ARTICLES ARCHIVE

The aim of the work was to define and implement psychological analysis of the basic conditions and laws of compliance formation in patients with neurological and mental disorders. The methods of observation, psychodiagnostic and mathematical−statistical methods were used. The study revealed the content of the phenomenon of compliance in patients, which is considered as a system of assessments, attitudes, beliefs, emotional reactions, motivations and actions of the patient, ensuring the process of compliance with treatment and rehabilitation recommendations. Its structure, including emotional, mounting and evaluation, motivational and behavioral components was determined; and typology was worked out. Eight basic types of compliance were distinguished: constructive, formal, passive, symbiotic, and unstable, negativistic, deficiency and mixed. The basic groups of conditions of formation and functioning of compliance were determined: objective and subjective. The objective conditions are environmental (objective characteristics of the therapeutic environment of medical institutions; the objective efficacy of treatment and rehabilitation activities, etc.) and individual (clinical and socio−demographic). Subjective conditions are the main individual psychological characteristics of patients and psychological components of the treatment and rehabilitation process. In the process of formation and functioning of compliance, three phases can be distinguished: initial, basic and final. Each of these phases is characterized by specific conditions, which play a key role in the development of compliance at this stage.

This work analyzed the literature on the problem of stress and reaction to stress. The content of the terms "stressor factor", "stressor reaction", "stress", "reaction to a stress" is outlined, the place and their values in development of somatic and mental disorders are specified. The features of mechanisms of development of mental and somatic components predetermine development of options of the course of stressor disorders and interaction of acute reaction to stress and stressor reaction − formation of their subacute and chronic forms. The detailed analysis of manifestations of psychological reaction and their communication with neurotic and borderline rank in the structure of reaction to acute stress was carried out. Modern views on formation of post−traumatic stress disorders and social stressor disorders were analyzed in detail, comparative characteristic was carried out. Despite the importance of prestress features of the personality for development of reaction to stress, these factors are poorly presented in the literature. The data are fragmental, do not show the existence or lack of communications with development, phenomenology, options of the clinical course of reaction to stress. As a result of the analysis of the literature, lack of accurate delimitation between psychological and psychopathological ranks of sign was established. There are no criteria (markers) of threat of transformation of psychological reaction to psychopathological. In the literature there are no data on mutual influence of PTSD and SSD (social stressor disorder) that is extremely important for interpretation of symptomatology, psychocorrection and prognosis of the course of reaction to stress. The analysis demonstrated the necessity to systematize and delimit deadaptation disorders not only by symptomatology rank but also by the degree of completeness of adaptation (deadaptation) to results of stressor influence; as well as development of a uniform model of deadaptation disorders.

The article investigates psychological characteristics of marital relationship in a young family with tobacco smoking. The purpose of the work was to reveal the features of emotional relationships depending on smoking in a young married couple. The study involved young childless families with experience of no more than 3 years. Three groups were formed: Group 1 included married the couples in which both partners smoke, Group 2 involved the couples in which one partner smokes, Group 3 − non−smoking couples. Psychological testing was conducted using a structured interview and questionnaire "Understanding, emotional attraction, authority" by Volkova A. N. Statistical processing was performed using parametric Student's t−test. The findings show that the most harmonious interpersonal relationships were identified in non−smokers families. In couples where one partner smokes, there was a decrease of all indicators of interpersonal emotional relationships. In dyads where both partners smoke, emotional relationships were characterized by a decrease in respect of the husbands for their wives. Women were more tolerant to smoking, which manifested both at the social and at family levels. Marital relations were interconnected with consistency of attitudes toward smoking. The contradiction between the attitudes toward smoking and the behavior of a partner in dyads, where one spouse smokes, served as a family stressor, and led to reduction of understanding, respect and attraction to the partner, stimulates marital conflict. In couples, where both partners smoke, mindset of the spouses is not in conflict with their behavior and smoking does not act as a source of conflict in interpersonal interaction. The results of the study can be used to construct preventive anti−smoking models in the early stages of creating a young family.

Modern epidemiological, clinical and psychopathological studies illustrate that more than 50 % of patients with depression do not show significant clinical improvement. Based on these data, high proportions (30 to 60 %) of these disorders are designated as treatment resistant depression (TRD). The course of the TRD in most cases is very long with a load of significant stress and development of severe social desadaptation that is tangible for socio−economic problem. TRD are inherent of polymorphism and atypical clinical picture, structural complexity of depressive symptoms, the presence of heterogeneous inclusions, secretiveness, sameliness and stiffness increasing with repeated episodes, as well as process of somatization of psychopathological symptoms. At present a clear link between alexithymia syndrome and depressive symptoms has been established, and the level of alexithymia in patients with TRD is not a stable indicator and decreases with the reduction of clinical symptoms. Limiting the possibility to understand them, a significant lack of reflection is the impulse for formation of false mental model of functioning and selection nonadaptive strategies to eliminate or reduce impact of forces on the individual stress factors (coping strategies) and eventually becomes a significant barrier to effective treatment of patients with TRD. Thus, alexithymia is associated with nonadaptive forms of coping behavior in patients with TRD, which was found in this research. Nonadaptive options of coping strategies, including cognitive − confusion (40 %) and reconciliation (26.7 %), emotional − obedience (40.0 %), self−blame (33.4 %) suppression of emotions (13.3 %), behavioral − avoidance (46.6 %) and retreat (26.7 %) dominated in TRD.

The article deals with the relationship of clinical psychopathology and psychosocial factors in creation of social adaptation of youth. In the persons from group A an association between "fear and anxiety" or "avoiding the situation"; "fear or anxiety" with disadaptation, rejection itself, rejection of others, emotional discomfort, high internal controls, subordination, escapism at the were revealed at "high scientific level of statistical significance" and/ or "absolute level of statistical significance". Relationship indicators of social phobia and social frustration were established between representation anxiety and social interaction anxiety and "complete dissatisfaction" or "rather dissatisfied". That is, at social phobia and representation anxiety and social interaction anxiety arise at the presence of social frustration at the level "rather dissatisfied" and "complete dissatisfaction". The analysis of state and trait anxiety and indicators of emotional intelligence revealed that there was a high correlation (absolute) and average (trend) at the "levels of statistical significance". On the "high scientific level of statistical significance" and/or "absolute level of statistical significance", relationship between depression at the level "mild depression of situational or neurotic origin" and indicators of social and psychological adaptation was found out. Analysis of the relationship of psychosocial stress indicators and indicators of socio−psychological adaptation manifestation revealed their presence with high levels of psychosocial stress. The obtained findings were used in development of a comprehensive program of psychocorrection and psychoprevention of social exclusion in students.

Analysis of foreign literature for the recent 10 years and the author's personal empirical research of 2006−2009 academic years revealed new opportunities for the problem of development of efficient use of four blocks of psychodiagnostic methods for screening investigation of early psychosomatic health disorders in female students in the structure of educational process. The purpose of this study was to conduct a detailed analysis of differential individually typological characteristics of female students (n = 375) divided into three groups: introverts (n = 79), ambiverts (n = 111), extroverts (n = 185). A comprehensive study of all stages (general statistical, correlative, factors, comparative analysis of intergroup for sample of ambiverts considering complicated dynamics of 45 total indicators of four blocks of psychodiagnostic methods was performed. The investigation of individual psychodiagnostic screening in the group of ambiverts showed the following results. Unlike introverts, ambiverts demonstrated three major factors: majoring field, objective age self−esteem, ambiverted emotional stability. The first significant difference between the two groups was the total number of psychosomatically oriented correlations in the group of introverts − 11, ambiverts − 22. Direction and nature of these relationships in these two groups were significantly different. Thus, the factor of ambiverted emotional stability can be considered the leading indicator contributing to accumulation of traits mediated by basic conceptual positions of H. Eysenk's two−factor personality theory (intro/ extroversion, emotional stability / instability) as leading to the formation of personality transformation in female ambiverts from borderline psychosomatic state of health/disease to psychosomatic illness.

The features of mental behavior regulation were investigated in former military personnel with adaptation disorders who survived their dismissal from the Armed Forces as a traumatic event. It was revealed that those transferred to the reserve chose different ways of coping. Those for whom it was a psychological trauma, used as the unconscious the defense mechanisms of the psyche and conscious ways of coping that were characterized by emotionally oriented and maladaptive character. Such regulatory features did not allow the military with adaptation disorders cope with life difficulties. Former military personnel who did not have adaptive disorders, and did not worry about the dismissal from the army as a traumatic event, resorted to a productive problem−oriented coping style. Both demonstrated peculiar correlation of behavior adaptive mechanisms. Servicemen without adaptation disorders were characterized by close ties of behavior control, psychological defenses and coping, in most cases having compensatory character, with preference to the most productive strategies. Former military personnel with adaptive system disorder are characterized by multiple links between the studied parameters with lower compensatory capacity, which did not promote successful coping but only added to the overall mental stress of the personality. The practical significance of this investigation consists in the possibility of using the data obtained in development of individual programs of psychological rehabilitation of former military personnel experiencing the fact of dismissal from the army as a traumatic event and showing the signs of adaptation disorder.

The problems of psychosocial adaptation of family members of children with congenital heart disease are featured. At present in Ukraine there are no standards and algorithms to provide medical and psychological care in pediatric cardiac surgery. The data of social survey of mothers and their subjective evaluation of psycho−physical health and development of children after surgical correction of congenital heart disease were analyzed. It is known that cerebral blood flow complications and hypoxia can affect the fetal brain development and newborn surgery using a heart−lung machine increases the risk of complications of the central nervous system and the overall mental and physical development. However, the survey findings did not reveal deadaptation social indicators in the mothers, only 5 % of them noticed delay in development of their children. This requires medical attention to every mother and child with congenital heart disease and, if necessary, formation of an appropriate program of early psychosocial support to the patients. An important aspect of improving the efficiency of care for children with congenital heart disease is change in the model of domination of expert professionals of the parents and formation mutually responsible working alliance. The relevance of the research with further development and implementation of medical and psychological assistance are due to the range of medical and psychological problems in this area and the importance of maintaining physical and mental health of the child and his family members.

The paper presents the empirical study which explores the attitude to factors of healthy and unhealthy behavior in Ukrainian adolescents. Analysis of the literature showed that the problem of positive and negative lifestyle among adolescents in spite of its relevance and active learning in other European countries is still not fully explored in Ukraine. The purpose of this paper was to study the attitude to factors of healthy and unhealthy behavior in adolescents, the hierarchy of these factors, as well as their relationship with chronic diseases, actual health self−evaluation and the parental involvement in the lives of adolescents. The study involving 589 students (mean age 14.866 years, SD = 1,107 years) was conducted in 10 secondary schools in the city of Odessa. Different types of schools were covered: public schools, gymnasium, lyceum, college and boarding school. The study was performed as a part of the Swedish−Ukrainian project to study the mental health of adolescents (director Prof. Rozanov V. A.) in collaboration with the Swedish National Research Centre (director. Prof. D. Wasserman), supported by the Swedish Institute (Swedish Institute). The study examined the following parameters within the inventory SEYLE: the attitude to factors of healthy and unhealthy behavior in adolescents, presence of chronic deceases, actual health self−evaluation, parents' alcohol and drug use. The relationship of these parameters with the factors of positive and negative lifestyle of adolescents was investigated. It was revealed that adolescents considered bad habits the most harmful for their health among all other negative factors. Smoking factor was not perceived as harmful as alcohol and drug use. It was observed that students with high health self−evaluation are oriented to active healthy factors and realize the harm of passive time spending. Parents' alcohol use in the presence of their children had a negative effect on adolescents' attitudes to healthy nutrition and regular physical exercises. The results of this study can be used in educational and psychological practice for promotion of healthy behavior among adolescents.

Atopic dermatitis (AD) is a chronic allergic disease characterized by a recurrent course. Considering the prevalence of AD in children, the tendency to severe course, sequellae of the disease, determining psycho−emotional stressors as triggers of dermatosis relapse, the impact of psychological factors on the course of AD is one of the priorities in the treatment of the disease. The aim of study was to determine the behavioral patterns in adolescents suffering from AD. Questionnaire by R. Lazarus was used. The study involved 108 children with AD, the main group (MG, 67 girls and 41 boys) and 48 apparently healthy adolescents, comparison group (CG, 29 girls and 19 boys). Analysis of coping types revealed differences between the degree of their manifestation in adolescents from MG and CG. The girls in MG compared to CG had higher level of coping based on confrontation, distancing, self−control, search for social support, and avoided taking responsibility, r < 0.05. The boys in MG compared to boys in CG had greater coping intensity based on confrontation, distancing, self−control, search for social support, avoidance and positive reappraisal, r < 0.05. Differences in the intensity of coping strategies caused by gender were revealed, namely, higher expression in girls compared with boys in the MG distancing, search for social support and avoidance, while boys in−group had higher rates of positive revaluation. In MG differences related to higher levels of manifestation planning solution and positive evaluation of stressful situation in boys compared to girls. In the structure of stress behavior in adolescent girls from MG, a greater number of respondents with a high level of tension by type distancing, finding social support and avoidance was observed. In the structure of coping strategies in males, more respondents with a high level of tension in MG by type of distancing, searching for social support and avoidance, middle−tension was found. Higher number of respondents with high intensity and average intensity of self−confrontation and taking responsibility was present in boys from MG compared with girls. In CG higher number of boys with low tension of searching social support and avoidance was revealed. Our investigation revealed that adolescents who suffered from AD had higher level of coping tension in comparison with somatically healthy peers; existing differences in the choice of coping differed by gender; a large proportion of respondents with high levels of tension distancing and avoidance in adolescents with AD showed the need for psychological interventions aimed at correcting adaptive resource.

Motherhood is a complex biopsychosocial developing through a series of stages. Unconditional basis is biological and physiological processes in combination with genetic, social and psychological factors for procreation. Medical support of pregnant during pregnancy is important, but psychological support is no less important. Because during pregnancy woman models herself as a mother in the future, imagines future relationship with the child and thinks about meeting other interests (professional, social, gender, etc.), the question of maternal identity arises. Psychological support during pregnancy is very important as transformation of the individual woman personality changes her "self−concept". The attitude of pregnant towards herself and prosperity in pregnancy depend on it. The aim of this work was to study the personality traits in women with physiological pregnancy. The study was conducted at prenatal maternity hospital of Chernihiv City Council and Municipal nonprofit company "Consultation and Diagnostic Center" of Goloseevskiy district, Kyiv on 185 pregnant women aged 17−36 (group 1 μ = 25.5±0.27, Group 2 − μ = 24.8±0.27). The criterion for division into groups of the respondents were subjective feeling of fear of future delivery and psycho−emotional state of the women. The results indicate a statistically significant difference between the groups. Pregnant from Group 1 had the following personality traits: irritability, reactive aggression, introvertion and femininity. Pregnant from Group 2 had statistically sinificant inherent personality traits: communication, extravertion, masculinity. The results confirmed the correctness of division into groups as women from Group 1 could not express fear externally and ask for help, even when necessary. Women from group 2 express all fears and experiences externaslly, which manifests in requests for support and sincere expression of emotions.

Characterological peculiarities, value orientations, and peculiarities of a social−psychological adjustment of patients were analyzed in order to investigate individual psychological peculiarities of patients with depressive episode (F32.1−F32.2) and recurrent depression (F33.1−F33.2) with different levels of medication compliance (MC). The group of examined persons consisted of 111 patients with depressive episode and 106 patients with recurrent depression. Predominated requirements were an active life, freedom and independence in deeds and actions for patients with depressive episode and lack of MC; active life and self−confidence (absence of internal contradictions and doubts) for patients with partial MC; health for patients with complete MC. In recurrent depression leading requirements were material well−being and happy family life for patients with lack of MC; material well−being and existence of good and true friends for patients with partial MC; and health and knowledge for patients with complete MC. Our investigation revealed that complete MC was associated with pedantic (in F32.1−F32.2) and anxious (in F33.1−F33.2) peculiarities of personality, leading requirement of health, and sufficient social−psychological adjustment. Predictors of lack of MC were affective−rigid (in F32.1−F32.2) and excitatory (in F33.1−F.33.2) peculiarities of personality, predominated requirements of material well−being and happy family life with a low level of the social−psychological adjustment. The above criteria should be taken into account in diagnosis and correction of medication compliance.

Nowadays in Ukraine there is a tendency of incense of acute pathological conditions of non−surgical origin. These include such conditions as coronary artery disease (CAD), myocardial infarction (MI), crises in patients with essential hypertension (EH) and transient ischemic attack (TIA), asthma, gastric and duodenal ulcers, diabetic coma, etc. A number of scientific studies have shown a definite level of affective and neurotic disorders in this category of patients. Our investigation involving 187 patients was aimed to study asthenic manifestations among patients after acute conditions of therapeutic profile. Clinical and psychopathological examination of patients showed that the complaints were formed immediately after the relief of pain symptoms, usually without any stressful influences. Somatogenic asthenic syndrome in the examined patients formed rapidly and was directly linked to general medical condition. Severity of ASSP increased with the severity of physical illness. Thus, the analysis of clinical manifestations allowed to form structure of clinical mental disorders scope in patients with acute conditions of therapeutic profile. Asthenic symptoms were observed in the acute period in different versions of syndromal manifestation. Different clinical phenomenology allowed to identify 4 different ASSP variants: asthenic, asthenic−anxious, asthenic−depressive, insomniac. Such structured representation allowed to form differentiated system of early treatment, recovery and rehabilitation of medical and psychological interventions.

The problem of resistance in psychiatry has been actively investigated, but the phenomenon of resistance in neurotic pathology has not been studied. To determine pathopsychological features of patients with resistant forms of neurasthenia 50 patients were examined. psychodiagnostic methods were used (Self−actualization scale; methodology "Attitude to the illness"; questionnaire Personal Change−Readiness Survey; method of diagnosis of social−psychological adaptation; methodology "University of Rhode Island Change Assessment" (URICA). Exposed personal externality was shown to determine lack of motivation for self−change or self−development, which in combination with low energetic potential lead to feeling of helplessness, block the urge for necessity of personal work on self−change and caused feeling of dissatisfaction with the present and expectations of changes in the future. Low level of synergy, monotonous behavioral pattern, rejection of others as well as patients' aggression resulted in leveling all positive moments, escalation of dissatisfaction level, which was evident in hypochondriac and neurasthenic attitude towards the disease and the whole life in general, and in inactivity. Using the determined factors of resistance as a "target" of therapeutic intervention could help the patients with neurasthenia to overcome resistance.

Modern social psychiatry has an arsenal of diagnostic and therapeutic tactics in case of development of various mental illnesses in difficult conditions of work. However, mental disorders among industrial workers have not been investigated in detail. The factors affecting the psychogenesis, especially organic non−psychotic mental disorders have not been evaluated in full. These circumstances form a circle of difficulties with respect to differential diagnostic measures and further provision of skilled care. We have made an attempt to address the identified problem. Using the analysis of social, biological and production, main qualities affecting the risk of organic non−psychotic disorders were analyzed. Emphasis was placed on certain socio−demographic characteristics and detailed clinical and psychopathological examination of patients. The obtained findings suggest that of the variety of influence of biological factors was most significant for development of organic non−psychotic mental disorders, namely, female gender and age of 50−60 years. Among the factors of production, most significant were total work experience, work experience in the industry, the physical appearance of moderate severity of labor, work at night, high air temperature and vibration. Social factors (alcohol abuse) were relatively less.

At present increasing interest of internists to psychotherapy, including with the purpose of personalized diagnostic and therapeutic processes, has been noted. In this context, psychophenomenological profile is proportional to the qualitative and quantitative relationship established psychotherapeutic phenomena is an important tool in the hands of the physician. The basis of psychophenomenological profile is a group of psychotherapeutic phenomena that are characteristic for individual and/or brought with his disease, which are identified through clinical psychophenomenological method. In this regard, the aim of the study was to establish and compare the features of group psychotherapeutic phenomena on the basis of clinical and psychopathological symptomatology and medical−psychological characteristics of 129 patients suffering from gastric ulcer and/or duodenal ulcers, as well as somatoform disorder of the upper parts of the gastrointestinal tract. As the result, in patients suffering from gastric ulcers, catharsis, geshtal−insight, authenticity, forgetting were determined among sanogenic psychotherapeutic phenomena. In patients with somatoform disorder of the upper gastrointestinal tract knowledge, learning, persuasion, suggestion, group dynamics and catharsis were revealed. Thus, the study allowed to define the complex of psychotherapeutic phenomena designed to be the basis of psychophenomenological profile in this group of patients.

Psychosis in elderly is traditionally considered in the context of organic register of psychopathology, but each clinical observation reveals in their structure psychogenic and somatogenic semiotics. Multifactorial pathogenesis of psychopathological disorders of late life leads to formation of heterogeneous complex and deeply personal psychiatric semiotics of different registers. With this psychodiagnosis de facto is limited by clinical identification of major psychiatric syndromes leading to application of generalized therapeutic schemes where impact on any particular group in the complex semiotics forming a complete picture of psychopathological disorders is necessary. This fact points to the need of focused psychotherapy as well as impact on individual psychopreventive semiotic formations level the key elements in the pathogenesis of psychopathological disorders. In order to develop a system of psychotherapy of cardiogenic exacerbations of depressive−paranoid structure of psychopathological disorders in elderly and senile patients our study was conducted on 100 elderly patients suffering from cardiovascular disease and treated as inpatients for depressive−paranoid structure psychopathological disorders by means of anamnestic, clinical and psychopathological, clinical and psychophenomenological, psychodiagnostic, catamnestic, statistical methods. As a result, an effective system of psychotherapy forming the correct mode of personal response to different levels of psychogeny and improve the quality, depth and duration of remission was developed.

The known methods of treatment for hashish addiction are based on the use of psychological and autotrenings correction. The main disadvantage is polypharmacy pharmacotherapy and psychotherapy disadvantage is the fact that it does not cover patients who are not amenable to suggestion. The aim of the work was to develop new integrated and more effective therapeutic approach to the treatment of hashish addiction. The study involved 23 patients with hashish addiction. Clinical− psychopathological and pathopsychological examination to test the degree of craving for the drug, severity of withdrawal disorders, laboratory and biochemical studies, methods of computer and computer REG and computer EEG were used. A method of efficiently integrated pathogenetic treatment of hashish addiction, in which a minimum set of standard products integrates the original non−pharmacologically−nonmedicinal triad: a) hepatoprotector L'esfal 5.0 ml in autologous blood intravenously once a day during the course of treatment of 5−10 injections and hepatoprotector Antral in oral tablets of 0.2 g 3 times a day for 20−30 minutes after ingestion, with continuation of Antral for 3−4 weeks and, if necessary, further administration of Antral for 3−4 weeks; b) membrane plasmapheresis (apparatus "Hemofenix" Nanotechnology plasma filter "Rosa") exfusion plasma volume from 800 to 1000 ml, the duration of the procedure 60 to 90 min with the course of treatment of 2 to 3 treatments with intervals between treatments 3−5 days; c) anticraving method of bioadaptive systems control (Biofeedback) − from 7 to 10 sessions of biofeedback each lasting 20 to 30 min, the hardware computer bioadaptive regulatory system "BARS−PC" Hartron−APKOS; external module rheoencephalogram. The proposed method is recommended for implementation.

Several specific issues of the legal and regulatory support of educational work with students and interns are featured. Urgency of this problem due to the autonomy of higher education institutions, which is one of the main conceptual principles of the new Law of Ukraine "On Higher Education", is emphasized. In accordance with the methodology of legal science and scientific methods, main provisions of the laws of Ukraine, decrees of the Cabinet of Ministers, orders of Ministry of Education and Ministry of Health of Ukraine are discussed. Organizational ways of forming a healthy lifestyle, an important aspect of educational work with students was proposed: a) to focus in the curriculum of higher medical education in the undergraduate and postgraduate stages on issues of fight against HIV/AIDS, tuberculosis, prevention and early detection of alcoholism, drug addiction, substance abuse; formation of the principles of informed parenthood; b) to engage students and interns to work with young people on healthy lifestyles; c) to create medical and psychological centers and offices of "confidence" in each higher education institution; d) to create sports facilities, playgrounds and recreational as well as to hold mass physical culture and sports activities.