The problem of conditionality of the digestive system pathology affective disorders in children and teens is relevant at the moment because of the frequent occurrence and high prevalence of gastrointestinal disorders, socio-biology, psychosomatic in nature and relatively high rate of affective (depressive buy antidepressants online) disorders occur in 27, 3-51,9% of the population in the (2,3) and 30% of hospitalizations of children and adolescents (4). Moreover, it is for children ages atypical (masked, somatisation) depression - typical (5), as in the early stages of the development of mental disorders and depression, in particular, have often somatovegetativnyh expression (6).
There were examined 220 patients between the ages of 5 months. 15 years (boys - 106, girls - 114) with gastrointestinal and mental disorders. The average age of the surveyed 8.8 + 0.4 years. The average age of onset of the disease (appearance of complaints of gastrointestinal disorders) - 4.0 + 0.5 years. The duration average 2 of the disease - 4.9 + 0.4 years.
Psychosomatic disorders of the digestive system acts as appetite disorders (decrease or increase), aerophagia, nausea, vomiting, abdominal pain, bloating, stool disorders (constipation, diarrhea). In 35 children and adolescents, these manifestations were decisive, monosistemnymi, and at 185 leading, polysystemic, performed in conjunction with vegetovascular disturbances in other organs and systems.
Complaints to be met by these patients usually are concise and uncertainties. That is, there was a limited ability to perceive their own feelings and emotions, their adequate verbalization and expressive transmission characteristic of patients with psychosomatic disorders.
A history revealed the following biological factors influencing the development of psychosomatic disorders. Pathology of pregnancy in 131 (59.5%) and delivery in 124 (56.4%) patients. Violations of feeding in the first year of life in 157 (71.4%) of children and adolescents: artificial feeding - 10.9% of patients, breast up to 6 months - 52.3%, 8.2% more than a year of patients. Delayed mental development in 30 (13.6%) patients, uskorennnoe - in 8 (3.6%), motor retardation in 25 (11.4%) patients. In 207 (94.1%) cases of residual-organic insufficiency of the central nervous system (MMD), accented character traits identified in 200 (90.9%) cases - mostly emotionally labile (52), hysteria (45), labile-hysterical (38 ) and sensitive (31).
The most represented were from psychosocial factors, pathology education - in 117 (53.2%) cases, the presence of brothers and sisters - in 77 (35%), psycho-emotional overload - in 36 (16.4%), incomplete3 family - in 34 (15.5%), visiting child care centers - in 31 (14.1%), family conflicts - in 29 (13.2%) and the death of parents, relatives - in 21 (9.5% ) case.
As the genetic factors that influence the occurrence of psychosomatic disorders revealed: in 31 (14.1%) case of family history (in 22 (10%) non-psychotic mental disorders, and 9 (4.1%), psychotic character). Psychosomatic illness in the immediate family observed in 106 (48.2%) patients, 60 (27.3%) of these pathology of the gastrointestinal tract. In 114 (51.8%) of parents revealed pathological personality traits.
Paraclinical examination: fibroezofagogastroduodenoskopiya (FEGDS) in 136 (84.5%) of children and adolescents from 161 to identify the different pathology - antrumgastrit, bulbit, duodenitis (43), gastroduodenitis (32), antrumgastrit (14), gastritis (10), peptic ulcer disease 12 duodenum (7) etc .; sigmoidoscopy (PPC) in 16 (88.9%) of 18 cases of established Proctosigmoiditis; fibrocolonoscopy (FCC) in all 8 cases - colitis. Ultrasonography (ultrasound) in 186 (94.4%) of the 197 surveyed noted changes in the gastrointestinal tract - reactive pancreatitis (64), biliary dyskinesia (54), a combination of these disorders (33), etc.
A study of the autonomic nervous system via cardiointervalography (CIG) held 152 patients, established the predominance of parasympathetic autonomic nervous system in 112 (73.7%) patients, and sympathetic - in 29 (19.1%), whereas the normal homeostasis marked only 11 (7.2%) patients with gipersimpatocheskoy - 71 (46.7%) cases, the sympathetic - 55 (36.2%), asimpaticheskoy - 21 (13.8%) and normal - 5 (3.3%) autonomic reactivity.
Experimental psychological tests using proektivnyh Ch.D.Spilbergera, JL Hanin and Lusher all surveyed revealed the average level of situational anxiety (average - 39.2) and high trait anxiety (average - 50.9), low mood and accentuated personality traits.
The above-described disorders were diagnosed as chronic gastroduodenitis (65 patients), biliary dyskinesia (20), gastroduodenitis (15), duodenal ulcer (15), gastritis (12), dolichosigma (8), malsorbtsii syndrome (7), gastroholepatiya (7 ) etc. Based on the qualitative features, severity and duration of the existence of clinical manifestations of gastrointestinal disorders marked psychosomatic reactions (90 cases), the state (115) and psychosomatic disorders (15 cases).
In all patients with digestive system disorders neurotic depressive symptoms levels were identified. In 208 (94.5%) cases mild (subdepression - 201 cases, latent depression - 7) and 12 (5.5%) expressed medium (dysthymia and dysphoria). In 134 children depressive disorders of various origins determined the clinical picture of psychopathological conditions, 86 were in the structure of other borderline mental diseases.
Clinical and psychopathological analysis of the affective (depressive) displays allowed on the basis of the prevailing passion highlight the following typological variants of depression: asthenic, anxious, melancholy and mixed (astenotrevozhny and anxious and dreary).
The majority of patients (97) had a disturbing version of the depression in which mood was defined as decreased with a sense of inner tension, anxiety, restlessness, most often in the evenings, with restlessness, excessive motor, chaotic activity. Grimace of discontent, sadness, fear, crying often replaced in a short time. We are normal or slightly accelerated. Sometimes patients spontaneously expressed concern for life when tapped rasprosy fear of death, fear for the lives of family members. Less common asthenia (53) variant of depression with lethargy, weakness, easy fatigue, exhaustion, reluctance to do anything, complaining of boredom, sadness. Very rarely (8) To identify dreary depression was more expressive. Patients more inhibited, often crouching posture, face amimichno, look old, pale gray skin. Voice quiet, sometimes fading to a plaintive, pleading intonations. Usually complained of boredom, feelings of depression, sadness, sadness, sometimes the lack of joy in life, dislike relatives, expressed ideas of inferiority. Daily mood swings are not expressed - "always bad", but in the evening increased motor activity and facial expressions became more lively. Occasional marked insomnia. Mixed variant of depression (62 cases) included along with other gipotimiey unspoken affective symptoms. By a slight predominance of affect could be isolated astenotrevozhny (51) and anxiety and melancholy (11) type.
In the vast majority of cases (162) depression was psychogenic (reactive) origin, in 47 somatogenic (residual-organic), and only 11 cases of endogenous.
Since basically psychosomatic disorders have emotional (depressive) disorder, leading position in the treatment of patients took antidepressants, and drugs having antidepressive action oriented.
When asthenic and dreary depression in children up to 7 years were used herbal drugs have antidepressant action: Eleutherococcus extract, tincture devil, lemongrass, at age doses - 1 drop per year of life in the morning and in the afternoon, with the addition of newly-Passito in half or age (1 drop per year of life) doses 3 times a day. When the low efficiency of these funds were added to the treatment or antidepressants azafen pirazidol to 25 - 50 mg per day. At older (7 - 9 years) were used age, basically, the following drugs: azafen to 100 mg, and 50 mg pirazidol amitriptyline to 25 mg per day, usually in combination with herbal remedies. At the age of 10 to 15 years, taking into account the severity of depression were used especially dreary Melipraminum to 25 - 50 mg, pirazidol to 75 - 100 mg, azafen to 150 mg amitriptyline and 50 mg per day. In order to enhance the antidepressant effect and better tolerability of the treatment prescribed nootropics - nootropil (piracetam), piriditol, Sermion.