COORDINATA - first Russian multicenter prospective (3 year long) study having the aim to elucidate prevalence of symptoms of anxiety and depression among patients with arterial hypertension (AH) and ischemic heart disease (IHD) and their influence on cardiovascular (CV) prognosis. Results of baseline epidemiological part of the study are presented. Results of prospective phase will be published in 2008.
Symptoms of depression and anxiety were assessed by validated in Russia Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. Prevalence of CV risk factors was also studied and their association with anxiety/depressive symptoms were evaluated in a framework of multivariate regression analysis.
Clinically significant symptoms of anxiety (HADS score >or=11) took place in 33 and 38%, symptoms of depression - in 30 and 38% of patients with AH and IHD, respectively. Relationship of symptoms of anxiety and depression was established with a number of psychosocial and biological risk factors of CV diseases (D) specifically low levels of education and income, insufficient level of physical activity, high level of chronic psychoemotional stress, exposition to acute stresses of great power, lack of social support, social isolation, elevated blood pressure level. It was shown that CVD comorbid anxiety and depressive states might cause excessive use of health care resources by patients.
To study clinical and pathogenetic aspects of depression in Alzheimer's disease (AD), 65 patients with AD have been studied. The higher frequency of depressive symptoms has been revealed in different types of AD and all stages of the disease. Different syndrome variants of depression have been found: anxious (35,4%), apathic (29,2%), depression with delusions (16,9%), hypochondriac (10,8%) and melancholic (7,7%). The variety of clinico-phychopathological signs and mechanisms of depressive pathology formation in patients with AD suggests its heterogenic character.
100 children of 1-3 years old were observed. In 50 of them depressive states developed in conditions of total deprivation--the situation of orphanhood. In other 50 children the depressions were caused by partial deprivation--upbringing by schizophrenic mother (children from group with high risk of schizophrenia). Three variations of depression were found in the first group: autonomic, somatizated, and regressive-apathetic. Depressions in the second group were presented either by infantile depression or by infantile distress-syndrome in frames of schizotypic diathesis.
To identify gender differences in the prevalence of depression in an open population of individuals aged 25-64 years and to evaluate its impact on the risk of cardiovascular diseases (CVD) in the population of Siberia.
A random representative sample of a 25-64-year-old Novosibirsk population (657 men and 689 women) was surveyed within the framework of the third screening of the WHO MONICA-psychosocial program in 1994. The screening program included sociodemographic data registration and depression detection. Over a 16-year study period, women had myocardial infarction (MI) in 15 cases and stroke in 35 cases and men had these conditions in 30 and 22 cases, respectively.
In the open 25-64-year-old population, depression was detected in 54.5% of the women and in 29% of the men; major depression was present in 11.8% of the women and 3.1% of the men (?2=66.724; ?=2; p=0.0001). The risk of MI in the depressed patients was higher in the women (hazard ratio (HR)=2.5) than in the men (HR=2); when social parameters and age are included in the model, only a trend towards the impact of depression on the risk of MI persisted in the women (HR=3.4; p>0.05) and the men were observed to have a 1.6-fold higher risk for MI. The greatest risk of MI was seen in the men (HR=6.8) and women (HR=6.3) at the age of 55-64 years, as well as in the men who had incomplete secondary or primary education (HR=3.2); in blue-collar workers (HR=6.7), in the men who were single (HR=3.6), divorced (HR=4.5), or widowed (HR=6). The risk of stroke in the depressed patients during a 16-year study period was greater in the men (HR=5.8) than in the women (HR=4.6); after adjusting for age and social gradient, the risk of stroke in the women was higher in both the population and those who were aged 55-64 years (HR=8.5 and 6.9, respectively) than that in the men (HR=4.2 and 3.1, respectively). Among the men, the risk of stroke was higher in those who had primary education (HR=8.8), were widowed (HR=8.4) or divorced (HR=2.7).
The women are much more susceptible to depression than are the men. The risk of MI with depression is higher in the women than in the men; at the same time, the risk of stroke is higher in the men than in the women. The picture is opposite in the older age group. The risk of CVD in the depressed men is exacerbated by a social gradient; these relationships have not been revealed in the women.
To study blood insulin level in patients with coronary heart disease (CHD) with and without metabolic syndrome (MS) and its relation to cardiovascular risk factors.
We examined 127 patients with stable coronary heart disease (mean age 59.4 ± 5.7 yr) including 63 with MS and 64 without it. The control group consisted of 80 practically healthy subjects. Bloods insulin was determined by immunochemoluminescence, glycated hemoglobin (HbA,) by immunoturbidimetry, total cholesterol, HDLP cholesterol and triglycerides by enzymatic colorimetric method, oxidized LDLP IL-l, IL-6, and tunour necrosis factor-a by enzyme immunoassay. The degree of depression was estimated using the Zung scale.
Blood insulin level in healthy subjects, CHD patients with and without MS was 6.3 (6.20;6.62), 15.5 (13.96, 16.3) and 9.5 (9.2, 10.1) mcIE/ml respectively (p
Some results reported concerning patients with masked depressions (MD), detected in one of the district consultative-diagnostic centers (DCDC). Masked depressions were established in 22.7% of patients who were consulted in the center during one year. Studies on the past history and motions of MD patients in the system of the city public health network, the psychopathological and nosological structure of MDs, controversial clinical evaluation in psychiatric institutions demonstrate a relatively large number of MDs in therapeutic and diagnostic work in general. The conclusion is made about the necessity of new forms in delivering care in this population and, in particular, of feasibility of including a psychiatrist in the staff of DCDC. This would make it possible to set up in the future psychosomatic wards of an intermediate type between a somatic and psychiatric hospital with open doors.
The professional dysadaptation syndrome (PDS) has just recently been recognized in Russian medicine and regarded as a response to long-term professional stresses. PDS has a high tropicity for educated anesthetists-resuscitators (AR) whose profession is socionomic and high-technonomic. Irrespective of the length of service, psychoemotional stress in AR is significantly higher than that in surgeons. Typical PDS, the so-called alexithymia, the psychological characteristics of a personality, which includes a difficulty in defining and describing his/her own emotions, was identified in 82% of anesthetics and in only 57% of surgeons. Alexithymia is considered as a risk factor of cardiovascular and gastrointestinal diseases. Its correction assumes psychotherapeutic care in the conventional forms. However, only 7.6% of the respondents agreed to be questioned.
A total of 200 persons victims of the Chernobyl accident presenting with different exogenous organic depressions were examined. Radiation exposure did not exceed medium levels. The pattern of depressive syndrome of exogenous organic genesis was studied as was the incidence of its varieties. The article contains a description of different varieties of depression and sums up studies on premorbid and neurological status and additional research methods together with studies on suicidal intentions and disposition to alcoholization in the studied groups.
[The multicenter non-interventional, prospective observational program on the study of practical use of teraligen in patients diagnosed with autonomic disorder (START2): a local Russian experience with the use of the Russian version of The Four-Dimensional Symptom Questionnaire (4DSQ). An intermediate analysis].
To develop a new instrument able to identify pathological states and assess their changes during medication treatment. We aimed to study the typical practice of using alimemazine (teraligen) in patients with the diagnosis of autonomic nervous system disorder and to test the Russian version of @The Four-Dimensional Symptom Questionnaire@ (4DSQ) for measuring distress, depression, anxiety and somatization.
We examined 3053 patients (mean age 42.09 ± 11.71 years) who received teraligen in doses gradually increasing from 5 to 15 mg per day. The observational program was carried out in over 600 outpatient clinics of the Russian Federation. The 4DSQ was administered before treatment and 4 weeks after treatment. The Clinical Global Impression (CGI) scale was used before, during (after 2 weeks) and after (4 weeks) treatment with teraligen.
There was a significant improvement of patient's state assessed both by physicians (CGI scale) and by patients (96 and 98%, respectively). The 4DSQ was sensitive to the parameters of response to treatment with teraligen: parameters obtained at baseline and 4 weeks after the beginning of treatment differed significantly demonstrating a significant decrease in distress, anxiety and somatization.