ARTICLES ARCHIVE

To date, the combat ocular traumas are considered to be among the most serious injuries in terms of predicting the recovery of social functioning and disability absence in patient. Lifestyle change, participation in combat activities, the impact of all these factors together form a complex of mental signs of somatic trauma. Aiming to comparatively investigate the methods of psychological defence in phenomena of psychological maladaptation or post−traumatic syndrome in combatants with eye trauma and partial vision loss, we surveyed 191 combatants in order to outline the further targets for their medical and psychological rehabilitation. A mental status was screened in all the respondents using the Clinically Administered PTSD Scale, an inventory to evaluate the neurotization and psychopathization level, as well as they were examined by psychiatric specialist and got psychodiagnostical evaluation. Our findings showed these methods of psychological defence, mostly in psychological maladaptation of combatant, to indicate, by their orientation, the delegation of causes and solutions of stressful situations from one individual to other people. Herewith, the combatants were ready for using the deviant behaviour in solving their problems. In the surveyed patients, the signs of psychological maladaptation were accompanied by an increased vitality, indicating the activation of psychological mechanisms to cope with stress. The need in developing the algorithms to correct the processes of psychological defence method formation in combat eye trauma against the background of psychological maladaptation or post−traumatic syndrome manifestation, was concluded. Our findings should be taken into account when developing the specialized high−targeted approaches to medical and psychological rehabilitation for this group of patients.

Among the individual psychological traits, directly involved into the depression emergence and development, there were determined the peculiarities of the value and personality sphere as a potential source of imbalance between the system of values of individuals and their real behavior, as well as, under favorable circumstances, an internal resource for controlling the disease and forming the attitude towards a successful therapeutic outcome. There were surveyed 252 women diagnosed with depressive disorder (F43.21, F32.0−F32.3; F33.0−33.3; F31.3, F31.4, F31.5 and F06.3 by ICD−10). To identify and measure the severity of psychosocial maladaptation, an original scale was developed for a combined assessment of psychosocial maladaptation extent in various domains. The features of the value and personality sphere in the surveyed patients were analyzed using the method of studying the value orientations modified by O. B. Fontalova. The patients with depressive disorders were characterized by an average level of disintegration by the type of internal conflict, in patients with endogenous and organic depression with no maladaptation signs it was the most pronounced, being slightly lower in those with all the types of depression with the signs of maladaptation and the lowest in persons with psychogenic depression with no maladaptation signs. The dissociation by type of internal vacuum was more pronounced in patients with maladaptation signs, but the differences were not statistically significant. In general, the patients with maladaptation signs showed a higher level of dissociation in key areas. In this case, the signs of dissociation were the highest in patients with organic depression, slightly lower in those with endogenous depression and the lowest in patients with psychogenic depression. The revealed patterns should be taken into account in developing the therapeutic, rehabilitative and preventive measures.

The emphasis on a positive impact of family involvement into therapeutic process has become an important direction in developing psychosocial treatment for patients with endogenous mental disorders. Studying the basic descriptors of coping behavior in family caregivers of patients with schizophrenia and affective disorders is important for designing a comprehensive system of medical and psychological support for these families. The family caregivers of patients with paranoid schizophrenia and those with affective disorders were examined to determine the descriptors of coping behavior. Here, we used the test for psychological diagnosis of coping mechanisms (E. Heim). The personal communicative resources of family caregivers were evaluated using the measure of emotional empathy (A. Mehrabian). Based on the in−depth study of some descriptors of coping behavior in family caregivers of patients with endogenous mental disorders in context of understanding the importance of family as social and therapeutic environment of patients, we have identified the main targets and tasks of integrative system of psychological correction aimed at normalization of psycho−emotional state, development of adaptive forms of coping behavior in family caregivers of patients with endogenous mental illnesses, augmentation of their empathic−affiliative resources, creation of favorable psycho−social conditions for activating personal resources and adaptation potential in patients with endogenous mental disorders.

When the aggression is unexpressed and unconscious by personality, it may act as an internal stimulus, triggering a stress response and development of negative changes in body functioning. In order to investigate the features of aggression manifestation in patients with cerebrovascular pathology at different stages of disease course as the targets for psychological assistance in the structure of health−centered approach, there were surveyed 430 patients with cardiovascular risk, and such clinical symptoms as transient ischemic attacks in a post−stroke state. Here, we used the Bass−Durkee Hostility Inventory and the Boston Stress Test. The continuum of "conditionally healthy − risk group − clinical signs of cerebrovascular pathology − post stroke" revealed an increase in the importance of indirect aggression, irritability, negativism, resentment, and suspicion in patients with cerebrovascular pathology as the disease progressed, that generally led to an increase in total level of aggression and hostility. The manifestations of aggression forms had differences depending on the level of stress risk, namely an increase in stress risk was accompanied by an augmented level of aggression and hostility as integrative indices. In the structure of aggression forms in the subgroup with a moderate stress risk, it was manifested mainly in the form of irritability and verbal aggression, in the subgroup with a high stress risk they were joined by resentment and guilt, and in the group with ultra−high stress risk a significant role was played by indirect aggression and suspicion. It was concluded that psychological correction of forms and manifestations of aggressive behaviour was an important component of medical and psychological assistance for patients with cerebrovascular pathology in context of health−centered approach implementation.

The main structural components of happiness such as: emotional, social, material, physical, dynamic and existential ones were emphasized, and the features of their structure and interaction were described. Basing on these factors, a semantic differential of happiness was compiled. An emotional component of happiness reflects the affective experiences, their need and sufficiency in semantic space of an individual, the brightness and abundance of daily existence. The material component characterizes the degree of satisfaction with current financial situation, and also reflects the degree of expression of material needs in general structure of person's view of happiness. The dynamic component of happiness reflects the rate of mental processes, the feeling of energetic fullness of psychological life of a person, a high intellectual and emotional involvement. Physical factor of happiness is an indicator of satisfaction degree of basic needs at physiological level. Social component of happiness is formed from the desire of individual to be involved in social interaction, its attitude towards society, as well as the importance and stability of contacts with others. The existential factor of happiness characterizes the degree of relevance of higher personal needs, including harmonious coexistence within civilization, along with the awareness of individual meaning, self−identity. The application of semantic differential technique of happiness is a universal tool to assess the level of subjective perception of happiness, allowing to evaluate not only an affective component of this construct, but use the general semantic field of this concept to construct a comprehensive picture of objectification of existential integrity as well.

The mild traumatic brain injuries (m−TBI) are present in more than 33 % of cases in the structure of combat trauma in Ukrainian combatants. Post−concussion syndrome is a long−term consequence and/or complication of m−TBI, diagnosed in near 27.5 % of all the concussed persons. The mental health problems are leading among symptoms of this disease. But only drug therapy and psychological intervention in hospital are not efficient for combatants. Family rehabilitation under supervision of medical and psychological specialists is one of the ways to solve the task. The family rehabilitation program was proposed to solve this problem. At the beginning of the rehabilitation course, the personal psychological problems were found in combatants and their wives (by anonymous survey and testing). Weekly courses included physical component of rehabilitation (hiking and walking, mountain climbing, training in the gym, sports games, visiting a salt cave), psychological (psychotherapeutic) one (individual and group work with psychologist, art therapy using projective techniques, training courses on psychological recovery and acquisition of skills for stress management) and the activities that were conditionally related to microsocial re−adaptation (group intellectual games, culinary master classes and joint cooking, fishing, mushroom and berry picking, marine yacht trips, two rider vehicle and horse riding). The applied methods of psychological assistance together with physical and social components of the program improved the personal psycho−emotional state in 96 % of program participants. The improvement of intra−family mutual understanding and psychological micro−climate was observed in 100 % of families. Some families (about 60 %) wished to continue the therapy. Two−year experience of rehabilitation courses (8 groups, 46 families of combatants) showed good and long−term results in 86.5 % of families. The process of rehabilitation and re−socialization of combatants with post−concussion syndrome should begin with working with psychotherapist and continue in family. The family for combatants is a micro−social space and a psychotherapeutic tool as well. The main components of "family therapy" should include such psychosocial actions as understanding, motivation and support.

The workplace stress negatively affects the mental health of employees, by exhausting the compensatory mechanisms of personality. This may result in maladaptation development, which will disorder a normal functioning of individual in work, society, family. Medical and psychological correction of social−psychological maladapatation states was performed in 159 government employees and its efficiency was evaluated. Here, we used the clinical−psychological, psychodiagnostic and medical−statistical methods. The psychodiagnostic toolkit included the Hospital Alarm and Depression Scale; "Assessment of Professional Maladaptation" questionnaire; "Diagnosis of Coping Mechanisms" technique; "Internal Motivation" questionnaire; Gissen personal questionnaire. The proposed complex of medical and psychological measures consisted of three stages: psychological diagnostics; active medical and psychological correction; supportive psychological correction, psychoprophylaxis and psychoeducation, differentiated by purpose, methods and means of medical and psychological impact. Our findings proved the selected model of psychological correction to be efficient for eliminating anxiety and maladaptation symptoms, but to be poorly efficient in dealing with depressive symptoms. In the surveyed government employees we managed to optimize and augment the efficiency of coping strategies and motivation through psycho−corrective and psychotherapeutic work. By applying the psycho−corrective and psychotherapeutic impact on personal determinants of government employees, the level of self−esteem and social interaction was optimized and improved as well. However, the work with psycho−emotional sphere (tendency to depressed mood) and personal seclusion showed poorer results. The psychological correction with personal determinants and depressive symptoms in government employees have still remained a problematic issue, since their system of personal priorities first includes work, career, professional image, money reward and only then the issues of personal mental and physical health.

Here, we have analyzed the psychological features in chronic pain syndrome resulted from musculoskeletal diseases. The relevance of the problem, caused by medical, social and psychological significance, has been substantiated. Musculoskeletal diseases and pain syndromes, associated with rachiopathy (dorsalgia), due to their prevalence and the tendency for chronization and regressions, significantly affect the quality of life, i.e. significantly impair functional activity, limit freedom to move around, increase emotional, mental stress through chronic or periodic pain, enforce maladaptation, reduce the possibilities of self−fulfillment, affect the development and complications of other diseases. Chronic pain syndrome resulted from musculoskeletal diseases was considered in terms of medicine, psychosomatics, and psychology. It was determined that numerous data of psychological examinations of patients were not unambiguous. Their personal characteristic were as follows: increased emotional excitability, excessive modesty, high sensitivity and self−discipline, traits of anxiety, dependence, excessive introspection, tendency to quietness and excessive confidence, psychasthenic features, predominance in personal profile of hypochondrical and depressive features. Such patients often demonstrated an increased self−control and desire to be perfect. They could not afford healthy aggressive impulses. Blocked aggressive impulses of patients were expressed in an increased muscular tension and, finally, in localized or generalized pain. The necessity of further study of affective, conative sphere in patients with chronic back pain syndrome was determined.

To reveal the peculiarities of family predetereminancy of socio−psychological maladaptation of adolescents in the context of different socialization models in subcultural space, 143 adolescents were examined, among which 3 respondents were youth subculture representatives: extremals and gamers. The study was carried out using the psychodiagnostic method. The features of parent−child relationships were determined using the questionnaire "Parental Behaviour and Adolescents' Attitude to Parents" (E. Schaefer), and the "Parental Attitude Questionnaire" (A. Ya. Vargi, V. V. Stolin, 2001). The choice of socialization models by adolescent was established to be affected by different aspects of parental−child relationship, built on mutual sense of perception. There were determined the following significant factors such as: paternal and maternal inconsistency, authoritarian hypersocialization, maternal hostility, paternal positive interest, maternal positive interest and directivity, paternal autonomy (distancing), paternal hostility, symbiosis of relationships, excessively critical attitude to child's failures, high cooperation, high child rejection rates. The typology of mutual common ground of adolescents and parents, determining the specification of family interaction among the surveyed, represented by five factors, that determined the functions of interaction, was proposed. The family predictors of social and psychological maladaptation in adolescents, which included a parental style of cooperation (low rates), rejection style, that of symbiotic interaction, were specified.

Chronic pruritus significantly reduces the quality of life, working capacity and social activity of patients with dermatological diseases. The patients with atopic dermatitis, psoriasis and seborrheic dermatitis have been examined to reveal the features of psycho−emotional state in them depending on chronic pruritus severity. All the patients were divided into the groups depending on chronic pruritus severity, using an electronic screening devices "Calculator for Chronic Pruritus" and symptomatic questionnaire (E. Aleksanrovich). Our findings demonstrated the pronouncement of psychopathological symptoms to increase from low up to high severity of chronic pruritus by each studied components. In dermatologic patients a growing intensity of chronic pruritus was accompanied by an increased severity of psychopathological symptoms. A low severity of pruritus caused the situational changes such as tension, irritability, decreased concentration span, mood, sleep disturbance, while the mild one caused the formation of persistent anxiety as for the current disease state and health in general, aggravation of emotional reactions, increasing uncertainty, interpersonal problems. The high pruritus severity differed by anxious−depressive mood, hypochondria, emotional dramatization, uncertainty, loneliness, low self−sufficiency, loss of control of situation, interpersonal difficulties. Studying a psycho−emotional state and determining the targets for psychological assistance are the important components of measures of medical and psycological assistance for dermatological patients with chronic pruritus.

Rheumatoid arthritis is the chronic systemic disease, accompanied by significant impairment of joint function, having some of the most strong medical and social consequences. In order to study the individual−psychological characteristics and clinical−phenomenological features, associated with rheumatoid arthritis in a gender aspect, 32 men and 113 women were examined. Here, we used an abbreviated multivariate personality questionnaire, C. Spilberger's reactive and personal anxiety scales and scoring questionnaire of subjective characteristics of sleep. It was found that in psychological profile of men with rheumatoid arthritis, the signs of impulsiveness, rigidity, paranoia, and individuality were much more pronounced, that might be associated with the formation of a specific patocharacterological pattern, related to the features of rheumatoid arthritis clinical course (severe pain syndrome, limited mobility); and depressions, demonstrativeness and asthenia, which could be considered as signs of neuroticism were revealed in women. The level of reactive and personal anxiety in women with rheumatoid arthritis was established as significantly higher than in men. When studying the insomnia, a lack of night sleep and rest during the day was found in most patients. Herewith, in men, the severity of insomnia was higher than in women. The revealed patterns should be taken into account when developing the treatment−and−rehabilitation and preventive measures for patients with rheumatoid arthritis.

The findings of current studies worldwide have pointed to a high relevance of mental health problems, especially during long−term surgeries in pre−senile and senile patients. One of the "difficult" for surgery and correction of cognitive and emotional disorders in pre−senile and senile patients is the therapy of proximal femur fractures (due to a long−term bed rest and a significant rehabilitation post−surgical period, a high prevalence of elderly−inherent cognitive disorders, etc). The existing cognitive and emotional disorders during a long−term surgery (especially in the elderly) definitely require special pharmacological correction. These findings demonstrated the presence of moderate (41.67 %) and high (58.33 %) levels of reactive and personal anxiety among these patients. They showed a subdepression (75.00 %) and a mild depression (25.00 %), as well as general limit levels between moderate and high (anxiety) and between mild depression and subdepression. The necessity to correct the cognitive and emotional disorders during surgery of proximal femur fractures, especially in senile and pre−senile patients, was confirmed.

Aiming to study the risk factors of paranoid−hallucinatory disorders in patients with vascular dementia, 75 patients were examined. When selecting patients with vascular dementia, both ICD−10 criteria and those, developed by the National Institute of Neurological Disorders and Stroke − International Association for Research and Education in Neuroscience were used. The Geriatric Depression Scale was used when assessing the severity of cognitive impairment (normal, physiological aging, mild memory impairment, mild, moderate, moderately severe and severe dementia). Our finings resulted in establishing the risk factors (constitutional−biological, socio−demographic and psychosocial) of paranoid−hallucinatory disorder development in patients with vascular dementia. They were as follows: female gender; hereditary affective disorders (mainly depressive spectrum); perinatal pathology in history; concomitant pathology of the nervous system (history of stroke, transient ischemic attacks); lack of family (no marriage, divorce), poor financial and living conditions; physical nature of labor; chronic psychogenic factors associated with worsening of financial situation, loneliness, need for love and close relationships. The described risk factors for paranoid−hallucinatory disorder development in vascular dementia patients should be used to improve the diagnostic techniques for these patients and design a personalized program for their psychosocial rehabilitation.

This research topicality is stipulated by a need to improve the quality of diagnostic techniques for depressive disorders in patients with epilepsy. In order to investigate the features of clinical and psychopathological signs of depressions in epilepsy, we examined 109 epileptic patients (G 40.0−40.8 by ICD−10) with depressions within interictal period. The entire spectrum of depressive symptoms was studied, and its severity and structure were determined, as well as a syndromological analysis as for specific forms of depressive disorders was performed. The depressive disorders in patients with epilepsy in interictal period were established as heterogeneous in severity and structure of psychopathological symptoms. By severity, the depressions in interictal period of epilepsy could be moderate and severe, the highest level of which was observed in endogenous depressions. The specificity of depressive syndrome structure in epilepsy included the presence of dysphoric manifestations against the background of the leading depressive syndrome, to which, the other psychopathological syndromes depending on the depression form, were added, i.e. somatovegetative and asthenic ones in organic depressions; somatovegetative and anxious were done in psychogenic; and apathetic − in endogenous ones. Our findings are of practical importance and should be taken into account in therapy of epilepsy patients.

The reported data on the impact of psychoactive substances' abuse on sexual functioning and the prevalence of sexual dysfunction among the patients with different types of addictions were summarized and analyzed. Depending on the substance, a sexual dysfunction is of high clinical significance, since it often leads to reduced adherence to therapy and sexual and/or marital disharmony. Nevertheless, the symptoms of sexual dysfunction are often ignored and not studied in the routine clinical practice. This review suggests that a long−term use of alcohol and opioids is associated with sexual dysfunction in almost all the areas of sexual functioning. The patients does not inform spontaneously any facts about sexual side effects, because of the sense of inadequacy, associated with it. A thorough examination can set the patient's basic level of expectation, its excitation and orgasmic function and determine whether there is a plausible chronological relationship between the onset of substance dependency and the onset of sexual dysfunction.

The problem of alcohol−related harm, i.e. how much the alcohol consumption by one person harms the health, financial status, quality and living conditions of others, is now actualized in narcological discourse. In the context of pathogenesis of the impaired adaptation states among the students, the alcohol−related harm they receive may be a significant psycho−traumatic factor. With an informed consent and anonymous questioning, 50 medical students were surveyed. Here, we applied the following methods such as: clinical−anamnestic, narcological, psychodiagnostic, and statistical ones. According to the anamnestic data, the interviewed students spent most of the time for learning, so the criteria for assessing the disorder of mental adaptation were the worsening of academic performance, academic failures, social conflicts with teachers or students, and other problems with learning, that respondents associated to a harm, caused be alcohol consumption by others. The revealed facts of alcohol−related harm in terms of a complex pathogenesis of adaptation disorders in students may be considered as the factors of psychotraumatization and divided into the following clusters: economic, verbal and physical. The most desadapotogenic cluster of psychotraumatization is physical one, when the state of adaptation disorder lasted 24.25±2.06 days on average.

The family can strongly affect its members, meeting their biological, emotional, psychosocial and economic needs. Family is one of the most important social and educational institutions, the importance of which could be difficult to overestimate, therefore the problems associated with its life activity and functioning have always attracted the attention of teachers, sociologists and psychologists. The family impact on children is unique by its intensity and efficiency, since implemented continuously, and comprised simultaneously all the aspects of forming personality, being lasted for many years, based on the persistence of contacts and, that is very important, on emotional relationships of children and parents. It is often said that dysfunctional parent−child relationships at the early stages of development, when a person was still a child (teenager), may affect how much he or she may be prone to various mental health disorders and, above all, addiction. To determine the degree of stress load at different stages of life in the group of chemical addicts, we have examined the persons with drug, and alcohol addiction. To involve them into research, we contacted the higher education institutions, state and private companies, in anonymous and voluntary ways. In average, testing took 90 minutes and was performed under standardized conditions and quiet environment. Here, we applied the SUMLE index of the psychometric personality inventory based on the five−factor model of the Big Five (Revised NEO Personality Inventory). The survey found that the stress life−long load was much more intense in addicts than in conditionally healthy individuals. It was noted that the differences in composite indices of each age period were statistically significant and strong by the effect. It was shown that the total stress load in addicts at the early age period was almost three times higher than in conditionally healthy persons, and in the older age period it was four times higher. The prospects for further research have been formulated to explore the relationship between early life stress and addiction formation.