[Dynamics of cognitive functions using the rehabilitation program of cognitive training]. / Dinamika kognitivnykh funktsii pri ispol'zovanii reabilitatsionnoi programmy kognitivnogo treninga.

OBJECTIVE: To study the efficiency of the neuropsychological rehabilitation of patients with mild cognitive impairments. MATERIAL AND METHODS: The study included 103 elderly people, aged 59 to 88 years, including 90 women and 13 men with subjective complaints of memory loss (ICD-10: F06.70; F06.71; F06.78; F06.79). Participants were divided into experimental group (n=43) and comparison group (n=42). The estimated impact was the rehabilitation program «The psychosocial therapy and neurocognitive rehabilitation of elderly patients with cognitive impairments¼, within which the principle of complex stimulation of various parameters of the cognitive sphere was used in rehabilitation work with patients in the experimental group in accordance with the «Memory Clinic¼ program. The study was conducted using randomized, equalized comparison groups, and the principle of «triple-blind¼ research. Non-parametric statistics (SPSS) methods were used to assess differences. RESULTS: A significant difference between the comparison and experimental groups has been identified, primarily in relation to high-level mental processes associated with the function of the third structural-functional block according to A.R. Luria. After the training, the number of correct answers significantly increased (t(42)=-2.67, p<0.001) in the experimental group, while in the comparison group the indicator did not change (t(41)=0.50, p=0.617). The number of false alarms in the experimental group decreased significantly (t(42)=2.13, p=0.039). CONCLUSION: The results confirm the leading role of these processes in the hierarchy of mental functions, which suggests that they should primarily be targets of rehabilitation interventions.

[Peculiarities of emotional-cognitive assessment of sensations by patients with neurological diseases].

To study peculiarities of emotional-cognitive assessment of color sensations and sensation descriptors in patients with autonomic dystonia and cerebrovascular diseases, 70 healthy subjects and 113 patients including 27 with autonomic dystonia, 48 - with discirculatory encephalopathy and 38 - with ischemic stroke have been studied in the rehabilitation period. Clinical-neurological examination, assessment of headache intensity on the Visual-Analogous scale, anxiety and depression levels on the Hospital anxiety and depression scale, the level of mental maladaptation on an author's scale as well as a study of emotional-cognitive assessment of color sensations and sensation descriptors have been carried out. Assessments of color sensations were studied using 20 color standards, indices of positive and negative assessment of all groups of colors and colors of certain categories were determined. The relation to sensation descriptors was studied by showing a list of 50 words; indices of positive and negative ratings of different categories of descriptors (% to the total number of words listed) were determined. It has been shown that the system of assessment of color sensations is most substantially changed in patients with autonomic dystonia that appeared in the more negative, compared to healthy people, perception of cold color tones, dark tones and chromatically non-saturated colors. These changes were less represented in patients with cerebrovascular diseases and disappear after stroke. Changes in the system of sensation descriptors rating are evenly expressed in patients with autonomic dystonia and cerebrovascular diseases: patients' ratings of sensation descriptors are more negative compared to healthy people. These changes are related to the increase of anxiety and depression levels and may contribute to mental health problems of patients.

[A historical analysis of "insight" category in psychiatry].

This work presents a historical analysis of the formation and development of "insight" category (awareness of illness) in the process of interdisciplinary collaboration between psychiatry, psychology and social sciences. Different meanings of the term "insight" and their impact on the modern perception of the awareness of illness phenomenon are analyzed. The differences in particular aspects of the clinical reality described by insight and other concepts used in the studies of awareness of illness are highlighted. The need for introduction of a new conventional category "insight" for studying the problem of awareness of a mental illness and perspectives of their empirical investigation.

[Attitude of district internists to the problem of secondary prevention of ischemic heart disease (results of a special questionnaire survey)].

Attitude of district internists to the realization of a concept of secondary prevention (SP) of ischemic heart disease was studied in one of large cities in Russia. Among preparations most necessary for SP the following were named: b-blockers (79.5%), angiotensin converting enzyme inhibitors (49.3%), antiaggregants (43.8%), hypolipidemic drugs (13.7%), nitrates (63%), biologically active supplements, phyto-preparations, metabolic drugs, and glycosides (3-5% each). However actually prescribed drugs were b-blockers (100%), nitrates (96%), angiotensin converting enzyme inhibitors (89%), calcium antagonists (87%), antiaggregants (83%), cardiac glycosides (66%), vitamins (39%). Average doses of drugs were low: 21.7, 47.4 and 35.5% of possible maximal doses for statins, angiotensin converting enzyme inhibitors, and beta-blockers, respectively. Nondrug measures were used "rarely" and "often" by 26 and 74% of physicians, respectively. Only 18% of physicians directed their patients to corresponding specialists. Recommendations were mostly formal, without explanation of goals, methods and specific features of recommended measures. Moreover their prescription by physician was determined largely by subjective factors: availability of sufficient time (50%), cultural level of a patient (79%), patient's own initiative (33%), physician's personal attitude to a patient (21%).

[Evaluation of stress tolerance in the neurological patients].

A purpose of the study was to develop the Stress Tolerance Scale (STS) and to assess its diagnostic efficacy in neurological clinical practice. The theoretical ground for stress tolerance measurement is the concept of personal environmental interaction as a process including phases of the subjective stress event appraisal, active reaction and subjective result appraisal. The STS encompasses the response items of the descriptions of the accomplished and unaccomplished person-environment and self-personal relations that result in stress overcoming or in stress maintenance, respectively. Within each group, the additional variants of the transactions were specified according to their space-temporal characteristics. Data sets from 112 healthy people and 247 patients (60 with chronic tension headache, 72 with chronic low back pain, 51 with myasthenia gravis, 14 with progressive muscular dystrophy, 27 with hereditary polyneuropathy and 23 with torticollis) have been analyzed. The validity and quiantitation of the STS were determined by Rasch analysis and comparison of the results with those of total STS score and subscale scores of the Hospital Anxiety and Depression Scale and Russian brief version of MMPI. All correlations were at a level of significance. A decrease of stress tolerance was found in patients with chronic pain syndromes and torticollis. The results indicate that the STS allows assessing stress tolerance and a structure of person-environment interactions used by a patient. It can be utilized for optimization of short-term psychotherapy of neurological patients.

[Psychological mechanisms of refusal reactions in schizophrenic patients].

The psychological study is based on the clinical typology of refusal reactions (RR) in schizophrenic patients--"capitulation", "avoidance", "absenteism". Seventy patients with RR, mean age 27 years, 25 women, 45 men, were examined with the use of a number of psychological methods. The findings prove the hypothesis on the disturbances of motivation as a psychological mechanism of RR in schizophrenic patients. Deficiency is related to functions of the motivational process: incentive function, goal achievement, sense making and strengthened by trait anxiety and desize to avoid danger. The main factor promoting RR formation is basic motivation deficiency caused by endogenous process (schizophrenia). A mechanism of capitulation reaction formation is closely related to expectation of failure and refusal from acting as an opportunity to preserve self-estimation; avoidance reaction is characterized by significant disturbance of the motivation at the stage of incentive, goal achievement and sense making. Motivation deficiency in patients with absenteism reactions is predominantly associated with an specific individual's sense.

[Psychological aspects of contrast obsessions]. / Psikhologicheskie aspekty kontrastnykh obsessii.

The paper presents a clinical-psychological examination of 40 patients with contrast obsessions of homicidal- and suicidal-phobic contents. The cohort of patients was divided into two groups by the prevalence of the possibility to commit either autodestructive and criminal actions (group 1-24 patients) or violence and murder (group 2-16 patients) in clinical picture of contrast phobias with anxious apprehension. It was found that in patients of group 1 pathology of personality presented with disorders of the hysteric-hyperthymic sphere together with features of overanxiety, while in patients of group 2--with disorders of the anancastic-schizoid sphere. Differences between the groups in terms of the objective direction of anxiety were associated with peculiarities of the structure of the personality: in group 1 the choice of the object of anxiety from the individuals of the nearest surrounding or the very patient himself, was determined by diffusion or widening of Ego boundaries and identification of patients with their microsocial environment; in group 2 the choice of such object of the "accidental other" was determined by the fixing, narrowing of Ego boundaries and by separation from the microsocial environment. Chronological direction of the anxiety in group 1 was conditioned by the peculiarities of the imagination function: hypertrophy of fantasy, abundance of the means of the symbolization of intrapsychic experience and emotional style of thinking determined an anticipatory anxiety; while an insufficiency of fantasy, alexythymia and the operational style of thinking in group 2 determined a retrospective anxiety.

[Clinical aspects of somatic disease and internal course of the disease (heart ischemia and bronchial asthma model)]. / Klinicheskie osobennosti somaticheskogo zabolevaniia i vnutrenniaia kartina bolezni (na modeli ishemicheskoi bolezni serdtsa i bronkhial'noi astmy]

Criteria of subjective severity (SS) and subjective control of the condition (SC) associated with establishment of the disease internal picture (DIP) were determined in 67 patients with verified coronary heart disease (CHD) and 68 with verified bronchial asthma (BA). Essential for SS were: severity of the subjective symptoms, features of the somatic condition debut, the speed of the disease progression. Essential for SC were the following components: effectiveness of self-care, severity of noticeable or ugly symptoms, features of the triggers (attack provokers). SS and SC criteria can be used for differentiation of the interventions to change the patient's attitude to their disease and therapy in the direction of more compliance with the doctor.

[The clinical and psychological aspects of the reaction to disease (the problem of nosogenias)]. / Klinicheskie i psikhologicheskie aspekty reaktsii na bolezn' (k probleme nozogenii).

"Nosogenias" is the term describing some reactive states. They account for 15-90% of all the patients of somatic hospital. They are due to constellation of some psychotraumatic events related to somatic disease. A total of 166 patients were examined, among them 55 patients with ischemic heart disease, 56 cases with hypertension and 56 ones with bronchial asthma. The results evidence for the existence of two independent vectors which characterise "extremal" points of continuum of disease perception. The importance of somatic trouble (hyper- or hyponosognomia) was the basis of the first vector while the degree of completeness of independent and the whole image of disease as something which differed from "self" (ego-dystonic and ego-syntonic perception of disease) was the basis of the second vector. Combination of the above vectors with clinical and psychological characteristics in the whole clinical pattern of disease was recorded.

[The psychopathological structure of depressions]. / K psikhopatologicheskoi strukture depressii.

The theoretical model of depression has been developed on the basis of 275 psychopathological observations of the affective disorders. The primary symptom complexes of hypothymia and alienation are considered to be the obligatory components of the syndrome structure. Depressions are ranged into the system with variants according to comorbid correlations between hypothymia and alienation. The anesthetic depression (in which the signs of vital affective suppression and alienation are characterized by total symptomatological comorbidity) considered to form the center of such system. The variations of affective disorders (vital, existential, "self-torture" depressions, "depression without depression") in which the comorbidity phenomenon is just partly realized and in which one of the symptom complex is totally expressed have the marginal position.

[The psychopharmacotherapy of anxious-depressive states (the interrelationship of the structure of the comorbidity to the choice of drug therapy)]. / Psikhofarmakoterapiia anksiozno-depressivnykh sostoianii (vzaimosviaz' struktury komorbidnosti s vyborom medikamentoznoi terapii).

The authors examined 65 inpatients aged 20-61 admitted to the clinic with obsessional-phobic and depressive conditions (comorbidity). According to DSM-III-R, the patients suffered from panic and major depressive disorders, dysthymia, atypical depression within schizoaffective disturbance. By the response of the patients to alprazolam (anxiolytic) and fluoketin (antidepressant) given by a special scheme, 3 types of comorbidity of obsessional-phobic and affective disturbances were recognized: 1) prevalent depression, 2) combination of dysthymia with marked obsessional-phobic disorders, 3) overcoming of obsessional-phobic and affective disorders. Type 1 and 2 patients benefited more from monotherapy with antidepressants or tranquilizers. Type 3 patients did well on combined chemotherapy with tranquilizers, antidepressants, neuroleptics.

[The psychological rehabilitation of patients following reconstructive operations in congenital deformities of the jaw bones]. / Psikhologicheskaia reabilitatsiia bol'nykh posle rekonstruktivnykh operatsii pri vrozhdennykh deformatsiiakh cheliustnykh kostei.

Various methods of psychotherapeutic correction, used in patients with congenital deformations of the jaw bones, are described. Individual and group psychotherapy before, immediately and in late periods after surgery was used. Good results were achieved, confirmed by objective psychologic tests.

[The psychological aspects of the rehabilitative treatment of patients operated on stomach cancer]. / Psikhologicheskie aspekty vosstanovitel'nogo lecheniia bol'nykh, operirovannykh po povodu raka zheludka.

Psychic status was evaluated in 250 radically operated patients with gastric cancer at different stages of treatment (inpatient hospital-health resort-outpatient hospital) and adequate therapy was administered. Timely correction of depression proved a component of complex treatment of postresection disorders in gastric cancer patients.

[Social contacts and attitude toward cancer patients]. / Sotsial'nye ustanovki i otnoshenie k onkologicheskim bol'nym.

The study was concerned with social attitudes to cancer, cancer patients and readiness to make contact with former in-patients of cancer clinics. A specially-developed questionnaire was used to interview 300 persons. It was shown that certain attitudes to problems of cancer prevention and treatment as well as preparedness to make social contact are determined by relevant concepts and available knowledge on malignant diseases.

[Disease awareness among oncology patients]. / Osoznanie zabolevaniia u onkologicheskikh bol'nykh.

The characteristics of the disease awareness in cancer patients were analyzed. On the basis of the clinico-psychological examination over time of 250 cancer patients, the mechanisms of disorders of the disease awareness have been specified. These include a shift of the subjective zero of assessment, a change in the health ideal standard, fragmentation and retrospective overestimation of one's health, formation of a specific semantico-perceptive protection leading to an increase in the level of idefiniteness of negatively evaluated stimuli. The factors influencing the structure of the disease awareness as well as their association with deontological approaches are described.