Невротическая депрессия: проблема нозологической квалификации

Abstract

Objective: to\xa0 study\xa0 the\xa0 clinical\xa0 characteristics,\xa0 dynamics,\xa0 nosological\xa0 qualifications\xa0 and\xa0 factors\xa0 involved\xa0 in\xa0 the\xa0 formation\xa0 of neurotic depression. Material\xa0 and\xa0 methods: 60\xa0 patients\xa0 (women\xa0 —\xa0 55,\xa0 men\xa0 —\xa0 5)\xa0 with\xa0 an\xa0 average\xa0 age\xa0 36,9\xa0 ±\xa0 10,8\xa0 years\xa0 were\xa0 examined,\xa0 the\xa0 average\xa0 duration\xa0 of\xa0 depressive\xa0 phases\xa0 was\xa0 18,1\xa0 ±\xa0 10,8\xa0 months.\xa0 The\xa0 study\xa0 was\xa0 conducted\xa0 with\xa0 using\xa0 clinical,\xa0 catamnestic,\xa0 pathopsychological, statistical methods. Psychometric scales (HAM-D, MFI-20, SANS, PANSS) and questionnaires (Questionnaire of personality traits of an adult, SPQ-A, SCL-90, Holmes–Ray Stress Inventory) were used. Results: the states combined by the term «neurotic depression» are clinically heterogeneous (depressions with victimization phenomena\xa0 with\xa0 the\xa0 separation\xa0 anxiety\xa0 and\xa0 depressions\xa0 with\xa0 love\xa0 addiction \xa0—\xa0 erotomania),\xa0 primarily\xa0 in\xa0 the\xa0 content\xa0 of\xa0 the\xa0 catathymic complexes (anxiety-phobic and overvalued catathymic complexes). The differences in the structure of the denotation correlated\xa0 with\xa0 the\xa0 heterogeneity\xa0 of\xa0 clinical\xa0 manifestations\xa0 and\xa0 the\xa0 dynamics\xa0 of\xa0 depression.\xa0 The\xa0 clinical\xa0 picture\xa0 of\xa0 neurotic\xa0 depressions\xa0 in\xa0 patients\xa0 of\xa0 the\xa0 first\xa0 group\xa0 transformed:\xa0 the\xa0 initially\xa0 dominant\xa0 anxiety\xa0 was\xa0 replaced\xa0 by\xa0 negative\xa0 affectivity\xa0 (apathy, anhedonia), and there was an acquisition of endoform traits. In addition to affective pathology, which was detected in 38,2%, 61,8% of patients in this group had diagnosis of schizophrenic spectrum disorders. At the same time, most of the neurotic depressions with erotomania with overvalued attachment (76,9%) did not go beyond the affective phases of the neurotic register,which\xa0 are\xa0 realized\xa0 on\xa0 the\xa0 trajectory\xa0 of\xa0 personality\xa0 disorders.\xa0 It\xa0 has\xa0 been\xa0 established\xa0 that\xa0 the\xa0 main\xa0 personality\xa0 dimension\xa0 for\xa0 all\xa0 patients\xa0 participating \xa0in\xa0 the\xa0 formation\xa0 of\xa0 neurotic\xa0 depression\xa0 was\xa0 the\xa0 phenomenon\xa0 of\xa0 victimization,\xa0 which\xa0 characterizes\xa0 the ability of patients to get into and stay in a psycho-traumatic (frustrating) environment for a long time. In addition, it was found that 83,3% of patients had premorbid traits of cluster A (DSM-5), along with the characteristic features of clusters B and C. Conclusions: the heterogeneity of denotation of neurotic depression determined the differences in the clinical picture, dynamics\xa0 (with\xa0 different\xa0 social\xa0 and\xa0 labor\xa0 prognosis).\xa0 The\xa0 nosological\xa0 heterogeneity\xa0 of\xa0 the\xa0 conditions\xa0 combined\xa0 by\xa0 the\xa0 term\xa0 «neurotic depression» was established: along with affective pathology, the diagnosis of personality disorder and diseases of the schizophrenic spectrum was detected. The structure of the catathymic complexes is also interconnected with different personal predispositions with sensitivity to certain stressful triggers.