Mutual influence of intensity of pain syndrome and borderline mental disorders in patients with coxarthrosis

Abstract

The objective of this study is to evaluate the mutual influence of pain syndrome and borderline psychiatric disorders depending on its intensity and tolerability in patients with coxarthrosis who need endoprosthetics. 76 patients with coxarthrosis aged from 25 to 68 who were hospitalized in the Department of Endoprosthetics at Mechnikov Regional Clinical Hospital in Dnipro City in the period from November 2015 to September 2016 were observed. For diagnosis of psychopathological disorders, and for evaluation of the effectiveness of therapeutic interventions, the following methods were used in our research: clinical and psychopathological (technique SCL-90-R), Tаylor anxiety scale, study of the type of attitude to the disease (LOBI), Dembo-Rubinstein self-esteem scale, Leonhard-Schmieschek questionnaire for assessment of accentuation of personality traits, the Luscher 8-colour test and the Toronto alexithymia scale (TAS). Severity of pain syndrome was assessed using a visual analogue scale of pain (VAS). Forms of borderline mental disorders were diagnosed in 51 patients with coxarthrosis, such as depressive disorder (F 32) – 19 (24.8%), neurasthenia (F 48) – 12 (16.2), anxiety and phobic disorders (F 40–41) – 14 (18.1%), and personality disorders (F 60.5, F 60.6, F 60.7) – 6 (7.6%). In 25 (33.3%) patients clinically-defined forms of mental disorders were identified. Leading syndromes in these disorders were depression – 19 (24.8%) patients, anxiety and phobic – 15 (20.0%), asthenic – 10 (12.4%), hypochondriacal – 7 (9.5%) patients. According to the results of the correlation analysis, a close correlation between the severity of pain syndrome and borderline mental disorders (r = 0.779) was established for patients in the preoperative stage. The average level of pain syndrome on the VAS scale in patients with borderline mental disorders was twice as high as in patients without these disorders (63.4 vs. 32.4 points), but it does not depend on the main psychopathological syndrome. The average level of pain on the VAS scale in patients with borderline mental disorders at the preoperative stage was twice as high as in patients without these disorders (63.4 vs 32.4 points), and after surgical intervention the level decreased only by 5.9 points or 9.3%. In patients with coxarthrosis with detected borderline mental disorders (51 people) the therapy had a complex character and was conducted both at the hospital stage for one month, and in the outpatient stage as "maintenance" therapy for 3 months or more. Therapy of the neurotic state with decompensation lasted on average 6 months. Treatment included psycho-educational and therapeutic arrangements (conversations, lectures, autotraining) and psychopharmatherapy (tranquilizers, antidepressants, antipsychotics in small and medium therapeutic doses). The conducting of simultaneous corrective measures for identified borderline mental disorders in patients of the main groups contributed to a significant reduction in the severity of pain within the six-month period of observation and moved them towards the level of the patients in the control group. Borderline mental disorders that take place in patients with chronic somatic diseases, which include, in particular, coxarthrosis, significantly amplify the severity of the condition, reduce the possibility of adaptation, and thus aggravate the course and the outcome of the main disease.