The dissertation is devoted to the determination of factors of the prognosis of formation, course and outcome of depressive disorders on the basis of a comprehensive investigation of their clinical-psychopathological, pathopsychological peculiarities and biochemical correlates in the dynamics of disorder, to the improvement of the principles of diagnosis and to the development of a personified integrated system of therapy for this pathology. It has been worked out the concept of development and the course of depressive disorders, in which the key role belongs not only to the clinical and psychopathological phenomena, but rather to the structural-personal peculiarities of patients and their neurochemical provision, that determines an individual level of resources for stress resistance. It is these characteristics that influence on the development of the pathological process, determine its prognosis and basic personified approaches to therapy. The base of the study was an examination of 157 persons, including 122 patients with depressive disorders (40 with depressive episode (F 32.0, 32.1, 32.2), 44 with recurrent depressive disorder (F 33.0, 33.1, 33.2), and 38 with dysthymia (F 34.1)) and 35 persons without mental disorders (from the general population).The trajectory of development of a depressive disorder was investigated and its stages (initial, intermediate, longitudinal) were defined. These stages are determined with the number of previous episodes and have specific clinical-psychopathological characteristics. The phenomenology and mechanisms of formation of depressive behavior, as a result of transformation of actual coping strategies, peculiarities of a subjective perception of an individual time and personality orientations of patients at different stages of the development of depressive disorder, are determined. The specific peculiarities of the cytokine and catecholamine statuses of patients with depressive disorders, depending on age, gender and nosology of the disorder, were analyzed. The diagnostic value of an increased level of anti-inflammatory interleukin-10 in patients with depressive disorders was established. Norepinephrine has been shown to be a prognostic factor for the course of depressive disorders. The performed regression analysis (according to the linear regression with stepwise inclusion) allowed us to establish that the peculiarities of the clinical structure of disorders, patients’ subjective perception of their conditions, and the personality characteristics of the patient (in the form of coping strategies, personal orientations and perception of his/her individual time) affected the formation of severity of depressive disorder, its course and outcome and could be used as factors of prognosis and specific targets for treatment and rehabilitation measures. Taking into account the specificity of the clinical-psychopathological and pathopsychological factors of the prognosis of the course of depressive disorders, a personified integrated system of therapy has been developed and tested. This system is based on the principles of phasing (stage I - initial, stage II - stabilizing, stage III - psychopreventive), integrity (a combination of pharmacotherapy and psychotherapy), the use of integrated psychotherapeutic approaches (combination of cognitive behavioral therapy, family and art therapy), the combination of methods of individual and group therapy, and the focus on developing an adequate attitude to the morbid condition, mitigation of the intensity of negative emotions, restoration of a motivation potential, development of flexibility of internal psychological dispositions and behavior patterns, actualization of internal and external resources of the patient. The results of approbation of the personified integrated system of depressive disorders treatment, taking into account the prognostic factors of their course, have demonstrated its high efficiency and effectiveness in comparison with traditional programs of treatment and an expediency of its use in practical work.
