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Depressive disorders in patients after myocardial infarction
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-119-120
Muxamadiyeva Nigina Bakhodirovna, Assistant of the Department of Psychiatry and Narcology, Bukhara State Medical Institute, Bukhara, Uzbekistan E-mail: [email protected]
Depressive disorders in patients after myocardial infarction
Abstract: In article the depressions arising at patients after a myocardial infarction (MI) are shined, necessity of overcoming stigma concerning weight of the transferred MI, rational under-standing of illness especially in early period of the post infraction is defined.
Keywords: depressive disorders, myocardial infarction (MI), work capacity of patients, post infarct depression, risk factors.
High prevalence of a mental pathology is noted both among a contingent of polyclinic establishments, and in versatile hospitals where basically mental frustration are presented by out-patient "neurotic" forms among which prevail somatic disturbing-depressive frustration. Depre-ssion, irrespective of its origin, developed against available heavy somatic disease, considerably burdens its current and rehabilitation of the patient. In a number of researches it is established that depression symptoms are authentic prognostic indicators of death rate from cardiovascular diseases after the transferred MI
[1; 4].
Nervous and mental disorders at a acute myocardium infarction (AMI) are connected substantially with infringement of brain blood circulation, more often functional character, and sometimes owing to a thrombosis or thromboembolism small vessels of a brain. In the acute period of a MI there can be the fear of death accompanied by anxiety, alarm, melancholy. Some patients are silent, motionless, others, on the contrary, are extremely irritable [2; 3].
In clinic of psychopathological infringements at a AMI the big place is occupied with emotional disorders. In the first days of a MI the disturbing-depressive syndrome more often is found out. The fear of death, melancholy, alarm, disturbing depression can be replaced by psychomotor excitation. Patients in such condition try to get up, go, speak much. The disturbing depression accompanied by steady and long melancholy, can be at the bottom of suicide actions [5].
The aim of the research — the analysis of influence of depressive disorders (DD) on clini-cal and social characteristics at patients with AMI.
Materials and methods. During the period of2010-2013 years, It is surveyed 121 patients in cardiological department of Bukhara branch ofRepublican centre ofscience of urgent medical aid. Patients have been divided into two groups: the first group have made 88 pa-
tients who have transferred a AMI at whom in the subsequent the DD have developed, the second group — 33 patients who also have transferred a AMI, but without depression symptoms. Re-search methods were: clinical and psychopathological, clinical catamnesis, reliability of results was estimated with use of criterion of Student.
Results and discussion. At the characteristic of clinical features of DD at patients in the period of post infarction it is necessary to note the allocated variants of depressions: disturbing (77.3%), melancholic (11.2%), dysphoretic (4.8%), masked (6.7%). Irrespective of a depression variant in conversation patients first of all showed complaints to pressing, compressing pains behind a breast, eccentric in characteristic zones, and aching, pricking in the left half of thorax. Patients passed an opinion experiences of the physical condition, painful sensations, prospects on the future. From shown complaints the sleeplessness was following. From the subjective comp-laints specifying in DD, depression, a breakdown, sensation of hopelessness are noted. In ex-periences with identical frequency the fear of repetition of a AMI, pessimistic views on the future and a low self-estimation were reflected.
A well educated person often occurs in 2 groups of survey is more often (72.7%), average vocational education is more characteristic for patients of 1 group (45.4%). Obviously, that fact matters that the person who is engaged in brainwork, does not think of possible loss of work whereas the person who is engaged more in a physical activity, is compelled to limit loadings after the transferred MI and to replace activity that conducts to decrease or change of qualifica-tion and can change not only a habitual rhythm oflife of the patient, but also indirectly affect a material prosperity.
Convinces of it and that the reason of depressions at patients with a AMI in most parts of cases (81.8%) is the present somatic disease (table № 1).
Sectiom 6. Medical science
Table 1. - The reasons of development of depressions
The reasons of development of depressions Group1
Abs %
Absent 0 -
Psychotrauma 14 15.9 ± 3.9
The present somatic disease 72 81.8 ± 4.11
Physical pressure 0 -
Intellectual overstrain 2 2.3 ± 1.6
Mental disease 0 -
In total 88 100
The depression beginning in the first days after a AMI (40.9% — in a current 1-7 days, 37.5% — in a current 8-30 days) confirms thought that for the patient the diagnosis of a MI and connected with it change of the relation to, the habitual active life, is the most serious psy-chologic traumatic factor. Obviously, work of the internship doctor, the cardiologist in early post infract the period should be directed on overcoming stigma concerning weight of the transferred MI, on development of rational understanding of illness, possibility of logic reconsideration of life after a AMI.
At a part surveyed (19 patients — 21.6%) the AMI was observed repeatedly and in all cases at this group of patients development of DD was observed. It is interesting that in an origin of the majority of depressions (17.1%) at patients with repeated cases of a MI the reason also is the fact of the transferred AMI.
MI and the depression arising as consequence of the transferred AMI it is reflected in work capacity of patients (table № 2). So, at 27.3% of patients of group1 and 69.7% of patients of group2
(p<0,001) work capacity is lowered, whereas disability authentically is more often observed at patients of group1 (p<0,001). It can serve as the obvious proof of negative influence of the joined depression on sociolabor adaptation of patients.
Table 2. - Work capacity of patients
Work capacity Group1 Group 2
abs % abs %
It is kept 18 20.4 ± 4,30 7 21,2 ± 7.15
It is lowered 24 27.3 ± 4,75 23 69.7 ± 7.80
It is lost 46 52.3 ± 5,57 3 9.1 ± 5.01
It is raised 0 - 0 -
In total 88 100 33 100
Thus, for the majority of patients with a AMI the fact of presence ofheavy somatic disease is at the bottom of development of DD among which to a thicket there are disturbing depressions. A MI and depressions leads to decrease in work capacity and activity of patients.
Conclusion:
1. It is necessary to optimize rendering of the specialized (psychiatric) help by the patient with a AMI.
2. In early period of post infract work with the patient should be directed on overcoming stigma concerning weight of the transferred MI, on development of rational understanding of illness.
3. Great significance gets the organization of the advisory psychiatric help corresponding to modern requirements in cardiological hospitals, and also working out of educational programs on clinical psychiatry and psychopharmacotherapy for cardiologists, cardiosurgeon and other experts.
References:
1. Barth J., Schumacher M., Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis//Psychosom Med. - 2004. - Vol. 66. - P. 802-813.
2. Carney R. M., Freedland K. E., Sheps D. S. Depression is a risk factor for mortality in coronary heart disease//Psychosom Med. -2004. - Vol. 66. - P. 66:799-801.
3. Huffman J. C., Smith F. A., Blais M. A. at al. Recognition and treatment of depression and an-xiety in patients with acute myocardial infarction/Mm J Cardiol. - 2006. - Vol. 98. - P. 319-324.
4. Smulevich A. B. Depression in general medicine: a guide for physicians. - Moscow: Medical News Agency; - 2001. (in Russian).
5. Muxamadiyeva N. B. Features of formation and clinics depressive disorders in patients after myocardial infarction//Eur Sci Rev. -2016. - № 3-4 (March-April). - P. 181-182.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-120-123
Navruzova Visola Sarimbekovna, National cancer research center of Uzbekistan E-mail: [email protected]
Modern possibilities of combined and complex cervical cancer treatment in fertile age patients
Abstract: The main treatments for patients with cervical cancer are radiation, surgical and medical, which are used in combination with each other or separately. The study included 204 patients with cervical cancer younger who underwent traditional combined radiotherapy, chemoradiotherapy and chemotherapy and radiation treatment. The results of treatment showed that the effectiveness of the therapy and quality of life is higher in the group where the received chemotherapy and radiation therapy using radiomodifier.
Keywords: fertile age, systemic chemotherapy, endoarterial regional chemotherapy, cervical cancer, fertility-sparing surgery, ovarian transposition, quality of life, effectiveness of treatment, dynamic monitoring.
The world marked increase in the incidence of cervical cancer in that in patients with preserved ovarian function, not only the effec-young women, especially from 29 to 45 years old. Analysis showed tiveness of the treatment, but also the quality of life. It is associated
