ARTICLES ARCHIVE

This paper covers the basic current notions and views on the problem of maladaptation as a psychological phenomenon. Psychological manifestations of maladaptation and disadaptation are based on integrative influence of psychophysiological, psychological and social factors of the individual's consciousness, behavior, activity, communication and cognition. Adaptation disorders are closely stress−linked. The stressor, independently on its origin, causes similar nonspecific responses, specific consequences of those are determined by individual personal features. The main factors affecting the development of this group of disorders are described; the definitions and diagnostic criteria are provided in accordance with the main international classifications of diseases. Basic manifestations of symptoms of adaptation disorders, as well as basic approaches to therapy, based on psychotherapy and individual approaches to pharmacotherapy have been described. The psychotherapy is concluded to be basic pathogenetically oriented component. Choice of pharmacotherapy should always be individual and complement the psychotherapeutic activity.

To investigate the psychopathological constellations of the psychosmatic register in patients with occupational pathology of respiratory system and peripheral nervous system, 333 patients were clinically examined. The study used the Symptom Check List−90−Revised questionnaire. The dominance among the subjective symptoms of the manifestations of dysthymia, asthenic symptoms, insomnia, emotional lability, anxiety, apathetic manifestations, cognitive impairment and obsessions was revealed. In syndromological structure the anxiety−depressive, hypochondriacal, astheno−depressive, depressive and obsessive syndromes were prevailing. Patients with occupational pathology revealed high levels of somatization, interpersonal sensitivity, depression and anxiety, lower levels of obsessive−compulsive symptoms. These changes reflect the somatogenic effect on the psyche of distress caused by somatic dysfunction and the associated restriction of social functioning on the background of stable transformations of an affective sphere. The found features should be taken into account when developing the treatment and rehabilitation as well as preventive measures for an occupational pathology.

To study the cognitive functioning of adolescents with cerebral palsy and their dynamics during their rehabilitation using the Kozyavkin method, 73 patients aged from 14 to 17 years with various clinical forms of cerebral palsy were diagnosed with nonpsychotic mental disorders of residual organic origin: mild cognitive impairment (F06.7), organic emotionally labile disorder (F06.6). The following psychodiagnostic methods were used to assess the basic cognitive functions and intelligence of children: "Remembering 10 words", "Schulte Tables", and the Raven's progressive matrices. All the adolescents underwent a rehabilitation course using the neurophysiological rehabilitation system at the Kozyavkin International Rehabilitation Clinic. The results of the study indicate positive changes in the level of cognitive productivity of the patients with cerebral palsy during their rehabilitation, namely, the patients have an improvement in the functions of verbal memory, an increase in the volume and functions of switching, concentration and distribution of voluntary attention; stabilization of the level of mental performance; positive dynamics of non−verbal intelligence.

Endogenous mental disorders significantly impair the mental and social functioning of patients and their family environment. Mental and family maladaptations in family caregivers are influenced by intra−personal and interpersonal factors. Family caregivers (168 individuals) of the patients with paranoid schizophrenia and 75 family caregivers of the patients with affective disorders (bipolar affective disorder, recurrent depressive disorder) were examined. The Spielberger−Hanin test, Zung's depression scale, test for psychological diagnostics of coping mechanisms by E. Heim were used to investigate their psycho−emotional state. A tendency to a gradual decrease in anxiety−depressive psychopathological symptoms with an increasing duration of the disease in a mentally ill family member has been revealed. Family caregivers of the patients with schizophrenia and affective disorders show a reduced social intelligence across all constructs, which creates significant barriers to effective interpersonal family communication.

Recently there has been a downturn trend in the number of children with psychophysical developmental disabilities in Ukraine due to environmental, biological, socio−psychological and other factors. Therefore, approbation and application of techniques that will contribute to the early detection of developmental delays and disabilities is relevant, as timely assistance to such children is important to maximize their overall development and further socialization in society. To determine the overall development of children in the first three years of life using the Age and Stage Developmental Screening (ASQ−3), a study was conducted at the State Institution of Children and Adolescent Health of the National Academy of Medical Sciences of Ukraine and Charitable Foundation for Early Intervention Institute (Kharkiv), which comprised 1,610 children aged from 2 to 36 months. Screening assessment of overall development of children has allowed to establish that one third of the surveyed children need further observation and orientation for in−depth assessment of development. Gender peculiarities of developmental disorders in young children were determined, namely the indices of the level of disorders were significantly more frequently recorded in boys than in girls. The features of age dynamics of the signs of developmental disorders in young children have been established. The necessity to introduce into the practical physicians and psychologists of the screening assessment of early childhood development, which will allow timely identification of these problems and provide developmental assistance to the child, prevent the occurrence of secondary deviations in its development, ensure maximum implementation of opportunities, increase the level of social adaptation, as well as normalize the family life.

Living in a forced displacement and under the effect of other chronic stressors has a negative impact on the adaptive mechanisms of persons leaving the zones of the Joint Forces Operation. In order to study the psycho−emotional state of pregnant women and the ones who have premature infants, babies with pathology and newborns being in a serious condition after delivery, temporarily displaced from Luhansk and Donetsk regions, and also continue to reside in the Joint Forces Operation area, 74 women were examined. Clinical−anamnestic, clinical−psychopathological, socio−demographic, psychodiagnostic and mathematical−statistical methods were used in the research. Women were most often diagnosed with the disturbances of anxious, phobic, depressive and asthenic−neurotic spectrum, which made it possible to form a syndromic structure of disturbances, i. e. in most of them there were monosymptomatic disturbances of the emotional sphere, and in some of the surveyed there were found quite pronounced phobia syndromes with neurotic or anxiety−depressive components. It was noted that at the beginning of the war in the East of Ukraine, the women who left the area of the Joint Forces Operation were characterized with an expressed anxiety and fears about the health and lives of the loved ones who remained there. But in the second half of 2017 and in 2018, long−term inpatients with a pregnancy complication and / or preterm or severely ill health were already dominated by the pregnancy and childbearing fears only, though there were more complaints of a social nature (financial factor, housing problems, etc.). Thus, over time, the women's psyche adapted to hostilities and a sense of motherhood was dominating.

Origin and development mechanisms of hypochondrial personality disorders under psychosomatic interpretations and basic psychodiagnostic approaches to the study of this phenomenon are considered. The list of symptomatic features of the disorder under conditions of differential similarity and differences of the control and experimental groups is indicated. The development etiology of hypochondriacal nosologies in the group examined when they were performing the professional duties was analyzed. Emphasis is placed on the transformation of their life values and determination of future priorities in the case of pathogenetic action of suggestion on complaints of dysfunction of one's health. The combined approach in coverage of the main directions of psychodiagnostics and treatment of hypochondria as a mechanism of psychological burnout of a person is used. Complexity of coverage of the basic principles of diagnostics is characterized by multimodality of the methods of collecting information on the etiology of the disease, in the context of which the ability to integrate the information obtained by different methods is taken into account. In particular, the focus is on identifying a number of determinants of the development of these pathogenic phenomena, i. e. biological (biochemical, neurophysiological, psychophysiological sphere), psychological (internal individual experiences and human behavior), social (specificity of interpersonal interaction in society), and environmental).

Recently the personality type D (distressor) has been referred to a chronic type of risk factors of the development of cardiovascular disease. To establish a link between the distressor personality type and course of primary arterial hypertension in adolescents, 7 girls and 27 boys, aged 11�17 and being under inpatient treatment, were examined. The psychological study included the determination of reactive and personality anxiety using the Spielberger �� Hanin test, alexithymia was examined using the Toronto Mindfulness Scale, depression level was found with the Zung's test, DS−14 test was used to establish personality type D, as well the SF−36 quality of life was assessed. Significantly more often type D personality was detected in girls. In boys with the type D personality an average daily systolic blood pressure was significantly lower than in other patients. Teenagers with the personality type were strongly below the mean of the SF−36 "Physical Function", "Role Function", "Pain", "Viability" and "Social Function" scales, as well as significantly higher were reactive and personality anxieties and alexithymia. During this study, the following has been concluded, namely, the type D personality was more common in girls with primary arterial hypertension, in boys it was basically combined with a labile form of the disease. In patients with type D personality there was revealed a high reactive and personality anxiety, alexithymia, low quality of life indices were noted. The results obtained should be taken into account when developing the measures for psycho−correction of adolescents with a primary arterial hypertension.

In the face of a prolonged military conflict in Ukraine, the problem of internal migration and its associated social, economic and medical consequences is a particularly acute. Due to a high risk of psychopathological disorders in internally displaced persons, the question of investigating the peculiarities of their mental state, in particular, the structure of existing mental pathology, is crucial for the organization of providing them with an effective assistance and rehabilitation. To study the peculiarities of the mental state of internally displaced persons and to determine the spectrum of their psychopathological disorders, 155 persons were under screening in places of their temporary residence, as well as there were clinically and psychopathologically examined 68 patients who asked for a help and were hospitalized for an inpatient care. Based on the results of screening, it was found that internally displaced persons are at a high risk of developing psychopathological disorders of preclinical and clinical levels. The structure of psychopathological disorders of internally displaced persons shows clear signs of post−traumatic stress disorder, anxiety, depression and somatoform disorders from mild to severe grades. The results of the study make it possible to classify the internally displaced persons into five groups according to an assessment of their mental state and a need for psychological and psychiatric care. Creation and application of differentiated approaches in carrying out the psychoprophylaxis and psycho−corrective actions is necessary for the most complete restoration of the mental state of internally displaced persons, as well as for increasing their adaptation resources.

A high level of neuroticism causes a low productivity and for students it means−low learning success, conflict, depression. In order to study the level of neuroticism in diagnosis of non−psychotic mental disorders in students of the institutions of higher education, 1,235 students were comprehensively surveyed. There were used the methods as follows: clinical, clinical and psychopathological, clinical and epidemiological, clinical and anamnestic, experimental, psychological and statistical ones. A primary survey revealed a high level of neuroticism in 15,63 % of students. In the main group, high levels of neuroticism were diagnosed in 47,63 % of persons, if compared to 4,57 % (p < 0,05), which indicates a notably higher level of neuroticism in young people with non−psychotic psychiatric disorders. Analyzing the gender characteristics of neuroticism, we found high levels of neuroticism in 60 boys (16,44 %) and 133 (15,29 %) girls. The highest number of people with high levels of neuroticism was found at the fourth; the lowest at in the second year of studying. Taking into account a high importance of neuroticism in the formation of non−psychotic psychiatric disorders, screening is recommended to identify clinically relevant levels of neuroticism for young adults during routine medical examinations.

The study identified the structure and types of disease response and adaptive / maladaptive indices in patients with schizoaffective disorder and affective disorders in remission / intermissions and they were comparatively analyzed. The distribution of disease response by structure revealed its "pure", "mixed" and "diffuse" types. In schizoaffective disorder, anxious−egocentric, egocentric−ergopathic, and ergopathic−anosognosis types predominate; harmonic, sensitive, and melancholic types are more characteristic of schizoaffective disorder. It has been noted that patients have a reserve of personal adaptive capacity that can be used to reduce a maladaptation and improve social adaptation. The characteristics of a response to the disease and the adaptability / maladaptive indices in the period of remission / intermissions are a sign of persistent post−manifested patho−personal transformations and have nosospecific differences that can be used as the components when developing the differential diagnostic algorithm and psychocorrectional programs.

To study the features of social functioning of patients with mixed dementia, complicated by hallucinatory−paranoid disorders, 133 persons were examined. The research used a comprehensive approach, which provided a clinical and psychopathological method, supplemented with the scales GAF, WHO (DAS), BADL, BEHAVE−AD. The findings showed that the magnitude of the overall social functioning of patients corresponded to a range of disorders varying from a marked impairment of functioning in the social and occupational spheres to the need for monitoring to maintain the minimal personal activity. The pronounced negative influence of psychotic disorders on the functions of self−care, communication, efficiency and necessity of family activity and level of participation in household affairs, efficiency and necessity in fulfilling the parental role, on the level of interest and awareness was established. It has been shown that most caregivers of patients with mixed dementia, complicated by hallucinatory−paranoid disorders, were characterized with a low family support and moderate and severe concern about patients' psychopathological symptoms. The data obtained will enable to develop the personalized approaches to psychosocial rehabilitation of patients with this pathology.

In order to assess the informative attitude of the respondents to the topics concerning their mental status, 97 patients with diagnoses of depressive episode (F32) and recurrent depressive disorder (F33) were surveyed as markers for the diagnosis of depressive disorders. Clinical psychopathological, psychometric (Zung, HADS, Spielberger �� Hanin tests, AUDIT and Derogatis questionnaire) methods were used in the work. The pathophysiological study was carried out using the software−hardware complex "Reocom−Stres" ("KhAI−Medica", Kharkiv) in the "Attitude to the Mode" mode with the registration of psychophysiological response to the question groups (thematic groups) contained in psychometric methods. All the described methods were applied twice during the study: with an interval of 17�19 days. Attitude (involuntary psychophysiological response of respondents to topics related to their mental status) is shown to be a valuable source of information, in particular, for the diagnosis of depressive disorders and quality control of patients with this pathology. It was shown that among the thematic groups, the highest diagnostic value had at the beginning of inpatient treatment the question of the Derogatis questionnaire, and at the end of the question (approval) of the Spielberger �� Hanin test.

The relevance of psychotherapy assistance to women and girls affected by gender−based violence has increased over the past six years as a result of hostilities in Eastern Ukraine. In this regard, 64 women, aged 19�53, affected by gender−based violence, diagnosed with neurotic disorders, were screened. The experimental and psychological study included the following methods: Spielberger �� Hanin scale, Eysenck questionnaire, Thomas test, Hamilton scale, health−activity−mood test. The results of the study showed that the affected women had predominantly neurasthenic syndrome, combined dysomonic syndrome, anxiety−phobic disorder, somatoform autonomic dysfunction. The combined psychotherapy was focused at increasing the possibility of marital adaptation of women and sexual partners, attracting them and family members to express their emotions and feelings, emphasizing the strong personality traits, leveling the damaging factor of neurotic disorder, emergence of new opportunities for communication, appearance of sexual communication, prevention of recurrent gender−based violence.

The relevance of the study is explained by the fact that in Ukraine there is a constant growth of suicidal manifestations and actions, including those among cancer patients. In order to study the effect of psychopathological phenomenology of patients, the formation of neurotic psychiatric disorders in them 104 patients with suicidal tendencies were examined. The study evaluated the suicidal risk according to the Back Scale for Suicide Ideation, there were used structured diagnostic interviews of patients, the Spielberger−Hanin scale, Zung depression scale, the study of accentuation of personality according to the method of Leonhard−Schmieschek. In psychopathological symptoms, neurotic disorders such as neurasthenic syndrome, sleep disorders, depressive syndrome, mixed anxiety and depressive disorders are much more frequently identified. Performed personality−oriented psychotherapy in cancer patients focused on current tasks and increasing the resources of the patient's personality, formation of basic coping strategies to solve the problem and support the social environment, minimizing the formation of a coping strategy on problem avoidance type.

Over the six years of military conflict in the East of our country, along with the improvement of the Armed Forces of Ukraine, the services of moral and psychological support of military personnel have been developed. Changes from a peaceful to a military system have affected all the aspects of social life, including scientific and practical psychology, i. e. societal, social and medical. The purpose of this study was to analyze the existing system of providing medical and psychological assistance in the Armed Forces, to determine the priority directions of its development and problematic issues of the organization. The study was based on regulations of national, sectoral and departmental origin and related materials adopted by the North Atlantic Treaty Organization (NATO). The system of medical and psychological rehabilitation is a set of organizational−managerial, psychological, psychophysiological, social measures aimed at restoration, correction or compensation of the disturbed mental functions of the states, personal and social status of servicemen, carried out by units, institutions of health care together with all involved services and structural units of the Defense Forces and the civilian health care system. It is concluded that in the Armed Forces this system is in a state of dynamic development according to the time demands. It is emphasized that in order to ensure the consistency of rendering medical and psychological assistance to the servicemen, the clinical routes of the patient and the volume of medical as well as diagnostic measures should be developed and implemented in accordance with the logistical and personnel support. The future development of the service is to develop and implement the protocols for medical and psychological care in accordance with the NATO standards.

The genesis of psychopathological symptoms in individuals with opioid dependence and long−term systemic parenteral use of narcotic agents is a complicated combination of pathological factors, namely exogenous, organic, pathological and psychogenic aspects. This leads not only to difficulties in tracing the pathogenesis of psychopathological symptoms and their complexes, but also causes atypical character of their clinical manifestations, which requires a detailed study in the perspective of pathoplastic modification analysis. To determine the features of pathoplastic modification of psychopathological symptoms in persons undergoing a substitution maintenance therapy, the patients with a diagnosis of "Psychiatric and behavioral disorders caused by addiction" were examined using anamnestic, clinical, psychopathological and psychodiagnostic methods according to the ICD−10−CM Code F11.22. As our results show, the levels of manifestation of psychopathological symptoms were established and ranked, which are organized into three classes of symptoms, they are pathoactive, pseudoneurotic, psychoorganic ones. The factors of pathoplastic modification of symptoms have been established as follows: psychoorganic disorders, distortions of psychic and psychosomatic (psychovegetative) reactions, somatic and psycho−vegetative manifestations of abstinence, secondary personality distortions, social disadaptation, loss of critical attitude to manifestations of addiction.

In order to identify the early signs of alcohol dependence, the patterns of current malignant variants of the disease, search for the necessary measures of early reconstruction and prevention, the results of the pathopsychological examination of three groups of vocational students aged 15�19 years, reflecting the stages of formation of alcohol addiction, as well as the group of young people aged 21�33 were analyzed. There were applied the following tests and questionnaires: MMSE, AUDIT, SADQ, SCL−90−R, a Test of Lazarus' Stress and Coping Model. It was found that in all surveyed groups the indices of cognitive functioning at the level of pre−dementia were reduced, while in the group of adolescents who have certain signs of alcohol dependence, they were significantly lower than in the group of abstinent individuals. The AUDIT test and SADQ questionnaire are already responsive in the early preclinical stages of alcohol addiction formation, although their rates are within normal limits. Adolescents with certain signs of alcohol dependence are characterized by the lowest average index of overall cognitive functioning, the highest intensity of coping strategies "Confrontation" and "Escape, avoidance", they have reduced self−control, which may reflect their desire for self−assertion, searching for their own self−esteem opportunities and resources. Patients with alcohol dependence at a young age are characterized by significantly higher rates of psychopathological symptoms due to the long−term negative effects of alcohol intoxication. Thus, the system of early reconstruction and prevention of alcohol dependence can rely on multidisciplinary teams and changing the format of educational events in educational institutions.