OBJECTIVE: To study the structure and dynamics of anxiety-depressive disorders in patients with dissection/aneurysm of the ascending aorta and aortic arch before and in the long term after surgical treatment and to identify factors associated with disturbances in psycho-emotional status.
METHODS: We examined 124 patients with dissection/aneurysm of the ascending aorta and arch before and in the long-term period after aortic replacement, assessing anxiety and depression using the Generalized Anxiety Disorder (GAD-7) and Beck Depression Questionnaires. Multivariate regression analysis was used to identify factors associated with clinically significant anxiety and depressive disorders.
RESULTS: Average scores on the GAD and the depression scale before surgery decreased from 6.5 (4.0-9.0) and 12.0 (8.0-16.0) to 3.0 (2.0-5.0) and 6.0 (3.0-10.0) (p<0.05) respectively, in the long-term postoperative period. There was no significant decrease in the proportion of patients with clinically significant levels of GAD and depression (p>0.05). Before surgery, clinically significant anxiety and depressive disorders are associated with older age, chronic cerebrovascular insufficiency (CCI) and atrial fibrillation (AF) in the hospital period. After surgery, clinically significant GAD was associated with older age, CCI, and a history of stroke. Depressive disorders were associated with older age and a history of stroke.
CONCLUSIONS: In all patients with aortic disease, GAD and depression of varying severity are recorded; clinically significant GAD and depression are recorded in 19.2 and 23.2% of cases. In the long-term postoperative period, there is no significant decrease in the proportion of patients with clinically significant levels of GAD and depression, which amounted to 10.1 and 13.1%. Clinically significant anxiety and depressive disorders before and after surgery are associated with older age and the history of cerebrovascular disorders. In addition, the baseline clinically significant anxiety and depressive disorders showed an association with the subsequent development of AF in the early postoperative period.
UNASSIGNED: Изучить структуру и динамику тревожно-депрессивных расстройств у пациентов с расслоением/аневризмой восходящего отдела и дуги аорты до и в отдаленные сроки после хирургического лечения и выявить факторы, ассоциированные с нарушением психоэмоционального статуса.
UNASSIGNED: Обследованы 124 пациента с расслоением/аневризмой восходящего отдела и дуги аорты до и в отдаленный период после протезирования аорты с оценкой тревоги и депрессии с помощью опросников генерализованного тревожного расстройства — ГТР (GAD-7) и депрессии Бека. Методом многофакторного регрессионного анализа выявлялись факторы, ассоциированные с клинически выраженными тревожно-депрессивными расстройствами.
UNASSIGNED: Средние баллы по шкалам ГТР и депрессии до операции снизились с 6,5 (4,0—9,0) и 12,0 (8,0—16,0) до 3,0 (2,0—5,0) и 6,0 (3,0—10,0) соответственно (p<0,05) в отдаленном послеоперационном периоде. Не было выявлено достоверного снижения доли больных с клинически значимыми уровнями ГТР и депрессии (p>0,05). До операции клинически выраженные тревожно-депрессивные расстройства ассоциированы с более старшим возрастом, хронической ишемией головного мозга (ХИМ) и фибрилляцией предсердий (ФП) в госпитальном периоде. После операции клинически выраженное ГТР ассоциировано со старшим возрастом, ХИМ и инсультом в анамнезе. Депрессивные расстройства были взаимосвязаны со старшим возрастом и инсультом в анамнезе.
UNASSIGNED: У всех пациентов с хирургически значимой патологией аорты зарегистрированы ГТР и депрессия разной степени выраженности, клинически значимые ГТР и депрессия зарегистрированы в 19,2 и 23,2% случаев. В отдаленном послеоперационном периоде не выявлено достоверного снижения доли больных с клинически значимыми уровнями ГТР и депрессии, 10,1 и 13,1% соответственно. Клинически выраженные тревожно-депрессивные расстройства до и после операции ассоциированы со старшим возрастом и наличием цереброваскулярных нарушений в анамнезе. Кроме того, исходные клинически выраженные тревожно-депрессивные расстройства имеют связь с последующим развитием ФП в раннем послеоперационном периоде.

The RSCI and PubMed search databases have requested publications over the past 40 years on the search queries «fluvoxamine», «anxiety-depressive disorders», «anxiety», «depression», «comorbidity», devoted to the effectiveness of fluvoxamine in various variants of disorders of the anxiety-depressive spectrum, anxiety depressions. The data of the above studies indicate that fluvoxamine (Zovart San) in doses of 50-300 mg / day is a highly effective remedy for the treatment of not only anxiety depressions and genesis (psychogenic, organic, mixed, autochthonous-endogenous) and severity (up to psychotic), but also a wider range of anxiety-depressive disorders, including adaptation disorders, obsessive-compulsive disorder, somatized, dysmorphic, insomniac symptom complexes and eating disorders. A wide range of clinical effects of fluvoxamine is due to its main and additional mechanisms of action: blockade of serotonin reuptake, σ1-agonist activity and the effect on the metabolism of melatonin and neurosteroids catabolism.
В поисковых базах РИНЦ и PubMed запрошены публикации за последние 40 лет по запросам «флувоксамин», «тревожно-депрессивные расстройства», «тревога», «депрессия», «коморбидность», посвященные эффективности флувоксамина при различных вариантах расстройств тревожно-депрессивного спектра, тревожных депрессиях. Данные приведенных исследований свидетельствуют о том, что флувоксамин (Зоварт Сан) в дозах 50—300 мг/сут является высоко эффективным средством для лечения не только тревожных депрессий и генеза (психогенные, органические, смешанные, аутохтонно-эндогенные) и степени тяжести (вплоть до психотических), но и более широкого спектра тревожно-депрессивных расстройств, включающих расстройства адаптации, обсессивно-компульсивное расстройство, соматизированные, дисморфофобические, инсомнические симптомокомплексы и нарушения пищевого поведения. Широкий спектр клинического действия флувоксамина обусловлен его основным и дополнительными механизмами действия: блокадой обратного захвата серотонина, σ1-агонистической активностью и влиянием на обмен катаболизма мелатонина и нейростероидов.

OBJECTIVE: To evaluate the effect of the drug Cortexin on the clinical course and treatment of comorbid insomnia.
METHODS: The study included 50 patients, average age 50.4±2.26 years, with CHI stage 1-2. with concomitant diseases arterial hypertension, atherosclerosis, diabetes mellitus (study CHRONAS). All patients were examined on the day of treatment, 11-15 days and 30-31 days after the end of therapy. At all visits, complaints, neurological status, and changes in physiological and laboratory parameters were assessed. The condition was assessed using the following scales: mental status assessment (MMSE), quality of life questionnaire (EQ-5D), assessment of general health, Pittsburgh Sleep Quality Index (PSQI), Epworth daytime sleepiness assessment, hospital anxiety and depression (HADS)).: Patients with additional diabetic polyneuropathy were assessed using the Central Sensitization Inventory (CSI).
RESULTS: A high percentage of the prevalence of comorbid insomnia in patients was revealed. The structure of sleep disturbances in patients with chronic cerebral ischemia consisted of disturbances in sleep duration, difficulty falling asleep, frequent awakenings at night, and daytime sleepiness. After treatment, there was a regression of the main complaints, the severity of symptoms, including anxiety and depression, decreased, and a significant stabilization of cognitive status was observed. The positive dynamics persisted 1 month after the end of therapy. An additional normalizing effect of the drug on a number of biochemical parameters was revealed. Clinical dynamics were recorded already by the 11-15th day of treatment and persisted for up to 1 month. During observation, no patient had adverse drug interactions with other drugs (hypotensives, antiplatelet agents, statins).
CONCLUSIONS: The clinical effectiveness of the drug Cortexin has been proven for all types of sleep disorders. The clinical effectiveness of the drug Cortexin at a dose of 10 mg IM for 10 days has been proven in patients with chronic sleep disorders due to CHI.
UNASSIGNED: Изучение структуры нарушений сна и оценка влияния препарата Кортексин на течение коморбидной бессонницы у пациентов с хронической ишемией головного мозга (ХИМ).
UNASSIGNED: В проспективное исследование структуры и терапии ХРОнических НАрушений Сна (исследование ХРОНАС) у пациентов с ХИМ включены 50 пациентов (средний возраст 50,4±2,2 года) с ХИМ I—II ст. на фоне артериальной гипертензии, атеросклероза, сахарного диабета. Все пациенты были обследованы в день обращения, через 11—15 дней и на 30—31-й день после окончания терапии. На всех визитах проводилась оценка жалоб, неврологического статуса, анализ изменений физиологических и лабораторных показателей. Оценка состояния проводилась на основании опросников MMSE, качества жизни (EQ-5D), оценки общего состояния здоровья, Питтсбургского опросника качества сна (PSQI), оценки дневной сонливости Epworth, госпитальной шкалы тревоги и депрессии (HADS). Состояние пациентов с диабетической полинейропатией оценивалось по опроснику центральной сенситизации (CSI).
UNASSIGNED: Выявлена значительная распространенность коморбидной бессонницы у пациентов с ХИМ. Структура нарушений сна у пациентов с ХИМ складывалась из нарушений продолжительности сна, трудностей с засыпанием, частых ночных пробуждений, дневной сонливости. Положительная динамика сохранялась спустя 1 мес после окончания терапии. Выявлено дополнительное нормализующее влияние препарата на ряд биохимических показателей. Положительная динамика зафиксирована уже к 11—15-му дню лечения и сохранялась до 1 мес. За время наблюдения ни у одного пациента не было отмечено неблагоприятных лекарственных взаимодействий с другими препаратами (антигипертентензивные, антиагреганты, статины).
UNASSIGNED: Доказана клиническая эффективность препарата Кортексин в дозе 10 мг в/м курсом 10 дней у пациентов с хроническими нарушениями сна на фоне ХИМ. После лечения отмечался регресс основных жалоб, уменьшилась выраженность симптомов, включая тревогу и депрессию, прослеживалась стабилизация когнитивного статуса.

BACKGROUND: The impact of occupational stress and work environment fitness on mental health disparities between physicians and nurses are not well understood. This study aims to identify and rank key determinants of mental health in physicians and nurses in China and compare the differences in their impact on mental health between physicians and nurses.
METHODS: A large cross-sectional survey with multistage cluster sampling was conducted. The survey included the Self-Rating Anxiety Scale (SAS Scale), the Center for Epidemiologic Studies Depression Scale (CES-D Scale), the Maslach Burnout Inventory-General Survey (MBI-GS) and the Person-Environment (PE) Fit. We applied a principled, machine learning-based variable selection algorithm, using random forests, to identify and rank the determinants of the mental health in physicians and nurses.
RESULTS: In our study, we analyzed a sample of 9964 healthcare workers, and 2729 (27 %) were physicians. The prevalence of anxiety and depressive disorders among physicians and nurses was 31.0 % and 53.3 %, 30.8 % and 47.9 %, respectively. Among physicians with anxiety disorder, we observed a higher likelihood of cynicism, emotional exhaustion, reduced personal accomplishment, and poor organization fitness, job fitness, group fitness, and supervisor fitness, in order of importance. When comparing the effects on depressive disorder in physicians, group fitness and supervisor fitness did not have significant impacts. For nurses, emotional exhaustion had a more significant effect on depressive disorder compared to cynicism. Supervisor fitness did not have a significant impact on anxiety disorder in nurses.
CONCLUSIONS: Cross-sectional design, self-reporting screening scales.
CONCLUSIONS: Compared to individual and hospital characteristics, the primary factors influencing mental health disorders are occupational burnout and the compatibility of the work environment. Additionally, the key determinants of depressive and anxiety disorders among doctors and nurses exhibit slight variations. Employing machine learning methods proves beneficial for identifying determinants of mental health disorders among physicians and nurses in China. These findings could help improve policymaking aimed at addressing the mental well-being of healthcare professionals.

OBJECTIVE: The aim of this study is to investigate the characteristics of \'not just right experiences\' (NJREs) in patients with obsessive-compulsive disorder (OCD), anxiety disorders (ADs) or major depressive disorder (MDD), compared with those of healthy controls (HCs).
METHODS: One hundred adults with OCD, 86 adults with ADs, 57 adults with MDD and 60 HCs were enrolled in the study. The Not Just Right Experiences Questionnaire Revised (NJRE-QR), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to evaluate clinical symptoms in patients with OCD, ADs or MDD. The Obsessive Belief Questionnaire-44 (OBQ-44) was used to evaluate OC beliefs in the OCD patients. The HCs only received assessment using the NJRE-QR. Analysis of variance (ANOVA) and covariance (ANCOVA) were performed to compare the NJREs scores across the groups, while Pearson correlation and partial correlation analyses were used to examine the association between NJREs and other clinical features. The contribution of NJREs to predict OC symptoms was determined by multiple stratified linear regression.
RESULTS: Individuals with OCD had significantly higher scores for the number of NJREs than ADs, but not MDD. The severity of NJREs was also significantly higher in patients with OCD than those with MDD or ADs (F = 5.23 and F = 19.79, respectively, P < 0.01). All the clinical scores in the NJRE-QR were significantly higher than those in the HC group. The number and severity of NJREs correlated significantly with the Y-BOCS total score (r = 0.29 and r = 0.39, respectively, P < 0.01). NJREs showed an independent contribution to OC symptoms, which alone explained 8% of the variation (F = 16.49, ΔR2  = 0.08; P < 0.01).
CONCLUSIONS: NJREs are related closely to OC symptoms, with their severity discriminating between OCD patients and those with ADs or MDD. NJREs were more specific for OCD in the Chinese population and are therefore worthy of further study in the future.

Both anxiety and depressive disorders are associated with significant long-term disability. Since experienced impairments vary between patients independent of diagnosis and disease severity, identifying transdiagnostic factors that predict the course of disability may provide new targets to reduce disability. This study examines transdiagnostic factors predicting the 2-year disability outcome in patients with anxiety and/or depressive disorders (ADD), focusing on potentially malleable factors.
Six hundred fifteen participants with a current diagnosis of ADD from the Netherlands Study of Depression and Anxiety (NESDA) were included. Disability was assessed at baseline and after 2 years of follow-up, using the 32-item WHODAS II questionnaire. Transdiagnostic predictors of 2-year disability outcome were identified using linear regression analysis.
In univariable analyses, transdiagnostic factors associated with the 2-year disability outcome were locus of control (standardized β = -0.116, p = 0.011), extraversion (standardized β = -0.123 p = 0.004) and experiential avoidance (standardized β = 0.139, p = 0.001). In multivariable analysis, extraversion had a unique predictive value (standardized β = -0.143 p = 0.003). A combination of sociodemographic, clinical and transdiagnostic variables resulted in an explained variance (R2) of 0.090). The explained variance of a combination of transdiagnostic factors was 0.050.
The studied transdiagnostic variables explain a small but unique part of variability in the 2-year disability outcome. Extraversion is the only malleable transdiagnostic factor predictive of the course of disability independent of other variables. Due to the small contribution to the variance in the disability outcome, the clinical relevance of targeting extraversion seems limited. However, its predictive value is comparable to that of accepted disease severity measures, supporting the importance of looking beyond using disease severity measures as predictors. Furthermore, studies including extraversion in combination with other transdiagnostic and environmental factors may elucidate the unexplained part of variability of the course of disability in patients with ADD.

UNASSIGNED: To investigate the relationship between changes in circadian patterns of melatonin and clinical manifestations of polymorbid cardiovascular pathology (PCVP) in young men and to analyze the effectiveness of their complex treatment.
UNASSIGNED: We made the immunohistochemical (IHC) analysis of epiphysis tissues from autopsies of 25 men aged 32-44 with PCVP and metabolic syndrome (MS) who had died as a result of ischemic cardiomyopathy (IC) and 25 persons after the car accident as a control group. Then, 93 young men aged 35-44 with PCVP, metabolic syndrome, and depressive spectrum disorders (DSD) were divided into three groups: (1) standard therapy; (2) standard therapy and psychotherapy sessions; (3) standard therapy in combination with psychotherapeutic and psychophysiological visual and auditory correction sessions. The control group included 24 conditionally healthy male volunteers. Before and after the treatment, we studied the anthropometric status, lipid and carbohydrate metabolism indicators, the level of urinary 6-hydroxymelatonin sulfate, the degree of nocturnal decrease in blood pressure (BP), and the relationship of these indicators with circadian variations of melatonin excretion.
UNASSIGNED: Young polymorbid patients who died from IC have a lower expression of melatonin type 1 and 2 receptors. All patients with PCVP showed a decrease in the nocturnal melatonin excretion fraction and a correlation with higher severity of depressive (r = -0.72) and anxiety (r = -0.66) symptoms. Reduced values of the 6-hydroxymelatonin sulfate (6-SM) in the 1st (r = 0.45), 2nd (r = 0.39), and 3rd (r = 0.51) groups before treatment was associated with periods of increased BP. The achievement of melatonin excretion reference values and normalization of biochemical parameters of carbohydrate and lipid metabolism, daily BP profile, and psychophysiological state were noted in all three patients\' groups, with a more pronounced effect in group 3.
UNASSIGNED: Low nocturnal melatonin excretion levels are associated with greater severity of clinical symptoms and a higher risk of death in patients with PCVP. Therefore, comprehensive therapy may be more effective for correcting this disease.

BACKGROUND: A high prevalence of obsessive-compulsive symptoms (OCSs) in anxiety-depressive disorders ranging from 30 to 67% has been described.
OBJECTIVE: This study aims to assess the presence and persistence of OCSs in an outpatient sample of subjects with anxiety and depressive disorders, as well as its relationship with recent life events (RLEs) and/or traumatic experiences (TEs).
METHODS: We conducted a prospective, observational, analytical study of 200 subjects with DSM-5 diagnoses of anxiety and/or depression. Participants were included by consecutive sampling and were evaluated at baseline and after 6-12 months (mean 8.5 months) of follow-up. The severity of the symptoms was assessed through the Hamilton Anxiety Scale (HARS) and Hamilton Scale for the evaluation of depression (HRSD-17), and comorbidity was assessed through the International Neuropsychiatric Interview (MINI). The Revised Inventory of Obsessions and Compulsions (OCI-R), the Recent Vital Changes Questionnaire (CVSV), and the Diagnostic Scale for Post-Traumatic Stress (PDS) were also administered.
RESULTS: 54% of the sample presented OCSs, and 30.5% presented one or more TEs throughout life. At the baseline visit, the presence of OCSs was associated with the severity of depressive symptoms (p=0.028), the presence of TEs (p<0.01), symptoms of post-traumatic stress disorder (p<0.01) and the number of RLEs (p<0.01). Response rate at follow-up was 38%, and persistence of OCSs was found in 60.5% of patients, independent of depressive or anxious symptoms, but was associated with the number of RLEs (p<0.01).
CONCLUSIONS: The presence of OCSs in patients with anxiety and depressive disorders is frequent and persistent. Anxious-depressive patients with a history of TEs and RLEs had higher OCS levels. These findings highlight the importance of early detection and the use of therapeutic strategies focused on resilience to stress and trauma.

BACKGROUND: A high prevalence of obsessive-compulsive symptoms (OCSs) in anxiety-depressive disorders ranging from 30 to 67% has been described.
OBJECTIVE: This study aims to assess the presence and persistence of OCSs in an outpatient sample of subjects with anxiety and depressive disorders, as well as its relationship with recent life events (RLEs) and/or traumatic experiences (TEs).
METHODS: We conducted a prospective, observational, analytical study of 200 subjects with DSM-5 diagnoses of anxiety and/or depression. Participants were included by consecutive sampling and were evaluated at baseline and after 6-12 months (mean 8.5 months) of follow-up. The severity of the symptoms was assessed through the Hamilton Anxiety Scale (HARS) and Hamilton Scale for the evaluation of depression (HRSD-17), and comorbidity was assessed through the International Neuropsychiatric Interview (MINI). The Revised Inventory of Obsessions and Compulsions (OCI-R), the Recent Vital Changes Questionnaire (CVSV), and the Diagnostic Scale for Post-Traumatic Stress (PDS) were also administered.
RESULTS: 54% of the sample presented OCSs, and 30.5% presented one or more TEs throughout life. At the baseline visit, the presence of OCSs was associated with the severity of depressive symptoms (p=0.028), the presence of TEs (p<0.01), symptoms of post-traumatic stress disorder (p<0.01) and the number of RLEs (p<0.01). Response rate at follow-up was 38%, and persistence of OCSs was found in 60.5% of patients, independent of depressive or anxious symptoms, but was associated with the number of RLEs (p<0.01).
CONCLUSIONS: The presence of OCSs in patients with anxiety and depressive disorders is frequent and persistent. Anxious-depressive patients with a history of TEs and RLEs had higher OCS levels. These findings highlight the importance of early detection and the use of therapeutic strategies focused on resilience to stress and trauma.

The aim of the study was to analyze the factors affecting chronic pain in patients with rheumatoid arthritis (RA).
METHODS: 128 patients with reliable diagnosis of RA [111 (86.7%) women and 17 (13.3%) men] were examined. The mean age of patients was 47.4±11.3 years, the median duration of the disease was 96 [48; 228] months. When included in the study in most patients, the activity of RA in DAS28 was moderate (n=56; 43.7%) or high (n=48; 37.5%). BPI (Brief Pain Inventory) scale was used to determine the severity of pain and its impact on various aspects of life. The anxiety - depressive spectrum disorders (ADDs) were diagnosed by psychiatrist during a semistructured interview according to ICD-10 criteria in 123 (96.1%) patients. The severity of depression was determined by the Montgomery-Asberg depression rating scale, anxiety - by Hamilton anxiety scale. For the diagnosis of cognitive impairment used clinical and psychological techniques. Psychopharmacotherapy (PPhT) by antidepressants or anxiolytics is offered to all patients with ADDs, 52 of them agreed to treatment, 71 patients refused. The next groups selected depending on the therapy: 1st - with conventional disease - modifying antirheumatic drugs (cDMARDs; n=39), 2nd - with cDMARDs+PPhT (n=43), 3d - with cDMARDs + biologic (b) DMARDs (n=32), 4th - with cDMARD+bDMARDs+PPhT (n=9). The dynamics of ADDs and outcomes of RA in 5 years were evaluated in 83 (67.5%) patients.
RESULTS: When included in the study, 94 (75.2%) patients with RA had moderate and severe pain. According to the regression analysis, the maximum intensity pain in BPImax after 5 years of follow - up associated not the only factors connected with RA - high DAS28, the serum level of C-reactive protein, the degree of radiological stage and functional insufficiency, duration of RA and a lesser duration of glucocorticoids intake, but also with continuing depressive episodes in the framework of recurrent depression and the initial presence of cognitive impairment. The severity of pain after 5 years of follow - up was higher in RA patients receiving only сDMARDs, without the use of bDMARDs and in the absence of PPhT associated with ADDs.
CONCLUSIONS: Depressive episode within recurrent major depression is a significant factor in the chronicity of pain in patients with RA. Timely effective PPhT of depression, selected taking into account depression structure and personal characteristics of the patient, leads to a steady decrease in the severity of pain in patients with RA.
Цель исследования - анализ факторов, влияющих на хроническую боль у пациентов с ревматоидным артритом (РА). Материалы и методы. Обследовано 128 пациентов с достоверным диагнозом РА [111 (86,7%) женщин и 17 (13,3%) мужчин]. Средний возраст больных составил 47,4±11,3 года, медиана длительности заболевания - 96 [48; 228] мес. При включении в исследование у большинства пациентов активность РА по DAS28 была умеренной (n=56; 43,7%) или высокой (n=48; 37,5%). Для определения выраженности боли и ее влияния на различные аспекты жизни использовали шкалу BPI (Brief Pain Inventory). Расстройства тревожно - депрессивного спектра (РТДС) диагностированы психиатром в ходе полуструктурированного интервью по критериям МКБ-10 у 123 (96,1%) пациентов. Выраженность депрессии определяли по шкале депрессии Монтгомери-Асберг, тревоги - по шкале тревоги Гамильтона. Для диагностики когнитивных нарушений использовали клинико - психологические методики. Психофармакотерапия (ПФТ) предложена всем пациентам с РТДС, из них согласились на лечение 52, отказался - 71 пациент. В зависимости от проводимой терапии выделены следующие терапевтические группы: 1-я - базисные противовоспалительные препараты (БПВП; n=39), 2-я - БПВП+ПФТ (n=43), 3-я - БПВП+генно - инженерные биологические препараты (ГИБП; n=32), 4-я - БПВП+ГИБП+ПФТ (n=9). Динамику РТДС и исходы РА через 5 лет оценивали у 83 (67,5%) больных. Результаты. При включении в исследование 94 (75,2%) пациента с РА испытывали умеренную и сильную боль. По данным регрессионного анализа, максимальная выраженность боли по BPImax через 5 лет наблюдения ассоциировалась не только с факторами, характеризующими РА - высокой активностью по DAS28, уровнем высокочувствительного С-реактивного белка, выраженностью суставной деструкции, степенью функциональных ограничений, длительностью РА и меньшей длительностью приема глюкокортикоидов, но также с сохраняющимися депрессивными эпизодами в рамках рекуррентной депрессии и исходным наличием когнитивных нарушений. Выраженность боли через 5 лет наблюдения была выше при лечении РА только базисными препаратами, без применения ГИБП и в отсутствии ПФТ сопутствующих РТДС. Заключение. Депрессивный эпизод в рамках рекуррентной депрессии является значимым фактором хронизации боли у больных РА. Своевременная эффективная ПФТ депрессии, подобранная с учетом ее структуры и личностных особенностей пациента, приводит к стойкому уменьшению выраженности боли у больных РА.