The dissertation is devoted to the actual problem of diagnosis and rehabilitation
of patients with schizophrenic spectrum disorders (SSD) who have manifestations of
self-destructive behavior (SDB). Given the significance of suicide mortality as a threat
to health and well-being and the high level of disability among these patients, there is
a need to develop new diagnostic and rehabilitation strategies for more effective and
targeted care.
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The study is based on the results of an examination of 112 patients with SSD and
SDB in the period from 2016 to 2023, who were treated in the Hospital «Psychiatry»
in Kyiv.
The study group included 55 men (49.1%) and 57 women (50.9%), 18 to 50
years aging. The average age of them was 32.61±10.92 years: the average age of: men
was 34.23±11.17 years, women was 30.77±10.49 years.
The study aim was to optimize approaches to the complex treatment and
rehabilitation of patients with SSD and manifestations of SDB based on the study of
its structural and dynamic features and the development of criteria for its differential
diagnosis in this group of patients.
The object of research – manifestation features of SDB in patients with SSD.
The subject of research – structural and dynamic manifestation features of SDB
(suicide attempts, suicide thoughts, suicide intentions, self-harm (SH)) in patients with
different types of SSD (schizophrenia (Sch), schizoaffective disorder (SchAfD), acute
and transient psychotic disorder (APTPsyD), schizotypal disorder (SchtypD)).
The tasks of research.
1. To investigate the relationship features of between the clinical manifestations
in patients with SSD who committed SH and signs of SDB in the study groups.
2. To explore the manifestation features of SDB and determine its differential
diagnostic criteria in patients of the study groups using psychometric scales.
3. To study the clinical features of the pathogenetic mechanisms of SDB in
patients in the study groups on the motivational basis of the SH realization.
4. To determine the clinical and motivational types (CMT) of SDB in patients in
the groups and their relationship with the clinical manifestations of SSD.
5. To develop an algorithm of complex therapy and rehabilitation (CTR) for
patients with various types SSD and SDB features and probate it in the study groups.
To solve the problems of the dissertation research, the following methods were
used: theoretical, clinical and anamnestic, socio-demographic, clinical and
psychopathological, psychodiagnostic and statistical.
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The psychometric method of patient assessment using a number of clinical
scales was used to analyze clinical and social characteristics in the study groups.
Namely, we used the following scales: Positive and Negative Syndrome Scale,
(PANSS), Patient Health Questionnaire (PHQ-9), Global Assessment of Functioning
Scale (GAF), Personal and social performance scale (PSP). In addition, to study the
pathogenesis of SDB in patients with SSD, the Self-destructive Behaviour Predictirs
Scale (SBPS) was used, namely, to determine the self-destructive predictors and their
severity (Pilyagina G., 2004)
The psychodiagnostic method was used to study pathopsychological
personality characteristics in both groups of patients. For this purpose, the A. Beck
Hopelessness Scale (BHS), R. Pluchik Impulsivity Scale (IS), and Big Five
Personality Test (BFPT) were used.
Clinical diagnostic, psychometric and psychodiagnostic studies of all patients
(second and third stages of the study) were conducted during the second to fourth
week of follow-up at the stage of achieving remission after leveling the acuteness of
the symptoms of the psychotic state and the emergence of a critical attitude towards
it.
All the examined patients were divided into two groups for the main
experiment, based on the nature of the manifestations and dynamics of SDB, namely,
the difference in the pathogenesis of the formation of its manifest signs and the
development of episodes with the realization of SDB.
The first group (Gr1 PermSDB) included 50 patients with SSD (44.6% of the
total number of subjects) in whom manifestations of SDB were present throughout
the entire period of the disease or more than half of this period - both according to
patients' information and medical records. These patients' suicidal ideation (in most
cases, suicide attempts) was influenced by a sharp exacerbation of suicidal ideation
or painful experiences with autodestructive content, which mainly depended on
psychological reasons, but not on the severity of psychopathological symptoms.
