СОМАТИЗИРОВАННЫЕ ПСИХИЧЕСКИЕ РАССТРОЙСТВА В ПЕРВИЧНОЙ МЕДИКО-САНИТАРНОЙ ПОМОЩИ: ПРОБЛЕМЫ ДИАГНОСТИКИ И МОДЕЛИ ИНТЕГРАЦИИ ПСИХИЧЕСКОГО ЗДОРОВЬЯ

Актуальность. Соматизированные психические расстройства и персистирующие физические симптомы являются важной, но часто недостаточно распознаваемой проблемой в системе первичной медико-санитарной помощи. Такие пациенты обычно сначала обращаются к врачам первичного звена, однако разнообразие симптомов, их сочетание с тревогой и депрессией, стигматизация и диагностические трудности затрудняют своевременное выявление. В связи с этим важными задачами являются интеграция психического здоровья в систему первичной помощи и развитие междисциплинарных моделей оказания медицинской помощи.

Цель. Систематизировать современные данные об эволюции терминологии, причинах недостаточного распознавания, инструментах ранней идентификации и организационных моделях интеграции психического здоровья, значимых для диагностики соматизированных психических расстройств на уровне первичной медико-санитарной помощи.

Материалы и методы. Исследование выполнено в формате нарративного обзора с систематическим поиском литературы в базах данных PubMed, Scopus и Web of Science, а также анализом документов Всемирной организации здравоохранения, Всемирная организации здравоохранения/Европа и WONCA. Основное внимание уделялось публикациям за период 2015-2025 гг., однако также были включены более ранние работы, имеющие концептуальное значение. В результате первичного поиска было выявлено 107 публикаций, из которых после скрининга заголовков, аннотаций и удаления дубликатов в окончательный анализ включено 43 источника.

Выводы. Современные научные данные показывают, что переход от понятий соматоформных расстройств и медицински необъяснимых симптомов к концепциям расстройства соматических симптомов, телесного дистресс-расстройства и персистирующих физических симптомов имеет важное значение для клинической практики в первичной медико-санитарной помощи. Диагностика этих состояний должна основываться на поэтапной клинической оценке, включающей использование скрининговых инструментов (PHQ-15, SSS-8, SSD-12), динамическое наблюдение и оценку функционального статуса. Интеграция психического здоровья в систему первичной помощи и развитие мультидисциплинарного подхода будут способствовать более раннему выявлению и улучшению доступа к медицинской помощи.

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