ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Patients’ Critical Attitude to Their Condition in Neurotic Disorders and Its Prognostic Significance

DOI:10.31550/1727-2378-2019-156-1-36-40
Bibliography link: Marchenko A.A., Lobachev A.V., Manantsev P.A. Patients’ Critical Attitude to Their Condition in Neurotic Disorders and Its Prognostic Significance. Doctor.Ru. 2019; 1(156): 36–40. DOI: 10.31550/1727-2378-2019-156-1-36-40
8 February 14:17

Study Objective: Development of approaches to assessment of the critical attitude to the severity of neurotic disorders using psychometric scales.

Study Design: Open comparative randomised study.

Materials and Methods: The study enrolled patients with neurotic disorders who were examined upon admission using the Clinical Global Impression scale (n = 310). 302 patients were also examined using the Hamilton Rating Scale for Depression (HAMD), 287 patients — using the Hamilton Anxiety Scale (HAMA). The experimental diagnostic results for the condition severity were supplemented with subjective evaluation using the Hospital Anxiety And Depression Scale (HADS) for examination of 103 patients who were previously examined using both expert scales. The follow-up lasted for 2.29 ± 0.64 years.

All data obtained were analysed in the prognostic point of view; their correlation with disease dynamics and outcome were assessed. Outcomes were evaluated using the rate of recurrence (where 0 was no repeated hospitalisation and 1 was repeated hospitalisations) and integral therapy outcome.

Study Results: Isolated objective and subjective assessment of the condition severity did not allow forecasting the neurotic disorder dynamics, therefore patients were divided into severity groups on the basis of the following threshold values: for HAMD less than 17 points — mild disorder, 17-22 points — moderate disorder, 26+ points — severe disorder; for HAMA < 16, 16-22, > 22; for HADS anxiety subscale < 6, 6-16, > 16; for HADS depression subscale < 5, 5-11, and > 11, respectively. When both severity ranges coincided, the critical attitude to the condition was seen as adequate. If the range with the subjective assessment was higher than that with the objective evaluation, patient’s attitude to his/her condition was seen as overevaluated, otherwise it was underevaluated. Significant correlations between repeated hospitalisations during follow-up and underestimated depressive symptoms (correlation factor (CF) = 0.41) and overevaluated anxiety (CF = 0.39) were identified. Outcomes demonstrated significant direct relationships with depression underestimation (CF = 0.32) and anxiety overestimation (CF = 0.37), and inverse relationships with the adequate condition evaluation (CF = -0.37).

Conclusion: Insight observation using a levelled approach seems to be a perspective for prognostic diagnostics of patients with neurotic disorders; and the level predictors of poor neurotic disorder outcome may include high rates of HAMA anxiety factor, a trend to overestimate the anxiety severity and underestimate symptoms of depression.

Keywords: neurotic disorders, assessment of the critical attitude to condition severity, prognostic significance, levelled scales.

The authors declare that they do not have any conflict of interests.

A.A. Marchenko — S.M. Kirov Military Medical Academyof the Ministry of Defence of the Russian Federation; 3 Bekhterev Str., St. Petersburg, 192019, Russian Federation. E-mail: andrew.marchenko1995@yandex.ru

A.V. Lobachev — S.M. Kirov Military Medical Academyof the Ministry of Defence of the Russian Federation; 3 Bekhterev Str., St. Petersburg, 192019, Russian Federation. E-mail: lobachev_alexand@mail.ru

P.A. Manantsev — S.M. Kirov Military Medical Academyof the Ministry of Defence of the Russian Federation; 3 Bekhterev Str., St. Petersburg, 192019, Russian Federation. E-mail: manantsev@mail.ru

Доктор.ру
8 February 14:17
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