bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTH10.31363/2313-7053-2024-1035bekhterev-1074Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWПроблема оценки уровня соматической коморбидности у пациентов с рекуррентным депрессивным расстройством и биполярным расстройством: метаболический синдром, сердечно-сосудистые заболевания и сахарный диабет II типаThe Problem of Assessing the Extent of Somatic Comorbidity in Patients with Major Depressive Disorder and Bipolar Disorder: Metabolic Syndrome, Cardiovascular Diseases, and Type II Diabetes Mellitushttps://orcid.org/0009-0000-2479-7905МакеенкоВ. Е.MakeenkoV. E.

Макеенко Владислава Евгеньевна - врач-психиатр отделения гериатрической психиатрии

Санкт-Петербург

Vladislava E. Makeenko

St. Petersburg

v.e.makeenko@mail.ruhttps://orcid.org/0009-0009-2859-8626ШумскаяД. С.ShumskaiaD. S.

Шумская Диана Сергеевна - лаборант-исследователь  отделения геномики психических расстройств

Санкт-Петербург

Diana S. Shumskaia

St. Petersburg

shumskaya.diana@yandex.ruhttps://orcid.org/0000-0002-8771-625XКибитовА. О.KibitovA. O.

Кибитов Александр Олегович - д.м.н., руководитель отделения геномики психических расстройств,  член правления Российского общества психиатров (РОП), председатель секции РОП по психиатрической генетике, координатор Российского национального консорциума по психиатрической генетике; и.о. заведующего лабораторией клинической фармакологии аддиктивных состояний

Санкт-Петербург

Alexander O. Kibitov

St. Petersburg

druggen@mail.ruФГБУ «Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева» Минздрава РоссииРоссияV.M. Bekhterev National Medical Research Center for Psychiatry and NeurologyRussian FederationФГБУ «Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева» Минздрава РоссииРоссияV.M. Bekhterev National Medical Research Center for Psychiatry and NeurologyRussian FederationФГБУ «Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева» Минздрава России; Институт фармакологии им. А.В. Вальдмана ФГБОУ ВО «Санкт-Петербургский государственный медицинский университет им. И.П.Павлова» Минздрава РоссииРоссияI.P. Pavlov First St. Petersburg State Medical UniversityRussian Federation202416122024584-22938Copyright © Макеенко В.Е., Шумская Д.С., Кибитов А.О., 20242024Макеенко В.Е., Шумская Д.С., Кибитов А.О.Makeenko V.E., Shumskaia D.S., Kibitov A.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/1074

Негативное влияние депрессии на течение и исход соматической патологии хорошо известно, однако, остается малоизученным вопрос о том, как соматические заболевания влияют на клиническую картину, течение и прогноз депрессии. Нет четкого представления о реальном уровне коморбидности соматических заболеваний у пациентов с депрессией, связи коморбидности с клиническими особенностями заболевания, возрастом и полом пациентов, а также с диагностическими вариантами депрессии. Наиболее распространенными вариантами соматической коморбидности с высоким уровнем инвалидизации и значительным вкладом в показатели смертности считаются метаболический синдром (МС), сердечно-сосудистые заболевания (ССЗ) и сахарный диабет II типа (СД2). Все эти заболевания и состояния тесно связаны с депрессией общими патофизиологическими механизмами нейро-иммунометаболической и кардио-метаболической природы. Воспалительные процессы и факторы генетического риска играют важнейшую роль в работе этих механизмов. Цель: проанализировать существующие научные данные о частоте встречаемости МС, ССЗ и СД2 у пациентов с РДР и БАР в сравнительном аспекте с учетом возможных эффектов пола и возраста, а также выделить специфические клинические особенности коморбидных пациентов. Материал и методы: Проведен анализ научной литературы по теме коморбидности РДР и БАР с МС, ССЗ и СД2. Для анализа отбирались преимущественно метаанализы и проспективные исследования с большими объемами изучаемых выборок. Результаты: По данным современных исследований МС обнаруживается в среднем у 30-35% пациентов как с БАР, так и с РДР с небольшим превалированием пациентов мужского пола. ССЗ выявляются в среднем у 18-20% пациентов с БАР и у 25-45% пациентов с РДР также с некоторым преобладанием пациентов мужского пола. СД2 имеется в среднем у 8-10% пациентов как с БАР, так и с РДР без различий по полу. Ни для БАР, ни для РДР не выявлены воспроизводимые и специфические клинические особенности коморбидных пациентов по сравнению с пациентами без коморбидности. Заключение: Необходимы дальнейшие исследования проблемы коморбидности депрессии и хронических соматических заболеваний, особенно с учетом отсутствия научных данных для российской популяции.

The deleterious impact of depression on the course and outcome of somatic illness is well understood, but the subject of how somatic diseases affect the clinical picture, course, and prognosis of depression has received little attention. There is a lack of awareness on the actual level of comorbidity of somatic diseases in patients with depression, as well as the relationship of comorbidity with clinical features of the disease, patient age, sex, and diagnostic variants of depression. Metabolic syndrome (MS), cardiovascular diseases (CVDs), and type II diabetes (T2D) are the most common comorbidities, causing significant impairment and contributing to mortality rates. All these diseases are closely related to depression through shared pathophysiologic mechanisms of neuro-immuno-metabolic and cardio-metabolic nature. Inflammatory processes and genetic risk factors play a crucial role in realization of these mechanisms. Objective: The aim of this study is to analyze the existent knowledge on prevalence of MS, CVDs, and T2D in patients with major depressive disorder (MDD) and bipolar disorder (BD) in comparative aspect, taking into account possible effects of sex and age. Additionally, we strive to highlight the specific clinical features of comorbid patients. Methods: We conducted a literature review on the topic of comorbidity of MDD and BD with MS, CVDs, and T2D. We mostly selected meta-analyses and prospective studies with large samples. Results: According to current research, MS affects an average of 30-35% of individuals with both BD and MDD, with a minor predominance of male patients. CVDs are detected in an average of 18-20% of patients with BD and 25-45% of patients with MDD, also with a slight predominance of male patients. T2D affects an average of 8-10% of people with both BD and MDD, with no gender differences. There are no consistent and identifiable clinical signs that distinguish comorbid patients from non-comorbid patients for either BD or MDD. Conclusion: More research into the comorbidity of depression and chronic somatic diseases is required, particularly given the scarcity of scientific data for the Russian population.

рекуррентное депрессивное расстройствобиполярное аффективное расстройствокоморбидностьметаболические нарушениявоспалениеметаболический синдромсердечно-сосудистые заболеваниясахарный диабет II типаrecurrent depressive disorderbipolar disordercomorbiditymetabolic disordersinflammationcardiovascular diseasestype II diabetes mellitusИсследование выполнено в рамках государственного задания ФГБУ «НМИЦ ПН им. В.М. Бехтерева» Минздрава России 2024-2026 гг. (XSOZ 2024 0012).The study was carried out within the framework of the state assignment of the Federal State Budgetary Institution «V.M. Bekhterev National Medical Research Center of PN» of the Ministry of Health of the Russian Federation for 2024-2026 (XSOZ 2024 0012).ReferencesНезнанов Н.Г., Кибитов А.О., Рукавишников Г.В., Мазо Г.Э. Прогностическая роль депрессии в качестве предиктора манифестации хронических соматических заболеваний. Терапевтический Архив. 2018;12(90):122-132.Neznanov NG, Kibitov AO, Rukavishnikov GV, & Mazo GE. 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The authors declare that there are no conflicts of interest present.