The aim: To study the influence of anxiety and depressive disorders on life quality of patients with arterial hypertension. Materials and methods: 55 patients with arterial hypertension (AH) of 2nd stage were examined to reach the goal. Age diapason was 25-73 years, the middle age was 53.56+10.28. There were 58.2% (32) of women and 41.8% (23) of men among the patients. Results: Results analysis of the investigation of patients with arterial hypertension and anxiety and depressive disorders using the Spielberger-Khanin anxiety inventory showed moderate (30.9%) and high (69.1%) level of trait anxiety. As for the state anxiety the high level of it was confirmed in 74.6% of studied patients and moderate level of state anxiety in 25.5% of patients. During the analysis of gender-based distribution the trait anxiety level was significantly higher in women (p<0.05). Results of PHQ-9 showed subclinical depression level (12.7%), mild (49.1%) and moderate (16.4%). Moderate manifestations of depression were found in 12.7%, severe depression in 9.1% (5 individuals). As for the gender-based distribution, anxiety indicators were significantly higher in women (p<0.01). HADS method did not show significant difference of depression levels of gender-based distribution. Conclusions: The majority of individuals with arterial hypertension and nonpsychotic mental disorders have a high level of trait and state anxiety. Direct correlation was found between the trait anxiety indicator and depression severity, which were defined according to HADS and PHQ-9 questionnaires. The level of anxiety and depressive episode severity were found to be reliably higher in women in gender-based distribution, that/which was accompanied by decrease in most of the life quality indicators.
Non-compliance to treatment recommendations of patients with chronic diseases is a global medical problem that significantly affects the effectiveness of treatment, leading to serious medical and economic consequences. Sufficient research on the problem of non-compliance with medical recommendations has led to the creation of a holistic concept of medical compliance. The purpose of the work was to estimate the main factors influencing the compliance to antihypertensive therapy of middle age patients with Arterial hypertension. Material and methods. We investigated 40 patients 50-60 years old (mean age 56.6±4.5 years) with Essential Arterial hypertension. Socio-demographic, clinical, pathopsychological, psycho-diagnostic methods (Morisky Medication Adherence Scale, self-assessment anxiety scale Charles D. Spielberger – Y. L Hanin, the Scale of Internality in relation to health and illness, the study of the self-esteem of mental states by H. J. Eysenck, the study of the level of depression by the Beck Depression Inventory), mathematical and statistical methods were used. Results and discussion. With the Morisky Medication Adherence Scale survey, we distinguished three groups of patients: with high (22.5%), middle (27.5%) and low (50.0%) levels of adherence to the combined therapy of hypertension. Socio-demographic factors in patients with low adherence to treatment were determined by lower level of education and absence of continuous marital relations. Clinical characteristics of patients with low compliance level included the presence of 3rd degree of severity, I stage of the Arterial hypertension, often comorbidities (Diabetes Mellitus 2nd type, Chronic Obstructive Pulmonary Disease, Ischemic Heart disease), long tobacco smoking. According to the psychopathological and psycho-diagnostic examination, patients with an internal type of personality control, low anxiety and depression mostly showed the low level of compliance and also more frequent aggressiveness in the self-esteem of mental states (p <0.05). Conclusion. Thus, patients of middle age with Essential arterial hypertension very often (up to 78%) showed the insufficient level of adherence to antihypertensive treatment. Socio-demographic, clinical and psychopathological factors significantly affect the level of compliance in these patients. Improving the effectiveness of therapy of Arterial hypertension in such patients is possible due to optimization of treatment regimens, wide introduction of psycho-diagnosis and psycho-correction with the involvement of psychologists into this process
The article identifies the features of the pathology of the gastrointestinal tract in patients with gastroesophageal reflux disease on the background of hypothyroidism. The frequency of gastroesophageal reflux disease and the severity of this disease increase with age and the presence of comorbid pathology. In the elderly, the frequency of the typical esophageal manifestations decreases, and the erosive esophagitis with atypical symptoms is more common. The growing number of cases of combined thyroid dysfunction with gastropathology requires in-depth study of the reasons for the relationship between these processes. Pathological changes in the gastrointestinal tract in these patients make their condition severer, contributing to the development and progression of metabolic disorders. An important aggravating effect on the regulatory mechanisms of esophageal kinetics has a pathological functioning of the thyroid gland on the background of iodine deficiency. Results and discussion. In patients with gastroesophageal reflux disease with hypothyroidism, all changes in gastric and duodenal function are associated with a decrease in the acid-forming function of the gastric mucosa, due to its atrophy, decreased tone and contractility of the stomach. This in turn leads to a slowing of gastric and duodenal evacuation, dysfunction of the closing capacity of the cardia and, as a consequence, the development of duodenogastroesophageal reflux. The esophageal contents are not so pronounced, so patients with non-erosive forms of esophagitis predominate (46.2%) against 16% of patients in the second group (patients with gastroesophageal reflux disease). At the same time, erosive forms predominate among patients in the control group with predominant acid reflux. It should be noted that there is a clear relationship between the frequency of erosive changes in the esophageal mucosa and the duration of the disease. Thus, among patients of the main group with a 5-year history of the disease, the number of erosive forms of gastroesophageal reflux disease was minimal. The number of erosive changes in the esophageal mucosa increased sharply in patients with a 10-year history and reached its maximum after 15 years from the onset of the disease. Conclusion. The delay in gastric evacuation is more pronounced in patients with gastroesophageal reflux disease on the background of hypothyroidism. It can be explained by a decrease in gastric motility and the presence of duodenostasis. The slowing of gastric evacuation was more pronounced in patients with gastroesophageal reflux disease on the background of reduced thyroid function. In patients with gastroesophageal reflux disease on the background of hypothyroidism there is an alkaline duodenogastroesophageal reflux as a consequence of reduced acid-forming function of the gastric mucosa and reduced contractility of the stomach and duodenum
The purpose of the work was to study the clinical course of gastroesophageal reflux disease with acid and alkaline refluxes, to investigate the psychosomatic state, the features of endoscopic changes in the esophageal mucosa, changes in pH-measurement and gastric motility in patients with gastroesophageal reflux disease depending on the type of reflux. Materials and methods. A study of 60 patients with gastroesophageal reflux disease aged 24-65 years (mean age 44.5±5.3 years) was carried out. The main group consisted of 35 patients with gastroesophageal reflux disease with concomitant acid reflux, and the comparison group included 25 patients with verified alkaline reflux. Control group consisted of 20 practically healthy people. The groups were representative by age and sex. All patients underwent a comprehensive diagnostic program, which included a careful collection of life and medical history, questionnaires, clinical examinations, anthropometric studies, laboratory and instrumental studies. Results and discussion. Among the examined patients with gastroesophageal reflux disease with acid reflux, men predominated (60%). In contrast, the patients with alkaline reflux were dominated by female patients –76%. Most patients with alkaline reflux were overweight and had obesity of I and II degree. Тhe abdominal type of the obesity prevailed in the patients with alkaline reflux (64%). In the main group of the patients there was an increase in the number of acid reflux per day – 125±2.6, alkaline – 60±2.1 in the comparison group – 113±44.2 (p <0.01). In the control group, weakly acidic reflux, which coincided with clinical manifestations, was registered less frequently – the average daily rate was 155±24.3. The average daily number of refluxes over 5 minutes in patients with acid reflux was 19.7±3.5, with alkaline – 16.8±3.3. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes in 14 (66.7%) people: reflux esophagitis grade A (38.1%), grade B (19.1%), grade C (9.5%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). Delayed gastric evacuation is more pronounced in patients with gastroesophageal reflux disease with alkaline reflux, which can be explained by slowing of motility of the stomach and the presence of duodenostasis. In the vast majority of patients in this group, complete evacuation of contrast from the stomach occurred in a period of 3 hours or more. This allows us to conclude that the violation of the contractile ability of the stomach is one of the main factors that slows gastric evacuation, increases intragastric pressure and contributes to the development of pathological dumping of gastric contents into the esophagus. Conclusion. The combined course of gastroesophageal reflux disease with acid and alkaline reflux is characterized by specific etiopathogenetic mechanisms of development, polymorphism of clinical symptoms, which worsens the psychosomatic state and quality of life of patients. In patients with gastroesophageal reflux disease with alkaline refluxes, concomitant lesions of the pancreato-biliary system were more often diagnosed. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes (66.7%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). A hiatal hernia was found in patients with acidic (22.9%) and alkaline reflux (28.1%). Insufficiency of the lower esophageal sphincter was observed in 40% of patients with alkaline reflux, in 34.2% of patients with acid reflux with normal body weight. In gastroesophageal reflux disease with acid reflux, persistent delay in gastric evacuation is caused by persistent pylorospasm
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