SOME PSYCHOSOMATIC ASPECTS OF RHEUMATOID ARTHRITIS IN CHILDREN AND ADOLESCENTS
L.I. Omelchenko, T.N. Pushkaryeva, I.V. Dudka, L.O. Datsenko, V.B. Nikolayenko, M.O. Vasylenko, L.B. Petrenko.
SU «Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine», Kiev, Ukraine
The range of state and trait anxiety in children with rheumatoid arthritis (RA), their structure peculiarities and personality type are underinvestigation. 100% of investigated children showed the increasing level of trait anxiety, and 42.7% — the state anxiety according to the Spielberg—Hanin test. 75% of those under investigation demonstrated the score rise according the psychiatric state scale and the results of personality dimension after Eysenck.
Key words: Juvenile rheumatoid arthritis, psychosomatics, trait and state anxiety, Spielberg—Hanin's scale, personality structure, personality typology.
Effective rheumatic disease treatment, especially locomotorium system, is one of the main medical and social problems of children's health care where juvenile rheumatoid arthritis is placed on the top.
According to the Ministry of Healthcare of Ukraine the frequency of the latter was 0.40–0.41 per 1000 children in 2006–2008.
The latest data show that the four factors that influence the development of JRA are: two biological (genetic predisposition to the rheumatoid arthritis and immunologic havoc) and two psychological ones (a personality who suffered the aggression and stress susceptibility with steady depression reactions and feeling of guilty [3,4,10,16,17]. Stress and immunological homeostasis disruption with chronic inflammation mainly in locomotorium is one of the possible ways to rheumatoid arthritis development (RA) as a psychosomatics pathology. Stress is proved to be one of the reasons of autoimmune diseases, and a psychological state stabilization leads to the positive changes in the immune system [1,12,18].
Children with RA are tended to a psychoemotional destabilization which makes the run of the main disease and its prognosis more complicated. RA prevalent rate in children with more than one percent cases in different countries that leads to decreasing their life quality and fast invalidization, specify medical and social importance for studying this pathology.
Chronic diseases influence the sick children's personality, reduce their life quality, lead to the secondary neurotization [4,5,8,10,11]. Despite the high level of pharmacological development, the treatment of these diseases is a difficult and frequently insolvable problem [4,10]. At the same time only a small number of researches have been devoted to the study of this subject among children [2,7,8,16,19]. It has been defined that many elements are meaningful in increasing psychosomatic disorder such as hereditary tained by psychosomatic diseases, disorders of autonomic nervous system, children personality peculiarities, specific family ambiance, consequences of traumatic brain injuries that lead to neurodynamics disorder; psycho traumatic circumstances, etc. [1,4,5,8,17].
Nevertheless, there exist countless studies of the psychogenic disorders, analysis of attitude to the disease, inner clinical picture, alexithymia in children with JA [5,14,16]. A significant quantity of sick children with JA form a cohort of chronic and far-gone patients who change their ordinary life stereotype completely due to somatic disability and have adaptation problems which is the precondition to border psychic disorders development [4,7,8,11,10].
Psychopathological disorder with JA includes a complex of psychopatalogical forms to which neurotic reactions, conditions, personality disorders and neurosis-like abnormalities belong. Border psychic disorders in patients with JA lead to clinic disease complication, have an influence on disease course, reduce therapy and rehabilitation effectiveness [7,16,19].
The actuality of the subject is determined by the lack of specific investigations on psychic disorders in children and adolescents with JA that is the reason of diagnostic pitfalls, delayed treatment that in its turn leads to term treatment increasing, therapy effectiveness and rehabilitation deterioration, fast incapacitation and maladjustment.
One of the main medical psychology problems is the investigation of mutual relation between sick personality and his somatic disease. In the first place, the structure of his personality has influence on his behavior and reaction during his illness. Also it is considered that type of reaction on the psychosomatic disease associated with assessment of his severe condition. The reaction of personality on his disease can have pathologic character and become apparent as anxiodepressive neurotic psychogenic reaction or be present by psycho adequate feelings about disease [6,9,13].
The case detection like these between sick people with JA and study of psychoemotional destabilization peculiarities demands an elaboration of new diagnostic clues for earlier sign identification of chronic psychiatric desadaptation formation among children.
Characteristic of psychoemotional destabilizations in this children pathology have been learned incomplete despite of the actual psychic and psychological aspects of the rheumatoid diseases and, in the first place, rheumatoid arthritis [6,13–15].
The aim of the study was the patopsychological examination of children and adolescents with JA by study of state anxiety and trait anxiety levels and specifics of structure and typology of their personality.
Material and methods
The anxiety level has been studied by the selfassessment scales of state and trait anxiety after Spielberg—Hanin [6,13]. The level of aggression, rigidity, frustration and anxiety were studied by Eysenck's detection method of the self-assessment psychocondition. The personality traits were analyzed by the Eysenck Personality Questionnaire [6,13].
The patho_psychology research included 28 children with JA, who were treated and outpatient examination in the clinicodiagnostic department of SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine». 11 children among them were with articular-visceral and 17 were mostly with articular disease forms. The study was conducted among 10 boys and 18 girls who were 10–17 years of age. All of them were at 1–2 stage of disease, primarily with acute stage, all of children were sick for 2 or more years and got a baseline therapy and expected treatment.
Results and discussion
According to the study that was conducted after Spielberg—Hanin test, 100% of children with JA show the medium and high level by the trait anxiety points, 42.7% of them show the high and medium level by the state anxiety points. The children with JA are divided in accordance with level of the trait anxiety and state anxiety which is presented in Table 1.
As Table 1 shows, sick children with JA have medium and high level (50% and 50% respectively) by the trait anxiety scale, that has determined researchers' attention to this category of children.
This points out a hidden tension that is not connected with extrinsic factors and can be background to anxiety and depressive disorder developing. 42.7% sick children of examined group have high or medium points of state anxiety, that can be connected both with the illness itself and clinical observation in separation from the usual microsocial and family environment.
For children with high, medium state and trait anxiety level are prescribed deep further clinico-diagnostic examination for detecting of neurotic register anxiety and/or depressive disorders. This category of children and adolescents needs clinical examination and observation to diagnose differentially border mental disorders such as neurotic, psychosomatic, stress connected or nosogenic disorders, their treatment and psychotherapeutic management.
In accordance with Eysenck's method, only 25% of children with JA did not have the rise psychic state score.
Table 2 presents the study diagnostic results of mental state by H.Eysenck in children with JA.
In assessing the data in table 2 can be noticed that all the average data of the examined scales more than 8 points and mean all rise level of psychic state's characteristics — anxiety, frustration, aggression and rigidity.
At the same time all the data remain in the borders moderate psychic tension which demonstrates the existence of the psychic processes tension without strongly-marked clinical manifestation and it may be underestimated by pediatricians, rheumatologists, generalists and parents (so-termed latent psychoemotional disorders or pre-clinical forms). The data adequacy is confirmed by the lie scale which were on the low level (2.6±0.43).
By the researcher's results of the personality orientation after H. Eysenck, 64.3% of children with JA have extraversion factors which can be indicative of high sensibility to stress situations and quality relationship with micro social area children's among this group. The personality orientation data by H.Eysenck's extraversion scale in children with JA are represented in Table 3.
The personality orientation data by H.Eysenck's neuroticism scale in children with JA are represented in Table 4.
In assessing the data in table 4 can be noticed that among children with long-term JA dominates the high neurotic level — 75% of examined. Thus, this discordant type prevalence of personality orientation has manifested the high emotional instability and tendency to neurotic in this children group. The average neurotic level in this group has become 13.7±1.15points.
The examined children with JA are characterized by increased sensibility to stress situation which are based on inadequately strong reaction caused by stimuli (discordant type),an easy rise of developing states of neuropsychic disadaptation, high emotional instability and high data by extraversion scale — orientation of the personality to the external world objects, poor control of emotions and impulsivity.
Thus, we have researched the psychoemotional particularities structure in children with JA. 100% of examined children had raise trait anxiety level by the Spielberg - Hanin scale. 75% of cases were marked by the score rise according the psychiatric state scale and the results of personality dimension after Eysenck.
According to the extraversion scale the majority of children with JA (64.3%) had extraversion features; and the discordant type of the personality dimension in the examined group prevailed — 75%, which were confirmed high emotional children instability in this group.
The result correlation have confirmed the rise sensibility of children with JA to stress situations by inadequate strong reactions stipulated their exciting cause, ease nervous psychological state development and social disadaptation, high emotional instability, personality dimension on real world, low emotional control, impulsivity.
These findings indicate also the mixed type reaction of children with JA on their condition, which is inherent the lack of personality compensative resources that lead to psychosomatic disadaptation variant.
The clinical observation data indicate that the majority of children and adolescents are in the state of psychological discomfort, have a rise anxiety level, strong sensibility to a stress situation and lack of psychological adaptation possibilities. The parents need additional cooperation with physicians and psychologists in order to medical-treatment optimization strategies to take into account the psychological station of each individual child and his relationship with his doctors, parents and peers.
The study confirms that psychological factors, along with the medical and biological components can lead to the formation or strengthening of psychosomatic diseases which demand the individual psychological correction. Psychiatric and psychotherapeutic care should be part of treatment and rehabilitation of children and adolescents with JA.
Thus, psycho-emotional factors that cause disruptions to the internals and reduce life quality lead to the formation of chronic psychological disadaptation, which make deeper the emotional discomfort and worsen run of disease. This requires the development and application such a complex therapy that reduces the level of stress and anxiety improving the emotional state of the child, which, in turn, along with the base and anti-inflammatory therapy will improve the emotional condition and the life quality of patients with JA.
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МедЭксперт. Медицинские статьи. Медицина, лечение,