Медицина / 3.Организация здравоохранения.

L.N. Gymenyuk

OBJECTS OF PSYCHOSOCIAL THERAPY

AND REHABILITATION OF SCHIZOPHRENIC PATIENTS

IN PSYCHONEUROLOGIC DISPENSARY ENVIRONMENT

Today psychosocial therapy and psychosocial rehabilitation have become not only widely-used, but ordinary and everyday components of psychiatric support [1-2]. The object of the psychosocial approach is to ensure the balance between the mental life of a person and social relationships which influence this person’s activity. [3-5]. To be able to estimate the extent of necessary psychosocial interferences and to single out target groups of patients who need the application of these interferences it is necessary to analyze not only clinic characteristics of patients, but also characteristics of their social status and functions[6-8].

The object of the research is analysis of clinic and social characteristics of schizophrenic patients who have been under the treatment at a psychoneurologic dispensary in order to estimate the necessary methods of psychosocial interferences.

75 schizophrenic patients aged from 18 to 55 who have been under the treatment at a psychoneurologic dispensary have been analyzed in an integrated way. The clinic characteristics of the patients, such as duration of the disease, duration of treatment at the psychoneurologic dispensary, disability (mental and somatic diseases), duration and dynamics of disability; the frequency of patients’ appealability for psychiatric support during 5 years: average dispensary appealability (per year); admissions to day hospital, admissions to hospital, the total duration of day hospital stay, the total duration of hospital stay; rates of the social status and functions of the patients. The measures which are necessary to solve the social problems have been discussed with the patients within the framework of a structured pointed interview with thematic questions. On the basis of the obtained results of analysis of mental disorders intensity, of the level of social functions of the patients, and also of their daily life problems, the following kinds of psychosocial support which must be realized at psychoneurologic dispensaries have been determined: 1) conducting of psychoeducation of schizophrenic patients and their relatives (in order to provide a patient with information about the disease, its reasons, effectiveness of treatment, forecast, and also about the necessity of constant cooperation with the supervising doctor); 2) family therapy based on the statement that a family communicative style of the strategy of controlling and solving problems relates directly to the diathesis-stress-vulnerability model in a mental case, according to the model, solving of problems in a family increases the patient’s capacity and ability to resist stressful influences, thus compensating their vulnerability to stress and decreasing the risk of periods; 3) social skills trainings which are aimed at the improvement of stability of vulnerability of psychobiological mental patients in respect to the demands of the society, family conflicts, etc, and which also facilitate the formation of habits of cooperation with state institutions, of housekeeping, of passing free time, habits of friendly and family relationships; 4) protected job placement which is aimed at enhancement of competitive job placement adjusted for the level of working ability and individual preferences of a patient; 5) “supportive accommodation” for the patients who have lost their social connections and skills of independent living in the society. The main goal is to restore social functions, to rehabilitate the patients and bring them back to the society; 6) active cooperation of psychoneurologic dispensaries with state and social organizations.

With an allowance for existing significant problems in the sphere of social functions of schizophrenic patients who have been under the treatment at a psychoneurologic dispensary, it is reasonable and necessary to include a wide range of psychosocial measures in the structure of psychiatric support of ambulatory patients.

Литература:

1. Абрамов В. А. Основы качественной психиатрической практики / В. А. Абрамов, С. И. Табачников, В. С. Подкорытов. – Донецк : Каштан, 2004. – 247 с.

2. Табачніков С. І. Актуальні проблеми психічного здоров’я населення України / С. І. Табачніков // Міжнар. психіатр., психотерапевт. та психоаналіт. журнал. – 2007. – Т.1, № 1. – С. 5–7.

3. Состояние психиатрической и психотерапевтической помощи в Украине / С. И. Табачников, А. К. Напреенко, В. В. Домбровская [и др.] // Психиатрия и общество : материалы конф., посвящ. 80-летию гос. науч. центра соц. и судеб. психиатрии им. В.П. Сербского, 5-7 дек. 2001 г. – М., 2001. – С. 184–188.

4. Абрамов В. А. Хронические психические расстройства и социальная реинтеграция пациентов / В. А. Абрамов, И. В. Жигулина, В. С. Подкорытов. – Донецк : Лебедь, 2002. – 279 с.

5. Особенности межличностных отношений больных параноидной шизофренией с симптомами госпитализма / В. А. Абрамов, Т. Л. Ряполова, И. В. Жигулина, Г. Г. Путятин // Тавр. журн. психиатрии. – 2007. – № 3. – С. 24–29.

6. Гурович И. Я. Психосоциальные подходы в практике лечения и реабилитации шизофрении: современные тенденции / И. Я. Гурович, Н. Д. Семенова // Соц. и клин. психиатрия. – 2007. – № 4. – С. 78–85.

7. Кондратьев Ф. В. Судебно-психиатрический аспект функционального диагноза и индивидуализированные программы профилактики общественно опасных действий психически больных / Ф. В. Кондратьев // Профилактика общественно опасных действий психически больных. – М. : Медицина, 1986. – С. 16–24.

8. Кондратьев Ф. В. Постпсихотическое развитие личности / Ф. В. Кон-дратьев, А. В. Велигорский // Профилактика общественно опасных действий психически больных : тез. докл. – Калуга, 1988. – С. 63–66.