Clinical and biochemical features of anxiety in children with hyperkinetic disorder

R G Gasanov,I V Makarov,D A Evelina

doi:10.31363/2313-7053-2020-1-30-38

Abstract

Clinical and biochemical features of anxiety in children with a hyperkinetic disorder, also known as a combined type of ADHD, have not been studied, although these data are extremely necessary for therapeutic intervention in cases of comorbidity of hyperkinetic and anxiety disorders.Objective: to study pathogenetic mechanisms and the role of anxiety level in the formation of the main symptoms of the disorder.Materials and methods. We examined 182 children with hyperkinetic disorder and 60 peers from control group aged 6–10 years. After clinical examination we studied the content of monoamines, their precursors, and metabolic products in daily urine. Assessment of the main clinical symptoms (inattention, hyperactivity, impulsivity) was carried out on the SNAP-IV scale. An assessment of the level of anxiety was carried out according to the questionnaire Lavrentieva G.P. and Titarenko T.M. Patients with hyperkinetic disorder were divided into subgroups according to the nature of the monoaminergic “profile”.The results of the study support the hypothesis that pathological and steady increase in anxiety level leads to increase in the impulsivity level in children with hyperkinetic disorder. And the main role in this process is played by the noradrenergic system and the weakening of the inhibitory effect of serotonin, causing an increase of anxiety level and aggravating the imbalance of the activity of monoamine systems.

Highlights

The results of the study support the hypothesis that pathological and steady increase in anxiety level leads to increase in the impulsivity level in children with hyperkinetic disorder
The main role in this process is played by the noradrenergic system and the weakening of the inhibitory effect of serotonin, causing an increase of anxiety level and aggravating the imbalance of the activity of monoamine systems
Сравнение с группой контроля выявило достоверное различие по низкой тревожности (15% и 67%, р=0,0268) и высокой (40% и 6%, р=0,0158), по средней тревожности различия оказались недостоверными

Summary

Materials and methods

We examined 182 children with hyperkinetic disorder and 60 peers from control group aged 6–10 years. An assessment of the level of anxiety was carried out according to the questionnaire Lavrentieva G.P. and Titarenko T.M. Patients with hyperkinetic disorder were divided into subgroups according to the nature of the monoaminergic “profile”. Показатели и распределение тревожности по баллам и уровням сравнивались как внутри группы/ подгрупп детей с ГР, так и между подгруппами. Перечисленные биохимические параметры изучались в суточной моче в Независимых лабораториях Северо-западного центра доказательной медицины методом высокоэффективной жидкостной хроматографии (ВЭЖХ) с электрохимической детекцией (ЭХД) с учетом возраста пациента и последующим анализом соответствияреферентных значений [4, 14].С целью косвенной оценки состояния ферментных систем обмена моноаминов были рассчитаны величины соотношения продуктов реакции к их предшественникам — ДА/Тир, ГВК/ДА, НА/ДА, А/ НА и ВМК/(НА+А) и 5-HTP/Тир. Если сравнивать отношение уровней выраженности тревоги в основной и контрольной группах, то в основной группе достоверно чаще встречаются уровни средней и высокой тревожности (40%, р=0,0045 и 45%, р=0,0029), чем низкая тревожность (15%).

Выраженность тревоги

Подгруппа III

Основная группа

Findings

Высокая тревожность