Treatment Of Cancer Patients With A Combination Of Chemotherapy And Hypnotherapy. Cases From The Practice Of Doctor Marat Shafigullin

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Male 48 years old, editor-translator from Spanish

Small cell carcinoma of the right lung. Neuroendocrine tumor of the mesentery of the small intestine. Pancreatic neuroendocrine tumor

Heredity is not burdened with manifest psychoses.

Father. Self-willed, stubborn, irritated over trifles, protected himself from participation in economic affairs, abused alcohol. He worked as a fitter assembler. He died at the age of 60 from heart failure.

Mother. 73 years old. Mild in character, caring, compliant, she took responsibility for the introduction of everyday life. He works as an engineer at a plant for the construction of a metallurgical mining and processing plant.

Born in Moscow as the only child in the family, from a normal pregnancy, on time. I did not attend preschool institutions, was brought up at home by my grandmother, in conditions of overprotection.

I went to school at the age of 7. He studied averagely, did not stand out for special talents, was diligent, obedient. In relations with children, he was withdrawn, uncommunicative. He studied at a music school until the eighth grade, was engaged in figure skating, was in the society of book lovers: he helped the librarian, spent a lot of time reading literature. There were few friends, he did not feel the need to communicate with peers. He graduated from 10 classes. I did not enter the institute right away, the first year I failed the entrance exams. At that time he worked as a courier in a literary newspaper, and then in a team of translators in the department of foreign technical information.

After school he graduated from the Moscow State Pedagogical University. IN AND. Lenin Faculty of Foreign Languages with a Spanish department. After graduation, he worked in various fields: a salesman in a store, an editor of scientific publications for foreign students - he mainly found work through the Internet. Since 2003 editor-translator from Spanish for the magazine.

He served in the army: left the first year of the institute. He was burdened by the statutory life and hazing for the first six months in training, then he served freely in the rifle troops.

In 2006, after the death of his father and grandmother, he experienced depression, longing in the form of compression behind the breastbone, decreased mood with guilt, insomnia, decreased appetite, fear of physical threats and agoraphobia against the background of functional auditory threatening pseudohallucinations, with blasphemous ideological sessions. voices”scolding him. I believed that this was actually happening. He thought that he had discovered God's gift of hearing voices from space, considered himself "the chosen one." A month after the onset of the attack, at the insistence of the mother, he turned to a psychiatrist, at the PND, where, after inpatient treatment and while taking Risperidone 4 mg, Finlepsinaretard 100 mg per day, Akineton 0.5 mg and Atarax 12, 5 mg, the attack stopped and did not recur.

She notes mood swings associated with a circadian rhythm, feels worse towards evening. Visits a psychiatrist annually, no deterioration in well-being was noted anymore.

He was not married, no children, lives with his mother. Relations with the opposite sex were formal, did not fall in love with anyone, did not plan to create a family with anyone, avoided acquaintances without communication. Against the background of taking medications, she notes a decrease in libido and impotence over the past 10 years.

In her free time she reads detective stories, enjoys watching detective series on TV, helping with the housework: preparing food, washing clothes, cleaning the apartment.

He fell ill in October 2016, when pneumonia developed, with a rise in temperature, dry cough and shortness of breath on exertion. October 20, 2016 in the clinic of the Russian State Medical University, a bronchoscopy was performed in connection with complaints of severe cough, chest pain, fever. After the examination, the patient was informed about the presence of cancer. According to the patient, he was shocked, felt a decrease in mood, depression, fear of death, was worried about the results of histological examination and computed tomography. After 2 days, I realized the presence of the disease and decided to be treated. He independently applied to the N. N. Blokhin. At an appointment with an oncologist, I learned that this is a neuroendocrine tumor and that it is treatable. The emotional state has leveled off somewhat. He is not aware of his disease, tries to protect himself in obtaining any information, does not ask questions to doctors, is not interested in the progress of diagnostics, does not read extracts from the second honey and the conclusion of the oncologist at the oncology center, not wanting to be upset once again. The idea of improving the body through the use of juices of vegetables and berries appeared - he drinks beet juice, lingonberry juice, eats vegetables and fish.

Mental condition

Looks age appropriate. Outwardly neat. Combing her hair up, in a youth fashion. The mood is closer to even. The facial expressions are rich. Emotional. Gestures actively. Mannered, pretentious, theatrical: rolls his eyes when questioned. Complains that “his whole soul was twisted”, “what he wanted to forget had to be remembered again” with chest aspiration and pueril intonations.

The voice is loud, modulated. Speech at a normal pace. He gives out information about himself with reluctance. Sometimes the answers are not to the point, not in terms of what was given with slipping into side associations, ambivalence is noted when asked about the attitude to the disease, replies that he painted rainbow pictures, immediately at the same time reports that the mood is decreasing in the evening and therefore does not note any iridescence

He describes himself as impressionable, self-sufficient, with no need for communication with other people.

Closed, uncommunicative, spends more time reading literature, no friends.

He says that he had never had serious illnesses before, and therefore did not go to doctors.

At the time of inspection, she does not complain about anything. He claims that after the news of the diagnosis he did not experience a strong shock and has now protected himself from receiving information.

Doesn't make plans. Denies suicidal thoughts.

After a clinical interview and anamnesis, a decision was made to use hypnotherapy.

Hypnotherapy protocol:

1. Induction "confusion".

2. Deepening of trance through extrapyramidal immersion in the form of countdown and catalepsy of limbs + eyelids.

3. Regression into childhood. Event: I remembered myself as a small child, at the age of 5-6, a feeling of loneliness, a feeling of fear of being rejected by my mother. Working out-getting rid of negative feelings (in more detail on the training course).

4. Formation of correct cognitive attitudes.

5. Progression into the future.

6. Anchoring a positive image of recovery.

7. Directives of recovery and the formation of positive thinking.

Woman, 56 years old

Oncological diagnosis: neuroendocrine tumor of the mesentery of the small intestine, metastases in the liver, in the peritoneum. 8 courses of chemotherapy were carried out. IHC: NEO GIT Ki67 up to 5%

Leonhard test result:

Accentuation of character for each type is diagnosed if the 12-point level is exceeded.

Accentuated personalities are not psychopathological, they are simply characterized by the allocation of striking character traits.

2. Excitable: 14 points.

4. Pedantic: 16 points.

6. Cyclothymic: 15 points.

8. Unbalanced: 21 points.

9. Disty: 21 points.

Cancer history:

She had a history of extirpation of the uterus with appendages due to adenofibroma of the right ovary and multiple fibroids of the uterus on August 17, 2000. In Saratov, she did not experience psychopathological disorders. She treated the operation as a compulsory measure of treatment to get rid of the disease. The doctors recommended not to work in a room with a high temperature, however, the patient did not listen to the recommendations and did not change the place of work. Has been ill since May 2015, when flushing of the face and neck appeared, hot flashes up to 5 times a day, unstable stools up to 3-4 times a day. At control ultrasound from 05.05.2015, In Saratov, a formation in the small pelvis and the right iliac region with compression of the right ureter and the development of ureterohydronephrosis on the right was revealed. The patient did not believe that she had an oncological disease, began to walk from specialist to specialist, rechecking the data obtained, and did analyzes in various clinics. Then there was a pronounced emotional reaction, aggression directed at doctors, society, relatives, God, anger, misunderstanding of the causes of the disease: "Why did this happen to me?" "How could this happen?" "I have so many plans." Later, there were attempts to "bargain" as much time as possible. I turned to God, used different ways to prolong life according to the principle: "If I do this, will it prolong my life?" So, I analyzed my past actions, felt guilty, mentally asked for forgiveness from those whom I had offended, repented, regretted that I did not follow the recommendations of doctors after the operation in 2000. Then came the phase of depression. The patient is aware of the severity of her situation. Her hands dropped, she stopped fighting, began to avoid her usual friends, left her usual affairs, closed at home and cried. I slept badly, felt a feeling of melancholy, in the form of heaviness behind the breastbone, a lump in the throat. I felt resentment against God "Why did he leave me in this situation?" Appetite was disturbed, I did not feel the taste of food. I didn’t lose weight.

Differential diagnosis was carried out between malignant neoplasm of the small intestine, malignant tumor of the ovary. I turned to the Russian Oncology Center. N. N. Blokhin, where a follow-up examination on 12.2015 revealed a tumor of the mesentery of the small intestine, metastases in the peritoneum, in the liver, ascites, ureterohydronephrosis on the right, an internal stent was installed in the right ureter. Markers: Serotonin 1779, Chromogranin A 1272. After I learned that the malignancy of the neoplasm is low, the prognosis is good, I calmed down, stopped crying, and began to take an interest in life. He comes for treatment from Saratov every 3 weeks. There is a break in treatment for 3 months.

Anamnesis of life:

The father is sociable, sociable, he loved feasts, loved to drink, the driver, 42, had a blunt head injury while taking alcohol.

Mother is carefree, easy-going, emotional, she had mood swings, worked at the bakery in 2013, myocardial infarction. Brother, 26 years old, with average head injury.

Brother Jr 2013 pancreatic necrosis on the background of alcohol consumption.

She was born in Saratov, the 1st out of 3 children. Pregnancy and childbirth were unremarkable. Early development was unremarkable. I attended a kindergarten. I went to school at the age of 7, finished 10 classes. She easily adapted among her peers, without taking a leading position, trying to keep on the sidelines. She studied well, grasped on the fly. She graduated from the Volsk Technological College, a glass technologist by education, worked for 7 years in her specialty, then after maternity leave, she decided to abandon the heavy work schedule in 3 shifts and switched to a bakery, however, here, too, a year later, she began to work in 3 shifts, worked 28 years. The child often stayed with the middle brother. She tries to keep the house clean, gets annoyed if someone violates her routine. Adjusts the tablecloth or curtain if it hangs crookedly. When leaving the house or going to bed, he checks whether the light, gas, water are turned off, and whether the doors are closed.

He distinguishes travel from a hobby, flies to different countries, is interested in the culture of different nations, the manner of communication, gastronomic preferences, and appearance. Dependent on praise, at work she tried to curry favor with her superiors in order to earn recognition. I met my future husband at the age of 20, after 2, 5 years of courtship, they got married, a daughter from marriage, also married. They live peacefully with her husband, he obeys her in everything, does not reread, earlier, if he showed self-will, the patient was angry with irritability. All decisions on the conduct of life and organizational issues are made by the subject.

With the loss of relatives, there were periods of decreased mood, about 2 months, with a feeling of a lump in the throat, heaviness behind the breastbone, tearfulness, sleep disturbances. These attacks were stopped on their own, I did not go to the doctors.

She rarely went to doctors, was careless about her health, Hashimoto's goiter practically does not heal, she missed taking medications, and forgot about preventive examinations.

Mental condition:

She is neatly dressed. Looks age appropriate. Movement slowed down. Sits in a monotonous position, hunched over. Holds the table with his hands. Tense. The speech is modulated. The vocabulary is limited, he uses well-established expressions such as "ability oh-oh-oh", "plans above the roof, huge", "my husband thinks that he is a king, aha", "I was not there, so potatoes can be planted on a carpet." Thinking is slowed down. The memory is not broken. The mood is lowered, when talking about the disease, tears appear in the eyes. She says that she has many plans, and the illness interferes with their implementation. Reports a feeling of melancholy, which feels in the form of heaviness behind the sternum, in the form of a lump in the throat, also reports pain in the back, in the region of the cervicothoracic spine. At the same time, treatment results are ignored. In response to the doctors' statements about the lack of dynamics, she presents them with a table made by her daughter, indicating a slight decrease in the foci of neoplasm. When the doctor says that others have better results, the tumor shrinks faster, the patient replies that everyone is different. "Maybe I harness it slowly, but then I drive quickly." Currently, he periodically receives a sick leave, goes to work for a short period and again goes on sick leave. At work, he limits himself to stress, shifts his responsibilities to others, and rests most of the time. Limits himself to food, adheres to a diet.

Excitable hysterics, dissociative-depressive reaction.

Hypnotherapy protocol:

1. Induction of progressive relaxation of skeletal muscles.

2. Deepening of trance through extrapyramidal immersion in the form of countdown and catalepsy of limbs + eyelids.

3. Regression into childhood. Event: I remembered the loss of loved ones, there was a fear of death and a subconscious mindset: “I wish I died with them,” most likely this served to activate the nocebo effect.

4. Getting rid of negative feelings (in more detail on the course).

4. Formation of correct cognitive attitudes + forgiving yourself

5. Progression into the future, with Parkhill's words

6. Anchoring a positive image of recovery.

7. Directives of recovery and the formation of positive thinking.

54 year old woman

Diagnosis: neuroendocrine tumor of the pancreas, mts in the liver

Condition after surgical treatment, 2013-11-07 in the abdominal department of the Russian Cancer Research Center of the Russian Academy of Medical Sciences, distal resection of the pancreas, atypical liver resection, splenectomy, omenectomy, with histological examination No. 26980/13 dated July 17, 2013: neuroendocrine tumor, G1 (Ki67 less than 2%) … PCT, from 09/30/13 to 10/02/13 1 course of chemotherapy with aranose in mono-regimen 500 mg / m2, OD 700 mg i.v. pages 1-3 days, on admission on 23.10.13 developed febrile neutropenia, requiring the introduction of leucostym 300 mg / day s / c No. 3 and antibiotic therapy with thienam. After the restoration of blood counts, chemotherapy was continued with aranose reduction to 375 mg / m2. From 10/29/13 to 03/13/14, 2-8 courses of chemotherapy for aranose 375 mg / m2, OD 500 mg intravenously were carried out on days 1-3. According to MRI data on March 31, 2014, the appearance of new mts in the liver less than 0.3 cm in diameter was noted. However, there is also a decrease in cystic formation in the projection of the resected tail of the pancreas after 3 courses of PCT.4-8 courses of chemotherapy were carried out according to the previous scheme with stabilization of the disease according to MRI data. On March 31, 2014, the appearance of new mts in the liver less than 0.3 cm in diameter was noted. However, there is also a decrease in cystic neoplasm in the projection of the tail of the pancreas. The patient was consulted by the head. department V. A. Gorbunova. It was recommended to carry out the next two courses of chemotherapy according to the previous scheme, followed by an assessment of the dynamics. From 02.04.2014, the 9th and 10th courses of chemotherapy were carried out according to the same scheme. According to MRI data from 19.05, 09.07, 08.09, 10.11.2014 and 09.02, 12.05, 17.08, 16.11.15 and 15.02.16, the stabilization of the disease.

Anamnesis of life:

My father died at the age of 48 from stomach cancer with metastases, worked as a carpenter, was good at drawing. By nature, imperious, strict, he loved order in everything, so that everything was in its place, according to the schedule, took food at a certain time, did not like to come home for an unprepared lunch, was irritated if water was not poured in the sink, bread was not cut, expressed his dissatisfaction with his wife and children, whom he brought up in severity, punished for pranks, could beat him with a belt.

Mother of 77 years old, calm in character, was afraid of her father, stubborn, kind, sympathetic, did not tolerate the use of alcohol by her father in the last months of her life. She worked in a sanitary and epidemiological station, as an entomologist, treated ponds from insects. She is neat in everyday life, loves order, gets annoyed if someone breaks it, each thing should have its place, could go away with a towel of children.

Twin sister is a history teacher.

The younger sister is a teacher-philologist for 7 years, teaches Russian and literature.

Born in western Kazakhstan, Peremetnaya station, Kamensky state farm, 2nd child of 3 children, twin with sister, and younger sister. Pregnancy proceeded normally, childbirth with complications, using obstetric forceps, with birth trauma, deformed skull, without further consequences.

We lived in a barrack with our parents. She was brought up in a family, in severity. She has been attending children's institutions since 6 months. She suffered from childhood infections, ARVI. As a child, she went in for sports, went to a music school.

She was subjected to moral violence by her twin sister, who forced the patient to do a lot for herself, for example, the sister did not like to clean up and forced to clean up behind herself, by driving the patient under the table and locking her with a stool until she agreed. The sister also shifted responsibility for her misdeeds onto the subject, the aunt sewed 2 dresses for them when they were 5 years old, the sister climbed over the fence, tore the dress, and forced them to change so as not to be punished by their parents. The elder twin was always punished, and the patient cried, taking pity on her sister. The twin sister told her that she had freckles, sharp elbows, crooked legs, the patient was impressed and withdrawn, feeling inferior.

She graduated from 10 classes, studied well, was diligent, responsible, accurate. In the 6th grade, I wanted to remove freckles and asked my mother to go to the pharmacy for ointment. Having entered the pharmacy, she saw a different world, purity, order, it seemed that pharmacists were conjuring over magic ointments and solutions, was impressed, and firmly decided to choose this specialty in the future. And so it happened, she entered the Orenburg Medical Institute, where she received the specialty of a pharmacist. After school, we parted with my twin sister, got into a new environment, lived in the apartment of a woman who forbade them to eat their own food in her absence, and limited the consumption of electricity and water. She experienced a depressed mood, depression, resentment, anxiety, she still remembers this time with tears in her eyes.

She was worried about trifles, the new environment, the new team caused fears, discomfort, she was afraid of the assessment of others, not wanting to be shameless, to dishonor her parents. After graduating from the institute, she arrived in Saratov by assignment, spent the night in the house of the head of the pharmacy, having learned before that that 2 managers had been killed, did not sleep all night, listened to the sounds, was afraid to fall asleep, was afraid of death.

In dealing with the opposite sex, she was shy, she was afraid to be in the position of a twin sister, who became pregnant in the 10th grade and got married, did not let anyone close to her. She avoided close contact, such as dancing. She married a young man whom she met after graduation, in p. Red October, after 2 years of courtship. They have been married for 33 years, have two children, sons (31 and 24 years old). There were no serious conflicts in the marriage.

She worked as a pharmacy manager until 2013, got a disability, worked diligently, trying to please customers, went out to work on holidays, to the detriment of her interests.

I did not monitor my health, did not go to the doctors, if I fell ill with a cold, even with a temperature of 38, I went to work. I have never been on sick leave.

Asthma and allergies to NSAIDs and other drugs. I was afraid to take medicine.

Fibroids of the uterus surgical treatment. After the operation, Phenibut was prescribed amid anxiety.

Medical history:

From October 2012 to April 2013, she felt heaviness after eating, pain in the lumbar region, which the patient explained with age-related changes, radiculitis. In April 2013, weakness, acute pain in the iliac region, indigestion, constipation, heaviness in the stomach, fever up to 40 appeared, she called a doctor who diagnosed a viral infection, although the patient thought about an attack of pancreatitis. But, nevertheless, I went to work after 3 days, with pain and weakness. On the way to work she was met by a doctor friend who insisted on an examination, although the patient did not want it. During the ultrasound examination, a tumor of the pancreas and metastases in the liver were found. The patient did not believe it, remembered the death of her mother-in-law from pancreatic cancer a year before, remembered that she had thoughts that she would also get pancreatic cancer, but remembered this when she was diagnosed with a tumor. After MRI in Saratov, the diagnosis was confirmed, however, the patient did not believe the doctors, believed that they were mistaken, there was a hope that the subsequent examination would refute the previous one, turned to different specialists, compared the examinations, hoped that they would say that she had a cyst. Even after the 3rd confirmation of the diagnosis, she waited for a biopsy, which would refute the preliminary diagnoses. She did not actively look for the possibility of conducting this survey, she was helped to obtain a quota and was sent to Moscow, to the Russian Oncological Research Center. N. N. Blokhin. She was afraid of death, compared herself to her mother-in-law, hoped that she had a benign tumor. She felt everything that was happening, as if in a dream, with a feeling of unreality, as if it had not happened to her, followed the events from the perspective of an outside observer. In Moscow, after a biopsy, it was revealed that she had a neuroendocrine tumor that could be treated, and the volume of the operation and subsequent therapy was announced. After that, she wanted to run away from the situation, to hide, she went home to Saratov, her mood dropped, her sleep was disturbed, she fell asleep with a desire to disconnect from reality, not think about the disease and woke up early, felt sorry for herself and her family, felt anxiety for her health, life expectancy. She lost interest in life, stopped looking after her appearance, stopped using creams and cosmetics. I read the literature on my illness before the RCRC, read that pancreatic cancer is a fatal disease, was afraid of death, began to prepare for it, dismantled the documents, put them in one folder, insisted on renovating the apartment, thinking that her will not, people will come to her funeral, and her wallpaper is old, I bought black underwear, although before that all my life I wore white, imagined the scenes of the funeral, in which she would lie in the coffin. I was afraid to eat so as not to experience pain. She lost 9 kg. I called all my friends and relatives, hoping for their material support. After the operation and a course of chemotherapy, she was told about a positive example of recovery, 8 years old, the patient calmed down, became convinced that there was no danger of the disease, relief appeared, hopes for the benign quality of the disease were justified, she was less worried about her health and life. The volume of the operation was not upsetting against the background of the hope of recovery. Appetite and sleep were restored.

Mental condition:

Looks age appropriate. Does not reveal psychopathological disorders. The mood is even. Emotionally labile, recalling the grievances of childhood and adolescence, she begins to cry, in a minute she already laughs. Feels guilt for all his actions, at the same time feels suffocation, lack of air, unpleasant sensations in the region of the heart and behind the breastbone. He tries to show his best side, speaks for a long time about his responsibility and responsiveness. Making mistakes in pronouncing some words, apologizing, correcting himself, speaks correctly. She speaks calmly about the disease, is confident in the safety of the disease, knows the prognosis and treatment plan, there is no fear of the unknown, but notes depression during chemotherapy, believes that it is negatively influenced by the environment of the cancer center, communication with patients, information received from them, about relapses, complications. She believes that she is better than many in work, in life and in recovery, she is also better than other patients, that she is a fighter, she will cope. They relapse because they are worse. At the same time, he is ashamed to praise himself, scolds himself for selfishness. He says that he does not like to leave the comfort zone, change his usual way of life, which overcomes the fear of coming to the RCRC. He gets irritated because of the long wait for the examination, the flow without the next patients, considers himself infringed in his rights, humiliated. She notes that after the onset of the disease, she began to love herself more, defends her rights, but does not actively speak about it. It is oppressive that she cannot work because of her illness, she is afraid of losing her professional skills, although when she went to work to replace another person, she coped with all the responsibilities. She gets upset that she looks worse. She entered her usual way of life, takes care of herself, walks a lot, does household chores.

Conducted 2 sessions of hypnotherapy, after the first one notes an improvement in the quality of sleep, a decrease in the level of anxiety.

Conclusion: Hypertensive, histrionic hysterical, with a thirst for recognition. There is a problem of sensitization, the psychogenic factor has worked. Compact dissociation, 1, 5 months. 2nd hysterical depression. And now the status of a gallant soldier. Everything is supplanted. For 8 years everything should be as it should, but in fact there are 2 distinct reactions. Synthonic woman. Affective, not schizoid. A little paranoid, filtering out good and useful information. Mechanisms are structured hysterical, a rigid image of the situation, there is clarity, a rational grain, in the manner of conversation, as if it does not displace, but sweeps aside. Egodistonna in relation to the body, somatotonic.

Hypnotherapy protocol:

1. Induction "confusion".

2. Deepening of trance through extrapyramidal immersion in the form of countdown and catalepsy of limbs + eyelids.

3. Regression into childhood. Event: I remembered myself as a small child, at the age of 3-4, a feeling of loneliness, a feeling of fear of being rejected by my mother. I was left alone at home and saw a man looking out the window. She was very scared. Working out-getting rid of negative feelings (in more detail on the training course).

4. Formation of correct cognitive attitudes.

5. Progression into the future.

6. Anchoring a positive image of recovery.

7. Directives of recovery and the formation of positive thinking.

➤ Site of a psychotherapist, Ph. D. Marat Rifkatovich Shafigullina

➤ Trance techniques and cognitive hypnoanalysis for getting rid of psychosomatics (internally in a mini-group in Moscow).