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53MEDICAL SCIENCES
ТИПЫ ПСИХОЛОГИЧЕСКИХ РЕАКЦИЙ ПАЦИЕНТА НА БОЛЕЗНЬ
Бидучак А.С.
Высшее государственное учебное заведение Украины «Буковинский государственный медицинский университет» к.мед.н., ассистент кафедры социальной медицины и организации здравоохранения
TYPES OF PSYCHOLOGICAL REACTIONS PATIENT FOR DISEASE
Biduchak A.
Higher State Educational Institution of Ukraine «Bukovinian State Medical University» Ph.D, assistant of the Department of Social Medicine and Public Health
Аннотация
В статье рассматриваются типы психологических реакций пациента на болезнь. Исследование посвящено анализу психологических реакций на заболевание в разных возрастных категориях и их отношение к болезни. Abstract
The article discusses the types of psychological reactions of the patient to the disease. The study is devoted to the analysis of psychological reactions to the disease in different age categories and their relationship to the disease.
Ключевые слова: типы психологических реакций, болезнь, пациент, отношение к болезни. Keywords: types of psychological reactions, disease, patient, attitude to the disease.
The reflection of a disease in a person's experiences is usually defined as an internal picture of the disease. It was introduced by the Soviet medical scientist, therapist, gastroenterologist, health organizer R.A. Lu-ria is now widely used in medical psychology. This concept, by definition, a scientist, unites in itself everything «that the patient feels and experiences, the whole mass of his sensations, his general well-being, self-observation, his ideas about his illness, its causes - the whole vast world of the patient, which consists of highly complex combinations of perception and sensation, emotions, affects, conflicts, mental experiences and traumas».
As a complex structured education, the internal picture of the disease includes several levels: sensitive, emotional, intellectual, volitional, rational. The internal picture of the disease is not determined by the nosolog-ical unit, but by the personality of the person; it is also individual and dynamic, like the inner world of each of us. At the same time there are a number of studies that reveal the characteristic features of the patient's experience of his condition.
So, at the heart of the concept of V.D. Mendelevich («Terminological basis of phenomenological diagnosis») is the idea that the type of response to a particular disease is determined by two characteristics: the objective severity of the disease (determined by the criterion of mortality and the likelihood of disability) and the subjective severity of the disease (the patient's own assessment of his condition).
The idea of the subjective severity of the disease consists of socio-constitutional characteristics, which
include gender, age and the profession of the individual. For each age group, there is a register of the severity of the disease - a kind of distribution of diseases according to socio-psychological significance and severity.
Thus, during adolescence, the most severe psychological reactions may be caused not by diseases that are objectively threatening the preservation of the organism from a medical point of view, but by those that change its appearance, make it unattractive. This is due to the existence in the mind of a teenager of the basic need - «satisfaction with one's own appearance».
Persons of mature age will more psychologically react to chronic and disabling diseases. «This is connected with the system of values and reflects the aspiration of a person of a mature age to meet such social needs as the need for well-being, well-being, independence, independence, etc». In this respect, the strongest experiences are connected with oncological diseases. For the elderly and the elderly, the most significant are the diseases that can lead to death, loss of work and performance.
The individual psychological characteristics affecting the specifics of experiencing a disease include features of temperament (regarding the following criteria: emotionality, pain tolerance, as a sign of emotionality, and limitation of movements and immobility), as well as features of a person's character, personality (worldview, the level of education).
There is a typology of ways to respond to a patient's disease. Knowledge of the type of patient's re-
sponse helps to select an adequate strategy of interaction with him and his family, to use appropriate methods of communication, motivation for treatment.
Types of psychological response to severe somatic disease
Typology of the response to the disease A.E.Lichko and N.Ya. Ivanova («Medical and Psychological Examination of Somatic Patients») includes 13 types of psychological response to the disease, identified on the basis of an assessment of the influence of three factors: the nature of the somatic disease itself, the type of personality, in which the type of accentuation of the character and attitude to this disease in the reference (significant) for the patient group.
In the first block are those types of attitudes towards the disease, in which there is no significant violation of adaptation:
Harmonious: for this type of response, a sober assessment of one's condition is characteristic without a tendency to exaggerate its severity and without reason to see everything in a gloomy light, but also without underestimating the severity of the disease. The desire to actively promote the success of treatment in everything. Unwillingness to burden others with self-care. In the event of an unfavorable prognosis in the sense of disability, a shift of interests to those areas of life that remain available to the patient. In case of an unfavorable prognosis, attention, worries, and interests are focused on the fate of loved ones and their business.
Ergopathic: characterized by «taking care of the disease in the work». Even with the severity of the disease and suffering, they try to continue the work at any cost. They work with bitterness, with even more zeal than before the disease, they give up their work all the time, try to be treated and undergo research so that it leaves an opportunity to continue working.
Anosognosic: an active rejection of the thought about the disease, its possible consequences, the denial of the obvious in the manifestation of the disease, attribution to random circumstances or other frivolous diseases. Refusal of examination and treatment, the desire to do with their means.
The second block includes types of response to the disease, characterized by the presence of mental maladjustment:
Disturbing: for this type of response, there is continuous concern and suspicion regarding the unfavorable course of the disease, possible complications, inefficiency and even the danger of treatment. The search for new methods of treatment, the thirst for more information about the disease, probable complications, methods of treatment, the continuous search for «authorities». In contrast, hypochondria are more interested in objective data about the disease (test result, expert opinion), than their own feelings. Therefore, they prefer to listen to the statements of others more than endlessly present their complaints. The mood is above all anxious, depression - due to this alarm).
Hypochondriac: characterized by focusing on subjective painful and other unpleasant sensations. The desire to constantly talk about them to others. On their basis, exaggeration of real and searching for nonexist-
ent diseases and sufferings. Exaggeration of the side effects of drugs. The combination of the desire to be treated and disbelief in success, the requirements of a thorough examination and fear of harm and painful procedures).
Neurasthenic: characteristic behavior of «irritable weakness». Outbreaks of irritation, especially with pain, with unpleasant sensations, with treatment failures, adverse survey data. Irritation often pours out on the first one and often ends with remorse and tears. Intolerance to pain. Impatience. Inability to wait for relief. In the following - repentance for anxiety and incontinence.
Melancholic: characterized by dejection of the disease, lack of confidence in recovery, in a possible improvement in the effect of treatment. Active depressive expressions up to suicidal thoughts. A pessimistic view of everything around, disbelief in the success of treatment even with favorable objective data.
Euphoric: characterized by unreasonably high spirits, often fake. Neglect, frivolous attitude to the disease and treatment. Hope that «everything will cost». The desire to receive everything from life, despite the disease. Ease of violation of the regime, although these violations may adversely affect the course of the disease.
Apathetic: characterized by complete indifference to his fate, to the outcome of the disease, to the results of treatment. Passive obedience to the procedures and treatment with persistent outside motivation, loss of interest in everything that previously worried.
Obsessive-phobic: anxious suspiciousness is characteristic above all concerns concerns not real, but unlikely complications of the disease, treatment failures, as well as possible (but poorly founded) failures in life, work, family situation due to the disease. Imaginary dangers worry more than real ones. Signs and rituals become protection from anxiety.
Sensitive: characterized by excessive concern about the possible adverse impression that can produce on the surrounding information about his illness. Fears that others will avoid, be considered inferior, dismissive or cautious about, gossip or unfavorable information about the cause and nature of the disease. Fear of becoming a burden for loved ones due to illness and the unfriendly relationship on their part in this regard.
Egocentric: characterized by «Care of the disease», parading the family and others of their sufferings and experiences in order to fully capture their attention. The requirement of exceptional care - everyone should forget and drop everything and only care for the sick. Conversations of others are quickly translated «to themselves». In others, also requiring attention and care, they see only «competitors» and treat them with hostility. The constant desire to show their special position, their exclusivity in relation to the disease.
Paranoiac: characterized by confidence that the disease - the result of someone else's malice. Extreme suspicion of drugs and procedures. The desire to attribute the possible complications of treatment and the side effects of negligence drugs or the malicious intent of doctors and staff. Charges and penalties in connection with this.
Dysphoric (typical sad-bitter mood). Interaction with some of these patients can bring a pronounced psychological discomfort to the doctor. But knowledge of the psychological basis of this type of patient behavior will help the doctor better understand his needs, expectations, fears and emotional reactions, optimally organize the process of interaction with him, use certain tools of influence. It is important to understand that, even showing complete indifference to the outcome of treatment, the patient most wants to hear the words of hope and needs to strengthen his faith in the best. Patients who are constantly worried about their condition need a calm, optimistic and attentive conversation with the doctor, and patients who show aggression reactions to others and the doctor need a reputable confident position of the doctor who will help to cope with the strongest fear for their lives hidden in their souls.
Thus, understanding the type of patient's response to the disease will help make the union of the doctor and the patient more effective, contributing to the psychological well-being of both participants in the treatment process.
References
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HUMORAL IMMUNITY OF ORAL CAVITY IN CHILDREN WITH CHRONIC CATARRHAL GINGIVITIS AND COMORBID DIABETES MELLITUS
Kotelban A.,
Department of Pediatric Stomatology, PHD, Assistant
Moroz P.
Department of Surgery №1, PHD, Assistant Higher State Educational Establishment of Ukraine «Bukovinian State Medical University»
Abstract
Stomatological examination of 30 children 12-aged with diabetes type I that was treated at the endocrinological departments of Regional Children's Clinical Hospital, 30 children with chronic catarrhal gingivitis and 30 sameaged absolutely healthy children, the pupils at school №22, on the base of chirurgical and children dentistry department, has been carried out. Various violations has been established humoral immunity of oral cavity in children with chronic catarrhal gingivitis and diabetes type I.
Keywords: diabetes type I, gingivitis, lysozyme, immunoglobulins.
Diabetes mellitus (DM) is the fourth degree in the structure of all diseases of the endocrine system among the children's population in Ukraine and most often causes severe chronic damage to organs and systems [2]. The classic clinical complications of diabetes include retinopathy, nephropathy, neuropathy, and macro-vascular disease. In 1993, Loe proposed another complication - periodontal tissue diseases [1, 2]. In own studies, Taylor and Borgnakke characterized this dental nosology as a consequence of impaired glycemic control in such a cohort of patients. Diseases of perio-dontal tissues on the background of metabolic disorders, according to literary data, occurs in 90% of cases [3, 4, 8].
The main factor in the development and progression of diabetic changes in periodontal tissues is chronic hyperglycemia, which, in turn, triggers a whole range of pathophysiological mechanisms. According to many researchers, immunological mechanisms play a special role in the pathogenesis of inflammatory diseases of periodontal tissues [5, 6, 7]. Immunopathogen-
esis of inflammatory and dystrophic diseases of perio-dontal tissues is realized through cellular and humoral factors of specific and nonspecific resistance.
Researchers pay special attention to the role of violation of general and local immunity, which is not enough studied and relevant.
The aim is to study the characteristics of humoral local immunity of the oral cavity in children with chronic catarrhal gingivitis and comorbid diabetes mellitus, on the base of the existing metabolic disorders.
Materials and research methods.
To achieve this aim 12-year-old children with type 1 diabetes mellitus (30 people), who were hospitalized at the endocrinology department of the regional children's clinical hospital, Chernivtsi, were examined. A comparison group (30 somatically healthy children with signs of chronic catarrhal gingivitis) and a control group (30 somatically and dental healthy children of the same age) were formed from pupils of school No. 22 in Chernivtsi.
