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8PSYCHODIAGNOSTIC PREDICTORS OF IMMUNE DISTURBANCES AMONG DRUG ABUSERS
Abstract
Violation of neuroimmune interactions, that are typical for drug addiction, is also an essential link in the pathogenesis of psychosomatic disorders, such AIDS; and can serve as a factor that contributes to accelerated progression of HIV infection among drug addicts. The work is devoted to investigation of HIV-infection accelerated progress psychological risk factors among intravenous drug abusers. Experimental group included HIV-seropositive injecting drug abusers (IDA) being regular hospitalized. Psychological investigations of the patients, including Szondy test, has been carried out since 2006 to 2008 years. The clinical catamnesis archive data for 2004-2015 years were analyzed. Szondy test revealed multicomponent factor, reliably positively associated with HIV- infection accelerating progress. These patterns diagnostics might be applied as one of the bases equally with clinical anamnesis data for personalized design and realization antiretroviral therapy of drug abusers.
Keywords
drug addiction, psychosomatic disorders, HIV- infection, psychodiagnostic predictors
AUTHORS
Evgeniya Valeryevna Markova
PhD, head of Neuroimmunology Lab, State Research Institute of Fundamental and Clinical Immunology, Russian Academy of Sciences, professor, Novosibirsk State Pedagogical University, Novosibirsk, Russia. E-mail: [email protected]
Ivan Vladimirovich Savkin
Researcher of Neuroimmunology Lab, State Research Institute of Fundamental and Clinical
Immunology, Russian Academy of Sciences, Novosibirsk, Russia. E-mail: [email protected]
1. Introduction.
The questions of addiction genesis and treatment represent urgent problem of contemporary medicine. Addictive disorders indicate individual micro social adaptation troubles and consist in tendency to escape from reality by means of one's psychical status artificial change with chemical or nonchemical factors. According to one of the main addictive disorder neurobiological conception, psychoactive substances dependence reflexes brain neurochemical disbalance, in particular serotoninergic dysfunction, i.e. serotonin increased uptake or synthesis disturbance which leads to the deficiency and causes affective disorders, based on positive stimuli fail, urging ones to seek positive stimuli in alcohol, drugs and other psychoactive substances. Addiction biological mechanisms also include dopamine release in brain mesolimbic nucleus accumbens which is triggered by a number of drugs to enhance the addiction [1, 2, 3, 4]. There is an evidence that ''cortisone shunt", biochemical reactions cascade is also involved in addiction genesis process [5, 6].
At present also addiction states genesis is known to be based on central nervous system and immune system cross regulation disturbances, forming parasite feedback loop including both neuroimmunoregulatory processes and behavioral addictive patterns. Neuroimmune disregulation typical for drug addiction turns out to be an essential part of AIDS pathogenesis and may serve as an accelerated HIV-infection progression factor among drug abusers.
Thus, the aim of the present work was longitude investigation focused on accelerated HIV-infection progression psychological factors revelation among drug abusers.
2. Materials and Methods.
Experimental group includes HIV-seropositive not gay injecting drug abusers (IDA) being
regular hospitalized at the "AIDS Centre" (Novosibirsk, Russia). Psychological investigations of the patients had been carried out since 2006 to 2008 years. The clinical catamnesis archive data for 2004-2015 years were analyzed. The main clinical and social characteristics of the sample were provided in our previous investigation [8]. As integral HIV-infection accelerated progression criteria the 10-years survival, temporal decrement and fore - exponential coefficient of absolute CD4+ concentration decrease for the 2004-2015 period were chosen.
As experimental psycho diagnostic methodic was chosen Szondy test in L.Sobchik adaptation [7]. This test is comparatively invariant at social status, gender, age, education level, nationality. Moreover, this test is projective and very resistant to deliberate results falsification.
Data reduction was carried out by means of factor analysis and exponential regression. The cross correlation was estimated by Spearman.
3. Results.
The main integral clinical and psychometrical characteristics of the sample for 2004-2015 years period were provided before [8], so here we focused on the data factor and correlation analyses. Szondy test data reduction results in six factors (eigenvalue>1) from the former sixteen variables, containing 87% of the total variability. Reliable correlation between survival, the exponential indexes and one of the factors obtained (Szondy factor 4, containing 12% of the total variability) (p<0.05) has been revealed. The major components of the Szondy factor 4 are: p=0,786463, ^(h)= 0,563259, -^(k)=-0,41182, ^(hy)= 0,408538, m=0,377891, -s=-0,35301, -^(m)=-0,35063, -k=-0,3474, in order of the significance decrease. The central constellation of the factor is p+, ^(h)+, s-, ^(k)-, ^(hy)+, which represents Ego-diastolic tendencies combined with undifferentiated sexuality and base aggression level decrease.
More detailed analysis of the data obtained allows us to conclude that accelerated HIV-infection progression among drug abusers is inherent to the patients with:
a) external opposite gender traits level increase based on undifferentiated sexuality (h+, s-, hy+);
b) increased Ego expiation, resulting from primary projection (overpressure p, irrelative to the signum);
c) angedanite tendencies (m-);
d) poor, emotionally immature, inflatively-projective Ego in absence of rigid mature Super Ego, inherent for Dual-union (h+, s-, hy+).
The data obtained totally prove our earlier assumption about association of Dual-union indicating immature expansive Ego on the psychical plan with the immune reactivity decrease on the physiological; i.e. internal psychological resources of an addictive personality closely linked with the psychophysiological systems. [1, 2].
The patterns identified previously have not been described elsewhere, however, there are indirect data, fully consistent with our model. Thus, among HIV-positive gay men (which already demonstrate "h+") external rigid Dual-union staty manifestation (gay status concealment, more heavy emotional reaction at sexual partner death and the death fact aversion and denying) is positively associated with the accelerated HIV-infection progression [9, 25, 33]. Antisocial personality disorder (immature expansive Ego) is also positively associated with the frequency and severity of the HIV-infection course among drug abusers [10]. On the other hand group therapy, meditation, social support groups, i.e. all the procedures aimed on the Ego development, strengthening and socialization are negatively associated with HIV-infection severity [11, 29, 35, 40].
There is also detailed model which explains HIV-infection accelerated progression neuroimmune cross correlation, the intermediation mechanism suggested being A protein kinase dependent cytokines genes suppression in blood mononuclear cells, caused by systemic noradrenalin level increase [12, 13]. This model partially agrees with our experimental data (noradrenalin mechanism is reflected in pattern "s-," "m-"), but still the model does not explain the crucial role of the factor "h". The answer is obvious to be concealed in the differences between the HIV-infected patients groups tested. Noradrenalin model was suggested presumably for the gay men group [11, 13], in which monoamine signaling mechanisms are comparatively intact; whereas in drug abusers group (especially opioid addiction) monoamine signaling mechanisms are significantly damaged [14], the sexual steroids signaling pathways are relatively safe. Indeed sufficient literature volume point out the protective role of estrogens anB androgens
for female and mail respectively at HIV-infection [10, 13, 15]. The foregoing allows us to consider steroid mediated mechanisms as an essential part of psychoneuroendocrine immunoprotection and to suppose accelerated HIV-infection progression among drug abusers to be primary associated sexual steroids level decrease and secondary associated with noradrenalin production increase.
Conclusion.
Based upon the longitude study results accelerated HIV-infection progression among drug abusers is found out to be associated with rough, immature, expansive Dual-union inherent Ego on the psychological plan. The physiological derivatives of this psychic phenomenon are considered to be connected with the systemic and local immunomodulatory properties of androgens, estrogens and monoamines.
Hence, definite basal fundamental personality properties able to be revealed by means of the projective methodics result in accelerated HIV-infection progression risk increase. So these diagnostics patterns might serve as one of the bases equally with clinical anamnesis data for personalized design and realization antiretroviral therapy of drug abusers.
Recommendation.
In the context of the psychoanalytic support of the drug addicts infected with HIV it is recommended to focus an attention on the identification, analysis and permission of the relations pathological Dual-Union, and also on the reasonable balance of support and frustration caused by the specified personal features of this group of patients.
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ABOUT EXPANSION OF THE NURSE FUNCTIONS IN APPLICATION OF A SPELEOTHERAPY IN SOME EUROPEAN COUNTRIES AND IN THE REPUBLIC OF BELARUS
Abstract
There is the analysis of the history and state of speleotherapy in different countries of the world, such as Poland, Rumania, Russia, Uzbekistan, Kirgizia and Germany during the XX century. The analysis of speleotherapy in a number of European countries is given; the unique method developed in the Republic of Belarus and possibilities for training of nurses are described.
Keywords
bronchial asthma, quality of life, nurse, rehabilitation, rhinitis, speleotherapy
AUTHORS
Tatyana Vladimirovna Matveychik
PhD, Associate Professor, Public Health and Health Care, Belarusian Medical Academy of Postdegree Education", Minsk, Belarus. E-mail: [email protected]
Rostislav Ivanovich Delendik
Doctor, Republican Hospital of Speleotherapy, Soligorsk, Belarus. E-mail: [email protected]
Relevance
Consequences of human activity concerning ecological shifts, impurities of the air environment, increase of respiratory viral infections promote growth of respiratory organs diseases, including allergic diseases of a nose mucous membrane and perirhinal bosoms. Prevalence of allergy in the world represents a global problem of public health care for 30-40% of population with one or several allergic diseases. According to the statistics of the World Health Organization (WHO), hundreds of millions people suffer from allergic rhinitis and about 300 million of people - from bronchial asthma (BA), most of them are children and teenagers. There are over 60 thousand of patients in the Republic of Belarus. In this connection, the research of effective methods of influence at chronic respiratory diseases is actual. Such diseases are bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic diseases - rhinitises, pollinoza, dermatitis, chronic polipoid rhinosinusitis. Efficiency of treatment can be reached by inclusion of nonmedicamentous methods of treatment, including speleotherapy and expansion of nurse's functions.
Research objective is studying regularities of speleotherapy formation on the example of the European countries (Poland, Romania, Russia, Uzbekistan, Kyrgyzstan, Germany), domestic scientific researches with search of possible regularities and sisterly pedagogical potential in instilling skills of health preservation during patients' sanatorium treatment.
