RU2697976C1 - Method of selecting a therapeutic approach to mental disorder - Google Patents

Abstract

FIELD: medicine; psychophysiology.

SUBSTANCE: invention refers to medicine, psychiatry, psychology and can be used to select a therapeutic approach to mental disorder. Performing the immunological, pathopsychological and neurophysiological studies. Immunological examination involves the following: activity of leukocyte elastase (LE), the level of autoantibodies to neuroscientific proteins S-100 (aAT-S100), the level of autoantibodies to myelin basic protein (aAT-MBP), concentration of C-reactive protein (CRP) in blood serum. Pathopsychological examination is used to determine the state of functioning of mental spheres. Neurophysiological examination is carried out by performing EEG and evaluating parameters of evoked potentials by tests: antisaccades, P50, startle reflex (SR). Type of mental disorder is determined based on the set of obtained data. Presence of schizophrenia is established in case of detecting: level LE more than 259 nmol/min ml, level aAT-S 100 and/or aAT-MBP more than 0.81 units o.d., CRP more than 5 mg/l; presence of disturbed thinking in the form of at least one of the following: disorganization, inconsistency, versatility, paralogicality, disintegration, slipping, distortion of generalization processes; presence of emotional disorders: inadequacy of emotions and/or ambivalence; deviation in all three tests or two tests: antisaccades and P50. Presence of a schizotypical disorder is established in case of detecting: a level LE higher than 259 nmol/min ml, aAT-S 100 level below 0.9 units o.d., level aAT-MBP more than 0.81 units o.d., CRP not more than 5 mg/l; presence of thinking disorders by type of overvalued ideas, obsessions in the absence of delusions, disconnection and disorganization of thinking; presence of emotional disorders in the form of at least one of the following: anxiety, fear, depression, social self-isolation; deviation in antisaccade test or in two tests: antisaccades and SR. Presence of non-psychotic disorders – affective, neurotic or personality disorders, is established in case of detecting: a level LE below 280 nmol/min ml, aAT S100 and OBM levels below 0.81 units o.d., CRP up to 5 mg/l; absence of thinking disorders in the form of: disorganization, inconsistency, versatility, paralogicality, breaking, slipping, distortion of generalization processes; presence of emotional disorders in the form of at least one of the following: anxiety, fear, depression, social self-isolation; absence of deviations in three neurophysiological tests or presence of isolated deviation in SR test. If observing schizophrenia, each session of the psychotherapeutic treatment involves: during the acute process: rational psychotherapy with establishing a confidential contact and setting the need for treatment; after relief of acute process: rational psychotherapy with establishment of need for treatment; neurolinguistic programming aimed at replacing negative experiences with positive, psychoemotional state BFB-therapy involving biofeedback and neurofeedback; when achieving stabilization of the condition: rational psychotherapy, during which forming an image of a positive future and motivated to achieve the desired result, neurolinguistic programming aimed at replacing negative experiences with positive, psychoemotional state BFU-therapy involving biofeedback and neurofeedback, Erickson's hypnosis, in the process of which psychopathological symptoms are recovered; psychotherapeutic exposure is combined with receiving psychopharmacological treatment, including neuroleptics and antidepressants selected based on leading psychopathological syndrome. If observing a schizotypical disorder, each psychotherapeutic exposure involves: during the acute process: rational psychotherapy with establishing a confidential contact and setting the need for treatment, as well as Erickson's hypnosis, in the process of which the psychopathological symptoms are recovered; after acute relief of the process and when the condition stabilizes: rational psychotherapy, during which the patient is explained to the psychopathological mechanisms of his painful symptoms and inadequate behavioral reactions, forming an image of a positive future and motivating to achieve the desired result; neurolinguistic programming aimed at replacing negative experiences with positive ones; psychoemotional state BFU-therapy involving biofeedback and neurofeedback; Erickson's hypnosis, in the process of which psychopathological symptoms are recovered; psychotherapeutic exposure is performed with underlying psychopharmacological treatment, including neuroleptics, antidepressants and tranquillizers selected taking into account leading psychopathological syndrome. If observing a non-psychotic disorder, each session of the psychotherapeutic exposure involves: during the acute process: rational psychotherapy with establishing a confidential contact and setting the need for treatment, as well as Erickson's hypnosis, in the process of which psychopathological symptoms are recovered; after relief of acute process and when stabilization of condition is achieved: rational psychotherapy, during which patient is explained to the psychopathological mechanisms of his painful symptoms and inadequate behavioral reactions, forming an image of a positive future and motivating to achieve the desired result; neurolinguistic programming aimed at replacing negative experiences with positive ones; psychoemotional state BFU-therapy involving biofeedback and neurofeedback; Erickson's hypnosis, in the process of which psychopathological symptoms are recovered; psychotherapeutic exposure is conducted with underlying psychopharmacological treatment, including antidepressants and tranquillizers selected with account of leading psychopathological syndrome.

EFFECT: method enables to obtain a positive effect of reducing mental disorders ensured by integrated diagnosis and a treatment regimen that is tailored to the established diagnosis.

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Description

The invention relates to the field of medicine, psychiatry, psychology and can be used for individually oriented treatment of mental disorders in people of working age and not only.

Mental disorder, according to ICD-10, is a clinically defined group of symptoms or behavioral signs characterizing mental disorders that cause distress or maladaptation, which are not a manifestation of normal development or cultural norms. Such disorders are considered systemic multifactorial disorders, in the development of which psychosocial, neuroimmune and neuroendocrine factors are involved.

At present, a universal method of monotherapy has not been identified, and psychopharmacotherapy, in itself, is usually insufficient to achieve effectiveness in the treatment. Due to the fact that the disease is multifactorial, the therapeutic effect should be comprehensive, and its choice in each case should be based on a comprehensive examination of the patient, since only in this case it is possible to achieve the optimal result of the therapeutic measures.

State of the art

The main method of treating patients with mental disorders is psychopharmacotherapy (Davydov AT, Agishev VG Strategy and tactics of choosing treatment methods in psychiatric practice (the role and place of psychopharmacotherapy). Reviews on clinical pharmacology and drug therapy. Volume 3/2004 / 4, p. 42-54). The main objectives of psychopharmacotherapy are the relief of productive psychopathological symptoms and the containment of the progressive nature of the endogenous process. Moreover, the success of combined psychopharmacological therapy largely depends on the strict individualization of the treatment method, corresponding to the psychopathological features and the clinical picture of the disease. The choice of psychotropic drugs in each case is due to the presence of a leading psychopathological syndrome.

A known method of psychotherapy (RU 2173183 C1, S. Semenov, published September 10, 2001), in which rational therapy is carried out, followed by neurolinguistic programming and the patient is brought into a trance state. Before introducing the patient into a trance state, pressure bandages are applied to the fingers of his right and left hands and / or legs. The degree of compression is carried out until a ripple sensation appears. In the process of suggestion, before pronouncing the formulas, the patient focuses on the sensation of pulsation and verbally establishes a connection between the suggested change and the sensation of pulsation. The method improves the effectiveness of the impact. At the same time, although the effect is achieved in 2 ongoing sessions, however, the technique does not take into account the individual characteristics of the patient's condition.

The effectiveness of using various complexes of psychotherapeutic effects in the form of combinations of hypnotic effects and biological feedback (BFB, biofeedback), neurobiological control (neuroBOC, neurofeedback): Shenefelt P.D. Use of hypnosis, meditation, and biofeedback in dermatology // Clin Dermatol. 2017 May-Jun; 35 (3): 285-291. doi: 10.1016 / j.clindermatol.2017.01.007. Epub 2017 Jan 22; Sugarman L.I. et al. Symptoms as solutions: hypnosis and biofeedback for autonomic regulation in autism spectrum disorders // Am J Clin Hypn. 2013 Oct; 56 (2): 152-73; Batty M.J. et al. Relaxation strategies and enhancement of hypnotic susceptibility: EEG neurofeedback, progressive muscle relaxation and self-hypnosis // Brain Res Bull. 2006 Dec 11; 71 (l-3): 83-90. Epub 2006 Sep 1; Olness K. Helping children and adults with hypnosis and biofeedback // Cleve Clin J Med. 2008 Mar; 75 Suppl 2: S39-43.

However, the well-known methods do not take into account the multifactorial nature of the etiology of mental disorder; the principle of individual selection of treatment regimens depending on the type of violation is not disclosed.

Theoretical foundations, the use in our method of development of a complex of three psychotherapeutic methods: biofeedback therapy, Erickson hypnosis, NLP.

With the help of biofeedback therapy, a person learns to regulate his physiological functions, to control the body. Any parameter: pulse, blood pressure, respiratory rate, skin-galvanic reaction, body temperature, EEG rhythm, muscle tension and relaxation, signals from involuntary muscles - can be regulated by a person.

This allows you to influence the body in two directions - neurophysiological (BOS-therapy) and psychological (hypnosis, meditation, autotraining), combining them to achieve the goal.

How is the BOS therapy session going? The necessary biosensor sensors are fixed on the human body, physiological parameters are recorded and transmitted to a computer, processed and shown in an understandable form to the subject. He sees on the monitor screen how his body reacts to thoughts, movements, experiences, and understands that he can regulate all these processes himself.

With urinary incontinence in women, BF-therapy allows you to form an adequate control of the function of the bladder and completely get rid of the problem.

Experiments are being conducted on the use of biofeedback therapy in the presence of tremor. If successful, the person himself is able to reduce the trembling of the arm, head and even the whole body.

Using biofeedback therapy, you can adjust the EEG indicators, change the state of consciousness, increasing mood, self-confidence, and resistance to stress. The undoubted advantage of biofeedback therapy is its visibility. The subject sees a reflection of his behavior in the form of specific readings of devices and can affect his body by dosing the intensity of the load.

Psychophysiological self-regulation is the main goal of the method, the return of information contributes to the relatively rapid development of the skill of physiological control of various functional states of the body and the nervous system in particular.

For the purposes of the proposed method, any suitable sensors are used for the patient, measuring the corresponding parameters of his body.

Neurobio-feedback (neurofeedback, neurofitness) is a specialized area in the framework of biofeedback therapy, which is based on the control of electrophysiological processes in the brain (brain rhythms: alpha, beta, gamma, etc.) using EEG. Many neurological disorders and diseases are accompanied by “irregular patterns” (patterns of rhythmic activity of the brain), mainly the cerebral cortex.

Neurofeedback assessment uses the basis of comparison with regulatory data for EEG recordings to identify “incorrect” samples. EEG feedback trainings allow a person to normalize and optimize brain activity.

The practice of neurofeedback is expanding, covering such problem areas as attention deficit hyperactivity disorder (ADHD), learning disabilities, epi-activity, depression, brain injury, substance abuse, anxiety, etc.

Studies show that biofeedback therapy, alone and in combination with other methods of psychotherapy, is effective in correcting a variety of psychological disorders, from headache and hypertension to attention disorders and numerous phobias. The method has been widely used in neuropathological rehabilitation practice using contactless controllers and virtual reality environments.

Recently, the method of neuro-linguistic programming (NLP) is in demand.

The brightness and apparent lightness of NLP technology, unfortunately, led to the uncritical operation of this approach. A huge number of trainings and seminars are conducted by non-specialists who have mastered, or rather appropriated, these technologies, but are poorly versed in the basics, the concept of NLP (Drapak E.V., 2014).

“Neuro-linguistic programming” is a bulky phrase, behind which are three simple ideas. The “neuro” part reflects the fundamental idea that behavior originates in the neurological processes of seeing, listening, perceiving smell, taste, touch and sensation. We perceive the world through the five senses, extract the “meaning” from the information, and then follow it. Our neurology includes not only invisible thought processes, but visible physiological reactions to ideas and events. One is a reflection of the other on the physical level. The body and mind are an inseparable unity, a human being.

The “linguistic” part of the name shows that we use language to organize thoughts and behavior, entering into communication with other people.

“Programming” refers to the ways in which we organize our ideas and actions to get results.

In the definition of R. Dilts, NLP describes the dynamics of the interaction between consciousness (“neuro-”) and language (“linguistics”) and determines how this interaction affects our activity and behavior.

Here's what is said about NLP in the Psychotherapeutic Encyclopedia: NLP is a “model of human communications and behavior that can be effectively used to organize and describe interactions in psychotherapy, pedagogy, and management with the goal of optimizing them: the modern direction of post-Ericksonian psychotherapy. NLP is based on a number of sources:

1) the study and analysis of the practice of M. Erickson, Satyr, Perls and other representatives of American psychotherapy;

2) on modern data on interhemispheric asymmetry - differences in information processing by the right and left hemispheres; Bateson's works devoted to the "ecology of the mind", with reference to zoopsychological data on the formation of non-standard "creative" stereotypes of dolphin behavior under certain conditions of training;

3) on the transformational grammar of Chomsky, highlighting the deep structures of the language, the rules of organization and transformation of the message;

4) on the research of cybernetics of the 1950-1960s, blurring the boundaries between artificial and natural intelligence; on the theory of logical types of Russell.

Thus, NLP is an interdisciplinary integrative concept of neo-behavioral orientation.

Although NLP was initially positioned as an applied area in psychology and therapy, a number of declared conceptual provisions can be distinguished that underlie the proposed technologies and the knowledge of which makes these technologies understandable.

Conceptual provisions of NLP:

1. Human beings have the ability to learn, regardless of age.

The brain learns very fast. This is both good and bad. It is good that a person can learn quickly and perfectly. It is bad that you can easily learn non-adaptive forms of behavior. For example, a phobia is the result of instant fear training.

2. If someone knows how to do something, then this behavior becomes the object of modeling.

This provision is one of the most important in NLP. It was with his awareness that his formation began. Analyzing the experience of leading experts (V. Satir, M. Erickson), R. Bandler and D. Grinder identified patterns of thinking and behavior that ensure success, i.e. those methods of work that are not always realized, but are used and have a common sequence.

3. Each person within himself has all the resources for change.

The therapist's task is to find access to these resources and update them in a particular situation. NLP provides methods, techniques that provide access to human resources.

4. “Map” is not a territory.

From the point of view of R. Dilts, this is one of the fundamental principles of NLP, meaning that:

• People do not respond to reality, but to their own perception of reality.

• Each person has his own individual “world map”. No separate "map" - a reflection of the world - is more genuine or real than any other.

• The meaning of interpersonal interaction is the reaction that it causes, regardless of the initial intentions of the people who enter into the interaction.

• The most “wise” and “friendliest” cards - those that provide the widest and richest choice of options, and not those that are the most “authentic” or “accurate”.

• People potentially already have all the resources necessary for effective action.

• Any behavior - even the most cruel, crazy and unimaginable - represents the choice of the best option that this person has at the moment, based on his capabilities and abilities, determined by his model, the "map" of the world.

• Changes occur upon the release or activation of suitable resources within a specific context, by enriching the person’s “world map”.

Man can never comprehend the fullness of reality. What we know is only our perception of this reality. We create an idea of the world around us and respond to it through sensory representative systems. And it is our “neurolinguistic” maps of reality, and not reality itself, that determine our actions and give them meaning.

And, as a rule, it is not reality itself that holds back or, conversely, makes us move forward, but our “map” is a reflection of this reality.

5. The goal of modeling human experience is to overcome limitations and turn them into opportunities that are rich in choice. Choice is always better than no choice.

6. “Life and consciousness are systemic processes,” namely:

• The processes occurring in a person and in the interaction of a person with the environment are systemic. Our bodies, communities and the Universe form the ecology of complex systems and subsystems that constantly interact and influence each other. Such systems are based on certain principles of self-organization and, of course, try to come to a state of optimal equilibrium, called homeostasis.

• It is not possible to completely isolate any part of the system from the rest of the system. People cannot but influence each other. Interactions between people form such feedback chains that a person experiences the effects of his actions on other people.

• Systems are self-organizing and strive for a natural state of balance and stability. No defeat - there is only feedback.

• No reaction, experience or deed makes sense outside of its context or out of the response that they entail. Any behavior, experience or reaction can serve as a resource or a limiting factor, depending on how much they are consistent with the rest of the system.

• Not all interactions in the system occur at the same level. What is positive on one level can be negative on another. It is useful to separate one’s deed from one’s self, i.e. positive intentions, function, beliefs, etc., causing this act, from the act itself.

• Any behavior has, at certain levels, a positive intention. It is perceived or perceived as positive and acceptable in the context where it has developed and from the point of view of the person who committed the action. It is much easier and more productive to respond to intention than to problem behavior.

• The environment and contexts are changing all the time. The same action will not always lead to the same result. Successful adaptation and survival require some flexibility. The level of flexibility is proportional to the variability of the rest of the system. As the system becomes more complex, the number of options for its state increases and an increasing degree of flexibility is required.

• The system of logical levels G. Bateson. You can look at any problem from different angles, from different levels. In order for someone to exist in the world, something happened to him, it must be somewhere. This is the level of the environment. Questions addressed to the environment: “Where?” When? ”At this level, it’s difficult to talk about problems; rather, you can solve some problems. For example, it is inconvenient to sit in this chair - you can transfer to another. Do not like a person - you can exclude him from your environment.

The next is the level of behavior. Indeed, in any environment, a person does something (speaks, moves, experiences emotions, breathes, eats, etc.). And you can do something in this environment, or you can do something completely different. Behavioral level questions: “What? What are you doing?"

The level of abilities and capabilities is decisive for behavior. Indeed, in order to implement this or that behavior, you need abilities and capabilities that allow you to do something in this environment. Abilities are a more complex system than behavior. Having the ability to write, this can be done in many ways, i.e. a certain ability determines a fairly wide range of behavior and, accordingly, expands the environment. The question at this level is “How?”

The level of beliefs and values allows us to understand why there can be abilities and opportunities, but a person does not want to do something. The question at this level is: “Why?” Everything that a person consciously and unconsciously attaches importance to determines his behavior, abilities, the ability to choose his environment. If a person is convinced that he cannot do anything (sing, swim, perform in front of an audience), then he will not have the corresponding abilities and capabilities, so he will in every way avoid behavior that is supposedly inaccessible to him. At the level of beliefs, there is a maximum of limitations that can create a rigid and rigid model of the world. Sometimes the level of beliefs dissociates and a person ceases to be aware of his beliefs and values, and begins to live on the basis of the requirements of his environment. This creates the basis for the formation of neurotic behavior and addictions. For there is an internal conflict, which means mental discomfort, which must be removed. Therefore, one of the goals of therapy is to return a person to his true beliefs and values.

An essential level or identity is a basic sense of oneself associated with the basic personal values of the subject. Answers the question: "Who am I?" It is unrecognizable, but very important because it determines everything else. If a woman says “I am mother” in the sense that motherhood is her destiny, this is the level of identity. Each logical level has its own symptomatology, its own problems and approaches to correction and working techniques. A technique has been developed that allows us to separate logical levels that can be mixed up in a person. The higher the logical level of the problem, the more difficult it is to work.

Most behavioral level techniques: integration of anchors, techniques for the rapid treatment of phobias, etc. At the two levels (behavior, abilities and capabilities), the swing technique and six-step reframing work. At the level of beliefs and values, the technique of changing beliefs works, and reprinting affects not only the level of beliefs, but also identity.

In the inventive method, various NLP techniques from this series are used.

7. If your actions do not find the expected result, you need to change the behavior until the desired is achieved.

These provisions are used in the claimed invention to replace negative experiences with positive ones.

Erickson psychotherapy is a technology for providing access to a person’s internal resources necessary for adaptive resolution of his psychological and behavioral problems. Its most important component is Erickson hypnosis - a flexible, non-directive, indirect and permissive model of guidance and use of trance, based on the active interpersonal interaction of the psychotherapist and the client.

The method is strategic in nature, i.e. the psychotherapist identifies the main problems of the client, outlines the goals of psychotherapy and offers certain approaches to achieve them. Its main goal is to correct dysfunctional symptoms and / or maladaptive behavior of those who seek help. Psychotherapeutic interventions largely play the role of the “lever” necessary to start the process of systemic changes. Therefore, M. Erickson said that "psychotherapy often resembles the push of the first domino bone." Learning to cope with symptoms, patients often get rid of rigid mental attitudes. Then beneficial changes can affect other aspects of their lives. According to Erickson, the solution to the problem may not be related to what caused it. Achieving positive results is considered more important than clarifying the past or understanding the meaning and function of the symptom.

The therapeutic effect is carried out both in an ordinary and in a trance state through activation of unconscious mechanisms. The technical arsenal is very diverse. Indirect and open suggestions, associative techniques (stories, metaphors or assignments, searching for pleasant memories, working with images and symbols), hypnosis techniques, paradoxical techniques, reframing, etc. are widely used.

The Erickson approach increases the susceptibility to hypnosis and the effectiveness of work in a trance, avoids or circumvents the resistance that often occurs in a subject when using directive, template hypnotization methods, as well as direct suggestions.

The method is based on two premises:

1. the unconscious part of the psyche of the patient, which, in principle, is ready to work in the interests of the patient and look for ways to health;

2. the unconscious contains the resources necessary to solve almost any human problem, and psychotherapy allows you to access them.

Therefore, the main task of Erickson psychotherapy is the activation and purposeful use of internal resources necessary for positive changes in a person’s life and gaining psychological comfort.

One of the features of the Erickson approach is the desire to avoid complex theoretical constructions when considering specific problems of a particular subject. M. Erickson himself spoke quite definitely about this: “Each person is unique. Therefore, psychotherapy should be carried out so as to meet the needs of this particular person, and not try to adapt the individual to the Procrustean bed of one or another hypothetical theory of human existence. ”

Nevertheless, with certain reservations, the following can be attributed to the theoretical foundations of Erickson psychotherapy:

• general theories of psychology and pathopsychology;

• The theory of an interactive system approach in psychology and psychiatry of the G. Bateson research group;

• consistent basic theoretical principles of a number of psychotherapeutic approaches (strategic, systemic family, cognitive-behavioral, multimodal - the concept of technical eclecticism by A. Lazarus).

Erickson therapy is used for clinical problems: neurotic, associated with stress and somatoform disorders, psychogenic and mixed sexual dysfunctions, dependence on psychoactive substances, personality disorders (anxiety, anancaste), psychosomatic diseases.

In advisory psychology: with problems of interpersonal relationships, including co-dependence; experiencing guilt, loss; low self-esteem, motivation for activity, to increase creativity, stress management, etc.

A distinctive feature of Erickson psychotherapy is that it has a short-term strategic nature with an emphasis on latent, indirect suggestive effects, both in a hypnotic trance and in an awake state.

The main distinguishing feature of the Erickson approach and the most important source of successful therapy is utilization - the therapist’s willingness to use absolutely everything that happens to the patient and around him during therapy.

Erickson's model of psychotherapy involves the use of multi-level communication. If the verbal wording contains many meanings, then on the conscious level only one of the possible meanings of the word is processed, and on the unconscious - all the meanings of the word.

In Erickson psychotherapy, metaphors, humor, and contextual suggestions are simultaneously used to convey several meanings. In the latter case, we are talking about the intonation of certain words in the sentence, which are unconsciously captured by the patient and perceived as inserted commands.

M. Erickson himself considered multilevel speech as a way to activate unconscious processes. It allows you to offer the patient a new solution or a different view of the problem that is not recognized consciously, as suggested by another person.

Ideas proposed in this way can be accepted or rejected, but if accepted, they are recognized as their own, and not imposed from outside.

The Erickson hypnotization model differs from the classical one, which uses the technique of programming a passive patient. In Erickson hypnosis, a relationship based on interaction and collaboration is established between the patient and the therapist. At the same time, the therapist constantly monitors the signals emanating from the patient and makes it clear that he perceives them, thereby encouraging cooperation and deepening of hypnotic functioning. In a trance there is an interaction of two unconscious, their dialogue and exchange of information. According to Jacques Palaci, "the patient uses the psyche of the therapist to complete work that he could not have done alone."

Flexible, adaptive strategies are used to achieve a state of altered consciousness: the psychotherapist first follows the current behavior of the patient (joins his posture, breathing, speech characteristics), and then quietly begins to guide him more and more, gradually introducing him into a hypnotic trance.

Such hypnosis allows the patient's psyche to go beyond the usual limitations caused by past experience, overcome them and gain access to new resources, and, ultimately, to new adaptive models of personal functioning.

Currently, two methods of hypnosis are used (Domoratsky V.A., 2016). One of them uses the classical technique of free association, and hypnosis is a way to overcome resistance.

Another technique developed by M. Erickson and his followers is very flexible. A variety of techniques are used to obtain crowded out material and clarify the causes of a customer’s problems. Within the framework of the Erickson approach, one can successfully work with a problem without knowing its cause. But in some cases, it is useful to find out the origins of problematic behavior or painful symptoms.

Hypnosis allows you to trance to the causes of problems and symptoms in a trance. Moreover, the identified traumatic material can be immediately processed, so a number of hypnosis techniques are diagnostic and therapeutic in nature.

Thus, the main task of Erickson hypnosis, realized in the process of its implementation, used in the developed invention, is to alleviate psychopathological symptoms.

One of the significant problems of psychiatry at present is the emphasis in establishing a diagnosis on the results of a patient survey (Kotsyubinsky A.P. et al. Problems of modern diagnosis of mental disorders. Review of psychiatry and medical psychology. No. 4, 2012, p. 8-11) . Questionnaires took a leading place, including in differential diagnosis. However, practice shows that often patients cannot give objective information; the initially erroneous concept of the doctor conducting the interview can distort the information he collects: usually doctors attach great importance to the first impression of the patient and appreciate only the information that reflects his idea of the patient’s dysfunction; individuals respond differently to interviewers, for example, tend to provide less information to a strict and cold doctor than to a soft and warm doctor, etc.

In this connection, the issue of finding objective methods for differential diagnosis of the type of mental disorder, taking into account the multifactorial nature of this pathology, remains relevant.

The objective of the invention is to develop a personified combined effect, which would be most effective in eliminating mental disorders with long-term preservation of the resulting therapeutic effect.

The technical result of the invention is the acceleration of obtaining a positive effect on the relief of mental, psychological, emotional, behavioral disorders, with the achievement of lasting results - up to a year or more (even in conditions of repetition of traumatic, stressful situations), which is due to the accuracy of the identified type of mental disorder and individually selected, taking into account the established diagnosis, treatment regimen.

The developed method for choosing the tactics of treatment of mental disorder is as follows.

At the first stage, a comprehensive examination of the patient is carried out, including immunological, pathopsychological and neurophysiological studies.

An immunological study (by conducting a neurotest) determines: the activity of leukocyte elastase (LE), the level of autoantibodies to neurospecific proteins S-100 (aAT-S100), the level of autoantibodies to the main myelin protein (aAT-OBM), the concentration of C-reactive protein (CRP ) in blood serum.

In a pathopsychological study, the state of functioning of the mental spheres is determined (by using appropriate questionnaires): thinking, emotions.

A neurophysiological study is carried out by performing EEG and evaluating the parameters of evoked potentials by tests: antisaccades, P50, start-reflex (CP).

At the second stage, based on the totality of the data obtained, the type of mental disorder is determined.

The presence of schizophrenia is established in case of detection: level LE more than 259 nmol / min. ml, the level of aAT-S100 and / or aAT-OBM is more than 0.81 units. opt. pl, CRP more than 5 mg / l; the presence of impaired thinking in the form of at least one of the following: disorganization, inconsistency, diversity, paralogy, disruption, slippage, distortion of generalization processes; the presence of emotional disturbances: inadequacy of emotions and / or ambivalence; deviations in all three tests or in two tests: anti-saccades and P50.

The presence of a schizotypic disorder is established if it is detected: LE levels are higher than 259 nmol / min. ml, aAT-S100 level is below 0.9 units. opt. pl, aAT-OBM level of more than 0.81 units. opt. pl, CRP not more than 5 mg / l; the presence of thinking disorders as super-valuable ideas, obsessions in the absence of delusional ideas, disruption and disorganization of thinking; the presence of emotional disturbances in the form of at least one of the following: anxiety, fear, depression, social self-isolation; deviations in the antisaccade test or in two tests: antisaccades and CP.

The presence of nonpsychotic disorders - affective, neurotic or personality disorders, is established in case of detection: the level of LE is below 280 nmol / min. ml, the level of aAT S100 and OBM below 0.81 units. opt. pl., CRP up to 5 mg / l; lack of thinking disorders in the form of disorganization, inconsistency, diversity, paralogy, disruption, slippage, distortion of generalization processes; the presence of emotional disturbances in the form of at least one of the following: anxiety, fear, depression, social self-isolation; absence of deviations in three neurophysiological tests or in the presence of an isolated deviation in the CP test.

At the third stage, taking into account the revealed mental disorder, individual treatment tactics are selected.

When schizophrenia is detected, each session of a psychotherapeutic effect includes:

during the acute process: rational psychotherapy with the establishment of confidential contact and installation on the need for treatment;

after stopping the acute process: rational psychotherapy with a focus on the need for treatment; neurolinguistic programming aimed at replacing negative experiences with positive ones, biofeedback therapy of a psychoemotional state, including biofeedback and neurofeedback;

upon reaching stabilization of the state: rational psychotherapy, during which they shape the image of a positive future and motivate to achieve the desired result, neurolinguistic programming aimed at replacing negative experiences with positive ones, biofeedback and neurofeedback, biofeedback, Erickson hypnosis, during which the relief of psychopathological symptoms; psychotherapeutic effect is carried out against the background of psychopharmacological treatment, including antipsychotics and antidepressants, selected taking into account the leading psychopathological syndrome.

When a schizotypic disorder is identified, each session of a psychotherapeutic effect includes:

during the acute process: rational psychotherapy with the establishment of confidential contact and the installation of the need for treatment, as well as Erickson hypnosis, during which relief of psychopathological symptoms is carried out;

after stopping the acute process and when stabilization is achieved: rational psychotherapy, during which the patient is explained the psychopathological mechanisms of his painful symptoms and inappropriate behavioral reactions, form an image of a positive future and motivate to achieve the desired result; neurolinguistic programming aimed at replacing negative experiences with positive ones; Biofeedback therapy of psychoemotional state, including biofeedback and neurofeedback; Erickson hypnosis, during which the relief of psychopathological symptoms; psychotherapeutic effect is carried out against the background of psychopharmacological treatment, including antipsychotics, antidepressants and tranquilizers, selected taking into account the leading psychopathological syndrome;

When identifying a nonpsychotic disorder, each session of a psychotherapeutic effect includes:

during the period of acute progress: rational psychotherapy with the establishment of confidential contact and the installation of the need for treatment, as well as Erickson hypnosis, during which relief of psychopathological symptoms is carried out;

after stopping the acute process and when stabilization is achieved: rational psychotherapy, during which the patient is explained the psychopathological mechanisms of his painful symptoms and inappropriate behavioral reactions, form an image of a positive future and motivate to achieve the desired result; neurolinguistic programming aimed at replacing negative experiences with positive ones; Biofeedback therapy of psychoemotional state, including biofeedback and neurofeedback; Erickson hypnosis, during which the relief of psychopathological symptoms; psychotherapeutic effect is carried out against the background of psychopharmacological treatment, including antidepressants and tranquilizers, selected taking into account the leading psychopathological syndrome.

The developed method was tested in the treatment of mental disorders in patients by employees of commercial Centers: Mental Health Center Alliance LLC and Alvian Center for Psychosomatic Medicine and Psychotherapy, whose priorities are to obtain positive results from their work, rather than commercial benefits.

Several groups of patients were formed, which differed in the type of mental disorder and the diagnostic or therapeutic methods performed.

The groups did not statistically significantly differ by gender or age (average age 33 years old - from 24 to 56 years old).

Written consent was obtained from all participants to the experiment, in compliance with ethical requirements. The study did not include patients who, according to the medical records, have objective data on the presence of organic somatic and nervous pathology (in particular, diseases of the cardiovascular system, gastrointestinal tract, respiratory system, organic damage to the central nervous system and sensory organs, etc. .).

All patients of all groups for 2 months before the study and for 2 weeks of the study itself received the average therapeutic dose of psychopharmacological drugs that affect the leading psychopathological syndrome.

In the 1st group (28 patients), the treatment schemes developed by us were applied without a preliminary diagnostic stage, based on a previously established type of mental disorder.

In the 2nd group (40 patients), the method developed by us was used.

In the 3rd group (32 patients), the developed method was used, but the treatment regimen for patients with all three types of mental disorders did not include NLP.

In the 4th group (19 patients with the diagnosis of “psychosis” established by us), only NLP and Erickson hypnosis were performed when the condition was stabilized against the background of psychopharmacotherapy.

All patients in the four groups during the diagnosis showed the above options for the implementation of the diagnostic stage (the second stage described above). For example, in some patients with a diagnosis of “nonpsychotic disorders”, which was established according to the diagnostic technique developed by us, at the diagnostic stage, the following were detected: impaired thinking in the form of disorganization and paralogy, emotional disturbances of the type of anxiety and fear; and in other patients, thinking disorders in the form of tearing and slipping, emotional disorders of the type of depression.

All sessions lasted 1-1.5 hours, were conducted twice a week with a break of 2-3 days until a steady improvement was achieved (when the patient subjectively noted that he no longer needed psychological help, a second test was conducted for mental disorder, as a result of which a decision was made to end psychotherapy).

The safety of the psychotherapeutic effect was monitored after 6 months, 9 months, and a year after the study.

It should be noted that the most effective treatment was carried out in group 2, the patients of which passed the stage of diagnosis and the choice of treatment tactics according to the method developed by us. Significant improvement was observed already from the second session. The acute process was stopped in 1-2 sessions, and stabilization was achieved after 5-6 treatment sessions. The effect persisted for a year after the course of complex therapy, according to our method.

In groups 3 and 4, where NLP and BOS therapy were not performed, respectively, the acute process was stopped by 4-5 sessions, a stable effect was achieved after no less than 10-12 sessions, and lasted no more than six months.

In group 1, the acute process was stopped in only 8 patients by the 7-8th session, and in 9 patients by the 5-6th session. 17 patients of this group, due to the failure to achieve the desired therapeutic results, required an additional examination according to the developed method. The results of the examination revealed the fallacy of the earlier established diagnoses. Correction of the complex method of treatment, taking into account the newly established diagnoses, made it possible to achieve stabilization of the state by 5-7 sessions.

A clinical example demonstrating the effectiveness of the invention.

Patient B., male, 40 years old, higher education, 12 years running an IT company, married, lives in his own apartment, no children. Over the past year, he notes anxiety, fear, the desire for social self-isolation, the fragmentation of thinking. There are no objective data on organic somatic and nervous pathology.

According to a comprehensive examination, according to the method developed by us, a schizotypal disorder was established:

- the results of the "neurotest": level LE 280 nmol / min. ml, aAT-S100 level of 0.6 units op. pl, aAT-OBM level of 0.98 units. opt. pl, CRP 3 mg / l;

- the results of a pathopsychological study: the fragmentation of thinking, anxiety, fear, the desire for social self-isolation;

results of a neurophysiological study: the presence of deviations in the tests of antisaccade and SR.

The patient was assigned:

- Cipralex (Escitalopram) 10 mg. in the morning (antidepressant)

- Eglonil (Sulpirid) 100 mg each. morning and afternoon (antipsychotic)

- Grandaxinum (Tofisopam) 50 mg. 3 times a day (tranquilizer)

Against the background of psychopharmacotherapy, psychotherapy sessions were conducted:

1. during the acute process: rational psychotherapy with the establishment of confidential contact and installation on the need for treatment, as well as Erickson hypnosis.

The acute process was stopped in 3 sessions.

2. after stopping the acute process and when stabilization is achieved: rational psychotherapy, during which the patient was explained the psychopathological mechanisms of his painful symptoms and inappropriate behavioral reactions, an image of a positive future was formed, the patient was motivated to achieve the desired result; neurolinguistic programming aimed at replacing negative experiences with positive ones; Biofeedback therapy of psychoemotional state, including biofeedback and neurofeedback; Erickson hypnosis, during which the relief of psychopathological symptoms was carried out.

After 2 months after achieving stabilization of the state against the background of the complex therapy by the method developed by us, while continuing to take psychopharmacotherapy, the patient underwent an examination, the results of which showed a marked improvement in the condition and, based on the results of repeated testing, psychotherapy was discontinued.

At the same time, after a year, despite the traumatic situations that took place in his life during this period (theft of a new car), the patient's condition remained stable, and there were no relapses of disorders.

Claims (30)

A method for choosing the tactics of treating a mental disorder, including conducting psychotherapy sessions of neurophysiological effects against a background of psychopharmacological treatment by performing biofeedback therapy, the particularities of which are selected taking into account the type of mental disorder determined on the basis of the results of immunological, pathopsychological and neurophysiological studies, moreover, an immunological study determines: the activity of leukocyte elastase (LE), the level of autoantibodies to neurospecific proteins S-100 (aAT-S100), the level of autoantibodies to the main myelin protein (aAT-OBM), the concentration of C-reactive protein (CRP) in blood serum ; with a pathopsychological study, the state of functioning of the mental spheres is determined; a neurophysiological study is carried out by performing an EEG and evaluating the parameters caused by the potentials according to the tests: anti-saccades, P50, start-reflex (CP); Based on the totality of the data obtained, the type of mental disorder is determined: the presence of schizophrenia is established if: level LE more than 259 nmol / min ml, level aAT-S 100 and / or aAT-OBM more than 0.81 units. opt. pl, CRP more than 5 mg / l; the presence of impaired thinking in the form of at least one of the following: disorganization, inconsistency, diversity, paralogy, disruption, slippage, distortion of generalization processes; the presence of emotional disturbances: inadequacy of emotions and / or ambivalence; deviations in all three tests or in two tests: anti-saccades and P50; the presence of a schizotypic disorder is established if: the level of LE is higher than 259 nmol / min ml, the level of aAT-S 100 is below 0.9 units. opt. pl, aAT-OBM level of more than 0.81 units. opt. pl, CRP not more than 5 mg / l; the presence of thinking disorders as super-valuable ideas, obsessions in the absence of delusional ideas, disruption and disorganization of thinking; the presence of emotional disturbances in the form of at least one of the following: anxiety, fear, depression, social self-isolation; deviations in the anti-saccade test or in two tests: anti-saccades and CP; the presence of nonpsychotic disorders - affective, neurotic or personality disorders, is established if: the level of LE is below 280 nmol / min ml, the level of AAT S100 and MBP is below 0.81 units. opt. pl., CRP up to 5 mg / l; lack of thinking disorders in the form of disorganization, inconsistency, diversity, paralogy, disruption, slippage, distortion of generalization processes; the presence of emotional disturbances in the form of at least one of the following: anxiety, fear, depression, social self-isolation;  absence of deviations in three neurophysiological tests or in the presence of an isolated deviation in the CP test; in the identification of schizophrenia, each session of the therapeutic effect includes: during the acute process: rational psychotherapy with the establishment of confidential contact and installation on the need for treatment; after stopping the acute process: rational psychotherapy with a focus on the need for treatment; neurolinguistic programming aimed at replacing negative experiences with positive ones, biofeedback therapy of a psychoemotional state, including biofeedback and neurofeedback; upon reaching stabilization of the state: rational psychotherapy, during which they shape the image of a positive future and motivate to achieve the desired result, neurolinguistic programming aimed at replacing negative experiences with positive ones, biofeedback and neurofeedback, biofeedback, Erickson hypnosis, during which the relief of psychopathological symptoms; psychotherapeutic effect is carried out against the background of psychopharmacological treatment, including antipsychotics and antidepressants, selected taking into account the leading psychopathological syndrome; if a schizotypic disorder is detected, each session of the psychotherapeutic effect includes: during the acute process: rational psychotherapy with the establishment of confidential contact and the installation of the need for treatment, as well as Erickson hypnosis, during which relief of psychopathological symptoms is carried out; after stopping the acute process and when stabilization is achieved: rational psychotherapy, during which the patient is explained the psychopathological mechanisms of his painful symptoms and inappropriate behavioral reactions, form an image of a positive future and motivate to achieve the desired result; neurolinguistic programming aimed at replacing negative experiences with positive ones; Biofeedback therapy of psychoemotional state, including biofeedback and neurofeedback; Erickson hypnosis, during which the relief of psychopathological symptoms; psychotherapeutic effect is carried out against the background of psychopharmacological treatment, including antipsychotics, antidepressants and tranquilizers, selected taking into account the leading psychopathological syndrome; in the detection of nonpsychotic disorder, each session of psychotherapeutic intervention includes: during the acute process: rational psychotherapy with the establishment of confidential contact and the installation of the need for treatment, as well as Erickson hypnosis, during which relief of psychopathological symptoms is carried out; after stopping the acute process and when stabilization is achieved: rational psychotherapy, during which the patient is explained the psychopathological mechanisms of his painful symptoms and inappropriate behavioral reactions, form an image of a positive future and motivate to achieve the desired result; neurolinguistic programming aimed at replacing negative experiences with positive ones; Biofeedback therapy of psychoemotional state, including biofeedback and neurofeedback; Erickson hypnosis, during which the relief of psychopathological symptoms; psychotherapeutic effect is carried out against the background of psychopharmacological treatment, including antidepressants and tranquilizers, selected taking into account the leading psychopathological syndrome.