Malygin Y V, Orlova A S, Malygin V L
Evdokimov Moscow State University of Medical Dentistry, Moscow, Russia.
Pirogov Russian National Research Medical University, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2022;122(6):48-54. doi: 10.17116/jnevro202212206148.
Anxiety and depressive disorders are characterized with frequent co-occurance. Depression comorbid to anxiety disorder increases severity of main disorder, aggravates it`s clinical course, worsens social functioning of the patients and decreases life quality, results resistance to therapy and increases the probability of suicidal attempts. In patients with depressive disorders onset of anxiety disorder results increased severity of disorder and decrease in quality of remission. There are different opinions on nature and phenomenology of comorbidity of anxiety and depressive disorders. There are biological and psychological factors of risk of comorbidity. Some scientists consider comorbid disorders to be independent and not to effect each other; others pay attention at common anatomic basis of comorbid disorders, which explains manifestation of comorbid disorder. Hierarchical analysis of clinical features of comorbid disorders favors nosological approach to understanding of comorbidity, and implicates the need for inclusion of transdiagnostic elements. Some authors consider comorbid disorders to be separate type of disorder, characterized with special dynamics of syndromes which reveals transformation of one disorder into another. Phenomenon of comorbidity can be described as part of concept of disease spread which estimates important role of bridge psychic states. Considering clinical features of comorbid disorders, difficulties of their therapy based on concepts of phenomenology of comorbid depressive and anxiety disorders recommendations on prevention, early diagnosing and managing of comorbid disorders were elaborated. Psychotherapy (including CBT, which demonstrated high efficiency) is an essential element of treatment of comorbid depressive and anxiety disorders. Psychotherapy is supposed to be correcting personality traits, cognitive mistakes and maladaptive strategies of coping with disorder, which support the comorbidity.
焦虑症和抑郁症的特点是经常同时出现。与焦虑症共病的抑郁症会增加主要疾病的严重程度，加剧其临床病程，恶化患者的社会功能并降低生活质量，导致对治疗产生抵抗，并增加自杀企图的可能性。在患有抑郁症的患者中，焦虑症的发作会导致疾病严重程度增加和缓解质量下降。关于焦虑症和抑郁症共病的性质和现象学存在不同观点。存在共病的生物和心理风险因素。一些科学家认为共病的疾病是独立的，彼此不相互影响；另一些人则关注共病疾病的共同解剖学基础，这解释了共病疾病的表现。对共病疾病临床特征的层次分析有利于从疾病分类学角度理解共病，并暗示需要纳入跨诊断要素。一些作者认为共病疾病是一种单独的疾病类型，其特征是综合征具有特殊的动态变化，表现为一种疾病转变为另一种疾病。共病现象可被描述为疾病传播概念的一部分，该概念估计了过渡心理状态的重要作用。考虑到共病疾病的临床特征、基于共病抑郁和焦虑症现象学概念的治疗困难，阐述了关于共病疾病预防、早期诊断和管理的建议。心理治疗（包括已证明具有高效性的认知行为疗法）是共病抑郁和焦虑症治疗的重要组成部分。心理治疗应该纠正人格特质、认知错误和应对疾病的适应不良策略，这些因素会助长共病情况。
