INITIAL STEPS IN ASSESSING THE EFFECTS OF SUPPORTING TREATMENT OF ELECTROMAGNETICS WITH SOME MIXED ANXIETY DISORDERS AND DEPRESSION IN 10 PATIENTS

Summary

Objective: Evaluate the therapeutic support effect of electroacupuncture on some mixed disorders of anxiety and depression in Hanoi. Subjects and methods: Conducted by prospective method, purposive sampling, clinical intervention, with comparison before and after treatment on 10 patients. Results: Symptoms of anxiety and depression gradually decreased over time of treatment as shown by the HARS and HDRS scores (all reducing the number of patients from moderate to mild or no longer having symptoms). The Zung test gradually decreased from 62.4 ± 6.3 to 48.4 ± 8.1 and the Beck Test scale decreased from 23.1±2.8 to 14.8±3.7 at the end of treatment. value (with p<0.05). Conclusion: There is a positive clinical change, improving indicators on the assessment scale. Unwanted effects appear with low frequency and can be remedied. The electroacupuncture procedure can be deployed to support mixed anxiety and depression disorders on all 60 patients in the research group.

I. INTRODUCTION

Mixed anxiety and depression disorder is a common disease in the community. With modern life becoming increasingly stressful and stressful, the disease tends to increase. Worldwide, the incidence rate ranges from about 0.8 to 1.7% of the population, accounting for 10 to 20% of inpatients at specialized psychiatric facilities [1]. Newly acquired diseases have unclear symptoms, sometimes the severity is not severe, leading to patients not going to the doctor or going to the wrong psychiatric specialist, leading to more serious illness, long treatment time, and expensive costs. for society and affects the patient's own working ability.

Currently, the treatment of mixed anxiety and depression disorders is mainly with pharmacotherapy and psychotherapy. However, treatment with pharmaceutical chemicals often has some unwanted effects. Treatment with psychotherapy lasts a long time. Patients need time to get acquainted with the doctor to gain trust in the treatment method. treatment, therefore the need to find new methods to improve the effectiveness of disease treatment is always raised.

With thousands of years of experience in traditional medicine, mixed anxiety and depression disorders are within the scope of melancholia, the symptoms of the disease are effectively treated with pharmacological or non-pharmacological methods such as electroacupuncture. , thread implantation, acupressure massage....

Therefore, with the aim of providing an effective treatment method with few unwanted effects, taking advantage of the strengths of Modern Medicine and Traditional Medicine, in accordance with the trends of the times and modernization. Traditional medicine, combining Traditional Medicine and Modern Medicine, we conducted research: "Evaluating the therapeutic support effects of electroacupuncture on some mixed disorders of anxiety and depression in Hanoi".

Before applying a new technical process to treat a large number of patients, we conduct a trial on 10 patients to determine the degree of acceptance of the treatment support effect in clinical practice. monitor unwanted effects...

II. SUBJECTS AND METHODS

1. Research object

Patients diagnosed with mixed anxiety and depression code F41.2 according to ICD - 10 standards from April 2022 to June 2022 at Hanoi Psychiatric Hospital, were selected for the study satisfactorily. the following standards:

1.1 Selection criteria according to modern medicine:

- Are patients diagnosed with mixed anxiety and depressive disorder according to the standards of the international classification of diseases ICD 10 (F41.2), with symptoms of anxiety without a clear theme. clear, vague. There are a number of autonomic nervous system symptoms such as shaking limbs, sweating, poor concentration, loss of appetite, tension, restlessness, difficulty relaxing, palpitations, dry mouth, and confusion. sleep...

- Patients > 18 years old, voluntarily participate in the study and comply with the research process.

1.2 Selection criteria according to traditional medicine:

- The patient was diagnosed with the medical name according to Traditional Medicine as liver qi condensation and qi condensation fire with the following symptoms:

1.3 Exclusion criteria:

- The patient has excessive anxiety and worry, without autonomic nervous system symptoms.

- Symptoms respond fully but occur in close association with significant changes in life.

- Symptoms of depression and anxiety lasting more than 1 year. There are clear suicidal thoughts.

- Patients with physical diseases affecting brain function and accompanying physical brain damage. (Cranial MRI with physical damage, electroencephalogram).

- Have cardiovascular disease.

  - Use other methods.

- Pregnant.

- Failure to comply with treatment procedures.

- The patient does not belong to either of the two types: Liver qi condenses or Qi qi turns into fire.

2. Research methods

  2.1 Research design:

- Prospective research method, clinical intervention, with comparison before and after treatment.

2.2 Research sample size:

- Purposively select a sample of 10 patients in accordance with research standards.

2.3 Research materials:

- Electro-acupuncture acupuncture point formula supports the treatment of mixed disorders of anxiety and despression according to the form of Liver Qi and Fire (according to the technical process of the Ministry of Health)[2]:

* Liver qi excess

- Disperssion:  

- Tonification:

+ Huyết Hải (Sp10)     + Tam âm giao (Sp6)    + Quan nguyên (VC4)     + Khí hải (VC6)

* Fire qi excess

- Disperssion:

- Tonification:

+ Quan nguyên (VC4)     + Huyết hải (Sp10)    + Tam âm giao (Sp6)   + Khí hải (VC6)

2.4 Research facilities:

- Acupuncture needles: needle size specification 0.3 x 25mm, needle 0.3 x 40mm made of stainless steel, silver base, sterile, disposable, manufactured by Hai Nam Medical Equipment Joint Stock Company .

- M8 electroacupuncture machine manufactured by Central Acupuncture Hospital.

   2.5 Research process:

- Take medication according to the Hanoi Psychiatric Hospital's regimen to treat mixed anxiety and depression disorders.

- SSRI group (selective effect on Serotonin): Zoloft 50mg x 02 tablets/day x 56 days (8 weeks).

      - Sedative: Seduxen 05mg x 02 tablets/day x 14 days (2 weeks - from day 1 to day 14).

- Electroacupuncture according to acupoint regimen supports the treatment of some mixed disorders of anxiety and depression: 30 minutes/time/day x 40 days (8 weeks, off Saturday and Sunday).

2.6 Research indicators and how to determine them

- Assessment of general characteristics: distribution by age and gender, disease duration, distribution by disease type.

- Evaluate clinical treatment effectiveness using the following scales: Hamilton Anxiety Rating Scale (HSRS), Hamilton Depression Rating Scale (HDRS), Zung Test (anxiety level assessment), Test Beck (assess the level of depression) at 3 time points D0, D28, D56.

- Evaluate unwanted effects of electroacupuncture method.

3. Data processing method

- For variables where the index is a ratio, use the χ2 test to compare the difference between two or more ratios of groups before and after treatment.

- For variables whose index is the average, use a paired t-test to compare the average value before and after treatment.

- Analytical data are processed according to biomedical statistical methods on computers with the help of SPSS 20 software.

III. RESEARCH RESULTS

1. General characteristics of research subjects

Table 1: . Distribution of study patients by age and sex

Comment: Among the 10 tested patients, the age distribution was from 38 to 69 years old, the group of patients from 56 to 65 years old accounted for the most with 4 patients, all 10 patients were female, there were no male patients.

Table 2. Time of symptom appearance

Comment: The time from the appearance of symptoms to the time of participating in research is usually about 8 months to 1 year. Patients often do not immediately go to a psychiatric specialist but seek treatment at other specialists.

Table 3: Distribution of mixed anxiety and depressive disorders according

to Traditional Medicine

Comment: In the experimental study, the form of Qi Duc Hoa Hoa disease had 7 patients, accounting for the majority.

2. Evaluate the clinical effectiveness of symptomatic treatment using scoring scales

Table 4: Effectiveness of treating anxiety symptoms through the HARS scale

Comment: The level of anxiety according to the HARS scale at moderate level gradually decreased over time of treatment, the number of patients with mild anxiety increased because the number of patients with moderate level changed to mild level. At time D28, no patient was at a level without anxiety, while at time D56, 1 patient was at a level without anxiety (p<0.05).

Table 5: Effectiveness of treating anxiety symptoms according to the Zung Test scale

Comment: The total Zung Test score is 80 points, a score ≥ 40 means there is an anxiety disorder, less than 40 means there is no anxiety disorder. At time 0, the total average score of 10 patients was 62.4 ± 6.3, improving at time 28 with an average score of 54.7 ± 7.4, continuing to improve at the end. At the end of treatment, the score was 48.4 ± 8.1 (p<0.05).

Table 6: Effectiveness of treating depressive symptoms based on the HDRS scale

Comment: Most of the 10 patients undergoing experimental treatment had mild depression. After 28 days of treatment, no patient had moderate depression, and by D56 there were 4 patients without depression. cold (p<0.05).

Table 7: Effectiveness of treating depressive symptoms according to the Beck Test scale

Comment: Assess the level of depression through the Beck Test scale including 21 answers with a scale of 0 to 3 for each answer, the minimum total score is 0, the maximum is 33, less than 14 points is normal. , from 14 to 19 mild depression, from 20 to 29 moderate depression, from 30 and above severe depression. Study patients had a significant improvement in depression assessed through the Beck Test scale (p<0.05).

3. Evaluate unwanted effects of electroacupuncture

Table 8: Assess general condition, pulse, temperature, blood pressure, and respiratory rate before and after performing electroacupuncture (400 times)

Comment: The patient's overall condition before and after acupuncture did not change, the patient was alert and had good contact. Pulse, blood pressure, and breathing rate tend to decrease after electroacupuncture ends, but are not statistically significant with P> 0.05.

Table 9: Unwanted effects of electroacupuncture method

Comment: There are almost no unwanted effects of electroacupuncture. The cases that occur are mainly due to incorrect acupuncture techniques.

IV.DISCUSS

1. General characteristics of the research object

-About age and gender characteristics: According to Table 1, with a small sample size, the characteristics of the research subjects are not very meaningful, however the 10 patients participating in the study were all female, quite suitable for the disorder. Mixed anxiety and depression are more common in women. Ages from 38 to 69, average age is 53.2 ± 12.3, are the ages under a lot of pressure in life.

-About the time characteristics of disease detection: Symptom onset time according to ICD-10 standards is from 1 month to 1 year, most patients come for examination between 8 months and 1 year, according to table 2 The rate of patients arriving early is low, because patients often do not go to a psychiatric specialist immediately but go to other specialists, so they are not diagnosed with mixed anxiety and depression disorder, prolonging the time to detect the disease.

-Regarding the characteristics of distribution according to type of traditional medicine: In table 3, we see that the majority of patients belong to the Fire qi excess type (7/10 patients). It matches the patient's symptoms due to life pressures.

2. The effectiveness of electroacupuncture supports the treatment of anxiety symptoms

Table 4 evaluates the level of anxiety disorder through the HARS scale, showing the number of patients moving from moderate to mild, with one patient no longer having anxiety disorder.

Table 5 also shows the therapeutic support effect of electroacupuncture with a reduction in scores according to the Zung test scale through the time points D28 and D56. At time 0, the total average score of 10 patients was 62.4 ± 6.3, improving at time 28 with an average score of 54.7 ± 7.4, continuing to improve at the end. At the end of treatment, the score was 48.4 ± 8.1. The frequency of symptoms during the week as well as the duration of symptoms are also significantly improved. The number of symptoms in patients also decreased at the time of evaluation.

Separate assessment of groups of symptoms of anxiety disorders such as symptoms of autonomic nervous stimulation, symptoms related to the chest and abdomen, symptoms related to mental status, systemic symptoms, and tension symptoms. and other groups of non-specific symptoms, the number of patients with those symptoms also gradually decreases with each assessment time. This confirms that electroacupuncture is effective in supporting the treatment of anxiety symptoms in patients with mixed anxiety and depression disorders.

However, due to the small number of patients, we have not been able to evaluate whether the change is statistically significant or

3. The effectiveness of electroacupuncture supports the treatment of depressive symptoms

According to table 7, the level of depression in patients with mixed anxiety and depressive disorders is mostly mild, electroacupuncture shows effectiveness in supporting treatment when the number of patients no longer depressed is 4/10, no more. There are no patients with moderate depression.

In table 7, the score according to the Beck Test scale also decreased significantly over the treatment periods, confirming the acceptability of electroacupuncture in supporting the treatment of mixed anxiety and depression disorders.

4. Survey on unwanted effects of electroacupuncture to support the treatment of mixed anxiety and depression disorders

Through 400 rounds of electroacupuncture, the patient's general condition was evaluated, measuring pulse, temperature, blood pressure, and breathing rate before and after each electroacupuncture session, showing that the patient's general condition was completely stable before and after electroacupuncture. For patients with mixed anxiety and depression disorders, in many cases, due to the medical condition, the patient's pulse, blood pressure, and breathing rate increase. There is a tendency to decrease and improve the patient's condition, but it is not statistically significant (Table 8).

A few sessions of acupuncture had pain and bleeding due to incorrect acupuncture techniques, accounting for 1% and 0.5% respectively. Other unwanted effects that were monitored did not occur, this is it is perfectly acceptable to apply the method to a complete study (table 9).

V. CONCLUSION

Through experimental work applying the electroacupuncture process to support the treatment of some mixed disorders of anxiety and depression, it has shown positive clinical changes, improving indicators on the assessment scale. .

Unwanted effects appear with low frequency and can be remedie

Keyword

Mixed anxiety and depressive disorder,HARS,HDRS,Beck Test,electroacupuncture