ARTICLES ARCHIVE

One hundred and three patients were investigated at Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine with the purpose to determine the structural features and level of confidence in doctor in patients with neurological and mental disorders. Observation, interview, psychodiagnostic, and statistical methods were used. The findings of the research demonstrated that main structural elements of confidence in the doctor are knowledge of the professional and personal qualities, convergence of worldview orientation, positive emotional attitude to it and role expectance. Compliance level correlated with emotional comfort, readiness of the patient to co-operate with the specialist. The obtained findings can be used to develop psychocorrection and psychoeducation measures aimed at optimizing the patients' compliance and their co-operation with the doctor at large, for various categories of the patients including those with neurological mental disorders.

The authors worked out a system of medical rehabilitation of children and adolescents with organic brain lesions based of the findings of the original comprehensive investigation. The medical psychological aspect is based on the principles of consistency, complexity, differentiation, individualization, stage-by-stage approach, coherence and sufficient continuation of the measures. Stratification of the system of medical psychological abilitation/rehabilitation offers three levels: level 1 - complex diagnosis of the mental state of the patient and the family in which he/she is raised, level 2 - determining the family rehabilitation potential; level 3 - medical psychological correction. Special attention is paid to the stage-by-state approach of medical psychological abilitation of the patients. There main stages were distinguished, i.e. 1) formation of healthy psychological mindsets; 2) overcoming the existing emotional-behavioral disorders; 3) teaching the correct behavior to adolescents. Testing of the system in the groups of children with various clinical forms of infantile cerebral paralysis demonstrated its high efficacy.

The question of professional adaptation of interns to professional activity is urgent and requires development of technique of training stress resistance and adaptive mechanisms in them. Adaptation disorders in the form of depressive and anxiety depression reactions were reveled in 207 of 512 investigated physicians. A system of psychopreventive support of the doctor including programs of psychological and psychosocial training as well as psychological counseling was developed and tested during the investigation. Special attention was paid to cognitive therapy aimed at improvement of the ability to react adequately to problem situations and take constructive decisions, formation of adequate self-comprehension, disclosure and processing of psychological conflicts, adequacy and realism of own needs, aspirations, motives, personal attitudes, peculiarities of forming own system of relations. The findings of the investigation show that the use of cognitive therapy contributes to the overall effectiveness of therapy, but its influence on the long-term prognosis with a significant difference in the frequency of recurrence during follow-up period is pronounced in a greater degree. Administration of cognitive psychotherapy to interns reduces the risk of recurrence of depressive and anxiety reactions. Thus, it can be concluded that cognitive therapy allows developing a mechanism of matching behavior (coping), which promotes achievement continuous remission in the patients.

A subjective aspect of the disease was featured considering that the clinical picture of somatogenic disorders depends not only on the nature of the underlying disease, its severity and effectiveness of therapeutic interventions, but also, to a large extent, on the patient's individual characteristics such as hereditary predisposition, constitution, premorbid personality pattern, age, gender, body reactivity, presence of stressful situations in the family, general attitude to cure and return to normal life style. Two problems, the system of relations "personality and disease" - the role of personality in the etiology of the disease, the outcome of the disease, in the process of readaptation, and philosophical understanding of the disease condition, search for its existential meaning, activation of internal resources to overcome the disease state, and in order to improve the quality of life, were determined. The role of the family as a significant microsocial environment in which deformity of relations and roles can result in appearance or exacerbation of psychosomatic disorders is emphasized.

At present the issue of restorative psychocorrcection of both the patients and their parents surviving guilt in relation to the sick child and each other and demonstrating deadaptive behavior is urgent due to the increase of the number of disabled children. The aim of this work was to investigate the types of emotional response of the father and mother to the presence of a disabling illness in the child and to provide them with psychological support at all stages of care for the child and his/her upbringing. Typical cognitive misconceptions of the parents related to the lack of information about the cause of the disease, its manifestations, prognosis and treatment of the disease were revealed in the process of psychodiagnostic and psychocorrective work. The proposed scheme of correction showed good results owing to its diversity and promoted elevation of adaptation level in the families having a child with a disabling disease.

The peculiarities of the quality of life (QL) of the patients with malignant skin melanoma (SM) and dysplastic nevi (DN) have not been sufficiently investigated, however quantitative assessment of QL allows to improve the treatment efficacy. SF-36 questionnaire was used to investigate 40 patients with histologically verified diagnosis of DN and SM. The data were statistically processed using standard variation analysis and Statistica v6 software. The patients with DN demonstrated higher score for the scales of physical function, general health, viability, social function, psychological health and general mental health. The SM postsurgical patients improved a number of QL components. Thus, mean values for the scales of physical function, pain intensity, general health, and social function significantly increased (p<0.05) from 44.2; 52.8; 44.8; 47.9 before treatment to 45.6; 53.7; 47.7; 49.0 after treatment, accordingly. The higher score of the total index of psychological component of health showed statistical trend (p=0.06). The findings of the investigation of QL parameters can be used to develop treatment programs for patients with DN and SM as well as to evaluate the efficacy of treatment and rehabilitation.

Taking into account the fact that pediatric oncology is one of the priority areas of psychological practice development in Ukraine, the author considers basic principles of medical psychological aid to the sick children, their relatives and all participants of the treatment process. Clinical psychological and psychodiagnostic investigation of children with cancer and their parents (339 families) was performed. Manifestations of burn-out syndrome in medical staff, stress in volunteers working in the sphere of pediatric oncology were investigated. Main psychological problems and consequences caused by cancer and its treatment in children and their parents were revealed. Short- and long-term tasks and objectives of medical psychological aid were determined. The targets of medical psychological influence on all participants of treatment process were distinguished (project techniques for children, techniques of rational, cognitive behavioral and gestalt therapy for parents). An algorithm of psychological aid including differentiated psychoeducational and psychocorrection measures was developed.

To identify the influence of contextual factors on formation and development of addictive behavior in students, a two-stage psychodiagnostic study using AUDIT-like tests to detect the disorders related to the use of alcohol, tobacco, and psychostimulants (chemical addiction) and excessive absorption in sport, sex and food (non-chemical addiction) was performed. The original diagnostic questionnaire for investigation of the impact of contextual factors on development of addictive behavior, the results of which were subjected to comparative quantitative analysis using Kruskal - Wallis and Mann - Whitney tests, is presented. The study was performed in 2009-2012 in Kyiv National University of Technologies and Design. After informed consent and in accordance with the criteria for inclusion and exclusion the core sample amounted to 320 1st-3rd year students. On summing up the results of the comparative analysis of the data sets demonstrated their sequence can be noted. The findings schematically mimic pathogenesis of affective disorders and addictive behavior, namely, their prodrome. The obtained data were the basis of the suggested system of psychcorrection and psychoprevention of addictive behavior in the students.

To study the peculiarities of eating behavior and associated with it quality of life in adolescents with obesity vs. their peers with normal body weight, 118 boys and girls were investigated. It was found out that adolescents with obesity paid more attention to control over food consumption and were less dependent on external stimuli to eating. The presence of obesity manifested by decreased estimation of the general health condition, poor physical and role functioning caused by the physical state. The features of the eating behavior and quality of life were determined depending on the gender of patients. The relationships between eating style peculiarities and characteristics of the quality of life in obese adolescents were investigated. The intensity of emotional eating behavior in the group of obese adolescents revealed strong negative relations with the majority of the life quality parameters. The extent of limiting intentions in the diet of patients did not have any correlations with the parameters of the quality of life.

One hundred and nineteen patients with chronic obstructive pulmonary disease (of them 66 with vital activity limitation, were investigated using International Functioning Classification to study vital activity limitation in major life areas and influence of psychological protections, personality and emotional peculiarities and external respiration function on them. Personality and behavior characteristics were determined using a psychodiagnostic method. The most significant spheres of life for patients with chronic obstructive pulmonary disease were work and occupation, possibility to get education and economic life. The factors preventing job execution were personality characteristics (psychopathy, paranoia, psychasthenia), severity of condition (external respiration function) and vital capacity of the lungs on inspiration, maximum expiratory flow 50 and 75% of forced and vital capacity of the lungs, those promoting tranquility. The obstacles in the working activity were hysterical residue, paranoia, depression, soreness, anxiety and melancholic types of attitude to the disease; the favorable factor was decision planning. Revealing the psychological barriers, determining the entity of adaptation mechanisms as stimulants of compensation can be the basis for assessment of vital activity limitation in patients with chronic obstructive pulmonary disease.

Complex investigation of 155 persons aged 18-35 of both genders with the history of suicide attempt and treated with the diagnosis F43.0 (acute reaction to stress) was performed with the purpose to optimize psychotherapy approaches to correction of psychogenic depressive disorders accompanied by suicide behavior. Pathogenetically significant psychotrauma situations resulting in suicidal behavior within acute stress reaction in young persons were systematized. Anxiety, asthenoanxiety, asthenic, and anxiety-melancholy variants of psychopathological signs were distinguished. Complex programs of psychocorrection including rational psychotherapy, pathogenetic behavioral group therapy, cognitive-behavioral-analytical psychotherapy, autogenic training were suggested. The principles and methods of outpatient long-term therapy including methods of family therapy, art therapy and imagoterapy were developed. Preventive measures for the young persons who express suicidal thoughts should be directed to mastering the skills of active forms of adaptive behavior, independent decision taking, refusal from the unattainable purposes and reconciliation of vital losses.

Historic cultural, clinical disciplinary evolutional analysis of development of scientific ideas about psychosomatic and somatoform disorders was made. The peculiarities of somatogeny and psychogeny were analyzed in historiographic and psychopathogenetic contexts, their correlation with psychosomatic and somatoform disorders were determined. Etiopathogenetic pathways of personality disorders development allowing the choice of therapeutic strategies were investigated. The periods of psychotherapy evolution were considered: Greco-Roman, scholastic and hospital. Contemporary development of psychotherapeutic ideas was generalized using the principles of psychosomatic medicine. Psychotherapeutic direction in therapy of psychosomatic and somatoform disorders was described from historic perspective, first of all ideas about conditional-reflex interrelation of mind and body, vegetative neurosis concept, theory of psychological stress and other views from the basis of psychosomatic medicine.

The efficacy of integration to the clinical practice of the suggested integrative set of measures of hospital deadaptation psychosocial correction in patients with paranoid schizophrenia under the conditions of coercive treatment is analyzed. The study involved 118 patients, of them 80 were administered psychocorrection therapy and 38 standard one. The changes in the state of the patients were assessed using the WHO disability scale, hospitalism assessment scale, interpersonal relations questionnaire, technique of assessment of therapeutic environment type. The findings were used to develop a strategy of optimizing the patients' ability under the conditions of coercive treatment to keep up a high motivation to take part in psychocorrection measures. Significant positive changes were determined in all spheres of inpatient functioning of the patients and their interpersonal behavior, i.e. the tonicity reduced, the regimen of supporting therapy was followed, psychocorrection measures promoted adaptation to the inpatient conditions, common grounds with medical personnel were established.

Sixty persons were investigated to study the state of nonspecific adaptive reactions (NSAR) in patients suffering from neurasthenia and their impact on the clinical course of the disease. The main methods of the study were investigation of the case history and clinical-psychopathological method. Clinical laboratory method (peripheral blood leukocyte count) allowed to determined NSAR level in patients with neurasthenia. Analysis of the obtained findings demonstrated a low level of reactivity of patients and, therefore, pathological failure of NSAR was detected. Adaptation reactions did not correspond the normal ones indicating the presence of distress and subcompensated adaptation stress resulting in exhaustion. The duration of such states has extremely negative consequences resulting in decompensation of human adaptive-compensatory mechanisms, thereby reducing the quality of life of patients with neurasthenia. The findings of the clinical laboratory investigation were used to develop additional paraclinical criteria of diagnosis considering NSAR in these patients.

Complex investigation of 100 patients of Kharkiv Regional and Kharkiv City Perinatal Centers was done with the purpose to study the clinical manifestations of sleep disorders and to determine the peculiarities of dream in women with various clinical variants of the course of adaptation disorders. According to the findings of clinical diagnostic examination all patients were divided into the following groups: those with anxiety reaction (34%), with short-term depressive reaction (37%), without clinical manifestations of adaptation disorders (29%). History taking, psychodiagnostic method with the use of integrative anxiety test, Hamilton's standard scale of anxiety and depression, Beck Self-Rating Depression Inventory, Heck and Hess neurosis express-diagnosis, clinical psychopathological examination were used. The findings of the research demonstrated that all women who delivered a premature baby had qualitative and quantitative sleep disorders. The variant of adaptation disorders contained the changes of physiological sleep process in the clinical picture, the signs of which were different in the investigated groups and could be due to the peculiarities of the clinical picture of the described disorders. The obtained findings can be used as an early express method for diagnosis of possible adaptation disorders in new mothers.

The possibility of practical use of theoretic principles of gestalt therapy at analysis of group processes by the leaders of groups with different orientation were described. Association of systemic approach to group typology with typology of gestalt groups by criteria (aim of the group, role of the group, leader style) was shown from the perspective of their function. The model of psychotherapy in the group corresponded to classical model of gestalt group, the model of group psychotherapy - to gestalt group of personality growth, the model of psychotherapy by means of the group - process-oriented group. The up-to-date approach in group gestalt therapy allows combining existing group typology with the purpose of their more effective and extensive use. The leader can base himself not only on group typology but also on the psychological levels and processes in them (intrapersonal, interpersonal and group), which can enrich the experience of group members.

Emotional disorders in patients with the history of reconstructive-restorative surgery of the hand (RRSH) were investigated. A complex system of measures for their psychotherapy correction was worked out. The study involved 100 patients whose emotional disorders were investigated using the scales of subjective (Zung scale) and objective (Hamilton scale) rating of depression level, scale for assessment of state and trait anxiety of Spielberger-Khanin. The analysis of the findings of clinical psychopathological and psychodiagnostic investigations of the emotional sphere in patients after RRSH demonstrated prevalence of a high level of state anxiety at moderate trait one. A complex model of psychotherapeutic correction consisting of four stages (compliance forming, preparation for the operation, correction of reaction to the surgery, consolidation of results by means of positive emotions potentionalizing) was suggested and tested. The developed protocol allowed to reduce anxiety and depression signs as well as to level the manifestations of psychological deadaptation by means of stimulation of adaptation-compensation personality reservoir, elevate the level of social function and quality of life in patients after RRSH. Its testing demonstrated high efficacy in 82% of cases.

Forty-eight sexually readapted married couples in which the wives had various disorders of individual copulative cycle and dangerous prenosological pattern of alcohol consumption were investigated with the purpose to study the qualities of interpersonal attraction. AUDIT-like tests, scales of love and sympathy by Z.Rubin were used. It was determined that love feeling and sympathy can be considered as an integrative parameter characterizing the quality of interpersonal attraction in dyadic relations. Loss of love and sympathy to the parameter in women is a significant pathophysiological factor of sexual dysharmony development. The findings of the research show that positive correlation dependence between low attraction and alcohol consumption pattern in wives allows to consider them a factor of forming addiction behavior in women.

The original techniques of quiasilaser photomagnetotherapy used to treat 61 men and 18 women were suggested due to a more common occurrence of symbiosis of urogenital, protozoan and viral infections among sexually transmitted ones with resultant excretory-toxic sterility in representatives of both sexes, and little effect of traditional (protocol) therapy. The administered therapy allowed to achieve a full-fledged restoration of the endocrine-reproductive function in the patients. Elimination of the inflammatory process with normalization of the hormonal mirror at combination of quasilaser photomagnetotherapy with boosters of antiprotosoal therapy, immune correctors and interferon inductors was noted in 80% of observations, when quasilaser photomagnetotherapy was combined with ozone therapy - in 93.2 %. This allowed restoration of the reproductive function in 75.4 % of patients due to considerable improvement of the potency, spermatogenesis, complete eradication of mixed infection agents, detoxication, elimination of hormonal disturbances, dyspareunia and restoration of potency in the uterine tubes.

Historical facts, which served the creation, establishment and subsequent reorganization and development of Postgraduate Medical Institute in a wide range of areas, from infectious diseases and health concerns, surgical pathology and internal medicine questions to organization of medical institutions in the conditions of economic development of the country, are analyzed. Notable achievements of education science and introduction of intensive techniques and training facilities, fruitful cooperation with leading medical universities in Ukraine, CIS and oversees countries are described.