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Терапия и профилактика посттравматического стрессового расстройства при чрезвычайных ситуациях (алгоритм биологической терапии) : Алгоритм биологической терапии

Аннотация

Посттравматическое стрессовое расстройство (ПТСР) является тяжелым, как правило хроническим, психическим расстройством, принадлежащим к кругу тревожных расстройств и имеющим серьезные последствия для личностного, семейного, трудового и социального функционирования пациента. ПТСР характеризуется широким набором тревожных, невротических, аффективных и психотических симптомов, которые плохо поддаются терапии. Наиболее эффективно при лечении ПТСР применение комбинированной фармако- и психотерапии. Единственными препаратами, одобренными в международных клинических рекомендациях в качестве первого выбора, являются только три селективных ингибитора обратного захвата серотонина – сертралин, пароксетин и флуоксетин, а также один селективный ингибитор обратного захвата серотонина и норадреналина – венлафаксин. Некоторые атипичные антипсихотики, антиконвульсанты, альфа-адреноблокаторы и бензодиазепины используются в основном для аугментации эффекта антидепрессантов и психотерапии или для симптоматической терапии. Среди экспериментальных методов лечения, нуждающихся в дальнейшем изучении, следует указать на гормональные нейромодуляторы, антагонисты каннабиноидных рецепторов, антагонисты метаботропных глутаматных рецепторов, антагонисты глюкокортикоидных рецепторов, некоторые психостимуляторы и противовоспалительные препараты, а также новые методы нейростимуляции, прежде всего транскраниальную магнитную стимуляцию. Однако, только половина больных достигают ремиссии при проведении такой терапии, поэтому в реальной клинической практике широкое распространение получили симптоматическая терапия, применение препаратов вне показаний и полипрагмазия, связанная с попытками воздействия на разнообразную коморбидную психопатологическую симптоматику. Настоящий нарративный обзор посвящен анализу литературы и имеющимся доказательным исследованиям методов профилактики и терапии ПТСР, на основании которых предложен алгоритм биологической терапии ПТСР.

Ключевые слова

посттравматическое стрессовое расстройство, чрезвычайные ситуации, фармакотерапия, психотерапия, доказательные исследования, алгоритм терапии

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