Solomko S. Special features of pathomorphism, principles of differential diagnostics and ambulatory psychotherapy for the modern forms of somatoform disorders

Українська версія

Thesis for the degree of Candidate of Sciences (CSc)

State registration number

0410U002614

Applicant for

Specialization

  • 19.00.04 - Медична психологія

18-05-2010

Specialized Academic Board

Д 64.609.03

The Kharkiv Medical Academy of Postgraduate Education, Ministry of Health of Ukraine

Essay

The thesis is devoted to clinical psychopathological, clinical psychophenomenological, medico-psychological, neurophysiologic features and principles of differential diagnostics and ambulatory psychotherapy for modern forms of somatoform disorders. Unmatched and polymorphic psychopathologic expressions of neurotic register, which cannot reach the syndrome-based level, prevail in the clinical background of modern forms of somatoform disorders; if the existing clinical pathognomy is close to the syndrome-based organization, then it turns out interfacing the somatic (somatosensory) expressions (the very fact of this interfacing differs somatoform disorders from the "field-typical" somatic dis-eases). The somatoform disorders patients turned out to have the predominance of psycho-pathological syndromes of asthenic spectrum with hypochondriac or vexatious depressively phobic arrangement, somatosensory follow-up and hysteroid impregnation. It is characteristic of somatoform disorders patients that they elaborate active coping strategies with simultaneous psychotic-specialized-doctors-directed compliance abruption. Differential diagnostics of somatoform disorders must include obligatory psychoanam-nestic data research aimed at the revelation of specific psychophenomenological, clinic-psychological, pathopersonological and syndrome-based nosological markers. The essential features of the clinical pathomorphism of modern somatoform disorders forms include: clinical pathognomy blurring, comorbidity with various somatic diseases of the "specific" organ or system, clinical presentation dissociativity, torpidity towards medi-cated therapy, clinical presentation "psychologization" and "socialization", high level of experience intornization ("somatoform disorders psychosomatization"), extranosological behavior modifications, high frequency of aggravation-pensional mindsets. In ambulatory-polyclinical practice one should apply the adapted psychotherapeutic di-agnosis: only the syndrome-based clinic-diagnostic part with pathopersonological exten-sion reduction and accent on aetiopathogenetic extension, a limited range of clinical psy-chotherapeutic effect-syndromes in psychotechnical part, pharmacotherapeutical back-ground indication only. The developed principles of somatoform disorders ambulatory psychotherapy (and psycho-logical correction) include: consistency, relative step-by-step approach, variety of psycho-therapeutic and psychocorrectional influences, dominations of short-term forms, training with autopsychotherapeutic elements predomination, supporting psychotherapy, course approach. The developed system of ambulatory psychotherapy includes frame circumstances, ba-sis psychotherapeutic method (of reasonable, neurodynamic and behavioral paradigms), integrated psychotherapeutic elements (of mnestological and psychodynamic paradigms), autogenous modus of psychotherapeutic measures. Key words: somatoform disorders disorders, clinic, pathomorphism, psychopathologi-cal syndromes, clinical psychotherapeutic effect-syndromes, psychotherapeutic diagnosis, ambulatory psychotherapy.

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