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Section 5. Medicine
Abdullaeva Vasila Karimbekovna, Doctor of Sciences in Medicine, head of the department of psychiatry, addiction and child psychiatry, medical psychology, psychotherapy
Tashkent Pediatric Medical Institute E-mail: vasila.abdullaeva@tashpmi.uz Nurkhodjaev Sabir Nasirkhodjaevich, Research assistant, department of psychiatry, addiction and child psychiatry, medical psychology, psychotherapy Tashkent Pediatric Medical Institute E-mail: sabir.nurkhodjaev@tashpmi.uz
THE STRUCTURE OF PERSONALITY DISORDERS IN PATIENTS WITH THERAPEUTICALLY RESISTANT DEPRESSIONS
Abstract: The article is devoted to reveal the correlation between affective disorders and personality disorders with the evaluation of the diagnostic structure of personality disorders. It was revealed that among patients with therapeutically resistant depressions in the main group with personality disorders and in the group of affective disorders without personality pathology was dominated by the diagnosis of recurrent depressive disorder with depressive episodes of varying severity.
Keywords: personality disorders, therapeutically resistant depressions, relation.
The problem of the relationship between personality disorders and affective pathology is reflected in such an important discussion as the differentiation of manifestations of the dynamics of personality disorders and affective phases [1, 15-20; 3, 4-10]. In recent years, there are several theoretical models justifying the modern views on the relationship of affective and personality disorders: the total causality spectrum, predispositional or model of vulnerability, photoplasticity and model complications [4, 32-34]. In the work of Klein D. N. et al. (2011) presents data on the relationship between personality and depression with the release of association between depression and personality types [5, 270-280]. Most personality traits associated with depression are related to other forms of psychopathology, especially anxiety disorders [6, 13-20]. However, it remains unclear how best to present personality traits: as predecessors or predisposition to depressive disorders, as there is evidence sup-
porting both hypotheses. In addition, it appears unlikely that depressive episodes produce long-term changes in most personality traits, but personality traits can have predictive value and can affect the course of depression and therapeutic response [2, 91-95].
The aim: of the investigation was to reveal the correlation between affective disorders and personality disorders with the evaluation of the diagnostic structure of personality disorders.
Material and methods: 68 patients, 44 women and 22 men, with a current moderate or severe depressive episode in the framework of a depressive episode, recurrent depressive disorder, bipolar affective disorder who were screened and treated at the City clinical psychiatric hospital in Tashkent. The average age of women was 44,4± ± 10,2 years and men 40,6 ± 11,0 years. The diagnosis of depressive and personality disorders was verified according to the ICD-10 diagnostic criteria.
Section 5. Medicine
Quantitative assessment of the severity of depression, as well as the dynamics of the state and efficacy of antidepressant therapy was carried out using a reduced version of the scale SIGH-SAD [Williams J., Link M., Rosentha N. E. et al., 1992], which includes 17 points of the Hamilton depression scale and 7 points concerning atypical depressive symptoms: social departure, weight gain, appetite increase, hyperphagia, craving for carbohydrates, hypersomnia, fatigue. Assessment of personality disorders was carried out with a Standardized method of multi-factor research personality-SMIL (MMPI) [Sobchik L. N., 2002]. The TCI-125 personality and temperament structure questionnaire was used to study the personality structure [Cloninger S. et al., 1991].
For statistical processing of material was used statistical analysis and information delivery SAS (Statistical Analysis System).
Results and discussion: In accordance with the aim of the study, one of the main tasks was to identify the cases of the relationship of monopolar and bipolar affective disorders with personality disorders in a continuous sample of patients with affective disorders in the framework of F31-33 with an assessment of the diagnostic structure of the identified personality disorders (according to the criteria of ICD-10).
The general study group of patients with therapeutically resistant depressions was divided into two groups, taking into account the frequency of occurrence of personality disorders among patients with affective disorders. The main group-38 patients, including 28 women
(73.7%), 10 men (26.3%), which consisted of patients with concomitant personality disorders. Comparison group-30 patients, including 22 women (73.3%), 8 men (26.7%) without concomitant personality disorder. The mean age of patients of the main group at the time of examination was 39.9 ± 10.8 years, patients of the comparison group - 46.3 ± 9.5 years (p < 0.001).
Thus, the main group and the comparison group were comparable in age with the predominance of women in both groups (p < 0.05).
According to the design of the study, patients with the current depressive episode of varying severity were examined. In the main group of patients - the only depressive episode (DE) - 9 (23.7%) patients, depressive episode in the framework of recurrent depressive disorder (RDR) (F32-33) - 18 (47.4%) patients, as well as depressive episode in the framework of bipolar affective disorder (BAR) (F31) - 11 (28.9%) patients, and in the comparison group- 7 (23.4%), 19 (63.3%) and 4 (13.3%) patients, respectively.
In our study, personality disorders in the main group were presented in 73.7% (n = 28) cases - mixed personality disorder (F61.0), 10.5% ( n = 4) borderline personality disorder (F60.31), in 15.8% (n = 6) - hysterical personality disorder (F60.4). In the main group, gender-related personality disorders are presented as follows: 28 women (73.7%) and 10 men (26.3%) and had statistical differences in sex (p < 0.05).
The distribution of patients of the main group with personality disorders depending on the nosological affiliation of affective disorders is presented in (Table 1).
Table 1. - Nosological structure of personal pathology in patients of the main group depending on the structure of affective disorders
Affective disorders Personal disorders Number of patients
n %
Hysterical personality disorder 2 22.2
DE (n = 9) Mixed personality disorder 5 55.6
Borderline personality disorder 2 22.2
Hysterical personality disorder 2 11.1
RDR (n = 18) Mixed personality disorder 15* 83.3
Borderline personality disorder 1 5.6
Hysterical personality disorder 2 18.2
BAR (n = 11) Mixed personality disorder 8 72.7
Borderline personality disorder 1 9.1
* - intragroup difference (p < 0,05)
It should be noted that the diagnosis of mixed personality disorder prevailed in all diagnostic categories (p < 0.05).
According to our data also revealed statistically significant intergroup differences: in 57,9% of cases with RDR significantly more often diagnosed mixed personality disorder (p < 0.05).
Conclusions:
Thus, among patients with therapeutically resistant depressions, the frequency of personal pathology was 55,9% with predominance of cases of mixed personality disorder - 73,7%, while both in the main group with personality disorders and in the group of affective disorders without personal pathology prevailed diagnosis of the recurrent depressive disorder with depressive episodes of varying severity (47,4% and 63,3%) (p > 0.05).
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