Orlova O.V. Non-psychotic mental disorders in caregivers of patients with dementia. – Qualification research work on a manuscript basis.
The aim of the study is to develop and implement a comprehensive rehabilitation program for caregivers of patients with dementia based on a systematic study of socio-demographic, clinical and anamnestic, clinical, psychopathological and adaptive features of caregivers.
In accordance with the aim of the research and the tasks set at the screening stage, the study enrolled 126 caregivers of patients with dementia who had non-psychotic complaints, as well as 126 people diagnosed with dementia in accordance with ICD-10 who needed constant care. Care was provided both professionally and on a non-professional level by family members.
For the first time, it was found that for non-professional caregivers (family members), anxiety was the basic, “cross-cutting” disorder, whereas asthenia prevailed among professional caregivers.
For the first time, it was found that family caregivers were significantly more likely to have non-psychotic mental disorders, and the group of professional caregivers was characterized by a lower prevalence of symptoms of mental disorders and was manifested mainly by psychosocial maladaptation and emotional burnout syndrome.
For the first time, it was determined that psychosocial maladaptation was more pronounced in family caregivers, and it was represented mainly by family, occupational and economic variants. Professional caregivers most often showed signs of psychosocial maladaptation of the communicative variant.
The study proved for the first time that the physical and psychological state of caregivers was negatively affected by an increase in the time spent on caregiving.
For the first time, the study established a direct correlation between high stress load scores and high severity of psychosocial maladaptation in caregivers of patients with dementia of different genesis.
The sources of distress that contributed to the disruption of general adaptive mechanisms were identified for the first time. The micro- and macrosocial factors that influence the state of adaptation during the provision of care services for patients with dementia were clarified, and the role of psychological factors in the development of psychosocial maladaptation, distress, decreased quality of life and their impact on the formation of emotional burnout syndrome and non-psychotic mental disorders was taken into account.
The obtained results allowed us to identify and evaluate the key areas, options and severity of psychosocial maladaptation in caregivers of patients with dementia of different genesis, to establish the level of distress for family and professional caregivers, to analyze their quality of life, which provided an understanding of the key etiopathogenetic links in the formation of psychosocial maladaptive behavior and, accordingly, contributed to the formation of a comprehensive program of rehabilitation and prevention measures.
The practical significance of the research findings is the improved quality of rehabilitation of caregivers for patients with dementia of various geneses.
A well-grounded comprehensive personalized system of differentiated rehabilitation for caregivers of patients with dementia of different genesis, based on a combination of psychoeducation, psycho- and pharmacotherapy, has been developed.
It has been established that for family caregivers, the main goal of the rehabilitation process should be adaptation to new changed living conditions associated with a serious illness of a relative and therapy of psychopathological disorders, for which the use of cognitive-behavioral and family psychotherapy has shown high efficiency. Preventive work with family caregivers should be primarily aimed at preventing relapses of non-psychotic mental disorders and restoring psychosocial adaptation.
It has been proved that for professional caregivers, the leading goal of rehabilitation was the correction of maladaptive behavioral tendencies using methods of group psychotherapeutic correction and personality-oriented reconstructive psychotherapy. For professional caregivers, the main focus should be on the prevention of emotional burnout syndrome through autogenous training with an emphasis on teaching methods of relaxation and self-regulation of autonomic functions to increase stress resistance.
Key words: non-psychotic mental disorders, dementia, psychosocial maladaptation, caregiver, rehabilitation.
