References

ssmu

Бюллетень сибирской медицины

Bulletin of Siberian Medicine

1682-03631819-3684

Siberian State Medical University, the Ministry of Healthcare of the Russian Federation

10.20538/1682-0363-2014-3-5-24

ssmu-37

Research Article

ПЕРЕДОВАЯ СТАТЬЯ

EDITORIAL

СЕМИОТИКА, ДИАГНОСТИКА И ТАКТИКА ВЕДЕНИЯ ТЕРАПИИ ДЕПРЕССИВНОГО РАССТРОЙСТВА В КЛИНИЧЕСКОЙ МЕДИЦИНЕ

SEMIOTICS, DIAGNOSTICS AND THERAPY TACTICS OF DEPRESSIVE DISORDERS IN CLINICAL MEDICINE

Корнетов

Н. А.

Kornetov

N. A.

Корнетов Николай Алексеевич, заслуженный деятель науки РФ, доктор медицинских наук, профессор, зав. кафедрой психиатрии, наркологии и психотерапии

Kornetov Nikolai A.

korn@mail.tomsknet.ru

Сибирский государственный медицинский университет, ТомскРоссияSiberian State Medical University, TomskRussian Federation

2014

28062014

133524

2014

Корнетов Н.А.

Kornetov N.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://bulletin.ssmu.ru/jour/article/view/37

Исследование посвящено синтезированному созданию стандарта диагностики, тактики ведения терапии депрессивных расстройств (ДР) в клинической медицине для преподавания в общемедицинской практике.Настоящее исследование основано на собственных данных и 4 модулях образовательной программы Всемирной психиатрической ассоциации (ВПА) и Международного комитета по терапии и профилактике депрессий. Различные части и формы обучающей программы по депрессивным расстройствам в клинической практике врачей различных специальностей были апробированы при участии ВПА в 24 городах России и Украины. Кроме того, с 2004 по 2013 г. были проведены 39 тематических усовершенствований 858 врачам-интернистам в первичной медицинской сети на факультете усовершенствования врачей СибГМУ.В алгоритм образовательной программы был включен ряд основных положений. Создание оптимального контакта врача с депрессивным пациентом для выявления признаков и симптомов расстройства, выработка навыка встречи. Умение выделять при опросе эмоциональные, когнитивные, вегетативные, психомоторные и невербальные паттерны поведения. Помимо этого, после получения информированного согласия необходимо развивать приверженность терапии и терапевтический альянс. Отдельно проводилось обучение по стандартам применения лекарств, являющихся первым выбором в терапии. Закрепление этих знаний производилось при интерактивных многократных обсуждениях эффективности антидепрессантов в терапии депрессий. Они основаны на трехфазной модели лечения ДР. Процесс выработки тактики ведения депрессивных пациентов основывался на систематике и диагностике депрессивных расстройств (Международная классификация болезней 10-го пересмотра), обсуждениях степени выраженности ДР, развернутой семиотики депрессии и подходах в тактике ведения разных по степени выраженности ДР.Основу образования врачей составляла идея о том, что ДР в целостном подходе нельзя рассматривать как отдельное психиатрическое заболевание при его легких и умеренных формах проявления. Депрессия наряду с ишемической болезнью сердца, цереброваскулярными заболеваниями, сахарным диабетом, остеопорозом и ожирением должна рассматриваться клинической медициной в одном кластере неинфекционных, мультифакториальных хронических заболеваний.

Study objectives are dedicated to brief synthesized establishment of diagnostics general standard, management and therapy of major depressive disorders (MDD) in clinical medicine to provide education in medical practice.Study methods are based on short-term, medium-term and long-term educational programs in 24 Russian and Ukraine cities, which were based on original educational programs under the direction of World Psychiatric Association (WPA) and International Committee For Prevention and Treatment of Depression (PTD). There, about 1450 doctors of different occupations were acquainted with the detection, management and treatment of MDD. The Russian version of WPA/PTD programs was created. The program of education included 4 modules. The Core module included an overview of the epidemiology, impact, concepts and classification, and etiology of depressive disorders as well as their recognition, diagnosis, and management in the primary care setting. The second module focused on depressive disorders in physical illness and covered those major illnesses for which is reasonable evidence for an association with depressive disorders. The third module included the development of the depressive disorders in older persons. The forth module included training physicians in mental health skills. 39 theme improvements for 858 primary care setting physicians within the framework of faculty training program of physicians’ development were the part of other programs of physicians’ occupations.Results. A number of highlights were included in the general algorithm of the educational programs. The creation of optimum «physician-depressive patient» contact demands a number of new skills to establish effective communication. These skills involve training of meeting of depressive patient and physician, the ability to follow a certain communication style; identify emotional, cognitive, psychomotor and nonverbal patterns of behavior. Besides that, the education included adherence to therapy and therapeutic alliance during the period of informed agreement. There was an education of fluent grasp of medicaments, which are the first choice in therapy. Integration of this knowledge is done during the periods of repeated interactive discussions of antidepressants’ effectiveness in depression therapy which is based on three-phased MDD therapy model. The process of working out the depressive patients’ management was based on systematization and diagnostic of depression disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or International Classification of Diseases, Revision 10); detailed discussions of manifestation and thorough depression symptomatology; management approaches in depression disorders, different in manifestation.Conclusion. The basis of physicians' education was the idea that depressive disorder in holistic approach can't be considered as an independent psychiatric disease in its mild and moderate forms of manifestation. Depression, along with coronary artery disease, cerebrovascular diseases, diabetes, osteoporosis, obesity and fatness should be considered by clinical medicine within one cluster of noninfectious multifactorial chronic diseases.

депрессивное расстройствоклиническая медицинаврачи-интернистыобразовательная программатерапия

depressive disordeclinical medicinephysicianseducational programtreatment

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