hfbHealth, Food & BiotechnologyHealth, Food & Biotechnology2712-7648РОСБИОТЕХ10.36107/hfb.2020.i1.s168hfb-57Research ArticleЗДОРОВЬЕHEALTHПсихические расстройства у ветеранов локальных войн, перенесших черепно-мозговую травмуMental Disorders of Local Wars Veterans Suffered from Traumatic Brain InjuryРезникА. М.ReznikA. M.

Резник Александр Михайлович

125080, город Москва, Волоколамское шоссе, дом 11

Aleksandr M. Reznik

11 Volokolamskoe highway, Moscow, 125080

a.m.reznik1969@gmail.comФГБОУ ВО «Московский государственный университет пищевых производств»РоссияMoscow University of Food ProductionRussian Federation202008052021211123Copyright © Резник А.М., 20212021Резник А.М.Reznik A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.hfb-mgupp.com/jour/article/view/57

Обследовано 264 ветерана локальных войн, прошедших лечение в психиатрических отделениях военного госпиталя. В группы сравнения включались военнослужащие кадра и запаса, не принимавшие участия в боевых действиях. В первую группу (296 чел.) включались все пациенты, проходившие лечение в психиатрических отделениях госпиталя в 1999 году. Вторая группа сравнения (125 чел.) комплектовалась таким образом, чтобы соответствовать не только среднему возрасту, но и кривой распределения возраста основной группы. Проведено сравнение клинических проявлений психических расстройств в связи с травмой головного мозга с преобладанием неврозоподобной симптоматики (56 человек) и диагностированных у ветеранов невротических расстройств (51 пациент).Органические психические расстройства в связи травмой головного мозга были диагностированы у 80 ветеранов (30,3%), тогда как у пациентов из 1-й и 2-й групп сравнения они диагностировались лишь в 22 (7,4%) и 15 (12%) случаев соответственно. Во всех трех группах преобладали психопатологические синдромы непсихотического уровня, диагностированные почти с равной частотой. В 1-й группе сравнения незначительно чаще диагностировались психотические расстройства и деменция, что может быть связано с возрастом. Главной особенностью проявлений болезни у ветеранов, в отличие от других групп пациентов, оказалось наличие симптомов стрессовых расстройств. У них выявлялись «комбатантные» изменения личности (30%) и симптомы повторного переживания психической травмы. Симптомы повышенной реактивности или возбудимости у ветеранов встречались также часто, как у других пациентов. Однако у ветеранов повышенная возбудимость часто сочеталась с типичными изменениями личности и агрессивным поведением. Сравнение органических психических расстройств в связи с травмой головного мозга с диагностированными у ветеранов невротическими расстройствами, показало то, что у них преобладают схожие по тяжести и психопатологическим проявлениям синдромы.

264 veterans of the local wars which have passed treatment in psychiatric unit of military hospital were surveyed. Groups of comparison included the career military servicemen and retires, who were not taking part in combat actions. The first group (296 people) included all patients who passed treatment in psychiatric hospital department in 1999. Second comparison group (125 people) was completed from patients of psychiatric hospital department in such manner as to correspond not only to the middle age, but also to the age distribution curve of the main group. The frequency of organic mental disorder due to brain trauma appeared more often among combat veterans (30.3%) than among the patients who were not taking part in the actions (7.4% and 12%, respectively). In all three compared groups the non-psychotic symptoms were prevalent. The symptoms of stress disorders were the main difference of veterans from other patients. The combat-related personality disorders (30%) and intrusive symptoms (21.3%) were among them. The occurence of excitability in veterans with organic mental disorder due to brain trauma (56.3%) has not significant difference from the comparison groups (68.2% and 80% respectively). But in veterans the hyperarousal symptoms were often associated with personality disorders and aggressive behavior. The psychopathology among veterans with organic mental disorder due to brain trauma with predominant functional or neurotic register symptoms (56 people) and veterans with diagnosis of neurotic disorder or adjustment disorder (51 people) was compared and the appreciable differences in their symptoms were not diagnosed.

боевой стрессбоевое стрессовое расстройствопосттравматическое стрессовое расстройствочерепно-мозговая травма умеренной тяжестисотрясение мозгапоследствия черепно-мозговой травмыорганическое психическое расстройствоcombat stresscombat stress disorderposttraumatic stress disordermild traumatic brain injuryconcussionpostconcussive symptomsorganic mental disorderReferencesГиляровский, В. А. (1944). Психореактивные состояния и нервно-вегетативные реакции военного времени. Военная медицина на Западном фронте в Великой Отечественной войне, 8, 76–81.Gilyarovskiy, V. A. (1944). Psychoreactive conditions and wartime neuro-vegetative reactions. Voennaya medicina na Zapadnom fronte v Velikoj Otechestvennoj vojne [Military medicine on the Russian Western Front in Great Patriotic War (World War II)], 8, 76–81.Литвинцев, С. В., Снедков, Е. В., Резник, А. М. (2005). Боевая психическая травма: Руководство для врачей. Издательство «Медицина».Litvincev, S. V., Snedkov, E. V., Reznik, A. M. (2005). Boevaya psihicheskaya travma: Rukovodstvo dlya vrachej [Combat Mental Trauma: Guideline for Physicians]. Medicina.Лобастов, О. С., Спивак, Л. И. (1985) Организация психоневрологической помощи во время Великой Отечественной войны. В Советская психиатрия в годы Великой Отечественной войны: Сборник научных трудов (c. 7–14). Питер.Lobastov, O. S., Spivak, L. I. (1985) Organization of neuropsychiatric aid during the Great Patriotic War. In Sovetskaya psihiatriya v gody Velikoj Otechestvennoj vojny. Sbornik nauchnyh trudov [Soviet psychiatry during the Great Patriotic War: Collection of scientific papers] (pp. 7–14). Piter.Снежневский, А. В. (1947). К клинике травмы головного мозга взрывной волной. Труды Центрального института психиатрии МЗ РСФСР, 3, 162–178.Snezhnevskij, A. V. (1947). To the clinic of burst wave brain injury. Trudy Centr. instituta psihiatrii MZ RSFSR [Proceedings of the Central Institute of Psychiatry of the Ministry of Health of Russia], 3, 162–178.Сухарева, Г. Е. (1943). Психогенные типы реакций военного времени. Невропатология и психиатрия, 12(2), 3–10.Sukhareva, G. E. (1943) Psychogenic types of wartime reactions. Nevropatologiya i psihiatriya [Neuropathology and Psychiatry], 12(2), 3–10.Тимофеев, Н. Н. (1945). Опыт организации психиатрической службы в период Отечественной войны. В Тезисы докладов юбилейной сессии Центрального научно-исследовательского института психиатрии Наркомздрава РСФСР (с. 23–26). Наркомздрав.Timofeev, N. N. (1945). The experience of organizing psychiatric services during the Great Patriotic War. In Tezisy dokladov yubilejnoj sessii Central’nogo nauchno-issledovatel’skogo instituta psihiatrii Narkomazdrava RSFSR [Abstracts of the anniversary session of the Central Research Institute of Psychiatry of the People’s Commissariat of Health of the Soviet Russia (RSFSR)] (pp. 23–26). Narkomzdrav.Garber, B. G., Rusu, C., Zamorski, M. A. (2014). Deployment-related mild traumatic brain injury, mental health problems, and post-concussive symptoms in Canadian armed forces personnel. BMC Psychiatry, 14, Article 325. https://doi.org/10.1186/s12888-014-0325-5Garber, B. G., Rusu, C., Zamorski, M. A. (2014). Deployment-related mild traumatic brain injury, mental health problems, and post-concussive symptoms in Canadian armed forces personnel. BMC Psychiatry, 14, Article 325. https://doi.org/10.1186/s12888-014-0325-5Glenn, D. M., Beckham, J. C., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., Moore, S. D. (2002). Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder. Violence and Victims, 17(4), 473–489. https://doi.org/10.1891/vivi.17.4.473.33685Glenn D.M., Beckham J.C., Feldman M.E., Kirby A.C., Hertzberg M.A., Moore S.D. (2002). Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder. Violence and Victims, 17 (4), 473–489. https://doi.org/10.1891/vivi.17.4.473.33685Hoge, C. W., McGurk, D., Thomas, J. L., Cox, A. L., Engel, C. C., Castro, C. A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New English Journal of Medicine, 358(5), 453–463. https://doi.org/10.1056/NEJMoa072972Hoge, C. W., McGurk, D., Thomas, J. L., Cox, A. L., Engel, C. C., Castro, C. A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New English Journal of Medicine, 358(5), 453–463. https://doi.org/10.1056/NEJMoa072972Kennedy, J. E., Jaffee, M. S., Leskin, G. A., Stokes, J. W., Leal, F. O., Fitzpatrick, P. J. (2007). Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury. Journal of Rehabilitation, Research and Development, 44(7), 895–920. https://doi.org/10.1682/JRRD.2006.12.0166Kennedy, J. E., Jaffee, M. S., Leskin, G. A., Stokes, J. W., Leal, F. O., Fitzpatrick, P. J. (2007). Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury. Journal of Rehabilitation, Research and Development, 44(7), 895–920. https://doi.org/10.1682/JRRD.2006.12.0166Koren, D., Hemel, D., Klein, E.(2006). Injury increases the risk for PTSD: An examination of potential neurobiological and psychological mediators. CNS Spectrums, 11(8), 616–624. https://doi.org/10.1017/S1092852900013675Koren, D., Hemel, D., Klein, E.(2006). Injury increases the risk for PTSD: An examination of potential neurobiological and psychological mediators. CNS Spectrums, 11(8), 616–624. https://doi.org/10.1017/S1092852900013675Miller, S. C., Whitehead, C. R., Otte, C. N., Wells, T. S., Webb, T. S., Gore, R. K., Maynard, C. (2015). Risk for broad-spectrum neuropsychiatric disorders after mild traumatic brain injury in a cohort of US Air Force personnel. Occupational & Environmental Medicine, 72(8), 560–566. https://doi.org/10.1136/oemed-2014-102646Miller, S. C., Whitehead, C. R., Otte, C. N., Wells, T. S., Webb, T. S., Gore, R. K., Maynard, C. (2015). Risk for broad-spectrum neuropsychiatric disorders after mild traumatic brain injury in a cohort of US Air Force personnel. Occupational & Environmental Medicine, 72(8), 560–566. https://doi.org/10.1136/oemed-2014-102646Morissette, S. B., Woodward, M., Kimbrel, N. A., Meyer, E. C., Kruse, M.I., Dolan, S., Gulliver, S. B. (2011). Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans. Rehabilitation Psychology, 56 (4), 340–350. https://doi.org/10.1037/a0025462Morissette, S. B., Woodward, M., Kimbrel, N. A., Meyer, E. C., Kruse, M.I., Dolan, S., Gulliver, S. B. (2011). Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans. Rehabilitation Psychology, 56(4), 340–350. https://doi.org/10.1037/a0025462Perkonigg, A., Kessler, R. C., Storz, S., Wittchen, H. U. (2000). Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101(1), 46–59. https://doi.org/10.1034/j.1600-0447.2000.101001046.xPerkonigg, A., Kessler, R. C., Storz, S., Wittchen, H. U. (2000). Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101(1), 46–59. https://doi.org/10.1034/j.1600-0447.2000.101001046.xPolusny, M. A., Kehle, S. M., Nelson, N. W., Erbes, C. R., Arbisi, P. A., Thuras, P. (2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Archives of General Psychiatry, 68(1), 79–89. https://doi.org/10.1001/archgenpsychiatry.2010.172Polusny, M. A., Kehle, S. M., Nelson, N. W., Erbes, C. R., Arbisi, P. A., Thuras, P. (2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Archives of General Psychiatry, 68(1), 79–89. https://doi.org/10.1001/archgenpsychiatry.2010.172Ruff, R. L., Riechers, R. G., Wang, X. F., Piero T., & Ruff S. S. (2012). A case-control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI. BMJ Open, 2(2), Article e000312. https://doi.org/10.1136/bmjopen-2011-000312Ruff, R. L., Riechers, R. G., Wang, X. F., Piero T., & Ruff S. S. (2012). A case-control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI. BMJ Open, 2(2), Article e000312. https://doi.org/10.1136/bmjopen-2011-000312Schneiderman, A. I., Braver, E. R., Kang, H. K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167(12), 1446–1452. https://doi.org/10.1093/aje/kwn068Schneiderman, A. I., Braver, E. R., Kang, H. K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167(12), 1446–1452. https://doi.org/10.1093/aje/kwn068Stein, M. B., Kessler, R. C., Heeringa, S. G., Jain, S., Campbell-Sills, L., Colpe, L. J., … Fullerton, C. S. (2015). Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: Results from Army Study to Assess Risk and Resikience in Servicemembers (Army STARRS). The American Journal of Psychiatry, 172(11), 1101–1111. https://doi.org/10.1176/appi.ajp.2015.14121572Stein, M. B., Kessler, R. C., Heeringa, S. G., Jain, S., Campbell-Sills, L., Colpe, L. J., … Fullerton, C. S. (2015). Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: Results from Army Study to Assess Risk and Resikience in Servicemembers (Army STARRS). The American Journal of Psychiatry, 172(11), 1101–1111. https://doi.org/10.1176/appi.ajp.2015.14121572Taylor, B. C., Hagel, E. M., Carlson, K. F., Cifu, D. X., Cutting, A., Bidelspach, D. E., Sayer, N. A. (2012). Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War Veteran V.A. users. Medical Care, 50(4), 342–346. https://doi.org/10.1097/MLR.0b013e318245a558Taylor, B. C., Hagel, E. M., Carlson, K. F., Cifu, D. X., Cutting, A., Bidelspach, D. E., Sayer, N. A. (2012). Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War Veteran V.A. users. Medical Care, 50(4), 342–346. https://doi.org/10.1097/MLR.0b013e318245a558Vasterling, J. J., Verfaellie, M., Sullivan, K. D. (2009). Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience. Clinical Psychology Review, 29(8), 674–684. https://doi.org/10.1016/j.cpr.2009.08.004Vasterling, J. J., Verfaellie, M., Sullivan, K. D. (2009). Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience. Clinical Psychology Review, 29(8), 674–684. https://doi.org/10.1016/j.cpr.2009.08.004Vasterling, J. J., Jacob, S. N., & Rasmusson, A. (2018) Traumatic brain injury and posttraumatic stress disorder: Conceptual, diagnostic, and therapeutic considerations in the context of co-Occurrence. The Journal of Nueropsychiatry and Clinical Neurosciences, 30(2), 91-100. https://doi.org/10.1176/appi.neuropsych.17090180Vasterling, J. J., Jacob, S. N., & Rasmusson, A. (2018) Traumatic brain injury and posttraumatic stress disorder: Conceptual, diagnostic, and therapeutic considerations in the context of co-Occurrence. The Journal of Nueropsychiatry and Clinical Neurosciences, 30(2), 91-100. https://doi.org/10.1176/appi.neuropsych.17090180Wilk, J. E., Herrell, R. K., Wynn, G. H., Riviere, L. A., Hoge, C. W. (2012). Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms. Psychosomatic Medicine, 74(3), 249–257. https://doi.org/10.1097/PSY.0b013e318244c604Wilk, J. E., Herrell, R. K., Wynn, G. H., Riviere, L. A., Hoge, C. W. (2012). Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms. Psychosomatic Medicine, 74(3), 249–257. https://doi.org/10.1097/PSY.0b013e318244c604Zatzick, D. F., Rivara, F. P., Jurkovich, G. J., Hoge, C. W., Wang, J., Fan, M.-Y., Russo, J., Trusz, S. G., Nathens, A., & Mackenzie, E. J. (2010). Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments. Archives of General Psychiatry, 67(12), 1291–1300. https://doi.org/10.1001/archgenpsychiatry.2010.158Zatzick, D. F., Rivara, F. P., Jurkovich, G. J., Hoge, C. W., Wang, J., Fan, M.-Y., Russo, J., Trusz, S. G., Nathens, A., & Mackenzie, E. J. (2010). Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments. Archives of General Psychiatry, 67(12), 1291–1300. https://doi.org/10.1001/archgenpsychiatry.2010.158

The authors declare that there are no conflicts of interest present.