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11International scientific journal "Interpretation and researches"
Volume 1 issue 3 | ISSN: 2181-4163 | UIF-2023: 8.2
DEPRESSIVE-ANXIETY DISORDERS IN PATIENTS WITH RHEUMATOID
ARTHRITIS AND METHODS OF THEIR PSYCHOCORRECTION
Yusuphojaeva S.T., Gafurova S.Sh.
Tashkent Medical Academy, Tashkent.
https://doi.org/10.5281/zenodo.7658843
Abstract: The article describes methods for the study of psycho-emotional disorders in rheumatoid arthritis. To determine the degree of psycho-emotional disorders, the method was used HADS and Spielberger-Xanin test. Also, in patients with rheumatoid arthritis (RA), methods of psychopharmacotherapy and psychotherapy were used to correct psychoemotional disorders. According to the data obtained, such an approach in the treatment process helps to lengthen the period of remission of the disease and improve the quality of life.
Key words: Depression, rheumatoid arthritis, psychocorrection, psychopharmatherapy, psychotherapy, cognitive therapy, pain, test, method.
DEPRESSIV-XAVOTIR BUZILISHLARINI REVMATOID ARTRIT BILAN KASALLANGAN BEMORLARDA UCHRASH KO'RSATKICHI VA ULARNI PSIXOKORREKSIYA QILISH USULLARI
Yusuphodjayeva Surayyo, Gafurova Sabohat
Toshkent tibbiyot akademiyasi assistentlari
Annotatsiya: Maqolada revmatoid artritdagi psixoemotsional buzilishlarni o'rganish usullari tasvirlangan. Psixoemotsional buzilish darajasini aniqlash maqsadida HADS va Spilberger-Xanin testidan foydalanilgan. Shuningdek, revmatoid artrit (RA) bilan kasallangan bemorlarda psixoemotsional buzilishlarni davolash uchun psixofarmakoterapiya va psixoterapiya usullari qo'llanilgan. Olingan ma'lumotlarga ko'ra, davolanash jarayonida bunday yondashuv kasallikning remissiya davrini uzaytirishga va hayot sifatini yaxshilashga yordam beradi.
Kalit so'zlar: Depressiya, revmatoid artrit, psixokorreksiya, psixofarmaterapiya, psixoterapiya, kognitiv terapiya, og'riq, test, usul.
ДЕПРЕССИВНО-ТРЕВОЖНЫЕ РАССТРОЙСТВА У БОЛЬНЫХ РЕВМАТОИДНЫМ АРТРИТОМ И МЕТОДЫ ИХ ПСИХОКОРРЕКЦИИ
Юсупходжаева С.Т., Гафурова С.Ш.
Ташкентская медицинская академия, Ташкент
Аннотация: В статье описаны методы исследования психоэмоциональных расстройств при ревматоидном артрите. Для определения степени психоэмоциональных нарушений использовали метод HADS и тест Спилбергера-Ксанина. Также у больных ревматоидным артритом (РА) применяли методы психофармакотерапии и психотерапии для коррекции психоэмоциональных нарушений. Согласно полученным данным, такой подход в лечебном процессе способствует удлинению периода ремиссии заболевания и улучшению качества жизни.
Ключевые слова: Депрессия, ревматоидный артрит, психокоррекция, психофармакотерапия, психотерапия, когнитивная терапия, боль, тест, метод.
Introduction: A review of European studies on the relationship between depression and pain revealed a positive relationship between them in 46 out of 70 studies [3]. Somatic symptoms are often (up to 69%) the main symptoms in patients with depression. Epidemiological studies have revealed the presence of pain in 2437% of patients with depression [5]. It has been shown that the presence of somatic complaints makes it difficult to diagnose depression.
Rheumatoid arthritis (RA) is an autoimmune rheumatic disease of unknown etiology that affects 0.5-1% of the adult population of working age and is characterized by chronic erosive arthritis and systemic damage to internal organs. This syndrome is more common in people between the ages of 20 and 40. Among women, its prevalence prevails twice. The incidence is also increasing in childhood and adolescence [9]. The most common psycho-emotional disorders such as anxiety-phobic, hypochondriacal, depressive, hysterical syndromes [13]. The continuing high degree of disability in RA patients explains the need for research on the etiology of this disease, its course, treatment options, and factors affecting the quality of life. [1]. Complex problems and psychological deviations of patients with chronic inflammatory diseases of the joints raise the question of the advisability of introducing psychocorrective approaches into treatment [6]. This condition contributes to a more severe course of the disease and has a psychosomatic basis [8]. For this reason, this syndrome is included in composition of psychosomatic disorders. Permanent psycho-emotional overstrain, melancholy and the formation of personality according to neurotic type serves as an impetus for the development of the present diseases [11].
Depressive disorders in RA are widespread. Perhaps this is due to the fact that depression and inflammatory rheumatic diseases have largely similar causes and mechanisms of development, they are characterized by a systematic pathogenetic and clinical manifestations, which necessitates a systematic approach to complex
treatment [4]. Further study of predictors, pathogenesis and course of mental disorders in patients with RA, as well as improvement of psychopharmacological and psychotherapeutic strategies will help not only reduce the contribution of mental disorders to the overall picture of the disease and improve the quality of life of patients, but also significantly improve the prognosis of this severe rheumatic disease.
Modern research shows that RA and depression often have a common precipitating factor - psychosocial stress. The diathesis-stress model not only allows us to identify a number of common pathogenetic mechanisms of RA and depression, affecting the impact of stress factors on neuroimmune and neuroendocrine regulation against the background of a specific predisposition, but also to comprehensively consider the effect of psychotropic therapy both on psychopathological symptoms, and on inflammatory processes and pain [ 4.5]. Psychiatric disorders, especially depression, often go unrecognized and untreated in RA patients. This is due to the fact that all the attention of doctors is drawn to the physical aspects of the disease, and depression and anxiety are considered as a normal reaction to a chronic disease [2]. In addition to the above methods, interviews were conducted with each patient and, based on the analysis of the oral survey, it was determined that the clinical symptoms of depression and trebogi, such as depression, nervousness, tearfulness, phobic state, sleep disturbance, distrust of people, were largely eliminated in patients[10].
Treatment of depressive disorders in patients with RA is a complex task. Its solution is possible only under the condition of timely diagnosis and adequate treatment of the underlying disease. One of the important links in the system of psychological assistance with problems in this pathology is psychological correction. For the successful implementation of psychological assistance, a medical psychologist-practitioner needs to use the methods of psychological correction in combination with basic treatment [14]. This approach in the treatment process helps to lengthen the period of remission of the disease and improve the quality of life[12].
Purpose of the study: The purpose of this study is to study psycho-emotional disorders in rheumatoid arthritis and the introduction of methods of medical and psychological testing and confirmation of the effectiveness of psycho-correction methods for providing high-quality medical care to patients with RA.
Materials and methods: Studies were carried out at the department of "Rheumatology" 1 clinic of the Tashkent Medical Academy. The group consisted of 30 patients with grade II rheumatoid arthritis. In the anamnesis of patients, psychoemotional disorders were noted. When examining patients, the method of objective status and psychological status was used. Psychoemotional disorders were determined by the method HADS and Spielberger - Xanin test. In RA patients with psychoemotional disorders, methods of psychopharmacotherapy and psychotherapy
were used to correct this condition. Fluoxamine , which belongs to the group of antidepressants, was used as the chosen drug for psychopharmacotherapy. The drug was used for 1 month 1 time per day at a dose of 20 mg. Also, along with psychopharmacotherapy, cognitive therapy was used.
Results: It was found that in RA patients, when both depression and anxiety are found in a state, it leads to a deterioration in the general condition of the patient. We examined patients in the amount of 30 people. The data obtained indicate that, according to the HADS test , clinical manifestations of a depressive state were detected in 18 people. At the same time, the average indicator of a depressive state was 14±2.5 points , subclinical depressive state was detected in 8 people. The average score for this group according to the method HADS was 9±1.5 points. In 4 patients, depression was not observed. At the same time, the average score according to the method HADS a 5±1 , 2 in the group without depression (Fig. 1).
БЕЗ.ДЕПР.СОСТ.
СУБКЛ. ДЕПР. СОСТ.
ДЕПР. СОСТ.
1
13%
27% l
60%
1 1
0%
10% 20% 30% 40%
50% 60%
70%
депр. сост. субкл. депр. сост. без.депр.сост.
Ряд1 60% 27% 13%
Ряд1
Figure 1. Clinical manifestation of a depressive state according to the HADS method
According to the Spilberger-Xanin test, anxiety was detected in 12 patients. Average score was 37±6.4. According to the test, a reactive anxiety state was found in 6 patients with RA. The average score was 48±4.2. Also, in 12 patients, according to the test indicators, an anxiety state of a mild form was observed and had an average mark of 26 ± 3.5 points (Fig. 2).
TPEB.COCT./IEn0OPMbl
PEAKT.TPEB.COCT.
TPEB.COCT.
40%
20%
40%
1 1 1 1 1 r^ 1
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
Pflfl!
Figure 2. Determination of an alarming state according to the Spilberger-Xanin test
Based on the results obtained, depression and anxiety were corrected using the methods described above and re-examined after 1 month. To determine the effectiveness of the drug fluoxamine and the use of cognitive psychotherapy, patients were retested according to Spielberger-Xanin and the condition was determined using the HADS scale. In patients after psychocorrection, the following results were obtained: according to the HADS scale, clinically detected depression in 7 patients had an average score of 12±1.4; subclinical depression was observed in 3 patients and the average score on the scale was 8±0.5 points; and in the remaining 20 patients, the average score was 4 ± 2.5 , and, as can be seen from the indicator, the depressive state was not determined (Fig. 3).
Figure 3 Clinical manifestations of depression before and after treatment
Spielberger-Xanin test, the indicators were as follows: the average value of personal and reactive anxiety was determined in 2 patients and the average score was 49 ± 3.5; and in 21 patients, the mean score was 23 ± 4.5, which means that they did not have personal and reactive anxiety (Fig. 4).
ПОСЛЕ ЛЕЧ. ТРЕВ.СОСТ.ЛЕГ.ФОРМЫ ПОСЛЕ ЛЕЧ. РЕАКТ.ТРЕВ.СОСТ. ПОСЛЕ ЛЕЧ. ТРЕВ.СОСТ.
0% 10% 20% 30% 40% 50% 60% 70% 80%
Figure 4 Determination of an alarming state according to the Spilberger-Xanin test before and after treatment
In addition to the above methods, interviews were conducted with each patient and, based on the analysis of the oral survey, it was determined that the clinical symptoms of depression and trebogi, such as depression, nervousness, tearfulness, phobic state, sleep disturbance, distrust of people, were largely eliminated in patients.
Conclusions: In patients with rheumatoid arthritis, the method HADS and the Spielberger-Xanin test revealed depression and anxiety. This condition contributes to a more severe course of the disease and has a psychosomatic basis. Deviations were found in RA disease in the form of a depressive state at different levels and a state of anxiety that has a psychological basis. These symptoms can be corrected by methods of psychotherapy and psychopharmacotherapy. From the data obtained, it should be concluded that RA patients, along with basic therapy, should be prescribed psychopharmacotherapy and psychotherapy, which contributes to the effective suppression of the detected depressive and anxiety states. This approach in the treatment process helps to lengthen the period of remission of the disease and improve the quality of life.
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