Vasiuk Iu A, Lebedev A V, Dovzhenko T V, Semiglazova M V
Ter Arkh. 2010;82(10):28-33.
to study the prevalence, pattern of and trends in affective disorders (AD) in patients with acute myocardial infarction (AMI) and to assess whether they might be corrected with the antidepressant tianeptin.
The study enrolled 108 patients with AMI. To detect and evaluate affective spectrum disorders, all the enrolled patients were interviewed on days 2-3 of AMI, by using the screening questionnaire developed at the Moscow Research Institute of Psychiatry (MRIP), Russian Agency for Health Care, and 4-5 days and 2 and 6 months after the onset of AMI they underwent an in-depth psychopathological examination by a psychiatrist who applied the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). To correct affective symptomatology in some patients with verified depression, the antidepressant tianeptin was added to the conventional therapy for AMI on its days 5-7.
The screening questionnaire study revealed depressive spectrum disorders in 45.4% of the patients with AMI. The in-depth psychopathological examination confirmed the presence of AD in 40.7%. Mild and moderate depressive episodes were observed in 26.9% of the patients and adjustment disorders were seen in 13.8%. The sensitivity and specificity of the MRIP screening questionnaire for the diagnosis of depressive spectrum disorders in patients with AIM was 86.2 and 69.6%, respectively. The concomitant symptoms of anxiety were detected in 27.8% of the patients with AMI. The duration of a course of antidepressant therapy with tianeptin averaged 3.9 +/- 1.1 months. Six moths after AMI, the tianeptin group a showed significant reduction in HDRS scores by 50% (p = 0.0013) and in HARS scores by 52.7% (p = 0.0004) versus the baseline values. During a follow-up, there was no significant decrease in HDRS and HARS scores in a group of patients who refused antidepressant therapy.
Affective spectrum disorders are most common in myocardial infarction (MI). The use of the MRIP screening questionnaire favors a more adequate diagnosis of depressive spectrum disorders in patients with AMI. Tianeptin therapy for AD concurrent with MI causes an evident reduction in psychopathological symptomatology and a statistically significant decrease in HDRS and HARS scores.
研究急性心肌梗死（AMI）患者情感障碍（AD）的患病率、模式及趋势，并评估抗抑郁药噻奈普汀是否可纠正这些障碍。
本研究纳入108例AMI患者。为检测和评估情感谱系障碍，所有纳入患者在AMI发病后第2 - 3天接受使用莫斯科精神医学研究所（MRIP）、俄罗斯医疗保健机构编制的筛查问卷进行的访谈，并在AMI发病后4 - 5天以及2个月和6个月时由精神科医生进行深入的精神病理学检查，医生使用汉密尔顿抑郁评定量表（HDRS）和汉密尔顿焦虑评定量表（HARS）。为纠正部分确诊为抑郁症患者的情感症状，在AMI发病后第5 - 7天，在常规治疗基础上加用抗抑郁药噻奈普汀。
筛查问卷研究显示，45.4%的AMI患者存在抑郁谱系障碍。深入的精神病理学检查证实40.7%的患者存在情感障碍。26.9%的患者观察到轻度和中度抑郁发作，13.8%的患者出现适应障碍。MRIP筛查问卷对AMI患者抑郁谱系障碍诊断的敏感性和特异性分别为86.2%和69.6%。27.8%的AMI患者检测到伴有焦虑症状。噻奈普汀抗抑郁治疗疗程平均为3.9±1.1个月。AMI发病6个月后，噻奈普汀组HDRS评分较基线值显著降低50%（p = 0.0013），HARS评分降低52.7%（p = 0.0004）。随访期间，拒绝抗抑郁治疗的患者组HDRS和HARS评分无显著下降。
情感谱系障碍在心肌梗死（MI）患者中最为常见。使用MRIP筛查问卷有助于更准确地诊断AMI患者的抑郁谱系障碍。噻奈普汀治疗并发MI的AD可明显减轻精神病理学症状，且HDRS和HARS评分有统计学意义的下降。
