№ 89 (2024)
Medical psychology
Adherence to chronic disease treatment in specific social conditions: a review of studies during the COVID-19 pandemic
Аннотация
Relevance. The COVID-19 pandemic has affected both the economy and the organisation of health care, functioning and the health status of the majority of patients with chronic diseases, which require systematic adherence to medical recommendations. The imposed restrictions and self-isolation have introduced difficulties in disease therapy, treatment adherence and monitoring of health indicators. Patients reported stress, depressive symptoms and limited social support that may have significantly reduced adherence to chronic disease therapy during the pandemic; this is associated with an increased risk of disease aggravation and lethal outcomes in patients, which determines the relevance of the topic.
Intention. This review addresses the issue of patients’ adherence to chronic disease therapy during the COVID-19 pandemic, including nosology-specific effects and adherence behaviours.
Methodology. An analytical review of the results of research in the field of the problem under study was conducted; 50 scientific articles, published mainly in 2020–2023 and indexed in international databases, were the material of the present study.
Results. It is noted that despite some controversies in the empirical evidence for increased/ decreased adherence among authors, researchers agree that individuals with chronic diseases during the COVID-19 pandemic experienced the combined effects of a range of challenges in the context of inaccessible health care, sedentary lifestyle, and increased stress and anxiety. In some cases, these factors led to increased vulnerability to chronic disease risk as well as risk factors for severe coronavirus.
Patients’ experiences during the pandemic allow to draw conclusions regarding the need for timely diagnosis of emotional disorders as well as the use of counselling to increase adherence to treatment. Baseline interventions may relate to the use of innovative digital health solutions, self- management education/training for patients.
Conclusion. The described results and conclusions are of interest in the long term, as they allow us to formulate goals and objectives to optimise the organisation of patient care in COVID-19 pandemic-like situations that may await us in the future.
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The influence of social perception on satisfaction with interpersonal relationships in people with obsessive-compulsive disorder
Аннотация
Relevance. The continuous pathomorphosis of OCD and the increase in disability of patients determine the need to search for new specific criteria to improve the accuracy of differential diagnosis, as well as the foundations of effective strategies for psychoprophylaxis, therapy and rehabilitation.
Intention. To study the relationship between social perception and satisfaction with interpersonal relationships in people with OCD.
Methodology. 240 people participated in the study. 120 subjects aged 25 to 50 years (37.5 ± 1.57 years), 60 men and 60 women, had OCD with a predominance of obsessive symptoms (F42.0). The data obtained were correlated with the results of 120 healthy people, whose age and gender composition are similar to the main group. The quasi-experimental nature of the study using emotion recognition tests required the use of analytical-synthesizing and comparative methods, theoretical modeling, the implementation of a “cross-section” to establish the profile ex-post facto, quantitative analysis on the SPSS Statistics 17.0.1 platform. Procedures for calculating the average, standard deviation, significance of differences (Fisher’s F-criterion) were applied. Correlation and cluster analyses are implemented.
The results and their analysis. An empirical study revealed a weak concentration of patients’ attention on the nuances of facial expressions and pantomimics, the lack of a stable orientation towards a communication partner due to pathological autofixation. The subjects have a low level of quality of life in the field of interpersonal relations. They are not satisfied with personal communication, sexual sphere and social support. A violation of social perception has a direct connection with a lack of satisfaction with interpersonal relationships. There is a lack of pleasure from communicating with people and anxiety, prompting withdrawal from communication with a distant society, loss of friendships. The results obtained confirm the domestic and foreign traditions of considering people with neurotic disorders, and are innovative directly for the OCD contingent.
Conclusion. The results show the nosospecific markers of social perception, as well as reveal the features of their relationship with the formation of a defect in the social sphere. The presented conclusions are applicable in the practical activities of psychologists and psychiatrists: in psychodiagnostics, non-medical psychotherapy, rehabilitation of the disabled, and should be introduced into the training process of specialized specialists.
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The relationship between personal decision-making factors and rigidity as personality trait in young people
Аннотация
Relevance. Poor adaptability may interfere with the use of cognitive coping strategies and increase dependence on more maladaptive strategies. It is believed that the structural components of personal potential and personality traits that determine its adaptability can act as psychological resources that determine its readiness to take risks and the ability to exercise conscious control over the transformation of risk situations through its decisions.
Intention − to study the relationship between personal decision-making factors and rigidity as a personality trait in young people with the aim of improving their medical and psychological support. Methodology. 200 young people took part in the experimental psychological study (men / group «M» – 100 people / 50.0 %; women / group «W» – 100 people / 50.0%; average age of «M» = 20,5 ± 1,8, of «W» = 19,2 ± 1,2 years, p < 0.05). The study of personal decision-making factors was carried out using the «Personal Decision-Making Factors » method [9], which is a Russian-language modification of the Q-sorting technique by the German psychologist H. Wolfram [5]. The study of rigidity (as a stable personality trait, manifested in the inability to one degree or another to perceive new experience and incorporate it into the personality system) was conducted using the Tomsk Rigidity Questionnaire by G.V. Zalevsky [18].
Results and Discussion. The study demonstrates that the statistical difference between the rigidity scale scores of the Tomsk Questionnaire in groups of men and women is not significant. The expression of rigidity in both groups is predominantly moderate. The absence of statistically significant differences between decision-making factors in men and women was found, which likely finds its reflection in the levels of personality decision-making factors (similar in both groups; differences in factor levels between the examined groups are presumably due to gender identity of individuals). In both groups, significantly higher values of the ‘Subjective Rationality’ parameter are noted with weak and very weak negative correlation with ‘Personal Readiness for Risk,’ which may be attributed to professional-psychological selection.
Conclusion. The data obtained in the present study may allow for a more differentiated approach to medical and psychological support for young individuals, and, if necessary, to the development of psycho-correctional work with them.
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Risk factors for psychological maladjustment in women with cosmetological issues
Аннотация
Relevance. Due to the practical absence of domestic research in the field of psychological aspects of cosmetological treatment and, conversely, the presence in foreign literature of indications of a number of psychological peculiarities and disorders, as well as difficulties in socio-psychological adaptation and decreased quality of life among patients of cosmetology clinics [18, 20–21, 23–25], the aim of this study is to investigate the psychological characteristics of women with facial cosmetological issues and to identify among these characteristics the most prognostically informative ones regarding the risk of psychological maladjustment.
Materials and methods. To achieve the goal of the study of the female patients of cosmetological clinic were studied using 8 psychodiagnostic methods: Neuropsychic Adaptation Test (NAT), Level of Neuroticism (LN), Perceived Stress Scale (PSS-10), Wellness Index (WHO-V), Quality of Life Satisfaction Questionnaire (QL), BIG Five (BIG-V), Ways of Coping Behavior (WCB) and Meaningful Life Orientations (MLO). There were compared groups of patients without mental adaptation disorders (group 1, n = 74) and with such disorders (group 2, n = 87), formed on the basis of the final score of the NPA-test; groups are comparable in terms of basic socio-demographic and clinical characteristics.
Results. Statistically significant differences were identified and analyzed between groups across 27 psychodiagnostic indicators, characterizing both the current emotional state of the patients and stable individual psychological traits. Using multiple regression analysis, the most prognostically informative indicators regarding the risk of psychological maladjustment were identified: «Level of Neuroticism» (LN), «Locus of Control – I» (MLO), «Emotional Stability» (BIG-V), «Support» (QL); the lower the value of these indicators, the higher the risk of adaptation disorders. Limitations and prospects of the study associated with assessing the dynamics of psychological characteristics of patients in two groups during cosmetological treatment and studying the relationship of these characteristics with treatment effectiveness have been outlined.
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Dynamic of indicators of the psychological state of the examined patients with Acne vulgaris in the process of isotretinoin treatment
Аннотация
Relevance. In the course of their practical work, medical workers in various fields encounter the problem of acne (acne vulgaris). This disease is common, has a high social significance, and often leads to the development of psychogenic disorders.
Target. The purpose of the study is to evaluate the dynamics of changes in the psychological state of men suffering from acne during the treatment with isotretinoin.
Materials and methods. A study was conducted of the effect of the drug isotretinoin on the psychological state of 118 people, men aged 15 to 45 years, suffering from acne vulgaris.
The study participants were divided into 2 groups. Group 1 included 58 patients aged 15-19 years with severe and moderate-severe forms of acne, seeking medical help for the first time, undergoing isotretinoin therapy.
Group 2 included 60 people aged 40–45 years, suffering from moderate to severe forms of acne, with relapse 18–22 years after manifestation, taking isotretinoin during therapy.
Results. During the study, it was revealed that young patients who first sought medical help and received isotretinoin during therapy, exhibited a more pronounced level of tolerance and empathy, improved mood, absence of cognitive difficulties, decisiveness, openness, and a tendency to experiment with sufficient self-discipline at the end of the treatment course. This serves as evidence of their more resilient adaptation post-treatment.
Patients of middle age, experiencing a relapse 18-22 years after the manifestation of the disease, show a predominance of concern, avoidance of responsibility, increased self-control, a certain dissatisfaction with living conditions, alongside an increase in emotional calmness upon completion of the therapy course.
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Social-psychological adaptation to motherhood in women with alexithymia
Аннотация
Relevance. In contemporary psychology, the phenomenon of motherhood is predominantly examined in the context of the formation of parent-child relationship structure, while the significant role of self-perception and self-realization of the future mother is marginalized. Considering the transformation of social relations towards the balanced involvement of both father and mother in child rearing, it is pertinent to study women’s perception of their professional and personal prospects and their subjective evaluation of «personal effectiveness» in motherhood planning. In this regard, alexithymic traits act as moderators, regulating interactions within the marital couple and in relationships with the social environment. Emotional and cognitive avoidance of parenthood- related information, as well as lack of interest in psychological understanding from the spouse, as significant factors of alexithymic traits, significantly influence readiness for motherhood.
Intention. To assess the specifics of socio-psychological adaptation to motherhood in women with alexithymic radical. The research objectives included diagnosing psychological readiness for motherhood and identifying the structure of adaptive mechanisms changes in the situation of motherhood among women with an alexithymic radical.
Methods. The study was conducted on the basis of Prof. V.F. Snegirev Maternity Hospital No. 6 (St. Petersburg). The study sample consisted of 226 women aged 18 to 41 years (26.1 ± 5.3), who were in the second and third trimester of pregnancy at the time of the survey. Each expectant mother was interviewed. According to the results of the application of the Toronto alexithymia scale, a main group of 41 women with an increased level of alexithymia expression was singled out. Women with a normal value on the alexithymia scale were considered as a control group. The object of the study is psychological characteristics of pregnant women. The set of psychodiagnostic techniques included: the technique «Pregnant Women’s Relationship Test» (I.V. Dobryakov), the technique of studying the value system (M. Rokich), the technique of determining the level of personality anxiety and reactive anxiety (C.D. Spielberger in the adaptation of Y.L. Khanin), the technique «Understanding, emotional attraction, authority» (A.N. Volkova, V.I. Slepkova).
Results and discussion. The combination of professional and family roles during pregnancy is characterized by substantive specificity and is assessed as a critical period. When studying the implicit structure of representations about motherhood among pregnant women with alexithymia, pronounced illusions of readiness for childbirth and childcare are noted, with an orientation towards returning to career self-realization in the short and medium term. For them, the leading importance is attached to the values of individualism: «active productive life» and «freedom» combined with a decrease in the stability of motives in accepting the parental role. Future mothers from the control group are more oriented towards self-realization in the family and accepting parental attitudes.
Conclusion. The structure of the value-sense sphere of an expectant mother with an alexithymic radical is determined by a high orientation to professional achievements in the short and medium term. These beliefs can be regarded as predictors of maladaptive reactions to the process of pregnancy and childbirth and determine the need to implement an individual-personal approach in the management of pregnancy in women with alexithymia.
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Discussion club
Clinical and psychological approach in working with codependents
Аннотация
Relevance. Codependency is increasingly prevalent in the modern world and is becoming an independent unit not only in psychological but also in clinical practice. However, there is a noticeable gap between the definitions of codependency, its actual content, and the directions of psychological assistance. A unified approach is needed that integrates the essence of codependency, its component structure, and the practical tasks aimed at providing clinical-psychological assistance to codependents from a single perspective.
Aim – the proposed author’s clinical and psychological approach contains two blocks: 1. theoretical and methodological foundations for the construction of a hypothetical model of codependency and its definition as an integral biopsychosocial phenomenon; 2. the design of the program for providing clinical and psychological assistance to codependents, called the «Sunny Circle».
Codependency is understood by the authors as a heterogeneous, multidimensional, polyfunctional, and dynamic biopsychosocial phenomenon, which is caused by the deficit nature of the personality, particularly by the distorted self-relationship of codependents, and implies identification with the close dependent due to goal-setting deficit and subsequent pathological adaptation to a difficult life situation. The main target of clinical-psychological intervention in the «Sunny Circle» program is the restoration of full personality functioning through the harmonization of its relationships and overcoming codependency.
The program of clinical and psychological assistance to codependents includes 16 online classes and involves four stages: informational and diagnostic, basic, integration, and reflexive. The general structure of classes is maintained at all stages of the program.
The program contributes to increasing the awareness of participants about codependency as a systemic and simultaneously multi-component biopsychosocial dynamic phenomenon, ensuring the mastery of synthesized highly effective methods of clinical-psychological intervention: elements of social perception training, body-oriented practice, cognitive-behavioral therapy, gestalt therapy, art therapy (with a special emphasis on cinematherapy), and constructive behavior training.
This approach of clinical and psychological assistance to codependents represents the author’s view of the problem of codependency. The authors invite colleagues to a scientific discussion.
89-101
Pychoterapy. Psychiatry and narcology. Medical psychology
Analysis of the content of dissertation abstracts on psychotherapy and psychological correction submitted to dissertation councils of Russia in 2010-2021
Аннотация
Relevance. In contrast to foreign countries, dissertation research in Russia undergoes a multi- level scientific expertise, much more extensive than even articles in peer-reviewed journals or monographs. Consequently, for the informational support of new research, it is necessary to thoroughly study the content of previous dissertation abstracts.
The goal is to conduct a substantive analysis of dissertation abstracts on psychotherapy and psychological correction, submitted to dissertation councils in Russia in 2010–2021.
Methodology. We studied the full texts of 227 dissertation abstracts that were digitized in the Russian State Library [https://www.rsl.ru/]. We also utilized the electronic resource of the “Announcements of Defenses” section of the Higher Attestation Commission of the Ministry of Science and Higher Education of Russia [https://vak.minobrnauki.gov.ru/] and the “Medical Dissertations” [https://medical-diss.com/]. To standardize the data, we filled in a table that included bibliographic information, the direction, method, form, model of psychotherapy, type of psychotherapeutic assistance, intervention techniques, and statistical methods of evidence-based medicine (psychology). Patients’ nosologies were matched with the International Classification of Diseases and Related Health Problems (ICD-10). Due to the nonparametric distribution, medians with upper and lower quartiles (Me Q1; Q3) were provided. The data trends were analyzed using time series analysis and a second-order polynomial trend.
Results and their analysis. In the years 2010-2021, on average, about 16 [9; 27] dissertations were submitted to dissertation councils of Russia. There has been a notable decrease in the number of dissertations presented, with 41 dissertations in 2010 compared to only 8 in 2021, representing a 5.1-fold decrease. In the overall sample of doctoral dissertations studied, 11.9 % were in the field of psychological correction, with 46.3% in medical sciences, 45.8 % in psychology, 4 % in education, and 3.9 % in other fields. Works in the specialties of “Psychiatry” and “Medical Psychology” accounted for 44.1 % of the research, with the remaining scientific specialties making up 55.9 %. Lack of leading specialists in psychotherapy and psychological correction in the dissertation councils reduced the adequacy of discussions and the objectivity of decision-making. The theoretical and methodological foundations of psychological interventions were studied in 7.3 % of dissertations, while the forms and methods of psychological intervention considering nosological, syndromal, socio- demographic, cultural, and individual-psychological characteristics were examined in 49.8 % of cases. Psychological assistance in extreme and crisis situations was covered in 2.9 % of dissertations, psychological characteristics of participants in psychological interventions in 22.8 %, family and parent-child relationships in 4.7 %, therapist and consultant personality in 0.5 %, therapeutic tactics and interaction in the process of psychological assistance in 3.9 %, and issues related to evaluating effectiveness in 8.1 %. The dynamic approach to psychotherapy was present in 8.3 % of all dissertations, cognitive-behavioral in 49 %, existential-humanistic in 34.7 %, and linguistic in 8 %. Individual form of therapeutic intervention was found in 56.5 %, group therapy in 29.8 %, family therapy in 10.5 %, social environment intervention in 2 %, and affective intervention in 1.2 %. The clinical model was utilized in 53.2 % of cases, while the non-clinical model was used in 46.7 %. Among the types of psychotherapeutic assistance, treatment was provided in 20.9 %, correction in 38.3 %, rehabilitation in 20.9 %, and prevention and hygiene in 19.9 %. When studying patients (clients), neuropsychological methods were used in 6.1 %, psychological methods in 17.7 %, social- psychological methods in 30.1 %, and social methods in 9.4 %. Methods of evidence were utilized in 88.1 % of dissertations, with single methods used in 87.1 % and multidimensional methods in 24.7 %. The structure of the listed aspects of psychotherapy was studied based on the directions of scientific research. Out of 227 dissertations, 153 (67.4 %) investigated treatment outcomes of diseases, including patients with mental and behavioral disorders (F00–F99 according to ICD-10) in 88 (38.8 %), cardiovascular diseases (I00–I99) in 25 (11 %), and other nosologies in 40 (17.6 %) works. In 69 (30.4 %) dissertations, seeking psychological help was motivated not by illness, but by social-economic, psychosocial, or other circumstances (Z40–Z99 according to ICD-10).
Conclusion. The obtained results expand the informational capabilities of scientists and allow for outlining the results of their own research.
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