Всемирная психиатрия. №3 2020

Описание клинической характеристики взрослого пациента с депрессией для персонификации лечения

Mario Maj1 , Dan J. Stein2 , Gordon Parker3 , Mark Zimmerman4 , Giovanni A. Fava5 , Marc De Hert6 , Koen Demyttenaere7 , Roger S. McIntyre8 , Thomas Widiger9,10, Hans-Ulrich Wittchen11,12

1 Department of Psychiatry, University of Campania «L. Vanvitelli», Naples, Italy (Италия); 2 South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town South Africa (ЮАР); 3 School of Psychiatry, University of New South Wales, Sydney NSW, Australia (Австралия); 4 Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence RI, USA (США); 5 Department of Psychiatry, University at Buffalo, State University of New York, Buffalo NY, USA (США); 6 University Psychiatric Centre KU Leuven, Kortenberg Belgium (Бельгия); 7 KU Leuven Department of Neurosciences, Leuven Belgium (Бельгия); 8 University Psychiatric Centre, University of Leuven, Leuven Belgium (Бельгия); 9 Department of Psychiatry, University of Toronto, Toronto Canada (Канада); 10Department of Psychology, University of Kentucky, Lexington KY, USA (США); 11Institute of Clinical Psychology and Psy- chotherapy, Technische Universität Dresden, Dresden, Germany (Германия); 12Department of Psychiatry and Psychotherapy, Ludwig Maximilans Uni- versität Munich, Munich, Germany (Германия).

Стр. 269-293

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Опубликовано: 1 октября 2020

Аннотация / Abstract

a:2:{s:4:"TEXT";s:65533:"a:2:{s:4:"TYPE";s:4:"HTML";s:4:"TEXT";s:114124:"Депрессия – это наиболее часто диагностируемый в психиатрической практике синдром. Широко известно, что этот синдром не является однородным и что для персонификации плана лечения требуется дальнейшая клиническая характеристика конкретного пациента1,2. Однако общепринятой практикой является выбор лечения в каждом конкретном случае исключительно на основе синдромального диагноза. Клинические исследования показали, что различные препараты и психотерапия являются «эквивалентными» в лечении синдрома, и поэтому эти вмешательства обычно воспринимаются как взаимозаменяемые.Подбор терапии депрессии в настоящее время обычно основан на предпочтениях врача/пациента, вопросах безопасности по методу проб и ошибок, без должного внимания к особенностям конкретного случая. Это может быть одной из причин почему большинство пациентов с диагнозом депрессии не достигают ремиссии на фоне первого подобранного метода лечения3, и по крайней мере 30% не отвечают на два последующих доказательных метода лечения, и могут быть считаться резистентными к терапии4.Рекомендации по лечению не помогают в этом отношении. Они склонны фокусироваться на тяжести депрессивного эпизода как основном или единственном элементе, на котором основывается выбор лечения5,6, но этот акцент подрывается в клинической практике отсутствием надежного и общепринятого способа оценки этой тяжести. На самом деле определения различных степеней тяжести депрессивного эпизода, представленные DSM-57 и ICD-118 (возможно, несколько общие, без четких опорных точек, не основанные на доказательствах и с низкой межэкспертной надежностью), часто игнорируются клиницистами. Кроме того, самые последние данные исследований, по-видимому, не подтверждают идею о том, что реакция на антидепрессанты или психотерапию зависит от тяжести депрессивного синдрома9,10.На протяжении десятилетий были предложены различные клинические и биологические предикторы ответа на антидепресс...

Депрессия – это наиболее часто диагностируемый в психиатрической практике синдром. Широко известно, что этот синдром не является однородным и что для персонификации плана лечения требуется дальнейшая клиническая характеристика конкретного пациента1,2. Однако общепринятой практикой является выбор лечения в каждом конкретном случае исключительно на основе синдромального диагноза. Клинические исследования показали, что различные препараты и психотерапия являются «эквивалентными» в лечении синдрома, и поэтому эти вмешательства обычно воспринимаются как взаимозаменяемые.Подбор терапии депрессии в настоящее время обычно основан на предпочтениях врача/пациента, вопросах безопасности по методу проб и ошибок, без должного внимания к особенностям конкретного случая. Это может быть одной из причин почему ...

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