Assessment of efficiency of antistressor protection of surgical dental patients with different level of neuroticism
DOI:
https://doi.org/10.11603/2311-9624.2019.4.10880Keywords:
neuroticism, psycho-emotional stress, adaptive reaction, pain sensitivity, pupillo-algometry, GABA, L – tryptophan, dalarginAbstract
Surgery in the maxillofacial area is accompanied by the appearance of stress reactions. The severity of stress reactions depends largely on the individual-typological features of each patient. An important condition for successful surgical intervention is the providing of adequate antistressor protection of patients, which is realized through the activation of natural stress-limiting systems of the body (GABA-ergic, serotonergic and opiate systems).
The aim of the study – to give an objective assessment of the effectiveness of drug regimens of antistressor protection of surgical dental patients with different levels of neuroticism.
Materials and Methods. Clinical observations and laboratory studies were performed in 97 outpatient surgical dental patients. The types of temperament and the level of neuroticism in patients were detected by their testing according to the method of G. Eysenck. The manifestations of psychological stress (emotional, somatic, behavioral) that occurred in patients during the last week prior to surgery were detected according to the PSM-25 (Lemyr – Tessier – Fillion) scale. The level of anxiety and depressive manifestations in patients before surgery were determined by using the Hospital Anxiety and Depression Scale (HADS). The assessment of the state of the autonomic nervous system in patients before the start of antistressor therapy and after its completion was determined by the Kerdo index, the adaptive potential of the cardiovascular system under stress conditions was determined by the functional capacity index (FCI) according to the method of Baevsky R.M. The reactivity of the autonomic nervous system in response to the action of a painful factor was evaluated by means of pupilloalgometry on the background of a "turnstile" test by our method. Cortisol levels in mixed saliva were determined before and after antistressor therapy. This biochemical marker was examined by enzyme-linked immunosorbent assay.
Depending on the medication antistressor regimens used, patients were divided into two clinical groups. For premedication of patients of both clinical groups, gidazepam was used – sublingually 0.05 g, an hour before surgery. In the main group (50 patients) at the stage of preparation for routine surgery, for 7 days, was prescribed L-tryptophan and endonasal solution of dalargin for sympathicotonia in patients. In the comparison group (47 patients) for the treatment of psycho-emotional stress within 7 days before surgery was prescribed the drug "Gamalate B6" (Spain), which contains γ-aminobutyric acid – 75 mg; γ-amino-β-hydroxybutyric acid – 37 mg; magnesium glutamate hydrobromide (anhydrous) – 75 mg; of vitamin B6 – 37 mg, 2 tablets 2 times a day (morning and evening).
Statistical analysis of the results of the study was performed by using the Student's t-test of the methods of variational statistics (using the computer program "Statistica 8"). To determine the probability and strength of correlation relationships, we determined the Pearson correlation coefficient χ2.
Results and Discussion. Patients with moderate and high levels of neuroticism on the PSM-25 scale have been diagnosed with psychological stress of varying degrees of severity. In the group of comparison in patients with moderate level of neuroticism (30 people) during applying the "Gamalate B6" of antistressor therapy to achieve before the start of surgery the necessary clinical effect: low anxiety, balance of components of the autonomic nervous system, satisfactory adaptation to the stress of the cardiovascular system and slight increase (p > 0.05) of cortisol in saliva, 86.7 % were successful, and at high neuroticism level – in 58.8 %. In the main clinical group, after the course of therapy with L-tryptophan and dalargin in patients with moderate neuroticism level (32 people), before the start of surgery, the necessary level of antistress protection was achieved in 100 % of cases, χ2 – 4.561 (р = 0.033), and among patients with high levels of neuroticism (18 people) – in 83.3 % of cases, χ2 – 2.574 (р = 0.109).
In these patients, on the background of the activation of stress-limiting systems (serotonergic and opiate), the resistance to nociceptive factor was also statistically significantly increased, which was confirmed by the results of pupilloalgometry.
Conclusions. In dental patients before surgery, manifestations of psychological stress of varying degrees of severity, depending on their level of neuroticism are present. In people with high levels of neuroticism on the background of chronic psycho-emotional stress there is a functional imbalance of the autonomic nervous system with increasing activity of its sympathetic department. When used for anti-stress protection, pharmacological drugs that affect the GABA-ergic system, it is possible to achieve the expected therapeutic effect in the majority of patients with moderate neuroticism and in 58.8 % of cases in persons with high neuroticism. When combined with L-tryptophan and dalargin, antistressor protection is achieved in 100 % of patients with moderate and 83.3 % with high levels of neuroticism.
References
Liau, F.L., Kok, S.H, Lee, J.J., Kuo, R.C, Hwang, C.R, & Yang, P.J. (2008). Cardiovascular influence of dental anxiety during local anesthesia for tooth extraction. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 105 (1), 16-26. DOI: https://doi.org/10.1016/j.tripleo.2007.03.015
Sirin, Y., Yucel, B., Firat, D., & Husseinova-Sen, S. (2011). Assessment of dental fear and anxiety levels in eating disorder patients undergoing minor oral surgery. J. Oral Maxillofac. Surg, 69 (8), 2078-2085. DOI: https://doi.org/10.1016/j.joms.2010.12.050
Pani, Sh.Ch., Al Garni, B., AlZain L.M., & AlQahtani, N.S. (2014). Assessment of the impact of stress and anxiety on pain perception in patients undergoing surgery for placement of their first dental implant. OHDM, 13 (2), 464-468.
Mufti, N., Mufti, S., & Mufti, Kh. (2017). Stress and anxiety in patients undergoing dental extraction. International Journal Oral Care Res., 5 (1), 75-77. DOI: https://doi.org/10.5005/jp-journals-10051-0087
Gadve, V.R., Shenoi, R., Vats V., & Shrivastava A. (2018). Evaluation of anxiety, pain, and hemodynamic changes during surgical removal of lower third molar under local anesthesia. Ann. Maxillofac. Surg., 8, 247-253. DOI: https://doi.org/10.4103/ams.ams_216_18
Sharma, A., Pant, R., Priyadarshi, S., Agarwal, N., Tripathi, S., & Chaudhary, M. (2019). Cardiovascular changes due to dental anxiety during local anesthesia injection for extraction. J. Maxillofac. Oral Surg., 18 (1), 80-87. DOI: https://doi.org/10.1007/s12663-018-1085-4
Tarazona-Álvarez, P., Pellicer-Chover, H., Tarazona-Álvarez, B., Peñarrocha-Oltra, D., & Peñarrocha-Diago, M. (2019). Hemodynamic variations and anxiety during the surgical extraction of impacted lower third molars. J. Clin. Exp. Dent., 11 (1), e27-e32. DOI: https://doi.org/10.4317/jced.55294
Pêgo, J.M., Sousa, J.C., Almeida, O.F., & Sousa, N. (2010). Stress and the neuroendocrinology of anxiety disorders. Curr. Top Behav. Neurosci., 2, 97-117. DOI: https://doi.org/10.1007/7854_2009_13
Astramskaitė, I., Poškevičius, L, & Juodžbalys, G. (2016). Factors determining tooth extraction anxiety and fear in adult dental patients: a systematic review. Int. J. Oral Maxillofac. Surg., 45 (12), 1630-1643. DOI: https://doi.org/10.1016/j.ijom.2016.06.019
Lyu, J., Voegele, B., Nadeau, R., Born, D., & Tu, H. (2017). Evaluation of stress and well-being of oral and maxillofacial surgery residents. International Journal of Oral and Maxillofacial Surgery, 46 (1), 370-371. DOI: https://doi.org/10.1016/j.ijom.2017.02.1246
Jeronimus, B.F., Kotov, R., Riese, H., & Ormel, J. (2016). Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443-313 participants. Psychol. Med., 46 (14), 2883-2906. DOI: https://doi.org/10.1017/S0033291716001653
Vassenda, O., Røysamba, E., & Nielsen, Ch.S. (2011). Dental anxiety in relation to neuroticism and pain sensitivity. A twin study. Journal of Anxiety Disorders, 25, 302-308. DOI: https://doi.org/10.1016/j.janxdis.2010.09.015
Payne, L.A., Seidman, L.C., & Lung, K.C. (2013). Relationship of neuroticism and laboratory pain in healthy children: does anxiety sensitivity play a role? Pain, 154 (1), 103-109. DOI: https://doi.org/10.1016/j.pain.2012.09.013
Banozic, A., Miljkovic, A., & Bras, M. (2018). Neuroticism and pain catastrophizing aggravate response to pain in healthy adults: an experimental study. Korean J. Pain, 31 (1), 16-26. DOI: https://doi.org/10.3344/kjp.2018.31.1.16
Amanda, A., Uliaszek, R.E., Zinbarg, S.М., Michelle, G.C., Jonathan, M.S., James, W.G, Raphael, R., Allison, W., & Constance, H. (2010). The role of neuroticism and extraversion in the stress-anxiety and stress-depression relationships. Anxiety Stress Coping, 23 (4), 363-381.
Jylhä, P., Melartin, T., & Isometsä, E. (2009). Relationships of neuroticism and extraversion with axis I and II comorbidity among patients with DSM-IV major depressive disorder. J. Affect. Disord, 114 (1-3), 110-121. DOI: https://doi.org/10.1016/j.jad.2008.06.011
Syusyuka, V.G. (2017). Otsenka vzaimosvyazi lichnostnoy i situativnoy trevozhnosti s tipom temperamenta u beremennykh [Assessing the relationship of personal and situational anxiety with the type of temperament in pregnant women]. Health of Woman, 3 (119), 69-72 [in Russian].
Khaykin, S.S., Bobrinskaya, I.G., Yaltonskiy, V.M., & Shilnikov, V.A. (2007). Psikhoemotsionalnoye sostoyaniye bolnykh v predoperatsionnom periode, kak kriteriy effektivnosti premediktsii [Psycho-emotional state of patients in the preoperative period, as a criterion for the effectiveness of premedication]. Zabaykalskiy meditsinskiy vestnik – Trans-Baikal Medical Bulletin, 1, 15-18 [in Russian].
Markin, S.M., Maystrenko, H.A., Korovin, A.Ye. & Svyatov, D.I. (2010). Variabelnost ritma serdtsa v diagnostike stressornoy ustoychivosti bolnykh v predoperatsionnom periode [Heart rate variability in the diagnosis of stress tolerance of patients in the preoperative period]. Klinicheskaya patofiziologiya – Clinical Pathophysiology, 1-2, 45-48 [in Russian].
Goncharov, A.S., Novikova, S.G., Rabinovich, S.A., Novikov, D.V., & Goncharova, N.A. (2014). Sovremennyye podkhody k sedatsii v stomatologii [Modern approaches to sedation in dentistry]. Rossiyskaya stomatologiya – Russian Dentistry, 3, 15-18 [in Russian].
Gvak, G.V., & Yeremenko, V.G. (2012). Stress-limitiruyushchiye sistemy v optimizatsii i uluchshenii kachestva obshchego obezbolivaniya u detey [Stress-limiting systems in optimizing and improving the quality of general anesthesia in children]. Sibirskiy meditsinskiy zhurnal – Siberian Medical Journal, 6, 90-93 [in Russian].
Bezrukov, S.G., & Dzhereley, A.A. (2005). Rezultaty korrektsii patologicheskikh psikhosomaticheskikh sostoyaniy u khirurgicheskikh stomatologicheskikh bolnykh [The results of the correction of pathological psychosomatic conditions in surgical dental patients]. Sovremennaya stomatologiya – Modern Dentistry, 4, 111-115 [in Russian].
Zabrodin, O.N. (2016). K noradrenergicheskomu komponentu mekhanizmov stress-limitiruyushchego i zazhivlyayushchego effektov dalargina [To the noradrenergic component of the mechanisms of stress-limiting and healing effects of dalargin]. Obzory po klinicheskoy farmakologii i lekarstvennoy terapii – Clinical Pharmacology and Drug Therapy Reviews, 14 (4), 61-66 [in Russian].
Ayzenk, G.Yu. (1999). Struktura lichnosti [Personality structure]. Saint-Petersburg: Yuventa [in Russian].
Kupriyanov, R.V., & Kuzmina, Yu.M. (2012). Psikhodiagnostika stressa [Psychodiagnosis of stress: workshop]. Kazan: KNITU [in Russian].
Zigmond, A.S., & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatr. Scand., 67, 361-370. DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Rekova, L.P., & Dmitriyeva, A.A. (2004). Indeks Kerdo kak kharakteristika reaktsii na stressovuyu situatsiyu u khirurgicheskikh stomatologicheskikh bolnykh [Kerdo index as a response to stress in surgical dental patients]. Voprosy Eksperimentalnoy i Klinicheskoy Stomatologii – Questions of Experimental and Clinical Dentistry: Sbornik nauchnykh trudov – Collection of Scientific Papers. Kharkiv: KhSMU [in Russian].
Bayevskiy, R.M. & Bersenova, A.P. (1997). Otsenka adaptatsionnykh vozmozhnostey organizma i riska razvitiya zabolevaniy [Assessment of the adaptive capabilities of the body and the risk of developing diseases]. Moscow: Meditsina [in Russian].
Firmino, M., Kuntze, L.B., Lagatta, D.C., Martins Dias, D.P., & Moraes Resstel L.B. (2019). Consequence of chronic stress on cardiovascular and ventilatory responses activated by both chemoreflex and baroreflex in rats. Journal of Experimental Biology, 222 (Pt 20), 204883. DOI: https://doi.org/10.1242/jeb.204883
Mokryk, O.Ya., & Zaplatynskyi, V.O. (2014). Rozrobka ekspres-metodu diahnostyky bolovoi reaktsii liudyny [Development of express method of diagnostics of pain response of a person]. Visnyk problem biolohii i medytsyny – Bulletin of Problems of Biology and Medicine, 2 (108), 13-17 [in Ukrainian].
Umeanuka, O.T., Saheeb, B.D., Uguru, C.C. & Chukwuneke, F.N. (2015). Evaluation of cortisol concentrations in saliva as a measure of stress in patients having routine dental extractions. Br. J. Oral Maxillofac. Surg, 53, 557-560. DOI: https://doi.org/10.1016/j.bjoms.2015.03.011
Vasianina, A.A., Kiseleva, Ye.G., Vasyanina, A.A., & Zhukova, L.V. (2006). Opredeleniye pokazaniy k primeneniyu gidazepama i lorazepama u detey pered lecheniyem zubov na osnovanii metodiki Lyushera [Determination of indications for the use of gidazepam and lorazepam in children before dental treatment based on the Lusher method]. Uchenyye zapiski Sankt-Peterburgskogo meditsinskogo universiteta im akad. I.P. Pavlova – Scientific notes of the St. Petersburg Medical University named after acad. I.P. Pavlov, 13 (1), 57-61[in Russian].
Kulyhina, V.M., & Komnatskyi, B.Yu. (2014). Efektyvnist kombinovanoi mistsevoi anestezii u patsientiv iz stomatolohichnymy zakhvoriuvanniamy, poiednanymy z tsukrovym diabetom [Efficacy of combined local anesthesia in patients with dental disease combined with diabetes]. Zhurnal vushnykh, nosovykh i horlovykh khvorob – Journal of Ear, Nose and Throat Diseases, 3, 51-58 [in Ukrainian].
Kushta, A.O., Voloshchuk, N.I., & Shuvalov, S.M. (2016). Obhruntuvannia premedykatsii u stomatolohichnii praktytsi zalezhno vid rivnia tryvozhnosti na osnovi eksperymentalnoho doslidzhennia [Substantiation of premedication in dental practice depending on the level of anxiety based on experimental research]. Novyny stomatolohii – Dentistry News, 4 (89), 80-84 [in Ukrainian].
Palego, L., Betti, L., Rossi, A., & Giannaccini, G. (2016). Tryptophan biochemistry: Structural, nutritional, metabolic, and medical aspects in humans. Journal of Amino Acids. Article ID 8952520, 13. DOI: https://doi.org/10.1155/2016/8952520
Bokhan, N.A, Ivanova, S.A, & Levchuk, L.A. (2013). Serotoninovaya sistema v modulyatsii depressivnogo i addiktivnogo povedeniya [Serotonin system in modulation of depressive and addictive behavior]. Tomsk, Izd-vo “Ivan Fedorov” [in Russian].
Kiank, C., Zeden, J.-P., Drude, S., Domanska, G., Fusch, G., Otten, W., & Schuett, C. (2010). Psychological stress-induced, IDO1-dependent tryptophan catabolism: Implications on immunosuppression in mice and humans. PLoS ONE, 5(7). Article ID e11825. DOI: https://doi.org/10.1371/journal.pone.0011825
Trisha, A.J., Jason, C.D., Nguyen, K. E., & Polglaze, P.P. (2016). Bertrand. Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis. Nutrients, 8 (1), 56.
Savchenko, V.N., Kratenko, A.S., Nikolenko, Ye.Ya., Sokruto, O. V., Vovk, K.V., Letik, I.V., & Kvitchataya, A.I. (2016). Antistressovyye effekty L – triptofana i yego metabolicheskiye korrelyaty, kak prediktory nevrologicheskikh zabolevaniy [Antistress effects of L-tryptophan and its metabolic correlates as predictors of neurological diseases]. Ukrainskyi zhurnal medytsyny, biolohii ta sportu – Ukrainian Journal of Medicine, Biology and Sports, 2, 172-175 [in Ukrainian].
Martin, SL., Power, A., Boyle. Y., Anderson, I.M., Silverdale, M.A., & Jones, A.K.P. (2017). 5-HT modulation of pain perception in humans. Psychopharmacology (Berl), 234 (19), 2929-2939. DOI: https://doi.org/10.1007/s00213-017-4686-6
Glazunova, I.B., Bobshtssn, I.I., & Splina, L.V. (2008). Vliyaniye dalargina na effektivnost terapii atopicheskogo dermatita [The effect of dalargin on the effectiveness of treatment of atopic dermatitis]. Kurskiy nauchno-prakticheskiy vestnik “Chelovek i yego zdorovye” – Kursk Scientific and Practical Bulletin “Man and his health”, 3, 22-26 [in Russian].
Dontsov, A.V. (2013). Dalargin v korrektsii trevozhno-depressivnykh rasstroystv u bolnykh s metabolicheskim sindromom [Dalargin in the correction of anxiety-depressive disorders in patients with metabolic syndrome]. Farmatsiya – Pharmacy, 6, 44-46 [in Russian].
