The current state of the problem of diagnosis and therapy of depressive disorders (a literature review)

Abstract

The article presents the results of an analytical review of current literature data on the problem of diagnosis and treatment of depressive disorders. The issues of a high incidence and polymorphism of the clinical presentation of these disorders are considered. The tendency towards formalization and objectification in the process of diagnosing depressive disorders in modern psychiatric discourse is covered, in particular, through the use of neuroimaging, neurophysiological and biochemical methods with the involvement of machine learning and artificial intelligence technologies. The classic method of a structured or semi-structured interview, as a tool for diagnosing clinical depression, currently remains one of the most common, but it has certain limitations and disadvantages, the most significant of which are a considerable degree of the method subjectivity and its dependence on the perception by specialists conducting the diagnosis, that causes low sensitivity and specificity of this method. The significant role of a general practitioner as a key link in the identification and treatment of the described phenomena, which automatically presents to these specialists a number of professional, qualification and personal requirements, such as knowing pathogenesis of depressive disorders, the features of their pharmacotherapy, skills to build compliant relationships with patients, is highlighted apart. The article also emphasizes the lack of information in available sources about measures to assess the risk of depressive episode recurrence, as well as insufficient attention to the methods of neurophysiological examination and their narrow arsenal. Thus, based on the results of the review, it has been found that a promising direction to improve diagnosis and assessment of therapeutic measure effectiveness, as a part of follow-up among patients with depression, in addition to classical psychodiagnostic tools, is the development and implementation of ethological and neurophysiological methods of examination for objectifying evaluation of patients’ condition and elimination of subjective factors associated with specialists’ perception of patients, as well as symptoms of anosognosia or aggravation.