Клинические фенотипы нервной анорексии: математические модели на основании анализа латентных классов психопатологических симптомов

ВВЕДЕНИЕ: Нервная анорексия (НА) характеризуется гетерогенными клиническими проявлениями, что затрудняет ее диагностику и лечение. Описание клинических вариантов и мишеней терапии НА является актуальной задачей.

ЦЕЛЬ: Изучение наличия эмпирических фенотипов пациентов внутри диагностической категории «нервная анорексия» с применением анализа латентных классов (LCA) психопатологических симптомов, выявленных в результате клинической оценки психического состояния врачами-психиатрами.

МЕТОДЫ: Психопатологические симптомы НА были клинически оценены психиатрами с использованием оригинального чек-листа (всего 57 симптомов), для выявления психических расстройств применялся опросник Mini-International Neuropsychiatric Interview (M.I.N.I.). Для самооценки психопатологических симптомов и дистресса пациенты использовали опросник Symptom Check List-90-Revised (SCL-90-R). Клинически гомогенные подгруппы пациентов были выделены с помощью LCA.

РЕЗУЛЬТАТЫ: Обследовано 115 пациентов с НА. По результатам LCA выделены 4 группы пациентов (К1–К4) с высокой определенностью классификации (R²=0,908), значимостью модели (p<0,001) и четким разделением латентных групп (индекс несходства классов = 0,957). Симптомы расстройства пищевого поведения (РПП) являлись ключевыми для формирования кластера только у 68 (59%) — в группах К1 и К3. Статистически значимых различий между классами по субшкалам SCL-90-R или большинству диагнозов M.I.N.I. выявлено не было. В группе К1 (n=41) доминировали ключевые симптомы РПП: дисморфофобия, страхи, связанные с едой, набором веса, потерей контроля. В группе К2 наблюдалась низкая частота ключевых симптомов РПП, для этой группы была характерна высокая распространенность нарушений сна, тревоги, апатии, тоски и ангедонии. Группа К3 представляет полиморфный клинический профиль с сочетанием ключевых симптомов РПП, аффективных симптомов, расстройств мышления, когнитивных нарушений и нарушений сна. Группа К4 определялась наличием ипохондрических опасений, соматоформных вегетативных симптомов и апатии; ни один из ключевых симптомов РПП не был типичен для К4.

ЗАКЛЮЧЕНИЕ: Выделены 4 эмпирических клинических фенотипа НА, каждый из которых отличался уникальным симптоматическим профилем. Были определены специфичные для каждой группы симптомы, которые включали ключевые симптомы расстройства пищевого поведения и общие психопатологические проявления.

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