GENDER FEATURES IN THE TREATMENT OF SOMATOFORM DISORDES

G.G. Beskrovny, G.N.Khandourina
Khabarovsk, Russia

Over the last years a considerable interest has arisen to various pseudosomatic disorders because of their increasing prevalence in patients of general medical 1 settings.
In the medical practice of general hospitels there is a special sort of patients whose affectiv disturbances are subclinically manifested as asthenic, anxiety, depressive, asthenodepressive and hypochondriac ones. At the same time physical complaints predominate.
In compliance with ICD-I0 the disorders observed can be qualified as affective (cyclothimia, dysthymia) disorders, adaptation impairment, anxiety , conversion and somatoform (somatization, hypochondriac and pain) disorders. A lot of investigators have noticed its high comorbidity.
Inaccurate prompt diagnosis of somatic problems by therapeutists unable to manage psychosomatic desorders results in the chronic course of the disease, the administration of unreasonable hard-to perform investigations and expensive charges for treatment. Further, the primary disorder accompanied by iatrogenic anxieties leads to long-term disability.
Such patiets fail to respond to treatment either at the mentel hospitels or specialized somatic centers. They need specific health care. To get a beneficial effect it is reasonable to combine drug therapy and profound psychotherapy.
Over the last 12 years we have deen managing patients with somatoform disorders in general hospital. They are mainly females of middle age. The majority of the patients have middle or liw social status.
Despite various clinical manifestations the majority of the disordes are of reactive (psyhogenic) character. However, the patients are unable to recognize the true causes of their disturbances; consequently, the real causes are not adequately responded to. The reactive character of the clinical presentation of the disease resembles just a reflexive response to a stressful situation. This mechanism seems to be close to "reflex arch" term. The fixation of the disturbances is likely to result from minor degree of socialization in this type of pations, insufficient self-comprehension and self-regulation skills such as autogenic training and meditation techniques.
Along with drug therapy modified narcopsyhotherapy sessions aimed at motivation such as autogenic training and meditation techniques, activation to change the situation and leave the patient,s status were performed.
The state of trance coused purposely with medication enables the patient to feel his own resource. Getting beyond the limits of common consciousness inhibits the left hemisphere where logic and estimation predominate. A woman faced to live in compliance with males, logic regulations is unable to solve her problems with reasonable means. Gaining access to the right hemisphere known for its intuition. It is possible to change the scale of values. The work with active imagination enables the patients to experience inner phenomena at fantasy level, to comprehend the symbolic sense of the symptom, "the vital scenario" (E.Bern). The sense of safety and altered world outlook give new perspectives to solving existencial problems and putting forward definite goals.
What is the sanogenic mechanism of simbolic virtual examination of the problem situation? Whether it is insight, catharsis, reframing or behevioral investigation is not clear. However, an altered mind is of benefit in breaking emotional set capsule, that makes these emotions more accessible to both the patient and the therapeutist. An altered mind allows these emotions to be taken as a bridge to a real life.