The role of antipsychotics in the treatment of psychosomatic disorders

The growing prevalence of psychosomatic disorders has become a daily reality in the work of general practitioners and other non-psychiatric professionals. In a somatic hospital and on an outpatient basis, the number of patients requiring psychiatric treatment reaches half [2].
Currently, there is no generally accepted systematics of psychosomatic disorders. There is no such diagnostic category in ICD-10, and psychosomatic disorders are scattered mainly under the following sections: F0 (Organic, including symptomatic, mental disorders); F4 (neurotic, stress-related and somatoform disorders); F5 (Behavioral syndromes associated with physiological disorders and physical factors). However, many authors adhere to the following typology of disorders, depending on psychosomatic relationships.
Somatized mental disorders – characterized by the occurrence of somatic complaints and functional disorders due to psychosocial stress, without corresponding morphological changes, for example, “organ neuroses”, somatoform disorders (F.45 according to ICD-10).
Somatogenic mental disorders (nosogeny) – arise as a result of a traumatic event, which is a somatic illness.
Psychosomatic diseases in the traditional sense of this term are psychogenically provoked manifestations or exacerbations of somatic diseases.
Reactions exogenous type (somatogenically) – psychiatric disorders arising from somatic harmfulness is mainly symptomatic psychosis -. Delirium, dementia, hallucinations, etc.
Besides the above, psychosomatic often include state arising from the generative women cycle (syndrome “premenstrual tension “, Postpartum depression, involutionary hysteria, etc.). Psychosomatic disorders also include mental disorders that are complicated by somatic pathology (alcoholism, bulimia) or complicate some types of treatment (depression, asthenia, anxiety – in patients receiving hemodialysis treatment, emotional disturbances and memory disorders – after coronary artery bypass grafting, etc. ).
The bulk of patients with psychosomatic disorders are patients with somatoform disorders and nosogenesis. According to Russian researchers [3], among the identified patients with psychosomatic disorders, three quarters can receive psychopharmacotherapy in the general somatic network after consulting a psychiatrist. Thus, in the treatment of mental disorders, the role of physicians with a somatic profile is increasing every year.

When using psychopharmacotherapeutic agents for the treatment of patients with psychosomatic disorders, it is advisable to use one drug, which should have a minimum number of side effects, not interact with somatotropic drugs, be easy to use and safe in case of overdose. Doses are used smaller than in “big” psychiatry. These conditions are met and most often prescribed by tranquilizers, as well as some antidepressants and neuroleptics. The pharmacological action of tranquilizers is addressed mainly to anxiety states. The most significant limitation to use is the high risk of drug dependence during long-term treatment, because insufficient duration of therapy leads to a resumption of symptoms. In addition, the achievement of an effective dosage is often accompanied by side effects in the form of psychomotor inhibition. Modern antidepressants are devoid of these drawbacks, but the therapeutic target for them is disorders with a depressive component or obsessions.
General practitioners are wary of antipsychotics as to purely psychiatric drugs. This attitude is justified by the significant number of undesirable effects of these drugs on the somatic sphere. However, a number of antipsychotics meet the above requirements for psychotropic drugs for the treatment of psychosomatic disorders and are drugs of “first choice”. This list includes individual phenothiazine derivatives (alimemazine, thioridazine, perphenazine), thioxanthene (chlorprothixene), benzamides (sulpiride, tiapride).
The absence of significant extrapyramidal side effects, behavioral toxicity, a weak anticholinergic effect, and a special “mild” action – gave grounds to designate these drugs as “minor” antipsychotics and led to the widespread use of these drugs for the treatment of “borderline” mental disorders [1]. The pharmacological effect of the discussed neuroleptics is predominantly dose-dependent. In small doses, they eliminate irritability, anxiety and have some activating effect, up to a mild antidepressant. As the dosage increases, their sedative and antipsychotic effects increase. In addition to symptomatic psychosis, alcoholism, this group of drugs is effective in a wide range of other psychosomatic disorders. It is also necessary to take into account the somatotropic effects of neuroleptics. For example, all drugs in this group have antiemetic, analgesic and hypnotic effects in one way or another. There are also individual characteristics for each drug [1, 4]. For example, sulpiride reduces gastric secretion, unlike other drugs that have a mild hypotensive effect, slightly increases blood pressure. Chlorprothixene promotes the excretion of uric acid in the urine and is therefore especially indicated for patients with gout. Tiapride has a pronounced analgesic effect, and thioridazine is especially effective in relieving cardialgia.

The high safety of the drugs under discussion allows them to be prescribed in a wide range of doses, with varying frequency during the day, for the elderly and children. For example, thioridazine in neurosis-like conditions with irritability and anxiety, functional gastrointestinal and cardiovascular disorders, as well as in chronic sleep disorders is prescribed 5-25 mg 2-3 times a day; with climacteric disorders and premenstrual nervous tension – 25 mg 1-2 times a day. Children of preschool and early school age with psychopathic behavior, increased irritability, anxiety, night fears, etc. are prescribed 5-10 mg of the drug 2-3 times a day, and older children – up to 40-60 mg per day.
Careful planning of therapy with the consultative participation of a psychiatrist allows doctors of the general somatic network to independently use antipsychotics “first choice” in the treatment of psychosomatic disorders and achieve the best result with minimal side effects.

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