Adjustment disorder (AD) is one of the most common mental disorders. Considering the social and economic situation in Ukraine at present, in almost 50% of the population, there are non-psychotic mental health disorders, and this number tends to increase. Individual risk factors that are particularly important for the AD development include the experience of significant stress in childhood, problems with mental health in the past, difficult life circumstances, etc. At the same time, pathogenetically approaches to AD therapy are not fully understood. Pathogenetically oriented therapy of AD should be based on neurotransmitter causes and systemic therapeutic approach. The neurometabolic, anxiolytic, and psycho-stimulating action of the regulatory peptide allows it to be used in the therapy of psychogenic adaptation disorders.
Clinical manifestations of the AD were studied in different age groups - 21-34 years (n=153), 35-50 years (n=257), 51-65 years (n=167) using the Patient Health Questionnaire (PHQ) and Questionnaire of Stress Resistance (QSR). For the study on the effectiveness of the selank (a synthetic analogue of the immunomodulatory peptide tuftsin) were included 30 patients with the AD. Main (experimental group) received selank for two weeks; the control group didn’t receive any treatment (wait list). Patients were monitored for additional two weeks after the treatment with an assessment at the end of follow-up.
According to the study results, selank significantly reduced PHQ score in patients with AD compared to control group. PHQ scores in the selank group after 2 weeks of follow-up were significantly lower for somatic symptoms (mean score 1.2 vs. 3.6; p<0.05), nutritional problems (0.1 vs. 3.4; p<0.05), and alcohol misuses (0.3 vs. 1.5; p<0.05).
The use of the synthetic analogue of the immunomodulatory peptide tuftsin has a therapeutic effect on the somatic and mental symptoms of the adjustment disorder.
Adjustment disorder (AD) is one of the most common mental disorders. Considering the social and economic situation in Ukraine at present, almost 50% of the population has symptoms of mental health disorders, and this number tends to increase
The most significant combination of factors is the presence of provoking agents (individually substantial types of stressful life events) combined with an individual response (stress vulnerability) and constant personal difficulties in combination with other aversive social and psychosocial factors of vulnerability (low self-esteem, self-blame, pessimism)
The ICD-10 indicates that a predisposition or individual vulnerability plays the more significant role in the onset of the AD than in other disorders of the same cluster (F43). This association implies a kind of "stress-vulnerability syndrome" that usually declines social or professional functioning, even if it doesn’t correspond to the diagnostic group.
In the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5)
According to DSM-5 criteria, for AD diagnosis emotional or behavioral symptoms should develop within three months after identifiable stress had taken place (A). Symptoms or behavior are clinically significant, as evidenced by one or both of the following (B):
A pronounced disorder that does not correspond to the severity or intensity of the stressor, even with an external context and cultural factors that may affect the severity of the symptoms and presentation.
Significant deterioration in social, professional or other fields of functioning.
A stress-related disorder does not meet the criteria of another mental disorder and is not simply an aggravation of a pre-existing mental disorder (C). Symptoms do not represent a normal bereavement (D). After the termination of the stressor (or its consequences), the symptoms persist for no more than 6 additional months (D)
Symptoms may include: a feeling of sadness, hopelessness or lack of enjoyment with the things you used; frequent crying; feeling of anxiety, nervousness, stress; problems with sleep; lack of appetite, concentration of attention; a sense of congestion; difficulties in daily activities; a sense of lack of social support; avoidance of important things (such as work or paying bills); suicidal thoughts or behavior. The persistent or chronic AD can last more than 6 months, especially if the stressor continues, for example, in case of unemployment. Many publications note that AD is most often (up to 37%) observed in primary health care facilities and outpatient psychiatric practice
AD occurs when the need for adaptation exceeds the ability of a person to maintain a psychological or physiological balance. Adaptation at the physiological level is associated with the activity of monoamine neurotransmitters, hormones (e.g., glucocorticoids) and other neuromodulators that affect several areas of the brain and various organ systems
At the same time, pathogenetically approaches to AD therapy are not fully understood
Modern pathogenetically oriented therapy of AD should be targeted on neurotransmitter causes and use systemic therapeutic approach, taking into account, first of all, the safety of the drugs. In this aspect, in our opinion, the use of new classes of regulatory medications looks promising. Regulatory peptides have a wide spectrum of biological activity, which is of great importance in coordination of body functions, because of neuroendocrine, immunological, cellular and molecular interactions
In the study were included individuals aged 21 to 65 years, which were admitted to hospital for routine examination. The survey was conducted using the Health Questionnaire (PHQ) and Express Diagnostics of the Stress Level (BCS) (K. Schreiner, 1993)
Clinical examination included assessment of objective physical and mental status and measurement of physiological parameters. To clarify the nature and severity of psychoemotional status alteration, a PHQ health questionnaire was used
Performance parameters were evaluated at an interim and final visit compared to the initial state. Evaluation of the safety of therapy was conducted on the basis of registration of adverse events, analysis of complaints and subjective symptoms, their severity. Statistical processing of the results was carried out using MS Excel and Statistic 6 software.
The results of the screening revealed the following features in different age groups. The low level of regulation in stressful situations was detected in 31.4% of participants from the age group 21-34 years, 44.0% of participants aged 35-50 years and in 50.9% from the age group 51-65 years, which demonstrates decrease in stress resistance with age (
Parameters/groups | 21-34 years, N = 153 | 35-50 years, N = 257 | 51-65 years, N = 167 |
---|---|---|---|
Mild regulation in stressful situations | 48 (31.4%) | 113 (44.0%) | 85 (50.9%) |
Moderate regulation in stressful situations | 53 (34.6%) | 85 (33.1%) | 46 (27.5%) |
Severe of regulation in stressful situations | 52 (34.0%) | 59 (22.9%) | 36 (21.6%) |
As shown in
The analysis of the clinical examination, including data regarding psychoemotional state and the PHQ, made it possible to assess the presence of somatic symptoms, nutrition characteristics, and attitudes towards alcohol use in the studied age groups. The results of the screening according to the PHQ health status questionnaire are presented in
Parameters/groups | 21-34 years, N = 153 | 35-50 years, N = 257 | 51-65 years, N = 167 |
---|---|---|---|
Mild somatic symptoms | 52 (34.0%) | 89 (34.6%) | 36 (21.6%) |
Moderate somatic symptoms | 53 (34.6%) | 108 (42.1%) | 46 (27.5%) |
Severe somatic symptoms | 48 (31.4%) | 60 (23.3%) | 85 (50.9%) |
Mild alcohol use | 52 (34.0%) | 57 (22.2%) | 36 (21.6%) |
Moderate alcohol use | 48 (31.4%) | 88 (34.2%) | 46 (27.5%) |
Severe alcohol use | 53 (34.6%) | 112 (43.6%) | 85 (50.9%) |
Mild eating disorders | 53 (34.6%) | 57 (22.2%) | 46 (27.5%) |
Moderate eating disorders (overeating) | 52 (34.0%) | 112 (43.6%) | 85 (50.9%) |
Severe eating disorders (overeating) | 48 (31.4%) | 88 (34.2%) | 36 (21.6%) |
Despite the absence of complaints at the time of the survey, according to the questionnaire, during the last three weeks, 31.4% of participants in the 21-34 age group, 23.3% of participants aged 35-50 years and 50.9% of the age group the group of 51-65 years noted the presence of somatic (predominantly algic) pain with a frequency corresponding to high severity. In the studied sample, 34.6% of participants from the 21-34 age group, 34.2% of participants aged 35-50 years and 27.5% in the age group 51-65 years consumed alcohol more than twice a week. Among frequent reasons of alcohol consumption was to relieve tension and anxiety. Abnormal eating habits were absent in 34.6% of participants in the 21-34 age group, 22.2% of participants aged 35-50 years and 27.5% in the 51-65 age group. The rest noted that they had episodes of diet misuses.
The results of the screening study demonstrated the prevalence of a decrease in stress resistance and subjective deterioration in all age groups with an increase to 50.9% in the age group 51-65 years. The data obtained are comparable with international studies
A study was made of the efficacy of the synthesized analogue of the endogenous peptide taftcin (Thr-Lys-Pro-Arg-Pro-Gly-Pro) in the treatment of symptoms of adaptation disorders. The results of the study are presented in
Notes: * - statistically significant (p<0.05) compared to the initial state, ** - statistically significant (p<0.05) compared to CG.
Symptoms | Level of assessment | Baseline | 14 days (end of treatment) | 28 days (follow-up) | |||
---|---|---|---|---|---|---|---|
MG | CG | MG | CG | MG | CG | ||
Somatic symptoms | Mean score | 5.1±1.0 | 3.6±0.8 | 1.9±0.6* | - | 1.2±0.5*/** | 3.6±0.8 |
Symptoms prevalence in the group | 100% | 100% | 80% | - | 73% | 100% | |
Nutritional disorders | Mean score | 2.3±0,8 | 2.7±0.7 | 0.1±0.1 | - | 0.1±0.1*/** | 3.4±0.6* |
Symptoms prevalence in the group | 73% | 93% | 13% | - | 13% | 100% | |
Alcohol consumption | Mean score | 1.3±0.4 | 1.3±0.4 | 0.3±0.1 | - | 0.3±0.1*/** | 1.5±0.4 |
The prevalence of symptomatology in the group | 80% | 73% | 13% | - | 13% | 80% |
As shown in
The average score of alcohol consumption in CG was 1.3 ± 0.4. After 2 weeks of follow-up (28th day of the study), the number of alcohol users did not change, but the frequency of alcohol consumption increased, and the average score on this subscale increased to 1.5 ± 0.4 (
According to the analysis, the regulatory peptide had a significant positive effect on the emotion regulation and AD symptoms; moreover, medication had pronounced post-therapeutic effect. The study confirmed that “Selank” (synthesized analogue of the endogenous peptide taftcin) can be used for the treatment of AD. It significantly improves somatic symptoms, helps to reduce alcohol consumption and correct eating habits in patients with this diagnosis.
The pharmacological and therapeutic effects of the regulatory peptides, such as synthesized analogue of the endogenous peptide taftcin, is determined by the presence of a normalizing effect on the activity of the primary neurotransmitter systems of the brain.
The use of analogue regulatory peptides has a positive effect on the somatic and mental symptoms in patients with AD.
One of the therapeutic effects of the “Selank” is the preservation of psychoemotional health, which predetermines its role not only for treatment but also for prevention of stress-related disorders.
The authors have no conflicts of interest to declare.