Psycho-emotional state of patients with chronic prostatitis
Diseases of the pancreas accompanied by not only impaired sexual function, but also cause a variety of common mental disorders. Psychiatric burdened detected in approximately 75% of patients with chronic prostatitis.
In 60.2% of patients with psychiatric burdened prior sexual frustration, and in 17.8% of patients psychoneurological symptoms occur following prolonged and ineffective treatment of the underlying disease and makes a certain specificity in the sexual disorders clinic. At the core lies the fear and anxiety about their condition, the fear of the possible consequences. In XIX century Russian psychiatrists AN Kovalevsky and V. Popov introduced the concept of "neurasthenia psihotravmaticheskaya been ill." Creates a vicious circle: the fear of the patient over a body affects the function of the latter, and the growing functional disorders further reinforce the fear. The special features of patients with long-term chronic prostatitis is hypochondriac and willingness to commit the slightest discomfort in the genitals.
Sexual disorders - decreased libido (40%), decrease in the frequency and strength of spontaneous erections (15%), weakening adequate erections (30%) - will inevitably lead to the emergence of affective disorders. The presence of patients with anxious depression, obsessive show (that dominate the mind and uncontrollable thoughts disturbing content of his "male", and therefore of human inferiority, the "incurable disease" and "futile treatment" of an impending "loss family well-being." It's the same anxiety and fear for their condition and determine any actions almost every step of the patient, the behavior of which is classified as a "disease care with a separation from reality." For this group of patients is characterized by a tendency to self-diagnosis and self-treatment. In clinical picture of anxious depression are typical of patients with disorders of sleep and appetite, marked autonomic symptoms: sweating, labile pulse.
The structure of sexual pathology in patients with chronic prostatitis depends on many factors and is characterized by damage to the ejaculatory isolated component, which clinically manifested rapid ejaculation (47%), painful ejaculation (52%), and smoothed (with a change in color) orgasm (20%). The basis of most cases of mental disorders are changes and neurohumoral component copulative cycle.
Along with depressive states and astenonevroticheskih erectile disorders resulting syndrome suspense failure occurs after one or more unsuccessful attempts coitus. Clinically, among other options phobic obsessive compulsive phenomena observed doubt, fear, fear, desire, and action related to sexuality, such as the unfounded fear of failure during intercourse (koitofobiya), fear of inevitable consequences of masturbation (onanofobiya), incurable sexual disorders, venereal disease, etc. Ground for psychosomatic disorders copulative cycle are those "soft" depression, which, accompanied by anxiety with a focus on normal things really become a breeding ground for potential psychogenic disorders by type of neurosis expectations.
HP may act as a predisposing factor in the development of sexual disorders, provoking ("trigger") and worse (secondary to sexual misconduct) factor. In the sexual relation neurotic syndromes can be divided into two groups: primary (ie direct) defeat of sexuality and with secondary involvement of this sector in the picture of neurosis. The core symptoms of the first group observed in approximately 23% of men seeking help, and the second group of syndromes - in 7% of patients. Thus, the primary sexological syndromes in patients with chronic prostatitis are found in more than three times as often secondary.
Aseptic HP has more psychosomatic base. It occurs usually in people with certain types of characterological and notes the high resistance to therapy. Often, analyzing the premorbid characteristics of patients in this group, it is possible to note the presence of cyclothymia, accentuation of character, residual-organic CNS, postkontuzionny syndrome, which in turn can cause sexual dysfunction. In the history of these patients affective fluctuations preceded clinical manifestations HP.
The origin of the organ changes are significant, many social and psychological factors that cause neurotic condition causing their leading role, which gives reason to believe abacterial prostatitis, which may remain even after the bacterial factor, the result that comes from the psychosomatic pathogenic conditions. In the general description of the model of pathogenesis can be presented also as follows: traumatic factors (stress) of various degrees by interacting with specific to particular individual premorbid characteristics psychosexual causes neurotic state, which forms the autonomic imbalance and, as a consequence - the hemodynamic changes in the pancreas. Disorders of sexual function locked into neurotic "hold" (commit) a pathophysiological state. In the relative characteristics of all the components appear initially on equal terms. Over time, changes in organ formed, develops immune imbalance. As a result, the disease process has transformed the level of persistent reproductive disorders associated directly with HP. Insufficient attention to the mental state of CP patients can significantly reduce the effectiveness of treatment.
Long duration of CP, confirmed by objective data, inevitably leads to the appearance, and eventually even predominance, neuropsychiatric symptoms and accentuation on urination disorders, sexual disorders. Feature localization of the pathological process and its clinical manifestations, determine a number of violations of the sexual sphere mainly on psychosomatic principle. According to some authors to 22% of reproductive disorders of homeostasis must be attributed to the effects of stress, as signs that confirm the inflammatory process in the prostate, but there is her involvement in the psychosomatic condition. These data convinced of the need to more actively identify and assess changes in mental function in patients with CP.
Timely and targeted correction of mental disorders in CP prevents the development of more serious violations of mind and allows you to successfully treat somatic pain. Erectile disorders, found at the HP, in most cases, have the structure of asthenic, anxious hypochondriac, astenoipohondricheskih, astenodepressivnyh syndromes and conditions. As a rule, these states do not require a special correction psychotropic drugs. It is enough to launch a campaign of conversations within a rational therapy. Powerful psychotropic effects and factors have physiotherapy.
In the combined treatment CPs need involve specialist neuropsychiatrist arises only in cases of so-called "difficult" patients. But even in these cases, sexual dysfunction with masked depression relatively resistant to psychostimulants, therapy male sex hormones, and vice versa - is heavily positive for fiziterapiyu.
Given the severity of psycho-emotional disorders, the vast majority of patients with CP, it seems appropriate to mandatory inclusion of a set of basic syndromes of CPs (dysuric, pain, sexual dysfunction) of the fourth syndrome defining psycho-emotional state of the patient. On this basis, the system diagnostic tests CP patients need to make an in-depth assessment of their psychophysiological state. According to our research, reliable prognostic criteria izlechivaemosti CP patients are dynamic regression major disease syndromes, as well as indicators of psychophysiological status (level of depression, changes in relation to the types of the disease, Luscher color test).
In identifying the survey marked changes psychophysiological state of patients prescribed antidepressants and other means medical treatment.
Consequently, diagnosis, severity, timely correction of psychological status, including the use of physical factors of general and central reflex action, the simplest methods of psychotherapy, which can use the GP should take its place in the complex diagnostic and treatment measures in HP.