Федеральное государственное бюджетное образовательное учреждение

высшего образования
«Астраханский государственный медицинский университет»
Министерства здравоохранения Российской Федерации

Кафедра психологии и педагогики

Факультет иностранных студентов. Специальность «Лечебное дело»

Курс 5

«УТВЕРЖДАЮ»
Заведующая кафедрой психологии и педагогики, к.м.н. ______________ Л.А. Костина

Протокол заседания кафедры №___

от «__»_________20 г.

«СОГЛАСОВАНО»
Декан лечебного факультета,
д.м.н. ______________ Е.И. Каширская

ЭКЗАМЕНАЦИОННЫЕ ВОПРОСЫ
Дисциплина «Психиатрия. Медицинская психология»
Раздел «Медицинская психология»

1. Medical and clinical psychology: concept, subject, tasks. Founders of medical

and clinical psychology. General and private medical psychology.
PANCH

Historically Clinical psychology was a main part of Medical psychology. Domestic doctors
used medical psychology and Psychologists used clinical psychology.

Medical psychology is a branch of psychology that studies the psychological aspects of

hygiene, prevention, diagnostics, treatment, examination and rehabilitation of patients.
Medical psychology includes a number of sections: clinical psychology, psychohygiene,
psychopharmacology, psychotherapy, psychic rehabilitation.

The interaction of psychic and physical processes in the development of disease.

Personalizing the setting ( medicines, procedures, surgical interventions) to treatment and
patient. Also, the psychological aspects of relationship between medical environment
,relatives and medical staff.
Clinical Psychology

Clinical psychology is the field of medical psychology, studying the psychic factors of origin
and flow of diseases, the impact of disease on the personality, the psychological aspects of
therapeutic effect

Clinical psychology deals with the issues of diagnosis and expert work, the psychological
potentization of therapeutic measures, the study of the relationships of patients, the
organization of the work of the staff and the optimization of the clinical environment of clinics,
the development of techniques that enhance the effectiveness and effect of treatment, the
correction of personality changes in the patient, arising during the course of the disease.

Object – person with psychic pains and difficulties with adaptation with self-realization
related to spirituality etc.

Subject – laws of influence of the psyche on strengthening health and improving

adaptations.

General medical psychology

1.Psychology of patient and the doctor

2. Psychosomatic and somatopsychic interferences

3. Individuality (character and personality) and postnatal ontogeny like childhood to

adulthood)

4.Medical deontology (medical ethics and secrecy)

5.Psychohygiene (psychology during crisis in life, marriage and relationship between doctor
and patient) .

Private Medical psychology

1.Psychic processes inn patients

2. Psychic features during preparation, performance of surgical interventions

3. Psychic features during suffering of the disease.

4. Psychic features of patients defects in organs like deafness.

5.Psychic features during labor and military examinations.

6. Psychic features of drug addicts and alcoholics

7. Private psychotherapy.
Founders of medical psychology - 1885, when the great psychoneurologist Vladimir
Mikhailovich Bekhterev opened in Kazan the first experimental psychological laboratory in
a psychiatric clinic (to investigate the psychological reactions of the psychiatric patient), and
a little later – similar in St. Petersburg.

Founders of clinical psychology - Gucho Munsterberg, who proposed the treatment of

various psychic disorders by psychological influences.

Sections of clinical psychology :

· General clinical psychology

· Private clinical psychology

General clinical psychology is represented by the following branches :

- neuropsychology

- pathopsychology

- psychosomatics

- psychotherapy

Private clinical psychology studies particular symptoms and syndromes: violations of

reproduction of voluntary movements and actions; memory and speech; attention and
thinking; violations of the emotional and personal sphere and disturbances of
consciousness.

2. Clinical interviewing: the concept, goals and principles of construction. REMYA

A clinical interview is a method of obtaining information about the individual psychological

properties of a person, psychological phenomena and psychopathological symptoms and
syndromes, the internal picture of the patient's illness and the structure of the client's
problem, as well as a method of psychological influence on a person, made directly on the
basis of personal contact between the psychologist and the client.

The functions of interviews in clinical psychology are: diagnostic and therapeutic. They
should be carried out in parallel, since only their combination can lead to the desired result
for the psychologist - the patient's recovery and rehabilitation.

Patients often cannot accurately describe their condition and formulate complaints and
problems. That is why the ability to listen to the presentation of a person's problems is only
part of the interview, the second is the ability to tactfully help him formulate his problem, to
let him understand the origins of psychological discomfort - to crystallize the problem.
“Speech is given to a person in order to better understand himself,” wrote L. Vygotsky, and
this understanding through verbalization in the process of a clinical interview can be
considered essential and fundamental.

Clinical interview principles are:

Unambiguity and accuracy,

The availability of question wording,

Adequacy, consistency

The adequacy and verifiability of the information received,

· The impartiality of the survey.- This principle assumes acceptance of the patient without
dependence from own life principles of the psychologist, his cultural values. Absence of
imposing to the patient own representations about the presence of that psychopathological
symptomatology.

3. Requirements for personal characteristics of the doctor. Deontology. KABELO

One of the main components of a doctor's personality is humanism. It includes:

● first, a sincere and deep love for one's neighbor (fellow creature),
● Secondly, the existence of innate (natural) or specially bred feelings of compassion
for anyone in trouble.
● Third, humanity is manifested in persistent and sincere desire, even need, to help
the patient.
1. Respect for life – «I will not give a lethal drug to anyone if I am asked, nor will I
advise such a plan».
2. The prohibition on causing harm to the patient – «I will prescribe regimens for the
good of my patients according to my ability and my judgment and never do harm to
anyone».
3. Respect for the patient's personality – «In every house where I come I will enter
only for the good of my patients, keeping myself far from all intentional ill-doing and
 all seduction and especially from the pleasures of love with women or with men, be
they free or slaves».
4. Medical secrecy – «All that may come to my knowledge in the exercise of my
profession or in daily commerce with men, which ought not to be spread abroad, I will
keep secret and will never reveal».
5. Respect for the profession – «I swear… To consider dear to me, as my parents,
him who taught me this art…But I will preserve the purity of my life and my arts».
● Didactic is the ability to transmit clear and understandable to patients, their
families, colleagues and subordinates of any material, nature of the problem, perform
any tasks.
● Academic ability is the ability to appropriate the field of medicine.
● Perceptual is the ability to perceive into the inner world of the patient, colleagues,
subordinates.
● Speech is the ability to clearly and to accurately express thoughts and feelings
through speech, facial expressions and pantomime (gestures).
● Organizational is the ability to organize a subordinate medical staff, consolidate it, to
inspire the decision of the important problems
● Authoritarian is the ability to direct the emotional and volitional influence on patients,
colleagues, subordinates, the ability to achieve their authority.

4. Communicative competence of the doctor. Psychological features of

personality, affecting communicative compétence. MUPULA

The ability to communicate, or communicative competence, ensure mutual understanding,

trust in relationships, effective in solving the problems.
● Affiliation -The need for other people, the desire to interact with them, referred to as
«affiliation» term. Affiliation is a human need to be with other people in society, the
pursuit of «accession».
● Emotional stability, balance, maintain control over emotional reactions and
behavior in general. Emotional stability helps the doctor in relationships with patients
to avoid «psychological breakdowns» conflicts.
● Empathy. It is the capacity for compassion. Emotional participation helps to establish
the psychological contact with the patient to receive more complete and accurate
information about him, about his condition, to inspire confidence in the doctor's
competence, the adequacy of ongoing treatment and diagnostic process, instill belief
in recovery.
● Sensitivity to rejection is the ability to perceive the negative attitude of others, in
particular patients, which may occur at certain stages of treatment. Sensitivity to
rejection represents a kind of «feedback», allows the physician to adjust his behavior
in relationships with the patient.

Psychological features of reducing the communicative competence of the doctor

Anxiety
Depression
introversion
 5. Professional adaptation and deformation. Stages of professional development.
AMJED

● Adaptation is a constant process of active coordination of a person’s individual

characteristics (individual, personal) with environmental conditions (workplace
requirements, characteristics of partners, social groups, organizational culture, etc.),
guaranteeing the success of one’s professional activity and the full personal
realization of all spheres of life.

● Stages of professional development

1). Option - the period of choice of an occupation in an educational institution;

2). Adaptation - entering and becoming accustomed to the profession;
3). Internalization - gaining work experience; 2-3 years
4). Mastery - qualified performance of the work activity;
5). Authority phase - obtaining a highly qualified professional;
6). Mentoring - the transfer of work experience.

● Professional deformation
○ The professional deformation of personality is the process and result of the
influence on the personality characteristics of a person of the specific
characteristics of a certain professional activity performed for a long time.
○ Occupational deformation (of lat. Deformatio) - cognitive distortion,
psychological disorientation of personality , formed because of the constant
pressure of external and internal factors of the professional activity and
leading to the formation of a specific professional type of personality.

6. Syndrome of emotional burnout. External and internal factors contributing to

the development or inhibition of the syndrome of emotional burnout.
Prevention of emotional burnout syndrome.

«psychic burnout» is a state of physical, emotional and psychic exhaustion,

manifested in the professions of the social sphere.

Adaptation of a young doctor to professional activity takes about two years. This time is
used to develop new skills and develop an individual image for oneself. Getting the feedback
and helps from elders and colleagues a young doctor finds the right amount of dosing of
empathic involvement. IF failed to do that and if the young doctor gets too involved in the
patients experience, he/she will have excess level of anxiety, uncertainty and fear. This leads
to chronic emotional overload. Adaptive and compensatory abilities are reduced so will
experience decreased immunity, frequent colds and exacerbations of chronic somatic
disorders.

This is emotional burnout syndrome. Burnout is a payment for empathy. The main reason is
psychological and emotional overstrain.
American psychiatrist H.J. Freidenberger introduced the term «emotional burnout» in 1974.

Phases of development of burnout syndrome by V.V. Boyko

● Phase of nervous stress – experiencing psycho-traumatic circumstance

○ Symptom of «experiencing psycho-traumatic circumstances»
○ Symptom of «dissatisfaction with yourself»
○ Symptom of «driven into a cage»
○ Symptom of «anxiety and depression».
● Phase of resistance - emotional and moral disorientation
○ Symptom of «inadequate selective emotional response».
○ Symptom of «emotional and moral disorientation»
○ Symptom of «expanding the sphere of saving emotions»
○ Symptom of «reduction of professional duties».
● Phase of exhaustion – emotional detachment
○ Symptom of «emotional deficiency»
○ Symptom of «emotional detachment».
○ Symptom of «personal detachment, or depersonalization»
○ Symptom of «psychosomatic and psycho-vegetative disorders»

Phase of development of burnout syndrome according to M.Burish

· Warning phase – excessive participation and exhaustion

· Decrease in level of own participation

· Emotional reaction – depression and aggression

· The phase of destructive behavior

· Psychosomatic reactions

· Disappointment, reduction in concentration, lack of ability to perform task.

Factors affecting the development of syndrome of emotional burnout

● External factors
○ Chronic tense psycho-emotional activity
○ Destabilizing organization of activities
○ Increased responsibility for executable and operations .
○ Unfavourable psychological atmosphere of professional activity.
○ A psychologically difficult contingent with whom a professional in the sphere
of communication deals.
● Internal factors
○ The tendency to emotional rigidity
 ○ Intense internalization of the circumstance of professional activity.
○ A weak motivation for emotional return in professional activity.
○ Moral defects and disorientation of the person
○ Inability to distinguish between good and bad, benefit from harm caused to
another person.

Prevention of emotional burnout.

a person affected by this syndrome often has little awareness of its symptoms.

Cultivaton of other interest

Combining work with study research

Introduction of diversity in their work

Maintaining health

Satisfactory social life

Friends presence

Self esteem

Not hurry

Reading

Participate in seminars and conferences

Collaborations with colleagues

Professional groups

Hobbies

7. Internal vision of the disease, its components and parameters of the patient's
assessment of his illness. Factors determining the internal vision of the disease.
REMYA

The type of patient response to somatic disease is primarily associated with an assessment
of the severity of the disease. At the same time, we can speak about the subjective and
objective severity of the disease. The objective severity of the disease consists of
information accumulated in medicine about a particular disease (mortality, disability,
disability). The subjective severity of the disease is otherwise called the internal vision of
the disease.
Internal vision of the disease is an intellectual interpretation of the diagnosis, cognitive
assessment of the severity of the disease and prognosis, the formation of the emotional and
behavioral pattern on this basis.

For the patient, the internal vision of the disease consists of understanding the mechanisms
of the onset of painful sensations, emotional experiences associated with the disease,
choosing the mode of action and behavior in the new conditions of the disease. The
formation of the internal vision of the disease is also affected by the objective severity of the
disease, however, the patient is inclined to analyze the situation through the prism of the
subjective severity of the disease.

V.N. Myasishchev identifies three components of the relationship to the disease:

emotional, behavioral and cognitive. The emotional component reflects the whole range of
feelings caused by the disease, as well as those emotional experiences that arise in
situations associated with the disease. The motivational-behavioral component reflects a
sample of a certain behavior strategy in life situations associated with pain (taking the
patient’s «role», active disease control, ignoring the disease, pessimistic attitudes, etc.), as
well as disease-related reactions that contribute to adaptation or maladjustment to it. The
cognitive component reflects the knowledge of the disease, its awareness, understanding of
its role and influence on the vital functioning of the patient, the predicted prediction.

It is possible to single out the following parameters, on the basis of which any disease is
evaluated and a TV psychological attitude to it is formed:

1. The probability of death.

2. The likelihood of disability and chronification.

3. Pain characteristics of the disease.

4. The need for radical or palliative treatment.

5. The influence of the disease on the ability to maintain the same level of communication.

6. The social significance of the disease and the traditional attitude towards the sick in the
microsociety.

7. The effect of the disease on the family and sexual spheres.

8. Influence of the disease on the sphere of entertainment and interests.

The factors determining the domestic image of the disease:

1. Paul. The features that have correlations with the sex of the human being include
well-known facts of better tolerance of painful sensation by women, states of prolonged
limitation of movement or immobility. This fact can be explained both by the
psycho-physiological characteristics of gender, and by the psychological traditions of the role
of women and men in certain societies and cultures.
2. Age. For children, adolescents and young people, the most difficult psycho ¬ logically are
diseases that change the appearance of a person, make him unattractive. The most severe
psychological reactions can cause illnesses that are not medically life threatening. Mature
people will be more psychologically difficult to react to chronic and disabling diseases. The
second most significant group of diseases for a mature person are so-called. «Shameful»
diseases to which venereal and psychic diseases, as well as diseases bearing the tinge of
subjective lack of prestige (hemorrhoids) are usually attributed For the elderly and the
elderly, the most significant diseases are those that can lead to death. A heart attack, stroke,
malignant tumors are terrible for them not because they can lead to the loss of labor and
work ability, but because they are associated with death.

3. Profession. Professionally determined value of a body becomes significant. The severity

of pain is estimated based on the influence of the symptoms of the disease on the present
and future work capacity.

4. Features of temperament. Extroverts and intraworms react differently to pain. According

to Aysenck, extroverts perceive all levels of stimulation (including more ¬ less) less intensely
than introverts. Lower thresholds for choleric and melancholic compared with phlegmatic and
sanguine. Restricted mobility can serve as a cause of frustration for persons with high motor
activity (choleric and sanguine).

5. Characteristics. The type of character accentuation influences the formation of the type
of human response. In addition, attitudes toward illness can be formed on the basis of family
education. There are two opposing family traditions of cultivating a subjective attitude
towards diseases – «stoic» and «ipo ¬ chondric». As part of the first, the child is constantly
encouraged for behavior aimed at overcoming illnesses and feeling unwell. Opposite to her
is the family tradition of forming an overvalued attitude to health. Parents are encouraged to
be attentive to health, to identify the first signs of the disease.

6. Personality characteristics. From personal characteristics, first of all, the worldview and
philosophical position about the meaning of life and life after death affect the formation of the
inner picture of the disease. There are several worldview installations in relation to the origin
of the diseases:

- illness like a punishment;

- disease as a test

- illness as edification to others;

- illness as payment for the sins of the ancestors.

8. Classification of types of reaction to the disease. Psychological-psychiatric

classification of the types of attitude towards the disease. Basic principles of
classification. The first block (harmonious, ergopathic and anosognosic types
of attitude towards the disease). The tactics of the doctor. KABELO
Classification of types of reactions to the disease.
1. Normanosognosia – an adequate assessment of the disease. The opinion of the
patient coincides with the opinion of the doctor.
2. Hypernosognosia – exaggeration of the severity of the disease.
3. Hyponosognosia – an understatement of the severity of the disease.
4. Disnosognosia – a distorted vision of the disease or its denial for the purpose of
dissimulation (the process of reverse simulation).
5. Anosognosia – denial of the disease.

Classification of types of reactions to the disease:

I. Medical-psychological (Yakubov, 1982)
1. Friendly reaction. It is typical for people with developed intelligence. From the first
days of illness, they are prone to become «assistants» of a doctor, they are
obedient, punctual and attentive.
2. Calm reaction. It is characteristic for people with stable emotional-volitional
processes. Punctual, adequately react to all instructions of the doctor, carry out all his
instructions, but without the scrupulousness inherent to the first type.
3. Unconscious reaction. Denies his illness. It is a pathological reaction.
4. Trace reaction. When recovering, the person remains fear of recurring disease.
They are constantly waiting for him.
5. Negative reaction. Patients are at the mercy of prejudice, going from one doctor to
another, accusing the previous one of incompetence.
6. Panic reaction. Patients are at the mercy of fear, are being treated at several
institutions at the same time, trying to learn more about the disease and connect all
medical measures.
7. Destructive reaction. Patients behave inadequately, ignoring all instructions of the
doctor. They refuse to use medicines and change their lifestyle.

Harmonious, ergopathic and anosognosic types of attitude towards the disease

1. Harmonious type: Assessing condition w/o exaggerating its severity, but also w/o
underestimating its severity. Active promotion of success of treatment,
unwillingness to burden others with their condition.
Doctors Tactics: Address patient as normal.
2. Ergopathic type: Characteristically super-responsible, sometimes obsessed,
sthenic attitude to work, which in some cases expressed even more than before the
disease. Selective attitude to the examination and treatment. The desire to continue
active work.
Doctors Tactics: Address patient with conviction. In some cases, it is acceptable in
the interests of the patient to overestimate the severity of the disease. It is necessary
to draw the patient’s attention to the fact that as a result of refusing treatment, the
patient may lose his ability to work.
3. Anosognosic type: Active rejection of the disease, and about its possible
consequences. Distinct tendencies to view the symptoms of the disease as
«unserious» diseases or random fluctuations of well-being. In this regard, the refusal
of medical examination and treatment, the desire to «figure it out for yourself» and
«do your own means», the hope that «everything will go away».
 Doctors Tactics: Should be very persistent with the patient. To explain the possible
consequences of dissimulation: the appearance of dangerous symptoms, the
protracted course of the disease, various complications. Here the explanation should
be encouraging, as well as contribute to the examination and treatment.

9. Psychological-psychiatric classification of the types of attitude towards the

disease. The second block (neurasthenic, hypochondriacal, apathic, anxious
and melancholic types of attitude towards the disease). The tactics of the
doctor. MUPULA.

II block
The alarming type. There are two variants of this type of attitude towards the
disease: anxiety-depressive and obsessive-phobic.
anxiety -depressive is when continuous anxiety and suspiciousness regarding the
unfavorable course of the disease, possible complications of failure, and even the
danger of treatment.they are interested in medical examination and data.
doctors tactics: explanation to the patient in the expressions available to him, the
nature of the disease, indicating his relatively miserable physical condition, the great
potential of medical science
Obsessive-phobic type manifested in the form of alarming suspiciousness, which
primarily concerns fears of not real, but unlikely complications of the disease,
treatment failures, and possible life, work, relationships with loved ones due to
illness.
Doctors tactics : groundlessness and temporary nature of their fears, it is advisable
to talk with them on distracting topics.

Hypochondria type. Excessive concentration on subjective painful and other unpleasant

sensations. The desire to talk constantly about them to doctors, medical staff and others
.doctors tactics : correct the desire of these patients to lead pessimistic conversations
about diseases and severe outcomes, as this may induce other patients.

Neurasthenic type. Behavior of the type of «irritable weakness». Outbreaks of irritation,

especially with pain, with unpleasant sensations, with treatment failures.
doctors tactics: understood that irritation is a natural phenomenon, a reaction to their
disease. It is desirable that the patient had the opportunity to speak, thereby responding to
his negative emotion

Melancholic (vital-dreary) type. Overdrying disease, disbelief in recovery, in a possible

improvement, in the effect of treatment.
doctors tactics : patient’s attention should be paid to favorable objective changes,
comparing them with the recent unsatisfactory state.

Apathetic type. Complete indifference to his fate, to the outcome of the disease, to the
results of treatment. Passive obedience to procedures and treatment with persistent outside
motivation.
doctors tactics :find out the reasons for this condition of the patient, maybe it is caused by
misinforming him about his illness. In this case, the correct explanatory work will be able to
correct the psychological state of the patient.

10. Psychological-psychiatric classification of the types of attitude towards the

disease. The third block (sensitive, egocentric, dysphoric and paranoid types
of attitude towards the disease). The tactics of the doctor. AMJED

● Sensitive type: Sensitive to interpersonal relationships. Characterized by

concern about unfavourable attitude of others due to illness, the fear of
becoming a burden to others
Doctors tactics: Should communicate well, instill self-esteem, instill hope for
positive treatment result
● Egocentric type: Characterized by requirement of exclusive care, flaunting
suffering in order to undividedly capture the attention of others
Doctors tactics: Relationships should be built on an adult-adult basis,
involve them in activity to reverse their attitude.
● Paranoiac type: Characterized by extreme suspicion of drugs and
procedures, blaming others for possible complications or side effects of drugs
Doctors tactics: Avoid value judgements and avoid sense of humor during
patients appointments, explain disease w/o using misleading terms
● Dysphoric type: Distinguished by gloomy, angry mood, jealous of the
healthy, accusations of others for their illness.
Doctors tactics: Establish a formal relationship with the patient, let the
patient calm down and release their emotions, listen to complaints but ignore
insults.
`

11. Psychological meaning of the disease. The influence of the family on human
health. Disease as a way of solving family problems. PANCH

Meaning of disease is vital significance of the circumstances of the disease in relation to the
motives of activity for the subject.
3 meanings of disease and they are
● Barrier meaning -
● Positive meaning - the disease provides a legal opportunity to refuse individual
responsibility for failures.Chronically ill patients often have rental facilities that allow
them to extract certain advantages from their condition: retirement, attention, care,
special treatment, specific material benefits, justified «escape from freedom»,
legalized possibility of regression.Even illnesses that at first had a clearly barrier
meaning, such as cancer, may be acquiring a positive meaning, however, after the
immediate danger has passed.

● Confilct meaning - meaning a disease acquires when it contributes to the

achievement of some motives and impedes the achievement of others.Conflict
meaning can be realized in the simple case of the requirement to limit activity in order
 to preserve health, which contradicts the need to implement other motives associated
with achievements. At the same time, depending on the motivating force of conflicting
motives, the result will be either ignoring the disease, or abandoning ambitious plans,
or constant fluctuations between them.

The influence of the family on human health.

Family is a cell of the society,most important organization of personal life. Function of family -
the family activities related to satisfaction of specific needs of its members. It’s classified into
upbringing function, spiritual function , household function , emotional function, Primary
social function and sexual erotic function.

Family structure - there is an authoritarian system of relationships(one family member holds

the leadership) or democratic system of relationship ( expressed equal participation in the
management).

Family dynamics have a family life cycle that was introduced by E.K Vasilyeva.
First stage - Marriage to 1st child
Second stage - Birth and bringing up, where it ends with the beginning of work activity of at
least one child.
Third stage - ending of family upbringing.
Fourth stage - children live with their parents or have no spouse.
Fifth stage - Spouses live alone or with children who have their own families.

Disease as a way of solving family problems

Rental attitude is the behavior of the patient or his relatives, emphasizing the inconsistency
of the functions of the body of the patient or simulating their violation, aimed at obtaining a
disability group so they can benefit from it.
Persons with disabilities often view their diagnosis as social discrimination so rental attitude
is uncommon.
When the spouse falls ill the rest of the family has to act accordingly like cook broth and stay
quiet. This is more psychological than physiological. This could also be manipulation to
satisfy a sense of superiority in case of hidden struggle for leadership between spouses.

With chronic diseases, people learn to live with the disease. Chronic disease makes the
main event in their life. They are happy to talk about their disease, discuss symptoms and
healers. They make acquaintances from the same circle of patients. Leads to collapse of
relationships.
To prevent this:
● Provide necessary assistance but not support the simulator.
● Show criticism to excessive assistance.
● Stops attempts to fall into despair
● Switch attention to normal things
● Do not feel the condition of patient deeply
● Repeat that most diseases are treated

In case of very serious diseases then encourage the patient that sometimes miracle.
 12. Features of the internal vision of the disease in children. The components of
the internal vision of the disease of children (objective manifestations of the
disease, the characteristics of the emotional response of the personality,
sexual characteristics, the level of intellectual functioning, personal
experience, information obtained about health, internal organs, disease, its
causes). REMYA

A sick child is different from a healthy one. His mood is changing, he can become
depressed, irritable, whiny, anxious, restless. Sometimes a sick child has persistent thoughts
about the severity of the disease, its unusualness, even exclusivity, the impossibility of cure
or, conversely, its insignificance and frivolity. In this regard, the attitude to the treatment is
either adequate and even dependent, or dismissive, rejecting the procedures, manipulations,
medicines.

Many children change their behavior. They stop playing, lose the immediacy of
communication and do not get joy from entertainment. Some children have a reluctance to
meet peers and adults. As a rule, children are constrained by the limitations that the disease
imposes on them. Often they refuse to perform the regime, act up and allow pranks and
unexpected actions.

Such experiences and behavioral changes are a kind of reaction of the child's personality to
the disease.

The formation of the internal picture of the disease in children is different from adults.

Emotional response to the disease. The child, entering the clinic, is primarily afraid. He is
afraid of being left without his mother, he is afraid of the new atmosphere, people dressed in
robes are afraid of every touch, because he is afraid of pain. Most often, children show their
fear through tears. Of course, such an emotional state does not contribute to recovery, so
you should first of all reassure the child. This is only possible if the doctor is sincere in his
words and tolerant of the little patient.

In children, the following types of attitudes towards the disease are most common:

- anxiety-phobic;

- depressive-asthenic;

- hypochondriacal;

- egocentric;

- anosognosic.

Features of gender. Boys more often suffer from self-esteem as a result of the disease than
girls, the level of conflict among girls is higher than among boys. In girls, the idea of ​the
disease is more often crowded out. Girls adapt more quickly to changes in living conditions
because of illness, although more often than boys they are afraid for their future. In girls,
experiencing the disease is more objective than in boys.
The level of intellectual functioning. Depends on the age of the child. To create an idea of
​the disease, its causes and an analysis of the perceived symptoms is required, it is
necessary to be able to systematize and explain one's impressions and experiences. The
low level of intellectual functioning of younger children hinders the development of an
adequate internal picture of the disease, this leads to a primitive type of reaction to the
disease.

However, children with serious illnesses, deprived of the opportunity to take part in outdoor
games, usually read a lot, reflect and are not age intelligent. They can be very attentive to
the doctors' conversations, any information that comes to them about their disease, so in
talking with them the doctor should be very careful and, if possible, create optimal conditions
for the formation of an adequate attitude to the disease.

Child's life experience and the internal picture of the disease. Prescription and the
outcome of events in the life of a child connected with his own early diseases or diseases of
his close ones matter. The earlier it was, the less trace left by these events. Severe chronic
diseases of loved ones, as a rule, adversely affect the formation of WKB. Any surgical
operations, instrumental examinations and painful procedures always leave unpleasant
memories.

Knowledge of health, internal organs, disease, treatment. Without the concept of health,
it is very difficult to form an idea about the disease. Children find it difficult to determine
health, although they are aware of the limited ability to preserve health and people's
susceptibility to disease. As a rule, this is realized by 7 years. Girls have a higher level of
fears of upsetting health than boys, and it is higher among older children.

At age 10, children present health as the opposite of illness. All children and younger and
older associate health with an emotionally comfortable state (well, joyfully, cheerfully,
cheerfully).

In preserving health, younger children occupy a passive position, believing that it is enough
to fulfill the requirements of adults, and seniors understand the need for personal activity
(compliance with the regime, hardening, sports, hygiene).

For the formation of WKB have knowledge of the internal organs. Children believe that the
number of internal organs is different for different people. Depending on age, the importance
of organs changes. Older children judge the importance of different organs in accordance
with their participation in the life of the organism, and the younger ones – by the time that is
required to care for them (the feet are called in connection with the need to wash them).
There is a tendency to consider organs not mandatory if there are more than one (fingers,
lungs).

Also for the formation of WKB have knowledge of the causes of the disease. Children often
view their illnesses as a result of bad behavior, but they can also see reasons for not
following the rules of hygiene and poor nutrition. Older children see the reason in heredity,
conflicts.

Information about the disease can be obtained from parents, other relatives, peers, books,
television, radio programs and the school curriculum. The most significant are information
from parents. This is of particular importance in the case of a serious illness of a child, when
he is divorced from other sources of information, and parents depressed by his illness create
conditions for forming a pessimistic assessment of their illness.

Other adults can significantly influence the concept of the disease in the case when they
have authority for the child, or the child is deeply attached to them (favorite teacher).

Books, programs sometimes create a wrong idea in children about the causes of the disease
due to the inability of children to work with information, to comprehend it correctly, not to be
proficient in terminology.

13. Features of the internal vision of the disease in children. The components of
the internal vision of the disease of children (understanding of the universality
and irreversibility of death, the attitude of parents and other persons from the
environment to the child's illness, the influence of the doctor and medical
personnel on the patient). Hospitalisé. KABELO

Children's understanding of death, its universality and irreversibility.

● In preschool children: Children believe that death is not final and understand it as
sleep or departure; they talk about death as a temporary phenomenon, don’t
recognize its irreversibility or don’t understand it as a long departure or a dream.
● Children of primary school age: children begin to understand that death is finite, but
do not understand its inevitability and true causality. Often they can assume that
death is a punishment for bad deeds, can happen at any time from 7 to 300 years.
There is an understanding of the irreversibility of death. The causes of death are
concrete actions (knives, axes, pistols, age), and not general processes.
● Only at 10 years old: Children begin to realize their mortality. Awareness of the fact
that death is not only of course irreversible, but also inevitable.
● For adolescents: Their own potential demise becomes apparent and this is causing
great anxiety. To protect against it, a negation mechanism is used.
● Teenagers actually ignore death, creating life-threatening situations (motorcycle
racing). The cause of death is seen in the wear and tear of the body.

The attitude of parents to the child's illness.

● The child’s perceptions of the world around him depend on the worldview of the
parents -> all the reactions of parents to the child’s illness form the basis of the
internal picture of the disease.
● Parents may experience feelings of guilt, resentment
● In the process of treating children, the doctor may have problems of contact with
parents.
● There are different options for parents to respond to their child’s illness:
○ panic, hysterical reaction, exaggeration of the severity of the disease;
○ indifferent attitude (as a rule, these are parents who abuse alcohol, drugs);
○ inadequate assessment of the severity of the disease, as a result of which
they do not fulfill the prescription of a doctor or are engaged in self-treatment
of the child;
 ○ anxious and suspicious attitude is manifested in the form of fear for the
child's well-being and over-caring education, which leads to the formation of
the most often hypochondriacal type of attitude towards the disease;
○ excessive care for the child, the satisfaction of all its whims leads to the
formation of a secondary benefit from the disease and an egocentric type of
attitude towards the disease.

The influence of the doctor and medical personnel on the patient

● The physician should remember that his appearance, goodwill, calmness affect the
condition of the little patient.
● First, you need to find out what fears or worries the child or teenager might have,
and attempt to diminish any associated anxiety.
● Contact with young children is easier to establish when communicating with them in
a playful way. Therefore, it is necessary for a doctor in the office to have a set of
children's toys, pictures, etc.

Hospitalization

● To a large extent on the attitude of children and adolescents to the disease, their
placement in the hospital, neighborhood with the sick, restriction of activity,
separation from the usual environment plays.
● Children under the age of 12: particularly sensitive to hospitalization. One of the
main features of children of this age is the need to be close to their parents,
especially with their mother. There are circumstances of the child’s life when his most
important psychological needs are not satisfied. Psychic deprivation can manifest
itself:
○ in the sensory area – due to the lack of various sensations, the poverty of
impressions;
○ in the emotional area, with insufficient warmth, love, care, emotional support;
○ in the intellectual sphere, due to the reduction of incentives that promote
exercise and the development of psychic abilities.
● Upon admission to the hospital, the child may have the following protest reactions:
crying, shouting, displaying aggression, refusing to let go of parents, and protesting
against everything.
● You can observe 3 stages of the child’s psychic state as they stay in the hospital (if
he is there without parents):
○ Protest – anxiety, crying, crying, the search for the mother can last for many
hours, days and even weeks.
○ Despair – quiet monotonous constant or periodic crying; the child sometimes
calls the mother; possible depression, keeps to themselves.
○ The appearance of signs of indifference to the mother; the child calms
down, does not cry, can make friends with the medical staff, help him; meets
mother without joy, without crying.
 14. Choice of the form of interaction between the doctor and the patient depending
on the nature of the disease (therapeutic, surgical, oncological, gynecological
diseases).
MUPULA

15. Information and emotional aspects of the "doctor-patient" conversation. The

technique of the correct collection and transmission of information; mistakes
of the doctor, possible with this. AMJED

Technique proper collection of information

● The right balance of open and closed questions.

Open questions allow for the patient to explain certain things to the doctor
and closed questions are in the form of «yes» or «no» answers. The doctor
should listen when open questions are being answered.
● Silence. You must learn the proper use of silence as a way to encourage the
patient to speak more fully, to remember important information.
● Clarification of the expectations of the patient from consultation. It is
necessary to find out from the patient, what are his expectations from this
consultation; it should be w/o premature conclusions about the reasons that
led the patient to the doctor. This can help identify cases where the patient's
presenting symptom really is not a major concern for the patient. The latter
can be defined as the «hidden curriculum», if ignored, can lead to an incorrect
diagnosis of the patient's problems.
● Clarification of the information given by the patient. It is necessary to
clarify the meaning of what the patient says, as the value obtained by
non-verbal means, to be sure that you understand the patient correctly.
● Managing the flow of information. It is necessary to maintain control of
the interview in his hands tactfully guiding the content of the conversation in
the direction of the diagnosis of the problem.
● Summation. During the consultation, a large amount of information can be
obtained, among which is necessary to summarize the main data, should
also make sure that the patient shares your point of view on this issue.

Information transfer rules to patients

● Providing clear and simple information. The absence of slang words, medical
terms, it is simple and understandable to the patient. You should also check the
level of understanding of the problems of the patient, as previously («What do you
know about asthma?»), Using specific tips with specific examples.
● Presenting more things that are important first and last. Use of the edge effect -
The Physician should give important information at the beginning & end of the
conversation.
● The use of repetition. In the case where the clear wording of the patient only
partially, should summarize the same information, but in other words.
● Summation. The summation should be short and repeat the main points, which in
the course of the conversation was agreed in unambiguous and clear terms. The
 patient may also offer to repeat the doctors' instructions in order to be sure of its
meaning.
● Categorizing information to reduce complexity and to facilitate memorization.
Information should be divided into sections, as it should be clearly signaled to the
patient by using the word-labels, such as: «There are three things that we should
think about... First / Second / Third etc…».
● Non-verbal methods of information transfer Facial expressions, eye contact, tone
of voice). Nonverbal communication can be used on patients who are particularly
anxious, distrustful and suspicious. Eye contact is especially important when the
patient reports his intimate experiences, in this case, do not avert their eyes, it will
lead to momentary loss of contact.
● Use of additional funds. If the information is difficult, it may be accompanied by a
presentation of a series of points, briefly recorded on a sheet of paper as a way to
facilitate memorization.

Possible errors in the doctor's actions the collection and transfer of

information:

● Excessive «testing», «interrogation» during a conversation with a patient causes

resistance, withdrawal, isolation of the patient.
● Asking questions in such a way that the question contains an answer
● Use medical terminology when explaining to a patient of his condition.
● The erroneous view of the patient's physician awareness.
● Contradictory or vague information from the doctor, which is subject to its ambiguity.
Mysterious sayings, innuendo, hints, bad jokes, which are not clearly understood by
patients.

16. Techniques of active listening. Directive and non-directive ways of the doctor's
behavior in a conversation with the patient. Forms of contact between the
doctor and the patient, depending on the activity of the doctor.
PANCH
Techniques of active listening
● Non-judgemental listening.
Listen to the patient with interest and allow the patient to speak.
Eye contact
The main thing is the ability to remain silent, nodding assent, periodically repeating
and paraphrasing patients post.
Show empathy
Don't overload the conversation.
Let the patient talk and don't force any questions.
Pay attention to the emotions involved when the patient is giving the history.
● Physician self control
Doctors when dealing with a patient need to focus their attention not only on his
reactions but also their own feelings and behavior as feedback helps in conversation
Excessive empathic attitude is also undesirable.
From the point of view of the nature of the doctor’s activity and the participation of the patient
in the treatment process, two main forms of their interaction can be distinguished:
collaboration (partnership) and management.
The manual is a model of the completely dominant position of the doctor when solving all
issues related to the patient and his treatment, while the patient remains relatively inactive. -
this type is for relatively immature psyche who need guidance.

Collaboration is a form of interaction in which the doctor acts as a specialist consultant who,
together with the patient, decides the issues of treatment and rehabilitation.

. The doctor avoids giving direct orders and recommendations. This type of interaction is
especially important in the chronic course of the disease or in the period of healing after an
acute period.

17. Psychological factors of the effectiveness of the treatment process (specific

and nonspecific). REMYA

Psychological factors affecting the effectiveness of the treatment process may be

non-specific and specific.

Non-specific factors effectiveness of the treatment process

The non-specific factors of the effectiveness of the treatment process include:

1. Waiting for the patient.

2. Placebo effect.

3. Informational and emotional support.

4. The similarity and compatibility of the positions of the doctor and patient.

Starting the treatment, the patient experiences a whole range of expectations related to the
hope of recovery, with presentations about possible changes in his life. The physician should
find out what the patient’s expectations from this consultation and subsequent treatment are.

Placebo effect (from lat. Рlacebo – I am recovering) – a change in the physiological or

psychological state of the subject, caused by taking a placebo (harmless drug), prescribed
under the guise of any drug. In this case, the fact of taking the drug matters.

In practice, the result of a placebo can be manifested in the fact that the same medicine,
prescribed by different doctors, can have a different effect, that the medicine can favorably
act on such diseases, which are not a direct indication for its purpose, that the action of one
and the same the same medication may manifest itself in different ways at different periods,
at different stages of therapy. Experience shows that injections are more effective than oral
medications; medicines in bright packaging, color act better than colorless; preparations with
a pronounced taste – better than tasteless.
The effect of the placebo effect depends on the behavior of the doctor. He should know what
the patient has expectations, which of them he should specifically support. This
reinforcement will also work as a positive placebo effect.

The most widely occurring phenomenon is the placebo effect in drug therapy. It can be
detected in two cases – 1) when using a placebo substance, pharmacologically ineffective
(«pacifier»); 2) when using a drug that has a therapeutic effect in relation to this disease, it is
possible to supplement its existing (real) properties and the qualities that this patient needs,

The therapeutic environment has a significant impact on the nature of the placebo effect.
The behavior of the staff, his attitude to the medication is transmitted to patients, which must
be taken into account. Therefore, when using the placebo effect, it is necessary to inform the
junior medical staff so that when distributing medicines the nurse confirms the prescription of
a «special» drug or even strengthens the suggestion of the doctor.

The similarity and compatibility of the positions of the doctor and the patient regarding the
disease. Psychological compatibility affects the effectiveness of the treatment process
through the development of positive relationships, creating a favorable «healing
atmosphere». Still, it is necessary to establish a certain distance between the doctor and the
patient, because it keeps faith in the doctor as a specialist. The development of friendly
relations with the patient eliminates the element of business collaboration.

Specific factors effectiveness of the treatment process

The specific factors of the effectiveness of the treatment process include:

1. Catharsis.

2. Persuasion.

3. Suggestion.

Catharsis (greek «catharsis» – purification). A patient at first meetings with a doctor feels
the need to reveal his fears, fears, anxieties, feel relief and get emotional support from a
doctor. The catharsis in this case is the response of real anxieties, which contributes to the
real relief of the patient’s psychological state.

Emotional discharge- in the case when the patient has confidence in the doctor, a sense of
security in a situation of communication with the doctor, i.e. don’t expect criticism.

One should not perceive catharsis as a «confession» It is necessary to create an

atmosphere of trust that facilitates the frankness of the patient. This will serve as a stimulus
for patients to reveal their feelings.

Persuasion is the most common method of influence of the doctor on the patient.
Persuasion is a conscious reasoned influence on another person, which has as its goal the
change of his judgments, attitudes, intentions and decisions.

Techniques of persuasion:
 - Method of choice. The patient should describe all the positive and
negative aspects of any phenomenon, for example, the operation, bringing
him as close as possible to the final choice, allowing him to make a
decision himself.

- Socratic dialogue method. The doctor should prepare 7 questions that

the patient will answer in the affirmative, the last is what you need to
convince the patient. Pain of inertia can answer «yes» and this question.

- Method of credibility. Reference should be made to the opinion of a

reputable expert («the professor who consulted you considers...»).

- Method of calling. It is necessary to provoke the activity of the patient in

the direction «challenging him», influencing his vanity («If you cannot do
these exercises, I will understand you, because only a strong-willed
person is able to overcome his weakness»). Virtually no effect on women.

- Method of deficiency. A certain group of patients believes that the

deficient procedure is a priori good. By putting a patient in a situation of
scarcity, for example, a waiting list for an examination, it is easy to
convince him to undergo this examination. The method works best when
convincing women.

- The method of projection of expectations. The doctor expresses his

positional expectations with regard to the patient («You, as a smart
person, of course, agree with me that...»).

Suggestion (suggestion)

Suggestion is a conscious irregular influence on a person, which has as its goal a change in
his condition, a relationship to something, a change in predisposition to certain actions. To
implement the suggestion, the doctor must have high authority in the eyes of the patient and
use personal magnetism. It is also necessary to demonstrate confident verbal and
non-verbal behavior, as far as verbal behavior is concerned, the speech of the doctor must
be clear and measured. Naturally, the personality of the patient also matters, in relation to
patients whose personalities are characteristic of addiction, the suggestion should be
avoided. Every doctor, in whatever field of medicine he works, should remember that his
words have a great suggestive effect, which can be beneficial, and it can also be harmful.
Suggestions are widely used in all types of therapy as mediating, potentiating agents for
various therapeutic measures (drug therapy, physiotherapeutic methods, etc.).

18. The psychology of dying and death. Basic principles of interaction with the
dying. Euthanasia. KABELO

● Each person has his own philosophical ideas about death, formed by his previous
experience.
● Fear of death is a differentiated phenomenon associated with the body, actual
abilities, attitude to the past, present and future.
● The formation of the emotional attitude of a person to death depends on the following
aspects:
a. Attitude to the health of the child in the parental family * Not sure what this
means*
b. Family death attitudes
c. Attitude to death with regards to religion

● The Kubler-Ross change curve which is also known as the 5 stages of grief is a
model consisting of the various levels or stages of emotions which are experienced
by a person who is soon going to approach death or is a survivor of an intimate
death.
a. The phase of denial of disease (anosognosis). At this point, the patient, who
learned for the first time a fatal diagnosis and a clear prognosis, refuses to
accept his illness and the fact of imminent death.
b. The phase of protest or anger (dysphoric). The main question a person asks
during this period is: "Why me?" Hence the feelings of indignation, anger, a
constant comparison of self and others, an analysis of destiny, of the severity
of diseases
c. The "negotiation" phase. The main content of this phase is the patient’s
attempt to take control of his state, his life, promising everyone around him,
the doctor, God, anything.
d. The depression phase. Unfortunately, this is inevitable in most cases. Here,
the patient already accepts to a greater extent the inevitability of a near end,
and sadness and adequate desire emotions occur
e. The phase of acceptance of death (apathetic). This phase is final, it means
reconciliation with destiny. The patient humbly awaits his end.

Basic principles of interaction with the dying

R. Kochjunas (2003) lists several important principles from his point of view that
should be considered for providing psychological assistance to dying people:

1. Very often, people die alone. The well-known philosophical dictum: «A person always
dies in solitude» is often understood too literally and justifies a protective isolation
from the dying person. However, don’t leave a person to die alone.
2. One should listen carefully to the complaints of the dying person and carefully
satisfy his needs.
3. The efforts of all the people around him should be directed to the benefit of the dying
person. In dealing with him, one should avoid superficial optimism, which causes
suspicion and mistrust.
4. Dying people prefer to talk more than listen to visitors.
5. The speech of the dying is often symbolic. For a better understanding of it, it is
necessary to decipher the meaning of the symbols used. Usually indicative of the
patient's gestures, stories and memories, which he shares.
6. One should not treat a dying person only as an object of concern and
sympathy. Often those around them with the best of intentions are trying to decide
what is best for the dying person. However, excessive acceptance of responsibility
reduces the range of patient autonomy. Instead, you should listen to him; allow him to
participate in making decisions about treatment, visitors, etc.
 7. The most that a dying person can take advantage of is our personality. Of course, we
do not represent the ideal means of help, but still the best way to deal with this
situation. Staying with a dying person requires simple human responsiveness,
which we must show.
8. Psychologists and doctors should confess their doubts, guilt feelings,
disadvantaged narcissism, and thoughts of their own death.

Euthanasia

Euthanasia (Greek, «pleasant death») means accelerating a person or animal's death for
some idea of goodness, usually to end their suffering.
● Euthanasia includes:
1. Actively causing death,
2. Aiding suicide,
3. Not interfering with a suicide.

Arguments from opponents of euthanasia can be divided in two main

categories: religious and prudential.

Many religious people, primarily Christians, object that they do not love to kill
someone, and that pain medications are good enough, that suffering is preventable if
doctors have the will. Many religions also regard one's life as from God and that either it is
His (not yours), or throwing it away insults Him.
The second type of argument against euthanasia is that it is not prudent (acting
with or showing care and thought for the future) to advocate it; that eventually we all
may be suffering, and if we think ahead, we may think it better if the doctors on whom we
depend are not tempted to perform euthanasia. If euthanasia were to be allowed, it is feared
by some, doctors might press people into euthanasia to reduce medical costs, or
because their family wants them to die.

19. Psychosomatic medicine. Psychosomatic approach. Psychosomatic

phenomena. Factors of the pathogenesis of psychosomatic disorders.
MUPULA

Greek words psyche - spirit, soul and soma - body.

- direction in medicine and psychology, which studies the influence of psychological
factors on the occurrence and subsequent dynamics of somatic diseases.
- The term «psychosomatics» was introduced into scientific use by the German
psychiatrist Johan Heinrot in 1818.
- He considered the causes of tuberculosis, cancer and epilepsy as a result of
experiencing feelings of anger and shame, especially in the presence of sexual
suffering.
- Heinroth identified three levels of the psyche 1) instincts; 2) Ego, as self-awareness
and intellectual provision of the joy of life; 3) Over-We are both conscience and
altruism.

Psychosomatic approach
 ➢ psychosomatic disorder - property of the human body as a system in which the
psychic and somatic subsystems closely interact and where only the interaction
of these two can lead to a new state of the body. Therefore, its treatment must take
into account the variety of causes that led to it.
➢ The psychosomatic approach - a patient is not the carrier of the sick organ, but
an integral system. This approach includes the analysis of psychosocial negative
factors involved in the development of any disease.
Modern research, based on all the above-mentioned theories, allows to identify factors that
make an individual sensitive to psycho-emotional influences that complicate psychological
and biological protection causing somatic disorders.

Pathogenic factors of psychosomatic disorders

1. Nonspecific hereditary and congenital burden of somatic disorders. -
chromosome aberrations, drug use by mother.
2. Hereditary predisposition to psychosomatic disorders - arterial hypertension,
arthritis, bronchial asthma
3. Neurodynamic changes (change in the activity of the central nervous system). -
Neurodynamic changes can be primary (due to damage to CNS structures) or
secondary (due to functional CNS disorder).
4. Personality features. - : isolation, restraint, distrust, anxiety, sensitivity, a tendency
to easy occurrence of frustration (disappointment), the predominance of negative
emotions over positive, a low level of intellectual functioning in combination with the
installation to achieve high results.

20. Psychological theories of the occurrence of psychosomatic disorders. AMJED

● Modern psychosomatics, resulting from the work of psychoanalytic directing

clinicians, currently includes various heterogeneous and inconsistent areas of
research in problem formulation and research methods. There are a number of
theories that explain the onset of psychosomatic disorders. Here is a brief
description of some of them.
○ Theory of conversion - S. Freud: conversion - the displacement of
mental conflict and an attempt to resolve it through various symptoms
in the body area. The body symptom symbolizes the patient’s
unconscious conflict
○ Theory of a specific psychodynamic conflict (F. Alexander): if the
unconscious conflict has no outcome in the corresponding external
manifestation, it leads to emotional stress, accompanied by regular
changes of the autonomic nervous system
○ Theory of 'personality profiles' (F. Dunbar): After studying a large
number of patients with various somatic diseases, Dunbar noted a
significant similarity in the personality characteristics of patients with a
single nosology. He described the «ulcerative personality», the
«coronary personality», the «arthritic personality»,
○ Theory of dematization model (Resomatization) - M. Shur: It is
based on the concept of «regression» - a return from the highest to
 the lowest stage of development. In early childhood, a person is
characterized by a single “psychophysiological experience”. Diseases
are still largely associated with the somatic processes that accompany
them.

21. Neurohumoral and physiological theories of the occurrence of psychosomatic

disorders. PANCH
Neurohumoral theories
a) Theory of vegetative accompaniment of emotions (American physiologist W. Kennon,
30s of the 20th century). bodily changes during emotions are biologically expedient and are
a means to achieve the goal – they prepare the body for a fight or flight.

b) Theory of life events by Holmes and the Reich (1962). traumatic event has its own
degree of severity (measured in points). The risk of a physical response to stress and, as a
result, the development of a psychosomatic disorder is determined depending on the
frequency and severity of the events experienced.

c) The concept of coping mechanisms (R. Lazarus, 1970). (Coping – adaptation). The
emergence of any life situation requires coping with it . Coping depends on the personality of
the individual and is a conscious mechanism to reduce or eliminate the existing stressor.
Resistance to the development of psychosomatic pathology depends on the effectiveness of
using coping strategies.

d) Theory by Y.M. Gubachev, E.M. Stabrowski (St. Petersburg, 1981). Long-term

emotional experience occurs under the influence of intense stress and changes the function
of autonomic nervous system. This is reflected in the work of the organs. The most
constitutionally weak organ fails at work.

e) Theory of non-specific chronic stress by G. Selye (1953). It equalizes the influence of

psychic and physical factors.Overloading , increased demands, disturbances of
homeostasis, which are understood as a manifestation of the general nonspecific adaptation
syndrome., psychosomatic diseases are understood as a response to physical as well as
psychic ill effects.

Physiological theories
(R. Brun, 1954; R.R. Grinker, 1932; J.W. Harris, 1962; S.G. Margolin, 1953; L. Michaux,
1961).
Presented in diverse and contraindictory manner.

The occurrence of psychosomatic diseases is explained by the participation of subcortical

structures, the blood-brain barrier, or a decrease in tissue tolerance to physiological
instability.

cortico-visceral theory (K.M. Bykov, I.T. Kurtsin, 1960).

The origins of this theory is in the works of I.P. Pavlova to create experimental neuroses.
Primary violation of the cortical mechanisms of control of the visceral organs, due to the
overvoltage of excitation and inhibition in the cortex. This ultimately causes neurosis (organ
neurosis).
psychosomatic disorders occur in individuals with weak and unbalanced strong types of the
nervous system.
Cortico-visceral theory gave the answer to some fundamental questions like use of external
factors to form experiences and conditioned reflexes in psychic activity. This theory
criticised.
The statement about the starting and regulating nature of the effects of the cerebral cortex
to visceral functions caused an objection. In fact, the cortex should be free from the
constant influence of internal organs, its main concern is the external world, and
everything in the body functions automatically (I.P. Pavlov).
Visceral systems have self-regulation mechanisms that operate without the participation of
cortical systems.

The research of K.M. Bykov and I.T. Kurtsyn continues to be relevant for the formation of
modern concepts of psychosomatic medicine. They show that the initial defectiveness of a
particular system (organ) is of particular importance for the localization of its damage. Any
weakening physiological system (organ) is involved in the pathological process, regardless
of the specific psychological content of the conflict. For an understanding of the causes of
organ damage localization requires consideration of the functional state of systems and
organs during the period of emotional stress.

22. Psychosomatic disorders: concept, classification, characteristic. KABELO

Psychosomatics (Greek. Psyche – the soul, soma – the body) is a direction in

medicine and psychology, which studies the influence of psychological factors on
the occurrence and subsequent dynamics of somatic diseases.
Psychosomatic disorder is a violation of the functions of internal organs and
systems, the onset and development of which are mainly associated with
neuropsychic factors, experience of acute or chronic psychological trauma,
specific characteristics of an individual’s emotional response.

Classification of psychosomatic diseases

1. Conversion symptoms: Conversion manifestations primarily affect
voluntary motility and sensory organs. Examples include hysterical
paralysis and paresthesia, psychogenic blindness and deafness,
2. Functional syndromes. This group includes the overwhelming majority of
'problem patients' who come with a varied picture of often vague complaints
(non-specific) that can affect the cardiovascular system, gastrointestinal
tract, locomotor system, respiratory system or urogenital system.
3. Psychosomatosis - psychosomatic diseases in a narrower sense. They are
based on a mainly bodily reaction to an experience of conflict associated
 with morphologically established changes and pathological disorders in the
organs.
4. Psychosomatic disorders associated with the peculiarities of emotional and
personal response and behaviour - a tendency to injury and other types of
self-destructive behaviours (alcohol, substance abuse, smoking, overeating
with obesity, etc.).

The pathogenesis of psychosomatic disorders is extremely complex and is

determined by:
● inherited somatic disorders and non-specific congenital disorders and.
defects;
● hereditary predisposition to psychosomatic disorders;
● neurodynamic changes (disorders of the central nervous system);
● personality traits; mental and physical state in the course of traumatic events;
● adverse family history and other social factors;
● characteristics of traumatic events.

23. Somatoform disorders: concept, classification, characteristic. Somatized and

hypochondriacal disorders. MUPULA

Somatoform disease -translation of internal psychological problems into specific

somatic diseases.

Characteristics

1. Constant health complaints that persist even with negative research results.
2. Somatic complaints are likely to be related to psychological factors and
subconscious conflicts.
3. Constant demand for medical examinations.
4. Refusal of patients to discuss the possibility of mental causes of the disorder.
5. Bad mood (requires distinction from depression).

Classification

● Somatized disorders (except for somatized depression and anxiety).

● Hypochondriacal disorder.
● Somatoform autonomic dysfunction.
● Chronic somatoform pain disorder.

Somatization - internal psychological problems into specific somatic

diseases.
women from large families, marriage-oriented.
 Complaints :
● 4 symptoms in different places or different organ systems
● very frequent complaints about the sexual sphere,
● the symptoms cannot clearly identify a physical or mental illness, which
requires a lengthy examination

There is a history of violation at work and family.

Hypochondrial

Painful fear or belief in a serious physical illness and it is not a delusional

disorder.

They seek helps and agree to do test. When reassured by the doctor the
patient forgets the ‘’illness’’ for sometime.

Mostly men.

Last for more than 6 months.

Complaints of somatic trouble for several years. The complaints are numerous. The
patient insistently demands an examination.

24. Somatoform disorders: concept, classification, characteristic. Somatoform autonomic

dysfunction, chronic pain disorder. AMJED

Somatoform autonomic dysfunction covers a very wide range of disorders, since

the autonomic nervous system controls the activity of all internal organs.

Causes: Problem life situations in combination with a biological predisposition can

lead to disruption of the functioning of the autonomic nervous system, responsible for
the coordinated work of organs and systems.

Violation of autonomic regulation manifests itself in the form of somatoform

autonomic dysfunction – functional deviations in health, which manifest themselves
in the form of various bodily diseases, misleading doctors.
Somatoform autonomic dysfunction is characterized by two types of symptoms:

● Symptoms of the first type reflect the objective signs of autonomic

excitation (heartbeat, sweating, redness and tremor). Skin changes are
most noticeable. At the same time, the color and vascular pattern change;
disrupted sebaceous and sweat glands; there are acne, excessive skin
pigmentation. Also, there is an uneven distribution of subcutaneous
adipose tissue (in the thighs, buttocks, breasts).
● The second type of symptom is the patient's complaints (feeling of fleeting
pain, burning, heaviness, tension, bloating, stretching), which relate to a
particular organ or system.
 Somatoform autonomic dysfunction is observed in both adults and children.
The causes of somatoform autonomic dysfunction in childhood can be:
1. The hereditary features
2. Pathology of pregnancy and childbirth
In adults, psycho-vegetative syndromes occur predominantly in the age group from
30 to 60 years. This is the phase of the highest professional loads. A history of the
following phenomena is often observed: ambitious attitudes, the hectic pace of work,
the pressure of unfulfilled circumstances, and general dissatisfaction with the activity
being performed.
The following factors can be a trigger for vegetative phenomena:
● violations of the rhythm of day-night, sleep-wakefulness;
● rapid lifestyle;
● the feeling of irritation ;
● increasing loss of ideals.
The following factors most often lead to the sphere of object relations to vegetative
disturbances:
● financial difficulties;
● isolation, loss of roots, lack of interpersonal contact;
● conflicts associated with love, sexuality or acceptance;
● overwork due to double load in the profession and everyday life;
● difficulties in the process growing children up ;
● conflicts in the professional field;
● work addiction
This vegetative decompensation proceeds in two stages:
1. Vegetative irritation syndrome. The cardinal symptoms are irritability,
internal stress and fear.
2. Autonomic exhaustion syndrome, characterized by increased fatigue,
exhaustion and depressive manifestations.

25. Dissociative (conversion) disorders: concept, classification, characteristic.

Primary and secondary benefit of the disease. PANCH

presence of so-called «pseudo-neurological symptoms» in the form of a sudden loss of

consciousness, memory, eye-sight, hearing, speech, smell, movements, sensation, against
the background of the psychotraumatic situation.

they are accompanied by excessive demonstration and dramatization

They are classified as various form of conversion hysteria.

«Hyster» (womb) is a term that came to us from ancient Greek medicine, introduced by
Hippocrates.
As a neurotic disorder, it is the second most common form of neurosis (after neurasthenia)
and is much more common in women than in men.
According to the concept of I.P. Pavlov, hysteria most often occurs in people of weak,
nervous, artistic type, living primarily emotional life, they are characterized by the
dominance of subcortical influences over cortical ones.
More often, these are persons with hysterical and auto-suggestibility (autosuggestion) are
characteristic, an increased need for recognition, being in the center of attention,
theatricality, and demonstrative behavior. Such personal characteristics can be formed as a
result of improper upbringing of the «idol of the family» type and be combined with psychic
infantilism.
So characteristic of hysteria:
· the desire to attract attention;
· condition «conditional pleasantness, desirability, benefits» symptom, contributing to the
fixation of the hysterical response;
· suggestibility and self-suggestion;
· brightness of emotional manifestations;
· demonstrative and theatrical.

According to psychoanalytic concept, sexual complexes and early childhood truama have
been forced out into the unconsciousn, play the main role in the pathogenesis,

These repressed complexes and traumatic experiences create a certain «constitutional

predisposition» to the development of neurosis,.Under these conditions, suppression leads
to the appearance of neurotic hysterical symptoms, which are a substitute form of satisfying
sexual instinct.
The process of transforming libido into sensory-motor symptoms is called
conversion.

Today, the convertible mechanism of hysterical symptoms is understood more broadly as

suppression of unconscious («crowding out») unreacted affective reactions to
negative experiences with their simultaneous separation from the content and direction
from the psychic to the somatic sphere in the form of a symptom.

Another described mechanism of hysterical symptom formation is dissociation. In this

mechanism, a violation of the personality synthesis function occurs, which is expressed
primarily by the loss of the ability to synthesize psychic functions and consciousness, which
is mainly characterized by a narrowing of the field of consciousness, which, in turn, allows
dissociation, splitting (rather than splitting, as in schizophrenia) of some psychic functions,
i.e. dropping them out of the control of the individual, thanks to which they acquire autonomy
and begin to independently («regardless of the will») control the behavior of a person. The
mechanism of dissociation drives only automated psychic functions.

The common signs are the partial or complete loss of normal integration between memory
for the past, awareness of identity and immediate sensations, on the one hand, and control
of body movements, on the other. In these disorders, conscious and elective control is
disturbed to such an extent that it can vary from day to day and even from hour to hour.
.
Clinic
Dissociative (hysterical) psychic disorders in hysteria can be very diverse.

The leading clinical syndrome in hysterical neurotic disorder is hysteric neurotic (hysteria
conversion, dissocioatinous) syndrome, which in turn can manifest itself in different clinical
options.

The primary benefit is the transition of an unbearable conflict for the psyche to an
unconscious level of bodily functioning (conversion). This implies the avoidance of conflict or
the need for a conscious area, which reduces anxiety, associated with them and contributes
to the partial resolution of the conflict underlying the disorder.

The secondary benefit lies in the possibility, due to the violation of functions, to avoid
responsibility for certain actions, to punish offenders, to cause compassion, to get rid of
burdensome duties, to receive material compensation, etc.

26. Psychosomatics of eating behavior: the symbolic meaning of eating behavior,

classification, characteristics; obesity. REMYA

Eating style is a reflection of the emotional needs and mental state of a person.
. Satisfaction of hunger causes a feeling of security and well-being

Thus, feelings of satiety, security and love remain inseparable in the experience of the
infant.

27. Psychosomatics of eating behavior: the symbolic meaning of eating behavior,

classification, characteristics; anorexia nervosa. KABELO

The term «anorexia» is defined as a painful condition associated with the desire to
lose weight, have a graceful figure and maintain this shape.
The disorder is more common in females who fear becoming fat, and girls from
wealthy families.
The classic triad of symptoms of anorexia nervosa in females consists of
1. Amenorrhea,
2. A distortion of the body image
3. Lack of energy

Mv Korkina (1986) and V.V. Marilov (2004) divided the course of anorexia into the
following stages:

● The first stage, dysmorphic-phobic, begins with the appearance of overvalued

ideas of perfection and fear of being made fun of. Decrease in mood, there are ideas
that others critically examine them. Patients weigh regularly, avoid high-calorie
foods. Appetite persists, and after periods of fasting even increases. Often they cut
food into small pieces and produce long manipulations with it. This stage of the
disease lasts an average of 2-3 years.
● The second stage, dysmorphomaniac. Dysmorphia manifests itself in delusional
ideas of having «excessive fat» (especially the abdomen, buttocks, upper thighs).
Patients often look at themselves in the mirror and complain to others about their
body. Attempts are made to actively correct the «excessive fat».
● The third stage cachectic, may occur 1.5-2 years after the onset of the disease.
Appetite disappears, because the acidity of gastric juice decreases and there are
general dystrophic disturbances due to constantly induced vomiting. Vomiting can
occur reflex, immediately after a meal. There is disgust for food.
 28. Psychosomatics of eating behavior: the symbolic meaning of eating behavior,
classification, characteristics; bulimia. MUPULA

Bulimia (bull hunger) is referred to as obsessive eating / vomiting or food / defecation.

Like anorexia nervosa, bulimia is manifested mainly in women. The leading symptoms of the
disease are:
- the frequent occurrence of time-consuming attacks of overeating high-calorie foods;
- active weight control through frequent vomiting or use of laxatives.
The attack of gluttony begins with unbearable stress. A person feels irritation, considers
himself removed from real life and is powerless to suppress in himself a craving to eat
«forbidden» food. Preference is given to soft, sweet and fatty foods that do not need to be
chewed for a long time (ice cream, cakes, cottage cheese, butter, chocolate). Overeating, a
person realizes that he can not stop. Attacks of gluttony with subsequent vomiting
temporarily discharge tension. Then the fear of being caught up with this occupation and the
fear of gaining weight, depression, anxiety and self-accusation come. Most often, after an
attack of overeating, patients, fearing obesity and exposure, cause artificial vomiting.
The stereotype «gluttony – vomiting» can acquire the character of obsession, while the
process of greedy, illegible food gives sensual pleasure, and vomiting becomes involuntary,
conditional-reflex. The usual amount of food outside the attack does not make the patients
feel satiated. The frequency of attack of bulimia ranges from 2 to 40 per week, on average
10 times a week.
Patients with bulimia are outwardly safe: they have a good figure (although weight
fluctuations are in the range of 4-5 kg). They are successful and active. The superb façade
hides, however, extremely low self-esteem. They constantly ask themselves what others are
expecting from them, whether they behave correctly. They strive for greater success and
often confuse the love they seek with recognition.
At first impression, patients often appear to be strong, independent, purposeful, ambitious,
and restrained. This, however, is significantly different from their self-esteem. It is marked by
a sense of inner emptiness, meaninglessness, and a pessimistic depressive background
because of patterns of thinking and behavior leading to a feeling of helplessness, shame,
guilt, and inefficiency. The perception of self and the «I-ideal» diverge sharply, patients put
this splitting into a seemingly good and badly concealed picture.
Often they come from families in which communication is impulsive and has significant
potential for violence. The structure of relationships in families is marked by high conflict and
impulsiveness, weak ties between themselves, a high level of life stress and a little
successful problem-solving behavior with a high level of expectations of social success. In
this situation, patients early take responsible tasks and parental functions.
Bulimia usually develops in connection with interpersonal conflict in the family, sexual or
educational and professional sphere, joining a new team. Often disadaptation develops in all
spheres of life. Most often, it is caused by the death of a spouse, separation, leaving the
parental home, exams, etc. On this background, experiences of abandonment, emptiness,
loneliness and frustration in other people, boredom, sadness and depression develop.
Patients in the children's habit of try to console themselves with the procedure of eating and
drinking, but overstep the bounds.
The course of bulimia is usually perennial, chronic, with spontaneous remissions. The
disease is often skillfully hidden even from family members. Personality features of bulimics:
- perfectionists (they want to do everything perfectly);
- prone to despondency, depression, obsessive thoughts or actions;
- impulsive, chaotic, willing to take risks;
- have low and unstable self-esteem;
- not satisfied with their own body;
- set unrealistic goals;
- despair when these goals cannot be achieved;
- personal relations are also based on the «bulimic» scheme: a passionate passion – a
sharp break;
- have unpleasant childhood memories associated with eating (food as a punishment,
force-feeding, scandals, etc.).

29. Psychosomatic disorders of children and adolescents. Etiology, pathogenesis,

characterization and prevention. AMJED

30. Psychogenic diseases: definition, etiology, pathogenesis, clinical forms and

dynamics. PANCH
Psychogenic disease (psycho – soul, gene – generation,)
- is a painful condition in the form of a short-term reaction or a long-term condition
(illness), due to its occurrence to the influence of factors that traumatize the psyche
(psychotrauma).

Triad of K. Jaspers (1910):

● psychogenic illness develops immediately after exposure to psychotrauma ;

● manifestations of the disease directly follow from the content of psychotrauma
, there are psychologically understandable connections between them;
● the course of the disease is closely related to the severity and urgency of
psychotrauma ; resolution of psychotrauma leads to cessation or significant
weakening of the manifestation of the disease.

Psychotrauma is understood to mean a traumatizing psyche of an emotionally

negatively colored experience about a certain life event (phenomenon, situation) with a
subjective personal significance (emotional significance).

- disease can appear in the form of psychic disorders as

● neurotic level – neuroses (neurotic and somatoform disorders),
● psychotic level – stress response (reactive psychosis)

traumatic life events (phenomena, situations) can act as leading etiological factors
(producing factor), in others – as etiological conditions (predisposing, manifesting and
supporting factor).

Allocate acute and chronic psychotrauma.

An acute psychotrauma is considered to mean a sudden, one-time (limited time) effecting
psychotrauma of considerable intensity.
They are divided into
● Shock
 ● depressing
● disturbing.

On their basis, as a rule, reactive states and psychosis (acute reactions to stress) occur.
Under chronic psychotrauma is understood psychotrauma of less intensity, but existing for a
long time. They tend to lead to the development of neurosis (neurotic and somatoform
disorders).

31. Neuroses: etiology, pathogenesis, types. Clinical manifestations.

REMYA
32. Psychohygiene: the subject, tasks, general and particular problems. KABELO

Psychohygiene is the science of securing, retaining and maintaining psychic health.

● It is an integral part of the more general medical science of human health –

hygiene.
● A specific feature of psychohygiene is its close connection with clinical
(medical) psychology, which is considered as the scientific basis of
psychohygiene.
● In the system of psychological sciences, psycho-hygiene is included in
medical psychology.
● The main interests of psycho-hygiene are focused on ecology, education,
social status and the environment of the individual. Psychohygiene studies
the factors that ensure the harmonious development of the personality,
and determines the conditions for the full manifestation of its positive
properties in all spheres of activity (work, study, family-household relations,
etc.).

Psychic health
According to WHO, health is «a state of complete physical, psychic and social
wellbeing, and not only the absence of disease and physical defects».

Psychic health should, like health in general, be characterized by:

● absence of psychic or psychosomatic diseases;
● normal development of the psyche, when it comes to its age
characteristics;
● favorable (normal) functional state.

The tasks of psychohygiene:

● Study of living conditions (including the environment and the specific social
conditions) individuals and groups to identify factors that positively or negatively affect the
psychic health;
● Development of recommendations and guidelines on psycho-hygiene
conditions of work, life and leisure of individuals, groups and collectives (creation of
scientifically grounded standards and recommendations for state and public institutions
regulating the conditions for ensuring various types of human social functioning);
● Development and theoretical basis of different methods of psycho-hygienic
education (transfer of psycho-hygienic knowledge and training in psycho-hygienic skills of
medical workers, teachers, parents and other groups of the population who can significantly
influence the psycho-hygienic situation in general);
● Creation and application of new additional incentives for the
development of all reserve psychic capabilities and abilities of a person (introduction to
practice of measures to strengthen the nerve system, increase its resistance to harmful
effects and provide the best conditions for the normal development and functioning of the
human psyche);
● Psychohygienic health education work among the general population, the
attraction to propaganda psycho-hygienic knowledge of various social organizations.

Sections of psychohygiene
1. General
● war;
● economic downturns;
● the spread of alcoholism;
● incorrect organization of work;
● the effect on the nervous system of injuries, harmful and poisonous
substances.
2. Private
● age,
● family,
● household,
● Production.
3. Special:
● psychohygiene of a student,
● psychohygiene of a sick person,
● cosmic psycho-hygiene,
● engineering psychohygiene and others.

33. Psychoprophylaxis: concept and types. MUPULA

Psychoprophylaxis - independent branch of general prevention, which includes a system of

measures that provide psychic health through prevention of personality, age and
professional crises, preventing the occurrence, development and spread of neuropsychiatric
diseases.

psycho-prophylaxis deals with subclinical and clinical disorders.

Types of psychoprophylaxis:
1. Primary psychoprophylaxis is prevention of psychic illness.
Minimizing the effect of unfavorable production factors combined with an increase in the
general and psychological resistance of the organism will contribute to the effective
prevention of neuropsychic diseases.The study and prediction of possible hereditary
diseases, the hygiene of marriage and conception, the protection of the mother from
possible harmful effects on the fetus and the organization of obstetrics, the early detection of
malformations in newborns, the timely application of methods of therapeutic and pedagogical
correction at all stages of development.
2. Secondary psychoprophylaxis is prevention of psychic illness transition in the chronic
form. Includes An important factor affecting the quality of the treatment process is the
psychological climate prevailing in the hospital.early diagnosis, prognosis and prevention of
life- threatening conditions, early treatment and the use of adequate correction methods to
achieve the most complete remission, prolonged maintenance therapy, excluding the
possibility of recurrence of the disease.
3. Tertiary psychoprophylaxis is not only the prevention of relapses of neuropsychiatric
diseases, but also the prevention of disability of the psychically sick, rehabilitation.
In this, an important role is played by the correct use of medicinal and other means, the
application of medical and pedagogical correction, and the systematic use of measures for
rehabilitation, social and labor rehabilitation.

34. Psychological climate of medical institutions. AMJED

An important factor affecting the quality of the treatment process is the psychological climate
prevailing in the hospital.

The psychological climate is an emotional coloring of the psychological connections of team

members based on their sympathy, the coincidence of characters, interests, and inclinations
(Shepel V.M.).

The psychological climate of the team of a medical institution depends on the structure of the
team itself.
At the first stage of the development of the collective, the formal structure prevails, at the
second – the informal one.
The determination of the formation of the informal structure depends on the subjective and
objective factors.The formation of the informal structure is determined by the presence of
both objective and subjective factors.

The first can be attributed to the nature and schedule of work the possibility of contacts
between members of the group, as well as optimal in terms of number, gender and age
structure, etc. the composition of the group, allowing to meet the need for interpersonal
communication.

Subjective factors, in turn, depend on the personality of the manager, the individual
characteristics of employees. The ability of the management to rally the team, psychological
compatibility, satisfaction of the subordinate working conditions, their status and professional
role, affect spontaneously friendly relations, mutual sympathies and antipathies.
The informal structure develops under the influence of psychological mechanisms of
regulation of collective activity:

● Socio-psychological adaptation implies the active adoption and assimilation of the

values and norms of the existing traditions by new members of the working group.
● Communication involves the active exchange of information and mutual spiritual
enrichment of group members.
 ● Identification is associated with the formation of a sense of belonging to a group in
the process of interpersonal communication.
● The successful implementation of the integration process leads to the
transformation of the collective into a cohesive, self-regulating social organism, well
adapted to joint-individual activities.

A positive impact on the effectiveness of the diagnostic and treatment process of the
psychological climate in a medical institution is exerted by:
• hygienic and comfortable environment of the medical institution;
• staff coherence («uniformity», i.e., consistency of the order requirements in the wards.
Organization of the daily routine of the bypass time in the medical institution, regrouping of
forces in violation of the work rhythm, etc.);
• regulation of relationships between patients, their grouping in the wards, depending
on personal characteristics, the nature of the disease, etc.
• the attending team, the atmosphere of the medical institution;
• psychotherapeutic effects.

35. Rehabilitation: definition, types, basic principles and stages. PANCH

Rehabilitation - system of medical, psychological, pedagogical and socio-economic

activities. They are aimed at eliminating or fully compensating for the limitations of a
person’s vital activity caused by a health disorder with a persistent disorder of body
functions.

WHO classification for rehabilitation:

● medical rehabilitation (rehabilitation therapy, reconstructive surgery, prosthetics and
orthotics);
● vocational rehabilitation (vocational guidance, vocational education, employment,
and professional adaptation) is the search for new resources in professional
activities, opportunities for other professional growth or change of profession;
● social rehabilitation (social and environmental and social adaptation) is the creation
of the most favorable conditions for a sick person when he returns to his usual
environment;
● psychological rehabilitation is the use of various diagnostic, therapeutic and
restorative and psychotherapeutic methods aimed at activating the internal forces of
the individual to restore impaired psychic functions and emotional-volitional stability.
Basic principles of rehabilitation:
➔ partnership. Formulation of tasks and the choice of ways to solve constant appeal
to the identity of the patient by the doctor and nurses.
➔ versatility of impacts. Use of different measures of exposure from biological
treatment to different types of psychotherapy and sociotherapy, involvement of the
patient, his inner circle in the restoration of the family;
➔ unity of psychosocial and biological methods of influence. This emphasizes the
unity of the treatment of the disease, the effects on the body and the personality of
the patient;
➔ aliasing effects. This includes a phased transition from some rehabilitation
measures to others (for example, biological methods of treating the disease may
prevail at the initial stages of the disease, and psycho- and sociotherapeutic ones at
the recovery stages).

In the process of rehabilitation there are three main stages:

1. The stage of rehabilitation treatment (restoration of biomedical status);
2. The stage of socialization / re-socialization (restoration of individual personal status);
3. The stage of social integration / reintegration (restoration of social status).