ПРЕОДОЛЕНИЕ ФАРМАКОРЕЗИСТЕНТНОСТИ ПРИ ДЕПРЕССИИ НА ФОНЕ БОЛЕЗНИ АДДИСОНА У ПОЖИЛОЙ ПАЦИЕНТКИ: ОБЗОР ЛИТЕРАТУРЫ И КЛИНИЧЕСКИЙ СЛУЧАЙ
Аннотация
Цель исследования. Представить читателю систематический обзор литературы о взаимосвязи депрессивных состояний и, шире, психических расстройств с недостаточностью коры надпочечников, о роли надпочечниковой патологии в развитии резистентности к психотропным средствам или их непереносимости, о принципах адекватной заместительной терапии при первичной недостаточности коры надпочечников (болезни Аддисона), о роли максимально физиологической заместительной терапии в нормализации не только соматического, но и психического состояния пациентов с этим расстройством, о важности учёта возможного полиэндокринного характера расстройства, а затем описать клинический случай из нашей практики, ярко иллюстрирующий эти тезисы.
Методология проведения работы. Нами был проведён поиск литературы с использованием соответствующих ключевых слов в международных базах данных PubMed, Google Scholar, Elsevier ClinicalKey и Elsevier ScienceDirect, а также в российской базе данных РИНЦ e-library и в библиографических списках основополагающих руководств по эндокринологии и по терапевтически резистентным депрессиям.
Результаты. Представленные нами в настоящем обзоре литературные данные, вкупе с анализом приводимого авторами клинического случая, иллюстрируют важность максимально приближённой к физиологическому паттерну секреции коры надпочечников заместительной терапии при болезни Аддисона, роль коррекции недостаточности минералокортикоидов, надпочечниковых андрогенов и нейростероидов, наряду с глюкокортикоидной недостаточностью, в устранении всех симптомов болезни, включая психические, а также важность психообучения этих пациентов и их родственников, и важность тесного союза психиатра и эндокринолога при лечении таких пациентов.
Область применения результатов. Полученные нами в процессе составления настоящего обзора результаты и выводы, вкупе с представленным нами анализом клинического случая и выводами из него, заслуживают самого широкого применения при лечении пациентов с недостаточностью коры надпочечников и сопутствующей психической патологией.
Скачивания
Литература
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