Рецепт. 2019; : 389-397
Оценка эффективности лечения женщин с психоэмоциональными расстройствами и угрозой прерывания данной беременности в анамнезе
Аннотация
Беременность – это состояние повышенной уязвимости для развития тревоги и депрессии, которые являются наиболее распространенными психическими расстройствами во время беременности и после родов.
Цель исследования: оценить эффективность 2 лечебных стратегий с использованием психотерапии и психотерапии в сочетании с медикаментозным лечением у женщин в I и II триместрах с угрожающим прерыванием настоящей беременности в анамнезе для совершенствования лечебно-профилактических мероприятий и профилактики акушерских и перинатальных осложнений у таких женщин.
Материалы и методы. В исследовании приняли участие 42 пациентки в I и II триместрах, настоящая беременность которых протекала с угрозой прерывания и которые получали психотерапевтическое лечение. Пациентки методом случайной выборки были разделены на подгруппы (1а и 1б), женщины подгруппы 1б дополнительно получали лечение с использованием L-аргинина. Клинико-акушерское и психометрическое обследование проводилось до и после проведения лечения. Для оценки уровня тревожности применялся тест Спилбергера, депрессивных проявлений – опросник Бека, качества сна – Опросник качества сна Центра сомнологии.
Результаты и обсуждение. После проведенного лечения в обследованных группах было отмечено статистически достоверное снижение показателей реактивной тревоги, депрессивных проявлений. Показатель личностной тревоги в группе 1а после окончания лечения достоверно не изменился. Параметры сна у пациенток обеих групп достоверно изменились в сторону улучшения, кроме показателей группы 1а, характеризующих количество ночных пробуждений и количество сновидений.
Выводы. Психотерапевтическое лечение в сочетании с применением L-аргинина привело к полному нивелированию психоэмоциональных расстройств. Снижение показателей реактивной и личностной тревожности, улучшение показателей качества сна могут служить критериями эффективности проводимого лечения. Изучение аффективных показателей и качества сна в каждом конкретном случае позволит индивидуализировать подход к ведению и разработать в случае необходимости реабилитационные мероприятия, направленные на оздоровление женщин во время беременности и совершенствование системы антенатального наблюдения, повышение уровня качества жизни.
Список литературы
1. Bourgoin E., Callahan S., Séjourné N., Denis A. (2012) Image du corps et grossesse: vécu subjectif de 12 femmes selon une approche mixte et exploratoire. Psychol Fr, no 57, рр. 205–213.
2. Ry`balka A. (2011) Psikhologicheskaya adaptacziya zhenshhin vo vremya beremennosti i posle rodov [Psychological adaptation of women during pregnancy and after childbirth]. Zdorov`e Ukrainy`, vol. 3, no 42, рр. 44–9.
3. Ibanez G., Blondel B., Prunet C., Kaminski M., Saurel-Cubizolles M-J. (2015) Prevalence and characteristics of women reporting poor mental health during pregnancy: findings from the 2010 French National Perinatal Survey. Rev Epidemiol Sante Publique, no 63, рр. 85–95. doi: 10.1016/j.respe.2015.02.023.
4. Da Costa D., Dritsa M., Larouche J., Brender W. (2000) Psychosocial predictors of labor/delivery complications and infant birth weight: a prospective multivariate study. J Psychosom Obstet Gynaecol, no 21, рр. 137–148. doi: 10.3109/01674820009075621.
5. Pearson R.M., O’Mahen H., Burns A., Bennert K., Shepherd C., Baxter H., Chauhan D., Evans J. (2013) The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy. J Affect Disord, vol. 145, no 2, рр. 208–13. doi: 10.1016/j.jad.2012.07.033.
6. Biaggi A., Conroy S., Pawlby S., Pariante C.M. (2016) Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord, no 191, рр. 62–77. doi: 10.1016/j. jad.2015.11.014.
7. Rallis S., Skouteris H., McCabe M., Milgrom J. (2014) A prospective examination of depression, anxiety and stress throughout pregnancy. Women Birth, vol. 27, no 4, рр. e36–42. doi: 10.1016/j. wombi.2014.08.002.
8. Johnson R.C., Slade P. (2003) Obstetric complications and anxiety during pregnancy: is there a relationship? J Psychosom Obstet Gynaecol, vol. 24, no 1, рр. 1–14.
9. Rwakarema M., Premji S.S., Nyanza E.C., Riziki P., Palacios-Derflingher L. (2015) Antenatal depression is associated with pregnancy-related anxiety, partner relations, and wealth in women in Northern Tanzania: a cross-sectional study. BMC Womens Health, vol. 2, no 15, рр. 68. doi: 10.1186/s12905-015-0225-y.
10. Alder J., Fink N., Bitzer J., Hösli I., Holzgreve W. (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med, vol. 20, no 3, рр. 189–209.
11. Vesga-López O., Blanco C., Keyes K., Olfson M., Grant B.F., Hasin D.S. (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry, vol. 65, no 7, рр. 805–15. doi: 10.1001/archpsyc.65.7.805.
12. Lee A.M., Lam S.K., Sze Mun Lau S.M., Chong C.S., Chui H.W., Fong D.Y. (2007) Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol, vol. 110, no 5, рр. 1102–12.
13. Milgrom J., Holt C. (2014) Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial. Trials, no 15, рр. 385. doi: 10.1186/1745-6215-15-385.
14. National Institute for Health and Care Excellence (NICE) (2014) Antenatal and postnatal mental health: clinical management and service guidance: Guideline CG192. National Institute for Health and Care Excellence. Available at: http://guidance.nice.org.uk/cg192. (accessed 12 Mar 2016).
15. Dalke K.B., Wenzel A., Kim D.R. (2016) Depression and Anxiety During Pregnancy: Evaluating the Literature in Support of Clinical Risk-Benefit Decision-Making. Curr Psychiatry Rep, vol. 18, no 6, рр. 59. doi: 10.1007/s11920-016-0698-x.
16. Fedotchev A., Kim E. (2009) Characteristics of EEG-based biofeedback treatment procedures in normal and complicated pregnancy. Zh Vyssh Nerv Deiat Im I P Pavlova, vol. 59, no 4, рр. 421–8.
17. Nwebube C., Glover V., Stewart L. (2017) Prenatal listening to songs composed for pregnancy and symptoms of anxiety and depression: a pilot study. BMC Complement Altern Med, vol. 17, no 1, рр. 256. doi: 10.1186/s12906-017-1759-3.
18. San Lazaro Campillo I., Meaney S., McNamara K., O’Donoghue K. (2017) Psychological and support interventions to reduce levels of stress, anxiety or depression on women›s subsequent pregnancy with a history of miscarriage: an empty systematic review. BMJ Open, vol. 7, no 9, рр. e017802. doi: 10.1136/bmjopen-2017-017802.
19. Green S., Frey B.N., Donegan E., Randi E., Cabe R.E. (2018) Cognitive Behavioral Therapy for Anxiety and Depression During Pregnancy and Beyond: How to Manage Symptoms and Maximize Well- Being. 1st Edition.
20. Arch J., Dimidjian S., Chessick C. (2012). Are exposure-based cognitive behavioral therapies safe during pregnancy? Archives of women’s mental health, vol. 15, no 6. doi: 10.1007 / s00737-012- 0308-9.
21. Hanin YU. (1978) Issledovanie trevogi v sporte [Study of anxiety in sports]. Vopr. Psihologii, no 6, рр. 72–5.
22. Beck A.T., Ward C.H., Mendelson M., Mock J., Erbaugh J. (1961) An inventory for measuring depression. Arch Gen Psychiatry, no 4, рр. 561–71.
23. Vein A., Eligulashvili T., Poluektov M. (2002) Sindrom apnoe vo sne i drugie rasstroistva dihaniya, svyazannie so snom: klinika, diagnostika, lechenie [Sleep apnea syndrome and other respiratory disorders associated with sleep: clinic, diagnosis, treatment]. Moscow: Eidos Media. (in Russian)
24. Spinelli M.G., Endicott J. (2003) Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry, no 160, рр. 555–562.
25. Zhu C.S., Tan T.C., Chen H.Y., Malhotra R., Allen J.C., Оstbye T. (2018) Threatened miscarriage and depressive and anxiety symptoms among women and partners in early pregnancy. J Affect Disord, no 237, рр. 1–9. doi: 10.1016/j.jad.2018.04.012.
Recipe. 2019; : 389-397
Assessment of the Efficiency of Treatment of Women with Psychoemotional Disorders and Threaten Interruption of Pregnancy in Anamnesis
Abstract
Pregnancy is a state of increased vulnerability for the development of anxiety and depression, which are the most common mental disorders during pregnancy and after childbirth.
Purpose: to evaluate the effectiveness of 2 treatment strategies using psychotherapy alone and psychotherapy in combination with drug treatment in pregnant women in the first and second trimesters with threatened interruption of this pregnancy to improve treatment and preventive measures and prevent obstetric and perinatal complications in such women.
Materials and Methods. The study included 42 patients in first and second trimesters of pregnancy with threatened interruption of this pregnancy in anamnesis who received psychotherapeutic treatment. Patients were randomly divided into subgroups (1a and 1b). Women of subgroup 1b were additionally treated with L-arginine. Clinical obstetric and psychometric examination was carried out before and after the treatment. Spielberger State-Trait Anxiety Inventory was used to assess the level of anxiety, Beck’s depression Inventory – to asses the level of depression, the Sleep Quality Survey Questionnaire of the Center for Somnology – to assess the quality of sleep.
Results and discussion. After treatment a statistically significant decrease in state anxiety and depressive manifestations was observed in the examined groups. The indicator of trait anxiety in group 1a did not significantly change after the treatment. The sleep parameters in patients of both groups significantly changed towards improvement, except for indicators of group 1a, which characterize the number of nighttime awakenings and the number of dreams.
Conclusions. Psychotherapeutic treatment in combination with the application of L-arginine led to the complete leveling of psycho-emotional disorders. Reduced state and trait anxiety, improved sleep quality indicators can serve as criteria for the effectiveness of the treatment. The study of affective indicators and quality of sleep in each specific case will allow individualizing the management approach and developing, if necessary, rehabilitation measures with the aim of improving the women’s health during pregnancy and improving the antenatal monitoring system, improving the quality of life.
References
1. Bourgoin E., Callahan S., Séjourné N., Denis A. (2012) Image du corps et grossesse: vécu subjectif de 12 femmes selon une approche mixte et exploratoire. Psychol Fr, no 57, rr. 205–213.
2. Ry`balka A. (2011) Psikhologicheskaya adaptacziya zhenshhin vo vremya beremennosti i posle rodov [Psychological adaptation of women during pregnancy and after childbirth]. Zdorov`e Ukrainy`, vol. 3, no 42, rr. 44–9.
3. Ibanez G., Blondel B., Prunet C., Kaminski M., Saurel-Cubizolles M-J. (2015) Prevalence and characteristics of women reporting poor mental health during pregnancy: findings from the 2010 French National Perinatal Survey. Rev Epidemiol Sante Publique, no 63, rr. 85–95. doi: 10.1016/j.respe.2015.02.023.
4. Da Costa D., Dritsa M., Larouche J., Brender W. (2000) Psychosocial predictors of labor/delivery complications and infant birth weight: a prospective multivariate study. J Psychosom Obstet Gynaecol, no 21, rr. 137–148. doi: 10.3109/01674820009075621.
5. Pearson R.M., O’Mahen H., Burns A., Bennert K., Shepherd C., Baxter H., Chauhan D., Evans J. (2013) The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy. J Affect Disord, vol. 145, no 2, rr. 208–13. doi: 10.1016/j.jad.2012.07.033.
6. Biaggi A., Conroy S., Pawlby S., Pariante C.M. (2016) Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord, no 191, rr. 62–77. doi: 10.1016/j. jad.2015.11.014.
7. Rallis S., Skouteris H., McCabe M., Milgrom J. (2014) A prospective examination of depression, anxiety and stress throughout pregnancy. Women Birth, vol. 27, no 4, rr. e36–42. doi: 10.1016/j. wombi.2014.08.002.
8. Johnson R.C., Slade P. (2003) Obstetric complications and anxiety during pregnancy: is there a relationship? J Psychosom Obstet Gynaecol, vol. 24, no 1, rr. 1–14.
9. Rwakarema M., Premji S.S., Nyanza E.C., Riziki P., Palacios-Derflingher L. (2015) Antenatal depression is associated with pregnancy-related anxiety, partner relations, and wealth in women in Northern Tanzania: a cross-sectional study. BMC Womens Health, vol. 2, no 15, rr. 68. doi: 10.1186/s12905-015-0225-y.
10. Alder J., Fink N., Bitzer J., Hösli I., Holzgreve W. (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med, vol. 20, no 3, rr. 189–209.
11. Vesga-López O., Blanco C., Keyes K., Olfson M., Grant B.F., Hasin D.S. (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry, vol. 65, no 7, rr. 805–15. doi: 10.1001/archpsyc.65.7.805.
12. Lee A.M., Lam S.K., Sze Mun Lau S.M., Chong C.S., Chui H.W., Fong D.Y. (2007) Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol, vol. 110, no 5, rr. 1102–12.
13. Milgrom J., Holt C. (2014) Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial. Trials, no 15, rr. 385. doi: 10.1186/1745-6215-15-385.
14. National Institute for Health and Care Excellence (NICE) (2014) Antenatal and postnatal mental health: clinical management and service guidance: Guideline CG192. National Institute for Health and Care Excellence. Available at: http://guidance.nice.org.uk/cg192. (accessed 12 Mar 2016).
15. Dalke K.B., Wenzel A., Kim D.R. (2016) Depression and Anxiety During Pregnancy: Evaluating the Literature in Support of Clinical Risk-Benefit Decision-Making. Curr Psychiatry Rep, vol. 18, no 6, rr. 59. doi: 10.1007/s11920-016-0698-x.
16. Fedotchev A., Kim E. (2009) Characteristics of EEG-based biofeedback treatment procedures in normal and complicated pregnancy. Zh Vyssh Nerv Deiat Im I P Pavlova, vol. 59, no 4, rr. 421–8.
17. Nwebube C., Glover V., Stewart L. (2017) Prenatal listening to songs composed for pregnancy and symptoms of anxiety and depression: a pilot study. BMC Complement Altern Med, vol. 17, no 1, rr. 256. doi: 10.1186/s12906-017-1759-3.
18. San Lazaro Campillo I., Meaney S., McNamara K., O’Donoghue K. (2017) Psychological and support interventions to reduce levels of stress, anxiety or depression on women›s subsequent pregnancy with a history of miscarriage: an empty systematic review. BMJ Open, vol. 7, no 9, rr. e017802. doi: 10.1136/bmjopen-2017-017802.
19. Green S., Frey B.N., Donegan E., Randi E., Cabe R.E. (2018) Cognitive Behavioral Therapy for Anxiety and Depression During Pregnancy and Beyond: How to Manage Symptoms and Maximize Well- Being. 1st Edition.
20. Arch J., Dimidjian S., Chessick C. (2012). Are exposure-based cognitive behavioral therapies safe during pregnancy? Archives of women’s mental health, vol. 15, no 6. doi: 10.1007 / s00737-012- 0308-9.
21. Hanin YU. (1978) Issledovanie trevogi v sporte [Study of anxiety in sports]. Vopr. Psihologii, no 6, rr. 72–5.
22. Beck A.T., Ward C.H., Mendelson M., Mock J., Erbaugh J. (1961) An inventory for measuring depression. Arch Gen Psychiatry, no 4, rr. 561–71.
23. Vein A., Eligulashvili T., Poluektov M. (2002) Sindrom apnoe vo sne i drugie rasstroistva dihaniya, svyazannie so snom: klinika, diagnostika, lechenie [Sleep apnea syndrome and other respiratory disorders associated with sleep: clinic, diagnosis, treatment]. Moscow: Eidos Media. (in Russian)
24. Spinelli M.G., Endicott J. (2003) Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry, no 160, rr. 555–562.
25. Zhu C.S., Tan T.C., Chen H.Y., Malhotra R., Allen J.C., Ostbye T. (2018) Threatened miscarriage and depressive and anxiety symptoms among women and partners in early pregnancy. J Affect Disord, no 237, rr. 1–9. doi: 10.1016/j.jad.2018.04.012.
