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Ponomarev Sergey Borisovich, Research Institute of the Federal Penitentiary Service of Russia, head of the branch (Izhevsk), MD, Professor E-mail: [email protected] Burt Albina Anasovna, Research Institute of the Federal Penitentiary Service of Russia, Leading Researcher of the branch (Izhevsk), PhD E-mail: [email protected]
Description of the prison social deprivation syndrome: clinical aspects
Abstract: Research prison health correlates of stress lead to the statistically valid conclusion: in a prison social isolation, along with deep mental disorder of convicted person also observed global changes in basic physiological regulatory systems. Changes to such a specific, have been described as independent syndrome, called by us the syndrome of prison social deprivation.
Keywords: prisoners, prison social deprivation, penitentiary stress, maladjustment.
As you know, the conditions of detention of prisoners in the penal system are characterized by strict regulation of behavior, coupled with the continuous influence of criminal society, restriction of freedom — social deprivation, isolation from family and convict the usual social environment of existence.
Influenced by significant strength and duration of internal and external stimuli, or more precisely, under chronic stress are consistently condemned in all its development stage adaptation syndrome. And if in the life around us influence of external stimuli on the body are often short and ends, mostly, his functional rehabilitation on some new level
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Description of the prison social deprivation syndrome: clinical aspects
when adaptive resources of the organism again as balanced, the conditions of prolonged stress reaction reserve of protective forces gradually depleted with followed by disruption of compensatory possibilities and alteration of target organs. If short-term stress response is a protective adaptive, or eustress, mobilizing the body to overcome the obstacles to achieving the vital biosocial goals, in a brief but heavy or, on the contrary, a long and continuing influence, called distress, it is transformed into its opposite — pathogen factor leading to the breakdown of the compensation and the formation of psychosomatic diseases.
The human body is dynamically balanced on the basis of neurohormonal mechanisms for selfregulation, functional system, becomes labile phase of short-term exposure to external stress factors, achieving homeostasis through change adaptation strategies of interaction of the subject with the external environment. In this primary response to an external stimulus Biosystems first nonspecific ultimately always specific and is a multistage reaction system for complex external environmental influences, the nonspecific and specific adaptation units are a single functional mechanism of defining typology response in accordance with external exposure. According to R. M. Baevsky [1], these changes are the result of an adequate response of the autonomic nervous system — a multi-level and self-regulatory system homeostasis, where each level has a self-regulating ability to influence downstream or upstream segments of the downlink (forward) or upward (reciprocity) type.
Long and continuous stress, first transiently then stably affects the mechanisms of self-regulation of the autonomic nervous system, leading to a breach of her jet lag, disintegration nejrogumoralnoj, hormonal system, somatic dysfunction in the central nervous, cardiovascular, respiratory, and other life-support systems, breaking mechanism permeability various tissue barriers disorganization of connective tissue, secondary immunodeficiency. According to K. V Sudakov [2], against the background of distress observed summation ofpathological changes, it becomes a prerequisite for the formation of irreversible consequences, and somatic disorders. These are
generally the basic pathophysiological mechanisms that accompany the psychological stress penitentiary in prison.
The penitentiary science topic of social deprivation and stress penitentiary devoted quite a lot of research. It should be noted that the number of these materials is growing from year to year and reveals new aspects of the problem.
Research carried out previously allow us to make a statistically valid conclusion: in conditions of social isolation prison along with deep psychopathy of the convicted person for the first time are also observed and global changes of basic physiological regulatory systems. Changes to such a specific, have been described independent syndrome, called by us the syndrome of prison social deprivation.
Developed using the methods of correlation, variance and regression analysis algorithm, during which analyzes heart rate variability and the immune status of the body of a teenager, allows a high degree of certainty to diagnose the presence of this syndrome.
In this context it is very difficult problem of the formation on the basis of expressed maladjustment syndrome so-called diseases of adaptation — of pathological conditions that develop as a consequence of chronic stress.
We know that social isolation as punishment is triune beginning, viewed from three perspectives, each of which is inseparable from the other two. On the one hand, the violent prison social deprivation — a punitive measure — society response to illegal actions of one of its members. In this incarnation of the punishment of imprisonment it has two functions — deterrence and retribution. However, the problem lies in society to rehabilitate the criminal resocialise it. This is the second component of the prison. Finally, the third objective of punishment — is prevention, prevention of possible new socially dangerous acts.
Those mental suffering experienced by convicted for the first time the teenager in an artificial situation, deprivation, fit into the concept of social retribution, retribution for the crime. But whether they promote re-socialization of the young citizen of Russia, if they help prevent further conflict with the law?
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As has been shown in studies, the psychological prison (penitentiary) prolonged stress causes significant dysfunction of the immune, endocrine, nervous and cardio-respiratory systems of preclinical level. Thus, the inmates increases the risk of many diseases in the future: cancer, cardiovascular disease, autoimmune diseases, neuropsychiatric disorders, infectious lesions [3].
As the results of our research, the majority of the surveyed convicts were observed such phenomena characteristic of the syndrome of prison social deprivation as pronounced immunodeficiency, permanent catecholamine “storm”, “burnout” adaptation reserves of the body, desynchronosis biorhythms.
In such circumstances, in a situation of prolonged, chronic distress of juvenile offenders, the preservation of their health — it is a truly titanic and often an impossible task for prison doctors. The best solution here would be an elimination of deprivation situation as a cause of the disease state of the young man. But it is just impossible to do.
Carrying out earlier in one educational colony comprehensive research that addresses psychological, physiological, immunological, hormonal, and other characteristics of the pupil allowed to make one more important step to understanding the essence of psycho-physiological state in which the person under artificial prison deprivation [3].
The fundamental difference between our proposed methodology for assessing the stress of prison is that it is based on objective data (heart rate variability, immunological characteristics, etc.), Giving less importance to subjective factors — in particular, the complaints of patients [18; 19; 20]. This is not least due to the fact that in the penal system, in most cases doctors have to deal with antisocial personalities are often prone to simulation, aggravation and lies. Recall that, for example, specified in the ICD-10 Chronic Fatigue Syndrome is placed on the basis of complaints of the patient, in the event that a person, in addition to debilitating fatigue, there are at least four of the following symptoms: 1) muscle pain; 2) pain in multiple joints; 3) unrefreshing sleep; 4) discomfort after physical or nervous and mental load of more than 24 hours; 5) violation of short-term memory or concentration; 6) signs of inflammation
of the mucous membrane of the throat; 7) neck pain or axillary lymph nodes. As seen from the above, the proposed criteria are highly subjective (anyway — the first five), and offer ample opportunity for cheating the doctor stating the purpose of the false diagnosis of “chronic fatigue syndrome”.
The application of criteria based on the measurement of parameters of heart rate variability and data immunograms, can completely eliminate the subjective factor. However, to rely only on these criteria — would be to neglect the classical canons propedeutics, principles of differential diagnosis. Therefore, in each case it is important to determine — whether the changes in the regulatory systems direct consequence of the psychological experiences associated with the presence of a person in a prison or what they are due, or other factors (severe organic damage, infection, disease of the cardiovascular system, tuberculosis, HIV, drug addiction, etc.).
It should be emphasized that intervalokardiogra-phy — an inexpensive, highly sensitive and simple in execution of a method that is widely used at present in various fields of medicine: from monitoring the health of astronauts in orbit, to forecast life-threatening conditions of patients in the intensive care unit. The new application of the method under the penal system will undoubtedly be interesting for prison doctors and pediatric therapeutic and Prison psychologists.
A role in the diagnosis of prison stress also plays an analysis of the immune system. While currently holding immunograms still very expensive and very time-consuming diagnostic procedure, it is possible to objectively estimate premorbid background and make informed choices about the health of the first convicts held in detention.
In general, the main features of the syndrome of social deprivation in prison contingent subordinated MIS can be reduced to the following key points:
— the basis of formation of the syndrome is an artificial social deprivation, implemented in the form of imprisonment; the primary role in the development of the syndrome have psychological stressors;
— pathophysiological basis of a significant increase in serum cortisol, and as a result, improved
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Description of the prison social deprivation syndrome: clinical aspects
metabolism with prevalence of catabolic component intensification energy expenditure, chronic energy crisis, which can be determined by indirect methods of investigation [4];
— for the test condition characterized by specific immunologic changes — the development of immunodeficiency with reactions to the first indicators of nonspecific immunity, T-helper cells, suppressor and natural killer cells [5];
— The condition is characterized as specific changes in the autonomic nervous system — the development of complex physiological rhythms of DS, which is manifested, in particular, a decrease in the relative power of fast and slow waves and a significant increase in the overall proportion of the spectrum is very slow waves in the analysis of heart rate variability [4];
— the inmates found a high proportion of asymptomatic detection ofarrhythmias and conduction with a predominance among them combined arrhythmias (atrial and ventricular premature beats) [5];
— there is a high proportion ofdetection ofthe virus Epstein-Barr, isotropic to lymphoid tissue [5];
— the probability of developing this syndrome can be calculated using the prognostic indices;
method showed highly informative when testing on the materials independent groups.
However, despite the positive results of the research, it should be emphasized that identified the inmates of the prison of social deprivation syndrome needs further study and comprehensive analysis. This is great interest in issues of its prevalence, the possible ways of treatment and refinement of diagnostic criteria.
As practical recommendations that can be formulated based on the results of the research, we propose the following:
— It is necessary to improve the competence of prison doctors and health workers in recognition of symptoms of stress penitentiary in order to carry out the correction of these conditions with medications, or with the assistance of the prison psychologist and psychiatrist.
— As a measure of prevention is necessary to conduct diagnostic prison stress using non-invasive methods of screening, what, for example, a heart rate variability. The techniques demonstrated highly informative when testing materials for independent groups.
References:
1. Baevsky R. M. Estimation of adaptation capabilities of the organism, and the risk of disease. M.: Medicine. 1997. 235 p.
2. Sudakov K. V. The disintegration of functional systems under emotional stress: rehabilitation strategies//^.: Guide for the rehabilitation of persons exposed to stressor loads, ed. ak. RAMS VI Pokrovsky. M.: Medicine. 2004, P. 21-42.
3. Syndrome of the prison social deprivation at an early age/Ponomarev S. B., Polovnikova A. A., Totski S. I., Chubarov A. L. Ekaterinburg, Ural Branch of Russian Academy of Sciences, 2008. 148 p.
4. Chubarov A. L., Polovnikova A. A., Ponomarev S. B., Totskiy S. I., Aleksandrov A. B., Soboleva N. P. On the issue of finding ways to adapt disease prevention at a young age//Disease Prevention and Health Promotion. Moscow, 2007. № 4. P. 3-8.
5. Polovnikova A. A., Ponomarev S. B., Chubarov A. L., Totskiy S. I., Isakova L. S. Immunological aspects of social deprivation syndrome in adolescents who are deprived of their liberty//Immunology Urals. Proceedings of the VI Conference of Immunologists Urals. Izhevsk, October 28-31, 2007. № 1 (6), 2007, P. 84-86.
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