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
本文档为【前列腺炎的心理异常】,请使用软件OFFICE或WPS软件打开。作品中的文字与图均可以修改和编辑,
图片更改请在作品中右键图片并更换,文字修改请直接点击文字进行修改,也可以新增和删除文档中的内容。
该文档来自用户分享,如有侵权行为请发邮件ishare@vip.sina.com联系网站客服,我们会及时删除。
[版权声明] 本站所有资料为用户分享产生,若发现您的权利被侵害,请联系客服邮件isharekefu@iask.cn,我们尽快处理。
本作品所展示的图片、画像、字体、音乐的版权可能需版权方额外授权,请谨慎使用。
网站提供的党政主题相关内容(国旗、国徽、党徽..)目的在于配合国家政策宣传,仅限个人学习分享使用,禁止用于任何广告和商用目的。