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Volume 09, №2' 2014


Maxim Gorky Donetsk Medical University
The content and efficacy assessment of existentially−personal rehabilitation of schizophrenia patients
3 - 7
This article describes an innovative model of existentially-personal rehabilitation of schizophrenia patients aimed at personal recovery of patients and improving the quality of life of people with mental disorders. The rehabilitation model is based on the phenomenological approach to the study of psychosis, existential ideas of personality and analysis of the fundamental existential phenomena (freedom, responsibility, death, isolation, sense) actualized by mental illness. The existentially-personal rehabilitation includes the newest technology of psychotherapeutic interventions and original techniques. The program consists of three areas: control and self-control of the disease, stress-management and personal-existential recovery. Introduction of this rehabilitation model to medical practice proved its efficacy, which manifested by improvement of medical indicators (the quality of remission improved, the number of relapses and readmissions during a two-year period reduced) and social indicators (the rate of disability reduced, over 90% of the patients continued the work (school), preserving their professional level, over 85% kept their family, over 66% of the patients had a satisfactory level of social functioning, over 55% rated their quality of life as satisfactory) and personality indicators.
Key words: existentially-personal rehabilitation, schizophrenia patients.
Regional Clinical Hospital - Center for Medical Emergency and Catastrophe Medicine (Kharkiv)
Clinical structure of nonpsychotic disorders of mental sphere in patients somatic diseases
8 - 11
Numerous studies indicate insufficient development of medical psychological aspect of the problem of increased number of acute inner diseases such as coronary artery disease, myocardial infarction, crises in patients with arterial hypertension, transient ischemic attack, cerebral stroke, gastric and duodenal ulcer. A number of works have shown a high level of affective and neurotic disorders in this category of patients. However, the issues of clinical structure, dynamics, course and relationship with a somatic disease have not been investigated in detail. The purpose of this work was to determine the scope of mental disorders in patients after acute inner condition. The study involved 187 patients (65 % men and 35 % women aged 20-60), of them 34 with coronary artery disease, 37 with myocardial infarction, 38 with transient ischemic attack, 39 with arterial hypertension, 39 with gastric and duodenal ulcer. The structured analysis of the clinical phenomenology allowed to identify four main variants of disorders: nosogenic reactions of mental deadaptation; somatogenical asthenic syndrome; reactions of mental deadaptation; acute stress reactions in patients with pronounced pain syndrome. Stratification of the structure of psychopathological symptoms allowed to identify four variants of manifestations: asthenic; anxious; subdepressive; somatoform. The findings of the research demonstrated disorders of the mental sphere of nonpsychotic level in the majority of patients, which served as the basis for recognition of the objects of psychological correction during medical-psychological support for these patients.
Key words: mental disorder, somatic diseases, nosogenic reactions of mental deadaptation.
Kharkiv Medical Academy of Postgraduate Education
Influence of depressive disorders of various origins in mothers on their children’s mental state (clinical−psychopathological features, diagnosis)
12 - 16
The state of the family of the patient with mental disorders is poorly investigated in spite of the fact that depressive disorders in one of the spouses inevitably cause disorders in relations with the children and endanger the family health. This study involved 399 families in which the women were diagnosed depressions of different origin. These families educated 428 children, the majority were under observation of a psychiatrist. Character accentuations of various types were revealed in these patients: chiefly hyperthymic, cycloid, psychasthenic, more seldom sensitive, epileptoid, unstable and schizoid in solitary cases in boys, while in girls psychasthenic, sensitive, schizoid, more seldom hysteroid, cycloid, demonstrative. The disease (unsocialized and socialized, fobic anxiety and tic disorders, inorganic enuresis, autism) developed due to psychotraumatic factors, including prolonged depressive disorder in the mother. The findings of the research demonstrate that correction of family health disorders at this pathology in women requires systemic differentiated approach.
Key words: children, depressive disorders, mother, family.
Kharkiv Medical Academy of Postgraduate Education
Odessa Regional Psychoneurology Hospital
The features of clinical psychopathology signs of paranoid schizophrenia in women with different models of family interaction
16 - 28
As the family promotes daily needs of a psychiatric patient and the necessary regimen, together with the patient and physician it is considered as one of the participants of the therapeutic process. To perform comparative analysis of clinical pathological signs of paranoid schizophrenia in women with various models of family relations we investigated 150 patients. Clinical psychopathological investigation included structured interview with the use of Z-codes by ICD-10, questionnaire WHO Checklist for Mental Symptoms and Glossary for Mental Disorders, Qualification scale for assessment of positive, negative and general psychopathological syndromes. It was determined that unpredictable character of combination of mental manifestations resulted in poor family function. Preservation of the skills of social function in women depended on the model of family interaction. These skills should be basic. The level of their preservation determines planning the strategy of family interaction restoration.
Key words: paranoid schizophrenia, family interaction, women.
Kharkiv National Medical University
Depressive disorders in children and adolescents with disorders of the musculoskeletal system
28 - 32
The study involving 206 children and adolescents (99 girls and 107 boys, aged 10-17) with musculoskeletal system pathology was aimed at investigation of the peculiarities of forming depressive disorders in children and adolescents with musculoskeletal system disorders. The following methods were used: history taking, clinical psychopathological supplemented with a specially designed chart for mental state assessment, psychodiagnostic methods, methods of mathematical statistics. The study revealed that formation of depressive neurotic disorders in children and adolescents with diseases of the musculoskeletal system is a multifactorial phenomenon, in which biological, social and psychological factors are presented as an indissoluble complex determining the syndromogenesis specificity and pathogenesis of mental disorders in persons with disabilities. Anxious, asthenic, asthenic-anxious and anxious-depressive variants were revealed. Neurotic depression in children with developmental disabilities develops against a background of affective behavior due to adaptation to the conditions of everyday life.
Key words: disabled children, musculoskeletal system disorders, depressive disorders.
Kharkiv Medical Academy of Postgraduate Education
The peculiarities of perception by the parents of behavior disorders and emotions in children from the families in which mothers suffer from depression of various origins
33 - 35
The presence of a depressive disorder in one parent leads not only to violation of interpersonal relationships between the spouses, but inevitably deteriorates relations with the children. Both parents� perception of the child's illness is crucial for family adaptation which will contribute to treatment effectiveness. The purpose of this work was to study the peculiarities of the parents� perception of behavioral and emotional disorders of children in families where mothers suffer from depressions of different origin. The study involved 399 families in which the wives were diagnosed a depressive disorder of various origin. The families had 428 children, of them under the supervision of a psychiatrist were 306 with diagnosed emotional and behavioral disorders. The technique developed by V. S. Podkorytov et al. was used. Six types of perception were distinguished: ignoring, superficial, demonstratively heroic, bashful-catastrophic, self-blaming, adequate. Inconsistent perception of the child�s disease occurred in 73% (p ? 0.05). Gender differences in emotional response of parents to the child's mental disorders were identified. The dominant mode of the mother's response to behavioral and emotional disorders of children was self-blaming. The fathers demonstrated superficial and adequate perception of the child's illness, rarely showing bashful-catastrophic perception (7%). The findings of the research demonstrate that the correct response of the parents to the state of the child during the disease and the present disorders of behavior and emotions, concurrent reaction of the mother and father determine mental comfort, adaptation of the child in the family and team as well the results of the treatment.
Key words: children, disorders of behavior and emotions, parents, depressions in mothers.
V. N. Karazin Kharkiv National University
Institute of Neurology, Psychiatry and Narcology, NAMS of Ukraine, Kharkiv
Diagnostic significance of addictive disorders severity in patients with traumatic brain injury sequelae
36 - 40
The purpose of the research was to study the addictive status of patients with psychopathological sequelae of brain injury using AUDIT-like tests with calculating of frequency of disorders associated with the "using" of addictive objects and determining the diagnostic value of severity addictive disorders in patients with the consequences of traumatic brain injury. Complex assessment of addictive state of the patients with psychopathological sequelae of brain injury using AUDIT-like system revealed more pronounced inclination to formation of addiction compared to healthy individuals in the control group. Assessment of addictive disorders severity was used as the markers for diagnosis and differential diagnosis of the presence of traumatic brain injury sequelae. It was revealed that the use of alcohol, tobacco and cannabinoids significantly distinguished the patients with different sequelae of traumatic brain injury from healthy individuals.
Key words: psychopathologic sequelae of traumatic brain injury, AUDIT-like tests, addictive status, diagnostic markers.
Institute of Neurology, Psychiatry and Narcology, NAMS of Ukraine, Kharkiv
Prof. M. S. Bokarius Kharkiv Research Institute of Forensic Expertise
Compliance features in patients with hypertension
41 - 45
Adherence to the therapeutic regimen and administered treatment is an urgent issue of contemporary cynical practice, which is especially crucial in treatment of chronic diseases, in particular essential hypertension. Based on comprehensive psychodiagnostic study of 114 patients with stage I-II hypertension and the use of modern methods of statistics, the authors identified typological features of compliance in patients with essential hypertension: mixed (57%), constructive (33%) and formal (10%) types. Main psychological factors of compliance (personality differences of patients with essential hypertension, the properties of the communicative sphere, coping stress strategies, the locus of control, internal picture of the disease, violation in personal and emotional sphere, subjective assessment of the quality of life) were identified. The original system of psychological treatment aimed at increase of motivation to treatment adherence and optimizing therapeutic mode of these patients was suggested. The basic techniques of interaction with the patient were psychoeducational training, relaxation techniques, cognitive-behavioral and rational-emotive therapy. Their use promoted increase in the level of awareness about the disease and methods of the treatment; awareness of the responsibility for the treatment outcome; increased adherence to medical recommendations; as well as readiness to partnership with the doctor.
Key words: compliance, essential hypertension, treatment and rehabilitation process, psychological factors, psychocorrection system.
Kharkiv Medical Academy of Postgraduate Education
The features of personal sphere in women with different pregnancy course
46 - 53
Pregnancy is a natural process requiring increased attention of psychologists as it involves development of personality sphere of the woman. The investigation involving 150 women with complicated pregnancy and 100 with physiological pregnancy was performed to determine its characteristics. The following psychodiagnostic techniques were used (testing the attitude to the pregnancy, differentiated scale of K. Izard, hospital scale of anxiety and depression, a method of "meaning-life orientation". During the first stage of the work the spouses were delivered a lecture, during the second consisting of four parts, psychoemotional state of women, peculiarities of spouse relations were investigated and measures were taken to harmonize them. Efficacy of medical psychological support of the family was assessed. The findings of the research show that the women with complicated pregnancy are characterized by insufficient understanding of the life, orientation to recall, lack of self-trust, self-blaming. At the same time they are more careful to themselves, care for themselves and their health for the future child�s sake. Determining life and value orientations, the structure of self-assessment allows to determine the peculiarities of Ego-concept of the pregnant with complicated pregnancy, which plays a role in the choice of methods for psychological aid as well as necessitates clarifying intrafamily relations influencing the course of the pregnancy.
Key words: personality sphere, hierarchy of values, self-attitude, life-meaning orientations, complicated pregnancy.
S. I. Georgiyevsky Crimean State Medical University, Simferopol
Dynamics of the quality of life of patients with chronic obstructive pulmonary disease against a background of rehabilitation treatment
54 - 58
Priority directions in management of the patients with chronic obstructive lung diseases are medical rehabilitation, an important component of which is spa treatment including climate, physical therapy, nonmedicinal treatment. MOS SF-36 questionnaire was used to compare the influence of hypoxic-hypercapnic training, diaphragm electrical stimulation and aerophytotherapy on the quality of the life of the patients with chronic obstructive pulmonary disease during spa treatment at I.M. Sechenov Research Institute of Physical Methods of Treatment and Medical Climatology (Yalta), sanatorium Veteran (Alushta)/ The findings of the research demonstrate that additional administration of hypoxic-hypercapnic training, diaphragm electrical stimulation and aerophytotherapy increased the efficacy of restorative climate therapy. The most pronounced influence was produced by hypoxic-hypercapnic training. Analysis and dynamics of the indices of the quality of life allow to assess the efficacy of treatment, which is necessary to consider when working out therapeutic complexes.
Key words: chronic obstructive pulmonary disease, quality of life, electrical stimulation of the diaphragm, aerophytotherapy, hypoxic-hypercapnic training.
Ukrainian Research Institute of Social and Forensic Expertise and Narcology, Ministry of Health of Ukraine
Clinical organizational and conceptual aspects of complex medical aid to patients with nonpsychotic mental disorders due to partial loss of vision of traumatic origin
59 - 62
Clinical organizational and conceptual aspects of complex medical aid were determined based on clinical psychopathological and psychodiagnostic investigation of 200 patients with nonpsychotic mental disorders due to partial loss of vision of traumatic origin. The purpose of the organizational aspects of comprehensive care is maximum recovery of performance, personal and social status of patients, achieving financial and social independence, integration and reintegration into normal living conditions. The process of comprehensive care involves three steps: development of comprehensive care activities considering comorbidity of two disorders; measures of integrated care; evaluation of the effectiveness of comprehensive care. A scheme of complex medical aid to the patients with nonpsychotic mental disorders due to partial loss of vision of traumatic origin with such aspects as psychodiagnosis, psychotherapeutic correction, psychotherapeutic support, psychoeducation and psychoprevention was suggested. An important component of psychotherapy intervention implementation at all stages is a dfferentialted approach to the patients with the account of their needs.
Key words: partial loss of vision of traumatic origin, nonpsychotic mental disorders, complex medical aid.
O. F. Maltsev Poltava Regional Clinical Psychiatry Hospital
Complex multilevel program of correction and psychoprevention of autoagressive behavior in adolescents with disorders of conduct and emotions
63 - 68
The study with the purpose to determine the mechanisms of forming autoaggressive behavior involved 100 adolescents with mixed disorders of conduct and emotions F 92, of them 50 with the history of the signs of autoagressive behavior in the form of suicidal thoughts, plans, intentions, decisions or suicide attempt. Depressive avoidance, anxiety suspicious and asthenohysterois clinical variants of emotional disorders were revealed in the patients. Analysis of the findings allowed to distinguish contextual biological and psychosocial factors in the developmentof predisposition to autoaggressive behavior in adolescents. A program of treatment, psychocorrection and psychoprevention of autoaggressive behavior considering general characteristics of this group as well as the specific factors in patients with mixed disorders of conduct and emotions was created. The suggested program is multilevel, focused on the latest psychopreventive trends and technologies, which makes it versatile for different groups of adolescents.
Key words: autoagressive behavior, adolescents, mixed disorders of conduct and emotions, psychoprevention, correction.
Kharkiv Medical Academy of Postgraduate Education
Children�s Clinical Hospital N. 6, Kyiv
The impact of medical psychological support on the dynamics of psychoemotional state of adolescents with somatoform vegetative dysfunction of the cardiovascular system at the stage of hospital treatment
69 - 73
Adolescents with somatoform vegetative dysfunction are at risk of hyperdiagnosis, they often undergo unnecessary investigations and are consulted by specialists, therefore participation of medical psychologists in diagnostic and treatment process is important. Our study investigated the impact of medical psychological support by way of psychotherapy on the psychoemotional state of adolescents with somatoform vegetative dysfunction of the cardiovascular system. To determine the mental state of the patients the following methods were used: anxiety self-esteem by Spielberger-Hanin, diagnosis of operative assessment of well-being, activity and mood, Zung�s depression scale. On discharge the patients who took part in psychoterapeutic interventions had better rates of psychoemotional state then those who got usual (medicamental) cure. They demonstrated reduction of state and trait anxiety levels, decrease of depression rates, improvement of general health, activity and mood. The findings of the research suggest in favor of medical psychological consultation for more effective improvement of mental and somatic state of the adolescents with somatoform vegetative dysfunction of the cardiovascular system during inpatient treatment.
Key words: medical and psychological support, psychotherapy, somatoform vegetative dysfunction, adolescents, psychoemotional state, dynamics.
Kharkiv Medical Academy of Postgraduate Education
Individual psychological and psychosocial characteristics of patients with urolithiasis of one or solitary kidney
74 - 81
In 2010-2014 one hundred and twenty patients of urology department of Donetsk Medical Association were investigated to analyze individual psychological and psychosocial characteristics of patients with urolithiasis of one or single kidney with the purpose to substantiate the targets of treatment within the range of medical psychological management of these patients. The following methods were used: Toronto Alexithymia Scale, diagnosis of type of attitude to the disease, Zimet scale, quality of life assessment scale. The following targets were determined: high alexithymia, prevailing manifestations of mental interpsychic deadaptation, a potential resource of family support, more pronounced in patients with a single kidney, underestimation of the sources of support by the friends, more pronounced involvement of such spheres of the quality of life as physical well-being, socioemotional support, performance. The obtained findings suggest that the quality of life of such patients deteriorates in all spheres of function, which requires complex medical psychological work, the general directions of which were determined in this study.
Key words: psychological characteristics, psychosocial support, quality of life, urolithiasis.
Kharkiv National Medical University
Mechanisms of formation and psychotherapeutic correction adapattion disorder in doctors in the process of professional activities
82 - 86
Based on systemic approach to the study of mechanisms of forming mental adaptation of a general practitioner to the professional activity, a system of psychotherapy correction and psychopreventive support during professional training of specialists was worked out. The basic personality qualities of a general practitioner determining successful fulfillment of professional functions and a high level of adaptation to the therapeutic activity were distinguished. Individual personal, social psychological factors, mechanisms and conditions of psychological adaptation were identified. The necessary components of psychological readiness of health workers to an independent productive activity with the account of the significance of self-awareness of the specialist, positive attitude to the profession, awareness and perception of the patient as a personality in a certain mental state, the choice of interpersonal relations and the use of ethical deontological knowledge and skills at different stages of treatment process were determined. The concept of an integrated model of a medical specialist with the rational correlation of subjective and objective components was developed. Its function in the process of planning and organization of training and refreshment of medical personnel were determined. The meaning of "psychological readiness" of a medical specialist to the profession was clarified and specified. The nature and structure of the necessary personal qualities of a doctor as an integral entity are described. The stages of target-oriented psychological training of a general practitioner as a means of implementing an integrated system of training of medical workers in Ukraine are featured.
Key words: psychological adaptation, professional activities of a general practitioner, deadaptation, psychotherapy, psychoprevention.
Zaporizhzhya State Medical University, Ukraine
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Hypnosuggestive psychotherapy in the sphere of competence of psychosomatic medicine and neurosology
87 - 93
The authors analyze the modern use of hypnotherapy in medicine. Decline in the frequency of clinical use of hypnotherapy in the post-soviet period was noted. At present the use of hypnosis in medicine has undergone considerable qualitative changes, and, in addition to therapeutic application, acquired the properties of a psychomodeling (experimentally directional) tool to induce a number of psychopathological states. Hypnotherapy appeared to be a highly effective method of treatment of the diseases resistive to other types of treatment. Effectiveness of hypnosis in treatment of not only neurotic, but also somatic disorders, in particular at chemotherapy to cancer patients, treatment of gastroenterological pathology, was proven. The article provides evidence of the impact of hypnotherapy not only on the psychological state of the patient, but also on morphofunctional characteristics of the organism. It is concluded that clinical hypnosis, despite the decline and even undeserved rejection in medicine in the post-soviet period, is a promising tool for both research and clinical medicine.
Key words: hypnosuggestive therapy, hypnosis, psychotherapy, somatoform disorders, psychosomatic disorders.
Zaporizhzhya Regional Dermatovenereology Hospital
Experience of psychocorrective methods application to treatment of patients with chronic allergic dermatoses
94 - 98
Nowadays a number of research deal with the problem of treatment of patients with chronic allergic dermatoses, however, insufficient attention is paid to the possibility of psychological correction in complex treatment of this disease. To determine psychological characteristics of the patients with chronic allergic dermatosis, 98 patients and a group of healthy men were investigated. Disease severity was assessed using SCORAD, anxiety level - Spielberger-Hanin scale, neurotization level � Wasserman�s scale, depression level - Beck�s scale were used. Assessment of life quality was performed using a Ukrainian version of DLQI questionnaire. Administration of a nootropic medication and autogenic training by Schultz in combination with basic therapy for chronic allergic dermatoses improved the clinical picture of the disease, which manifested in lower SCORAD index compared with the groups of patients before the treatment and after basic therapy, improved the quality of the life of the patients. After the treatment the patients, who received nootropic medication or practiced autogenic training, had significantly lower levels of DLQI index after treatment in comparison with the patients before treatment, as well as with group of the patients after the basic therapy. Our findings suggest that the use of nootropic medications and Schultz autogenous training in combination with the basic therapy is an effective method for treating patients with chronic allergic dermatoses.
Key words: chronic allergic dermatoses, treatment, nootropic medications, autogenous training.
Kharkiv National Medical University
Complex approach to psychotherapeutic correction of organic affective disorders
99 - 102
Complex examination of 60 patients was performed to do clinical psychopathological characteristics of organic affective disorders and to work out the principles of their prevention and rehabilitation of the patients. The obtained findings suggest the existence of a number of factors inducing development of affective disorders in the investigated category of patients resulting from residual organic pathology of combined origin, life dynamism, necessity of rapid reactions and decision making, switching from one type of activity to another, disharmonic relations in the family, conflicts in micro- and macrosocium, interpersoanal conflicts and limitations in the choice of profession. The peculiarities of the clinical presentation of organic affective disorders are determined by their cause. Depending on the etiology, the following variants of organic affective disorders were distinguished: nosogenic, psychogenic, pharmacogenic, and mixed. It was established that the investigated patients significantly more frequently demonstrated depressive disorders, affective reactions, dysphorias and obsessive phobic disorders, hypomanias. A complex system of pathogenetically substantiated psychotherapeutic correction of organic affective disorders was developed. Its use is a decisive prerequisite of effective social and labor restoration of the patients.
Key words: organic affective disorders, clinical features, psychotherapeutic correction.
Kharkiv Medical Academy of Postgraduate Education
S. n. smirnova: «my profession of psychiatrist is to bring goodness to patients»
103 - 107
The article covers the life and activity of a psychiatrist, curator of Saburova Dacha Museum, S.N. Smirnova. The museum was renovated and reopened in what is now Kharkov Regional Clinical Psychiatric Hospital No. 3 in 1998 year. During operation of the museum S. Smirnova organized 8 exhibitions. In 2007 the book �Essays on the History of Saburova Dacha�, in which S. Smirnova summarized and consistently introduced the results of 60 years of work on collection of documents related to the history of the oldest and largest in Ukraine medical-scientific psychiatric institution, was published. A special place in the article is occupied by the autobiographical memories of S.N. Smirnova related to her personal acquaintance with prominent figures in psychiatry, neurology, neurosurgery. Scientific trends, innovations of medical practice, life and the economic part of Saburova Dacha at different times are described. The article draws on personal papers and materials of interviewing S.N. Smirnova, some archival documents from Saburova Dacha Museum as well as monographs and publications in scientific periodicals covering the aspects of the history of psychiatry and mental health.
Key words: psychiatrist mental health, history of psychiatry, Saburova Dacha museum.
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