[Posttraumatic stress disorder clinical guidelines and treatment standards: focus on the symptoms of the psychophysiological arousal]

The article describes the main diagnostic criteria and principles of posttraumatic stress disorder (PTSD) diagnostic with the consideration of risk factors and specific clinical features. The main biomarkers search trends and existing limitations are considered. The role of the psychophysiological arousal symptoms claster is highlighted in the clinical picture of PTSD as well as in connection with the main cluster of re-experiencing symptoms activation and slowing of sanogenesis process. The necessity of PTSD detection in somatic medicine is thoroughly described. The article presents therapeutic algorithms of the latest international and Russian PTSD treatment clinical guidelines based on the individual combination of psychotherapy and psychopharmacotherapy treatment choice. Additionally the accumulated during the last decades national clinical experience of the anxiety disorders treatment, including the symptoms of psychophysiological arousal is highlighted that determined the list of the recommended drugs indicating the evidence level, in the PTSD treatment standards and guidelines. The treatment choices possibilities with the consideration of different PTSD symptoms cluster expression and comorbid states and individual case distress level specific are presented. Main evidence based psychotherapeutic methods are described.

[The effectiveness of short and prolonged course treatment of anxiety with Anvifen]

OBJECTIVE

To determine the effectiveness of the treatment of anxiety disorder with Anvifen (aminophenylbutyric acid) in a short (21 days) and prolonged (60 days) course of treatment.

MATERIAL AND METHODS

Patients were randomly divided into two groups: a short course (21 days) of treatment with Anvifen (group 1) and a prolonged course (60 days) of treatment with Avifen (group 2). In each group, patients were divided into age subgroups: 20-40 years old (1a - n=30, mean age 32 [21; 39], 2a - n=30, mean age 33 [23; 38] years) and 41-70 years (1b - n=30, mean age 62 [51; 67] years; 2b - n=30, mean age 60 [51; 68] years). Evaluated by: Hospital Anxiety and Depression Scale (HADS); fatigue according to the Russian version of the fatigue assessment scale (The Fatigue Assessment Scale - FAS); sleep assessment according to the questionnaire for scoring the subjective characteristics of sleep (sleep assessment - OS); mean frequency per month of attacks meeting the criteria for a panic attack (PA) in the previous 6 months; a comprehensive assessment of the severity of all subjective symptoms on a 10-point numerical rank scale (NRS), where «0» corresponded to the complete absence of any significant subjective symptoms, «10» - the maximum degree of bodily and mental discomfort presented by the patient. Anvifen patients took at a dose of 500 mg three times a day. The evaluation of the studied parameters was carried out at the point «1» (before the start of treatment), at point «2» at the end of the course of treatment (for group 1 - on the 21st day of treatment, for group 2 - on the 60th day of treatment), at point «3» (30 days after the end of treatment for patients in both groups).

RESULTS

The indicators of subgroups 1a and 1b at point 2 had a significant positive trend (p<0.05) compared with the indicators at point 1, but at point 3 these indicators did not differ significantly (p>0.05). The indicators of subgroups 2a and 2b at point 2 had a significant positive trend (p<0.05) compared with the indicators at point 1, and these differences persisted at point 3 (p<0.05).

CONCLUSION

Anvifen effectively eliminates anxiety symptoms, but the effect of a short course lasts less than 1 month, the effect of prolonged treatment lasts more than 1 month. The authors recommend prolonged treatment of anxiety with Anvifen for at least 2 months.