Biochemical aspects of the use of additional pharmacotherapy in the treatment of psychosis of late age

Background. Psychotic disorders, which are formed as a result of the mutual influence of biological, psychophysiological, psychological and socio-environmental factors, are a frequent occurrence in the elderly. The connection between the increasing dynamics of psychosis and high morbidity and mortality in the contingent of elderly patients is indisputable, despite the different etiology and variety of clinical manifestations of psychotic states. An antipsychotic drug strategy should be used with punctual precautions to optimize outcomes. From the standpoint of a systematic approach to improving the effectiveness of complex personalized therapy for patients with gerontopsychiatric profile, there is no doubt that it is necessary to search for the most optimal drugs prescribed in addition to psychotropic therapy for patients with late-life psychoses (LLPs). The connection of additional therapy is due to the high incidence of undesirable symptoms associated with the manifestation of side effects of psychotropic drugs and the heterogeneity of clinical and biochemical parameters of elderly patients with LLPs. Objective: to highlight the clinical criteria for prescribing additional antioxidant/antihypoxant therapy to patients with LLPs and determine the biochemical parameters of the blood, which are specific enzymatic features for this category of patients. Material and Methods. Using nonparametric statistical methods, a comparative analysis of therapeutic efficacy was carried out in three clinical groups of patients with LLPs treated according to standard algorithms of antipsychotic and antidepressant therapy. Group 1 - patients who did not receive additional therapy, except for the main psychotropic one (Gr1, n=16). Group 2 - patients who, in addition to psychotropic therapy, received 2-ethyl-6-methyl-3-hydroxypyridine succinate (Mexidol, Gr2, n=20), which has antioxidant, antihypoxant and membrane-protective effects. Group 3 - patients who received other neurometabolic drugs in addition to psychotropic therapy (Gr3, n=22). Adjunctive therapy was prescribed to eliminate/reduce the risk of developing unwanted side symptoms as a result of the action of psychotropic drugs. Before and after the course of treatment in patients with LLPs, the mental state was assessed (scores) using psychometric scales and biochemical blood parameters were determined (the activity of glutamate and glutathione metabolism enzymes in platelets and erythrocytes). Enzymatic activity was also determined in the control group, matched by age and number of representatives of each sex (n=38). Results. According to the comparative analysis, it was found that the activity of erythrocyte glutathione reductase (GR) was reduced before and after the course of treatment in all three clinical groups of patients when compared with the control group. In contrast to Gr1 and Gr3, a statistically significant decrease in the initial activity of platelet glutamate dehydrogenase (GDH) and glutathione-S-transferase (GST) was registered in Gr2. After a course of combined therapy, GDH and GST levels in Gr2 reached values corresponding to those in the control group. At the same time, in Gr1, GDH and GST indicators showed an even greater decrease relative to the initial level after psychotropic treatment without the addition of antioxidant/antihypoxant therapy. Various statistically significant relationships have been established between biochemical parameters and quantitative scores on psychometric scales in all three clinical groups of patients with LLPs, and some of them can act as prognostic predictors of treatment efficiency.