psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2021-19-2-63-76psychiatry-647Research ArticleПСИХОПАТОЛОГИЯ, КЛИНИЧЕСКАЯ И БИОЛОГИЧЕСКАЯ ПСИХИАТРИЯPSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRYНейрофизиологические подтипы депрессивных расстройствNeurophysiological Subtypes of Depressive Disordershttps://orcid.org/0000-0002-6023-8542ЛапинИ. А.LapinI. A.

Лапин Игорь Александрович, кандидат медицинских наук, старший научный сотрудник, лаборатория патологии мозга, заведующий отделением инструментальной диагностики

Москва

Igor A. Lapin, MD, PhD, Cand. of Sci. (Med.), Laboratory of Brain Pathology, Head of the Department of Instrumental Diagnostics

Moscow

igor_lapin@mail.ruhttps://orcid.org/0000-0003-3101-0650РогачеваТ. А.RogachevaT. A.

Рогачева Татьяна Анатольевна, доктор медицинских наук, заведующая отделением экзогенно-органических расстройств и эпилепсии

Москва

Tatyana A. Rogacheva, MD, PhD, Dr. of Sci. (Med.), Head of the Department of Exogenous Organic Disorders and Epilepsy

Moscow

32316@mail.ruhttps://orcid.org/0000-0002-8431-0107МитрофановА. А.MitrofanovA. A.

Митрофанов Андрей Алексеевич, научный сотрудник, лаборатория патологии мозга

Москва

Andrew A. Mitrofanov, Researcher of Laboratory of Brain Pathology

Moscow

Brainsys@yandex.ruФГБУ «Национальный медицинский исследовательский центр психиатрии и наркологии им. В.П. Сербского» Минздрава РоссииРоссияFSBI “National Medical Research Center for Psychiatry and Narcology” Ministry of Health of RussiaRussian Federation2021250620211926376Copyright © Лапин И.А., Рогачева Т.А., Митрофанов А.А., 20212021Лапин И.А., Рогачева Т.А., Митрофанов А.А.Lapin I.A., Rogacheva T.A., Mitrofanov A.A.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/647Обоснование

Обоснование: клинический полиморфизм депрессивных расстройств в совокупности с имеющимися данными о различной реакции пациентов на терапию мотивируют современную нейронауку на поиск моделей, позволяющих объяснить подобную гетерогенность.

Цель исследования

Цель исследования: выделить нейрофизиологические подтипы депрессивных расстройств.

Пациенты и методы

Пациенты и методы: 189 больных с депрессией умеренной тяжести в рамках депрессивного эпизода (n = 42), рекуррентного депрессивного (n = 102) и биполярного аффективного расстройств (n = 45); 56 здоровых испытуемых. В работе использовались клинико-психопатологический, психометрический, нейрофизиологический и статистический методы исследования.

Результаты

Результаты: факторная структура отклонений от нормы мнимой когерентности позволила выделить шесть подтипов расстройства. Выделенные подтипы определялись профилями дисфункционального взаимодействия различных корковых зон в альфа-, бета- и гамма-диапазонах ЭЭГ. Первый подтип характеризовался снижением относительно нормы мнимой альфа-когерентности между правым теменным и левым центральным, правым теменным и левым передним височным, а также правым теменным и правым передним височным отведениями ЭЭГ (Р4-С3, Р4-F7, Р4-F8) и объяснял часть депрессий нарушением продвижения позитивного и подавления негативного аффекта. При 2-м подтипе повышение мнимой бета-2-когерентности между лобными отведениями левого и правого полушария, между левой лобной и правой центральной корой (F3-F4; F3-С4) и ее снижение между центральными корковыми зонами (С4-С3) было ассоциировано с клиникой атипичной депрессии. При 3-м подтипе повышение мнимой альфа-когерентности между лобными (F4-F3) и ее снижение между центральными отведениями левой и правой гемисферы (С4-С3) коррелировало с выраженностью депрессивных руминаций. Для 4-го подтипа оказалось характерным снижение мнимой альфа-когерентности между передней височной и лобной, а также передней височной и центральной корой правого полушария (F8-F4 и F8-C4), что объясняло часть депрессий при расстройстве личности по типу избегания. При 5-м подтипе снижение мнимой гамма-когерентности между лобной и теменной, а также центральной и затылочной корковыми зонами левой гемисферы (F3-P3 и C3-O1) было связано с внешне ориентированным утилитарным стилем мышления (алекситимией). Шестой подтип характеризовался снижением мнимой бета-1-когерентности между левой центральной и правой передней височной корой (С3-F8) наблюдался отчасти при депрессиях с фобическими и ипохондрическими нарушениями в рамках рекуррентного депрессивного расстройства.

Вывод

Вывод: подобная клинико-биологическая типология представляется перспективной в плане поиска специфических нейрофизиологических нарушений при разных вариантах депрессий и, соответственно, выхода на дифференцированные терапевтические рекомендации.

Background

Background: the clinical polymorphism of depressive disorders, together with the available data on the different responses of patients to treatment, motivate modern neuroscience to search for models that can explain such heterogeneity.

Objective

Objective: to identify neurophysiological subtypes of depressive disorders.

Patients and methods

Patients and methods: 189 patients with moderate depression in the structure of a depressive episode (n = 42), recurrent depressive (n = 102) and bipolar affective disorders (n = 45); 56 healthy subjects. Clinical-psychopathological, psychometric, neurophysiological and statistical research methods were used in the work.

The results

The results: with the help of coherent EEG analysis, it is possible to identify at least 6 subtypes of the disorder, which characterize various branches of the pathogenesis of affective pathology, which go beyond the currently accepted nomenclature. The selected subtypes were determined by the profi les of dysfunctional interaction of various cortical zones in the alpha, beta and gamma ranges of the EEG. Subtype 1 was characterized by a decrease relative to the norm of imaginary alpha-coherence between the right parietal and left central, right parietal and left anterior temporal, as well as the right parietal and right anterior temporal EEG leads (P4-C3, P4-F7, P4-F8) and explained part of depressions, in the pathogenesis of which the leading role was played by violations of the promotion of positive and suppression of negative affect. Subtype 2 — an increase in beta-2-imaginary-coherence between the frontal leads of the left and right hemispheres, between the left frontal and right central cortex (F3-F4; F3-C4) and its decrease between the central cortical zones (C4-C3), in clinical terms this subtype was characterized by a persistent hedonic response and was associated with the clinical picture of atypical depression. Subtype 3 — an increase in imaginary alpha-coherence between the frontal (F4-F3) and its decrease between the central leads of the left and right hemisphere (C4-C3), correlated with the severity of depressive rumination. Subtype 4 — a decrease in imaginary alpha-coherence between the anterior temporal and frontal, as well as the anterior temporal and central cortex of the right hemisphere (F8-F4 and F8-C4), explained part of the depressions that developed against the background of avoidance personality disorder. Subtype 5 — a decrease in imaginary gamma coherence between the frontal and parietal, as well as the central and occipital cortical zones of the left hemisphere (F3-P3 and C3-O1), was associated with an outwardly oriented utilitarian style of thinking (alexithymia). Subtype 6 — a decrease in imaginary beta-1 coherence between the left central and right anterior temporal cortex (C3-F8), explained part of the depression with phobic and hypochondriacal disorders in the structure of recurrent depressive disorder. Such a clinical and biological typology seems new and promising in terms of searching for specifi c neurophysiological disorders in different types of depression and, accordingly, reaching differentiated therapeutic recommendations.

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