ARTICLES ARCHIVE

Determining the character of limitations in life the activities of daily living in patients with arterial hypertension after a stroke is necessary to establish the existence of disability and development of individual rehabilitation programs. The purpose of the work was to determine the features of the influence of psychological factors on vital activity limitation in the main spheres of life in such patients. In the course of the study, the character accentuations, personality and characterological features, attitude to the disease, attention, memory and thinking, emotional intelligence, general mental abilities were established. Methods of mathematical statistics were used for the analysis. In patients with grade 3 arterial hypertension the most expressive of the limitations of life activity in the main spheres of life in the domain "learning and using knowledge" were the use of sight and hearing, solution of simple and complex tasks, concentration and thought; solution of simple and complex problems, attention, the use of vision and hearing, independent implementation of individual, multifaceted and complex tasks, reading, decision−making were significant. Thus, increased excitable accentuation, emotional instability, depressive and paranoid tendencies, decreased memory, work efficiency, emotional intelligence and logical thinking increased the limits of vital activity in the domain "learning and using knowledge". The algorithm for filling individual rehabilitation problems in the section of psychological and pedagogical diagnosis should be based on the definition of these psychological characteristics.

Alzheimer's disease affects not only the patient but the whole family. With the progression of the disease the need for care increases, and leads to the need for round−the−clock supervision, resulting in constant emotional tension and exhaustion, violation of adaptive mechanisms at the level of organism and personality. The survey of caretakers of patients with Alzheimer's disease revealed their main complaints, such as feeling of grief and sorrow, despair and helplessness, shame for the behavior of the patient, irritability and bouts of anger, guilt, loneliness, exhaustion, fatigue, lack of time for themselves and other family members. According to the data obtained from the study of the state of psychosocial maladjustment by Scale of Psychosocial Maladjustment, family and mixed types of social maladjustment were determined. The main elements of family maladjustment in the caretakers were irritability, dissatisfaction with psychological climate in the family, relationship with spouse and children, as well as assessment of the period of married life as "not very good" and "very bad". Disruption of adaptive behavior mechanisms due to psychosocial maladjustment occurred in the area of greatest tension in the premorbid period. The obtained data can be used to construct an effective system of psychotherapeutic correction of psychosocial maladjustment manifestations.

One of the characteristic features of modern society is a rapid acceleration of information processes, accompanied by the changes in socio−political, economic, cultural, psychological conditions of lives. This study was conducted to establish the gender− and age−dependent characteristics of non−chemical addictions in patients of both sexes with mean age 32 years. Such research methods as analysis, synthesis and generalization of scientific results of investigation of non−chemical addiction, as well as analysis of the data obtained during the psychological examination of patients, including observation, testing and questioning, based on the methods of sensor−vivid orientations by Leontiev, value orientations by Rokeach. The findings of the research showed that men are more inclined to computer addiction, sports, while women to promiscuity, shopping, bulimia or anorexia, and work addiction. A significant difference between non−chemical addiction and chemical is the special role of stress factors in simulation of mental health, precisely with information−behavioral types of addiction. The "blows" launched by addictive behavior on the social status of such patients are stronger than at alcohol or drug addiction. The obtained data can be used in the practical work of doctors, psychiatrists, narcologists, psychologists and social workers rendering aid to addicts with non−chemical addiction, as well as in the creation of individual comprehensive programs of medical rehabilitation, development of group psycho−corrective measures.

Psychological correction and psychotherapeutic impact associated with neurotic disorders in adolescents who experienced physical, psychological and sexual violence, became especially relevant in the context of armed conflict in the East of Ukraine. Regardless of the type of violence, its consequences are detrimental to the adolescent's mental health. Adolescents aged 10−17 were surveyed to investigate neurotic disorders in patients who experienced violence and ways of their psychological correction and psychotherapy. The experimental psychological study was carried out with using tests of Spielberger−Khanin, Eysenck, Thomas, Hamilton scale, Buss−Durkey questionnaire. Some of the tested adolescents who survived violence were aggressive, others −− excessively passive. Manifestations of neurotic disorders were observed in the form of disorders of adaptation, sleep, neurasthenic syndrome, acute reaction to stress, depressive disorders. The principles of psychocorrection and psychotherapy of the patients corresponded to those of complexity, consistency, phasing. Psychological counseling, play and fairy−tale therapy, autogenous therapy, training of assertiveness were used. The complex of the taken measures showed their effectiveness in adolescents and their families.

Clinical psychopathological analysis and systematization of psychopathological disorders in the structure of psychoendocrine syndrome at hypothyroidism were carried out. This retrospective−prospective investigation involved the patients of Ukrainian Research and Practice Center for Endocrine Surgery, Endocrine Organs and Tissue Transplantation of Ministry of Health of Ukraine (Kyiv). Clinical and psychopathological characteristics of patients were compared with the account of the state of decompensation and compensation in the structure of one type of endocrine dysfunction, which allowed analyzing, on the one hand, dependence of the clinical filling of the psychoendocrine syndrome on metabolic disorders, and on the other, to distinguish its stable and labile components. Based on the data of the symptomatic questionnaire SCL−90−R, a significant reduction in the number of severe and moderate forms of somatization, moderately severe and moderate forms of obsessive−compulsive disorders, severe forms of depression, severe and moderately severe forms of anxiety, severe phobic disorders and paranoia. A reverse effect was observed with respect to hostility. The obtained results indicate the character of dependence psychoendocrine syndrome components in hypotheroidism on the presence of clinically expressed endocrine disorders.

A dominant role in following medical advice by the patients with type 2 diabetes is played by the features of the attitude of the patients to their disease. Therefore, features of the response to the disease are one of the main factors contributing to compliance to therapy. To establish the features of the response to the disease depending on the disease severity, the patients with type 2 diabetes were investigated. Research methods included anamnestic, clinical, laboratory, clinical−psychopathological, psycho−diagnostic. Within the framework of psycho−diagnostic examination, Personality inventory of Behterev Institute was used with the aim of diagnosing the type of response to the disease and existing patterns of compliance. The study established the dominant role of the attitude to the disease in formation of compliance to treatment of type 2 diabetes. The factors of violation of compliance to the therapy of type 2 diabetes, the main of which was the type of response to the disease, were determined. Two main areas of violation of compliance to pharmacotherapy in patients with type 2 diabetes included lack of assignments and surplus of the assignment execution. The deficit in the execution of assignments correlated with the average severity of type 2 diabetes and anxiety type of attitude to the disease; the surplus of the execution of the assignments was typical for all severity levels of type 2 diabetes and correlated with anosognosic and euphoric type of the attitude to the disease.

Currently, the problem of disability growth is highly relevant in the whole world. Among the causes of this phenomenon, pathology of the musculoskeletal system occupies one of the leading places. A fundamental psychological factor mediating the diversity of treatment and rehabilitation is motivation of the patient and interpersonal relationships of the patient and therapist. To investigate the compliance, find the factors that determine it, the patients with the musculoskeletal pathology undergoing the programs of resort rehabilitation were investigated. In patients, disorders of the mental sphere were identified at the nosological level as adaptation disorders, on the prenosological level, in the form of situationally conditioned reactions of psychological maladjustment. Since the effectiveness of the treatment depends on the degree of compliance, it should be advisable to determine the level of compliance at the beginning of the therapeutic process and monitor it during the resort rehabilitation. Compliance is determined by such individual psychological factors of the patients as personality traits, locus of control, anxiety level and that of responsibility related to health. These parameters should be taken into account in the formation of the therapeutic alliance.

The study of new forms of behavioral addictions is an urgent socio−psychological and medical problem. One of such widespread deviant forms of behavior with the desire to escape from reality is the clubbing, a pathological tendency to visit clubs, adherence to club life. However, the term "clubbing", along with the notion of behavioral addiction, is used to characterize a socially acceptable form of leisure. For their differentiation, the author proposes to use the term "pathological clubbing" and consider it under the heading F63.8 ICD−10. The author also indicates the signs by which this pathology can be diagnosed. To determine the incidence of pathological clubbing in a social group of representatives of the club subculture, 112 clubbers were examined. The original AUDIT−like clubbing test was used. The findings testify to the high addictogenic potential of clubbing, the prevalence of men among those with pathological clubbing. The obtained data indicate the need for further study of clubbing as a social phenomenon with a dangerous addictogenic potential of development of specific behavioral addiction in young people.

The aim of the study was to determine the clinical psychopathological and pathopsychological features of children with attention deficit hyperactivity disorder (ADHD). The methods of observation, clinical and medical history taking, clinical psychopathological and psychodiagnostic. Within psychodiagnostic method, Raven's test (children's version) Toulouse−Peyron test; a set of neuropsychological tests for children were used. It was shown that psychopathological symptoms characteristic of the investigated children were polymorphic and heterogeneous. The main clinical types of ADHD were distinguished: mixed type, with predominance of hyperactivity / impulsivity and the type with predominance of attention deficit. Major psychopathological disorders of ADHD (disorders of voluntary attention, impulsivity and hyperactivity) are often combined with the signs of other disorders of functions and behavior (speech disorders, emotional disorders and school maladjustment). Disorders of age dynamics of mental development, its uneven and partial delay are also observed. The peculiarities of basic mental functions and the level of intellectual development were determined. It was shown that the level of intellectual development in children with ADHD is within the age norm. Disorders of voluntary regulation of mental activity and voluntary attention of varying severity are obligate for ADHD. These children lack formation of a number of other mental functions (memory, praxis, gnosis, speech); they are characterized by emotional lability, emotional tension and irritability.

It is known that pronounced anxiety−depressive signs in cancer patients can lead to formation of suicidal thoughts and tendencies, and to suicidal actions in individual patients. However, until now there is no system of reliable signs signaling about the forthcoming plan of committing suicide. The relevance of the topic determined the purpose of the work: to develop the principles of psychotherapeutic correction of these disorders on the basis of studying the psychopathological phenomenology of suicidal behavior in cancer patients and the pathopsychological mechanisms of their formation. The conducted experimental psychological investigation included diagnostic interviews, methods of Spielberger−Khanin, Zung, Buss−Durkey scales. The analysis of the data obtained showed that the patients had lower moods, significant state and trait anxiety, as well as severe depressive disorder. Wave−like character of the neurotic manifestations was noted with the main peaks at the diagnostic and preoperative stages. Typical reactions to the disease (anosognosia and hypochondria) were been identified. Staged character, sequence, prolongation, non−directivity, focus on real problems of daily life were identified as the main principles of psychocorrection, psychotherapy, psychosocial rehabilitation of cancer patients. It is concluded that in each specific case the tasks of psychocorrection, psychotherapy and psychosocial rehabilitation are determined by the peculiarities of the life situation of the patient and his family, the degree of functional disorders severity, psychopathological and neurological disorders, the level of quality of life, the risk factors of suicidal ideation and trends.

The problem of psycho−social rehabilitation of patients with organic brain lesions, who are socially dangerous, requires a further solution. It is important to identify the state of emotional sphere in patients because emotional disturbances are the basis for implementation of socially dangerous actions. This conditioned the purpose of the work, i.e. to determine the level of social dysfunction on social functioning spheres in patients with organic brain lesions with different mechanisms of socially dangerous acts implementation and the state of the emotional sphere, as the target of constructing a system of medical and psychological rehabilitation. The findings showed that a significant proportion of participants used non−adaptive coping strategies to "prevent specific problems" due to psychopathology. The sphere of social relations appeared to be most deformed, less deformed family and domestic sphere and the sphere of working capacity. The data obtained allowed to work out a system of psychotherapeutic correction. Inclusion in the system of psychotherapy the elements of cognitive−behavioral training correcting interpersonal relationships was basic. The next direction of rehabilitation work was assertive training, aimed at raising the level of patient awareness, formation of their respective interests, communication, which in this group is very limited. Almost all patients with organic brain lesions who committed socially dangerous actions had a very low level of social functioning, which significantly limited their ability to conduct a socially congruent way of life. This determined the choice of the most important targets of psychotherapeutic intervention, namely, life activity and work capacity, social sphere and emotional relations in family life. The volume and sequence of psychotherapy application are discussed taking into account the state of the emotional, cognitive and communicative spheres of patients and low resource of their psychosocial adaptation. Therefore, targets for restorative therapy and medical and psychological rehabilitation should be identified taking into account the capabilities of pharmacotherapy and psychotherapy.

The problem of health of students is particularly relevant in the current complex social and economic conditions. University students are the future socio−economic, intellectual and creative potential of the country. Therewith, students can be attributed to an increased risk there is valid evidence of their health deterioration with the negative dynamics during the period of studies, high values and rates of increase of morbidity, outspread of negative tendencies in the way of life. This was the purpose of the investigation conducted in the students of the medical college. The emotional sphere was assessed using scales for self−assessment of state and trait anxiety by Ch. Spielberger, adapted by Yu. L. Khanin and Beck Depression Scale. Individual psychological personality features were determined using Buss−Durkey questionnaire of aggression degree. Reducing the level of health of the younger age group of the working population makes more attention to the young generation's health. The study of phenomenology and determining pathopsychological mechanisms of formation of psychological maladjustment in the college students allowed developing the criteria for their early diagnosis and correction. High mental and psycho−emotional stress, perception and processing of various information under time pressure, mismatch of the labor intensity and good rest, especially during sessions, intensive use of computer technology in the educational process are the factors provoking the emergence of adaptation disorders. The study showed prevalence of psycho−emotional disorders in the patients. These data suggest that alteration of physical activity at an early age reduces greatly the quality of life of the students. Increased tension in psychological protection, indicating the urgency of studying the mechanisms of adaptation of students to mental stress and formation of constructive behaviors in stressful situations, was revealed.

Today, when military operations and forced migration take place in Ukraine, every day new contingents of persons exposed to stress factors appear. The most common of them are post−traumatic stress disorder (PTSD), the prevalence of which in the population depends on the frequency of traumatic events. The aim of this work was to investigate the emotional state of the participants of the antiterrorist operation with PTSD during resort rehabilitation and implementation of the program of medical and psychological rehabilitation in this contingent. The program of medical and psychological rehabilitation was carried out for 40 hours in three main phases: diagnostic, remedial and supportive. This system consisted in a program of medical and psychological rehabilitation of persons affected by participation in the antiterrorist operation, developed in accordance with European and international standards. The program was implemented in there phases: initial (adjustment of therapeutic contact −− compliance); basic (rehabilitation); supportive. The results showed that the medical and psychological rehabilitation stabilized the emotional state through the development of skills of self−regulation, restoring the physical capacity of the military and prolonged psychological measures. Sleep stabilization, reduced irritability, improved appetite, reduced level of state anxiety, stabilization of depressive disorder were observed in the mental state of patients with PTSD. The patients noted reduction in the incidence of emotional experience and return to the traumatic situation. Implementation of our program of medical and psychological rehabilitation of demobilized participants of the antiterorist operation demonstrated a high level of efficiency.

An important moment for creating a program of prevention of intentional self−harm is establishment of the predictors of such behavior in different social groups. To distinguish the social predictors of parasuicidal behavior in a group of women with depressive disorders and a history of fetal loss, 91 patients were examined. The following methods were used: clinical−psychopathological, clinical−suicidological, psychodiagnostic (Pierce Suicide Intent Scale, the SAD PERSONS Scale, P. Drego's prescriptions), mathematical statistics. The study was conducted in two stages: the first one consisted in inventory of the known social predictors of suicide in women, the second −− comparative analysis of the frequency of occurrence of characteristic signs with the calculation of diagnostic coefficients and measures of information. As a result, a scale was developed that allows concluding about affiliation to a group of social predictors. The study identified nine social predictors of parasuicidal behavior of women with depressive disorders and a history of fetal loss: negative parental messages "Do not live", "Do not be healthy", dissatisfaction with the marriage, lack of support from the nearest, education in an incomplete family, living in a disintegrated family with a high level of conflict, education as pandering hyperprotection, emotional rejection. The data obtained can be used to prevent suicidal behavior in a potentially suicide−dangerous group of women with depressive disorders and a history of fetal loss.

One hundred persons were investigated to review and organize clinical and psychopathological characteristics of an initial set of psychiatric symptoms in schizophrenia simplex. For this purpose history analysis, clinically−psychopathological, clinically−statistical methods were used. Eight types (attributive, pseudoneurotic, pseudo−obsessive, pathoaffective, psychopathic, parabulic, autistic and apathy−abulic) were identified in the result of the analysis of the distribution of initial symptoms in the clinical presentation of the disease. The cohort study distinguished a typical version of the disease debut (autistic and apathy−abulic), presented by negative signs and volitional and behavioral disorders (parabolic and psychopathic types). One third of the patients had productive types of symptoms (attributive, pseudoneurotic, pseudo−obsessive and pathoaffective). Displacement of the clinical presentation of initial symptoms in the structure of schizophrenia simplex from classically described "simplex complex" to productive psychopathological symptoms in patients with catamnestic resistant diagnosis within the period of > 10 years, indicating vertical direction and approximate depth of the pathomorphosis of the initial stage of schizophrenia simplex.

Non−psychotic spectrum psychopathological disorders are extremely common in patients with neurological disorders. In this context, special attention should be paid to organic anxiety and depressive disorders. Patients with disorders of cerebrovascular and cerebrotraumatic origin constitute a specific group with a high risk of various complications. This investigation was conducted using history analysis, clinical and psychopathological, psychodiagnostic methods to determine medical and psychological characteristics and clinical psychological maladjustment factors in patients with organic anxiety and depressive disorders. The resulting high rates of pathological (dysharmonic) types of attitude to the disease in the patients indicate a characteristic variant disorders of social adaptation, pathological affective arrangements, the state of "soaking oneself in the disease" and decrease their ability to build compliant therapeutic relationship. The investigation established dominance of sticking, dysthymic and anxious arrangements of character accentuation, indicating torpidity and inertia of the mental processes in this group, lower self−esteem, disorders of social functioning, lability affect and high levels of anxiety. The patients with organic anxiety and depressive disorders of cerebrovascular origin demonstrated the patterns of anxiety−introvert personal response and cerebrotraumatic origin −− high levels of aggressiveness and emotional lability. The range of the factors of maladjustment of adaptive compensation was defined and systematized: psychogenic (short−term, cumulative, existential), somatogenic (hypochondriacal, illogical) and sociogenic (microsocial). Correction and prevention of anxiety and depressive disorders is possible by raising compliance with psychotherapy. The results of the investigation and systematization of medical and psychological characteristics can form the basis for development of psycho−compliance system.

The concept of emotional stress− psychotherapy in addiction medicine defines the psychotherapeutic process as a system of active intervention in the vital activity of the organism with the aim of restoring the internal altered parameters of personal and biological homeostasis. The materials of many−year research (history analysis, electrophysiological, biochemical, physiological of 1640 patients with alcoholism aged 20−60 after applying stress−psychotherapy by A. R. Dovzhenko) allowed distinguishing biological express−criteria for predicting the results of treatment. All studies were conducted in four stages: before stress−psychotherapy at the stage of arresting alcohol withdrawal syndrome −− the first study; during stress−psychotherapy after the completion of a 2.5−hour relaxation session (second study); after a procedure of 25−40−second individual stress−coding (third study); on the second−fifth days after stress−psychotherapy (fourth study). It was established that such criteria include positive changes in the indicators of arterial and temporal pressure; the content of a number of central and peripheral hormones in the blood; the content of adrenaline and noradrenaline in the urine; increase of serum levels of apoB−containing lipoproteins, normalizing concentration of apoA−containing lipoproteins; electroactivity of the brain (restoration of cerebral mechanisms of vegetative reactivity with an increase in the tone of the sympathetic nervous system, restoration of ?−rhythm parameters). It was noted that the most unfavorable in terms of predicting the results of stress−psychoterapy are the patients engaged in production processes that have occupational harm of toxic chemical composition (electric gas welders, foundry workers, chemical workers). The most prognostically successful were builders and office workers. The data obtained during the study can be used as objective biological prognostic criteria for development of therapeutic remission in alcohol−dependent patients after stress−psychotherapy.

In pediatrics techniques of art therapy is widely used for seriously ill children. As the hospital can cause both a sense of hope for recovery and stress. Hospital walls, unexplained medical terminology, people in white coats, constant bright light in the intensive care unit, the specific smells, sound of equipment, and most importantly, separation from loved ones, can be the cause of the child's maladjustment. Congenital heart defects (CHD) treatment often require repeated operations and invasive diagnostic procedures which can provoke anxiety, fears and acute stress disorder in children with CHD and their parents. Our study presents the results of art therapeutic approach in working with 68 children, aged 4−10 years with СHD who were waiting for heart surgery. The aim of the study was to analyze the emotional state of children and improve their psychological preoperative preparation. Art therapeutic approach included the graphical test "Fantastic animal", "My family" and specially designed coloring book "My health guide". "My health guide" consisted of such sections as: 1) a short message for parents with tips on how to best help child before the heart surgery; 2) the first meeting with the doctor and scheduling the date and time of surgery; 3) the team of medical specialists; 4) the body structure and location of the operation; 5) what you can take with you from home to hospital 6) registry; 7) hospital ward; 8) medical devices and equipment; 9) medicines; 10) anesthesia; 11) operating room; 12) electrodes; 13) catheters and inhalation mask; 14) intensive care unit; 15) rehabilitation; 16) returning home. Projective tests revealed graphic symbols of insecurity and depression in 41.8 % of persons, high anxiety in 69.12 % of children and hostility in 51.47 % of children. The coloring book "My health guide" proved its effectiveness in psychological preparation for heart surgery and helped the patients to become familiar with hospital staff, medical equipment, medicines and necessary medical procedures. The future research will be development of creative exercises for improving cognitive function in children with CHD and their inclusion into the art therapy classes with preschool and primary school children in the hospital.