Невротическая депрессия: проблема нозологической квалификации

Abstract

Objective: to study the clinical characteristics, dynamics, nosological qualifications and factors involved in the formation of neurotic depression. Material and methods: 60 patients (women — 55, men — 5) with an average age 36,9 ± 10,8 years were examined, the average duration of depressive phases was 18,1 ± 10,8 months. The study was conducted with using clinical, catamnestic, pathopsychological, statistical methods. Psychometric scales (HAM-D, MFI-20, SANS, PANSS) and questionnaires (Questionnaire of personality traits of an adult, SPQ-A, SCL-90, Holmes–Ray Stress Inventory) were used. Results: the states combined by the term «neurotic depression» are clinically heterogeneous (depressions with victimization phenomena with the separation anxiety and depressions with love addiction — erotomania), primarily in the content of the catathymic complexes (anxiety-phobic and overvalued catathymic complexes). The differences in the structure of the denotation correlated with the heterogeneity of clinical manifestations and the dynamics of depression. The clinical picture of neurotic depressions in patients of the first group transformed: the initially dominant anxiety was replaced by negative affectivity (apathy, anhedonia), and there was an acquisition of endoform traits. In addition to affective pathology, which was detected in 38,2%, 61,8% of patients in this group had diagnosis of schizophrenic spectrum disorders. At the same time, most of the neurotic depressions with erotomania with overvalued attachment (76,9%) did not go beyond the affective phases of the neurotic register,which are realized on the trajectory of personality disorders. It has been established that the main personality dimension for all patients participating in the formation of neurotic depression was the phenomenon of victimization, which characterizes the ability of patients to get into and stay in a psycho-traumatic (frustrating) environment for a long time. In addition, it was found that 83,3% of patients had premorbid traits of cluster A (DSM-5), along with the characteristic features of clusters B and C. Conclusions: the heterogeneity of denotation of neurotic depression determined the differences in the clinical picture, dynamics (with different social and labor prognosis). The nosological heterogeneity of the conditions combined by the term «neurotic depression» was established: along with affective pathology, the diagnosis of personality disorder and diseases of the schizophrenic spectrum was detected. The structure of the catathymic complexes is also interconnected with different personal predispositions with sensitivity to certain stressful triggers.