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Section 6. Medical science
Section 6. Medical science
Abdullaeva Vasila Karimbekovna, Tashkent Pediatric Medical Institute, chief of department of psychiatry and addiction E-mail: vasila.abdullaeva@tashpmi.uz
Features motivational orientation of patients with heroin addiction
Abstract: The special features of motivational and incentive focus in patients with heroin addiction is examined in the article. Motivational orientation of addicts was considered in the context of the concept of “personal element” psychoactive substance dependence.
Keywords: heroin addiction, psychoactive substance dependenceб personality features, motivational orientation.
Motivational orientation is one of the main parts of addicted patients. However, research of this kind featuring a large spread of conceptual approaches to the problem [1, 372-373]. There is opinion that the formation of addiction psychological motives that determine the commitment to use a psychoactive substance (PAS) in the premorbid phase saved and moreover, largely determine the course of the disease [3, 795-796]. Many researchers emphasized that patients with PAS dependence is driven by complex of motives [4, 155-156]. At the stage of clinical signs depending on their psychological problems, most patients begin to solve it by pathological way — by systematic intoxication — motives, that are determine by requirements in reducing ofwithdrawal subjective psychopathological symptom. However, according to some researchers, addicted people even at this stage the regulatory mechanisms of mental adaptation are partly saved [2, 266-280].
The aim of the study was to investigate the special features of motivational and incentive focus in patients with heroin addiction.
Material and methods. We observed 126 male patients with heroin addiction in aged 18 to 41 years. They systematically abused heroin for 1 to 10 years. To assess the dynamics of the disease, all patients underwent a standard comprehensive examination: clinical observation with a history of clinical and psychopathological analysis of the mental status of patients. Clinical and psychopathological method studied motivational processes by establishing a clinical-dynamic affinity premorbid personality psychopathology deviations from the dependence syndrome — craving for PAS, and withdrawal syndrome. Diagnosis of drug addiction carried out in accordance with the ICD-10 criteria. The intensity of the craving for the drug was measured using a scale ofM. A. Vinnikova (2001). To increase the number of differentiating features, as well as for the purpose of objectifying the data obtained in the process of clinical diagnostics personal sphere, all patients underwent patopsycological screening by using SMSP test (standardized method for the study of personality — an adapted version of a technique MMPI — Minnesota Multiphasic Personality Inventory).
Results. Motivational orientation of addicts was considered in the context of the concept of “personal element” PAS dependence. Among addicts dominant part of them were people with personality disorders of emotional instability (38.6%), narcissistic (14.2%) and dependent (18.7%) types. Exactly personality disorders determines features of motivational and incentive sphere and behavior styles of patients with PAS dependence. In the structure of the
syndrome craving for the drug is one of the main places belongs to affective pathology. Abnormalities in the affective sphere of patients in dynamics identified at all stages of the disease and most were expressed in the structure of the withdrawal. There was a clear relationship between the severity of mood disorders and the intensity of craving for drugs. There was affinity affective disorders with the syndrome of overvalued ideas in which pathological attraction to psychoactive substances accompanied by persistent, dominant ideas around the situation of usage. In development process ofheroin addiction personality deviation transformed into the main syndrome of dependence or exercise influence on their patoplastic structure. Affective disorders during reduction personality expressed in the loss of stability of mood, which was determined by the presence or absence of drugs, the loss of control over the expression of feelings. In the spectrum of personality changes in patients with heroin addiction dominated expressed intolerance of discomfort — both mental and physical. This feature was shown in the early stages of drug dependence and reaches its highest expression in the clinical course of the disease.
Thus, premorbid disorders occurring on the type of “negative affectivity” acquired syndromic clearance within the affective component of pathological craving syndrome. During exacerbation of the syndrome occurred dysphoria, apathy, anhedonia, affect boredom, meaning less floating anxiety with a predominance of internal stress undifferentiated bodily discomfort. With the development of withdrawal symptoms was observed inversion of the structure of affectivity of the patient: negative symptoms, prevailing in the premorbid personality dynamics and in the picture exacerbation of pathological craving partially gave way to positive (hyperaestet-ics) fairly the configuration of the affective “triad”. The study of personality component of drug addiction was revealed the clinical significance of the motives in the development of PAS dependence. Among them — the personal (motivational) sense of direct toxic effect of the drug — intoxication. PAS helps to reduce anhedonic state, vital estrangement, apathy, and eliminate phase dissociating affect, eliminate subjectively withdrawal depersonalized excitement that associated with these phenomens, reduce reactive lability which accompanying interpersonal relationships, but for the short period of time. Reveal facts are confirm in favor of the proposed earlier position by several authors that the motives associated with heroin addicts syndrome of pathological inclination are determined not so much initially heightened desire for satisfaction (“hedonistic ac-
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Features motivational orientation of patients with heroin addiction
centuation”), as the need for relief systematically arising from them subjectively withdrawal mental sensations that ascending to premorbid personal development.
Personality characteristics of painful narcotization determined not only by the effects of intoxication, but also extended on excitements associated with stop craving PAS. At an altitude of more abstinence mood went down, intensified irritability, a tendency to dysphoria. Feature of anxiety disorders in patients in the acute phase of the deprivation ofheroin unlike post abstinent period was marked tendency to hypochondriacal fabulation. Many people have noted that during the withdrawal syndrome, they felt subjectively pleasant, but painfully heightened sensitivity, “sentimentality”, in which depression, soulless tearfulness easily gave way to euphoria. Some have noted increased activity in state of abstinent, for example, increased libido and erectile function despite painful general physical condition. Heroin addicts emphasized that “breaking” as the actual toxic effect of the “arrival”, overlapping the sense of “deadness”, boredom and apathy that accompany their sober life — before craving drug, and also in remissions and, especially, in prerelapse periods on exacerbation of pathological craving. Even with the most frequent and “typical” cases of opiate withdrawal, accompanied by feelings of guilt or shame, many patients noticed positive meaning: at that moment they are mostly intensively covered by longing for change, build optimistic plans for the future.
Thus, as intoxication a withdrawal is couple to patients with the experiences of “revival” of feelings, inclination, total activity, “comprehension” of existence, “clarify” picture of the world, with the illusion of finding the integrity of the self and, though false, ordering subject- object relations.
Total combination of the reveal motivations that determine various aspects of addictive behavior, represented by the fact that the disease which associated with the systematic use of drugs and with periodic attempts to overcome addiction is concretizing difficulty and contradictory meaning of life — now this sense becomes getting just another dose of PAS.
Another motive in the dynamics of dependence by PAS associated with reactions on its own addiction. The last one determined by the nature of personal mediation of withdrawal narcotization and also negative somatical, psychological and social consequences (“nosogenic reactions” by A. O. Filz, 1993). The study of the nature of disease processes in heroin addicts is important to identify the motives that directed to recovery and therefore for the construction of psychotherapeutic programs in addiction.
In 65.5% of cases nosogenic reaction proceeds in the form of effaced, abnormal anxiety-apathetic and depersonalization states. Wereobserved an increasing phenomen of emotional estrangement
(“negative affectivity”). Patients only formally recognized the indesirability usage of PAS, its risk to health and social functioning; anxietment, hyperaestheticcatatimic affects expressed slightly.
In 18.5% of cases in the picture of nozogenic reactions with heroin addiction was observed typical depressive symptoms with catatimic painted with ideas of guilt, shame, self-flagellation about own “will-less”, absent of control, with feelings about the victimed reputation, deteriorating of professional situation, misfortunes, that were caused by addicts to their family members and other loved ones. Also, were observed the reaction of anxious-hypochondriac nature, the content of which is the theme of the harm caused to the health by drugs.
In 10.8% of patients met hypomanic (“rejects”) type of respond to the of disease with an idle way of life, denial of pathological or at least psychologically destructive character of narcotization with the conviction of its necessity and even a “helpful” for the development of creative skills, increasing activity.
The general rule of nozognozis of addicted patients is well known: if the motives to narcotization is prevailing (increased pathological inclination), the criticism to the disease is reduced up to anosognosia. At this periods in fact patients lose the ability to adequately test the reality. During periods of remission with complete or partial reduction of pathological attraction criticism to disease may become more appropriate to the real situation.
It was revealed that 90% of cases addicted patients detected features of ambivalent nozognozis. Even in states overcoming with generalized pathological craving negation of the disease with a positive argument of use PAS competed with elements of his morbid awareness state and reflects in content of the “struggle of motives.” During the period of withdrawal prevailed hypergnozia, behind which concealed a formal criticality, easily replaced at a hypo- and anosognosia with negation of fact depending, ignoring the painful experiences of the past. For 10% of the cases almost entirely noncritical patients with hypomanic type nozogenic response.
Conclusion. Thus, in the survey identified the elements of the dual, split attitude to the disease and to himself. This relationship between the individual components of the personal consistence, which reflected in the internal picture of the disease was associated with a state of need-motivational orientation of heroin addicts, with the content of the phenomenon of “the struggle of motives.” Selected elements ofpersonal component of PAS dependence mainly were in the ratio of feedback with each other. Personality characteristics was determined an intensity of the pathological craving, nosogenic reaction — to contain the motives of the pathological process, for an end to PAS use.
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