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7
DOI: 10.12731/2658-4034-2022-13-2-89-101 UDC 159.9.07:616-059
PSYCHOLOGICAL ASSISTANCE TO PATIENTS WITH VASCULAR DISEASES AFTER SURGERY
N.V. Popenko, V.B. Chupina, L.S. Gavrilenko
Currently, in the situation ofcoronavirus infection, diseases of the vascular system still occupy one of the leading positions among the causes of mortality. At this moment, an important task is providing psychological assistance to patients after surgery in a hospital setting.
Purpose. The research of the possibilities ofpsychological assistance after surgery for patients with chronic obliterating diseases of the arteries of the lower limbs.
Materials and methods of research. The Hospital Anxiety and Depression Scale (HADS) (A.S. Sigmondi R.P. Snaith) was usedfor diagnosis. The analysis of the results ofpsychological examination ofpatients with chronic obliterating diseases of the arteries of the lower limbs was carried out in the period from 2020 to 2021 in Krasnoyarsk.
Results. The conducted research demonstrates the availability of depression as one of the clinical manifestations in the emotional sphere of patients with obliterating diseases of the arteries of the lower limbs. The information of the effectiveness ofpsychological assistance to patients in a vascular hospital are presented. Methods of autogenic training, short-term positive psychotherapy and one of the methods of a standardized program of complex non-medicated therapy were used.
Conclusions. The obtained information allows us to talk about the positive impact of psychological care on patients after reconstructive operations in vascular surgery departments. With the activation of internal psychological resources, patients pay less attention to the issue ofpossible disability and strive to adapt to the conditions of the disease.
Practical implications. The results can be used in the psychothera-peutic practice of clinical psychologists.
Keywords: obliterating atherosclerosis; patients with obliterating diseases of lower limb arteries; vascular profile hospital; depression; anxiety; internal resources; psychological help
ПСИХОЛОГИЧЕСКАЯ ПОМОЩЬ ПАЦИЕНТАМ С СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИ ПОСЛЕ ОПЕРАТИВНОГО ВМЕШАТЕЛЬСТВА
Н.В. Попенко, В.Б. Чупина, Л.С. Гавриленко
В настоящее время в ситуации коронавирусной инфекции заболевания сосудистой системы по-прежнему занимают одно из лидирующих положений среди причин летальности. На современном этапе важной задачей является оказание психологической помощи пациентам после оперативного вмешательства в условиях стационара.
Цель. Изучение возможностей психологической помощи после оперативного вмешательства пациентам с хроническими облите-рирующими заболеваниями артерий нижних конечностей.
Материалы и методы исследования. Для диагностики использовалась больничная шкала тревоги и депрессии (HADS) (А.С. Зиг-монд и Р.П. Снайт). Проведен анализ результатов психологического обследования пациентов с хроническими облитерирующими заболеваниями артерий нижних конечностей в период с 2020 по 2021 гг. в г. Красноярск.
Результаты. Проведенное исследование демонстрируют наличие депрессии как одного из клинических проявлений в эмоциональной сфере пациентов с облитерирующими заболеваниями артерий нижних конечностей. Представлены данные об эффективности оказания психологической помощи пациентам в условиях стационара сосудистого профиля. Использовались методы аутогенной тренировки, краткосрочной позитивной психотерапии и один из методов стандартизированной программы комплексной немедикаментозной терапии.
Выводы. Полученные данные позволяет говорить о положительном влиянии психологической помощи на пациентов после реконструктивных операций в отделениях сосудистой хирургии. При активизации внутренних психологических ресурсов пациенты в меньшей степени уделяют вопросу возможной инвалидизации и стремятся адаптироваться в условиях протекания болезни.
Область применения результатов. Результаты могут быть использованы в психотерапевтической практике клинических психологов.
Ключевые слова: облитерирующий атеросклероз; пациенты с облитерирующими заболеваниями артерий нижних конечностей; больница сосудистого профиля; депрессия; тревога; внутренние ресурсы; психологическая помощь
Introduction
During the pandemic, according to available data, the incidence of cardiovascular diseases in patients remains quite high. In the structure of cardiovascular diseases, lesions of the arteries of the lower limbs occupy the second place. About 10% of patients suffer from atherosclerosis of the vessels of the lower limbs [4].
Nowadays the obliterating diseases of vessels come out on the top on the frequency of implications and clinical value. The obliterating atherosclerosis of the arteries of the lower extremities (OAALE) occurs in 2-3% of population that makes 20% of all patients with cardiovascular diseases. Within 3-5 years gangrene develops at 10-40% of patients that leads to ablation of an extremity (WHO) [12].
Results of numerous research studies demonstrate that obliterating atherosclerosis of the arteries of the lower extremities tends to manifest in the younger generation. This disease is taped even more often at patients of working-age. In Russia the peak of this disease is the boundary of elderly and old age (60-70 y.o.) [2].
A difficult life situation such as illness influences the mental activity of a patient and triggers changes under the influence of illness severity. The operation executed brilliantly from the technical side cannot give
to the patient relief and convalescence if the mentality has undergone changes [10]. At the present stage an important task is to render psychological assistance to patients who underwent surgical interventions in the conditions of a hospital. The long-term goal such as awareness of illness in the context of whole life cannot be set, but it is possible to allocate achievement of the adequate purpose, according to this period of time - improvement of an emotional state by means of internal psychological resources of the patient [7].
Materials and methods
The first stage of the research was conducted in 2011-2012 [13], the results being the development and testing a program of psychological support for patients with chronical obliterating diseases of the arteries of the lower limbs. Those conclusions became the basis for current research. The hospital, where the research was conducted, did the request about rendering of the psychological assistance to patients of this nosological group. For us the purpose was the check of the effectiveness of the above-mentioned program in modern conditions.
This research was conducted from 2020 till 2021 in Krasnoyarsk. Fifteen patients took part in this program for the accuracy of the experiment. The psychological assistance was provided individually during hospital treatment with the autogenic training method, the short-term positive psychotherapy and the methods of the standardized program of the complex non-medical therapy.
Patients who had undergone the reconstructive surgery (aorto-femoral bypass) were receiving the treatment over the period of 18 days. They had seven sessions with a psychologist. At the end of the program, patients passed the next phase of the diagnostic procedures.
Hospital Anxiety and Depression Scale (HADS) (A.S. Zigmond and R.P. Snaith), which is aimed at identification of emotional disorders, was used for the diagnostic. HADS was developed to provide doctors with the acceptable and easy in use practical tool for identification and quantitative assessment of depression and anxiety [14]. The use of this questionnaire does not serve for the statement of the psychiatric diag-
nosis, but it does for identification of depression and anxiety symptoms for the purpose of their further psychological correction.
Considering the person as a united system, such methods as the autogenic training method, techniques of short-term positive psychotherapy, one of methods of the standardized complex non-drug therapy program were used in the course of the implemented program [6].
This stage of investigation was directed to determination of changes in indices of depression and anxiety.
Statistical processing of the received data was executed by means of the SPSS program, version 22.0. For evaluation of significant changes in quality of life, the statistical analysis was performed before and after psychological rehabilitation.
The assessment of the variable distinction significance in the connected sample groups for the quantitative signs was made with the use of the Student T-test. The Wilcoxon signed-rank test was used in case of the distributions differing from normal ones. In comparison of ordinal signs in the connected groups, for binary variables and criterion of marginal homogeneity with more than two categories the Mac-Nema-ra's criterion was used. Distinctions were evaluated as statistically significant in case of p<0.05.
Results and their discussion
Level of anxiety and depression. By results of the research the most noticeable changes happened (Fig. 1) towards augmentation of number of patients with lack of authentically expressed symptoms (p<0.05).
Before holding psychological assistance patients demonstrated the following signs: the lowered mood, negative judgment concerning the events, pessimistic view on the future. Patients noted such disturbances as sadness, sleeplessness, loss of appetite [3]. After psychological assistance according to the program patients showed improvement in the emotional sphere, many of them noticed that their sleep was normalized.
We can note minor changes on «Anxiety» indicator with subclinical symptoms during the comparative analysis (Fig. 2) before and after the psychological assistance for the patients after reconstructive opera-
tions. The increase in the number of patients with these symptoms was revealed during the research.
Fig. 1. Depression indicators in patients before and after implementing the program of psychological assistance
Fig. 2. Anxiety indicators in patients before and after implementation of the program of psychological assistance
No patients with clinical manifestations of anxiety were identified. The number of patients with the absence of reliably expressed symptoms of anxiety is believed to have increased.
Before participation in the program of psychological assistance, patients demonstrated the following features: negative consequences of illness situations, feeling of uncertainty [5]. Patients often transferred negative thoughts from the experience of the past diseases and bound them to the future. Such clinical implications as heartbeat, sleeplessness, loss of appetite were also registered. After rendering the program of psychological assistance, the tendency to decrease anxiety clinical symptoms was observed. Patients adapted to new living conditions and ceased to project "anxious" thoughts on the future [8].
In given cases decrease of "Anxiety" indicator with implications of clinical symptoms is bound to the fact that patients ceased to consider illness as "crash of life" [11].
The conducted research was referred on studying the decrease of depression and anxiety level after implementation of the program of psychological assistance in the postoperative period in the patients with an ischaemia of the III-IV degree according to A.V. Pokrovsky. A total of 15 patients were examined on Day 5 after surgery and the repeated psychological diagnostics was carried out after rendering the organized psychological assistance. As atherosclerosis is a multifocal disease, the obliterating atherosclerosis of the arteries of the lower extremities is usually diagnosed much later. The main clinical implication is a pain syndrome. It is necessary to consider that this disease has the progressing character, and this research gives the ground to assume that the nature of this depression and anxiety is somatogenic [9]. If after the performed reconstructive operation the painful symptoms either decrease or are absent, it is logical to consider that the level of anxiety and depression will decrease to norm limits. However, rather high percentage of patients with clinical and subclinical implications of depression and anxiety was revealed [1].
Therefore, the pain syndrome is not the main cause of high rates of depression and anxiety. The data of this study allow assuming that the serious illness, which may lead to disability and death, puts a person in special life conditions. After psychological assistance the percentage of patients with clinical and subclinical manifestations of depression and anxiety decreased. This proves the benefits of the offered psychological assistance in case of impairments in the emotional sphere.
Conclusion
In that way, we confirm the relevance and the effectiveness of the program that was developed and implemented in 2012. Patients with the high level of the depression and the anxiety on the scale HADS during the postoperative period demonstrate the positive dynamic after the implementation of the specially organized psychological assistance. The conducted research allows us to state the relevance of the program of the psychological assistance to patients after reconstructive operations in the vascular surgery departments in modern conditions.
Conflicts of interest. The authors declare no conflicts of interest. The information about sponsorship. The research was conducted without financial support.
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DATA ABOUT THE AUTHOR Natalya V. Popenko, Associate Professor of the Department of Clinical Psychology and Psychotherapy with a postgraduate course, PhD in Psychology
Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky
1, Partizan Zheleznyak Str., Krasnoyarsk, 660022, Russian Federation
popenkonv@yandex.ru SPIN-code: 1535-0044 ORCID: 0000-0003-1399-8722
Viktoriia B. Chupina, Associate Professor, Department of Clinical Psychology and Psychotherapy with a postgraduate course, PhD in Psychology
Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky
1, Partizan Zheleznyak Str., Krasnoyarsk, 660022, Russian Federation
ionessi@yandex.ru SPIN-code: 2215-4081 ORCID: 0000-0002-9846-2216
Larisa S. Gavrilenko, Associate Professor of the Department of Clinical Psychology and Psychotherapy with a postgraduate course, PhD in Pedagogy
Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky
1, Partizan Zheleznyak Str., Krasnoyarsk, 660022, Russian Federation
dm-gavrilenko@mail.ru
SPIN-code: 1092-0742 ORCID: 0000-0001-7493-4947
ДАННЫЕ ОБ АВТОРАХ Попенко Наталья Валерьевна, доцент кафедры клинической психологии и психотерапии с курсом последипломного образования, кандидат психологических наук ФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого» Министерства здравоохранения Российской Федерации ул. Партизана Железняка, 1, г. Красноярск, Красноярский край, 660022, Российская Федерация popenkonv@yandex.ru
Чупина Виктория Борисовна, доцент кафедры клинической психологии и психотерапии с курсом последипломного образования, кандидат психологических наук, доцент ФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого» Министерства здравоохранения Российской Федерации ул. Партизана Железняка, 1, г. Красноярск, Красноярский край, 660022, Российская Федерация ionessi@yandex.ru
Гавриленко Лариса Станиславовна, доцент кафедры клинической психологии и психотерапии с курсом последипломного образования, кандидат педагогических наук ФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого» Министерства здравоохранения Российской Федерации ул. Партизана Железняка, 1, г. Красноярск, Красноярский край, 660022, Российская Федерация dm-gavrilenko@mail.ru
Поступила 02.03.2022 Received 02.03.2022
После рецензирования 24.03.2022 Revised 24.03.2022
Принята 01.04.2022 Accepted 01.04.2022
