ARTICLES ARCHIVE

Today the task of improving the efficacy and quality of training the students of higher medical educational institutions, including those majoring in medical psychology is particularly urgent. Most progressive trend was recognized to be the use of interactive techniques such as problem−based learning, based on the principle of partnership, in which the teacher's activity gives way to the student's activity; method of collaboration and analysis of integrated clinical cases, when the conditions for positive motivation of students are created in the teaching process. Case method, or situational training with specific examples, allowing to bring the process of learning the real practice, is especially effective. Based on the analysis of case histories of patients and psychodiagnostic findings of psycho−neurological department of Kyiv Hospital in Rail Transport № 1, the most illustrative cases were selected and situational tasks were compiled. To solve them, the students not only apply their knowledge but also the ability of clinical thinking. The findings of the research indicate the need for further development and widespread introduction of this format of training in medical schools of Ukraine.

The problem of mental disease preservation is one of the significant priorities in our country. According to different data, every fourth family in the world has a family member with a mental illness. We face the problems of stigmatization, discrimination and unequal opportunities for social realization of mentally sick and those who provide them with socio−economic assistance. Reference relatives are individuals that most personally care for patients with mental illness, provide socio−emotional support, build adequate interpersonal relationships in a family, control the compliance process. In this research clinical and psychological features of reference relatives in families with a patient with paranoid schizophrenia were studied. The study involved 168 respondents of the first and second affinity degree to a patient with diagnosed paranoid schizophrenia. According to clinical and psychopathological study affective spectrum disorders were diagnosed in 43.4 % of respondents while neurotic disorders were diagnosed in 56.6 %. psychodiagnostic research confirmed moderate level of depression in 42.9 % of respondents, mild level of depression in 57.1 % of respondents. Also anxiety disorders were revealed, among which severe and mild anxiety dominated in 86.2 % of respondents. Thus, according to the conducted research, affective (depressive) and neurotic disorders were often found in reference relatives of patients with schizophrenia. Among reference relatives of patients with schizophrenia in which illness existed from 4 to 8 years there was an evident tendency to increase of the number of mental disorders compared to other studied groups (p < 0.001). The discovered features require development of psychoeducational programs for reference relatives of patients with schizophrenia depending on illness duration of a family member.

The purpose of the work was to study microsocial factors, motivations of sexual behavior, typology of marriage, methods of resolving family conflicts, patterns of violations of interpersonal, partner communication, to determine the mechanisms for the development of health disorders, functioning of the family, marital, partnership deadaptation in families with excretory−toxic and secretory infertility in men and to develop a system of medical−psychological support of its violations, differentiated medico−social rehabilitation and psychocorrection based on the system approach to the problem. The study involved 107 men with inflammatory diseases, excretory−toxic (73, 78.2 %) making group 1, and secretory infertility (34, 31.8 %) included in group 2. The status of the family and the degree of its violations were assessed with the help of a questionnaire by V. V. Kryshtal, I. A. Semenkina, typology of marriage was defined according to V.V. Kryshtal, Y. Z. Kuzmenko. The conducted research established that in marital (partnership pairs) the men with excretory−toxic, secretory infertility had dysadaptable models of formation of sexual behavior, disharmonious personal characteristics and models of education in the parent families, both in men and women, disharmonious (67.5 %) or pseudoharmonic (32.5 %) types of marriage.

The authors conducted a literature review which demonstrated the relevance of the issue of support of mental health in patients with partial vision loss due to general prevalence of mental disorders in this category of patients. These are chiefly depressive and anxiety disorders. Both development of effective methods of prevention and treatment of these disorders are important. The latter, of course, requires the knowledge of their manifestations and the course at partial loss of vision. At present the developed countries actively develop specific programs for working with patients with partial loss of vision, which will include educational and psychotherapeutic elements and socialization skills for these patients. Despite a number of scientific papers covering this subject, there is a need to improve existing preventive, curative and rehabilitative interventions considering the biopsychosocial and patient−centered approach to management of vision problems.

The purpose of our research was to investigate the characteristics of value−personal sphere of emigrants and re−emigrants. The aim of our research was to study the characteristics of value−motivational sphere of emigrants and re−emigrants in order to understand comprehensively the problem of emigration and re−emigration, and establish the social and psychological causes and consequences. Using the methodology "The level of values correlation and availability in different spheres of life" by E. B. Fentalova, survey of 196 emigrants, 191 re−emigrants and 198 non−emigrants with depressive disorders was carried out. Investigating the patients' value sphere, we found out the major differences in the groups of patients with psychogenic depressive disorder. Emigrants and non−emigrants believed that the most valuable thing in their life was a happy family life (on an average 8.63±1.94 points and 9.28±1.79 points, respectively). In patients with endogenous and organic depressive disorders, differences in the value sphere between emigrants, re−emigrants and non−emigrants were expressed less significantly than in patients with psychogenic depression. The study of the availability sphere of emigrants and re−emigrants with psychogenic depression showed a strong dissociation with the sphere of values. Thus, health was the less available in all groups (the average indicator in emigrants was 2.28±0.69 points, in re−emigrants 2.01±0.79 points, in non−emigrants 1.84±0.66 points), with endogenous depression −− in emigrants (2.30±0.68 points), re−emigrants (2.00±0.72 points), and non−emigrants (1.89±0.71 points). With organic depression (2.29±0.71 points), the hierarchy availability of re−emigrants was the following: health (2.05±0.69 points), but for non−emigrants health was also unavailable (1.81±0.64 points). Analyzing the dissociation in the value sphere (availability of emigrants and re−emigrants), the features of internal conflict and internal vacuum were found out in key areas: happy family life (6.16±1.19 points), health (5.95±1.38 points) and love (4.10±0.86 points). In the re−emigrants the features of internal conflict can be found in such spheres as health (5.93±1.41 points), happy family life (5.61±0.97 points), financially secure life (4.30±0.82 points). In non−emigrants the features of internal conflict were found in such spheres as health (6.03±1.56 points) and happy family life (5.45±1.04 points). The study of integral indicators of patients with organic depressive disorders showed that the rate of internal conflict of emigrants was the highest and measured 44.98 %, in re−emigrants it was slightly lower (43.10 %), and of non−emigrants it was the lowest (36.72 %). The discovered features indicate significant violations in the emigrants and re−emigrants' sphere of values with depressive disorders. It is obviously, that the impact factor of emigration (re−emigration) on the value system is implemented through the objective socio−economic conditions of these people. The changes in the value sphere of emigrants and re−emigrants with depressive disorders should be considered in the complex of their personal characteristics and the nature of the depressive process.

The addictive status of a married couple, depending on addictive behavior (AB) in the women and health of families was investigated. The study involved 321 married couples (MC) with disorders of family relationships and AB in women, 50 MC with disorders of family health, in which women had no problems of addictive nature (comparison group) and 50 conventionally harmonic M.Th. majority of women with AB demonstrated interest in addictive object within behavioral and/or physiological addiction, unlike chemical. Their husbands demonstrated AB at the level of the use with harmful aftereffects and dangerous use. Which affected the personality and functioning of wives, and contributed to development and progression of women in their addictions and contributed to development of family health disorders. The married couples from comparison group though showed the presence of interest in addictive object, it was expressed in much smaller quantitative and qualitative parameters. The women from the families with family health disorders can be attributed to the risk zone. The women and men from conventionally harmonious groups were characterized by the absence of tension in the addictive status. Some indicators of harmful use and use with harmful consequences did not have any clinical signs and were due to socio−cultural factors. The indices of AB severity in the study group were almost 2 higher than those of the comparison group in sexual, computer, game addiction as well as the use of sedative−hypnotic drugs. The obtained data were used as a basis for developing the psychological correction and psychoprevention support of the family health at the presence of addictive behavior in women.

160 wives of men with AA and 50 women whose husbands did not have alcohol problems were investigated at Kyiv City Narcological Hospital "Sociotherapy" within the period of 2012−2015 to understand the possible targets of complex therapeutic and rehabilitation work with this group, to determine the content of codependency as pathological state. Depending on the type of AA by classification of T. F. Babor, the wives of the patients were divided into two groups: group A included 80 wives of the patients with type A alcohol addiction (AA) (group of relatives A, GRA) and group B, which amounted to 80 wives of individuals with type B AA by T. F. Babor (group of relatives B, GRB). Comparison group (CG) included 50 married women whose husbands did not have AA. Inclusion criterion in the study group was absence of clinically manifested AA in women. Psychosocial peculiarities of functioning in women were studied using the technique of determining the level of subjective control by J. Rotter (adapted by Bazhin E. F.) and the questionnaire "Ways of Overcoming Behavior" by S. Folkman, R. Lazarus (adapted by L. I. Wasserman, E. A. Tryfonova); the inherent characteristics of family function established by the method of analysis of family anxiety by Eidmiller E., W. Yustitskis and scale of structured interviews to identify the type of family by V. A. Abramov et al. The study found that the features of psychosocial parameters of personal functioning in the wives of men with AA, is their predictive role in development of maladaptive state of codependence, and inability to play a preventive role in its occurrence. Family functioning of such families also underwent significant transformation in the direction of strain in family relationships with prevalence of pathological level of family anxiety in women and destructive types of families. These data suggest the need to include therapeutic interventions aimed at optimizing family and psychosocial functioning in treatment and psychotherapeutic support of codependent wives of patients with AA in men.

It is important for pediatricians and psychologists to understand what is going on in the family as the influence of the parents on the development of children's psychopathology is well known. However, specific family patterns and attitudes which in a certain ratio and interrelation cause mental disorders in a child are less clear. It is well−known that in remote results of surgery for congenital heart disease (CHD), psychomotor development of one third of children is characterized by retardation of cognitive sphere, communication problems, emotional disorders and low quality of life in the future. Besides, it is known that the situation with prenatal CHD diagnosis is characterized by distress and strong emotions for the family. Therefore we decided to examine parental attitude of pregnant women and their husbands with the aim to determine the targets for medical and psychological follow−up of the family with prenatally diagnosed CHD in the fetus. At the outpatient department in Scientific and Practical Medical Centre of Pediatric Cardiology and Cardiosurgery of Ministry of Health of Ukraine, 9 persons (of them, 5 pregnant women aged 23−36 with gestational age from 24−37 weeks, with prenatally confirmed fetus CHD and 4 husbands aged 25−41, 4 married couples) were invited to participate in the study. The couples lived in marriage from 1.5 to 10 years. To research the family attitude Parental Attitude Research Instrument −− PARI developed by E. Schaefer & R. Bell in 1958 was used. The aim was to study the parental attitude (mothers in the first place) towards different aspects of family life (roles in the family). While interpreting the results of the method we analyzed solely the highest (18−20 points) and the lowest (5−8 points) marks. PARI method results according to "Attitude to the family role" by women demonstrated that by sum of digital importance the most vivid was the trade according to the subscale "Dependency of the mother" points to the importance of the support of the pregnant woman by the husband. The results of scale "Optimal emotional contact" showed high points in 4 of 5 pregnant women according to "Encouraging verbalization" subsclale that suggests the incentive to talk and discuss the worrying topics. At the same time 3 out of 5 pregnant women displayed high points according to e "Comradeship and sharing" subscale that demonstrates the pregnant women intention to guard and control their children excessively. The results of the scale of "Excessive concentration on the child" showed that the women will exhibit hyper control for child's behavior and restrict its freedom. Statistically significant difference in subscales "Strictness", "Excluding outside influences", "Homemaking role's rejection", "Equalitarianism" and "Comradeship and sharing" for women and men were found. These results indicate that pregnant women are stricter with their children than men, and that men are more than women admit outside family influence on the education of the child. In addition, women are dissatisfied with the distribution of homemaking roles and need help men in this regard. The women's attitudes showed the abundance of strictness and hypercontrol on the issue of bringing up children, while the majority of husbands psychologically accepted their child as it is. Thus, PARI method turned out to be an effective instrument in the research of parents' family attitude to an expected child with CHD. The results of the method can be useful both for psychodiagnosis and psychotherapeutic talk with a family. The targets of medical and psychological follow−up of the family with prenatally diagnosed CHD in the fetus can be regarded as interpersonal relationship within the couple with the focus on adequate attitude to the role in the family and the optimal emotional contact with the child without excessive concentration on it.

The aim of the study was to identify the main diagnostic markers of various forms of neurotic pathology, which reflect the transformation of the subjective picture of life. We used the methods of observation, psychodiagnostic and mathematical−statistical. The results of psychodiagnostic study of representation of subjective picture of life in patients with various forms of neurotic disorders showed that they were characterized by impaired event perception of structure of life, that displayed in reducing the number of past and future positive developments, increasing the proportion of minor events, as well as low−structuring activity, the magnitude and sense of future events. For diagnostic criteria of dissociative disorders attributed growth in the number of future adverse events, reducing the number of significant events, the index of meaningfulness of life and reducing the time predictive competence. In anxiety disorders as diagnostic criteria identified low flashback sequence of events and future developments, low structuring way of life, focus on the process. Diagnostic criteria for neurasthenia were weak focus on goals and results, the reduction of the spatial predictive competence and high overall level of depression. Using the criteria developed improves the quality of diagnosis of neurotic pathology and can be used in the process of psychocorrection in this category of patients.

Sociological analysis revealed association of social isolation with psychopathology, particularly depression, phobia, schizophrenia, etc. Isolation phenomenon (behavior characterized by solitude or alienation from society for 6 months) is spreading in the world and in Ukraine. In order to identify pathopsychological features of the patients with acute social withdrawal we surveyed 20 patients, which showed high levels of alexithymia, hostility index due to the increased level of resentment, irritability, low level of the quality of life; they have a high rate of victimization. The value of trauma index leads to the conclusion about the experience of the effects of traumatic stress. The patients with acute self−isolation are characterized by increased impulsivity, excessive affect resistance, depressed mood, pessimism. The obtained results confirm validity of the selected diagnostic methods for this patients and the importance of its continuation.

Psychological examination of cancer patients which revealed that a number of factors stage (medical psychological, psychosocial and medical) influenced the duration of pre−diagnosis, was conducted in Kyiv City Clinical Cancer Center. Medical psychological factors included personal and behavioral patterns, current psychoemotional condition, previous experience of illnesses; psychosocial factors included behavior associated with social roles, psychosocial resources, the financial component, social myths about oncology, medical ones −− somatic and psychological morbidity, age, attitude to the health system, availability of medical care. An important parameter of seeking for medical aid was sociomedical habits. Along with psychoemotional reactions to the potential threat of oncological disease cognitive perception of the situation and such criteria as idea of health and illness, reflection of physical condition, attitude to disease, extent of caring for themselves, cognitive features in response to stress played an important role. The length of pre−diagnosis period was influenced by specificity of clinical picture, namely variants of common somatic, somatic−specific and asymptomatic initial manifestations of the disease. Several types, characterized by a specific set of negative sociomedical habits with manifestations of low medical knowledge, specific personal organization and behavioral disorders were revealed in patients with a long prediagnostic period found. Evaluation of the mental state of cancer patients at the prediagnostic stage was used to predict future behavior of the patients during the treatment process, development of recommendations related to the changes in sociomedical habits.

The article discusses the history and features of development and functioning of pheochromocytomas dysfunction. Complexity of the diagnosis and treatment is noted which is associated with not only medical, but also psychological factors. Psychological perception of the diagnosis by the patient is crucial for the healing process. Classification of pheochromocytomas, main clinical forms (paroxysmal, regular, mixed) is presented. The results of this work show that manifestations of pheochromocytoma are due to increased levels of circulating catecholamines.

The purpose of the study was to examine pathopsychological peculiarities of neurotic disorders associated with addictive disorders. The study involved 150 patients with neurotic disorders. According to the purpose of the study and data of AUDIT−like tests all patients were divided into 2 groups: 110 persons with addictive disorders (main group) and 40 patients without any addictive disorder (comparison group). The complex of methods consisted of AUDIT−like tests, SACS Questionnaire "Strategy for Stressful Situations Overcoming", Leonhard and Shmishek Questionnaire, statistical data processing methods (Student's t−test and Fisher's φ−test) with Excel and Statistica Electronic Manual Features 6.0. Examination of addictive disorders frequency in neurotic disorders showed that 58. 66 % of patients had high risk of addictions, 26.00 % demonstrated low risk of addictions, 14.00 % had above average risk score, and 1.34 % had below average risk score. Based on the obtained data, risk factors of neurotic disorders development, complicated by addictive disorders, which consisted of polymorphism and manifestation of personality traits accentuation; joining of pessimism, impulsiveness, acute unmotivated emotional instability to the emotive and ecstatic personality traits, and severe actualization of "avoidance" and "aggressive actions" coping; decrease of coping strategies constructiveness were established.

Obsessional phenomena are one of the most common pathologies of the psychic sphere. There are indications on the identification of obsessive manifestations with a broad spectrum of psychopathology, from neurotic to endogenous. References to manifestations of obsession spectrum in patients with schizophrenia can be found in daily practice of psychiatrists. However, in the majority of cases the question is pseudo−obsessions/schizo−obsessions as a nosospecific for schizophrenia phenomenological unit. Pseudo−obsessions, usually disrupting life activity, social adaptation of patients and burdening the obligate manifestations of the underlying disease, are hard to treat and make a differentiated diagnosis.

The presence of depressive symptoms in patients with schizophrenia has been reported recently. The presence of depressive symptoms in the clinical picture of psychosis in patients with schizophrenia complicates differential diagnosis, provokes excessive drug treatment and further uncertainty in therapeutic therapy for this category of patients. The aim of the study was to establish depressive and paradepressive characteristics in patients with schizophrenia. The study revealed that more than half of the patients with schizophrenia were characterized by the presence of signs of clinical and subclinical depression and anxiety in the structure of psychopathological continuum of schizophrenia. Discrepancy between the qualifications of anxiety and depressive symptoms according to clinical and psychodiagnostic examination of patients with schizophrenia, in absence of such differences in patients with schizoaffective disorder was noted. This can be explained by the inability of schizophrenic patients to identify correctly their own emotional state and dissociation between the emotional state of patients and its ethological and mimic and pantomimic correlates. Anxious experiences for patients with schizophrenia with subclinical and clinical depression were much less pronounced than greater clinical severity of gained depression; at patients with no clinical signs of depression, symptoms of anxiety persisted and were more expressive than depressed.

The purpose of research was the study of pathopsychological features of patients with schizophrenia, depending on the duration of the disease. 120 patients with schizophrenia with depressive symptoms were examined, of them 38 patients with schizophrenia duration less than 5 years, 39 patients with schizophrenia duration of 7−8 years, and 43 patients with schizophrenia duration of more than 13 years. The following methods were used: Calgary's Depression Scale in Schizophrenia (CDSS), short questionnaire to assess quality of life (WHOQOL−BREF), questionnaire of social exclusion, the scale of alexithymia, the method of determining suicide risk, the test "Finding the quantitative expression level of self−esteem" and statistical methods. The investigation revealed that the features of depression symptoms manifestation in schizophrenia, the level of social isolation, risk of suicide, the quality of life, self−esteem and alexithymia had negative dynamics as the disease course. The obtained data should be considered as a pathopsychological differential (depending on the duration of the disease) diagnostic criteria of depressive disorders in schizophrenia and taken into account during pharmacotherapy and psychotherapy of schizophrenia with depressive disorders.

Literature review was done to find the most appropriate scales for screening and severity assessment for military and civil persons from the zone of antiterrorist operation with the aim to unify the protocol of their investigation. The suggested protocol includes Acute Stress Disorder Scale (ASDS), Clinician−Administered PTSD Scale for DSM−5 (CAPS−5), PTSD Checklist for DSM−5 (PCL−5), Hospital Anxiety Disorder Scale (HADS), The Short Form−36 (SF−36). Their advantages are simplicity of use, small amount of questions with a high reliability when used with the USA and Western Europe residents. Assessment of the patient's state with these scales reveals in him important clinical signs of post−traumatic disorders which significantly accelerate the process of taking clinical decision and improves the quality of medical aid.

Dissociative disorders are a class of the most difficulty cured pathology of the spectrum of neurotic disorders. Primarily, this is associated with impaired compliance of patients to therapy. The system of motivation of the patient with dissociative disorder and interpersonal interaction with medical personnel determine important features of the process of psychotherapy, affect compliance. The purpose of the research was to reveal the features of formation of therapeutic compliance in patients with dissociative disorders. The investigation involved 50 patients with dissociative disorders (F44), treated at Regional Clinical Psychiatric Hospital using clinical psychopathological, psychodiagnostic, clinical psychophenomenological, clinical and catamnestic methods. The investigation identified and examined a number of contradictions acting as factors of violation of compliance to psychotherapy in patients with dissociative disorders. The methods of successful resolution of dyscomplience factors in patients with dissociative disorders forming compliance and effectiveness of therapeutic process in general were noted. It can be concluded that compliance to therapy plays a significant role in the treatment of dissociative disorders. Controversies in the psychotherapy of dissociative disorders observed in the study are the factors of influencing the achievement of compliance to therapy, and, indirectly, to the therapeutic process in general. Resolution of contradictions arising in the course of therapy for dissociative disorders will improve the compliance of patients to treatment, to accelerate the onset and quality of therapeutic effect.