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62apy reduces the risk of development of acute cardiovascular events and sudden cardiac death in patients with heart failure.
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РОЛЬ ПСИХОЛОГИЧЕСКОГО ИССЛЕДОВАНИЯ СУИЦИДАЛЬНОГО ПОВЕДЕНИЯ У
ПОДРОСТКОВ
Бабарахимова С.Б.
соискатель степени PhD базовой докторантуры, ассистент кафедры психиатрии, наркологии,
детской психиатрии, медицинской психологии и психотерапии
Абдуллаева В.К.
доцент, д.м.н., заведующая кафедрой психиатрии, наркологии, детской психиатрии, медицинской психологии и психотерапии
Султонова К.Б. ассистент кафедры психиатрии, наркологии, детской психиатрии, медицинской психологии и психотерапии
Аббасова Д.С.
ассистент кафедры психиатрии, наркологии, детской психиатрии,
медицинской психологии и психотерапии Ташкентский Педиатрический Медицинский институт, Ташкент, Республика Узбекистан.
ROLE OF PSYCHOLOGICAL RESEARCH OF SUICIDAL BEHAVIOR IN ADOLESCENTS
Babarakhimova S.B.,
assistant of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy Abdullaeva V.K., doctor of science,
of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy Sultonova K.B.,
assistant of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy Abbasova D.S.
assistant of the Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
АННОТАЦИЯ
В статье представлено исследование аутоагрессивных тенденций в структуре подростковых депрессивных расстройств поведения, которое определило, что у подростков чаще наблюдается демонстративно-шантажное суицидальное поведение, формирующееся на фоне депрессивного аффекта, в результате внут-риличностных конфликтов и являются в основном проблемой поведенческих и связанных со стрессом расстройств, возникают на фоне психопатологических состояний непсихотического уровня. Проведенное исследование клинических особенностей аутодеструктивных действий у подростков с поведенческими нарушениями депрессивного регистра позволяет выявить группы риска по суицидальной готовности среди данного контингента населения.
ABSTRACT
Article presents the experience of analysis of the self-destructive behaviors in adolescents revealed that adolescents often observed demonstratively-blackmailing suicidal behavior, emerging against the background of depressive affect, as a result of intrapersonal conflicts and are mainly a problem of behavioral and stress-related disorders, occur against a background of non-psychotic level of psychopathological conditions. The study of clinical features of self-destructive actions in adolescents with behavioral disorders depressive register reveals the risk for suicidal willingness among this group of patient.
Ключевые слова: поведенческие нарушения, депрессивные расстройства, подростки, суицидальные тенденции.
Keywords: behavioral disorders, depressive disorders, adolescents, self-destructive actions
Relevance. The problem of suicide among young people is extremely urgent in many countries, Suicide is the third or fourth leading cause of death among young people [1, p.7]. Increased risk of suicidal tendencies of the often disproportionate severity of depressive affect is associated with a low threshold and suicidal insufficient psychosocial maturity. High probability of suicidal intent is explained aborted "antisuicidal barrier" against the background of already possible at this age clearly depressive attitude [2, p.45]. The depression in both children and adolescents who recognized with difficulty due to the fact that depressive symptoms laminated usually on psychological characteristics age [3, p.11; 4, p.87]. Depressive disorders of adolescence are one of the most difficult medical problems are also due to severe social consequences, which include suicide, violence, drug addiction and behavioral deviation [5, p.41; 6, p.114]. The first depression in adolescence and early adulthood are associated with suicid, have a "mark erased", the masked character, manifested most often behavioral disorders [7, p.780; 8].
The aim to study the clinical features of self-destructive actions in adolescents with depressive disorders and behavioral problems to improve the quality of diagnostic and therapeutic correctional help this group of patients.
Materials and Methods: The subject for the study 46 adolescents were selected between the ages of 15 to 17 years with depressive disorders and behavioral disorders. The leading methods of investigation were clinical-psychopathological and clinical-catamnestic. To assess the severity of depressive symptoms were applied the Hamilton scale and the Beck Scale, to determine the level of anxiety - anxiety questionnaire Spiel-berger-Hanin, for the determination of stable personal characteristics of subjects and features of emotional response test used Luscher.
Results and discussion: depending on the prevalence of depressive symptoms, all patients were divided into five groups: depression with dysphoric -56% (n = 26), anxious depression -16% (n = 7), dismorfofobic depression -13% (n = 6 ), masked depression -8% (n =
4), asthenic- apathetic depression - 7% (n = 3). In assessing the severity of depressive disorders on the Hamilton scale, severe depression among teenagers has been identified, the bulk of the 80% were patients with mild depression, and only 20% of the cases (9 patients) was detected depression of moderate severity. Among all surveyed were 28 boys and 18 girls. Gender differences in the severity of depressive symptoms was as follows: boys depression mild was identified in 71% of cases and in 17% of cases diagnosed depression of moderate severity, and the girls depression of moderate severity met more often - 70% of cases, depression is mild It was detected in 29% of patients. All patients complained of depressed mood, disturbed sleep or appetite, suicidal tendencies and difficulties in learning activities, impaired concentration, increased response to external situations and sources of stress, irritability, suddenly occurring feeling of sadness, dejection, periods marked a pronounced feeling of boredom lack of desire to do anything, have expressed the idea of self-blame, and hopelessness. In 76% of cases (35 patients) parents reported a significant decline in school performance, violation of intrafamily relationships, fatigue, which was more pronounced in the second half of the day. In the studied group as a result of the test using a questionnaire Spielberger- Hanin revealed the presence of anxiety disorders of varying severity in 93% of adolescents, more than half of the study, it was noted the presence of manifestations of anxiety moderate severity (56%), 27% of subjects - without clinically significant anxiety, and 16% of teenagers - stated expressed alarm. In accordance with the traditional systematics of suicide patients were divided into three groups: group demonstratively-blackmailing suicidal tendencies (56%), the group of mood (32%) and real suicides (13%). The study revealed the presence of suicidal thoughts only in 50% of subjects, suicidal ideation with intent and planning in 31% of subjects, 15% of teens with suicidal thoughts have made suicide attempts. Suicidal thoughts are not always identified with the patient survey. In some cases, as they are known in completing the teenagers subjective evaluation of Beck depression scale. When targeted survey of these patients
and their parents turned out that for some time before making a suicide attempt have been noted in the reasoning mortal threads, sometimes the patient experiences reflect the figures in school notebooks, which had suicidal content.
Analysis of the self-destructive behaviors in adolescents and found differences in the heterogeneity of clinical manifestations of suicidal tendencies depending on the type of depression. So, when dysphoric depression found in 80% of cases the presence of impulsive suicidal thoughts and tendencies in the main boys, occurring at the height of pathological passion under the influence of stressful factors, conflicts with parents and peers, as well as in the use of alcohol and drugs for abuse. The clinical picture of depression dysphoric installed addictive forms of behavior problems: petty theft, running away from home, loitering, smoking, substance use. Two teenagers in the group made a suicide attempt in the form of self-cutting application in the elbow and five teenage girls with psychopathic personality characteristics radical resorted to take large doses of drugs that are stated as a demonstrative-blackmailing autoaggressive action. Adolescents with anxious depression anxiety was observed throughout the day, with the strengthening in the evening, 6 patients gain anxiety symptoms was associated with finding way out of their condition and the absence of an understanding on the part of relatives in 3 patients emerged a sense of fear, appeared suicidal thoughts and trends that have, according to the traditional classification of suicides, suicides affective character. Suicidal behavior in depression anxiety-type limited to occasional thoughts about the unwillingness to live or threats during agitation episodes.
The clinical picture of depression dismorphopho-bic major complaints were the presence of defects and deficiencies in the structure of his own body, his own belief in the external unattractiveness or physical disability. This type of depression was observed only in girls, and was accompanied by eating disorder in the form of restrictive eating behavior in compliance with the strict diets and an initial phase of anorexia nervosa. In most cases, the premorbid in adolescent girls is not observed increased weight. Patients sought to change their inner peace, self-improvement, in some cases, the patients revealed a tendency to various reactions of protest. The girls expressed their dissatisfaction with their weight, excessive deposition of fat in different parts of his body, curves and thick legs, painful attitude to having chubby cheeks, oversized belly and chest, complained of weakness, blamed himself stiffness, had a feeling of insecurity within society , fear of appearing in public, the desire to retire and be alone. Suicidal tendencies in this group were limited to thoughts and planning, statements were unstable passive nature, teens are reluctant to report their plans and intentions, data were mainly collected from parents who found the registration of their children at various community sites on the Internet, promoting the cult of death. Assessment of suicidal thoughts and intentions in this group of adolescents can be attributed to their true suicides and include the risk group. When using the Luscher test patients can not rely on self- assessment of his condition,
which allows you to define the content of the psychological situation experienced by. These tests showed that all adolescents noted a negative emotional state, the severity of which is correlated with the data obtained by testing on the Hamilton scale. In 80% of patients revealed a desire to find a way out of this situation, 20% of patients with depression of moderate severity were detected negative attitude to life, according to Lusher test these patients sought to loneliness, the desire to avoid outside help. In 56% of cases (26 study), patients have experienced the frustration, the fear of setting new goals, which in some cases led to the formation of anxiety. In patients with dysphoric depression Luscher test showed stress, dissatisfaction with the current situation, the desire to elevate and strengthen his position that the inability to complete the implementation has led to cases of addictive and delinquent behavior. In some cases, 7 patients (15%), asthenic-apathic and masked depression detected lack of energy, inability to further activity in 11% of cases found stress caused by an attempt to cope with some of the circumstances that are unbearable for him. This condition is caused by stress and a feeling of inferiority, the desire for self-restraint and self-control that 4 patients manifested in intrapersonal conflicts, violation of relationships with parents and friends, in violation of school adaptation in 10% of cases led to the emergence of suicidal thoughts and intentions.
Patients with masked depression tests showed the presence of anxiety and worry, the experience of feeling the lack of close and sympathetic relations. Against the background of depressive disorders in patients significantly decreased school performance (80%), unwillingness to continue their studies (40%), there were conflicts with peers (60%), leaving home, systematic school absenteeism, abuse of alcohol. In most cases predominant demonstrative suicidal behavior, bearing in itself the elements of blackmail, but do not lose at the same time their danger. Along with this impulsive met suicidal action. In a survey of patients revealed that the basis of suicidal behavior on the ideas of punishment his parents' death, and the fear of punishment for their own actions actually committed. Suicidal intentions and actions are justified in 5 cases, the ideas of their own inadequacy and emerging "conscious aversion to life", only 1 case of guilt.
Conclusion: the results of the study revealed that adolescents often observed demonstratively- blackmailing suicidal behavior, emerging against the background of depressive affect, as a result of intrapersonal conflicts and are mainly a problem of behavioral and stress-related disorders, occur against a background of non-psychotic level of psychopathological conditions. The study of clinical features of self-destructive actions in adolescents with behavioral disorders depressive register reveals the risk for suicidal willingness among this group of patients.
References
1. Alekseeva M.V., Vaulin S.V. Kompleksnaja profilaktika suicidal'nogo povedenija podrostkov // «Jubilejnye Suharevskie chtenija». Nauchno-praktich-eskaja konferencija «Sluzhba psihicheskogo zdorov'ja:
kachestvo poliprofessional'noj pomoshhi detjam» / Sbornik tezisov pod obshhej red. M.A. Bebchuk. - M. - 2016. - S. 7-8. (in Russian)
2. Babarahimova SB., Iskandarova JM. Emotcion-alnye rasstrojstva u podrostkov s komputernoj zavisi-mostyu. // Sborniki nauchnyh konferencij NII Sotciosfera. 2014. №23 S.45-48. (in Russian)
3. Babarahimova S.B., Iskandarova J.M. Influence dismorfofobic disorders on the formation of depression in adolescents, taking into account personal characteristics .// Current mental health issues // Collection of materials of scientific-practical conference with international participation dedicated to the memory of Professor VI Grigoriev. Ryazan, 2015. S.11-18 (in Russian)
4. Ivanova T.I. Suicidal behavior in children with depressive disorders. Modern problems of mental
health of children. Problems of diagnostics, therapy and instrumental studies in child psychiatry. Volgograd. 2426 April 2007 Volgograd, 2007; .87-88(in Russian)
5. Kalacheva I.O., Pronina L.A., Larionov V.A. Social and personal factors that influence suicidal behavior adolescent psychiatrist Ross // Journal 2006; 4: 41-45(in Russian)
6. Wasserman D., Cheng Q., Jiang G.X. Global suicide rates among young people aged 15-19.World Psychiatry 2005; 4: 2: 114-120.
7. Weinberg I. The prisoners of despair: right hemisphere defi ciency and suicide. Neuroscience and Bi-obehavioral Reviews, 2011; 24, 799-815
8. https ://www. nimh. nih. gov/about/director/2014/ suicide-a-global-issue.shtml
СОВРЕМЕННЫЕ ПОДХОДЫ В КОМПЛЕКСНОМ ЛЕЧЕНИИ ВОСПАЛИТЕЛЬНО-ДЕСТРУКТИВНЫХ ОСЛОЖНЕНИЙ ДЕНТАЛЬНОЙ ИМПЛАНТАЦИИ
Гударьян А.А.
Ширинкин С.В.
ГУ «Днепропетровская медицинская академия МЗ Украины», кафедра хирургической стоматологии, имплантологии и пародонтологии (зав. - канд.мед.н Идашкина Н.Г.)
MODERN APPROACHES IN TREATMENT OF PERIIMPLANT MUCOSITIS AND
PERIIMPLANTITIS
Gudaryan A.A., Shirinkin S. V.
SE "Dnipropetrovsk medical academy Ministry of Health of Ukraine" Oral surgery, implantology and peri-
odontology department Dnipropetrovsk, Ukraine
АННОТАЦИЯ
В статье описаны результаты комплексного лечения периимплантного мукозита и периимплантита в 128 пациентов. Выявлено, что у больных периимплантним мукозиты при микроскопии преобладает условно-патогенная микрофлора наряду с локальным иммунодефицитом, в то время как при периимплантита доминируют пародонту- патогенные микроорганизмы рядом с нарушениями местных иммунологических факторов защиты и выраженным дисбалансом в системе цитокинового профиля. Предложена методика комплексного лечения и профилактики возникновения повторных рецидивов у больных периим-плантим мукозиты и периимплантита, которая включает курсовое применение антибактериальных препаратов, пробиотиков, иммуномодуляторов и препаратов, стимулирующих процессы костного метаболизма, в свою очередь позволило ликвидировать патогенную микрофлору, вызвать стойкую нормализацию показателей местного гуммарального иммунитета, а также добиться полного восстановления костных структур в области костного дефекта у больных периимплантитом I- II степени и избежать развития послеоперационных осложнений в близлежащем и отдаленном периодах после лечения.
ABSTRACT
This article describes the results of treatment of periimplant mucositis and peri-implantitis in 128 patients . Found, that patients with periimplant mucositis have microscopy prevails conditionally pathogenic microflora and local immune deficiency, while dominated by periimplantitis of periodontal pathogenic microorganisms, along with impaired local immune protection factors and severe imbalance of the cytokine profile. The technique of comprehensive treatment and prevention of the occurrence of recurrent relapses in patients with periimplantit mu-cositis and periimplantitis, including a course application of antibacterial drugs, probiotics, immunomodulators and drugs that stimulat the processes of bone metabolism, which in turn allowed to eliminate pathogenic flora, caused by persistent normalization of the local gummaral immunity and achieve full recovery of bone structures in the area of the bone defect in patients with periimplantitis I-II degree and to avoid the development of postoperative complications in the nearby and distant periods after treatment.
Ключевые слова: периимплантит, мукозит, дентальная имплантация, направленная регенерации костной ткани
Keywords: periimplantit, mucositis, dental implantation, directed regeneration of bone tissue
