S-05-01

Borders of depression: Old and new problems of psychiatric diagnosis

V. V. Solojenkin, K. V. Solojertkina, T. A. Nelubova. Kyrgyz State Medical Academy Head, Dept. of Psychiatry, Bishek, Kyrgyzistan

Objective: Analyses of the diagnostic of the affective disorders in Central Asiatic countries.

Results: Empiric analyses of the diagnostic approaches in Central Asiatic countries demonstrates that the usage of Chapters F3 and F4 of ICD-10. for the diagnosis very often keeps the traditional clinic evaluation of endogenical and psychogenical disorders. One meets very seldom the evaluation of the co-morbidity of anxiety and depressive disorders. Construction of the practically obligate combination of anxiety and depression and co-morbidity not only for depression but also for their symptoms for the collateral ones the intersection is characteristic and does not dominate. An intention to follow pedantically the diagnostic criteria of ICD-10. is combined with the psychological analysis which seems rather eclectic. The existing accesses for diagnoses for affective disorders can be considered both like a difficulty of transition from traditional classifications, and like real difficulties that F3 and F4 contain, and theories that are parallel to ICD-10. The conception of distress as one of the leading diagnostic principles in the new classification allows to treat it as a reaction at psychopathological symptoms and mechanisms of their origin. But the co-morbidity of anxiety and depression may be carried out through design of scientific approaches based on biological research of conception of co-morbidity of disorder in all its three variants and comorbidity of symptom, adaptational psychological analyses of the transformation of anxiety into another psychopathological phenomenon, exploration of phenomenon of the somatisation of affective disorders (F4.5), that represents a very heterogeneous group.

S-05-02

The variety of depressive disorders in primary care: Case of Belarus

R. A. Evsegneev. Byelorussian Medical Academy f Postgraduate Training Nivinky, Minsk, Balarus, Belarus

Objective: The purpose of the study was to recognize and to discuss the main reasons of poor recognition of the depressive disorders in the primary care system in Belarus. Method.About 100 cases finally treated in psychiatric hospital in Minsk with recurrent depression end bipolar affective disorder were retrospectively investigated. Results. About 70% of the patients in the past have contacted with primary care system but none of them were diagnosed in a proper way. The objective (i.e. connected with the disorder itself) and subjective reasons (i.e. connected with the doctors skills and views and care system in Belarus) are discussed.

S-05-03

Criteria of psychotic level of anxiety-depression syndrome

Y. Savenko, L. N. Vinogradova. Novyi Arbat, Moscow, Russia

Objective: To check up the traditional clinical idea about qualitative differences between “psychotic and non-psychotic” depressive syndrome, in spite of presence of symptoms of deeper registers (because understanding of “psychotic” in the ICD-10. has withdrawn the problem instead of solving it).

Methods: Analysis of results of clinical-psychopathological and experimental-psychological research with use of phenomenological.

Results: Evaluation of 373 patients with anxiety-depression disorders allowed to show the presence of “psychotic” level of disorganization of psychic activity in the framework of pure affective register and to formulate criteria of differentiation psychotic - nonpsychotic” in anxiety depression. Conclusions: Using the worked out criteria allows qualify psychotic level of depression, which demands principally more intensive therapy than the one used everywhere under continual approach (which falsely identifies intensity and depth of depression). We face here the choice of fundamentally different ways of further development of our subject.

S-05-04

Transcultural specific features of affective disorders in the European North of Russia

A. Bogdanov. Arkhangelsk, Russia

There are noticeable differences in frequency of presence and registration of affective disorders in the Ninets population (the Mongoloid Race) in comparison with Russians (the European Race) living in the European North of Russia. Differences in clinical picture, first of all, of depressive syndromes and in their subjective - personal assessment by patients have also been noted. The noted special features refer not only to “pure” affective syndromes, but also to other complicated psychopathological conditions for instance in the framework of schizophrenia. Possible hypotheses and causes of differences in clinical qualifications and statistical registrations of affective disorders among the Nenets" and the Russians have been discussed. As principal hypotheses one should consider the historiccultural hypothesis and also adaptive-adjustive one.

S-05-05

Affective spectrum disorders: On the way to unitary concept

V. Krasnov. Moscow Research Institute of Psychiatry, Moscow, Russia

Objective: Purpose of this study is to assess of the prevalence of affective spectrum disorders in primary care settings.

Methods: screening questionnaire, semistructured psychiatric interview, SCL-90, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS).

Results: 14,230 adult out-patients from 18 to 55 years in several primary care settings have been screened over six years. 51.3 % of the screened out-patients showing different affective (depressive and anxious) disturbances and somatoform disorders. In the majority of cases, the anxiety symptoms overlapped with depression. During the six-year study, 30.3% of the patients were identified with depression by standardized clinical instruments; in 23.9% the HDRS score was 15 or more. At the same time, there were different combinations of depression with anxiety and somatoform disorders-with similar score levels of somatization, depression and anxiety by SCL-90, and HARS score average of about 20. In clinical course, anxiety and/or somatoform disorders usually preceded depression or combined with it at early, and further on were replaced by typical depressive syndrome. Anxiety clearly dominated in only 4.7%, but included background subsyndrome depression in the majority of cases. Separate somatoform disorders without depressive and anxiety features were identified only in rare cases. Treatment with SSRIs and others modem antidepressants has shown significant positive response for both depression and anxiety, as well as for persistent somatoform disorders.

Conclusion: The data have been obtained in favour of the unity concept of a single affective spectrum, which considers anxiousdepressive affective disorder with psychovegetative components as a cohesive entity.