psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2015-67-58-64psychiatry-47Research ArticleВОПРОСЫ КЛИНИЧЕСКОЙ И БИОЛОГИЧЕСКОЙ ПСИХИАТРИИРоль антиконвульсантов и антидепрессантов в терапии аффективных и тревожных расстройств у больных эпилепсиейThe role of anticonvulsants and antidepressants in the treatment of affective and anxiety disorders in patients with epilepsyКалининВладимир ВениаминовичKalininVladimirdoct.kalinin@mail.ruМосковский НИИ психиатрии, филиал ФГБУ «ФМИЦПН» Минздрава РоссииРоссияMoscow Scientific Research Institute of Psychiatry, Branch of FSBI «FMRCPN» of RosminzdravRussian Federation201528092015035864Copyright © Калинин В.В., 20152015Калинин В.В.Kalinin V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/47

Эпилепсия сопряжена с развитием широкой гаммы психических расстройств, требующих непосредственного участия психиатра в их распознавании, диагностике и терапии. Среди всех психопатологических расстройств наибольшее значение имеют аффективные и тревожные расстройства.Цель работы представить клинические характеристики депрессивных и тревожных расстройств при эпилепсии и обосновать современную психофармакотерапию этих нарушений. На основании данных литературы и собственных исследований показаны свойственные эпилепсии особенности аффективной симптоматики, подчеркнута значимость когнитивных нарушений с нарушением исполнительских функций. Проведено сопоставление клинических проявлений депрессивных и тревожных расстройств с локализацией и латерализацией эпилептического фокуса, фактором ведущей руки и наличием алекситимии. Обсуждается влияние фармакологических механизмов действия (ГАМКергических и антиглутаматергических) противоэпилептических препаратов на аффективные расстройства, а также возможности уменьшения частоты припадков и редукции судорожных расстройств на терапии антидепрессантами из группы СИОЗС.Сделан вывод об индивидуализированном подходе к выбору антиэпилептических и антидепрессивных препаратов для лечения больных эпилепсией с аффективными и тревожными расстройствами.

Background. Epilepsy is associated with the development of a wide range of mental disorders, requiring direct participation of the psychiatrist in their recognition, diagnostics, and therapy. Among all psychopathological disorders affective and anxiety disorders are the most important.The aim of the paper was to present clinical characteristics of depressive and anxiety disorders in epilepsy and to substantiate current psychopharmacology of these impairments. Based on the literature data and our own studies specificities of the affective symptomatology characteristic of epilepsy were demonstrated. Significance of cognitive impairments with impairments of executive functioning was emphasized. Comparison of clinical manifestations of depressive and anxiety disorders was carried out with localization and lateralization of epileptic focus, the leading arm factor, and the presence of alexithymia. The impact of pharmacological mechanisms of action of (GABA-ergic and antiglumatergic) antiepileptic drugs on affective disorders was discussed, as well as possibility of decrease in frequency of seizures and reduction of seizure disorders during treatment with antidepressants from SSRI group.Conclusion was made, emphasizing individualized approach to the choice of antiepileptic and antidepressive drugs for the treatment of patients with epilepsy with affective and anxiety disorders.

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