ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2021-3-79-87ssmu-4483Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSСтруктура аффективных колебаний в неклинической выборкеThe structure of affective fluctuations in a non-clinical samplehttps://orcid.org/0000-0002-8034-4457ОсиповаН. Н.OsipovaN. N.

 канд. мед. наук, доцент, кафедра психиатрии и наркологии

Россия, 127473, г. Москва, ул. Делегатская, 20/1 

20/1, Delegatskaya Str., Moscow, 127473, Russian Federation

natinen@yandex.ruhttps://orcid.org/0000-0002-1171-5517БарденштейнЛ. М.BardensteinL. M.

 д-р мед. наук, профессор, заслуженный врач РФ, зав. кафедрой психиатрии и наркологии

Россия, 127473, г. Москва, ул. Делегатская, 20/1 

20/1, Delegatskaya Str., Moscow, 127473, Russian Federation

https://orcid.org/0000-0001-7028-8669АлешкинаГ. А.AleshkinaG. A.

 д-р мед. наук, профессор, кафедра психиатрии и наркологии

Россия, 127473, г. Москва, ул. Делегатская, 20/1 

20/1, Delegatskaya Str., Moscow, 127473, Russian Federation

https://orcid.org/0000-0003-0375-0870ДмитриеваЕ. В.DmitrievaE. V.

 ст. преподаватель, кафедра физики, математики и медицинской информатики

Россия, 214019, г. Смоленск, ул. Крупской, 28 

28, Krupskoy Str., Smolensk, 214019, Russian Federation 

Московский государственный медико-стоматологический университет им. А.И. ЕвдокимоваРоссияMoscow State University of Medicine and Dentistry named after А.I. EvdokimovRussian FederationСмоленский государственный медицинский университетРоссияSmolensk State Medical UniversityRussian Federation2021201020212037987Copyright © Осипова Н.Н., Барденштейн Л.М., Алешкина Г.А., Дмитриева Е.В., 20212021Осипова Н.Н., Барденштейн Л.М., Алешкина Г.А., Дмитриева Е.В.Osipova N.N., Bardenstein L.M., Aleshkina G.A., Dmitrieva E.V.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/4483 

 

Цель

Цель. Изучение структуры колебаний настроения на доклиническом этапе по результатам скрининговых методов.Материалы и методы. В исследовании приняли участие 129 студентов. Средний возраст 18,95 ± 0,08 лет. Применялись клинико-психопатологический метод, краткий международный нейропсихиатрический опросник Mini-International Neuropsychiatric Interview, а также скрининговые методы: диагностический опросник по биполярному расстройству (Hypomania Checklist (HCL-32), шкала депрессии Гамильтона (HAMD-17).Результаты. При клинико-психопатологическом исследовании в соответствии с критериями Международной классификации болезней 10-го пересмотра, класс V: психические расстройства и расстройства поведения (F00-F99) психические расстройства, в том числе аффективная патология, выявлены не были. По результатам скрининговой методики HCL-32, у 61,2% (n = 79) респондентов суммарный балл превышал пороговое значение. Анализ отдельных пунктов шкалы HCL-32 на всей выборке выявил, что большинство исследуемых положительно оценивали влияние подъемов настроения на семейную сферу (63,57%; n = 82), общественную деятельность (68,99%; n = 89), работу (75,19%; n = 91), сферу досуга (82,17%; n = 106). Положительная (36,43%; n = 47; 95%-й доверительный интервал (ДИ) 28,13–44,74) и нейтральная (37,21%; n = 48; 95%-й ДИ 33,35–50,37) оценка подъемов настроения также выявлена со стороны ближайшего окружения респондентов, что в целом существенно затрудняет распознавание гипоманиакальных симптомов и задерживает обращение за специализированной помощью. В структуре эпизодов подъемов настроения преобладали раздражительность (r = –0,684), конфликтность (r = –0,665), рискованное поведение (r = –0,550), усиление сексуальных побуждений (r = 0,527), повышение энергии и активности (r = 0,431), отвлекаемость (r = –0,467), употребление стимулирующих веществ (r = –0,467), снижение потребности во сне (r = 0,408). Эти признаки во многом сходны с клиническими проявлениями гипоманикального эпизода при биполярном расстройстве II типа. Выявленные по шкале HAMD-17 у 34,8% (n = 45) респондентов признаки легкой депрессии были представлены нарушениями сна (r = 0,693), снижением работоспособности (r = 0,520), депрессивным настроением (r = 0,579), ипохондрией (r = 0,466), общесоматическими симптомами (r = –0,508), нарушением функции желудочно-кишечного тракта (r = 0,513). Данные признаки не носили характер активных жалоб и не служили поводом для обращения за специализированной помощью.Заключение. В неклинической выборке в структуре колебаний настроения преобладали подъемы, которые субъективно не идентифицировались как болезненные симптомы и не выступали в качестве жалоб при клинико-психопатологическом исследовании. Сниженный фон настроения сочетался с общесоматическими симптомами, что может указывать на последующее формирование коморбидной патологии. Выявленные субсиндромальные признаки гипомании и депрессии в неклинической выборке при отсутствии активных жалоб и обращений за психиатрической помощью представляют клиническую значимость как предикторы аффективной патологии биполярного спектра и требуют дальнейшего клинико-динамического наблюдения.

Aim. To study the structure of mood fluctuations at the preclinical stage based on the findings of screening methods.Materials and methods. A total of 129 students participated in the study. The average age was 18.95 ± 0.08 years. We used the clinical and psychopathological method, the Mini-International Neuropsychiatric Interview (MINI), and screening methods, such as the diagnostic questionnaire for bipolar disorder (Hypomania Checklist-32 (HCL-32)), and Hamilton Depression Scale (HAMD-17).Results. Upon a clinical and psychopathological examination according to ICD-10 criteria, class V, mental and behavioral disorders (F00-F99), including affective pathology, were not detected. According to the findings of the HCL-32 screening technique, 61.2% (n = 79) of respondents had a cumulative score above the threshold. Analysis of individual items on the HCL-32 scale across the entire sample revealed that the majority of examinees positively assessed the impact of mood elevations on the family sphere (63.57%; n = 82), social activities (68.99%; n = 89), work (75.19%; n = 91), and recreational sphere (82.17%; n = 106). Positive (36.43%; n = 47; 95% confidence interval (CI) 28.13–44.74) and neutral (37.21%; n = 48; 95% CI 33.35–50.37) assessments of mood elevations were also detected by the respondents’ immediate circle, which, in general, significantly complicates recognition of hypomania symptoms and delays seeking specialized care. In the structure of mood elevation episodes irritability (r = –0.684), conflict (r = –0.665), risk-taking behavior (r = –0.550), increased sexual desire (r = 0.527), increased energy and activity (r = 0.431), distractibility (r = –0.467), stimulant use (r = –0.467), and decreased need for sleep (r = 0.408) dominated. These signs are very similar to the clinical manifestations of a hypomanic episode in bipolar II disorder.Signs of mild depression revealed according to the HAMD-17 scale in 34.8% (n = 45) of respondents included sleep disorders (r = 0.693), decreased ability to work (r = 0.520), depressive mood (r = 0.579), hypochondria (r = 0.466), general somatic symptoms (r = –0.508), and gastrointestinal disorders (r = 0.513). These signs did not result in chief complaints and were not the reason for seeking specialized care.Conclusion. In the non-clinical sample, in the structure of mood swings, mood elevations dominated, which were not subjectively identified as illness symptoms and did not appear as complaints in clinical and psychopathological examinations. Low mood was accompanied by general somatic symptoms, which may indicate subsequent formation of comorbid pathology. The identified subsyndromal signs of hypomania and depression in the nonclinical sample in the absence of complaints and psychiatric care-seeking are of clinical significance as predictors of a bipolar affective disorder and require further clinical and dynamic monitoring.

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