ARTICLES ARCHIVE

In the recent decade a great attention has been paid to disease prevention. Modern cardiosurgey opportunities can help patients with congenital heart disease to improve significantly their health and life expectancy, but at the same time, many patients still complain of weakness, fast tiredness, bad mood and low quality of life. Previously the prognosis for these patients used to be very poor, however nowadays most of them survive reaching adulthood. The role of the psychologist in the care of patients with congenital heart disease was outlined, starting from the definition of clinical psychology, and its contribution to psychocardiology development. Some differences between acquired and congenital heart disease were also outlined. The literature regarding the psychosocial aspects of children with congenital heart disease was presented, paying particular attention to research on quality of life and psychosocial functioning.

This article considers the problem of loneliness of an adult person in the modern world, the psychological aspects of his/her experience with emergence of existential vacuum, narrowing the scope of communication, loss of a sense of community with their social group. The authors analyze different kinds of loneliness, the basic criterion of differentiation which is a subjective assessment of self−isolation, emergence of a new social role of an exile or voluntary hermit existential search for niches for further existence. Detailed characteristics of the two main strategies of behavior of a lonely person are given: sad−passive and active−compensatory, the choice of which always depends on a unique set of personality traits, including introversion−extraversion and sthenicity level as well as on life experience of the person, the presence in his/her biography of successful examples of overcoming negative situations and subjective unsolvable problems. This article may be useful to medical psychologists in their practice.

Pregnancy is associated with hormonal changes in the woman's organism, which leave a mark on the psychoemotional state. Optimal attitude to pregnancy forms attachment of the mother and father to the child and intuitive communication of the parents with the prenate, which forms during pregnancy (bonding). However, when carrying an unwanted or unplanned baby, pregnancy without a partner or family approval, asthenic negative emotions dominate. The aim of the study was to investigate the emotional state of pregnant women and determine the necessity of medical and psychological assistance, its scope and targets. The aim of the study was to investigate the emotional state of pregnant women and determine necessity of medical and psychological assistance, its scope and targets. The study was conducted at Prenatal Maternity Hospital of Chernihiv City Council. The study involved 185 persons. The criterion for stratification of the respondents was feeling of fear of future delivery. In the first phase of the study clinical interviews and psychodiagnostic tests were performed. To assess the emotional state of the respondents, methods of differential diagnosis of depression by U. Zunge, the scale of anxiety self−assessment by Spielberger−Hanin were used. Further observation allowed forming two groups: 60 persons (group 1 −− are not afraid of birth) and 63 persons (group 2 −− fear of childbirth). The psyhodiagnostic investigation revealed statistically significant findings on higher level of the average value of state and trait anxiety in women from group 1. The level of depression in terms of the average value was higher in group 1 with cases of subdepression and severe depression; in group 2 these were not detected. The obtained findings allowed to conclude about the necessity of medical psychological assistance to women in both groups in varying degrees. Pregnant in group 1 were suggested to visit psyhoeducational program, group 2 −− programs of psychocorrection. To work effectively on the causes of fear and prepare for the partnership birth the spouses are recommended to attend psychological lessons.

Patients who seek an appointment with the medical practitioners or pediatricians quite frequently express multiple complaints, which are difficult to describe as the clinical picture of a specific disease. In primary care 20 % to 50 % of all patients complaining of physical symptoms can be categorized as medically unexplained symptoms. Medically unexplained symptoms usually resolve spontaneously, but sometimes the complaints persist, leading to functional impairment such as somatoform vegetative dysfunction. In this case adolescents with somatoform vegetative dysfunction are at risk of hyperdiagnosis and overtesting, excessive special investigations and unnecessary treatment, which leads to repeated medical contacts with different specialists and expectations of "right" diagnosis and cure. Thus, engaging and cooperation not only with pediatricians but also with medical psychologists for effective diagnosis and treatment is necessary. Our study investigated the impact of medical and psychological support (psychotherapy) on the psychoemotional state of adolescents with somatoform vegetative dysfunction of cardiovascular system. All adolescents were treated in cardioreumatology department of Kyiv Children's Hospital No. 6. After the discharge the adolescents who took part in psychotherapeutic interventions had better rates of psychoemotional state than the patients who got usual (medicinal) treatment. The dynamics of indices were as follows: reduction of state and trait anxiety levels, depression rates, improvement of general health state, activity and mood. Our findings demonstrate the necessity of medical and psychological consultation, as well as better effectiveness of treatment and faster recovery of adolescents with somatoform vegetative dysfunction of the cardiovascular system in case of medical and psychological support.

The article describes the clinical and psychopathological features of treatment−resistant states at recurrent depressive disorder. The relationship between alexithymic radical and clinical features of depression resistant to treatment was investigated. It was found that alexithymia was one of the permanent symptoms in patients with treatment−resistant depression, which subsequently affects the ability to correctly describe the personal emotional experience, the ability to understand other people's feelings. Such patients have difficulty in determining the difference between emotional processes and bodily sensations; fix their mental activity to external events with loss in the internal experience. To investigate this issue, a group of patients (84 persons) with the diagnosis of recurrent depressive disorder (F 33) with signs of resistance to treatment was formed. Depression was considered treatment−resistant if adequate immunotherapy by at least two courses of antidepressants from different pharmacological groups for 3−4 weeks did not result in improvement, i.e. reduction of symptoms by Hamilton scale was less than 50 %. To study the phenomenon of alexithymia Toronto alexithymia scale −− 20 points (TAS−20) was used. The study allocated 6 clinical and psychopathological variants of depressive syndrome in the structure of recurrent depressive disorder with the signs of resistance: anxious (agitated), melancholic, senesto−hypochondrical, apatho−adynamic, asthenic−anergic, and obsessive. Prevalence of senesto−hypochondrical, anxious (agitated) and melancholic variants was found. TAS−20 revealed the presence of alexithymia in all patients from this category. Thus, treatment−resistant depression in the structure of recurrent depressive disorder has alexithymic character. These data suggest that alexithymia may be used as a diagnostic and prognostic marker in treatment−resistant depression.

The approach including both clinical and psychopathological method as well as the use of various diagnostic instruments is of great importance. The purpose of the work was to examine the characteristics of the emotional sphere in women with depressive disorders of different origin and its influence on the degree of adaptation at all levels of interaction between the spouses. The study involved 399 families in which a comprehensive survey diagnosed depressive disorders (DD) of various origin: affective disorders (AD) −− 172 women, neurotic depression (ND) −− 227 women aged 19−48. In addition to clinical and psychopathological approach, psychodiagnostic methods: self−assessment scale of state and trait anxiety by S. D. Spielberger and Y. L. Hanin (S. D. Spielberger, 1972 as modified by Y. L. Hanin, 1976), Hamilton scale to assess depression (HDRS), special sexological examination and clinical and statistical analysis were applied. Psychodiagnostic findings were processed using significance of sample differences (t −− test with p < 0.05 and p < 0.001). In general, as the level of state anxiety and trait anxiety was higher in patients with ND, but no statistically significant differences between the groups were identified, only in terms of state anxiety and indicators of low trait anxiety. Both groups were characterized by high trait anxiety. Low level of trait anxiety was statistically significant (p < 0.01) in patients with ND, in patients with AD it was not found. The average level of depression in patients with moderate AD corresponded to moderate and was slightly higher than in patients with ND, average HDRS was 17.4 and 15.7 points, respectively, the differences were not statistically significant. The level of psychological compatibility in the spouses was low in 272 (75.6 %) spouses. 360 (90 %) spouses had sexual−erotic deadaptation, while 39 (10 %) had a high level of psychological, social−psychological and sexual−erotic adaptation. The used psychodiagnostic methods (self−assessment scale of state and trait anxiety by S. D. Spielberger and Y. L. Hanin and HDRS) can detect differences in personality characteristics and emotional sphere of women with different DD origin. The indices of psychodiagnostic methods corresponded to those of conventional clinical method. Psychodiagnostic research suggests a great importance of the personality characteristics of patients, their emotional sphere promoting abnormal personal reactions in these patients to sexual failures and the degree of adaptation at all levels of interaction in the origin of family health disorder.

In modern social psychiatry a special role is played by investigation of development and course of mental disorders against a background of job seniority. This is primarily concerned with psychopathology in heavy industry. Industrial workers are subjects of many research. However, there are no systematic investigations of the mechanisms of development and formation of personality−abnormal pathologies. Personality disorders require consideration at working out psychotherapeutic and psychopreventive activities, which can improve the quality of life and social functioning level in the workers. The study implemented a set of measures aimed at detailed, multifactorial study of personality disorders in industrial workers. Thus, using specialized clinical and psychopathological, psychodiagnostic and medicosocial tools, the work summarizes the results which indicate the interaction of numerous correlatives. They define the properties and quality of personality disorders against a background of the environment. It is emphasized that in the psychogenesis personality−abnormal pathology in industrial workers the most pronounced role is played by the operation time in unfavorable conditions, heaviness of work, age, presence of somatic pathology. Everyday social factors (education level) are less important. The described factors and exacerbation of personality disorders are interrelated; this is more pronounced for the total length of service in industry and correlates with the age. This allows prediction of risk of personality disorders, taking into account the impact of production, biopsychosocial factors and development of comprehensive recommendations to prevent them.

Currently, psychiatric rehabilitation in Ukraine includes variety of ways to improve social functioning of patients. One of the most in need of such assistance is the category of persons suffering from disorders of schizophrenia circle. Loss of mental competence and limited social inclusion at a young age are frequently in question. Therefore, selection of medical and social, psychosocial services is important to adapt the patients to the new conditions of life after suffering psychosis. A new set of psychosocial support for medical psychologists / practical psychologists of the health care system applicable to psychiatric rehabilitation of patients with paranoid schizophrenia was suggested. These interventions were designed based on the concept of autobiographical memory, the concept of psychological time, and personality theory in simultaneous−mnestic psychotherapy (psychomethodology). Theoretical and methodological investigation on chronodynamic organization of autobiographical memory in patients with paranoid schizophrenia resulted in creation of a specialized set of investigation, the aim of which was to develop a system of psychosocial support for patients with schizophrenia based on a comprehensive analysis of their autobiographical memories after recovery from the psychotic state. Our activities were divided into three basic subsystems: psychodiagnostic, psychocorrection, psychoeducation. Each of them included a set of mutually compatible modules that outline the logic of the proposed developments. The battery of psychodiagnosis included creation of the original modified methodology to study the dynamics of autobiographical memories as a slice of data about adaptive capacities. Later these data were formulated in the target of psychosocial support. Psychocorrection and psychoeducation were translated into individualized sessions, taking into account pathopersonology, intra− and interpersonal functioning of the patients.

Phobic disorders and anxiety are non−psychotic disorders often associated with long periods of emotionally hard psychoemotional stress. They include phobic disorders, panic disorder, generalized anxiety disorder, mixed anxiety and depressive disorder, obsessive compulsive disorder. The factors contributing development of anxiety and phobic disorders include mental disorders (primarily neurotic and depressive); heredity; presence of organic predisposition as perinatal, intrapartum (birth asphyxia) and postnatal (cerebrocranial injury, neurological infection, acute and chronic intoxication) brain damage; personality features: anxious−hypochondriac, anancastic features; a history of neurotic and depressive disorders; psychoemotional stress in the period preceding the disease. Clinical characteristics of various disorders are common; however, they often manifest by varying degrees of severity and may occur simultaneously (combined) or at different stages of the disease, acquiring clinical or subsyndromal forms. In clinical cases, a combination of various symptomatic complexes in the stage of independent disorders means comorbidity disorders. The main directions in the treatment of anxiety disorders at the present stage are combination of pharmacotherapy and psychotherapy.

Method of complex assessment of the addictive status of the individual and population by means of AUDIT−system similar tests (I. V. Linskiy, A. I. Minko, A. F. Artemchuk et al., 2009) was used to investigate special characteristics of the addictive profile and behavior in different types and sub−types of adaptation disorders (AD) (F46.2 according to the ICD−10 criteria) in 99 military professionals retired from armed forces within the period of 2010−2013. The addictive profile in patients with AD was found to be complex, which was proven by presence of two prenosological patterns of use of psychological active substances (PAS) of different risk degree (relatively safe and dangerous pattern of alcohol consumption and relatively safe and dangerous pattern of tobacco consumption), presence of two prenosological patterns of use of PAS (mono−substantial and poly−substantial). The positive dynamics of average score according the AUDIT−test in patients with AD (1.54 times increase of average values and 1.75 times increase of the number of patients with behavioral AD) as well as the average score 9.21±4.60 at the moment of the study allowed to conclude about the change of risk degree of addictive behavior with AD after the retirement from the armed forces. Addictive behavior changed from relatively safe to dangerous, i.e. the risk of alcohol addiction in patients with AD and, first of all, in patients with behavioral type of AD, increased. Alcohol consumption as a corrector of psychological and emotional state during AD significantly increases risks of development of concurrent disorders of adaptation and addictive spectrum.

The author presents the findings of the research of path psychological features in patients with neurotic and organic non−psychotic disorders residing in rural areas. The main group consisted of the residents of rural areas: 292 patients with neurotic disorders and 295 patients with organic non−psychotic disorders. The comparison group included 148 urban residents who were diagnosed neurotic disorders and 146 patients with organic non−psychotic disorders. The features of the individual, severity of alexithymia, aggression were investigated. The level of specificity of social frustration, especially the quality of life, social and psychological adaptation, individual values and their implementation in various spheres of life, as well as features of interpersonal interaction in patients with various forms of neurotic and organic disorders were determined. General and specific psychological characteristics that are typical for patients with neurotic and organic non−psychotic disorders that should be considered during medical and preventive measures were distinguished.

Atopic dermatitis (AD) is one of the most common problems of modern medicine. The action of somatic pathogens in childhood and adolescence is a particularly urgent issue. Investigation of intrapsychological patterns is an important step in working out psychological measures because individual typological features manifest differently in a situation of physical stress, have different effects on the behavior during treatment process and disease. This makes development of programs of psychological support, psychological assistance and psychorehabilitation relevant in a number of medical fields. The aim of study was to determine individual psychological characteristics of adolescents with AD. Pathocharacterological diagnostic questionnaire was used to measure the intrapsychological patterns. The study involved 108 children with AD −− main group (MG, 67 girls and 41 boys) and 48 somatically healthy adolescents −− comparison group (CG, 29 girls and 19 boys). The age of the respondents was 15−17 years. Investigation of the character accentuations in adolescents revealed greater number of persons with pathocharacterological features in MG (70.1 % of females and 75.6 % males) vs. CG, where the corresponding figures were 51.7 % and 57.9 %, respectively, p < 0.05. In MG, asthenic−neurotic (20.9 %), hysteroid (13.4 %) and labile types (11.9 %) prevailed in girls and asthenic−neurotic (22.0 %) and hyperthymic types (17.1 %) prevailed in boys. In CG, dominant accentuations in girls were hyperthymic (17.2 %) and sensitive (13.8 %), while in boys, hyperthymic (26.3 %). In girls from MG, the number of respondents with asthenic−neurotic and labile type of accentuation was higher (20.9 % in MG and 6.9 % in CG, 11.9 % in MG and 0 % in CG, p < 0.05). In boys, differences were found for hyperthymic type: a larger proportion of persons in CG (26.3 %) in contrast to the MG (17.1 %), asthenic−neurotic and epileptic types with higher number in MG (22.0 % in MG and 5.3 % in CG, 7.3 % and 0 % in MG and CG, p < 0.05). Differences in the structure of accentuations were revealed between girls and boys from MG: the boys were characterized by greater proportion of persons with hyperthymic and epileptic types (p < 0.05). Investigation of intrapsychological patterns in adolescents with atopic dermatitis showed significant differences in the structure of accentuations compared to somatically healthy peers, namely, the prevalence of labile and asthenic−neurotic types in girls and asthenic−neurotic and epileptic in boys. This proves increased susceptibility of certain psychotypes to development of some diseases and deepening preexistent deadaptation patterns of psychiatric and neuropsychological states. Each type had positive and negative effects on the treatment process. Basic patterns associated with treatment process in adolescents with different accentuation, namely, the attitude to the disease and treatment, problems in the immediate implementation of the therapeutic plan and methods of correction were described. Differences in the response and behavior during the treatment process in adolescents with different accentuation indicate the need for consideration of individual features in development of medical psychological activities for children with atopic dermatitis.

The concept of psychophenomenological profile acting as an operational unit in the structure of clinical psychophenomenological method, acquires, in the further evolution, the character of a universal tool of implicit argumentation of methods selection and construction of psychotherapeutic intervention systems. The process of further development of the concept of psychophenomenological profile by means of including in its structure of a growing number of phenomena and their further systematization, as well as improvement of clinical and psychophenomenological method is a priority of [clinical] psychotherapy. Basing on clinical psychophenomenological survey of 100 patients with diagnoses J45.01; J45.08; J45.09; K25.07; I10, as well as 100 healthy volunteers at Department of Psychotherapy (Kharkiv Medical Academy of Postgraduate Education) and Hospital "Men's Health", metaparadigmatic model of sentencious−semantic intervention in the competention sphere of psychotherary was formed.

Psychocorrection is the basis of the work of a psychiatrist/psychotherapist. This is necessary both as therapeutic weapons and as an auxiliary component of work with the patient. It helps to achieve compliance, influences the entire treatment process. It is known that a personality is always included in the pathological process. This leads to disruption or distortion of the individual. It is therefore necessary to study individual and personal components, for which the use of SMIL was proposed. The total number of 65 patients were examined, of them 17 with clinically identified neurotic disorders (F4), 25 had behavior and personality disorders (F6), 20 demonstarted certain psychotic disorders including schizophrenia register (F2). The controls (21 persons) consisted of respondents without mental disorders. Application of SMIL questionnaire identified combinations of profile disintegration corresponding to the available clinical picture. The data obtained using control scales were also helpful. The obtained findings were confirmed statistically. The data obtained can be used in formation of psychodiagnostic and psychocorrectional approach when dealing with the patients of psychiatric and psychotherapeutic orientation, as well as in development of psychopreventive and psychohygienic measures aimed at formation of stress−resistance and positive motivational component of personality.

Our study involved 315 patients of therapeutic profile with acute condition aged 22−70. Clinical−psychopathological investigation revealed various disturbances of the mental sphere in patients of somatic profile with acute states. Pathogenetically substantiated system of medical and psychological correction of mental deadaptation was developed. Integrative approach with the elements of cognitive−behavioral therapy (CBT), rational psychotherapy, AT, individual and group personality−oriented psychotherapy, family psychotherapy was applied. The goals of therapy were to achieve reduction of pathological symptoms, to identify and verify negative cognition, to develop alternative and more flexible scheme of extension and to regulate new cognitive abilities. The findings of the investigation were used to develop psychocorrection program, which proved its effectiveness.

Investigation of the capabilities of psychotherapeutic correction of non−psychotic mental disorders (NPMD), psychosomatic disorders and somatic complications in women during pregnancy is urgent. Major disorders which can be corrected by medical and psychological intervention are NPMD, abnormal weight gain in pregnant women, headaches, blood pressure fluctuations, threat of miscarriage and premature birth. The aim of the study was to form a modern system of psychoprevention, mental health and psychotherapy in pregnant based on the detected clinical phenomenology of structure, causes and characteristics of the course of non−psychotic mental disorders and somatic complications of pregnancy in pregnant. The state of the emotional sphere in different trimesters and its relationship with somatic complications of pregnancy (increased blood pressure, headaches, threat of miscarriage, pathological weight gain and toxemia) were investigated in 65 pregnant women. The findings of psychotherapeutic methods of correction of these complications and their effect on delivery were also studied. The study group included 65 pregnant women who underwent investigation of the psychoemotional sphere and comprehensive medical and psychological support throughout the pregnancy, including psychotherapeutic methods of correction (relaxation, autogenic training, individual and group psychotherapy sessions and others). Medical complications of pregnancy (toxemia, headache, fluctuations in blood pressure and abnormal weight gain) were controlled with psychocorrection in 29−37 % of women. This reduced the risk and promoted low values of the obstetric scale according to Coopland (0−2) in 70 % of women as well as improved the outcome of pregnancy and delivery.

Treatment of addiction to psychoactive substances is one of the key issues in medicine because of poor response to therapy, significant percentage of recurrence and rehospitalization. Comorbid affective pathology plays the role in it, thus indicating the need to include sanogenic measures normalizing the emotional state of patients in the complex therapeutic tactics of addiction treatment. Therefore, the aim of the study was to develop a system of psychotherapy in addictive patients with affective disorders. The study was performed at Regional Clinical Narcology Hospital of Zaporizhzhia Regional Council and involved 100 patients with polydrug abuse (opioids, cannabinoids, alcohol, tobacco). The study analyzed clinical psychophenomenological state of the patients with polydrug abuse with affective disorders. Such sanogenic psychotherapeutic phenomena as hypnability, suggestively, reinforcement, learning, understanding, reassurance, forgetting were detected in all patients. Correlation of the existing psychotherapeutic phenomena and clinical psychotherapeutic effect−syndromes with most congruent psychotherapeutic methods was revealed. The system of psychotherapy in patients with polydrug abuse and affective disorders consisting of five sequential stages, and including short−term dynamic, rational, suggestive and hypnosuggestive, simultaneous−mental, aversive, cognitive−behavioral therapy, self−hypnosis in the form of individual, group, family forms of implementation was developed and tested.

Despite constant refinement of gender factors in development, pathomorphism and outcomes of alcohol addiction in women, holistic view on the role of individual psychosexual ontogeny in formation of addiction is absent; the problem of sexual identity and its correlation with other substructures of individuality in alcohol addicted women remains insufficiently investigated. There are no data on the prevalence and variations of gender−role behavior deviations in regional groups of alcohol addicted women. The methodological basis of this study was the concept of gender−role behavior proposed by B.Е. Alekseev. The aim of the study was to examine the characteristics of psychosexual sphere in alcohol addicted women. Clinical−psychopathological (main), psychodiagnostic, methods of mathematical statistics were used. One hundred and thirty three alcohol addicted women and 30 healthy women from general population of Kharkiv were studied. Based on criteria of G. S. Vasylchenko, V. M. Maslov, I. L. Botneva (1983), incidences of normative (feminine) and deviated (non−normative according to medical criteria) stereotype of gender−role behavior was established in regional populations of healthy and alcohol addicted women. In particular, 66.17 % of addicted women had deviations of gender−role behavior of non−transsexual type which were expressed as non−pathologic and pathologic variants. In the structure of the non−pathologic variant, non−pathologic transformation of gender−role behavior prevailed (F64.9.); in the structure of the pathologic variant, pathologic transformation of gender−role behavior prevailed: F64.9, F65.5 (sadism). Maximal values of cross−sexual behavior index (CBI) equal 1 (diagnostic method of cross−sexual accentuations of gender−role behavior by B. E. Alexeev, 2006) were found in addicted women with pathologic transformation of stereotype of gender−role behavior, whereas minimal values of CBI equal 0 were found in addicted women with non−pathologic hyper−role stereotype. Values of cross−sexual behavior index equal 1 reflect maximum expressed cross−sexual accentuation of gender−role behavior, whereas values close to 0 show its absence. The presence of a significant number of explicit cross−sexual (37.59 %) and hidden (13.53 %) accentuations of M−F measurement and gender−role behavior in alcohol addicted women is not occasional and directly indicates to the existence of clinically significant pathogenetic link in the female alcoholism formation. The presence of multivariate and poly−form deviations of gender−role behavior in the majority of alcohol addicted women allow to suggest the importance of a new dysontogenetic (psychosexual) factor in the pathogenesis of alcohol dependence and to state that the outcome of gender roles and behavioral stereotypes formation and sexual preferences associated with this situation (clinical significance of which is obvious) is underestimated, making incomplete the traditional medical and psychological diagnosis and treatment of addicted patients.