[Nosogenic psychosomatic disorders in patients with skin diseases]

OBJECTIVE

Development of a clinical typology of nosogenic psychosomatic disorders in patients with skin diseases.

MATERIAL AND METHODS

The study was carried out in the interclinical psychosomatic department of the Clinical Center and the Clinic of Skin and Venereal Diseases named after. V.A. Rakhmanov Sechenov University in 2007 to 2022. Nine hundred and forty-two patients (253 males, 689 females, average age 37.3±12.4 years) with nosogenic psychosomatic disorders in chronic dermatoses, including ichen planus (n=143), psoriasis (n=137), atopic dermatitis (n=132), acne (n=118), rosacea (n=115), eczema n=10), seborrheic dermatitis (n=88), vitiligo (n=52), pemphigus (n=48), were studied. Index of clinical symptoms (ICS); the Dermatology Quality of Life Index (DQLI); itching severity questionnaire - Behavioral rating scores (BRS); the Hospital Anxiety and Depression Scale (HADS) and statistical methods were used.

RESULTS

In patients with chronic dermatoses, nosogenic psychosomatic disorders were diagnosed according to ICD-10 criteria within adaptation disorders [F43.8] (n=465; 49.3%); hypochondriacal disorder [F45.2] (n=235; 24.9%); constitutionally determined and acquired (hypochondriac development) personality disorders [F60] (n=118; 12.5%); schizotypal disorder [F21] (n=65; 6.9%); recurrent depressive disorder [F33] (n=59; 6.2%). A typological model of nosogenic disorders in dermatology has been developed: hypochondriacal nosogenies in severe clinical forms of dermatosis (pemphigus, psoriasis, lichen planus, atopic dermatitis, eczema) and dysmorphic nosogenies in objectively mild, but cosmetically significant forms of dermatosis (acne, rosacea, seborrheic dermatitis, vitiligo). When analyzing socio-demographic and psychometric indicators, significant differences were revealed between the selected groups (p<0.001). In turn, the selected groups of nosogenic disorders demonstrate significant clinical heterogeneity and include various types of nosogenies that form a unique palette of the nosogenic spectrum in the structure of an extensive psychodermatological continuum. Along with the severity of the skin process, the dominant role in the formation of the clinical picture of nosogeny, including cases of paradoxical dissociation of the quality of life with the severity of dermatosis, amplification and somatization of itching, has a premorbid personality structure and somatoperceptive accentuation of the patient, as well as the presence of a comorbid mental disorder.

CONCLUSION

The typology of nosogenic psychosomatic disorders in patients with skin diseases requires consideration of both the psychopathological structure of the disorders under discussion and the severity/clinical features of the skin process.

[Chemotherapy-associated clinical dynamics of nosogenic reactions in breast and ovarian cancer model]

OBJECTIVE

To study the clinical features, dynamics and factors of nosogenic reactions (NR) development in patients with breast and ovarian cancers at the stage of chemotherapy.

MATERIAL AND METHODS

The study involved 35 patients who underwent chemotherapy. Clinical-psychopathological and psychometric methods were used to assess the mental state.

RESULTS

We distinguished 3 clinical types of nosogenic reactions: anxiety-phobic (n=14, 40%), anxiety-depression (n=13, 37%) and dissociative reaction (n=8, 23%). It was discovered that nosogenic reactions reflect the dynamics of psychopathological disorders associated with chemotherapy and they are connected with premorbid personality structure of the patients. When compared on the Mini-mult scales, differences were found between patients of the anxiety-phobic and dissociative groups: the score on the Anxiety and Depressive Tendencies scale was significantly higher in the group of patients with anxious-phobic NR (p<0.01), as was the score on the scale «Anxiety fixation and restrictive behavior», which was correlated with such personality traits as sensitivity, self-doubt, low self-esteem, obsessive fears (p<0.05). According to the results of the Spielberger-Khanin anxiety scale, in general, the sample was characterized by an increased level of anxiety compared to the norm: the average scores were 49.7 for trait anxiety and 47.7 for state anxiety.

CONCLUSION

Nosogenic reactions can undergo dynamic changes at various stages of treatment. The proposed typology of nosogenies in a more detailed study can have not only scientific, but also practical significance for determining the personalized tactics of psychiatric care for cancer patients at different stages of the disease.

[Psyhosomatic aspects of dysuria in women from the perspective of an interdisciplinary approach]

In clinical practice, urologist often has to treat women who have various forms of dysuria that do not have a pathomorphological substrate and manifest by various types of urinary disturbances and pathological sensations in the urinary tract. The relevance of this topic can be explained by the increasing prevalence of dysuria, its recurrent nature and insufficient efficiency of routine urotherapy, including the use of an extensive armamentarium of drugs and interventions, as well as by pronounced discomfort and a significant decrease in the quality of life and working capacity in the socially active adult patients. Despite a steady growing of interest in this problem, most researchers use a variety of questionnaires and evaluation methods and receive extremely unreliable data that do not contribute to an understanding of the serious psychourological problem of a particular patient with dysuria. In this article, such cases are discussed from the perspective of an interdisciplinary approach using the qualification apparatus of modern psychosomatic medicine and relying on the clinical experience of leading specialists in the field of urology and psychosomatics. The introduction of a comprehensive multidisciplinary approach into clinical practice will contribute to adequate referring, timely provision of specialized care, a reduction of medical costs and an increase in the quality of life in a large group of patients with dysuria.