Summary: The effectiveness of treatment of panic disorder with the use of the drug Alprazolam in two groups of patients - with typical and atypical panic attacks. Analysis of indicators in the studied groups was a significant positive trend under the influence of treatment for most of the investigated parameters in patients with typical panic attacks (high anxiety). In the group of patients with atypical panic attacks (low anxiety) after treatment with alprazolam improvement is less significant. These patients require other pharmacological agents.
Panic disorder (PD) is one of the most frequent clinical forms of anxiety disorders. OL Prevalence in the population is 1,9-4%. Approximately 6% of persons seeking primary medical care to general practitioners, have panic attacks (PA). PD Negotiability patients to doctors of different specialties vary, remaining consistently higher in somatic practice, especially in the ambulance service and cardiology, where the value of the indicator PD prevalence reached 9-10%. The actual prevalence of panic attacks as a clinical phenomenon is significantly higher. This position is illustrated by international epidemiological studies, according to which the panic attacks as an episodic phenomenon with no apparent secondary effects experienced over 10% of the population and only 2% have panic disorder. When account is taken of individual attacks is that the panic at least once in their lives experienced 35,9-46% of the population.
Panic disorder - diagnostic category that includes repeated panic attacks (PA).
PD has a particular stereotype formation and development of symptoms. Often the first attack left an indelible mark in the memory of the patient, which leads to the appearance of "anticipatory anxiety" syndrome attack, which in turn establishes the recurrence of attacks. Repeat attacks in similar situations (transportation, stay in a crowd, etc.) contributes to the formation of avoidant - agoraphobic behavior. Increase agoraphobic symptomatology leads to social exclusion of patients: they may not be able to leave the house or be alone. The presence of agoraphobia with PD indicates a more severe disease and a worse prognosis requires special treatment strategies.
Study the effectiveness of the correction of alprazolam for panic disorder
Alprazolam belongs to a group of high-potential benzodiazepines. The anxiolytic effect of alprazolam can be explained by its effect on the GABAergic system - the main link "alarm control" as a common characteristic of high potential of benzodiazepines is their high affinity to the central benzodiazepine receptors. At the same time, partially counteracted the effect of alprazolam due to its activating effect on the α2-adrenergic receptors, which in turn reduces noradrenergic activity; partially - the possible impact on the functional activity of postsynaptic β-adrenergic receptors, which also leads to a decrease in the functional activity of the noradrenergic system. As compared with other benzodiazepines acting on the GABA-receptors of the limbic system, Alprazolam exhibits a high affinity for them, which explains the achievement anxiolytic effect of the drug when used in low doses - 1-1.5 mg of. Described antidepressant action of alprazolam associated with its influence on the α2-adrenergic receptors. Since the 1980s, the drug is widely used in clinical practice for the treatment of generalized anxiety and panic disorders.
Material and Methods
Held an open comparative study of 34 patients with various forms of PD. All patients were divided into 2 groups: 1-I (23 observations: - 9 men, 14 women, mean age 31.5 years) - with panic attacks, defined by AM Wayne et al. As typical; Group 2 - patients (11 observations 4 males, 7 females; mean age 35.6 years) who have panic attacks were atypical ("conversion") character (along with symptoms allocated as diagnostic criteria of the PA, identified hysterical phenomena - the feeling of "lump in the throat" of weakness in an arm or leg, blurred vision or hearing, gait, speech / voice, cramps in the hands or feet, etc., as well as algopaticheskie sensations).
All patients received a daily dose of alprazolam 1.5 - 4 mg in 3 divided doses. Dose picked individually by gradually increasing, the initial dose is 0.75 mg / day. The survey was carried out before the treatment and after 4 weeks of therapy alprazolam.
Results of the study
Of the 34 patients included in the study completed the course of treatment 32 (94%) patients, which is high anxiolytic activity and good tolerability. Alprazolam average effective dose was 3 mg / day (0.75 to 4 mg). The proportion of patients receiving the maximum therapeutic dosage of the drug Alprazolam (3.5 - 4 mg / day), was equal to 56% (18 of 32 patients who completed the study), which also characterizes the favorable tolerability profile of the drug.
Reasons for exclusion from the study (2 patients from group 2) had significant side effects, is not amenable to correction by means of symptomatic or decrease the dose (persistent daytime sleepiness, lethargy, ataxia, mental retardation and motor reactions).
Assessment of the level of anxiety on Hamilton depression scale (HARS) and Spielberg Hanina was conducted at baseline and 4 weeks after completion of therapy. The average total score on the Hamilton Rating Scale for patients in Group 1 at baseline was 25.2 on a scale Spielberg Hanina - 57.3. In the 2nd group - 18.5 and 39.7 respectively.
After a 4-week course of therapy at a dose of alprazolam 1.5-4 mg / day clinical efficacy was assessed as a significant improvement in 54% - 12 patients (evaluation anxiety level on the Hamilton scale score was 11.5 on a scale Spielberg Hanina - 25, 2 points); as an improvement in 29% - 7 patients (17.2 and 39.5 points, respectively); 17% (4 patients) - improvement is not registered.
During treatment alprazolam (patients in Group 1) showed a trend toward a reduction of all clinical manifestations of autonomic dystonia severity of unpleasant sensations in the left side of the chest, the disappearance of headaches, normalization of sleep a night. Patients reported significant improvement in quality of life.
Positive clinical effect of reducing the severity of a number of autonomic disorders, headaches, improvement of social adaptation is related primarily to the anxiolytic effects of the drug, ie, a decrease in anxiety disorders.
Patients in group 2 with atypical panic attacks level of reactive anxiety was initially lower (18.5 and 39.7 points). After the 4-week course of alprazolam therapy in 33.3% - 3 patients Clinical efficacy was evaluated as better (evaluation anxiety level on the Hamilton scale score was 15.5 on a scale Spielberg Hanina - 32.2 points), from 66.7 % - 6 patients no improvement occurred.
Analysis of patients with high (group 1) and low (Group 2) anxiety was a significant positive trend under the influence of alprazolam treatment, most patients in Group 1; in group 2, signs of improvement are less significant. Reduction of anxiety, loss of autonomic disorders, improved sleep, reduction in severity of headaches and improving the quality of life due to an anxiolytic effect of alprazolam, and the drug can be considered effective in the treatment of panic disorder with typical panic attacks. In patients suffering from panic disorder, panic attacks, atypical lower levels of anxiety, should apparently, to use other pharmacological agents.