INTRASYNDROMIC PHENOMENOLOGY OF ENDOGENOUS DEPRESSIVE DISORDERS IN ASPECT OF CLINICAL PATHOMORPHOSIS

Abstract

Problem of phenomenological pathomorphosis of depressive disorders is one of the actual problems in modern clinical psychiatry.

The aim of the study – to investigate features of clinical pathomorphosis of endogenous depression in comparative aspect.

Materials and Methods. We studied medical records of 236 patients with endogenous depressive disorders, who applied for medical aid in 1971–1995; 189 patients with endogenous depression who applied for medical aid in 2015–2018 were examined clinically.

Results and Discussion. It is revealed that clinical pathomorphosis of depressive disorders at modern stage is characterized by an increase in prevalence of asthenic symptomatology (79.9 % vs. 67.4 %, p<0.01), inability to concentrate and make decisions (71.4 % vs. 61.0 %, p<0.05), anxiety symptoms (81.0 % vs. 73.7 %, p<0.05), pessimism (80.4 % vs. 79.2 %, p<0.05), suicidal thoughts (70.4 % vs. 60.2 %, p<0.05), gastrointestinal symptoms (60.3 % vs. 51.7 %, p<0.05), insomnia manifestations (93.1 % vs. 81.8 %, p<0.01), and decrease in manifestations of anhedonia (76.2 % vs. 84.3 %, p<0.05) and low self-esteem (80.5 % vs. 73.0 %, p<0.05). It was revealed that intrasyndromological structure of depressive disorders at modern stage is characterized by decrease in prevalence of vital depression (from 56.8 % to 42.9 %, p <0.05) and anesthetic depression (from 25.8 % to 18.0 %, p < 0.05) with an increase in prevalence of apathic depression (24.3 % vs. 17.4 %, p <0.05), presence of anxiety-phobic and hypochondriac inclusions (56.1 % vs. 47.5 %, p <0.05), insomnic disorders in form of presomnic, intrasomnic, postsomnic manifestations with predominance of the latter (93.1 % vs. 81.8 %, p<0.01), vegetative-somatic disorders and somatization manifestations in the form of polymorphic cenestopathy (77.8 % vs. 68.2 %, p<0.05), cenesto-algetic syndrome (11.6 % vs. 6.4 %, p<0.05) and asthenic depression (79.9 % versus 66.9 %, p<0.01), agitated depression (38.6 % vs. 30.1 %, p<0.05) and depression with flight of ideas (28.0 % vs. 20.8 %, p<0.05).

Conclusions. Change in the intrasyndromic structure of depressive disorders due to prevalence of apathic and anxiety depression with reducing of vital and anesthetic forms is the basis of modern clinical pathomorphosis of depressive disorders. Study of total constellation of symptoms of dyssomnical register demonstrates predominance of postsomnic manifestations with domination of obsessive-phobic reflections and inferiority ideas. Revealed patterns of pathomorphosis should be taken into consideration while developing differentiated therapeutic, rehabilitation and preventive measures.