Коморбидность ишемической болезни сердца и аффективных расстройств тревожно-депрессивного спектра: клинико-патогенетические аспекты, прогноз и возможности медикаментозной коррекции
При этом в различных исследованиях убедительно показано, что депрессия является независимым фактором риска ИБС. У пациентов с депрессией сердечно-сосудистые заболевания развиваются в 2−4 раза чаще, а летальность после перенесенных коронарных событий у них в 2−4 раза выше. В опубликованных научных обзорах было продемонстрировано, что симптомы депрессии — это фактор риска не только будущего… Читать ещё >
Содержание
- Список сокращений
- Введение
- Глава 1. Особенности коморбидности депрессии, тревоги и ишемической болезни сердца (обзор литературы)
- 1. 1. Современный взгляд на проблему коморбидности, диагностику и прогноз тревожно-депрессивных расстройств и ишемической болезни сердца
- 1. 2. Различные аспекты коморбидности ишемической болезни сердца и депрессивных расстройств
- 1. 2. 1. Факторы риска ишемической болезни сердца, ассоциированные с депрессивными нарушениями у больных ишемической болезнью сердца
- 1. 2. 2. Клинические особенности, качество жизни и приверженность к лечению больных ишемической болезнью сердца с коморбидными депрессивными нарушениями
- 1. 2. 3. Роль серотонина и активации тромбоцитов у больных ишемической болезнью сердца с коморбидными депрессивными расстройствами
- 1. 2. 4. Значение иммунного воспаления у больных ишемической болезнью сердца с коморбидными депрессивными нарушениями
- 1. 2. 5. Место активации гипоталамо-гипофизарной и симпато-адреналовой систем у больных ишемической болезнью сердца с коморбидными депрессивными расстройствами
- 1. 2. 6. Нейрональная пластичность, церебральная гипоперфузия и когнитивная дисфункция у больных ишемической болезнью сердца с коморбидными депрессивными нарушениями
- 1. 3. Общие звенья патогенеза ишемической болезни сердца и тревожных расстройств
- 1. 3. 1. Тревога — возможные механизмы развития, связь с ишемической болезнью сердца
- 1. 3. 2. Тревожная депрессия — коморбидный вариант аффективных нарушений настроения, ассоциация с ишемической болезнью сердца
- 1. 4. Медикаментозная коррекция тревожно-депрессивных расстройств у больных ишемической болезнью сердца
- 1. 4. 1. Влияние небензодиазепиновых транквилизаторов на проявления тревоги и депрессии у больных ишемической болезнью сердца
- 1. 4. 2. Влияние селективных ингибиторов обратного захвата серотонина на проявления тревоги и депрессии у больных ишемической болезнью сердца
- 1. 4. 3. Влияние фолиевой кислоты на проявления тревоги и депрессии у больных ишемической болезнью сердца
- 2. 1. Методика обследования больных ишемической болезнью сердца с коморбидными тревожно-депрессивными расстройствами
- 2. 2. Исследование влияния фармакологической терапии на динамику тревожно-депрессивных расстройств у больных ишемической болезнью сердца
- 2. 3. Клиническая характеристика обследованных больных
- 2. 4. Методы исследования
- 2. 4. 1. Методы оценки тревожно-депрессивных расстройств
- 2. 4. 2. Методы оценки качества жизни, приверженности к лечению и когнитивной функции
- 2. 4. 3. Определение толерантности к физической нагрузке
- 2. 4. 4. Лабораторные методы исследования
- 2. 4. 5. Инструментальные методы исследования
- 2. 4. 6. Методы статистического анализа
- 3. 1. Факторы риска сердечно-сосудистых заболеваний у больных ишемической болезнью сердца с коморбидными тревожно-депрессивными нарушениями
- 3. 2. Психо-социальные аспекты у больных ишемической болезнью сердца, страдающих тревожно-депрессивными расстройствами
4.1 Клинические особенности и качество жизни больных ишемической болезнью сердца с коморбидными тревожно-депрессивными нарушениями. 128 4.2 Приверженность к лечению сердечно-сосудистыми препаратами больных ишемической болезнью сердца, страдающих тревожно-депрессивными расстройствами.
Резюме.
Глава 5. Клинико-патогенетические сопоставления ишемической болезни сердца и коморбидных тревожно-депрессивных расстройств.
5.1 Серотонин и функциональная активность тромбоцитов у больных ишемической болезнью сердца с нарушениями настроения.
5.1.1 Содержание серотонина тромбоцитов и плазмы крови у больных ишемической болезнью сердца с коморбидными аффективными нарушениями.
5.1.2 Оценка аденозиндифосфат-индуцированной агрегации тромбоцитов у больных ишемической болезнью сердца с коморбидными нарушениями настроения.
5.2 Оценка уровня активации гипоталамо-гипофизарной и симпато-адреналовой систем у больных ишемической болезнью сердца, страдающих аффективными расстройствами.
5.2.1 Суточная катехоламинурия у больных ишемической болезнью сердца с коморбидными нарушениями настроения.
5.2.2 Суточная кортизолурия у больных ишемической болезнью сердца с коморбидными нарушениями настроения.
5.3 Оценка цитокиновой активности, мозгового нейротрофического фактора, когнитивной функции и церебральной перфузии у больных ишемической болезнью сердца с коморбидными аффективными расстройствами.
5.3.1 Содержание интерлейкина-1, интерлейкина-6 и фактора некроза опухоли-а в сыворотке крови у больных ишемической болезнью сердца с коморбидными нарушениями настроения.
5.3.2 Содержание мозгового нейротрофического фактора в сыворотке крови у больных ишемической болезнью сердца с коморбидными аффективными нарушениями.
5.3.3 Когнитивная функция у больных ишемической болезнью сердца с сопутствующими расстройствами настроения.
5.3.4 Оценка церебральной перфузии у больных ишемической болезнью сердца с коморбидными аффективными нарушениями.
Резюме.
Глава 6. Способ диагностики тревожно-депрессивных расстройств у пациентов с ишемической болезнью сердца в условиях терапевтического стационара.
6.1 Модель диагностики тревожно-депрессивного расстройства у пациента с ишемической болезнью сердца.
6.2 Методика выявления тревожно-депрессивного расстройства у пациента с ишемической болезнью сердца.
Резюме.
Глава 7. Медикаментозная коррекция тревожных расстройств у больных ишемической болезнью сердца. Открытое, рандомизированное, сравнительное исследование эффективности и безопасности гидроксизина гидрохлорида и пароксетина у больных ишемической болезнью сердца с коморбидными тревожно-депрессивными расстройствами с преобладанием тревожного компонента.
7.1 Влияние гидроксизина гидрохлорида и пароксетина на клинические показатели больных ишемической болезнью сердца с коморбидными тревожно-депрессивными расстройствами с преобладанием тревожного компонента.
7.2 Влияние гидроксизина гидрохлорида и пароксетина на серотонин тромбоцитов, плазмы крови и тромбообразование у больных ишемической болезни сердца с сопутствующими тревожно-депрессивными расстройствами с преобладанием тревожного компонента.
7.3 Влияние гидроксизина гидрохлорида и пароксетина на содержание цитокинов и мозгового нейротрофического фактора у больных ишемической болезнью сердца с коморбидными тревожно-депрессивными расстройствами с преобладанием тревожного компонента.
7.4 Влияние гидроксизина гидрохлорида и пароксетина на липидный спектр, содержание гомоцистеина и фолиевой кислоты сыворотки крови у больных ишемической болезнью сердца с сопутствующими тревожно-депрессивными расстройствами с преобладанием тревожного компонента.
Резюме.
Глава 8. Медикаментозная коррекция смешанных тревожно-депрессивных расстройств у больных ишемической болезнью сердца. Открытое, рандомизированное, сравнительное исследование эффективности и безопасности пароксетина и фолиевой кислоты у больных ишемической болезнью сердца с коморбидными смешанными тревожно-депрессивными расстройствами.
8.1 Влияние пароксетина и фолиевой кислоты на клинические показатели больных ишемической болезнью сердца с коморбидными смешанными тревожно-депрессивными расстройствами.
8.2 Влияние пароксетина и фолиевой кислоты на серотонин тромбоцитов, плазмы крови и тромбообразование у больных ишемической болезнью сердца с сопутствующими смешанными тревожно-депрессивными расстройствами.
8.3 Влияние пароксетина и фолиевой кислоты на содержание цитокинов и мозгового нейротрофического фактора у больных ишемической болезнью сердца с коморбидными смешанными тревожно-депрессивными расстройствами.
8.4 Влияние пароксетина и фолиевой кислоты на липидный спектр, содержание гомоцистеина и фолиевой кислоты сыворотки крови у больных ишемической болезнью сердца с сопутствующими смешанными тревожнодепрессивными расстройствами.
Резюме.
Глава 9. Анализ выживаемости больных ишемической болезнью сердца с коморбидными тревожно-депрессивными расстройствами — результаты 4-х летнего наблюдения.
Резюме.
Глава 10. Обсуждение.
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