Сравнительная характеристика психопатологического профиля пациентов с соматоформными расстройствами в первичном амбулаторном (соматическом) и психиатрическом звене

Background. Somatization is characterized by the transfer of psychological problems to the level of bodily sensations. In connection with the growth of somatization among patients in general clinical practice, the proportion ofsomatoform disorders (SFD) of a psychogenic nature is increasing, often occurring in the form of polymorphic symptoms (vegetative dysfunction, alexithymia, hypochondriacal, asthenic-neurotic, depressive, anxiety, obsessive-compulsive, etc.). The personality profile of such patients is characterized by disharmony, emotional instability, increased rigidity, anxiety, and loss of self-control. Patients with SFD often have a family history of mental illness. Improving the diagnosis, therapy and prognosis of SFD requires a comprehensive clinical, psychopathological and psychological assessment of the patients' condition. The relevance of this topic is due to the research activity of representatives of leading national scientific schools. Objective: to compare the psychopathological profiles of patientswith somatoform disorders in primary (outpatient somatic) and psychiatric care. Material and Methods. From thetotal (n=200) sample of the study, two groups were formed: the main group (hereinafter referred to as the 1 st group)(n=98) - patients observed in the primary outpatient (somatic) link, the comparison group (hereinafter referred to asthe 2nd group) (n=102) - patients under the supervision of psychiatrists. In patients of both groups at different periodsof observation, the diagnosis from the group of somatoform disorders (F45) according to ICD-10 was verified anddifferential diagnosis with other mental disorders was carried out. The groups are similar in terms of the number ofpatients, gender, age, marital status, education, employment. The assessment of the current mental status was carriedout in accordance with the standard clinical and psychiatric survey, taking into account the anamnesis according tomedical documentation, a survey of relatives. Psychometric examination was performed using a test battery of psychological scales (Beck depression, Spielberger anxiety, Toronto alexithymia scale, patient health questionnairePHQ-15). Results. Alexithymia, which is manifested by a low differentiation of feelings and bodily sensations andincreases the course of somatic disorders, is more common in the 1st group and is the reason for late visits to psychiatrists. The increase in alexithymia and personality changes further increases self-stigmatization, promotes the launchof iatrogeny, worsens compliance and prognosis of the disease. The higher number of patients with manifestations ofbasic disorders (anxiety and depression) revealed is indicative of frequent comorbidity with anxiety and depressivedisorders and reflects the characteristics of the patients' personality structure. Conclusion. Factors that worsen compliance and increase the risk of iatrogenic complications were identified: alexithymic personality structure and highpersonal anxiety. A higher severity of anxiety and depression was registered in patients of the 2nd group. A higherlevel of somatization in the 2nd group is a factor that not only aggravates the course and prognosis of the disease, butat the same time contributes to the patient's contact with the psychiatric link and receiving adequate psychopharmaco-logical and psychotherapeutic therapy, even despite the formal nature of the recognition of mental nature of SFD.