No 90 (2024)
Psychotherapy
Comparison of clinical and psychological characteristics in patients with neurotic disorders who chose active and passive positions in psychotherapy. Part 3
Abstract
The relevance is determined by the need to assess the clinical, medical, and clinical-psychological changes of patients with neurotic disorders who make a passive and active choice in psychotherapy, which is currently one of the most challenging methodological tasks in evidence-based psychotherapy. The aim of the study is to conduct a comparative analysis of the clinical and psychological characteristics of patients with neurotic disorders who actively choose psychotherapeutic treatment
and take part in psychotherapy passively.
Methodology. The main methods used in the work were clinical and clinical-psychological. The present study describes the comparative dynamics of the clinical and psychological characteristics in patients who actively and passively choose psychotherapy and have undergone psychotherapeutic treatment.
Results and their analysis. The results of previous studies have shown that an active choice of psychotherapy as the primary method of assistance is more effective for patients, as evidenced by a reduction in symptom severity and most clinical-psychological characteristics. In patients who passively chose psychotherapy, despite a decrease in distress and improvement in several clinical-psychological characteristics, there was also a reduction in the level of “constructive aggression,” which led to a decreased desire to openly express emotional experiences, set, and pursue life goals. Such patients exhibited an increase in certain symptoms that contribute to interpersonal isolation and a decrease in the level of internality concerning their attitudes towards health and illness. This publication presents comparative data between two groups: patients who actively choose psychotherapy and those who choose psychotherapy passively.
Conclusion. The obtained data indicate the specificity of the dynamics of clinical and clinical-psychological characteristics and suggest a positive effect of the active choice of psychotherapy on the effectiveness of psychotherapy, as well as a greater adaptive value of neurotic symptoms aimed at managing interpersonal distance in patients who passively choose psychotherapy.
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Psychiatry and narcology
Factors of suicidal behavior in patients who have experienced a first psychotic episode
Abstract
Relevance and intention. Psychological rehabilitation of patients with a first psychotic episode remains relevant due to their young age, work capacity, and high rehabilitation potential. One of the severe and dramatic manifestations of the disease is the increased risk of suicidal behavior, associated not only with psychopathological experiences, but also with psychological stress from the fact of the disease, the need for long-term psychopharmacotherapy, and regular monitoring. Finding the most significant clinical, socio-demographic and psychological characteristics of patients with an increased risk of suicidal activity is the intention of this study.
Methodology. 139 patients were studied: 60 (43.2 %) men and 79 (56.8 %) women; average age 25.65 ± 0.53 years. Based on medical documentation analysis, two groups of patients were identified: those with suicidal risk (74 individuals) and those without suicidal risk (65 individuals). The collection of empirical material was carried out using the author’s structured interview, a battery of traditional pathopsychological tests, the A. Beck Depression Inventory (BDI), the Mini-Mult test questionnaire and the Ways of Coping Behavior (WCB). Mathematical and statistical data processing was carried out using SPSS v. 25.0 and Excel.2010.
Results and discussion. In the group of patients with suicidal risk, compared to patients without suicidal risk, the following clinical and socio-demographic characteristics are more common at a statistically significant level: young age (from 18 to 23 years), low educational level, diagnosis of schizotypal disorder, preserved criticism of their condition, a positive reaction to hospitalization in a psychiatric hospital, experience of psychotherapy before hospitalization, low social activity and difficulties in social adaptation, conflictual relationships in the family, the presence of traumatic events that preceded hospitalization, a peculiar appearance (tattoos, self-cuts); Also, among patients with an increased risk of suicide, psychological characteristics are more pronounced: instability of active attention, a complex of personal and behavioral traits measured by the scales “hypochondria”, “depression”, “hysteria”, “psychopathy”, and “psychasthenia” (Mini-Mult), “confrontation” and “distancing” (WCB). Conclusion. The study revealed statistically significant differences in several clinical, socio-demographic, and psychological parameters between patients who experienced a first psychotic episode with and without suicidal risk. Based on these findings, plans are underway to develop primary directions for psycho-prophylactic and socio-rehabilitative work with patients who have experienced a first psychotic episode.
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Indicators of mental disorders among military personnel of the Russian Ministry of Defense serving under contract (2009–2021)
Abstract
Introduction. The professional activity of military personnel serving under contract is considered extreme, often associated with excessive emotional stress, which increases the risk of developing mental disorders.
The intention is to assess the dynamics of mental disorder development among military personnel serving under contract with the Russian Ministry of Defense over a 13-year period from 2009 to 2021.
Methodology. The research subject consisted of the primary morbidity rates among military personnel of the Russian Ministry of Defense serving under contract (officers, warrant officers, sergeants major, sergeants, and privates). Data from open annual statistical compilations “Indicators of the Health Status of Military Personnel of the Armed Forces of the Russian Federation, as well as the Activities of Military Medical Units, Parts, and Organizations” were used. The indicators of mental disorders among military personnel were assessed per 10,000 people (×10−4). Nosologies were correlated with V Chapter Mental and behavioural disorders International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The average annual levels are indicated in the form of mean arithmetic indicators and their errors (M ± m).
Results and analysis. The level of primary morbidity due to mental disorders among contract military personnel was (25.93 ± 1.12) ∙ 10−4 with a share of 0.5 % of the total primary morbidity across 19 classes of diseases according to ICD-10. Generally, a trend of decreasing morbidity across all nosological groups was noted. The level of primary morbidity due to mental disorders among contract military personnel in 2011–2021 was statistically significantly lower (p < 0.001) than that of the adult working-age population. The first rank of significance for mental disorders was composed of indicators of neurotic, stress-related, and somatoform disorders with a level of (15.74 ± 0.80) ∙ 10−4 and a share of 60.8% of the structure, the second rank – mental and behavioral disorders due to psychoactive substance use – (4.35 ± 0.60) ∙ 10−4 and 16.8%, the third rank – organic, including symptomatic, mental disorders – (1.56 ± 0.37) ∙ 10−4 and 6.0 % respectively. The cumulative specific weight of cases for the aforementioned reasons of primary morbidity due to mental disorders among contract military personnel amounted to 83.6 %.
Conclusion. The implementation of targeted, based on the prevailing mental disorders, and differentiated (taking into account the category of military personnel) psychoprophylactic measures not only allows for the preservation of the mental health of military personnel serving under contract in the Armed Forces of the Russian Federation but also extends their professional longevity.
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Medical psychology
Study of the dynamics of psychological factors in patients with coronary heart disease after coronary artery bypass surgery
Abstract
Relevance. Nowadays cardiovascular diseases are the leading cause of prevalence and mortality. One of the most common cardiovascular diseases is coronary heart disease (CHD). Contemporary treatment for CHD includes both pharmacotherapeutic and cardio-surgical methods. It is well-established that psychological factors contribute to the etiopathogenesis of the disease and can influence its course and prognosis. To plan and improve psychological rehabilitation measures, it is crucial to identify the specific psychological characteristics and their dynamics in the postoperative period. Traditionally, studies on patients’ psychological characteristics are conducted during the inpatient treatment period and are focused on identifying the intensity and dynamics of specific indicators (such as anxiety, depression, coping behavior, personality traits, etc.). However, for a comprehensive understanding of the manifestations of the complex of studied characteristics, their interrelationships, and changes at different stages of treatment and rehabilitation, an approach involving the study of the factor dynamics of psychological indicators is of interest.
The aim of the study is to identify the dynamics of psychological factors based on a set of psychological characteristics (including psychoemotional and cognitive aspects, coping behavior, and quality of life) in patients with coronary heart disease (CHD) after coronary artery bypass grafting (CABG).
Methods. A total of 254 patients with CHD undergoing CABG were assessed. The study consisted of three stages: 1) preoperative assessment, 2) postoperative assessment during the inpatient treatment, and 3) evaluation three months after the surgery. The clinical-psychological approach and the following psychodiagnostic methods were used: The Trail-Making Test (TMT), Luria´s Memory Words Test, Integrative Anxiety Test, Asthenic State Scale modified by L.D. Malkova and T.G. Chertova, the Symptom Checklist-90-Revised (SCL-90-R), The Ways of Coping Questionnaire (WCQ) by Lazarus and Folkman, 36-Item Short Form Survey (SF-36), and the Big Five Personality Test.
Results and Analysis: Factor analysis of the obtained data was conducted, and factor dynamics were examined. The factor “Psychopathological Manifestations and Impairment of Memory and Attention” is characterized by a slight increase at the second stage and a decrease at the final stage of the study. The factor “Anxiety-Phobic Manifestations” shows a decreasing trend at the second stage and a significant increase at the third stage. The factor “Coping with Difficulties Orientation” demonstrates a clear and consistent decrease from the first stage to the third stage of the study. The factor “Reduced Quality of Life and Unsatisfactory Somatic Condition” shows a significant increase in intensity by the second stage of the study and a decline by the third stage. The factor “Neurotic Manifestations of an Anxious-Rumination Type” is most pronounced at the first stage, experiences a decrease by the second stage, and rises again by the third stage. The factor “Asthenic Manifestations in the Context of Aggressive Tendencies” is not characterized by pronounced dynamics (noted only a slight increase in intensity at the second stage and a gradual decrease at the third stage).
Conclusion. Six psychological factors were identified based on the studied psychological characteristics. The study of factor dynamics yielded practical significance. Specifically, for the planning of psychological rehabilitation, it is noteworthy that there was a significant increase in the intensity of the “Anxiety-Phobic Manifestations” factor at the third stage of the study (exceeding preoperative levels). The consistent decrease in the “Coping with Difficulties Orientation” factor (from the first to the second stage and from the second to the third stage) is also relevant. These findings should be considered in the rehabilitation process for patients with coronary heart disease after coronary artery bypass grafting.
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The relationship between mental burnout and socio-psychological personality traits of specialists in socionomic professions
Abstract
Relevance. There are numerous sources dedicated to the study of burnout, yet contemporary psychological science lacks a unified understanding of the mechanisms underlying its origin.
The purpose of our study is to analyze the relationships between “inhibitors,” “catalysts,” and indicators of burnout among professionals in sociological professions. The study involved 229 participants, including social workers (89) and teachers (140), all women, aged 22 to 71.
Materials and methods. The study employed a testing method (Professional Burnout Questionnaire, Volitional Self-Control Questionnaire, etc.) followed by analytical-synthetic processing of the obtained data through correlation analysis.
Results. The data obtained on the relationship between burnout and the personal characteristics of employees of socionomic professions suggest that there are certain application points for influencing them in the process of psychotherapy.
Conclusion. The conducted study can play a significant role in managing work-related stress and minimizing the risks of burnout syndrome. It may assist in developing a psychotherapeutic strategy for coping with burnout among professionals in socionomic professions.
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Analysis of hormonal status study results and its impact on individual psychological personality traits in acne patients (Acne vulgaris)
Abstract
Relevance. Acne is one of the most common diseases, affecting up to 85 % of people aged 12 to 25 years and 30–40 % of people over 25 years of age. Severe forms of the disease occur in 5–14 % of cases, which in more than 1/3 of cases requires serious, sometimes long-term treatment by a dermatologist. The psychological aspect of the phenomenon and its impact on daily functioning are still rarely mentioned. However, knowledge of the relationship between psychological status and dermatological disease is necessary for effective acne therapy.
Aim. The purpose of this study is to determine the mutual influence of the influence of hormonal status on individual psychological characteristics of personality in male patients with acne.
Materials and methods. The study involved 58 male patients aged 15–19 years with severe and moderate forms of acne (patient group). The control group consisted of 28 healthy men. The hormonal status of the participants was assessed by measuring serum levels of cortisol, estradiol, prolactin, dihydrotestosterone, free testosterone, T3, and T4.
Analysis of the dynamics of changes in the psychological state of patients suffering from acne was carried out using the 16-factor Cattell questionnaire. Statistical processing of the research results was performed using Microsoft Excel application packages.
Results. In the group of patients aged 16–19 years, changes in the hormonal system consisted of increased levels of DGTS, increased serum concentrations of cortisol, T3, when compared with a group of healthy individuals.
Conclusion. The study revealed significant strong correlations between hormonal status indicators (estradiol, cortisol, STS and DGTS) in a group of patients with acne, a significant strong correlation was revealed between the indicators of hormones (cortisol, T3 and DGTS) and the psychological characteristics of the personality of patients – less pronounced tolerance and empathy, determination, openness, there is a decrease in mood.
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About psychological rehabilitation for people living with HIV
Abstract
Relevance. HIV infection is a disabling disease. People living with HIV (PLH) with the help of modern antiretroviral therapy (ART) can significantly prolong their lives and improve biological health indicators. However, the lack of special rehabilitation interventions for PLH in combination with increasing comorbidity, including neurocognitive disorders, can lead to progression of pathology and decrease in quality of life. The objective of the analytical review is to study the prospects and approaches applicable for the psychological rehabilitation of PLH.
Materials and methods. We used meta-analysis as the main method. In search databases eLIBRARY.RU, PubMed, APA PsycARTICLES the studies on the psychological rehabilitation of patients with HIV infection were searched and described during the period of developed and available ART from 2012 to 2023. Additionally while conducting the analysis we also relied on our long-term practical experience in psychological interventions and psychological help for PLH.
Results. In total we analyzed 51 studies, of which 19 were written by domestic authors and 32 by foreign ones. In Russian peer-reviewed scientific publications and monographs which present works in the field of infectology, medical psychology, and health psychology, the topic we study is extremely rare and mostly at the theoretical level. In that regard most of our analysis concerns foreign studies carried out in different countries within the topic of psychological rehabilitation of HIV-infected people.
Conclusions. Psychological rehabilitation of patients with HIV infection should be carried out taking into account the awareness of the psychologist and the patient about the progression of HIV infection, treatment, cognitive impairments, HIV-associated diseases, resilience, etc. Patients living with HIV infection should be reccomended regular (not less than once every three years) psychodiagnostic assessment of cognitive functions, emotional functioning, and, behaviour, and should be differentially offered participation in psychological rehabilitation interventions. When preparing rehabilitation psychologists to work in the system of care for patients with HIV infection, it is important to teach not only psychodiagnostics, but also counseling and group interventions (including resilience training and cognitive training) that increase patients’ adaptation to a changed life situation.
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Psychophysiology
Factors of preoperative anxiety in primary school-aged children with orthopedic pathology undergoing surgical treatment
Abstract
Relevance. The situation of surgical treatment has a high stress potential contributing to the development of preoperative anxiety, which is a risk factor for adverse psychological states in the postoperative period.
Purpose: to determine the psychological content and factors influencing the risk of developing preoperative anxiety in children of primary school age.
Methodology. The study examined 20 mothers and 20 children (10 boys, 10 girls) aged 8 to 10 years with orthopedic pathology. Each examination was conducted on the 2nd–3rd day after hospitalization, 3–5 days before the anticipated surgical intervention. Psychological assessment of the child included observation aimed at assessing the severity of signs of anxiety; structured interview; questionnaire “Children’s Manifest Anxiety Scale” (CMAS), Visual Analogue Pain Scale. Psychological examination of the mother included a survey, “Assessment of the child’s anxiety level” (A.I. Zakharov); “Diagnostics of attitude towards a child’s illness”; “State Trait Anxiety Inventory” (STAI).
Results and Discussion. 80% of children showed behavioral signs of anxiety (tension, withdrawal, avoidance of contact, restlessness, repeated actions, tearfulness). Adaptation to hospital conditions is accompanied by sleep disturbances (40%) and loss of appetite (60 %). The average values on the CMAS questionnaire correspond to the borderline level (6.6 ± 0.52). Based on observation and survey, a subgroup (5 boys, 4 girls) with a high level of preoperative anxiety was identified. There were no significant differences in children with a high level of preoperative anxiety by gender, age, family status, presence/absence of siblings, age and education of the mother, experience of surgical treatment, duration of the disease, level of pain symptoms, or knowledge about treatment. At the same time, children with a high level of preoperative anxiety had increased personal anxiety (p = 0.03), more often mentioned the possibility of medical errors as a source of fear, and their mothers had a higher level of situational anxiety (STAI, p = 0.01) and increased tendency to control the child’s activity (p = 0.04).
Conclusion. Severe preoperative anxiety is observed in almost half of children awaiting surgical treatment. The risk factor for preoperative anxiety is the child’s personal anxiety, as well as the mother’s situational anxiety and her tendency to limit the child’s activity.
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Legal psychology and psychology of security
Post-traumatic stress disorder and рsychological mindedness in military personnel with combat surgical trauma
Abstract
Relevance. It is known that the wars of each subsequent era differ significantly from the wars of the previous era; modern local conflicts have become a war of missiles, smart projectiles, drones, electronic countermeasures, which immediately changes the nature of injuries. Against this background, post-traumatic stress disorder, in particular among military personnel, which arose after traumatic events, determines severe fear, helplessness, horror, guilt, shame, anger, which reduces the psychological well-being of the affected people and affects their psychosomatic state, which creates difficulties in their medical and psychological support.
Intention − to investigate the influence of post-traumatic stress reactions on psychological resilience in military personnel with combat surgical trauma (gunshot and non-gunshot wounds, closed and open injuries, combined injuries from various weapons classified as combat surgical pathology).
Methodology. An experimental psychological research to study the influence of post-traumatic stress reactions on рsychological mindedness in military personnel with combat surgical trauma was carried out in men aged 35.83 ± 9.26 years, who at the time of the study were undergoing inpatient examination, treatment and rehabilitation for combat surgical injuries in accordance with the requirements of regulatory documents in 2022–2023 for 6.28 ± 1.1 months (considering the issues of diagnosis and treatment of the lesion was not the purpose of this study). Psychometric measurements of the severity of post-traumatic stress reactions were carried out according to the «Mississippi Scale for Combat Related PTSD» (military version) [12], and psychological mindedness – according to the «The psychological mindedness scale» [16], adaptation in Russian [9].
Results and Discussion. It was found that in the group of patients with combat surgical trauma, when adequate medical and psychological support measures were carried out in the majority of examined patients, psycho-somatic adaptation was assessed as good. Few patients with impaired psychological adaptation have been identified; perhaps the changes are associated with premorbid problems. The main parameter of psychological mindedness was «Interest in the sphere of experiences», which implies entering into social contact, seeking social support; that is, the examined patients feel changes in their feelings, take a more meaningful approach to understanding their own behavior and show interest in the motives of other people’s behavior, which is important from the point of view of subsequent social adaptation.
Conclusion. Psychological prevention of mental adaptation’s disorders in unusual conditions of life involves knowledge of various aspects of life in order to form adequate behavior in changed conditions; this allows us to identify risk groups for which, according to indications, it is necessary to carry out preventive medical and psychological interventions. Thus, according to various sources, the most successful approach to solving the problem is considered to be a comprehensive strategy, including psychopharmacological, psychological and rehabilitation methods aimed at influencing victims.
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Discussion club
Psychoeducational program for parents of children with autism spectrum disorders
Abstract
Relevance. Informing parents of children with developmental disabilities is one of the important principles of a family-oriented approach when organizing comprehensive support for the children. One of the tasks of pediatric pathopsychology is to work with the child’s family, including psychoeducation and psychological support for parents raising children with developmental disorders.
Intention – the goal is to describe the content of the psychoeducation program for parents raising children with ASD.
The psychoeducation program for parents raising children with ASD is aimed at replenishing parents’ lack of knowledge about the characteristics of the disease and forms of medication and psychological and pedagogical assistance for children with ASD. The program consists of seven weekly meetings lasting 1.5-2 hours covering the following topics: getting to know each other; the concept of autism and autism spectrum disorders; modern approaches to the treatment and rehabilitation of children with ASD, the role of the family in the therapeutic and rehabilitative process; features of the formation and development of mental functions in children with ASD; peculiarities of emotional and communicative development in children with ASD; organization of educational and corrective-developmental activities for children with ASD; summing up, completing the work of the group.
Conclusion. The development and implementation of a psychological educational program for parents should be considered as a necessary link in the initial stage of providing a complex of treatment and rehabilitation measures to a child with a developmental disorder. Such programs do not require significant costs and time for training specialists. Among the positive effects of psychoeducation is a change in parents’ attitude towards the child’s illness towards recognition of the fact that the child has a diagnosis and an increase in parental commitment to recommendations by a multidisciplinary team of specialists.
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Psychological counseling for patients with bone tumors
Abstract
Relevance. Psychological difficulties are extremely common among patients with bone tumors. Patients often underestimate the severity of their condition, leading to unrealistic treatment expectations and the formation of a passive stance in the treatment process. This underscores the importance of studying the psychological status of patients with bone tumor lesions and exploring the possibilities of psychological assistance for this patient group. One of the main targets of clinical-psychological interventions in an oncological orthopedic clinic is the quality of life (QoL) of patients, encompassing experiences and relationships oriented towards understanding one’s existence, valuing health, and the individual’s ability to establish connections with the external world according to their needs and capabilities, even in the context of illness.
The purpose of the work is to formulate the main directions of psychological counseling for patients at oncology orthopedic clinic in accordance with the data on characteristics of their quality of life and emotional and personal sphere.
Methodology consists of analysis of data from the previous studies and review of modern scientific literature on this topic.
Results of the study indicate that each nosological group of patients, due to the specific parameters of QoL determined by the clinical picture of a particular form of bone tumor lesion, requires an individual approach within the framework of psychological counseling. The important aspect of psychological counseling in an orthopedic oncology clinic is working with the patient to see the possibility of influencing their QoL in a situation of illness and extensive surgical treatment. Psychological counseling for amputation of the lower limb is indicated for patients at all stages of treatment: in the preoperative period, in the early postoperative period and at the rehabilitation stage. Psychological assistance in the preoperative period includes work with acute reactions caused by the need for amputation. The early postoperative stage confronts the patient with the task of changing the body scheme and working with phantom sensations. It is advisable to consult patients with spine tumors in preoperative period to discuss the actual clinical situation and formulate correct expectations from surgical treatment, including the prognosis of the disease, the possible level of physical and social activity, expected limitations, the expected intensity and prevalence of pain in the postoperative period and the duration of rehabilitation process.
Conclusion. The article presents the main directions of work with patients of an oncology orthopedic clinic, formulated on the basis of previously conducted studies of QoL and emotional and personal characteristics of persons with bone tumors.
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