Original article

Praca oryginalna

SOME TRENDS OF CLINICAL AND SYMPTOMATIC PATHOMORPHOSIS OF DEPRESSIVE DISORDERS TAKING INTO ACCOUNT THE AGE FACTOR

Oleksandr O. Belov, Nataliya G. Pshuk

National Pirogov Memorial Medical University, Vinnytsia, Ukraine

Abstract

Introduction: Depressive disorders are one of the most complex and pressing problems of modern psychiatry; important scientific and practical importance is the study of the pathomorphosis of depression.

The aim of the study is to study the features of clinical pathomorphosis of depressive disorders, taking into account the age factor.

Materials and methods: Medical documentation of 115 men and 121 women with depressive disorders who applied for psychiatric care in 1971–1995 were studied, and 81 men and 108 women with similar depressive disorders who applied for medical care in 2015–2018 were examined clinically.

Results and conclusions: In modern patients, pathomorphosis is most pronounced in young patients (under 30 years of age): asthenia and pessimism were more common in them (65.9% versus 81.9%, p<0.05), suicidal thoughts (52.7% versus 68,7%, p<0.05), dyssomnias. In this age group, there was a decrease in anesthetic symptoms (34.8% versus 12.2%, p<0.01) with an increase in depressions with psychopathological symptoms, mainly in the form of obsessions (42.9% versus 59.0%, p<0,05), depressions with disturbances of biological rhythms, mainly in the form of postsomnic disorders (73.6% versus 96.4%, p<0.05), with vegetative-somatic disorders (63.7% versus 79.5%, p<0.05), asthenic (67.0% versus 81.9%, p<0.05) and agitated symptoms (26.4% versus 39.8%, p<0.05). In the middle age group (30-44 years), the share of vital forms of depression in the structure of depressive symptoms decreased (65.8% versus 44.6%, p<0.01) and depressions with senesto-algic symptomatology (6.6% against 9.6%, p<0.05). In patients of the older age group (45 years and more), the main trends in clinical pathomorphosis were a decrease in anhedonia (90.9% versus 70.7%, p<0.01) and low self-esteem (89.4% versus 65.9%, p<0.01), as well as an increase in apathetic depressions (13.6% versus 29.3%, p<0.05). The general tendency of modern pathomorphosis of depressive disorders is the reduction of vital forms of depression with an increase in depressions with asthenic, anxious and somatic symptomatology.

KEY WORDS: depressive disorders, clinical pathomorphosis

Wiad Lek 2019, 72, 9 cz II, 1787-1790

Introduction

Depressive disorders are one of the most complex and topical problems of modern psychiatry [1-3]. The presence of depressive disorders is an important risk factor for suicidal behavior, as well as a factor showing disorders of social adaptation both in patients with depressions and in their microsocial environment [4, 5]. One of the most important trends in the study of depression is the study of their pathomorphosis; several studies have convincingly demonstrated the presence of gender and age-related pathomorphosis of depressive disorders [6–8]. We have described some trends in the current socio-demographic and clinical pathomorphosis of endogenous depressions [9, 10]. At the same time, a number of important issues of clinical pathomorphosis of depressive disorders remain insufficiently studied, and the data of existing studies are incomplete and contradictory; special attention should be paid to the problem of a comprehensive assessment of modern pathomorphosis of depressive disorders.

The aim

The aim of the study is to study the features of clinical pathomorphosis of depressive disorders, taking into account the age factor.

Materials and methods

We have analyzed the clinical features of depressive disorders in 236 patients who applied for medical care at Vinnitsa Regional Psycho-Neurological Hospital from 1971 to 1995, based on an analysis of medical records (case histories, outpatient records, epicrises, extracts). Gender and nosological structure of the studied contingent is given in table. 1. These patients constituted group A. The average age of the patients in this group was 37.5 ± 12.2 years (men 38.3 ± 13.1 years, women 36.8 ± 11.2 years), the average duration of depression was 7 5 ± 4.6 years (men 7.7 ± 5.0 years, women 7.3 ± 4.2 years).

Besides, with the observance of the principles of biomedical ethics, we have clinically examined 189 patients with depressive disorders who applied for medical assistance at Vinnitsa Regional Psycho-Neurological Hospital from 2015 to 2018. Gender and nosological structure of the studied contingent is given in table I. These patients constituted group B. The average age of patients in this group was 32.6 ± 10.1 years (men 31.8 ± 9.5 years, women 33.3 ± 10.5 years), the average duration of depression was 7 , 8 ± 5.6 years (men 7.6 ± 5.8 years, women 7.9 ± 5.5 years).

Groups A and B were comparable by gender and age characteristics and according to the severity of depressive disorders.

3 subgroups were allocated in each group depending on the age of patients at the time of the study: up to 30 years (A1 and B1, respectively), from 33 to 44 years (A2 and B2 groups, respectively), 45 years and older (A3 and B3 groups, respectively).

Symptoms of depressive disorders were analyzed in relation to the criteria for depression ICD-10 (1996-2017) and the classification of depressions, as well as in the context of individual syndromes.

Statistical analysis of differences between groups was carried out using Fisher’s exact test.

Results and discussion

The results of the analysis of clinical symptoms are given in table II.

When analyzing the specific features of clinical pathomorphosis of depressive disorders, it was found that under modern conditions asthenia in the form of increased fatigue and decreased performance was found to be significantly more frequent in young patients under the age of 30 years (65.9% in group A1 versus 81.9% in group B1, p<0.05). The same ratio (65.9% versus 81.9%, p<0.05) was found for pessimism; suicidal thoughts were also significantly more frequently found in modern young patients (52.7% versus 68.7%, p<0.05), as well as various dissomnias (86.8% versus 96.4%, p<0.05). Less significant differences (p<0.1) were found for gastrointestinal symptoms (impaired appetite, change in body weight): 53.2% versus 64.6%.

In patients aged 30-45, the differences are less evident: the most apparent was an increase in the specific gravity of patients with manifestations of pessimism (72.2% in group A2 versus 84.6% in group B2, p<0.1), and a decrease in the specific gravity of patients with low self-esteem (83.5% versus 72.3%, p<0.1).

In the older age group (45 years and more), the main trends in clinical pathomorphosis were a statistically significant decrease in the specific gravity of patients with symptoms of anhedonia (90.9% in group A3 versus 70.7% in group B3, p<0.01) and with underestimated self-esteem (89.4% versus 65.9%, p<0.01). Less apparent (p<0.1) were a decrease in the specific gravity of patients with manifestations of pessimism (83.3% versus 70.7%), and an increase in the specific gravity of patients with manifestations of guilt, feelings of worthlessness, anxiety or fear (77.3% versus 90.2%), as well as complaints of the reduced ability to concentrate and make decisions (from 63.6% to 78.0%).

As it can be seen from table III, in the structure of depressive symptoms, the specific gravity of vital forms of depression in the age group 30-44 years decreased (from 65.8% to 44.6%, p<0.01) and anesthetic depression in age groups up to 30 years (from 34.8% to 12.2%, p<0.01). The specific gravity of apathetic depressions in the older age group increased (from 13.6% to 29.3%, p<0.05); depression with vegetative-somatic (from 63.7% to 79.5%, p<0.05), asthenic (from 67.0% to 81.9%, p<0.05) and agitated symptoms (from 26, 4% to 39.8%, p<0.05) in the group of young patients (up to 30 years); as well as with senesto-algic symptoms in the middle (30-44 years) age group (from 6.6% to 9.6%, p<0.05).

The study revealed some trends in modern clinical pathomorphosis of depressive disorders in different age groups.

It has been established that, in general, modern pathomorphosis of depressive disorders is characterized by a decrease in the specific gravity of “classical” vital forms of depression with an increase in depressions with asthenic, anxious, and somatovegetative symptomatology. At the same time, the dynamics of pathomorphisis is most evident in the age group up to 30 years; among modern young patients vital and anesthetic forms of depression were significantly less frequently detected, and more often are asthenia phenomena in the form of increased fatigue, decreased performance, pessimism, thoughts of death or suicide, as well as dyssomnia, mainly in the form of postsomnic disorders. Among young patients, we have observed an increase in vegetative-somatic disorders and agitation. The trends in pathomorphosis are less evident in the age group of 45 years and older; they are manifested mainly in the reduction of anhedonia with a higher self-esteem and a decrease in the specific gravity of apathetic forms of depression. Clinical pathomorphosis is less expressed in the age group from 30 to 44 years; it manifests itself mainly in reducing the specific gravity of vital forms of depression and senesto-algic symptoms.

The results obtained allow determining the main trends of modern clinical pathomorphosis of depression in different age groups, which is important for the development of therapeutic, rehabilitation and preventive measures.

Conclusions

The study of the specific features of modern clinical pathomorphosis of depressive disorders revealed its main tendencies, consisting in reducing the specific gravity of vital and anesthetic forms of depression with an increase in atypical anxiety, asthenic forms and forms with somatovegetative symptomatology. Clinical pathomorphosis is most apparent in young (up to 30 years) and older (over 45 years) patients, and less apparent in the middle age group (30-44 years).

References

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The work is done within complex theme “Mental disadaptation, clinical phenomenology, formation mechanisms, complex correction” (state registration number 0115U004000) Department of Medical Psychology and Psychiatry National Pirogov Memorial Medical University, Vinnytsia, Ukraine.

Authors’ contributions:

According to the order of the Authorship.

ORCID numbers:

Oleksandr O. Belov – 0000-0002-0156-0777 

Nataliya G. Pshuk – 0000-0001-9857-2565

Conflict of interest:

The Authors declare no conflict of interest.

CORRESPONDING AUTHOR

Oleksandr O. Belov

Pirogova street, 109, 21100 Vinnitsa, Ukraine

tel: +380678636827

e-mail: oleksbelov@gmail.com

Received: 28.04.2019

Accepted: 15.08.2019

Table I. Gender and nosological structure of the studied patients

ICD-9, ICD-10 code

Nosology

Number of patients

men

women

total

abs.

%

abs.

%

abs.

%

Patients who applied for psychiatric care in 1971–1995 (Group A)

296.3

Manic-depressive psychosis, circular type but currently depressed

51

44,3

38

31,4

89

37,7

296.1

Manic-depressive psychosis, depressive type

64

55,7

83

68,6

147

62,3

Total

115

100

121

100

236

100

Patients who applied for psychiatric care in 2015–2018 (Group B)

F. 31.3,

F. 31.4

Bipolar affective disorder, current episode mild or moderate depression

32

39,5

31

28,6

63

33,4

F. 32.0,

F. 32.1,

F. 32.2

Depressive episode

28

34,6

39

36,1

67

35,4

F. 33.0,

F. 33.1,

F. 33.2

Recurrent depressive disorder

21

25,9

38

35,3

59

31,2

Total

81

100

108

100

189

100

Table II. Features of clinical symptoms in patients of different age groups who applied for psychiatric care in 1971–1995 and 2015-2018

Symptoms

Age groups

abs.

%

abs.

%

abs.

%

abs.

%

A1

A2

A3

Total

Low mood

90

98,9

79

100

65

98,5

234

99,2

Anhedonia

72

79,1

67

84,8

60

90,9

199

84,3

Severe fatigue

60

65,9

56

70,9

43

65,2

159

67,4

Pessimism

60

65,9

57

72,2

55

83,3

172

72,9

Guilt, worthlessness, anxiety or fear

66

72,5

57

72,2

51

77,3

174

73,7

Low self-esteem

65

71,4

66

83,5

59

89,4

190

80,5

Inability to concentrate and make decisions

51

56,0

51

64,6

42

63,6

144

61,0

Thoughts of death and suicide

48

52,7

54

68,4

40

60,6

142

60,2

Unstable appetite, weight fluctuations

44

48,4

42

53,2

36

54,5

122

51,7

Dyssomnia

67

73,6

67

84,8

59

89,4

193

81,8

Symptoms

B1

B2

B3

Total

Low mood

81

97,6

64

98,5

41

100

186

98,4

Anhedonia

62

74,7

53

81,5

29

70,7

144

76,2

Severe fatigue

68

81,9

51

78,5

32

78,0

151

79,9

Pessimism

68

81,9

55

84,6

29

70,7

152

80,4

Guilt, worthlessness, anxiety or fear

66

79,5

50

76,9

37

90,2

153

81,0

Low self-esteem

64

77,1

47

72,3

27

65,9

138

73,0

Inability to concentrate and make decisions

54

65,1

49

75,4

32

78,0

135

71,4

Thoughts of death and suicide

57

68,7

46

70,8

30

73,2

133

70,4

Unstable appetite, weight fluctuations

50

60,2

42

64,6

22

53,7

114

60,3

Dyssomnia

80

96,4

61

93,8

35

85,4

176

93,1

Level of statistical significance of differences (p)

Symptoms

Age groups

A1-B1

A2-B2

A3-B3

A1-A2

A1-A3

A2-A3

B1-B2

B1-B3

B2-B3

Low mood

0,465

0,451

0,617

0,535

0,666

0,455

0,591

0,446

0,613

Anhedonia

0,304

0,381

0,008

0,225

0,036

0,197

0,215

0,396

0,146

Severe fatigue

0,013

0,200

0,114

0,300

0,562

0,288

0,374

0,387

0,572

Pessimism

0,013

0,055

0,098

0,240

0,011

0,080

0,419

0,118

0,072

Guilt, worthlessness, anxiety or fear

0,185

0,324

0,071

0,546

0,314

0,305

0,427

0,104

0,066

Low self-esteem

0,284

0,077

0,004

0,045

0,005

0,220

0,315

0,132

0,311

Inability to concentrate and make decisions

0,145

0,111

0,087

0,165

0,215

0,523

0,120

0,101

0,472

Thoughts of death and suicide

0,023

0,449

0,131

0,027

0,207

0,212

0,463

0,383

0,485

Unstable appetite, weight fluctuations

0,078

0,112

0,543

0,319

0,273

0,501

0,355

0,306

0,179

Dyssomnia

0,022

0,292

0,370

0,354

0,011

0,287

0,366

0,035

0,133

Table III. Symptoms of depression in patients of different age groups who applied for psychiatric care in 1971–1995 and 2015-2018

Option of depression

Age groups

abs.

%

abs.

%

abs.

%

abs.

%

A1

A2

A3

Total

Vital depression

48

52,7

52

65,8

34

51,5

134

56,8

Apathetic depression

20

22,0

12

15,2

9

13,6

41

17,4

Anesthetic depression

23

25,3

15

19,0

23

34,8

61

25,8

Somatic depressive disorders

58

63,7

58

73,4

45

68,2

161

68,2

Senesto-algic syndrome

6

6,6

4

5,1

5

7,6

15

6,4

Asthenic depression

61

67,0

53

67,1

44

66,7

158

66,9

Agitated depression

24

26,4

21

26,6

26

39,4

71

30,1

Symptoms

B1

B2

B3

Total

Vital depression

34

41,0

29

44,6

18

43,9

81

42,9

Apathetic depression

20

24,1

14

21,5

12

29,3

46

24,3

Anesthetic depression

19

22,9

10

15,4

5

12,2

34

18,0

Somatic depressive disorders

66

79,5

50

76,9

31

75,6

147

77,8

Senesto-algic syndrome

8

9,6

10

15,4

4

9,8

22

11,6

Asthenic depression

68

81,9

51

78,5

32

78,0

151

79,9

Agitated depression

33

39,8

22

33,8

18

43,9

73

38,6

Level of statistical significance of differences (p)

Symptoms

Age groups

A1-B1

A2-B2

A3-B3

A1-A2

A1-A3

A2-A3

B1-B2

B1-B3

B2-B3

Vital depression

0,080

0,009

0,372

0,058

0,504

0,057

0,390

0,452

0,552

Apathetic depression

0,439

0,221

0,043

0,176

0,131

0,491

0,434

0,341

0,250

Anesthetic depression

0,425

0,366

0,008

0,213

0,131

0,024

0,176

0,118

0,438

Somatic depressive disorders

0,016

0,387

0,275

0,117

0,342

0,571

0,427

0,390

0,528

Senesto-algic syndrome

0,323

0,036

0,476

0,465

0,525

0,388

0,209

0,607

0,300

Asthenic depression

0,019

0,091

0,148

0,562

0,548

0,548

0,374

0,387

0,572

Agitated depression

0,043

0,222

0,397

0,556

0,060

0,072

0,286

0,401

0,202