Интеграция помощи людям с РАС: коморбидные состояния в психиатрии и комплексная терапия

Сопутствующие психические заболевания осложняют процесс терапии при расстройствах аутистического спектра. В данной статье обсуждаются такие коморбидные состояния, сопутствующие РАС, как синдром дефицита внимания и гиперактивности, тревожность, депрессия, деструктивное расстройство дисрегуляции настроения, психотические и биполярные расстройства. Так как данные заболевания, как правило, затрагивают множество эндофенотипов, от генетического до поведенческого, то и терапия должна быть многоцелевой с максимально сниженными при этом побочными эффектами. Вмешательства с доказанной эффективностью при РАС и коморбидных состояниях могут варьировать от психосоциальной коррекции до лечения психотропными препаратами с различной степенью эффективности в зависимости от сочетания коморбидных состояний и комбинаций терапевтических стратегий. В данном обзоре поставлена цель краткого представления коморбидных состояний при РАС, а также обсуждение возможных вариантов терапии, основанной прежде всего на доказательных исследованиях. Подбор терапии зависит от симптоматики в каждом конкретном случае, но данные свидетельствуют о большей эффективности интегративно-целевой терапии по сравнению с терапией отдельных коморбидных состояний.

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