ПРЕОДОЛЕНИЕ ФАРМАКОРЕЗИСТЕНТНОСТИ ПРИ ДЕПРЕССИИ НА ФОНЕ БОЛЕЗНИ АДДИСОНА У ПОЖИЛОЙ ПАЦИЕНТКИ: ОБЗОР ЛИТЕРАТУРЫ И КЛИНИЧЕСКИЙ СЛУЧАЙ

  • Anastasia Yu. Bykova ФГБОУ ВО «Ставропольский государственный медицинский университет Минздрава России» https://orcid.org/0000-0001-9011-1887
  • Yuriy V. Bykov ФГБОУ ВО «Ставропольский государственный медицинский университет Минздрава России» https://orcid.org/0000-0003-4705-3823
  • Roman A. Bekker Университет им. Давида Бен-Гуриона в Негеве https://orcid.org/0000-0002-0773-3405
Ключевые слова: недостаточность надпочечников, болезнь Аддисона, пожилой возраст, гипокортицизм, кортизол, гидрокортизон, преднизолон, флудрокортизон, дегидроэпиандростерон, прегненолон, нейростероид

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.

Биографии авторов

Anastasia Yu. Bykova, ФГБОУ ВО «Ставропольский государственный медицинский университет Минздрава России»

студент

 

Yuriy V. Bykov, ФГБОУ ВО «Ставропольский государственный медицинский университет Минздрава России»

врач анестезиолог-реаниматолог, врач психиатр-нарколог, кандидат медицинских наук, ассистент кафедры анестезиологии, реаниматологии и скорой медицинской помощи, педиатрический факультет

 

Roman A. Bekker, Университет им. Давида Бен-Гуриона в Негеве

программист, инженер-математик, магистр в области компьютерных наук, исследователь лаборатории автономных роботов, факультет электроники и компьютерных наук

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Опубликован
2021-08-31
Как цитировать
Bykova, A., Bykov, Y., & Bekker, R. (2021). ПРЕОДОЛЕНИЕ ФАРМАКОРЕЗИСТЕНТНОСТИ ПРИ ДЕПРЕССИИ НА ФОНЕ БОЛЕЗНИ АДДИСОНА У ПОЖИЛОЙ ПАЦИЕНТКИ: ОБЗОР ЛИТЕРАТУРЫ И КЛИНИЧЕСКИЙ СЛУЧАЙ. Siberian Journal of Life Sciences and Agriculture, 13(4), 316-351. https://doi.org/10.12731/2658-6649-2021-13-4-316-351
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