The dissertation is devoted to the study of suicidal behavior (SB) in patients with different etiopathogenetic clinical variants of dementia (in Alzheimer's disease (AD), vascular (VD), mixed (MD)) based on the comprehensive clinical and psychopathological, pathopsychological, psychodiagnostic, neuroimaging, functional examinations of patients, assessment of psychogenic factors and resources of the environment in order to develop prognostic, diagnostic criteria of SB and complex differentiated program of medical and psychological rehabilitation (MPR) and SB prevention in various types of dementia. 203 patients were examined, including 75 with dementia at AD, 73 with VD and 60 patients with MD. Patients were divided into main and control group by the factor of presence / absence of signs of SB (intentions, attempts, thoughts, anti-vital mood, statements). Among patients with AD, 36 patients were the main group, 39 were the control group; at VD 39 patients were main group, 34 were control group; in mixed dementia, 30 patients were included in the main group, 30 patients were in the control group. The complex of factors of SB risk / anti-risk and suicide-genesis mechanisms in dementia, that became the targets for development of a differentiated program for MPR patients with SB in dementia were distinguished. The suicide-genesis concept in dementia that has complex structural and functional organization, formed by various clinical markers, being able to dynamic transformation under the influence of clinical and intra-personal indexes, was worked out. Intra-personal factors included clinical and psychopathological, pathopsychological and social special features of patient with SB, though extrapersonal – psychic traumatizing and surrounding resources. Clinical phenomenology and SB typology of various types of dementia was studied. Psychopathological mechanisms of SB formation were studied. They depend on the form and level of dementia seriousness, presence of comorbide symptoms, namely: depressive, psychotic and cognitive and their dominance in various types of dementia, and the consistent pattern of phenomenological demonstration in various SB mechanisms. Thus, in the depressive mechanism the internal-behavioral forms of SB prevailed, in psychotic – external-behavioral forms, in cognitive mechanism the transformation of SB depending on the seriousness of cognitive deficiency was observed. The special features of SB formation depending on gender were studied. Neurophysiologic and neuroimaging features, which correlate with SB in various types of dementia were distinguished. Accounting the formation mechanisms and SB predictors, special features of clinical and psychopathological, clinical and phenomenological SB demonstration in various types of dementia the complex and differentiated MPR program and SB prevention, realized on the basis of complex approach including usage of psychopharmacological, psychotherapeutic, psychoeducational psychosocial actions was worked out and tested. The result of the developed system testing proved its high efficiency, which is supported by the positive dynamics of clinical and psychopathological indexes of suicide status and level of independence in the everyday life of patients with SB in dementia.
