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1. Шакирова А.Т. - асс. кафедры дерматовенерологии КГМА им. И.К. Ахунбаева, совместитель кафедры инфекционных болезней и дерматовенерологии МВШМ;
+996 552 (707) 92-45-82;
2. Койбагарова А.А. - д.м.н., зав. кафедрой дерматовенерологии КГМА им. И.К. Ахунбаева;
3. Кожанов А.С. - к.м.н., асс. кафедры дерматовенерологии КГМА им. И.К. Ахунбаева;
4. Калыбекова Г.М. - асс. кафедры дерматовенерологии КГМА им. И.К. Ахунбаева;
5. Дилмурат у Т. - асс. кафедры дерматовенерологии КГМА им. И.К. Ахунбаева.
COMPLIANCE IN THE TREATMENT OF ROSACEA AND PSYCHOEMOTIONAL STATES.
Shakirova A. T., Chalikova A. U., Zamirbekova K.Z., Kainazarova K.A., Islamova G.R.
Kyrgyz State Medical Academy named after I.K. Akhunbaev Department of dermatovenerology International Higher School of Medicine Bishkek, Kyrgyz Repablic Department of infectious diseases and dermatovenerology
SUMMARY
The paper presents the main psychological problems in patients with rosacea, their impact on adherence to therapy, and the results of their own observations of complex therapy. Acquisition of rapid positive results in therapy affected the patients' compliance to the prescribed treatment.
Key words: rosacea, psychological problems, compliance therapy, depression.
Introduction. Rosacea - Rosacea is a chronic inflammatory skin disease that mainly affects the face. The most common manifestations of rosacea are hot flashes, erythema, telangiectasia, papules, and pustules.
In some patients, the eyelids and eyes are involved in the process, and eye symptoms may be the main ones. In some cases, there is a thickening and deformity of the skin (Fima) [1, 2]. In General, rosacea is more common in women, with the exception of the phymatous form, which is more common in men. Bright manifestations of rosacea, localized on an open and extremely important area of the skin for communication, cause significant psychological discomfort [3, 4]. Many authors consider rosacea to be a group of dermatoses that cause somatopsychic pathology due to real aesthetic discomfort [5]. At the same time, the psychological stress that arises from this disease is a traumatic factor [6]. It was found that rosacea has a negative impact on patients' self-esteem and self-awareness, assessment of their own health, interpersonal interactions and social adaptations [6-9]. Due to rosacea, introverted behavior, social phobias, anxiety, and depression may be formed [8-10]. Rosacea can provoke sensitive reactions and hypochondriacal disorders, and lead to the formation of suicidal thoughts [8, 9]. Mental disorders that develop against the background of rosacea become the causes of maladaptation in social, professional and family life and can change the attitude to the treatment of skin pathology [12, 13].
Aim of the study - to identify psychological problems in patients with rosacea and link them to the adherence of treatment regimens.
Recently, there has been a steady increase in the incidence of rosacea, despite the fact that this pathology has the largest share in the structure of dermatoses of facies localization — 36% [5, 7, 8]. It should be noted
that there is also an active tendency to rejuvenate the disease, although rosacea refers to diseases of people of the middle age period - the period of maximum social and physical activity. The first signs of rosacea can be observed at the age of 25 to 35 years and they reach a vivid clinical manifestation by 40-55 years of age. The development of clinical signs of rosacea in the face, and often the neck and décolleté, often leads to severe psychological disorders in patients, causing them anxiety, depression, reduced social adaptation, suppressed sexual activity, and in severe and individual cases, even suicidal attempts.
Materials and methods of research. On 30 patients with various types of rosacea aged from 26 to 68 years were under observation. The distribution of patients was based on the severity of clinical manifestations of dermatosis, the form of rosacea, the duration of the disease, and the gender of patients. The control group consisted of 10 practically healthy individuals aged 25 to 58 years. The average age of patients is 34.3±1.1 years; the duration of the disease is from 1 month to 20 years.
Erythematous-telangiectatic rosacea was detected in 9 patients (30%), papulopustular - in 18 patients (61.7%), nodular - in 1 man (3.3%) and 2 women (5%), respectively. The duration of the disease at the time of initial treatment ranged from a few days to 20 years. All patients underwent a full clinical and physical examination, which included complaints, life history and diseases, data from clinical, laboratory and instrumental research methods, as well as a study of their psychoemotional status. Before the start of the study, all patients gave written informed consent to participate in the study and to publish the results of diagnosis and treatment, while maintaining confidential information about themselves.
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The transformation of the quality of life involved the respondent's self-assessment of their physical, mental, social and economic well-being. The quality of life was assessed using a questionnaire. All patients were evaluated for their attitude to the disease and the impact of dermatosis on their lives using the dermatological "quality of life" questionnaires and the Hamilton Depression Rating Scale (HDRS) for assessing anxiety disorders.
Results and discussion. The prevalence of mental disorders of the anxiety-depressive spectrum among patients with rosacea was 35.2%, anxiety - 24.2%, depression - 26.2%, and a combination of anxiety and depression - 43.74%. The quality of life is significantly lower among rosacea patients with anxiety and depressive disorders than those suffering from rosacea, but without detected mental symptoms. Women were more likely to develop mental disorders.
Low compliance and non-compliance of the majority of young people with the principle of long-term use of external therapy and special skin care is one of the reasons for the unsatisfactory effectiveness of modern treatment regimens for even mild and moderate forms of rosacea [6, 8]. In the general sample, 82.7% of patients noted that the disease is poorly amenable to therapy. This response was given by 67.6% of patients with mild severity, 83.2% - with moderate and 91.5% - with severe. Men were somewhat more likely to make such estimates [15]
The total percentage of patients who reported at least 1 missed day of treatment to the doctor was 20.4% in the 1st month, 26.5% in the 2nd and 42.3% in the 3rd. On average, 19% of individuals reported missing days of therapy. Patients who had previously used any cosmetic services for a rash were more likely to skip taking the drug during the 1st month of treatment; this trend did not continue in the future. At the same time, the use of various external agents in independent therapy did not affect compliance [15]. Individuals with elements of a rash on the nose, perioral area, and chin were less likely to skip medication during the first weeks of treatment and further localization of the rash did not affect compliance. It should be noted that this localization of rashes is typical for women after 25 years. Younger individuals tended to skip treatment days in the 1st month of follow-up, but there was no significant difference in compliance due to age [15].
Compliance problems are observed in 34-45% of dermatological patients [16]. Compliance with rosacea therapy, according to some authors, ranges from 12,5 to 64%; it is higher with systemic treatment [17, 18] and lower in younger patients; in men; in unmarried people; in non-working people; in those who receive medication for free; in those who smoke or drink alcohol, as well as in those against the background of a decrease in the quality of life [18, 19].
The psychoemotional state of patients with rosacea (a persistent cosmetic defect of varying severity) depends on changes in the local status. It should be noted that the severity of psychoemotional disorders did not directly depend on the severity of rosacea, but indirectly affected their manifestation. With adequate therapy, there was an improvement in
indicators of psychoemotional status, and in some cases, even their normalization [4,7].
Rational treatment increases the patient's motivation for further therapy, which leads to an improvement in the quality of life and removes negative psychological problems.
Conclusions. Thus, rosacea therapy should be selected individually for patients depending on their clinical form of the disease, previously conducted therapy and somatic burden.
Literature:
1. Adaskevich V. P. Diagnostic indexes in dermatology. -N. Novgorod: Medical book, 2004: 118120.
2. Adaskevich V. P. Acne vulgar and pink. - N. Novgorod: Medical book, 2003.
3. Zakharova E. E. Pharmacological correction of violations of the regulatory systems of the body with pyrazidol in patients with rosacea with psychoemotional disorders: author's abstract. ... candidate of medical Sciences. - Kursk, 2007.
4. Kobtseva O. V. influence of essential phospholipid - Phosphogliv on the nature of the course and effectiveness of complex therapy of patients with rosacea: autoref. dis. ... candidate of medical Sciences.
- Kursk, 2012.
5. Kurdina M. I. Rosacea (etiology, pathogenesis, clinic, treatment).. Aesthetic medicine, 2005; (3): 5557.
6. Perlamutrov Yu. N., saidalieva V. sh., Olkhovskaya K. B. Comparative evaluation of the effectiveness of various methods of rosacea therapy. Bulletin of dermatology and venereology, 2011; 3: 7379.
7. Potekaev N. N. Rosacea. - M.-St. Petersburg: BINOM publishing house, Nevsky dialect, 2000. - 144 p.
8. Ryzhkova E. I. Clinical and morphological features, pathogenesis and treatment of rosacea: autoref. dis. ... l-hf med. Sciences - M., 1976.
9. Shvartz N.E., Silina L. V., Lazarenko V. A. quality of life of patients with acne and its changes due to various types of therapy// Kursk scientific practice.Bulletin "Man and his health". - 2008. - No. 1.
- Pp. 91-96.
Information about the authors:
1. Shakirova A.T. - assistant of department of dermatovenereology, KSMA named after I. K. Akhunbaev;
- assistant of department of infectious diseases and dermatovenerology, ISM (part-time).
+996 552 (707) 92-45-82;
2. Chalikova A.U. - assistant of department of dermatovenereology, KSMA named after I. K. Akhunbaev;
3. Zamirbekova K.Z. - assistant of department of dermatovenereology, KSMA named after I. K. Akhunbaev;
4. Kainazarova K.A. - assistant of department of dermatovenereology, KSMA named after I. K. Akhunbaev;
5. Islamova G.R. - assistant of department of dermatovenereology, KSMA named after I. K. Akhunbaev.
«ВЛИЯНИЕ COVID-19 НА ПСИХОЛОГИЧЕСКОЕ СОСТОЯНИЕ ЛЮДЕЙ»
Шакирова А. Т., Койбагарова А.А., Осмоналиев М.К., Ахмедов М. Т., Ибраимова А.Дж.
КГМА им. И.К. Ахунбаева кафедра дерматовенерологии, МВШМ, кафедра инфекционных болезней и дерматовенерологии
Бишкек, Кыргызская Республика
"IMPACT OF COVID-19 ON THE PSYCHOLOGICAL STATE OF PEOPLE"
Shakirova A. T., Koibagarova A.A., Osmonaliev M.K., Akhmedov M. T., Ibraimova A.J.
KSMA them I.K. Akhunbaev Department of Dermatovenerology, ISM, Department of Infectious Diseases and Dermatovenerology
Bishkek, Kyrgyz Republic
РЕЗЮМЕ
Пандемия стала причиной страха и тревоги миллионов людей по всему миру и оказала влияние на психическое здоровье миллионов людей - потеря близких, изоляция, экономические потрясения и неуверенность в завтрашнем дне. Сложившаяся ситуация стала тяжелым испытанием для многих жителей планеты.
ABSTRACT
The pandemic has caused fear and anxiety for millions of people around the world and has affected the mental health of millions of people - loss of loved ones, isolation, economic turmoil and uncertainty about the future. The current situation has become a difficult test for many inhabitants of the planet.
Ключевые слова: COVID-19, стресс, тревожность, изоляция, пандемия
Keywords: COVID-19, stress, anxiety, isolation, pandemic
После наводнений, землетрясений и ураганов до 10% пострадавшего населения сталкивается с серьезными психологическими проблемами. Не оказалась в стороне и новая инфекция СО'УГО-19. На фоне стремительного распространения пандемии по всему миру, у многих людей возникают проблемы с психикой, что является вполне естественной и нормальной реакцией на постоянно меняющуюся и непредсказуемую ситуацию. Сейчас каждый человек вынужден, как умеет, преодолевать стрессовую ситуацию, вызванную СОУТО-19.
11 марта 2020 года ВОЗ объявило, что вспышка заболевания СОУГО-19, вызванного новым коронавирусом SARS-CoV-2, приобрела характер пандемии, а 13 марта - ее центром стала Европа.
О возможных психических последствиях пандемии СО'УГО-19 можно говорить уже сейчас. И они затронули не только людей, которые заболели сами или пережили болезнь близких. Так, первые исследования, проведенные в Китае, продемонстрировали, что эпидемия коронавируса и связанные с ней карантинные меры привели к росту беспокойства, расстройству сна и депрессивным симптомам во всех группах населения.
Смерть близких, изоляция, потеря дохода, страхи - все эти последствия пандемии негативно действуют на психику и усугубляют уже
существующие расстройства. Многие страдают бессонницей, испытывают постоянную тревогу, растет потребление алкоголя и наркотиков. В то же время COVID-19 особенно опасен для людей с хроническими неврологическими или
психическими заболеваниями, а также с зависимостью - у них выше вероятность тяжелой формы COVID-19 и даже смерти.
Жертв с психологическими проблемами может быть намного больше. Это подтверждают и исследования людей, перенесших атипичную пневмонию (SARS) в 2003 году. Многолетние наблюдения за 70 пациентами показали, что 44% из них столкнулись с расстройствами психики. Даже спустя годы после физического восстановления 82% этих людей страдали психологическими проблемами. Симптомы проявлялись наиболее активно у тех, кто имел высокий риск умереть от болезни, ощущал недостаток социальной поддержки, и чьи близкие родственники пострадали или погибли от SARS.
В ходе исследования, в котором участвовали 7 000 взрослых из США и Канады, психолог Стивен Тэйлор даже ввёл новый термин «синдром COVID-стресса» (СOVID stress syndrome). На сегодняшний день он выявлен уже у 25% испытуемых с сильным страхом подхватить инфекцию. Они беспокоятся по поводу социальных и экономических последствий COVID-19. Им снятся кошмары,
