The dissertation research was conducted on the basis of studying the nature and role of compliance violations, quality of life and satisfaction of medical care in order to increase the effectiveness of treatment of mental disorders in elderly patients with polymorbidity by optimizing the therapeutic complex of pharmacotherapy associated with the psychotherapeutic component. To achieve this, socio-demographic, clinical-anamnestic, clinical-psychopathological, psychodiagnostical and statistical methods of research were used.
A total number of 325 patients at the age of 60 and more years of the gerontopsychiatric department of the psychoneurological hospital in Mariupol, whose informed consent was obtained, participated in the study. The main group (MG) of
238 people received standard treatment and psychotherapeutic intervention. A comparison group (CG) of 87 people had only standard treatment. After having solved the research tasks and achieved the goal of work, CG patients, as well as MG patients, in addition to standard pharmacotherapy, received full three-component psychotherapeutic treatment. According to the research results, elderly patients had a high level of polymorbidity according to the CIRS-G scale. The average number of concomitant diseases in the MG was 3.7; in CG – 3.4. The average amount of daily taken drugs in MG – 3.7; in CG – 3.0. The severity and number of concomitant diseases increased with age and was associated with a deterioration in life quality. The tendency of life quality’s decrease was directly proportional to the increase in the number of concomitant diseases, daily and periodic volume of pharmacotherapy, to a greater extent was observed in men and with increasing age of patients.
The obtained data allowed to develop an effective psychotherapeutic programme in the investigated contingent, which included a combination of psychosocial education, compliance therapy and pharmacomania prevention training. A cognitive-behavioural approach was used, 10 sessions (30–60 minutes each) were conducted in the form of motivational interviews and cognitive-behavioural trainings with explanatory psychotherapy, explanatory conversations about the harmful effects of tobacco-smoking.
Thus, an optimal algorithm for treatment of elderly polymorbide patients with mental disorders was developed and implemented, namely: a primary examination of the main and concomitant diseases → analysis of the pharmacotherapeutic load → the prescription of optimal pharmacotherapy according to the standards of treatment of the patient’s disease associated with psychotherapy aimed at awareness of the patient about his illness, methods of his treatment, creation of a therapeutic alliance, prevention of self-healing. The analysis of the results of the conducted medical work made it possible to conclude that the use of such therapeutic complex contributed to increasing compliance, quality of life and satisfaction with medical care of patients with the specified pathology
