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Title: COMPARATIVE CHARACTERISTIC OF «ALCOHOL DEPRESSION» IN PERSONS WHO PARTICIPATED IN COMBAT OPERATIONS (COMBATANS) AND AFFECTED BY RADIATION CATASTROP.
Author: Napryeyenko OK, Loganovsky KM, Napryeyenko NY, Loganovskaja TK, Gresko MV, Zdanevich NA.
Journal: Probl Radiac Med Radiobiol; 2018 Dec; 23():423-441. PubMed ID: 30582860.
Abstract:
The relevance of work is conditioned by the considerable prevalence of depressive disorders and alcohol abuseamong people who participated in combat operations (combatants) and affected by a radiation emergency, whichneeds to be optimized for providing them with a comprehensive social, psychological-psychiatric, medication andsomato-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 depres-sion associated with alcohol abuse through theoretical substantiation, development and implementation in theinstitutions of public health and other agencies involved of new principles and algorithms for diagnosis, treatmentand 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 81Chornobyl catastrophe clean-up workers (liquidators) with post-traumatic stress disorder and comorbid chroniccerebrovascular pathology, as well as other contingents affected by the Chornobyl catastrophe. Clinical-anamnestic,socio-demographic, clinical psychopathological, psychodiagnostic, neurophysiological and neuroimaging methodswere used. Somato-neurological clinical examinations and laboratory tests have been applied. The analysis of thedata was performed using MS Excel spreadsheets and statistical package Statistica 10.0 (StatSoft) with the Studentt-criterion, paired t-test, criterion χ2, and Fisher exact test.The study design of the main group consisted of 5 stages: 1) screening; 2) inclusion; 3) randomization; 4) treat-ment and 5) catamnestic (follow-up) observation.Results. In the main group the distribution of depressive syndromes was revealed as follows: depressive-hypochon-dric - 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 thebrain bioelectric activity, thickening of the intima-media complex and venous dyshaemia in the basal veins ofRosenthal. In liquidators there is an excess of depressive disorders, the frequency and severity of which increase inproportion to the radiation dose. These disorders are characterized by progressive course, personality changes withpsychosomatic pre-disposition, comorbidity with cerebrovascular pathology, neurocognitive deficits and high fre-quency (24 %) of secondary alcohol abuse. The relationship between depressive disorders and alcohol dependencein the examined patients is diverse. Their variants differ in certain clinical manifestations and to a large extentdetermine the differential diagnosis and differentiated approaches to treatment, prevention and medical and socialrehabilitationConclusions. The comorbidity of depressive disorders with the abuse of alcohol by combatants and person affectedby 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 med-ical and social rehabilitation may increase the level of medical care for the ATO /JFO combatants and the Chernobylcatastrophe survivors with depression associated with alcohol abuse. Aktual'nist' roboty zumovlena znachnoiu poshyrenistiu depresyvnykh rozladiv i zlovzhyvannia alkogolem v osib,iaki braly uchast' u boĭovykh diiakh (kombatantiv), i postrazhdalykh pry radiatsiĭnykh nadzvychaĭnykh sytuatsiiakh, shcho pot-rebuie optymizatsiï nadannia ïm kompleksnoï sotsial'noï, psykhologo-psykhiatrychnoï, narkologichnoï i somatonevro-logichnoï dopomogy na pidstavi biopsykhosotsial'noï paradygmy.Meta doslidzhen' – pidvyshchyty riven' medychnoï dopomogy kombatantam Antyterorystychnoï operatsiï / Operatsiïob’iednanykh syl (ATO/OOS) i postrazhdalym vnaslidok katastrofy na Chornobyl's'kiĭ AES (ChAES) z depresiieiu,asotsiĭovanoiu zi zlovzhyvanniam alkogolem, shliakhom teoretychnogo obґruntuvannia, rozrobky ta vprovadzhennia vzakladakh okhorony zdorov’ia ta inshykh prychetnykh vidomstvakh novykh pryntsypiv i algorytmiv diagnostyky, likuvan-nia ta profilaktyky.Ob’iekt i metody doslidzhennia – obstezheno 160 kombatantiv ATO/OOS cholovichoï stati, vikom vid 22 do 56 rokiv(M -#177; SD: (41,5 -#177; 16,5) roku) iz zalezhnistiu vid alkogoliu ta depresyvnymy rozladamy – osnovna grupa. Grupyporivniannia vkliuchaly 81 uchasnyka likvidatsiï naslidkiv avariï (ULNA) na ChAES z posttravmatychnym stresovymrozladom i komorbidnoiu khronichnoiu tserebrovaskuliarnoiu patologiieiu, a takozh inshi kontyngenty postrazhdalykhvnaslidok Chornobyl's'koï katastrofy. Vykorystani kliniko-anamnestychnyĭ, sotsial'no-demografichnyĭ, kliniko-psykhopatologichnyĭ, psykhodiagnostychnyĭ, neĭrofiziologichni ta neĭrovizualizatsiĭni metody. Zastosovano somato-nevrologichni klinichni obstezhennia i laboratorni doslidzhennia. Analiz otrymanykh danykh provodyly za dopomogoiuelektronnykh tablyts' MS Excel i statystychnogo paketu Statistica 10.0 (StatSoft) za t-kryteriiem St'iudenta, parnymt-testom, kryteriiem χ2 i tochnym testom Fishera.Dyzaĭn doslidzhennia osnovnoï grupy skladavsia z 5 etapiv: 1) skryningu; 2) vkliuchennia; 3) randomizatsiï; 4) liku-vannia ta 5) katamnestychnogo sposterezhennia.Rezul'taty. V osnovniĭ grupi vyiavleno nastupnyĭ rozpodil depresyvnykh syndromiv: depresyvno-ipokhondrych-nyĭ – u 68 (42,5 %) patsiientiv; 2) asteno-depresyvnyĭ – u 33 (20,6 %); 3) tryvozhno-depresyvnyĭ – u 31 (19,4 %);4) depresyvno-dysforychnyĭ – u 14 (8,8 %); 5) apato-depresyvnyĭ – u 7 (4,35 %); 6) prostyĭ depresyvnyĭ –u 7 (4,35 %). U biĭtsiv pislia uchasti v ATO/OOS sposterigaiut'sia deformatsiï osobystosti, irytatyvni zminy bioele-ktrychnoï aktyvnosti golovnogo mozku, potovshchennia kompleksu «intyma-media» i venozna dyzgemiia po bazal'nykhvenakh Rozentalia. V ULNA na ChAES sposterigaiet'sia ekstses depresyvnykh rozladiv, chastota i vyrazhenist' iakykhzrostaiut' proportsiĭno do dozy oprominennia. Tsi rozlady kharakteryzuiut'sia progresuiuchym perebigom, zminamyosobystosti z psykhosomatychnoiu predyspozytsiieiu, komorbidnistiu z tserebrovaskuliarnoiu patologiieiu, neĭrokog-nityvnym defitsytom i vysokoiu chastotoiu (24 %) vtorynnogo zlovzhyvannia alkogolem. Vzaiemyny depresyvnykhrozladiv i alkogol'noï zalezhnosti v obstezhenykh khvorykh ie riznomanitnymy. Ïkh varianty vidrizniaiut'sia pevnymyklinichnymy proiavamy i znachnoiu miroiu zumovliuiut' dyferentsiĭnu diagnostyku ta dyferentsiĭovani pidkhody dolikuvannia, profilaktyky i medyko-sotsial'noï reabilitatsiï:Vysnovky. Komorbidnist' depresyvnykh rozladiv zi zlovzhyvanniam alkogolem u kombatantiv i postrazhdalykh vna-slidok katastrofy na ChAES nabuvaie zrostaiuchoï znachushchosti peredusim cherez pidvyshchenu nebezpeku suïtsydal'noïpovedinky. Zaproponovani diagnostychnyĭ kompleks i dyferentsiĭovani pidkhody do likuvannia, profilaktyky ta medyko-sotsial'noï reabilitatsiï mozhut' pidvyshchyty riven' medychnoï dopomogy kombatantam ATO/OOS i postrazh-dalym vnaslidok Chornobyl's'koï katastrofy z depresiieiu, asotsiĭovanoiu zi zlovzhyvanniam alkogolem.

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