ARTICLES ARCHIVE

This paper presents the technology of medical and psychological correction of psychological maladjustment in children and adolescents with obesity. The purpose of the work was to determine the direction of therapeutic intervention in the framework of the medical and psychological correction of psychological maladjustment of patients based on analysis of the results of clinical psychopathological, somatoneurological, and psychodiagnostic examination of children and adolescents with obesity. Clinical and psychopathological, psychodiagnostic, psychocorrective methods were used. The survey of 304 children and adolescents with obesity revealed the structure of their psychological maladjustment. The role of the cognitive component of the self−attitude was highlighted, the structure of emotional and behavioral patterns of psychological maladjustment of children and adolescents with psychosomatic endocrine disorders was investigated. The directions of therapeutic intervention in the framework of the model, effective in recovery of psychological homeostasis and ensuring compliance in children and adolescents with obesity, were identified. Somatoform autonomic dysfunction, often masking depression and psychological component of maladjustment, is diagnosed in children and adolescents with obesity. It determines the significance of therapeutic intervention at an early stage of endocrine disease. For the first time, isolated stressors that aggravate psychological homeostasis of children and adolescents with obesity were identified. The technology of their medical and psychological correction was developed.

The purpose of the work was to develop a unified approach to the study of cognitive functions of patients in the practice of medical and social expertise. The International Classification of Functioning, Disability and Health (ICF) was used to develop the extended model for assessing cognitive functions, which included the study of global and specific mental functions. The set of special validated methods was proposed for the standardization of the process of psychological diagnosis. ICF considers mental functions among the other organism functions. The brain functions are listed in the section of mental functions: global (consciousness, strength and incentive) and specific mental functions (functions of memory, speech and calculation). Functions of consciousness, orientation, intelligence, temperament and personality, volitional and incentive, and sleep function are distinguished among global psychosocial ones. It is important to assess attention, memory, perception, emotions, thinking; psychomotor, high−level cognitive functions, mental functions of speech and complex sequential movements, calculation functions, self−awareness and sense of time during the examination of specific mental functions. The proposed approach to the study of cognitive functions is based on the investigation of personality and character traits, the inner picture of the disease and their interrelationships, attention, memory, thinking, intelligence of the patients. Standardized method selection and a common approach should be a part of a unified clinical protocol for various nosological forms.

Hospitalized patients with opioid addiction (n = 30) were investigated. The dynamics of complex psychological parameters in opiate detoxification in patients with drug addiction on days 1 and 4 of the hospital stay was studied using eight−color version of Luscher test, SAN (well−being, activity and mood) inventory. The personality structure was studied by MMPI. It was established that on admission they negatively evaluated their health, activity and mood as well as felt subjectively below average. Implementation of the first session of plasmapheresis caused an increase in withdrawal symptoms, leading to increased pain in joints and muscles; dysphoric disorder was observed in some patients. Anesthesia lasted on average for 4−6 hours. Further sessions of plasmapheresis shortened the stage of deployed withdrawal symptoms, reduced their expressiveness and intensity, weakened algic syndrome and autonomic disorders, normalized electrolyte balance and hemostasis, reduced the indicators of endogenous intoxication. On day 4, the residual effects of abstinence were observed and due to the rapid complex detoxification in studied patients the levels of parameters of well−being (p < 0.01), activity (p < 0.05), and mood (p < 0.01) were significantly increased. Color preference between the studied groups was significantly different only regarding the choice of brown and purple (p < 0.05). Beginning of the process of adaptation to new changing environmental conditions and reduction of physiological discomfort were revealed. The structure of the patients' personality, characterized by the difficulties of social adaptation, the originality of interests and motives, traits of emotional immaturity, was determined.

This work is based upon the conducted comprehensive clinical−anamnestic and psychodiagnostic research and a systematic study of the literature. It was discovered that 58 % of doctors−interns with adjustment disorder had anxious−depressive reaction, 40 % more severe disorders (depressive disorders), 2 % −− minor disorders, which can be attributed to neurotic reactions. Main clinical manifestations in the structure of each syndrome in doctors−interns with maladjustment were identified with the purpose to eliminate them and improve doctor's adaptation to medical activities. The structure of anxiety and depression, depressive and neurotic disorders was determined; leading clinical symptoms for each disorder were analyzed. The obtained findings showed that low mood, anxiety, weakness and fatigue dominated among the clinical manifestations. The obtained findings prove the necessity to create an adequate system of psychocorrection activities with primary purpose to overcome the symptoms of leading disorders in doctors−interns suffering from adjustment disorder.

The work features the psychological aspects of the disease impact on the family at cancer of one of its members, and the basic directions of psychotherapy. It was determined that experiencing the presence of cancer in a family member, a family tried to rebuild its functioning which caused destabilization (exclusion) even in resource and well adapted family systems. Such destabilization manifested in dyads «patient−spouse» and «child−patient» and was accompanied by distress. Both destabilization and distress are normal processes followed by adaptation and restabilizing the family system at a favorable course. In the process of adaptation the family learns to overcome and cope with the «key points»: the main problems of psychological experience of illness of a family member. These points are considered to be the problems of communication and support of the patient, response to the feelings and statements regarding cancer patient, influence of depressed mood both in the patient and his family on family functioning, family tensions that arise as a result of changing the roles and reconstruction of nonadaptive behavior strategies in the situation of the disease. It is these problems that are the essence of psychological help to the family members with the purpose to reduce the intensity, duration and level of destabilization (maladjustment) caused by the passage of the «key points». Particular importance is acquired by psychological assistance in situations of relapse, continued and prolonged disease, transition from a special treatment to palliative care and especially at the stage of «end−of−life care» (medical and psychosocial support).

Due to the complicated nature of treatment and children mortality rate the work with congenital heart disease patients is closely linked with constant psychoemotional, intellectual and physical stress, therefore the timely diagnosis and prevention of emotional burnout syndrome in medical staff is a key element of treatment in general. The purpose of the work was to increase the efficiency of medical and psychological assistance to congenital heart disease patients by determining the emotional burnout syndrome in medical staff and developing the appropriate preventions measures. Forty−eight medical workers aged 34 + 8.8 took part in the study anonymously. Maslach Burnout Inventory, (MBI) was used in the study to diagnose the professional burnout level. MBI investigation revealed that 44 % of medical staff had high or very high levels of emotional burnout syndrome, while 39 % persons were on the stage of its formation. There is a great need for comprehensive studies of the link between stress and burnout to obtain more solid evidence for their application to the practice.

The subject of the work was to investigate the features of depressive disorders in immigrants and returnees. The purpose of the work was to study the features of basic depressive disorders of psychogenic, endogenous and organic origin in immigrants and returnees. Montgomery−Asberg (Depression Rating Scale −− MADRS) and M. Hamilton (Hamilton Rating Scale for Depression −− HDRS) scales were used to survey 198 immigrants, 196 returnees and 191 non−emigrants with depressive disorders. It was revealed that the average level of the index in non−emigrant patients with psychogenic depression according to Montgomery−Asberg Scale was 26.3±8.0 points (from 16 to 45 points), the index in emigrants was 29.1±7. points (16−45 points), the index of returnees was 31.2±5.5 points (18−43 points). Similar patterns were revealed in the study of endogenous depression (Montgomery−Asberg Scale indicators were 32.2±5.2 points (21−43 points), 34.4±6.4 points (20−47 points) and 37.5±6. 0 points (27−50 points), respectively, as well as organic depression 32.7±6.9 points (18−46 points), 35.3±5.7 points (24−49 points), 37.8±7.3 points (25−49 points), respectively. It was found that the highest rate of depression according to M. Hamilton scale was also in returnees, 27.3±6.2 points. Slightly lower one was in immigrants (25.0±6.4 points), and the lowest was in non−immigrants (22.7±6.6 points). Patients with endogenous depression got 31.3±3.8 points, 29.3±5.7 points and 27.4±4.1 points, respectively. Patients with organic depression got 32.1±4.9 points, 29.9±2.9 points and 28.1±5.5 points), respectively. In typological structure of depression returnees turned out to have more distinct adynamic depression and undifferentiated depression, while emigrants had agitated depression and fear depression. The identified patterns can be explained by the influence of socio−psychological factors, in particular, the higher severity of frustration trends of returnees and mobilizing influence of necessity of returning abroad in immigrants, combined with concern about the possibility of continuing work due to mental illness. These patterns can be used in development of preventive measures.

Pathology of the endocrine system (endocrinopathy s.l.) occupies a central place among clinical entities with chronic type of the course in the structure of morbidity, eventually forming a group of patients of not only specialized endocrinological early treatment centers but also other medical institutions. In addition to somatotropic effects of metabolic disorders, psychiatric disorders, like chronic deterministic endocrinopathy, acute crises and hormone deficiency, are widely represented in their clinical structure. The aim of this study was to identify and systematize medical psychological predictors of formation of psychopathological disorders belonging to psychogenic and pathopersonological registers of defeat of mind in clinical structure of psychoendocrinological syndrome in patients with the most common forms of endocrinopathies (hypothyroidism, hyperthyroidism, type I and II diabetes mellitus). The study revealed the patterns of dynamics of the impact of medical psychological predictors of psychopathological disorders of psychogenic and pathopersonological registers that indicate the need for a differentiated psychoprophylactic impact on the specific groups of predictors at each stage of endocrinopathy.

Chronic pancreatitis (CP) is a typical physical illness with severe psychological components. The basis of the psychological actions is somatic disease distress, life−threatening complications of disease and disability. Studying the role and importance of individual psychological characteristics in the development, course and treatment of the disease is one of the important tasks of medical psychology. The aim of the study was to investigate the personal features in patients with CP of biliary and alcoholic etiology. The study involved 147 patients with biliary etiology of CP (group 1) of them, 98 females and 49 males and 140 patients with CP, the cause of which was alcohol (group 2), of them, 44 females and 96 males. It was found out that patients with alcoholic pancreatitis had pronounced features of spontaneous and reactive aggressiveness, extraversion, irritability, emotional lability, sociability, while the patients with biliary pancreatitis had depressiveness, stability, shyness, introversion. Gender characteristics included high levels of neurotic features in women v.s. men in both groups and better sociability, stability, shyness in females in the group of chronic pancreatitis of biliary etiology. Personality associations were used to form gender− and group specific personality profiles: stabile−affective, neurotic−depressive, aggressive and extraverted, aggressive and introverted, labile−affective, neurotic−introverted. More respondents with aggressive−introverted profile were found among women with biliary CP v.s. the patients with alcoholic CP, and aggressive−extraverted in males with alcohol etiology of pancreatitis and neurotic−introverted with biliary etiology. The dominant personality characteristics and profiles have practical importance for development of differentiated psychocorrection approach in the treatment of patients with CP.

The analysis of the level of emotional and social intelligence in young people with social maladjustment (SM), confirmed the hypothesis about the pathogenetic role of emotional and social components in its development. High levels of emotional intelligence was inherent in 11.1 % of patients in group A and 70.2 % in group B; average −− 22.2 % in group A and 21.1 % in group B; low −− 66.7 % in group A and 8.8 % in group B. A significant correlation between indicators of emotional intelligence «emotional awareness» and «recognition of emotions of others» and between «control of your emotions» and «self−motivation» was identified in persons with diabetes, indicating the inability to manage the emotions by group A. cluster analysis in group A revealed the relationship of the scales «emotional awareness» and «recognition of emotions of others», indicating that «not emotionally aware» respondents were not able to recognize the emotions of others. Correlation of scales «emotional awareness» and scale «empathy» was revealed, indicating that «not emotionally aware» respondents were not capable of empathy and high self−motivation. It was found out that group A had a high level of restraint in the manifestation of their emotions, and group B, in contrast, were much better able to determine the emotion of others, to recognize and support the emotional state, display and demonstrate their feelings. Group A v.s. group B demonstrated lower ability to learn verbal and nonverbal behavior, and lower capacity for the analysis of behavior. Altogether, students in group A v.s. group B showed worse indicators of social intelligence, the lowest level −− 33.3 % of those in group A; the average −− 15.9 % in group A and 24.6 % in group B; levels above the average −− 19 % in group A and 36.8 % in group B; high −− in 38.6 % of group B. The obtained findings were used to develop a comprehensive program of correction and psychoprophylaxis of diabetes mellitus in students.

This work features the effectiveness of cognitive−behavioral therapy (correction) of psychoemotional and volitional states in women, which were created by significant impact of anxiety and grief. Cognitive−behavioral therapy (correction) resulted in 50−60 % success rate after a rapid identification of the causes of anxiety (grief) and creation a positive period of adaptation of the person. The majority of subjects felt fear for their own future without their loved ones who went out of their lives, fear of absence of an important organ (mammary gland), which affected the adequate perception of themselves, fear of negative thoughts about the future, because thoughts were the basis of emotional experiences and following actions and reactions of the individual. After pathopsychological investigation with TAT, test by Spielberg−Khanin and psychodiagnostic interview the presence of symptoms of psychological, psychosomatic etiology was observed and confirmed. Considerable attention was attracted by people who felt anxiety and fear of the persistence of painful feelings about loss (grief), and severe anxiety (not able to be happy, cannot feel comfortable alone without a significant person that they lost). Providing timely and effective cognitive−behavioral therapy (correction) results in reduction of future personal anxiety and aggression, significant emotional errorts, search and treatment of non−existent diseases associated with unresolved anxiety situations and sad emotions associated with anxiety (grief) which periodically appear, depending on the intensity and frequency of annoying situations and triggers.

To justify the general principles of medical and psychological support for patients with urolithiasis (urolithiasis) of one or single kidney, 120 patients were comprehensively examined at Urology Department of Donetsk Territorial Medical Association in 2010−2014. Group 1included the persons with urolithiasis, group 2 −− patients with urolithiasis of single kidney. The study set out the general principles and the basic directions of medical and psychological work with these patients. Principles of medical and psychological care for patients with urolithiasis of one or single kidney included the following: 1. Medical and psychological impact should be built towards negative consequences of basic psychological / emotional anxiety, which in the majority of patients is the background for problems in other areas of operation. 2. More attention should be paid to treatment of not only their own physical condition, but also psychological and mental state of the patient and their effects in order to restore a sense of psychological and emotional well−being. 3. Compulsory recovery of so−called therapeutic effects of complex objects, namely, self−dependence and dependence in action on the total objective conditions caused by micro− and macro environment. 4. To overcome existing and prevent new problems in the areas of public and official support it is necessary to apply measures towards improving patient motivation to achieve socially important purposes. 5. Conducting medical and psychological intervention should be based on the general index of perception of quality of life, not just the assessment of individual areas of operation. General areas of medical and psychological work with this group of patients were defined: a) to promote awareness of their own health as the greatest value; b) to form the ability to take responsibility for their health; c) to familiarize with the specifics of emotional and behavioral responses of people with high levels of alexithymia and personal orientation intrapsychological response to the disease, followed by skills mastering their own individual psychological characteristics; d) to develop the skills to improve and preserve health; e) activation of sanogenic potential; d) the skills of preparation and realization of their individual health programs.

The article reports the results of investigation of social psychological and personality characteristics of 511 male patients with schizophrenia that accomplished publicly dangerous acts against person's life and were taken for compulsory treatment in the psychiatric hospital with intense supervision. Methodical instruments for detection and assessment of the personality features and social psychological adaption of patient and level of social functioning and dynamics of dysfunction in different areas of vital activity, degree of behavioral desadaptation, as well as for research of mechanisms of psychological defense and characteristics of coping behavior of these patients were proposed. The obtained findings were used to create differentiated programs of rehabilitation for these patients.

The study of etiopathogenetic mechanisms underlying the development of gastric and duodenal ulcer (GU and DU) for the recent ten years have led to the paradigmal concept of infectious origin of the disorders responsible for the clinical presentation. However, the data accumulated over years of research and clinical descriptive experience combined with a significant number of cases of clinical cases of H. pylori unassociated GU and widespread asymptomatic carriage of H. pylori, indicate the presence of other, different from the infectious, mechanisms of this pathology. Development of H. pylori unassociated GU and DU occurs due to gastric mucosa protective factors, in particular, the mechanisms of regeneration and mucus secretion, under the regulation of the autonomic system. Within the concept of psychosomatic H. pylori unassociated GU is considered from the perspective of chronic activation of the sympathoadrenal system as a result of constant psychogenic stress stimuli. This concept involves the use of psychotherapeutic methods of correction and prevention in relation to GU and DU. To study of the variability of the unified psychophenomenological profile in the group of patients with gastric ulcer, 60 patients with GU and DU (basic group) and 100 apparently healthy individuals (controls) were investigated using clinical psychophenomenological, psychodiagnostic, clinical psychopathological and statistical methods as well as methods of analysis and synthesis. Non−priority, acceptable and priority phenomena in relation to the effect of psychotherapy were revealed.

The increased role of depressive disorders particularly in Ukraine and throughout the world is an important problem of modern society. Despite the active interest of scientists to the study of this disease, the use of modern methods of treatment, the literature suggests that more than a third of patients with depressive disorders demonstrate inefficiency or low efficiency of initial antidepressant therapy. In chronic and prolonged depression, this figure reaches 40 %. The majority of people of working age suffer from depression, therefore this medical problem becomes serious socio−economic one. The modern concept of therapy of patients with treatment−resistant depression (TRD) considers not only achievement of effectiveness of the therapy, but also its performance. Basic principles of treatment of TRD include timeliness, stages, complexity, consistency and relative aggressiveness of treatment strategies (at least the average doses of medication, early use of potentiation treatment regimens and drug combinations, mandatory connection of non−drug methods (psychotherapy, electro−convulsive therapy). Administration of atypical neuroleptics in the combined treatment of TRD become more widespread at present. Everything above substantiated our research objectives, i.e. to study the effectiveness of atypical antipsychotics in treatment of TRD. Quetiapine was selected as an atypical neuroleptic as many authors drew attention to its antidepressant effect. Our study showed significantly greater efficacy of atypical antipsychotics along with basic therapy in treatment of TRD. In particular, potentiation of atypical neuroleptics leads to a rapid and qualitative reduction of affective, cognitive, anhedonic, and vital components of depression. TRD treatment was not accompanied by difficulties in tolerability of recommended therapy in the studied patients.

At present industry workers constitute a risk group of mental and behavioral disorders. Hazardous working conditions, abundance of stress factors, specific communication are some of the risk factors. Routine examination of industrial workers is a necessary procedure, which is carried out by medical specialists, deciding how the patients can continue their career. Psychiatrists participating in screening often do not have the full range of features to carry out a qualitative clinical and psychopathological diagnosis within a short time. It usually requires innovative approaches to personality of the subject. This article is exemplary in this regard because it contains the results of the author's screening scale, allowing multidimensional estimation of the whole spectrum of clinical psychopathological, clinical and phenomenological characteristics acquired during work in industry. The designed screening questionnaire for industrial populations, can be used in the practice of s checkups for preliminary assessment of mental problems and their clinical and phenomenological orientation with error−free forecast of a positive result. Application of this technique can dramatically reduce the time of wide−scale examinations and significantly improve detection of various, including clinically asymptomatic, mental health disorders.

The purpose of the study was to analyze expression of manifestations of fatigue, disorders of cognitive function, emotional state and sleep in the patients with uterine cancer during antitumor treatment and to evaluate psychological correction of psychosomatic disorders done at radiotherapy in this cohort of patients. Clinical laboratory investigation was made in 55 patients with stage I−II uterine cancer during antitumor treatment. All patients underwent panhysterectomy and postoperative radiotherapy. Besides, 15 patients got psychological correction at the radiotherapy stage. To evaluate the quality of life, SF−36 questionnaire was used. EORTC QLQ−C30 questionnaire was used to evaluate the degree of expression of psychosomatic disorders. As the result of the carried investigations it was established that even before the treatment started, the majority of patients demonstrated psychosomatic disorders of various degree. At the stage of surgical treatment the patients developed increased fatigue and sleep disorders as well as decreased cognitive function and emotional state. After completion of radiotherapy these parameters improved although they were worse than those before the antitumor treatment started. Psychological correction allowed to reduce the number of the patients with psychosomatic disorders of high intensity. The use of the elaborated scheme for medical psychological correction allows to reduce not only the number of the patients with low level of emotional condition but also the number of women with the disorders of sleep, cognitive function, and fatigue of high intensity. Therefore, introduction of medical psychological correction into the clinical practice is an essential part of the complex aid to the patients with uterine cancer at the radiotherapy stage.

Main problem of differential diagnosis of endogenous catatonic syndrome is the low specificity of individual semiotic groups in its structure. Having apparently similar pathogenetic mechanisms, semiotic constellations forming the syndrome, can occur within a wide range of other nososyndromal formations. In order to form the algorithm of differential diagnosis of catatonic syndrome nosology based on its structural and dynamic characteristics, 100 patients of Zaporizhzhia Regional Psychiatric Hospital with dominant catatonic syndrome in the structure of psychopathological disorders were examined. The study developed the principles of differential diagnosis of catatonic syndrome at semiotic, syndromal (subsyndromal) and nosology levels. The developed principles form a single differential diagnostic algorithm, the essence of which consists in identification of nosology characteristic of catatonic syndrome in clinical practice.

A comprehensive survey of 150 patients of both sexes, aged 20 to 55 with diagnosed bipolar disorder in the period of stabilization was performed. The clinical picture included depressive and manic phases of different structures. Typical affective states were primarily classic circular depression and mania. Psychoeducational program integration model, which included the use of individual and group methods and consisted of three stages. Stage I, initial, was held in individual form, with rational psychotherapy, where patients were explained the features of clinical manifestations of bipolar disorder, the need for taking medication, aimed at relief of symptoms. The patients were motivated to perform psychological training, aimed at creating a social and adaptive skills. Stage II, therapeutic, consisted in group work to discuss all the key issues relating to mental health. Stage III, final, had the purpose to secure new positive psychosocial tendencies, form response options, and manage behavior in the case of acute bipolar disorder. The high effectiveness of psychoeducation over traditional complex therapy and rehabilitation of patients with bipolar disorder was shown. It was proven that psychoeducation not only enhanced confidence in the fight against the disease, but also solved the problem of social reintegration of the patient.

The article reports the results of research of art therapy effectiveness in complex treatment in patients with recurrent depressive disorder (RDD). The study involved patients with current episodes of mild, moderate and severe degrees of severity with melancholic, anxious, hypochondriac and apathic clinical and pathological variants of depressive syndrome of RDD. Hypothymic, emotionally labile, asthenoneurotic, sensitive, hysteroid, hypochondriac, and anxious premorbid personality's features were revealed in the patients. The following methods of investigation: clinical psychopathological, psychodiagnostic (MMPI), psychometric (by using clinical scales of anxiety (HARS) and depression (HDRS) Hamilton) and the scale to determine the level of anhedonia SHARPS were used. Art−therapy sessions were conducted with the help of the picturesque technique on topics such as: «My illness», «Mandala», «The Five Senses», «Creating stories in pictures» and «Images dauber» in closed group sessions 2 times per week during 1.5 hours. The total number of sessions was 15−20. The study found that patients had reduction of anxiety, improvement of mood between sessions, increased self−estimation, stable and prolonged remission, positive vision of the future and reduction of anhedonia.

In order to establish differences in subjective and objective evaluation of the presence and severity of major clinical and psychopathological phenomena anxiety disorders (AD) of neurotic and organic genesis, we examined 200 patients with AD at Poltava Regional Neuropsychiatric Hospital during 2011−2015 using the principles of bioethics and ethics. One hundred patients with neurotic AD constituted group 1, 100 other patients with organic AD −− group 2. In group 1 mental symptoms dominated over somatic ones in the structure of psychiatric anxiety, while in group 2 the opposite trends with the release of somatic manifestations of anxiety were observed. Lowered mood, guilt, reduced ability to work and activities, lethargy thinking, somatic anxiety and somatic symptoms, sleep disturbance prevailed in the structure of diagnosed depressive symptoms in group 2. Depressive mood manifested by self−accusation, loss of interest in activities in the form of apathy, lethargy in conversation, agitation. In group 1 the leading entities in the structure of the diagnosed depressive symptoms were low mood and somatic anxiety. The analysis of subjective and objective data on psychopathology of AD of various origin demonstrated that disturbing and depressive manifestations were present in both groups. However, in individuals of group 1 the symptoms that made the clinical picture of mental disorder had lower severity than in patients of group 2. Altogether, the results of the study suggest the tendency for a slight underestimation of severity of the alarming symptoms by the patients in both groups and the overevaluation of the significance of depressive symptoms. Thus, when determining the strategy of medical psychological work with patients with AD, their origin should be considered, because it affects the different orientation of psychocorrection work. The obtained data were used to develop the measures of psychocorrection and psychoprophylaxis of AD in patients with neurotic or organic disorders.