Mental disorders in patients with breast cancer: a differentiated approach to the study of nozogeny

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Objective. To study mental disorders in patients with breast cancer (BC) at different stages of the disease taking into account premorbid characteristics and psychosomatic correlations in their development. Material and methods. The study included 82 patients with histologically confirmed BC. The first group consisted of 30 patients (mean age 49.7±11.1 years) with the first established diagnosis of BC and mental disorders caused by somatic disease (ICD-10 F40—F48, stress-related neurotic and somatoform disorders). The second group included 52 patients (mean age 56.8±6.7 years) with illness duration and follow-up ≥3 years (17 years in some cases) with signs of personality disorder (PD) according to ICD-10 F62. Clinical/pschopathological, follow-up and statistical methods were used. Results and conclusion. Mental disorders are represented by two nosologic categories: nosogenic reactions and pathological personality. Manifestation of a nozogeny reaction is closely correlated with premorbid personality characteristics. Anxious — depressive nozogenic reaction (n=17) is strongly correlated with the anxious type of personality accentuation and weakly correlated with personality characteristics of the affective (bipolar) range. Anxious-nozogenic dissociative response (n=9) was characteristic of hysterical and expansive schizotypal PD with a significant direct correlation with constitutional hyperthymia. Anxiety — hypomanic nozogeny response (n=4) was observed in schizotypal PD correlated with symptoms of persistent hyperthymia. Five types of PD are formed in the follow-up period: hypochondriacal dysthymia, «paranoia struggle», «aberrant hypochondria», hypomanic endoform response with the phenomenon of post-traumatic growth and «new life».

Keywords:

breast cancer

nosogenic reaction

pathological development of personality

constitutional features

Authors:

Shushpanova O.V.

Scientific center of mental health, Moscow, Russia

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