ARTICLES ARCHIVE

In today's world, investigation of the adaptation process is relevant, especially in the initial phase of study of the university students. Student life creates many psychological difficulties and requires activation of all internal reserves. This is the first step in independent living without parental care, which could be an additional factor in stress development. A pilot study of the first−year students was conducted at Odessa National Medical University, which helped not only to diagnose their adaptability to society of the higher school, but also to identify those who need special attention. Psychodiagnostic material contained two methods: test «Conflict self−assessment» and a clinical questionnaire for neurotic states by K. K. Yakhin and D. M. Mendelevich. The analysis of the obtained data allowed the conclusion about the necessity of psychocorrecting work with the respondents, who are in a state of mental maladjustment. The tutors of the groups were recommended to pay special attention to such students to effectively address inter−group conflicts and maintain a positive psychological climate.

Traumatic injuries of the upper extremities are important medical and social problems due to stabile and depth changes in the social status of the patient. at present both methodological and methodical approaches to rehabilitation of patients after injuring the tendons has been insufficiently developed; the information about these methods is not systematic. The main goal of rehabilitation is early return of the victims to socially active life. Rehabilitation of people with hand injuries should be individual and consider the possible use of reserves hand function, which is impossible without a powerful restorative psychological resource of the patient, activation of which is the task of psychological rehabilitation. Important elements of medical and psychological rehabilitation are occupational therapy, employment therapy, social environment therapy. Effective means are psychological correction, autogenic training, psychogymnastics, game therapy, family therapy. The problem of psychological rehabilitation of patients with traumas of upper extremities device is understudied. There are no reasonable approaches and algorithms of its provision that prevents its active implementation, harms the interests of the patients and reduces the effectiveness of the administered treatment.

Currently both in Ukraine and the world as a whole, the problem of disability growth is highly relevant. Among the causes of this phenomenon, the leading place is occupied by the pathology of the musculoskeletal system of different origin. To determine the characteristics of the disorders of the psychiatric sphere, in particular of neurotic character, the patients with pathology of the musculoskeletal system having clinical disorders of psychological adaptation at nosological and prenosological levels, were investigated. The study used the following methods: clinical, psychopathological, psychodiagnostic (scale of objective assessment, HDRS, M. Hamilton scale, scale of subjective evaluation of the level of depression «depression rating scale», U. Zung scale, scale of state anxiety and trait anxiety, C. D. Spielberger −− Yu. L. Hanin), statistical. Analysis of the findings of clinical psychopathological and psychodiagnostic investigation of the emotional sphere in patients with pathology of the musculoskeletal system, revealed domination of a high level of state anxiety in the presence of a moderate level of trait anxiety. Marked differences in the results of the investigation of objective and subjective levels of depression in this group pointed to the fact that the patients often subjectively underestimated the presence of depressive symptoms. The obtained findings were used to develop a comprehensive system of medical psychological correction of situation−related reactions of mental deadaptation and adaptation disorders in patients, considering the features of their emotional state.

The definition of bullying derived from English "to bully" is to harass, to threaten, to abuse. Bullying is widely known among the schoolchildren as the act of aggression with further harassing/threatening the personality and the possibility of his/her complete submission to one's interests. At the same type the phenomenon of bullying is studied in the professional environment. In 1990 the pediatrician Henry K. Silver was the first to study the psychological problems of medical students in the JAMA research and found 46.4 % of students were felt abused during their studies. During the recent 22 years the situation has not changed. Thus, the Association of American Medical Colleges has interviewed the graduates and found that 47.1 % of them marked the facts of mistreatment. According to scientists, the first bullying manifestation begins during the doctors' training. The current hierarchical system starts the specific training vicious cycle of abuse. Since some students are subjected to humiliation on the part of teachers they learn cynical and derogatory type of behavior. And then most are those that allow themselves to disparagingly refer to junior colleagues or new employees. According to the opinion of the Association of American Medical Colleges the cycle can be described as «transgeneration heritage» that teaches doctors cynicism and abuse. This culture of medical education is part of the «hidden curriculum» that prevents adequate interpersonal communication and adversely affect in patient care. This may be due to the fact that some workers who contemptuously refer to other colleagues can be powerful members of the medical team, and this can be an obstacle to notice this behavior because of fear of retaliation and a general reluctance to confront with this person. Also, organizations may be cautious in matters indiscriminately disparaging conduct of high profits employees and therefore be unable to take action. Overseas research shows that bullying victims experiencing dissatisfaction, have low self−esteem, symptoms of depression and post−traumatic stress disorder. We tried to explore the phenomenon of bullying in Ukraine. We have proposed a Kiev hospital to participate in an anonymous survey (without disclosing the names of medical institutions). The study involved 150 persons of anesthesiology department, intensive care and surgery units and outpatient department, of them 100 nurses, all women, aged 20−48 years and 50 doctors, aged 26−50 years, of which 60 % were men. It was found that 41 (27.33 %) persons worry because the colleagues bully them. Also it was noted that employees of surgical department (5 persons, 9.8 %), worry less than others because of bullying. However, there was no statistically significant difference between the other departments. Bullying in non−surgical units fluctuates from 28.13 % to 44.68 %. The results of the anonymous survey surprised most executives. Interesting was the fact that the vast majority of senior nurses wish to take part in psychological trainings on the topic: «How one could improve the atmosphere in the team and promote team work». In this regard, the hospital initiated bullying groups and lectures on various psychosocial problems that occur in hospitals. The study emphasized that bullying can affect the ability of staff to provide high quality professional help and avoid errors. Screening of bullying among medical workers must be conducted at least once a year. The active involvement of the doctor−psychologist contribute to solving these problems.

Cancer is classified as a disease with a high stress level. It forms in cancer patients the attitude to the disease as an extremely dangerous factor for their life, which determines availability of a wide spectrum of disorders of mental adaptation and development of mental disorders. However, despite the need for psychological care in oncology, there are still no guidelines of medical and psychological support of patients in health centers, protocols, standards, medical and psychological assistance strategy. To determine the priority forms of medical and psychological care a survey of patients which helped to formulate their basic attitudes and needs was conducted at Kyiv City Clinical Cancer Center. The findings showed the presence of a problem of informing the patients about the ways and methods of treatment, the need for taking sedatives, the difference in the level of psychological and psychosocial distress at different stages of the disease. Such factors as interaction with a doctor, clinical psychologist activity, a positive experience of work with him, psychocorrection of maladaptive personality concepts of psychological care influenced the referral for psychological help The survey data yielded useful information that formed the basis of the primary medical psychological help organization.

In recent years, the problem of alopecia has become relevant not only for men but also for women. Early onset, expressed clinical polymorphism, severe course, social and psychological maladjustment, torpid to therapy, the need for ongoing medical monitoring makes this issue important for medical practice. The main causes of alopecia are hormonal and genetic abnormalities. An important role in formation of femininity is played by internally integrated mindset of women to the rules of conduct in the society. Thus, parenting patterns aimed at aggressive, masculine behavior are recorded in the subconscious of the girl, and in the puberty they manifest by hormonal disorders and, as a consequence, development of androgenic alopecia. A special place among the determinants of alopecia is occupied by stress and nervous disorders as they cause disorders of the scalp circulation. However, alopecia itself leads to psychological stress with possible development of depression, anxiety, aggression, tension, etc. Alopecia has an extremely negative impact on the psychoemotional state of the woman who is fixed to discomfort, feelings of worthlessness. These patients demonstrate complexity of interpersonal relationship, difficulties in the process of communication, they form social timidity and dependence. Understanding the mechanisms of response to the disease can improve the quality of care and contribute to the choice of effective medical and psychological care. Thus, women with alopecia require a complex organization of psychocorrection support of the therapeutic process.

The article presents the findings of investigation of clinical manifestations of state anxiety (SA) and trait anxiety (TA) in children from the families of internal refugees on the scale of self−esteem by C. D. Spielberg and Yu. L. Hanin. Personality profiles of the levels of SA and TA in these children were determined as a whole and in the groups depending on age−sex characteristics and living conditions. The study established the presence of a fairly large number of children−internal refugees with a high level of SA and TA, which proves the need for more careful attention to this group of children, organizing special psychocorrecting trainings and classes aimed at developing stable psychological protection mechanisms for the action of different life factors. It was determined that the children from the families of internal refugees with a moderate level of SA were mainly was males and the age category of 11−14 years. The levels of SA in children from rural and urban areas were almost identical. The children of internal refugees with a high level of TA were mainly females; those aged 7−10 and 11−14 and children from rural areas. The children with a moderate level of TA were mainly females; children aged 11−14; persons from rural areas. Based on the obtained findings for the levels of SA and TA, personality profiles of children from the families of internal refugees and children from normal families were built. The findings indicate the need for more careful attention to children from the families of internal refugees, of special programs of psychocorrective trainings and classes aimed at developing persistent psychological protective mechanisms with regard to the effect of different lifestyle factors.

Dementia is one of the most pressing problems of modern neurology and psychiatry. The importance of this problem is due to several factors, including a significant increase in the number of older and elderly persons, among which dementia prevalence is great. Socio−economic and emotional burden of dementia lies not only on the patients but also their relatives, persons closest to them, the community, the society as a whole. The performed psychodiagnostic survey of family members of patients with vascular dementia with the use of complex of test methods helped to identify the features of the emotional state of the relatives, their personal characteristics, motivation for the care, behavior and family interaction, as well as quality of life of the family. The findings of the study indicate that significantly larger proportion of people had standard values of the level of anxiety; its high level manifested in increased susceptibility to experience. Asthenia values were rather high. Reduced activity and motivation were determined. The most common complaint was fatigue, they noted irritating weakness, hypersensitivity, autonomic disorders, sleep disorders (difficult falling asleep, superficial sleep). The relatives of patients with vascular dementia had reduced overall perception of quality of life. The obtained data can be used to develop the methods of psychocorrection of their clinical psychological maladjustment.

Acne is one of the most common problems in patients of dermatologists and cosmetologists. Acne negatively effects the psychological condition of patients. The problems associated with acne are negative emotions, anxiety, depression, disturbed body image and self−esteem, less satisfaction, reduced quality of life. The features of depressive symptoms, levels of trait and state anxiety in patients with acne were investigated. Beck Depression Inventory and method of subjective evaluation of state and trait anxiety by C. D. Spielberger and Y. L. Hanin were used. It was established that acne was an intensive traumatic factor that caused changes in the psychological state of the patients. In almost half of the patients, depression of varying degrees of severity with prevalence of mild depression was formed. Females had high levels of depressive and anxious condition. The leading manifestations were pessimism, sadness, dysmorphophobia, dissatisfaction, irritability, sleep disorders, health concern, social alienation, decreased libido, self−blame. Gender differences in girls were expression of self−incrimination with a tendency to form guilt feeling, insomnia, indecisiveness, social alienation, and in boys high health concern and decreased libido. Dysmorphophobia was a highly specific symptom for patients with acne disorders. High levels of anxiety, especially state associated with social interaction were observed. Severity and extent of the changes in the emotional state of patients with acne indicate the need for correction of psychological state of patients as a part of a comprehensive program of psychological help.

The aim of this study was to investigate the clinical features of patients with psychiatric autoagressive behavior during the initial psychotic episode, their premorbid features with the influence of circadian biological rhythms. Characteristic of clinical manifestations of the first psychotic episode was performed using BPRS scale, the risk of suicide using Liuban−Plotstsa scale, the features of premorbid state using PAS questionnaire, biological rhythms were characterized using Osberg questionnaire. The investigation with Liubann−Plotstsa scale to assess the degree of suicidal risk the degree of suicide risk allowed to determine that in the patients in the age periods of 12−15 years, 17−18 years, after 19 years, disorders of adaptation to school dominated. In the period of 12−15 years, most of the patients demonstrated disorders of relationships with the peers. Disorders of sociability were observed in patients aged 12−15, 17−18, over 19 years. Dissatisfaction with sexual aspects of life prevailed in patients aged 17−18, and over 19, the same people noted dissatisfaction with the level of success. The analysis of data obtained with Ostberg questionnaire showed that patients aged 11 and 12−15 had predominantly an evening type of biorhythm organization. Morning organization was more common in patients from age groups 17−18 and over 19. The results of the study allowed to conclude about the impact of premorbid characteristics of the degree of suicide risk and prevalence of certain groups of symptoms in the clinical picture, depending on its level. Biological rhythms were determined to have an influence not only on the clinical features, but also on the degree of suicide risk.

According to official statistics, the frequency of suicide attempts in Ukraine is significantly higher in comparison with North America and the European Union. Regular statistical studies allow to find out the features of suicidal behavior in the population and implement preventive scientifically substantiated measures. 113 case histories of Kharkiv residents who tried to commit a suicidal self−poisoning during 2014 were investigated. In the surveyed population men made 34 suicide attempts and women 79, repeated self−poisoning were not recorded. The minimum age was 18 years, maximum −− 84. The largest number of self−poisoning were recorded in those aged 20−29, which made 42 cases (37.17 % of attempts). In 88.50 % of suicide cases the victims did not exceed the age of 60. Almost half of the total number of suicide attempts was committed in the interval between 6 pm and 12 pm, the lowest incidence (5.0 % of cases) were reported from 12 pm to 6 am. The majority of suicide attempts were recorded on Tuesday. The lowest number of poisoning happened on Fridays. According to the medical history, nearly 40.0 % of suicides were committed during or after drinking alcohol. In men drunken suicide made about 60 % of all attempts made by men, in women about 30 % of all attempts made by women. Most often drugs were used as a means of the suicide (analgin, hidazepam, amitriptyline and paracetamol). Statistical analysis of the acts of suicide by self−poisoning can be used in development of scientifically based prevention of suicide attempts among the population of Kharkiv.

The presence of appearance defects and deformations, particularly in the face area, affects the personality, changing the character and behavior, causing impaired emotional and motivational spheres. In the vast majority of cases cosmetic defects do not affect the physiological function, although some of them can cause development of severe physical and mental disorders. The aim of the research was to study the internal picture of the disease (IPD) women with defects and deformities of the face in the pre− and the postoperative period, taking into account their clinical and psychopathological features using clinical and diagnostic assessment of the mental health, typology of psychological response to the disease by A. Lychko and N. Ivanov (1987). According to the obtained data the women had mental disorders such as dysthymia F34.1, mixed anxiety and depressive disorder F41.2, adjustment disorder F43.2, post−traumatic stress disorder F43.1, neurasthenia F 48.0 and somatoform disorders F45.0. Syndrome structure of diagnosed mental disorders was presented by anxiety disorder, anxiety−depressive, anxious−hypochondriac, asthenic−neurotic, insomnic, dysmorphophobic, and hysterical syndromes. The technique of determining the types of attitude to disease (Lychko A., Ivanov N., 1987) revealed that in the first group of women the vast majority was presented by anxious, neurotic and hypochondriac type. The second group of women had harmonious, ergotamine and anosognosic types. Determining IPD with the account of clinical psychopathological features of the patients with defects and deformities of the face provides an opportunity to positively affect the quality of both therapeutic and surgical activities.

The purpose of research was to study pathopsychological features of depressive disorders in schizophrenia. The study involved 162 patients with schizophrenia, of them 120 patients with depressive disorders at schizophrenia (study group) and 42 patients with schizophrenia without depression in the clinical picture (comparison group). As a result, the pathopsychological typical features of patients with depressive disorders at schizophrenia were identified. It was proved that feeling of somatic dysfunction, a sense of personal inadequacy and inferiority, apathy, lack of motivation, loss of vitality, the presence of anxiety, disturbance of value−semantic sphere and ability to express their feelings, low self−acceptance, inadequate self−esteem, disturbance of human representations, dissatisfaction of physical/psychological well−being and interpersonal relationships distinguish the schizophrenia patients with depressive disorders from the comparison group. The data should be considered as a pathopsychological differential diagnostic criteria of depressive disorders in schizophrenia and should be taken into account during pharmacotherapy and psychotherapy of schizophrenia with depressive disorders.

The effectiveness of the tactics of treatment of dissociative disorders depends on the quality of compliance of patients to therapy compared to other nosology. The features of compliance in patients with dissociative disorders were identified with the help of history study, follow−up, clinical psychopathology, psycho−diagnostic methods. The patients completed a questionnaire «The scale of compliance by Moriski−Green» in a modified form for each type of therapy. The level of objective medical identification and self−identification of compliance in patients with dissociative disorders was determined for pharmacological, psychological and physical therapy; its dynamics at different stages of treatment was traced. The correlation of the levels of subjective and objective procompliance of patients to different types of treatment depending on the variant of the dominant arranging factor of psychological maladjustment was determined. Procompliant and dyscompliant variants in patients with dissociative disorders were distinguished.

Differential diagnosis of obsessive−compulsive disorder is becoming increasingly important in the context of the frequent references to the presence of obsessional phenomena, i.e. (pseudo)obsessions, in the structure of the clinical continuum of schizophrenia. To establish medicopsychological and psychophysiological features of patients with (pseudo)obsessions in etiopsychopathogenetic and differential diagnostic context, 154 patients were investigated at Regional Clinical Mental Hospital. History taking, clinical−psychopathological, psychodiagnostic and statistical methods were used. It was determined that in the majority of the patients the etiopathogenetic basis of (pseudo)obsessions was an endogenic component, and only in some cases true obsessions of neurotic origin were considered a comorbid state. The key role in the pathogenesis of endogenic obsessions is played by the strength of the nervous system. The greater the strength of the nervous system of patients with schizophrenia, the greater the likelihood that productive, in fact psychotic, symptoms, including in the onset of the disease, will not develop to a full−fledged paranoid syndrome, and will have reduced expression in the form of (pseudo)obsessions. Whereas the patients with true obsessions were characterized by a weak nervous system with a shift of the balance towards excitation. In schizophrenia patients with comorbid true obsessions of neurotic origin, expressiveness of obsessive phenomena was significantly weaker than in patients with obsessive symptoms without schizophrenia, which is due to a specific deficiency of schizophrenia. Based on the analysis of differential medicopsychological and psychophysiological characteristics of patients, the criteria of correlation of the obsessive thoughts and schizophrenia were distinguished, and the scale of diagnostic differential correlations of obsessive thoughts and schizophrenia was developed.

From the psychological perspective, esthetic medicine is a specific area of health services, in which the criterion for result evaluating is a very subjective concept of beauty. Negative emotions of patients who are dissatisfied with the effect of cosmetic procedures because of inflated expectations, have traumatic effect on the doctors, leading to burnout and professional maladjustment. To evaluate the prevalence of burnout among doctors working in the field of esthetic medicine in relation to the peculiarities of the professional interaction investigation with MBI−HSS questionnaire was performed. Unrealistic ideas of the patients about their appearance, hard concentration on their own attractiveness, high expectations regarding the results of cosmetic interventions caused problems and conflicts in the practice of the surveyed doctors. The central element of emotional burnout in doctors−cosmetologists was emotional exhaustion, the major manifestations of burnout were feeling emptiness, mental exhaustion with the desire to retire, fatigue, negative emotions from high expectations of patients. The findings of the research show that the level of emotional exhaustion corresponded to the average for assessing the severity of the syndrome. The low rates of the components of burnout (emotional exhaustion, depersonalization, performance appraisal) indicated formation of sufficient mental adaptation to the activities carried out, while high ones characterize the state of maladjustment. The average severity of burning represented a buffer zone with a mosaic manifestation of professional malfunctions. The share of persons with an average degree of severity of the components of burnout was the greatest. The analysis of the results indicates the need to develop programs of psychological preparation of doctors−cosmeticians aimed at improvement of the skills of their professional interaction.

The problem of crisis psychological help to children is very urgent in Ukraine. The hybrid war led to a large number of mentally injured children with different psychiatric disorders after experiencing a crisis event (F43 according to ICD−10). The clinical psychological characteristics of children from immigrant families who experienced traumatic events during «stress» and «neurotic» reactions. The children with their parents attended group and individual sessions of fairy−tale therapy for young people. The therapeutic effect of this method consists in creation of individual medical methods using drawing, sculpting, sand therapy, dramatization, movement exercises, dance. Fairy−tale therapy allows delicate treatment of traumatic experience, promotes its cognitive reinterpretation, enhances creative resources. The obtained results proved high efficacy of active early intervention using fairy−tale therapy and Noophen administration.

To determine the presence of specific neurological disorders in elderly patients with major etiological types of mild neurocognitive disorders and to define their differential diagnostic value, elderly persons with these disorders caused by Alzheimer's disease with mild subcortical neurocognitive disorders were investigated. The clinical protocol included neuropsychological tests (MMSE, Luria's tests, etc.), neurological examination with a detailed assessment of the statics and locomotion using Tinetti scale. The main neurological syndromes identified in the elderly were disorders of higher−level walk, pyramidal and pseudobulbar ones. Statistical significance was revealed only in the group of patients with mild subcortical neurocognitive disorders. The study traced close correlation between pathognomonic cognitive disorder (executive dysfunction) and identified neurological syndromes: disorders of higher−level walk, pyramidal (rs = −0.53, p < 0.01) and pseudobulbar syndromes (rs = −0.46, p < 0.01). The results are consistent with the existing literature data and evidence on the impact of microvascular frontosubcortical brain damage on formation of these neurological syndromes in persons with subcortical mild neurocognitive disorders. The findings suggest that specific neurological disorders with mild subcortical neurocognitive disorders in the elderly can include higher−level walk disorder, pyramidal and pseudobulbar syndromes, which can be recommended for differential diagnosis algorithm between the main etiological types of mild neurocognitive disorders.