КЛИНИКА И ЛЕЧЕНИЕ АЛКОГОЛЬНОЙ ЗАВИСИМОСТИ У ПАЦИЕНТОВ С АГРЕССИВНЫМ И АУТОАГРЕССИВНЫМ ПОВЕДЕНИЕМ (ОБЗОР ЛИТЕРАТУРЫ)

Abstract

This review article is an attempt to generalize and systematize the knowledge on the issues of affective disorders accompanied by the acts of aggression in the context of alcohol addiction. Achieving this goal required the consistent implementation of a number of tasks, and namely, a theoretical review of the material accumulated in recent years within the framework of the topic under study, its subsequent analysis and meaningful generalization. The methods of theoretical analysis and synthesis of the obtained material were used in the given work. The indicated topic of the review seems to be relevant due to the fact that, in modern psychiatry, narcology and related specialties, much attention is currently paid to aggressiveness as a stable personality trait to show aggression in all its forms. The reason for such close attention to aggressiveness is high probability of lethality in people of working age due to aggressive or autoaggressive actions. As living standards, well-being, and, subsequently, health care system improve, people are less likely to die of urgent pathology, most diseases respond to treatment and do not lead to sudden death of a patient. The situation is different with external causes of death, the lion’s share of them being caused precisely by aggressive actions in their various forms. The latter in one way or another are often interconnected with alcoholization of an individual: acts of aggression are either provoked by alcohol intoxication, or may result from an already formed dependence syndrome. The special features of the development, clinical pattern and treatment of affective disorders in alcohol dependence syndrome, accompanied by aggression and autoaggression have been considered in the present paper. As a result of the review, the main concepts of the development of affective disorders accompanied by the acts of aggressive behavior in the alcohol dependence syndrome have been identified; the main mechanisms of the occurrence of aggression in alcohol-dependent patients have been indicated; the key points of pharmacotherapy influence have been determined, and namely, the use of normotimic drugs, the most rational of which, in terms of the effectiveness-adverse reactions ratio, are oxcarbazepine and topiramate, as well as the use of drugs of the selective serotonin reuptake inhibitors (SSRIs) group, as the most relevant when choosing antidepressant therapy for alcohol-dependent patients. The effectiveness of the long-term therapy with disulfiram has been determined in cases of ensuring compliance control. The relevance of the proper use of lithium salts in the treatment of this group of patients has been designated.