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 HEALTH10.31363/2313-7053-2023-854bekhterev-890Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWКонцепция мультиморбидности как интегративный метод изучения механизмов формирования психических и соматических заболеванийMultimorbidity concept as integrative research method of mental and somatic disorders mechanismshttps://orcid.org/0000-0002-5282-2036РукавишниковГ. В.RukavishnikovG. V.

Рукавишников Григорий Викторович – кандидат медицинских наук., ведущий научный сотрудник, руководитель отделения социальной нейропсихиатрии

192019, Санкт-Петербург, ул. Бехтерева, д.3

Grigory V. Rukavishnikov

St. Petersburg

grigory_v_r@mail.ruhttps://orcid.org/0000-0002-4658-2195КасьяновЕ. Д.KasyanovE. D.

Касьянов Евгений Дмитриевич – младший научный сотрудник отделения социальной нейропсихиатрии

192019, Санкт-Петербург, ул. Бехтерева, д.3

Evgeny D. Kasyanov 

St. Petersburg

ohkasyan@yandex.ruhttps://orcid.org/0000-0001-9896-6556ПинахинаД. В.PinakhinaD. V.

Пинахина Дарья Владимировна – к.г.н., научный сотрудник отделения социальной нейропсихиатрии

192019, Санкт-Петербург, ул. Бехтерева, д.3

Daria V. Pinakhina

St. Petersburg

acanthodasha@gmail.comhttps://orcid.org/0000-0002-8771-625XКибитовА. О.KibitovA. O.

Кибитов Александр Олегович – доктор медицинских наук, руководитель отделения геномики психических расстройств

192019, Санкт-Петербург, ул. Бехтерева, д.3

Alexander O. Kibitov

St. Petersburg

druggen@mail.ruhttps://orcid.org/0000-0001-9838-4003НезнановН. Г.NeznanovN. G.

Незнанов Николай Григорьевич – доктор медицинских наук, профессор, директор ФГБУ «Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева» Минздрава РФ ; зав. кафедрой психиатрии и наркологии ФГБУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава РФ

192019, Санкт-Петербург, ул. Бехтерева, д.3; 197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Nickolay G. Neznanov

St. Petersburg

spbinstb@bekhterev.ruhttps://orcid.org/0000-0001-7910-9129МазоГ. Э.MazoG. E.

Мазо Галина Элевна – доктор медицинских наук, зам. директора по инновационному развитию, руководитель института трансляционной психиатрии

192019, Санкт-Петербург, ул. Бехтерева, д.3

Galina E. Mazo

St. Petersburg

galina-mazo@yandex.ruНациональный медицинский исследовательский центр психиатрии и неврологии им. В.М. БехтереваРоссияV.M. Bekhterev National Medical Research Center for Psychiatry and NeurologyRussian FederationНациональный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева; Первый Санкт-Петербургский государственный медицинский университет им. И.П. ПавловаРоссияV.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; I.P. Pavlov First St. Petersburg State Medical UniversityRussian Federation202302112023574819Copyright © Рукавишников Г.В., Касьянов Е.Д., Пинахина Д.В., Кибитов А.О., Незнанов Н.Г., Мазо Г.Э., 20232023Рукавишников Г.В., Касьянов Е.Д., Пинахина Д.В., Кибитов А.О., Незнанов Н.Г., Мазо Г.Э.Rukavishnikov G.V., Kasyanov E.D., Pinakhina D.V., Kibitov A.O., Neznanov N.G., Mazo G.E.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/890

Проблема одновременного наличия нескольких заболеваний, включая соматические, у одного пациента имеет высокую актуальность в рамках профилактики, диагностики и терапии психических расстройств. Сложность и многовариантность взаимосвязей сочетанных заболеваний не позволяет оценивать их комплексное взаимодействие в рамках понятия коморбидности. Концепция мультиморбидности является удобной и перспективной для изучения различных аспектов сочетания как собственно психических расстройств, так и их ассоциаций с соматической патологией. Однако в настоящее время большинство исследований в области мультиморбидности основаны в первую очередь на учетных эпидемиологических оценках, в то время как вопросам механизмов развития мультиморбидных состояний уделено существенно меньше внимания. В данном обзоре мы рассматриваем основные современные подходы, связанные с исследованием мультиморбидности психических расстройств и соматических заболеваний, с целью определения оптимальных исследовательских стратегий в указанной области. Дальнейшие исследования этиопатогенетических аспектов мультиморбидности, механизмов формирования мультиморбидных кластеров и особенностей течения и прогноза мультиморбидных заболеваний необходимы для оптимизации концепции как для научных проектов, так и для клинической практики. Наиболее важными направлениями для будущих исследований феномена мультиморбидности психических расстройств и соматических заболеваний являются: 1) изучение их общих генетических и молекулярных механизмов развития; 2) клинические и фундаментальные проспективные исследования манифеста, сопутствующего течения и исходов мультиморбидных заболеваний; 3) изучение эффективности и переносимости психофармакотерапии у мультиморбидных пациентов с различными соматическими диагнозами с учётом комплексного взаимодействия используемых препаратов.

The problem of the simultaneous history of several diseases, including somatic ones, in one patient is of high relevance in the context of the prevention, diagnosis and treatment of mental disorders. The complexity and multivariance of the relationships of concomitant diseases does not allow us to evaluate their complex interaction according to the concept of comorbidity. The concept of multimorbidity is convenient and promising for studying various aspects of the combination of both mental disorders and their associations with somatic pathology. However, at present, most studies in the area of multimorbidity are based primarily on epidemiological assessments, while much less attention has been paid to the mechanisms of multimorbid conditions. In this review, we consider the main recent approaches related to the study of the multimorbidity of mental disorders and somatic diseases in order to determine the optimal research strategies in this area. Further studies of the etiopathogenetic aspects of multimorbidity, the mechanisms of multimorbid clusters, and the aspects of the course and prognosis of multimorbid diseases are necessary to optimize the concept for both scientific projects and clinical practice. The most important directions for future research on the phenomenon of multimorbidity of mental disorders and somatic diseases are: 1) the study of their shared genetic and molecular mechanisms of development; 2) clinical and fundamental prospective studies of the manifestation, concomitant course and outcomes of multimorbid diseases; 3) study of the effectiveness and tolerability of psychopharmacotherapy in multimorbid patients with various somatic diagnoses, considering the complex interaction of the drugs used.

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