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Section 6. Medical science
Ashurov Zarifjon Sharipovich, CMS, senior lecturer, chief of Psychiatry and Study of Narcomania Department, Tashkent Medical Academy
E-mail: [email protected]
Addictive patients with deviant behavior and their relatives
Abstract: The results of the study widen the capabilities of the diagnostics of suicidal behavior patterns in patients with addictive impairments and provide prognosis of readaptation and re-socialization ways. Keywords: opiate drug addiction, deviant behavior, readaptation, re-socialization.
Modern stage of psychiatry and narcology development is characterized by deepening of the deviant behavior problem. Increase of the number of deviant behavior cases especially among people suffering psychic and narcologic diseases conditions the necessity of study and design of the therapy, rehabilitation, and prophylactic strategies [2; 3].
Practical solution of the problems of deviant behavior prevention mostly depends on duly diagnostics of these states and early medical and social-psychological help to people with addictions [1; 2].
The objective: is to study the character of clinical symptoms in addictive patients with deviant behavior.
Materials and methods of the study. From the total number of102 patients with opiate narcomania 45 patients with opiate narcomania without deviant behavior (44.1%) were distributed to the 1st group including 27 men (60.0%) and 18 women (40.0%). 2nd group involved 57 patients with opiate narcomania with deviant behavior (55.9%), among them 36 men (64.9%) and 20 women (35.1%).
The 1st group included 45 patients the age of which was 25.65±3.54 years old. It is important to note that this group was presented mostly by young patients: about half of them were younger than 25 years old — 20 patients (46.51%), and it was reliably higher than in the 2nd group. The prevalence of heredity was reliably lower than in the 2nd group, and it was 72.09%. In the most cases as well as in the 2nd group there was hereditary father's alcoholism in 20.93% cases. Personal deviations were registered in 18.60% cases. Analysis of micro social environment in pre morbid showed that patients of that group were raised in full families in 65.13% cases (28 patients), and it was reliably more often than in the 2nd group. Patients in the 2nd group were raised in hyper care conditions (19 patients — 44.18%), and it was reliably more often than in the 1st group; in the conditions of all-permissiveness almost reaching total absence of control — 14 patients (32.56%). In this group the total characteristic peculiarity ofpre-morbid background was presence of affective and reactive lability, affective excitability, diminished control over emotional reactions. In this group there is prevalence of patients with excitable, hysterical and passive-aggressive personal radicals in pre morbid respectively in 30.23%, 16.28% and in 16.28% cases. Excitable personal features in the 2nd group in pre morbid diagnosed reliably more often than in the 1st group. In comparison with the first group there was reliably higher prevalence of instability and narcissism features. Psychic infantilism in the patients of the second group was diagnosed in 23.26% cases. Different from the 1st group, in the 2nd group expression degree of personal deviations in pre morbid period did not reach the level of psychopathy, and it was limited by character accentuation.
Peculiarities of pre morbid personality development in the patients of the 2nd group included neurotic reactions (in 34.88% cases), which differed by easy appearance under influence of some
psychic traumatizing factors and short-term emotional-psychic impairments. Before the start of the disease the patients of the 2nd group had affective impairments reliably more often than in the 1st group. These were mostly of the depressive spectrum, and in the clinical progress there was prevailing of bad mood, sadness, suppression status, rare asthenic and ipochondric inclusions. There were fluctuations of mood with individual significant events and dates; there were also alterations of mood independent of external reasons. In 20.93% cases patients of that group together with the periods of decreased mood had periods of "raise", when there appeared confidence in own forces and increase of the energy. In the patients of the 2nd group we observed protest reactions in pre morbid period reliably more often than in the patient of yhe lgroup (28 patients — 65.12% cases). Deviant behavior was observed in the 1st group less than in the 2nd group — 23.26% cases.
Results of the research. In patients of both groups term from the start of drug taking till the appearance ofAAS was from three to four months (35.0% and 68.9%; p<0.05). The number of patients with that period duration less than lmonth was greater in the 2nd group than in the 1st one (29.8% and 17.8%; p=0.05). Increase was registered according to the value — from 31 to 90 days (28.0% and 13.3%; p<0.05). Period from 121 to 180 days covered only BNS (7.0%; p<0.05).
Light degree of AAS was fixed only among the patients of the 1st group (28.8%; p<001). Expressed degree of the impairments was more often registered in the 2nd group in comparison with the 1st group (38.6% and 11.1%; p<0.05).
Spontaneous remissions were registered less in the 2nd group (8.8% and 24.4%; p<0.05). Therapeutic remissions were registered less in the patients of the main group (35.0% and 68.9%; p<0.05). The values of forced remissions were more often detected in the 2nd group than in the 1st one (56.1% and 6.6%; p<0.01).
Probably low therapeutic efficacy of treatment and rehabilitation programs in comparison with the patients of the control group was explained by underestimation of deviant behavior factor and, as s result exclusion of therapeutic measures aiming prevention of that behavior from the scheme of treatment. Though some authors underline that deviant behavior is qualitative psychic pathologic prediction of incomplete therapy and restart of psychoactive substances administration (Farley T. A. et al., 1994).
Dysphoric status was more often observed both in the structure of AAS (50.9% and 24.4%; p<0.05), and in remission (28.0% and 13.3%; p<0.05). We revealed irritability and sad malicious emotional status.
Differences were detected both in AAS (29.8% and 17.8%; p=0.05), and in remission (45.6% and 24.4%; p<0.05) also in anxious-ipochondric syndrome. Anxious-ipochondric impairments revealed a link with other psychic pathologic phenomena. Though these impairments had no clinical-syndromal completeness. That's why we had no sufficient basis for inclusion of that state
Efficacy assessment of the activities for prophylaxis of micro nutrients deficit in children
to ipochondric neurosis (F45.2). Ipochondric symptoms in the observed patients differed by expressed polymorphism. Raised anxiety, concentration on body feelings and own emotional status in these patients provoked non-satisfaction with these sensations and desire to its improvement and demanding additional medicines from doctors. In the discussion of their status with each other these patients soon got notions about bad feeling, uselessness of the performed therapeutic measures. All these were accompanied by worsening of mood and intensification of pain feeling.
Asthenic-depressive symptoms reliably prevailed in the 1st group (19.3% and 57.8%; p<0.01); (26.3% and 62.2%; p<0.05). They complained about fatigue, unpleasant feeling in the area of heart. Depressive symptoms were characterized by little depth and instability. Often complaints were about bad mood.
Quantification of the components ofpathologic inclination for drugs (PID) was performed according to the scale worked out by M. A. Vinnikova (2004).
Periodic thoughts about narcotic drug appeared rarer in the 1st group than in the 2nd one (22.8% and 48.8%; p<0.01), and constant thoughts about drug — more in the 2nd group (45.6% and 20.0%; p<0.05). Some patients of the 2nd group associated memories about narcotic intoxication with possible application of "the right of golden injection", i. e. leave this life.
Specific weight of the expressed depression with anguish was higher in the 2nd group (35.0% and 20.0%). First of all there were complaints about feeling everything gray around, no perspective for future, no will to communicate with anybody. The result according to anxiety demand attention, as there are differences in all expression degrees: slight — 14.0% and 2.2% (p<0.05); middle — 29.8% and
17.7% (p=0.05); severe — 38.5% and 11.1%; p<0.01). Dysphoria state with prevailing in the 2nd group was expressed in increased conflict making, malignancy (49.1% and 28.8%; p<0.05). Specific weight of the patients with dysphoria was 82.3% in group 2 and 53.1% in group 1.
We revealed high level of sleeping disorders in the 2nd group (43.8% and 33.3%; p>0.05). Qualitative characteristics of dyssom-nia was change of its day rhythms. Specificity of dreams in the patients of the 2nd group was that besides dreams with narcotic theme these patients had fearful dreams, including aggressive ones. Dreams repeating for several times (31.5% and 13.3%; p<0.05) conditioned the decrease of mood, exacerbation of vegetative symptoms. It should be noted that maximally expressed disorders of behavior were registered in the patients of the 2nd group (29.8% and 17.7%; p=0.05).
Formal and formal-forced programming for the therapy as met less in the 1st group (33.3% and 62.2%; p<0.05), while negative programming was higher in the 2nd one (52.6 and 31.1%; p<0.05). The patients of both groups were aware of their disease (59.6% and 71.1%).
Conclusion. The established affective impairments have certain interrelation with personal characteristics of the examined patients. Results of the study widen the capabilities of diagnostics of suicidal behavior patterns in the patients with addictive impairments and provide prognosis of readaptation and re-socialization ways. The obtained results of clinical, structural and dynamic peculiarities of deviant behavior in addictive patients provide the possibility for scientific basis and design of complex differentiated therapeutic-rehabilitation programs.
References:
1. Keselman L. E., Matskevich M. G. Social space of narcotism. - SPb.: Medical press, 2001.
2. Mendelevich V. D. Psychology of deviant behavoir. - M.: "MEDpress", 2001.
3. Khanzian E. D. Vulnerance of self-regulation sphere in addictive patients: possible therapy methods./Psychology and therapy of addictive behavior./Edited by S. Dawling. - M.: Independent company "Class", 2000. P. 29.
4. McArdle P. & est. International variations in youth drug use: the effect of individual behaviours, peer and family influences, and geographical location//European Addiction Research. Karger, 2000. P. 163-169.
Ashurova Dilfuza Tashpulatovna, CMS, Chief of the Department of Propaedeutics of Children's Diseases,
Tashkent Pediatric medical institute E-mail: [email protected]
Efficacy assessment of the activities for prophylaxis of micro nutrients deficit in children
Abstract: Programs in the field of nutrition implemented in Uzbekistan, such as supplementation of children from 6 to 59 months old with vitamin A, rational nutrition and consumption of fortified flour promote the improvement of immunity indicators and normalization of serum retinol. It conditions the prophylaxis and liquidation of nutrition disorders and harmonic development of children during initial 5 years of life.
Keywords: supplementation of vitamin A, nutrition disorders, physical development, children.
The notion of vitamin deficit being one of the important reasons of children's health deterioration occupies a stable place in the modern pediatrics and children's nutriology. At the same time many aspects ofthat problem, and particularly causes of appearance ofvi-tal micro nutrients deficiency, forms of that deficiency and various approaches to its prevention, did not find sufficient reflection in the modern literature. In our opinion it is linked especially with pro-
phylaxis of vitamin deficiency in children during initial 5 years of life [4; 5; 8].
Though subnormal supply ofvitamins is not accompanied with expressed clinical impairments, it significantly diminishes resistance of children to the impact of infectious and toxic factors, physical and mental workability; it slows down the terms of recovery in children with various pathologies including children with severe trauma,
