On the Problem of the Efficacy of Psychotherapy in Diabetic Foot Ulcer Patients

摘要

Introduction: It is known that patients suffering from diabetes and its complications have expressed psycho-emotional disorders that worsen the disease's prognosis and quality of patients life and require appropriate correction. However, the efficacy of psychotherapy in these patients is often low and depends on various factors, among which the severity of psychosomatic disorders are probably important. The aim of the study was to investigate the psychological and somatic disorders affecting the choice of psychotherapeutic methods and its results. Methods: The levels of anxiety, depression, alexithymia, emotional and cognitive intelligence, personality type, and also the concentration of glycated hemoglobin, severity of cardiovascular and neuro-angiopathic violations were determined in 120 diabetic foot ulcer patients at the age of 43 to 73 years. Results: The study revealed two main groups of patients with varying degrees of severity of psychosomatic disorders. In the first group of patients there was observed a high level of depression, alexithymia, psychopathic personality type, combined with deep encephalopathy, cognitive disorders and long duration of disease (more than 15 years). Expressed metabolic, cardiovascular, neuropathic disorders and a large number of lower limb amputations were observed also in this group of patients. In the second group there were small or no depression, enough emotional and cognitive intelligence, neuropathic type of person, less impaired somatic condition and high motivation for psychotherapy. All patients obtained autogenic relaxation sessions. The first group of patients recieved supplemental antidepressants, the second group of patients - CBT therapy. Satisfactory efficacy of this treatment was observed in approximately 40% patients in the first group and 70% - in the second group. Conclusions: The study identified two main groups of patients with varying degree psychosomatic disorders which suggest different therapeutic approaches to increase efficacy.