Some Trends of Clinical Phenomenology of Modern Depressive Disorders

Materials and methods

With the observance of the principles of biomedical ethics, we have clinically examined 245 patients (107 men and 138 women) with depressive disorders who applied for medical assistance at Vinnitsa Regional PsychoNeurological Hospital from 2015 to 2019: 80 patients (42 men and 38 women) with bipolar affective disorder (ICD-10 codes F31.3 - F31.4), 96 patients (32 men and 64 women) with depressive episode (ICD-10 codes F32.0 - F32.2), and 69 patients (33 men and 36 women) with recurrent depressive disorder (ICD-10 codes F33.0 - F33.2). The average age of patients was 33.6±11.2 years (men 34.2±11.1 years, women 33.2±11.4 years), the average duration of depression was 5.0±5.6 years (men 5.7±5.8 years, women 4.5±5.4 years).

Three groups were allocated depending on the age of patients at the time of the study: up to 30 years, numbering 89 patients (group A), from 33 to 44 years, numbering 99 patients (group B), from 45 to 60 years, numbering 57 patients (group C). The average age of patients of group A was 21.6±2.1 years, group B - 35.3±3.4 years, group C - 49.5±5.3 years.

Statistical analysis of differences between groups was carried out using Fisher's exact test.

Results

An analysis of the characteristics of depressive symptoms with regard to gender factor revealed an approximately equal prevalence of mood sad in men (91.6%) and women (91.3%); in general, this symptom was detected in 91.4% of the patients (Table 1).

Most of other depressive symptoms were more common in women, in particular, anxiety and phobic symptoms: 89.1% versus 78.5% in men (84.5% in general, p<0.05), asthenic symptoms (86.2% versus 69.2%, overall 78.8%, p<0.01), loss of pleasure (84.8% versus 76.6%, overall 81.2%, p<0.1), suicidal thoughts and thoughts of death (69.6% versus 57.9%, overall 64.5%, p<0.05), senesto-hypochondriac and pseudo- somatic symptoms (87.0% versus 77.6%, overall 82.9%, p<0.05).

Table 1

The structure of clinical depressive symptoms, taking into account the gender factor

In women insignificantly more revealed lowed concentration/decision making (84.8% versus 81.3%, overall 83.3%, p>0.05) and dyssomnical symptoms (93.5% versus 92.5%, in general, 93.1%, p>0.05), and in men - dysthymic symptoms (54.2% vs. 48.6%, in general, 51.0%, p>0.05).

The study of the clinical symptoms of depression, taking into account age, revealed some regularities.

The general trend is the lower severity of typical depressive symptoms in younger age groups and an increase in the proportion of asthenic, dysthymic and pseudosomatic manifestations in these groups (Table 2).

In group A persistent mood sad was detected in 83.1% of those patients. In group B the proportion of patients with this symptom increased to 94.9% (p<0.01), and in group C to 98.2% (p<0.01). The differences between groups B and C are not statistically significant.

Similar patterns were identified for anxiety and dissomnical symptoms, lowed concentration/decision making and suicidal manifestations: the smallest proportion of these symptoms was found in group A, and the largest - in group C.

Table 2

Table 3

The structure of the main forms of depression, taking into account the gender factor

Thus, in women revealed forms with prevalence of anergic and asthenic components (30.4% versus 19.6%, overall 25.7%, p<0.05), anxiety and phobic forms (46.4% versus 26, 2%, overall 37.6%, p<0.01), senesto-hypochondriac and pseudo-somatic components (43.5% versus 30.8%, overall 38.0%, p<0.05) were significantly more common, and insignificantly more often the vital forms of depression (45.7% versus 42.1%, overall, 44.1%, p>0.05).

In men, adynamic (31.8% versus 12.3%, overall, 20.8%, p<0.01) and dysphoric (28.0% versus 11.6%, overall, 18.8%, p<0.01) forms of depression prevalied.

Combined forms of depression were more frequently detected in women (73.2% versus 65.4%, 69.8% in total, p>0.05).

The study of forms of depression, taking into account the leading syndrome and age groups, also identify a some features (table 4).

Anergic, adynamic and senesto-hypochondriac depression is characterized by the highest prevalence in group A, the lower - in group B, and the most lowest - in group C.

Table 4

Structure of the main forms of depression by age groups

Depression with anergic components was detected in 33.7% of patients in group A, in 22.2% patients in group B, and in 19.3% of patients in group C, adynamic depression - respectively in 22.5%, in 20.2% and in 19.3% of patients, senesto-hypochondriac depression - respectively in 44.9%, in 36.4% and 29.8% of those surveyed.

The differences are statistically significant when comparing groups A and C for anergic and senesto- hypochondriacal forms (p<0.05), close to the accepted level of statistical significance when comparing groups A and B for anergic depression (p=0.055), for the rest - not statistically significant.

The opposite tendency was revealed for anxiety-phobic and vital depressions: the largest share of these types of depression was found in group C, and the least - in group A.

Anxious depression prevailed in 49.1% of patients in group C, in 35.4% of patients in group B, and in 32.6% of patients in group A, vital depression - in 47.4%, 44.4%, and 41.6% respectively. The differences are statistically significant for anxiety-phobic depression when comparing groups A and C (p<0.05), and are close to the accepted level of statistical significance when comparing groups B and C (p=0.065).

Several other patterns identified for dysphoric depression. It was most often met in group B (26.3%), somewhat less often in group A (15.7%), and least often in group C (10.5%). Differences are statistically significant when comparing groups B and C (p<0.05), and are close to the accepted level of statistical significance when comparing groups A and B (p=0.056).

In the majority of those examined (71.4% in total), combined forms of depression occurred. At the same time, the most often combined forms of depression were detected in groups A (77.5%) and B (73.7%), and less often in group C (57.9%). Differences between groups A and C, B and C are statistically significant (p<0.05).

Discussion

The results obtained allow us to identify several major trends characterizing the features of the course of depressive disorders at the modern stage. this decrease in the share of classical variants of depression with an increase in the proportion of atypical forms of depressive disorders due to the inclusion of anxious and phobic components and dysthymic circle disorders in the clinical picture of depression against the background of persistent dyssomnia. These trends, in our opinion, can be considered as one of the manifestations of modern pathomorphosis of depressive disorders.

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