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19MEDICAL AND PSYCHOLOGICAL ASPECTS OF PSYCHOTHERAPY IN ADOLESCENTS WITH
DIABETES MELLITUS
Sultonova K.
assistant of the Department of Psychiatry, Narcology, Child Psychiatry,
Medical Psychology and Psychotherapy Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
ABSTRACT
The article examines new approaches to providing psychotherapeutic assistance to adolescents with type 1 diabetes. At the initial stage, adolescents were tested for emotional changes using psychometric scales. During the study of the psycho-emotional background, 96.6% of the examined adolescents showed signs of depressive disorder of the neurotic register. Various types of active group work were used to conduct psychological and pedagogical assistance: functional training for the development of skills and self-confidence, communication training, music therapy, body-oriented and dance-movement therapy, cognitive training. All adolescents who received combined integrative psychological and pedagogical help in the surveyed group showed an improvement in their general condition, emotional background, and intra-family relationships.
Keywords: psychology, psychotherapy, adolescents, diabetes mellitus.
Relevance. In connection with the progress in pharmacotherapy, the issues of an integrated approach to the treatment and organization of psychosocial rehabilitation, social adaptation and correction of anxiety-phobic and depressive symptoms in children and adolescents with psychosomatic diseases in general medical practice are becoming more urgent [8]. A reasonable direction of work with children and adolescents with type I diabetes mellitus (DM) is the optimization of complex pharmacotherapeutic and medical and psychological care with psychotherapeutic, psychosocial and rehabilitation measures [7]. Modern trends in clinical psychology show the importance of studying the processes of mental adaptation in a situation of illness, that is, how children with diabetes react to a chronic frustrating situation of blocking their actual vital needs. Diabetes mellitus (DM) is a widespread endocrine disease that is reaching the proportions of a non-communicable epidemic. Most patients who are diagnosed with diabetes mellitus experience shock, it is difficult for them to realize that now they need to check their blood sugar several times a day and take antihyperglycemic drugs, it is difficult to accept that their physical condition will depend on the prescription of an endocrinolo-gist, on medications, which are vital for them and regular laboratory examinations. It is especially difficult to imagine for children and adolescents that they will have to constantly observe the therapeutic regimen and accept that this disease is forever. Sick children and adolescents with newly diagnosed diabetes mellitus need individual psychological and pedagogical support [6]. This contingent of patients is shown psychotherapeutic assistance, which contributes to the creation of a partnership between a psychologist and a patient; for more effective and complex treatment, timely psychodiagnostics and psychocorrection of disorders of the anxiety-depressive and phobic spectrum of the neurotic level are required [1]. Depressive symptoms in adolescents with severe somatic diseases, including type 1 diabetes mellitus, provoke the risk of developing suicidal tendencies and suicidal behavior [2,3,4,5,9].
Purpose of the study: to study the newest possibilities of optimizing the psycho-correction of emotional disorders in adolescents with type I diabetes
mellitus to improve psychological, pedagogical and psychotherapeutic help to this contingent of patients with type I diabetes mellitus.
Materials and methods of research: in the conditions of the Research Institute of Endocrinology of the city of Tashkent, a group of 110 adolescents aged 12-15 years with a verified diagnosis of type I diabetes was recruited, who were on outpatient treatment, receiving complex therapy in the form of pharmacother-apy and psychotherapy for 3 months of observation. To identify emotional changes, experimental psychological research methods were used: the Hamilton Depression Scale, the Hospital Anxiety and Depression Scale, the Spielberger-Khanin Anxiety Questionnaire, the Luscher eight-color test, the asthenia scale and the Nemchin neuropsychic stress assessment. The group conducted classes by medical psychologists, teachers in rhythm and dance staging, psychotherapists for 3 months, according to a technique developed by specialists with a frequency of 2 times a week, lasting about 2 hours.
Results: at the initial stage, adolescents were tested for the presence of emotional changes using psychometric scales. In the course of a study of the emotional background, signs of mild or moderate depressive disorder of the neurotic register were found in 96.6% of the examined adolescents. Patients developed rather long periods of low mood with internal tension, daily mood swings, decreased motivational activity, and deterioration of intra-family relationships were noted. Against the background of depressive disorders in adolescents, school performance significantly decreased (58%), the lack of desire to continue their studies (25%), conflicts with peers and behavioral disorders (60%), suicidal thoughts and tendencies (15%) appeared. In the surveyed group, during testing using the Spielberger-Khanin questionnaire, the presence of anxiety disorders of varying severity was revealed in 86% of adolescents, while more than half of the patients had manifestations of moderate anxiety (67%), in 20% of the subjects - without clinically significant anxiety and in 13% of adolescents - pronounced anxiety was stated. The anxiety intensified mainly in the afternoon and was
Sciences of Europe # 64, (2021)_
associated with worries about a physical illness. In adolescents with type 1 diabetes, a relationship was found between the level of reactive anxiety and the level of personal anxiety. High reactive and personal anxiety was accompanied by the formation of mild and moderate depressive disorders, which makes it possible to formulate the concept of the comorbidity of affective disorders and type 1 diabetes mellitus. The structure of affective disorders changed depending on the stage and severity of diabetes mellitus. At the stage of a high level of hyperglycemia, 90 adolescents (82%) showed: anxiety-phobic disorders, affective fluctuations, emotional lability with irritability. In 75% of cases, the symptoms of a depressive register were the first clinical manifestations of an exacerbation of the disease. Adolescents were found to have rather long periods of asthenic states with internal tension (23%), a feeling of hostility from others and a high level of personal and reactive anxiety (36%), episodes of unmotivated aggression (27%), obsessive fears (16%). Dysthymia was noted in 100% of cases. As a result of changes in the emotional state in adolescents, self-esteem significantly decreased (77%), stress resistance to external factors was impaired (65%), a tendency towards autism and isolation (70%), suicidal intentions and statements (15%) were formed.
The main goals of the psychological and pedagogical work being carried out were:
1. Conducting family and rational psychotherapy.
2. Rehabilitation program. Improving the social adaptation of adolescents (the formation of motivation for social activity).
3. Teaching new forms of self-expression, skills of creative activity and applied arts.
During the implementation of the rehabilitation program, various types of active group work were successfully used: functional training for the development of skills and self-confidence, communication training, music therapy, body-oriented and dance-movement therapy, cognitive training. Integrative dance-movement therapy was carried out in combination with art therapy and made it possible to fully reveal the emotional sphere of the personality of adolescents. In the course of the lesson, the participants learned bodily reflection, trained the ability to track their own experiences and excitement, to be aware of and accept yourself, your negative and positive emotions and their causes through the reflection of the inner world through dance and elements of pantomime. The expressiveness of the dance helped to express a variety of feelings. The analysis of dance-motor activity allows you to remove body blocks and clamps, which are observed in large numbers in adolescence. Using dance as a metaphor makes it possible to structure and transform the inner world of an individual as a whole. The main principles of dance and movement therapy in working with adolescents are the use of non-verbal forms of interaction and spontaneity, the ability to interpret the feelings and emotions experienced through dance and plastics, music and rhythm. The absence of words forces us to focus on the human body, its main expressive expressions, bodily reactions in a social context. The playful and creative components of the method involve the teenager in group work, arouse interest, a lively emotional
response, as well as a willingness to explore oneself and the surrounding reality. Teenagers were happy to show originality and creativity, creating their own dance. The deep psychotherapeutic effect of such work is associated with the fact that dance also serves as a good psycho-emotional release, helps to express meaningful feelings, as well as to get rid of negative emotions that accumulate in the daily life of a teenager burdened with psychosomatic illness. At the initial stage of the rehabilitation program, our specialists tried to conduct classes within the framework of such a psychotherapeutic technique as art therapy. The research process involved pedagogues with extensive experience in the field of creatively applied areas. In the course of these classes, a new form of activity was proposed within the framework of applied arts: beading, decoupage, wood carving, jewelry making, painting on glass, wood, weaving macrame, embroidery with colored floss threads, modeling from plasticine and white clay. The attendance of group psycho-correctional classes was 98%. During the training, the patients showed positive dynamics - they began to cope with tasks faster and more efficiently, aimed at revealing their creative potential, fantasy, imagination, the opportunity to express self-expression, their inner world through art. At the same time, we drew attention to the fact that during the trainings there is not only an improvement in intra-family relationships, but also a revival of the emotional complex, the emergence of interest in others, a desire to continue classes, an improvement in social functioning, a reduction in anxiety-phobic manifestations. In this regard, it became necessary, after the training, to continue group work in the form of training in cognitive and social skills. The teenagers showed great interest in creative self-expression, offered their own options for art therapy. Homework in the form of psycho pictures on the themes: "My family", "Home.Tree.Man" were performed with great enthusiasm. All adolescents who received combined integrative psychological and pedagogical help in the surveyed group showed an improvement in their general condition and emotional background. The desire to actively participate in the recovery process, the restoration of social contacts, and the normalization of intra-family and interpersonal relationships were revealed.
Conclusion: thus, carrying out correctly selected psychological and pedagogical help, using new creative approaches to psycho-correction and psychotherapy in the complex treatment of anxiety-depressive disorders in adolescents with type I diabetes mellitus, makes it possible to increase the effectiveness of therapeutic measures in relation to this category of adolescents. In the course of combined psychotherapy, adolescents with type 1 diabetes mellitus have mastered a number of psychotherapeutic techniques that allow them to independently cope with negative affective reactions and life stresses. By the end of group trainings, 85% of patients showed a reduction in affective symptoms and a rapid onset of remission, which indicates the effectiveness of the use of combined methods of psychological and pedagogical help.
References
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СТАН КЛ1Н1ЧНИХ ПОКА3НИК1В ПРИ Р13НИХ ВИДАХ КОМБIНОВАНОÏ АНЕСТЕЗП У Д1ТЕЙ 13 ПРИРОДЖЕНОЮ Х1РУРГ1ЧНОЮ ПАТОЛПСЮ
Власов О. О.
КП "Днтропетровська обласна дитяча клШчналтарня"
м. Днтро, Украша
CONDITION OF CLINICAL INDICATORS WITH DIFFERENT TYPES OF COMBINED ANESTHESIA IN CHILDREN WITH CONGENITAL SURGICAL PATHOLOGY
Vlasov O.
CU "DnipropetrovskRegional Children's Clinical Hospital"
Dnipro, Ukraine
АНОТАЦ1Я
У статп встановлеш абсолютш значения клшчних показнишв у новонароджених i немовлят з приро-дженою хiрургiчною патолопею при рiзних видах комбшовано! анестезп та порiвняти !х мiж собою. Доведено, що серед обстежених груп найб№ш уразливими до патолопчних змш були дгги, яким анестезю-лопчний супровщ забезпечувався шгаляцшно севораном з репональною анестезiею.
ABSTRACT
The article establishes the absolute values of clinical indicators in newborns and infants with congenital surgical pathology under different types of combined anesthesia and compare them with each other. It is proved that аmong the examined groups, the most vulnerable to pathological changes were children who were provided with anesthesia by inhalation sevoran with regional anesthesia.
Ключовi слова: Новонароджеш, немовлята, природжеш вади розвитку, комбшована анестезiя, пока-зники.
Keywords: Newborns, infants, congenital malformations, combined anesthesia, indicators.
Природжеш вади розвитку (ПВР) ввдносяться до числа патологш, що найчаспше зустрiчаються в новонароджених та потребують переважно негай-но1 хiрургiчноï корекцп тсля народження дитини. Операщя дозволяе провести радикальну або посту-пову корекцш аномалп розвитку у новонародже-ного, полшшити стан дитини та ввдновити житте-здатшсть органiв [1,2]. Результат хiрургiчного втручання залежить вiд важкостi вади, супутшх, фонових захворювань у дитини, вщ квалiфiкацiï ди-тячих хiрурга та анестезiолога зокрема, тому що об-раний вид анестезiологiчного супроводу та якiсть його проведення впливае на стан дитини в перь та
тсляоперацшний перiоди, на швидшсть вiднов-лення органiв i систем, на катамнестичний прогноз пiсля виписки з лiкарнi.
На тлi важ^' основноï, супутньо1 патологiï у дггей з ПВР виникають ускладненя в виглядi гiпок-семiï органiв i тканини, артерiальноï гiпотензiï та зниження серцевого викиду пiд час анестезп у зв'язку з впливом знеболюючих лiкiв на дихальний центр i/або повного виключення дихання дитини, а також у зв'язку з поганою еластичшстю шлуночшв серця, неадекватною реакщею симпатично!' нерво-во1' системи, шдвищенням сприйнятливостi до дй' мiокардiодепресантiв на шгаляцшш анестетики
