LAST EDITION

In obstetric and gynecological practice, psychological help becomes important in a complex of medical, psychological and psychosocial measures. In the publication conducted a clinical-psychological analysis of the psychological state of women in the medical practice of obstetrics and gynecology and to develop a medical-psychological passport to assess the clinical-psychological status of patients in terms of planning and organizing psychological help and psychoprophylaxis. Materials and methods. Conducted content analysis of the publications presented in the "Resources of the National Library of Ukraine», PubMed, ScienceDirect, Medscape, Directory of Open Access Books, Google Scholar, OpenDOAR during 2009-2019 years, concerning aspects of psychological reactions and clinical-psychological phenomena, formation and disadaptation to physiological or pathological conditions associated with obstetric and gynecological pathology in medical practice. Results. It is determined that in gynecological practice, disorders in patients occur not only in the reproductive, but also in the somatic, sexual and mental spheres. Somatogenic and psychogenic factors are involved in the formation of the psychological reaction to the gynecological disease, the combination of which determines the peculiarities of the patient's state. The defeat of the sexual sphere and especially the reproductive function of women at the psychological level is closely related to the perception of femininity, attractiveness, motherhood, socio-role expectations for the realization of the biological role. The main psychological problems associated with gynecological diseases include psycho-emotional distress, tension in the relationship with a partner, spouse, fear of losing a partner, fear of negative consequences after abortion, self-perception, self-esteem, low self-esteem, feelings of inferiority, unattractiveness, sexual disorders, socio-role disorders, reduced quality of life, reduced social status, gender identity disorders. The psychological state and reactions of gynecological patients determine the need for special communicative approaches to interact with patients during diagnosis (collection of complaints, anamnesis, gynecological examination) and treatment. Pregnancy is an important stage in a woman's life, accompanied with significant physiological, psychosocial and psychological changes. The criteria for assessing the psychological state of a woman during pregnancy are identified: planning, desirability, state of physical health, mental health, support from a partner, support from a social environment, the presence of children, obstetric and/or gynecological pathology in anamnesis, financial and living conditions. Like medical periodization, each trimester has its own defining psychological features and typical experiences. Conclusions. The organization of medical-psychological help in obstetrics and gynecology should include the permanent presence of a mental health specialist in gynecological departments, women's clinics, maternity hospitals to ensure the availability of specialists and the possibility of its delegation after medical examination of patients. The medical-psychological passport in obstetrics and gynecology is actually a tool that determines the key clinical situations, criteria for assessing the psychological status of patients and practical algorithms for communication and interaction in this area of medical practice.

Throughout life, everyone is faced with a variety of emotionally complex situations. For a woman, one of such situations is pregnancy - a very strong level of experience and a specific set of sensations in life, the study of which has recently received increasing attention. Circumstances that have developed in Ukraine in connection with environmental disadvantages mainly determine the low health index of pregnant women, which creates the preconditions for an increase in the frequency of premature pregnancies in future generations. This problem is of great medical and social importance. More than a third of babies born prematurely lag in physical and psychomotor development. Given the above, it can be argued that the creation of a system of medical and psychological support for pregnant women at risk of preterm birth in the last trimester of pregnancy is relevant, necessary and timely. The purpose of the study - based on a systematic approach to the study of individual psychological, pathopsychological and psychosocial characteristics of women at risk of preterm birth in the last trimester of pregnancy and after childbirth, to develop a set of measures for their medical and psychological support. Materials and methods. On the basis of Storozhynets Central District Hospital in Chernivtsi region, a study was conducted during 2016-2019. 150 pregnant women in the third trimester of pregnancy (23-37 weeks) and their husbands were examined. The main group (MG) - 120 women with the risk of premature birth in the last trimester of pregnancy. The comparison group (CG) - 30 women with physiological pregnancy. Results and discussion. Analysis of the evaluation of the developed system of medical and psychological support of the family during pregnancy showed the following (p<0,001): a) improvement of psycho-emotional state, well-being and overcoming emotional stress demonstrated by women MTG1 (up to 43.7 ± 0.8 and 42.5 ± 1.5, respectively, and after 20.8 ± 1.5 and 22.1 ± 1.2, respectively), the level of depression and anxiety on the Hamilton scale (up to HDRS 11.4 ± 1.2 and HARS 12.5 ± 1.2 after HDRS 4.2 ± 0.4 and HARS 5.7 ± 0.4) and female MTG2 indicators of RT and PT on the Spielberger-Khanin scale (up to 51.7 ± 0.8 and 50.7 ± 1.5, respectively, and after 21.4 ± 1.8 and 23.1 ± 1.5, respectively), the level of depression and anxiety on the Hamilton scale (up to HDRS 16.3 ± 1.2 and HARS 18.3 ± 1.2 after HDRS 7.6 ± 0.7 and HARS 6.9 ± 0.6). Among women CG indicators RT and PT on the Spielberger-Khanin scale (up to 47.7 ± 0.8 and 46.6 ± 1.5, respectively; after 45.8 ± 1.5 and 42.1 ± 1.2, respectively), the level of depression and anxiety on the Hamilton scale (before HDRS 13.8 ± 1.2 and HARS 15.4 ± 1.2; after HDRS 12.2 ± 0.4 and HARS 14.7 ± 0.4) were higher. b) among women MTG1 and MTG2 there was an increase in the level of social support on the last two scales - "support of colleagues" and "support of public organizations" (up to 25.3%, after 55.2% / up to 14.8%, after 45, 2%, respectively) compared with women CG (up to 18.5%, after 24.5%). c) in the majority of women MTG1 (83.3%) and MTG2 (75%) there was a complete reduction of the deformation of marital relations, in contrast to the examined CG. Conclusions. The implementation of a system of medical and psychological support for women at risk of preterm birth in the last trimester of pregnancy and after childbirth allowed to optimize the choice of adequate behavioral strategies in the family, improve emotional state and well-being, optimize women's attitudes to pregnancy and harmonize family interaction (72.5%). p<0.001), to harmonize the relationship in the triad "mother - child - father" in the postpartum period (66.4%) (p<0.001).

Relevance. Acute disorders of the coronary and cerebral circulation occupy a significant place among the pathology of the cardiovascular system. Now there are opportunities to urgently get rid of their fatal influence. Such manipulations as coronary artery bypass grafting, stenting, thrombolytic therapy allow to some extent to permanently solve the problem of coronary and cerebral circulation disorders. But both the most urgent conditions and their treatment leave traces on the patient's mental sphere, causing mental disorders. Influence is exerted by both real and far-fetched further threats to the patient, the development of various restrictions in the spheres of life. In the future, severe relapses and complications associated with disorders of the coronary and cerebral circulation often occur. Purpose of the study. The actual research is aimed at studying the characteristics of the impact of the stress state of the postponed acute disorders of the coronary and cerebral circulation on the further state of the mental sphere of the personality of patients. Materials and methods. The study involved: a) 168 patients with ischemic heart disease at the age of 55-65 years, of whom 64 underwent emergency CABG for occlusion of the coronary artery 54 - stenting of the coronary arteries for the same reason 50 - thrombolytic therapy; The comparison group consisted of 56 patients with uncomplicated ischemic heart disease; b) 114 patients with GB II - III Art. at the age of 55-65 years, of whom 59 underwent TIA with hospitalization. 55 patients with hypertension without complications constituted the comparison group. The study was conducted on an outpatient basis 30-45 days after discharge from the hospital. For the examination, we used clinical and pathological research, psycho-diagnostic using the following methods: the Spielberger-Khanin scale for determining personal and situational anxiety, the test "Diagnostics of Haim's coping strategies", the World Health Organization's quality of life questionnaire ("WHOQOL - 100"). The results were processed by statistical methods with the calculation of the degree of reliability. Research results. After suffering acute disorders of the coronary and cerebral circulation and therapy with coronary artery bypass grafting, stenting and thrombolytic therapy, patients were in a state of mental stress, which was confirmed by high levels of reactive and personal anxiety. This is due to both acute mental trauma during the development of acute disorders of the coronary and cerebral circulation, and the therapy itself. In addition, they have manifestations of a chronic stress state. This is due to the presence of threats of repeated acute circulatory disorders and complications. The most pronounced stress states were found during thrombolytic therapy. After the treatment of acute disorders of the coronary and cerebral circulation, the presence of maladjustment phenomena was found in patients, the most pronounced after the thrombolytic therapy. This is due to the presence of a stressful state, the need to abandon the usual coping strategies and master new (adaptive, compensatory) strategies. The main factors in the development of maladjustment phenomena are states of frustration, which become the basis for a chronic stress state. The presence of a stressful state and the phenomenon of maladjustment significantly worsen the quality of life after the treatment of acute disorders of the coronary and cerebral circulation and change the significance of the studied areas of life for the personality. The presence of mental changes after therapy indicates the need for psychocorrection. An approximate necessary scheme of psychocorrection is given, taking into account individual personal characteristics and manifestations, which allows to significantly level mental changes. Further research should be aimed at studying the methods of psychological protection and the individualization of methods of psychocorrection

Based on the results of clinical and psychopathological, psychometric and psychodiagnostic examination of 252 women with depressive disorders (94 people with psychogenic, 83 women with endogenous and 75 patients with organic depression), of which 48 women had no signs of psychosocial maladaptation, and 204 other patients had macro-, meso- and microsocial maladaptation of various severity, the system of personalized psychodiagnostics and rehabilitation of women with psychosocial maladaptation and depressive disorders has been substantiated and developed. The specified system, combined with heredity, etiopathogenetic orientation and complexity of measures, is individually oriented, and takes into account the peculiarities of psychosocial maladaptation of women with signs of depressive disorders in various fields. The system consists of two stages - psychodiagnostic and psychocorrectional, each of which is structured into diagnostic and corrective measures depending on the area in which psychosocial maladaptation is detected, and the degree of maladaptation in each of the areas. The structure of the stages is standardized, which makes the proposed system suitable for use at the initial stage of providing medical care, and the content of measures is individualized, which ensures maximum targeting and effectiveness of psychocorrectional measures.

The purpose of the work: based on the identification of clinical manifestations and patterns of formation of psychological maladaptation of servicemen - participants in military actions with traumatic injuries of the main vessels of the extremities, to develop a set of psychocorrection measures for this category of patients. To achieve this goal, during 2018-2019 on the basis of the Military Medical Clinical Center of the Northern region, 150 combatants who were receiving treatment there after participating in military actions were examined. The main group consisted of 120 people who had traumatic injuries of the main vessels of the extremities, and the comparison group included 30 servicemen without somatic combat injuries. According to the criterion of the extent of surgical interventions, the patients of the main group were divided into two subgroups: Main group 1 consisted of 60 wounded patients with traumatic injuries of the main vessels of the extremities, who managed to save the injured limb after surgery; Main group 2 included 60 wounded people with traumatic injuries of the main vessels of the extremities, which led to amputation of the extremities. The study used clinical-psychological, psychodiagnostic and statistical methods. The study has substantiated the structural-dynamic model of the continuum of post-stress psychological maladaptation in combatants who received combat injuries of the main vessels of the extremities, based on which a set of measures for psychocorrection of psychological maladaptation of combatants who received injuries of the main vessels of the extremities. The developed complex consisted of 6 stages, most of which were universal and were aimed at working with servicemen, regardless of the extent of surgical interventions. At the initial stage, measures were taken to form motivation to participate in psychocorrection and psycho-educational preparation for it was carried out. The general clinical and psychological stage was devoted to the reduction of psychopathological symptoms and processing of psychotraumatic experience gained through injuries and participation in military actions. The general stress-protective phase included measures aimed at activating personal stress-protective resources for the adaptation of servicemen, and gradually moved to a specifically-differentiated adaptive phase, in which special attention was paid to working with servicemen who lost limbs, which was done to adapt the combatant to the consequences of surgical intervention, formation of adequate self-attitude and skills of social and interpersonal communication in new living conditions. The evaluation of effectiveness, conducted at the end of psychocorrection, showed a significant improvement in the psycho-emotional state and quality of life of the servicemen who participated in the activities, compared with the control group.

The purpose of the work is to substantiate and develop measures for medical and psychological correction of marital dysfunction in patients with chronic prostatitis (CP), and to assess their effectiveness. 109 men with CP and their wives were examined. According to the criterion of presence / absence of marital satisfaction, the surveyed couples were divided into two groups. The first group included 73 (67.0%) couples with low or low levels of marital satisfaction. The second included 36 (33.0%) married couples who were satisfied with their own relationship. The comprehensive examination included, in addition to standard clinical methods, sexological, clinical-psychological and psychodiagnostic studies. Among couples with a lack of marital satisfaction, 24 couples with continuous marital dysfunction, with a rod lesion of its socio-psychological and psychological components, in the other 49 couples with a partial marital dysfunction, the rod was the defeat of the biological component due to male CP. We have proposed measures of psychocorrection, differentiated depending on the degree of marital dysfunction for families of men with CP. Psycho-correctional interventions should be implemented in three blocks: 1) the formation of new psychological attitudes (the stage of compliance and psycho-educational stage); 2) reduction of psychopathological symptoms and restoration of sexual marital communication (stages of individual and pair work); 3) final deactualization of psycho-traumatic factors and consolidation of new skills of adaptive marital functioning (stage of homework and consolidating stage). The personification of medical and psychological interventions is that, after the deactualization and reduction of anxious-depressive signs of response to CP and deformation of marital interaction, with a continuous violation of marital functioning comes to the fore work on normalization of interpersonal and personal patterns of spouses. partial violation of marital functioning is based on the leveling of physiological (biological) consequences of CP, and interpersonal and individual psychological optimization occurs against the background of normalization of biological parameters. The introduction of this set of measures of medical and psychological care has improved marital satisfaction in 62.5% of couples with a continuous violation of marital functioning and in 77.6% of couples with a partial violation of it.

The functioning of the family changes after the diagnosis of severe somatic pathology in a patient, which is expressed in disorders of family, marital and child-parent interaction. Studies of families with a seriously ill patient reveal significant changes in the psycho-emotional state of patients' relatives. The high levels of mental stress and loss of physical health that accompany cancer determine the important role of the family in supporting and caring for cancer patients. Contingent and research methods. Based on informed consent in Medical-psychological center of Vinnitsa National Pirogov Memorial Medical University and Vinnytsa Regional Clinical Oncology Clinic during 2015-2019 years 288 cancer patients were examined: with women - 174 families, and men - 144. Respondents divided into subgroups depending on the stage of the cancer and the level of adaptation of the family system. At the stage of primary contact with oncological pathology there were 78 families of women (P1w) and 51 families of men (P1m), and in the period after the return of the disease (P2w) 96 and 63 families (P2m), respectively. Among the surveyed families, 55 were adaptive (A), 127 (M) were "border" and 106 (D) families classified as "disadapted". The following psychodiagnostic tools were used in the study: HADS, Family Anxiety Analysis Questionnaire, Family Adaptation and Cohesion Scale (FACES-3), Perceived Guilt Index (PGI), Love and Sympathy Scale by Rubin, Scale of Responsibility. Results. Factors of psychotraumatization of family members cancer patients included: an acute change in family life and lifestyle; transformation of family roles, responsibilities, rules as a result of illness in a loved one; confrontation with the threat of losing significant relationships; collision with one's own existential experiences; the patient has negative emotions and cognitions that are difficult to contain; lack of family resources to overcome the disease. Family cancer was a powerful stressor that affected family functioning and potentiated changes in marital relationships, perceptions of family events, and attitudes toward family responsibilities. The progression of the disease provoked changes in marital relations due to the growing challenges facing the family and the couple - increasing the need for effective and psycho-emotional support, redistribution of family roles. Family members of cancer patients experienced existential experiences, threats to interpersonal relationships, a change in the pattern of family functioning, negative psychosocial effects of the disease, difficulties in interpersonal communication, problems in fulfilling family roles, expectations for treatment and prognosis. Relatives of patients had high (clinical) and subclinical levels of anxiety, high levels of depression, "maladaptive" and "borderline" type of family system, high levels of family anxiety, emotional disturbances, low or high levels of duty, high severity of guilt. In providing psychological help for family cancer patients have shown effectiveness in solving psychological problems, family, cognitive-behavioral, problem-oriented, personality-centered psychotherapy, existential analysis and logotherapy, relaxation therapy, and psychoeducation. Conclusions. The diagnosis and continuation of cancer in the patient was extremely stressful for family members of the patient, which was expressed in a wide range of psycho-emotional reactions and psychopathological manifestations. Medical-psychological interventions for the family of a cancer patient is important components in a set of medical help measures in clinical practice.

The article presents the results of differentiated psychocorrectional work performed on a sample of civil servants (СS) (n=35) with states of psychological disadaptation and prevalence of anxiety-depressive symptoms. According to the psychotherapeutic and psychocorrectional model, CS were divided into 2 therapeutic groups - MG1a (n=15; 19.23%) and MG1b (n=20; 25.64%). Both groups provided medical and psychological assistance in the form of individual and/or group therapy. The results of the psychodiagnostic stage of the study with the interpretation of the psycho-emotional sphere are presented. The scheme of conducting the stage of differentiated psychocorrection with the substantiation of the choice of psychotherapeutic tactics (autogenous training, cognitive-behavioral therapy) is described. Respondents' self-assessment and statistical processing of data evaluated the effectiveness of psycho-corrective measures taken to select CS. It was found that the conducted stage of differentiated psychocorrection was effective at reducing anxiety symptoms and manifestations (p%%0.01) and reducing manifestations of psychological disadaptation (p<0.01). The average level of efficacy was determined when acting on depressive symptoms (p<0.05), due to the need for longer psychotherapy for this disorder.

Depressive disorders are one of the most pressing problems of modern psychiatry due to profound changes in the psyche and significant violations of the social functioning of patients. The aim of the work was to study the features of social support for patients with endogenous depressive disorders. 107 men and 138 women with depressive disorders (codes MKH-10 F 31.3, F 31.4, F 32.0, F 32.1, F 32.2, F 33.0, F 33.1, F 33.2) was clinically examined. The average age of the examined patients was 33.6±11.2 years, men 34.2±11.1 years, women 33.2±11.4 years, the average duration of the disease was 5.0±5.6 years (5.7±5.8 years and 4.5±5.4 years). Among the surveyed, three groups were identified: under the age of 30 years (38 men and 51 women), 30-44 years (46 men and 53 women), and 45 years and older (23 men and 34 women). The survey was conducted using the multidimensional scale of perception of social support and scales of depression and anxiety M. Hamilton. The study found low rates of social support in the examined patients; the indicators of social support in various spheres for men were significantly lower than for women: social support for the family – 1.40±0.94 points against 1.67±1.05 points (p=0.040), friends – 1,47±0.94 points against 1.89±1.16 points (p=0.004), significant others – 1.27±1.05 points against 1.59±1.10 points (p=0.023), the total social support – 4.14±2.17 points against 5.14±2.35 points (p=0.001). The lowest indicators of social support were significant others, which may be associated with impaired communication and deterioration of social functioning of patients during affective episodes and loss of social ties. The rates of social support of the family were slightly higher, which can be explained by family maladaptation and the destruction of families while maintaining the basic level of family support from close relatives. The highest rates of social support were friends, which may be associated with the formation of a small but stable microsocial circle in patients with depressive disorders. The study of social support taking into account the age of patients showed a tendency to decrease the indicators of social support in all areas with age. The indicator of social support of the family in the age group up to 30 years was 1.84±0.99 points, in the group 30-44 years – 1.48±0.94 points (p=0.010), in the group 45 years and older – 1.21±1.05 points (p=0.048); social support of friends – respectively 2.02±1.11 points, 1.71±1.12 points (p=0.043) and 1.21±0.82 points (p=0.011); social support of significant others – respectively 1.79±1.13 points, 1.40±1.08 points (p=0.027) and 1.00±0.85 points (p=0.029), the total indicator of social support – 5, 65±2.34 points, 4.60±2.20 points (p=0.002) and 3.42±1.81 points (p=0.002). Social support from family and friends differs more significantly when comparing groups 30-44 years and 45 years and older than when comparing groups under 30 years and 30-44 years, while for the indicator of social support from significant these differences are almost absent, which can be explained by the increase in psychopathological manifestations of depression with age and a decrease in the number of people from whom the patient can receive support. Correlation analysis found inverse correlations between depression and anxiety and social support. The least close correlation was found for family support (rS=-0.264 for depression and rS=-0.262 for anxiety), the largest – for social support from friends (rS=-0.463 and rS=-0.399, respectively), intermediate values were found for social support of significant others (rS=-0.370 and rS=-0.348 respectively). These patterns can be explained by the presence among the patient's family environment of a stable group of people who care about the patient and provide him with social support, regardless of the severity of affective manifestations. The severity of depressive and anxiety manifestations is significantly correlated with a decrease in social

The aim of the study was to study the structure of psychosocial maladaptation in internally displaced persons in the presence of non-psychotic mental disorders. 102 internally displaced persons from Donetsk, Luhansk oblasts and the Crimea who suffered from non-psychotic mental pathology and showed signs of psychosocial maladaptation were studied. A comprehensive examination with the use of clinical-psychopathological, psychodiagnostic, psychometric methods and a thorough and in-depth study of life history. For the diagnosis of various forms and severity of psychosocial maladaptation used "Scale of psychosocial maladaptation" L. Herasymenko, А. Skripnikov. The correlation between nosological features and the profile of psychosocial maladaptation is established. Anxiety-depressive disorder was dominated by adaptive disorders in the information sphere, in the medium and mild degree, as well as in the economic sphere, but with a predominance of severe maladaptation. Adaptation disorders correlated with the production type of maladaptation, which was expressed mainly in moderate severity, and with the information type, which was mostly in mild degree. Somatized disorder in most cases was represented by the production type of maladaptation, with a predominance of severe degree. PTSD was dominated by a correlation with the informational type of maladaptation, which accounted for the vast majority of all patients with this disorder, moreover, in the severe degree. Patients with neurasthenia correlated with a familial type of maladaptation with a predominance of moderate severity. Prolonged depressive reaction, respectively, correlated with the economic type of maladaptation with a predominance of severe degree. Thus, according to the results of the study, it was found that internally displaced persons with non-psychotic mental disorders were dominated by mixed variants of psychosocial maladaptation, the leading place among which was occupied by the information type of maladaptation.

The author proposes a psychological Model of Panic Disorder, which includes three mandatory elements. The first element is giving any event a pronounced negative meaning in relation to personality, health, life. The second element is the readiness for an arbitrary significant increase in emotional stress. The third element is to focus on certain physical sensations and functions of own body. Describing the first element, it should be emphasized that a negative meaning can be fixed for any previously neutrally perceived event. There is a fixation of a new meaning, its merging with the characteristic circumstances of life. So, a specific person or circumstance can be perceived as a triggering factor for a panic attack, but its occurrence is always based on the expectation of adverse consequences from a certain action performed by the patient. At its core, a panic attack is seen as one of the adaptive responses. Its feature is the avoidance of unwanted action. In fact, we are talking about creating conditions for a reasonable refusal from the active realization of own needs. All response energy is channeled into experience, emotional and vegetative responses, which are subjectively perceived as a reason for stopping. At the same time, a direct, open refusal from active behavior is not used in connection with a negative assessment of such an option in society, the inability to formulate one's need for help in socially acceptable ways. The readiness for an arbitrary significant increase in emotional stress is individually acquired and dynamically developed in the context of the corresponding culture. Such behavioral reactions, not accompanied by an action, lead to the consolidation of the skill of suppressing the relevance of the request formed by the circumstances. Increased attention to certain bodily sensations and the functioning of one's own body, becomes an invariable companion with this disease. The patient tries to constantly assess his condition and vital activity, paying attention to functions that traditionally do not require conscious control. Constant fixation of attention leads to an increase in internal tension. In fact, it is the repeated attempts to control involuntary functions that lead to the formation of a panic attack. It should be emphasized that the panic attack itself performs a protective function in relation to human health. It does not allow reaching a critical level of stress for health and thus protects the body from real danger. From our point of view, it is the subconscious control over the entire process of stress accumulation and its release that explains the absolute safety of the experienced reactions. The therapy is based on the possibility of creating a more effective model of behavior through the development of self-regulation skills and the formation of a conscious attitude towards individual avoidance reactions.

Pathopsychological features of stress-related disorders in survivors of military operations were studied in the course of present work. Combat mental trauma is a virtual operational diagnostic category that characterizes a new form of adaptation of the fighter to the requirements of a dangerous environment and explains the causes of adjustment disorders among servicemen. Combatant's mental trauma is the most important obstacle in the way of adapting combatants to military service in places of permanent dislocation and a peaceful life after discharge from the Armed Forces. Aim: to study the pathopsychological features of stress-related disorders in survivors of hostilities, as the basis of the system of medical and psychological support for combatants. In order to achieve this goal, in the Military Medical Center of the Northern Region was conducted a comprehensive survey of 112 servicemen of the Armed Forces, who took part in hostilities in the ATO/JFO zone, aged 25-55 years old, both sexes. Written informed consent by the principles of bioethics and deontology was obtained from all participants. Clinical psychopathological method, which was based on generally accepted approaches to psychiatric examination by interviewing, observation method, using diagnostic and research criteria ICD-10, and psycho-diagnostical method were used in the research. According to the results of the study, the clinical structure of stress-associated disorders in the examined patients is represented by post-traumatic stress disorder (35.6% of subjects), prolonged depressive reaction (23.1%), mixed anxiety-depressive reaction (27.5%), mixed behavioral and emotional disorder (13.8%). In military patients, the intensity of combat experience was 17.2 ± 5.3 points, found in a range of medium-high level and characterized by repeated prolonged situations of immediate life-threatening, observation of death and injury of comrades in combat actions. According to the Impact of Event Scale, the tested militaries have severe clinical manifestations of PTSD (62.3% of surveyed). The high level of impact of the traumatic event in the subjects was observed on all scales of PTSD: intrusion (51.2%), avoidance (47.9%) and physiological excitability (39.8%), which indicates the importance of excessive force of combat stress, as risk factor for the formation of stress-related disorders. According to the analysis of the severity of traumatic stress, 48.1% of respondents have a full manifestation of stress disorder, 35.2% have an obvious manifestation and 16.7% have a partial manifestation. The study of stress-coping behavior styles allowed to state the predominance of non-constructive forms of behavior: in 49.2% of examined patients were noted focus on avoidance coping strategies, in 33.4% - on distraction, in 11.6% - on emotions, in 5.8%, respectively - on solving problems. It is established that pathological psychological predictors of stress-related disorders are a high level of traumatic event, ultra-high strength of combat stress, ultra-high level of social frustration, prevalence of unconstructive forms of coping strategies. And the severity of psychopathological symptoms is determined by the severity of combat mental trauma.

One of the most dramatic medical and social consequences of depressive disorders is suicide. Modern research has shown that depressive disorders have the highest risk of suicide among all mental and behavioral disorders. Patients with depressive disorders are 30 times more likely to commit suicide, than people, who do not suffer from depression. Therefore, mortality among patients with depressive disorders is very high and insignificantly different from that for cardiovascular disease. The aim of the study: to develop and test personalized programs of psychotherapeutic support and prevention of suicidal behavior in patients with depressive disorders. Materials and methods of research. To achieve this goal in the Kharkiv Regional Clinical Psychiatric Hospital № 3 was conducted a comprehensive examination of 155 patients with depressive disorders, both sexes (86 females and 69 males) aged 25-65 years (mean age 43.0 ± 2.0 years), who were diagnosed with depressive disorders with signs of autoaggressive behavior. Informed consent by the principles of bioethics and deontology was obtained from all participants. The following methods were used in research: clinical psychopathological and psychodiagnostic. According to the study about severity of suicidal risk, suicidal attempts were made by 26.2% of patients with a depressive reaction, 25.3% with a depressive episode, 24.6% with recurrent depressive disorder and 23.9% with bipolar affective disorder with a persistent episode of major depression; suicidal decisions and intentions were observed in 35.6%, 32.9%, 43.2% and 39.6% of patients, respectively; passive and active suicidal thoughts occurred steadily in 38.2% of patients with a depressive reaction, 42.5% with a depressive episode, 32.2% with recurrent depressive disorder, and 36.5% with bipolar affective disorder with a continuous episode of major depression. A personalized program for psychotherapeutic support and prevention of suicidal behavior in patients with depressive disorders was developed and tested. It was based on the data obtained from research. Program was used simultaneously with pharmacotherapy. Psychotherapeutic program for patients with a depressive reaction included using of individual crisis psychotherapy, cognitive behavioral therapy by A. Beck, and biosuggestive therapy. In the depressive episode, the following were used: rational psychotherapy, individual and group cognitive behavioral therapy by A. Beck, personality oriented psychotherapy, existential therapy by C. Rogers. Rational psychotherapy, cognitive behavioral analytical psychotherapy according to D. McCullough, psychotonic variant of autogenic training and body-oriented psychotherapy were used in recurrent depressive disorder. Individual-oriented short-term psychodynamic psychotherapy, individual and group cognitive behavioral therapy by A. Beck, progressive muscle relaxation according to E. Jacobson, family psychotherapy were used in patients with a depressive episode of BPAD. The obligatory component of all psychotherapeutic programs was psychoeducation, which included using of: information training, training of interpersonal interaction, training "Psychological balance", discussion of the problem of suicidal behavior. A 1.5-year follow-up study confirmed the effectiveness of the developed differentiated programs of personalized psychotherapeutic support and prevention of suicidal behavior in patients.

The purpose of the work is to develop a technology for comprehensive risk assessment of the development of borderline mental disorders in sailors of long-distance voyages. During 2016-2019, 110 officers of the command staff of the Merchant Fleet, 90 workers of the Merchant Fleet, 70 representatives of the command unit of the Passenger-Carrying Fleet and 30 sailors of the Passenger-Carrying Fleet were examined. All surveyed people were men, citizens of Ukraine. The study included the use of clinical and psychopathological, psychometric and psychodiagnostic methods. As a result, the mechanism of clinical and pathogenetic interaction of psychopathological, predispositionbiological, stress and socio-psychological factors and their correlation in the mechanisms of development of borderline mental disorders in sailors of long-distance voyages has been found out, on the basis of which the technology of comprehensive risk assessment of their development has been substantiated. Stress, sociopsychological and predisposition-biological clusters that influence the development of psychopathological symptoms of borderline mental disorders have been identified and calculated, on the basis of which an evaluation scale is proposed to determine the probable severity of psychopathological symptoms in four main areas: somatization, obsessive-compulsive disorders, depression and anxiety. The developed technology can be used in health care practice to identify the contingent of risk for the development of psychopathological symptoms.

The purpose of the article was to carry out a comparative analysis of coping behavior strategies in civilians who have experienced psychosocial stress in a military conflict, to substantiate the differentiation of therapeutic approaches in providing specialized medical care. To achieve this goal, in accordance with the principles of bioethics and deontology, clinical, psychopathological and psychodiagnostic methods, 109 people who experienced psychosocial stress in a military conflict were examined. Group 1 (G1) included 6 wives of fallen servicemen; Group 2 (G2) included mothers, fathers and wives of combatants who returned to peaceful life - a total of 71 people; Group 3 (G3) consisted of 32 internally displaced persons (12 men and 20 women). All subjects were diagnosed with mental disorders of the F43.2 cluster - adaptive disorders. In the course of the work, it was found that the relatives of the fallen soldiers have higher indicators of constructive coping strategies (problem solving planning) and positive revaluation strategies (in which the death of a relative is considered a feat, a sacrifice made by a combatant to protect the state from external aggression) in comparison with other groups. Relatives of servicemen who have returned after participating in hostilities have shown a predominance of self-control strategies, problem solving planning, positive reassessment in search of social support, which may reflect adaptation to new conditions associated with the return of a relative from the front. The dominance of the strategy of problem solving planning has been revealed in internally displaced persons, which can be explained mainly by the influence of socio-psychological factors: the need to rely primarily on themselves, insufficient state support, indifference (and sometimes hostility) of the new environment; it is natural in this sense to combine this strategy with distancing and self-control. The identified features should be taken into account when developing treatment, rehabilitation and preventive measures for this contingent.

Background. The growing urgency of the problem of depression is due to their prevalence, the significant impact of the disease on quality of life and social functioning, as well as the highest level of mental disorders caused by suicides. According to statistics, more than 110 million people in the world suffer from depression, of which only 10 – 20 % seek specialized psychiatric care. Timely diagnosis of depressive disorders in many cases becomes a crucial condition for successful medical care, so research aimed at clarifying the differential clinical and psychopathological features of anxiety and depressive manifestations in patients with cognitive impairment in depressive disorders is relevant and will improve treatment criteria and improve diagnostic criteria. types of depression. The aim of the study was to determine the clinical and psychopathological features of anxiety and depressive manifestations in patients with cognitive impairment in depressive disorders. Materials and methods of research. 362 patients with cognitive impairment in depressive disorders were examined: 123 patients with recurrent depressive disorder (RDD), 141 patients with bipolar affective disorder (BAD) and 98 patients with prolonged depressive reaction (PDR). A set of research methods was used: clinical-psychopathological, psychometric and statistical. Results. Specific clinical and psychopathological features of anxiety and depressive manifestations in patients with cognitive impairment in different types of depressive disorders were established: a combination of apathetic-dynamic, astheno-energetic and anxiety symptoms; the predominance of high and severe levels of anxiety; representation of anxiety-depressive mood, signs of depression, guilt, somatic anxiety, weight loss, hypochondriac disorders and somato-autonomic symptoms were determined in patients with RDD. A combination of astheno-energetic, apathetic-dynamic and melancholic symptom complexes; the predominance of high and severe levels of anxiety; representation of depressed mood, subjective signs of depression, suicidal thoughts, agitation, tension, intellectual impairment, symptoms of derealization / depersonalization, daily fluctuations were determined in patients with BAD. A combination of anxiety and apathy-adynamic symptom complexes; the predominance of high and severe levels of anxiety; representation of mental and somatic anxiety, feelings of tension and fear, suicidal thoughts, autonomic symptoms and hypochondriac disorders were determined in patients with PDR. Conclusion. Clinical and psychopathological features of anxiety and depressive manifestations in patients with cognitive impairment in different types of depressive disorders, which can act as diagnostic criteria in the differential diagnosis of this group of patients, were determined.

The study aimed to investigate the effectiveness of cryopreserved cord blood serum (CCBS) in the acute phase of ischemic stroke (IS) for the prevention of cognitive and neurological deficits. The work was based on the materials of a comprehensive examination of 350 patients with the first of IS in the life on the 1st, 10th and 21st day of the disease. The criteria for selecting patients were: age from 46 to 79 years; the first in the life of IS with localization in the middle cerebral artery; hospitalization up to 24 hours from the onset of the disease; MRI results that ruled out intracranial haemorrhage or other non-ischemic brain damage. The severity of the condition and the degree of neurological deficit were determined using the stroke scale of the National Institutes of Health (NIHSS) with a score of 15 indicators, expressed in points in the first hours of the disease, in the dynamics of treatment on the 10th and 21st day. Depending on the prescribed drug therapy, all patients were randomly divided into two groups before treatment: the first (n = 175) – undifferentiated therapy + differentiated with the appointment of acetylsalicylic acid (ASA); the second (n = 175) – undifferentiated therapy + differentiated with the appointment of ASA, which was supplemented by the introduction of 1 ml of intravenous CCBS solution for ten days. Assessment of the clinical picture of IS showed that the complaints of patients at the onset of the disease were virtually absent in most individuals. Only 40 patients (11.3 %) complained of various types of cephalgia. At the same time, the headache most often had local character, mainly in the occipital area, was observed at the patients suffering from arterial hypertension. Objectively, the neurological status in 249 (71.1 %) patients was determined by central paresis of the facial nerves, and in 213 (60.8 %) – central paresis of the 12th pair. Motor disorders in the form of contralateral foci of central paresis and paralysis were observed in 260 (74.5 %) patients; signs of damage to the pyramidal tracts in the form of a revival of tendon and periosteal reflexes were found in 305 (87.1 %) of the examined, pathological grade marks – In 281 (80.4 %) patients. Sensitivity disorders in the form of hemihypesthesia were observed in 323 (92.4 %) individuals. Processes in the right hemisphere were accompanied by cortical disorders in the form of agnostic phenomena in 186 (53.0 %) patients. Violations of mild and moderate severity in the ratio close to 3.5:1 prevailed. The additional appointment of CCBS significantly inhibited the progress of aphatic and agnostic disorders (the difference between the groups was 9.4 %). In both groups, there was a tendency to the general improvement in the form of a decrease in the total clinical score in the 1st group from 16.33 ± 0.56 to 13.77 ± 0.74, and in the 2nd – from 16.74 ± 0, 44 to 11.68 ± 0.51. Decreased short-term auditory memory was observed in 17.9 % of patients in group 1 and 12.2 % in group 2. That is, patients who additionally received CCBS showed more positive dynamics of regression of neurological symptoms and inhibition of the progression of cognitive disorders during treatment. The study showed the additional inclusion of CCBS in the complex therapy of IS by 6.9 % increases the degree of recovery of neurological functions and inhibits the development of cognitive impairment by 7.3 %.

The article presents the results of an empirical research of the features of early maladaptive schemes and emotional states of drug addicts, as personality patterns of transformation of addicts. Objective of the research: to study the severity of early maladaptive schemes and basic emotional states of drug addicts. Materials and methods. Based on informed consent in compliance with the principles of bioethics and deontology during 2019-2020. a psychodiagnostic study was carried out on 102 male patients with drug addiction of the opioid group on the basis of the "Vertical" rehabilitation center at the age of 18-26 years, and 54 healthy males at the age of 18-27 years without signs of somatic, mental pathology and drug addiction. To diagnose early maladaptive schemes, the methodology "Diagnostics of early maladaptive schemes" (YSQ - S3R) was used in the adaptation of P. N. Kasyanik, E. V. Romanova; basic emotional states - methodology "Scale of differential emotions" K. Izard. Methods of mathematical Statistics (SPSS Statistics 21): A method for validating the differences between unrelated samples (Mann-Whitney U-test). Results of research. The formation of early maladaptive schemes of drug addicts occurs in childhood and is based on parent-child relationships, which carry only emotional coldness, rejection of the child, reduction of positive emotions, lack of acceptance and support. In the future, such relationships determine the accumulation of negative experience, which can act as a factor in the premorbid formation of addiction and certain styles of personality behavior in adulthood. For drug addicts, stable experiences of negative states of the emotional sphere are characteristic. Drug addicts compensate for the inability to control their own psychological state, to regulate emotional states by using psychoactive substances. Reduction of the emotional state of "shame" causes irrational behavior of drug addicts, the formation of which occurs in early childhood due to a defect in parent-child relationships and carries a traumatic relationship in which the child is forced to "suppress" his own aggressive feelings, feel constant frustration, receive false attitudes from parents. As a result of this upbringing scheme, the child accumulates negative experience, which, at the stage of growing up, turns into opposition and manifests itself in rebellious behavior, a "protest against socially acceptable norms" occurs, which determines the blocking of the aspect of consciousness of the Super Ego and brings to the fore the unconscious component, the main the purpose of which is to satisfy instinctive desires. This aspect of the psyche levels out the feeling of shame, which is observed in the study group, the degradation of the personality progresses in moral and spiritual terms. This destructive chain reaction is also fueled by the formation of false attitudes by drug addicts under the influence of society. The study of the emotional states of drug addicts complements the awareness of the holistic picture of the formation of addictive behavior, since emotional states and early maladaptive schemes are interrelated, since early maladaptive schemes are one of the predictors of the formation of the emotional sphere of a personality and later emotional states act as an actualizing factor in the activation of already formed early maladaptive schemes. Conclusions. The formation of early maladaptive schemes of drug addicts occurs in childhood and is based on parent-child relationships, which carry out only emotional coldness, rejection of the child, reduction of positive emotions, lack of acceptance and support. In the future, such relationships determine the accumulation of negative experience, which can act as a factor in the premorbid formation of addiction and certain styles of personality behavior in adulthood. For drug addicts, stable experiences of negative states of the emotional sphere of the individual are characteristic, which come

The article provides a theoretical analysis of the scientific literature on the problem of studying the phenomenon of "I-concept". Scientists have presented various conceptual theoretical positions, which allows us to consider the various components of the I-concept, and deepen the essence of this concept. An analysis of the views of the authors who studied the peculiarities of the formation of the professional "I-concept" of future lawyers, psychologists, teachers and others. There are isolated investigations of the professional identity of doctors and future nurses; psychological factors influencing the professional activity of medical staff and other scientific issues are analyzed, however, among the scientific achievements, there is no systematic analysis and study of the professional I-concept of the doctor, which led to the choice of research topic. Purpose: to present and substantiate the theoretical model of the professional "I-concept" of the doctor, to carry out the theoretical analysis of the content, structural components. Methods or methodology of the article: the general theoretical methods of literature analysis and the method of observation on the research problem are applied. The methodology of scientific work included methods of analysis, synthesis, induction / deduction and descriptive method. Results. Among scientists, the professional I-concept is defined by the following characteristics: 1) part of the structure of the general "I-concept"; 2) the ratio of personality development and professional development; 3) the system of ideas of the professional about himself as a subject of professional activity. The professional I-concept of a doctor, as a phenomenon that includes the idea of the individual about himself and his professional qualities, and is characterized by cognitive-emotional assessment of their professional knowledge, skills, the process of professional self-realization under the influence of subjective and objective factors. The author proposes a theoretical model of the professional I-concept of a doctor, which was based on the scientific concepts of both scientists and practical experience of doctors, as well as taking into account the neuropsychophysiological theory of emotions and theories of personality. Given the analysis of both personal and professional qualities of doctors, the peculiarities of their professional activities, the theoretical model of the professional I-concept of a doctor contains the following structural components: doctor's professional genesis, socio-psychological factors, professional I-concept of a doctor (cognitive, emotional-evaluation, behavioral, social components), self-esteem (I-real, I-ideal, I-mirror), professional roles, "I-image" of a doctor, "Acme-I-image" of the doctor. Socio-psychological factors of a doctor's professional activity are considered: 1) subjective factors (personal sphere of the doctor, the sphere of interaction "doctor - doctor / colleague", the sphere of interaction "doctor-patient"); 2) subjective-objective; 3) objective. Conclusions. The article considers theoretical approaches to the definition of the phenomenon of "I-concept" and the concept of "professional I-concept", which are presented through the cognitive-evaluative-value representation of the individual about himself. The definition of "professional I-concept of a doctor" is offered. The theoretical model of the professional I-concept of a doctor is presented, and its main components are analyzed. The content of cognitive, emotional-evaluation, behavioral and social components of the theoretical model of professional I-concept of a doctor is characterized.

The problem of behavioral level of predisposition, predication, genesis, nosospecificity of somatization and socio-psychological maladaptation of personality in the context of social and behavioral sciences is considered. The question of determining the interdependence of the phenomenology of learned helplessness, including its psycho-emotional and psychosomatic correlates, coping strategies, mechanisms of psychological protection, behavioral and attributive patterns in time and subjective control of personality-regulatory features and ways of processing conflicts in the system of adaptive possible. The phenomenology of learned helplessness is considered in the context of the development of the belief in the inability to process the unfavorable context of events that have personal meaning for a person, as a special form of learned verbal process due to psychological flexibility and attitude to the experience of helplessness. The question of predisposition of secondary psychosomatic neoplasms of social and psychological genesis is considered; mechanisms of psychosomatic illness; nosospecific manifestations of learned helplessness; predicative factors of somatization and socio-psychological maladaptation. The four-component structure of personal helplessness is analyzed.