M.I.PyrogovVinnitsaNationalMedicalUniversity

Chairof Psychiatry and Addictology

MENTAL DISORDERS IN SOMATIC DISEASES, ENDOCRINE ANDCEREBRAL VASCULAR PATHOLOGY.

Abstracts oflecture

Lecturer: Associated Professor, PhD Teklyuk S.V.

Vinnytsya 2009 y.

Plan of the lecture

  1. MENTAL DISORDERS IN SOMATIC DISEASES.
  2. General characteristic of mental disordersin somatic diseases.
  3. Peculiarities of mental disorders in different somatic diseases.

1)Cordial diseases. Cardiophobia. Cardiosurgery.

2)Mental disorders in diseases of respiratory organs.

3)Mental disorders in patients with a gastrointestinal pathology.

4)Mental disorders in renal diseases.

5)Mental disorders in hepatic diseases.

6)Mental disorders in women with an obstetric-gynaecological pathology.

  1. Principles of the treatment of mental disordersin somatic diseases.
  2. The prophylaxis.
  1. MENTAL DISORDERS IN ENDOCRINE DISEASES.
  1. General characteristic of mental disordersin endocrine diseases.
  2. Peculiarities of mental disorders in different endocrinediseases.
  3. Principles of the treatment of mental disordersin endocrinediseases.
  4. The prophylaxis
  1. MENTAL DISORDERS IN CEREBRAL VASCULAR PATHOLOGY.
  1. General characteristic of mental disordersin cerebralvasculardiseases.
  2. Peculiarities of mental disorders in different cerebralvasculardiseases.

1)Mental disorders caused by cerebral atherosclerosis.

2)Mental disorders in the hypertensive disease.

3)Mental disorders after the cerebrovascular accident.

  1. Treatment.
  2. Prophylaxis.

List of recommended literature

Basic literature.

  1. Concise Oxford Textbook of Psychiatry. M. Gelder, D. Gath, R.Mayou. – Oxford; New York; Tokyo; OxfordUniversity Press, 2007. – 953 p.
  2. Modern Synopsis of Psychiatry. A.M. Freedman, H.I. Kaplan, B.J. Sadock. – USA, 1982. – 433 p.
  3. Psychiatric Dictionary / 5th ed. R.J. Campbell. – Oxford; New York; OxfordUniversity Press, – 1981. – 693 p.
  4. Psychopatology and addictive Disorders / Ed. By Meyer. - New York; London, 1986. – 283 p.
  5. Psychiatry: course of lecture /Ed.by V.S. Bitensky. – Odessa, 2005. – 336 p.
  6. Zimbardo Ph.G. Psychology and Life. - USA, 19991. – 189 p.

Additional literature.

  1. Brundtland G.H. Mental health in the 21st century // Bulletin of the World Helth Organization. – 2000. - №87. – Р. 411.
  2. Desjarlais R., Eisenberg L., Good B. et al. World Mental Health: Problems and Priorities in Low-Income Countries. – New York: Oxford University Press, 1995. – 144 p.
  3. MarsellaA., Kleinman A., Good B. Cross-cultural studies of depressive disorders. An overview. Culture and depression. – Berkley: University of California Press, 1985. – 213 p.
  4. Mulrow C.D., Williams J.W. Jr., Trivedi M., et al. Treatment of depression: newer pharmacotherapies. Rockville, MD: Agency for Health Care Policy and Research, 1999. – 253 р.
  5. Murray C.J.L., Lopez A.D. The global burden of disease: a comprehensive assessment of mortality and disability from disease, injuries and risk factors in 1990 and projected to 2020.Cambridge,MA: HarvardUniversity Press, 1996. – 68 p.
  6. Kielholz P. Masked Depression. — Berne, 1973. – 97 p.
  7. Lopez-Ibor J. J. The Present Status of Psychotropic Drugs / Ed. by A. Cerletti, F. J. Bove. - New York, 1999. - 519 p
  8. Preskorn, S.H. Outpatient management of depression: A guide for the Primary-care practitioner/ S.H. Preskorn. - Wichita; Kansas: Professional Communications,Inc., 1994. - 147 p.
  9. UstunT.B., SartoriusN. Mental Illness in General Health Care. An International Study. – Chichester: John Willey @ Sons Ltd, 1995. – 336 p.
  1. MENTAL DISORDERS IN SOMATIC DISEASES.

Patients with various somatic diseases develop disturbances in their psychic activity, which often remain unnoticed.

The patient's mental state significantly influences an outcome of the disease, complicating and delaying the process of recovery from the somatic disease.

Mental disorders related to a somatic disease are widely spread. For instance, they are observed in 44 % of patients with postoperative complications. As checkups have shown, more than a quarter of patients of therapeutic departments of hospitals suffer from mental disorders, whose rate and character depend upon the patients' age and sex, and the type of the department.

The literature describes criteria for diagnosing somatically caused psychoses: a) presence of a somatic disease causing mental disorders; b) a temporary relation between the development of a basic disease and mental disorders; c) a reduction of a mental disorder with the recovery from a basic disease or with its significant alleviation; d) absence of any data about other causes of a mental disorder.

The clinical picture of somatogenic disorders depends upon the character of a basic disease, the degree of its severity, the stage of the course, the level of efficacy of therapeutic influences, as well as such individual peculiarities of the patient as heredity, constitution, premorbid composition of the personality, age, sometimes sex, responsiveness of the organism, presence of previous hazards. Thus, affective disorders are more frequent among younger women, while organic mental ones are particularly common among elderly people, and the problems related to alcoholism are undoubtedly typical for younger males.

The clinical manifestations may be expressed by various syndromes. At the same time there are some pathological states, particularly typical at present for somatogenic mental disorders. These are such disorders as: 1) asthenic; 2) neurosis-like; 3) affective; 4) psychopathy-like; 5) delusive states; 6) stales of cloudiness of consciousness (delirium); 7) the psychoorganic syndrome, demenlia.

In ICD-10, These states are classified in section F06 as "menial disorders caused by a somatic disease".

Peculiarities of mental disorders in different somatic diseases

Coronary disease. The risk factors of development of mental disorders in coronary disease are as follows: a chronic emotional disorder, social-economic difficulties, overstrain or other aggressors continuously acting for a long period of time; typically the patients have such personality streaks as hostility, an excessive striving for competition, ambition, a constant feeling of a lack of time and concentration on restrictions and prohibitions. While making the primary and secondary prevention, the main approach consists in elimination of such risk factors as smoking, malnutrition, use of alcoholic drinks, insufficient physical loading.

Angina pectoris. Attacks of angina are often provoked by such emotions as anxiety, anger and excitement. The feelings which the patient has during an attack may be extremely frightening, and often later the patient becomes superfluously careful despite all his doctors' positive statements and against their efforts to induce him to return to his usual active way of life. Angina pectoris may be accompanied by an atypical pain in the chest and dyspnoea caused by anxiety or hyperventilation. In many cases there is some lack of correspondence between the patient's real ability to bear physical loads, established with help of objective examinations, and his complaints about a chest pain and a limited activity. A good effect in overcoming these problems is usually achieved by conservative treatment in combination with regular physical exercises corresponding to the patient's state. In some cases, behaviour therapy conducted in accordance with an individually devised program helps the patients to find again self-reliance.

Myocardial infarction. As a severe somatic disease, myocardial infarction exerts an intensive psychotraumatizing, stressful effect first of all by its acuteness, suddenness, subjective severity, probable disability, uncertainty and a possible tragic outcome. Mental disorders in myocardial infarction are various and complex, they may develop acutely, subacutely or gradually. Within the acute period of myocardial infarction it is possible to observe appearance of states of a disturbed consciousness in the form of a variously expressed torpor, beginning with obnubilation and ending with sopor and coma. There may be delirious changes of the consciousness, as well as its twilight disturbances which are particularly typical for elderly people whose myocardial infarction has developed against a background of already existing hypertensive disease and cerebral atherosclerosis.