PSYCHOSOCIAL MANAGEMENT OF PATIENTS WITH CHRONIC DERMATOSES: STRATEGY OF PATIENT-SPECIFIC EDUCATION-BEHAVIORAL CORRECTION AND ITS IMPLEMENTATION AT THE PRIMARY MEDICAL CARE STAGE
About the author:
Cherkashyna L. V.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The results of the medical and psychological research have determined the decrease in the basic functional status parameters among 114 patients with chronic dermatoses, which amounted to 75.4−86.0% of patients, and the depth of these disorders (in points) was by 18.0 ÷ 31.5 % lower than the referential values, which can be explained by the formation of a special psychosomatic state with psychosocial adaptation to life in conditions of chronic dermatosis. According to the self-assessment data (averagely, in absolute points) the indicators of the everyday activity of the patients were reduced by 18.0%, which was determined by its unsatisfactory level in 98 patients − (86.0 ± 3.3)%, and the normal values of the activity index were registered only among (14.0 ± 3.3)% of patients with chronic dermatosis (p <0.05). The mood level analysis also revealed the significant (p <0.05) decrease in the mentioned indicator in (75.4 ± 4.0)% of patients with chronic dermatosis; however, despite a somewhat lower frequency (p <0.05) of patients with the low mood level, it was found that in the absolute points the decrease in mood indicators to (3.5 ± 0.2) points was more marked, than the indicators of activity or general state (reduced by 31.4%). When analyzing the personal anxiety levels, it was found out that generally the patients presented with the excessive (averagely, by 50.5% higher than the referential values) anxiety: the proportion of individuals with the moderately (within 31−45 points) increased level of personal anxiety amounted to (44, 7 ± 4.7)%, whereas the majority of patients had a high (more than 45 points) personal anxiety − (53.5 ± 4.7)%. The analysis of the reactive anxiety indicators revealed that, averagely, its level was (39.8 ± 1.6) points and by 27.7% higher than the referential values and within these values − only (2.6 ± 1.5) patients, but the moderate level (31 ÷ 45 points) of reactive anxiety was (58.8 ±4.6)%; the high level of reactive anxiety – (38.6±4.6)% was observed in more than a third of the patients. The data obtained have indicated the peculiarities of patients’ response, manifested in formation of the psychosomatic state, which is characterized by the high level of personal and reactive anxiety. In the presence of chronic dermatoses in (19.3 ± 3.7)% of patients the disharmony in relationships with other people can be observed; anxiety was diagnosed in (48,2 ± 4,7)% of patients. In this case the expressiveness (intensity) of harmony disorders and anxiety amounted to (5.3 ± 0.3) points and (3.7 ± 0.2) points, correspondingly. The results of the study make it possible to conclude that in chronic dermatoses the high incidence of hypochondria occurred; it was diagnosed in (15.8 ± 3.4)% of patients, and the expressiveness of hypochondria was (2.4 ± 0.4) points. It was determined that in case of chronic dermatoses on the background of psychosomatic disorders formation characterized by the high level of personal and reactive anxiety as the manifestations of mental disadaptation response, the emotional tension and neuropsychic processes imbalance, lability of the autonomic nervous system and excitability were aggravating. Chronic dermatoses can cause the changes in the character traits of the patients and fixation of the resistant psychosomatic disorders in the inner course of health. The rank distribution of psychological factors according to their differential informativity indicator in case of chronic dermatoses was carried out. It has been proved that the most informative acceptor indicators of the education-behavioral correction at the level of PHC which can be reasonably applied are: the personal anxiety indicator (first rank place), activity (second), the general health state (third), reactive anxiety (fourth) and the level of mood (fifth rank place).
general practice, chronic dermatosis, acceptor indicator, education-behavioral correction
- Mavrov II, Savenkova VV, Cherkashyna LV, Shklyar SP. Metodyka vyvchennya regionalnoyi poshyrenosti dermatoziv z urakhuvannyam faktoriv dovkillya. Reyestr galuzevykh novovveden MOZ Ukrayiny. 2009;73/30/09. [in Ukrainian].
- Mavrov II, Shklyar SP, Savenkova VV, Cherkashy`na LV. Poshyrenist systemnykh zakhvoryuvan spoluchnoyi tkanyny (z perevazhny`m urazhennyam shkiry) u Kharkivskomu regioni zalezhno vid faktoriv dovkillya. Dermatologiya ta venerologiya. 2009;1:3-18. [in Ukrainian].
- Cherkashyna LV, Mavrov II, Myasoyedov VV. Metodyka ocinky ryzyku psykhogennogo zakhvoryuvannya shkiry za kompleksom konstytucijnobiologichnykh faktoriv. Reyestr galuzevykh novovveden MOZ Ukrayiny. 2009;72/30/09. [in Ukrainian].
- Cherkashyna LV. Psykhogenni dermatozy: ocinka psykhosocialnoyi znachymosti na etapakh dermatologichnogo monitoryngu. Zbirnyk naukovykh pracz spivrobitnykiv NMAPO imeni P.L. Shupyka. 2012;21:122-30. [in Ukrainian].
- Garnyk TP, Myhajlov BV, Cherkashyna LV, Shklyar SP, Serdyuk OI. Ocinka rivnya somatogennoyi astenizaciyi pry` khronichny`kh zakhvoryuvannyakh ta dermatozax riznogo genezu. Reyestr galuzevykh novovveden MOZ Ukrayiny. 2010;477/33/10. [in Ukrainian].
- Cherkashyna LV, vynakhidnyk; Kharkivska medychna akademiya pislyadyplomnoyi osvity, patentovlasnyk. Sposib ocinky rivnya psykhosocialnoyi znachymosti dermatozu. Patent Ukrayiny № 40546. 2009 Kvit 10. [in Ukrainian].
- Cherkashyna LV. Psykhogenni dermatozy: ocinka rivnya psykhotravmatyzaciyi khvorykh. Medycyna I. 2009;2(24):78-84. [in Ukrainian].
- Cherkashyna LV. Somatogeniyi sered paciyentiv dermatologichnogo profilyu: innovacijne zabezpechennya diagnostychnykh texnologij. Problemy ekologichnoyi ta medychnoyi genetyky i klinichnoyi imunologiyi. 2013;2(116):345-58. [in Ukrainian].
- Shklyar SP, Cherkashyna LV, Frolova TV, Okhapkina OV. Monitoryng zdorovya naselennya – udoskonalennya pervynnoyi medyko – sanitarnoyi dopomogy v umovakh reformuvannya galuzi: innovacijne zabezpechennya. Zyizd specialistiv z socialnoyi medycyny ta organizatoriv okhorony zdorovya. 2008 Trav 15-17; Zhytomyr. Kyyiv: MOZ Ukrayiny; 2008. s. 260-2. [in Ukrainian].
- Lychko AE, Yvanov NYa. Medyko-psykhologycheskoe obsledovanye somatycheskykh bolnykh. Zhurn. nevropat. y psykhyatryy. 1980;8:1195-8. [in Russiаn].
- Lyshhuk VA. Ynformatyzacyya klynycheskoj medycy`ne. Klynycheskaya ynformatyka y telemedycyna. 2004;1:7-13. [in Russiаn].
- Moskalenko VM, redaktor. Socialna medycyna ta organizaciya okhorony zdorovya. Ternopil: 2002. s. 50-75. [in Ukrainian].
- Cherkashyna LV, vynakhidnyk; Kharkivska medychna akademiya pislyadyplomnoyi osvity, patentovlasnyk. Sposib ocinky rivnya psykhotravmatyzaciyi khvoryh dermatozom. Patent Ukrayiny № 40547. 2009 Ly`p 15. [in Ukrainian].
Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 194-199 pages, index UDK 616.517-092: 616.1/8 - 036.12 - 06: 616.85:612.26.015.11