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12.4. ХРОНИЧЕСКИЕ АФФЕКТИВНЫЕ РАССТРОЙСТВА

В.Н. Краснов

12.4.1. Дистимия Термин «дистимия» как не достигающий психотического уровня вариант

меланхолии ввел Карл Кальбаум в 1963 г. В последующие десятилетия термин употреблялся относительно редко и преимущественно как симптом либо симптомокомплекс астенически окрашенной гипотимии типа недовольно-

раздражительного настроения. Дистимия снова получила статус нозографической категории в разделе аффективных расстройств в американском диагностическом руководстве DSM-III (1980). Интерес исследователей к дистимии был обусловлен пониманием значимости неразвернутых клинических форм расстройств и их влиянием на снижение социального функционирования (Burton S.W.,

Akiskal H.S., 1990).

ЭПИДЕМИОЛОГИЯ

По результатам эпидемиологического исследования W. Weissman и соавт. (1988),

распространенность дистимии в течение жизни составила 3,1% (вдвое чаще у женщин по сравнению с мужчинами). Это соотношение подтвердило и более позднее исследование (Kessler R.C. et al., 2005), при общем показателе распространенности в течение жизни 2,5%.

ЭТИОЛОГИЯ И ПАТОГЕНЕЗ Этиология дистимии наиболее проблематична среди депрессивных расстройств.

Принадлежность к депрессивному спектру аффективных расстройств предполагает определенные наследственно-генетические предпосылки заболевания, что подтверждается установленной в части случаев возможностью развития отчетливого депрессивного эпизода (так называемая двойная депрессия, Keller

M.B., Shapiro R.W., 1982) на фоне длительно существующей характерной симптоматики дистимии. В то же время анамнестические данные и структурные характеристики свидетельствуют о значительном участии в клинических проявлениях и самом протрагировании, малокурабельности состояния неблагоприятных средовых, в первую очередь микросоциальных, факторов.

КЛИНИЧЕСКАЯ КАРТИНА Дистимию в современных классификациях рассматривают как вариант

аффективных (депрессивных) расстройств с умеренно или слабо выраженными

800

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