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Импульсивность как ключ к трансдиагностическому пониманию психических расстройств

Импульсивность как ключ к трансдиагностическому пониманию психических расстройств

Авторы:
Петровский Владислав Павлович,
Скрябин Валентин Юрьевич,
Соколова Светлана Игоревна,
Масякин Антон Валерьевич

Журнал: Журнал неврологии и психиатрии им. С.С. Корсакова. 2026;126(1):53-60.

DOI: 10.17116/jnevro202612601153

Прочитано: 1353 раза

Резюме

Импульсивность рассматривается как один из ключевых трансдиагностических конструктов в психиатрии, расширяющий представления об этиопатогенезе, клиническом течении и подходах к терапии психических расстройств. Эпидемиологические данные указывают на ее высокую распространенность и роль в качестве ключевого патогенетического фактора, опосредующего тяжесть течения, коморбидность и суицидальный риск. Настоящий обзор систематизирует современные представления об импульсивности. Проведен поиск публикаций в информационных базах PubMed, Scopus, ScienceDirect и Mendeley. Конвергентные данные нейровизуализации (структурная и функциональная МРТ), генетики и нейропсихологии выявляют общий нейробиологический субстрат — дисфункцию префронтально-стриато-таламических сетей контроля и нарушение моноаминергической (дофамин, серотонин, норадреналин) модуляции, лежащий в основе импульсивности при синдроме дефицита внимания и гиперактивности (СДВГ), пограничном расстройстве личности (ПРЛ), аддиктивных и аффективных расстройствах. Психометрические модели и нейроповеденческие исследования подтверждают гетерогенность конструкта (моторная, когнитивная, аффективная импульсивность, поиск ощущений) с дифференцированными нейрокоррелятами. Высокие уровни импульсивности являются мощным предиктором неблагоприятных исходов: рецидивов при зависимостях, самоповреждающего и суицидального поведения при ПРЛ, функционального дефицита при СДВГ. Эффективная коррекция требует многоуровневых стратегий, учитывающих специфику фенотипа: психотерапию, нейромодуляцию и таргетную фармакотерапию. Обзор обосновывает необходимость перехода от синдромально-ориентированных моделей к трансдиагностическим, интегрирующим достижения нейронаук для персонализированного подхода и преодоления кризиса традиционной диагностики.

Ключевые слова

  • импульсивность
  • трансдиагностический подход
  • нейробиология
  • нейромодуляция
  • психотерапия
  • пограничное расстройство личности (ПРЛ)
  • синдром дефицита внимания и гиперактивности (СДВГ)

Дата поступления: 11.09.2025

Дата принятия в печать: 18.10.2025

Дата публикации: 09.02.2026

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