Friday, July 27, 2012

Psychology of somatic patients


In the middle of this century have long noticed the unpleasant feelings that accompany certain diseases of the device to move. At that time it was noted that there are some personality traits physically ill (problems with aggression in the foreground), and their relatively complicated family situations (aggressive and dominant father).


It was not until the seventies are accepted in somatic medicine and so-called explanations. depth psychology of intrapersonal conflict and the activation of some of the 'neurotic' defense mechanisms, as well as possible 'background' bodily diseases. Later, in orthopedics penetrate attitudes to authority for the movement disorders may have a protective function in relation to psihičiki integrity, preventing organic mentally ill patient to regress, and sometimes psychosis. Somatic defect would have, in this sense, the purpose to cover the lack of personal self, so that psychotherapy only managed to remove the organic symptom.

In orthopedic practice, psychogenic component of certain diseases, the most respected post factum, after more or less conventional orthopedic treatment of successful interventions.

Psychology and psychopathology of orthopedic patients

In orthopedics, for lumbago, rheumatism, or at tendopatija, the so-called impact. psychological components of the patient is more than obvious. It should be noted, and called. psychogenic pain, which otherwise is very similar to the lumboishialgije pain and pain in some other orthopedic diseases. They are distinguished by psychogenic pain drama which follows his communication, in an untrusted location, heat of passion, which is inadequate and, finally, the resistance to analgesics and other orthopedic intervention. Of the patients with psychogenic (usually a conversion) pain is very often heard: "It hurts everybody," and appealed to the pressure in front of the thorax. The pain is already certified to the result of physical changes of tissue, fixed for a specific body part and have a reliable neurological localization.

Regarding the relationship between pain and psychological status of orthopedic patients, it was noted, with cervikoalgija example, to reinforce the incriminating statements of the environment, and in the extreme dorsalgija bereavement and discouragement. Condition of patients with lumbago, on the other hand, is usually worse after a general mental overload and frustration experienced on different levels, including sex life. Brahialgija, according to observations Vajntrauba, more related to problems in controlling anger and aggression, the patient usually difficult to control. Thus, the clenched fist clutching a patient with pain in the legs, which give the impression that they are of organic origin, reveal a man who, by the same author, insecure.

In orthopedics it crystallized the view that the pain in the lower spine directly related to the psychological status of the patient. On the other hand, the nespinalnom localized pain (rheumatoid arthritis, osteoarthritis and leg injury) did not show a direct correlation of this kind. This is confirmed by the research Gray, Maine and Wejdela, 335 patients of Eysenck Personality Inventory and the Zung depression scale.

Chronic muscular tension, as well as other general symptoms of orthopedic diseases (especially present in acute and chronic spinal syndromes), is related to the so-called. "Muted personality", which is in its emotional aleksitimičnosti unable to express feelings of pain, so it does through the locomotor system.

As for specific orthopedic disorders and mental symptoms, V. Laer was in 1973 patients with fractures of juvenile bone cysts, found that surgery does not significantly affect recurrence. Similar to the problems noted in the patients (302 patients) with fibula-tibial tendon, in which Lear noted prolonged instability walk, regardless of whether the intervention was a conservative or operative, concluding that the reason for poor mental state, ie, protective role in preserving the physical symptoms of psychological integrity of the patient.

Kitmejer speaks of "depression without depression" or larviranoj depression in frequent pain in the muscles of patients in orthopedic clinics, without positive laboratory results, which are in favor of organic changes. In doing so the patient does not complain about no fear, no bad mood, not even respond to conventional orthopedic therapies. Such pain sometimes disappear spontaneously, during relaxation or when the conversation about the possible symptoms of psychological background.

Research with the MMPI have confirmed the presence of orthopedic patients, particularly symptoms of hypochondriasis (scale 1) and hysteria (scale 3), and partly signs of depression (scale 5). Higher values ​​on the MMPI hypochondriasis scale with back pain show, with almost 80% probability, other researchers believe that the psychogenic component of orthopedic diseases played a determining role in the onset of the disease. When it comes to the depressing line of orthopedic patients, one of the more recent research has shown that the depression of people operated for spinal cord injury, the only statistically significant psychopathological feature separately. It is interesting that the bad mood of orthopedic patients was significantly higher than estimated by the tested osobija than the patients.

I in patients with prolapse of intervertebral discs was found, using the Beck Scale for Depression, the significant presence of depressive symptoms (insomnia, decreased appetite, impotence). In the same study identified some traits with disc herniation, which increase the likelihood of depressive reactions, such as the unconscious need for adaptation to the environment at all costs, which the authors interpret the passive patient conflict with its environment.

For rheumatic artritičare long have assumed that it is the opinion of persons who do not know how to express their own ill kanalizuju aggression. They, like the psihosomatici widely known, belong to the so-called. Type A personality, which tends to be more or less consciously, constantly exposed to stressful situations. In addition to describing as a perfectionist, that is cynical. verbally aggressive as those in everyday life more important factor in respect of accuracy, who live under tension, as oriented to success and so on. For rheumatic artritičare has proven to be significantly more often treated with the clinical picture of neurotic disorders, or suffer from a sense of fatigue, social withdrawal and hipovigilnosti attention.

As for the personality traits of patients injured in traffic accidents (which are pathological features of patients with reumatidnog arthritis, most commonly studied), even with more than 50% of this species, were found certain psychopathological traits. Perpetrators of road accidents are described, namely, as an impulsive, prone to risk-viduals, as well as those who have problems with authority, latently aggressive, potentially suicidal, self-harming behavior, as people with a permanent sense of guilt in short, as a neurotic. True, few researchers have confirmed the previous findings, maintaining the view that patients are injured in traffic accidents psychopathological least different from healthy subjects. Not, of course, difficult to draw the conclusion that the registration of psychopathological trait of those who caused the accident at work affects a number of different factors. Among them are mentioned even diminished intelligence of subjects. They did not however neglect the indirect effects of social characteristics of the injured. Given the fact that most of them young age and to encourage the industry skill, that is, workers' environment.

Pronounced neurotic traits were determined, and the wounded soldiers from the front. With them it is a significant percentage confirmed that the bodily injury (and, in general, exposure to war stress) in 30% a significant factor in the appearance of post-traumatic stress disorder, whose prevalence is positively correlated with duration of exposure to danger of war. Some of them are registered visibly present, clinical "psychosomatic Regression" (stomach ulcers, infections, etc..), Especially among the wounded in the intensity of the trauma which was more pronounced. All in all, the role of stress (especially that the cumulative nature) in the development of psychosomatic disorders is increasingly apparent, especially when it comes to malignant disease and heart attacks, most often mentioned as the immediate cause of death.

Finally, psychopathological changes that orthopedic patients may be present to such an extent that is recognized and known as a psychiatric entity. Also in the survey Kuna et al. with instruments such as the BSI (Brief Symptom Inventory) and SMAST (Short Michigan Screening Test Alcocholism) found that of 101 patients with fracture of the leg bones, as many as 70% were patients with a known psychiatric diagnosis, although only 6% of them required consulting psychiatrist. Of this, half is accounted for on Alcoholism, 38% of personality disorders, 21% of the neuroses and the same number of dysthymic disorder. Vidžej and associates in 45% of patients treated with outpatient orthopedic disease also have found psychiatric symptoms, and Kinspek associates, with close to half of hospitalized orthopedic patients, symptoms of anxiety-depressive neurosis.

Only sometimes, mental changes bodily suffering (najčesšće injured) require psychiatric treatment in hospital. This is the case when the somatic patients attempted suicide, when the family met with incomprehension and obviously inappropriate or in conflict with aggressive family member. It is similar to situations in orthopedic patients diagnosed in delirantnoj alcoholism or chronic phase, and finally, when the clinical picture suggests the homicidal behavior of paranoia, so hospilalizacijom temporarily protect its environment.
Emotional diagnosis

Timely detection of somatic psychopathological state, ie. orthopedic patients for fast simulation of the differential diagnosis of hypochondriasis, subclinical depression, and conversion of somatic disorders, as well as predicting the behavior of the patient during and after intensive treatment. It is important to avoid unnecessary hospitalizations and even nekorisnije operative intervention, and because the patient promptly to appropriate psychotherapy, ie, psychiatric treatment.

At the same time, from beginning to end of treatment, invaluable psychotherapeutic attitude toward physically ill, which includes goodwill (sympathy for the patient), the willingness to patiently listen to his "theory of disease", to be made after expert "clip" with her , as well as to provide a timely and realistic information about his illness and the therapeutic measures taken.

Moreover, it should listen to their own emotions about the patients, using the so-called. "Emotional diagnosis," or, as some orthopedic surgeons wrote, "soft facts". Psychoanalysts would say that we should bear in mind the transfer counter emotional response to the therapist's overall habitus, physical and mental condition of the patient, especially in his expectations. An orthopedic surgeon should be particularly alert to a widespread sense of his own omnipotence, that is., To experiencing yourself as a savior. Not so rare or unconscious defense of their own doctors fear, aggression or depression. All that would help doctors somatičarima to faster, more accurate and more intuitive, but simply by paying attention to the psychological status of the patient, gave a hint or even recognize the psychological background of organic disorders and the current time satisfy psychological needs of the patient, paving the way also the positive outcome of their basic professional procedures.

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