Ryapolova T. Early rehabilitation of Schizophrenic patients (a biopsychosocial model)

Dissertation deals with elaboration of the conception and integrative model of the early psychosocial rehabilitation on the basis of a multilevel diagnostic assessment of the clinico-functional insufficiency, a rehabilitation potential and resources of social support for the patients with manifestative schizophrenic episode as well as a complex evaluation of its efficacy. 316 paranoid schizophrenia patients (143 main group patients with a manifestative schizophrenic episode who were at the stage of drug remission formation directly following the reduction of productive symptoms; 173 comparison group patients were with enhancing defect episodic schizophrenia and comparable sociodemografic characteristics, experienced at least 3 psychotic episodes for 5 years and were at the stage of drug remission formation) have been studied. The patients with a manifestative schizophrenic episode were divided into two groups to assess the efficacy of the early rehabilitative intervention. The medical help rendered to the main group patients (73 subjects) included the methods of biological and psychosocial treatment. 70 patients of the comparison group were treated only biologically and were not involved in the participation in the special rehabilitative programes. The integrative approach to understanding the systemic character of the disorder and of rehabilitative activity at the initial stages of schizophrenia has been substentiated scientifically, developed and put in practice. The structure and technology of the functional rehabilitative diagnosis as the main instrument of an adequate rehabilitative intervention have been developed. Two types of adaptive behaviour of schizophrenic patients have been defined and described. A mathematic model of prognosing the risk of regressive adaptive behaviour formation has been developed on the basis of the factor analysis. The algorithm of rehabilitative intervention in case of manifestative schizophrenic episode has been developed and put in practice. It shows itself as a complex of individual and group psychotheraputic approaches including psychoeducation, the training of social skills, cognitive therapy, compliance therapy, employment therapy, prevention and correction of stygma, family therapy. The criteria of assesing the model of rehabilitation efficacy into consideration the functional failure, the rehabilitative potential and the adaptive behaviour of patients have been developed. The adequacy of conception and the high effectiveness of the developed model of early psychosocial rehabilitation of the schizophrenic patients have been proved by means of the factor mathematic analysis. Key words: schizophrenia, biopsychosocial model, early psychosocial rehabilitation.