Relevance. Informing patients about the carriage of a pathogenic mutation may result in a psychologically traumatizing situation, characterized by acute stress reactions, post-traumatic stress disorder symptoms, or anxiety-depressive disorder. This highlights the importance of psychological counseling.Objective. To investigate the effectiveness of psychological support in a patient with mutations in genes associated with hereditary breast cancer.Materials and methods. Description of patient's medical history and results of instrumental psychological diagnosis after identifying a pathogenic mutation in the CHEK2 gene, which increases a risk of developing breast cancer to 20–40 % via genetic testing.Results. The nature of emotional response in this case is determined by personal history — identification of ideas about one's possible disease with mother's one. The conducted psychological consultations mitigated acute stress reactions and minimized the perception of received genetic information as a psychologically traumatic event. Furthermore, significant positive shifts were observed in the formation of adaptive stresscoping strategies, awareness of one's own mental resources, and reinforcement of adherence to the dynamic observation plan.Conclusion: Patients in situations involving the identification of mutations in genes associated with hereditary breast cancer require a personalized approach. Development of criteria for psychological support should be aimed at improving patients' quality of life not only in the immediate aftermath of information disclosure but also in the long term.

The article deals with diseases of the digestive system, pathogenetically associated with obesity; presents a description of the two most common bariatric surgeries at present, with an emphasis on changes in the gastrointestinal tract in the postoperative period

The article discusses the spectrum of the mental disorders that are potentially possible in obese patients, when they seek metabolic surgery; the personal characteristics of this category of patients are examined in detail, as well as questions of the motive and the purpose of the operation in terms of the degree of awareness of the decision made

AIM To comparatively analyze clinical manifestations in patients with primary esophageal spasm (ES) and its concurrence with gastroesophageal reflux disease (GERD) and the results of their instrumental examinations and psychodiagnostic tests. SUBJECTS AND METHODS A total of 104 patients with the clinical and manometric signs of ES were examined and divided into two groups: 1) 42 patients with primary ES; 2) 62 patients with ES concurrent with GERD. The examination encompassed esophageal manometry, esophagogastroduodenoscopy, 24-hour pH metry, and an interview using a questionnaire to identify autonomic disorders, and the Mini-Mult test. RESULTS The patients with primary ES compared to those with ES concurrent with GERD significantly more frequently showed severe pain syndrome (p = 0.009) and a paradoxical dysphagia pattern (p = 0.03); manometry revealed an incoordination in the motility of the entire esophagus (p = 0.001). Comparison of the statistical series of values for contraction amplitude and duration in the distal esophagus found no significant difference in the patients of both groups. Autonomic disturbances were detected in 76.0% of the patients with ES; but the intergroup differences were insignificant. Mental maladaptation was observed in 81.7% of the patients in the absence of intergroup differences. CONCLUSION The etiopathogenetic factor of ES is a psychoautonomic response to chronic stress in both primary ES and its concurrence with GERD. The reflux of gastric contents into the esophagus does not appear to be one of the leading causes of ES. In primary ES, esophageal motor function is generally impaired to a much greater extent than that in ES concurrent with GERD. The degree of motor disorders is embodied in the specific clinical features of the disease.

In the presented clinical case the theme of the need for an integrated therapeutic intervention has been disclosed, including nutritional support on the various links of the pathogenesis of esophagospasm to the effectiveness of the patient's treatment.

In the presented clinical case the theme of the need for an integrated therapeutic intervention has been disclosed, including nutritional support on the various links of the pathogenesis of esophagospasm to the effectiveness of the patient's treatment.

THE PURPOSE OF THE STUDY:To evaluate the degree of adherence to treatment in comparison with the psychological reactions to the disease in patients with chronic diseases of the digestive system.MATERIAL AND METHODS:We examined 106 patients with chronic diseases of the upper gastrointestinal tract. Psychological reactions to the disease were studied using personality questionnaires of the Bekhterev Institute (the St. Petersburg V.M. Bekhterev Psychoneurological Research Institute), adherence to treatment--using a specially designed questionnaire. 52 patients were polled again at 6 months after discharge from hospital.RESULTS:High adherence was diagnosed in 47.2%, satisfactory--in 44.3%, and lower--in 8.5% of cases. Hypernosognosia reaction to the disease in patients with low levels of compliance were more frequent than in patients with a high level of compliance (77.8 and 12.0%, respectively). The obtained result suggests that excessive emotional tension, high levels of anxiety and the stress response prevent adequate inclusion of patients in the treatment process. A similar situation persists in 6 months after discharge from hospital. This is confirmed by clinical observations indicating that this type of reaction to a disease peculiar to the mature person who knows how to extract the experience of adverse life situations.CONCLUSIONS:The results confirm the absence of an adequate level of adherence to treatment in patients with chronic diseases of the digestive system. In particular this applies to patients with inadequate emotional response to diseases. In this regard, in terms of improving adherence increases the importance of timely diagnosis of anxiety and depression with subsequent correction of the violations.

The aim of the work was to evaluate the esophageal motility in patients after distal gastrectomy of different sizes. It was found that in patients after gastrectomy with erosive and ulcerative lesions of the esophagus innofective esophageal motility often registered and this correlates with the reduction clearance indicator of the esophagus according to the pH-impedance monitoring.

Aim. The aim of the study was to determine causes of proton pump inhibitors. (PPIs) inefficacy in some patients suffering from gastroesophageal reflux disease (GERD). Material and methods. In our study of 154 GERD patients, 50 received omeprazole. 51 - lansoprazole and 53 - pantoprazole in a standard daily dose. GERD symptoms (heartburn and regurgitation) were scored by Likert scale: the patients' quality of life (SF-36) and their mental status (SMALL) were examined. Upper gastrointestinal endoscopy. 24-h intraesophageal pH monitoring, esophageal manometry and pharmacokinetic study were performed. Results. The treatment with a standard dose of PPIs was ineffective in 21 (13.6%) patients. Causes of PPIs inefficacy in 4.5% patients were rapid PPI metabolism and in 9.1% - "driving gear" of symptoms formation related with psychic dysadaptation.

The aim of the work was to evaluate the esophageal motility in patients after distal gastrectomy of different sizes. It was found that in patients after gastrectomy with erosive and ulcerative lesions of the esophagus innofective esophageal motility often registered and this correlates with the reduction clearance indicator of the esophagus according to the pH-impedance monitoring.

The purpose of this study was to increase the effectiveness of tobacco control by improving the treatment of tobacco dependence. The article presents the data results of different methods of treatments of tobacco dependence among 135 patients with digestive diseases. As the most effective is a comprehensive approach combining psychotherapy and physiotherapy methods is designated. The possible reasons of due treatment effect absence are separately analysed: a sharp severity of tobacco withdrawal syndrome, inadequate primary motivation of smoking refusal, premorbid personality characteristics, a pathological variant of response to disease.

The purpose of this study was to increase the effectiveness of tobacco control by improving the treatment of tobacco dependence. The article presents the data results of different methods of treatments of tobacco dependence among 135 patients with digestive diseases. As the most effective is a comprehensive approach combining psychotherapy and physiotherapy methods is designated. The possible reasons of due treatment effect absence are separately analysed: a sharp severity of tobacco withdrawal syndrome, inadequate primary motivation of smoking refusal, premorbid personality characteristics, a pathological variant of response to disease.

The purpose of study is to expand notions of personal factors of adherence to treatment chronic diseases of digestive system. The article presents data on the patients accuracy of performing medical recommendations on pre-hospital and in the delayed period. Analyzed the influence of socio-demographic characteristics (gender, age, educational level), the characteristics of the disease (duration of history, the frequency of hospitalizations, complications) to the compliance of patients. The psychological aspect of the formation of adherence to treatment was considered in the interactions of personality and disease. Was underlined the role of the doctor's deontological work aimed on the involving of the personality of patient in therapeutic process as an active subject of the therapeutic interaction.