Rakhman L. Treatment resistant depressive disorders (clinical characteristic, pathomorphosis, biological and psychosocial correlates, complex therapy)

In the thesis, using the method of retrospective analysis, it was conducted a content analysis of 200 archival patients medical cards with treatment resistance depressive disorders of 20 years period who was hospitalized at the Municipal institution "Lviv Regional Clinical Psychiatric Hospital." It was established pathomorphosis structure for treatment resistant depressive disorder (TRD) with the release of clinical, therapeutic and psychosocial levels. Based on comparative socio-demographic, clinical and patho-psychological, psycho-diagnostic, laboratory biochemical and neurophysiological analysis at the Municipal Institution "LvivRegionalClinicalPsychiatric Hospital," 187 patients with TRD was examined and was identified clinical markers, also biological and psychosocial predictors of TRD. It was identified biological predictors of TRD. Neurochemical studies have shown that in TRD marked imbalance for prooxidant and antioxidant systems with upward last one, also infringement mechanisms of active transport of Na into the extracellular environment, which is a marker of violation of the integrity of cells and their subsequent damage. Neuroimunological research in TRD showed significant disregulation systems, cellular and humoral immune deficiency with the appearance of activity. The predominance of rhythm changes in brain structures in the right hemisphere, expressed interhemispheric assymmetry that preferentially localized in the frontal and parietal lobe of the right hemisphere, reducing synchronization signals in the frontal, parietal and central temporal cortical areas with potentiation reduce integration in both hemispheres was identificated as neurophysiological predictors for TRD pathogenesis. During research individual psychological characteristics, especially social and family functioning of patients with TRD was studied. Patients with TRD inherent alexithymia in 79.7%, in 20.3% cases it was mark as "risk zone" for alexithymia. Clinical and organizational aspects, formulated basis, principles and components of a complex treatment system for TRD were defined. The treatment program includes a combination of pharmacological, psychotherapeutic and psycho educational interventions, which differentiated in depending on the clinical specificity of TRD, individual psychological characteristics of patients with mandatory engagement their families. The implemented system showed efficacy, based on clinical and psychopathological dynamics, positive changes in social functioning and quality of life in patients with TRD.