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Clinical and therapeutic strategies in resistant depression

Author: Сărăușu Ghenadie
Degree:doctor habilitat of medicine
Speciality: 14.00.18 - Psihiatrics and Narcology
Scientific adviser: Anatol Nacu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova


The thesis was presented on the 12 September, 2018
Approved by NCAA on the 23 November, 2018


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269 pages


recurrent depressive disorder, resistant depression, compliance, pharmacotherapy, psychotherapy


Structure of the thesis: The thesis consists of 184 pages; it begins wit h introduction, followed by 5 chapters, general conclusions, practical recommendat ions, 472 bibliographical sources and includes 27 annexes, 15 tables and 14 figures. The results were reflected in 70 scient ific publications. Key words: recurrent depressive disorder, resistant depression, compliance, pharmacotherapy, psychotherapy The field of the study: psychiatry and narcology Purpose and objectives of the thesis: the aim of the thesis was to evaluate the role of the factors that determine the therapeutic resistance in patients with refractory depressive disorders with clinical management and treatment.

Object ives:elucidat ing and evaluat ing predisposing factors that lead to resistance in refractory depressive disorders; estimation of precipitating and favoring factors in the development, development and maintenance of resistance in depression; clinicalpsychopathological and evolutionary analysis of resistant depressions and identification of their specific clinical particularities; highlighting clinical variants of resistant depressions; developing therapeutic strategies in resistant depressions; determining the efficacy of treatment of patients with various clinical forms of resistant depression.

The novelty and scientific originality: the risk factors for the development of resistant depression have been studied for the first time. We have determined the role of precipitating and favored factors in triggering and maintaining refractory depressions. The structure of resistant depressive syndrome has been specified. We have established the psychopathological particularities of the main clinical variants, with the elaboration of the treatment methods. New results have been obtained regarding the application of therapeutic management to overcome resistance. The scientific reasoning of the efficacy of appropriate therapy with the development of the dosing scheme was performed. The proposed therapeutic strategies have made it possible to determine the efficacy of the treatment in the patients studied.

New scientific results for science and practice that led to the creation of a new scientific direction or the solving of a major scientific application problem consist in the determinat ion of the most frequent risk factors in the development of resistance to treatment in patients with depressive disorders, the identification of specific psychopathology, which led to the management of overcoming resistance to antidepressant therapy in order to apply the effective treatment of resistant depressions.

Theoretical value: the obtained results reflect novel data on the essence of the resistance phenomenon, the role of different condit ions in the occurrence, the triggering of the therapeutic resistance in depressions. The results obtained completed, expanded and deepened the existing knowledge on early diagnosis, new directions in treatment strategies according to pathogenetic mechanisms and the main affective syndromes.

Applied value: the results already implemented in the medical pract ice and pedagogical activit y in the Republic will improve the quality of the medical services provided to the population.

Practical implementation: New methods of diagnosis and treatment of patients with resistant depression were implemented in the Community Centers of Mental Health, Psychiatric Hospitals, District Hospitals of the Republic of Moldova, Republican Dispensary of Narcology, and in the Didactic Process at the Department of psychiatry, narcology and medical psychology of „Nicolae Testemitanu” State University of Medicine and Pharmacy.

In medical practice was applied the National Clinical Protocol-116 Affective Disorder (mood) in Adult, Standard Clinical Protocol Affective Disorders (mood) for Family Physicians. The results of the study are supported by 4 innovator certificates, 4 innovations implementation and 9 proposals for implementation in practice.