Psychopharmacotherapy of late-stage hypochondriac conditions: frequency of use and effectiveness of drugs

Abstract

To conduct a comparative analysis of psychopharmacotherapy effectiveness in hypochondriac disorders of late age and to identify the optimal combinations of drugs depending on the thymopathic (hypothymic and/or anxiety) components accompanying the main hypochondriac manifestation. One hundred and eight female inpatients, aged from 50 to 88 years, with leading hypochondriac symptoms of non-delusional level were enrolled in the study. All patients were examined clinically and psychopathologically using psychometric scales: the Montgomery-Asberg Depression Rating Scale, the Hamilton Anxiety Rating Scale, the hypochondria rating scale and the UKU side-effect rating scale. Based on the psychometric assessment, the patients were divided into the following groups: group 1 - subjects with hypochondriac symptoms without accented thymopathic component (n=18); group 2 - subjects with a high level of hypothymia (n=49); group 3 - subjects with a high level of anxiety (n=22); group 4 - subjects with a high level of both anxiety and depression (n=19). Hypochondriac disorder without a thymopathic component was treated with monotherapy with antipsychotic drugs in low therapeutic dosages or with a combination of antipsychotic drugs in low therapeutic dosages with tricyclic antidepressants in low and medium dosages. Hypothymic hypochondriac disorders were treated with antidepressants of mainly SSRIs group and of tricyclic structure in combination with typical and atypical antipsychotic drugs in low therapeutic dosages. In these patients monotherapy with antidepressants or a combination of different antidepressants was effective in rare cases only. Hypochondriac disorder with an anxiety component was significantly more often treated by complex therapy with the addition of anxiolytic drugs, as well as a combination of antidepressants with antiptychotic drugs. Mixed hypochondriac states were treated with a combination of antidepressants and antipsychotic drugs or complex therapy with the addition of an anxiolytic drug. Hypochondriac disorders of late age in most cases are accompanied by depressive and/or anxiety symptoms, which must be taken into account for improvement of diagnostic effectiveness and relevant selection of therapy.