ARTICLES ARCHIVE

The increase in the number of children with mental retardation is observed all over the world and the problem of their upbringing and social rehabilitation has become a pressing psychological and pedagogical issue. In studies on the problems of social development of children with mental retardation, their lagging behind in communicative development has been noted. At different age stages they have reduced need for communication, simple orientation of communication with the adult dominates, there is an insufficient level of possession of verbal and nonverbal communication with others, which complicates the process of interpersonal interaction and pushes children to affective manifestations in communication, violates their social adaptation. It can be noted that in special education the processes of diagnosis, training, education and correction should be interrelated and complementary. Educational and correction−development processes should be carried out with children who have delayed mental development both in everyday life and in specially organized classes. An indispensable condition for effectiveness of the corrective−developing process is integrated activity of narrow specialists and parents (families) with children with special needs. One of the modern approaches is the use of game animal−therapy in children with mental retardation, which is aimed at developing child−centered relationships in which the therapist provides an emotional and safe environment. At Feldman EcoPark Center for Psychosocial Rehabilitation of Children and Adolescents, game animal−assisted therapy is based on natural methods of intervention, through which children learn about themselves and their relationships with the surrounding world. This approach helps them to quickly navigate in the environment, to create comfortable relationships with peers, to be aware of their feelings and in general to adapt to new situations.

It has been frequently noted that neuropsychological rehabilitation of mnestic functions is not always effective in patients in the chronic phase after stroke. The methods focused on verbatim learning do not yield consistent results. This problem is considered within the paradigm of complex perceptual image, where mnestic functions and thought processes are closely interrelated, and semantic memory acts as their integrative indicator. The imbalanced relations may form a pathological process in the form of fragmentation and memorization disorder. A total of 20 persons aged 38 −and 57 without memory improvement after rehabilitation took part in the study. The developed methodology was aimed at forming an integrated polymodal perceptual image. Its completeness was achieved through bringing auditory, speech, visual, spatial and motor components together, forming integral constructs of semantic memory through a series of active memorizations of short stories and reenacting them with the body in space. Transitions from one task to another were individualized. Positive trends for verbal, visual, auditory, semantic and long−term memory amid the overall recovery up to norms of thought processes were observed. In the long run, their memory retention, reasoning, and semantic memory were not worsening. Thus, neuropsychological rehabilitation program for patients with mnestic disorders has to be supplemented with approaches addressing both aspects: thought process development and integration of cognitive function components through reenacting the movement.

In recent years, the problem of Internet addiction, including dependence on the Internet games has become important. It is customary to distinguish the Internet gaming addiction and the Internet addiction. The prevalence of these conditions led to introduction of these addictions to ICD−11 and DSM−5 as specific psychiatric disorders. To study differences in computer and Internet game addiction for improving differential diagnosis, identifying risk groups and prevention of these disorders, 31 persons with game addiction were examined. History−taking, clinical−psychopathological, psycho−diagnostic methods, follow−up study, statistical research were used. The results of the research made it possible to reveal the following differences between computer game addiction and Internet game addiction: the shift of the age category of persons with the Internet games addiction to a more adult, in relation to persons with computer games addiction; a later debut of the Internet games addiction in comparison with the computer games addiction; among females, the prevalence of the Internet games addiction was higher, compared with the computer games addiction; territorial expansion of the "game zone" for the Internet games in comparison with computer games; a qualitative modification of social behavior in persons with the Internet game addiction in comparison with the computer games addiction. The study demonstrated the need to distinguish between the concepts of "computer games addiction" and "Internet games addiction" as well as the need to distinguish between the concepts of "Internet games addiction" depending on the type of Internet game, which is due to differences in psychopathological symptoms in individuals, having addiction to different types of games.

Emotional intelligence as a basic component of communicative competence is associated with the patient's commitment to treatment and the success of therapy. The research was conducted in medical health care institutions of Kharkiv during 2016−2018. Based on the informed consent, 113 healthcare professionals of different specialties who provided medical care for patients with cerebrovascular diseases at different stages of treatment (42 internists, 33 cardiologists and 38 neurologists) were included in the study. Emotional Intelligence Test by N. Hall and the data of a semi−structured clinical diagnostic interview were used. Our findings suggest that doctors, regardless of specialization, were sufficiently well aware of their own emotions and showed empathy. Moderate communicative difficulties were caused by identification and influence on the psycho−emotional state of the patients, self−regulation of behavior through emotion control. Management of the emotional sphere was the most difficult task in terms of emotional intelligence implementation. It was revealed that main causes of reducing the emotional competence of doctors were insufficiently developed skills of managing their own emotional state; restructuring negative emotions with the purpose of their productive transformation; "self−producing" positive emotions; creativity in interaction; sensitivity to the emotional needs of the interlocutor; presenting yourself competent in communication; motivation through the emotional sphere. The obtained results indicate the need to develop and implement psychological measures aimed at enhancing the communicative competence of doctors through conducting communicative trainings and psycho−educational seminars.

In the process of development of behavioral medicine and psychology of health, positive emotional states have received the status of sanogeneous resources that enable to improve the quality of life, influence its duration, stimulate the immune system, and resist diseases. However, despite the presence of a certain number of studies, relationships between the level of happiness and psychopathological symptoms of mental illness have not been identified. The purpose of this study was to determine the patterns of psychological symptoms of patients with mental disorders of different origin, depending on the level of subjective perception of happiness. It was shown that patients with mental disorders had significant decrease in the level of happiness, the lowest level of subjective perception of happiness was observed in the group of patients with neurotic disorders, and the highest − in those with organic pathology. Analysis of the relationship between happiness and patterns of pathopsychological symptoms in patients with mental disorders showed that a decrease in the level of happiness in such patients is associated with an increase in intensity of interpersonal sensitivity and anxiety−depressive experiences. This manifests in the lack of interest in life, motivation and loss of vital energy, a feeling of hopelessness that reflects the perception of their life as unhappy in general. In patients with neurotic disorders, a decrease in the level of happiness was accompanied by intensification of interpersonal sensitivity, obsessive−compulsive manifestations and hostility. In patients with psychopathology of endogenous origin, a low level of happiness was reflected in intensification of anxiety−depressive experiences and general paranoia. In patients with organic mental illness, an increase in the level of happiness was associated with a decrease in somatization, interpersonal sensitivity and depressive symptoms.

The aim of the study was to investigate the pathosychological features of patients with recurrent depressive disorders, depending on the duration of the disease. The study involved 44 patients with recurrent depressive disorders of varying degrees of severity with no history of rapid cycles and complete pre−remission. With the acquisition of depressive experience, the person undergoes certain transformations with the gradual formation of a depressive style of behavior, which at different stages of the disease is characterized by the following manifestations: at the initial stage (two episodes in history) − confidence that life does not bring them pleasure and requires from them additional effort, is accompanied by the prevalent use of coping strategies of confusion and fixing difficulties with maintained flexibility of behavior and contact, as well as the significance of the present; at the intermediate stage (3−5 episodes in history), the conviction of patients that their life was unsuccessful and the belief that they are worse than others lead to the formation of coping strategies of waiting for help and passive co−operation, reducing motivation and negative evaluation present and future; on a long−term stage (more than 5 episodes in history) − absence of hope for a good future, the experience of loneliness and belief in the biased attitude of others are associated with the coping strategies of confinement and retreat, the depletion of value−motivational sphere and a decrease in self−esteem, and as well as confidence in the devastation of the present and future. The obtained results prove that under the influence of depressive experience the personality of the patient changes and there is a gradual formation of a depressive style of behavior that should become the key target of psychotherapeutic work.

Cardiovascular pathology is the most common cause of disability in the world's population and Ukraine, in particular. The studies of this group of diseases are the focus of attention of the majority of medical disciplines of a somatic profile. There is a complex of pathological factors pathopsychological and psychopathological circle, largely determining the quality of life of patients with coronary artery disease, hypertension, atherosclerosis and other forms of diseases of the cardiovascular system. In order to establish the subjective clinical and psychological factors in people with different types of hypochondria symptoms that underwent vascular accidents, 100 patients were examined. The study used clinical and psychological methods. It was found that according to the questionnaires of the social significance disease by Serdiuk and "Well−being, activity, mood" there were differences in subjective clinical and psychological factors of the existence of primary and secondary hypochondria in patients who survived cardiovascular accidents. Significant differences between the groups of patients were identified according to the following criteria: limitation of pleasure, limitation of free time, limitation of career, formation of feeling of inferiority and material damage, and in terms of mood reduction. The obtained data allow supplementing the ideas about the heterogeneity of variants of hypochondria symptoms within the framework of the dichotomy of the "primary" and "secondary" hypochondria.

The presence of maxillofacial defect and the need to seek surgical help in this regard are accompanied by a complex set of pathological personality reactions, experiences, significant increase in psychoemotional load, an increase in the level of neuroticism and worsen the life quality. Searching for psychocorrectional methods to minimize the psycho−traumatic effects of the maxillofacial defect is urgent. The purpose of the study was to develop a defect−related system of medical−psychological support for persons who underwent injuries of the maxillofacial area. The study was carried out using clinical−anamnestic and psychodiagnostic methods. During the work surgical and medical−psychological characteristics of various variants of lesions of the maxillofacial area were analyzed. The basic techniques of medical−psychological support to patients with traumatic lesions of the maxillofacial area of various localization, were established, of them: at the fracture of the mandible, the alveolar process, upper jaw, zygomatic bone, and nose bones, which are reduced to three types of surgical defects: aesthetic, functional and odontological ones. Based on the results of the study, a methodology of combined use of reconstructive surgical intervention and the technique of medical−psychological support of patients in the postoperative period, which is a 4−stage protocol, was developed.

A civil servant, working in conditions of increased responsibility, making important decisions and in the shortest possible time, is constantly in a state of psychosocial stress. This ultimately leads to development of pathopsychological syndromes in civil servants, which have a negative effect on both physical and psychological health. Maladjustment is one of such syndromes. To identify the structural components of professional psychological adaptation with a further definition of the need for medical and psychological support, a psycho−diagnostic examination of 159 civil servants was conducted. According to the results of the study using the questionnaire "The level of professional maladjustment" (O. N. Rodin), manifestations of maladjustment were found in almost half of the sample. Maladjustment in the respondents was reflected both in the clinical and psychological field (deterioration of concentration and memory, sleep disorders, somatic vegetative disorders, decreased mood, increased fatigue, low overall activity), and in social production (fatigue after work and reduced work capacity, job responsibilities and tasks requires greater effort, conflicts in the motivational sphere). In addition, they have manifestations of anxiety−depressive symptoms. It is concluded that civil servants with manifestations of anxiety−depressive symptoms in combination with socio−psychological maladjustment have high risks of deterioration of the psycho−physiological state, social interaction and connections, individual indicators in the production sector.

The subject of leadership in nursing as an integral part of rapid adaptation to the work in health care institutions is relevant during the reform of health system. In order to determine the degree of leadership qualities in the students of the medical college, the method of individual−typological features of personality by L. M. Sobchyk was used as well as the author's program of medical and psychological support for the process of adaptation of students of medical colleges to perform their professional duties in primary positions. The importance of developing leadership skills among the junior medical staff is due to the fact that they spend a lot of time with patients, sometimes much more than doctors. It is the nurses who have to respond quickly to unpredictable changes in both the physical and psychological state of the patient. In the period of reforms in health protection and education, nurses and paramedical personnel must possess not only practical skills, but also directly participate in the process of patient psychotherapy. Important in the work of nurses is the ability to build their time management. Sometimes they have to quickly make the right decision and make an action plan in a situation that goes beyond the staffing. Frequent changes of staff do not have a positive effect on the work of medical and preventive institutions. In order to study leadership qualities and the possibility of their formation in the future nurses, the first study was conducted among the second−year students, and after two years, a repeated testing was done. The conducted research shows that students of higher medical educational institutions of the accreditation levels 1−3 do not always have individual−typological features of the individual in line with the requirements of the individual−typological features of medical workers, which prevents them from adapting quickly to work, performing their professional duties and being competitive in the labor market. By introducing into the educational process a comprehensive program for the adaptation of future nurses and paramedical personnel to the work in primary positions, one can not only develop leadership qualities, but also prevent emotional burnout. All this will improve the provision of medical care to the population and prevent development of psychosomatic pathology in health care workers.

Arterial hypertension is a multifactor disease. It has been proved that there is a close link between emotional reactivity and arterial hypertension, however the role of anxiety in development of arterial hypertension in teenagers is still poorly explored. To identify the role of anxiety and alexithymia as risk factors for primary arterial hypertension in teenagers, 19 girls and 53 boys aged 11−17 with arterial hypertension changes were examined. The diagnosis was verified by 24−hour blood pressure monitoring. Three main 24−hour blood pressure profiles were identified: stable hypertension, labile hypertension and normal (control group). Psychological study included identification of state and trait anxiety by Spielberger−Khanin test using Toronto Alexithymia Scale. Our findings suggest that along with excess body weight high state anxiety is an independent risk factor for severe (stable) progress of primary arterial hypertension in teenagers.

Most often in the context of the problem of differential diagnosis of delusional symptoms, psychiatrists are faced with such nosological units as schizophrenia and dementia with psychotic symptoms. Therefore, the problem of distinguishing the etiology of delusional syndromes and nosological belonging delusions in elderly and senile patients is an urgent task of modern psychiatry and gerontology. To analyze the peculiarities of delusional syndromes in the structure of the paranoid form of schizophrenia and vascular dementia with paranoid inclusions and to consider their syndromokinesis, 122 patients with the diagnosis of mixed cortical and subcortical vascular dementia (F01.3 ICD−10) and residual schizophrenia (F20.5) were examined. The methods of investigation included the study of medical documentation, clinical−anamnestic, clinical−psychopathological, catamnestic, statistical ones. The structure and dynamics of delusional syndromes in patients with vascular dementia, the etiological basis of which was organic brain damage, were described. The continuums of psychopathogenesis of delusional syndromes in the structure of the paranoid form of schizophrenia were presented taking into account the pathoplastic effect of the organic radical. Three stages of syndromokinesis were identified; the syndromal structure of psychopathological disorders in the patients under study was systematized; syndromic variants of each isolated stage of syndromokinesis for the investigated nosological forms were described. The obtained results of the study allow determining the targets of the syndromic differentiation at each stage of the syndromokinesis of delusional disorders necessary for further improvement of the differential diagnostic methodology.

Anxiety and fear syndromes are one of the most common psychopathological phenomena in childhood. Such psychopathological phenomena can persist in adolescence and adulthood. In order to study the relationship between phobia and formation of anxiety disorder, 103 children and adolescents were examined. In the course of the study, clinico−psychopathological method, sociopsychological interview, psychodiagnostic methods were used. The fears of children with anxiety disorders were analyzed depending on the age. Fears were noted in all patients, with multiple phobia predominantly in children, isolated one in adolescents. The gender characteristics of anxiety disorders in children were determined: anxiety−phobic is significantly more common in boys, and anxiety−depressive in girls. Phenomenology of anxiety disorder in children and adolescents is presented in the form of three variants: domination of symptoms of secondary anxiety with the presence of cognitive (the directional vector outside) and emotional components; person−dependent states − the presence of symptoms of secondary anxiety with a cognitive component (the vector of anxiety is directed to the actual "I" with the domination of the emotional rigid component); vital. The level of severity of anxiety disorder by CGI scale indicates that children have a prevalence of indicators "noticeable", and in adolescents − "serious". Consequently, the results of the study indicate the need to consider phobic formations when developing programs of medical−psychological intervention in children and adolescents. The work requires further extension to allocate clinical phenomenological markers of anxiety disorder and development of diagnostic criteria for options for anxiety disorder in children.

In case of alcoholic encephalopathy, various disorders of the higher cognitive functions of a person, accompanied by attention disorder, memory of perception, etc., develop first. Recently, violation of these functions has become a frequent cause of social maladjustment and disability of a large population group, in particular in Ukraine. One of the leading syndromes of alcohol brain involvement is progressive violation of human intellectual function, which is found in 50.0−70.0 % of cases, and in more than 10.0 % of patients they reach the degree of dementia. At the same time, according to the results of many studies, alcohol dementia makes 5.0−10.0 % of all cases of dementia, especially in young people. Among the main pathogenetic mechanisms of the occurrence and development of alcoholic encephalopathy, damage to the gray and white matter of the brain by membrane−toxic ethanol as a result of systemic use of alcohol and alcohol−containing substances, causing significant loss of myelin fibers and neurons, gradual development of atrophic changes in the brain, degradation of the corpus callosum microstructures, reduction of neuronal and glial markers, etc., due to the release of especially dangerous substances − aldehydes resulting from metabolism of alcohol and poisoning brain neurons. In addition, one of the leading factors in damaging the nervous tissue at alcohol abuse is the lack of vitamins B (primarily thiamine). In addition to the above−mentioned symptomatic manifestations of various forms of alcoholic encephalopathy, many world and Ukrainian authors point to the presence of epileptic paroxysmal states in the context of prolonged chronic alcohol abuse, which are manifestations of the most threatening conditions that may occur in patients with alcoholic encephalopathy.

In the context of the Anti−Terrorist Operation and Joint Forces Operation on the territory of Donetsk and Luhansk regions, absolute identity of the clinical picture of posttraumatic stress disorder with its classical descriptions is not observed, despite the presence of axial symptoms that make up the nucleus of the pathology. This, among other things, is connected with the specificity of hostilities in Ukraine, which are unconventional, hybrid and closely intertwined with the information−psychological war. To establish the amplification, exacerbation and structural−dynamic features of posttraumatic stress disorder, in the servicemen with posttraumatic stress disorder were examined. Clinical−anamnestic, clinical−psychopathological, psychodiagnostic, catamnestic methods were used. The factors amplifying and exacerbating posttraumatic stress disorder were determined: the presence of basic neuroticism; socio−psychological unpreparedness to engage in hostilities; long−time stay in a psychologically uncomfortable environment with lesions by psycho−traumatic factors; psychological inability to abstract and reduced critical attitude to their own mental products and behavior. The following structural and dynamic peculiarities of posttraumatic stress disorder were identified: the gradual nature of posttraumatic stress disorder development; appearance of sleep disorders before the main symptomatology; specific weight of anxiety−phobic reactions; domination of fear of death in the plot of emotions; dominance of intrapsychic rather than not external circumstances as provocative factors of obsessive, phobic−colored memories; domination of depressive component at late stages of the disease; suppression of posttraumatic stress disorder symptoms by comorbid pathology; development of posttraumatic stress disorder against a background of psycho−organic syndrome; addition of psychopathisation as a comorbid posttraumatic stress disorder state; long and poorly controlled signs; tendency to violation of compliance with therapy.

The symptoms of the catatonic spectrum has been one of the most discussed aspects of a psychiatric clinic for over 50 years. At the moment, despite the expansion of unifying taxonomists and statistical classifiers of mental disorders, there is a gaping definitive failure in understanding catatonic manifestations between the post−Soviet psychiatry on the one hand and the American Psychiatric Association on the other hand. To provide the comparative description of catatonic syndrome of endogenous origin and catatonia−like conditions of dissociative and neuroleptic origin, 158 patients of the Zaporizhiozhia Regional Clinical Psychiatric Hospital were examined, among them 32 patients with a catatonic form of schizophrenia, 62 patients with mixed dissociative disorders, 64 patients with manifestations of late neurotropic neuroleptic effects. Twelve signs corresponding to psychomotor and behavioral signs used for formal diagnosis of catatonia (within the diagnostic tools: DSM−IV−TR, DSM−V, MRS, BFCRS, Fink−Taylor CRS, Kanner CRS), namely: ambition, waxy flexibility, aggression, motor excitement, motor stereotypes, congestion, mutism, negativism, orofacial dyskinesia, passive subordination, stupor and echo phenomena, were distinguished. For each sign, the distinctive features of its presentation in endogenous catatonia, and catatonia−like conditions of dissociative and neuroleptic origin were established on the basis of examination and clinical−anamnestic analysis of the disease of relevant groups of patients.

The recent armed conflict in the East of Ukraine is characterized by intensity, intensity, transience. In these conditions the psyche of the military is on the verge of the permissible loads, its depletion leads to decreased effectiveness of activities in the extreme conditions of the armed conflict, mental trauma and mental disorders of a short−term or long−term nature. The constant impact of a complex of factors of military operations causes the military personnel to develop pronounced negative mental states. Combat stress, individual adaptive capabilities of servicemen, their psychosocial characteristics predispose to addictive behavior, post−traumatic stress disorders, etc. Various approaches to the concept of combat stress, the main factors of its occurrence, as well as its consequences for military personnel are featured. Attention is focused on the stage of prediction of probable mental disorders among combatants who were exposed to combat stress in order to identify its main markers. It is concluded that this problem has recently begun to attract the attention of psychologists, necessitating development of an effective system of primary and secondary prevention of the occurrence of such negative phenomena in the mental sphere of servicemen in order to increase their fighting efficiency and adaptability after demobilization.

The urgency of the problem of correlation of mental and somatic pathology is determined by the significant increase in the level of such comorbid states and their negative medical and social consequences, which are related to the expressed complications of both variants of the pathology, formation of complicated forms of disorders and premature mortality. Disorders in awareness of the disease is one of the pathognomonic criteria for diagnosis of schizophrenia. According to statistics, 30−97 % of these patients are not aware of the presence of a mental illness, which greatly complicates the treatment and affects its effectiveness. To investigate the features of the "insight" of a mental illness in patients with schizophrenia combined with chronic somatic disorders, schizophrenia patients (F20) with chronic somatic pathology (cardiovascular diseases, type 2 diabetes mellitus, obesity) were examined. An adapted variant of the SUMD was used to assess the level of awareness of mental illness, insight in patients with schizophrenia. PANSS was used to assess the peculiarities and level of psychopathological symptoms and to determine the relationship between it and the level of insight. It was established that patients with schizophrenia with somatic diseases were characterized by a higher level of insight of the mental illness, as compared to patients without somatic complications. The highest rates of insight of mental illness were noted in patients with schizophrenia with cardiovascular diseases. It was determined that a high level of insight of a mental illness is associated with the severity of anxiety−depressive symptoms, hypochondriasis and autisation, with a low degree of conceptual disorganization and thinking abnormalities.