Perinatal cerebrovascular lesions represent one of the important causes of the onset of mental disorders. The research addresses specific psychic pathologies of this type such as hypochondriac and obsessive-compulsive disorders. The main focus of the research is the psychotherapy for that contingent of patients. Tests and statistical trials were conducted for groups composed of persons suffering from the said disorders. Based on the results of data analysis the research reviews specific recommendations for using psychotherapeutic techniques considering their influence on clinical manifestations of hypochondria and obsessive-compulsive disorder. Keywords: perinatal cerebrovascular lesions, obsessive-compulsive disorder, psychotherapy.
The aim of the research was to obtain data for scientific justification and development of an algorithm of medico-social rehabilitation for patients with schizophrenia under compulsory out- and inpatient treatment. During the research clinical and social-demographic conditions were evaluated for the chosen group of people currently undergoing coercive treatment and for the control group. The role of the clinical-psychopathological and social-environmental agents that caused patients compulsory hospitalization was determined. The level of social functioning and the dissocializing factors were evaluated. Keywords: schizophrenia, coercive treatment, social-psychological characteristics.
The study presents the identification and study of the characteristics of the formation and dynamics of various forms of deviant behavior in the clinic of neurosis-like states of residual-organic genesis, that is guided by the principles not previously used in the study of the studied pathology. Behavioral disorders were studied in a comparative aspect in two clinical variants, which are asthenohyperdynamic and astheno-adynamic manifestations of the cerebrastenic syndrome, which is a part of the structure of a neurosis-like state. The age dynamics of behavioral disorders was studied at different stages of ontogenesis, including childhood, prepubertal and puberty, by comparing the obtained data labeled by the subheadings "Period of the first age crisis", "Period of the second age crisis" and "Puberty period". The study found that age response forms reflect the low personal resources of adolescents and the massiveness of negative social influences. As the analysis of clinical material has shown, during puberty, violations in the sphere of cravings became more distinct. Disorders in the sphere of inclinations at this age are closely correlated with the features of the somato-endocrine metamorphosis and with the unfavorable influence of socio-psychological factors. Lack of sexual desire was in direct proportion with a pronounced delay in puberty. Violations in the sphere of sexual desire, reflecting the nondifferentiation of the sexual attitudes of adolescents with delayed puberty, were characteristic of those studied with pronounced volitional immaturity, in particular with such signs as suggestibility, a tendency to imitation. During puberty, the clinical picture of the studied adolescents revealed more clearly the qualitatively new pathological properties of the personality due to the development of excitable, unstable, less often labile and hysterical manifestations. In contrast to psychopathic behavior in sick children and adolescents, no correlation was found between the first signs of deviant behavior and cerebrastenic disorders. In all cases, behavioral disturbances are caused by unfavorable micro-social factors. Based on the follow-up data, the study has found that the studied group of sick children and adolescents is characterized by both favorable dynamics (22) and a negative outcome (20 patients). This suggests that the pubertal period is characterized by a polymorphism of behavioral disorders and is one of the decisive factors in the prognosis of the further development of the child.
Introduction. The prevalence of obsessive-compulsive symptoms in modern conditions of high stress and the lack of detailed recommendations for this category of patients determine the relevance of this publication. The emergence of suffering at a young age forms insufficiently adaptive behaviors and complicates the socialization of such persons. And the emergence of these symptoms within different etiological disorders requires the development of differentiated diagnostic and therapeutic approaches. Materials and methods. The study involved 69 outpatients with leading obsessive-compulsive disorder within schizotypal disorder (F21). The following methods were used: clinical-psychopathological, psychodiagnostic, clinical-follow-up and mathematical statistics. Patients were examined using psychodiagnostic techniques: clinical scale of obsessions and Yel-Brown compulsions (Y-BOCS - Obsessive-compulsive Scale); hospital anxiety and depression scale (HADS); quality of life scale (Chaban OS, 2008); multidimensional scale of perception of social support ("MSPSS" D. Zimet); questionnaire "Lifestyle Index" ("LSI" by R. Plutchik - G. Kellerman - H. R. Conte), method "Psychological diagnosis of coping behavior strategy" by R. Lazarus. Results. The clinical typology of these symptoms: type of avoidance, type of ambivalence and type of accumulation was studied by processing the clinical scale of obsessions and Yel-Brown compulsions (Y-BOCS) in patients with schizotypal disorder (F21). It was found that these symptoms were accompanied by anxiety and depressive symptoms only at the subclinical level, which indicates a lack of criticism of one’s condition. In patients with the leading obsessive-compulsive symptoms in schizotypal disorder, not quite mature variants of the protective structure are actualized, namely, substitution (62.3%), displacement (60.9%), regression (58%) and denial (26.1%). The leading coping strategies of such individuals are self-control (73.9%) and escape-avoidance (55.1%), which differs significantly from the strategies more often used by patients with ACS at the neurotic level. We have proposed a program of comprehensive treatment of this group of patients. Patients were divided into 2 groups, the first of which received a combined (differentiated psychopharmacological interventions and psychotherapy) option of therapy, and the second – only differentiated psychopharmacotherapy. The psychotherapeutic formulation was determined by different focus targets depending on the type of obsessive-compulsive symptoms and consisted of a combination of techniques of cognitive-behavioral therapy (CBT) and gestalt therapy (GT). The results of the follow-up study indicate the effective impact of the developed treatment and rehabilitation program on all components of the mental state and social functioning of patients with all types of obsessive-compulsive symptoms of subpsychotic level. Conclusions. The leading types of ACS in schizotypal disorder and features of psychosocial functioning in patients have been identified, which allowed to create a differentiated approach to the formation of a program of their comprehensive treatment and rehabilitation. Such persons need mandatory psychopharmacotherapy and differentiated psychotherapeutic intervention. The application of the program made it possible to improve the mental state and quality of life and achieve the optimal level of adaptation of patients in various spheres of life, increase periods of remission and prevent recurrence of the disorder.
Nowadays the problems of obsessive-compulsive disorders and hypochondriasis have become quite urgent. The disorders are often encountered both in mental institutions and in general medicine clinics. They are resistant to treatment and there is always a menace of them transforming into a chronic mental illness. So, it’s important to deal with the issue of the psychiatric rehabilitation (reintegration into the social environment) of those suffering from said disorders. To achieve good results psycho-social treatment and rehabilitation measures should be taken beginning from the earliest mental treatment stages. However, there are still many unclear and misunderstood points both in design and application of the rehabilitation program. In this study during the years 2012-2016 based on the previous work we have developed the programs for the group of 80 patients with said disorders. The results of the evaluation of the patient’s basic functioning after application of the programs are presented in the paper. Key words: coping resource, coping strategy, obsessive-compulsive disorder, hypochondriasis, rehabilitation.
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