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Феномен импульсивности при биполярном аффективном расстройстве: частота и коморбидность

https://doi.org/10.30629/2618-6667-2022-20-1-97-109

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Аннотация

Введение: импульсивность считается дезадаптирующим фактором при многих психических заболеваниях. Клинический опыт показывает, что часто именно импульсивность в большей степени, чем другие психопатологические расстройства, приводит к грубым нарушениям поведения и госпитализации. Известно, что при биполярном аффективном расстройстве (БАР) импульсивность является характерным симптомом гипомании и мании. В некоторых исследованиях импульсивность обнаруживается и в другие периоды болезни, как во время депрессивного эпизода, так и в ремиссии, что придает наличию импульсивности прогностическое значение.

Цель систематического обзора: провести анализ научных исследований феномена импульсивности и оценить по данным публикаций: 1) выраженность импульсивности у пациентов с БАР в сравнении с популяцией здоровых лиц; 2) частоту коморбидных с БАР состояний с проявлениями импульсивности.

Материалы и методы: в GoogleScholar, PubMed, eLIBRARY проведен поиск исследований по ключевым словам «bipolar disorder, impulsivity», «bipolar disorder, impulsivity, comorbidity», «биполярное расстройство, импульсивность» и «биполярное расстройство, импульсивность, коморбидность» за последние 20 лет. Поиск по базе данных PubMed дал 147 результатов, GoogleScholar — 142, eLIBRARY — 0. В результате обработки полученных данных было отобрано 11 исследований, соответствующих критериям поиска «биполярное расстройство и импульсивность», «bipolar disorder impulsivity».

Заключение: во всех исследованиях пациенты, находящиеся в той или иной активной фазе БАР, отличались от контрольной группы по факту наличия импульсивности, тогда как в отношении пациентов в ремиссии полученные в исследованиях результаты разошлись. Для проверки гипотезы о том, что импульсивность при БАР связана с коморбидными состояниями, был проведен поиск по ключевым словам «биполярное расстройство, импульсивность и коморбидность», «bipolar disorder, impulsivity, comorbidity», в результате которого было отобрано 38 исследований. Рассматривались только те коморбидные состояния, в патогенезе которых ведущую роль играет импульсивность: синдром дефицита внимания у взрослых, расстройство пищевого поведения, злоупотребление и зависимость от алкоголя и других психоактивных веществ и различные формы нехимической поведенческой зависимости. По всем видам коморбидных состояний частота их встречаемости у пациентов с БАР существенно превышала контроль. Остается неясным, является ли импульсивность свойством, присущим БАР, или же следствием высокой распространенности коморбидных состояний. В любом случае обнаружение признаков импульсивности в клинической картине БАР на разных стадиях заболевания является важной диагностической задачей, так как определяет особую терапевтическую стратегию и тактику реабилитации этих больных.

 

Об авторах

М. А. Морозова
ФГБНУ Научный центр психического здоровья
Россия

Маргарита Алексеевна Морозова, доктор медицинских наук, руководитель лаборатории, лаборатория психофармакологии

Москва



С. С. Потанин
ФГБНУ Научный центр психического здоровья
Россия

Сергей Сергеевич Потанин, кандидат медицинских наук, лаборатория психофармакологии

Москва



Д. С. Бурминский
ФГБНУ Научный центр психического здоровья
Россия

Денис Сергеевич Бурминский, кандидат медицинских наук, лаборатория психофармакологии

Москва



Г. Е. Рупчев
ФГБНУ Научный центр психического здоровья
Россия

Георгий Евгеньевич Рупчев, кандидат психологических наук, лаборатория психофармакологии

Москва



А. Г. Бениашвили
ФГБНУ Научный центр психического здоровья
Россия

Аллан Герович Бениашвили, кандидат медицинских наук, лаборатория психофармакологии

Москва



Т. А. Лепилкина
ФГБНУ Научный центр психического здоровья
Россия

Таисия Алексеевна Лепилкина, кандидат психологических наук, лаборатория психофармакологии

Москва



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Рецензия

Для цитирования:


Морозова М.А., Потанин С.С., Бурминский Д.С., Рупчев Г.Е., Бениашвили А.Г., Лепилкина Т.А. Феномен импульсивности при биполярном аффективном расстройстве: частота и коморбидность. ПСИХИАТРИЯ. 2022;20(1):97-109. https://doi.org/10.30629/2618-6667-2022-20-1-97-109

For citation:


Morozova M.A., Potanin S.S., Burminskiy D.S., Rupchev G.E., Beniashvili A.G., Lepilkina T.A. Impulsivity in Bipolar Affective Disorder: Prevalence and Comorbidity. Psikhiatriya. 2022;20(1):97-109. (In Russ.) https://doi.org/10.30629/2618-6667-2022-20-1-97-109

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