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 HEALTH10.31363/2313-7053-2026-23-1260bekhterev-1427Research ArticleИССЛЕДОВАНИЯINVESTIGATIONSПрогностическая значимость клинических и психосоциальных факторов детского возраста в траектории развития психических расстройств у взрослых: клинико-катамнестическое исследованиеPrognostic significance of clinical and psychosocial factors of childhood in the dynamics of mental disorders in adults: a clinical and follow-up studyhttps://orcid.org/0000-0003-3471-5293ЧинаревВ. А.ChinarevV. A.

Чинарев Виталий Александрович - врач психиатр, заведующий клиническим отделением первого психотического эпизода; ассистент кафедры психиатрии

454087, г. Челябинск. ул. Кузнецова, 2А

454141, г. Челябинск, ул. Воровского, 64

Vitaly A. Chinarev

Chelyabinsk

va.chinarev@bk.ruhttps://orcid.org/0009-0003-4337-5005КозловМ. А.KozlovM. A.

Козлов Михаил Арьевич - врач психиатр, главный врач

454087, г. Челябинск. ул. Кузнецова, 2А

Mikhail A. Kozlov

Chelyabinsk

dr_minion@mail.ruhttps://orcid.org/0009-0007-4184-8998ЧижоваТ. Н.ChizhovaT. N.

Чижова Татьяна Николаевна - кандидат медицинских наук, заместитель главного врача по работе с детьми

454087, г. Челябинск. ул. Кузнецова, 2А

Tatiana N. Chizhova

Chelyabinsk

chizhova_tn@mail.ruhttps://orcid.org/0009-0009-5594-1119ДомановаЕ. В.DomanovaE. V.

Доманова Евгения Викторовна - врач психиатр, заместитель главного врача по лечебной работе

454087, г. Челябинск. ул. Кузнецова, 2А

Evgeniya V. Domanova

Chelyabinsk

takoivotadres@mail.ruОбластная клиническая специализированная психоневрологическая больница №1; Южно-Уральский государственный медицинский университетРоссияRegional Clinical Specialized Neuropsychiatric Hospital No. 1; South Ural State Medical UniversityRussian FederationОбластная клиническая специализированная психоневрологическая больница №1РоссияRegional Clinical Specialized Neuropsychiatric Hospital No. 1Russian Federation20262007202660394107Copyright © Чинарев В.А., Козлов М.А., Чижова Т.Н., Доманова Е.В., 20262026Чинарев В.А., Козлов М.А., Чижова Т.Н., Доманова Е.В.Chinarev V.A., Kozlov M.A., Chizhova T.N., Domanova E.V.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/1427

Психические расстройства детского возраста представляют собой динамические образования, характеризующиеся периодами ремиссии, изменением клинической картины и коморбидным наслоением. Цель исследования установить прогностическую значимость клинических и психосоциальных факторов психических расстройств детского возраста для дифференциации динамики их течения во взрослом периоде. Материалы и методы: проведено проспективное когортное клинико-катамнестическое исследование 175 пациентов детской психиатрической службы с продолжительностью наблюдения не менее 10 лет. Применен комплексный подход, сочетавший ретроспективный анализ медицинской документации с проспективным катамнестическим обследованием.

Результаты и обсуждение: выявлена значительная гетерогенность диагностических траекторий: полная стабильность диагноза наблюдалась у 56,0% пациентов, смена нозологической группы у 24,0%. Модель множественной логистической регрессии выявила ключевые предикторы благоприятного исхода: диагноз "расстройство адаптации" (OR=6,17), отсутствие госпитализаций (OR=4,26) и полная семья (OR=1,97). Кластерный анализ выявил три гомогенные группы с различными траекториями развития. Выводы. Выявлены три дискретных пути развития психической патологии, соответствующие неблагоприятному (ранний дебют с поведенческими нарушениями), промежуточному и благоприятному (поздний дебют с расстройствами адаптации) прогнозам. Полученные данные подтверждают необходимость дифференцированного подхода к прогнозированию и раннему вмешательству в условиях региональной психиатрической службы.

Mental disorders of childhood are dynamic formations characterized by complex patterns of development with periods of remission, changes in the clinical picture and comorbid stratification. he aim of the study is to establish the prognostic significance of clinical and psychosocial factors of childhood psychiatric disorders for differentiating the dynamics of their course in adulthood. Materials and methods: a prospective cohort clinical and follow-up study of 175 patients of the children’s psychiatric service with a follow-up period of at least 10 years was conducted. An integrated approach was applied, combining a retrospective analysis of medical documentation with a prospective follow-up examination.

Results and discussion: significant heterogeneity of diagnostic pathways was revealed: complete stability of the diagnosis was observed in 56.0% of patients, and a change in the nosological group was observed in 24.0%. The multiple logistic regression model revealed key predictors of a favorable outcome: diagnosis of «adjustment disorder» (OR=6.17), absence of hospitalization (OR=4.26), and complete family (OR=1.97). Cluster analysis revealed three homogeneous groups with different development trajectories corresponding to modern typological models. Conclusions. The study confirms the complex nature of the interaction of clinical and psychosocial factors in shaping the trajectories of mental pathology. The data confirm the need for a differentiated approach to prognosis and early intervention in the conditions of a regional psychiatric service.

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The authors declare that there are no conflicts of interest present.