Co-dependence of psychiatric disorders and gastric and duodenal ulcer disease

At present, there is a significant growth and phenomenon of "rejuvenation" of psychosomatic diseases. Gastric ulcer and duodenal ulcer are multifactorial organic diseases in terms of etiopathogenesis, in the occurrence, course and outcome of which, as is assumed, psychogenic factors play an important role along with hereditary predisposition and the action of various environmental factors.

At present, there are many explanatory hypotheses of the etiopathogenetic relationships and interactions of mental and somatic factors in peptic ulcer disease. The authors cite more than a dozen and a half theories, arguing that each of them undoubtedly has a right to exist, since it reflects one of the facets of this complex problem.

V. S. Rotenberg and I. S. Korosteleva noted an intrapersonal conflict in patients with peptic ulcer disease, which manifests itself when the desire to achieve success collides with the idea of the inevitability of a negative result of one's own actions. Most gastroenterologists adhere to the most well-known and recognized physiological theory proposed by N. Shay, according to which the development of peptic ulcer disease is caused by an imbalance between the factors of "aggression" and "defense" of the mucous membrane of the stomach and duodenum.

Based on the psychological criterion of intense needs for dependence and care, a high percentage of cases was predicted. The most popular psychodynamic concept of intrapsychic motivational conflict today interprets duodenal ulcer as a consequence of an unmet need for psychological protection. Moreover, the subject cannot recognize this need because it contradicts his conscious attitude towards independence and strength. Certain personality traits are also considered as psychological determinants that provoke the appearance of an ulcer.

V. A. Ananyev emphasizes the presence of a motivational conflict in patients with peptic ulcer disease, expressed in subjective dissatisfaction with their social role and their work.

F. Dunbar believed that ulcer disease develops in acutely reacting individuals who have a tendency to excessive dependence, displaced by a commitment to self-harm. Some researchers note a feeling of helplessness, typical for patients with ulcer disease, but believe that it did not arise with the development of the ulcer, but existed before.

O. T. Zhuzzhanov notes that there are two variants of pathogenic mechanisms of development of peptic ulcer disease: with a predominance of socio-psychological risk factors - an explicit variant; with a predominance of the constitutional-hereditary risk factor - an implicit variant.

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

This led to the conduct of our study, the purpose of which was to study the phenomenology of mental disorders in patients with peptic ulcer disease undergoing treatment in a sanatorium.

A total of 114 people aged 23±2.8 years with gastroduodenal diseases were examined. The main group consisted of 69 patients with gastric ulcer and duodenal ulcer, the comparison group consisted of 45 people who underwent restorative and rehabilitation treatment at the Berezovskie Mineralnye Vody sanatorium, but did not have gastrointestinal diseases.

Both groups were comparable by gender and age. The diagnoses of diseases were verified in accordance with the ICD-10 diagnostic standards. The state of the mental sphere was assessed based on the data of the clinical-psychopathological study and pathopsychological research. The assessment of personal characteristics and the state of the emotional sphere was carried out using the Mini-Mult questionnaire (an abbreviated version of the Minnesota Multidimensional Personality Inventory); the Holmes and Ray Stress Resistance and Social Adaptation Scale method; the C. Spielberger Self-Assessment Scale of Situational and Personal Anxiety method, adapted by Yu. L. Khanin; the Hamilton Depression Rating Scale and the Beck Depression Inventory.

Statistical processing of the results was carried out using the standardized computer program SPSS.

Analysis of clinical symptoms showed that in 69% of patients they reached the degree of syndromal development of the nosological level, in 31% of patients they were of the pre-nosological level. At the same time, astheno-depressive syndrome accounted for 54%, astheno-hypochondriac - 31%, depressive-hypochondriac - 15%. Symptomatology in patients of the pre-nosological level was assessed by us as a somatogenic asthenic symptom complex - 64%, nosogenically conditioned reactions of mental maladaptation - 36%. The data of pathopsychological studies showed the following: analysis of the profile using the "Mini-mult" method in the main group and the comparison group made it possible to identify the average indicators for all scales of the multidimensional personality questionnaire (fluctuations in all scales did not go beyond the normative range (40-70 standard units), which indicates the absence of psychopathic disorders in this category of subjects).

When analyzing the Mini-Mult scale scores in the group of patients with peptic ulcer disease in the acute stage, a reliable (p < 0.0001) increase in scores for scales 1, 2, 8, 9 was found in comparison with the group of patients with peptic ulcer disease in the remission stage and healthy individuals. High scores (over 70) were noted for the hypochondria scale - 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-suspicious and astheno-neurotic types of reaction, indecisiveness and constant doubts. Such individuals are characterized by passivity, obedience, as well as indecisiveness and constant anxiety. Many problems are solved by "escaping into illness", when the symptoms of a somatic disease are used as a means of avoiding responsibility and running away from problems. Despite the fact that these people are diligent, conscientious and highly moral in business, they are not able to make decisions independently and easily fall into despair at the slightest failure.

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

Measuring the level of anxiety as a personality trait is especially important, since it largely determines the patient’s behavior and reflects his predisposition to anxiety, when a fairly large range of life situations is perceived as threatening and dangerous.

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

Analysis of the Hamilton Depression Rating Scale data revealed a wide range of scores (6-37) in the group of patients with exacerbation of peptic ulcer disease, averaging 11.8±1.1 points; in patients with peptic ulcer disease in remission, the range was 0-23 points, averaging 9.7±1.1. In the group of healthy individuals, the range of scores was from 0 to 17, averaging 5.7±0.9 points. When analyzing the structure of depression, 36.8% of patients with exacerbation of peptic ulcer disease reported depressed mood, p = 0.04; a feeling of failure, fatigue - 44.7%, anxiety - 60.5%, p = 0.001, sleep disturbance, mental anxiety manifested by tension and irritability - 52.6% of patients, p = 0.001; somatic anxiety of varying severity - 89.5%; preoccupation with one's own health - 52.6%, p = 0.001.

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

Thus, the relationship and interdependence of mental disorders and the underlying disease were established. Most patients had symptoms of asthenic, anxious and depressive spectrum. The data of pathopsychological study showed a high level of personal sensitivity, psychasthenoidity, hypochondria. The emotional sphere was characterized by high values of anxiety and depression.

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

A. A. Spasibukhov. Codependency of mental disorders and gastric ulcer and duodenal ulcer // International Medical Journal - No. 3 - 2012

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