Impact of anxiety and depression disorders on adherence to anticoagulant therapy among patients with atrial fibrillation

Aim. To determine the possible impact of anxiety and depression disorders on the adherence of patients with atrial fibrillation (AF) to anticoagulant the rapy.Material and methods. The study included outpatients with AF of any type. After signing the informed consent, patients filled out questionnaires and scales that determined the level of anxiety and personal predisposition (MMAS-8, MMAS-4, SF-36, SHAI, STAI, HADS, NEO-FFI).Results. A total of 117 outpatients treated for AF were included. The mean age of patients was 74±5 years (men, 38%). Based on MMAS-4 and MMAS-8 results, adherent and non-adherent cohorts of patients were formed. Low adherence group had significantly higher situational anxiety according to STAI (45,9±9,9 vs 41,1±10,7, p=0,045) and depression according to HADS (7,9±3,6 vs 5,9±3,5, p=0,018). SF 36 showed that non-adherent patients had a lower general health (41,6±12,9 vs 52,2±20,0, p=0,01). Five-factor model revealed an association between low compliance and low extraversion (21,3±6,6 vs 26,4±7,2, p=0,002). Pharmacokinetic data on blood concentrations of anticoagulants or its metabolites at the second visit were available in 76 (67%) patients. Assessment of pharmacokinetic and compliance data revealed a moderate direct correlation (Matthews correlation coefficient (MCC), 0,345) and a weak direct correlation with the MMAS-8 (MCC, 0,177). The difference in MMAS-4 and MMAS-8 scores between high and low pharmacokinetic adherence groups was significant on both scales (p=0,011 and 0,015, respectively).Conclusion. The rationale for widespread introduction of standardized questionnaires and scales (MMAS 4, MMAS 8, STAI, HADS, SF 36, Big 5) was shown in order to early identify patients with low adherence to treatment. The results highlight the need for further study of the contribution of psychiatric disorders to low compliance to anticoagulant therapy

Психосоматические функциональные расстройства в пульмонологической практике

The relevance of studying psychosomatic disorders in somatic clinical practice (including pulmonary practice) stems from the significant prevalence of these disorders, as well as the difficulties in making a differential diagnosis and choosing the most effective tactics for patient management.The aim of this review was to analyze the available publications on the problem of psychosomatic functional disorders in pulmonary practice, such as hyperventilation syndrome (HVS), including HVS associated with Severe Acute Respiratory Syndrome-related CoronaVirus 2 (SARS-CoV-2) infection, vocal cord dysfunction, and psychogenic cough. The article discusses clinical features of different variants of functional disorders and accompanying psychopathological symptoms (panic attacks, generalized anxiety, etc.), as well as psychogenic factors of their manifestation and changes in the clinical features over time. The corresponding section briefly summarizes current ideas about approaches to effective treatment of this group of disorders and prevention of their chronification.Conclusion. The clinical heterogeneity of psychosomatic functional disorders in pulmonological practice has been demonstrated, as have important aspects of the diagnosis and treatment of these disorders.Актуальность изучения психосоматических расстройств (ПСР) в соматической клинике (в т. ч. пульмонологической практике) продиктована значительной распространенностью рассматриваемой патологии, а также трудностями проведения дифференциального диагноза и выбора наиболее эффективной тактики ведения пациентов.Целью настоящего обзора явился анализ доступных публикаций по проблеме функциональных ПСР в пульмонологической практике – гипервентиляционный синдром (ГВС), включая ГВС, ассоциированный с перенесенной коронавирусной инфекцией SARS-CoV-2 (Severe Acute Respiratory Syndrome-related CoronaVirus 2), дисфункция голосовых связок и психогенный кашель. Обсуждаются клинические, клинико-динамические особенности различных вариантов функциональных расстройств и сопутствующей психопатологической симптоматики (панические атаки, генерализованная тревога и пр.), а также психогенные факторы их манифестации. Кратко резюмированы современные представления о подходах к эффективной терапии расстройств этой группы и профилактики их хронизации.Заключение. Продемонстрирована клиническая гетерогенность функциональных ПСР в пульмонологической практике, представлены важные аспекты диагностики и терапии данных нарушений

Типология расстройств личности и реагирования на заболевание при хронической обструктивной болезни легких

Summary. Patterns of disease-related psychological response, some of which are anxiety and depression, determine the adherence to treatment, the course and prognosis of the disease. Though an important role of disease-related psychological response is accepted in international guidelines on the management of chronic obstructive pulmonary disease (COPD), this problem and the patients' personality traits require further investigations.The aim of this study was to investigate relationships between COPD-related psychological response and personality disorders (PD) in COPD patients. The study sample included 56 patients (mean age 64.6 ± 8.5 years) admitted to a clinical hospital of I.M. Sechenov's Medical University. All patients were observed by a psychiatrist, psychologist and therapist. Psychometric scales (Beck Depression Inventory scale (BDI), projective psychological questionnaires "Color Relation Test" and "Draw-A-Person test") and the Russian-version SF-36 were used. Basic types of COPD-related psychological response and PD have been determined. In hyponosognostic patients (51.9 %), a dissociative PD was predominantly found (34.5 % of patients with this response type); in neurotic hypochondria (health-related anxiety) patients (32.1 %), histrionic PD prevailed (38.9 %); and in depressive patients (8.9 %), hypertimic PD was diagnosed more often (60 %). Personality traits significantly contributed to the COPD-related psychological response. These results could be used to improving the COPD patient's therapy and rehabilitation.Резюме. Типы реагирования на соматическое заболевание (СЗ), такие как тревога и депрессия, во многом определяют приверженность лечению, течение и прогноз заболевания. Несмотря на большую роль типов реагирования, закрепленную основными документами по менеджменту хронической обструктивной болезни легких (ХОБЛ), эта проблема, как и личностные характеристики больных ХОБЛ, способные, в свою очередь, вносить вклад в формирование представлений пациента о болезни, остаются недостаточно изученными. Целью исследования было изучение соотношения типов реагирования и расстройств личности (РЛ) у пациентов с ХОБЛ.Выборка составила 56 пациентов (средний возраст – 64,6 ± 8,5 года) УКБ № 1 Первого МГМУ им. И.М.Сеченова. Все больные были обследованы психиатром, психологом и терапевтом. Использовались следующие психометрические шкалы: шкала Beck Depression Inventory (BDI), проективные психологические опросники "Цветовой тест отношений" и "Проективный рисунок человека". Оценивалось качество жизни больных при помощи русскоязычной версии опросника SF-36. Были определены основные типы реагирования на СЗ и РЛ, а также их соотношение у пациентов с ХОБЛ. При аберрантной ипохондрии (гипонозогнозия), выявленной у 51,9 % больных ХОБЛ, наиболее распространенным было диссоциальное РЛ (34,5 %); при невротической ипохондрии (тревога за здоровье) у 32,1 % больных наиболее часто обнаруживалось истерическое РЛ (38,9 %); при депрессии (8,9 %) – гипертимное РЛ (60 %).Таким образом, личностные черты вносят существенный вклад в формирование типов реагирования на СЗ. Полученные данные могут быть использованы для оптимизации лечебного процесса при проведении реабилитационных мероприятий у больных ХОБЛ

TOWARDS A CLASSIFICATION ISSUE OF PSYCHIATRIC DISORDERS IN CARDIOLOGY (DISPUTABLE ASPECTS OF THE ARTICLE BY DROBIZHEV M. YU., KIKTA S.V., MACHILSKY O.V., “CARDIOPSYCHIATRY. TRANSLATION ISSUES”)

The article is on the discussion of the article by Drobizhev M. Yu., Kikta S. V., Machilsky O. V. “Cardiopsychiatry. Translation issues”, published in Cardiovascular Therapy and Prevention 2016; 15(4): 88-97. The authors propose classification of cardiopsychiatric disorders which is based only on literary data and is itself just a reductionist attempt to relate neurophysiological mechanisms with complex psychopathological and psychosomatic compounds being reified at the level of cardiovascular system. Also, it cannot be agreed, the publication part on psychopharmacotherapy of psychiatric disorders cardiological practice, where the authors position is just an application of one single medication

DIFFERENT APPROACHES TO THERAPY OF DEPRESSIVE DISORDERS IN CLINICAL PRACTICE

Depressive disorders, being the most common psychiatric pathology in general somatic practice, often act as a cause of aggravation of somatic/neurological pathology, increasing the risk of disability and death of patients. There is no uniform clinical pattern to the depressive disorders. Neurotic depression, nosogeny/somatogeny, and somatoreactive cyclothymia are the most common in the general medicine. Due to variety of clinical forms of affective diseases, they should be detected in a timely manner and referred for appropriate differentiated antidepressant treatment. As a prescribed drug, you should opt for an antidepressant that has an optimally balanced effect, fewer side effects and a minimal interaction with other drugs

Somatic depression with cognitive impairment in a female patient with hypertension

The paper describes a clinical case of hypertension and somatic depression in a female patient. It considers the differential diagnosis of somatic symptomatology within affective disorders, depicts the manifestations of a somatic disease, and analyzes the aspects of personal predisposition to a mental disorder. The authors note the  advantages of an interdisciplinary approach to therapy with  antihypertensive drugs and antidepressants and psychotherapy. Of  particular interest is the problem in the diagnosis and therapy of  moderate cognitive impairment in a patient with cardiac and psychiatric comorbidities

DEPRESSION IN NEUROLOGICAL PRACTICE

The article presents a short literature review on depressive disorders in neurological practice. It summarizes information on the prevalence rates for depressive disorders in the main forms of neurological pathology, their negative impact on the quality of life and the course of a neurological disease, the clinical features of the affective pathology in certain diseases, and modern approaches to the therapy of depression comorbid with neurological disorders. The article is illustrated with a clinical case that confirms the importance of timely diagnostics and treatment of depressive disorders

Chronic back pain and mental disorders

Chronic back pain is a significant biomedical problem due to its high prevalence and negative impact on quality of life and socioeconomic indicators. Mental disorders play a substantial role in the genesis of chronic pain. This review discusses the issues of back pain comorbid with depressive, anxiety disorders, post-traumatic stress disorder, and somatoform disorder. It also considers the features of the clinical manifestations of pain associated with mental disorders. There are data on the neurobiological relationship between pain and mental disorders and on the personality traits of patients with chronic back pain