Невротическая депрессия: проблема нозологической квалификации

Objective: to  study  the  clinical  characteristics,  dynamics,  nosological  qualifications  and  factors  involved  in  the  formation  of neurotic depression. Material  and  methods: 60  patients  (women  —  55,  men  —  5)  with  an  average  age  36,9  ±  10,8  years  were  examined,  the  average  duration  of  depressive  phases  was  18,1  ±  10,8  months.  The  study  was  conducted  with  using  clinical,  catamnestic,  pathopsychological, statistical methods. Psychometric scales (HAM-D, MFI-20, SANS, PANSS) and questionnaires (Questionnaire of personality traits of an adult, SPQ-A, SCL-90, Holmes–Ray Stress Inventory) were used. Results: the states combined by the term «neurotic depression» are clinically heterogeneous (depressions with victimization phenomena  with  the  separation  anxiety  and  depressions  with  love  addiction  —  erotomania),  primarily  in  the  content  of  the  catathymic complexes (anxiety-phobic and overvalued catathymic complexes). The differences in the structure of the denotation correlated  with  the  heterogeneity  of  clinical  manifestations  and  the  dynamics  of  depression.  The  clinical  picture  of  neurotic  depressions  in  patients  of  the  first  group  transformed:  the  initially  dominant  anxiety  was  replaced  by  negative  affectivity  (apathy, anhedonia), and there was an acquisition of endoform traits. In addition to affective pathology, which was detected in 38,2%, 61,8% of patients in this group had diagnosis of schizophrenic spectrum disorders. At the same time, most of the neurotic depressions with erotomania with overvalued attachment (76,9%) did not go beyond the affective phases of the neurotic register,which  are  realized  on  the  trajectory  of  personality  disorders.  It  has  been  established  that  the  main  personality  dimension  for  all  patients  participating  in  the  formation  of  neurotic  depression  was  the  phenomenon  of  victimization,  which  characterizes  the ability of patients to get into and stay in a psycho-traumatic (frustrating) environment for a long time. In addition, it was found that 83,3% of patients had premorbid traits of cluster A (DSM-5), along with the characteristic features of clusters B and C. Conclusions: the heterogeneity of denotation of neurotic depression determined the differences in the clinical picture, dynamics  (with  different  social  and  labor  prognosis).  The  nosological  heterogeneity  of  the  conditions  combined  by  the  term  «neurotic depression» was established: along with affective pathology, the diagnosis of personality disorder and diseases of the schizophrenic spectrum was detected. The structure of the catathymic complexes is also interconnected with different personal predispositions with sensitivity to certain stressful triggers.