psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2022-20-2-42-50psychiatry-823Research ArticleПСИХОПАТОЛОГИЯ, КЛИНИЧЕСКАЯ И БИОЛОГИЧЕСКАЯ ПСИХИАТРИЯPSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRYСимптомы аффективного регистра в дебюте психических расстройств в подростковом возрастеSymptoms of Affective Register as an Onset of Mental Disorders in Adolescentshttps://orcid.org/0000-0002-8034-4457ОсиповаН. Н.OsipovaN. N.

Наталья Николаевна Осипова, кандидат медицинских наук, кафедра психиатрии и наркологии

Москва

Natalya N. Osipova, Cand. of Sci. (Med.), Associate Professor

Моscow

natinen@yandex.ruhttps://orcid.org/0000-0002-4638-7461БеглянкинН. И.BeglyankinN. I.

Николай Игоревич Беглянкин, кандидат медицинских наук, кафедра психиатрии и наркологии

Москва

Nikolay I. Beglyankin, Cand. of Sci. (Med.)

Моscow

begnik@yandex.ruhttps://orcid.org/0000-0002-1171-5517БарденштейнЛ. М.BardenshteynL. M.

Леонид Михайлович Барденштейн, доктор медицинских наук, профессор, заведующий кафедрой психиатрии и наркологии

Москва

Leonid M. Bardenshteyn, Dr. of Sci. (Med.), Professor, Head of the Department

Моscow

barden@mail.ruhttps://orcid.org/0000-0003-0375-0870ДмитриеваЕ. В.DmitrievaE. V.

Елена Владимировна Дмитриева, старший преподаватель, кафедра физики, математики и медицинской информатики

Смоленск

Elena V. Dmitrieva, Senior Lecture

Smolensk

vernulas@mail.ruФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Министерства здравоохранения Российской ФедерацииРоссияDepartment of Psychiatry and Narcology, Moscow State University of Medicine and Dentistry named after А.I. Evdokimov of the Ministry of Healthcare of the Russian FederationRussian FederationФГБОУ ВО «Смоленский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияDepartment of Physics, Mathematics and Medical Informatics, Smolensk State University of Medicine of the Ministry of Healthcare of the Russian FederationRussian Federation2022060720222024250Copyright © Осипова Н.Н., Беглянкин Н.И., Барденштейн Л.М., Дмитриева Е.В., 20222022Осипова Н.Н., Беглянкин Н.И., Барденштейн Л.М., Дмитриева Е.В.Osipova N.N., Beglyankin N.I., Bardenshteyn L.M., Dmitrieva E.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/823

Обоснование: психические заболевания различного генеза нередко дебютируют в подростковом возрасте аффективными расстройствами. Признаются патопластическое влияние возрастного фактора на клинико-психопатологические особенности этих нарушений и одновременно значительные трудности однозначной нозологической оценки. Целью настоящего исследования было изучение структуры психических расстройств с симптомами аффективного регистра у подростков, впервые обратившихся за психиатрической помощью. Пациенты и метод: были обследованы 120 подростков (средний возраст 17,1 ± 2,37 года), впервые обратившиеся за психиатрической помощью в ПНД в период с 2020 по 2021 г. с преобладанием симптомов аффективного регистра. В исследовании применялись клинико-психопатологический и статистический методы. Результаты: у всех респондентов до момента обращения за психиатрической помощью выявлены инициальные симптомы, средний возраст появления которых составил 14,53 ± 3,18 года. Среди этих симптомов преобладали снижение настроения, раздражительность, эмоциональная лабильность. Выявленные на инициальном этапе, они сохранялись до момента обращения за психиатрической помощью и были причиной нарушения социальной адаптации: снижения успеваемости у 52 пациентов (42,28%), пропусков школьных занятий в 44 случаях (35,77%), сужения круга интересов в 17 наблюдениях (13,82%) и конфликтности у 11 пациентов (8,94%). Вместе с тем заметные для самих подростков и их родителей психопатологические симптомы не становились поводом для обращения за помощью и в большинстве случаев расценивались как признаки пубертатного криза. В распределении диагнозов психических расстройств (по МКБ-10) при первом обращении подростков за психиатрической помощью преобладали расстройства настроения (F30–F39; 48,5%) и невротические, связанные со стрессом и соматоформные расстройства (F40–F49; 25%). Выводы: психические расстройства, прежде всего аффективные заболевания, дебютирующие в подростковом возрасте, имеют продромальный период, который часто интерпретируется как пубертатный криз. Недооценка инициальных проявлений аффективной патологии, несмотря на наличие существенных проблем социальной адаптации, может приводить к несвоевременности терапевтического вмешательства, повышает риск утяжеления клинической картины заболевания и его хронификации. Полученные данные свидетельствуют о необходимости тщательной дифференциальной диагностики инициальных проявлений психических расстройств, последующего клинико-динамического наблюдения и лечения.

Background: mental disorders of different origin often begin with affective symptoms. The inuence of adolescence is recognized and concerns psychopathological manifestations following diagnostics difculties. The aim of the study was to investigate the structure of mental disorders with symptoms of affective disorder in adolescents rstly admitted for psychiatric advice. Patients and method: the study involved 120 adolescents (aged 17.1 ± 2.37) who became patients of the psychoneurological dispensary for the rst time in 2020–2021 due to affective register symptoms. The clinical, psychopathological and statistical methods were used in the study. Results: all respondents had initial symptoms before seeking psychiatric help, the average age of occurrence of which was 14.5 ± 33.18 years. Among the initial manifestations, a decrease in mood, irritability, and emotional lability predominated. Symptoms detected at the initial stage, persisted until the moment of seeking psychiatric help, and were the cause of the violation of social adaptation: a decrease in academic performance in 52 cases (42.28%), school absences in 44 patients (35.77%), narrowing of the range of interests in 17 (13.82%) and conicts in 11 (8.94%) cases. At the same time, psychopathological symptoms noticed by the adolescents themselves and their parents were not a reason to seek help and, in most cases, were considered as manifestations of the puberty crisis. At the rst request of teenagers for psychiatric help, mood disorders (F30–F39) — 48,5%, neurotic, stress-related and somatoform disorders (F40–F49) — 25% dominated in the structure of diagnoses, according to ICD-10. Conclusions: mental disorders, including affective pathology, debuting in adolescence, can have a prodromal period and be often misinterpreted as a puberty crisis. The symptoms of affective disorder in adolescence differ in polymorphism and can lead to a variety of diagnoses. Underestimation of initial preclinical manifestations of affective pathology, despite signicant difculties in social adaptation, can result in untimely therapeutic intervention, severe clinical manifestations and conversion of the diseases into a chronic course. The obtained data conrm the need for a thorough differential diagnosis of initial manifestations of mental disorders, subsequent clinical and follow up care and proper treatment.

аффективные расстройстваподросткипродромальный периодпубертатный кризaffective disordersadolescentsprodromal periodpuberty crisisReferencesКаледа ВГ, Мигалина ВВ, Хронические эндогенные депрессии юношеского возраста. Журнал неврологии и психиатрии имени С.С. Корсакова. 2021;121(5– 2):19–26. doi: 10.17116/jnevro202112105219Kaleda VG, Migalina VV. Chronic endogenous depression sofyouth. S.S. Korsakov Journal of Neurology and Psychiatry/Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2021;121(5–2):19–26. (In Russ.). doi: 10.17116/jnevro202112105219Омельченко МА, Каледа ВГ. Возможности выделения клинических маркеров риска развития шизофрении. Интердисциплинарный подход к коморбидности психических расстройств на пути к интегративному лечению: Сборник тезисов, Санкт-Петербург, 15–18 мая 2021 года. Санкт-Петербург. 2021:2211–2212.Omelchenko МA, Kaleda VG. Vozmozhnosti vydeleniya klinicheskih markerov riska razvitiya shizofrenii. Interdisciplinarnyj podhod k komorbidnosti psihicheskih rasstrojstv na puti k integrativnomu lecheniyu: Sbornik tezisov, Saint Petersburg, 15–18 maya 2021 goda. Saint Petersburg. 2021:2211–2212. (In Russ.).Baldessarini RJ, Tondo L, Vázquez GH. Pharmacological treatment of adult bipolar disorder. Mol Psychiatry. 2019;24(2):198–217. doi: 10.1038/s41380-0180044-2Baldessarini RJ, Tondo L, Vázquez GH. Pharmacological treatment of adult bipolar disorder. Mol Psychiatry. 2019;24(2):198–217. doi: 10.1038/s41380-0180044-2Hayes JF, Miles J, Walters K, King M, Osborn DP. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand. 2015;131(6):417–425. doi: 10.1111/acps.12408Hayes JF, Miles J, Walters K, King M, Osborn DP. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand. 2015;131(6):417–425. doi: 10.1111/acps.12408Ösby U, Westman J, Hällgren J, Gissler M. Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987-2010. Eur J Public Health. 2016;26(5):867–871. doi: 10.1093/eurpub/ckv245Ösby U, Westman J, Hällgren J, Gissler M. Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987-2010. Eur J Public Health. 2016;26(5):867–871. doi: 10.1093/eurpub/ckv245Dickerson F, Origoni A, Schroeder J, Adamos M, Katsafanas E, Khushalani S, Savage CLG, Schweinfurth LAB, Stallings C, Sweeney K, Yolken R. Natural cause mortality in persons with serious mental illness. Acta Psychiatr Scand. 2018;137(5):371–379. doi: 10.1111/acps.12880Dickerson F, Origoni A, Schroeder J, Adamos M, Katsafanas E, Khushalani S, Savage CLG, Schweinfurth LAB, Stallings C, Sweeney K, Yolken R. Natural cause mortality in persons with serious mental illness. Acta Psychiatr Scand. 2018;137(5):371–379. doi: 10.1111/acps.12880Chen TY, Kamali M, Chu CS, Yeh CB, Huang SY, Mao WC, Lin PY, Chen YW, Tseng PT, Hsu CY. Divalproex and its effect on suicide risk in bipolar disorder: A systematic review and meta-analysis of multinational observational studies. J Affect Disord. 2019;245:812–818. doi: 10.1016/j.jad.2018.11.093Chen TY, Kamali M, Chu CS, Yeh CB, Huang SY, Mao WC, Lin PY, Chen YW, Tseng PT, Hsu CY. Divalproex and its effect on suicide risk in bipolar disorder: A systematic review and meta-analysis of multinational observational studies. J Affect Disord. 2019;245:812–818. doi: 10.1016/j.jad.2018.11.093Kazakovtsev BA, Demcheva NK, Yazdovskaya AV, Sidoryuk OV. Psychiatric assistance to the population of the Russian Federation in 2017. https:// www.elibrary.ru/item.asp?id=37088247& (accessed 9.3.20).Kazakovtsev BA, Demcheva NK, Yazdovskaya AV, Sidoryuk OV. Psychiatric assistance to the population of the Russian Federation in 2017. https:// www.elibrary.ru/item.asp?id=37088247& (accessed 9.3.20).Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol. 2018;8:251–269. doi: 10.1177/2045125318769235Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol. 2018;8:251–269. doi: 10.1177/2045125318769235Birmaher B. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study. Am J Psychiat. 2009;166(7):795–804.Birmaher B. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study. Am J Psychiat. 2009;166(7):795–804.Findling RL, Jo B, Frazier TW, Youngstrom EA, Demeter CA, Fristad MA, Horwitz SM. The 24-month course of manic symptoms in children. Bipol Disord. 2013;15(6):669–679.Findling RL, Jo B, Frazier TW, Youngstrom EA, Demeter CA, Fristad MA, Horwitz SM. The 24-month course of manic symptoms in children. Bipol Disord. 2013;15(6):669–679.Berk M, Post R, Ratheesh A, Gliddon E, Singh A, Vieta E. Staging in bipolar disorder: from theoretical framework to clinical utility. World Psychiatry. 2017;16(3):236–244.Berk M, Post R, Ratheesh A, Gliddon E, Singh A, Vieta E. Staging in bipolar disorder: from theoretical framework to clinical utility. World Psychiatry. 2017;16(3):236–244.Kapczinski F, Dias VV, Kauer-Sant’Anna M, Brietzke E, Vázquez GH, Vieta E, Berk M. The potential use of biomarkers as an adjunctive tool for staging bipolar disorder. Prog Neuro-Psychopharmacol and Biol Psychiatry. 2009;33(8):1366–1371.Kapczinski F, Dias VV, Kauer-Sant’Anna M, Brietzke E, Vázquez GH, Vieta E, Berk M. The potential use of biomarkers as an adjunctive tool for staging bipolar disorder. Prog Neuro-Psychopharmacol and Biol Psychiatry. 2009;33(8):1366–1371.Post RM. Clinical staging in bipolar disorder: a historical perspective. Neuroprogression and Staging in Bipolar Disorder. 2015;2:1–16.Post RM. Clinical staging in bipolar disorder: a historical perspective. Neuroprogression and Staging in Bipolar Disorder. 2015;2:1–16.Post RM. The new news about lithium: an underutilized treatment in the United States. Neuropsychopharmacology. 2018;43(5):1174–1179. doi: 10.1038/ npp.2017.238Post RM. The new news about lithium: an underutilized treatment in the United States. Neuropsychopharmacology. 2018;43(5):1174–1179. doi: 10.1038/ npp.2017.238Etain B, Lajnef M, Bellivier F, Mathieu F, Raust A, Cochet B, Henry C. Clinical expression of bipolar disorder type I as a function of age and polarity at onset: convergent ndings in samples from France and the United States. J Clin Psychiatry. 2012;73(4):561–566.Etain B, Lajnef M, Bellivier F, Mathieu F, Raust A, Cochet B, Henry C. Clinical expression of bipolar disorder type I as a function of age and polarity at onset: convergent ndings in samples from France and the United States. J Clin Psychiatry. 2012;73(4):561–566.Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP. Long-term implications of early onset in bipolar disorder: data from the rst 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2004;55(9):875–881. doi: 10.1016/j.biopsych.2004.01.022Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP. Long-term implications of early onset in bipolar disorder: data from the rst 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2004;55(9):875–881. doi: 10.1016/j.biopsych.2004.01.022Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Nolen WA. More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention. Neuroscien Biobehav Rev. 2017;4:204–213. doi: 10.1016/j. neubiorev.2017.01.022Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Nolen WA. More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention. Neuroscien Biobehav Rev. 2017;4:204–213. doi: 10.1016/j. neubiorev.2017.01.022Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Swendsen J. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adoles Psychiatry. 2010;49(10):980–989.Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Swendsen J. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adoles Psychiatry. 2010;49(10):980–989.Fava GA, Tossani E. Prodromal stage of major depression. Early Interv Psychiatry. 2007;1(1):9–18. doi: 10.1111/j.1751-7893.2007.00005.xFava GA, Tossani E. Prodromal stage of major depression. Early Interv Psychiatry. 2007;1(1):9–18. doi: 10.1111/j.1751-7893.2007.00005.xBardenshteyn L, Slavgorodsky Ya, Beglyankin N, Kekelidze D, Aleshkina G. PS62. Early recognition of bipolar depression. International Journal of Neuropsychopharmacology. 2016;19:21–22. doi: 10.1093/ijnp/pyw043.062Bardenshteyn L, Slavgorodsky Ya, Beglyankin N, Kekelidze D, Aleshkina G. PS62. Early recognition of bipolar depression. International Journal of Neuropsychopharmacology. 2016;19:21–22. doi: 10.1093/ijnp/pyw043.062Vöhringer PA, Perlis RH. Discriminating between bipolar disorder and major depressive disorder. Psychiatr Clin N Am. 2016;39(1):1–10. doi: 10.1016/j. psc.2015.10.001Vöhringer PA, Perlis RH. Discriminating between bipolar disorder and major depressive disorder. Psychiatr Clin N Am. 2016;39(1):1–10. doi: 10.1016/j. psc.2015.10.001Zimmerman M. Screening for bipolar disorder with self-administered questionnaires: a critique of the concept and a call to stop publishing studies of their performance in psychiatric samples. Depress Anxiety. 2017;34(9):779–785. doi: 10.1002/da.22644Zimmerman M. Screening for bipolar disorder with self-administered questionnaires: a critique of the concept and a call to stop publishing studies of their performance in psychiatric samples. Depress Anxiety. 2017;34(9):779–785. doi: 10.1002/da.22644Benazzi F, Akiskal H. Irritable-hostile depression: further validation as a bipolar depressive mixed state. J Affect Disord. 2005;84(2–3):197–207. doi: 10.1016/j. jad.2004.07.006Benazzi F, Akiskal H. Irritable-hostile depression: further validation as a bipolar depressive mixed state. J Affect Disord. 2005;84(2–3):197–207. doi: 10.1016/j. jad.2004.07.006Frazier EA, Hunt JI, Hower H, Jones RN, Birmaher B, Strober M, Goldstein BI, Keller MB, Goldstein TR, Weinstock LM, Dickstein DP, Diler RS, Ryan ND, Gill MK, Axelson D, Yen S, Loftus J, Scott J, Vorspan F, Icick R, Henry C, Gard S, Kahn JP, Leboyer M, Bellivier F, Etain B. Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype. J Affect Disord. 2020;267:258–263. doi: 10.1016/j.jad.2020.02.035Frazier EA, Hunt JI, Hower H, Jones RN, Birmaher B, Strober M, Goldstein BI, Keller MB, Goldstein TR, Weinstock LM, Dickstein DP, Diler RS, Ryan ND, Gill MK, Axelson D, Yen S, Loftus J, Scott J, Vorspan F, Icick R, Henry C, Gard S, Kahn JP, Leboyer M, Bellivier F, Etain B. Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype. J Affect Disord. 2020;267:258–263. doi: 10.1016/j.jad.2020.02.035McDonald CE, Rossell SL, Phillipou A. The comorbidity of eating disorders in bipolar disorder and associated clinical correlates characterised by emotion dysregulation and impulsivity: a systematic review. J Affect Disord. 2019;259:228–243. doi: 10.1016/j.jad.2019.08.070McDonald CE, Rossell SL, Phillipou A. The comorbidity of eating disorders in bipolar disorder and associated clinical correlates characterised by emotion dysregulation and impulsivity: a systematic review. J Affect Disord. 2019;259:228–243. doi: 10.1016/j.jad.2019.08.070Baldessarini RJ, Tondo L, Visioli C. First-episode types in bipolar disorder: predictive associations with later illness. Acta Psychiatr Scand. 2014;129(5):383–392.Baldessarini RJ, Tondo L, Visioli C. First-episode types in bipolar disorder: predictive associations with later illness. Acta Psychiatr Scand. 2014;129(5):383–392.Гурьева ВА. К систематике пубертатной психопатологии. В кн.: Современные проблемы подростковой общей и судебной психиатрии. М. 1987:3–12.Gur’eva VA. K sistematike pubertatnoj psihopatologii. V kn.: Sovremennye problem podrostkovoj obshcei I sudebnoi psichiatrii. M. 1987:3–12. (In Russ.).Музыченко ЕН, Вандыш ВВ. Возрастная динамика психических расстройств подросткового возраста (по данным судебно-психиатрической экспертизы). Бехтеревские чтения: Сб. науч. тр. СПб.; Киров. 2003:105–108.Muzychenko EN, Vandysh VV. Vozrastnaya dinamika psihicheskih rasstrojstv podrostkovogo vozrasta (po dannym sudebno-psihiatricheskoj ekspertizy). Bekhterevskie chteniya: Sb. nauch. tr. SPb.; Kirov. 2003:105–108. (In Russ.).

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