Anxiety-depressive Spectrum Disorders Research Articles

Mental disorders in antiphospholipid syndrome patients: association with clinical and immunological manifestations of the disease

The aim of this work is to clarify the association between the clinical and psychopathological features of mental disorders (MD) and the clinical and immunological features of antiphospholipid syndrome (APS).Material and methods. The study included 107 patients (34 (31.8%) men and 73 (68.2%) women) aged 18 to 69 years (40.6±10.4 years (M±SD)), 54 (50.5%) – with primary APS (PAPS), established according to the international criteria of 2006 and 53 (49.5%) patients – with reliable diagnosis of systemic lupus erythematosus (SLE), according to the European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ ACR) 2019 criteria, with a secondary APS. Risk of thrombosis in APS was assessed by the GAPSS (Global Anti-Phospholipid Syndrome Score). MD were diagnosed by a psychiatrist in accordance with 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and Diagnostic and Statistical Manual of mental disorders, 5th edition (DSM-5).Results. Mental disorders are detected in the vast majority of patients with APS (98 (91.6%)), predominantly in anxiety-depressive spectrum disorders (ADSD; 90 (84.1%)). Depressive disorders are not associated with a high risk of thrombosis according to the GAPSS, but more severe variants of depression are more common in patients with high anti-β2 -glycoprotein I (anti-β2 GP1) and low/moderate anti cardiolipin (aCL) antibodies. Anxiety disorders were diagnosed only in patients with a high risk of thrombosis according to GAPSS, high aCL and IgG anti-β2 GP1. Schizotypal disorder was identified only in patients with a high risk of thrombosis and positive anti-phosphatidylserine/prothrombin complex antibodies (aPS/PT) regardless of class, and also more often in patients with high IgG anti-β2 GP1. Epilepsy was observed only in patients with positive aPS/PT, regardless of class. Cognitive impairment (CI), mostly mild and moderate, was found in the vast majority of patients with APS (102 (95.3%)). Dementia was detected in 7 (6.5%) patients, and only in those who had acute or transient cerebrovascular accident. When compared with the general population, dementia developed at an earlier age (up to 65 years). For patients with a high risk of thrombosis, moderate CI is more typical. CI and their severity are not associated with the duration of APS, but are associated with positivity for IgG aPS/PT, acute or transient cerebrovascular accident and the duration of comorbid ADSD.Conclusion. A high frequency of MD in patients with APS revealed. Associations of MD with clinical and immunological manifestations of APS were determined. CI in patients with APS is heterogeneous and are associated with both clinical and immunological manifestations of APS and MD. Identification of CI and determination of their characteristics should be confirmed by clinical, psychopathological and pathopsychological methods in order to personalize their correction within the partnership model of care.

Adherence to treatment of hematological malignancies patients with anxiety and depression

To establish the features of the influence of anxiety and depressive disorders on treatment adherence, as well as to clarify the factors associated with it in hematologic malignancies patients. The study included 117 patients: 51 men and 66 women, aged 19 to 67 years, with Hodgkin's lymphoma - 88, acute lymphoblastic leukemia - 16 and aplastic anemia - 13 patients. Patients were examined by psychiatrist using the Brief Psychiatric Rating Scale, as well as some psychometric methods. Anxiety-depressive spectrum disorders were detected in 36 (40.9%) patients with Hodgkin's lymphoma and 8 (50%) with acute lymphoblastic leukemia, in the aplastic anemia group there were three (23.1%) of such patients. It was found that the average adherence to treatment was in 2/3 of patients, low and high - in the remaining 1/3 of patients. With medium and low adherence to treatment, the risk of adverse events increases by an average of 1.7 times. The adherence to treatment it is significantly higher in patients older than 45 years. Signs of depression that negatively correlated with adherence to treatment were pessimism and disruption of social ties. Adherence to treatment significantly positively correlates with the following types of attitudes towards the disease: anosognosic, hypochondriac and egocentric, and significantly negatively correlates with the following types of attitudes towards the disease: anxious, melancholic and dysphoric. Anxiety/depressive disorders contribute to reduced adherence of hematologic malignancies patients to treatment. Their correction and increased adherence should be carried out jointly by hematologists and mental health professionals.

Mental disorders in patients with systemic lupus erythematosus: association with activity and the course of rheumatic disease

To clarify the relationship between the clinical and psychopathological features of mental disorders, clinical and laboratory manifestations of activity and the nature of the course of systemic lupus erythematosus (SLE). The study included 119 patients - 98 (82.4%) women, mean age 36.5±12.4 years (M±SD) - with a reliable diagnosis of SLE (EULAR/ACR 2019 criteria), 51 (29.5%) of them - with secondary antiphospholipid syndrome - APS (International criteria of 2006). Among patients with SLE a high frequency of anxiety-depressive spectrum disorders (ADSD) and cognitive impairment (CI) was revealed. There was an association of greater severity of depression with high SLE activity index, acute/subacute onset of the disease course according to the classification of V.A. Nasonova, relapsing-remitting and chronic active current disease activity patterns of SLE according to the classification of S. Barr - M. Petri. Anxiety disorders were associated with subacute onset and relapsing-remitting disease activity patterns of SLE and were not associated with SLE activity index. Bipolar disorder was detected more often in patients with chronic SLE. Acute psychosis/delirium was associated with acute onset of SLE. Organic CI was associated with APS, chronic onset and long quiescent disease activity patterns of SLE. The episindrome and schizotypal disorder in patients with SLE are more often caused by concomitant APS. Patients with high SLE activity index should be of particular concern to rheumatologists regarding the diagnosis of depressive disorders. Patients with concomitant APS need timely diagnosis and treatment of CI and episindrome in order to improve the prognosis of the disease and the overall quality of life.

Transcranial magnetic stimulation in late-aged people with depressive disorders

IntroductionOne of the most common mental disorders in the elderly is depression.Because of the high frequency of side effects of pharmacotherapy and the comorbid medical illnesses, there are not many ways to treat it.Non-drug therapies, such as repetitive transcranial magnetic stimulation (rTMS), could help overcome the limitations of standard drug therapy for this type of mental disorders.ObjectivesDevelopment of approaches to improving improve the provision of psychiatric care to elderly patients using rTMS.Methods30 patients over the age of 60 with anxiety-depressive spectrum disorders meeting criteria F30-39, F06.3, F06.4 (ICD-10) and a control group with similar criteria that were not treated with rTMS, were recruited from the psychiatric department at a university hospital (Moscow Scientific Research Institute of Psychiatry). Clinical, psychopathological, anamnestic, psychometric (Montgomery-Asberg scale (MADRS), Hamilton scale (HARS), Mini-mental state examination scale (MMSE) instrumental (electroencephalography) research methods were used. Patients of the experimental group underwent 15 sessions of low-frequency rTMS on the right dorsolateral prefrontal cortex (RDLPC). Conditions for the application of 1200 pulses were as follows: frequency - 1 Hz; intensity - 120% of the threshold of motor response (RMT) of the subject; pulse number - 1200; pulse sequence - 300; sequence duration - 300 seconds; sequence interval - 60 seconds; and stimulation time - 23 minutes. Subsequently, the patients were re-examined using the above-mentioned scales to assess their mental state in dynamics.ResultsAnalysis of the collected data shows an increase in the number of respondents and the frequency of achieving remission in the experimental group compared to the control group. No severe side effects of rTMS were observed.ConclusionsrTMS may be a safe method of adjuvant therapy in groups of elderly patients with anxiety-depressive spectrum disorders. Further studies will be needed to clarify the results.Disclosure of InterestNone Declared

Improvement of the psycho-emotional state and cytokine profile of patients with rheumatoid ­arthritis and hepatic steatosis after therapy with thioctic (lipoic) acid and methotrexate

Background. The social significance of such inflammatory diseases as rheumatoid arthritis is growing all over the world, which determines the need to find new ways to optimize the ongoing standard therapy.
 Aim. Evaluation of the effect of combined use of thioctic (lipoic) acid with methotrexate in comparison with methotrexate and meloxicam therapy on the psycho-emotional state of patients with rheumatoid arthritis and hepatic steatosis.
 Material and methods. The study included 60 women diagnosed with rheumatoid arthritis and hepatic steatosis. By the beginning of the observation, patients divided into two groups were comparable according to all criteria for inclusion in the study. The first group took methotrexate and thioctic (lipoic) acid, the second group methotrexate and meloxicam daily for a month. The psycho-emotional state of the patients according to the Spielberger tests modified by Yu.L. Khanin and depression according to Beck were assessed. Determination of pro-inflammatory cytokines was carried out by enzyme immunoassay. The research results were subjected to statistical processing.
 Results. An intergroup analysis showed that the use of thioctic acid and methotrexate led to a significant decrease in the level of anxiety in patients, in contrast to women taking methotrexate and meloxicam (the level of reactive anxiety decreased by 2.7 times compared with baseline data; p=0.03). It is also important to note the revealed correlation between the degree of decrease in the level of tumor necrosis factor and the severity of anxiety 1 month after taking the cytostatic and the hepatoprotector (Kendal's Tay-b correlation coefficient, r=0.732, p=0.046).
 Conclusion. The inclusion of thioctic (lipoic) acid in the basic therapy with methotrexate in patients with rheumatoid arthritis and hepatic steatosis improves their psycho-emotional state in the form of a decrease in anxiety-depressive spectrum disorders, practically normalizing the level of pro-inflammatory tumor necrosis factor , the degree of reduction of which correlates with the degree of reduction in the level of anxiety.

Features of the course of ankylosing spondylitis depending on the psychosocial status and duration of the disease

Purpose: to study the influence of psychosocial indicators and duration of the disease on the quality of life (QL), anxiety-depressive spectrum disorders (ADSD) and clinical and laboratory activity in patients with ankylosing spondylitis (AS). Materials and methods: the study involved 112 patients with AS. The author assessed clinical and laboratory activity of the disease, QOL (SF-36), the presence of ADSD (using the Taylor, Hamilton, and Spielberger scales), and autonomic disorders depending on the duration of the disease and the level of education. Results: in most patients with AS, signs of ADSD were detected, while in persons with higher education (HE), ADSD were significantly more common, and they had a higher level of anxiety and depression. Patients with HE have lower vital activity, the ability to adapt to social functioning, and an indicator of mental health. The study of the effect of AS duration on QL allowed the author to establish an association between an increase in AS duration and a decrease in the indicator of the psychological component of health. Conclusions: male patients with a higher level of education, who are characterized by lower indicators of QOL, mainly psychological health, have a greater tendency to develop ADSD. An increase in the duration of AS disease does not affect the development of ADSD. With the duration of AS for over 10 years, the indicators of the psycho-emotional and physical components of QOL decrease. There is a tendency in the increase in anxiety and depression levels, antioxidant protection factors are getting exhausted, inflammatory activity progresses, and personal perception of pain intensifies.

Anxiety-depressive spectrum disorders in cervical dystonia

A decrease in the quality of life (QoL) in cervical dystonia (CD) is often due to anxiety and depressive manifestations. However, the change in the emotional state of patients with CD after botulinum therapy has not been studied enough. Objective : a comparative analysis of the severity of anxiety and depressive disorders in CD and their dynamics during the year with a decrease in movement disorders during botulinum therapy. Patients and methods . 25 patients with CD (9 men and 16 women) and 25 healthy volunteers (11 men and 14 women) were examined. The severity of CD was assessed using the Tsui Rating Scale. To assess the level of anxiety, the GAD-7 scales were used, depression – PHQ-9. The EQ-5D questionnaire was used to assess the quality of life. The emotional state was assessed before and after 4, 8 and 12 months of the correction of movement disorders using botulinum therapy. The control group was examined at similar time intervals. Results and discussion . Patients with CD have a significant increase in anxiety (13.5±3.6) and depression (7.72±5.2), as well as a decrease in QoL (66.6±11.0) compared with the control group (p<0.001). Anxiety symptoms show a significant dependence on the clinical severity of CD symptoms and regress against the background of successful botulinum therapy – from 13.50±3.6 at the time of the first visit to 8.20±2.9 (p<0.001) by the fourth visit. Depressive symptoms do not depend on the motor manifestations of CD and do not improve as a result of successful botulinum therapy, tending to increase from 7.72±5.2 to 10.12±5.8 (p<0.05). Conclusion . The persistence of depression after successful botulinum therapy in CD indicates its role as an emotional manifestation of the disease independent of motor disorders.

Anxiety, depression and stress tension screening in patients with rheumatic and musculoskeletal diseases at the onset of the 2019 coronavirus disease (COVID-19) pandemic

The aim - screening of anxiety, depression and stress in patients with rheumatic and musculoskeletal diseases (RMD) and medical workers at the beginning of the COVID-19.Material and methods. 150 patients (men/women: 39 (26.0%)/111 (74.0%); mean age - 43.2±16.1 years) with RMD, hospitalized at the V.A. Nasonova Research Institute of Rheumatology (Moscow) from July to November 2020, and 32 relatively healthy medical workers (men/women: 3 (9.38%)/29 (90.6%), mean age - 40.7±14.6 years) as a control group was included in the study. The Hospital Anxiety and Depression Scale (HADS) and the Depression Anxiety and Stress Scale - 21 Items (DASS-21) were used for anxiety, depression and stress screening. Results. Frequency of anxiety-depressive spectrum disorders in patients with RMD was 48% (according to DASS-21) and 27.2% (according to HADS), which did not differ significantly from the control group - 46.9% and 18.8% respectively. According to the DASS-21, patients with systemic sclerosis were significantly more likely to have a combination of clinically significant anxiety, depression and stress compared to healthy control (6 (46.2%) vs 4 (12.5%); p=0.02) and patients with spondyloarthritis (6 (46.2% vs 5 (16.1%); p=0.045). The severity of anxiety was significantly higher among patients with RMD - systemic lupus erythematosus, primary Sjogren's syndrome and systemic sclerosis, according to both scales. The severity of depression, anxiety and stress was significantly higher in women with RMD, rural residents and patients taking moderate and high doses of glucocorticoids. The pathological stress level was experienced by younger medical workers (27.5±5.45 vs 45.8±13.8 years; p=0.001). The transferred coronavirus infection did not lead to an increase in the severity of depression, anxiety and stress tension among patients, however, among medical workers, the frequency of clinically significant anxiety (4 (57.1%) vs 6 (24%)) and stress (3 (42.8%) vs 5 (20%)) was 2.2-2.9 times higher in those who have been ill. When compared with the results of the similar screening by HADS in 2012, the proportion of RМD-patients with clinically significant anxiety and depression over the past 8 years and in connection with the pandemic COVID-19 has not significantly changed.Conclusion. A new threat to health, isolation and uncertainty at the beginning of the COVID-19 were an additional stressful factor for patients with RМD, however, given the high background prevalence of low-severity chronic depression with frequent onset before RМD, the factor of the COVID-19 is not a key factor in provoking mental disorders.

Influence of successful psychopharmacotherapy of anxiety-depressive spectrum disorders on the severity of chronic fatigue in patients with rheumatoid arthritis

To assess the influence of psychopharmacotherapy (PPT) of anxiety and depressive disorders on fatigue severity in patients with rheumatoid arthritis (RA). 128 RA-patients were included. Severity of fatigue was measured with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with MontgomeryAsberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 сDMARDs (n=39), 2 сDMARDs+PPT (sertraline or mianserine), n=43, 3 сDMARDs+bDMARDs (n=32), 4 сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 5 years, antidepressants from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Multinominal logistic regression analysis was conducted to determine factors associated with clinically important fatigue. Multinominal logistic regression analysis showed clinically important fatigue at baseline to be positively associated (OR 13.57; 95% CI 3.04460.486; p=0.01) and remission of ADD negatively associated (OR 0.162; 95% CI 0.0320.809; p=0.027), with clinically important fatigue at 5 years follow-up (R2=0.385, p0.0001). Due to significant relationship between mental health status, antidepressants treatment and clinically important fatigue in RA-patients, all patients reporting clinically important fatigue should be recommended mental health counselling by a licensed psychiatrist.

Psychiatric aspects of spondyloarthritis

Spondyloarthritis refers to immune-mediated inflammatory rheumatic diseases characterized by the most pronounced pain, inflammatory activity and disability of patients of working age. One of the most frequent comorbid to spondy-loarthritis diseases that weigh down the course and outcomes are anxiety-depressive spectrum disorders. Chronic inflammation with hyperproduction of cytokines of the interleukin-23/interleukin-17 axis and violation of intracellular signaling of these cytokines, developing against the background of a violation of the stress and immune response, is a key pathogenetic mechanism that combines spondyloarthritis and anxiety-depressive spectrum disorders, and dictates approaches to their therapy. The article discusses the current understanding of the prevalence of mental disorders among patients with spondyloarthritis and their negative impact on the course and outcomes of the rheumatic disease, the common pathogenesis and provoking factors, the influence of antidepressants on spondyloarthritis outcomes and anti-inflammatory drugs, primarily interleukin-17 inhibitors and tumor necrosis factor alpha inhibitors on the symptoms of anxiety-depressive spectrum disorders.

Experience with citicoline in patients with post-stroke cognitive impairment

Objective: to investigate the efficacy and safety of citicoline (Ceresil® Canon) in patients with post-stroke cognitive impairment.Patients and methods. Examinations were made in 33 patients aged 45 years and older who had experienced primary ischemic hemispheric stroke with complaints of a decline in memory or other cognitive functions. The cognitive status was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The presence of anxiety-depressive spectrum disorders was determined on the Hospital Anxiety and Depression Scale. All the patients received citicoline (Ceresil® Canon) oral solution at a dose of 1000 mg/day for 3 months.Results and discussion. Citicoline administration showed a statistically significant reduction in the severity of cognitive impairment (p<0.001). The time course of positive changes in the cognitive status of patients was reflected by an increase in the median score on the MMSE from 26 [25; 27.5] to 28 [26.5; 29] and on MoCA from 23 [21; 25] to 25 [22; 26]. There was a decline in the number of patients with anxiety-depressive disorders. No adverse events or side effects were found in the patients.Conclusion. The findings suggest that citicoline (Ceresil® Canon) produced as an oral solution is well tolerated and improves cognitive functions and affective sphere in patients in the recovery period of ischemic stroke.

Chronic pain and depression in patients with rheumatoid arthritis: results of five - year follow - up

128 patients with reliable diagnosis of RA [111 (86.7%) women and 17 (13.3%) men] were examined. The mean age of patients was 47.4±11.3 years, the median duration of the disease was 96 [48; 228] months. When included in the study in most patients, the activity of RA in DAS28 was moderate (n=56; 43.7%) or high (n=48; 37.5%). BPI (Brief Pain Inventory) scale was used to determine the severity of pain and its impact on various aspects of life. The anxiety - depressive spectrum disorders (ADDs) were diagnosed by psychiatrist during a semistructured interview according to ICD-10 criteria in 123 (96.1%) patients. The severity of depression was determined by the Montgomery-Asberg depression rating scale, anxiety - by Hamilton anxiety scale. For the diagnosis of cognitive impairment used clinical and psychological techniques. Psychopharmacotherapy (PPhT) by antidepressants or anxiolytics is offered to all patients with ADDs, 52 of them agreed to treatment, 71 patients refused. The next groups selected depending on the therapy: 1st - with conventional disease - modifying antirheumatic drugs (cDMARDs; n=39), 2nd - with cDMARDs+PPhT (n=43), 3d - with cDMARDs + biologic (b) DMARDs (n=32), 4th - with cDMARD+bDMARDs+PPhT (n=9). The dynamics of ADDs and outcomes of RA in 5 years were evaluated in 83 (67.5%) patients. When included in the study, 94 (75.2%) patients with RA had moderate and severe pain. According to the regression analysis, the maximum intensity pain in BPImax after 5 years of follow - up associated not the only factors connected with RA - high DAS28, the serum level of C-reactive protein, the degree of radiological stage and functional insufficiency, duration of RA and a lesser duration of glucocorticoids intake, but also with continuing depressive episodes in the framework of recurrent depression and the initial presence of cognitive impairment. The severity of pain after 5 years of follow - up was higher in RA patients receiving only сDMARDs, without the use of bDMARDs and in the absence of PPhT associated with ADDs. Depressive episode within recurrent major depression is a significant factor in the chronicity of pain in patients with RA. Timely effective PPhT of depression, selected taking into account depression structure and personal characteristics of the patient, leads to a steady decrease in the severity of pain in patients with RA.

AFFECTIVE DISORDERS AND QUALITY OF LIFE IN PATIENTS WITH CORONARY HEART DISEASE ACCORDING TO PSYCHOMETRIC TESTS DATA

The aim was to study the frequency and severity of affective disorders and quality of life in patients with coronary heart disease (CHD): unstable and stable angina of II–III functional class. Materials and methods. 488 patients with verified CHD were examined to identify and assess anxiety-depressive spectrum disorders by the screening questionnaire of Moscow Research Institute of Psychiatry, Ministry of Health of Russia. 172 patients with CHD from the screening group – 96 (55.81 %) patients with unstable angina and 76 (44.19 %) with stable angina, 136 (79.07 %) men and 36 (20.93 %) women were examined with psychometric tests: Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI). Modified Seattle Angina Questionnaire (SAQ) was used to study quality of life. Excel and Statistica 6.0 programs were used to assess statistical process of the material. Results. According to the screening questionnaire, in screening group of patients with CHD (n = 488) the symptoms of anxiety-depressive disorder were present in 398 (81.56 %) patients, in 90 patients (18.44 %) they were absent (p <0.0001). In the group of patients with CHD examined by psychometric tests (n = 172), the symptoms of anxiety-depressive disorder according to the screening questionnaire were revealed in 137 (79.65 %) patients, in 35 (20.35 %) patients they were absent (p <0.0001). The severity of depression symptoms according to BDI scale (17.11 ± 9.38 vs. 12.73 ± 8.1 points; p <0.04) and the symptoms of anxiety-depressive disorder according to the screening questionnaire were noted more often (p <0.0008) in patients with unstable angina compared with stable angina – in 85 (88.54 %) vs. 52 (68.42 %) patients (р <0.0008). In the group of patients with stable angina the level of depression according to BDI scale in patients taking pharmacological treatment was higher in comparison with the patients who underwent myocardial revascularization (14.56 ± 9.0 vs. 10.03 ± 6.13 points; p <0.01). Quality of life parameter according to modified SAQ was statistically significantly decreased in the subgroups of patients with increasing severity of depression symptoms according to BDI scale (10–63 points) compared with the subgroup of patients with no depression (0–9 points). Conclusion. According to the screening questionnaire, a high incidence of anxiety-depressive disorder was found in patients with CHD. The symptoms of anxiety-depressive disorder and the severity of depression symptoms according to BDI scale were noted more often in the group of patients with unstable angina compared with the group of patients with stable angina. Quality of life parameter according to modified SAQ was statistically significantly reduced with increasing severity of depression symptoms according to BDI scale in subgroup of patients with symptoms of depression compared with the subgroup of patients without depression. According to the results of the study the BDI scale is more sensitive for the diagnosis of depression than the HADS scale.

EFFECTIVENESS OF SHORT-TERM PSYCHOTHERAPY OF DEPRESSIVE AND ANXIETY DISORDERS

The article features the effectiveness of different psychotherapeutic approaches to psychological care in order to determine the most effective type of psychotherapy for depressive and anxiety disorders. The research considers the place of anxiety and depressive disorders in the ICD-10 classification; the article notes a contradiction between the theoretical separation of these disorders in ICD-10 and the frequent comorbidity (50 %) of these disorders in the clinical picture; the authors justify the choice of one form of psychotherapy for disorders of the anxiety-depressive spectrum. The paper contains an overview of the results of meta- analyses for person-centered, psychodynamic, cognitive-behavioral psychotherapy. It describes and analyses the most common approaches to psychotherapy of anxiety-depressive spectrum disorders by applying combined pharmacotherapy and psychotherapy in the cognitive-behavioral and interpersonal approaches. Based on the overview of meta-analyses of evidencebased studies of the effectiveness of these types of psychotherapy, it is concluded that short-term interpersonal and cognitive-behavioral approaches are most preferable in the therapy of anxiety and depressive disorders. There is a tendency towards further integration of approaches on the methodological basis of cognitive-behavioral therapy.

Comparative analysis of anxiety-depressive spectrum disorders in patients with rheumatic diseases.

Research objective - comparative analysis of incidence and structure of anxiety-depressive spectrum disorders (ADD) in patients with various rheumatic diseases (RD). 613 patients with RD were enrolled in the study: 180 with a reliable diagnosis of systemic lupus erythematosus (SLE), 128 with rheumatoid arthritis (RA), 110 with systemic sclerosis (SSc), 115 with Behcet's disease (BD), 80 with primary Sjögren's syndrome (pSS). Female prevailed in all groups (95% of patients with pSS, 88,2% - SSc, 87,2% - RA, 85,5% of SLE) except BD patients (70% male). The mean age was 42.3±1.54 years and was lower in patients with BD (33.3±0.98 years) and SLE (34.6±0.93 years) compared to patients with SSc (49.9±2.47 years), RA (47.4±0.99 years) and pSS (46.2±2.3 years). The mean RD duration was 130,0±8,65 months and was more at BD - 148,5±10,4 months, pSS - 141,6±8,92 months, RA - 138,4±10,1months, and less at SLE - 134,9±8,8 months and SSc - 87,0±5,04 months. The mean SLE activity index SLEDAI was 9,13±0,63 points (high), RA (DAS28) - 5,26±0,17 points (high), BD (BDCAF) - 3,79±0,2 points (moderate) and SSc by G. Valentini - 1,1±0,20 points (moderate). Glucocorticoids took 100% of patients with pSS, 91,1% - SLE, 90% - SSc, 87% - BD and 67,2% - RA patients; conventional disease modifying anti-rheumatic drugs (cDMARDs) took 90% of patients with SSc, 84% - BD, 79,6% - RA, 68% - pSS, 40,6% - SLE. Biologic DMARDs took 32% of patients with RA, 17,4% - BD, 7,3% - SSc and 7,2% - SLE. Mental disorders were diagnosed by psychiatrist as a result of screening by the hospital anxiety and depression scale (HADS) and in semi-structured interview in accordance with the ICD-10/ DSM-IV. The severity of depression was evaluated by Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety - by Hamilton Anxiety Rating Scale (HAM-A). Projective psychological methods were used for cognitive impairment detection. Screening of depressive disorders (HADS-D≥8) was positive in 180 (29,4%) patients with RD, including 74 (41%) patients with SLE, 38 (35%) - SSc, 29 (23%) - RA, 23 (20%) - BD and 16 (20%) - pSS; anxiety disorders (HADS-A≥8) - in 272 (44,4%) patients, including 66 (52%) patients with RA, 40 (50%) - pSS, 77 (43%) - SLE, 45 (41%) - SSc and 44 (38%) - BD. In accordance with the ICD-10/ DSM-IV depressive disorders have been identified in 389 (63%) patients, including 94 (73%) patients with RA, 71 (64,5%) - SSc, 69 (60%) - BD, 90 (50%) - SLE and 39 (49%) - pSS; anxiety disorders - in 377 (61,5%) patients, including 20 (25%) patients with pSS, 44 (24,5%) - SLE, 29 (23%) - RA, 20 (17%) - BD and 7 (6,4%) - SSc. Anxiety-depressive spectrum disorders are typical for most patients with RA, SLE, SSc, pSS and BD. ADDs diagnosis in RD patients with the use of the HADS did not reveal a significant proportion. To obtain objective data on the frequency and structure of ADDs, psychopathological and clinical psychological diagnosis is necessary.

A role of progesterone and its metabolites in regulation functions of the brain

The review presents literature data reflecting the nature and mechanism of the effect of progesterone and its metabolites on human and animal brain structures. Particular attention is paid to neuroprotective, anticonvulsant, anti-anxiety and sedative properties of this hormone, which determines the prospect of its use for the prevention and treatment of human neurodegenerative diseases, epilepsy, sleep disorders, and anxiety-depressive spectrum disorders, including premenstrual and climacteric syndromes.

ASSOCIATION BETWEEN ANXIETY-DEPRESSIVE SPECTRUM DISORDERS AND JOINT DISEASE IN WOMEN

The frequency of anxiety-depressive spectrum disorders (ADSDs) in patients with rheumatic diseases (RDs) is much higher than that in the general population. ADSDs are known to be associated with pain intensity, disease activity, and functional limitations. However, the majority of available papers are limited by the framework of a certain disease. Objective: to investigate the association of ADSDs with the characteristics of joint damage beyond the nosological approach. Subjects and methods. The investigation enrolled 38 women aged 18 years and older who had different RDs and preserved reproductive function, were treated at round-the-clock hospitals, and had no clinically significant comorbid diseases. All the patients were divided into two subgroups: 1) those with predominant hand joint injury and 2) those with joint involvement at other sites. All the patients were evaluated for disease activity (DAS-28-ESR, ASDAS-ESR), pain (visual analogue scale), and functional status (HAQ). The Hospital Anxiety and Depression Scale (HADS) was used to detect ADSDs and the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale were employed to rate the severity of anxiety and depression, respectively. Results and discussion. The frequency of anxiety disorders evaluated through the HADS and the HAM-A was 44.7 and 34.2%, that of depressions was 34.2 and 60.5% respectively. The clinically evident level of HADS anxiety (11+) in Subgroup 1 was detected 5 times more frequently (30.0%) than in Subgroup 2 (5.5%); and that of HAM-A anxiety (18+) was twice as often: 45.0 and 22.2%, respectively. The frequency of clinically significant depression according to HADS (11+) and HAM-D (14+) in Subgroup 1 was 30.0 and 40.0%, and that in Group 2 was 11.1 and 16.7% respectively. The probability of severe depressions (HAM-D 19+) in hand joint injury was twice higher (odds ratio, 2.2; 95% confidence interval, 1.51–3.19) than in arthritis at various sites. Thus, this investigation provides evidence for the high frequency of ADSDS in patients with RDs. Reproductive-aged women with hand joint injury are one of the most vulnerable groups.

The anxiety-depressive spectrum disorders in patients with larynx diseases

To perform a psychopathological and clinical/psychological analysis of anxiety-depressive spectrum disorders (ADSD) in inflammatory otorhinolaryngological disease - larynx granuloma. We examined 30 patients, aged 33-65 years, including 13 patients with post-surgical recurrence of granuloma and 17 patients diagnosed for the first time with granuloma. The relationship between larynx granuloma and ADSD, predominantly of chronic type was shown. Prolonged psychotraumatic factors play a significant role in the development of ADSD. A role of anxiety in the ADSD structure as well as an importance of their diagnosis for a choice of therapeutic tactics was confirmed. Psychopharmacotherapy has led to a reduction in the frequency of granuloma relapses. The results confirmed the productivity of affective-stress model, based on the type of affectivity, in the analysis of ADSD.

P-742 - Cognitive disturbances in the primary health care patients suffering with organic and anxiety-depressive disorders

Differential evaluation of cognitive, anxiety and depressive disturbances presents an important issue in clinical qualification of the patients attending primary health care. The paper studies the feasibility of the psychometric tests application for this purpose. A total of 60 patients (10 men, 50 female) aged from 18 to 75, that were on treatment in a district policlinic, were studied. The first group included 23 patients with anxiety-depressive spectrum disorders (ADSD), the second group - 17 patients with mild organic mental disorders (MOMD), the third group - 20 patients with combination of these disorders (ADSD+MOMD). The fourth group consisted of 26 healthy persons. The following psychometric instruments were used: Screening Questionnaire for Identifying Risk of Affective Disorder Spectrum, Hospital Anxiety and Depression Scale, Beck Depression Inventory, the methods “10 Words List Recall”, “Six Figures Recall”, and “Objects Exclusion”. Results of the study showed, that these tests help to improve diagnosing and differentiation of cognitive impairments in ADSD, MOMD, and ADSD+MOMD. In particular, the patients with MOMD are characterized by disorders of verbal and visual image memory, decrease of internal determination of estimates, and narrowing of the range of the meaning articulation. The patients with ADSD have no symptoms of the cognitive deficit changes, but they do have the cognitive style disturbances with some decrease of the working memory capacity, the trend to the decrease of the internal selection consistency and rather good ability to articulate the meanings. In the cases of ADSD+MOMD there is a combination of the above specified traits.

P-1467 - Relationship between women infertility and depression, anxiety and stress disorders

Introduction According to WHO data about 60–80 million people around the world suffer from infertility. This problem causes huge negative impact on family life. Forty percent of women with infertility experience various mental disorders. Aims/objectives: Investigation of anxiety-depressive spectrum disorders in women with infertility. Assessment of impact of women infertility on self-esteem and certain aspects of life. Development of recommendations on mental health services for women, experiencing infertility problems. Methods Sixty women at the age of 21 to 36 years, experiencing infertility problems for maximum period of 60 months participated in the study. Anxiety, depression and stress rates were assessed using Depression, Anxiety and Stress Scale - DASS-21, the level of self-esteem was determined with Rosenberg Self-Esteem Scale. Data was analyzed using SPSS 16.0. Results Such factors as education, occupation, religious beliefs, and accessibility of proper medical services were determined to have significant impact on depression, anxiety and stress rates as well as on self-esteem and satisfaction with life of women with infertility. Conclusions Screening for early detection of mental health problems, psychological counseling and family therapy for couples encountering infertility problems was recommended.