The role of anxiety, depression, and psychological stress on the clinical status of recurrent aphthous stomatitis and oral lichen planus.

BACKGROUND: In spite of all the efforts, recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP) still have unexplained etiology. The role of anxiety, depression, and psychological stress in occurrence and intensity of symptoms in RAS and OLP patients has been investigated in this study. METHODS: A total of 110 patients with RAS in the acute phase and 112 patients with OLP also in acute phase participated in this study. All patients filled out questionnaires related to the primary disease (RAS/OLP) after which they took the following psychological tests: Beck Depression Inventory (BDI), The State-Trait Anxiety Inventory (STAI), and Ways of Coping Questionnaire (WCQ). RESULTS: According to multiple regression analysis, in patients with RAS, the highest correlation was found between results of the pain intensity and STAI test (ß= 0.66; p < 0.000). In the patients with OLP, the highest correlation was found between the level of hyperkeratosis and WCQ test (ß = 0.53; P < 0.000), inflammation and results of BDI test (ß = 0.33; P < 0.002), and results of dynia test and STAI test (ß = 0.31; P < 0.004). CONCLUSIONS: In this study, a high correlation between anxiety, depression, and psychological stress with symptoms of RAS and OLP has been observed.

The impact of psychological testing on the patients suffering from stomatopyrosis.

Stomatopyrosis is commonly associated with stressful situations, which implies the importance of psychological conditions of the patients with this symptom. Patients suffering from burning mouth syndrome suffered from some psychical disturbances as well. The fact that depression and anxiety are closely connected with stomatopyrosis has been scientifically confirmed. The data which systematically led to this conclusion suggest the possibility of the existence of a psychogenic disturbance as an aetiological factor which leads to stomatopyrosis. Research which might be conducted in order to relate psychogenic disturbances with stomatopyrosis by means of various drugs and procedures, might provide an insight into the relatedness of these factors, which would enable us to treat the cause and not the consequence. This research has been directed towards establishing this "relatedness" by means of psychopharmatics and psychotherapy, and has been confirmed by means of psychological depression and anxiety tests. The research has been conducted on 120 respondents suffering from stomatopyrosis, who were also, as previously diagnosed, suffering from a psychical disturbance. The respondents were divided into 4 groups. Each group contained 30 respondents suffering from stomatopyrosis as the basic symptom, but with different psychogenic disturbances. These groups were: 1) antidepressants, 2) anxiolytics, 3) autogenic training and 4) control group. A detailed clinical and psychiatric check-up was conducted before the treatment started, and was repeated several times in different intervals: after a month, after two months and after four months. Respondents are still undergoing a therapy. Subjective assessment of the intensity of the burning sensation was obtained according to Visual analogue scale and two psychological questionnaires (depression test and anxiety test). Conclusion is: 1) Antidepressants and anxiolytic drugs have a prominent role in the treatment of stomatopyrosis. Psychological tests conducted after a four-month period have shown improvement--there was a decrease in anxiety--7.5%-8.8%, while depression has in some of the tested groups completely disappeared. At the same time, subjective evaluation of the intensity of the symptom has, according to VAS, showed a fall from 6.93-7.8 cm to 2.13-3.0 cm. At the beginning of the treatment, symptoms were described as "pretty often" with 36.7%-76.7% respondents, and as "permanent" with 23.3%-63.3% respondents. At the end of the treatment, the most frequent description regarding the frequency of the symptoms was "very rarely". 2) Autogenic training--psychotherapeutic anxiolytic technique--is the therapy of choice as far as stomatopyrosis is concerned, as it both eliminates the problems and emotionally rehabilitates the patient. 3) As far as the therapeutic progress is concerned, it can be taken as the "progress" of the time when the symptoms appear: during the treatment, the frequency and the duration of the symptoms have been shortened at night, while their occurrence during the day has been reported as relatively more frequent.

Lichen ruber planus as a psychiatric problem.

Our mouth is the mirror of our health and it might be said that numerous diseases which affect our organism may be manifested in the mouth. Early symptoms occurring within the oral cavity may emerge with diseases related to our blood system, gastrointestinal system, renal system, cardiovascular system, and mental system. They are manifested as a hyperkeratosis, which may have an erithematous background. What we talk about here is lichen ruber planus. Lichen ruber planus is a common chronic immunological inflammatory disease of mucosa and skin, whose manifestations vary from karatolytic to eritematous and ulcerating lesions. The most frequent psychogenic diseases which may lead to the emerging of lichen planus are depression, anxiety and stress. Depression is a condition of decreased psychophysical activity predominated by sadness, apathy and slowed-down pessimistic thinking. Anxiety is a complex feeling comprising anxiety, fear, tension and insecurity, and is accompanied by the activation of autonomic nervous system. Stress is a reaction to trauma, and it enhances survival.

Salivation quantum--stomatopyrosis--autogenic training.

Stomatopyrosis of 'burning mouth' syndrome, in a narrower sense of definition, is a condition characterized by sensation of burning and heating in mouth, despite its normal mucosa. This research has been directed towards treatment of stomatopyrosis, putting emphasis on the implementation of psychopharmacotherapy and psychotherapy. The research was conducted on altogether 120 respondents suffering from stomatopyrosis. The respondents were divided into two equal groups: each one comprising 60 members. All the respondents were treated by means of a standard topical therapy. All the patients were assessed clinically and by means of psychological tests measuring depression and anxiety four times: once before the treatment, after one month, after two months and after four months since the beginning of the treatment. The acquired data were afterwards statistically processed. When grading the symptoms on VAS, i.e. visual analogous scale, the subjective assessment of symptoms was marked as 7-8 cm, which shows a high degree of burning sensation. According to our study, the quantity of saliva, which was at the beginning of the research slightly decreased, normalized after the treatment. Apart from the clinical investigation of stomatopyrosis, we applied Depression and Anxiety questionnaires. On the basis of our research, we have concluded the following: the comorbidity of stomatopyrosis with the phenomena of anxiety and depression proves that, among other factors, there is a psychogenic aetiology of this disease. Autogenic training, which is a psychotherapeutic anxiolytic technique, is a therapy of choice for stomatopyrosis, which contributes not only to the elimination of oral complaints, but to the emotional rehabilitation of the patients as well, and to the reduction of dryness in the mouth.

Regression analysis of the symptoms.

Stomatopyrosis of 'burning mouth' syndrome, in a narrower sense of definition, is a condition characterized by sensation of burning and heating in mouth, despite its normal mucosa. This research has been directed towards treatment of stomatopyrosis, putting emphasis on the implementation of psychopharmacotherapy and psychotherapy. The research was conducted on altogether 120 respondents suffering from stomatopyrosis. The respondents were divided into two equal groups: each one comprising 60 members. All the respondents were treated by means of a standard topical therapy. All the patients were assessed clinically and by means of psychological tests measuring depression and anxiety four times: once before the treatment, after one month, after two months and after four months since the beginning of the treatment. The acquired data were afterwards statistically processed. Our research led to the conclusion that stomatopyrosis occurs with elderly people, primarily women. Regarding their occupation, majority of the respondents were clerks, followed by retirees. The burning sensation in mouth was present with all the respondents, the dominating site being the lips, while the nature of sensation was reported as mostly unbearable. Anxiety, tension and stress tend to aggravate the symptoms. When grading the symptoms on VAS, i.e. visual analogous scale, the subjective assessment of symptoms was marked as 7-8 cm, which shows a high degree of burning sensation. According to our study, the quantity of saliva, which was at the beginning of the research slightly decreased, normalized after the treatment. Apart from the clinical investigation of stomatopyrosis, we applied Depression and Anxiety questionnaires. During the therapy, the results of the depression test have shown a decrease in depression (from 56.7% to 0.00%), which is particularly apparent in the group treated by autogenic training and in the first group of respondents, i.e. the one treated with antidepressants. The Anxiety tests have shown a higher percentage and intensity of anxiety with men (62.5%, as opposed to women - 32.5%) in the beginning, which has dropped to 7.5% with men during the treatment and 8.8% with women. Clinical presentation of stomatopyrosis has also apparently improved. This improvement in clinical symptoms and psychological condition of patients is statistically significant. On the basis of our research, we have concluded the following: the comorbidity of stomatopyrosis with the phenomena of anxiety and depression proves that, among other factors, there is a psychogenic aetiology of this disease. Further research should provide answers to the questions whether stomatopyrosis is a psychosomatic or a conversive disorder Antidepressants and anxiolytics have an important role in the therapy of stomatopyrosis. Autogenic training, which is a psychotherapeutic anxiolytic technique, is a therapy of choice for stomatopyrosis, which contributes not only to the elimination of oral complaints, but to the emotional rehabilitation of the patients as well.

[Diagnostic and therapeutic guidelines for posttraumatic stress disorders]. / Dijagnosticke i terapijske smjernice za posttraumatski stresni poremecaj.

Posttraumatic stress disorder (PTSD) presents an important medical and social problem in the Republic of Croatia with prevalence of 10-30% depending on the population. On the basis of our 8-year clinical experience in treating PTSD and detailed analysis of related literature a special team of the Department of Psychological Medicine, Zagreb University Hospital, compiled the proposed guidelines for diagnostics and treatment of PTSD. The established guidelines are independently developed, clinically proven at our Clinic and in terms of custom made procedure world wide unique. Their essential feature is psychoanalytic comprehension and approach to etiopathogenesis of PTSD, although it also applies to other psychotherapeutic techniques (cognitive-behavioral, relaxation, existential). The diagnostic model is based upon structured clinical interview (DSM-IV, ICD-10), but it also complies with the principles of psychotherapeutic interview. Therapeutic interventions as proposed are divided according to therapeutic goal into symptomatic and etiological.