Aspetti psicologici della prostatite

PSYICHOLOGICAL ASPECTS OF PROSTATITIS Prof. ALESSANDRO NATALI Responsabile Servizio di Andrologia Urologica Clinica Urologica I UniversitĂ degli Studi di Firenze

CHRONIC PROSTATITIS Psychological aspects

¾ ¾ PAIN PAIN ¾ ¾ LOWER LOWER URINARY URINARY TRACT TRACT SYMPTOMS SYMPTOMS ¾ ¾ SEXUAL SEXUAL DYSFUNCTIONS DYSFUNCTIONS

•• serious serious difficulty difficulty in in concentration concentration •• interference interference with with work work activities activities •• limited limited social social life life with with resulting resulting loss loss of of interests interests •• inexistent inexistent or or limited limited sexual sexual activity activity

CHRONIC PROSTATITIS Impact on daily life 他 他 Sexual Sexual dysfunction dysfunction -- 52% 52% total total or or periodic periodic impotence impotence or or decreased decreased libido libido (Keltikangas-Jarvinen (Keltikangas-Jarvinen LL et et al, al, 1981) 1981)

-- 45% 45% exacerbation exacerbation of of pain pain during during or or after after intercourse intercourse (Egan (Egan KJ KJ et et al, al, 1994) 1994)

-- 19% 19% erectile erectile deficiency, deficiency, 28.4% 28.4% ejaculatio ejaculatio praecox, praecox, 33.5% (Rizzo M M et et al, al, 2003) 2003) 33.5% pain pain or or discomfort discomfort at at the the penis penis (Rizzo

他 他 Absence Absence from from work work -- 46% 46% of of patients patients had had missed missed some some work work because because of of this this disease disease (Alexander (Alexander RB RB et et al, al, 1996) 1996) -- 15% 15% of of patients patients absents absents from from work work because because of of the the actual actual prostatitis; prostatitis; mean mean absence: absence: 7.6 7.6 days days (range (range 1-60) 1-60) (Rizzo (Rizzo M M et et al, al, 2003) 2003)

CHRONIC PROSTATITIS Psychological aspects

¾ ¾ Symptoms’ Symptoms’ characteristics characteristics ¾ ¾ Irritating Irritating tendency tendency to to suffer suffer from from relapse relapse ¾ ¾ Poor Poor response response to to therapy therapy

Quality Quality of of life life similar similar to to that that of of patients patients suffering suffering from from recent recent miocardial miocardial infarction, infarction, unstable unstable angina angina or or active active Crohn’s Crohn’s disease disease (Wenninger (Wenninger KK et et al, al, 1996; 1996; McNaughton-Collins McNaughton-Collins et et al, al, 2000) 2000)

CHRONIC PROSTATITIS Psychological aspects

¾ ¾ Symptoms’ Symptoms’ characteristics characteristics ¾ ¾ Irritating Irritating tendency tendency to to suffer suffer from from relapse relapse ¾ ¾ Poor Poor response response to to therapy therapy ** Frequently Frequently psychiatric psychiatric disorders disorders coexist coexist with with CP/CPPS, CP/CPPS, but but the the assessment assessment of of their their relative relative contribution contribution and and causal causal role role is is not not often often feasible feasible ** In In more more than than 60% 60% of of patients patients with with chronic chronic prostatitis prostatitis there there are are also also psycological psycological or or depressive depressive problems problems up up to to aa certain certain point point (Keltikangas-Jarvinen (Keltikangas-Jarvinen LL et et al, al, 1981; 1981; Egan Egan KJ KJ et etal, al, 1994; 1994; Krieger Krieger JN JN et et al, al, 1996; 1996; Drabick Drabick JJ JJ et et al., al., 1997) 1997)

CHRONIC PROSTATITIS Psychological aspects ¾ ¾ 1832 1832 patients patients ¾ ¾ Fear Fear of of undetected undetected prostate prostate cancer cancer or or of of having having aa sexual sexual transmitted transmitted disease disease and and suicidal suicidal tendencies tendencies are are significatively significatively more more common common in in patients patients with with aa history history of of C.P./C.P.P.S. C.P./C.P.P.S. ¾ ¾ Erectile Erectile dysfunction: dysfunction: 43% 43% ¾ ¾ Decreased Decreased libido: libido: 24% 24% ¾ ¾ Marital Marital difficulties: difficulties: 17% 17% ¾ ¾ Higher Higher tendency tendency towards towards suffering suffering from from anxiety, anxiety, worry worry and and nerves nerves (Mehik (Mehik A. A. et et al., al., BJU BJU 2001) 2001)

CHRONIC PROSTATITIS Personality pathology ¾ ¾ Psychologic Psychologic factors factors have have been been considered considered to to play play an an important important role role in in the the etiology etiology of of CP/CPPS CP/CPPS and and aa variety variety of of psychopathological psychopathological findings findings is is described: described: depression, depression, anxiety anxiety and and hypocondriasis, hypocondriasis, identity identity disorders, disorders, hysteria, hysteria, others. others. ¾ ¾ It It is is suggested suggested aa certain certain etiological etiological role role of of psychic psychic factors factors in in CP/CPPS, CP/CPPS, but but itit ss not not proved proved whether whether CP/CPPS CP/CPPS symptoms symptoms lead lead to to psychiatric psychiatric disease disease or or whether whether psychiatric psychiatric disease disease leads leads to to worse worse CP/CPPS CP/CPPS symptoms symptoms ¾ ¾ It It is is impossible impossible to to conclude conclude that that there there are are personality personality variables variables that that specifically specifically identify identify the the CP CP patients patients (Keltikangas-Jarvinen (Keltikangas-Jarvinen LL et et al, al, 1981; 1981; Nickel Nickel JC, JC, 2003; 2003; McNaughton McNaughton Collins Collins M M et et al., al., 2003; 2003; Ku Ku JH JH et et al., al., 2005) 2005)

CHRONIC PROSTATITIS Psychological aspects

他 他 Functional Functional somatic somatic syndromes syndromes were were found found in in 65.1% 65.1% of of CP/CPPS CP/CPPS patients patients :: irritable irritable bowel bowel syndrome syndrome (35%), (35%), chronic chronic headache headache (36%), (36%), fibromyalgia fibromyalgia (5%) (5%) and and non non specific specific rheumatogic rheumatogic an an dermatologic dermatologic symptoms symptoms (25%) (25%) (Potts (Potts JM JM et et al, al, 2001) 2001) 他 他 Psychological Psychological stress stress has has been been shown shown to to be be aa precipitating precipitating or or exacerbating exacerbating factor factor in in CP/CPPS CP/CPPS (Mehik (Mehik et et al, al, 2001) 2001)

CHRONIC PROSTATITIS Psychological aspects LONG-TERM LONG-TERM STRESS STRESS SYNDROME SYNDROME ¾ ¾ Persistence Persistence of of stress stress agents agents (complaints) (complaints) despite despite all all treatments treatments ¾ ¾ Patients Patients are are dissatisfied dissatisfied and and unhappy, unhappy, often often discouraged: discouraged: in in addition addition is is feeling feeling tired, tired, ill, ill, impotent. impotent. AA feeling feeling of of non non being being given given consideration consideration and and care, care, as as well well as as the the fear fear of of having having aa malignant malignant disease disease

DEPRESSION DEPRESSION –– MOODS MOODS OF OF DEPRESSION DEPRESSION

CHRONIC PROSTATITIS Psychological aspects ¾ ¾ Chronic Chronic pain pain causes causes somatization somatization and and consequently consequently feelings feelings of of dependency dependency and and vulnerability vulnerability ¾ ¾ Patients Patients need need to to be be frequently frequently reassured reassured ¾ ¾ Frequent Frequent beginning beginning of of aa vicious vicious circle: circle: chronic chronic stress stress may may cause cause organic organic changes changes in in certain certain biological biological systems, systems, which, which, in in their their turn, turn, may may condition condition the the psycho-emotional psycho-emotional status status of of the the individual individual

Importance Importance of of aa multidisciplinary multidisciplinary approach, approach, which which includes includes an an intensive intensive psycological psycological support support for for these these frustrated frustrated and and frustrating frustrating patients patients (Keltikangas-Jarvinen (Keltikangas-Jarvinen et et al., al., 1989; 1989; Egan Egan KJ, KJ, Krieger Krieger JL, JL, 1997).

1997).

CHRONIC PROSTATITIS (CP/CPPS)

UROLOGIST

PSYCHOLOGIST

MULTIDISCIPLINARY APPROACH SEXUOLOGIST

REABILITATION PHYSICIAN

COLONPROCTOLOGIST PAIN THERAPIST

URETHRAL/PERINEAL CHRONIC PAIN Need of a multidisciplinary approach UROLOGIST UROLOGIST •• Traditional Traditional pharmacological pharmacological therapy therapy •• Topical Topical therapy therapy •• Anaesthetic Anaesthetic block block PSYCOLOGIST PSYCOLOGIST •• Psycholoical Psycholoical evaluation evaluation of of the the patient patient •• Pharmacological Pharmacological therapy therapy (psychotropic (psychotropic drugs) drugs) •• Psychoanalitical Psychoanalitical and and behavioural behavioural therapies therapies NURSING NURSING •• Home Home support support •• Coordination Coordination of of therapies therapies offerd offerd by by other other specialists specialists SOCIAL SOCIAL ASSISTANCE ASSISTANCE •• Rehabilitation Rehabilitation of of patient patient in in home home and and working working environments environments PHARMACOLOGIST PHARMACOLOGIST •• Evaluation Evaluation of of correct correct pharmacological pharmacological treatment treatment •• Suggestions Suggestions as as to to experimental experimental therapy therapy in in clinical clinical phase phase

CHRONIC PROSTATITIS Psychological support THE THE CONTRIBUTION CONTRIBUTION OF OF THE THE PSYCHOLOGIST PSYCHOLOGIST ¾ ¾ Frequently Frequently the the patient patient arrives arrives at at the the psychological psychological consultation consultation at at the the end end of of aa tiring tiring and and unsuccessfull unsuccessfull clinical clinical course course of of treatment treatment ¾ ¾ The The patient patient experiences experiences this this as as aa failure failure to to offer offer aa medical medical explanation explanation ¾ ¾ Importance Importance of of the the preventive preventive phase phase in in the the beginning beginning of of the the illness illness with with accurate accurate details details of of each each case case history history and and psycodiagnostic psycodiagnostic organization organization Clarify Clarify the the psychic psychic components components of of the the patient patient in in the the face face of of his his experience experience of of pain pain

CHRONIC PROSTATITIS Psychological support THE THE CONTRIBUTION CONTRIBUTION OF OF THE THE PSICOLOGIST PSICOLOGIST ¾ ¾ Knowledge Knowledge of of psychological psychological mechanisms mechanisms che che that that regulate regulate pain pain perception perception

¾ ¾ Patients Patients should should be be guided guided in in their their understanding understanding of of the the interrelation interrelation of of psychological psychological factors factors and and physical physical symptoms symptoms ¾ ¾ Educate Educate the the patients patients about about coping coping with with distress distress and and pain pain (behavioral (behavioral modifications) modifications) ¾ ¾ Antistress Antistress therapies therapies

CONCLUSIONS - I ¾ ¾ Patients Patients with with CP/CPPS CP/CPPS have have recurrent recurrent physical physical symptoms symptoms but but also also many many psychological psychological problems. problems. ¾The ¾The possible possible contribution contribution of of psychological psychological factors factors has has been been considered considered to to play play an an important important role role in in CP/CPPS CP/CPPS ¾ ¾ However However the the incidence, incidence, nature nature and and importance importance of this psychopathology are largely of this psychopathology are largely underdetermined underdetermined ¾ ¾ Similar Similar to to what what is is often often observed observed in in other other pain pain syndromes, syndromes, physical physical disease disease and and psychiatric psychiatric disorders disorders coexist coexist and and the the assessment assessment of of their their relative relative contribution contribution is is often often not not feasible. feasible.

CONCLUSIONS - II

¾ ¾ CP/CPPS CP/CPPS symptoms symptoms have have aa clear clear negative negative impact impact on on the the daily daily lives lives and and relationships relationships of of these these patients patients (sexual (sexual life, life, work) work) ¾ ¾ Psychosocial Psychosocial factors factors cannot cannot be be overlooked overlooked when when evaluating evaluating patients patients with with CP/CPPS, CP/CPPS, avoiding avoiding trapping trapping patients patients with with diagnoses diagnoses that that would would imply imply aa nonphysiologic nonphysiologic basis basis for for their their symptoms symptoms ¾ ¾ Similar Similar in in other other chronic chronic pain pain syndromes, syndromes, aa multidisciplinary multidisciplinary approach approach is is recommended recommended ¾ ¾ Several Several studies studies indicate indicate aa strong strong need need for for psychic psychic support support of of patients patients with with CP/CPPS. CP/CPPS.