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 HEALTH10.31363/2313-7053-2021-1-102-112bekhterev-541Research ArticleВ ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУGUIDELINES FOR THE PRACTITIONERДиагностика и терапия коморбидных тревожных и депрессивных расстройств в клинической практикеThe diagnosis and therapy of comorbid anxiety and depression disorders in clinical practicehttps://orcid.org/0000-0003-4096-6208ПетроваН. Н.PetrovaN. N.petrova_nn@mail.ruСавицкаяК. С.SavickayaK. S.K18021987@yandex.ruСанкт-Петербургский государственный университетРоссияSaint-Petersburg UniversityRussian FederationРоссийский университет дружбы народовРоссияPeoples’ Friendship University of RussiaRussian Federation202112042021551102112Copyright © Петрова Н.Н., Савицкая К.С., 20212021Петрова Н.Н., Савицкая К.С.Petrova N.N., Savickaya K.S.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/541Цель

Цель: обсуждение проблем диагностики и психофармакотерапии ассоциированных депрессивных расстройств и расстройств тревожного круга.

Материал и методы

Материал и методы. Статья представляет собой анализ клинического случая с применением клинико-катамнестического метода.

Результаты

Результаты. Обсуждается диагностика Генерализованного тревожного расстройства, вопросы его коморбидности с другими психическими расстройствами, включая тревожные и депрессивные нарушения. Анализируются принципы диагностики панического расстройства. Рассматриваются диагностические критерии ассоциированных тревоги и депрессии в МКБ-10, DSM-5 и МКБ-11. Приводятся современные подходы к выбору терапевтической тактики при коморбидных тревожных расстройствах и депрессии. Проводится анализ лечения пациентки с обоснованием выбора препаратов. Продемонстрированы возможности комбинированной терапии ассоциированных тревожных и депрессивных расстройств с применением вортиоксетина. Показано достижение качественной ремиссии психического расстройства без остаточной симптоматики и полным восстановлением социального функционирования пациентки с ассоциированными депрессивными и тревожными расстройствами.

Заключение

Заключение. Клинический случай демонстрирует характерное хроническое флуктуирующее течение ГТР как в сочетании с разной глубины депрессией, так и с другими тревожными расстройствами (паническими атаками). Проведен анализ трудностей диагностики и возможностей терапии пациентки с двойным диагнозом: Генерализованное тревожное расстройство и Депрессивный эпизод.

Objective

Objective: to discuss problems of diagnostics and psychopharmacotherapy of associated depressive disorders and anxiety circle disorders.

Material and methods

Material and methods. The article is an analysis of a clinical case with the use of clinical and catamnestic method.

Results

Results. Diagnostics of Generalized Anxiety Disorder, issues of its comorbidity with other mental disorders including anxiety and depressive disorders are discussed. The principles of panic disorder diagnosis are analyzed. Diagnostic criteria of associated anxiety and depression in ICD-10, DSM-5 and ICD-11 are considered. Modern approaches to the choice of therapeutic tactics in comorbidal anxiety and depression are given. The analysis of the patient’s treatment is carried out with the justification of the choice of drugs. The possibilities of combined therapy of associated anxiety and depression disorders using vortioxetine are demonstrated. Achievement of qualitative remission of mental disorder without residual symptomatology and full restoration of social functioning of the patient with associated depressive and anxious disorders is shown.

Conclusion

Conclusion. The clinical case demonstrates a characteristic chronic fluctuating course of GTR both in combination with different depths of depression and with other anxiety disorders (panic attacks). Diagnostic difficulties and therapeutic possibilities of a patient with double diagnosis: Generalized Anxiety Disorder and Depressive Episode have been analyzed.

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