Клініко-психопатологічні аспекти психогенно обумовлених депресивних розладів

Abstract

Проведено комплексне обстеження 45 пацієнтів з психогенними депресивними розладами. В результаті проведеного дослідження в залежності від характеристики психопатологічних симптомів та ступеню їх вираженості виокремлено наступні варіанти депресивного синдрому: тривожний, дисфоричний, астенічний, іпохондричний. Визначено типи копінг-стратегій подолання конфліктних ситуацій в залежності від провідного афективного симптомокомплексу; Проведено комплексное обследование 45 пациентов с психогенными депрессивными рас- стройствами. В результате проведенного исследования в зависимости от характеристики психопатологи- ческих симптомов и степени их выраженности выделены следующие варианты депрессивного синдрома: тревожный, дисфорический, астенический, ипохондрический. Определены типы копинг-стратегий преодо- ления конфликтных ситуаций в зависимости от ведущего аффективного симптомокомплекса; The increasing urgency of the depressive disorders problem is caused by their prevalence, significant influence on the life quality and social activity of a person. The aim of research was to study clinical and psychopathological features of patients with psychogenic depressive disorders. A complete physical examination of 45 patients (35 women, 10 men) aged from 23 to 44 years was performed. According to ICD-10, the adjustment disorder (F43.2) was diagnosed in all the patients. The disease duration at the time of the examination ranged from 1 to 6 months. To define the state of the patients, clinical and psychopathological, clinical and anamnestic, psychometric, and statistical methods were used. The clinical picture of the patients indicated depression, loss of interest in former activities, reduction of enthusiasm and initiative that affected their self-perception, work decrement and cognitive activity level. The sleep disorders were stated in 38 (84.4%) of examined patients, loss of appetite in 31 (68,9%), different degrees of somatic symptom disorders in 37 (82,2%). On the basis of clinical and psychopathological data examinations, the following types of psychogenic depressions of neurotic level were defined: anxious in 19 (42,2%) persons, dysphoric in 7 (15,6%), asthenic in 11 (24.4%), and hypochondriac in 8 (17.8%) persons. Anxious type of psychogenic depression was characterized by feeling of anxiety based on depressed mood, tension and inability to relax, feeling of threat associated with the presence of altered somatic sensations, autonomic paroxysms. There were high (>46 points) and moderate (31-45 points) levels of reactive and personal anxiety according to Spielberger – Hanin scale, severe (>28 points) and moderate (17-27 points) depression level according to HDRS scale, the clinical manifestations of anxiety and depression according to Hamilton scale (>11points). The clinical picture of dysphoric type of psychogenic depression was characterized by depression, sadness, anxiety, severe irritability, dreariness, anger. Predominantly moderate (31-45 points) and low (11points) or subclinical (8-10 points) anxiety and depression manifestations according to HADS scale were stated. Asthenic type of depression tended to lingering course. On the background of clinical symptoms of depressive spectrum, asthenic manifestations in the form of physical weakness, emotional instability, fatigue, attention diminution, tearfulness were observed. Low anxiety according to Spielberger – Hanin scale, moderate (17- 27 points) or easy (7-16 points) depressive episode according to HDRS scale, subclinical manifestations of anxiety and depression according to HADS scale were mainly noted. The clinical picture of hypochondriac type of psychogenic depression was characterized by the dominance of motiveless anxiety pertaining health on the background of depressed mood in combination with intolerance to emotional pain, fixation on discomfort. Predominantly moderate and low anxiety levels according to Spielberger – Hanin scale, easy depressive episode according to Hamilton scale, subclinical manifestations of anxiety and depression according to HADS scale were noted. In the process of individual coping strategies diagnostics that aimed to solve conflict situations using technique of coping mechanisms diagnostics (Heim E., 1995) it was found, that among cognitive strategies, the choice of non-adaptive models in patients with psychogenic depression was demonstrated in 38 (84,4%) cases, relatively adaptive in 3 (6,7%), adaptive in 4(8,8%) cases; among emotional – in 34 (75,6%), 7 (15,6%) and 4 (8,8%) correspondingly; among behavioral – in 30 (66,7%), 8 (17,7%) and 7 (15.6%) cases. The analysis of the data showed that the non-adaptive models of the coping behavior were dominated among the examined patients, mostly of the emotional and cognitive type. Thus, the analysis of clinical and psychopathological structure of psychogenic depressive disorders stated that depending on the dominant leading affective component, different clinical variants of psychopathological symptoms can be defined, that significantly influences the coping strategies structure of solving conflict situations in cognitive, emotional and behavioral types.