ARTICLES ARCHIVE

The increasing morbidity and disability of children, endeavor of young people to maintain the status of disabled, uncertainty of leading psychological mechanisms forming the limitations of their vital activity have become important factors in developing the approaches to investigation of psychological aspects in medico−social expertise and rehabilitation of this group of young people. The model of life perspective assessment based on E. Erikson's theory of psychosocial personality development, the model of B. Orum (three systems of adult development) and M. E. Khylko's age parameters, as the background and results of development, the mod3l of determining the dynamic structure «Me as a personality» (emotional−volitional sphere, sensitivity, personal growths), «Me as a family member» (social development situation, circle of relations, forms of communication), «Me as an employee» (the leading type and a new activity) and realization vector (identity, values, perspective) in the context of society and culture was proposed. The leading limitations of vital activity of young people with the status of a disabled child: in the main spheres of life (49.3±2.9 points), household life (30.3±2.4 points), interpersonal interaction (26.3±2.2), mobility (24.8±2.5 points), education (16.9±1.9 points) and communication (15.1±1.9 points), which significantly deteriorated their integration into society and the possibility of choosing active life position and realization, were determined. Evaluation of personal characteristics, adaptability, identity and temporal perspective showed the increase in the level of identification with the social status of a disabled person, and strengthening the tendency to preserve the disability set, which were recognized the markers of unfavorable self−concept formation for young people with the status of a disabled child.

A significant number of Ukrainian servicemen who were involved in the antiterrorist operation (ATO) and underwent in−patient treatment for somatic diseases, have psychopathological disorders of varying degrees of severity. In addition, the fact of staying in hospitals often acts as an independent psycho−destabilizing factor. Therefore, the issue of psychological support, psychoprevention and treatment of psychopathological disorders at the hospital stage is urgent. The purpose of the study was to investigate the psychosupportive ability of art therapy as a structural component of the psychological support of servicemen involved in ATO in Ukraine undergoing treatment at the Garrison Military Hospital. The findings of the research demonstrated that implementation of psycho−supportive sessions can be considered as an additional component of psychological support not only for persons with pre−psychopathological disorders, but also for mentally healthy servicemen undergoing treatment for somatic diseases. These measures improve their psychological state and motivation to further military service, psychological adaptation of patients to stationary conditions of treatment and increase of compliance to therapy. Involvement of civilian volunteer psychologists to work with military men with mental disorders of the nosological level with the prevalence of depressive symptoms is not recommended, given the destabilizing nature of such sessions, due to the mental condition of the patients. The paradoxical response to psycho−supportive classes with the participation of civilian volunteer psychologists with servicemen with the signs of psychopathological disorders of depressive spectrum can serve as a marker of the severity of the mental condition of servicemen. In the indicated cases, the advice of a psychiatrist is recommended.

The increasing incidence of the Internet addiction in the young people causes a continuing interest in this problem. The recent explosion−like increase to the Internet access in Ukraine has pinpointed the attention upon the questions of the Internet addiction diagnosis. However, there are indications of significant mistakes in the diagnosis of the Internet addiction with the help of existing psychodiagnostic tools. To assess the diagnostic capability of psychodiagnostic tests to identify the Internet addiction, the students of medical universities without the clinical signs of the Internet addiction were examined. The respondents were asked to fill in a number of existing psycho−diagnostic questionnaires: screening diagnosis of computer dependence (L. N. Yurieva, T. Yu. Bolbot, 2005); K. S. Young's Internet Addiction Test (IAT) (K. S. Young, 1994); Chen Internet addiction Scale (CIAS), S.−H. Chen, 2003); test for Internet addiction (S. A. Kulakov, 2004). In the course of the study psychopathological, psychodiagnostic, statistical methods were used. The findings of the research suggest that the existing psychodiagnostic tests for detecting the Internet addiction show the presence of false positive results at the level 2.70−32.43% when diagnosing conditionally healthy students of medical universities who, according to clinical observations, do not have the Internet addiction, which testifies to hyperdiagnostic orientation of the existing psychodiagnostic tests. Diagnostic failure of psychodiagnostic tests to detect the Internet addiction in the university students may be related to the specifics of the study as well as cultural and branch−related qualities of a particular social group. The authors conclude about the necessity to develop new psychometric tools for the diagnosis of addictions associated with the Internet in a given category of citizens.

The present−day rapid social changes, financial unsafety, economic crisis, increase of unemployment, reduced social mobility among the youth people and widespread use of the Internet and virtual reality resulted in the phenomenon of social withdrawal in the developed countries. The phenomenon of hikikomori describes a psychopathological and sociological behavior characterized by complete isolation/withdrawal from the society for 6 months or longer, not caused by psychosis or mental retardation. This behavior contains elements of social withdrawal (withdraw from society, avoidance of attending school or work, at least six months) and social isolation (termination of a relationship outside the family during isolation). To develop and study the effectiveness of a psychological correction program for social withdrawal, taking into account psychological, social and behavioral factors, the patients with the respective criteria were investigated. The methods used included Toronto scale of alexithymia, Buss−Durkey Inventory, and scales for assessing the quality of life. The revealed parameters of social withdrawal and types of social interaction were described as asocial staying at home; asocial, but with going out; selectively social. The psychological features of a socially withdrawn person include over−dependent, maladaptive interdependent and counterdependent. Micro and macro social antecedents of this behavior such as family, school and society were identified and analyzed. Modern psychosocial interventions toward social withdrawal include impact on several levels: individual, family, social. The analysis of psychological, social and behavioral factors of social withdrawal allowed suggesting an effective complex program for psychological correction and prevention of this behavior.

In Ukraine, the problem of injuries is determined by its high prevalence and serious medical, social and economic consequences. At the same time in recent years, the emphasis is placed on the diagnosis and treatment of mental disorders in somatic diseases, including traumatic origin. In this case, nonpsychotic mental disorders occupy the first place by the frequency of occurrence. The loss or limitation of ability to work as a result of the musculoskeletal disorders in adults lead to certain maladjustment disorders of the psyche and behavior. Major components of his personality change in the persons with disability: worldview, values, motivation, attitude to people and activities, and others. In addressing this problem, an important role is played by spa treatment, one of which is psychotherapy. The purpose of the work was to analyze the literature data concerning the psychological maladjustment of patients with musculoskeletal pathology and the existing model of psychosocial rehabilitation of this group at the sanatorium−rehabilitation stage of rehabilitation. Treatment of mental disorders associated with the response to severe stress, is a process which should combine psychotherapy, psychopharmacotherapy and rehabilitation aspects. In the process of rehabilitation of patients with musculoskeletal injuries, the patient's psychological choice of the strategy of «avoiding failure» or «striving for success» becomes significant, which determines his further behavior and motivation. A short−term stay of patients in the sanatorium, a large number of patients served −− all this requires adaptation of existing methods of psychotherapy to the conditions of the resort and a certain tactic of their management by the psychotherapist (active nature of psychotherapeutic techniques, mandatory combination of them with resort factors, psychotherapeutic potentiation). The need to develop an effective program of psychocorrection in patients with injuries of the musculoskeletal system was emphasized. The study of the features of formation and clinical manifestations of nonpsychotic psychiatric disorders in such patients will determine the main goal of the psychotherapeutic intervention, which in turn will increase the rehabilitation potential of the patients.

Investigation of individual psychological mechanisms of adaptation disorders in students is important both from the perspective of the mental health and in the context of the future professional identity of a specialist. The features of the development and course of adaptation disorders in medical college students, their early manifestations, ways of their detection and prevention are not clear. The causative factors of adaptation disorders, the importance of predisposition factors in the occurrence of adaptive response disorders require clarification. Especially acute problem in adaptation disorders is socially destructive behavior patterns, which are extremely dangerous for the mental health of future young professionals. The students of the medical college were investigated to elucidate the characteristics of the adaptation disorders under the influence of the mechanisms of development of social and psychological factors, to determine their causal structure and to develop approaches to their prevention. The investigation of the impact of situational factors and premorbid personality traits contributing to adaptation disruptions showed that the immediate causes in deviations of adaptive response in medical college students are not some extreme distressing circumstances, but the daily difficulties of ordinary learning activity. However, at the same time, each has a combination of causal factors. The most powerful pathogenic factor in all examined students was adaptation to new learning conditions in combination with the infantile personal attitude to the fact of separation from the friends and other significant persons. Against a background of these experiences, pathogenic influences gained strength, like the usual difficulties of the educational process. Clinically expressed manifestations of adaptation disorders were preceded by an initial period of gradual decline in the productivity of the social functioning of students and the growth of mental changes, in which there were clear signs (signals) of developing disorders in the spheres: emotional, somatic and behavioral.

Although in recent years the views on the strategy and tactics of managing the patients with acute ischemic disorders of the cerebral circulation have changed, prevention, diagnosis and treatment of cerebrovascular disorders as well as ischemic stroke and their long−term complications in the post−stroke period remain one of the most urgent problems of modern medicine. Stroke is often accompanied by severe motor and speech disorders, which are traditionally taken into account when assessing the severity of the patient's condition and are considered as the main causes of disability and ability of self−service. Such patients often have cognitive and psycho−emotional disorders, which greatly complicate rehabilitation. In the absence of the prospects for the restoration of functions, they need care, prevention of recurrent stroke and complications associated with immobility, which become the causes of depression. The presence of depression increases the risk of developing a recurrent stroke, myocardial infarction and complications, in particular diabetes related to the pathology of the autonomic nervous system, progression of atherosclerosis, and increased aggregation of platelets. Consequently, there is a need to review the methods of early diagnosis and the use of modern technologies in the diagnosis and prevention of post−stroke depression. Synthesis and analysis of scientific and theoretical achievements and the results of experimental research was aimed at analysis of modern investigation methods in order to select an adequate method of prevention of this disease. The research methods were theoretical and statistical analysis, synthesis of scientific achievements from the mentioned problem. The authors conclude that depression can adversely affect recovery of cognitive and neurological deficits, increase the relative risk of developing repeated strokes and have a negative impact on the course of concomitant somatic diseases. Prevention of post−stroke depressions should be not only pharmacological, but also multidisciplinary, involving not only physicians of a different profile, but also medical psychologists, nurses, social workers and other professionals, which predetermines the need to develop and create an integrated approach to the prevention of this type of disease on the principles of a biopsychosocial approach.

To date, depressive manifestations are the most widespread among mental disorders. The recent epidemiological studies have shown a significant increase in depression and indicated disappointing future forecasts, taking into account global trends in the spread of affective disorders. However, although the achievements of modern medicine are undoubted, the problem of depression, its development, improving the necessary volume of medical care, psychosocial rehabilitation of patients remains the priority tasks of psychiatry. The greater portion of these tasks consists in the study of treatment resistant depression. The investigation was devoted to examining the structure and indicators of social functioning of patients with treatment resistant depression in comparison with non−resistance depressions. Clinical−psychopathological, psychometric, pathopsychological and statistical methods were used. The study of social functioning was carried out using the WHO −− Psychiatric Disability Assessment Schedule (WHO/DAS) scale. The results established violations of social functioning in patients with treatment resistant depression that meets the criteria of «serious» social dysfunction. Reducing of role−performing parameters is takes of leading position in the structure of social dysfunction, while the presence of resistance to treatment depressive symptoms acts as a formative factor through the mechanism of emotional interaction with the environment.

Vascular dementia is an acute or chronic disorder of cognitive function resulting from diffuse or local cerebrovascular abnormalities associated with cerebrovascular disease. To substantiate the role of disturbances in various spheres of the psyche in formation of suicidal behavior in patients with vascular dementia, the patients with vascular dementia underwent clinical−psychopathological examination during in−patient treatment in Sumy hospitals. Analysis of thinking disorders showed that the leading disorders were those of the tempo of thinking, attention in the form of exertion manifesting as a progressive attention weakening during work. The analysis of the clinical and psychopathological structure of higher mental functions and the emotional−volitional sphere allowed to determine that retardation of thinking, delusions of self−deprecation, feeling of despair, hopelessness, depressive mood, asthenia, violation of the tempo of speech, reduction of libido, decrease of attention, reduction of initiative and volitional impulses, lower severity of fixation amnesia were characteristic for the patients with high suicide risk. The obtained data should be taken into account for the diagnosis of suicidally dangerous conditions among the patients with vascular dementia.

The wide range of clinico−psychopathological aspects of the participation of addicted persons in the programs of substitution therapy includes the question of the diagnosis of disorders of the neurotic spectrum. Due to its medical and social status, this contingent is subjected to the massive influence of predictors of neurosogenesis affecting the pathologically altered personality of the dependent person. The optimal model for analyzing the pathogenetic aspects of the existence of a comorbid neurotic pathology in persons with an actual addictive status is substitution therapy for addiction to synthetic opioids. To establish the characteristics of the comorbid psychopathology of the neurotic spectrum in persons undergoing substitution treatment, to identify and classify the main types of symptoms, the patients of a drug abuse hospital undergoing the program of substitutional therapy were examined. Psychodiagnostic (semi−structured psychodiagnostic interview), clinical−psychopathological (symptomatic questionnaire «Symptom Check List−90−Revised»), clinical−statistical methods were used. The findings of the research allowed to systematize the following levels of clinical severity of neurotic manifestations in the continuum of «asthenia ⊆ anxiety ⊆ depression»: psycho−autonomic, anxious−phobic, depressive. The investigation of the patients undergoing substitution therapy revealed the tendencies to intensity increase of anxiety and depressive symptoms at transition to each subsequent level; to absorption by depressive manifestations of anxious and obsessional symptoms, of aggressive and explosive response forms, and of somato−autonomic disorders; to the threshold realization of associative dysfunction at the depressive level of neurotic manifestations.

A properly performed differential diagnosis of endogenous psychoses is a determining factor in effective treatment and rehabilitation. For many decades differentiation of schizoaffective disorder and schizophrenia has constitutes the greatest difficulty. As a result of true (pre−therapeutic) and therapeutic pathomorphosis, atypical and marginal variants of endogenous psychosis are more common, which greatly complicates the diagnosis, especially at the initial stage of the endogenous disease. In order to improve the diagnosis of these pathologies, the results of the study of clinical−psychopathological disorders and clinical ethological features during the period of remission in patients with schizoaffective disorder and paranoid schizophrenia were compared. The examination employed PANSS scale and clinical ethological investigation with the original quantitative and qualitative analysis of schizophrenia markers in the verbal behavior of the patients. The presence of negative and general disorders in patients as well as an important indicator of the relevant ethological markers was revealed,. In patients with schizophrenia, vs the patients with schizoaffective disorders, more severe negative and general PANSS disorders were detected. The behavior of patients with schizophrenia was characterized by a greater percentage of nonverbal markers of schizophrenia and reduced polymorphism. The latter was confirmed by significant prevalence of manipulative behavior and the proportion of solitary complexes in comparison with schizoaffective disorder. The obtained results indicate the presence of persistent changes in patients with schizoaffective disorder that differ from pathological personology of schizophrenia. The degree of its severity, structure and possible causes of its development require further investigation.

In recent years, the issues of rendering assistance to women who suffered from physical, mental, gender−based violence in which psychogenic disorders were identified have become more urgent in Ukraine. The conducted experimental psychological study included the following methods: a test of differential self−evaluation of the functional state of SAN; test for determining the level of reactive and personal anxiety by C. D. Spielberger −− Yu. L. Hanin; personal questionnaire for determining the level of neuroticism by H. J. Eysenck, scale for determining the style of behavior in the conflict situation by K. Thomas, a scale for determining the depression by Hamilton. The women who suffered from domestic violence and gender−based violence were diagnosed psychopathological personality changes in the form of formation of victim traits, increased conflict, irritability, quick temper, anger, passivity, subordination, psychological dependence on communication with the aggressor, feeling pity for the aggressor. The main principles of psychotherapy of women and their family members were the staged character, complexity, consistency, continuity during the whole psychocorrection work. The psychotherapy complex of psychogenic disorders of women affected by violence included a differentiated mix of methods of psychological counseling, family, individual and group, behavioral, hypnosuggestive psychotherapy and auto−training. The course of psychotherapeutic and psychocorrection measures developed and tested in practice made it possible to restore family and social−psychological adaptation in women who suffered from violence, to implement secondary psycho−prevention for the formation of psychogenic disorders. As a result of the conducted psychotherapy, 97 % of the patients reduced manifestations of psychogenic neurotic and somatoform disorders; improvement of their well−being, increase of self−esteem was noted.

Thyroid hormones metabolism disorder is one of the most common endocrine pathology. Taking into account the biological activity of thyroid hormones with intense psychostimulatory effects, their secretory imbalance, besides the somatic semiotic cluster, causes formation of psychoendocrine syndrome. Its manifestations are included in the pathogenesis of the endocrine pathology, significantly aggravating its course (due to the destabilization of the course of the disease and violation of compliance) and dramatically reducing the quality of life of the patient (due to the accumulation of stress in response to the pathological mode of perception of the psychologically difficult aspects of the disease −− nosogeny and the resultant formation of satellite neurotic disorders). Thus, establishment of an actual spectrum of nosogeny in the structure of hypothyroidism and the search for congruent forms of their psychological correction is an important task of clinical psychology. In order to form a nosogenically−differentiated system of psychotherapeutic support of the patients with psychoendocrine syndrome against a background of hypothyroidism, 100 patients with hypothyroidism were examined. The psychodiagnostic study included, in particular, a structured psychodiagnostic interview aimed at identifying and systematizing nosogenic predictors of psychotraumatism; chronopathological and introspective−vital groups were identified. The analysis of the severity of nosogenic influence of 12 factors was carried out: formation of functional and morphological disorders; the fact of having a chronic (incurable) disease; restriction of physical activity; presence of burdensome experienced symptoms of the disease; the need for therapy with drugs that show pronounced side effects; carcinophobic experiences; introspectively defined cognitive and mnestic disorders; the need for diagnostic procedures and therapeutic measures of high cost; availability of labor restrictions, causes financial difficulties; restriction of the circle of communication, due to the presence of the disease or its symptoms; the need to comply with the diet, refusal to drink alcohol and any stimulant substances; dependence on hormone replacement therapy. On the basis of the obtained data, a nosogenically−differentiated system of prolonged psychotherapeutic support of patients with psychoendocrine syndrome against a background of hypothyroidism was developed.

During the anti−terrorist operation in Ukraine, a significant number of servicemen received combat physical and mental trauma. The reaction of servicemen to the impact of the stressors of the combat situation depends both on their significance for a particular combatant and on the specifics of their coping behavior. To study adaptation disorders in the servicemen due to the combat stress as well as the efficacy of psychocorrection work the servicemen demobilized from the zone of combat action were examined. The investigation employed the following methods: A. Beck's Depression Scale, D. D. Spilberger −− Yu. L. Hanin scale for diagnosis of state and trait anxiety, Mississippi Scale (Post−Traumatic Stress Disorder), military option. The main psychopathological manifestations in patients with the adjustment disorder were observed in the form of obligate symptoms: depressive mood; anxiety; a sense of inability to decide and plan; high level of aggression; concern; irritability; hypothyroidism; low operability. The results of the pathopsychological study showed that all those studied had a high level of reactive anxiety as a reaction to the stress experienced, while the level of personal anxiety prevailed among those who had a diagnosis of adjustment disorder, both with objective and subjective evaluation. In order to restore the mental state of the participants in the combat actions, a program of medical and psychological rehabilitation in sanatorium−resort conditions: individual psychotherapy (4 sessions), treatment in a group (10−12 sessions), auto−training method, was developed. The results of psycho−corrective work with patients with adjustment disorders showed a positive dynamics in stabilizing the psychoemotional background and activity.

The urgency of studying the problem of reducing the risk of suicide in cancer patients is dictated by an annual increase in the incidence of cancer. In the structure of the expressed depressive and anxiety syndromes in cancer patients it is especially important to diagnose the formation of suicidal thoughts and trends and to conduct timely psychoprevention of suicidal behavior. For this purpose, the psychopathological changes in the personality of cancer patients, manifestations of neurotic anxiety and depressive symptoms in them, which led to suicidal thoughts, tendencies and an increase in suicidal risk were assessed. The internal picture of the disease, severity of neurotic manifestations in cancer patients, and the types of supportive relationships among family members were studied. The experimental psychological study included a structured diagnostic interview of the patient, a scale of anxiety by Ch. D. Spielberger −− Yu. L. Hanin, Zung depression scale, the study of personal accentuation using Leonhard−Shmishek method, the WHO QOL−100 quality of life assessment scale. The complex of measures of psychocorrection and psychotherapy was determined primarily by the presence of risk factors for the formation of suicidal thoughts and trends, as well as by the peculiarities of the life situation of an oncological patient, the degree of manifestation of psychopathological neurotic disorders, and the level of decline in the quality of life. The entire course of psychotherapeutic and psychoprevention measures was aimed at increasing the anti−suicide barrier of the individual, the stress resistance of cancer patients.

Disorders of sexual function in patients with multiple sclerosis aggravate their own self−esteem, self−confidence and negatively influence the quality of life. The benign course of the disease, which manifests by prolonged periods of remission, can occur in young people, more often women, with initial manifestations of lesions of the cranial nerves. The risk of the onset of malignant disease increases with a multisymptomatic disease onset, the presence of cerebellar disorders, the duration of remission less than a year, at a later age. Sexual function disorders are one of the manifestations of the disease, which manifests by reduced desire, excitement, violation of orgasm, in men by disorders of the ejaculatory function, in women −− dyspareunia. However, to determine the state of sexual function of the patient, based only on an objective assessment of the severity of its neurological status, is not enough. To find the prognostic criteria for development of sexual dysfunction in multiple sclerosis, a study was conducted in which patients were also examined according to other clinical indicators. They passed anonymous testing using questionnaires to determine the state of sexual function (MFSQ, IIEF), fatigue (MFIS), anxiety and depression (HADS), and the presence of cognitive changes (MMSE). According to the anonymous survey of patients on the scale of IIEF and MFSQ, sexual function disorders of varying degrees were detected in all subjects, despite the fact that almost a third of them had these disorders. A generalized assessment of the results of the analysis suggests that fatigue (MFIS), neurological deficiency (EDSS scale), anxiety and depression (HADS scale), cognitive impairment (MMSE scale) can be used as prognostic criteria that influence the further development of sexual dysfunction in patients with multiple sclerosis.

To study the dynamics of clinical and psychopathological manifestations and the level of general functioning in patients with drinking forms of alcohol dependence at application of an optimized system of treatment and rehabilitation measures, the results of a comprehensive survey of 80 individuals were analyzed. The examination was carried out using history analysis, clinico−psychopathological, psychodiagnostic methods with Mini−Mult questionnaire for assessing the personality profile, Estberg questionnaire for assessing the biorhythmologic status. The optimized system of treatment and rehabilitation measures consisted of three stages. The first was to stop acute alcohol manifestations with the help of a combination of traditional therapy and laser therapy, taking into account the individual chronotype, the second − to deactivate pathological addiction to alcohol, both traditional pharmacotherapy and psychotherapy considering the personality type were used, the third −− group supporting psychotherapy, aimed at transforming the support of the environment into patient self−support. To evaluate the therapeutic effects, at the first stage of treatment and rehabilitation activities, a psychopharmacotherapeutic method was used after 2 weeks to determine the severity of the symptoms and the scale of the overall clinical impression of CGI−I (1976). The dynamics of the level of overall operation in the second and third stages after 2 and 12 weeks of observation was determined on the scale of McCullough Vaillant, allowing assessment of the overall clinical and social progress of patients. The obtained results testify to a significant improvement in the indicators of the state of the emotional and personal sphere when using an optimized system of therapeutic and rehabilitation measures in patients with drinking forms of alcohol dependence, which contributed to formation of internal motivation, raising the level of psychological, social and professional functioning.