Features of psychological adaptation and compensatory mechanisms in patients with severe chronic diseases

The aim of the study was self-regulation of behavior and other psychological aspects of adaptive-compensatory mechanisms in patients with schizophrenia and myasthenia, in comparison with a group of healthy subjects.

Materials and methods. The study involved 91 people: patients with schizophrenia (N=30); patients with moderate and severe myasthenia gravis (N=31); comparison group — conditionally healthy people (N=30). The participants were examined by experimental psychological methods: «The style of self-regulation of behavior», «Test of life-meaning orientations», «Semantic time differential».

Results. Differences in the general level of self-regulation of behavior and its particular aspects in patients with schizophrenia and healthy were revealed, patients with myasthenia gravis don’t show differences from patients with schizophrenia and the control group. In terms of the general meaningfulness of life, patients with schizophrenia differ from healthy ones, while they don’t differ from those suffering from myasthenia gravis, which don’t have differences with the comparison group. In external internality, chronically ill patients don’t reveal differences, but differ from healthy ones. In the psychological perception of the present, patients with schizophrenia and myasthenia differ from healthy ones in assessing its activity and size. Patients with schizophrenia reveal differences with healthy ones in its emotional coloration and structure, not differing from those suffering from myasthenia gravis, which don’t show differences with the control group. Patients with schizophrenia differ from healthy patients in the sensibility of the future, but don’t differ from patients with myasthenia gravis who don’t reveal differences with healthy individuals.

Conclusions. The targets of psychocorrectional effects are indicated. For patients with schizophrenia — the development of skills for differentiation and impulse control, behavioral flexibility and correlation of results with the original goals. For patients with myasthenia gravis — reliance on available classes in the cognitive and spiritual spheres that compensate for the appearance of physical limitations. Common to both nosologies are measures that increase the meaningfulness of life, highlighting the spheres of influence on the disease, rational acceptance of responsibility for what is happening. The skills to enjoy everyday activities are important.

1. Brautigam B., Kristian P., Rad M. Psikhosomaticheskaya meditsina: Kratkiy uchebnik. M.: GEOTAR-MEDITSINA; 1999. (In Russ.).

2. Budza V.G., AntokhinYe.YU., Bomov P.O. Psikhiatriya na rubezhe vekov v trudakh orenburgskikh psikhiatrov. Khrestomatiya v 2-ukh tomakh. Orenburg: OrGMA; 2014. (In Russ.).

3. Bugental J.F.T. Iskusstvo psikhoterapevta. SPb.:Piter; 2015. (In Russ.).

4. Vasserman L.I., Kuznetsov O.N., Tashlykov V.A., Teyverlaur M., Chervinskaya K.R., Shchelkova O.YU. Semanticheskiy differentsial vremeni kak metod psikhologicheskoy diagnostiki lichnosti pri depressivnykh rasstroystvakh. Posobiye dlya psikhologov i vrachey. SPb.: NIPNI im. Bekhtereva; 2005

5. Volkova O.N. Vzaimosvyaz’ gendernykh i kliniko-psikhologicheskikh kharakteristik s kachestvom zhizni bol’nykh nevroticheskimi rasstroystvami. Avtoreferat diss. kand. med. nauk. SPb. 2009;21-23.(In Russ.).

6. ГGrigor’yeva V.N., Tkhostov A.SH. Psikhologicheskaya pomoshch’ v nevrologii. N. Novgorod: izdatel’stvo PIMU. 2009 (In Russ.).

7. Dolgikh V.T. Obshchaya patofiziologiya (lektsi-idlyastudentov i vrachey) 2–ye izd., pererab. i dop. — N.Novgorod: Izdatel’stvo NGMA. 1997. (In Russ.).

8. Zaslavskiy LG, Khurshilov AB, Skornyakova YeN. Quality of life and psychoemotional disorders in patients with myasthenia. Klinitsist. 2015;4(9):35-38. (In Russ.).] DOI: 10.17650/1818-8338-2015-10-4-35-38

9. Ivanov MV, Tumova MA, Kosterin DN, Stanzhevsky AA, Lukin VO, Ilyushchenko YuR. Neuromorphometric characteristics (results of PET diagnostics with 18F-FDG) in patients with chronic auditory hallucinosis in schizophrenia. Sibirskij vestnik psihiatrii i narkologii. 2018;1(98):11–17 (In Russ.). DOI: 10.26617/1810-3111-2018-1(98)-11-17

10. Konkova DYu, Karnaukh VN. Affective disorders in myasthenia. Nevrologiya, neiropsikhiatriya, psikhosomatika. 2016;8(4):21—24. (In Russ.). DOI: 10.14412/2074-2711-2016-4-21-24

11. Kotsyubinskiy A.P. Mnogomernaya (kholisticheskaya) diagnostika v psikhiatrii (biologicheskiy, psikhologicheskiy, sotsial’nyy i funktsional’nyydiagnozy). A.P. Kotsyubinskiy. SPb.:SpetsLit. 2017. (In Russ.).

12. Kotsyubinskiy AP, Skorik AI, Penchul NA. The value of adaptation-compensatory mechanisms in schizophrenia syndromogenesis. Sotsial’naya i klinicheskaya psikhiatriya. 2007;2:103-107. (In Russ.).

13. Kudryashova VY, Lutova NB. Self-regulation of behavior as one of the adaptation-compensatory mechanisms of the psyche in patients with paranoid schizophrenia. Article 2.Obozrenie psihiatrii i medicinskoj psihologii im. V.M. Bekhtereva. 2019;(4-2):60-67. (In Russ.). DOI: 10.31363/2313-7053-2019-4-2-60-67

14. KudryashovaVYu,Saraykin DM, Ivanov MV. Copings and self-regulation of behavior in patients with schizophrenia and affective disorders. Obozrenie psihiatrii i medicinskoj psihologii im. V.M. Bekhtereva. 2017;2:33-39. (In Russ.).

15. Kuzin M. I. Miasteniya. M. I. Kuzin, B. M. Gekht. M.: Meditsina; 1996. (In Russ.).

16. Kulikova OS. Kognitivno-stilevyye faktory zashchitnogo povedeniya bol’nykh shizofreniyey. Rossiyskiy psikhologicheskiy zhurnal. 2014;11(40):104-115. (In Russ.).

17. Laysek R.P. Miasteniya. R.P. Laysek, R.L. Barchi. M.: Meditsina; 1984. (In Russ.)

18. Leont’yev DA. Labirint identichnostey: ne chelovek dlya identichnosti, a identichnost’ dlya cheloveka. Filosofskiye nauki. 2009;10:5–10. (In Russ.).

19. Test smyslozhiznennykh oriyentatsii (SZHO). 2-ye izd. M.: Smysl;2000. (In Russ.).

20. Lutova NB, SorokinMYu, Vid VD. Stigma in patients with mental disorders — it’s manifestations and consequences. Obozrenie psihiatrii i medicinskoj psihologii im. V.M. Bekhtereva. 2017;3:41-45. (In Russ.).

21. Serdyuk A.I., Fedoseyev V.A. Psikhoterapiya v obshchesomaticheskoymeditsine: Klinicheskoye rukovodstvo pod obshch. red. B.V. Mikhaylova. Khar›kov: Prapor. 2002. (In Russ.).

22. Morosanova V.I. Individual’nyy stil’ samoregulyatsii: fenomen, struktura i funktsii v proizvol’noy aktivnosti cheloveka. M.: Nauka. 1998. (In Russ.).

23. Nal’kin SA, Lobzin SV, Sokolova MG. Osobennosti kognitivnykh funktsiy u bol’nykh miasteniyey. Meditsinskiy akademicheskiy zhurnal. 2018;8(3):41-45. (In Russ.).] DOI: 0.17816/MAJ18341-45

24. Nikolayeva V.V. Vliyaniye khronicheskoy bolezni na psikhiku. M.: Izdatel’stvo Moskovskogo universiteta. 1987. (In Russ.).

25. Ovchinnikov B.V., D’yakonov I.F., Bogdanova L.V. Psikhicheskaya predpatologiya. Preventivnaya diagnostika i korrektsiya. SPb: ELBI-SPb. 2010. (In Russ.).

26. Osokina OI, Abramov VA, Putyatin GG, Pyrkov SG, Vygovskaya YeM, Denisov EM, Golodenko ON. The study of life meanings and value orientations in patients who have had a manifest bout of schizophrenia. Zaporozhskiy meditsinskiy zhurnal. 2014;3(84):77-80. (In Russ.).

27. Petrova NN, Vishnevskaya OA. Characteristic of suicidal behavior of patients with depression in remission of schizophrenia. Tyumenskiy meditsinskiy zhurnal. 2015;15(3):12-13.(In Russ.).

28. ПPetrova NN, Chukhlovina ML, Chukhlovin AA. Affektivnyye rasstroystva u bol’nykh miasteniyey. Obozreniye psikhiatrii i meditsinskoy psikhologii im. V.M. Bekhtereva. 2005;4:79-80. (In Russ.).

29. Rakova VA, Shchelkova OYu. Osobennosti vospriyatiya vremennoy perspektivy bol’nymi paranoidnoy shizofreniyey. Vestnik Yuzhno-Ural’skogo gosudarstvennogo universiteta. Seriya: Psikhologiya. 2011;5:89-94. (In Russ.).

30. Rasskazova YeI, Gordeyeva TO. Koping-strategii v psikhologiistressa: podkhody, metodyiperspektivy [Elektronnyy resurs]. Psikhologicheskiye issledovaniya: elektron. nauch. zhurn. 2011;(17). (In Russ.).

31. Romanova T.V. Issledovaniye psikhologicheskik osobennostey bol’nykh miasteniyey. Doktor.ru, 2013;5(83):34-37. (In Russ.).

32. Sanadze A.G. Miasteniya i miastenicheskiye sindromy. M.: Litterra. 2012. (In Russ.).

33. Smulevich A.B. Depressii v obshchey meditsine. Rukovodstvo dlya vrachey. M.: Meditsinskoye informatsionnoye agentstvo. 2001. (In Russ.).

34. Smulevich A.B. Depressii pri somaticheskikh i psikhicheskikh zabolevaniyakh. — M.: Meditsinskoye informatsionnoye agentstvo. 2003. (In Russ.).

35. Stepanova AV, Isayeva YeR, Kotsyubinskiy AP. Association between mechanisms of psychological adaptation and cognitive function in patients with schizotypal disorder. Obozreniye psikhiatrii i meditsinskoy psikhologii im. V.M. Bekhtereva. 2017;4:51-58. (In Rus.).

36. Shmukler AB. Depressive symptoms and their treatment in schizophrenic patients. Sotsial’naya i klinicheskaya psikhiatriya. 2015;25(2):101-105. (In Rus.).

37. Yalom I. Ekzistentsial’naya psikhoterapiya. M.: Klass.1999. (In Russ.).

38. Yanushko MG. The relationship of cognitive impairment and side effects of antipsychotic therapy in patients with schizophrenia. Rossiyskiy psikhiatricheskiy zhurnal. 2010;6:64-69.(In Russ.). 39. Amador XF, David AS. Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders. London: OxfordUniv. Press. 2004.

39. Baumeister RF, DeWall CN, Ciarocco NJ, Twenge JM, Pers J. Social exclusion impairs self-regulation. JournalofPersonalityandSocialPsychology. 2005;88(4):589-604. DOI:10.1037/0022-3514.88.4.589.

40. Hagger MS, Wood C, Stiff C, Chatzisarantis NL. Ego depletion and the strength model of self-control: a meta-analysis. PsychologicalBulletin. 2010;136(4):495-525. DOI:10.1037/a0019486.

41. Heatherton TF, Wagner DD. Cognitive neuroscience of self-regulation failure. Trends in Cognitive Sciences. 2011;15(3):132-139. DOI:10.1016/j.tics.2010.12.005.

42. Heatherton TF. Neuroscience of Self and Self-Regulation. Annual Review of Psychology. 2011;62(1):363–390. DOI:10.1146/annurev.psych.121208.131616.

43. Inzlicht M, Schmeichel BJ, Macrae CN. Why self-control seems (but may not be) limited. Trends in Cognitive Sciences. 2014;18(3):127-133. DOI:10.1016/j.tics.2013.12.009.

44. Kulaksizoglu IB. Mood and anxiety disorders in patients with myasthenia gravis: aetiology, diagnosis and treatment. CNS Drugs. 2007;21(6):473–481.

45. Rohr W. Situational anxiety in myasthenia gravis. Psychotherapie Psychosomatik Medizinische Psychologie. 2003;43(3–4):93–99.

46. Ruddy, R., House, A. Psychosocial interventions for conversion disorder. Cochrane Database of Systematic Reviews. 2005. DOI: 10.1002/14651858.CD005331.pub2

47. William MK, Dylan DW, Heatherton TF. In Search of a Human Self-Regulation System. Annual Reviewof Psychology. 2015;38:389-411. DOI:10.1146/annurev-neuro-071013-014243