The study is devoted to the Epifamin effect on values of carbohydrate and lipid metabolism, immune status in blood, and also content of 6-sulfatohymelatonin as the main metabolite of melatonin, in urine of the patients with non-alcoholic steatohepatitis developing at type 2 diabetes mellitus. It is shown that fasting glucose, postprandial glucose level and glycated hemoglobin content in the blood of patients decreased significantly during combined treatment with the Epifamin compared to the basic therapy. The results of the Epifamin reception are as follows: more expressed normalization of lipid metabolism, and content of β -lipoproteins, cholesterol, lipoproteins of low density and high density lipoprotein, and atherogenic index in comparison with the results obtained after basic treatment. The obtained results testify to positive Epifamin effect on values of the immune status of patients: level of circulating immune complexes, the main classes of immunoglobulins – IgA, IgM, IgG. It was established that in the patients with non-alcoholic steatohepatitis developing at type 2 diabetes mellitus, 6-sulfatohymelatonin level in urine was lowered on the average by 1,2 times in comparison with control. After basic treatment the reliable changes of the 6-sulfatohymelatonin content in the patients didn’t reveal. After the combined therapy with the Epifamin, the 6-sulfatohymelatonin content in the patients increased on the average for 13.9%. The obtained results allow to conclude about correction the Epifamin effect on melatonin content as a hormone, which able to participate in regulation of carbohydrate and lipid metabolism and to have immune modulating action. The Epifamin use in basic treatment had favorable influence on the immune status, values of carbohydrate and lipid metabolism in blood in the patients with non-alcoholic steatohepatitis developing at type 2 diabetes mellitus that was apparently due to melatonin-corrective effect of this drug.

The authors of this review demonstrate the correlation between the cultural features, social factors and the patients’ expectations from the psychotherapy. Russian psychologists have been paying very little attention to client expectations. It is very often that convergence between the patient´s expectations from psychotherapy and that the psychotherapist offers the patient - often depends on the success of the therapy. The results of many studies confirm that clients´ expectations are an important factor with regards to the efficiency of psy-chotherapy as well as to the rate of drop-outs. Reliable methods of assessment of clients´ expectations allow to create and to implement strategies of pre-therapy interventions. The theoretical structure of patients´ expectations is complex, as is the set of their determinants. Patients´ choices reflect their mentality, the social stratum and cultural tradition they belong to, their personal traits and value systems, inner dynamic factors including the type of attachment and particularities of the psychopathology, and so on. The paper covers multiple aspects of determination of the construct «patient´s expectations». Particular focus is on the cultural determinants of Russian patients´ expectations. In the analysis of cultural determinants of therapy expectations the authors used approaches of Ruth Benedict and Geert Hofstede. According to Benedict´s classification Russian culture might be considered more as so-called Dionysian culture. According to authors’ analysis more pertinent patients´ expectations formed by Russian culture might be such psychotherapies as psychodrama, NLP, Gestalt-therapy Holotropic Breathwork; and in a less degree – psychoanalysis.

One of the most important factors, influencing the development on concept of confidence in psychotherapy is social environment. The analysis of expectations of Russian patients towards psychotherapy (this construct with a certain limitations can be assimilated to concept of confidence in psychotherapy) requires taking into account social environment factor, including social-demographic situation in the Russian Federation. According to the results of a survey of the Public Opinion Foundation (POF) including 1500 individuals aged 18+ years (dated November 2014), the use of psychotherapeutic and psychological services decreased since 2006 by 20% (!) and today constitutes less than 20%. According to participant’s opinion, the accessibility of psychotherapeutic service slightly increased (by 5%). During the same time period the number of respondents who are certain that reference to psychologists or psychotherapists is worthless increased by 8%. At the same time, according to national statistical investigations, more than 30% of population has psychiatric conditions requiring medical help or consultation of a psychiatrist, or, more often, a psychotherapist or clinical psychologist. Consequently, there is a decrease of confidence in psychotherapy among potential service consumers in our country, which is to no small degree associated with concern of disapproval of psychotherapeutic help by reference group (friends, colleagues, family members etc.). In other words, psychotherapeutic or psychological help will be associated with shame and insecurity. The reason for such an attitude of population to psychotherapeutic treatment are likely distorted perception, associated with lack of information, apprehensive attitude towards psychiatric treatment (which is closely related in the public consciousness to psychotherapy). The attitude of internists and health officials towards psychotherapy may play an important role in the discrediting psychotherapy. One gets the impression that nowadays at the present stage of development of psychotherapy in our country, educational function of psychotherapist becomes of paramount significance. It should be aimed both at the development of knowledge on the efficacy of psychotherapeutic methods and at the necessity of engagement of psychotherapists and psychologists in diagnostics and treatment alongside with internal medicine doctors, and also at the promotion of credibility of psychotherapy among the potential users of psychotherapeutic services.

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