Clinical typology and mechanisms of psychogenesis of states of psychological maladaptation of internship doctors

Abstract

A comprehensive examination of 213 interns of both sexes was carried out. A system of psychotherapeutic correction of maladaptive states and psycho-preventive support of interns during the period of professional training has been developed. Levels of adaptation of internship doctors for professional activity were emphasized: high (14,1 %), average (20,2 %) and low level (65,7 %). It was described the asthenical (25,8 % of men and 22,5 % of women), hypersthenic (20,6 % of men and 23,2 % of women), anxiodepressive (11,3 % and 20,6 % respectively), psychosomatic (14,5 % of men and 18,1 % of women), asthenic-apathetical (12,3 % and 11,2 % respectively) and addictive (15,5 % of men and 4,4 % of women) variants of maladaptive reactions among the internship doctors. The developed model of the formation of disorders of adaptation of internship doctors is presented by a complex of pathogenic factors. It was established that the basis for the formation of maladaptive reactions among the internship doctors is the presence of somatic pathology, craniocerebral injury and neuroinfection in the anamnesis and the tendency to addictive behavior. Prognostically important factors in the formation of adaptation disorders are conflicts of family and professional relations, disturbing suspiciousness, low communicativeness, difficult working conditions, lack of positive emotions, awareness of inadequate level of competence, low level of motivation, and imperfectiveness of mechanisms of psychological protection. Triggers for the development of maladaptive states are the high level of professional stress, depletion of adaptation, prolonged mental stress, frustration of significant basic needs, and high rates of clinical scale of anxiety and depression HDRS. An individualized three-stage system of medical and psychological support during the professional training period, which involves the application of complex psychodiagnostic, psychotherapeutic, psychoeducational and psychoprophylactic influences, has been developed and tested.