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.
Objective:To study role of psychosocial factors in formation of mental disorders (MD) in patients with diabetes mellitus (DM).Material and Methods:We examined 210 patients (age 48.57±8.65 years) with DM of type 2 and glucose tolerance disturbance (GTD) at Borderline States Department.Results:DM patients were diagnosed as having neurotic, stress-related (44%), and affective (14%), organic (35%), personality (7%) disorders. Method of logistic regression has identified totality of prognostic signs in values (Concordant; Somers'D) of Hosmer and Lemeshow's test (0,7-0,9). We studied significance of psychogenic factors (life events, medical, working, family-housing ones) in formation of mental disorders. Predictors were as follows: level of glycemia (p=0.0001), body mass index (p=0.0001), diabetic retinal angiopathy (p=0.02), family history (p=0.044). Psychosocial predictors: duration of MD (p=0.0001), age of onset of MD (p=0.0001), ratio of age of onset and duration of MD and DM (p=0.0001), disorders of neurotic and affective level (p=0.0001). Anosognosia DM was combined with anxiety, fears and fear of death, inappropriate assessment of their abilities, hypothymia, anxiousness, and vegetative dysfunctions.Two-factor disperse analysis has identified relationship between level of glycemia on an empty stomach, MD (p=0.0001; p=0.007) and DM (p=0.003). Instability of blood glucose (4.63-19.3 mmol/l) was observed in 40% of patients with leading syndrome of depression. Depressive disorders contributed to quicker development or decompensation of DM 2 for the first six months.Conclusions:High risk of complications of DM was associated with influence of psychostressors and depressive disorders. Treatment of patients requires interaction of therapist (endocrinologist), psychiatrist, and psychotherapist.
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