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SPECIFIC CHARACTERISTICS AND PREVALENCE OF
MENTAL DISORDERS IN ONCOLOGICAL DISEASES OF THE
LUNG AND GASTROINTESTINAL TRACT
Rustamov U.T.
Bukhara State Medical Institute
Abstract:
Mental disorders are more common in cancer patients than other somatic
diseases, which reduces their flexibility and the quality of rehabilitation. The article
describes the clinical characteristics of mental disorders in patients with various
oncological diseases (lung, gastrointestinal tract cancer).
Key words:
Depression, organic disorders, mental disorders, hypochondria, anxiety,
panic, agitation
Relevance:
(Global Cancer Observatory) According to Globocan, an interactive web-
based cancer statistics platform, 8.2 million people worldwide die from cancer every year
[2]. In 2016, 599,348 oncological diseases were diagnosed in the Russian Federation, the
increase of this indicator compared to 2015 was 1.7% [5]. Cancer deaths among all causes.
In Tomsk region, according to Tomskstat in 2010, 15,202 patients were registered with a
malignant tumor for the first time in their lives, and in 2015, this figure increased to 18,413
[4]. In general, the morbidity and mortality rates in the Siberian Federal District the
increase is from malignant tumors [17]. Although cancer control programs are being
established, cancer continues to occupy the top five places in the world for the incidence
of lung, colon and stomach cancer [3]. Thus, oncological diseases cause fear of death,
disability, pain and helplessness among the population, serious psychological problems
that can lead to psychological stress, long and severe mental disorders, personality changes
and even suicide. In oncological pathology, adjustment disorder is often observed (up to
68% among respondents) and clinical depression (up to 13%) [8]. Anxiety and depressive
disorders are usually more common in cancer patients than in their peers[9].
The etiology
and pathogenesis of malignant tumors are not well understood. The hypothesis that
psychosocial, immune or endocrine mechanisms can be determined, through which
emotional factors can affect the growth or reduction of a possible tumor, has been discussed
several times in the literature. In addition, many authors have expressed the opinion that
mental disorders, in turn, affect the development of cancer [7, 12, 13, 14, 15]. Almost half
of cancer patients suffer from postoperative depression or other psychological disorders.
report difficulties in most cases are alleviated after a few months Stomatized patients face
social, personal problems and an intimate life related to feelings Shame and embarrassment
due to the possibility of leaking intestinal contents, which other, already adapted patients
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to overcome can best help [16]. Patients with lung cancer are characterized by severe
anxiety, asthenia, and fear. In stomach and intestinal cancer, severe hypochondria can be
observed [12].
OBJECTIVE OF THE RESEARCH:
Study of clinical and psychopathological
characteristics of patients diagnosed with cancer of different localization (gastrointestinal
tract, lung cancer).
MATERIALS AND METHODS:
56 patients, 32 men and 24 women with
malignant tumors of certain localization (lung, stomach, sigmoid, colon and rectum) were
taken for observation. The age of the examined patients ranged from 28 to 76 years, the
average age of the patients was 56.2±1.5 years. The study included patients in the thoracic-
abdominal surgery department. The following methods were used in the work: clinical-
psychopathological examination, clinical-psychological examination Hamilton depression
scale (HADS-21) [18]. Statistical package "Statistica v.6.0" was used to process the
obtained data.
Results
. The following distribution of patients according to the nosological structure
was obtained: adjustment disorder (20% of cases), affective disorders (11%), organic
mental disorders (15%), prenosological disorders (54%). The severity of depression
assessed by the Hamilton depression scale was compared in patients with the following
diagnoses: adjustment disorder (13.3 ± 1.1 points), affective disorders (12.8 ± 2.2 points),
organic disorders (11 .3 ± 1.5 points) (p>0.05), but it was statistically significantly more
accurate compared to patients with prenosological disorders (6.3±0.4, p<0.05). It was
found that patients diagnosed with colon cancer had more frequent prenosological diseases
than other groups. The article discusses psychotherapeutic and psychopharmacological
studies of mental disorders observed for each type of oncological nosology. The
distribution of patients with oncological disorders according to adaptation, affective
disorders, organic mental disorders, and prenosological disorders depending on the
localization of oncopathology is presented in Table 1.
Distribution of mental disorders according to nosological structure in patients
with various oncological pathologies Table 1
Stomach
Cancer%
LUNG
CANCER%
Colon
cancer %
Total %
Adjustment disorder
8 (33.3%) 2 (12.5%)
3 (16.7%)
9 (20%)
Affective disorders
7 (8.3%)
2 (12.5%)
2 (11.1%)
5 (11%)
Mental organic disorders
2 (16.7%) 3 (18.7%)
2 (11.1%)
7 (15%)
Pre-morbid mental disorders
5 (41.7%) 9 (56.25%)
11 (61.1%)
25 (54%)
Total:
22
(100%)
16 (100%)
18 (100%)
56(100%)
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The largest number in the study sample was in patients with prenozological diseases,
their volume share was 54.35% (n=25). In terms of the frequency of development, patients
with affective disorders were the smallest group (11% - n = 5). A brief description of
mental disorders was found in patients with the following oncopathology. Clinically,
prognostic diseases were manifested with milder symptoms than diagnosed patients. This
group included 25 people (18 men and 7 women) with prenozological diseases (asthenic
variant with a predominance of mental diseases). Weakness was detected in 15 people,
asthenic variant with predominant physical weakness – in 8 people, somatovegetative
variant – in 2 people). In the asthenic variant of the prenozological disorder, where mental
weakness prevails, patients, as a rule, complained of apathy and fatigue. Asthenic variant,
where physical weakness prevailed, was characterized by tears, emotional instability.
When going to sleep, fatigue, the desire to rest, sit or lie down during the day, the
somatovegetative variant is expressed by periodic headaches, unexpected anxiety, a feeling
of restlessness, general heaviness in the div. - decreased within 4 weeks. Adjustment
disorder in patients with oncological pathology was characterized by low mood, anxiety,
obsessive thoughts about serious illness, life-threatening consequences. Patients "cannot
survive the operation", believe that the upcoming treatment will be "ineffective and only
cause pain and suffering". These thoughts are painful, they prevent patients from focusing
on something else, from some useful or pleasant activity. In addition, patients with
adjustment disorders are associated with feelings of helplessness in the face of the current
situation and reduced performance. Among the examined patients, adjustment disorder was
found in 19 people (18 women and 1 man diagnosed with lung cancer). In 18 women with
adjustment disorders, oncological pathology was distributed as follows: lung cancer - 6
people, intestinal cancer - 2 people, stomach cancer - 10 people. Patients are worried about
the next inevitable changes in their social status, the need to register in disability groups,
and notice the financial difficulties that arise in this case. In addition, family and personal
conflicts intensify, even suicidal thoughts appear, however, adjustment disorders are not
always associated with the diagnosis of cancer in some patients, several traumatic
situations or a psychotraumatic situation.
Affective disorders:
In this group of patients, depressive manifestations developed
with the deepening and strengthening of the oncological disease. Anxiety was more
characteristic of acute illness and depression was characteristic of long-term cancer
patients. The following affective disorders were diagnosed: mild to moderate depressive
episode without psychotic symptoms (2 people), dysthymia (2 people), hypomania (1
person) , characterized by carelessness, slight irritability and general weakness. At the
same time, patients tried to hide their mood and make a good impression on others. A 30-
year-old man was diagnosed with hypomania with a diagnosis of rectal cancer. The patient
spoke in detail, actively gestured, spoke quickly, expressed confidence that "everything is
great" with him, randomly switching from one topic to another, elevated mood, not
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sleeping well at night, sleeping late, waking up early One of the reasons for the sad and
depressed mood is after the surgical procedure for oncological pathology, painful
experiences, for example, may be associated with the disorder, the removal of the damaged
organ or the unsuccessful result of the operation, which is still psychologically re- not
worked. The inability to process existing negative information can lead to the formation of
psychopathological symptoms such as hopelessness, apathy, insomnia, loss of appetite,
return to children's protective reactions, actualization of suicidal behavior. With these
disorders, crisis psychotherapy is indicated. It is discussed in complex psychotherapy that
the early postoperative period increases the effectiveness of treatment [10].
Organic disorders:
The following organic disorders were identified in the examined
sample of patients: organic depressive disorder (n=3) and organic emotionally labile
asthenic disorder (n=4), cerebral circulation caused by an acute event (n = 3), brain injury
(n = 2). In addition, it is necessary to take into account the development or deterioration of
organic diseases against the background of toxic effects of chemotherapy and radiotherapy
in oncology patients (n=2). Typical manifestations of organic depressive disorder were
observed, such as a constant decrease in mood, a feeling of guilt, and a depressive disorder
in the form of loss of interests. , feeling of fatigue and weakness, poor sleep and appetite
were found. In one case, the patient expressed suicidal thoughts. Organic asthenic disorders
are characterized by emotional lability, irritability and even some rudeness, flatness in
judgments, and physical fatigue. It was necessary to reduce the severity of asthenic and
algic symptoms and cognitive disorders in patients with organic diseases [11]. The most
important indicators for the person to emphasize are the sub-items of this scale) and the
variant of mental disorder was determined. (Table 2)
Indicators on the Hamilton Depression Rating Scale (HADS-21) in patients with
various psychopathologies
Hamilton's
assessment of
this
Adjustment
disorder
Affective
disorders
Mental
organic
disorders
Mental
disorders
leading to
illness
Average overall
score
13.3+1.1
-
12.8+2.2
11.3=1.5
6.3=0.4
Low mood
1.3=0.2
2.0=0.5
1.0=0.4
0.6=0.1
Guilt
0.9=0.4
1.4=0.4
1.0=0.4
0.4=0.1
Early insomnia
0.9=0.1
0.6=0.3
0.7=0.2
0.7=0.1
Mental anxiety
1.1=0.3
1.0=0.0
0.9=0.1
0.6=0.1
Statistically significant data were found when comparing data on the HADS 21 scale
in patients with different mental pathologies. It is obtained only when comparing
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prenozological disorders with mental disorders (p<0.05). No statistically significant
differences were found in the group of mental disorders (p>0.05). At the same time, there
is a tendency to increase current depression symptoms in adjustment disorders due to sleep
disorders and mental disturbance. It should be noted that the indicators for separate
subsections are scales) depending on the localization of oncological pathology (stomach,
intestinal cancer, lung)
Table 3
Hamiltonian evaluation
Stomach
cancer
Colon cancer
Cancer lung
Average overall score
10.5±1.0
8.6±1.1
9.0±1.3
Low mood
1.4±0.2
0.7±0.2
0.9±0.3
Guilt
1.2±0.3
0.6±0.2
0.5±0.2
Early insomnia
0.7±0.1
0.8±0.1
0.7±0.1
Decrease in working capacity
0.4±0.2
0.4±0.1
0.8±0.2
Stiffness
0.3±0.2
0.3±0.1
0.7±0.2
Agitation
0.8±0.2
0.9±0.2
0.5±0.1
Mental anxiety
0.9±0.2
0.8±0.1
0.6±0.1
Statistically significant differences were found when comparing oncological
diagnoses (p>0.05), but there is a tendency for depression to increase in cancer patients.
However, we found a high level of depression in patients with stomach cancer due to the
emergence of feelings of guilt and mental anxiety. along with pathological reactions, we
observed symptoms of simple emotional reactions to the news of a cancer diagnosis:
rejection, irritation, acceptance disappointment, anxious reactions, panic and excessive
guilt. In addition, patients were worried about the future, fear of death, It was found that
there are feelings of hopelessness, anxiety about the upcoming operation, its results,
possible complications after the operation, sleep disorders, lack of confidence in the future,
and discomfort about the old way of life. In the acute period of the disease, with severe
anxiety and insomnia, anxiolytics and hypnotics are prescribed. In case of adjustment
disorders and depressive disorders, including organic disorders, the antidepressant
fluvoxamine from the SIOZS group was prescribed, which has a pronounced anti-anxiety
and hypnotic effect. Benzodiazepine tranquilizers were not used in the sample of patients
reviewed because there were no severe anxiety states. Patients with organic pathology were
additionally observed by a neurologist and received vascular and nootropic therapy. In the
presence of mental disorders associated with oncopathology, the combination of drug
treatment and psychotherapy has a positive effect in the long term. which helps to increase
the adaptability of patients. leads to a decrease in the risk of suicide [11]. When conducting
this study, psychotherapeutic counseling had an individual character, because in the first
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stages of hospitalization in the department, patients underwent many medical
examinations, and therefore for them joining a psychotherapeutic group was difficult.
Patients with prenosological diseases and patients without mental disorders (normal
emotional reaction), as a rule, they turned to a psychotherapist (problem-oriented therapy)
with a specific request. In relation to patients with adjustment disorders, attention was paid
to reducing anxiety, guilt, adaptation, the situation (this was not always adaptation to the
diagnosis), normalization of sleep and mood within the framework of supportive and
existential psychotherapy, cognitive for affective disorders in psychotherapeutic work -
elements of behavioral therapy were used, normalization of mood, reduction of sleep and
mental disturbance, normalization of mental state in organic mental disorders, reduction of
mental stress was achieved due to support. In the course of work, we found that patients
have certain characteristics depending on the localization of oncopathology. Thus, patients
diagnosed with lung cancer responded well to care. For patients diagnosed with colon
cancer, supportive psychotherapy is needed in the pre- and post-operative periods, and an
educational program on colostomy maintenance skills should also be included at this stage.
Gastrointestinal cancer patients have responded positively to information and education
programs about proper nutrition and a healthy lifestyle. Patients of an oncological hospital
are often outside the scope of specialists, although they should be treated not only by a
psychiatrist-psychotherapist. In the postoperative period, specialists: staff, psychiatrists,
oncologists, ward staff, especially junior staff, should help alleviate the feelings of
discomfort, shame and physical weakness that arise in patients.
CONCLUSION:
Thus, in oncological diseases, a wide range of mental pathologies
appears: prenozological diseases, adjustment disorders, affective disorders, external
organic diseases depending on the location of cancer (intestines, stomach, lungs).
important factors for In relevant patients, worsening of the mental state becomes the
consequences of oncological diagnosis and extensive surgical treatment, as well as
subsequent chemotherapy and radiation therapy. Psychopathological Manifestations of
various oncopathologies require individual psychopharmacological and psychotherapeutic
programs within the framework of individual therapy. to be the next direction of research.
collision
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