), reduces the incidence of PWS in 2.1 times, reduces the intensity of the manifestations of asthenic and neurotic depression, and invokes positive changes in endocrine, immune and metabolic status of patients. Under the influence of levothyroxine in the blood serum increases the amount of hormones T3 and T4 and reduced TSH. Positive changes of immune status have manifested in the decrease in the number of leukocytes, lymphocytes and their populations with phenotype CD3+, CD4+, CD8+ and CD19+ concentrations, CEC, γ-IFN, α-IFN, IL-6, IL-8 and TNF-α with increasing immunoregulatory index CD4+/CD8+, and serum`s concentrations of IL-1β . Positive changes of metabolic status under the influence of hormone replacement therapy have a manifestation in reducing chemiluminescence glow serum - SKHL, IHL, square chemiluminogenic, and to reduce the concentrations of metabolites serum LP - DK and MDA, and decrease in serum activity of key enzymes of the antioxidant defense system of catalase and SOD. It has been developed method for predicting of PWS in women with LP OD and comorbid AT & HT, which includes laboratory, clinical and psychological symptoms. The most significant discriminant weight ratio F: the level of TSH in the blood serum, the concentration of free T4 in serum, the overall affective component, the severity of asthenic-depressive syndrome. Forecast for the development of PWS is considered to be significant (p<0.05) in the subsequent 3 months after discharge from hospital, if the value of F1 (risk of development of PWS within 3 months after discharge from the hospital) is more than F2 (no risk of development of PWS within 3 months after discharge from the hospital). The sensitivity of the proposed method is 88.2%, a specificity is of 74.6%, accuracy is 77.6%. - 136 - The scientific novelty of the obtained results. It was first established that 44.85% of women LP OD took place comorbid AT & HT, which stimulates the development of PWS. The incidence of PWS in women with LP OD in the background comorbid AT & HT is 63.5% and it was 2.14 times more than women with the LP OD and the lack of comorbid AT & HT. It has been first established that the clinical signs of decompensated HT (weakness, depression, loss of cognitive function, lethargy, drowsiness, etc), drugaddicted women have regarde as the beginning of withdrawal syndrome that encourages them to relapse of opioid use. It has been first studied thyroid, immune and metabolic status of women with the LP OD and comorbid AT & HT. It was shown that on the background of the lack of production of thyroid gland hormones T3, T4 and detrimental production of TSH in women with LP OD is formed supressory option imunopatological state, which is typical of autoimmune processes, there is a hyperproduction of the circulating immune complexes, γ-IFN, α-IFN, IL-6, IL-8, TNF-α, and activation the lipid peroxidation and system of antioxidant protection. For the first time in the complex therapy used pharmacopaea levothyroxine (50 to 150 micrograms daily) as the drug of hormone replacement therapy, to prevent the development of PWS in women with LP OD and comorbid AT & HT; which reduced the incidence of PWS in 2,1 times, to reduce the intensity of the manifestations of asthenic and neurotic depression, and cause positive changes in endocrine, immune and metabolic status of patients. For the first time developed a method for predicting of PAS in women with LP OD and comorbid AT & HT, which includes laboratory, clinical and psychological symptoms. The sensitivity of the proposed method is 88.2%, a specificity of 74.6%, accuracy – 77.6 %. Practical significance of the obtained results. A method of treating women with LP OD and comorbid AT & HT, using the basic treatment of levothyroxine, which reduces to 2.1 times the incidence of PAS. The results are used in medical practice Luhansk regional drug dispensary (Health Ministry of Ukraine), Kharkiv regional narcological dispensary, Poltava regional narcological dispensary, Lviv regional narcological dispensary, the Zakarpatye`s regional drug treatment clinic and in the lecture course and practical training at the departments of psychiatry and addiction se "Luhansk state medical University" health Ministry of Ukraine, Kharkiv medical Academy of postgraduate education, Ternopil state medical University named Danylo Galitsky, Kiev medical Academy of postgraduate education named after Shupyk, which is confirmed by corresponding certificates of implementation. The main scientific positions, conclusions of the dissertation were announced and discussed at the scientific symposium with international participation "Brain and stress" (Dnipropetrovsk, 2015), "Dovzhenko readings: prevention of dependence on psychoactive substances as the basis of human mental health" (Kharkiv, 2016).), A scientific symposium with international participation "Cognitive im - 137 - pairment in neurological, psychiatric and narcological diseases" (Uzhhorod, 2016), the National Congress of Neurologists, Psychiatrists and Narcologists of Ukraine "Neurological, Psychiatric and Narcological Aid in Ukraine: Development Trends and Modern Challenges "(Kharkiv, 2017), a scientific-practical conference with international participation "Topical Issues of the Development of the Public Health System of Ukraine "(Uzhhorod, 2017), the All-Ukrainian Scientific and Practical Conference "Infectious Diseases in the Practice of Internist: Modern Aspects"(Sumy, 2017), as well as at the meetings of the Luhansk Regional Society of Psychiatrists and Narcologists during 2014–2017