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№ 3 (2022)

ОБЩИЕ ВOПРОСЫ ТЕРАПИИ И ОБЗОРЫ

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

https://doi.org/10.21265/PSYPH.2022.92.41.004

Опубликован 2022-09-30

  • С.Н. Мосолов

С.Н. Мосолов
ФГБУ «Национальный медицинский исследовательский центр психиатрии и наркологии имени В.П. Сербского» Министерства здравоохранения Российской Федерации, ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской Федерации

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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