With an acute onset of the disease, patients have anxiety, a sense of confusion, fear of death. With a protracted illness, the mood decreases, irritability and irritability appear.
The presence of a chronic somatic disease provokes the development of a psychological crisis. The objective situation of a serious, dangerous somatic disease, separation from the usual social environment, the possibility of crippling surgery, disability, leading to a change in the objective position of a person in a social environment.
With the progression of a chronic disease, the whole system of patient relationships changes. Only those events that do not contradict the newly emerging sense-forming motive of saving life become significant. As a result of this, isolation, alienation, impoverishment of contacts with people, passivity appear. The allocation of the motive for saving life leads to the formation of restrictive behavior: inertia, decreased activity.
Various diseases contribute to the formation of specific psychological changes due to the localization of the pathological process, the duration of the disease, the severity of the pain syndrome, etc. Thus, we can talk about the conditional difference in mental changes in a given somatic pathology.
Psychological characteristics of patients with diseases of the internal organs.
In the initial period of formation of valvular heart defects, unpleasant sensations arise, patients focus their attention on the work of the heart, and fear of death from cardiac arrest appears.
Pain, which is often accompanied by an instinctive fear of death can be observed at acute myocardial infarction. At an early stage of hypertension, irritability, sleep disturbance, fatigue, headaches can be observed. People with anxious hypochondriacal character perceive high blood pressure as a disaster. They focus their attention on unhealthy sensations, their range of interests is limited to the disease. With hypertension, some patients ignore the possibility of serious consequences and refuse treatment, without giving up bad habits.
At bronchial asthma the emotional tension promotes the origin of asphyxia attacks, moreover, the reaction at this to a considerable extent depends on peculiarities of the person. Such patients often feel fear connected with waiting for another attack. In chronic course of bronchial asthma the change of patient's character occurs. In pneumonia when the temperature is rising consciousness of patients can be disturbed. The chronic course of bronchial asthma are formed asthenic, euphoric, apathetic, anxiety, phobic and depressive reactions.
In acute pneumonia in some patients reduction of activity, hypodynamia, unsociability unhealthy attitude to investigation and treatment are observed. When the temperature is rising the consciousness of the patients can be disturbed.
In chronic lung diseases many patients feel reduction of mood, irritability, their attention is fixed on unpleasant sensations and thought of incurability appear.
In pathology of digestive organs psychological peculiarities of patients are formed under the influence of such symptoms as meteorism, frequent urges to defecate, which cause a sense of shyness, discomfort. The patients with chronic gastritis complain of weakness, reveal the activity in investigation and treatment, some of them are afraid of carcinoma of stomach.
In peptic and duodenum ulcer patients often "go into disease", fixing their attention on unpleasant sensations, they feel fear of pains. The loss of weight, gastric hemorrhage, diminution of efficiency cause anxiety for life, sensation of irreparability.
Nonspecific ulcerative colitis is often accompanied by sense of melancholy dissatisfaction with the fear of death. In severe ulcerative colitis may be expressed and apathetic depression.In chronic liver diseases in patient's nature such characteristics as dissatisfaction, grumbling "irritable" appear.
Some neurologic diseases. At cerebral atherosclerosis the patients become groundlessly susceptible, hesitation of mood, lacrimation, diminution of efficiency and irritability are noticed. The most characteristic personality traits of an epileptic are excessive diligence and pedantry.
The clinical symptoms of osteochondrosis of the spine, pain in the back and neck are associated with the psychological state of a person. Fear and anxiety lead to skeletal muscle tension and contribute to the formation of a muscular skeleton, which can provoke the formation of an inadequate motor stereotype. Patients with a high level of anxiety have high muscle tone. A posture is formed with tension of the torso muscles, a straight and "stiff" back. Among the psychological characteristics of patients, impatience, fussiness, lack of assembly and impaired coordination of movements are distinguished. Shyness, modesty, timidity, and dependence on authorities, which are externally manifested in the formation of posture, may predominate in the structure of personality. In patients with an inadequate motor stereotype with osteochondrosis of the lumbar spine, ergopathic, neurasthenic and anxious types of response to the disease are found, with an adequate motor stereotype - harmonious.
Diabetes. Personal traits: egocentrism, irritability, moodiness and restraint. Premorbid personality traits: a combination of schizoid traits with “paranoia readiness” (S. Elhardt), overt or covert anxiety, anxiety, traits of nervousness.
In recent years, a large number of works have appeared on the negative impact of hypoglycemia on cognitive function.
Diseases that affect the development of diabetes affect its development, as well as the development of diseases aged 8 to 9 years. The frequency of occurrence of psychopathological syndromes also depends on the type of diabetes. In type 1 diabetes mellitus (insulin-dependent), astheno-depressive and hysteriform personality changes are often found. In type 2 diabetes mellitus (non-insulin-dependent), asthenic and astheno -pochondria syndromes, obsessive, explosive, and psychosomatic variants of pathological personality development are more common. An important place among mental disorders in diabetes mellitus is occupied by “eating disorders” in the form of anorexia and bulimia.
In thyrotoxicosis are mental disorders of a non-psychotic nature are lack in achieving goals, frequent mood swings, nervousness, restlessness, irascibility, irritability.
In skin diseases patients may experience overvalued ideas of relationship that will make it more difficult to adapt and will affect their social position. Neurodermitis. Eczema and psoriasis are considered to be neurodermitis of psychosomatic origin. The patients are passive, they experience difficulties with self-confirmation.
Surgical pathology. The psychological readiness of the patient for therapeutic and surgical measures is radically different. The influence of “operational” stress (preoperative and postoperative) is noted. The main manifestations of operational stress are emotional phenomena, more often than others - anxiety. In a patient with chronic somatic disease, adaptation occurs, relatively speaking, to the present status, and in a patient with acute surgical pathology, to the future.
In surgical practice, the strategy of choosing the treatment method by the patient is significant. The patient, aimed at the psychological strategy of “avoiding failures,” will refer to surgery as the last means of relieving painful manifestations. He will agree to the operation only if all other palliative methods are used. A patient with the psychological strategy of “striving for success” can independently seek surgical help. He will insist on an early operation. The essence of the psychological differences of these patients lies in accepting the existing pathological condition and in relation to the risk of worsening it during treatment. “It would not be worse” - the fundamental psychological position of a patient taking painful symptoms of his disease and trying to adapt to even the most difficult of them. He is afraid to lose what he has and subsequently repent for his own decision to perform the operation. “Better let it be worse than tolerate what is” - the position of another group of patients who agree to take risks and go for surgery to radically improve their own state of health. Moreover, the former may have a better state of health than the latter.
Preoperative anxiety is a typical psychological response to a message about the need for surgery. It is expressed in constant anxiety, restlessness, inability to concentrate on anything, sleep disturbance. Anxiety is projected into the future, reflecting expectations of the quality of the operation, the future state, satisfaction with having agreed to the operation. Postoperative anxiety, which may be clinically identical to preoperative anxiety, is associated with previous operational stress, with a comparison of expectations and reality.
The postoperative state (both mental and general) largely depends on the psychological radical in the preoperative period. Persons with moderate anxiety respond more adequately to their own condition. A high or low level of anxiety, based either on high or low expectations, contributes to the formation of maladaptive mental states.
The psychophysiological and psychological adaptation of a person after a transplant of organs and tissues (in particular, a heart transplant) is one of the most difficult for the patient. After such operations, serious psychological changes are often noted up to the “change in moral and moral attitudes” (M. Buxton). After transplantation of a donor heart the "Alien Heart Syndrome" may be occurs.
Psychological characteristics of patients with infectious diseases.
The fact of revealing an infectious disease and the need for hospitalization make patients feel ashamed and afraid that they can become a source of infection for their loved ones.
Infectious diseases. At the prodromal stage of an infectious diseases, the assessment of the patient's condition depends on the traumatic situation and is determined by the fact that ethical emotions of a general toxic nature prevail, sometimes a disturbance of consciousness is observed at the recovery stage, various asthenic manifestations predominate. In patients with especially dangerous infections, the degree of morbidity, high infection, and dubious prognosis may be cause of delirium and acute psychological reactions, reminding the conduct of people in situations of mass natural calamity. Withinfluenza in the acute period are possible the mental disorders such as asthenia, sychosis with stupefaction, derealization,, agitated depression.
Psychological peculiarities of patients, infected by AIDS.
The reaction on the diagnosis of AIDS (the most terrible disease, "the plague of the XX century") is manifestation of psychological stress with reduction of mood, ideas of self-accusation, suicide thoughts or tendentions. The obsessive fear of death, ideas about the process of death appear in patients, some people are afraid of a thought about a possibility of infection of the relatives. In future the symptom of intellect reduction appears. In patients from the risk group, including the infected persons and the most exposed to contamination people, alarm, irritability, anxiety are observed, capacity to work is reduced. They are fixed on their health, read a lot of literature about this disease, look for the symptoms of this disease. Many people break their sexual contacts. Some of them reveal the frank antisocial tendencies, trying to pass the virus of AIDS to other people.
Psychological peculiarities of patients with tuberculosis.
Diagnosis of tuberculosis, necessity of prolonged hospital treatment are taken by some patients as a tragedy, as a catastrophe. The anxiety, fear of avoiding the contacts with the nearest people and colleagues develop. However, the majority of people receives the fact of disease and necessity of treatment correctly.
Psychological condition of the patients with tuberculosis is characterized by special sensitivity, sentimentality, emotional lability, exhaustion. The patients are asthenic and on this background there are situational conditioned affective manifestations and hysteric reactions. The doctor must take into account these peculiarities and estimate adequately appearing conflict situations with surrounding People and personnel as a manifestation of the disease. In these cases it is necessary to prescribe sedatives and not to reprimand the patients.
Defects in the body and sensory organs. Psychological features with cosmetic defects, defects in vision, hearing and speech. Psychological characteristics of people with various diseases. This is due to a violation of cognitive processes with defects in the senses.
Among cosmetic defects, the most significant are changes or deformations of the face or its individual components. A person who has lost an arm or leg draws attention to others. He has a feeling of self-loathing. People with disfiguring face changes react more self-derogatoryly. They are touchy, irritable, sensitive, avoid the appearance of people, are extremely limited in connection with others, often reflect on suicide. In case of skin changes and deformations of the face, patients may have fears of becoming infected.
This can lead to significant psychological consequences that can change the nature and orientation of personality formation. When stuttering occurs, the entire system of personal relationships begins to be violated .The most common clinical sign is fear of speech (logoophobia). It violates the communicative side of human life, leads to pathological isolation, refuses to communicate with others. A person tries to switch his interests to activities that exclude frequent and prolonged communication.
The psychological characteristics of blind and deaf people are caused by a violation of one of the areas of cognitive activity. Patients with similar defects in the sensory organs are indecisive, timid, dependent on loved ones. They often form ideas of harm that are combined with such personality traits as integrity, justice, law-abidingness, a high level of moral requirements in relation to oneself and the environment. In patients with hearing loss, ideas of relationships, resentment, and increased anxiety are more common. They are suspicious, incredulity and touchiness, shy, try to hide their defect.
A special group of people who have undergone radical surgical operations related to the so-called "crippling operations": mastectomy, hysterectomy, ovariectomy, cystectomy, etc. The psychological reactions to certain operations are due to the functional and often symbolic significance of the removed organs. Radical gynecological surgery affects the self-esteem of women. With a mastectomy, the patient may have dangerous fears about changes in relationships on the part of her husband or relatives due to an aesthetic defect, with hysterectomy and ovariectomy due to a sexual defect. Many women are forced to try to hide from relatives the true meaning of the operation.
Plastic surgery. According to this specialty two fields of psychological problems can be described, which are various to some degree, but equally labour-intensive and complicated. There are those conditions when the surgeon improves the results of severe traumas or burns and during the team-work with a personnel or psychologist he should prepare the patient to a sudden mental trauma. As example, the first look in a mirror after plastic operation the face looks aesthetically better when compared with what it was after the trauma or burn. The patient compares his appearance with that he had before the trauma or burn and he can be disappointed or shocked.
Another field of problems deals with cosmetic operations, with the dissatisfaction of appearance carries exclusively subjective character. For instance, the patient does not wish to have a "potato" hose or a "very snubnosed" and he persistently demands on improvement of this defect. Satisfaction of this requirement, if it has very subjective reasons, moreover, if it is accompanied by being striked, exalt, a hysterical conduct. There is also some danger, that such patient will not be satisfied of improving the defect and she will insist on one more operation.
In such patients their "defect" is a subjective internal justification of their vital failure, for example erotic. Then they put "guilt" for their problems on surgeons and try to punish them.
Psychological peculiarities of patients with dermal and venereal diseases.
Skin is the organ which the person shows to the surrounding people, as well as his figure. It has a significant psychological meaning. Mental reactions in skin disorders include more wide circle of disorders, conditioned by negative aesthetic ideas, squeamishness on the hand of surrounding people and by shame, a sense of own inferiority complex and uncertainty if future on the hand of a patient. The appearance of a patient is distorted the most by psoriasis, eczema, acne, scars after chronical granuloma and bums, colloids, hypertrichosis. Patient is feeling of shame, stiffness, timidity, constantly trying to hide body parts by clothing. He can become irritable, uncommunicative short-tempered, with thoughts of his own inferiority appeared. Especially in the pubertal period the patients fall into depression, often not corresponding to the character of the disease on the objective point of view, for example, at imperceptible acne or at moderate loss of hair. At some skin disorders a special problem is pruritus, which may lead to irritability, insonmia and depression. The patient is often thankful for elimination the signs of the disease.
Venereology. Some patients dissimulate their sexual life in order to avoid investigation of circumstances when the disease appeared. They look for prohibited methods of treatment; uncertainly in effectiveness of treatment may inspire with misgivings and tension, whether they have cured or complications have not appeared. The result of dissimulation may be infection of other people. According to the patient's conduct, opinions, partly to the appearance and hygiene, skilled venereologist decides whether he can rely upon the patient's information and his cooperation in the process of treatment. In contradistinction to socially doubtful persons, who are vulgar, toady, sly and insincere, some accidentally infected patients are shy or they suffer from shame and; feel pangs of conscience, sense of own inferiority complex and they need an approval and definite reduction of the disease significance. Gonorrhea and trichomoniasis are the examples of that somatically "banal" and easily cured disease may be very heavy on psychological point of view.
Psychological peculiarities of the work of dentists.
In dentistry the first place is occupied by a pain, which leads the patient to the doctor. Strong pain can form a tension, anxiety and fears of dental procedures. Dentists should use of rational psychotherapy. When rendering help a dentist usually takes into consideration the fact that the sensitivity to pain is various in different age categories; it is also due to refraction of the pulp with the age. Super-sensitive patients whose pains are not managed by ordinary methods of treatment should be cured gradually, dentists have to receive them repeatedly and use the all accessible means for reduction of pain. If the doctor has to hurt the patients he must act quickly without hesitation because uncertainty slows down manipulation reduces, the quality and none the less, harms the patient. The patient’s anxiety before the treat ment and his fear of pain complicate the work of the dentist considerably. That is why in some cases it is necessary to carry out the joint work of a dentist, psychotherapist and psychiatrist. Both psychotherapy and some psychopharmacologic facilities can reduce the fear and pain.
The patients insist on making dentures on different reasons: the most frequent - it is striving for improvement of jaw functions, sometimes there is an aesthetic reason, especially in women. There are great mental problems at removable dentures which uninterruptedly remind the patient about his age, association of his condition with the age and about other circumstances. Total denture change the face that is why the patient is not always satisfied by the denture even if it functions well. The term “ mental incorporation of a denture" is used for signification of patient’s adaptation to the denture. The most expressed prove of a perfect incorporation is that fact when the patient looks for his teeth and finds them at last in his mouth. Persons feeling shy of his denture sometimes isolate themselves from the society, avoid acquaintances and friends. Symbolically teeth have a significance of aggressiveness, success society and erotics; thus, depression and sense of inferiority complex develop in teeth defect.Children with teeth anomalies suffer from speech disturbances and can differ from others by appearance and face, they look "stupid". They suffer from mockeries of surrounding people and react for them differently; inferiority complex and aggressiveness appear, sometimes they take the part of "clown in class". Dentist should be consider age and stage of intellectual development of the child, child's personal-psychological features and behavior, parent relationship type for sucesses treatment.
The border between the health and disease is more pronounced in old people than in young age. In frequently repeated malaise in old people attitude to it plays an important role: whether this malaise will be felt more intensively, cause fear and diffidence or whether a person on the border between health and disease will be able to abstract from unpleasant sensations, to live more by impressions of events, happening in the word and the contacts with surrounding people than by own body and fear of it. At deficiency of other stimuli, aged solitary people concentrate their attention on somatic processes, intensively feel their sensations, conditioned by organic and neurotic causes, and do the only, which, to their opinion, makes sense: they go to the doctor and ask for help. The older people with somatic diseases have self-centeredness, alertness, anxiety,decreased sociability usualy.
Emotional reactions are the most often psychological manifestations of every somatic disease. They can be both psychological reactions on fact of disease, and symptoms of mental disorders as the result of somatic pathology.
Euphoria: pathologically high spirits which develop without any external causes.
Depression: pathological blues, deep grief, low spirits (it may often be accompanied by suicidal thoughts).
Apathy:indifference to the surroundings and the self; it is usually accompanied by reduced requirements, desires and inducements, a weakened volitional activity; more frequently, it is of a reversible type.
Fear: one of frequent symptoms of emotional disturbances in children and is of a different clinical value.
Alarm: emotional state which appears in the conditions of uncertain danger and manifests in waiting of unfavourable development of events. Alarm is generalized, diffuse, objectless fear.
Phobiae: annoying fears characterized by the patient’s critical attitude to them and aspiration for getting rid of them (e.g., annoying fears of height, open spaces, infections, etc.).
Dysphoria: a suddenly appearing and unmotivated melancholy-angry mood with an expressed irritability (in children – tearfulness) and tendency to affects of anger with aggression.
Lability of emotions: an easy change of emotions, a rapid transfer from one emotion to another; it is combined with a significant expressiveness of emotional responses.
Weak will (emotional weakness):it is manifested with an unsteady mood, an increased emotional excitability often accompanied by “unrestraint of emotions”. It is particularly difficult for such patients to repress their tears at the moments of tender emotions, a sentimental mood. A transfer from negative to positive emotions and vice versa occurs under the effect of insignificant causes.
Emotional states have both mental and somatoneurological symptoms. They are accompanied by metabolic changes, vegetative manifestations in the form of activation of sympathoadrenal system, changes in a functional state of cardiovascular, respiratory system, gastroenteric path. At excessive for the individual or long affective stress there can be psychovegetative disorders, both diffuse and with accent on certain internal organs. Thus, it is long existing not reacted emotions can be a risk factor of development of various psychosomatic diseases.