ARTICLES ARCHIVE

Obsessive−compulsive disorder (OCD) is one of the thought disorders (disorder of goal setting and implementation), characterized by obsessive states, self−checkings, rituals, which are regularly repeated. The above−mentioned phenomenon is referred to "small" psychiatry and considered as the neurosis, although OCD as the symptom is observed in different registers of mental illnesses. The inaccuracies in determining the obsessive−compulsive disorder are noticeable in ICD−10, where different varieties of OCD (F42) have not been formulated yet (ICD−10 does not take into account the factor of manifestations of compulsions and obsessions in psychotic, psychopathic and vegetative registers). In different medical standards this phenomenon is determined mainly in the coordinate system of the proportionality of obsessions and compulsions. Considering the obsessive−compulsive disorder exclusively in a format of neurosis, entails the cases when its incurability is stated. Such a situation results from a complicated history of this term formation. Here, we have analyzed different approaches to explain the OCD phenomenon such as: study of cyclic rituals in prehistoric people, research of fear as the regulator of human behavior and understanding of fear as philosophical concept, analysis of the impact of religion rituals on reorganization of thought, comprehension of connections between melancholy and obsessions (or compulsions), mastering of theoretical knowledge about dysautonomia, explanation of OCD within the range of neurotic and psychopathic registers, etc. The classification and system steps, which were involved to explain this phenomenon in different epochs, were shown. There was suggested to consider the OCD as a register−dependent symptom.

Since 2014, the Ukrainian military men have to defend their country by engaging in military actions. As of January 2019, more than 350 thousand of persons had an official status of combatant. Frequently, the return of a discharged combatant becomes a stress for the family and additional psycho−traumatic factor, by aggravating the already complicated psychological state of a combatant and his/her relatives. With the aim to study the phenomenology and development mechanisms of the family health problem in discharged combatants as the basis to develop a program for its psychological correction, we thoroughly examined 100 discharged combatants and their wives. The study was carried out using clinical−psychopathological and psychodiagnostic methods. According to the criterion of successful marital relations, the examined families were divided into two groups. The summarized findings confirmed the formulated by the authors hypothesis about the polymodality of the family health problem phenomenon in combatants, having at least psychopathological, behavioral, personal, psychosocial, sexual and family aspects of the problem. Proceeding from our findings, there were distinguished two clinical and psychological variants of the family health problem in combatants such as: destructive−congruent, inherent in 40.0 % of married couples with problems, and traumatically−uncoordinated one, found in 60.0 % of families from the main group. We have developed for combatant families with health problems the program of psychological correction, which takes into account both common regularities of its development, and substantial differences in its manifestations, depending on clinical and psychological variant. The assessment of the efficiency through a comparative analysis of the indices of marital satisfaction and life quality in persons of the psychological correction and control groups, proved its efficiency as for the selected targets of psychological correction impact.

In actual living conditions, the psycho−emotional and social stresses acquire greater importance. The experience of impossibility to solve a psychologically difficult situation for a long time becomes the basis for development of mental, somatic and psychosomatic disorders. The modern researchers point out an emotional stress and its consequences as still underestimated by the clinicians and researchers as a risk factor, the modification of which may significantly affect the epidemiology and prognosis of cerebrovascular pathology. A psychological assessment was carried out in 383 patients in order to investigate the psychoemotional stress level at various stages of its development. The level of psychosocial stress was measured with L. Reeder psychosocial stress scale. Our findings have shown the course of cerebrovascular diseases at different stages of their development to be accompanied by an increased level of psychosocial stress and to augment in the "healthy individuals − cardiovascular risk group − clinical signs − post stroke" continuum. For example, in the patients with cardiovascular risk and clinical manifestations of cerebrovascular disease, there was observed a stable tendency to psychosocial stress increase, reflected in subjective feeling of permanent overstress, its personalization, overwork state, when the usual daily activities caused difficulties. The stress state negatively affected the implementation of their professional duties, they had problems of communication with other people and family. Patients after stroke suffered acutely from the limitations in psychosocial sphere as a result of awareness of personal significance of a considerable decrease in disability, physical inability to normal activity, dependence on others, no clear forecasts for recovery of lost functions or rejection of inevitable consequences. Thus, a high level psychosocial stress is characterized by systematic stress effect, its personalization and extension from social to personal level of functioning. This is an important target of medical and psychological support of the patients with cerebrovascular pathology.

In order to investigate the features of the value−motivational sphere and subjective perception of happiness and money behavior in modern youth, we surveyed 186 students of such specialties as: "Medicine", "Medical Psychology" and "Dentistry", using the modified A. Farnham "Scale of Money Appraisals and Behavior" technique and that of S. Lybomirsky "Subjective Happiness Scale", adapted by D. Leontiev and a specially designed questionnaire. It was established the fact that most students spent more than 4000 UAH per month. In the structure of money expenses, the largest share is the cost of clothes and food, less was designated for living, entertainment and self−improvement. The structure of expenses varies greatly depending on the specialty. The priority positions in the hierarchy of values of modern students are taken by family, the less important ones are health, personal life and love, rest, money, status and friendship. At the same time, the dentistry students often selected a family as a priority value, love and personal relationship were chosen by medical student, and psychology students chose health. The lowest dependence on money was found in dentistry students, and a polar attitude to money was inherent in psychology students. The moderate level of subjective happiness is inherent in all the students, while the most and least happy are future dentists and psychologists, respectively.

The life perspective of young people with the child disability status is affected by many factors such as: relationships with parents, the availability of vocational training system for people with disabilities, site conditions, secondary socialization, stigmatization in society, disease or defect impact, limiting the life activity in various spheres. In this process, of importance are the parent family, relationship with other people, which may contribute to the formation of either inferiority complex and social irresponsibility, or an adequate self−conception and successful integration into the society. The self−perception through relationships, the ability to build new relationships not only with parents, but also with other relevant people is an important task of youth. The dynamics of these relationships begins in parent family, which was formed under specific historical and cultural conditions. The young people with child disability status showed quite a high level of control, testifying to an intrapersonal conflict, which might be formed between the desire to take decisions, to control yourself, to affect the surrounding people and inability to assume responsibility. Young people aged 18−22 were more likely to communicate with a small number of people and needed that others looked for their company, even without their own efforts. An emotional detachment was observed. The polar tendencies were expressed in the effort to take the lead, but avoiding any responsibility, in desire to belong to different groups, but with a tendency to avoid direct contacts, wishing to show friendly feelings to others, but with caution in establishing deep relationships.

Social adaptation in patients with endocrine pathology is very variable since the assessment and way of solving the life difficulties are a complex of both behavioral and cognitive efforts, which sets for patients a difficult task of independent search for ways of stress disposal. Therefore, it is relevant to study and systematize the coping strategies, determining the degree of psychosocial adaptation in patients. This research deals with systematization of the coping strategies in disordered metabolism of thyroid and adrenal hormones and hypogonadism. In order to determine and compare the patterns of stress−coping in psychoendocrine syndrome at the background of hypo− and hypercorticoidism, we examined 400 patients with following diagnosis: disordered metabolism of thyroid, adrenal hormones, and hypogonadism under therapeutic compensation of endocrine dysfunction and manifestations of psychoendocrine syndrome. Here, we used a structured psychodiagnostic interview, based on the Lazarus copying test to determine and compare the coping patterns. The impact of psychoendocrine syndrome on psychosocial adaptation of patients was revealed, and the copying patterns were systematized in patients with thyroid and adrenal hormone metabolic disorder and hypogonadism. These findings demonstrate the impact of endocrine disorders on psychosocial adaptation in patients.

The existential beliefs in patients with mental disorders of various genesis have not been analyzed yet despite a high relevance of life−purpose component in mental health maintenance. In order to determine the features of existential beliefs in patients with mental disorders of different genesis, we carried out the study, involving the persons with low existential content, which testified to a subjective nonconformity of internal values and convictions with external circumstances, an insufficiently arranged view of life perception, sense of injustice and meaninglessness. Herewith the highest and lowest rates of this parameter were observed in patients with organic and neurotic pathology, respectively. The indices of self−distancing and self−transcendence, as well as the general personality characteristics were also the lowest in neurotic disorders, and in patients with endogenous and organic disorders they were average and highest, respectively. The group of patients with organic mental disorders differed by a statistically and significantly high sense of freedom, and the patients with neurotic and endogenous psychopathology had low scores on this scale. A high sense of responsibility was inherent in patients with endogenous mental disorders, the average and low ones were in patients with organic and neurotic disorders, respectively. Our findings showed the existential features in patients with mental disorders of different genesis to differ depending on the disease etiology.

Cardiovascular pathology is one of the most common medical problems, involving huge healthcare sector resources for its solution. The world experience in studying the cardiovascular diseases resulted in the identification of a specific phenomenon, i.e. "cardiovascular accident", which specified the sudden exacerbation of cardiovascular disease with the life−threatening condition development. The myocardial infarction, pulmonary embolism and some states with similar genesis and life−threatening conditions are referred to cardiovascular accidents. In order to establish the coping mechanisms of nosogenic stress in patients with different variants of hypochondriacal symptoms, 100 patients who underwent cardiovascular accidents with manifestations of hypochondriacal symptoms, were examined. The patients were divided into the groups according to the hypochondriac symptoms presented. To determine the coping mechanisms, we applied here the psychodiagnostic method with the "Stress Coping Questionnaire" use. According to these findings, the coping strategies, inherent in the patients with primary and secondary hypochondriacal symptoms, were established. The revealed features of coping strategies, used by the patients from the studied groups confirmed the differences, consisting in separation of hypohondiacal states by the criteria of the personality attitude to experience, to the source of activity limitation, and behavior control locus.

At the present stage of society development, one of the priority directions in psychiatric research is the affective sphere pathology, especially the anxiety and depressive disorders. In this context the study of affective pathology proceeds in terms of biorhythmological organization of body functioning. It is known that circadian dysfunction not only causes the development of affective disorders, but may strengthen clinical symptoms and affect the disease course. A further search for the cause−and−effect relationship between an individual chronotype and affective disorders, and the study of these mechanisms and the disease course impact on the chronotype are carried out. The established biorhythmological status is taken into account when selecting the way of drug therapy prescription. The pharmacotherapy in desynchronosis is based on a distinct understanding of temporal dynamics of the certain disease, as well as its individual characteristics for a particular patient, and the nature of chronokinetics of the prescribed drug. The chronotherapeutic methods, being actively introduced into clinical practice for therapy of the patients with affective disorders, have a neurobiological effect on neurotransmitter systems in the same brain areas, as the antidepressants do. The scientists suggest them to be capable to resynchronize the disturbed biological rhythms, causing thereby the positive shifts in several physiological systems. Thus, the desynchronization of circadian rhythms plays a key role in pathogenesis of depression and affective disorders in general. The application of chrono− and pharmacotherapeutic methods, taking into account a biorhythmologic status, may significantly increase the therapy efficiency for these patients.

Visiting a dentist is a stressful procedure for both adults and children. Odontophobic reactions are a significant obstacle for performance dental procedures. In children, the responses of odontophobic spectrum are more frequent, than in adults and much more difficult to be corrected. The prevalence and type of dental pathology and the approaches to their correction for mentally healthy children, autistic children, children with oligophrenia and attention deficit hyperactivity disorder have some differences. In this research, based on the ethostomatological correlates analysis, we elaborated the typology and described the phenomenology of odontophobic reactions in children with different levels of mental health. Six types of odontophobic reactions were revealed. Herewith it was established the fact that for children with mental retardation the most characteristic were confrontational, agitated and vocalizational responses, the isolational, transaffectional and stenic−negativistic ones were in autistic children; the children with attention deficit hyperactivity disorder demonstrated motoric, mosaic−conformal and explosive reactions. In mentally healthy children, there were algophobic, transcompliant, and escapational ones.

An increase in the share of depressive disorders worldwide and particularly in Ukraine, is an actual problem of modern society. However, more than a third of patients with depressive disorders demonstrate the absence or low efficiency of initial antidepressant therapy. The patients with the "recurrent depressive disorder" diagnosis (F33 by ICD−10) were examined to investigate a biological component in the treatment−resistant depression development with the model of studying the peroxidation processes and designing the methods for strengthening the anti−depressant therapy algorithm. Here, we used the following methods: clinical and psychopathological, pathopsychological, psychometric, laboratory−biochemical, statistical. The problem of overcoming the treatment−resistant depressive disorders is to understand the mechanisms of such a state development, taking into account biological, psychological and social factors. Our study showed the role of peroxidation processes in tissues during treatment−resistant depressions. Proceeding from our findings, there was proposed as a potentiating agent a drug Citicoline with a membrane−stabilizing and antioxidant effect in therapy protocol for treatment−resistant depression. The analysis of dynamics of clinical symptoms established a significantly higher efficiency of Citicoline use, along with basic therapy in terms of temporary and qualitative indices of reduction of clinical symptoms.

The clinical and ethological characteristics of socio−communicative behavior in patients with paranoid schizophrenia and schizoaffective disorder during remission were comparatively analyzed. Patients with schizophrenia demonstrate a specific set of non−verbal behavioral elements, being a sign of autism and emotional−volitional decline. The social and communicative interaction of patients with schizoaffective disorder is characterized by a wide polymorphism, a more frequent demonstration of a smile and flanked eyebrows, more active gesticulation (pointing gesture, that with fixation on neck, hand rubbing gesture, and that of autogrooming in neck area). Social and communicative interaction in schizoaffective disorder as compared with schizophrenia is characterized by a higher level of signs of emotional tension and anxiety. They include non−verbal elements: blunting the foot, biting lips, gesture with fixation on neck, rubbing hand gesture, that of autogrooming in neck area. These findings testify to the presence of features of nosospecific post−manifestation pathopersonological transformations in post−manifestation period and may be used for differential diagnosis.

Schizophrenia is a risk factor for development of metabolic disorders, in particular type 2 Diabetes mellitus. According to the reported data the incidence of diabetes in schizophrenia is 2−3 times higher than in total population. There were examined 92 patients in order to determine the efficiency of the developed integrated program of rehabilitation for schizophrenic patients with type 2 Diabetes, taking into account their clinical−psychopathological and pathosychological characteristics. In testing the developed program of a complex rehabilitation of schizophrenic patients with type 2 Diabetes, 36 patients were involved. The proposed rehabilitation system is implemented in such directions as: the reduction of psychotic symptoms and stabilization of mental state of patient taking into account the features of somatic state; therapy and prevention of exacerbations of Diabetes mellitus at the background of psychotropic therapy; formation of awareness in patient about the presence of mental and somatic illness simultaneously; formation of skills for somatic state (symptom control) and stress control to prevent the provocations of launching the psychopathological symptoms; correction of the way of life in patients in the presence of combined psychosomatic states; increase of social competence level and adaptation of patients. A high efficiency of the proposed system of a complex rehabilitation of schizophrenic patients with type 2 Diabetes as compared with the standard therapeutic methods was established.

In order to assess the informativity of respondents' attitude towards the verbal and non−verbal sound stimuli, as well as the response time to them as diagnostic markers of depressive disorders, we examined 97 patients with following diagnoses: depressive episode (F32 by ICD−10) and recurrent depressive disorder (F33 by ICD−10). Here, we used the following examination methods: clinical−psychopathological, psychometric (HDRS, MADRS, BDI, HADS, Zung, Mezzich scales, Spilberger−Hanin test, Derogatis questionnaire) and psychophysiological ones. It was shown that the positive assessments ("I like") to sound verbal and non−verbal stimuli regardless of emotional coloration ("pleasant", "unpleasant" or "neutral") were significantly less frequent in patients with depression as compared to the healthy people, while the negative ("I do not like") or vague ("I do not know") assessments of the stimuli in question in such patients occurred more often. In the most cases, the response time to the stimuli was found to be longer in the patients than in healthy people. It was proved that the attitude ("like − dislike") to various non−verbal sound stimuli, as well as to verbal ones (in particular, to "emotionally neutral" questions beyond any psychodiagnostic scale), as well as the response time to the stimuli (time of choice of right answer option) were informative markers of depressive disorders and might be used for their objective diagnosis, as well as for an objective monitoring the quality of care in depressive patients.

A person in his/her life and activities is focused on the reference groups, being the model for imitation, formation of social norms and values. The reference groups are one of the factors of readaptation, since they play a key role in person−to−person interaction, they determine the life orientation and ways of self−development. The study of reference groups in clinical psychology has certain features due to stigmatization, self−stigmatization, and pathological changes in personality, occurred when the mental disorder is in progress. Proceeding from the reported data analysis, the peculiarities of reference groups of women with mental disorders were determined and the possible directions of psychocorrection, aimed at the extension of a number of referents during social rehabilitation, were outlined. In this study we used the following techniques: Kuhn−McPartland Twenty Statements Test "Who am I?", the V. V. Stolin − S. R. Panteleyev questionnaire to identify the self−conception, that of O. L. Muzyka − to study the dynamics of abilities. Our findings testify to the fact that for women with mental disorders the first place is occupied by family and close relatives, then friends and colleagues go, less important are the representatives of reference groups from other spheres of activity. The groups of mutual support and psychological assistance were not represented as the reference ones. One of the psychological characteristics, determining the adaptation degree is the sense of social support, stipulating the sense of personal relevance in a contact environment. But in women with the disorders of schizophrenic and organic spectra, a low level of anticipated attitude from others is observed. One of the areas of social rehabilitation may be the development of abilities, manifested and formed during activities. A change in the value attitude to the abilities, and their development during general self−development of personality affect the choice of the reference groups. As a result of an active meaningful activity, a person will be able to extend the range of reference persons and groups, which will increase the adaptive forms of behavior.

Chronic intoxication with psychoactive substances, irrespective of their pharmacological properties, is accompanied by gradual development of psycho−organic syndrome with persistent asthenic, affective, intellectual, mnemonic and other psychopathological (encephalopathic) disorders. It is known that the systematic use of ethanol entails the development of disorders in brain and central nervous system activities. Regardless of the type of the consumed psychoactive substance, the impairment of consciousness from narrowing to loss or clouded state of different severity with further memory impairment are quite frequent under acute intoxication state. With alcohol, sedative and psychedelic substance abuse, the altered forms of intoxication may be manifested by amnesias. At the initial stages of alcohol addiction under severe alcohol intoxication, the final periods of alcoholization as a rule are partially or completely amnesic. When became sober, a person can not remember what he/she did in the state of alcohol intoxication, what happened to him/her, moreover in this period the total amnesia is more frequent, and partial one occurs less often (a person remembers when arrived home, but does not remember the way). In narcology, the appearance of such spontaneous, amnestic episodes in acute intoxication serves as a diagnostic marker of tolerance limit of this person, an indicator of loss of quantitative control of consumed psychoactive substance. With a syndrome of dependence on psychoactive substances, the memory impairment affects all its three components: 1) memorization, fixation of new experience; 2) information storage; 3) reproduction of past experience, reproduction, memories. Stages of addictive disorders reflect not only the dynamics of major drug addiction syndromes, but also the severity of psychopathological mnemonic disorders, associated with the psychoactive substance use. The appearance of mnemonic disorders is a sign of systematic abuse of psychoactive substances clearly and qualitatively reflects the dynamics of all the stages of addiction development.

The structural and phenomenological analysis of aggressiveness and hostile reactions in patients with alcohol addiction with different levels of psychosocial stress was performed to understand the ways to modify the existing therapeutic and rehabilitation strategies taking into account the aggravating effect of this phenomenon on its formation and course. With this purpose we surveyed 312 men from different social groups: the combatants, who were experienced with engaging in military actions in Eastern Ukraine, forced displaced persons from temporarily occupied districts of Donetsk and Lugansk regions, residents of the city of Kharkiv and region. The regularities of severity and prevalence of both general phenomena of aggressiveness and hostility, and their components, were established to have no significant differences among the patients, however, there was determined a linear correlation between the severity of psychosocial stress, experienced by patients and the manifestations of physical, indirect and verbal aggression, negativism, and grievances, and a reverse−linear one for the sense of guilt. The tendency as for the presence of non−close linear correlation between the severity of aggressiveness and hostile reaction phenomena, and the level of stress response, inherent in the patients, was established. A high hostility with insignificant general aggressiveness was evidenced as resulted in the inability of constructive response to the aggressive impulses, being present in personality (first of all, suspicion, grievance, negativism, verbal and indirect aggression), which caused their inhibition and accumulation. It was accompanied by an increased irritation, potentiated the formation a more severe sense of grievance on yourself and against surrounding world and, accordingly, a sense of guilt, that, in general, had a predictatorial and provocative effect on alcohol addiction development and progression.

Recently, the problem of provoking the Internet addiction has assumed a greater importance. In the context of Internet involvement into daily life, the question arises how it affects the people not only in terms of online dependence formation, but also the modernization of behavioral patterns in the persons, suffering from other addictions, including that of psychoactive substances. In order to identify the features of Internet−associated behavioral patterns in alcohol−dependent patients, we surveyed 32 patients with diagnosed mental and behavioral disorders due to alcohol use, alcohol−dependence syndrome (F10.2 by ICD−10) and 35 students of Universities with no mental disorder symptoms. Here, we used such methods as: clinical−anamnestic, clinical−psychopathological, psychodiagnostic, and statistical ones. Psychodiagnostic study foresaw the application of S.A. Kulakov Internet−addiction test. Our findings showed that patients with alcohol addiction demonstrated no signs of increased commitment to Internet use, while the passion for Internet use was typical for some students, and no access to Internet caused a psychological discomfort in them. The daily time spent on Internet use in patients with alcohol addiction was almost 1/5 lower than in students. The scope of visited Internet resources was much poorer in patients in comparison with the variety of Internet resources visited by students. Thus, our findings testify to the impoverishment of motivational orientation as for Internet use in patients with alcohol addiction as compared to the mentally healthy persons, which may be explained by the shift of motivation toward the primary object of addiction, which is dominant and reduces the significance of other components of their life.