Організація медико-психологічного гендерно-специфічного сімейноцентрованого супроводу для пацєнтів з постшизофренічною депресією

Abstract

Метою даного дослідження стало вивчення гендерних клініко-психопатологічних та індивідуально-психологічних особливостей пацієнтів з постшизофренічною депресією, та розробка та впровадження заходів медико-психологічного сімейноцентрованого гендерно-специфічного супроводу пацієнтів з постшизофренічною депресією. До участі в дослідженні було включено 141 хворих на пост шизофренічну депресію. Всі обстежувані були розділені на дві групи за гендерною ознакою. Програма медико-психологічного супроводу включала два етапи: перший проводився впродовж стаціонарного лікування та мав психокорекційну спрямованість, другий етап, психопрофілактичний, підтримуючий, було організовано в амбулаторний період.

This research is devoted to the study of post-schizophrenic depression, its clinical and psychopathological features, the adaptation of patients with this pathology, and the development of approaches to rehabilitation. Interest in the study of this pathology is dictated by significant medical, social and economic consequences of schizophrenia associated with chronic course, high percentage of people with disabilities among patients, high cost of treatment. Therefore, the purpose of this study was to study the gender clinical and psychopathological and individual psychological characteristics of post-schizophrenic depression patients, and to develop and implement measures for the medical-psychological family-centered gender-specific support of postschizophrenic depression patients. 141 patients with post-schizophrenic depression participated in the study. All the subjects were divided into two groups according to gender: 68 men were the first group (G1), and 73 women comprised the second group (G2). Terms of work corresponded to generally accepted norms of ethics and morality, the requirements of observance of human rights, personal interests of all participants in the study. The patients and their relatives were acquainted with the subject, purpose and methods of this study. According to the results of the study, characteristic of individual psychological features of patients with PSD are defined: psycho-emotional - anxiety increase, depression, auto-aggressive tendencies; cognitive - depletion of attention, asthenia and reduction of the efficiency of memorization of verbal material, reduction of concentration, distribution and switching of attention, specific features of thinking, characteristic of the schizo phrenic symptom complex; socio-psychological low level of self-control, the risk of suicidal behavior, low use of social support resources, lower quality of life. The main distinguished factors of relapse risk at PSD are the following: biological: genetic burden, organic disorders, prenatal factors, intoxication; psychological disorders: attention violation, memory impairment, mental disorder, increased level of anxiety, depressive tendencies, aggressiveness; micro-social: lack of understanding and support in the family, conflicts, lack of own housing, lonely accommodation, lack of understanding at work, lack of friends and relatives, absence or loss of employment; macro-social: lack of tolerant attitude in society, low level of awareness in the community, lack of multidisciplinary support system at the outpatient stage. In clinical practice, we introduced the program of medical and psychological support, which included two stages: the first was conducted during inpatient treatment and had a psycho-correction orientation, the second stage – psycho prophylaxis/ supportive, was organized in the outpatient period. It is determined that implemented author's medical and psychological support is effective and can significantly improve the quality of patients life (the statistical difference between the main groups and the corresponding groups in comparison at the stage after the correction is reliable, p≤0.05). Thus, the conducted research proves that improving the quality of rehabilitation care for patients in psychiatric inpatient facilities is necessary due to the introduction of modern family-oriented approach – forms and methods of work with mentally ill people and their families. The qualification help of psychiatrists, psychotherapists, psychologists, social workers was also provided to these families. To solve the problem we need to conduct professional training of specialists on rehabilitation in psychiatry based on psychiatric inpatient institutions, dispensaries and departments of higher educational institutions.

Целью данного исследования стало изучение гендерных клинико-психопатологических и индивидуально-психологических особенностей пациентов с ПШД, и разработка и внедрение мероприятий медико-психологического симейноцентрованого гендерно-специфического сопровождения пациентов с постшизофренической депрессией. Для участия в исследовании были включены 141 пациент с постшизофренической депрессией. Все обследованные были разделены на две группы по гендерному признаку. Программа медико-психологического сопровождения включала два этапа: первый проводился в течение стационарного лечения и имел психокоррекционную направленность, второй этап, психопрофилактический, поддерживающий, был организован в амбулаторный период.