JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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Kuchimova Charos Azamatovna,
Assistant of the Department of Psychiatry,
Medical Psychology and Narcology
Samarkand State Medical Institute
Samarkand, Uzbekistan
Kubaev Rustam Muradullaevich,
Assistant of the Department of Psychiatry,
Medical Psychology and Narcology
Samarkand State Medical Institute
Samarkand, Uzbekistan
Ochilov Ulugbek Usmanovich,
PhD, Head of the Psychiatry Course, Faculty of Postgraduate Education, Samarkand State Medical Institute,
Samarkand, Uzbekistan
ANALYSIS OF THE STRUCTURE OF ADOLESCENT DYSTHYMIA
ANNOTATION
The reason for the in-depth study of dysthymia, which occurs in adolescence, is that the disease is almost as
common and it is difficult to identify this pathology in the early stages. Due to the difficulty of early diagnosis of
dysthymia in adolescents, suicidal risk, prognostic evaluation, treatment and relevance of prophylaxis, this pathology is
widely covered in foreign and our own literature. The nosological and Syndrome problems of adolescent dysthymia can
be explained by the fact that fullness has not been studied, the tactics of choosing adequate therapy are difficult, this
pathology is analyzed and studied psychopathologically in depth. Therefore, it requires a comprehensive in-depth study
of clinical-pathogenic legislation, characteristic of this pathology. In addition, the atypical nature and specificity of the
clinical picture of dysthymia in adolescents lead to an erroneous assessment of the pathology and even to the denial of
this condition. Despite the fact that the available data confirm the genetic basis of major depression, there is no definite
evidence of the genetic basis of dysthymia. Dysthymia can be one of the phenotypic manifestations of the underlying
hereditary diseases or various syndromes that have common symptoms with major depression. The prevalence of
dysthymia in children is 0.6-1.7%, in adolescents - 1.6-8%.
Keywords:
dysthymia,
structure, adolescent, subdepression, anxiety, fear, mechanism, syndrome
Кучимова Чарос Азаматовна,
Ассистент кафедры психиатрии, медицинской психологии и наркологии
Самаркандского государственного медицинского института
Самарканд, Узбекистан
Кубаев Рустам Мурадуллаевич,
Ассистент кафедры психиатрии, медицинской психологии и наркологии
Самаркандского государственного медицинского института
Самарканд, Узбекистан
Очилов Улугбек Усманович,
PhD, Заведующий курсом Психиатрии факультета последипломного образования Самаркандского
государственного медицинского института, Самарканд, Узбекистан
АНАЛИЗ СТРУКТУРЫ ДИСТИМИИ У ПОДРОСТКОВ
АННОТАЦИЯ
Причина углубленного изучения дистимии, которая возникает в подростковом возрасте, заключается в
том, что заболевание почти так же распространено и выявить эту патологию на ранних стадиях сложно. В связи
со сложностью ранней диагностики дистимии у подростков, суицидальным риском, прогностической оценкой,
лечением и актуальностью профилактики эта патология широко освещается в зарубежной и нашей собственной
литературе. Нозологические и синдромные проблемы подростковой дистимии можно объяснить тем, что
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полностью не изучена, тактика выбора адекватной терапии сложна, эта патология глубоко проанализирована и
изучена психопатологически. Поэтому требуется всестороннее углубленное изучение клинико-
патогенетического законодательства, характерного для данной патологии. Кроме того, нетипичный характер и
специфичность клинической картины дистимии у подростков приводят к ошибочной оценке патологии и даже
к отрицанию этого состояния. Несмотря на то, что имеющиеся данные подтверждают генетическую основу
глубокой депрессии, нет никаких определенных доказательств генетической основы дистимии. Дистимия
может быть одним из фенотипических проявлений основных наследственных заболеваний или различных
синдромов, имеющих общие симптомы с глубокой депрессией. Распространенность дистимии у детей
составляет 0,6-1,7%, у подростков - 1,6-8%.
Ключевые слова.
дистимия, структура, подросток, субдепрессия, тревога, страх, механизм, синдром.
Кучимова Чарос Азаматовна,
Самарқанд давлат тиббиёт институти
психиатрия, тиббий психология ва
наркология кафедраси ассистентлари
Самарқанд, Ўзбекистон
Кубаев Рустам Муродуллаевич,
Самарқанд давлат тиббиёт институти
психиатрия, тиббий психология ва
наркология кафедраси ассистентлари
Самарқанд, Ўзбекистон
Очилов Улуғбек Усмонович,
PhD
, Самарқанд давлат тиббиёт институти
дипломдан кейинги таълим факультети
психиатрия курси мудири, Самарқанд, Ўзбекистон
ЎСМИРЛАРДА ДИСТИМИЯНИНГ ТАРКИБИЙ ТАХЛИЛИ
АННОТАЦИЯ
Ўсмирлик даврида юзага келадиган дистимияни чуқур ўрганиш сабаби шундаки, касаллик деярли кенг
тарқалган ва бу патологияни дастлабки босқичларда аниқлаш қийин. Ўсмирларда дистимияни эрта ташхислаш
мураккаблиги, суицидал хавф, прогностик баҳолаш, даволаш ва олдини олишнинг долзарблиги туфайли бу
патология хорижий ва ўз адабиётларимизда кенг ёритилган. Ўсмир дистимиясининг нозологик ва синдромик
муаммоларини тулиқ ўрганилмаганлиги, адекват терапияни танлаш тактикаси мураккаб эканлиги, бу патология
чуқур тахлил қилиниб, психологик жиҳатдан ўрганилганлиги билан изоҳлаш мумкин. Шунинг учун бу
патологияга хос клиник ва патогенетик қонуниятларни ҳар томонлама чуқур ўрганиш талаб этилади. Бундан
ташқари, ўсмирларда дистимия клиник кўринишининг атипик табиати ва ўзига хослиги патологияни нотўғри
баҳолашга ва ҳатто бу ҳолатни инкор этишга олиб келади. Мавжуд маълумотлар чуқур депрессиянинг генетик
асосини тасдиқлашига қарамасдан, дистимиянинг генетик асослари ҳақида аниқ далиллар йўқ. Дистимия йирик
ирсий касалликларнинг фенотипик кўринишларидан ёки чуқур депрессияга учраган умумий белгиларга эга
бўлган турли синдромлардан бири бўлиши мумкин. Болаларда дистимиянинг тарқалиши 0,6-1,7%, ўсмирларда
эса 1,6 - 8% ни ташкил этади.
Калит сўзлар:
дистимия, структура, ўсмир, субдепрессия, вахима, куркув, механизм, синдром.
The actuality of the problem.
Globally
dysthymia occurs in about 105 million people a year
(1.5% of the population). It is 38% more common in
women (1.8% of women) than in men (1.3% of men).
The lifetime prevalence rate of dysthymia in community
settings appears to range from 3 to 6% in the United
States. However, in primary care settings the rate is
higher ranging from 5 to 15 percent. United States
prevalence rates tend to be somewhat higher than rates in
other countries.
Dysthymia, also known as persistent
depressive disorder (PDD), is a
, specifically a disorder primarily of
consisting of the same cognitive and physical problems as
, but with longer-lasting symptoms. The
for the term "depressive personality" in the late 1970s. In
the
Diagnostic and Statistical Manual of Mental
), dysthymia is a serious state of
chronic depression, which persists for at least two years
(one year for children and adolescents). Dysthymia is less
, but not necessarily
less severe. As dysthymia is a chronic disorder, sufferers
may experience symptoms for many years before it is
diagnosed, if diagnosis occurs at all. As a result, they
may believe that depression is a part of their character, so
they may not even discuss their symptoms with doctors,
family members or friends. In the
, dysthymia is
replaced by persistent depressive disorder. This new
condition includes both chronic major depressive disorder
and the previous dysthymic disorder. The reason for this
change is that there was no evidence for meaningful
differences between these two conditions.
The purpose of the study.
The purpose of the
study is to find out that the problems of dysthymia in
adolescents and the polymorphism and atypia of the
clinical picture of this condition are covered.
Research
materials
and
methods.
86
adolescent patients were taken for the study and these
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patients were selected according to the following criteria:
the presence of a non-psychotic degree of depression; the
disease began in adolescence (from 16 to 19 years of
age); the duration of observation was not less than two
years; For the research material, the following cases are
excluded: the absence of organic diseases of the central
nervous system in the investigated patients, chronic
alcoholism, toxicomania, severe somatic diseases, mental
and behavioral disorders caused by the intake of
psychoactive
substances,
drug
addiction,
mental
retardation, symptoms of dopol diphtheria schizophrenia,
psychotic disorders. The evaluation of dysthymia in
expression and mental state in dynamics is based on
clinical observations and the use of evaluation scales.
Research results.
Based on the conducted study,
a number of prominent psychopathological features of
dysthymia in adolescents were determined. They include:
prominent polymorphism in the clinical landscape,
fragmentation,
variability
of
psychopathological
symptoms, uncertainty of the formation of Tri Triada. The
analysis showed that the dysthymia abscesses in the
examined patients and its specificity are explained by the
psychobiological factors pubertal and its formation, in
which, in the first place, cognitive, behavioral,
somatovegetative seizures characteristic of adolescents
arise, this condition not only masks depression, but also
makes it difficult to cope with the disease. In connection
with this, affektiv, neurotic, non-depressive states,
expressed by extremely valuable ideas and psychopathic
hallucinations, cause difficulties. The link between the
disease and teenage eTap ontogenesis is much more
difficult. With a long analysis of dysthymia in
adolescents, it becomes clear that the clinical picture
approaches depression in adults, the classic depression
triad and typical ideator and motor components are
relatively different. Depressive syndrome in adolescents
attracts attention to Uzi with a pronounced pronounced
visual impairment of the structure, rudimentarization of
the thymic component, the difference in the ratio of
components in the clinic. Here, apato-adinamic
component dominates (37,2%), less dysphoric (25,3%),
panic (22,2%), sad (15,3%) components were observed.
Apato-adinamic
component
negativity
is
characterized by the predominance of signs. With a
decrease in the tone of life in the clinical landscape, the
diphthesis of the tendons dominates. Stored activity
masks the defect that has arisen (the external form of life
and the nature of activity practically does not change),
but all actions are carried out "automatically", "according
to the habit", as if the guyoki infected its internal
meaning. Since the apathicektekt is expressed, it is
observed with the impoverishment of mimicry, monotony
of speech, slowing of behavior. Dysthymia is observed
from the fullness with the loss of all available desires, the
inability to connect with the surrounding people, the
prevalence of interest in the result of one's own activities.
Self-perception with a change is contrasted with the
disease from tusat. In apathic dysthymia (in contrast to
melancholy), Vital disorders are observed with alienation
symptoms, as well as with a state of hyperesthetic
symptoms. All the time also do not plan to dominate the
internal dyskomfort character, turbulence, hopelessness,
tension associated with weakness. The priority (even if
under the guise of indifference to the events of the
surrounding world) is changed, theektekt comes out with
a crush associated with the awareness of events in life.
Adinamic seizures are accompanied by a predominance
of negativity in the phenomenon of inisiativa infection. In
the clinical landscape is dominated by movement
braking, adinemia, aspontanity, muscle stiffness. It is
observed with an increase in muscle stiffness, weakness,
burning desire and inclinations. When Apato-adinamik
affekt prevails, the condition of patients is often
misdiagnosed as apato-abulik syndrome in the debut of
schizophrenia.
In
this
case,
unlike
apato-abulic
depression, motor braking, manifested in the eyes in
patients, is not observed.
In the clinical picture, when dysphoric affekt
dominates, a pessimistic mood is observed with
stubbornness, discontent with respect to oneself and
others around, irritability, rapid irritability, psychomotor
convulsions, aggression, this condition resembles
psychopathic and psychopathetic symptoms from the
outside. Usually dysphoric depression is accompanied by
behavioral disorders, with antisocial behavior, disguised
as a reading-related and social degradation, which makes
it difficult to identify it on time. Patients in this group
often deny depression in themselves, and their complaints
are much sluggish, which makes it difficult to diagnose.
When panic attacks dominate the clinical picture of
depression in adolescents, they are accompanied by
irritability, accelerated speech, motion convulsions and
agitation. Bunda in some patients, panic is felt physically,
and it can be said that this is a Vital character. In addition,
in most patients, there is a changing panic, which is often
expressed in the second half of the day. When grief
dominates in the clinical landscape of depression, in
adolescents there is a decrease in tone, a decrease in
energy, a feeling of discontent in the psyche. At the same
time, ideas of low self-assessment, pessimistic evaluation
of the future, remembering unpleasant events in his life,
the idea of extinction of the goal in the existence of
humanity are observed, which in turn creates the ground
for the formation of an extremely valuable depressive
system. Other distinctive features of the clinical
landscape of dysthymia in adolescents are that movement
braking is not observed. When assessing patients in a
subset, there is some kind of divergence in their motor
skills, an increase in movements. Motor braking slow
down the pace of movement, mimic poverty, distress of
facial expression only 10.5% of patients have migraines.
In dysthymia in adolescents, again it is necessary to touch
on ideator disorders. These disorders almost all patients
with different manifestations of migraines. Along with
this symptomatology, it also irritates patients with
memory and attention disorders, which can trigger mental
processes from braking as well. Of the specific aspects of
adolescent dysthymia, high-frequency ideator seizures
observed in pubertal crises are threeraydi.
Typology of dysthymia in adolescents.
In the
clinical landscape, depressive syndrome is observed
clinical heterogeneity, which leads to a revision of the
typology of the classification of tumors dysthymia. In this
case, most researchers identified a syndromological
classification of depressive states, which served as an
adequate diagnosis, outcome, treatment of dysthymia in
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adolescence [7,8,9,10]. The conducted study showed that
almost all the syndrome symptoms of dysthymia were
observed in adolescence and were nomadic in the
following
variants:
asthenic,
dysmorphobic,
psychopathetic, psychostenic, depersonalization, senesto
– ipohondric variants. In addition, the clinical variants of
negativity, which surpassed positivity in dysthymia in
adolescents, attracted attention.
1.Asthenic depression
(exhausted depression,
neurasthenic melancholia). Among these options is
31.4%. Asthenia is one of the symptoms of depression.
The most characteristic sign in the clinical picture is the
predominance of cognitive signs (ideator braking, high
intellektual fatigue, a decrease in the concentration of
attention in mental activity, inability to read). In most
cases, asthenia affektiv becomes a prodromal sign of
violations. In the clinical picture of asthenic depression,
which is clearly visible, there is a very high state of
exhaustion, decreased activity, nausea, crying, physical
weakness, energy exhaustion. Any effort to overcome
weakness does not lead to a feeling of satisfaction. The
feeling of fatigue is felt even in a slight movement. In
patients with mild depression, the performance of tasks
will be preserved, but observed with exhaustion. The
specificity of depressive fatigue differs from ordinary
fatigue in that muscle weakness is observed with a
general violation of div sensitivity. Asthenia is
characterized by stagnation and non-dependence on
bullying. In much more pronounced depressions, patients
find it difficult to perform the usual morning movements
(washing, dressing, combing their hair). These actions
will overwhelm the patients and require more time than
usual. Impulsive weakness and asthenic hyperesthesia are
observed, patients can not bear external influences (loud
sound, strong light), a variety of sensations are observed
in physiological processes. Sof the characters of the net
are limited, grief, panic, self-discrimination, blame ideas
will not be specific.
2.In the dysmorphophobic variant
(11,7%) of
dysthymia in adolescents, there is a predominance of
extremely valuable ideas, a lack of enthusiasm from the
outside. In the overwhelming majority of cases, the ideas
of a sensitiv relationship are predominant, which is
observed with depesonalization disorders of the
obsessive-phobic, senestoalgic and somatopsychic type of
depesonalization.
3.Dysthymia
(angedonic
variant-10,8%),
observed with alienation of somatic inclinations
, is
observed with symptoms of the somatic circle (somatic
equivalents of depression)-a violation of the demand for
sleep, depressive anorexia, a weakening of the libido of
the sexual inclinations with the onset of the Fox. Sleep
disorders (short, interrupted sleep with difficulty waking
up) reduction of the feeling of hunger acquires a Total
character. Vomiting from food is observed with a refusal
of food, and therefore in 1-2 weeks of the disease patients
lose weight. In this case, the symptoms of pathological
miscarriage (circadian rhythm and depressive braking)
are limited to latent hypothymia. Also somatic
equivalents, which are observed with alienation of
somatic inclinations, do not determine the clinical picture
of depression for a long time, most often they mean the
origin of other types of affektiv disorders (vital
Ipoochondric depression).
4.In the psychopathetic variant
(9,1%) of the
clinical picture of dysthymia, psychopathetic disorders
arise in the first place, with these behavioral disorders,
with basic movements, with symptoms similar to the
signs of pathological course of the pebertate krizni, with
oppositions to the attitude of the surrounding people, with
the exclusion of conjunctivitis, with the inability to limit
sexual inclinations, delinkvent is characterized by a
tendency Bunda is characterized by stubbornness, which
is a typical component of a depressive Trida. Episodes of
grief, panic, apathy are poorly observed, the sad mood is
characterized by dysphoria.
5.Psychasthenic variant
(12,5%) of dysthymia
in adolescents is characterized by internal discomfort,
with inability to enter into a relationship with surrounding
people, with inability to make a decision that was not
specific to them before. With low mood in most patients,
panic attacks prevail.
6.
Depressive
symptomatology
in
depersonalization dysthymia
(9,9%) is observed with
severe dysphoric, less often with grief, panic. Signs of
depersonalization are expressed mainly in the form of
autopsychic depersonalization psychological anesthesia.
7.Obsessive-phobic disorders in dysthymia
(7.9%) with predominant dysthymia, adhesive fears are
observed with pessimismmga tendency. In most patients,
fear predominates.
8.In Senesto-ipohondric dysthymia
(6,8%)
affektiv disturbances are noted in the second place, and in
the first place there are unpleasant, unpleasant, abnormal
sensations in different parts of the div. The patient
focuses his attention on his somatic state of mind and
worries about his own health. Senestopathy seems to be
part of depression and is diagnosed with a disease that
can not be cured.
Conclusion.
1.Timely detection and treatment of dysthymia
in adolescence can prevent its spread and social
degradation.
2.In adolescence, the typical component of the
depressive triad is atypical and is often observed with
apato-adynamic symptoms (37,2%), less often with
dysphoria (25,3%), with panic (22,2%), less often with
sad mood symptoms.
3.Taking
into
account
the
clinical
phenomenological features of a special age, the following
variants of Syndrome dysthymia were identified: asthenic
variant,
dysmorphobic
variant,
dysthymia,
psychopathymic, psychostenic, depersonalization, senesto
– ipohondric variants, accompanied by alienation of
somatosesophageal inclinations.
4.In the clinical picture of tumors dysthymia is
characteristic
of
incomplete
polymorphism,
fragmentation,
variability
of
psychopathological
symptoms, tri unclear formation of Triad, vegeto vascular
disorders.
