medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-053medsovet-7418Research ArticleНЕРВНО-ПСИХИЧЕСКИЕ РАССТРОЙСТВАNEUROPSYCHIATRIC DISORDERSТревожные расстройства в общемедицинской практике – клиническая картина, диагностика, оптимизированные подходы к терапииAnxiety disorders in general medical practice – clinical picture, diagnosis, optimized approaches to therapyhttps://orcid.org/0000-0002-2228-6316ПетелинД. С.PetelinD. S.

Петелин Дмитрий Сергеевич - кандидат медицинских наук, ассистент кафедры психиатрии и психосоматики Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 1

Dmitry S. Petelin - Cand. Sci. (Med.), Assistant of the Department of Psychiatry and Psychosomatics of the Institute of Clinical Medicine named after N.V. Sklifosovsky.

8, Bldg. 1, Trubetskaya St., Moscow, 119991

petelinhome1@yandex.ruhttps://orcid.org/0000-0001-8863-8241СорокинаО. Ю.SorokinaO. Yu.

Сорокина Ольга Юрьевна - кандидат медицинских наук, заведующая психотерапевтическим отделением Университетской клинической больницы №3 Клинического центра.

119991, Москва, ул. Трубецкая, д. 8, стр. 1

Olga Yu. Sorokina - Cand. Sci. (Med.), Head of the Psychotherapeutic Department of the University Clinical Hospital No. 3 of the Clinical Center.

8, Bldg. 1, Trubetskaya St., Moscow, 119991

msolgasorokina@mail.ruhttps://orcid.org/0000-0002-5046-6699ТрошинаД. В.TroshinaD. V.

Трошина Дарья Викторовна - кандидат медицинских наук, специалист по научно-методической работе Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 1

Daria V. Troshina - Cand. Sci. (Med.), Specialist in Scientific and Methodological Work of the Institute of Clinical Medicine named after N.V. Sklifosovsky.

8, Bldg. 1, Trubetskaya St., Moscow, 119991

dtroshina@mail.ruhttps://orcid.org/0000-0002-4676-2719СигиневичЮ. А.SiginevichYu. A.

Сигиневич Юлия Алексеевна - врач психиатр-психотерапевт психотерапевтического отделения Университетской клинической больницы №3 Клинического центра.

119991, Москва, ул. Трубецкая, д. 8, стр. 1

Yulia A. Siginevich - Psychiatrist-psychotherapist of the Psychotherapeutic Department of the University Clinical Hospital No. 3 of the Clinical Center.

8, Bldg. 1, Trubetskaya St., Moscow, 119991

shedlina.yulia@mail.ruhttps://orcid.org/0000-0002-6196-4095ЕфимочкинаС. М.EfimochkinaS. M.

Ефимочкина Софья Михайловна - резидент СНК «Психиатрия и психосоматическая медицина».

119991, Москва, ул. Трубецкая, д. 8, стр. 1

Sofia M. Efimochkina - Resident of the Students Society Club “Psychiatry and Psychosomatic Medicine”.

8, Bldg. 1, Trubetskaya St., Moscow, 119991

efimochkina.sofi@gmail.comhttps://orcid.org/0000-0003-1667-5355ВолельБ. А.VolelB. A.

Волель Беатриса Альбертовна - доктор медицинских наук, директор Института клинической медицины имени Н.В. Склифосовского, Первый МГМУ имени И.М. Сеченова (Сеченовский Университет); ведущий научный сотрудник отдела по изучению пограничной психической патологии и психосоматических расстройств, Научный центр психического здоровья;

119991, Москва, ул. Трубецкая, д. 8, стр. 1; 115522, Москва, Каширское шоссе, д. 34

Beatrice A. Volel - Dr. Sci. (Med.), Head of the Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov FMSMU; Leading Researcher of the Department for the Study of Borderline Mental Pathology and Psychosomatic Disorders, Mental HRC.

8, Bldg. 1, Trubetskaya St., Moscow, 119991; 34A, Kashirskoe Shosse, Moscow, 115522

beatrice.volel@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Научный центр психического здоровьяРоссияSechenov First Moscow State Medical University (Sechenov University); Mental Health Research CenterRussian Federation20231104202303110118Copyright © Петелин Д.С., Сорокина О.Ю., Трошина Д.В., Сигиневич Ю.А., Ефимочкина С.М., Волель Б.А., 20232023Петелин Д.С., Сорокина О.Ю., Трошина Д.В., Сигиневич Ю.А., Ефимочкина С.М., Волель Б.А.Petelin D.S., Sorokina O.Y., Troshina D.V., Siginevich Y.A., Efimochkina S.M., Volel B.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7418

Тревожные расстройства широко распространены в популяции и в общемедицинской практике и оказывают выраженное негативное влияние на качество жизни и функционирование пациентов. В настоящее время накапливаются предпосылки для диагностики и терапии тревожных расстройств вне рамок психиатрической сети – силами терапевтов, врачей общей практики и других врачей непсихиатрического профиля. Дан обзор наиболее существенных факторов, способствующих более широкой диагностике и терапии тревожных расстройств в общемедицинской практике. В настоящем обзоре представлены современные представления о патогенезе тревожных расстройств, аргументированно обосновано современное представление об их мультифакторной природе, вкладе генетических и эпигенетических, психологических и социальных факторов, изложены основанные на нейровизуализационных исследованиях концепции нейробиологической основы патологической тревоги. Изложена информация об общих проявлениях тревожных расстройств, основных кластерах тревоги, систематике тревожных расстройств согласно МКБ-10. Даны современные представления о диагностике тревожных расстройств с использованием как шкал, так и клинического подхода, представлен детальный обзор доступных в настоящее время валидизированных для клинической практики диагностических шкал. Также представлены основные подходы к ведению клинической беседы, даны рекомендации по наиболее удачному сбору информации о клиническом состоянии пациентов. В завершении обзора дана информация о существующих подходах к психофармакотерапии и психотерапии тревожных расстройств. С учетом фармакологических и клинических исследований аргументировано место препаратов тофизопам (атипичный аллостерический модулятор рецепторов ГАМК) и буспирон (парциальный агонист серотониновых рецепторов 1А) в терапии тревожных расстройств в общемедицинской практике.

Anxiety disorders are widespread in the population and in general medical practice and have a pronounced negative impact on the quality of life and functioning of patients. Currently, the prerequisites for the diagnosis and treatment of anxiety disorders outside the psychiatric network are accumulating by therapists, general practitioners and other non-psychiatric doctors. A review of the most significant factors contributing to a wider diagnosis and treatment of anxiety disorders in general medical practice is given. This review presents modern ideas about the pathogenesis of anxiety disorders, substantiates the modern idea of their multifactorial nature, the contribution of genetic and epigenetic, psychological and social factors, outlines the concepts of the neurobiological basis of pathological anxiety based on neuroimaging studies. In the future, information is provided on the general manifestations of anxiety disorders, the main clusters of anxiety, the systematics of anxiety disorders according to ICD-10. Modern ideas about the diagnosis of anxiety disorders using both scales and a clinical approach are given, a detailed review of currently available diagnostic scales validated for clinical practice is presented. The main approaches to conducting a clinical conversation are also presented, recommendations are given for the most successful collection of information about the clinical condition of patients. At the end of the review, information is given on existing approaches to psychopharmacotherapy and psychotherapy of anxiety disorders. Taking into account pharmacological and clinical studies, the place of drugs tofisopam (an atypical allosteric modulator of GABA receptors) and buspirone (a partial agonist of serotonin 1A receptors) in the treatment of anxiety disorders in general medical practice has been argued.

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The authors declare that there are no conflicts of interest present.