前列腺炎的心理异常

PSYICHOLOGICAL ASPECTSOF PROSTATITISProf.ALESSANDRO NATALIResponsabile Servizio di Andrologia UrologicaClinica Urologica IUniversit degli Studi di FirenzeCHRONIC PROSTATITISPsychological aspectsCHRONIC PROSTATITISPsychological aspects?PAIN?LOWER URINARY TRACT SYMPTOMS?SEXUAL DYSFUNCTIONS?PAIN?LOWER URINARY TRACT SYMPTOMS?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 activityCHRONIC PROSTATITISImpact on daily lifeCHRONIC PROSTATITISImpact on daily life?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)?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)?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)?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)?Symptoms characteristics?Irritating tendency to suffer from relapse?Poor response to therapy?Symptoms characteristics?Irritating tendency to suffer from relapse?Poor response to therapyQuality of life similar to that of patientssuffering from recent miocardial infarction,unstable angina or active Crohns disease(Wenninger K et al,1996;McNaughton-Collins et al,2000)Quality of life similar to that of patientssuffering from recent miocardial infarction,unstable angina or active Crohns disease(Wenninger K et al,1996;McNaughton-Collins et al,2000)CHRONIC PROSTATITISPsychological aspectsCHRONIC PROSTATITISPsychological 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 prostatitisthere 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 prostatitisthere 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 PROSTATITISPsychological aspectsCHRONIC PROSTATITISPsychological aspects?Symptoms characteristics?Irritating tendency to suffer from relapse?Poor response to therapy?Symptoms characteristics?Irritating tendency to suffer from relapse?Poor response to therapy?1832 patients?Fear of undetected prostate cancer or of havinga sexual transmitted disease and suicidaltendencies are significatively more common inpatients with a history of C.P./C.P.P.S.?Erectile dysfunction:43%?Decreased libido:24%?Marital difficulties:17%?Higher tendency towards suffering from anxiety,worry and nerves(Mehik A.et al.,BJU 2001)?1832 patients?Fear of undetected prostate cancer or of havinga sexual transmitted disease and suicidaltendencies are significatively more common inpatients with a history of C.P./C.P.P.S.?Erectile dysfunction:43%?Decreased libido:24%?Marital difficulties:17%?Higher tendency towards suffering from anxiety,worry and nerves(Mehik A.et al.,BJU 2001)CHRONIC PROSTATITISPsychological aspectsCHRONIC PROSTATITISPsychological aspects?Psychologic factors have been considered to play animportant role in the etiology of CP/CPPS and a variety of psychopathologicalfindingsisdescribed:depression,anxiety and hypocondriasis,identity disorders,hysteria,others.?It is suggested a certain etiological role of psychic factorsin CP/CPPS,but it s not proved whether CP/CPPS symptomslead to psychiatric disease or whether psychiatric diseaseleads to worse CP/CPPS symptoms?It is impossible to conclude that there are personalityvariables 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)?Psychologic factors have been considered to play animportant role in the etiology of CP/CPPS and a variety of psychopathologicalfindingsisdescribed:depression,anxiety and hypocondriasis,identity disorders,hysteria,others.?It is suggested a certain etiological role of psychic factorsin CP/CPPS,but it s not proved whether CP/CPPS symptomslead to psychiatric disease or whether psychiatric diseaseleads to worse CP/CPPS symptoms?It is impossible to conclude that there are personalityvariables 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 PROSTATITISPersonality pathologyCHRONIC PROSTATITISPersonality pathology?Functional somatic syndromes werefound in 65.1%of CP/CPPS patients:irritable bowel syndrome(35%),chronicheadache(36%),fibromyalgia(5%)and non specific rheumatogic an dermatologicsymptoms(25%)(Potts JM et al,2001)?Psychological stress has been shown to bea precipitating or exacerbating factor in CP/CPPS(Mehik et al,2001)?Functional somatic syndromes werefound in 65.1%of CP/CPPS patients:irritable bowel syndrome(35%),chronicheadache(36%),fibromyalgia(5%)and non specific rheumatogic an dermatologicsymptoms(25%)(Potts JM et al,2001)?Psychological stress has been shown to bea precipitating or exacerbating factor in CP/CPPS(Mehik et al,2001)CHRONIC PROSTATITISPsychological aspectsCHRONIC PROSTATITISPsychological aspectsLONG-TERM STRESS SYNDROME?Persistence of stress agents(complaints)despite all treatments?Patients are dissatisfied and unhappy,oftendiscouraged:in addition is feeling tired,ill,impotent.A feeling of non being givenconsideration and care,as well as the fear ofhaving a malignant diseaseLONG-TERM STRESS SYNDROME?Persistence of stress agents(complaints)despite all treatments?Patients are dissatisfied and unhappy,oftendiscouraged:in addition is feeling tired,ill,impotent.A feeling of non being givenconsideration and care,as well as the fear ofhaving a malignant diseaseDEPRESSION MOODS OF DEPRESSIONDEPRESSION MOODS OF DEPRESSIONCHRONIC PROSTATITISPsychological aspectsCHRONIC PROSTATITISPsychological aspects?Chronic pain causes somatization and consequentlyfeelings of dependency and vulnerability?Patients need to be frequently reassured?Frequent beginning of a vicious circle:chronic stress may cause organic changes in certain biologicalsystems,which,in their turn,may condition thepsycho-emotional status of the individual?Chronic pain causes somatization and consequentlyfeelings of dependency and vulnerability?Patients need to be frequently reassured?Frequent beginning of a vicious circle:chronic stress may cause organic changes in certain biologicalsystems,which,in their turn,may condition thepsycho-emotional status of the individualImportance of a multidisciplinary approach,whichincludes an intensive psycological support for thesefrustrated and frustrating patients(Keltikangas-Jarvinen et al.,1989;Egan KJ,Krieger JL,1997).Importance of a multidisciplinary approach,whichincludes an intensive psycological support for thesefrustrated and frustrating patients(Keltikangas-Jarvinen et al.,1989;Egan KJ,Krieger JL,1997).CHRONIC PROSTATITISPsychological aspectsCHRONIC PROSTATITISPsychological aspectsCHRONIC PROSTATITIS(CP/CPPS)CHRONIC PROSTATITIS(CP/CPPS)MULTIDISCIPLINARYAPPROACHUROLOGISTSEXUOLOGISTCOLONPROCTOLOGISTREABILITATION PHYSICIANPSYCHOLOGISTPAIN THERAPISTURETHRAL/PERINEAL CHRONIC PAIN Need of a multidisciplinary approachURETHRAL/PERINEAL CHRONIC PAIN Need of a multidisciplinary approachUROLOGIST Traditional pharmacological therapy Topical therapy Anaesthetic blockPSYCOLOGIST Psycholoical evaluation of the patient Pharmacological therapy(psychotropic drugs)Psychoanalitical and behavioural therapiesNURSING Home support Coordination of therapies offerd by other specialistsSOCIAL ASSISTANCE Rehabilitation of patient in home and working environmentsPHARMACOLOGIST Evaluation of correct pharmacological treatment Suggestions as to experimental therapy in clinical phaseUROLOGIST Traditional pharmacological therapy Topical therapy Anaesthetic blockPSYCOLOGIST Psycholoical evaluation of the patient Pharmacological therapy(psychotropic drugs)Psychoanalitical and behavioural therapiesNURSING Home support Coordination of therapies offerd by other specialistsSOCIAL ASSISTANCE Rehabilitation of patient in home and working environmentsPHARMACOLOGIST Evaluation of correct pharmacological treatment Suggestions as to experimental therapy in clinical phaseTHE CONTRIBUTION OF THE PSYCHOLOGIST?Frequently the patient arrives at the psychological consultation at the end of atiring and unsuccessfull clinical course oftreatment?The patient experiences this as a failure tooffer a medical explanation?Importance of the preventive phase in thebeginning of the illness with accurate detailsof each case history and psycodiagnosticorganizationTHE CONTRIBUTION OF THE PSYCHOLOGIST?Frequently the patient arrives at the psychological consultation at the end of atiring and unsuccessfull clinical course oftreatment?The patient experiences this as a failure tooffer a medical explanation?Importance of the preventive phase in thebeginning of the illness with accurate detailsof each case history and psycodiagnosticorganizationClarify the psychic components of the patientin the face of his experience of painClarify the psychic components of the patientin the face of his experience of painCHRONIC PROSTATITISPsychological supportCHRONIC PROSTATITISPsychological supportTHE CONTRIBUTION OF THE PSICOLOGIST?Knowledge of psychological mechanisms chethat regulate pain perceptionTHE CONTRIBUTION OF THE PSICOLOGIST?Knowledge of psychological mechanisms chethat regulate pain perception?Patients should be guided in their understandingof the interrelation of psychological factorsand physical symptoms?Educate the patients about coping withdistress and pain(behavioral modifications)?Antistress therapies?Patients should be guided in their understandingof the interrelation of psychological factorsand physical symptoms?Educate the patients about coping withdistress and pain(behavioral modifications)?Antistress therapiesCHRONIC PROSTATITISPsychological supportCHRONIC PROSTATITISPsychological support?Patients with CP/CPPS have recurrent physicalsymptoms but also many psychological problems.?The possible contribution of psychological factorshas been considered to play an important role in CP/CPPS?However the incidence,nature and importanceof thispsychopathologyare largelyunderdetermined?Similar to what is often observed in other painsyndromes,physicaldiseaseand psychiatricdisorders coexist and the assessment of theirrelative contribution is often not feasible.?Patients with CP/CPPS have recurrent physicalsymptoms but also many psychological problems.?The possible contribution of psychological factorshas been considered to play an important role in CP/CPPS?However the incidence,nature and importanceof thispsychopathologyare largelyunderdetermined?Similar to what is often observed in other painsyndromes,physicaldiseaseand psychiatricdisorders coexist and the assessment of theirrelative contribution is often not feasible.CONCLUSIONS-ICONCLUSIONS-I?CP/CPPS symptomshavea clearnegative impact on the daily lives and relationships of thesepatients(sexual life,work)?Psychosocial factors cannot be overlooked whenevaluatingpatientswithCP/CPPS,avoidingtrapping patients with diagnoses that would implya nonphysiologic basis for their symptoms?Similarin otherchronicpainsyndromes,a multidisciplinary approach is recommended?Severalstudiesindicate a strong needforpsychic support of patients with CP/CPPS.?CP/CPPS symptomshavea clearnegative impact on the daily lives and relationships of thesepatients(sexual life,work)?Psychosocial factors cannot be overlooked whenevaluatingpatientswithCP/CPPS,avoidingtrapping patients with diagnoses that would implya nonphysiologic basis for their symptoms?Similarin otherchronicpainsyndromes,a multidisciplinary approach is recommended?Severalstudiesindicate a strong needforpsychic support of patients with CP/CPPS.CONCLUSIONS-IICONCLUSIONS-II