精神疾病和精神健康不孕妇女的心身相关性

A. O. Nikolaevskaya, N. A. Tyuvina, V. Morozova, E. P. Kesler
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摘要

妇女的精神状态对其生殖功能的影响问题尚未得到充分解决,需要进一步研究。目的:比较评价精神健康和精神疾病不孕妇女月经和生殖功能单项指标。材料和方法。我们研究了348名年龄在21至40岁之间的原发性和继发性不孕症女性,其中120人在本研究之前曾在精神病院接受过精神障碍治疗。采用专门设计的问卷卡,采用临床方法对患者进行病情评估。研究组患者生殖功能在多个指标上存在显著差异。精神疾病女性原发不孕症的特点是:月经来潮晚,月经少或多(p<0.05),疾病加重期月经不规律或无月经,月经来潮情绪反应不足(p<0.05),性生活不规律,对性生活不满(p<0.01)。自然流产和死产在精神病妇女中更为常见,特别是在患有内源性疾病(精神分裂症、情感性疾病)的妇女中,而堕胎和妇科手术在精神健康妇女中更为常见(p<0.001)。在精神健康方面,不孕症的预测因素是精神疾病的早期发病和慢性病程、疾病恶化的严重程度和持续时间、短暂和不完全缓解、人格改变的发展或精神疾病导致的缺陷(精神分裂症)。女性的月经和生殖功能取决于她们的精神状态。在患有精神障碍的妇女中,月经功能障碍连同疾病的精神病理症状(性欲减退、沟通能力下降、情绪麻木)、社会和家庭适应能力下降导致生殖功能受损。
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Psychosomatic correlations in mentally ill and mentally healthy women with infertility
The issue of the influence of women's mental state on their reproductive function has not been adequately addressed and requires further research.Objective: a comparative evaluation of individual indicators of menstrual and reproductive function in mentally healthy and mentally ill women with infertility.Material and methods. We studied 348 women aged 21 to 40 years with primary and secondary infertility, 120 of whom had been treated for a mental disorder in a psychiatric hospital prior to the present study. The patients' condition was assessed by a clinical method using a specially designed questionnaire card.Results. Reproductive function of patients in the studied groups differed significantly in several indicators. Mentally ill women with primary infertility are characterized by the following features: later onset of menstruation, scanty or heavy menstrual flow (p<0.05), irregularity or absence of menstruation during the period of exacerbation of the disease, insufficient emotional response to menarche (p<0.05), irregularity of sexual life and dissatisfaction with it (p<0.01). Spontaneous miscarriages and stillbirth occurred more frequently in mentally ill women, especially in women with endogenous disorders (schizophrenia, affective disorders), while abortions and gynecological surgeries were more frequent in mentally healthy women (p<0.001). Predictors of infertility on the part of mental health are the early onset and chronic course of a mental disorder, the severity and duration of an exacerbation of the illness, brief and incomplete remissions, the development of personality changes or a defect (schizophrenic) as a result of a mental illness.Conclusion. Menstrual and reproductive functions of women depend on their mental state. In women with mental disorders, menstrual dysfunction together with psychopathological symptoms of illness (decrease in libido, communication, emotional numbness), decrease in social and family adaptation leads to impairment of reproductive function.
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