Melekhin A.I. – Dr. Sc., Associate Professor, psychoanalyst; Humanitarian Institute. P.A. Stolypin; Moscow, Russia; https://orcid.org/0000-0001-5633-7639
Introduction. The use of psychotherapeutic strategies may be preferable for patients with interstitial cystitis, who do not respond to psychopharmacotherapy and even after somatotropic therapy. therapy, surgical interventions continue to experience uncomfortable sensations. However, many urologists, given the presence of the psychosocial etiology of cystitis in some patients, continue to advocate surgical treatment.
Goal. Familiarizing urologists, gynecologists, and mental health professionals with the fact that cystitis consists of heterogeneous subtypes with corresponding pathogenic pathways, comorbid mental disorders, and emotional characteristics. Among these subtypes, the psychosocial phenotype should be distinguished, which has its own specifics, psychodynamics and requires appropriate complex treatment tactics.
Materials and methods. 35 women from 25 to 48 years old suffering from recurrent cystitis for 7-12 years and 35 women without urological disorders. The following diagnoses are observed in patients: somatoform autonomic dysfunction of the genitourinary system (F45. 34); psychological factors in chronic recurrent cystitis (F54); recurrent depressive disorder, an episode of moderate severity (F33.1). The patients were examined using the questionnaire of the severity of psychopathological symptoms (SCL-90-R) and the scale of diagnosis of early maladaptive schemes (YSQ S3R).
Results. The psychosocial phenotype of cystitis is represented by high somatization, the presence of obsessive-compulsive traits, interpersonal sensitivity, a tendency to develop depression and an anxiety spectrum of disorders. Among the maladaptive cognitive behavioral patterns, the following predominate: negativism/ pessimism, search for approval, feeling of vulnerability, lack of self-control, submission, self-sacrifice, feeling of abandonment and instability, distrust of other people.
Conclusion. In addition to psychopharmacotherapy for the treatment of anxiety and depressive symptoms in patients with cystitis, psychotherapy aimed at minimizing difficulties in emotional awareness (alexithymia) and unresolved childhood trauma of relationships should be included in the treatment program. Multimodal psychodynamic psychotherapy and cognitive behavioral therapy can reduce symptoms, affect the immune and nervous systems, and the psychological well-being of patients with cystitis.