Some Trends of Clinical Phenomenology of Modern Depressive Disorders

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Some Trends of Clinical Phenomenology of Modern Depressive Disorders

Belov O., Pshuk N.

Vinnytsya National Medical University named after Pirogov, Vinnytsya, Ukraine

Abstract

In the article, there are analyzed the features of clinical phenomenology of depressive disorders at the modern stage.

The aim of research was to study the features of clinical phenomenology of depressive disorders at the modern stage, taking into account gender and age factors.

We examined 107 men and 138 women with depressive disorders; 3 groups were created depending on age: up to 30 years (A), from 33 to 44 years (B), from 45 to 60 years (C). There was revealed an approximately equal prevalence of sad mood in men and women; most of other depressive symptoms were more common in women: anxiety and phobic symptoms, asthenic symptoms, loss of pleasure, suicidal thoughts and thoughts of death, senesto-hypochondriac and pseudo-somatic symptoms; in men - dysthymic symptoms.

The general trend of the clinical symptoms of depression, taking into account age, is lower severity of typical depressive symptoms and increase of the proportion of asthenic, dysthymic and pseudosomatic manifestations in younger age groups. Anxiety and dissomnical symptoms, decrease of concentration/decision making, and suicidal manifestations were found less often in the group A, and most often - in the group C. Asthenic and pseudo-somatic symptoms were most often detected in the group A, less often - in the group C. The largest proportion of dysthymic symptoms was found in the group B, the smallest - in the group A, and slightly less - in the group C. The study of the forms of depression with regard to the leading syndrome revealed the prevalence of the majority of them among women. In women, there were revealed the forms with the prevalence of anxiety, anergic, senesto-hypochondriac components. In men, adynamic and dysphoric forms of depression prevailed. Combined forms of depression were more frequently detected in women. Anergic, adynamic and senesto-hypochondriac depression is characterized by the highest prevalence in the group A, anxiety and vital depressions - in the group C, dysphoric depression - in the group B. The most often combined forms of depression were detected in the groups A and B, and less often - in the group C.

Major trends that characterize the features of the course of depressive disorders at the modern stage are decrease of the share of classical variants of depression with the increase of the proportion of atypical forms due to inclusion of anxious and phobic components and dysthymic disorders on the background of persistent dyssomnia.

Keywords: depressive disorders, clinical phenomenology.

Некоторые тенденции клинической феноменологии современных депрессивных расстройств

БеловА.А., ПшукН.Г.

Винницкий национальный медицинский университет имени Н.И. Пирогова, Винница, Украина

Резюме

В статье анализируются особенности клинической феноменологии депрессивных расстройств на современном этапе.

Целью работы было исследование особенностей клинической феноменологии депрессивных расстройств на современном этапе с учетом гендерного и возрастного факторов.

Нами клинически обследовано 107 мужчин и 138 женщин, страдающих депрессивными расстройствами; при этом были выделены 3 группы в зависимости от возраста: до 30 лет (А), 33-44 года (В), 45-60 лет (С). Выявлена примерно одинаковая распространенность сниженного настроения у мужчин и женщин; большинство других депрессивных симптомов чаще встречались у женщин: тревожные, астенические, потеря удовольствия, суицидальные мысли и мысли о смерти, сенесто-ипохондрические и псевдосоматические симптомы, а у мужчин - дис- тимическая симптоматика.

Общей тенденцией клинической феноменологии депрессии с учетом возраста является снижение выраженности типичных депрессивных симптомов и увеличение доли астенических, дистимических и псевдосоматических проявлений в более молодых возрастных группах. Тревожность и диссомнические симптомы, снижение концентрации внимания и трудности принятия решений, а также суицидальные тенденции наименее часто обнаруживались в группе А, а наиболее часто - в группе С. Астенические и псевдосоматические симптомы чаще всего обнаруживались в группе А и наиболее редко - в группе С. Наибольшая представленность дистимических симптомов была выявлена в группе В, несколько меньшая - в группе С, наименьшая - в группе А.

Изучение форм депрессии с учетом ведущего синдрома выявило их большую распространенность среди женщин. У женщин выявлены формы с преобладанием анергического, тревожного, сенесто-ипохондрического компонентов. У мужчин преобладали адинамические и дисфориче- ские формы депрессии. Комбинированные формы депрессии чаще выявлялись у женщин. феноменология депрессивный расстройство тревожный

Для анергической, адинамической и сенесто-ипохондрической депрессий характерна наибольшая распространенность в группе А, для тревожной и витальной - в группе С, для дис- форической - в группе В. Наиболее часто комбинированные формы депрессии были обнаружены в группах А и В.

Основными тенденциями, характеризующими особенности течения депрессивных расстройств на современном этапе, являются снижение доли классических вариантов депрессии с увеличением доли атипичных форм за счет включения тревожных и фобических компонентов, а также дистимических расстройств на фоне стойкой диссомнии.

Ключевые слова: депрессивные расстройства, клиническая феноменология.

INTRODUCTION

Depressive disorders are one of the main problems of modern psychiatry [1-3]. Depressive disorders are one of the important risk factors for suicidal behavior, as well as social disadaptation in patients and their microsocial environment, in particular, disruption of family system homeostasis [4, 5]. An important factor in the development of preventive measures for depressive disorders is the study of their pathomorphosis, in particular, clinical phenomenology of depressive disorders at the modern stage [6-8]. At the same time, a some of important issues of clinical pathomorphosis of depressive disorders remain insufficiently studied, and the data of existing studies are incomplete and contradictory [9, 10].

PURPOSE

The aim is to investigate features of clinical phenomenology of depressive disorders at the modern stage, taking into account the gender and age factors.

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 pseudosomatic symptoms (87.0% versus 77.6%, overall 82.9%, p<0.05). 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.

Table 1