Anxiety-depressive Spectrum Research Articles

To study the features of vegetative homeostasis in patients with ankylosing spondylitis with anxiety-depressive spectrum disorders

Objective: study of indicators of vegetative homeostasis and psychosocial functioning in patients with ankylosing spondylitis (AS) with anxiety-depressive spectrum disorders (RTDS).Materials and methods: the study involved 112 patients with AS in whom the presence of RTDS was assessed according to the Taylor, Hamilton, Spielberger scales, autonomic disorders by testing according to the methods “Wayne-patient” (VP) and “Wayne-doctor” (BB), heart rate variability (HRV), quality of life (QOL) and clinical and laboratory activity of the disease.Results: the majority of patients with AS showed signs of RTDS, while this category of patients showed signs of autonomic dysfunction, lower indicators of vital activity, the ability to adapt social functioning and the level of mental health. The HRV indicators obtained in this category of patients indicate an imbalance of sympathetic and parasympathetic influences with the dominance of the sympathetic link of regulation, which confirms the correlation analysis.Conclusions: patients with AS with RTDS are characterized by low vital activity, reduced adaptation to social functioning, depletion of antioxidant potential. They are characterized by a deterioration in HRV indicators with a predominance of the sympathetic link of the ANS, low resistance to psychoemotional stress with a predominance of the defensive component in the structure of vegetative security.

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.

The peak of the ‘Blue Monday’ depression and winter blues.

IntroductionFor many people, January is the most depressing month of the year. “Blue Monday” encompasses the generally accepted belief that Monday is the hardest day of the week compared to Friday and Saturday, which are the most anticipated days of the week. The connection between the color blue and Monday is in the emotional stage, which is presented as emotional anger. The third Monday in January is currently known as the most depressing day of the year. Speaker Cliff Arnall was the first to declare that day in 2014. The theory says that this is the time of the year when respiratory diseases are common, the day is shorter, the weather conditions are worse, and the time when people are burdened with guilt about whether they will achieve their New Year’s resolutions.ObjectivesThe aim of this work was to investigate that on third Monday in January there were more suicide attempts and that there were more depressive disorders in emergency psychiatric admissions.Methods In the research, we included participants who were examined at the Emergency Psychiatric Admission of the Clinical Hospital Center in Split, in the period from 2019. until 2023. Inclusion criteria were respondents of both sexes, examined in the outpatient clinic on Mondays in January for five years.ResultsThere were 198 of them in total. The primary outcome of the research is to determine the occurrence (incidence) of psychological deterioration in patients diagnosed with the anxiety-depressive spectrum. The secondary research outcomes are of a descriptive nature, patient follow-up, examination outcome, and psychiatric heredity.ConclusionsFor now, there are no strong scientific foundations that justify the formula of “the most depressing day” of the year, some scientists believe that it is a marketing trick to achieve higher tourist revenues. However, the post-holiday period can have an impact on individuals.Disclosure of InterestNone Declared

Mental disorders in internally displaced persons: clinical features, therapy, prevention

IntroductionMilitary aggression significantly worsens the mental health of the population due to losses: human, economic-financial, social-psychological, ecological. One of the negative consequences of military aggression is migration, the movement of the population within the country and outside its borders, which disrupts adaptation and leads to the formation of a wide range of psychological and mental disorders.ObjectivesTo study the state of mental health of internally displaced persons (IDPs) and to develop, on this basis, a system of therapy and prevention of mental disorders.MethodsA combination of clinical-psychopathological and psychodiagnostics methods of studying were used to identify peculiarities of the mental state and various forms of mental pathology.Results270 IDPs were examined. It was established that the group of IDPs is heterogeneous and includes 3 categories: 1 group of IDPs who do not have signs of mental disorders (conditionally healthy) (34.81%), 2 group of IDPs who have separate symptoms of mental disorders (risk group) (25.19 %) and the 3 group of IDPs with established mental disorders (40.00 %). The assessment of the general condition of the IDPs of the 1 group shows that they have various somato-neurological disorders and the absence of mental disorders. The assessment of the emotional state of the IDPs of the 2 group indicates the presence of various emotional disorders that include asthenic syndrome (41.18 ± 5.97) %, agripnic syndrome (45.59 ± 6.04) %, somato-vegetative syndrom (30.88 ± 5.60) %, anxiety-depressive syndrome (20.59 ± 4.90) %). That separate syndromеs do not meet the criteria of ICD-10 and were subthreshold. The general features of mental disorders in group 3 IDPs are characterized by the predominance of disorders of the anxiety-depressive spectrum and includes adjustment disorders (F43.2) in 35,18%; post-traumatic stress disorder (F43.1) in 17.59%; a moderate depressive episode (F32.1) in 16, 67%; organic affective (depressive) disorder (F06.3) in 14.81%; organic anxiety disorder (F06.4) in 9.28%; recurrent depressive disorder (33.1) in 6.48%.ConclusionsA system of treatment of mental disorders in IDPs has been developed, which includes pharmacotherapy (the usage of antidepressants, anxiolytics and, if necessary, antipsychotics), cognitive-behavioral and family psychotherapy. For prevention mental disorders among IDPs of groups 1 and 2, a psychoeducational program was created, aimed at forming awareness of clinical manifestations of mental disorders, opportunities to prevent their formation, and necessary actions in conditions of exacerbation of the mental state. Evaluation of the effectiveness of the developed system of therapy and psychoeducation has testified to their effectiveness.Disclosure of InterestNone Declared

The structure of clinical and psychopathological consequences of coronavirus disease COVID-19 in people with a history of mental disorders

The impact of the COVID-19 pandemic on mental health indicates the need to define psychopathological manifestations to highlight diagnostic criteria. The purpose of the study is to determine the structural features of clinical and psychopathological manifestations of mental disorders after the coronavirus disease COVID-19 in people with a history of mental disorders. In the Department of Border Psychiatry of the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine", 95 patients with a history of mental disorders who had suffered the coronavirus disease COVID-19 were examined. The group examined included patients with recurrent depressive disorders (F32), with mental disorders of organic origin (F06.3, F06.4) and with neurotic, stress-related and somatoform disorders (F41.1, F42.3), F48.0). It was determined that the clinical manifestations of mental disorders in the examined patients are characterized by a predominance of affective symptoms in combination with pronounced specific cognitive, ideational, and somato-vegetative disorders, as well as disorders of the effector-volitional sphere. The results of a psychodiagnostics study (on the MADRS, HARS, GAD-7 and CGI-S scales) showed that the structure of clinical manifestations in these patients was characterized by a predominance of affective disorders of the anxiety-depressive spectrum of varying severity, which had certain differences among nosological groups. Determining the clinical and psychopathological features of the structure of mental disorders after suffering from COVID-19 is important not only for their diagnosis, but also for early and adequate therapy, taking into account the identified features that can act as targets for therapeutic intervention. Key words: clinical-psychopathological consequences, mental disorders, coronavirus disease COVID-19

A correlation between anxiety-depressive symptoms and immune-metabolic parameters in patients with mixed anxiety and depressive disorder

According to literature data, anxiety and depressive disorders are the most common mental diseases worldwide. Currently, a hypothesis of possible immune metabolic regulation of the central nervous system was put forward. The authors evaluated the indicators of humoral, cellular, and metabolic immunity in patients suffering from mixed anxiety and depressive disorder, who were under the supervision of a psychiatrist at the day hospital of the Voronezh Regional Clinical Psychoneurological Dispensary. Indicators of anxiety and depression were assessed by means of psychometric method, clinical interview, and clinical psychopathological examination, and the indicators of immune and metabolic status were examined. It was found that symptoms of anxiety and depression were accompanied by changes in immune and metabolic status. It is supposed that variations in clinical, immunological, and metabolic parameters are coordinated elements of a single pathogenetic mechanism for the formation of anxiet y-depressive spectrum disorders.

Features of olfactory impairment connected with trigeminal nerve system

Qualitative assessment of olfactory disorders after COVID-19 according to the system of olfactory and trigeminal nerves with a targeted assessment of the functional component of olfactory disorders. We examined 40 patients aged 19 to 66 who had a coronavirus infection. All patients underwent neurological, otorhinolaryngological examinations, olfactometry, filled out the hospital anxiety and depression scale. Anosmia was diagnosed in 5 (12.5%) patients, hyposmia in 21 (52.5%) patients, and normosmia in 14 (35%) patients. Formed: the 1st group - 14 patients (35%) with normogram according to olfactometry; the 2nd group - 26 patients (65%) with anosmia/hyposmia. In the 1st group, disorders of the anxiety-depressive spectrum were significantly more common. In the 2nd group, a low identification of odors was found, lying in the spectrum of fresh, sharp, unpleasant, irritating, compared with sweet and pleasant or neutral, which indicates a predominant lesion of the trigeminal system. In patients with complaints of impaired sense of smell after undergoing COVID-19, the possible functional nature of anosmia/hyposmia should be taken into account, which requires the referral of such patients to psychotherapeutic specialists, and the possible entry of olfactory disorders into the 'trigeminal' spectrum.

Fluvoxamine in the treatment of anxiety-depressive spectrum disorders

The RSCI and PubMed search databases have requested publications over the past 40 years on the search queries «fluvoxamine», «anxiety-depressive disorders», «anxiety», «depression», «comorbidity», devoted to the effectiveness of fluvoxamine in various variants of disorders of the anxiety-depressive spectrum, anxiety depressions. The data of the above studies indicate that fluvoxamine (Zovart San) in doses of 50-300 mg / day is a highly effective remedy for the treatment of not only anxiety depressions and genesis (psychogenic, organic, mixed, autochthonous-endogenous) and severity (up to psychotic), but also a wider range of anxiety-depressive disorders, including adaptation disorders, obsessive-compulsive disorder, somatized, dysmorphic, insomniac symptom complexes and eating disorders. A wide range of clinical effects of fluvoxamine is due to its main and additional mechanisms of action: blockade of serotonin reuptake, σ1-agonist activity and the effect on the metabolism of melatonin and neurosteroids catabolism.

Mental disorders, social and demographic characteristics of patients with chronic and episodic migraine

To compare socio-demographic, clinical and psychological characteristics and comorbid mental disorders in patients with chronic migraine (CM) and episodic migraine (EM). Eighty patients with migraine (40 with CM (16 men and 24 women, mean age 33.5±6.1 years) and 40 with EM (9 men and 31 women, mean age 31.4±5.7 years) were examined. All patients were interviewed and tested with psychometric methods. Socio-demographic and clinical-psychological characteristics were determined in all patients. The psychiatrist assessed the mental status of patients and diagnosed comorbid mental disorders according to the ICD-10 criteria. Symptoms of depression, high levels of trait and state anxiety, and a tendency to emotional inadequacy of response were more common in CM patients than in EM patients (p<0.05). Mental disorders, predominantly of the anxiety-depressive spectrum, were more common in CM patients than EM patients (OR (95% CI)=2.54 (2.03 to 2.98, p<0.001). Seventy-five percent of CM patients had more than one psychiatric diagnosis, almost a quarter of CM patients had schizotypal disorder, which is significantly higher than in EM patients (OR (95% CI)=1.99; 1.03 to 2.42, p<0.001). There were more unmarried, single (without constant partner), unemployed, high-education patients in the CM group than in the EM group. The negative impact of headache on the daily activity of patients was significantly higher in the CM group than in the EM group (p<0.05). Mental disorders and psychological features (anxiety, depression symptoms, a tendency to emotional inadequacy of response) are more common in CM patients than in EM patients. The presence of these factors may contribute to the chronification of migraine.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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).&#x0D; 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&lt;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&lt;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&lt;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.

Therapy of breast cancer patients with disorders of the anxiety-depressive spectrum

IntroductionBreast cancer (BC) is one of the leading causes of cancer death worldwide. The problem of mental health and quality of life of patients is currently particularly relevant. Most patients with breast cancer in the process of adapting to the disease experience certain mental disorders: depressive, anxiety-phobic and psychosomatic disorders.ObjectivesTo study the severity of anxiety-depressive disorders in the clinical picture in patients with breast cancer and evaluate the effectiveness of specialized pharmacotherapy using antidepressants in combination with antitumor therapy.MethodsThe study included 30 patients with a first established diagnosis of breast cancer and 52 patients with a follow-up history of 3-17 years. The main method of work was the clinical, psychopathological, and statistical research methods (a method using contingency tables and the Fechner coefficient, a method - Chi-square test).ResultsTo assess the severity in the clinical picture of anxiety-depressive tendencies and the effectiveness of treatment, special scales were used: hospital scale of anxiety and depression (HADS); general clinical impression scale (CGI) for assessing disease severity (CGI-S “severity”) and improvement (CGI-I “improvement”). High antidepressant therapy efficacy indicators were obtained in combination with benzodiazepine drugs and hypnotics in a group of patients with anxiety-depressive nosogenia (15 patients, 88% of respondents with reduction in starting anxiety and depression scores HADS more than 50%, CGI 85%), in the group with chronic hypochondriac dysthymia and cyclotymic endoform depression.ConclusionsThe data obtained in the study confirm the effectiveness of psychopharmacotherapy with antidepressants in breast cancer patients with identified disorders of the anxiety-depressive spectrum.DisclosureNo significant relationships.

Расстройства тревожно-депрессивного спектра у больных с ревматическими заболеваниями

Anxiety and depressive disorders play an important role not only as independent diseases, but also as conditions that occur against the background of other somatic diseases. In the practice of a rheumatologist, patients with anxiety and depression are a frequent occurrence. In patients with autoimmune rheumatic diseases, anxiety and depressive disorders are 7-15 times more common than in the general population. The main cause of depression in rheumatology is the presence of severe and chronic pain.&#x0D; Studies show that in patients with rheumatic diseases, as a rule, the following disorders of the anxiety-depressive spectrum of RTDS are detected: depressive episodes of various severity with concomitant anxiety, dysthymia, generalized anxiety disorder. Taking into account the peculiarities of diseases, the supervision of patients with anxiety and depressive disorders should be carried out by several specialists, namely a rheumatologist, a psychiatrist, a clinical psychologist. Therapy of anxiety and depressive disorders, in addition to drugs aimed at the main rheumatic disease, must also include drugs with antidepressant and anxiolytic properties (neuroleptics, antidepressants).

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.