| Abstrakt: |
The relevance of work is conditioned by the considerable prevalence of depressive disorders and alcohol abuse among people who participated in combat operations (combatants) and affected by a radiation emergency, which needs to be optimized for providing them with a comprehensive social, psychological-psychiatric, medication and somato-neurological help on the basis of a biopsychosocial paradigm. The objective of the study was to increase the level of medical care to combatants of the Antiterrorist Operation / Joint Forces Operation (ATO/JFO) and person affected by the catastrophe at the Chornobyl NPP (ChNPP) with depression associated with alcohol abuse through theoretical substantiation, development and implementation in the institutions of public health and other agencies involved of new principles and algorithms for diagnosis, treatment and prevention. The object and methods of the study were 160 ATO/JFO combatants from the age of 22 to 56 years old (M ± SD: (41.5 ± 16.5) years) with alcohol and depressive disorders the main group. The comparison groups included 81 Chornobyl catastrophe clean-up workers (liquidators) with post-traumatic stress disorder and comorbid chronic cerebrovascular pathology, as well as other contingents affected by the Chornobyl catastrophe. Clinical-anamnestic, socio-demographic, clinical psychopathological, psychodiagnostic, neurophysiological and neuroimaging methods were used. Somato-neurological clinical examinations and laboratory tests have been applied. The analysis of the data was performed using MS Excel spreadsheets and statistical package Statistica 10.0 (StatSoft) with the Student t-criterion, paired t-test, criterion %2, and Fisher exact test. The study design of the main group consisted of 5 stages: 1) screening; 2) inclusion; 3) randomization; 4) treatment and 5) catamnestic (follow-up) observation. Results. In the main group the distribution of depressive syndromes was revealed as follows: depressive-hypochondric - in 68 (42.5%) patients; 2) asthenic-depressive - in 33 (20.6%); 3) anxiety-depressive - in 31 (19.4%); 4) depressive-dysphoric - in 14 (8.8%); 5) apathetic-depressive - in 7 (4.35%); and 6) simple depressive - in7 (4.35%). The combatants after participation in the ATO/JFO had personality deformation and irritative changes of the brain bioelectric activity, thickening of the intima-media complex and venous dyshaemia in the basal veins of Rosenthal. In liquidators there is an excess of depressive disorders, the frequency and severity of which increase in proportion to the radiation dose. These disorders are characterized by progressive course, personality changes with psychosomatic pre-disposition, comorbidity with cerebrovascular pathology, neurocognitive deficits and high frequency (24%) of secondary alcohol abuse. The relationship between depressive disorders and alcohol dependence in the examined patients is diverse. Their variants differ in certain clinical manifestations and to a large extent determine the differential diagnosis and differentiated approaches to treatment, prevention and medical and social rehabilitation. Conclusions. The comorbidity of depressive disorders with the abuse of alcohol by combatants and person affected by the catastrophe at the ChNPP is gaining an increasing significance first of all because of the increased risk of suicidal behavior. The proposed diagnostic complex and differentiated approaches to treatment, prevention and medical and social rehabilitation may increase the level of medical care for the ATO/JFO combatants and the Chernobyl catastrophe survivors with depression associated with alcohol abuse. [ABSTRACT FROM AUTHOR] |
