Всемирная психиатрия. №3 2018

Тяжесть психических расстройств

Mark Zimmerman, Theresa A. Morgan, Kasey Stanton

Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA

Стр. 253-269

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Опубликовано: 28 декабря 2018

Аннотация / Abstract

a:2:{s:4:"TEXT";s:65533:"a:2:{s:4:"TYPE";s:4:"HTML";s:4:"TEXT";s:114340:"Перевод: Мурашко А.А. (Москва) Редактура: к.м.н. Рукавишников Г.В. (Санкт-Петербург) Вопрос об оценке тяжести психических расстройств имеет важное клиническое значение. Так, степень тяжести влияет на решения об объеме необходимой медицинской помощи и на решения о социальной помощи вследствие инвалидности по психическому расстройству. Противоречия существуют как по вопросам эффективности антидепрессантов в зависимости от степени тяжести депрессии, так и в том, что касается предпочтительности медикаментозных методов перед психотерапией при тяжелой депрессии. Степени тяжести используются для оценки исходов в исследованиях терапии и могут применяться в качестве предикторов в клинической практике. Но что на самом деле означает сказать, что у кого-то тяжелое заболевание? Означает ли тяжесть количество симптомов у пациента? Их выраженность? Частоту или персистенцию? Влияние симптомов на функционирование или качество жизни? Вероятность того, что заболевание приведет к бессрочной инвалидности или смерти? Не затрагивая вопрос операционализации тяжести расстройств, рассмотрим другой аспект – должна ли тяжесть концептуализироваться одинаково для всех заболеваний или ей следует быть быть специфичной для разных расстройств? В данной работе мы оцениваем, как характеризуют степени тяжести в исследованиях и современных психиатрических диагностических системах с акцентом на депрессию и расстройства личности. Наш обзор показывает, что в DSM-5 тяжесть различных расстройств оценивается по-разному и исследователи применяют множество способов определения тяжести как депрессии, так и расстройств личности, хотя тяжесть первой в основном определяется в соответствии со значениями шкал оценки симптомов, тогда как тяжесть вторых чаще определяется нарушениями функционирования. Ввиду того что влияние на функционирование симптоматических расстройств зависит от факторов, не связанных с собственно расстройством, таких ка...

Перевод: Мурашко А.А. (Москва) Редактура: к.м.н. Рукавишников Г.В. (Санкт-Петербург) Вопрос об оценке тяжести психических расстройств имеет важное клиническое значение. Так, степень тяжести влияет на решения об объеме необходимой медицинской помощи и на решения о социальной помощи вследствие инвалидности по психическому расстройству. Противоречия существуют как по вопросам эффективности антидепрессантов в зависимости от степени тяжести депрессии, так и в том, что касается предпочтительности медикаментозных методов перед психотерапией при тяжелой депрессии. Степени тяжести используются для оценки исходов в исследованиях терапии и могут применяться в качестве предикторов в клинической практике. Но что на самом деле означает сказать, что у кого-то тяжелое заболевание? Означает ли тяжесть количество симп...

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