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26DEFINITIONS OF ANXIETY DISORDERS ON OLD-AGED PERSONS
Abdullaeva V.K.,
Doctor of science, Chief of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy
Rustamova J.T.,
PhD, assistant of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy
Sharipova F.K.,
PhD, associate Professor of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy
Abbasova D.S.,
assistant of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy
Muhtorov B.O.,
assistant of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy
Ismatov S.Z.
masters degree student of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Abstract
We examined 40 patients (26 women, 14 men) by a clinical method aged 60 to 70 years with a diagnosis of F4 according to ICD-10 to study the clinical and psychopathological features of anxiety disorders in old age, the dynamics of their development. For this purpose, a clinical method was used using psychometric scales: the Hamilton scale for assessing the severity of anxiety (HARS) and depression (HRDS). As a result of the work, four main syndromes were identified in elderly patients, each of which is based on an obligate symptom - anxiety, which prevails at the beginning of the development of the disease. Their clinical and psychopathological structure was determined. It was found that the addition of other psychopathological symptoms to anxiety, such as depression, hypochondria, phobia, contributes to the aggravation and the formation of a more complex syndrome in structure, and increases the duration of the disease.
Key words: old age, anxiety syndrome, depression syndrome, hypochondria, phobia
Relevance. According to WHO, the most common neuropsychiatry disorders among the population aged 60 and over are dementia, which affects about 5% of the elderly population, depression, which is observed in 7% of the elderly, and anxiety disorders, which account for 3.8% of the elderly. The prevalence of anxiety states, according to numerous research results, is growing and covers over 50% of the elderly population [1]. According to various sources, due to late and unqualified diagnosis in the primary care setting, patients do not receive timely and adequate treatment, as a result of which individual symptoms of anxiety and depression are gradually getting worse and worse. Hypodiagnos-tics of anxiety-depressive states in elderly people at the initial visit to general practitioners is due to the lack of certainty of the characteristics of the psychopathological structure of anxiety and depression in this category of patients [3, 4]. Diagnosis is also complicated by the fact that anxiety-depressive states are often "masked" by various somatoneurological complaints, which are more attractive to specialists, while disorders of the mental register are left unattended [2,6]. Late seeking medical help or late detection of anxiety states by doctors is often the reason for hospitalization of patients in psychiatric hospitals. The lack of timely and adequate therapy for anxiety-depressive disorders leads to a decrease in the quality of life of the elderly [5]. The study
of psychopathological features of anxiety-depressive disorders, their clinical and dynamic characteristics will help to identify early diagnostic criteria and optimize medical and social measures for this category of patients.
Purpose of the study. To study the clinical and psychopathological features of anxiety disorders in old age, the dynamics of their development.
Material and research methods. 40 patients (26 women, 14 men) were examined by clinical-anamnes-tic and clinical-follow-up methods at the age from 60 to 70 in the conditions of the Tashkent city psychiatric hospital. For the study, patients were selected whose diagnosis was qualified by the F4 heading according to ICD-10. The study did not include patients with moderate and severe dementia, with hallucinatory-delusional syndromes, with dependence on psychoactive substances, and also suffering from schizophrenia. To assess the mental status of patients, a clinical-psycho-pathological method was used, which was supplemented by the use of psychometric scales: the Hamilton scale for assessing the severity of anxiety (HARS) and depression (HRDS). All patients underwent somatic and neurological examinations. Statistical methods were used to analyze the results.
Results and discussion. In the group of examined patients, the average age among women was 63.2 ± 6.8
years, among men - 60.3 ± 6.4 years. The average age at the onset of the disease was 51.4 ± 6.2 years. The duration of the disease averaged 12.5 ± 8.7 years. The results of the study of hereditary burden for somatic pathology stated its presence in 59.8% of patients, for mental pathology - in 37.4% of patients. The relationship between the frequency of anxiety states and the factor of hereditary burden turned out to be weak (Pearson's contingency coefficient C = 0.10; p> 0.05). 32.6% of patients had a higher education, 46.8% of patients had a secondary special education, and 20.6% of patients had a secondary education. 57.8% of patients had a family, 20.4% of patients were divorced, 21.8% of patients were widowed. Chronic somatic diseases were observed in 89.8% of patients, the correlation for this feature with the incidence of anxiety-depressive disorders turned out to be statistically significant and could be assessed within the framework of the average connection strength (C = 0.40; p <0.001). In the course of the study, in the overwhelming majority of patients, the dominance of anxiety symptoms in the clinical picture of diseases, less often of depression, which determined the severity of the condition, was established. Attention was drawn to the low syndromic and nosological specificity and significant polymorphism of anxiety-depressive states in the elderly. Anxiety, as an obligate component, from mild to moderately expressed and severe in various variations, was combined with asthenia, depression, senestopathies, phobias, hypochondria, cognitive impairments that did not reach the degree of dementia, and somato-vegetative dysfunctional disorders. To determine the severity of anxiety disorders, anxiety and depression were assessed using the Hamilton scale. Among the surveyed, the level of anxiety (HARS) in 15% of patients ranged from 5 to 12 points, which indicated a state of mild anxiety, in 31% of patients this indicator reached 25 points, revealing a more pronounced anxiety state, in 42% of patients the level of anxiety varied from 26 to 32 points, confirming the presence of panic disorders and in 12% of patients it approached the maximum mark from 35 to 50 points, revealing severe anxiety disorders. Analysis of the assessment of the level of depression revealed the presence of mild depressive symptoms in 65% of patients from 8 to 16 points on the HDRS scale, in 23% of patients this indicator ranged from 17 to 25 points, revealing moderate depressive manifestations, in 7% of patients the level of depression reached 30 points, indicating more pronounced depressive disorders and only in 5% of patients this indicator did not exceed 7 points, which indicated the absence of depressive symptoms. Within the surveyed group of anxious patients, the indicators for assessing the level of anxiety and depression according to the Hamilton scale in women turned out to be higher than in men, however, the reliability of differences was not found. Analysis of the symptoms of mental disorders and the assessment of the severity of the level of anxiety and depression using the Hamilton psychometric scale made it possible to conditionally divide the anxiety states of the elderly into several groups. Anxiety, as an obligate symptom, was the basis for the classification of syndromes. The picture of anx-
iety states changed depending on the degree of its severity. Another component was the presence and severity of an additional psychopathological symptom (depression, hypochondria, phobia). Thus, the main 4 syndromes were identified: 1) simple anxiety syndrome: anxiety prevailed, the rest of the symptoms were insignificant or mild; 2) anxiety-depressive syndrome: anxiety of varying severity was combined with symptoms of depression; 3) anxiety-hypochondriac syndrome: anxiety of different levels was combined with symptoms of hypochondria; 4) anxiety-phobic syndrome: anxiety was combined with various phobic disorders. In accordance with the identified syndromes according to the clinical and psychopathological structure, simple anxiety syndrome was observed in 18% of patients, anxiety-depressive syndrome - in 60% of patients, anxiety-hypochondriac syndrome - in 15% of patients, anxiety-phobic syndrome - in 7% of patients. The clinical picture of simple anxiety syndrome was characterized by symptoms of mental and somatic anxiety of moderate severity. Most often, patients complained of anxiety and burden with certain "painful thoughts", uncertainty about the future, "expecting something bad", internal tension, feeling of helplessness, restlessness, sweating, characteristic tremors, difficulty falling asleep, insomnia, unpleasant sensations in the region of the heart , chest, epigastric discomfort, feeling of "lack of air", dizziness, headaches, palpitations, increased blood pressure or its drops, nausea, decreased appetite. Elements of depression in the form of depressed mood were present, but did not determine the severity of the condition of patients with simple anxiety syndrome. In anxiety-depressive syndrome, symptoms of both anxiety and depression were present in various combinations. Anxiety was complemented by such symptoms of depression as feelings of longing, loneliness and hopelessness, low self-esteem, psychomotor retardation. Patients complained of "loss of the ability to enjoy life," "lack of desire to do anything," suicidal thoughts, feelings of guilt, and their own worthlessness. Patients reported decreased concentration, cognitive impairment, fatigue, difficulty falling asleep, insomnia, and shallow sleep with awakenings. In the first half of the day, the manifestations of depression prevailed in the patients: depressed mood, melancholy, ideational and motor inhibition, poor appetite, anxiety grew during the day, and by the evening the patients became more restless, capricious, irritable, presented numerous complaints of a somatic nature. Anxiety-hypochondriac syndrome manifested itself as symptoms of obsessive or overvalued hypochondria. The patients experienced fear and confidence in the presence of a serious, incurable disease, despite the receipt of the results of objective examinations, indicating the absence of any pathology. In all elderly patients with anxiety-hypochondria-cal syndrome, hypochondria was associated with preexisting anxious depression, complicating its psycho-pathological structure with the formation of a positive feedback. The increased level of anxiety drew the attention of patients to various sensations arising in the body or internal organs, subjective misinterpretation of "revealed new symptoms" reinforced hypochondriacal
ideas, in turn, hypochondria intensified anxiety and depression. Patients, presenting numerous complaints of a somatic nature, meanwhile, did not complain of depressed mood, anxiety, melancholy, despite the high level of anxiety and depression, confirmed by objective psychological examination methods. With anxiety-phobic syndrome against the background of increased anxiety, fears for their own health, their own life, various kinds of fears were noted: fear of contracting any disease, fear of cardiac arrest, fear of death, fear of losing self-control, fear of going crazy, etc. Phobic anxiety in certain situations, significant for patients, was accompanied by anxiety, palpitations, feeling of light-headedness, in intensity it varied from mild discomfort to horror. Low mood and other elements of depression were often associated with phobic anxiety. Considering the frequency of occurrence of one or another variant of anxiety disorder depending on gender, it should be noted that simple anxiety, anxiety-depressive and anxiety-phobic syndrome was more often observed in women, in 64.5%, 77.6% and 79.2%, respectively. % of cases. Anxiety-hypochondriac syndrome was more common in men in 67.3% of cases (p = 0.003). The average duration of the disease (5.9 ± 6.8 years) was the shortest in patients with simple anxiety syndrome. The average duration of the disease in patients with anxiety-depressive (14.3 ± 13.7 years), anxiety-hypochondriac syndrome (14.6 ± 11.2 years) and anxiety-phobic (14.8 ± 12.3 years) was significantly higher (p = 0.047). The longer duration of the disease with an indication of the last three syndromes makes it possible to explain the follow-up study of the dynamics of anxiety states in elderly patients. They all have a certain similarity in clinical manifestations, which are based on an obligate symptom - anxiety, which prevails over all other psy-chopathological disorders. Depending on the addition of additional psychopathological symptoms, an aggravation of anxiety disorder gradually occurs and the formation of more complex syndromes in structure, such as anxiety-depressive, anxious-hypochondriac and anxiety-phobic. However, in the clinical picture of almost any anxiety syndrome, elements of depression, as well as other psychopathological symptoms, can be observed in varying degrees of severity.
Conclusions: 1. The study of clinical and psychopathological features of anxiety states in elderly patients allowed us to conditionally distinguish four main syndromes: 1)
simple anxiety syndrome; 2) anxiety-depressive syndrome; 3) anxiety-hypochondriacal syndromes; 4) anxiety-phobic syndrome.
2. At the heart of each of these syndromes is an obligate symptom - anxiety, which prevails at the beginning of the development of the disease.
3. The addition of other additional psychopatho-logical symptoms, such as depression, hypochondria, phobia, contributes to the aggravation and the formation of a more complex syndrome.
4. The long duration of the disease demonstrates the presence of more severe and structurally complex anxiety syndromes.
5. In elderly patients, anxiety-depressive syndrome occurs with a higher frequency.
6. In elderly female patients, simple anxious, anxious-depressive and anxiety-phobic syndrome is more often observed, in male patients - anxiety-hypochondri-acal syndrome.
References
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