The dissertation is devoted to a comprehensive investigation of risk factors and predisposition factors for the development of hallucinatory-paranoid disorders (HPD) in dementia of various origins, the mechanisms of their formation, clinical and psychopathological structure, the mutual influence of HPD and cognitive impairments, medicational compliance, resources of the personal and social environment, global social functioning, individual social functions and roles, that became the basis for the development of an algorithm for diagnosing of HPD in dementia and of a comprehensive personalized program of psychosocial rehabilitation for this category of patients. The study was based on the examination of 271 patients with dementia of various origins and stages of development (147 patients with HPD - the main group, 124 patients without HPD - the control group). Among the examined main group, 75 patients with vascular dementia (VD) and 72 patients with mixed dementia (MD) were identified. In the control group, this distribution was as follows: 63 and 61 patients. To implement the goal and objectives of the study, the work used an approach using clinical-psychopathological, psychometric, psychodiagnostic and mathematical-statistical methods. According to the data of the performed study, the main clinical-psychopathological, constitutional-biological, socio-demographic, and psychosocial predispositional factors of the development of HPD in patients with dementia of various origins were studied. For the first time, a categorical and dimensional analysis of HPD in patients with dementia of various origins and stages of development was carried out, their clinical, psychopathological and phenomenological structure, the mutual influence of cognitive and non-cognitive components, and types of course were determined. It has been proven, that in the structure of cognitive impairments, thinking disorders to a greater extent reflect the mechanisms of the formation of HPD in dementia, reproducing a psychotic mechanism in VD and a neurodegenerative mechanism in MD. For the first time, the analysis of the mutual influence of cognitive and HPD in the structure of the pathological process of patients with dementia was carried out, that allowed us to study the cognitive determinants of the formation of HPD in patients with dementia of various origins and stages of development. As a result of the research carried out, a program of complex personified psychosocial rehabilitation (PCPPR) was developed for patients with HPD in dementia of various origins and stages of development. The developed program is based on the principles of: a personalized targeted approach (determination of the state of the targets of exposure - HPD, cognitive impairments, disorders of social functioning, general medical problems); a differentiated approach to assessing the dual relationship “patient with HPD in dementia - caregiver”; and the resource-oriented approach. The results of approbation of the developed PCPPR of patients with HPD in dementia of various origins and stages of development indicated its greater efficiency in comparison with traditional schemes of psychosocial rehabilitation of patients in this category, which do not take into account the main clinical and psychopathological, constitutional-biological, socio-demographic, psychosocial characteristics of development and course of HPD in this cohort of patients.
