Volume 12, №3' 2017
M. I. Pyrohov Vinnytsia National Medical University, Ukraine
The features of clinical psychopathological phenomenology and pathomorphism of endogenous depressive disorders
3 - 5
In order to study clinical psychopathological phenomenology and pathomorphism of endogenous depressive disorders, medical documentation of 297 patients treated within the period of 1991−2016 was studied. In the initial period, the presence of prodromal phenomena was detected in 37,0 % of patients. Emotional hyperesthesia, fatigue, autonomic symptoms, decreased mental capacity and physical performance and somatic discomfort predominated in the initial stage symptomatology. Pathomorphism of the initial stage included a greater degree of prodromal symptoms, mainly asthenic and somatovegetative. The presence of an external factor provoking manifestation was revealed in over a half of the patients, while the role of this factor in the process of pathomorphism gradually increased. Clinical psychopathological phenomenology of the manifest stage was represented by a combination of affective, asthenic and somatovegetative symptoms: decreased mood, anhedonia, asthenia, anxiety symptoms, feeling of guilt, thoughts of death or suicide, cognitive disorders, insomnia, vegetosomatic symptoms. Clinical pathomorphism of the manifestation stage of depressive disorders was characterized by a complex character and included a decrease in asthenic symptoms and suicidal manifestations with a simultaneous increase in the prevalence of anxiety and somatovegetative disorders. The revealed features should be taken into account in the development of therapeutic and rehabilitation measures for patients with endogenous depressive disorders.
Key words: depressive disorders, clinical psychopathological phenomenology, pathomorphism.
Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine, Kharkiv, Ukraine
6 - 12
At present, addictions are widely spread and are frequently diagnosed in the structure of other mental disorders, in particular neurotic disorders. Therefore, the issue of studying the factors of etiopathogenesis of addictions in the structure of neurotic disease, in particular the characteristics of coping behavior. To investigate the nature of the relationship between the characteristics of coping strategies and addictive behavior in patients with neurotic disorders the patients with anxiety−phobic, dissociative disorders and neurasthenia were examined. AUDIT−like tests, Coping Inventory for Stressful Situation −− CISS, Strategic Approach to Coping Scale, SACS were used. It is proven that the same addiction, depending on the form of the neurosis, was formed due to the realization of completely opposite copings. Abuse of food in anxiety−phobic disorders was associated with the use of a coping model of «avoidance"; dissociative disorders −− with copying «indirect actions" and «antisocial actions", and with neurasthenia −− with copying «impulsive actions"; a sexual discomfort in patients with anxiety−phobic disorders is associated with the strategy of «avoidance", while in patients with dissociative disorders using the strategy of «indirect (manipulative) actions". It is revealed that the basis of addictive behavior can be not only non−adaptive, non−constructive strategies, but also constructive, socially directed coping, which, depending on the form of the neurotic disorder, can be realized by one or another addictive passion: the use of alcohol and tobacco −− «assertiveness actions, contact with anxiety −− phobic disorders; shopping −− entering into contact with dissociative disorder and seeking support in neurasthenia; the use of tobacco and even cannabinoids −− an active coping strategy of «assertiveness action" in neurasthenia. That is, addictive behavior can be based not only on non−adaptive, non−constructive strategies", neurasthenia −− «impulsive actions". Sexual discomfort in patients with anxiety and phobic disorders was associated with the strategy of «avoidance", while in patients with dissociative disorders, using the strategy of «indirect (manipulative) actions". It was established that the basis of addictive behavior can be not only nonadaptive, non−constructive strategies, but also constructive, socially−directed copings, which, depending on the form of a neurotic disorder, are realized by one or another addiction: the use of alcohol and tobacco −− «assertive actions", entering into contact at anxiety−phobic disorders; shopping −− entering into contact with dissociative disorder and seeking for support in neurasthenia; the use of tobacco and even cannabinoids −− an active copy−strategy of «assertive action" in neurasthenia. The link between alcohol abuse and associative and indirect (manipulative) coping strategies was common to all forms of neurosis. It was noted that the use of alcohol allows to realize not only asocial, but also adaptive «assertive" coping strategies in patients with anxiety and phobic disorders. The obtained results can be used in psychocorrection practice in patients with neurotic disorders.
Key words: coping behavior, addiction, neurotic disorder.
Zaporizhzhia State Medical University, Ukraine
13 - 16
At the moment, the level of medical−psychological care for patients with newly diagnosed oncological pathology is inadequate, since it is carried out exclusively at the level of primary contact of patients with the cancer hospital and is considered in the context of common medical deontology. The analysis of typical variants of psychological distress at primary diagnosis of cancer pathology and the development of the principles of its prevention seems to be a priority task of medical psychology. To form a typology of psychological distress and develop the principles of its prevention in patients with a newly diagnosed oncological pathology retrospective investigation of a population of cancer patients was conducted using psychodiagnostic, clinico−anamnestic and clinical−statistical methods. The stereotypes of psychological distress of cancer patients were established, ranked by 3 levels according to the degree of violation of rational behavior: Level 1 −− normative−rational −− without behavior disorders in the context of the diagnostic and therapeutic process. Ii included hyperconformal (superconformal position of the patient, demonstration of high level compliance) and passive (inhibition of motivation, focus on internal experiences, passive submission to the requirements of the medical personnel and relatives) types of psychological distress; Level 2 −− conditionally−rational −− pathological patterns of patients' behavior, which complicate diagnostic or therapeutic procedures. It included manipulative (patients implemented demonstrative patterns of behavior, resorting to manipulation of relatives and medical personal) and explosive (patients required immediate help, resort to threats and pressure against medical personal) types of psychological distress; Level 3 −− irrational −− pathological behavior of the patient, which excluded normal conducting diagnostic or therapeutic procedures. It included negativistic (irrational, oppositional behavior in relation to medical procedures and medical personal) and paranoid (patients acritically accept the position of denying the diagnosis, perceiving it as a medical error) types of psychological distress. The principles of psychological correction of irrational behaviors were developed on the basis of the developed typology, which can be used in the context of medical−psychological support of this group of patients in cancer hospital to improve the effectiveness of diagnostic and treatment procedures.
Key words: distress, oncology, medical and psychological support, psychological adaptation, psychocorrection.
Zaporizhzhia Medical Academy of Postgraduate Education of MOH of Ukraine, Ukraine
Diabetic patho−personology: personality qualities and dynamics of the changes in type 2 diabetes mellitus
17 - 20
The qualities of personality of patients with type 2 diabetes mellitus play one of the leading roles in the pathogenesis of diabetes mellitus. Anxiety, anancastic and addictive types of personality are considered as one of the factors of type 2 diabetes mellitus development. Pathocharacterological changes are one of the complications of type 2 diabetes mellitus. The influence of the pathopsychological qualities of the individual, including those acquired as a result of diabetes, on the compliance of the patients to therapy, predetermines the high priority of their study. To determine the personality features influencing 2 diabetes development the patients treated at the hospital of Zaporizhzhia Medical Academy of Postgraduate were investigated. Anamnestic, clinical−psychopathological, psychodiagnostic, statistical methods were used. Personality traits preceding type 2 diabetes mellitus were established and divided into three components of the risk of the disease induction: link 1 −− high risk of induction of type 2 diabetes mellitus as one of the components of etiopathogenesis of type 2 diabetes mellitus; link 2 −− the average risk of induction of type 2 diabetes mellitus; link 3 −− low risk of induction of type 2 diabetes mellitus. The conducted research allowed to establish the personality characteristics of patients with type 2 diabetes mellitus and on their basis to conclude about modification of the personological continuum of patients with type 2 diabetes mellitus with the disease severity. The peculiarities of the personality of the patients with type 2 diabetes can be the basis of diabetic patho−personology, which improves the quality of differential diagnosis of comorbid type 2 diabetes mellitus mental disorders and approaches to therapy and psychoprevention of type 2 diabetes, improvement of the quality of treatment in patients with type 2 diabetes mellitus, including in the context of correction of compliance to treatment of type 2 diabetes mellitus due to the leveling personality traits of the dyscompliant character.
Key words: personality features, character accentuation, personality traits, type 2 diabetes mellitus, diabetic pathopersonology, psychodiagnosis.
O. O. Bohomolets National Medical University, Ukraine
21 - 26
Significance of the problem of providing comprehensive care to adolescents with scoliosis is determined not only by their increasing number, but also by the lack of a well−grounded, individually differentiated approach to their clinical and functional assessment and psychosocial aid. In order to develop a program of medical and social support for adolescents with scoliosis, a study involving 169 boys and girls was conducted. A set of methods was used: theoretical, socio−demographic, clinical−psychological (observation, structured interview), psychodiagnostic (psychological testing), statistical. Analysis of the data of the psychodiagnostic investigation allowed to describe the structure of the internal picture of the disease and develop a model for its formation in adolescents with scoliosis. The concept of the internal picture of the disease was divided into six components: sensory, emotional, personal, intellectual, motivational and social. For teenagers with scoliosis, it is important to organize interdisciplinary support with the purpose to support the emerging adaptive internal picture of the disease, socialization, adaptation and support for the highest possible quality of life. Such measures (based on definitions in the literature) should be called habilitation, because they are aimed at adapting to life; are the process of forming the missing (or underdeveloped) adolescents' abilities to participate in domestic, social, professional and other activities. The measures of medical and psychological support of adolescents with scoliosis, which included measures of psychocorrection and habilitation, taking into account the components of the internal picture of the disease were scientifically substantiated, developed and implemented in practice. The sensory component was influenced by the use of specific medication measures, physical rehabilitation, yoga; emotional −− RET therapy by A. Ellis; personal −− individual psychological counseling; intellectual −− psychoeducation; motivational −− motivational training; social «Family Interaction Training" and «Combating Violence Training". Testing of the program of medical and psychological support proved its effectiveness.
Key words: medical-psychological support, internal picture of disease, adolescents, scoliosis.
Ukrainian State Research Institute for Medical and Social problems of Disability, Dnipro, Ukraine
Pathophysological basis for formation of the response to the disease in patients with ischemic stroke
27 - 32
To determine pathopsychological basis for the disease response in individuals with arterial hypertension (АT) and ischemic cerebral stroke 99 patients were examined. Accentuation of personality traits, character and individual features and their role in shaping the type of attitude to the disease (TАD) were investigated. It was shown that in stage 3 hypertension, anxiety, hypochondria, neurasthenic and self−centered disease responses are most pronounced with prevalence of 80 % mixed TAD. Anosognosic type was the most widespread in the structure of pure types; sensitive, neurasthenic, anxious and anosognosic types were found in the structure of all diagnosed types. In most cases combinations of anxiety, hypochondriac, apathetic, neurotic, obsessive and phobic, sensitive, egocentric and euphoric types of attitude to the disease were typical. Psychological and social adaptation was violated in 97,8 % of patients with stage 3 hypertension, which significantly complicated the process of rehabilitation.
Key words: arterial hypertension, response to the disease, ischemic cerebral stroke.
H. S. Kostiuk Institute of Psychology, NAPS of Ukraine, Kyiv, Ukraine
32 - 36
The issues of adaptation disorders are studied at behavioral, physiological, social and other levels. For clinicians, the negative borderline states play an important role in the diagnosis of negative sequellae of stress situations. The article covers determining the indicators, factors and markers of disorders in servicemen of various types of military service. The features of the changes in the cognitive and psychoemotional, personality spheres of 100 servicemen with adaptation disorders were analyzed. The influence of professional stress on the professional activity was studied. The peculiarities of disorders in mnestic, emotional spheres were revealed. The mechanisms of forming and pathogenetic mechanisms leading to disorders of military professional adaptation of servicemen were identified. Statistical processing of the data obtained during the study showed that from the methods used to assess the mental state of the respondents those containing the indicators that can be considered as the pronounced factors of the development of adaptation disorders were Questionnaire 16−PF by R. Cattell, a technique for the study of character accentuations Accent 2−90, Schulte tables (attention study) and 10−word test (study of the memory). Systemic study of the problem of identifying the markers, indicators and factors that caused adaptation disorders in the servicemen, allowed to create a model for their development and formation. The results of in−depth study of the problem of adaptation disorders development became the basis for the creation of a comprehensive system of psychological correction of adaptation disorders in military personnel.
Key words: servicemen, adaptation disorders, factors, indicators, markers, psychological diagnosis.
Zaporizhzhia State Medical University, Ukraine
The target model of psychological adaptation of children with attention deficit hyperactivity disorder
37 - 40
Attention deficit hyperactivity disorder (ADHD) is an extremely difficult problem which includes psychopathological component, represented by disorders of conductive behavior control, dysprosection, impulsiveness, as well as conjunctural and biological factors. The search for mechanisms for adapting children with ADHD to the educational process has acquired extreme medical, social and humanistic significance in the recent decades. The inability of traditional pedagogical systems to deal with ADHD suggests that the ways of solving the problem of integrating children suffering from this pathology lies in the sphere of psychiatrics and is their priority task. To analyze the factors of ADHD psychopathogenesis in children, the patients aged 13,6 years were examined. All persons demonstrated identifying indicators of disprosection, impulsivity and hyperactivity with negative social consequences. At the level of conceptual analysis of ADHD manifestations, the presence of 4 levels of presentation of dysadaptive phenomena (impulsivity, disprosection, hyperactivity) were distinguished: biological, that reflects the functional basis for the existence of pathological phenomena and mechanisms of their exogenous potentiation; psychological, that reflects personality reaction to the presence of a pathological phenomenon and mechanisms of its psychogenic potentiation; behavioral, that displays realization of pathological phenomena in behavior and mechanisms of fixing pathological behavioral patterns; social, that reflects the mode of integration of pathological phenomena into an array of interpersonal relationships and communicative practices, as well as mechanisms of pseudo−adaptation of the personality in social context. A targeted model of correction of basic psychopathological symptoms (impulsivity, disprosection, hyperactivity) in children with attention deficit hyperactivity disorder was developed.
Key words: attention deficit hyperactivity disorder, children psychiatry, psychocorrection, target adaptation.
M. I. Pyrohov Vinnytsia National Medical University, Vinnytsia, Ukraine
40 - 43
In the recent years, the studies of social support system and the ability to accept it in patients with mental disorders in context of their social functioning gained particular importance. Identifying leading sources of social support and evaluating patients' ability to accept it might become an important step towards improving the effectiveness of treatment and social adaptation of patients. Our study was aimed to investigate peculiarities of the ability to accept social support in patients with paranoid schizophrenia and affective disorders. Under condition of informed consent, we examined 168 patients with paranoid schizophrenia (MGPS; 97 males and 71 females) and 75 patients with affective disorders −− bipolar affective and recurrent depressive disorder (MGAFD, 45 males and 30 females). The controls (CG) included 55 persons who never sought medical aid for a mental disorder. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to study the ability to accept social support [Zimet, 1998]. Main sources of social support for patients with schizophrenia and affective disorders were the family, friends and significant others. The social network «Family" in patients with schizophrenia appeared to be mostly represented by the parents' family, in patients with affective disorders −− by their own nuclear family. The examined patients, both in general and in particular social supporting spheres, demonstrated a significantly lower subjective level of acceptance of social support when compared to healthy individuals (5,9±2,0 points (or 49,2 % by maximum severity) in MGPS; 8,3±1,5 (69,2 %) in MGAFD, 10,5±1,1 (87,5 %) in CG). According to «Family" subscale, MGPS patients received lower rate than MGAFD patients and CG (2,6±0,7 points (65,0 %) in MGPS; 3,2±0,8 (80 %) in MGAFD; 3,8±0,2 (87,5 %) in CG. The reduced level of social support acceptance seems to be one of the important characteristics of socially supporting process in patients with schizophrenia and affective disorders. Family social support did not often correspond to patients' requests and did not coincide with their intentions, desires, needs and, as a consequence, patients showed decreased ability to accept support provided by family members. As for «Friends" social network, the study convincingly showed that in dynamics this social support system for patients with schizophrenia is small, gradually decreased and eventually ceased to exist, while patients with affective disorders in difficult situations preferred to get the support of the friends. The found features can be used to develop psychoeducational programs for families with family members who have schizophrenia and affective disorders.
Key words: paranoid schizophrenia, affective disorders, social support, social support donors.
Institute of Health of Children and Adolescents, NAMS of Ukraine
Institute of Early Intervention, Kharkiv, Ukraine
44 - 47
Based on the analysis of the main characteristics of the environment and its role in the child's development, the notion of «development facilitation" was defined as the process of supporting the personal potential of the little child in accordance with his/her psycho−emotional needs on the basis of the non−intrusive interaction and developmental parent−child relations. It was demonstrated that if the child had developmental disorders, and the parents had difficulties connected with emotional stress, the ability of the family for the facilitation of their child's development can be lost or reduced. This has a negative impact both on the psycho−physical and the socio−emotional development of the child, and the psychodynamics of the whole family. Consequently, the family bringing up the child with developmental disorders needs facilitating environment itself, and this function is performed by the early intervention system. The parents acquire their own facilitating skills as a result of mutual work with specialists during the implementation of early intervention programs. It was proven that the essence of the early intervention as a system of psychological assistance for the families brining up early−aged children with developmental disorders lies in the facilitation of the child's development through the reinforcement of the facilitating function of the parents. Simulation of the developmental interaction by the specialists during each session and interiorization of such a model by the parents was acknowledged as the leading mechanism of impact in early intervention. Thus, early intervention allows the parents to increase their ability to facilitate the development of the child through the formation of developing child−parent relationships at different levels: dyadic, when such relationships are not formed and the work involves creation of therapeutic conditions for the introjection of the mentally suggestive, supporting and developing functions of the parents, as well triad, when the couple «adult −− child" is harmonious, but faces such a developmental problem: separation and inclusion of the third with the counter process −− return the adult to his/her functioning in the society and reorientation of interests from the child to the wider society.
Key words: facilitation, development, early intervention, early-aged child, psychomotor disorders.
Ukrainian Medical Denatl Academy, Poltava, Ukraine
48 - 52
Psychotic symptoms in patients with paranoid schizophrenia and severity of their manifestations significantly affect the behavior of patients in the family, which, negatively affects the adequacy of their relationships with their immediate family and their own children. Behavior disorders and emotional response to conflict situations, as well as the motivational sphere in such patients, cause mental decompensation in the members of their families, creating conditions for the development of family disharmony. To reveal the impact of the changes in mental health in persons with paranoid schizophrenia on the quality of family relationships in general and the possibility of developing a traumatic situation affecting their children, a systematic and structural analysis of 124 couples was conducted. Its findings testified for the violation of almost all components of family health. The families were investigated taking into account the medical, social, psychological characteristics that would allow a diagnostic conclusion about the family. In all families, family disharmony was determined, due to the lack of mutual respect, violation of the quality emotional bonds and discrepancy of the role positions in the family. Pathological character traits in the mentally ill in the studied families lead to violation of the character of their family members. This had a direct impact on the performance of the family functions. The educational and emotional functions of the family were most violated. This was the main factor in the formation of frustration situations in children growing up in the conditions of emotional rejection, constant conflicts and ignoring attitudes toward children's problems. The results of the clinical and psychopathological study of children and their parents in the families in which one of the parents is ill with paranoid schizophrenia, the findings of the analysis of the health of such families allow us to conclude about direct causal mechanisms between the development of mental disorders in children and the disruption of the functions of families in which these children are brought up. The obtained data can be used for further development of tactics of psychosocial rehabilitation of children with an emphasis on the resource possibilities of the family.
Key words: paranoid schizophrenia, functioning of the family, disorders of the mental health in children.
Medical Institute of Sumy State University, Ukraine
53 - 57
The predictors of suicidal behavior in the elderly persons include chronic and/or incurable diseases, loneliness, awareness of the inevitability of death, financial failure, loss of work (change in social status), social isolation. There are also data on the involvement of neurodegenerative processes in the brain (Alzheimer's disease, dementia) to suicide. But until now social status, clinical psychopathological and psychogenic factors of the risk of suicide in dementia have not been insufficiently studied. Thus, the purpose of the work was to determine the gender, age characteristics of the patients and factors of mental traumatism affecting the risk of their suicidal behavior. The following methods were used: clinical interview (history taking from the patient and his relatives), psychometric (scale of determination of suicidal risk), suicidal risk scale of Los Angeles Suicidological Center. The obtained data testify that in patients aged 78−88, high suicide risk is determined more often, the symptoms of depression (sleep disorder, weight loss, depressed mood) dominated. The increase in suicidal risk was significantly influenced by feeling of hopelessness, helplessness and exhaustion; disorganization and disorientation; feelings of tension, anxiety and irritability; excessive consumption of alcohol and feelings of guilt. Among the stress factors that influenced the increase in suicidal risk were a life−threatening illness; loss of work, money or status; changes in the environment; threat of litigation. It should be emphasized that the impact of the stress event was significant. The results of the study indicate that the severity of depressive symptoms, the presence of stress factors, suicidal attempts in the past and lack of help from others were characteristic of patients with high suicide risk. These data should be taken into account when providing psychological assistance to the elderly patients with dementia.
Key words: dementia, psychotraumatic factors, age, gender characteristics.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Modern issues of tolerance of neuroleptics and compliance to the treatment of schizophrenic patients
57 - 61
The questions of therapy for patients with schizophrenia are among the most urgent. This pathology is difficult to cure, leads to a complex social maladjustment with disability. The effectiveness of the medical aid depends on the adherence of the patients to the treatment with neuroleptics, which is influenced by various factors. To establish pathopsychological patterns of compliance to antipsychotic treatment of patients with schizophrenia as a necessary approach to a sound choice of treatment methods, the psychodiagnostic study of the state of active attention and mechanical memory in patients was created. A special UKU scale was used to determine the side effects of taking medication, the method «Credits by Kraepelin" for learning active attention, the test of learning 10 words. The psychodiagnostic study of the memory and attention allowed to objectify the results of clinical and pathopsychological study and to deepen the notion of changes related to the dynamic disorganization of mental activity at different attitude of the patients to treatment. The administration of neuroleptics caused subjective discomfort, which was reflected in the state of memory and attention. Violation of these functions, along with extrapyramidal and other undesirable effects, greatly affected the patient's attitude to therapy. This requires psychocorrection aimed at making patients aware of the nature of such changes, and considering the importance of continuing the use of pathogenetic drugs, which is necessary to eliminate the more severe manifestations of psychosis and prevent the exacerbations of the disease.
Key words: schizophrenia, compliance to psychopharmacotherapy, psychodiagnosis, mechanical memory, active attention.
Odesa National Medical University, Ukraine
Investigation of basic dysfunctions of social functioning in patients with post−schizophrenic depression
62 - 66
Depression in schizophrenia is considered as a resistant symptom that negatively affects the therapeutic prognosis, enhances the patient's subjective suffering, greatly increases the risk of suicide, increases the duration of hospitalization, and in general, can lead to deterioration in the course of the disease. This, in turn, significantly increases the cost of treatment. The presence of depression in schizophrenia requires correction of therapeutic approaches. The purpose of this work was to detect main functions of social function of the patients with post−schizophrenic depression. Theoretical and statistical analysis, the synthesis of the scientific heritage on this topic revealed the presence of a very serious dysfunction in all indices of the general behavioral dysfunction: «self−service", «interests and employment", activities in the family and at home, «communication and isolation", «participation in household activities", «family role", «spouse role", «parental role", «social contacts", «behavior in non−standard and complex situations" (the difference is significant, p ? 0,05). The level of minimal dysfunction was revealed mainly in relation to the general behavioral dysfunction, and the indicators in the performance of social roles were considered obvious, serious or very serious dysfunction. To restore family, domestic and professional status of mentally ill patients, as well as support of the patients who lost social ties, housing, independent living skills, medical and rehabilitation assistance should be provided in the form of «shelter under protection". Psychosocial interventions should be conducted in conjunction with an outpatient psychiatric service. It is necessary to use a brigade approach involving a psychiatrist, a psychotherapist, a psychologist, a social worker.
Key words: post-schizophrenic depression, dysfunction of social functioning, relatives of patients, quality of life, psychotherapy, rehabilitation, medical and social support, psychosocial adaptation, psychosocial rehabilitation.
Ukrainian Medical Dental Academy, Poltava, Ukraine
67 - 70
Among the topical issues of modern narcology is the problem of studying the pathogenetic mechanisms of the formation of dipsomania in alcohol addiction, the characteristics of persons abusing alcohol and the development of therapeutic and preventive measures, taking into account the influence of these factors. To study the individual psychological features of patients with drinking bouts, 293 patients with drunken forms of alcohol dependence (F10.0−F10.5) were investigated. The majority had a permanent type of abuse, the rest had an episodic type (ETА). The examination was carried out with the help of clinical−psychopathological, psychodiagnostic and statistical methods. The use of Leonhard −− Schmieschek questionnaire made it possible to establish that dysthymic and emotionally labile types of accentuation were more common in patients with РTА, while with ETА −− excitable, cyclothymic and stuck. The data obtained with Mini−Mult questionnaire showed that in the first group of patients the personality profile with an elevated and high level of results was dominated by 2nd, 3rd, 7th, 8th scales and profile code 273 (8), reflecting the hyposthenic type of response, suggesting the neurotic variant of maladjustment. The patients with ETA had a personality profile with an elevated and high level of result prevailed over the 2nd, 4th, 6th and 9th scales with the profile code 642(9), which indicates a sthenic type of response and reflects maladjustment with predominance of asocial behavior. The identified individual psychological features of patients with drinking bouts can be used to select the methods and targets of psychotherapy, which makes it possible to improve treatment and rehabilitation activities for this category of patients.
Key words: alcohol addiction, dipsomaniac forms, type of accentuation, personality profile.
Ukrainian State Institute of Medical and Social Problems of Disability, Ministry of Health of Ukraine, Ukraine
71 - 74
The influence of the psychological component on the restoration of higher mental functions and psychosocial adaptation in patients who underwent cerebral stroke is significant. In the new understanding and comprehension of this problem, we developed a neuropsychological rehabilitation program for such patients based on the principles of synergy among living structures. In total, 22 patients aged 38−55 were rehabilitated, of them 13 men, and 8 women with the disease duration 2−7 years. The analysis involved the methods of mathematical statistics. Neuropsychological rehabilitation was aimed at forming an integral polymodal perceptual image − visual, auditory and speech components, spatial double lateralization of movements and fine motor functioning of hands. The emphasis on creating a tension between external stimuli and internal factors contributed to synchronization and increased neuroplasticity of the brain through pushing it to a critical state. Among the most recoverable ones were: spatial factor, lateralization of attention, thought processes, resistance to the damaging effect of indirect stimuli in the forming of primary memory engrams and facilitating an information extraction. Thus, the neuropsychological rehabilitation should be targeted at creating a complete semantic image and simultaneously stimulate many dispersed links for the greater synchronization and interaction, thereby increasing learning capacity and restoring cognitive processes and motor functions.
Key words: cognitive functions, neuropsychological rehabilitation, late post-stroke period, self-organization, metastable systems.
Ukrainian Psychiatric Hospital with Strict Supervision, Ministry of Health of Ukraine, Ukraine
The system of combined psychotherapy and psychopharmacotherapy in patients with organic brain lesions in a hospital with strict supervision
75 - 80
The problem of psychosocial rehabilitation of patients with organic brain lesions, which are socially dangerous, requires effective solution. At present, the main criteria for the effectiveness of medical and rehabilitation programs are the degree of ability of patients to independently provide their livelihoods, maintain and enhance their own social functioning and quality of life. To construct the system of combined psychotherapy and psychopharmacotherapy we conducted a study of patients with organic brain lesions, some of them received combined psychotherapy and psychopharmacotherap, the rest only psychopharmacotherapy. According to Spielberger−Hanin scale, the level of both state and trait anxiety was higher in patients with F 07.0, but statistically significant differences were detected only in low reactive anxiety. In analyzing the indicators of personality characteristics using the questionnaire by Leonhard−Schmieschek, it was found that the patients with F 07.0 against a background of excitability had weakened control of emotional manifestations with pronounced impulsivity in behavior. In patients with F 07.2, inadequate manageability, weakening of emotional−volitional control with manifestation of irritability and reduction in interpersonal interaction against a background of high levels of conflict are found. The analysis of the aggressiveness and hostility indicators using the Buss−Durkee Hostility Inventory was repeatedly conducted after treatment, in which certain differences were obtained in reducing the levels of aggressiveness and hostility in patients with F 07.0 MG when compared with CG, which reached reliability (at p ? 0.05). Based on the results obtained, the system of psychotherapy and psycho−correction of patients with organic brain lesions was substantiated and developed, which included the following stages: 1. Assessment of the psycho−emotional state. 2. Establishment of compliance. 3. Psychotherapy and psychocorrection. 4. Supportive psychological management. The main method of realizing medical and psychological rehabilitation of patients was cognitive−behavioral therapy. The analysis of the efficacy of the combined psychotherapy program and pharmacotherapy program was evaluated according to the following criteria: reactive anxiety level, presence of depressive symptoms according to subjective analysis, quality of life, according to the diary self−observation. Overall, a significant improvement was achieved in 72 % of patients diagnosed with F07.0−personality disorder of organic etiology and in 68 % of patients with F07.2−postconcussional syndrome.
Key words: organic brain lesions, hospital with strict supervision, emotional disorders, personality traits, medical and psychological support, psychotherapy, psychopharmacotherapy.