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Chronic hepatitis in the psychosomatic aspect


Author: Ina Romanciuc
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2005
Scientific adviser: Vlada-Tatiana Dumbrava
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Mircea Revenco
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 28 September, 2005
Approved by NCAA on the 22 December, 2005

Abstract

Adobe PDF document – 0.29 Mb / in romanian

Keywords

chronic hepatitis, psychosomatic, depression, nozogenic, personality’s profile, Hamilton test, MMPI, quality of life, questionnaire SF-36, metabolism of serotonine, serotonine, triptophan, 5-oxiindolacetic acid, immunological disorders

Summary

147 patients with chronic hepatitis (CH) of viral B, C, D ethiology were surveyed by clinical and laboratory methods (markers of citolitic, cholestatic, hepatodepressive, immunological syndroms). We effected specific researches to the patients: psychometric tests (Hamilton test, MMPI, SF-36 questionnaire); parameters describing serotonine metabolism (a level of srotonine and triptophan in integral blood and of 5-oxyindolacetic acid (5-OIA) in daily urine).

The main clinical syndromes (asthenic, dyspeptic, algic in a liver projection) were observed more often and had large expressivness at the patients with depression and corresponded to higher Hamilton degrees.

At the surveyed patients it is not revealed connection between activity of ALT, AST, AlcPhos, GGTP and emotional status; however presence of depression was accompanied by the greatest increase of IgM, CIC and immunoregulator index at reduction of number of a Т- theophyllinsensibile lymfocites.

The reduction of triptophan and serotonine concentration in blood and 5-OIA in urine of the patients with chronic viral hepatitis is revealed at the expense of the patients with depression and with immunological disorders of autoimmune type.

We have found high comorbidity of CH with depression (85,03 %), with the greatest frequency in the senior age group (is more senior than 40 years) and at the patients with active viral replication. The degree of depression on a Hamilton scale was higher at the women and at mixthepatitis. The changes of the immune status were accompanied by higher parameters on a depressive Hamilton scale and by greatest frequency of depression.

In group of the surveyed patients with CH the features of a personality’s profile are revealed: neurotisation, the somatisated anxiety, ipochondria, prevalented ideas about their health, autism, psyhastenia. These changes are most expressed at presence at the patients of depression, of immunological disorders and in low concentration of parameters of serotonine metabolism.

In the patients with chronic viral hepatitis, in particular in the depressive patients the parameters of quality of life are lowered. The given changes are less appreciable at the men, among the patients is younger 40 years and at absence of immunological disorders.