Clinical-psychopathological and pathopsychological features of NPMD in patients with FHAN are established in the dissertation. Interrelationships between the symptoms of NPMD are revealed and an assessment of their impact on patients' quality of life is provided. The problem of the mental component of the quality of life and the ways of its improvement in the postoperative period were investigated and the comprehensive care of patients with FHAN with NPMD in the postoperative period was optimized with the ultimate goal of improving the mental component of the quality of life and improving the results of treatment.
The dissertation was performed within the research department of psychiatry, narcology and medical psychology of Dnipro State Medical University: "Optimization of psychiatric care and psychosocial rehabilitation of patients with psychosomatic and somatopsychic disorders in accordance with modern conditions", work code IH.04.117U state registration number.
The study was based on the data of a comprehensive examination of 137 patients with FHAN aged 18 to 77 who were diagnosed with mental disorders of the non-psychotic register.
Patients were divided depending on the duration of the disease into two groups: with duration of FHAN up to 5 years and with duration of FHAN more than 5 years. It was established that there were no significant differences between the representatives of the studied groups in terms of gender, marital status, and level of education. In addition, the compared groups did not differ significantly in terms of age structure, social status, disability, and joint damage (р ˃ 0.05), which confirmed their homogeneity and allowed adequate comparison by other parameters.
The scientific novelty of the obtained materials.
For the first time, on the basis of complex clinical and anamnestic, clinical-psychopathological, psychodiagnostic and statistical studies, data on the features of non-psychotic mental disorders in patients with aseptic necrosis of the femoral head were obtained.
The individual and typological features of patients with FHAN with NPMD and their influence on the quality of life indicator were specified.
The main principles of correction and prevention of NPMD in patients with FHAN were formulated and their effectiveness was investigated.
Factors affecting the mental component of the quality of life of patients with FHAN have been determined.
For the first time, a prognostic model of the mental component of the quality of life in patients with FHAN with NPMD was developed.
The practical significance of the obtained results.
The following factors are recommended to be used as criteria for the early diagnosis of NPR in patients with ANGSC who require endoprosthetics: GSI index of overall severity of psychopathological symptoms, presence of astheno-apathetic or anxiety-depressive syndrome and alexithymia.
To improve the quality of diagnosis of mental disorders, justify treatment tactics and evaluate its effectiveness in patients with ANS, it is advisable to use the SCL-90-R questionnaire, the Taylor anxiety scale and BDI-II, the Toronto alexithymic scale, and the method of researching types of attitudes towards the disease (TOBOL).
In order to diagnose and control the effectiveness of treatment and rehabilitation measures for FHAN patients with NPMD, it is recommended to evaluate the quality of life and its components in patients according to the SF-12.
In order to identify patients at risk of not achieving a normal level of the mental component of quality of life during the next 6 months, with the aim of early correction of detected disorders, it is recommended to use the developed forecasting model, which includes indicators of the mental component of quality of life before the treatment start, the general severity index of the state of psychopathological symptoms GSI before treatment, the presence of astheno-apathetic or anxiety-depressive syndrome and the presence of alexithymia.
The use of complex psychotherapeutic and psychopharmacological correction of NPMD in patients with FHAN in comprehensive care will allow to optimize the treatment and diagnostic process in a short period of time and improve both the physical and mental components of the quality of life of this cohort of patients.
During the inpatient treatment of this contingent of patients, it is advisable to consult a psychiatrist or a medical psychologist, followed by psychotherapeutic and/or pharmacological correction of the patients' mental state
