RU2089231C1 - Method to treat neurosis-like and boundary disturbances - Google Patents

Abstract

FIELD: medicine, psychotherapy. SUBSTANCE: at the preliminary stage of treatment it is necessary to obtain and evaluate anamnesis data, analyze dynamics of somatic suffering and determine dominant cerebral hemisphere. Based on the data obtained psychotherapeutic impact is performed that includes efficient psychotherapy, motivation suggestion. Moreover, in patients with left dominant hemisphere verbal communicative aspects are used but in those with right dominant hemisphere the impact is fulfilled due to perceptive-descriptive concepts. At the final stages of seances for patients with left dominant hemisphere basic suggestive formula are reflectory associated with deep sigh, but in patients with right dominant hemisphere - with touching their left shoulder. Additionally, at taking patients with right dominant hemisphere out of hypnotic trance they are exhibited a green-colored screen, then due to verbal suggestion patient must visualize the image of a ring at this screen, in five minutes real image of a ring is presented at the screen, during next seances ring's diameter should be decreased and at the last seance only a spot is demonstrated for the patient. EFFECT: higher therapeutic efficiency, decreased terms of treatment. 4 cl, 1 tbl

Description

 The invention relates to medicine, namely to psychotherapy, and can be used in the practice of treating neurosis-like and borderline conditions.

 Currently, the number of disorders caused by a psychogenic factor has increased significantly. These are usually reversible borderline mental disorders, recognized by the patient, due to exposure to traumatic factors and occurring with emotional and somatovegetative disorders.

 The main reason for the occurrence of these conditions is mental trauma, but premorbid personality traits also matter. Moreover, the greater the predisposition to the development of psychogeny, the less important is the trauma. A premorbid personal predisposition to neurosises includes such traits of character as emotional instability, anxiety, vulnerability, personality formation and its maturity, various asthenic factors: for example, somatic diseases, overwork, lack of sleep, etc. Of great importance is the personality formation feature. Congenital weakness of the nervous system can be caused by toxicosis during pregnancy and the pathology of childbirth, and acquired by a psychic effect, which is often now associated with the common curse in the common people. So in the literature it is noted that mental injuries suffered in childhood contribute to the appearance of neurotic disorders in adults. With the development of these disorders, a certain sequence of symptoms appears. So at the first stages, the leading ones are autonomic disorders, in the future sensorimotor, emotional and ideational ones join. These disorders in various patients have their own characteristics.

 In the treatment of neurosis-like and borderline conditions, a complex of therapeutic measures is used, including fortifying therapy / vitamins, nootropic drugs, a rational diet, walks, physical exercises, massage, etc. /, the appointment of psychotropic drugs, as well as psychotherapy.

 Currently, psychotherapy is becoming increasingly developed as the most effective, humane method of treatment / Svyadosh A.M. "Neuroses", M. Medicine, 1982; Karvasarsky B.D. "Neuroses", M. Medicine, 1990, etc. /.

 Closest to the proposed method is a method of treating patients whose psychosomatoses are expressed in functional disorders that are, as it were, on the verge between normal and mental pathology, using the method of psychotherapy. In this approach, a complex of psychotherapeutic influences was used and carried out in stages. At the same time, when acquaintance with the patient, they collect and evaluate history data, examine the dynamics of somatic suffering, at the first stage of treatment, taking into account the etiology of a neurosis-like or borderline state, carry out a sedative and distracting effect using rational psychotherapy, i.e. leveling the leading syndrome. At the second stage, a comprehensive psychotherapeutic effect is carried out using motivated suggestions in a state of wakefulness and in a state of hypnotic trance; use motivated suggestion, including explanatory and active suggestion, repeated repetition of the formula of suggestion, as well as unconditionally reflex reinforcement. The third stage includes the creation of a "psychotherapeutic depot" / Zavilyanskaya L.I. "Psychotherapy of neurosis-like conditions." Kiev, Health. 1987, p. 29-56 /.

 However, the effectiveness of the known method remains insufficiently high, due to the fact that they did not pay attention to personality parameters related to the characteristics of the perception and processing of incoming information. The importance of these parameters is shown in the literature / Fedorov A.P. "On some methodological approaches to group psychotherapy taking into account interhemispheric functional asymmetry" in the book. On the methods of group psychotherapy for neuropsychiatric diseases / M. 1988, p. 47-51 /. It is also known that at the neurophysiological level, each person develops his own unique model of perceived information space, which includes all experiences and all generalizations related to these experiences, as well as all the rules for applying these generalizations / Gordon D. “Therapeutic metamorphoses”. St. Petersburg, 1995, p. 19-20, 23, 88-89 /.

 Our studies have shown that averaged personality profiles are only the total result of generalization, eliminating the diversity of personality differences. It is more correct to single out within each disease groups of patients whose personality characteristics are most consistent, and one of these features is the dominance of the hemisphere. This fact is well understood from the standpoint of the modern concept of the functional asymmetry of the brain and the peculiarities of information processing in the right and left hemispheres.

 Thus, the objective of our study was to develop an effective method of psychotherapeutic treatment of patients with neuropsychiatric disorders.

 To solve this problem, we used the features of processing and perception of incoming information by the patient, which, together with the well-known approach of psychotherapeutic treatment, allowed us to obtain a productive result.

 The method is as follows.

 At the preliminary conversation, the patient is introduced and at the same time anamnesis data is collected, including information on the duration and nature of the observed symptoms, domestic and social conditions of life, and determine the type of higher nervous activity, especially the nature, associated diseases. This is important, since psychotherapy is a method of psychological impact, it is built with mandatory consideration for the characteristics of the patient’s mental activity and, first of all, with his personal properties. The dominant cerebral hemisphere is also determined. To do this, use the method of "dichotic listening", which consists in the fact that the patient is presented with two sets of verbal / word pairs, syllables, numbers / or non-verbal acoustic signals / fragments of melodies, sounds using two-way stereo headphones through a headphone in both ears environment, different types of non-speech signals. To control the accuracy of perception using memories and reproduction of what was heard by the right and left ear, and determine the dominant hemisphere by the largest amount of correct answers / Balonov L.Ya. Deglin V.L. "Hearing and speech of the dominant and non-dominant hemispheres." L. Science, 1976, p. 42-49 /. In addition, simpler methods can be used for this purpose, for example: registration and analysis of motor activity when performing a series of tasks related to throwing a target, writing words, drawing / Mosidze V.M. and other "functional asymmetries of the brain", Tbilisi, Metsniereba, 1977, p. 69-70 /, as well as a number of techniques, such as crossing hands, Napolion's pose, etc. / Chuprikov A.P. and others. "Identification of left-handedness and the hygiene of left-handed children." Method. Recom. M. MH USSR, 1985, p. 4-5 /.

 At the preliminary stage, differential diagnosis is clarified, whether the syndrome neurotic in appearance is a sign of neurosis or does it reflect the pathogenetic mechanisms of other diseases. The patient is explained in an accessible form to him the essence and mechanisms of the treatment.

 After the patient's departure, the main provisions of a positive motivated suggestion of an emotionally imaginative, containing a belief system in its content, are made. If collective psychotherapy is supposed to be carried out, groups are formed taking into account individual and personal characteristics, as well as taking into account the peculiarities of perception and processing of information. The formed group should include patients who are better at verbal processing of information (left dominant hemisphere), the other group should include patients who prefer a non-verbal level of communication / right dominant hemisphere /.

 The treatment session is carried out the next day or 1-2 days after the conversation at the preliminary stage.

 At the first stage of treatment, with the help of logical constructions and rational psychotherapy, a sedative and distracting effect is performed, i.e. level the leading syndrome. In this case, patients with left dominant hemisphere use verbal communication. In patients with the right dominant hemisphere, in order to obtain a sedative and distracting effect, the conversation is accompanied by a large amount of demonstrative material / slides, posters, films, etc. /. At the same time, verbal communication is associated with certain sensations; they perform psycho-gymnastics, i.e., they focus the patient’s attention on which parts of the body carry the most essential information about the emotions experienced and through these sensations achieve relaxation and redistribution of attention. After the patient has emotionally calmed down and felt the need and the possibility of extraction, they proceed to the second stage, which is carried out after a 10-minute break.

 By the beginning of the second stage, the patient is mentally and emotionally ready for the treatment. The stage begins with a motivated suggestion while awake. Considering that during this period information is perceived by the patient without a critical assessment, it is important both its semantic content and the intonation of speech / confident tone, repeated repetitions of the main provisions /, facial expressions and authority of the doctor. For patients with the right dominant hemisphere, the information communicated is associated with his imaginative representations. The patient is then transferred to a state of mild hypnotic trance, i.e. a state of partial sleep with a “guard post”, the presence of which allows the use of a report, and verbal formulas make it possible to arbitrarily influence various systems of the body, creating an attitude of the body to a specific action. To introduce the patient into a state of hypnotic trance, various known techniques can be used, i.e. using monotonous sound, fixing the gaze, the pass method, the method of verbal images, the shock method, etc. / Svyadosh AM "Neuroses." M. Medicine, 1982, p. 223-231 /.

 Motivated suggestion is continued, it should contain a system of beliefs and explanations, which should be based on actual pathogenetic material, and in patients with the right dominant hemisphere it is necessarily emotionally-shaped. The reported information, which has emotional richness and is concise in form, allows you to introduce an element of concentration, to create a dominant attitude. For example: to eliminate pain, the muscles are relaxed. The breath is calm. Pain under a ray of attention. The ray of attention is gradually scattered. The pain is relieved. The pain is less bright. The pain is mild. Feeling calm. Feeling of freshness. Feeling good. To eliminate fear comes confidence. I take control of myself. Calmness is restored. Decision comes. Fear subsides. Good steady mood. To eliminate irritation, the muscles of the face are relaxed. Calm facial expression. Hands are relaxed. A critical attitude has come to irritation, to its causes, reasons. Instead of a gloomy cloud, a slight mocking smile. Calmness, cheerfulness, joy of overcoming. At the final stage / stage 3 / in patients with the left dominant hemisphere, the main suggestion formula is reflexively associated with a deep breath, and in patients with the right dominant hemisphere with a touch on the left shoulder. In addition, due to lesser possibilities regarding the verbal level of information processing in patients with the right dominant hemisphere, a special technique is included in the psychotherapy system to achieve a positive result. For this, immediately before the patient is taken out of a state of hypnotic trance, the screen is illuminated in green. The psychotherapist directs the patient’s attention to the screen, takes him out of a trance state, verbally helps him to present the ring on the screen, and after 5 minutes of figurative perception, they show a real image of the ring on the screen. In this case, in each subsequent treatment session, the diameter of the ring is reduced and a point is shown at the last session.

 The course of treatment includes 10-12 sessions, which are carried out daily or after 1-2 days.

 Example 1

 Patient B. 19 years. Diagnosis: consequences of a neuroinfection with micro-focal symptoms, asthenic syndrome, neurosis-like state.

 Complaints of severe weakness, fatigue, lethargy, a sharp decrease in mental performance, irritability, distracted attention, heaviness in the head, episodic dizziness of a non-systemic nature, sleep disorder.

 Subjectively associates his condition with childbirth, about which he was informed by a neighbor while relaxing in the village when he was 16 years old.

 Objectively: the patient is asthenized, emotionally labile. Symptoms of oral automatism are noted. Reflexes from the hands on the right are reduced, in the legs are low, torpid. The abdominal reflexes are sluggish, quickly exhausted. In a pose of Romberg a slight tremor of hands. Distal hyperhidrosis. Vegetative disorders in the form of excessive autonomic provision lying lying heart rate of 60 beats per minute, standing 100 beats per minute.

Additional research methods. On the electroencephalogram, pronounced phenomena of irritation of the diencephalic structures, mainly of the left temporal region and pathological changes in the biopotentials of the brain in the frontal lobes. On the rheoencephalogram, an increase in vascular tone in the basin of the vertebrobasilar artery with an amplitude of 0.142 Ohms. On the thermovisiogram of the head, the amplification of infrared radiation of both temporal areas with a temperature of the order of 29 ^o C. When dichotic listening, it was established that the patient’s left hemisphere is the dominant hemisphere.

 The patient underwent a course of psychotherapeutic treatment according to the above method, consisting of 10 sessions.

After the course of treatment, normalization of working capacity, disappearance of weakness, fatigue, heaviness in the head, restoration of sleep, disappearance of micro-focal symptoms, improvement of autonomic functions lying down, heart rate of 70 beats per minute, standing at 80 beats per minute, was noted. On the rheoencephalogram, the amplitude increased to 0.197 Ohms. On the thermovisiogram, the temperature of the temporal has become about 33 ^o C.

 Example 2

 Patient U. 49 years old. Diagnosis: neurosis-like somatogenic / hypertension stage II / condition, astheno-depressive syndrome. Complaints of headache, periodic dizziness, severe weakness, fatigue, decreased memory, performance, sleep disorder.

 Associates his condition with hypertension, about which he was repeatedly treated.

Objectively: the patient is asthenized, emotionally labile. An increase in tendon reflexes from the left limbs, pathological foot reflexes on the left, instability in the Romberg position, ataxia when performing coordinating tests, distal hyperhidrosis, the phenomena of excessive vegetative support
lying heart rate 64 beats per minute, standing 96 beats per minute.

Additional research methods. On the electroencephalogram, pronounced phenomena of irritation of diencephalic structures and mediobasal formations of the left temporal lobe. On the rheoencephalogram, an increase in vascular tone in the pools of the vertebrobasilar and internal carotid arteries with an oscillation amplitude of 0.135 Ohms. On the thermovisiogram of the head, the amplification of infrared radiation of both temporal regions with a temperature of about 29.6 ^o C. When dichotic listening established the dominance of the right hemisphere.

 The patient underwent a course of psychotherapeutic treatment according to the method described above, in compliance with the features provided for patients with dominant right hemisphere, consisting of 12 sessions.

After the treatment, the patient's condition improved significantly. Headaches, weakness decreased, performance increased, sleep improved. Indicators of vegetative support were recovered lying flat heart rate of 68 beats per minute, standing 82 beats per minute. On the rheoencephalogram, the amplitude of the oscillations increased to 0.168 ohms. On the thermovisiogram restored the intensity of infrared radiation in the temporal regions of the order of 33 ^o C.

 The proposed method of treatment was tested on 10 patients / 6 men, 4 women / aged 19 to 51 years with neurosis-like and borderline disorders represented by astheno-agripnic, astheno-depressive and depressive-hypochondria syndromes. In 6 patients, disorders developed within the framework of a neurosis-like state, in 4 patients within the framework of a borderline state on somatic and exogenous organic soil.

 Evaluation of the therapeutic effect was carried out through clinical observations, taking into account the data of a dynamic experimental psychological study.

 The effectiveness of the proposed method of treatment is shown in the table. As a control group, we used the data obtained by us in the treatment of patients without taking into account the dominant hemisphere of the brain, which in the clinical structure of the disease did not differ significantly from the experimental one.

As can be seen from the table, the treatment period was significantly reduced and amounted to 10-12 sessions. Significant improvement was observed in 50% of patients, while the condition did not change in only 10%
Thus, the application of the proposed method allows patients with neurosis-like and borderline conditions after 8-12 sessions to get mood equalization, increase activity, restore working capacity, normalize sleep and appetite, improve sensory-motor activity, and increase memory capacity. The proposed method also allows in a significant number of cases to abandon the use of psychotropic drugs with a number of contraindications and side effects, reduce treatment time and increase therapeutic efficacy. The method can be implemented on an outpatient basis.

Claims (4)

 1. A method of treating neurosis-like and borderline conditions, including an individual and / or group psychotherapeutic intervention, at the preliminary stage of which history data are collected and evaluated, the dynamics of somatic suffering are examined, at the first stage of the session, taking into account the obtained diagnostic data and the etiology of the disorder, rational psychotherapy is carried out sedative and distracting effect, in the second stage they carry out a detailed psychotherapeutic effect, first in a state outgrowths, and then in a state of hypnotic trance, carry out motivated suggestion, including clarification and activating suggestion using unconditionally reflex reinforcement, and at the third stage create a psychotherapeutic depot, characterized in that at the preliminary stage the dominant hemisphere of the patient’s brain is additionally determined and at the stages of the treatment sessions in patients with left dominant hemisphere, rational psychotherapy, suggestion and suggestion are carried out using verbal-logical communication aspect, and in patients with the right dominant hemisphere using perceptually-shaped representations, in this case at the final stage of the session in patients with the left dominant hemisphere, the main suggestion formulas are reflexively associated with a deep breath, and in patients with the right dominant hemisphere with a touch on the left on the shoulder and additionally, when a patient with the right dominant hemisphere is withdrawn from a state of hypnotic trance, they are shown a green screen using verbal suggestion to help They present the image of the ring on the screen, after five minutes they show the real image of the ring on the screen, and at each subsequent treatment session, the diameter of the ring is reduced and the point is shown at the last session.  2. The method according to claim 1, characterized in that when conducting group psychotherapy, the group is formed in such a way that it includes patients with an identical dominant hemisphere.  3. The method according to claims 1 and 2, characterized in that the dominant hemisphere is determined using the method of dichotic listening, and / or analysis of motor activity, and / or psychological tests on the degree of use of the right and left hands in various activities.  4. The method according to PP.1 to 3, characterized in that the course of treatment includes 10 to 12 sessions conducted daily or after 1 2 days.

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