Purpose of work based on analysis of clinical-anamnestic, clinical-psychopathological and clinical-psychological features of persons with addiction who are on the program of substitution maintenance therapy (SMT), to determine psychopathogenetic and structural-dynamic features of comorbid psychopathological symptoms (CPS) and their psychotherapy.
The scientific novelty of the obtained results is that for the first time the psychopathogenetic characteristics of CPS were established in persons who are on the SMT program, the psychopathogenetic role of 21 factors in 5 groups was investigated and analyzed, which allowed to formulate the concept of cofactor genesis of CPS; for the first time the structural and dynamic characteristics of the CPS in persons under the SMT program was revealed, the spectrum of manifestation of different CPS groups depending on their intensity level investigated, 14 constellations of symptoms in the structure of the 7 complexes of symptoms (CS) of CPS were revealed, which allowed to form a hierarchical systematic system of the CPS; which allowed to establish a discordance between the intensity of psychopathological manifestations and disturbance of psychosocial functioning; for the first time in psychotherapeutic perspective psycho-pathogenetic, clinical and psychopathological and psychosocial features of CPS were worked out in persons under the SMT program, which allowed to develop 5 principles and two components of their psychotherapy (PT) scheme.
The practical significance of the obtained results is that the concept of cofactor genesis of CPS in persons who are on the SMT program was formed, which allows to determine the role of clinical-anamnestic factors in the psychopathogenesis of CPS; 14 constellations of symptoms in structure 7 of CS were described on the basis of the structural-dynamic characteristics of the CPS in persons under the SMT program and hierarchical systematics of the CPS were developed, which allowing them to integrate into the general system of mental disorders and to develop standardized approaches to their therapy; the nature of the mutual influence of CPS and disorders of psychosocial functioning in persons who are on the SMT program was established, which allows to optimize the targeted effects of CPS therapy taking into account the discordant nature of changes in the intensity of these groups of phenomena; the principles and scheme of CPS PT in persons under the SMT program were developed, which allows to reduce the level of intensity of pseudoneurotic (somatization, obsessive-compulsive manifestations, phobia) and pathoaffective (anxiety, depression) groups of CPS and to reduce the level of stress related with disease social factors (limitation of feelings of strength and energy, limitation of pleasures, reduced feelings of physical wellness, unprofitability, restricted communication) in persons who are on the SMT program.
A prospective study was conducted on a contingent of 100 persons with «Mental and behavioral disorders due to use of opioids, Dependence syndrome» who were under the SMT program (ICD-10: F11.22) on the basis of «Zaporizhzhia Regional clinical narcological dispensary». The gender structure of the study contingent was: 20 women and 80 men. The average age was 41,2±5,6 years, the length of systematic use of opioids prior to enrollment in SMT program – 12,8±5,8 years, the average total length of opioid use – 16,1±7,4 years, the average life expectancy stay in the SMT program at the moment of the beginning of the study – 3,3±2,0 years.
