Construct Development of the Internal Picture of the Disease for Optimization of Medical and Psychological Rehabilitation

Abstract

The aim of the work is to develop a construct of the internal picture of the disease (IPD) in case of neurotic disorders (ND) as the main personality factor that determines the use of environmental resources and adherence to treatment under stressful conditions of the disease; based on the assessment of the structure and mechanisms of the IPD, the determination of the basic emotional, cognitive and behavioral components in connection with the tasks of optimization of medical and psychological rehabilitation. Methods. A multivariate cohort analytical observational study of 1,262 patients with ND was performed. Clinical, experimental-psychological and statistical methods were used. Results. Four main types of IPD were singled out: depressive somatocentric (DS), depressive psychocentric (DP), phobic somatocentric (FS) and phobic psychocentric (AF) with the prevalence of the latter (p = 0.036). Individuals with ND were more characterized by "depressed" types of IPD (p = 0.028), with anxiety-phobic disorders - "phobic" (p = 0.032), with dissociative, s a wide variation in the representation of IPD types: DP - 35.9 %, DS - 26, 0 %, AF - 25.0 %, FS - 13.1 % was observed. The disharmony of the interpersonal sphere in ND was shown: a clear prepotence to conflict and dominance (dominance factor V 1.17 ± 0.45) over the tendency to cooperate and subjection (benevolence factor G -0.10 ± 0.41). Regardless of the type of IPD in HP there was a mistuning of the concepts "I-real" and "I-ideal", which manifested in a low degree of self-acceptance and the presence of a conflict attitude to oneself. The peculiarity of self-esteem in patients with "depressed" types of IPD was expressed in emphasizing weakness in emotional experience and at the same time reflecting traits of confidence, independence, perseverance in self-ideal; with "phobic" - alertness and straightforwardness in relations with others. Conclusions: the developed concept of IPD in case of HP was an emotional-cognitive-behavioral construct of personality adaptation to a disease as the basis for a psychological strategy in therapy and medical-psychological rehabilitation aimed at increasing the level of psychological resource reserve of patients.

Conflict Management in the Professional Activities of a Doctor

“…Помимо морфофункциональных изменений в организме, болезнь активно влияет на психическое состояние человека, что определяет характер реакции на болезнь, субъективное представление о ней. Внутренняя картина болезни, в свою очередь, влияет на способность использовать (или не использовать) ресурсы личности (когнитивные, эмоциональные, поведенческие) для борьбы с недугом [2] и формировать мотивацию и приверженность к лечению.…”

“…Восстановление здоровья (реабилитация) как один из этапов лечения многие десятилетия интересовало ученых. В практической медицине была сформирована концепция реабилитации [2,3], изучено понятие реабилитационного потенциала и технология реабилитационного процесса [8][9][10].…”