RU2741226C1 - Method of preventing aggression of persons with internet addiction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to psychiatry, and can be used for prevention of aggression of individuals aged 14 to 18 years with internet addiction. Method involves examination of a patient, in which the intensity of Internet addiction (SAD_Ch) and points are determined by the Chen scale, the total aggressiveness index (GIA_BD) and points are determined on the Buss-Durkey scale. That is followed by calculating a therapeutic approach selection coefficient (C_TS), scores by formula: C_TS= SAD_Ch+GIA_BD. If C_TS<80 points for 3-6 months, family psychotherapy is performed. If value C_TS≥80 points of family psychotherapy for 3-6 months are supplemented by administering 200 mg of carbamazepine in morning, afternoon and evening.

EFFECT: use of the invention makes it possible to practically exclude aggression in Internet users from age of 14 to 18 years old.

1 cl, 1 tbl, 5 ex

Description

The invention relates to medicine, namely to psychiatry, and can be used to prevent aggression of persons aged 14 to 18 years with Internet addiction.

Internet addiction is an urgent and widespread problem. Modern population studies in the US and Europe show the prevalence of Internet addiction from 1.5 to 8.2% of the population (Weinstein, A. Comorbidity of Internet addiction with other psychiatric conditions (2015). Journal of Behavioral Addictions 4 (Suppl. 1): 43). At the same time, persons aged 14-18 years seem to be the most vulnerable group (Egorov A.Yu., Grechany S.V., Chuprova N.A., Soldatkin V.A., Yakovlev A.N., etc. Clinical and psychopathological features of persons with Internet Addiction: The Experience of a Pilot Study.S.S. Korsakov Journal of Neurology and Psychiatry. 2020; 120 (3): 13-19. https://doi.org/10.17116/jnevro202012003113).

It is known that Internet addiction is associated with a number of complex psychological, medical, social and legal problems, one of which is the aggression of Internet addicts. It was found that in patients with Internet addiction, the level of aggressiveness is 2.5 times higher than normal (Shutova N.V., Baranova Yu.M. Assessment of the risk of Internet addiction for the mental health of adolescents. Hygiene and sanitation. 2017; 96 (6): 568-572 DOI: http://dx.doi.org/10.18821/0016-9900-2017-96-6-568-572). It has been proved that the severity of aggression correlates with the severity of Internet addiction (Cuneyt Evren, Bilge Evren, Ercan Dalbudak, Merve Topcu, Nilay Kutlu. Relationships of Internet Addiction and Internet Gaming Disorder Symptom Severities With Probable Attention Deficit / hyperactivity Disorder, Aggctression and Negative Affective University Students // Atten Defic Hyperact Disord. 2019 Dec; 11 (4): 413-421.doi: 10.1007 / s 12402-019-00305-8. Epub 2019 May 6).

Today, there is clearly a lack of methodologically verified algorithms for comprehensive assistance to Internet addicts, in particular, in the prevention of aggression. Therefore, the development of new effective methods for the prevention of aggression in persons aged 14 to 18 with Internet addiction is an urgent task of modern medicine.

A search in the scientific, medical and patent literature did not find ways to prevent aggression in persons aged 14 to 18 years old with Internet addiction, therefore the proposed technical solution does not have a prototype.

The objective of the present invention is to develop a simple, highly effective method for preventing aggression in persons aged 14 to 18 years with Internet addiction.

The technical result, which is manifested in the implementation of the proposed method, is the prevention of aggression in persons aged 14 to 18 years with Internet addiction.

The technical result is achieved by the fact that a patient is examined at the age of 14 to 18 years old with Internet addiction, in which the severity of Internet addiction (VIZ _H ), points, is determined according to the Chen scale. On a scale of Bass-Darky determine the aggressiveness of the overall index (OIA _DB), points. Calculate the value of the coefficient of choice of treatment tactics (K _TL ), points, according to the formula: K _TL = VIZ _H + OIA _DB . If the K _TL value is <80 points, family psychotherapy is carried out within 3-6 months. With a K _TL value of ≥80 points, family psychotherapy for 3-6 months is supplemented by administering carbamazepine 200 mg to the patient in the morning, afternoon and evening.

Detailed description of the method.

A patient is examined at the age from 14 to 18 years old with Internet addiction.

According to the Chen scale (Clinical psychometrics. Textbook. Edited by Doctor of Medical Sciences Soldatkin V.A. - M .: KNORUS, 2019. S. 553-555) determine the value of the severity of Internet addiction (VIZ _H ), points ... The patient is offered to follow the instructions:

"Please read the statements in the table and tick the answer option that most closely reflects the nature of your Internet experience over the past 6 months. You are offered 4 options: 1-not at all suitable; 2- poorly suited; 3 - partially fits; 4 - totally fits. "

Each variant of the patient's answer is assessed in a certain number of points; option 1 - 1 point, option 2 - 2 points, option 3 - 3 points and option 4 are estimated at 4 points.

The points obtained are summed up; the result is the value of the severity of Internet addiction (EID _H ) of the patient.

According to the Bass-Darki scale (Clinical psychometrics. Textbook. Edited by V.A. Soldatkin, MD - M: KNORUS, 2019. S. 559-563), the value of the general index of aggressiveness (OIA _BD ) is determined, points ... In this case, the Bass-Darki questionnaire is used, consisting of 75 statements, to which the patient gives the answer "yes" or "no":

1. At times I can not cope with the desire to harm another.

2. Sometimes I gossip about people I don't like.

3. I get annoyed easily, but calm down quickly.

4. If I am not asked in an amicable way, I do not fulfill the request.

5. I don't always get what I'm supposed to.

6. I know that people are talking about me behind my back.

7. If I disapprove of my friends, I let them feel it.

8. If I happened to deceive someone, I felt an excruciating remorse.

9. It seems to me that I am not capable of hitting a person.

10. I never get annoyed enough to throw objects.

11. I am always condescending to other people's shortcomings.

12. If I do not like the established rule, I want to break it.

13. Others can almost always take advantage of favorable circumstances.

14. I am wary of people who are a little more friendly to me than I expected.

15. I often disagree with people.

16. Sometimes thoughts come to my mind that I am ashamed of.

17. If someone hits me first, I will not answer.

18. When I get annoyed, I slam doors.

19. I am much more irritable than I seem.

20. If someone poses as a boss, I always act contrary to him.

21. I am a little saddened by my fate.

22. I think a lot of people don't like me.

23. I cannot help but argue if people disagree with me.

24. People shying away from work should feel guilty.

25. The one who insults me or my family asks for a fight.

26. I am not capable of rude jokes.

27. I am seized with rage when I am mocked at home.

28. When people make themselves bosses, I do everything so that they are not arrogant.

29. Almost every week I see someone I don't like.

30. Quite a few people envy me.

31. I demand that people respect my rights.

32. I am depressed that I do little for my parents.

33. People who constantly harass you deserve to be snapped on the nose.

34. From anger I am sometimes gloomy.

35. If I am treated worse than I deserve, I am not upset.

36. If someone pisses me off, I do not pay attention.

37. Although I don’t show it, sometimes envy gnaws at me.

38. Sometimes it seems to me that they laugh at me.

39. Even if I am angry, I do not use "strong" expressions.

40. I want my sins to be forgiven.

41. I rarely fight back, even if someone hits me.

42. When it doesn't work out my way, I sometimes get offended.

43. Sometimes people annoy me with their presence.

44. There are no people I really hate.

45. My principle: "Never trust strangers."

46. If someone annoys me, I am ready to say whatever I think about him.

47. I do a lot of things that I later regret.

48. If I get angry, I can hit someone.

49. Since the age of ten, I have never shown outbursts of anger.

50. I often feel like a powder keg about to explode.

51. If everyone knew how I feel, I would be considered a person with whom it is not easy to get along.

52. I always think about what secret reasons make people do something nice for me.

53. When they shout at me, I start shouting back.

54. Failures make me sad.

55. I fight no less and no more than others.

56. I cannot remember the times when I was so angry that I grabbed a thing that came under my arm and broke it.

57. Sometimes I feel like I'm ready to start a fight first.

58. Sometimes I feel that life is not fair to me.

59. I used to think that most people are telling the truth, but now I don't believe it.

60. I swear only out of anger.

61. When I do wrong, my conscience torments me.

62. If I need to use physical force to protect my rights, I use it.

63. Sometimes I express my anger by knocking on the table with my fist.

64. I can be rude to people I don't like.

65. I have no enemies who would like to harm me.

66. I do not know how to put a person in his place, even if he deserves it.

67. I often think I lived wrong.

68. I know people who are able to bring me to a fight.

69. I am not upset about little things.

70. It rarely occurs to me that people are trying to anger or insult me.

71. I often just threaten people, although I am not going to carry out the threats.

72. Lately I've become a bore.

73. In an argument, I often raise my voice.

74. I try to hide my bad attitude towards people.

75. I'd rather agree with something than argue.

Calculate the values of the following indices of aggression:

1. Physical aggression: each answer "yes" in questions 1, 25, 33, 48, 55, 62, 68 and each answer "no" in questions 9, 17, 41 is estimated at 1 point; calculate the amount of points;

2. Indirect aggression: each answer "yes" in questions 2, 10, 18, 42, 34, 56, 63 and each answer "no" in questions 26, 49 is estimated at 1 point; calculate the amount of points;

3. Verbal aggression: each answer "yes" in questions 7, 15, 23, 31, 46, 53, 60, 71, 73 and each answer "no" in questions 39, 66, 74, 75 is estimated at 1 point; calculate the score

The obtained values of physical, indirect and verbal aggression are summed up and the value of the general index of aggression (GIA _BD ), points is obtained.

Then the value of the coefficient of choice of treatment tactics (K _TL ) is calculated, points, according to the formula: K _TL = VIZ _H + OIA _DB . If the K _TL value is <80 points, family psychotherapy is carried out within 3-6 months. With a K _TL value of ≥80 points, family psychotherapy for 3-6 months is supplemented by administering carbamazepine 200 mg to the patient in the morning, afternoon and evening.

Family psychotherapy in both cases is carried out as follows. Psychotherapy is based on the strategic approach of M. Erickson and J. Haley (Erickson M., Haley J. Strategies for family therapy - M .: Institute of Humanitarian Research. 2001, 448 pp.), On the basis of which it is assumed that problems with the behavior of the child in one way or another otherwise are directly related to the disorder of intrafamilial relationships. During the sessions, the psychotherapist assesses how family members communicate with each other, collects all the necessary information, builds a working hypothesis about what exactly the existing family problems are. Further work is carried out to stabilize the intra-family hierarchy and develop family rules, as well as the responsibility of family members for non-compliance.

At the first stage, the psychotherapist focuses the attention of family members on the problems in the behavior of an Internet addict, seeking to unite family members in overcoming them together. The specialist helps to unite family members in the process of jointly overcoming difficulties, due to which relations are established between elders, who are then trained to confidently achieve the necessary correction of the behavior of an Internet addict.

An important stage in family psychotherapeutic work is the establishment of intra-family rules and the development, together with family members, of a specific, primarily labor, responsibility of the person suffering from Internet addiction for non-compliance with these rules. Thus, with the active participation of family members, the Internet addiction is overcome with the directing of creative energy to constructive development and preparation for an independent adult life; a decrease in the severity and the final overcoming of dependence in itself leads to a decrease in the risk of acts of aggression. In addition, the acquisition by older family members of practical experience in normalizing the behavior of an Internet addict helps to prevent acts of aggression.

Karmabazepin, registration number Р N003759 / 01. Information from the instructions for use:

Pharmacological group: antiepileptic drug. Active ingredient (MIN): Carbamazepine. Dosage form: 200 mg tablets.

Pharmacological properties: Carbamazepine is an antiepileptic agent, a derivative of dibenzazepine, which also has a normotimic, antimanic and analgesic effect. Carbamazepine activates the central inhibitory GABA-ergic system. Blocks voltage-dependent sodium channels of nerve cell membranes, which leads to functional stabilization of neurons, reduces the activity of excitatory neurotransmitter acids (glutamate, aspartate), interacts with central adenosine receptors (suppression of adenylate cyclase activation).

The practical feasibility of the claimed method is illustrated by examples from clinical practice.

Example 1: patient B., 14 years old, applied to the Department of Psychiatry, Narcology and Medical Psychology of the Federal State Budgetary Educational Institution of Higher Education "Rostov State Medical University" of the Ministry of Health of the Russian Federation (FGBOU VO "Rostov State Medical University" of the Ministry of Health of the Russian Federation).

From the anamnesis. Heredity is psychopathologically burdened: on the mother's side - the grandmother of patient B. was characterized by emotionally labile character traits, suffered from shopaholism; the grandfather had a systematic consumption of alcohol; uncle suffers from computer addiction; the patient's mother has bipolar disorder and shopaholism; the father of patient B. had symptomatic alcoholism; the paternal half-brother of patient B. suffered from alcohol dependence and died from its complications; patient B.'s brother has an accentuation of the personality according to the psychasthenic type, neurosis-like tics.

Patient B. was born from the 9th pregnancy and second birth; this was preceded by 1 medical abortion, 6 miscarriages due to cervical insufficiency. Patient B.'s pregnancy proceeded throughout the course with severe toxicosis: nausea, edema. The doctors diagnosed increased uterine tone, fetal hypoxia. At the 5th month of pregnancy, patient B.'s mother suffered from sinusitis, received antibiotics, the names are unknown. Childbirth - naturally at 41 weeks gestation, after stimulation. From the words of the mother, it is known that the child in the hospital received a head injury. The corresponding medical documentation was not provided. The day after the birth, the child developed a rash, and therefore received antibiotics. In early childhood, he was a very restless child. Was on mixed feeding. After 4 months of life, he began to often suffer from infectious diseases, about which he was treated in hospitals. The doctors diagnosed a decrease in the size of the thymus gland. Concomitant diagnoses were often: "Minimal cerebral dysfunction", "Hypertensive-hydrocephalic syndrome", "Hyperdynamic syndrome". Received course treatment: diacarb, phenibut, stratter. At the age of 10 months, for the first time against the background of a cold, bronchospasm was noted, which was stopped by a single administration of aminophylline; later, at the age of 10, he was diagnosed with bronchial asthma. At the age of 2, patient B. with his parents moved to a new place of residence in the village. This was done by the patient's family in order to regularly give him goat milk for medicinal purposes. Living in the village, patient B. began to get sick less often. Enuresis was observed up to 3 years.

He was brought up in a structurally and functionally complete family. The mother paid more attention to the child. The upbringing was notable for its inconsistency. Patient B. often manipulated his father, who often fulfilled his requests, "learned to achieve his own by any means." He did not show emotional attachment to his mother, except for those cases when he fell ill with something and needed help. Patient B.'s mother did not punish. He was afraid of his father, obeyed, "for disobedience he could get a belt." For example, he could not react in any way to his mother's comments about his improper playing of the violin, but if his father made such a comment, he immediately corrected his mistake.

Beginning at the age of 3, patient B. had reactions in the form of motor excitement, screaming, crying whenever the mother had to leave the house. He did not explain his behavior in any way. At the age of 4, during the examination, acetone was detected in urine tests once.

Patient B. attended kindergarten from 4.5 years. I adapted to new conditions within six months. At home, his mother complained of discomfort when interacting with other children. The team did not accept generally accepted rules. I could not find a common language with my older brother. He was formed by a moderately sociable, cheerful boy. Preferred outdoor games. From 4.5 years he studied English. From 5.5 years old I became interested in music: I liked not the process, but a good result. At first I enjoyed playing the violin. The teacher at the music school found in patient B. good abilities in this direction. In the winter, patient B. refused to attend music classes, citing the darkness outside. At the same time, there was no fear of the dark. Often he persistently refused the offers of his parents, which he did not like. As a child, he was afraid of a machine haircut in a hairdresser, which he did not admit at home. Once he ran away from a hairdresser and went for several days with a haircut half done.

When patient B. was 6 years old, his parents bought him a play station. I was glad to buy, spent a lot of time playing, after 1 month the mother noted that patient B. could not stop playing on the console on his own - he was “immersed in the game”. During the game, he did not hear anything from what his mother told him. The game on the console was accompanied by emotional reactions. I played almost daily for 1 year, after which the console broke. Patient B. asked his parents to fix it or buy him a phone with games, but this was not done by the parents.

I went to school at the age of 7. He showed leadership qualities in the team. In addition to schoolwork, he studied vocals, music and English. From the age of 8, I began to spend more time watching TV. Patient B. found it difficult to “distract from the TV”. The mother noticed that while watching TV programs, patient B. had a certain "immersion" in them. If his parents made comments to him about spending a long time in front of the TV or turned off the TV, he always showed irritability in response. I could not tear myself away from watching TV programs, I ate in front of the TV screen. He preferred colorful Japanese cartoons with a fantastic plot or TV series. The viewing time averaged about 3 hours a day, after which he turned off the TV at the request of the mother. When my parents were not at home, I could sit in front of the TV for almost a day. This attraction to watching TV was noted for 1 year. However, the old interests remained. So, from 8 to 10 years old he often participated in music competitions, often winning prizes, but he always played in his own way, "according to his own rules, as he liked."

Parents bought a computer when patient B. was 11 years old. I immediately started playing computer games. At first I played for 1 hour, right after returning from school, while the computer was free. Most of the computer was used by the brother of patient B. Knowing that he would not be able to play without a password, he first turned on the computer, then demanded that his mother or brother, who was at school at the time, give the password. When the brother came and took the computer for himself, patient B. fought with him, knocked on the closed door of his room for a long time.

At the age of 12, while resting in a summer camp, he showed sympathy for the girl, communicated with her with pleasure, showed her attention. After returning home, he continued to communicate with her "in contact".

At the age of 12, he became interested in military-patriotic modeling: he was attracted by fantastic figures, which he sculpted, painted, and then played with. I devoted 2-3 hours a week to this activity. Using the Internet, he independently found an adult man who was also engaged in similar activities, patient B. asked to sell him the figurines. Patient B. learned from him that in the House of Pioneers, adult men play "live" in military-strategic games with the help of these figures. He persistently asked his parents to take him there. At first he was only a spectator, but then he began to play with the others in tournaments. Won a tournament among players 5 years older than him. At the same time, he asked his mother to stay away from him so that others would not know that he had come with his mother. Once, when his mother refused to take him to the House of Pioneers, patient B. got out of the car in the middle of the road and walked in the right direction. His mother had to put him back in the car, after which she called the police children's room to persuade patient B. not to go there.

At the age of 13, he began to make persistent demands on his parents about buying him a personal computer. At the age of 14 I received a present from my parents for my birthday - a tablet, which I was not particularly happy about, because expected to get a powerful desktop computer for gaming. Since that time, I spent 4 - 5 hours a day playing computer games. He stopped computer activity due to the appearance of a headache, fatigue. At night he went to bed with a tablet in his hands, "it helped to fall asleep." Soon I began to take the tablet with me to the toilet, playing there for 50 minutes. He refused to leave the toilet as soon as possible to the comments of his relatives. If the mother took the tablet away, then he showed both verbal and physical aggression: he fought, wringed her hands, threatened to sue the mother. He did not enter into conflict with his father because of fear of punishment: his father beat him with a belt for disobedience.

Interests in other spheres of life, not related to the computer, have significantly decreased: he has given up sports, music, does not go to the pool. He showed a desire to become an e-sportsman. If patient B. was not stopped, he could play at the computer all day. If you didn't have access to a computer or tablet, played games on your phone. On a summer vacation with my mother and brother, I found a cafe with free Wi-Fi, and, instead of walking with family to the sea, spent time in this cafe every day for a week, playing games and chatting. He started playing computer games in the morning before school, reacted to his mother's refusal with irritation, aggression, and in protest he crumpled the clothes that his mother was ironing at that time. During his stay at the computer, patient B. did not notice how quickly time passed. Patient B. himself believes that he spends a maximum of 2 hours a day at the computer, when, according to objective information, he plays for 6 hours. The presented objective data about his time spent at the computer casts doubt, referring to the fact that "the mother is deceiving the doctor." Against the background of patient B's long stay at the computer, school performance declined. Plays online games Dotta 2, World of tanks, Fifa; “I like the process in the game”. According to objective data, after repeated unsuccessful requests from parents to turn off the computer, they resort to a sole decision and turn off the router themselves. At the same time, patient B. reports that the parents turn off the router without warning. In addition to playing games on a computer, I often watched films on the Internet. Several times, having come home, he sat down to play, closing the front door, played for a long time, not noticing that his mother repeatedly rang at the door, and “maybe he didn’t want to let her go home so that he didn’t have to turn off the computer.” If he was at home alone or with his mother, he ate at the computer. According to objective data, patient B. began to "think worse", decreased concentration of attention. As soon as patient B. had free money, he tried to buy products “forbidden by his mother”: sweet soda, lots of sweets. I often began to deceive, the sense of responsibility diminished.

Somatic status: No complaints. Pulse = 78 beats / min, BP = 115/75 mm Hg. Art. The abdomen is soft, the stool is regular, the liver is of normal size.

Neurological status: no focal symptoms were found.

Mental status: entered by invitation. Allopsychic and autopsychic orientation is preserved. The appearance is neat. The vocabulary is sufficient. Complains of an occasional headache, eye fatigue, pain in the back. With a targeted survey, he reports that he spends a lot of time at the computer, playing online games. Has a pronounced desire to play computer games. Notes the loss of quantitative control while playing on the computer. Due to an uncontrollable pathological attraction, he began to play computer games right in the morning in front of school. According to objective data, patient B. began to show deceit, the sense of responsibility decreased, for example, he could easily refuse to perform at a music concert for no reason, which was not typical for him before. He complained of a lack of mood, poor memory and attention. However, when playing on the computer, the mood immediately returned to normal. He remembers the games "everything, to the smallest detail": what advantages he has in the game, weapons, how many points accumulated, even remembers the number of points scored for each character. He repeatedly missed appointments with the doctor, referring to the fact that he had forgotten, while spending time playing computer games. He notes that sometimes he sets himself the goal of playing for a certain time, but then “the game is addictive” and cannot stop. Especially waiting for the end of the game to go and perform physiological functions. It can close in the toilet room with a tablet, playing games, so it can spend up to 1 hour. He accepts food only near the computer, and then relatives have to warm food several times, because patient B. is busy playing. In the course of the game, complete immersion in it appears: "I sometimes do not understand how I move the mouse, it seems that I am that character."

A consultation was held. Conclusion: Internet addiction with violent behavior.

For the prevention of aggression, Internet-addicted patient B. with Internet addiction, a study was conducted according to the claimed method.

According to the Chen scale (Clinical psychometrics. Textbook. Edited by Doctor of Medical Sciences Soldatkin V.A., Moscow, KNORUS, 2019. S. 553-555), the following results were obtained: point 1-2 points, 2-4 points , 3-3 points, 4-3 points, 5-2 points, 6-2 points, 7-1 points, 8-2 points, 9-2 points, 10-2 points, 11-3 points, 12-2 points , 13-3 points, 14-2 points, 15-4 points, 16-4 points, 17-4 points, 18-2 points, 19-3 points, 20-1 points, 21-2 points, 22-3 points , 23-3 points, 24-2 points, 25-2 points and point 26-3 points.

Determined the value of the severity of Internet addiction (EID _H ), points: EID _H - 66 points.

According to the Bass-Darki scale (Clinical psychometrics. Tutorial. Edited by V.A. Soldatkin, MD, Moscow, KNORUS, 2019, pp. 559-563), the following results were obtained:

1. Physical aggression. Question 1 - yes, 25 - no, 33 - yes, 48 - no, 55 - yes, 62 - yes, 68 - no, 9 - yes, 17 - yes, 41 - yes. Points total - 4.

2. Indirect aggression. Question 2 - yes, 10 - no, 18 - yes, 42 - yes, 34 - no, 56 - no, 63 - no, 26 - no, 49 - yes. Points total - 4.

3. Verbal aggression. Question - 7 - no, 15 - yes, 23 - no, 31 - yes, 46 - no, 53 - no, 60 - no, 71 - no, 73 - no, 39 - yes, 66 - no, 74 - yes, 75 - yes. Points total 3.

The obtained values of physical, indirect and verbal aggression were summed up, having received the value of the general index of aggressiveness (GIA _BD ), points. OIA _DB = 11 points.

Then the value of the coefficient of choice of treatment tactics (K _TL ) was calculated, points, according to the formula: K _TL = VIZ _H + OIA _BD = 66 + 11 = 77.

Since the condition was met: K _TL = 77 <80 points, patient B. within 6 months was prescribed and carried out family psychotherapy according to the method of M. Erickson and J. Hayley (Ericson M., Hayley J. Family therapy strategies. M .: Institute of General Humanitarian Research. 2001, 448 p.).

During the sessions, the psychotherapist assessed how family members communicate with each other, collected all the necessary information, built a working hypothesis about what exactly the existing family problems are. Further, work was carried out to stabilize the intra-family hierarchy and develop family rules, as well as the responsibility of family members for non-compliance with them.

At the first stage, the psychotherapist focused the attention of family members on the problems in the behavior of an Internet addict, seeking to unite family members in overcoming them together. The specialist helped to unite family members in the process of jointly overcoming difficulties, due to which relations were established between elders, who were then trained to confidently achieve the necessary correction of the behavior of an Internet addict. An important stage in family psychotherapeutic work was the establishment of intra-family rules and the development, together with family members, of a specific, primarily labor, responsibility of a person suffering from Internet addiction for non-compliance with these rules. Thus, with the active participation of family members, the Internet addiction was overcome with the directing of creative energy to constructive development and preparation for an independent adult life; a decrease in the severity and the final overcoming of addiction in itself led to a decrease in the risk of acts of aggression. In addition, the acquisition by senior family members of practical experience in normalizing the behavior of an Internet addict and preventing acts of aggression contributed to the stability of the achieved treatment results.

Based on the results of 6-month work: Patient B.'s aggression was completely stopped, thoughts about the computer were leveled, pathological craving for the Internet practically disappeared, the time spent at the computer significantly decreased, the mood became euthy, irritability disappeared, new hobbies and interests appeared, academic performance in school.

Example 2: patient L., 18 years old, applied at the initiative of relatives to the Department of Psychiatry, Narcology and Medical Psychology of the Federal State Budgetary Educational Institution of Higher Education "Rostov State Medical University" of the Ministry of Health of the Russian Federation to choose a method for preventing aggression.

From the anamnesis. Heredity is aggravated by addiction to computer games in his paternal uncle, neurodermatitis in his mother.

Born from the first, without pathology, pregnancy. Childbirth by cesarean section, newborn weight - 3750 g, height - 52 cm; screamed at once. From 2 weeks on artificial feeding, due to polyallergy. From 2 to 7 years old he lived with his family in the Arctic. He grew obedient, got along with new people with difficulty, behaved "carefully" with them, at the same time, within the family he was kind, sympathetic, cheerful. Until 4 years old he was brought up at home, after that he went to kindergarten. Adapted easily, took part in matinees. He often caught cold, as a result of which he was at home under the supervision of a nanny in the winter. From 4.5 years of age, stuttering, dysarthria appeared - he worked with a speech therapist. Education by the type of dominant hyperprotection.

The first experience of a computer game - at the age of 6. He played irregularly, mainly in the company of his own uncle, who, according to the patient's father, spent a lot of time at the computer. The episode lasted no more than 2-3 hours.

At the age of 7, patient L. went to a full-time boarding school, where his grandmother and mother worked. Until the 9th grade I studied at "good" and "excellent", with pleasure. He took an active part in the life of the school. Graduated from the 9th grade "excellent". In his free time, he talked with friends, played, walked, spent a lot of time with his parents (hiking, skiing). At the age of 12 he suffered severe pneumonia without complications. Puberty from 15 years.

From the age of 15 he began to play on-line the role-playing game "World of Workraft". The time spent at the computer has increased to 6-8 hours a day. At the same time, he felt a sense of emotional uplift, "inspiration", which remained outside the game. Being in this state, he fantasized with pleasure, imagining himself as a "hero", coming up with a variety of fantastic adventures with his own participation. Remarks and other attempts by parents to limit the time spent at the computer did not lead to results. He played mainly in the evening and night, to the detriment of sleep. On awakening I felt lethargic, sleepy. Conversations with friends began to be reduced to a discussion of computer games. At the age of 16, by the decision of his parents, he entered the lyceum. With the group "did not get along", he preferred to be alone, for about six months "relations were neutral", after that peers began to hurt him, "do all sorts of dirty tricks." He motivated his parents that "the guys are not of his circle." At the same time, the passion for computer games increased, he could play for up to 8-10 hours in a row, mainly at night. By that time he was fascinated by several computer games, but the main hobby was "World of Workraft". I missed classes, could not attend them for 3 weeks, then return for a month, then again misses, deceived my parents - claiming that "everything is fine at the lyceum." At home he was passive, did not show initiative in household chores. In the 10th grade, academic performance dropped sharply: satisfactory grades prevailed. On this basis, conflicts with parents began to arise. In case of the forced impossibility of using the computer, I constantly thought about the game, felt a pronounced desire to return to it. He began to show pronounced reactions of the opposition, "rudeness", became more "headstrong". Parents persuaded to change the lyceum to another school, however, decided to stay in the lyceum. I moved to another class, where relations with peers were "tolerant". Based on the results of a well-passed USE, with the support of parents, I entered the university, planning to “start everything as normal”. I studied for about 2 months without any complaints, easily. At the same time, he continued to play actively, as a result of which he did not get enough sleep, began to miss classes, at first occasionally, then regularly; I "abandoned" my studies and was expelled, about which I did not experience strong feelings. Intra-family scandals intensified and became more frequent, often showed physical and verbal aggression. I played a lot. Somatic status: normal.

Neurological status: cranial nerves are normal. The reaction of the pupils to light is lively and friendly. Active movements in full; strength is somewhat reduced in the left limbs; tendon reflexes S <D; no sensitivity disorders. Stable in the Romberg position. Performs coordination tests correctly.

Mental status: Consciousness is clear. It is oriented correctly in all areas. Outwardly neat. Keeps tense, alert. Eye contact is not always maintained. After a while, he begins to behave more confidently. Mimic reactions are lively, adequate to the situation. Active pantomime, angular movements. Answers questions in terms of the given. Speech is grammatically correct, at a normal pace. The reason for the appeal is considered "inability to organize your day." With a directed inquiry, it turns out that about 3 years ago he was actively interested in computer games, for which he could spend up to 8-12 hours a day. In the classroom I could not concentrate, I thought about the game. Describes the characters in the game, focusing on their uniqueness, on their achievements in their images. In judgments, lightweight, superficial. At the moment, she is worried about the conflict with her parents: "I'm tired of listening to morality." In the future he plans to get a diploma, in the near future - to get a job as a waiter. The background of the mood is even. The state is formally critical.

A consultation was held. Conclusion: Internet addiction with violent behavior.

To prevent aggression, an Internet-addicted patient L. with Internet addiction was studied according to the claimed method.

According to the Chen scale (Clinical psychometrics. Textbook. Edited by Doctor of Medical Sciences Soldatkin V.A., Moscow, KNORUS, 2019. S. 553-555), the following results were obtained: point 1-2 points, 2-2 points , 3-3 points, 4-3 points, 5-2 points, 6-2 points, 7-1 points, 8-2 points, 9-2 points, 10-2 points, 11-3 points, 12-2 points , 13-3 points, 14-2 points, 15-4 points, 16-4 points, 17-2 points, 18-2 points, 19-3 points, 20-1 points, 21-2 points, 22-3 points , 23-3 points, 24-2 points, 25-2 points, 26-3 points.

The value of the severity of Internet addiction (VIZ _H ) was determined, points: VIZ _H = 62 points.

According to the Bass-Darki scale (Clinical psychometrics. Tutorial. Edited by V.A. Soldatkin, MD, Moscow, KNORUS, 2019, pp. 559-563), the following results were obtained:

1. Physical aggression. Question 1 - yes, 25 - yes, 33 - yes, 48 - no, 55 - yes, 62 - yes, 68 - no, 9 - yes, 17 - yes, 41 - yes. The amount of points is 5.

2. Indirect aggression. Question 2 - yes, 10 - no, 18 - yes, 42 - yes, 34 - yes, 56 - no, 63 - no, 26 - no, 49 - yes. The amount of points is 5.

3. Verbal aggression. Question - 7 - no, 15 - yes, 23 - no, 31 - yes, 46 - no, 53 - no, 60 - no, 71 - no, 73 - no, 39 - yes, 66 - no, 74 - yes, 75 - yes. Points total 3.

The obtained values of physical, indirect and verbal aggression were summed up, having received the value of the general index of aggressiveness (GIA _BD ), points. OIA _DB = 13 points.

Then the value of the coefficient of choice of treatment tactics (K _TL ) was calculated, points, according to the formula: K _TL = VIZ _H + OIA _BD = 62 + 13 = 75.

Since the condition was met: K _TL = 75 <80 points, patient L. within 3 months was prescribed and conducted family psychotherapy according to the method of M. Erickson and J. Haley (Erikson M., Haley J. Family therapy strategies. M .: Institute of General Humanitarian Research. 2001, 448 p.).

During the sessions, the psychotherapist assessed how family members communicate with each other, collected all the necessary information, built a working hypothesis about what exactly the existing family problems are. Further, work was carried out to stabilize the intra-family hierarchy and develop family rules, as well as the responsibility of family members for non-compliance with them.

At the first stage, the psychotherapist focused the attention of family members on the problems in the behavior of an Internet addict, seeking to unite family members in overcoming them together. The specialist helped to unite family members in the process of jointly overcoming difficulties, due to which relations were established between elders, who were then trained to confidently achieve the necessary correction of the behavior of an Internet addict. An important stage in family psychotherapeutic work was the establishment of intra-family rules and the development, together with family members, of a specific, primarily labor, responsibility of a person suffering from Internet addiction for non-compliance with these rules. Thus, with the active participation of family members, the Internet addiction was overcome with the directing of creative energy to constructive development and preparation for an independent adult life; a decrease in the severity and the final overcoming of addiction in itself led to a decrease in the risk of acts of aggression. In addition, the acquisition by senior family members of practical experience in normalizing the behavior of an Internet addict and preventing acts of aggression contributed to the stability of the achieved treatment results.

According to the results of 3-month work: patient L.'s aggression was completely stopped, the desire to play significantly decreased, the time spent at the computer decreased significantly, the mood became euthy, irritability disappeared.

Example 3: patient M., 14 years old, applied at the initiative of his family to the Department of Psychiatry, Narcology and Medical Psychology of the Federal State Budgetary Educational Institution of Higher Education "Rostov State Medical University" of the Ministry of Health of the Russian Federation to choose a method for preventing aggression.

From the anamnesis. Heredity: the patient's mother suffered from a tic disorder, the maternal uncle was a heavy drinker.

Patient M. was born from the first pregnancy, the first birth. Pregnancy proceeded with toxicosis in the third trimester. Delivery by Caesarean section, on time. Weight at birth 4150 g. Development is disharmonious, ahead of neuropsychic development: he began to sit and walk on time, speech from 7 months, phrasal speech from one and a half years. He was brought up in an incomplete family by his mother, grandfather and grandmother. The father left the family before patient M. was born. Due to the workload, the mother paid little attention to patient M., which they felt acutely. The grandparents spoiled patient M., allowed a lot, rarely punished him. As a child, he was active, cheerful, sociable, there were always many friends. He was a naughty boy, the mother often had to yell at him for patient M. to do the job. At the age of 1.5 years, there was frequent urination, anxiety, and was diagnosed with astheno-neurotic syndrome. For some time he received a sedative medicine for children. At 2.5, the mother turned to a pediatric neurologist with complaints of excitability, irritability of the child, trembling of the chin, and was diagnosed with "Minimal cerebral dysfunction, astheno-neurotic syndrome." Received glycine at 0.5 t. 3 r. a day and sedative mixture. At the age of 5, a neurosis-like tic was diagnosed: frequent blinking of the eyes; received an infusion of valerian root and glycine, without much effect. At the age of 6, frequent blinking of his eyes persisted, he made moaning sounds, he was diagnosed with "Generalized tic", received pantogam, a calming collection. In connection with the ineffectiveness of treatment, after 2 months, a psychiatric consultation was recommended. The psychiatrist was diagnosed with "chronic multiple tic disorder" and therapy was carried out.

I went to kindergarten at the age of 5. I adapted well to the team, took part in matinees with pleasure, strove for leadership. I spent my free time on the street with friends. I went to school at the age of 7. I adapted well to the team and the workload. I studied excellently until the 5th grade, if I got a lower mark, I always tried to correct it. The learning process was supervised by his grandfather, patient M. enjoyed doing homework with him. He was upset that he was appointed assistant headman, and not headman, said that "this is undemocratic." I enjoyed doing school activities. School behavior was exemplary. In the summer, I always went to children's camps, where I actively participated in various events. At the age of 8, he was diagnosed with "Localized motor tic" and received phenibut, cinnarizine, neuromultivitis, pantocalcin, glycine, clonazepam up to 3 mg per day. From the age of 8 he attended the karate section, studied with pleasure and interest, successfully participated in competitions for 5 years.

When patient M. was 9 years old, his grandfather died, after which patient M.'s academic performance deteriorated sharply due to a decrease in control. He felt the lack of a father in the family, asked his mother to "dye her hair, become like M. Monroe and remarry." After the death of his grandfather, the mood became depressed, at times dreary, he often cried, remembering his grandfather. The appetite has dropped. Sleep was disturbed, I could not sleep for a long time. Decreased desire to do what you love. Sometimes he went out with friends, but did not get the same pleasure. I experienced weakness, lethargy, fatigue. The condition had a classic diurnal dynamics with improvement in the evening. This state lasted about 6 months, after which it self-limited. During these 6 months, I began to spend much more time at the computer, which my mother bought for work some time before my grandfather's death. Patient M. immediately became interested in computer games. At first I played simple games, one hour 1-2 times a week. The mother, seeing her son's interest in computer games, bought the game herself and installed it. Patient M. liked it very much, gradually the interest in the game intensified. After 6 months, the frequency of playing the game increased to 2 hours a day every day. He actively discussed the topic of games with friends, exchanged discs, invited friends home to play together. The mother did not mind giving money to buy discs. After 2 hours of playing, patient M. got tired, a headache appeared, and therefore he stopped playing. While playing on the computer, I felt excitement, a desire to win back. If, during the game, his relatives asked him to complete a task, he would calmly react to it, he could pause the game or turn off the computer to go to complete the task. A year later I asked my mother to upgrade to play games with improved graphics. By the age of 10, the frequency of playing the game increased to 4 hours a day every day. There were no complaints from the mother, because the patient always completed his homework on time. Other interests also persisted - karate, walking with friends. Began to visit the computer room to play with friends. Most often I attended the gym after school, sometimes instead of classes. I played for 3 hours. "The money that my mother gave for meals was only enough for 3 hours of play."

At the age of 12, patient M.'s mother bought her own computer. From this period, the time of using the computer by M. patient increased dramatically - he played practically all day after coming from school. Entering the house, not yet changing clothes, immediately turned on the computer. Immersion in the game appeared, sometimes during the game there was a feeling that he was not only mentally, but also physically in the game: “I sometimes did not understand how I was moving the mouse, it seemed that I was the character I was playing for”. School performance deteriorated. He began to lie to his relatives on trifles. Notes that he lied where there was no need. For example, if the mother asked if he had taken the diary, he would reply that he had taken it, although in fact not. He explains this by the fact that "he wanted to just be left behind." The teacher asked to call the mother to school, to which she said that she could not come due to work.

At the age of 13, I played on the computer every day for many hours. I was waiting for the end of the game to perform physiological functions. It became difficult for his family to "tear" him away from the computer. If they succeeded, then patient M. became irritated, became rude, he could hit his mother, break the phone. In the summer, at the age of 13, I went to a children's camp, where I was bored due to the lack of a computer. The first few days "yearned" for the computer. Patient M. was not interested in communicating, walking, having fun. He was revived only when discussing the topic of computer games with peers. When I was driving back home, I planned in advance that he would come and immediately sit down at the computer and play. When he returned, he began to eat mostly at the computer. From that time on, he began to skip karate classes in order to play on the computer, and then stopped attending the section altogether. Once he left home without warning and did not come home to spend the night - he stayed with a friend, played computer games all night. His mother frightened that she would send him to a boarding school, after which he threatened suicide.

Recently, the patient M. began to complain of impairment of memory and attention. He noted that “in games he remembers everything to the smallest detail - what advantages he has in the game, weapons, how many points he has accumulated, and even remembers the points scored for each character, and serious events, such as a meeting with a doctor, a request from teachers or relatives, forgets. Sitting in the classroom, he develops the tactics of the game, for example, "what house he will build, who will he hire to get points." During recess, he develops joint tactics in the game and negotiates an online game.

Once, when the light was turned off at patient M.'s home for 2 days and he was therefore unable to play computer games, a feeling of irritability, impatience arose: "I could not find a place for myself, rushed about the apartment." Now, during the holidays, I began to sleep less on purpose, set the alarm clock to wake up early and immediately sit down at the computer. Somatic status - no pathology of the internal organs was revealed.

Neurological status - no focal symptoms were identified. Mental status - entered by invitation. Allopsychic and auto-psychic orientation is preserved. The appearance is neat. The vocabulary is sufficient. Complains of an occasional headache, fatigue in the eyes, pain in the back. With a targeted survey, he reports that he spends a lot of time at the computer, playing online games. The disappearance of the ability to control the time spent at the computer worries. If you do not stop the patient, then he can play all day. When the game is prohibited, irritability arises, it becomes rude: "You have to be a strong person to ask me to turn off the computer." In the course of the game, complete immersion in it appears: “sometimes I don’t understand how I move the mouse, it seems that I am that character”. Doesn't notice how quickly time flies during the game. Complains of lack of mood, poor memory and attention. However, when playing on a computer, the mood immediately returns to normal. In games he remembers everything to the smallest detail - what advantages he has in the game, weapons, how many points he has accumulated. He repeatedly missed appointments with the doctor, citing the fact that he forgot how to get to the center, while spending time playing free games in large shopping centers. Notes that sometimes he sets himself the goal of playing for a certain time, but then “the game is addictive” and the patient cannot stop. Especially waiting for the end of the game to perform physiological functions. He accepts food only near the computer. Delirium, hallucinations were not identified. The criticism is formal and incomplete.

A consultation was held. Conclusion: Internet addiction with violent behavior.

To prevent aggression, an Internet-addicted patient M. with Internet-addiction was studied according to the claimed method.

According to the Chen scale (Clinical psychometrics. Textbook. Edited by Doctor of Medical Sciences Soldatkin V.A., Moscow, KNORUS, 2019. S. 553-555), the following results were obtained: point 1-4 points, 2-4 points , 3-3 points, 4-3 points, 5-4 points, 6-2 points, 7-3 points, 8-3 points, 9-2 points, 10-2 points, 11-3 points, 12-4 points , 13-3 points, 14-2 points, 15-4 points, 16-4 points, 17-4 points, 18-4 points, 19-3 points, 20-3 points, 21-2 points, 22-4 points , 23-3 points, 24-4 points, 25-4 points, 26-3 points.

Determined the value of the severity of Internet addiction (VIZ _H ), points: VIZ _H = 84 points.

According to the Bass-Darki scale (Clinical psychometrics. Tutorial. Edited by V.A. Soldatkin, MD, Moscow, KNORUS, 2019, pp. 559-563), the following results were obtained:

1. Physical aggression. Question 1 - yes, 25 - yes, 33 - yes, 48 - yes, 55 - yes, 62 - yes, 68 - no, 9 - yes, 17 - yes, 41 - yes. Points total - 6.

2. Indirect aggression. Question 2 - yes, 10 - yes, 18 - yes, 42 - yes, 34 - yes, 56 - no, 63 - no, 26 - no, 49 - yes. Points total - 6.

3. Verbal aggression. Question - 7 - yes, 15 - yes, 23 - no, 31 - yes, 46 - no, 53 - no, 60 - no, 71 - no, 73 - no, 39 - yes, 66 - no, 74 - yes, 75 - yes. Points total 4.

The obtained values of physical, indirect and verbal aggression were summed up, having received the value of the general index of aggressiveness (GIA _BD ), points. OIA _DB = 16 points.

Then the value of the coefficient of choice of treatment tactics (K _TL ) was calculated, points, according to the formula: K _TL = VIZ _H + OIA _BD = 84 + 16 = 100.

Since the condition was fulfilled: K _TL = 100> 80 points, the patient M. within 3 months was prescribed and carried out family psychotherapy, supplemented by the introduction to patient M. of the drug carbamazepine 200 mg in the morning, afternoon and evening.

Family psychotherapy was carried out according to the method of M. Erickson and J. Haley (Erickson M., Haley J. Strategies for family therapy. M .: Institute of Humanitarian Research. 2001, 448 p.).

During the sessions, the psychotherapist assessed how family members communicate with each other, collected all the necessary information, built a working hypothesis about what exactly the existing family problems are. Further, work was carried out to stabilize the intra-family hierarchy and develop family rules, as well as the responsibility of family members for non-compliance with them.

At the first stage, the psychotherapist focused the attention of family members on the problems in the behavior of an Internet addict, seeking to unite family members in overcoming them together. The specialist helped to unite family members in the process of jointly overcoming difficulties, due to which relations were established between elders, who were then trained to confidently achieve the necessary correction of the behavior of an Internet addict. An important stage in family psychotherapeutic work was the establishment of intra-family rules and the development, together with family members, of a specific, primarily labor, responsibility of a person suffering from Internet addiction for non-compliance with these rules. Thus, with the active participation of family members, the Internet addiction was overcome with the directing of creative energy to constructive development and preparation for an independent adult life; a decrease in the severity and the final overcoming of addiction in itself led to a decrease in the risk of acts of aggression. In addition, the acquisition by senior family members of practical experience in normalizing the behavior of an Internet addict and preventing acts of aggression contributed to the stability of the achieved treatment results.

According to the results of 3-month work in patient M., the aggression was stopped completely, the pathological attraction to the Internet significantly decreased, the exposure of the computer game significantly decreased, new hobbies and interests appeared, and platonic love with a peer arose.

Example 4: patient N., 18 years old, applied at the initiative of his parents to the Department of Psychiatry, Narcology and Medical Psychology of the Federal State Budgetary Educational Institution of Higher Education "RostGMU" of the Ministry of Health of the Russian Federation to choose a method for preventing aggression.

From the anamnesis. Heredity is psychopathologically aggravated by cases of depressive disorders, alcohol abuse on the mother's side.

Patient N. was born from the second pregnancy, the first birth. The pregnancy was going well. Delivery on time, by cesarean section. Was breastfed for up to 3 months. Physical and neuropsychic development corresponded to age norms. I practically did not attend preschool institutions due to frequent ARVI. He was brought up in a complete family, in conditions of overprotection on the part of his parents, with elements of contradiction: there were disagreements in the family about upbringing, "they protected him from everything, gave everything the last for him." The parents at home did everything for the patient N., removed the toys, made the bed, etc. If he refused a certain dish, the father asked the mother to prepare another dish during lunch.

Until the age of 5, I was interested in designers, I liked to collect puzzles, listen to stories from books. At the same age, his parents consulted a neurologist with complaints of irritability, profuse sweating, bruxism during sleep. During the examination, the neurologist revealed “indirect signs of intracranial hypertension, moderately pronounced (closer to significant) cerebral disorders associated with diencephalic divisions of the trunk dysfunction; decrease in the functional lability of the cerebral cortex; pronounced paroxysmal activity of stem genesis with foci in the deep parts of the left hemisphere ”, the diagnosis was made:“ Organic lesion of the central neurological system, intracranial hypertension syndrome, autonomic dysfunction syndrome as a result of diencephalic syndrome. Psychomotor paroxysms. Residual effects of upper right spastic monoparesis. From 5 to 7 years old, 2 hours 2 times a week, he visited the center for early creative development of a child, where he studied with interest. Participated in matinees. I spoke with peers selectively. He was a very jealous boy, being among his parents, he always stood between them, if on the street his mother greeted a stranger, then “threatened” that she would tell my father about it. The parents tried to explain to the patient the incorrectness of his behavior, but he insisted on his opinion. At 6.5 years of age, a neurologist diagnosed "vegetative-vascular dystonia (VVD), cardiac and astheno-neurotic syndromes."

Before entering school, I attended several music lessons, but did not make any efforts, did not continue my studies at a music school.

At the age of 7 I went to school. He studied perfectly, showed diligence in his studies. At the age of 8 he began to study English. School behavior was exemplary. He carefully monitored his appearance, order: he cleaned his shoes, made sure that the school uniform was clean and ironed, always put things in order in his room.

At the age of 11, he was treated in the neuropsychiatric department with a diagnosis of Astheno-neurotic syndrome on a residual-organic background. He complained of curvature of the spine, increased fatigue, irritability, pain in the feet when walking, pain in the cervical spine, rare headaches, and sleep speech. Received the following therapy: Actovegin, Dibazol, Nootropil, Vit. B6, physiotherapy.

The computer appeared in the house when patient N. was 8 years old. He was offended by his parents for buying only educational discs instead of game discs. I spent little time at the computer, played "standard computer games" rarely and a little. From the age of 12, he began to save money given to him to buy food at school in order to buy discs with games on them. At this age, I played on the computer for 2-3 hours 3 times a week. Sometimes, at the request of his parents, he cleaned the apartment, but more and more often refused to do it. At the age of 12, his parents transferred him to a school with an English bias. I easily found a common language with other children, often walked with them.

At the age of 13, he played computer games for 5 hours a day, buying new discs once a month. At this age, several times he took money from his parents without asking to buy chips, Coca-Cola with them, because his parents forbade him to eat it. I also bought discs with games. At the age of 14 in the aqua park he received a closed craniocerebral injury, without loss of consciousness, did not seek help from doctors. At the age of 14, the first test of alcohol and smoking, but without the formation of dependence.

From the age of 14 he spent more time playing computer games. In order to limit his stay at the computer, the parents took the wire from the computer, the monitor, in response to this, the patient became irritable, and broke furniture at home. My school performance deteriorated, I was rude to teachers, I left some classes. On the recommendation of teachers, I attended psychologist sessions. On weekends, he played with the computer from morning to evening, completely stopped cleaning his room, and ate near the computer. He insisted on improving the characteristics of the computer, buying him an iPad, iPhone.

At the age of 15, he complained of numbness in the left leg, foot: 3 episodes lasting up to 30 minutes, weakness, lethargy, increased fatigue, headaches. "I came home from school and fell on the bed, even asked to take off his briefcase, trousers and shoes." He was consulted by a neurologist about his condition, and a diagnosis was made: "Vegeto-vascular dystonia, cephalgic syndrome?" The parents noticed that patient H became somewhat withdrawn, stopped telling them about the events that took place at school. He began to skip lessons, explaining that he did not get enough sleep due to the fact that he “played with the computer” for a long time. At the same time, waking up in the morning, immediately sat down to play. He stopped going to the cinema, walking with friends, watching educational programs that were previously interesting to him. If his parents forbade him to be at the computer, then he could pounce on them with fists. I began to take less care of my personal hygiene, my appearance, so I only bathed on the reminder of my parents. He took food only at the computer, "so as not to break away from the game," while the mother has to reheat the food several times, because the patient cannot stop playing in order to eat. Doesn't interrupt the game even to go to the toilet. Irritability, aggressiveness began to grow, especially in situations where parents forbade being at the computer, so in 2 years he broke the following things: 2 flashlights, 4 cell phones, 2 landline phones, glass in the entrance, interior doors and glass, a flower pot, 2 remote controls, some glass mugs, ironing board, bathroom mirrors, paintings, tore my shirt, my father's jacket. Can beat the cat in anger, throw food on the ceiling. He began to blackmail his parents, saying that if they did not turn on the Internet, he would jump out of the balcony, but he did not make an attempt.

At the age of 16, at the initiative of his mother, he went with her to England for English courses. A large loan was issued for the trip. Then they bought an iPad for patient N. so that he could communicate with his father via Skype. However, while in England, he refused to communicate with his father on Skype, because did not break away from games on the computer, which he asked a peer for. All 1.5 months of my stay in England I played computer games “all day long”.

At the age of 17, he forced his parents to take out a loan to pay for a trip to Italy with a school group. Upon returning from Italy, leaving the train, he immediately told his parents that if they did not connect the Internet, he would not go "neither home, nor to the hospital." Going home during school break, I sat down at the computer to download a certain game, which made me late for class. According to subjective data, he plays computer games for 5 hours a day, according to objective data, according to his parents, he spends 12-14 hours a day playing games.

Somatic status: general condition is satisfactory. Active position. The skin is of normal color, clean. The mucous membranes are clear, the pharynx-mucosa is pale pink. The lymph nodes are not enlarged. The thyroid gland is not enlarged. No edema. Heart sounds are rhythmic. Blood pressure 115/75 mm Hg. heart rate 80 beats per minute. Vesicular breathing in the lungs, no wheezing. The abdomen is soft and painless on palpation. Stool, urine output are normal.

Neurological status: no pathology.

Mental status: I entered the office by invitation. Consciousness is clear. The orientation in all views is preserved. The vocabulary is sufficient. Outwardly neat. Disturbing irritability, mainly during a conversation with parents. He believes that a conflict with parents arises more often due to the fact that the patient spends a lot of time at the computer: according to subjective data, 5-6 hours, according to objective data, 12-14 hours a day. He is "absorbed" into a computer game, when his family tries to distract him from the game, he quickly gets irritated, can show physical aggression. Plays online games late into the night, communicates in chat. He reports that in the morning he is feeling weak and weak. Occasionally, headaches of a pressing character in the temples are disturbed. The mood is generally cheerful, mood swings are situational. Lives up when talking about games, "the record for the last time 5-6 hours of continuous play." He admits that it is difficult for him to stop and stop playing. There is marked physical and verbal aggression against parents who try to restrict it while spending time at the computer. Attention, memory is normal. Delirium, hallucinations are not detected. The criticism is formal.

A consultation was held. Conclusion: Internet addiction with violent behavior.

For the prevention of aggression to the Internet-dependent patient N. with Internet addiction, a study was conducted according to the claimed method.

According to the Chen scale (Clinical psychometrics. Textbook. Edited by Doctor of Medical Sciences Soldatkin V.A., Moscow, KNORUS, 2019. S. 553-555), the following results were obtained: point 1-2 points, 2-4 points , 3-3 points, 4-3 points, 5-4 points, 6-2 points, 7-1 points, 8-4 points, 9-2 points, 10-2 points, 11-3 points, 12-2 points , 13-3 points, 14-2 points, 15-4 points, 16-4 points, 17-4 points, 18-2 points, 19-3 points, 20-3 points, 21-2 points, 22-3 points , 23-3 points, 24-2 points, 25-2 points, 26-3 points.

The value of the severity of Internet addiction (VIZ _H ) was determined, points: VIZ _H = 72 points.

According to the Bass-Darki scale (Clinical psychometrics. Tutorial. Edited by V.A. Soldatkin, MD, Moscow, KNORUS, 2019, pp. 559-563), the following results were obtained:

1. Physical aggression. Question 1 - yes, 25 - yes, 33 - yes, 48 - yes, 55 - yes, 62 - yes, 68 - no, 9 - no, 17 - no, 41 - no. Points total - 9.

2. Indirect aggression. Question 2 - yes, 10 - yes, 18 - yes, 42 - yes, 34 - yes, 56 - yes, 63 - no, 26 - no, 49 - no. Points total - 8.

3. Verbal aggression. Question - 7 - yes, 15 - yes, 23 - no, 31 - yes, 46 - yes, 53 - no, 60 - no, 71 - no, 73 - no, 39 - yes, 66 - no, 74 - no, 75 - yes. Points total 6.

The obtained values of physical, indirect and verbal aggression were summed up, having received the value of the general index of aggressiveness (GIA _BD ), points. OIA _DB = 23 points.

Then the value of the coefficient of choice of treatment tactics (K _TL ) was calculated, points, according to the formula: K _TL = VIZ _H + OIA _BD = 72 + 23 = 95.

Since the condition was met: K _TL = 95> 80 points, patient N. for 6 months was prescribed and carried out family psychotherapy, supplemented by administration of carbamazepine to patient N., 200 mg in the morning, afternoon and evening.

Family psychotherapy was carried out according to the method of M. Erickson and J. Haley (Erickson M., Haley J. Strategies for family therapy. M .: Institute of Humanitarian Research. 2001, 448 p.).

During the sessions, the psychotherapist assessed how family members communicate with each other, collected all the necessary information, built a working hypothesis about what exactly the existing family problems are. Further, work was carried out to stabilize the intra-family hierarchy and develop family rules, as well as the responsibility of family members for non-compliance with them. At the first stage, the psychotherapist focused the attention of family members on the problems in the behavior of an Internet addict, seeking to unite family members in overcoming them together. The specialist helped to unite family members in the process of jointly overcoming difficulties, due to which relations were established between elders, who were then trained to confidently achieve the necessary correction of the behavior of an Internet addict. An important stage in family psychotherapeutic work was the establishment of intra-family rules and the development, together with family members, of a specific, primarily labor, responsibility of a person suffering from Internet addiction for non-compliance with these rules. Thus, with the active participation of family members, the Internet addiction was overcome with the directing of creative energy to constructive development and preparation for an independent adult life; a decrease in the severity and the final overcoming of addiction in itself led to a decrease in the risk of acts of aggression. In addition, the acquisition by senior family members of practical experience in normalizing the behavior of an Internet addict and preventing acts of aggression contributed to the stability of the achieved treatment results.

According to the results of 6 months of work, the aggression in patient N. was stopped completely, the pathological attraction to the Internet practically disappeared, the time spent at the computer significantly decreased, irritability disappeared, new hobbies and interests appeared.

Example 5: patient O., 16 years old, applied at the initiative of his parents to the Department of Psychiatry, Narcology and Medical Psychology of the Federal State Budgetary Educational Institution of Higher Education "RostGMU" of the Ministry of Health of the Russian Federation to choose a method for preventing aggression.

From the anamnesis. Heredity is psychopathologically burdened: along the line of the mother - the grandmother showed "weirdness" and unusual behavior, the uncle - drunken consumption of alcohol and manifestations of cruelty towards loved ones; the patient's mother suffered from a depressive disorder, and the father showed signs of dysphoria.

Was born from the first pregnancy and first birth. In the first trimester of pregnancy, the mother had severe toxicosis in the form of nausea and vomiting, and therefore she reduced food intake. Pregnancy proceeded against the background of the internal tension experienced by the mother of patient O. about the manifestation of verbal and physical aggression towards her by his brother. Delivery on time. Shouted at once. Birth weight 3900 g.

In the first month, torticollis was noted, in connection with which the neurologist suggested the presence of a birth injury - it is known from the words of the mother of patient O. Was on mixed feeding due to hypogalactia in the mother. Early physical and neuropsychic development was age-appropriate. He was brought up in a structurally and functionally incomplete family, the parents of patient O. divorced shortly after his birth.

In preschool age, he showed interest in various calendars: he rewrote numbers, months, liked it when he read books. When he was 2 years old he knew letters and could count. I attended a kindergarten, but called it a "concentration camp". At the same time, he did not complain to his mother about anything. He reported about hostility towards a kindergarten only at school age. Formed by a reserved, shy boy. I took part in matinees, but I felt “squeezed”, “what role was given, that one and performed”. He was distinguished by some slowness, for example, at matinees, other children were actively running, jumping, following the orders of the educators, and the patient stood and looked at them, completing the task only after the teacher's repeated command. Sometimes before going to bed he “muttered something to himself,” without responding at that moment to the mother’s appeal to him. From the age of 4, he successfully studied accordion at a music school.

At the age of 7 I went to school. It was difficult to adapt to the new team. I practically did not communicate with other children. Patient O. often witnessed scandals in the family between his mother and grandmother: he cried, tried to reconcile them. From the age of 8, on the initiative of the mother, in order to protect the patient from listening to constant quarrels and conflicts in the family, he lived with his grandparents on his father's side, where education was of the type of hyperprotection. He had no housework responsibilities, and rarely saw his mother. Due to her busy schedule, the frequency of meetings could be from 1 time per week to 1 time per month. The boy had periodic episodes of unmotivated fear before his grandfather came home: he tried to hide, looked frightened and grimaced, and uttered groans from fear. According to objective information, the grandfather never scolded him, but spoke negatively about the patient's mother. Patient O. went with his grandmother to the sea with pleasure, he loved to swim. The grandmother regularly supervised the performance of homework by patient O. School performance was good, had a good memory, and easily memorized poems. Attended painting classes for 2.5 years. From the age of 7 I began to get involved in computers: several times a week I visited the computer room, where I enjoyed playing "shooters" for 1-2 hours.

From 9 to 13 years old he was friends with a girl, with whom he walked with pleasure, played, went to visit her. At the age of 11, a ten-minute episode was noted once in the daytime, when patient O., sitting on the couch with his mother, suddenly began "muttering to himself in some foreign language." According to the mother, it was like "a spell with a strange intonation from a horror movie." The mother was frightened at that time and did not ask her son anything. Patient O himself did not explain his behavior in any way.

According to subjective data, from about the age of 14, the state began to change: mood decreased, became depressed, former interests and hobbies gradually faded away, became less sociable, memory worsened, attention became scattered, academic performance decreased, fatigue, weakness and lethargy appeared: “I left the last lessons, because I was tired and no longer perceived information ”, I did not make plans for the future, I did not think about my future profession. From the age of 15 he attended martial arts classes - wushu, for 1 year. I reached the 3rd stage in this sport. Against the background of physical exertion, he noted some improvement in mood, however, over time, this also ceased to bring pleasure, and patient O. stopped playing sports. He noted that the mood improved only while playing on the computer. At the age of 16, his own computer appeared. At first I played for 2 - 3 hours a day. During the game, the patient could be distracted and asked to do something. Gradually, the time spent at the computer increased. Sitting in the classroom at school, I planned the time at the computer, fantasized on game themes: "Which car to choose, which weapon to use, etc." However, outside the game, he showed interest in cars, read magazines about cars, discussed this topic with his father.

From the age of 16 he began to eat while sitting at the computer, because "I couldn't stop playing." He spent up to 8 hours playing a computer game. He practically stopped communicating with his peers, communicated with his cousin only at the initiative of the latter. The range of interests has significantly narrowed. It became impossible to "tear" him away from the computer. If relatives at this time turned to him for any reason, he became irritable. Once, during a quarrel with his family, he hit the table so hard that he broke his finger.

Somatic status: No complaints. Pulse = 80 beats / min, BP = 125/80 mm Hg. Art. The abdomen is soft, the stool is regular, the liver is of normal size.

Neurological status: no focal symptoms were found. Mental status:

Entered by invitation. The appearance is neat. During the conversation, he sits in a monotonous position. Answers questions after long latent pauses, most often answers in monosyllables, formally (“I don’t know”). Speech is monotonous, low modulated. The voice is quiet. Denies the presence of attraction to the computer: "I can not play and at the same time do not feel the attraction to the computer, I can easily be distracted." In this case, patient O. plays for 10 hours a day, becomes irritable when he is taken away from the computer. The mood is described as depressed. Sleep is disturbed as late falling asleep. Reduced appetite. From time to time in his room freezes in place. Scattered attention, forgetfulness is noted. Delirium, hallucinations are not detected.

A consultation was held. Conclusion: Internet addiction with violent behavior.

For the prevention of aggression to patient O. with Internet addiction, a study was carried out according to the claimed method.

According to the Chen scale (Clinical psychometrics. Textbook. Edited by Doctor of Medical Sciences Soldatkin V.A., Moscow, KNORUS, 2019. S. 553-555), the following results were obtained: point 1-2 points, 2-2 points , 3-3 points, 4-2 points, 5-2 points, 6-2 points, 7-1 points, 8-2 points, 9-2 points, 10-2 points, 11-3 points, 12-2 points , 13-3 points, 14-2 points, 15-4 points, 16-4 points, 17-2 points, 18-2 points, 19-3 points, 20 - 1 point, 21-2 points, 22-3 points , 23-3 points, 24-2 points, 25-2 points, 26-3 points.

The value of the severity of Internet addiction (EID _H ) was determined, points: EID _H = 61 points.

According to the Bass-Darki scale (Clinical psychometrics. Tutorial. Edited by V.A. Soldatkin, MD, Moscow, KNORUS, 2019, pp. 559-563), the following results were obtained:

1. Physical aggression. Question 1 - yes, 25 - yes, 33 - yes, 48 - yes, 55 - yes, 62 - yes, 68 - no, 9 - no, 17 - no, 41 - no. Points total - 9.

2. Indirect aggression. Question 2 - yes, 10 - yes, 18 - yes, 42 - yes, 34 - yes, 56 - no, 63 - no, 26 - no, 49 - no. The amount of points is 7.

3. Verbal aggression. Question - 7 - no, 15 - yes, 23 - no, 31 - yes, 46 - no, 53 - no, 60 - no, 71 - no, 73 - no, 39 - yes, 66 - no, 74 - yes, 75 - yes. Points total 3.

The obtained values of physical, indirect and verbal aggression were summed up, having received the value of the general index of aggressiveness (GIA _BD ), points. OIA _DB = 19 points.

Then the value of the coefficient of choice of treatment tactics (K _TL ) was calculated, points, according to the formula: K _TL = VIZ _H + OIA _BD = 61 + 19 = 80.

Since the condition was met: K _TL = 80 points, patient O. within 4 months was prescribed and carried out family psychotherapy, supplemented by the administration of the drug carbamazepine to patient O. 200 mg in the morning, afternoon and evening.

Family psychotherapy was carried out according to the method of M. Erickson and J. Haley (Erickson M., Haley J. Strategies for family therapy. M .: Institute of Humanitarian Research. 2001, 448 p.).

During the sessions, the psychotherapist assessed how family members communicate with each other, collected all the necessary information, built a working hypothesis about what exactly the existing family problems are. Further, work was carried out to stabilize the intra-family hierarchy and develop family rules, as well as the responsibility of family members for non-compliance with them. At the first stage, the psychotherapist focused the attention of family members on the problems in the behavior of an Internet addict, seeking to unite family members in overcoming them together. The specialist helped to unite family members in the process of jointly overcoming difficulties, due to which relations were established between elders, who were then trained to confidently achieve the necessary correction of the behavior of an Internet addict. An important stage in family psychotherapeutic work was the establishment of intra-family rules and the development, together with family members, of a specific, primarily labor, responsibility of a person suffering from Internet addiction for non-compliance with these rules. Thus, with the active participation of family members, the Internet addiction was overcome with the directing of creative energy to constructive development and preparation for an independent adult life; a decrease in the severity and the final overcoming of addiction in itself led to a decrease in the risk of acts of aggression. In addition, the acquisition by senior family members of practical experience in normalizing the behavior of an Internet addict and preventing acts of aggression contributed to the stability of the achieved treatment results.

According to the results of 4 months of work in patient O., the aggression noticeably decreased, the pathological attraction to the Internet was reduced, the time spent at the computer significantly decreased, and irritability disappeared.

The proposed method for the prevention of aggression in persons with Internet addiction was examined in 68 patients aged 14 to 18 years, suffering from Internet addiction.

Of these, 42 (61.8%) people, according to the results of the study, had a K _TL value of less than 80 points, i.e. the condition K _TL <80 was satisfied. These 42 patients underwent family psychotherapy for 3-6 months. In 26 (38.2%) people, according to the results of the study, the value of K _TL was 80 or more points, i.e. the condition K _TL ≥80 was satisfied. These 26 patients underwent family psychotherapy for 3-6 months with the introduction of the drug carbamazepine 200 mg in the morning, afternoon and evening.

Complete relief of aggression with persistent de-escalation of family tension was achieved in 62 (91.2%) patients, the remaining 6 patients (8.8%) showed a clear positive trend in the form of a decrease in the frequency and severity of aggression, which confirmed the high reliability of the proposed method.

Thus, the proposed method for the prevention of aggression in persons aged 14 to 18 years with Internet addiction is simple to implement, reliable and is an effective method for solving the problem of aggression in Internet addiction.

Claims (1)

A method for the prevention of aggression in persons aged 14 to 18 years with Internet addiction, including examination of the patient, in which the severity of Internet addiction (VIZ _H ) is determined according to the Chen scale, points, according to the Bass-Darki scale - the general index of aggressiveness (OIA _BD ) , points; calculate the value of the coefficient of choice of treatment tactics (K _TL ), points, according to the formula: K _TL = VIZ _H + OIA _DB ; with a K _TL value of <80 points, family psychotherapy is carried out for 3-6 months, with a K _TL value of ≥80 points, family psychotherapy for 3-6 months is supplemented by administering carbamazepine 200 mg to the patient in the morning, afternoon and evening.