Achalasia cardia (“cardiospasm”, “phrenospasm”, “dolichoesophagus”, “megaesophagus”, “stenosis of cardia”) represents a primary impairment of esophageal motor function associated with impaired lower esophageal sphincter relaxation and peristalsis defects of the thoracic esophagus. It is diagnosed at the age of 25 to 60 years, making up to 20% of all diseases of the esophagus, and is characterized by a triad of symptoms: dysphagia, regurgitation and chest pain when swallowing. In most cases the first manifestations of achalasia are preceded by stress situations in the anamnesis that complicates the differential diagnosis of psychogenic esophageal spasm. The presented clinical case illustrates difficulties of early diagnosis of achalasia cardia in a young femalepatient with severe anxiety and depressive symptoms which develop under conditions of chronic stressful situations in the family or at work. The issues of interdisciplinary interaction of health professionals (physician, gastroenterologist, psychiatrist, psychotherapist, and surgeon) on the course of examination and management of patients with comorbid physical and mental pathology are discussed. The efficiency of the integrative approach to treatment and rehabilitation with the use of modern reconstructive surgical interventions as well as conservative methods of therapy, psychopharmacotherapy and personality-oriented psychotherapy proves the relevance of studying psychosomatic aspects of achalasia cardia.

Objective: We investigated biological and clinical-genealogical peculiarities in families of patients suffering from non-psychotic mental disorders with disturbance of respiratory system functionhyperventilation syndrome (HVS). Methods: We studied content of alveomucin in serum of blood of 43 patients from them 40 women and 3 men. Age was from 18 to 63 years. Genealogies of families of patients with indication of mental and somatic health of relatives were composed. Results: In personal assessment of patients in 39 from 43 cases (90%) hysteric traits of various degree of severity. In 18 cases HVS was manifested as vegetative crises while in 25 cases disturbances of respiration were not abruptly expressed but permanent. Concentration of alveomucin in persons with hysteric disorders constitutes 20,87±1,85, in patients with adjustment disorders with predominance of depressive reactions this index is 24,91±3,36, what is somewhat higher of content of alveomucin in mentally healthy persons (20,21±4,17). In families of patients relatives of first degree with personal peculiarities and mental disorders have been revealed as well as somatic diseases of organs of respiratory system. Conclusion: Non-psychotic mental disorders with disturbance of function of respiratory system are accompanied by increase of content of alveomucin in serum of blood of patients and mental peculiarities and diseases of respiratory system in nearest relatives.

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Study involved 102 combatants (mean age 31,78 ± 6,75 years). Clinical dynamics of PTSD brought neurotic (40) and pathocharacterological (62) variants of PTSD. Control group consisted of 80 healthy men. Clinical syndromes of secondary immune deficiency were detected in 51.4% of patients with neurotic version of PTSD and 75.9% with pathocharacterological version. It´s in 2 and 3 times higher than in controls. In pathocharacterological variant of PTSD we observed most frequently infection (53.4%) and autoimmune (17.2%) syndromes. In total group of combatants, as compared with control the overall pool of T-lymphocytes (SD2+), mature T-lymphocytes (SD3+), helper / inducer (CD4+), ACSF-activity of leukocytes, elevated number of cells expressing markers of late activation (HLADR+) and the percentage of peripheral lymphocytes, expressing receptors of Fas-readiness to apoptosis (CD95+) reduced. Comparative analysis of parameters of immunity in different variants of PTSD, revealed some differences. Significant features of the immune status in pathocharacterological variant compared with neurotic are significantly lower values of total pool of T-lymphocytes (CD2+) (p< 0,05), number of helpers/inducers (CD4+) (p< 0,05) and number of B-lymphocytes (CD20+) (p< 0,05). Ppathocharacterologically variant (diagnosis with adverse clinical dynamics), as compared with neurotic version of PTSD (more favorable in clinical terms) is characterized by increased frequency of occurrence of clinical signs of immune deficiency with predominance of infectious and autoimmune syndromes, more pronounced disturbances of indices of immunity. This strongly suggests role of immune mechanisms in formation of various variants for adaptation in clinical PTSD.