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Clinical-evaluative and therapeutic peculiarities of the non-psychotic depression at anxious persons


Author: Deliv Inga
Degree:doctor of medicine
Speciality: 14.00.18 - Psihiatrics and Narcology
Year:2007
Scientific adviser: Mircea Revenco
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 21 November, 2007
Approved by NCAA on the 20 December, 2007

Abstract

Adobe PDF document0.25 Mb / in romanian

Thesis

CZU 616. 89 – 008.454

Adobe PDF document 1.87 Mb / in romanian
171 pages


Keywords

non-psychotic depression, anxiety – trait, situation anxiety, clinical-evolutive peculiarities, therapeutically strategies, personality's profile, Hamilton test, quality of life, Spielberger test, MMPI.

Summary

There were investigated 124 of women from 18 to 45 years, suffering from a non-psychotic depression. For 95 patients (basic group), the depression has been accompanied with an increased level of the personal and/or reactive anxiety. 29 patients, with the anxiety level within the physiologically acceptable limits, formed a control group. All the patients have been examined clinically (criteria ICD-10); clinical-psychologically (Hamilton test, Spielberger scales, MMPI, SF-36 questionnaire, Kerdo vegetative index, sleep efficiency dynamics index). By applying the specially elaborated questionnaire and by establishing the correlation coefficients, the factors contributing to the development of depression at the persons with an increased level of anxiety have been studied. The coefficients of tricycles antidepressants and selective serotonin recapture inhibitors efficiency, for this category of patients, have been studied. The particularities of the depression clinics and course, depending on the type of anxiety, were established: for the persons with an increased level of the personal anxiety, the depression was developing gradually, its severity was correlating in a positive way with the anxiety level, in the clinical picture, the affective symptomatology without any wide daily oscillations was prevailing, having tendencies to a chronic course and incomplete remissions; the depression against the background of a reactive anxiety was characterizing with an acute beginning, in the clinical picture, somatic-vegetative and affective symptoms were observed, the suicidal thoughts, the psychomotor agitation was present; its evolution was depending on the stressogenic situation dynamics, while the personal and reactive anxiety was declaring itself to the same extent, the depressions were evolving acutely, even after non-considerable stresses, the clinic polymorphism, the grave depressive episodes with a tendency to the recidivism were prevailing. The vegetative dysfunctions, more often in the form of the sympathicotonia and sleep disturbance were present at the most examined patients.

The depressions that evolve against the background of a reactive anxiety and those that have been not associated with the anxiety are reducing faster under the influence of a complex treatment, as compared with the depressions accompanied with a big level of the personal anxiety (P<0,001). The patient life quality is reduced significantly and is recovering slower (P<0,001), especially from the psychical aspect, for the depressive patients with an increased level of anxiety, in particular the personal one. The treatment of the depression with a non-psychotic level of anxiety, for anxious persons, must be complex (psychotherapeutic and pharmacologic) and log-term, and must include obligatory the antidepressants with an anti-anxiety effect.