Феномен импульсивности при биполярном аффективном расстройстве: частота и коморбидность

Введение: импульсивность считается дезадаптирующим фактором при многих психических заболеваниях. Клинический опыт показывает, что часто именно импульсивность в большей степени, чем другие психопатологические расстройства, приводит к грубым нарушениям поведения и госпитализации. Известно, что при биполярном аффективном расстройстве (БАР) импульсивность является характерным симптомом гипомании и мании. В некоторых исследованиях импульсивность обнаруживается и в другие периоды болезни, как во время депрессивного эпизода, так и в ремиссии, что придает наличию импульсивности прогностическое значение.

Цель систематического обзора: провести анализ научных исследований феномена импульсивности и оценить по данным публикаций: 1) выраженность импульсивности у пациентов с БАР в сравнении с популяцией здоровых лиц; 2) частоту коморбидных с БАР состояний с проявлениями импульсивности.

Материалы и методы: в GoogleScholar, PubMed, eLIBRARY проведен поиск исследований по ключевым словам «bipolar disorder, impulsivity», «bipolar disorder, impulsivity, comorbidity», «биполярное расстройство, импульсивность» и «биполярное расстройство, импульсивность, коморбидность» за последние 20 лет. Поиск по базе данных PubMed дал 147 результатов, GoogleScholar — 142, eLIBRARY — 0. В результате обработки полученных данных было отобрано 11 исследований, соответствующих критериям поиска «биполярное расстройство и импульсивность», «bipolar disorder impulsivity».

Заключение: во всех исследованиях пациенты, находящиеся в той или иной активной фазе БАР, отличались от контрольной группы по факту наличия импульсивности, тогда как в отношении пациентов в ремиссии полученные в исследованиях результаты разошлись. Для проверки гипотезы о том, что импульсивность при БАР связана с коморбидными состояниями, был проведен поиск по ключевым словам «биполярное расстройство, импульсивность и коморбидность», «bipolar disorder, impulsivity, comorbidity», в результате которого было отобрано 38 исследований. Рассматривались только те коморбидные состояния, в патогенезе которых ведущую роль играет импульсивность: синдром дефицита внимания у взрослых, расстройство пищевого поведения, злоупотребление и зависимость от алкоголя и других психоактивных веществ и различные формы нехимической поведенческой зависимости. По всем видам коморбидных состояний частота их встречаемости у пациентов с БАР существенно превышала контроль. Остается неясным, является ли импульсивность свойством, присущим БАР, или же следствием высокой распространенности коморбидных состояний. В любом случае обнаружение признаков импульсивности в клинической картине БАР на разных стадиях заболевания является важной диагностической задачей, так как определяет особую терапевтическую стратегию и тактику реабилитации этих больных.

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