Goals and objectives of medical psychology.

Study of the influence of diseases on the human psyche and behavior; Analysis of the influence of psychological factors on the occurrence, development and treatment of diseases, as well as on prevention; Studying the role of the psyche as a factor opposing the emergence and development of the disease; Study of mental development disorders; Study of the manifestations and dynamics of mental disorders in various diseases; Development of principles and methods of psychological research in the clinic; Study of the influence of the characteristics of the patient’s relationship with medical personnel and the microenvironment on the process of the disease and recovery; Creation and study of psychological methods of influencing the human psyche for therapeutic purposes.

Research methods in medical psychology.

Methods are divided into main and auxiliary. The main ones are observation and experiment, all the rest are auxiliary. Observation – the study of psychological phenomena without interfering with their course. Everyday observation – limited to recording facts, has a random, unorganized nature. Scientific observation – organized, has a plan, recording the results in a special diary. Included observation - involves the participation of the researcher in the activity he is studying. Not included observation – does not involve the participation of the researcher. The observation method is the most fundamental method of psychological research. It consists of professional registration all identified in the external behavior of the subject manifestations internal psychological structure. A type of observation method is the clinical-psychological method (professional psychological conversation with the patient). The role of the observation method increases when there is a suspicion of simulation and dissimulation, Experiment – a method that involves the active intervention of the researcher in the activities of the subject in order to create the best conditions for the study of specific psychological phenomena. The experiment may be laboratory when it takes place in specially organized conditions, and the actions of the subject are determined by instructions, natural when the study is carried out in natural conditions, stating when only certain psychological phenomena are studied, formative– in the process of which certain qualities develop. Auxiliary methods. Survey – a method that involves the subjects’ answers to specific questions from the researcher. The survey can be written (questionnaire), oral (conversation) and in the form of an interview. The interview involves establishing personal contact with the subject and has its own principles, stages and flow chart. Testing – a method during which the subject performs certain actions on the instructions of the researcher. Many methods have been developed for testing. Difference between testing and survey:

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Introduction

1.The concept of medical psychology

2. Sections of medical psychology

Conclusion

Literature

Introduction

Medical psychology is relevant and one of the leading branches of modern psychology. Medical psychology is characterized by a close connection between its theoretical foundations and their practical use in solving a wide range of problems of protecting and promoting public health.

In modern conditions of worsening social problems in our country, deteriorating health indicators of the population, the objective need to solve interrelated problems of a medical and social nature at a qualitatively new level is increasing. Objectively, the need has become ripe for the active introduction of new forms and methods of social work into the practice of health care authorities.

In the 90s XX century A new direction of social work and type of professional activity - medical and social work - began to take shape and is actively being introduced into healthcare practice. The peculiarity of medical and social work is that it, as a type of professional activity, is formed at the junctions of two independent branches

- social protection of the population and healthcare. This nature of medical and social work requires special approaches to the training of social work specialists, aimed at developing the foundations of knowledge in the field of medicine and medical psychology.

The close connection between medical psychology and psychiatry is based on the commonality of the object of study, a common understanding of mental illness, manifested by disorders in the reflection of the real world and, as a consequence, disorganization of behavior or its changes.

In solving theoretical and practical problems, a medical psychologist relies on subject knowledge, consisting of two interconnected parts. On the one hand, these are the ideas accumulated to date about the nature, structure, brain mechanisms, basic patterns of individual development and manifestations of the human psyche, i.e. what is called general psychology, on the other hand, knowledge of one’s own subject, reflecting the psychological patterns of disorders and deviations in cognitive processes and a person’s personality, caused by a specific disease. In this case we are talking about medical psychology and, above all, about pathopsychology as one of its branches, formed within the framework of clinical psychology. But the basis of the approach to understanding pathology (anomalies, deviations in the psyche) is a system of views about the nature of mental reflection in a healthy normal person.

The problem of the structure and dynamic characteristics of the psyche is solved in different ways by different psychological schools and is interpreted differently by representatives of various directions within the framework of their own conceptual ideas about a person as a subject of reflection of the surrounding world. This is directly related to the solution of practical problems, since the psychological concept determines the methodology for studying a person, followed by a system of specific techniques for identifying the desired characteristics of the psyche in normal conditions and in pathology. In this sense, psychological methods are not neutral; they are created and implemented to identify and evaluate those components of the psyche that are adequate to the accepted psychological concept (or scientific paradigm). The choice of methodology is, first of all, a meaningful choice of a certain system of views on the essential components of the human psyche.

1. The concept of medical psychology

Medical psychology is a branch of psychology devoted to the study of the influence of mental factors on the occurrence and course of diseases, diagnosis of pathological conditions, psychoprophylaxis and psychocorrection of diseases. It is customary to distinguish two main areas of application of medical psychology: neuropsychic and somatic diseases. Based on the data obtained in medical psychology, productive hypotheses can be built about the process of normal mental development.

Medical psychology (from the Latin medicus - medical, therapeutic) is a branch of psychology that studies the psychological aspects of hygiene, prevention, diagnosis, treatment, examination and rehabilitation of patients. The field of study of Medical Psychology includes a wide range of psychological patterns associated with the occurrence and course of diseases, the influence of certain diseases on the human psyche, the provision of an optimal system of health-improving effects, and the nature of the relationship of a sick person with the macrosocial environment. The structure of Medical Psychology includes a number of sections focused on research in specific areas of medical science and practical healthcare. The most common of them is clinical psychology, including pathopsychology, neuropsychology and somatopsychology. Branches of Medical psychology related to psychocorrectional work - psychohygiene, psychopharmacology, psychotherapy, mental rehabilitation - are intensively developing. Kerbikov O. V., Izbr. works, M., 1971, p. 300--11: About psychohygienic work at school.

Among the most important problems of Medical Psychology are the interaction of mental and somatic (bodily, physiological) processes during the occurrence and development of diseases, the patterns of formation of the patient’s idea of ​​his illness, the study of the dynamics of awareness of the disease, the formation of adequate personal attitudes associated with treatment, the use of compensatory and protective mechanisms individuals for therapeutic purposes, studying the psychological impact of therapeutic methods and means (medicines, procedures, clinical and instrumental studies, surgical interventions, etc.) in order to ensure their maximum positive impact on the physical and mental state of the patient. A significant place among the issues studied by Medical Psychology is occupied by the psychological aspects of the organization of the medical environment (hospital, sanatorium, polyclinics, etc.), the study of the relationships of patients with relatives, staff and with each other. In the complex of problems of organizing therapeutic measures, of particular importance is the study of the patterns of psychological influence of a doctor during his diagnostic, therapeutic, preventive work, the rational construction of relationships between participants in the treatment process, the prevention of iatrogenics Psychology Dictionary. / Under the general editorship. A.V. Petrovsky, M.G. Yaroshevsky. - 2nd ed. M., 1990

2. Sections of medical psychology

medical psychology disease psychocorrection

Medical psychology includes the following sections:

1.) Pathopsychology, a branch of psychology that studies the patterns of disorders of mental activity and personality traits based on comparison with the patterns of their formation and course in the norm.

The formation of pathopsychology is closely intertwined with the development of psychiatry. The first experimental psychological laboratories in psychoneurological institutions were created at the end of the 19th century. German psychologist W. Wundt, Russian psychoneurologists V. M. Bekhterev and S. S. Korsakov.

At the beginning of the 20th century. The first manuals on the use of experimental psychological methods for studying mentally ill patients began to be published. The ideas of L. S. Vygotsky played a major role in the development of pathopsychology in Russia.

Pathopsychological research is of great importance for a number of general methodological problems in psychology, for example, for resolving the issue of the relationship between the biological and the social in the development of the psyche. The data from these studies show that personality disorder does not mean the “release” of its biological instincts and needs, but is characterized, first of all, by a change in the human motives and needs themselves. It is also established that the patterns of the disintegration of the psyche do not repeat in reverse order the stages of its development.

Data from pathopsychological studies are used in psychiatry: as diagnostic criteria; when establishing the degree of intellectual decline; during examination (judicial, labor, military); when taking into account the effectiveness of treatment, especially when using psychopharmacological agents; when analyzing mental disorders in the case of harmful working conditions; when deciding on the restoration of lost performance.

Pathopsychology uses experimental research methods, the main principle of which is a qualitative analysis of mental disorders as an indirect and motivated activity. A pathopsychological experiment provides an opportunity to update not only mental operations, but also the motives of a sick person. The pathopsychology of childhood has received particular development, in which, based on Vygotsky’s position on the “zone of proximal development,” special methods have been developed, in particular the method of a teaching experiment.

The methods of medical psychology, while not differing in principle from the methods of general psychology, are specified depending on the nature of the disease. Medical psychology pays special attention to anamnesis - an analysis of the patient’s past experiences from infancy to the moment of illness.

2). Anamnesis (Greek anamnesis - memory), information about the patient’s living conditions that preceded this disease, as well as the entire history of the development of the disease.

Anamnesis is an integral part of every medical examination, often providing the necessary instructions for the diagnosis of a disease. There is a general history and anamnesis of the disease. The general history includes answers to the following groups of questions: diseases of parents and immediate relatives (hereditary diseases, malignant tumors, mental illnesses, tuberculosis, syphilis, etc.); previous diseases and operations, lifestyle (marital status, nutritional conditions), habits (drinking alcohol, smoking), sex life, working conditions, all living conditions.

The history of this disease concerns the onset of the disease, its course and treatment until the day of the study. The anamnesis is collected from the story of the patient himself or those around him.

In veterinary practice, anamnesis is collected by interviewing those caring for animals, studying documentary data (medical histories, etc.). The origin of the animal and the health status of its parents, the presence of diseases in the farm to which the animal belongs, conditions of care and maintenance (characteristics of feeding, watering place, premises for the animal, operating conditions) are established. They find out previous diseases, the time of occurrence of the disease, its symptoms, cases of a similar disease on the farm, information about the treatment used. Shklyar V.S., Diagnosis of internal diseases. K., 1960

3). The painful nature of the experience, the intractability of the pathogenic situation, the duration of the traumatic stress - all these factors can be understood and explained only taking into account the individual characteristics of the personality and character of the patient.

Stress (from the English stress - pressure, pressure, tension),

1) in technology - an external force applied to an object and causing its deformation.

2) in psychology, physiology and medicine - a state of mental stress that occurs in a person when operating in difficult conditions (both in everyday life and in specific circumstances, for example during space flight). The concept of stress was introduced by the Canadian physiologist G. Selye (1936) when describing the adaptation syndrome.

Stress can have both a positive and negative impact on activity, up to its complete disorganization, which poses the task of studying a person’s adaptation to difficult (so-called extreme) conditions, as well as predicting his behavior, especially in such conditions.. Levitov N . D., On human mental states, M., 1964: Emotional stress, trans. from English, L., 1970.

The further development of medical psychology leads to the identification of such branches as clinical psychophysiology (clinical psychosomatology) and clinical neuropsychology, psychological problems of defectology and pathopegogy. Medical psychology is the basis of psychotherapy and mental hygiene.

4) Neuropsychology, a branch of psychology that studies the cerebral basis of mental processes and their connection with individual brain systems; developed as a branch of neurology.

For centuries, idealistic psychology proceeded from the idea of ​​the parallelism of brain (physiological) and conscious (mental) processes or from the idea of ​​interaction between these two areas, which were considered independent.

Only in the 2nd half of the 19th century. In connection with the successes of studying the brain and the development of clinical neurology, the question was raised about the role of individual parts of the cerebral cortex in mental activity. Pointing out that when certain zones of the cortex of the left (leading) hemisphere are damaged in a person, certain mental processes (vision, hearing, speech, writing, reading, counting) are disrupted, neurologists have suggested that these zones of the cerebral cortex are the centers of the corresponding mental processes and that “mental functions” are localized in certain limited areas of the brain. This is how the doctrine of the localization of mental functions in the cortex was created. However, this teaching, which was of a “psychomorphological” nature, was simplified.

Modern neuropsychology proceeds from the position that complex forms of mental activity, formed in the process of social development and representing the highest forms of conscious reflection of reality, are not localized in narrowly limited areas (“centers”) of the cortex, but represent complex functional systems in the existence of which the complex takes part jointly working areas of the brain. Each region of the brain makes a specific contribution to the construction of this functional system. Thus, the brain stem and reticular formation provide the energy tone of the cortex and are involved in maintaining wakefulness. The temporal, parietal and occipital regions of the cerebral cortex are an apparatus that ensures the receipt, processing and storage of modality-specific (auditory, tactile, visual) information that enters the primary sections of each cortical zone and is processed in more complex “secondary” sections of these zones and is combined and synthesized in “tertiary” zones (or “overlap zones”), especially developed in humans. The frontal, premotor and motor areas of the cortex are an apparatus that ensures the formation of complex intentions, plans and programs of activity, implements them in the system of corresponding movements and makes it possible to exercise constant control over their course.

Thus, the entire brain is involved in the performance of complex forms of mental activity.

Neuropsychology is important for understanding the mechanisms of mental processes. At the same time, by analyzing mental disturbances that arise from local brain lesions, neuropsychology helps to clarify the diagnosis of local brain lesions (tumors, hemorrhages, injuries), and also serves as the basis for the psychological qualification of the resulting defect and for restorative training, which is used in neuropathology and neurosurgery .

In Russia, problems of neuropsychology are dealt with at the Department of Neuropsychology of the Faculty of Psychology of Moscow State University, in a number of laboratories and neurological clinics. Scientists from other countries made a great contribution to the development of neuropsychology: H. L. Teuber and K. Pribram (USA), B. Milner (Canada), O. Zangwill (Great Britain), A. Ekaen (France), E. Weigl (GDR ). Special journals “Neuropsychologia” (Oxf., since 1963) are devoted to the problems of neuropsychology. “Cortex” (Mil., since 1964), etc. There is an international society of neuropsychology. Introduction to clinical neuropsychology, L., 1973; A. R. Luria.

5) Psychotherapy (from psycho... and Greek therapeia - treatment), a system of mental influences aimed at treating the patient. The goal of psychotherapy is to eliminate painful deviations, change the patient’s attitude towards himself, his condition and the environment. The ability to influence the human psyche was noticed in ancient times. The formation of scientific research began in the 40s. 19th century (works of the English physician J. Brad, who explained the effectiveness of mental influence by the functional characteristics of the human nervous system). The theoretical justification and practical development of special methods of psychotherapy are associated with the activities of J. M. Charcot, V. M. Bekhterev and many others. The method of psychoanalysis had a certain influence on the development of psychotherapy, which increased attention to the world of internal human experiences and the role they play in the origin and development of diseases; however, Freudianism (and earlier - in the 1st half of the 19th century - the school of “psychics”, which considered mental illness as a result of the “oppression of sin”) is characterized by an irrational approach to understanding the nature of mental illness. Psychotherapy in the USSR is based on data from medical psychology and physiology of higher nervous activity, clinical and experimental research methods.

There are general and private, or special, psychotherapy. General psychotherapy is understood as a complex of psychological influences that strengthen the patient’s strength in the fight against the disease (the relationship between the doctor and the patient, the optimal psychological climate in the institution, excluding mental trauma and iatrogenic diseases, the prevention and timely elimination of secondary neurotic layers that can be caused by the underlying disease). General psychotherapy is a necessary component of the treatment process for all forms of diseases. Private psychotherapy is a method of treating patients with so-called borderline forms of neuropsychic disorders (neuroses, psychopathy, etc.), using special methods of psychotherapeutic influence: rational (explanatory) psychotherapy, suggestion while awake and in hypnosis, distractive psychotherapy, autogenic training , collective psychotherapy, etc. (in combination with medication and other treatment methods). Psychotherapy is impossible without positive emotional contact with the patient. Platonov K.I., The word as a physiological and healing factor, 3rd ed., M., 1962;

6) Psychohygiene, a branch of hygiene that studies measures and means of forming, maintaining and strengthening people’s mental health and preventing mental illness. Theoretical basis Psychohygiene - social and general psychology, psychotherapy, social psychiatry and physiology of higher nervous activity. The first special work, “Hygiene of the Passions, or Moral Hygiene,” belongs to Galen. The original idea for Psychohygiene of the dependence of people’s mental health on the conditions of their social life was put forward by J. J. Cabanis. The founder of Psychohygiene in Russia, I.P. Merzheevsky, saw the most important means of preserving mental health and increasing productivity in the high aspirations and interests of the individual. Psychohygiene in Russia is characterized by predominant attention to such social measures as improving working and living conditions, the consistent formation of active socially valuable attitudes in adolescents, vocational guidance that contributes to the implementation of these attitudes, as well as psychohygienic education and training in special methods for managing one’s own mental state and well-being. An important method of Psychohygiene is medical examination of persons with neuropsychic disorders. P.’s current tasks include the prevention of mental trauma in children and the development of ways to rationalize the learning process in secondary and higher schools (in order to prevent neuropsychic overload). In connection with the consequences of the scientific and technological revolution, the importance of managing the psychological climate in large and small social groups, as well as methods of increasing the mental resilience of workers in professions of increased complexity, is increasing. Sections of Psychohygiene: industrial (Occupational Psychohygiene), mental work, sexual life and family relationships, children and adolescents, the elderly.

Conclusion

Thus, in solving the practical problems of psychiatry, a branch of psychological science takes part, which is designated as medical psychology (Currently, the tendency to rename medical psychology into clinical psychology is clearly defined. This is caused by the need for terminological unity at the level of international professional cooperation. In Western countries, medical psychology refers to the whole the context of general psychological knowledge that is necessary for a doctor and constitutes a significant part in the content of training programs for specialists in the field of medicine. In contrast, the sphere of scientific and practical activity of a psychologist in the health care system is designated abroad as clinical psychology. This situation of the transition period of changing names is characterized by the use in the domestic one. literature and regulatory documents of the concepts “medical” and “clinical” psychology as synonyms). Having its own subject and logic of development, it participates in solving problems of diagnosis, examination, and in the implementation of psychocorrectional, psychotherapeutic and rehabilitation measures aimed at adapting the patient to life in society. At the same time, psychological research contributes to the solution of theoretical problems of modern psychiatry.

Literature

Luria A. R. Fundamentals of neuropsychology, M., 1973;

Shklyar V.S. Diagnosis of internal diseases. K., 1960

Introduction to clinical neuropsychology, L., 1973;

Kerbikov O. V., Izbr. works, M., 1971, p. 300--11: About psychohygienic work at school.

Platonov K.I., The word as a physiological and healing factor, 3rd ed., M., 1962;

Psychology Dictionary. / Under the general editorship. A.V. Petrovsky, M.G. Yaroshevsky. - 2nd ed. M., 1990

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Medical psychology as an applied science has the following tasks :

• - study of mental factors influencing the development of diseases, their prevention and treatment;
• - study of the influence of certain diseases on the psyche;
• - study of various manifestations of the psyche in their dynamics;
• - study of mental development disorders;
• - studying the nature of the relationship of a sick person with medical personnel and the microenvironment around him;
• - development of principles and methods of psychological research in the clinic;
• - creation and study of psychological methods of influencing the human psyche for therapeutic and preventive purposes.

In the medical field, the term "clinical psychology" is often used. Sometimes the concepts “medical psychology” and “clinical psychology” are used interchangeably. This opinion was shared, for example, by M. S. Rogovin (1969), A. E. Lichko and N. Ya. Ivanov (1992), Yu. F. Polyakov (1996). However, the view of other authors in domestic psychology (N.V. Ivanov, V.M. Bleicher, V.M. Banshchikov) comes down to the understanding of clinical psychology as an area of ​​medical psychology that is of an applied nature and focused on the needs of psychiatric, somatic and neurological clinics.

In foreign psychology, the field of psychology, which in domestic science refers to medical psychology, is most often called clinical psychology. At the same time, the subject of clinical psychology can be understood in different ways. Clinical psychologists study mental disorders in various diseases, study personality traits and provide psychological counseling, and develop ways to eliminate signs of maladaptive behavior.

Clinical psychology focused to solve problems of clinical practice (psychiatric, neurological, somatic). The sections of clinical psychology include pathopsychology, neuropsychology, and somatopsychology.

IN pathopsychology painful changes in the psyche, patterns of disturbances in mental activity and personality traits in mental illness are studied. The value of pathopsychology in medical practice lies in the development and application of methods for diagnosing mental disorders in sick people. A pathopsychologist, according to the famous Russian specialist in the field of medical psychology B.V. Zeigarnik, must be, first of all, a psychologist and at the same time be well informed in the theoretical foundations and practical needs of a psychiatric clinic. The applied importance of pathopsychology is especially high in psychiatry. Pathopsychology is necessary to establish the degree and determine the structure of an intellectual defect, conduct an examination, and also when assessing the effectiveness of treatment. Pathopsychology studies disorders of consciousness and personality, perception, memory, and thinking.

Pathopsychology as a field of scientific and practical psychological knowledge should not be confused with psychopathology. Psychopathology - This is the doctrine of the pathology of the psyche, its painful changes. Psychopathology is a branch of psychiatry (i.e. medicine) and deals with the clinical description of signs of mental illness (using medical concepts such as etiology, pathogenesis, symptom, syndrome). She studies the patterns of development of mental illness.

The question of distinguishing between the subjects of pathopsychology and psychopathology remains debatable. Both spiders study mental disorders, but use different methods to do so. Pathopsychology studies mental disorders using psychological methods (pathopsychological experiment, testing), and psychopathology mainly resorts to the clinical descriptive method. The most authoritative specialists in the field of pathopsychology in our country are B.V. Zeigarnik, S.Ya. Rubinstein, V.M. Bleikher, I.V. Kruk.

V. M. Bleikher and I. V. Kruk (1986) highlight the following tasks facing practical pathopsychology:

• 1) obtaining data for diagnostics;
• 2) study of the dynamics of mental disorders in connection with the therapy - assessment of the effectiveness of the treatment process;
• 3) participation in expert work - military, medical-social, judicial, psychological, medical-pedagogical examinations;
• 4) participation in rehabilitation work;
• 5) study of insufficiently studied mental illnesses, as well as the structure of mental disorders in some neurological and somatic diseases;
• 6) participation in psychotherapy.

Human mental disorders are often associated with disturbances in brain activity as a result of trauma. Therefore, as a branch of medical psychology it is often called neuropsychology, which explores the dependence of mental phenomena on physiological processes occurring in the brain. Neuropsychology studies the brain mechanisms of higher mental functions, changes in the psyche of patients with local brain lesions. Neuropsychology studies disorders of perception (agnosia), voluntary purposeful movements and actions (apraxia), disorders of various forms of speech activity (aphasia), memory disorders (amnesia), attention, thinking, and emotions. New techniques for early and accurate diagnosis of local brain lesions, created in neuropsychology, make it possible to develop and apply scientifically based methods for restoring mental functions. The founder of neuropsychology in Russia was A. R. Luria. In recent decades, E. D. Khomskaya and L. S. Tsvetkova have also been actively working in the field of neuropsychology.

The most important area of ​​work for medical psychologists is working with somatic patients. The relationship between human mental functions and somatic diseases has been known for a long time. The origin of the term “psychosomatic” dates back to 1818, when the German physician Johann Heinroth first proposed it to refer to the connection between psychological conflicts and physical illness. In 1825, Jacobi used the related concept of “somatopsyche.” The origin of psychosomatic medicine is associated with the psychoanalytic works of Z. Freud.

It has now been proven that mental factors play an important role in the origin of diseases such as bronchial asthma, gastric ulcers, and hypertension. It is known that strong emotional disturbances and prolonged stressful experiences can negatively affect the body and cause somatic diseases. This connection of the mental factor with the emergence and development of somatic and neuropsychic diseases is expressed in the name “psychogenic diseases”. On the other hand, some neuropsychic disorders and personal characteristics of a person arise in connection with somatic diseases. Such changes in the patient’s psyche are usually called somatogenies. Thus, with cardiovascular pathology, patients experience anxiety and fear, especially in the afternoon. With gastrointestinal diseases, patients are depressed, irritable, and exhibit hypochondria (increased fears for their health). Tuberculosis is characterized by frequent manifestations of euphoria (an unreasonable state of excessive cheerfulness, characterized by complacency, joy, carelessness, serenity). Therefore, a medical psychologist should pay attention to patients who are often and chronically ill. They are very vulnerable, characterized by irritability, short temper, touchiness, and tearfulness.

WORKBOOK

FOR INDEPENDENT WORK OF STUDENTS

FACULTY OF MEDICINE

Copying for distribution in any form, in part or in full, is possible only with the permission of the authors of the textbook.

Medical psychology: guidelines for independent work of students of the medical faculty // A.M. Kozhina, V.L. Gavenko, G.A. Samardakova, V.M. Sinayko, T.P. Mozgovaya, V.I. Korostiy, N V. Gavenko, L. M. Gaichuk, M. N. Khaustov, I. N. Strelnikova, A. A. Cherkasova, I.M. Sokolova – Kharkov, 2014. – 122 p.

SUBJECT, TASKS OF MEDICAL PSYCHOLOGY AND METHODS OF STUDYING THE MENTAL STATE OF A HUMAN.

THE CONCEPT OF MENTAL HEALTH

Psychology is the science of the patterns of emergence, development and manifestations of the psyche. Psychology is divided into general, individual and social. General psychology includes developmental, medical, engineering, space, military, etc. Psychology is directly related to philosophy and other human sciences and plays a significant role in the scientific knowledge of the patterns of personality formation, its ideological, moral, ethical and aesthetic attitudes and values.

General psychology is the science of the patterns of formation and practical implementation of mental functions (perception, memory, attention, thinking, emotions, effector-volitional sphere, consciousness) separately and in their interaction, which makes up the personality. It gives the doctor methods that allow him to notice minor changes in the patient’s mental state, monitor the progress of the disease step by step, noting the positive or negative effects of treatment methods.

Medical psychology is a field of psychology that studies the patterns of functioning of the psyche in conditions of the onset and course of a disease, the treatment of sick people and the use of psychological factors in the treatment process, preventive and hygienic work of medical personnel.

Medical psychology is aimed at solving theoretical and practical problems related to strengthening and maintaining the psychological health of the population, preventing diseases, diagnosing pathological conditions, psychocorrective forms of influence on the recovery process, solving issues of examination, social and labor rehabilitation of healthy and sick people, as well as studying the psychological characteristics of the professional activity of a medical worker.

The place of medical psychology in clinical medicine is determined by the object of study of these sciences - a sick person who, with any disease, has an altered psyche. Psychological characteristics of a doctor’s behavior in case of a particular disease, correction of the psyche in the process of treating a patient, psychotherapeutic influence on the patient are the main points of contact of these sciences. Medical psychology is associated with all medical specialties (therapy, surgery, obstetrics and gynecology, pediatrics, hygiene, etc.), and has some specific approaches, and, accordingly, plays a large role in the training of doctors of any profile.

Main tasks of medical psychology:

Psychological assessment of the individual characteristics of the patient, changes in his mental functions under the influence of various mental and somatic diseases

Study of the influence of various mental and somato-neurological diseases on the mental sphere of children and adults

Assessment of the role of mental influences in the occurrence, course and prevention of psychosomatic diseases and their psychopathological complications

Analysis of individual and professional psychological characteristics of behavior and work with patients of a doctor and other medical workers

Studying the psychology of relationships between the patient and medical workers during the diagnostic and treatment process

Development of principles and methods of experimental psychological research in the clinic, methods of correction and psychotherapeutic support for diagnostic and treatment processes.

In Ukraine, psychology is developing as an integral part of world psychological science. At the beginning of the twentieth century. scientific schools were formed: Kiev (G.I. Chelpanov, I.A. Sikorsky, S.A. Ananyin), Odessa (I.M. Sechenov, I.I. Mechnikov, M.M. Lange, S.L. Rubinstein ). One of the most important centers for the development of experimental psychology in the 20-30s of the twentieth century was Kharkov. The history of the development of medical psychology is also associated with such famous scientists as A.R. Luria, L.S. Vygotsky, N.A. Bernstein, O.V. Zaporozhets, A.Ya. Anfimov, K.K. Platonov, O. M.Leontyev, V.P.Protopopov, P.I.Zinchenko, L.I.Bozhovich and others.

Thus, Alexander Romanovich Luria was the founder of neuropsychology in the USSR, his research was devoted to the problems of localization of higher mental functions and their disturbances during brain damage. Lev Semenovich Vygotsky dealt with the problems of the development of mental functions, developed the concept of “psychological systems”, which implied functional connections between various mental functions, and proposed a hypothesis about the localization of mental functions as structural units of the brain. The works of L.S. Vygotsky enriched psychiatry, defectology, and other human sciences. Nikolai Alekseevich Bernstein developed research methods - kymocyclography and cyclogrammetry, with the help of which human movements were studied normally and in patients with pathology of the nervous system, when using prosthetic limbs. The results he obtained made it possible to clarify the idea of ​​the localization of functions in the nervous system and to propose effective methods for restoring impaired functions. Pyotr Kuzmich Anokhin developed the theory of functional systems, which is one of the most important in psychophysiology. Bluma Vulfovna Zeigarnik stood at the origins of the formation of pathopsychology, was engaged in the development of cultural-historical theory in relation to the study of problems of pathology of various mental processes. Leonid Fokich Burlachuk worked on the methodology of psychological research, the principles of psychodiagnostics, and the development of concepts about the levels of mental health. Vadim Moiseevich Bleikher paid great attention to the development of principles of pathopsychological diagnosis for various mental illnesses.

Before moving on to a description of the methods used in medical psychology, we should dwell on the main stages of experimental psychological examination.

At the preparatory stage, a question (hypothesis) is formulated to which an answer must be found. Most often, this is a question about differential diagnosis, about the causes or factors that determine the specific course of a particular disease, about establishing the individual psychological characteristics of the patient’s personality.

Psychodiagnostic research includes the following stages:

Preparatory (hypothesis formulation, selection of methods)

Actually experimental

Quantitative processing of research data

Interpretation of the data obtained, writing a conclusion

After the problem has been formulated, it is possible, by going through all possible phenomena, to establish how and to what extent they influence the event that interests the researcher. Such a preliminary answer to the question about the nature of the connection between events is a hypothesis. The main requirement for a hypothesis is the ability to test it. Often, when planning a study, several equally probable hypotheses may arise, then they are tested sequentially.

Psychological diagnosis is the identification of hidden causes of visible trouble (L.F. Burlachuk).

The following methods are used in medical psychology:

1 - clinical guided conversation method,

2 - observation method

3 - experiment

4 – psychodiagnostic examination

Clinical conversation and observation are the main methods used in the daily practical work of a doctor and medical psychologist.

Clinical conversation method (interview). The conversation involves identifying connections of interest to the researcher based on empirical data obtained in real two-way communication with the subject. This is a method of obtaining information about the individual psychological properties of a person, psychological phenomena and psychopathological symptoms, the internal picture of the disease and the structure of the patient’s problem, as well as a method of psychological influence on a person, developed directly on the basis of personal contact between a doctor, a psychologist and a patient.

The principles of clinical conversation are: unambiguity, accuracy and accessibility of formulations, adequacy, consistency; flexibility, impartiality of the survey, verification of the information received. The success of the conversation depends on the qualifications of the researcher, which includes the ability to establish contact with the subject and give the opportunity to express their thoughts as freely as possible.

During the clinical conversation, anamnestic information is collected and the patient’s complaints are questioned. Anamnesis materials allow one to judge the nature of the disease, the causes and circumstances of its occurrence, the characteristics of the course and clinical manifestations. By collecting anamnestic information, the doctor can assess the neuropsychic state of the patient in the period preceding the disease, find out whether the patient was treated previously and in which departments, how effective the treatment was. Anamnesis allows the doctor to determine the patient’s attitude towards his disease and the characteristics of psychological reactions to the disease. When interviewing a patient, the doctor not only evaluates the factual material, but also has the opportunity to determine the psychological characteristics of the patient. It is necessary to give the patient the opportunity to independently talk about his illness, his life, but the conversation with the patient should be directed by a doctor. It is very important to ask questions to the patient correctly, in a certain order and form; you cannot use questions to instill in the patient certain sensations (for example, sometimes it is enough to ask the patient if he has pain in the heart area, and he begins to experience it). The most intimate issues of the patient’s life should be touched upon with particular delicacy. The doctor must take into account how carefully and thoughtfully the patient listens to his questions.

However, patients, suffering from discomfort and pain, may think that either the doctor did not examine him carefully, or the disease is very serious and incurable. In addition, some people strive to remain in the position of a patient, although recovery has occurred, and are afraid to return to their previous healthy lifestyle. In this case, we can talk about an attitude toward illness. Often patients underestimate the severity of their painful condition and either do not express complaints at all or soften the degree of their severity.

Clinical conversation is an important method not only for studying the patient, but also for the interaction of the doctor with the patient and influencing the patient.

Observation method. One of the most typical ways a researcher works is to observe an object (person, group) in the expectation that the phenomena of interest to the researcher will manifest themselves in such a way that they can be recorded and described. Using this method, mental processes, states and properties are studied in healthy and sick people. The study of the psyche is carried out in natural life conditions and differs from a natural experiment in that the doctor or psychologist is a passive observer and is forced to wait until he can see the phenomena that interest him a second time.

The advantage of this method is that during observation the natural course of mental phenomena is not disrupted. The disadvantage of the observation method is that it does not make it possible to establish with absolute accuracy the cause of a specific mental phenomenon, since in the process of observation it is impossible to take into account all the relationships of the mental phenomenon. Observation is carried out in ordinary living conditions: in the family, in the process of work, play, training, in a hospital ward. Independent activity, observation, characteristics of the patient’s reactions to what is happening, and his relationships with others are taken into account. Observation must be directed, i.e. pursue certain goals. In medical practice, it makes it possible to assess the patient’s sleep, appetite, mood, mental activity, etc.

Experiment. An experiment differs from observation in that it involves the organization of a research situation, which allows for what is impossible in observation - relatively complete control of variables. A variable is a reality that can be changed in an experimental situation. Manipulation of variables is one of the important advantages of the experimenter over the observer.

If a researcher is interested in any connection between phenomena, then in an experiment it is possible, having created a certain situation, to introduce a new element and determine whether this or that change in the situation will arise as a consequence of the change he created. When observing, the researcher is forced to wait for a change to occur, which may not occur. There are 4 types of experiments: laboratory, natural, ascertaining, formative.

The disadvantage of the method is that it is difficult to organize it in such a way that the subject does not know what is happening to him. Therefore, the subject may exhibit stiffness, uncertainty, conscious and unconscious anxiety, etc.

Psychodiagnostic examination. Based on psychodiagnostic research, hypotheses about dependencies between different psychological characteristics are tested. Having discovered their features in a sufficient number of subjects, it becomes possible to establish their relationship based on appropriate mathematical procedures. The requirements for a psychodiagnostic study are the same as for an experiment - control of variables. Psychodiagnostics, moreover, is an independent field of psychology and, in this case, the researcher focuses not on research, but on examination. Psychodiagnostics as a field of psychology is focused on measuring the personal and psychological properties of an individual.

Psychodiagnostics is the science and practice of establishing a psychological diagnosis. Diagnosis as the main goal of diagnosis can be established at different levels.

Level 1 - symptomatic or empirical. At this level, diagnosis is limited to the identification of features or symptoms (signs)

Level 2 – etiological, which takes into account not only the presence of characteristics, but also the reasons for their occurrence.

Level 3 - the level of typological diagnosis, which consists of determining the place and significance of the identified characteristics in the overall picture of a person’s mental life.

Methods of psychodiagnostics. The main methods of psychodiagnostics are testing and questioning, the methodological implementation of which is, respectively, tests and questionnaires, which are also called methods. The methods make it possible to collect diagnostic information in a relatively short time, provide information about a person in general, and specifically about one or another of its features (intelligence, anxiety, etc.), allowing for a qualitative and quantitative comparison of an individual with other people. Information obtained using psychodiagnostic techniques is useful from the point of view of choosing means of intervention, forecasting its effectiveness, as well as forecasting development, communication, and the effectiveness of one or another activity of an individual.

Testing. A test is a test, task or system of tasks that makes it possible to quickly assess the mental state or level of intellectual development of the person being studied.

Psychological diagnostics uses a number of experimental psychological techniques - tests, with the help of which it is possible to assess the functioning of both individual spheres of mental activity and integrative formations - types of temperament, character traits, personal qualities.

There are verbal (language) and nonverbal (drawing) tests. There are mainly two groups of tests - standardized and projective (projective).

A test focused on assessment is called a standardized test (tests of intelligence, special abilities, to measure creativity).

However, there are tests that are focused on something else: they determine not evaluative indicators (for example, the level of development of a certain property), but the qualitative characteristics of a person. Projective techniques belong to this group of tests. They are based on the fact that in various manifestations of an individual his personality is embodied, including hidden, unconscious needs, conflicts, and experiences. That is, the main thing is the subjective content and attitude that the test will evoke in the subject, which allows us to draw conclusions about personality characteristics.

Questionnaires are methods that contain a set of questions that the subject must answer whether he agrees with this statement or not. There are questionnaires of an “open” type (answers are given in free form) and “closed” type (the answer is chosen from the options presented in the questionnaire). In addition, a distinction is made between questionnaires and personality questionnaires. Questionnaires provide an opportunity to obtain information about the subject that does not directly reflect his personal characteristics. For example, biographical, questionnaires of interests, attitudes.

Personality questionnaires for measuring personality traits are divided into several groups:

a) typological questionnaires developed on the basis of determining personality types and allow the subjects to be classified into one or another type, which is distinguished by qualitatively unique manifestations;

b) a questionnaire of personality traits that determine the severity of traits - persistent personality traits;

c) motive questionnaire;

d) values ​​questionnaire;

e) attitude questionnaire;

f) interest questionnaires;

Methods of psychological research are not isolated; they can be integral parts of one another.

Basic psychodiagnostic techniques:

The last stage of experimental psychological research necessarily includes writing a conclusion based on the results obtained.

One of the most important concepts in medical psychology is the concept of mental health. According to the WHO Constitution, health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

The components of health are distinguished: 1) physical (physical activity, physical well-being, physical limitations); 2) mental (mental well-being, control of behavior and emotional reactions, functioning of cognitive processes); 3) social (interpersonal communication); 4) role (freedom to perform ordinary roles at home and at work); 5) general self-assessment of health.

Three interrelated aspects of health are described - somatic, mental and spiritual, which are based on the corresponding levels of personality, the consideration of which is necessary for the correct planning of valeological activities. The spiritual (moral) aspect of health is the motivation for a healthy lifestyle, an attitude towards a long and fulfilling life, the absence of a dependent attitude towards medicine, independent activity in the formation and strengthening of one’s own health, and a caring attitude towards the life and health of others.

According to WHO criteria, under mental health understand: a) the absence of severe mental disorders; b) a certain reserve of human strength, thanks to which he can overcome unexpected stresses and difficulties that arise in exceptional circumstances; c) a state of balance between a person and the world around him, harmony between him and society, the coexistence of the ideas of an individual with the ideas of other people about “objective reality”.

Mental health is the absence of mental illness, normal mental development and a favorable functional state of the higher parts of the central nervous system. For children, this is the presence of normal abilities to master knowledge and skills, the ability to fulfill all the requirements of school life, and compliance with norms of behavior in relationships with peers and teachers. Normal development is harmonious, age-appropriate, with a normal functional state and normal mental performance, with a positive emotional state.

It is generally accepted to distinguish 5 health groups:

Healthy with normal development and normal level of function.

Healthy, but having functional or some morphological abnormalities, as well as reduced resistance to acute and chronic diseases.

Patients with chronic diseases are in a state of compensation with preserved functional capabilities of the body.

Patients with chronic diseases are in a state of subcompensation, with reduced functionality.

Patients with chronic diseases are in a state of decompensation with significantly reduced functional capabilities of the body.

An important concept in medical psychology is the concept of psychological adaptation of a person, i.e. the ability to change structural connections to preserve functions and ensure human existence in a changed environment. Adaptation can include both physiological and behavioral responses. There are several types of adaptation states:

The state of “physiological adaptation” is the normal existence of a person in changing environmental conditions with an optimal regime of all functional systems.

A state of intense adaptation - when there is a need for restructuring, changing existing activity parameters that require a certain tension in the operation of the corresponding functional systems.

A state of pathological adaptation that occurs when the body's reserve capabilities are exceeded, which can lead to complete depletion of adaptation mechanisms and the development of maladaptation.

Control questions

Indicate the principles of constructing a targeted psychological conversation.

2. Psychology is:

A. The science that studies human behavior

B. The science of the patterns of emergence, development and manifestations of the psyche

C. Branch of science that studies the level of human intellectual development

D. Science aimed at developing adequate methods of treating mentally ill people

E. All of the above

3. Medical psychology is:

A. A branch of psychiatry that studies the main symptoms and syndromes of mental pathology

B. A branch of psychology that studies the basic patterns of mental functioning during the occurrence of a disease

C. The science of methods for determining the level of human intellectual development

D. Branch of human knowledge aimed at using the achievements of modern medicine in the study of human psychological characteristics

E. All of the above

4. Medical psychology is associated with specialties:

A. Pediatrics

B. Obstetrics and gynecology

C. Surgery

D. Psychiatry

E. All of the above

5. The “Corrective test” technique is used to study:

A. Sensations and perceptions

C. Psychological properties of personality

D. Thinking

E. Attentions

6. At an appointment with a psychologist, a 17-year-old teenager is experiencing inappropriate emotions. What methods can be used to clarify the emotional characteristics of a patient?

A. Aschaffenburg sample

B. Luscher method

C. Kraepelin account

D. 10 words test

E. All of the above

7. Relatives of a 35-year-old patient who suffered a traumatic brain injury several years ago began to notice that he was having difficulty in thinking. Which research method is most appropriate for assessing the patient’s intellectual state:

A. Reproduction of stories

B. Kraepelin account

C. Wechsler test

D. Pictogram technique

The role of medical psychology is

1. in improving the necessary contacts between medical staff and patients,

2. in the fastest and most complete recovery,

3. in the prevention of diseases, health protection, education of a harmonious personality.

She broadly studies the entire range of beneficial or harmful influences on a person’s personality, the impact of the nature of interpersonal relationships on his health and the occurrence of diseases.

The main purpose of teaching medical psychology comes down to

1. to educate students in humanism,

2. high medical culture,

3. ethical standards

4. a broad psychohygienic (psychoprophylactic) approach to correcting the condition of a sick person.

The most important task of medical psychology is the study of the patient’s psyche in various conditions.

Medical psychology should be developed in connection with current tasks posed by various medical disciplines.

GENERAL AND PRIVATE MEDICAL PSYCHOLOGY

Features of medical psychology today are increasing differentiation into various areas and expanding connections with other areas of knowledge. According to the direction of psychological research, we can distinguish general And private medical psychology.

General medical psychology studies general issues and includes the following sections:

Basic principles of the psychology of a sick person (criteria for normal, temporarily altered and painful psyche), the psychology of a doctor (medical worker), the psychology of everyday communication between a patient and a doctor, the psychological atmosphere of medical institutions.

Psychosomatic and somatopsychic interactions.

Individuality (temperament, character, personality), evolution and stages of its postnatal ontogenesis (including childhood, adolescence, adolescence, maturity and late age), affective-volitional processes.

Medical deontology, including issues of medical duty, ethics, and medical confidentiality.

Psychohygiene (psychology of medical advice and consultations, family psychology, psychohygiene of persons during crisis periods of their lives (for example, puberty, menopause). Psychology of marriage and sexual life. Psychohygienic training, psychotraining of the relationship between doctor and patient.

General psychotherapy.

Private medical psychology studies a specific patient, namely:

features of mental processes in mental patients;

the psyche of patients at the stages of preparation, performance of surgical interventions and in the postoperative period;

mental characteristics of patients suffering from various diseases (cardiovascular, infectious, oncological, gynecological, skin, etc.);

the psyche of patients with defects of organs and systems (blindness, deafness, etc.);

mental features of patients during labor, military and forensic examinations;

the psyche of patients with alcoholism and drug addiction;

private psychotherapy.

We can highlight specific clinics where knowledge of the relevant sections of medical psychology is put into practical use:

in a psychiatric clinic - pathopsychology;

in neurological - neuropsychology; in somatic - psychosomatics.

Pathopsychology studies, by definition B.V. Zeigarnik, the structure of mental disorders, patterns of mental disintegration in their comparison with the norm. Pathopsychology can consider the tasks of both general medical psychology (when the patterns of mental disintegration and personality changes in mental patients are studied) and private psychology (when the mental disorders of a particular patient are studied to clarify the diagnosis, conduct a labor, forensic or military examination).

Close to pathopsychology neuropsychology, the object of study of which are diseases of the central nervous system (CNS), mainly local focal lesions of the brain.

Psychosomatics studies the influence of the psyche on the occurrence of somatic manifestations.

Pathopsychology should be distinguished from psychopathology. The latter is part of psychiatry and studies the symptoms of mental illness using clinical methods, using medical concepts: diagnosis, etiology, pathogenesis, symptom, syndrome, etc. The main method of psychopathology is clinical descriptive.

The development of medical psychology is significantly influenced by the following medical disciplines: psychiatry, neurology, neurosurgery, psychotherapy, therapy. This influence is mutual. Medical psychology is also close to a number of other psychological and pedagogical sciences - experimental psychology, occupational therapy, oligophrenopedagogy, typhlopsychology, deaf psychology, etc.

Medical psychology has a significant influence on the development of general theoretical issues in psychology: the relationship between the social and biological in the development of the psyche; analysis of the components that make up mental processes; development and decay of the psyche; the role of the personal component in the structure of various forms of mental activity. Medical psychology uses knowledge of pedagogy, sociology, philosophy, etc.