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STUDY OF THE SPECTRUM OF EMOTIONAL PATHOLOGY IN ADOLESCENTS WITH TYPE I
DIABETES MELLITUS
Sultonova K.
The Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy
Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Abstract
The article examines the spectrum of emotional pathology in adolescents with diabetes mellitus. At the initial stage, adolescents were tested for the presence of emotional changes using psychometric scales. In the course of the study of the psychoemotional background, 96.6% of the examined adolescents showed signs of a depressive disorder of the neurotic register. To reduce depressive symptoms, psychotherapeutic intervention was performed, as a result of which positive dynamics was observed in 80% of patients.
Keywords: emotional disorders, psychology, psychotherapy, adolescents, diabetes mellitus.
Relevance. The need for a comprehensive approach to the treatment of diabetes mellitus in adolescents with diabetes mellitus is reflected in the litera-ture[8]. An appropriate direction of work with children and adolescents with type I diabetes mellitus (DM) is to optimize complex pharmacotherapeutic and medical-psychological care with psychotherapeutic, psychosocial and rehabilitation measures[7]. Current trends in
clinical psychology show the importance of studying the processes of mental adaptation in the situation of the disease, that is, how children with DM react to the chronic frustrating situation of blocking their actual life needs. Diabetes mellitus (DM) is a widespread endocrine disease that reaches the scale of a non-communicable epidemic. Most patients who are diagnosed with
diabetes experience shock, it is difficult for them to realize that now it is necessary to check blood sugar several times a day and take hypoglycemic drugs, it is difficult to accept that the physical condition will depend on the appointments of an endocrinologist, on medications that are vital to them and regular laboratory examinations. It is especially difficult for children and adolescents to imagine that they will have to constantly follow a therapeutic regime and accept that this disease is permanent. Sick children and adolescents with newly diagnosed DM need individual psychological and pedagogical support[6]. This contingent of patients is shown psychotherapeutic assistance that contributes to the creation of a partnership between the psychologist and the patient, for more effective and comprehensive treatment, timely psychodiagnostics and psychocorrection of disorders of the anxiety-depressive and phobic spectrum of the neurotic level are necessary[1]. Depressive symptoms in adolescents with severe somatic diseases, including type 1 diabetes, provoke the risk of developing suicidal tendencies and suicidal behavior [2,3,4,5,9].
The aim of to study: the range of emotional disorders in adolescents with type I diabetes mellitus and methods of optimizing psychological, pedagogical and psychotherapeutic assistance to this patient population.
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 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, 80 % 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.
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