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前列腺炎的心理异常

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前列腺炎的心理异常 PSYICHOLOGICAL ASPECTS OF PROSTATITIS Prof. ALESSANDRO NATALI Responsabile Servizio di Andrologia Urologica Clinica Urologica I Università degli Studi di Firenze CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS Psychological aspects ¾ PA...

前列腺炎的心理异常
PSYICHOLOGICAL ASPECTS OF PROSTATITIS Prof. ALESSANDRO NATALI Responsabile Servizio di Andrologia Urologica Clinica Urologica I Università degli Studi di Firenze CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS Psychological aspects ¾ PAIN ¾ LOWER URINARY TRACT SYMPTOMS ¾ SEXUAL DYSFUNCTIONS ¾ PAIN ¾ LOWER URINARY TRACT SYMPTOMS ¾ SEXUAL DYSFUNCTIONS • serious difficulty in concentration • interference with work activities • limited social life with resulting loss of interests • inexistent or limited sexual activity • serious difficulty in concentration • interference with work activities • limited social life with resulting loss of interests • inexistent or limited sexual activity CHRONIC PROSTATITIS Impact on daily life CHRONIC PROSTATITIS Impact on daily life ¾ Sexual dysfunction - 52% total or periodic impotence or decreased libido (Keltikangas-Jarvinen L et al, 1981) - 45% exacerbation of pain during or after intercourse (Egan KJ et al, 1994) - 19% erectile deficiency, 28.4% ejaculatio praecox, 33.5% pain or discomfort at the penis (Rizzo M et al, 2003) ¾ Absence from work - 46% of patients had missed some work because of this disease (Alexander RB et al, 1996) - 15% of patients absents from work because of the actual prostatitis; mean absence: 7.6 days (range 1-60) (Rizzo M et al, 2003) ¾ Sexual dysfunction - 52% total or periodic impotence or decreased libido (Keltikangas-Jarvinen L et al, 1981) - 45% exacerbation of pain during or after intercourse (Egan KJ et al, 1994) - 19% erectile deficiency, 28.4% ejaculatio praecox, 33.5% pain or discomfort at the penis (Rizzo M et al, 2003) ¾ Absence from work - 46% of patients had missed some work because of this disease (Alexander RB et al, 1996) - 15% of patients absents from work because of the actual prostatitis; mean absence: 7.6 days (range 1-60) (Rizzo M et al, 2003) ¾ Symptoms’ characteristics ¾ Irritating tendency to suffer from relapse ¾ Poor response to therapy ¾ Symptoms’ characteristics ¾ Irritating tendency to suffer from relapse ¾ Poor response to therapy Quality of life similar to that of patients suffering from recent miocardial infarction, unstable angina or active Crohn’s disease (Wenninger K et al, 1996; McNaughton-Collins et al, 2000) Quality of life similar to that of patients suffering from recent miocardial infarction, unstable angina or active Crohn’s disease (Wenninger K et al, 1996; McNaughton-Collins et al, 2000) CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS Psychological aspects * Frequently psychiatric disorders coexist with CP/CPPS, but the assessment of their relative contribution and causal role is not often feasible * Frequently psychiatric disorders coexist with CP/CPPS, but the assessment of their relative contribution and causal role is not often feasible * In more than 60% of patients with chronic prostatitis there are also psycological or depressive problems up to a certain point (Keltikangas-Jarvinen L et al, 1981; Egan KJ et al, 1994; Krieger JN et al, 1996; Drabick JJ et al., 1997) * In more than 60% of patients with chronic prostatitis there are also psycological or depressive problems up to a certain point (Keltikangas-Jarvinen L et al, 1981; Egan KJ et al, 1994; Krieger JN et al, 1996; Drabick JJ et al., 1997) CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS Psychological aspects ¾ Symptoms’ characteristics ¾ Irritating tendency to suffer from relapse ¾ Poor response to therapy ¾ Symptoms’ characteristics ¾ Irritating tendency to suffer from relapse ¾ Poor response to therapy ¾ 1832 patients ¾ Fear of undetected prostate cancer or of having a sexual transmitted disease and suicidal tendencies are significatively more common in patients with a history of C.P./C.P.P.S. ¾ Erectile dysfunction: 43% ¾ Decreased libido: 24% ¾ Marital difficulties: 17% ¾ Higher tendency towards suffering from anxiety, worry and nerves (Mehik A. et al., BJU 2001) ¾ 1832 patients ¾ Fear of undetected prostate cancer or of having a sexual transmitted disease and suicidal tendencies are significatively more common in patients with a history of C.P./C.P.P.S. ¾ Erectile dysfunction: 43% ¾ Decreased libido: 24% ¾ Marital difficulties: 17% ¾ Higher tendency towards suffering from anxiety, worry and nerves (Mehik A. et al., BJU 2001) CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS Psychological aspects ¾ Psychologic factors have been considered to play an important role in the etiology of CP/CPPS and a variety of psychopathological findings is described: depression, anxiety and hypocondriasis, identity disorders, hysteria, others. ¾ It is suggested a certain etiological role of psychic factors in CP/CPPS, but it s not proved whether CP/CPPS symptoms lead to psychiatric disease or whether psychiatric disease leads to worse CP/CPPS symptoms ¾ It is impossible to conclude that there are personality variables that specifically identify the CP patients (Keltikangas-Jarvinen L et al, 1981; Nickel JC, 2003; McNaughton Collins M et al., 2003; Ku JH et al., 2005) ¾ Psychologic factors have been considered to play an important role in the etiology of CP/CPPS and a variety of psychopathological findings is described: depression, anxiety and hypocondriasis, identity disorders, hysteria, others. ¾ It is suggested a certain etiological role of psychic factors in CP/CPPS, but it s not proved whether CP/CPPS symptoms lead to psychiatric disease or whether psychiatric disease leads to worse CP/CPPS symptoms ¾ It is impossible to conclude that there are personality variables that specifically identify the CP patients (Keltikangas-Jarvinen L et al, 1981; Nickel JC, 2003; McNaughton Collins M et al., 2003; Ku JH et al., 2005) CHRONIC PROSTATITIS Personality pathology CHRONIC PROSTATITIS Personality pathology ¾ Functional somatic syndromes were found in 65.1% of CP/CPPS patients : irritable bowel syndrome (35%), chronic headache (36%), fibromyalgia (5%) and non specific rheumatogic an dermatologic symptoms (25%) (Potts JM et al, 2001) ¾ Psychological stress has been shown to be a precipitating or exacerbating factor in CP/CPPS (Mehik et al, 2001) ¾ Functional somatic syndromes were found in 65.1% of CP/CPPS patients : irritable bowel syndrome (35%), chronic headache (36%), fibromyalgia (5%) and non specific rheumatogic an dermatologic symptoms (25%) (Potts JM et al, 2001) ¾ Psychological stress has been shown to be a precipitating or exacerbating factor in CP/CPPS (Mehik et al, 2001) CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS Psychological aspects LONG-TERM STRESS SYNDROME ¾ Persistence of stress agents (complaints) despite all treatments ¾ Patients are dissatisfied and unhappy, often discouraged: in addition is feeling tired, ill, impotent. A feeling of non being given consideration and care, as well as the fear of having a malignant disease LONG-TERM STRESS SYNDROME ¾ Persistence of stress agents (complaints) despite all treatments ¾ Patients are dissatisfied and unhappy, often discouraged: in addition is feeling tired, ill, impotent. A feeling of non being given consideration and care, as well as the fear of having a malignant disease DEPRESSION – MOODS OF DEPRESSIONDEPRESSION – MOODS OF DEPRESSION CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS Psychological aspects ¾ Chronic pain causes somatization and consequently feelings of dependency and vulnerability ¾ Patients need to be frequently reassured ¾ Frequent beginning of a vicious circle: chronic stress may cause organic changes in certain biological systems, which, in their turn, may condition the psycho-emotional status of the individual ¾ Chronic pain causes somatization and consequently feelings of dependency and vulnerability ¾ Patients need to be frequently reassured ¾ Frequent beginning of a vicious circle: chronic stress may cause organic changes in certain biological systems, which, in their turn, may condition the psycho-emotional status of the individual Importance of a multidisciplinary approach, which includes an intensive psycological support for these frustrated and frustrating patients (Keltikangas-Jarvinen et al., 1989; Egan KJ, Krieger JL, 1997). Importance of a multidisciplinary approach, which includes an intensive psycological support for these frustrated and frustrating patients (Keltikangas-Jarvinen et al., 1989; Egan KJ, Krieger JL, 1997). CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS Psychological aspects CHRONIC PROSTATITIS (CP/CPPS)CHRONIC PROSTATITIS (CP/CPPS) MULTIDISCIPLINARY APPROACH UROLOGIST SEXUOLOGIST COLONPROCTOLOGIST REABILITATION PHYSICIAN PSYCHOLOGIST PAIN THERAPIST URETHRAL/PERINEAL CHRONIC PAIN Need of a multidisciplinary approach URETHRAL/PERINEAL CHRONIC PAIN Need of a multidisciplinary approach UROLOGIST • Traditional pharmacological therapy • Topical therapy • Anaesthetic block PSYCOLOGIST • Psycholoical evaluation of the patient • Pharmacological therapy (psychotropic drugs) • Psychoanalitical and behavioural therapies NURSING • Home support • Coordination of therapies offerd by other specialists SOCIAL ASSISTANCE • Rehabilitation of patient in home and working environments PHARMACOLOGIST • Evaluation of correct pharmacological treatment • Suggestions as to experimental therapy in clinical phase UROLOGIST • Traditional pharmacological therapy • Topical therapy • Anaesthetic block PSYCOLOGIST • Psycholoical evaluation of the patient • Pharmacological therapy (psychotropic drugs) • Psychoanalitical and behavioural therapies NURSING • Home support • Coordination of therapies offerd by other specialists SOCIAL ASSISTANCE • Rehabilitation of patient in home and working environments PHARMACOLOGIST • Evaluation of correct pharmacological treatment • Suggestions as to experimental therapy in clinical phase THE CONTRIBUTION OF THE PSYCHOLOGIST ¾ Frequently the patient arrives at the psychological consultation at the end of a tiring and unsuccessfull clinical course of treatment ¾ The patient experiences this as a failure to offer a medical explanation ¾ Importance of the preventive phase in the beginning of the illness with accurate details of each case history and psycodiagnostic organization THE CONTRIBUTION OF THE PSYCHOLOGIST ¾ Frequently the patient arrives at the psychological consultation at the end of a tiring and unsuccessfull clinical course of treatment ¾ The patient experiences this as a failure to offer a medical explanation ¾ Importance of the preventive phase in the beginning of the illness with accurate details of each case history and psycodiagnostic organization Clarify the psychic components of the patient in the face of his experience of pain Clarify the psychic components of the patient in the face of his experience of pain CHRONIC PROSTATITIS Psychological support CHRONIC PROSTATITIS Psychological support THE CONTRIBUTION OF THE PSICOLOGIST ¾ Knowledge of psychological mechanisms che that regulate pain perception THE CONTRIBUTION OF THE PSICOLOGIST ¾ Knowledge of psychological mechanisms che that regulate pain perception ¾ Patients should be guided in their understanding of the interrelation of psychological factors and physical symptoms ¾ Educate the patients about coping with distress and pain (behavioral modifications) ¾ Antistress therapies ¾ Patients should be guided in their understanding of the interrelation of psychological factors and physical symptoms ¾ Educate the patients about coping with distress and pain (behavioral modifications) ¾ Antistress therapies CHRONIC PROSTATITIS Psychological support CHRONIC PROSTATITIS Psychological support ¾ Patients with CP/CPPS have recurrent physical symptoms but also many psychological problems. ¾The possible contribution of psychological factors has been considered to play an important role in CP/CPPS ¾ However the incidence, nature and importance of this psychopathology are largely underdetermined ¾ Similar to what is often observed in other pain syndromes, physical disease and psychiatric disorders coexist and the assessment of their relative contribution is often not feasible. ¾ Patients with CP/CPPS have recurrent physical symptoms but also many psychological problems. ¾The possible contribution of psychological factors has been considered to play an important role in CP/CPPS ¾ However the incidence, nature and importance of this psychopathology are largely underdetermined ¾ Similar to what is often observed in other pain syndromes, physical disease and psychiatric disorders coexist and the assessment of their relative contribution is often not feasible. CONCLUSIONS - ICONCLUSIONS - I ¾ CP/CPPS symptoms have a clear negative impact on the daily lives and relationships of these patients (sexual life, work) ¾ Psychosocial factors cannot be overlooked when evaluating patients with CP/CPPS, avoiding trapping patients with diagnoses that would imply a nonphysiologic basis for their symptoms ¾ Similar in other chronic pain syndromes, a multidisciplinary approach is recommended ¾ Several studies indicate a strong need for psychic support of patients with CP/CPPS. ¾ CP/CPPS symptoms have a clear negative impact on the daily lives and relationships of these patients (sexual life, work) ¾ Psychosocial factors cannot be overlooked when evaluating patients with CP/CPPS, avoiding trapping patients with diagnoses that would imply a nonphysiologic basis for their symptoms ¾ Similar in other chronic pain syndromes, a multidisciplinary approach is recommended ¾ Several studies indicate a strong need for psychic support of patients with CP/CPPS. CONCLUSIONS - IICONCLUSIONS - II
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