CC BY
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BecTHUK Ka3HMY, №4 - 2014
UDK 616.89:615.832.9; 615.851
S.A. ALTYNBEKOV, A.Y. TOLSTIKOVA
Department of psychiatry, psychotherapy and narcology of KazNMU named after Asfendiyarov S.D.
GROUP PSYCHOTHERAPY OF PEOPLE WITH SUICIDAL BEHAVIOR WITHIN THE ADDICTION TO PSYCHOACTIVE SUBSTANCES
This article shows the effectiveness of psychotherapy when working with psychoactive substance addicts. It was found that that group crisis psychotherapy performed diagnostic and therapeutic functions. The experimentally - psychological studies have shown differences in the structure of personal characteristics and stereotypes in response to the difficulties of life from patients with neuroses and those with suicidal behavior. However, these differences did not hinder the formation of a therapeutic atmosphere and intensive group work. Keywords: psychotherapy, psychoactive substance addicts, experimentally - psychological studies.
According to WHO's definition, "suicide is an act of self-annihilation with the fatal outcome; attempted suicide-analogous act without the fatal outcome".
The 2001 report on the world's condition of health ("Mental Health: New Understanding, New Hope") states, "suicide is the result of deliberate action by a certain person, who is fully aware of or awaiting death."
Depending on a person's views on suicide, there are several types of suicidal behavior: verbal, behavioral and situational. Verbal: direct statements like: " I'm thinking about committing suicide", " It is impossible to live like that", " Everyone would be better off if I died," etc. Indirect statements, for example, "I am fed up with everything", "You no longer have to worry about me". Allusion of death or jokes about it. Meaningful goodbye with others.
Behavioral: despair and mourning, self-isolation from family and loved ones, abuse of alcohol and / or drugs, increase and / or loss of appetite, withdrawal from normal social activities, insularity, suicide attempts in the past, guilt, reproaches for him/herself or change the will etc.
Situational: the death or leaving of a loved one, especially of a spouse, a recent relocation, troubles with the law, difficulties in communicating with others, social isolation, chronic and progressive disease, unwanted pregnancy, etc. We have distinguished three components in the structure of suicide dangerous reactions: emotional (anxiety, grief, sadness), cognitive (ideas about their own uselessness, the inability to resolve the situation) and behavioral (seeking for help - the emergence of ineffective coping, the emergence of psychological defenses, pathological compensation - the formation of the whole world of behavioral reactions) [1].
Considering suicidal behavior as a consequence of socio-psychological maladjustment of personality, it is advisable to use a psychotherapeutic intervention on people with suicidal behavior within the psychoactive substance addiction [2]. "The golden rule of crisis psychotherapy" states that the purpose of the intervention during the crisis is to restore or create the person's level of adaptation. It is not directed to cause drastic personality changes. Because of its focus, crisis psychotherapy belongs to the cognitive - behavioral [3,4]. Principles and tasks of crisis psychotherapy:
- Urgent character of help
- Focus on the identification and correction of maladaptive psychological mechanisms that contribute to the emergence and maintenance of pathological reactions
- Identification of cognitive phenomena, leading to the development of suicidal feelings and promoting recurrence of suicidal risk;
- The search and training of untested methods of resolution of interpersonal conflict, improving the socio-psychological adaptation, personal growth, frustrational tolerance;
- Aiming to return to the previous level or even better level of adaptation.
Features of crisis psychotherapy:
- Crisis psychotherapy focuses on the customer's request;
- Has no time limit
- Theoretically eclectic.
Materials and methods: our experience is based on a study of 80 people with suicidal thoughts and attempts with psychoactive substance addiction treated at the Republican Scientific -
Practical Center for Psychiatry, Psychotherapy and Narcology of the Ministry of Health of the Republic of Kazakhstan. The study included patients with a diagnosis of "Mental and behavioral disorders as a result of alcohol addiction". Currently, in abstinence, but in conditions that preclude use (F. 10.21) and "Mental and behavioral disorders due to use of opioids". Also, abstinence, but in conditions that preclude use (F. 11.21) according to MKB- 10. All subjects showed signs postabstinent depression with suicidal behavior.
Indications for group crisis psychotherapy were the objective isolation or a subjective feeling of loneliness, difficulties in establishing interpersonal contacts or dissatisfaction with them, the difficulty of affective control, a sense of worthlessness, inferiority, or inadequate self-esteem with nonconforming, rejected forms of behavior in society.
The indicated motives of suicidal behavior were caused by interpersonal conflicts in personal, family and working spheres. Grievances, conflicts, setbacks affecting the scope of meaningful relationships of personality were "trigger mechanisms" of suicidal behavior of patients. These issues and current conflict were discussed in the group psychotherapy [5]. Stages of the group crisis psychotherapy:
- Crisis Support (contact, disclosure experiences contract);
- Crisis intervention (cognitive analysis, correction of cognitive maladaptive mechanisms);
- Raising the level of adaptation.
People with suicidal behavior were brought to the group of patients with neurosis, preneurosis states and those with communication difficulties, which accounted for 50 % of the total. Experience has shown that the most optimal way was the gradual inclusion of these patients in the stage of the already established therapeutic atmosphere within the group. If these attempts were made during the formation of the group, they were unsuccessful. Patients with suicidal behavior could not withstand the voltage of the group. Patients with suicidal behavior dependent on psychoactive substances, unlike neurotic patients were characterized by instability of contacts and low degree of interest in the first stage of entering the group process. Discussion: group crisis psychotherapy performed diagnostic and therapeutic functions. The observations of the behavior and reactions of people with suicidal behavior confirmed the conclusion of experimentally-psychological study, which states that they have a greater sensitivity than patients with neuroses. They were indicators of stress and frustration in the group and often took the blame of other members of the group. One of the forms of reactions to group voltages were the emergence of the impression of group rejection, which in fact was not confirmed objectively.
The problems of current conflict in a meaningful relationship were also discussed within the group. Patients with suicidal behavior noted the similarity of their problems with the problems the other members that helped to reduce the scale of grievances and led to the deprivation of the uniqueness and insolubility. The group actively discussed topics of life and death, that moved work of the group in to the level of existential psychotherapy with elements tanatotherapy. Members of the group took over the functions of the therapist in relation to other patients with suicidal behavior, feeling responsible for their fates. It should be noted that the inclusion of patients with suicidal behavior to the group affected the rest of the group in
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terms of reducing the egocentric isolation on their experiences when meeting people that came close to death. The experimentally-psychological studies [6] have shown differences in the structure of personality characteristics and stereotypes in response to the difficulties of life of patients with neuroses and those with suicidal behavior , but these differences did not hinder the formation of a therapeutic atmosphere and intensive group work . Research team members using the Eisenach personality questionnaires, MMPI, techniques of "Unfinished offers" and frustrational tolerance of RosenZweig
revealed large areas of conflict of individuals with suicidal behavior compared to patients with neuroses, their sufficient communicability and low neuroticism. The essential difference is more expressed reactions of resolving type, along with the predominant reaction of needs continuation unlike the norm. Results: thus, the socio-psychological maladjustment and suicidal behavior during the addiction determined by the presence of anxious depression, behavioral disorders expressed in his regression (refusal of research activities as a result of non-constructive coping) or wrong direction.
REFERENCES
1 Ambrumova AG In collection: Relevant Issues of Social Psychiatry and borderline neuro - psychiatric disorders. - M.: 1975. - 211 p.
2 Ambrumova AG Individually - psychological aspects of suicidal behavior // In collection: Actual problems of Suicidology. -M.: 1978. - P. 44-59.
3 Galtsev EV Criteria for severity of suicide attempt in terms of predicting the risk of suicide // Materials of 14 Congress of Russian Psychiatrists. - 2005. - P. 436-437.
4 Favaro P.H. and Santonastaso S.P. The mechanism of action of antidepressants revised // G. Neural. Transm. - 2001. - Vol. 34.- P. 31-38.
5 Thomsen J.L. et al. Partial sleep deprivation as therapy for depression // Arch. gen. Psychiat. - 2002. - Vol. 37. - P. 262-268.
6 Masson D., Collard M. On the preferential abuse of heroin and amphetamine // J. Nerv. Ment. Dis. - 2003. - Vol. 156. - P. 242-248.
tywh: бершген ма;алада психоактивт заттарга тэуелдШкпен нау;астарда психотерапияныц тшмдШп керсетшген. Кризист психотерапия эдта ;олданылды. Тэжiрибелiк-психологиялык; эдк кемепмен невротикалы; депрессивт жагдайлармен жэне суицидальды эрекетпен эртYрлi нау;астар топтарыныц психотерапиялы; урдкке реакциясы керсетшген. Психотерапиялы; тэсшдеме терапияныц ;олайлы агымына непзделген арнайы емдеу атмосферасына жагдай жасады.
УДК 616.33/36:613.863
Б.Б. ДЖАРБУСЫНОВА
ПСИХОСОМАТИЧЕСКИЕ АСПЕКТЫ В ГАСТРОЭНТЕРОЛОГИИ
Психосоматические расстройства отнесены к категории психологических факторов, влияющих на соматическое состояние больных. Рассмотрены особенности применения препаратов из групп нейролептиков, анксиолитиков и антидепрессантов при психосоматической патологии
Ключевые слова: Эмоциональный стресс, Функциональные гастроинтестинальные расстройства, Транквилизаторы, Психотропные препараты, Психосоматика, Психогенная рвота, Общая врачебная практика, Нейролептики, Антидепрессанты, Анксиолитики, Абдоминальные алгии
Взаимодействие между «душой» и «телом», между психическими и соматическими факторами в болезни было известно и обсуждалось еще врачами античности. Демокрит (V в. до н. э.) полагал, что душа часто может служить причиной бедствий тела. Платон (IV в. до н. э.) был убежден, что сумасшествие (мания) у многих людей возникает в силу соматического недуга. Многие считают первым «психосоматиком» М. Цицерона (I в. до н. э.), который первым высказывал аргументированные суждения по поводу воздействия горя, сильных душевных волнений на здоровье человека и возникновение телесных болезней от душевных страданий. Еще 2400 лет назад Сократ утверждал, что не существует телесной болезни, отделенной от душевной, а Платон, его знаменитый ученик, сетовал: «Большая ошибка совершается там, где телесные и душевные болезни лечат разные врачи. Ведь тело неотделимо от души». Но эта ошибка повторяется постоянно. Вместо того чтобы подходить к лечению комплексно, изучать тело, душу и дух в их совокупности, углубляют специализацию, расчленяют человека все более дробно. Видный отечественный интернист Д. Д. Плетнев (1927 г.) писал: «Нет соматических болезней без психических из них вытекающих отклонений, как нет психических заболеваний, изолированных от соматических симптомов».
Психосоматические расстройства являются психогенно обусловленными патологическими расстройствами, они наряду с неврозами и психопатиями составляют значительную часть контингента больных, относимых к группе пограничных психических заболеваний. По объединенным данным Всемирной Организации Здравоохранения (ВОЗ), от 38% до 42% всех пациентов, посещающих кабинеты соматических врачей, относятся к группе психосоматиков [1]. По данным В. Д. Тополянского и М. В. Струковской (1982) 22% лиц с жалобами психосоматического характера занимают до 50% рабочего времени врача в общемедицинской сети [2]. Эти пациенты годами наблюдаются у врачей-интернистов, у специалистов различных областей внутренней медицины. Как правило, лечение при этом неэффективно, что наносит значительный моральный ущерб не только отдельным врачам и медицинским учреждениям, но и всей системе здравоохранения, дискредитируя в глазах больного и его семьи всю медицинскую науку и практику [2]. Это делает необходимым для врачей-терапевтов, гастроэнтерологов, кардиологов иметь основные сведения и представления о «психосоматозах» (современное обозначение
психосоматических расстройств).
В международной классификации болезней МКБ-10 психосоматические расстройства отнесены к категории психологических факторов, влияющих на соматическое
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