Статья посвящена проблеме постинсультной апатии, которая признается важным нейропсихиатрическим синдромом, что связано с ее воздействием на эффективность реабилитации, социальную адаптацию больного, возвращение к трудовой активности. В работе представлены литературные данные по распространенности, клиническим проявлениям, диагностическим критериям постинсультной апатии, ассоциация ее с возрастом, полом, депрессией, когнитивной дисфункцией. Рассмотрены вопросы патогенеза постинсультной апатии, взаимосвязи с локализацией очага поражения мозга, тяжестью инсульта, представлены направления лечения и прогноз. Ключевые слова: инсульт, постинсультная апатия. Для цитирования: Петрова Е.А., Поневежская Е.В., Савина М.А., Кольцова Е.А. Постинсультная апатия. Consilium Medicum. 2020; 22 (9): 33–37. DOI: 10.26442/20751753.2020.9.200274
BACKGROUND. Anxiety disorders are frequently observed in patients with schizophrenia. Meanwhile lifetime frequency of these disorders in late-onset schizophrenia remains unknown.
AIM. The aim of the study was to investigate frequency of anxiety disorders in patients with late-onset psychosis.
MATERIAL AND METHODS. 85 patients with late-manifesting psychoses (after 40 years) aged 45 to 86 years (average age 66.5=9.5 years) were examined. Patients with late schizophrenia (n=42), late schizoaffective disorder (n=12), late chronic delusional disorder (n=15), organic schizoform psychosis (n=8), recurrent depression with psychotic symptoms (n=8) underwent psychiatric examination (PANSS, HDRS-17, MMSE, MoCA) and standard interviews. The diagnosis was carried out according to the criteria of the International Classification of Diseases of the 10th revision. The control group included 24 people over 45 years old without signs of mental disorders (average age 57.68.8 years). Statistical analysis included nonparametric criteria.
RESULTS. Results. Patients with late schizophrenia were distinguished by certain premorbid features in the form of an increased frequency of social phobia, more animal phobias and multiple polysymptomatic habitual anxiety reactions. Patients with late schizoaffective disorder were characterized by a tendency to hypochondriac fears and multiple polysymptomatic habitual anxiety reactions. Patients with late delusional disorder were characterized by an increased frequency of animal phobias. Patients with late mental depression are characterized by the presence of multiple undeveloped anxiety reactions and hypochondriac fears. Patients with endomorphic organic psychoses were distinguished by a low frequency of hypochondriacal fears in the anamnesis.
CONCLUSION. High frequency of anxiety disorders in patients with late-onset schizophrenia was detected. This data could improve diagnostics of late-onset psychosis.
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