When assessing social phobia and avoidant personality disorder, a number of researchers consider their comorbidity in the continuum of social anxiety and avoidance within a single mental disorder. Based on the analysis and generalization of research data, it is shown that social phobia and avoidant personality disorder have close clinical and pathogenetic links, but very differentiated depending on the contribution of biological, socio-psychological and environmental factors to the formation of pathology. At the present stage of studying the problem, it is premature to talk about the existence of a single mental disorder or its alternative conceptualization. The directions for further study of comorbid relationships associated with the search for markers of differences between avoidant personality disorder and social phobia in the form of biological, personality, cognitive and behavioral (avoidant behavior) parameters are proposed. The study of these markers in dynamics, as well as in the context of the influence of environmental and sociocultural factors, seems promising. The data obtained in the course of further research will be in demand in therapeutic practice.
Achalasia cardia (“cardiospasm”, “phrenospasm”, “dolichoesophagus”, “megaesophagus”, “stenosis of cardia”) represents a primary impairment of esophageal motor function associated with impaired lower esophageal sphincter relaxation and peristalsis defects of the thoracic esophagus. It is diagnosed at the age of 25 to 60 years, making up to 20% of all diseases of the esophagus, and is characterized by a triad of symptoms: dysphagia, regurgitation and chest pain when swallowing. In most cases the first manifestations of achalasia are preceded by stress situations in the anamnesis that complicates the differential diagnosis of psychogenic esophageal spasm. The presented clinical case illustrates difficulties of early diagnosis of achalasia cardia in a young femalepatient with severe anxiety and depressive symptoms which develop under conditions of chronic stressful situations in the family or at work. The issues of interdisciplinary interaction of health professionals (physician, gastroenterologist, psychiatrist, psychotherapist, and surgeon) on the course of examination and management of patients with comorbid physical and mental pathology are discussed. The efficiency of the integrative approach to treatment and rehabilitation with the use of modern reconstructive surgical interventions as well as conservative methods of therapy, psychopharmacotherapy and personality-oriented psychotherapy proves the relevance of studying psychosomatic aspects of achalasia cardia.
1 ФГБНУ «Научный центр психического здоровья», Москва, Россия; 2 Научно-исследовательский институт психического здоровья Федерального государственного бюджетного научного учреждения «Томский национальный исследовательский медицинский центр» РАН, Томск, Россия Цель исследования. Определение воспалительных и аутоиммунных маркеров (энзиматическая активность ЛЭ, функциональная -α1-ПИ, уровень аутоантител к нейроспецифическим антигенам S100b и основному белку миелина (ОБМ), а также фагоцитарной активности нейтрофилов крови пациентов с расстройствами адаптации, выделение определенных иммунофенотипов и анализ возможной их связи с особенностями течения заболевания. Материал и методы. Обследовали 40 пациентов с расстройствами адаптации (по МКБ-10 F43.2). Контрольную группу составили 23 здоровых. Активность лейкоцитарной эластазы (ЛЭ) и α1-протеиназного ингибитора (α1-ПИ) определяли спектрофотометрическим методом, уровни аАТ к S100b и ОБМ -иммуноферментным методом, фагоцитарную активность -по поглотительной способности нейтрофилов периферической крови частиц меламиноформальдегидного латекса. Результаты. В общей группе пациентов с расстройствами адаптации выявлено повышение энзиматической активности ЛЭ и функциональной -α1-ПИ; не выявлено различий в уровне аутоантител к нейроантигенам, а также изменения фагоцитарного индекса (ФИ); установлена тенденция к снижению фагоцитарного числа (ФЧ). При разделении пациентов на подгруппы в зависимости от ведущей психопатологической симптоматики установлено, что выявленные иммунофенотипы встречаются с равной частотой. Заключение. Констатирована вовлеченность реакций воспаления в патогенез расстройств адаптации и отсутствие связи между иммунологическими вариантами по соотношению воспалительных маркеров с клиническими особенностями симптоматики.Ключевые слова: расстройства адаптации, маркеры воспаления, лейкоцитарная эластаза, α1-протеиназный ингибитор, аутоантитела к S100b и ОБМ, фагоцитарная активность полиморфно-ядерных лейкоцитов.Objective. To identify inflammatory and autoimmune markers (enzymatic activity of leukocyte elastase (LE), functional α1-proteinase inhibitor (α1-PI), the level of autoantibodies to neurospecific antigens S100b and myelin basic protein (MBP) as well as phagocytic activity of blood neutrophils of patients with disorders of adaptation, to determine certain immunophenotypes and analyze their possible relationships with disease characteristics. Material and methods. The study included 40 patients with adaptation disorders, mostly women. Diagnostic evaluation and clinical qualification of patients was carried out in accordance with ICD-10: «Adjustment disorder» (F43.2). The control group consisted of 23 individuals matched for age and sex with patients. The activity of LE and α1-PI was determined by spectrophotometry, and the levels of autoantibodies to S100b and MBP by ELISA, phagocytic activity by the absorptive capacity of neutrophils of peripheral blood of melamine-formaldehyde latex particles. Results. In the total group of patients with adaptation disorders,...
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