[Conceptualization of comorbid anxiety and depressive disorders and approaches to their managing]

Anxiety and depressive disorders are characterized with frequent co-occurance. Depression comorbid to anxiety disorder increases severity of main disorder, aggravates it`s clinical course, worsens social functioning of the patients and decreases life quality, results resistance to therapy and increases the probability of suicidal attempts. In patients with depressive disorders onset of anxiety disorder results increased severity of disorder and decrease in quality of remission. There are different opinions on nature and phenomenology of comorbidity of anxiety and depressive disorders. There are biological and psychological factors of risk of comorbidity. Some scientists consider comorbid disorders to be independent and not to effect each other; others pay attention at common anatomic basis of comorbid disorders, which explains manifestation of comorbid disorder. Hierarchical analysis of clinical features of comorbid disorders favors nosological approach to understanding of comorbidity, and implicates the need for inclusion of transdiagnostic elements. Some authors consider comorbid disorders to be separate type of disorder, characterized with special dynamics of syndromes which reveals transformation of one disorder into another. Phenomenon of comorbidity can be described as part of concept of disease spread which estimates important role of bridge psychic states. Considering clinical features of comorbid disorders, difficulties of their therapy based on concepts of phenomenology of comorbid depressive and anxiety disorders recommendations on prevention, early diagnosing and managing of comorbid disorders were elaborated. Psychotherapy (including CBT, which demonstrated high efficiency) is an essential element of treatment of comorbid depressive and anxiety disorders. Psychotherapy is supposed to be correcting personality traits, cognitive mistakes and maladaptive strategies of coping with disorder, which support the comorbidity.