Co-dependence of mental disorders and peptic ulcer of the stomach and duodenum

Currently, there is a significant increase in the phenomenon of "rejuvenation" of psychosomatic diseases. Stomach ulcer and duodenal ulcer refers to the multi-factor in the etiopathogenesis of organic diseases, in the emergence, flow and outcome of which, along with the hereditary predisposition and the action of various environmental factors, an important role is played by psychogenic factors.

Currently, there are many explanatory hypotheses of etiopathogenetic relationships and the interaction of mental and somatic factors in peptic ulcer disease. The authors give more than fifteen theories, arguing that each of them undoubtedly has the right to exist, as it reflects one of the facets of this complex problem.

VS Rothenberg and IS Korosteleva noted an intrapersonal conflict in patients with peptic ulcer, manifested in the case when the desire to achieve success collides with the notion of the inevitability of a negative result of one's own actions. Most gastroenterologists adhere to the most famous and recognized physiological theory proposed by N. Shay, according to which the development of peptic ulcer is caused by a violation of the balance between the factors of "aggression" and "protection" of the mucous membrane of the stomach and duodenum.

Based on the psychological criterion of intensive needs in dependence and care, a high percentage of cases was predicted. The most popular psychodynamic concept of intrapsychic motivational conflict today treats duodenal ulcer as a consequence of the unmet need for psychological protection. And this subject can not realize this need, because it contradicts his conscious attitude toward independence and strength. Certain personality traits are also considered as psychological determinants that provoke the appearance of ulcers.

VA Ananiev emphasizes the presence of patients who have a peptic ulcer motivational conflict, expressed in subjective dissatisfaction with their social role and their work.

F. Dunbar believed that peptic ulcer develops in acutely responsive individuals who are addicted to excessive dependence, replaced by a commitment to self-harm. Some researchers note the feeling of helplessness typical for patients with peptic ulcer, but it is believed that it did not occur with the development of an ulcer, but existed before.

OT Zhuzzhanov notes that there are two variants of pathogenic mechanisms of ulcer disease development: with the prevalence of socio-psychological risk factors - an explicative variant; with the predominance of a constitutionally hereditary risk factor - an implicit option.

Thus, attempts to combine existing hypotheses into a single concept led to the conclusion that peptic ulcer is a polyethological, multifactorial disease. This is confirmed by the diversity of forms of psychosomatosis itself. This issue becomes especially urgent in the conditions of the sanatorium-resort network as the final rehabilitation stage of patients with peptic ulcer disease.

This led to the conduct of our study, whose goal was to study the phenomenology of mental disorders in patients with peptic ulcer disease, being treated in a sanatorium.

114 people aged 23 ± 2,8 years with gastroduodenal zone diseases were examined. The main group consisted of 69 patients with peptic ulcer disease of the stomach and duodenum, a comparison group of 45 persons who underwent rehabilitation and rehabilitation treatment at the sanatorium "Berezovsky Mineral Waters", but did not have diseases of the gastrointestinal tract.

Both groups were comparable in gender and age. The diagnosis of the diseases was verified in accordance with the ICD-10 diagnostic standards. Assessment of the state of the mental sphere was carried out according to clinical and psychopathological studies and pathopsychological studies. Evaluation of personal characteristics and state of emotional sphere was carried out using the "Mini-Multt" questionnaire, (a shortened version of the Minnesota multidimensional personal list); methodology "Scale of stress-co-stability and social adaptation of Holmes and Ray; methodology "Scale of self-assessment of situational and personal anxiety of C. Spielberger," adapted by Yu. L. Khanin; the Hamilton scale for assessing depression and the Depression Depression Scale.

The statistical processing of the results was carried out using a standardized computer program SPSS.

Analysis of clinical symptoms showed that in 69% of patients it reached the level of syndromological appearance of the nosological level, in 31% of patients it was at the donor level. The astheno-depressive syndrome was 54%, astheno-hypochondriac - 31%, depressive-hypochondriac syndrome - 15%. Symptomatology in patients of the donor-level level was estimated by us as a somatogenic asthenic symptom-complex - 64%, nosogenously conditioned reactions of mental disadaptation - 36%. Data from pathopsychological studies showed the following: analysis of the profile using the "Mini-Mult" method in the main group and in the comparison group made it possible to reveal the averagedness of the scores across all scales of the multidimensional personality questionnaire (the oscillations of all scales did not exceed the normative range (40-70 standard units) testifies to the absence of psychopathic disorders in this category of subjects).

When analyzing the scores of the "Mini-multt" scales in the group of patients with peptic ulcer in the stage of exacerbation, a significant (p <0.0001) increase in values on scales 1, 2, 8, 9 was revealed in comparison with the group of patients with YaB in remission and healthy. High indicators (more than 70) were noted on the scale of hypochondria - 76.3 ± 4.2, depression - 72.1 ± 3.7 and psychasthenia - 71.0 ± 6.5. This indicates that this observation group is characterized by anxious-hypochondriac and asteno-neurotic types of response, indecisiveness and constant doubts. Such personalities are characterized by passivity, obedience, as well as indecisiveness and constant anxiety. Many problems are solved by "going to a disease", when the symptoms of a physical illness are used as a means to avoid responsibility and to get away from problems. Despite the fact that in cases these people are diligent, conscientious and highly moral, they are not able to make their own decisions and, with the slightest setbacks, easily fall into despair.

Analysis of stress resistance showed the presence in patients who have peptic ulcer in the stage of exacerbation and remission of "threshold" resistance to stressful situations - 233.8 ± 40.9 and 215.6 ± 67.7 points, respectively, p <0.02. In the group of healthy individuals, a high resistance to stress was identified, it was 84.3 ± 55.6 points (p <0.0001).

Measuring the level of anxiety as a personality is especially important, since it largely determines the behavior of the patient, reflects its predisposition to anxiety, when a rather large spectrum of life situations is perceived as threatening, dangerous.

According to the results of the study, a significant increase in the levels of personal anxiety in patients with peptic ulcer as compared with healthy. The level of personal anxiety was regarded as moderate in the group of patients with peptic ulcer in remission and as high in patients with peptic ulcer with erosive-ulcerative lesions. Most often, people suffering from peptic ulcer disease had high (more than 46 points) and moderate (31-45) personal anxiety and only 3 patients of this group had a low level of personal anxiety (less than 31 points). Thus, it is obvious that high anxiety is a certain characteristic of the personality, the so-called psychological premorbid of peptic ulcer. Anxiety, apparently, refers to the internal risk factor, which in certain situations disrupts the mechanisms of psychological adaptation and ultimately leads to the emergence of neuropsychic and somatic disorders.

Analysis of the data of the Hamilton scale for the assessment of depression revealed a wide range of indicators (6-37) in the group of patients with peptic ulcer exacerbation and averaged 11.8 ± 1.1 points, in patients with peptic ulcer in the remission phase, the spread was 0-23 points, an average of 9.7 + 1.1. In the healthy group, the scatter of the indices from 0 to 17 was found, which averaged 5.7 ± 0.9 points. When analyzing the structure of depression, 36.8% of patients with peptic ulcer noted exacerbation of mood at the stage of exacerbation, p = 0.04; a feeling of failure, a feeling of fatigue - 44.7%, anxiety - 60.5%, p = 0.001, sleep disturbance, psychic anxiety, manifested stress and irritability - 52.6% of patients, p = 0.001; somatic anxiety of varying severity - 89.5%; absorption by own health - 52,6%, р = 0,001.

Studies on the Beck depression scale also identified a high level of depression in patients with peptic ulcer disease, which was 9.8 ± 1.0 points during the period of exacerbation. In the group of patients with peptic ulcer during the remission, the depression level was 9.5 ± 1.6, in the comparison group 6.0 ± 0.8 points (p <0.05), respectively. Moreover, during the peptic ulcer exacerbation the level of depression is significantly higher than in the period of remission of the erosive-ulcerative process (p <0.05).

Thus, the relationship and interdependence of mental disorders and underlying disease has been established. In most patients, the symptoms of the asthenic, anxious and depressive spectrum are defined. Data of pathopsychological research showed a high level of personal sensitivity, psychhastenoidity, hypochondria. Emotional sphere was characterized by high values of indicators of anxiety and depression.

The data obtained served as the basis for the formation of a pathogenetically directed system of psychotherapeutic correction of patients with peptic ulcer, built on the basis of an integrative principle.

A. A. Spasibukhov. Co-dependence of mental disorders and peptic ulcer of the stomach and duodenum // International Medical Journal - №3 - 2012 

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