| E.A. Khaustova |
PSYCHICAL AND PSYCHOSOMATIC DISORDERS IN PATIENTS
WITH A METABOLIC SYNDROME X (DIAGNOSTICS, CLINIC, PROPHYLAXIS, THERAPY)
|
| Ukrainian research institute of social, forensic psychiatry
and drug abuse |
The thesis is devoted to complex research of psychical and psychosomatic disorders
for patients with metabolic syndrome X (MSX), to systematization of ethiopathogenetic
conformities to the law of their forming, determination of clinical-phenomenological
features of these disorders, development and introduction introduction in practice
the effective complex methods of diagnostics and therapy of psychical and psychosomatic
disorders for patients with MSX. Here were probed 136 patients with an incomplete
metabolic syndrome X, 128 patients with a complete metabolic syndrome X and
52 persons without the signs of MSX (control group). The alternative theoretical
model of pathogeny of MSX was offered and the necessity of determination of
psychosocial factors of his forming was proved on the basis of clinical experiment
during the research. The complex clinical phenomenological analysis of psychical
and psychosomatic disorders, system analysis of labour and family disadaptation
and personality deviations was conducted for patients with MSX. 21,32% patients
with incomplete metabolic syndrome X (IMSX) and 34,37% patients with complete
metabolic syndrome X (MSX) have psychical disorders such as adjustment, depressive,
dysthymic, anxiety, stress and organic asthenic disorders. Other clinical-phenomenological
psychopathological displays are skilled as psychosomatic disorders of different
syndromes’ structure: at IMSX group prevailed asthenic, anxious-phobical
and anxious-dysphoric syndromes; at MSX group - asthenic-depressed, anxious-hypochondrial
and depressed-phobical ones. Severity of psychical and psychosomatic disorders
has positive correlation with MSX severity; their pathomophosis was looked as
the increase of anxiety, alexithymia, hostility and depression, which was masked
by these phenomena. The patients of IMSX and MSX groups have high level of reactive
and personality anxiety with the association of the phenomena of alarm and fear,
thus at IMSX group - fears mainly behaved to the sphere of interpersonal relations,
and at MSX group - directly to the state of health. Depression was a situative
(easy) in the IMSX group and larvated in the MSX group due to alexithymia as
obligate MSX symptom. Blocking of emotional displays was accompanied the redistribution
of aggression with the increase of level of indirect aggression and conflicts.
The negative relation of patients with MSX to the own body confirmed that
syndrome X is the variation of autodestructive behavior. Thus, anxiety, fear,
aggression, both obvious and unrealized, and alexithymia - were appraised as
a basic psychopathological MSX phenomena r, therefore they were used as «targets»
of therapy. By the features of perception patients with MSKH of spatio-temporal
objective reality was been: expectation of less life-span; accent on the negative
events of preschool age and junior school for IMSX; accumulation of negative
events from year to year for MSX; reverse correlation between satisfaction by
life and degree of its tension, that testified to the orientation of patients
with MSX to the past and denial of the future. The patients with IMSX and MSX
have problematic interpersonality relations and deformation of communicative
connections in the form of violations of intergenerational, gender-role, socially-status,
emotional and behavioral mutual relations. Family dysadaptation was showed up
in families microclimate with predominance of conflicts and indifference;
in taciturnity, captiousness and harshness of parents. The level of parents
trust was higher than the level of paternal love feeling, that fact reflected
indifference and alexithymia in paternal families. Due to the deformation of
communicative connections as the forced excessive intercourse during a working
day. Industrial dysadaptation was provoked. These features of family (paternal
and aktual) and industrial patients mikrosociuml formed the style of ordinary
communication and lifestyle which was the instrument of MSX institualisation.
Problem perception of life was correlated with the presence of MSX: the modal
analysis of unrealized and forced out problems showed to sensibility of MSX
patients to the row of psychotraumatic factors, so the highest level of socially-psychological
traumatism was in the IMSX group. The problems of adaptation in transition from
one stage of life cycle to other, inadequate family support, dissatisfaction
by a social role, inadequate feed, feeling of shortage of weakening and rest,
insufficient physical activity, exhaustion, changed pattern of family
mutual relations in childhood, inadequate paternal interference, experiencing
of strong fear in childhood were meaningful in MSX forming. The low level of
adaptiveness in all of spheres of interpersonality contacts was marked for the
IMSX group, so for the MSX group - fixation on the problems of physical
health, which was accompanied with the complications in interpersonality relations.
Episodes of staying in a role «aggressor-victim» marked accordingly
in 1,46 and 1,28 times more frequent in the IMSX and MSX groups, than in a control
group, that confirmed the important role of aggressiveness and reactions
on frustrations in MSX ethiopathogensis. Here was scientifically grounded,
developed and established the complex program of biopsychosocial correction
of psychical and psychosomatic disorders for patients with MSX, which takes
into account transtheoretical approach to its forming, uniting principles of
existential and cognitive-behavioral psychotherapy. Statistics about the efficacy
of treatment were got due to clinical experiment. Identical tendencies of dynamics
of the clinical state, psychological testing data, the common «targets»
of intervention for patients with IMSX and MSX, testify in behalf on institualisation
of psychical constituent of MSX as psychical and psychosomatic disorders. The
groups of complex biopsychosocial correction of IMSX and MSX patients have the
quick distinct clinical effect and save him to the end of research, that is
confirmed by the dynamics of biological indexes. Thus, was made the successful
transition from the unsystem use of different therapeutic methods to the management
the system with the ultimate goal of receiption of high quality of patients
life on the example of the created alternative model of pathogeny, diagnostics
and treatments of MSX.
