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A Case of Severe Somatized Depression in a Young Adult: Diagnostic Challenges
- O. M. Pityk, I. M. Kuzhda, M. I. Pityk
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S772
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Introduction
Depressive disorders in adolescence and young adulthood have always been and remain an urgent problem due to their fairly high prevalence among the population, serious difficulties in diagnosis and untimely treatment. Timely diagnosis and adequate treatment can have a powerful impact on the future life of a person in a positive context. This process requires both standardized mechanisms, and an individual detailed study of each case, as the future of the individual depends on it.
ObjectivesA young adult M., 20 years old, a university student, from a socially prosperous family, approached us.
Main complaints: headaches that have been going on for almost 4 years. Pains did not depend on loads, both physical and mental, were of various characteristic and different localization. Non-steroidal anti-inflammatory drugs, as well as anti-migraine drugs, have little effect on the pathological experiences.
MethodsOur main method of examination was clinical interview. In the complex assessment detailed neurological and ophtalmological examination included.
ResultsThe parents referred patient for a medical examination about a year ago, because they noticed persistent mydriasis in him. During the year, the patient underwent a detailed examination (consultations of a therapist, endocrinologist, neurologist, ophthalmologist, MRI, EEG, dopplerography). Doctors expressed various assumptions about the diagnosis, because all the studies did not reveal any pathology that could explain the indicated complaints and mydriasis.
During the initial interview, a high level of intelligence and knowledge was revealed, as well as a sufficient ability to learn. Examining the emotional-volitional sphere, a slight level of emotional instability, mild irritability, anhedonia and a slight degree of hypobulia (which can be explained by long-lasting and persistent pathological somatic experiences in the form of headaches) were found. Incomplete Protopopov’s triad was revealed.
The patient was referred for repeated neurological and ophthalmological examination. Specialists with a high qualification level discovered the A. Athanassio symptom in him.
He was diagnosed with recurrent depressive disorder, a current episode of severe depression with somatic symptoms, and appropriate treatment was prescribed.
Conclusions1. Depressive disorders in adolescence and young adulthood require special attention from specialists of all medical specialties.
2. The need for a detailed medical examination and modern neuroimaging methods is beyond doubt.
3. Psychiatric examination cannot be limited to assessment of mental status only, and assessment of Protopopov’s triad should be part of psychiatric examination.
4. Neurological and ophthalmological examination must necessarily include an assessment of neuro-ophthalmological symptoms.
5. Individual selection of treatment should be carried out by a psychiatrist.
Sorry to say, Professor Mykola Pityk died 27.12.2020
Disclosure of InterestNone Declared
Social-Stress Disorder and Post-Traumatic Stress Disorder in Ukrainian Population.
- O. M. Pityk
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S906
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Introduction
The situation that has been going on in Ukraine for the past six months has led to catastrophic consequences. This forces neuroscientists and, including psychiatrists, to turn to the study of the impact of all these events on the mental health of the population of Ukraine. In 90th of XX Russian psychiatrist Y. A. Alexandrovsky expressed opinion of presence the group of so-called social-stress disorders (SSD) that was determined like psychogenic-actual for most people in definite social, economic and political situation. Most of the people in Ukraine now experience both SSD and post-traumatic stress disorder (PTSD).
ObjectivesMost of the people in Ukraine now experience both SSD and post-traumatic stress disorder (PTSD).
MethodsThe method of clinic-psychopathological interview with patients who applied out-patient consultation on the chair of psychiatry.
ResultsThe main changes in psychic state include following behaviors and clinical implications: loss of the value of human life, which is manifested in indifference to death in lowering caution when hazardous situations, willingness to sacrifice lives without any ideals. There is unrestrained lost for pleasure and moral promiscuity, exacerbation of personality typological traits, development of hyperstenic reactions (to self-destructive non-expedient behavior), hypostenic disorders, panic reactions, depression, dissociative and conversive irregularities, loss of communicational plasticity, loss of the ability to adapt to what happens with the preservation prospects of targeted actions, manifestations of cynicism, the tendency to antisocial actions. Patients had complaints on increase anxiety, pessimistic attitudes, existential vacuum, sense of uselessness and loss of perspectives, tendency to irrational perception of reality with including mechanisms of autistic and archaic thinking.
ConclusionsThus, psychological status of the population of Ukraine is a model of complicated combination of SSD plus PTSD can be considered like a basis which leads to the decreasing of the individual barrier of mental adaptation with the next manifestation of different forms of psychopathological syndromes and needs further in-depth and detailed research.
Disclosure of InterestNone Declared
Optimizing the Correction of Depressive Disorders in Patients with Primary Hypothyroidism
- O. M. Pityk
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S398
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Introduction
Population recent studies have shown that most patients with endocrine pathology suffer from at least one of the three DCPR syndromes: irritable mood, demoralization (despair), persistent somatization. The thyroid gland is a unique organ among the glands of internal secretion, in the pathology of which non-psychotic mental disorders are extremely common. Therefore, the use of a complex, integrative, systemic approach in the examination of patients with thyroid pathology should be the basis of planning the strategy and tactics of the treatment program for such patients.
ObjectivesWe examined 132 patients with primary hypothyroidism.
MethodsWe used psychopathological method and an adapted methodology for assessing typologies of psychological defence. It was the method of Robert Plutchik adapted by L.I.Wasserman, O.F.Eryshev, E.B.Klubova for assessment of the next mechanisms of defense: negation, projection, regression, displacement, repression, intellectualization, reactive formation, compensation.
ResultsIn 108 patients, who made up 81.12% of the total number of investigated, various forms of non-psychotic mental disorders were detected, among which 23 patients (12.04%) had an anxiety-depressive syndrome, and astheno-depressive syndrome (32.41%).
It was established that excessive compensation, projection, reactive formation formed a tendency to increased self-control, to analysis and introspection, self-justification, isolation, which in general influenced the structure of the astheno-depressive syndrome. Insufficient reactive formation, displacement, and excessive intellectualization in a complex contributed to the formation of subjective feelings of anxiety and fear in patients, led to the avoidance of problematic situations, unnatural slowness with behavioral manifestations of anxiety, therefore influenced the structuring of anxiety and depressive disorders at the same time. Thus, significant connections have been established between the intrapsychic level of functioning and the formation of astheno-depressive and anxiety-depressive disorders, which should be used in the planning of psychotherapeutic and psychocorrective measures.
ConclusionsThis approach ensures that endocrinologists and general practitioners master the simplest skills for providing psychocorrective care to patients with depressive disorders. It includes the application of elements of rational psychotherapy, in order to form a sense of control over their own condition and the ability to master negative influences, which contributes to stabilization their general condition and improvement of the quality of life. So medical care to such patients should focus on early diagnosis and correction of nonpsychotic mental disorders. Both medications and psychological influences should be used in the treatment of such patients.
Disclosure of InterestNone Declared
The soluble ST2 levels in patients with depression and comorbid heart failure
- A. Sikora, S. Fedorov, M. Vynnyk, M. Pustovoyt, O. Pityk, J. Bezuk
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S111-S112
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Introduction
Depression in HF has become a major issue as the burden of HF has continued to increase, and many studies have suggested poorer outcomes in HF patients reporting depression. The prevalence of major depression in HF is about 20–40 %, which is 4–5 % higher than in the normal population. Soluble ST2 is involved in multiple pathogenetic pathways including cardiac strain, inflammation, and myocardial necrosis with remodeling.
ObjectivesThe purpose of study was to assess the predictive effect of soluble ST2 (sST2) and depressive symptoms in patients with ischemic HF
MethodsIt this observational cross-sectional trial 129 patients with ischemic HF FC II-IV by New York Heart Association and depression were investigated. The diagnosis was verified by laboratory and instrumental methods according to European Society of Cardiology recommendations (2016). Depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale. The ST2 level in blood serum was detected by ELISA method. Statistical analyses were performed using the Statistica 12 (StatSoft, Tulsa, OK, USA).
ResultsThe prevalence of depression increases with NYHA functional class. With decreasing ejection fraction of left ventricle, levels of sST2 were gradually increased (P for trend < 0.001), as well as the prevalence of depressive symptoms (P for trend < 0.01). Multivariate Cox regression analysis demonstrated that depressive symptoms and elevation of sST2 were both independent predictors of all-cause mortality and HF-related hospitalization.
ConclusionsThe serum levels of sST2 and depressive symptoms were independent and additive predictors of all-cause mortality and heart failure-related hospitalization in patients with ischemic HF.
DisclosureNo significant relationships.
Effect of vortioxetine on proinflammatory cytokine levels in patients with heart failure and comorbid depression
- A. Sikora, S. Fedorov, O. Pityk, M. Vynnyk
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S91
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Introduction
Several studies have shown impaired cytokine status in both patients with depression and chronic heart failure (HF).
Objectivesto study the effect of vortioxetine on the level of pro-inflammatory cytokines: interleukin -1β (IL-1β) and interleukin - 6 (IL-6).
Methodsthere were examined 80 patients with HF with reduced ejection fraction (HFrEF) of ischemic genesis with functional class (FC) II-III (NYHA), 37 patients were without depression, 43 - with mild or moderate depressive disorders. Those with mild or moderate depressive disorders were divided into 2 subgroups: 21 patients received psychotherapy, 22 patients, in addition to psychotherapy, were prescribed vortioxetine at a dose of 10 mg / day in the morning after meals. The control group consisted of 20 healthy individuals. The level of cytokines in the blood was determined by ELISA method.
ResultsPatients with CHF have an increase in levels of pro-inflammatory cytokines. Thus, the concentration in the serum of IL-1β was 2.3 times higher than the same indicator in the control group: (56.45 ± 4.17) pg / ml, against (24.71 ± 4.21) pg / ml p <0.001). Depression caused an additional increase in the levels of IL-1β by 13.5% (p <0.05) and IL-6 - by 17.3% (p <0.01). Additional administration of vortioxetine caused a more rapid decrease in blood levels of both IL-1β (HR 0.87 [95% CI 0.72-0.97; p = 0.034]) and IL-6 (HR 0.81 [95% CI 0.68-0.93; p = 0.029]).
ConclusionsThus, vortioxetine causes a decrease in the concentration of pro-inflammatory cytokines IL-1β and IL-6 in patients with HF and comorbid depression.
DisclosureNo significant relationships.
Severity of Psychopathological Symptoms in Patients with Primary Hypothyroidism
- O. Pityk, L. Tkachuk, M. Pityk, I. Kuzhda
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- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Thyroid dysfunction such as hypothyroidism, is connected with numerous neurological and psychiatric disorders. However, the importance of assessing the interaction between brain, psyche and thyroid in clinical practice is often underestimated, and this has a direct impact on the planning of therapeutic interventions and treatment efficacy in patients with primary hypothyroidism. It was examined 132 patients with primary hypothyroidism. In 108 patients constituted various forms of non-psychotic mental disorders. Assessment of presence and severity of psychopathology was performed using the technique SCL-90-R (questionnaire severity of psychopathology). The results showed the highest scores on scales of somatization, depression, interpersonal anxiety, phobias. High rates of somatization scale showing a violation of bodily dysfunction of various body systems-cardiovascular, gastrointestinal, respiratory and headache, muscular discomfort and other unpleasant sensations in different parts of the body and manifest themselves in a complaint of patients. Demonstration of a high performance on a scale of interpersonal anxiety is self-exclusion, self-inadequacy,anxiety and expressed discomfort in interpersonal relationships. Scale depression revealed the presence of dysphoria, anhedonia, low affect, loss of vitality and interest in life. Relatively high on a scale of phobias indicate the presence in these patients persistent fear responses to certain situations and objects that are irrational and inadequate and lead to avoiding behavior. General index of severity of symptoms (GSI) and the index of an existing symptomatic distress (PSDI) were significantly higher in the following patients than in hypothyroid patients without mental disorders. Thus, these results should be taken into account when determining treatment strategy.
Social-stress Disorder. What Does it Mean for the people?
- O. Pityk, M. Pityk, I. Kuzhda
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, pp. S452-S453
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In 90th of 20 Russian psychiatrist Y.A. Alexandrovsky expressed opinion of presence the group of so-called social-stress disorders that was determined like psychogenic-actual for most people in definite social, economic and political situation.
Used the method of clinic-psychopathological interview with patients who applied outpatient psychological consultation on the chair of psychiatry.
The main changes in psychic state include following behaviors and clinical implications: loss of the value of human life, which is manifested in indifference to death in lowering caution when hazardous situations, willingness to sacrifice lives without any ideals. There is unrestrained lost for pleasure and moral promiscuity, exacerbation of personality typological traits, development of hyperstenic reactions (to self-destructive non-expedient behavior), hypostenic disorders, panic reactions, depression, dissociative and conversive irregularities, loss of communicational plasticity, loss of the ability to adapt to what happens with the preservation prospects of targeted actions, manifestations of cynicism, the tendency to antisocial actions. Patients had complaints on increase anxiety, pessimistic attitudes, existential vacuum, sense of uselessness and loss of perspectives, tendency to irrational perception of reality with including mechanisms of autistic and archaic thinking.
Thus, psychological status of the population of Ukraine is a model of social-stress disorder and can be considered like a basis, which leads to the decreasing of the individual barrier of mental adaptation with the next manifestation of different forms of psychological maladjustment.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
The role of alexithymia in non-psychotic mental disorders’ development in patients with primary hypothyroidism
- O. Pityk, M. Pityk, I. Kuzhda
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s501
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In the formation of non-psychotic psychiatric disorders in patients with thyroid pathologies are important neurohumoral mechanisms, and one reason is psychosomatic relationships. The modern concept of relationships includes alexithymia model. The situation of chronic physical illness is regarded by many authors as one that provokes a crisis of mental development (and in fact, identity crisis) and therefore is a traumatic situation, that is a risk factor for the development of mental disorder. The aim of the study was to investigate the alexithymia level in patients with primary hypothyroidism. We used Toronto Alexithymia scale proposed by Taylor G. 50 patients with hypofunction of the thyroid gland were investigated. In a study of 42 patients (84%) had a rate alexithymia more than 74 points, 12% of patients were classified as areas of uncertainty and only 4% of patients according to the method proved non-alexithymic. It was found that patients with an uncertain alexithymia level had difficulties in describing their inner feelings, did not give much attention to the absence of well-being in the emotional sphere, believed that painful symptoms of mental health problems are caused by only thyroid pathologies, even during sighting surveys ignored the presence of emotional stress and conflict experiences that showed a reduced capacity for understanding and expressing their own feelings, low emotional resonance. Thus, psychotherapeutic and psycho-corrective work with such patients should take into consideration alexithymia radical in the personal structure of such patients.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Psychological mechanisms of the formation of non-psychotic mental disorders in patients with hyperthyroidism
- O. Pityk, M. Pityk, I. Kuzhda
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S151
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The application of a comprehensive, integrative, systemic approach to the examination of patients with abnormal thyroid gland has to lie in the basis of planning strategies and tactics of medical programs such patients. On this point of view we consider that non- psychotic mental disorders are developing on the basis of both organic and adaptation levels. Population researches showed that the majority of patients with endocrinological pathology suffer from one of the three DCPR syndromes: irritant mood, demoralization thrown in (desperation), persistant somatization. The task of our work was to investigate mechanisms of psychological defense in patients with hyperthyroidism with non-psychotic mental disorders. One hundred and twenty-five patients were examined. Non-psychotic mental disorders with different syndromologic structure were found in 76% of patients (study group), among which anxious-asthenic (38.95%), anxiety and depression (23.16%) were dominant. The method of Robert Plutchik for assessment of the mechanisms of defense was used. In asthenic syndrome we found excessive functioning of negation and regression, inadequate functioning of intellectualization. In patients with astheno-anxious syndrome inadequate functioning of negation, intellectualization, compensation, and excessive repression contributed to the formation of the sensations of anxiety. Excessive compensation, projection, reactive formation generally affected the structure of the asteno-depressive syndrome. The lack of displacing of reactive formation, repression and excessive intellectualization in a complex influenced to the structuring of anxious-depressive syndrome. In hypochondrical syndrome projection, regression and negation were the basis of the formation of clinical picture. Thus, meaningful relationships between intrapsychic level of functioning and syndromological structure of non-psychotic disorders were installed.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
ADHD complex correction in children
- O. Pityk, M. Pityk, I. Kuzhda
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S358
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About a third of children are described as overactive by their parents, and up to a fifth of schoolchildren are described in this way by their teachers. Diagnosis of ADHD can be exhibited in 3–7% of children reached school age. It is not surprising that in children with ADHD as a result of such symptoms develop low self-esteem and emotional problems, often observed a variety of neurotic symptoms and behavioral disorders. The aim of our work was to investigate effectiveness of GABA-ergic medications in complex correction of ADHD children. It is investigated and treated 69 children with ADHD in age from 6 to 12 years. All the children were assigned GABA-ergic medications in doses that depended on the age of the child within three months. Besides medication, parents with their children carried out psychological adjustment, first of all it was a psychological training of parents based on system model of psychotherapy and appropriate recommendations for changes in behavioral strategies in relation to children. After treatment 100% of parents noted improvement of children's state. However, symptoms significantly smoothed in 51 children, children were more attentive, calmer, and more reflective. It was made significant changes in the relationships of parents with children that manifested itself in improving mutual understanding, increased positive reinforcement, reducing cases of different methods of punishment and expression of dissatisfaction with the behavior of children. Therefore, GABA-ergic medications can be successfully used in complex correction in children with ADHD.
Disclosure of interestThe authors have not supplied their declaration of competing interest.