The dissertation is devoted to integrated investigation of the addictive status, a rating of the most prevalent addictions, an addictive potential of the most “harmful” objects of usage in neurotic disorders, clinical-psychopathological and pathopsychological mechanisms and regularities of formation of addictions, which are comorbid with neurotic disorders, and a development of principles for their diagnosis and therapy.
The base of the study was an examination of 202 persons, including 150 patients with neurotic disorders (49 with anxiety-phobic disorders (F 40.8); 55 with mixed dissociative disorders (F 44.7), and 46 with neurasthenia (F 48.0)) and 52 persons from a general population (healthy persons). According to data from the integrated assessment, it was found out that neurotic disorder was often associated with addictive impairments: a presence of addictive conditions, which corresponded to the level of clinical dependence, was registered in 61.82 % of patients with dissociative disorders, in 56.52 % of patients with neurasthenia, and in 56.52 % of patients with anxiety-phobic disorders. This was significantly more frequently as compared with healthy persons – 40.38 %; with p<0.0087, p<0.0390, and p<0.0458, respectively. It was revealed that the most prevalent variants of addictions for all the evaluated groups were dependences on tobacco, food, Internet, and work/learning, i.e. non-substance socially acceptable dependences. Clinical manifestations of neuroses with a comorbid addictive behavior are characterized with a prominent intensity and variability of clinical-psychopathological symptoms. The basis of clinical-psychopathological manifestations of anxiety-phobic disorders is anxious syndrome combined with asthenic (57.10 %), phobic (38.10 %), and hypochondriac (38.10 %) ones; for dissociative disorders, they are somatic-vegetative (60.00 %) and anxious (51.43 %) syndromes combined with depressive (34.30 %), dysphoric (34.29 %), and hypochondriac (31.43 %) ones; for neurasthenia, it is asthenic syndrome combined with somatic-vegetative (53.84 %), depressive (46.15 %), and dysphoric (26.92 %) ones. In mechanisms of formation of neurotic disorders with an addictive behavior, the key role belongs to the sphere of needs and motivations that combines competing motivations directed to fulfilling of needs, which maintain addictive and neurotic conditions.
An opposite direction of motivations exacerbates the neurotic conflict, enhances frustration and distress, and leads to a predominant usage of copings focused on emotions, avoidance, aggressive and asocial behavior. Taking into account a specificity of clinical-psychopathological manifestations, psychopathological peculiarities and mechanisms of formation of neurotic disorders combined with addictions, the program of an integrative resource-motivational therapy has been worked out and tested. This program is an integrative approach to treatment with usage of psychopharmacotherapy and integration of psychotherapeutic approaches (motivational, personality focused and cognitive therapy, as well as the method of structural constellations). In accordance with the results of the testing of the integrative program of resource-motivational therapy for patients with neuroses with an addictive behavior in their structure, it was confirmed a high efficacy and impact of this program as compared with traditional programs to treat this pathology.
