PSYCHOLOGICAL FEATURES OF THE REHABILITATION OF PERSONS WITH UROLITHIASIS.

Abstract

Introduction: Urolithiasis, a common and painful condition, is influenced by various risk factors and can be mitigated through preventive measures and can be a painful condition associated with significant individual and health care burdens. For many, urolithiasis is a chronic disease, and chronic diseases are known to have a significant impact on the quality of life of the sufferers with development anxiety and depression. The goal of research was study of depression and anxiety level to develop and test a complex of psychological interventions in the system of psychosocial assistance of patients with urolithiasis.

Material and methods: The study included 134 patients (men - 74, women - 60) with non-obstructive stones of the renal pelvis who obtained prescription for uteroscopic lithotripsy or percutaneous nephrolithotripsy and psychological help was suggested. All patients were referred by complex team of specialists with including urologist and psychologists; such methodology was used as clinical and anamnestic method; to assess the presence of depression in patients, the Montgomery-Asberg Depression Rating Scale (MADRS) and GAD-7 scale were used.

Results: The signs of depression, psychoemotional disorders and of social maladaptation were evenly estimated in patients with urolithiasis as refusal to communicate, the reaction of "denying the diagnosis", irritability, increased aggressiveness, resigned from work immediately after the diagnosis. Signs of depression had tendency to increase before urological procedure and evenly reduced after performing in patients who refuse psychological assistance. The patients who receive psychological help are characterized by significant reducing signs of depression even before procedure. During the debriefing, the patients of that group were more actively interested in finding ways to solve both difficult everyday situations and problems related to the loss of health. Best psychological condition was established after performing procedure that could be explained escaping from expectation of possible complications in procedure. No one patient with severe level of depression was observed in one day after procedure. Similar picture was estimated and for anxiety dynamic. But absence of patients with high level of anxiety was found only for patients who obtained psychological assistance. Simultaneously there wasn't a close correlation between indicators of depression and anxiety (r=0.53).

Conclusions: Majority of people who endured urolithiasis have initial mild level of depression (average MADRS about 24 points) and medium level of anxiety (average GAD-7 about 11.5 points). Psychological assistance could reduce it till 10.21±2.03 and 7.88±0.53 accordingly. The data obtained in the course of the work testify to the effectiveness of conducting a complex of psychotherapeutic interventions using cognitive training, cognitive-behavioral psychotherapy in the system of psychosocial rehabilitation. Results provide critical information on the efficacy of psychological rehabilitation for people who expected uteroscopic lithotripsy or percutaneous nephrolithotripsy.