Components of the psychological diagnosis
Analysis of the behavior pattern
Psychological examination of the behavior of a patient or an invalid is analyzed according to the current life situation, which are:
- the professional route (how many jobs have been changed, whether there is a professional growth (or decrease), a production characteristic (how often the hospital sheets were in conflict, conflict or not), interviewing representatives from the place of work (team stability), family , informal communication.In the commission, the behavior pattern is analyzed: how the patient entered, how he sat, how he describes his claims.
The choice of methods and data on the behavior of its objectivity is not inferior to the experimental psychological and paraclinical instrumental data.
There are four degrees of declining adaptivity in behavior:
• Light - compensated, close to the behavior of a healthy person;
• Moderately expressed;
• the expressed patient is limited in the activity (for example, the maximum distance of his movement - on an entrance or on a court yard)
• significant - fragments of behavior caused by a significant degree of clinical symptoms.
It is necessary to distinguish between the constant and situational adequacy or inadequacy of behavior. Situational inadequacy of behavior (strangeness, inappropriateness, departing from the canons, as a consequence of various mental disorders) is always associated with the evidence with a nonpsychotic level (hypochondria, phobia), psycho-pathopodic disturbances (intolerance).
The adequacy or inadequacy of behavior is characterized by the homogeneity of the level of adaptability in different situations. If in all life situations (according to the information of a social worker, on visual observations of doctors and nurses), the decrease is the same for all levels.
In the expert judgment, judgments about the person are mainly based on the psycho-biographical method of personality analysis (PBM).
The reasons for this or that behavior in different life situations (study, work, family, informal communication, illness, disability) are analyzed within the framework of the PPS. If necessary, at the request of an expert doctor, all these information may be specified by a psychologist during an experimental study.
Internal disease model
The internal model of the disease (WBM) in the socio-psychological terms is a stereotyped form of response (equifinal) (RM Voitenko). It does not depend on the etiology of the disease and the specific cause of the disease. Equivalent form of response - is a kind of adaptability, adaptation to existence (existentiality).
The internal model of the disease is a two-sided process: it changes the entire structure of the personality, its components and, at the same time, significantly affects the clinic of the disease; degree of disability; on adaptive function, on forms and methods of rehabilitation; on social, medical and biological forecasts.
By internal model of the disease is understood the representation of the patient himself about the features of the clinic, the course of the disease of his social, biological and psychological abilities.
The components of the WBM are distinguished as follows:
1. Autoplastic picture of the disease, defined as a static experience, patients' perception of the disease in time (AR Luria). It includes:
• Amosnestopaticheskaya side of the disease - local pain and frustration frustrate the personality as a whole, can change the course of mental processes;
• The emotional side of the disease - fear, anxiety, anxiety, psychological emotional discomfort. Its roots lie in temperament;
• rational, or informative, side of the disease;
• volitional, or motivational, component.
In the autoplastic picture of the disease, there is a significant relationship between subjective and objective causes - the fewer personal layers (pathopsychological), the less the number of complaints and vice versa.
2. The ambivalence of the experiences of the disease.
First of all, the disease is associated with the breaking of the life stereotype, which has a dual character. The patient acquires some advantages, now he can avoid making an important decision, and shift responsibility for his decisions and actions to others. Socio-psychological situation disease compensates for the inferiority complex. At an older age, the disease allows you to escape from autism (especially in women). In addition, the emerging improvement in the state is also perceived ambivalently.
3. The experience of the disease in time, including several phases:
1) premedical phase - the onset of a disease or exacerbation, when biosocial discomfort occurs. Outwardly it is not always noticeable. In this phase, questions arise: "What should I do? Am I sick or not? How much? Go to the doctor or not? Often there may be a feeling of carelessness: "If I do not pay attention, it will pass by itself";
2) the phase primary frustration. Change of life stereotype: My homeostasis is so disturbed that it manifests itself objectively (hospitalization, sick leave, temporary incapacity for work). In the social plan, an autoplastic picture is formed, i.e. search for care, attention, participation, self-confidence is lost, self-esteem, level of pretension, further life perspective is destroyed;
3) the phase active adaptation, ie. the formation of a realistic perspective (treatment, complications, surgery, etc.). The state of primary frustration is reduced. The installation is forming. There is a positive attitude towards the doctor, illness, hospital, i.e. positive emotional state. The flow time of this phase is from one and a half to two or six months (for example, with tuberculosis). During this period, there may be a turn to recovery, improvement of the condition. If the prospect does not materialize, complications appear and the active adaptation phase goes into the next phase (secondary frustration);
4) the phase secondary frustration - a sudden change in the autosensopathic state (for example, pain intensification). Increased fear, uncertainty, there is a distant perspective, the realization of which the patient seems unreal at the moment. Begin a rough change in the motivational sphere, self-esteem, level of aspiration. New goals, values, interests are being formed. There is a decrease in moral and ethical standards of behavior (for example, violation of the hospital regime, treatment regimen). There is a negative attitude towards medical activities, to medical personnel, relatives. Often, this phase addresses the issue of primary disability;
5) the phase of surrender, the most difficult in the rehabilitation plan. There is an aggravation of all negative disorders in the state of the disease, in an emotional state. The negative components are stabilized: a decrease in self-esteem, a level of claims, a persistent change in emotional tone, suicidal thoughts and attempts, a neurosis-like component is formed.
The end of the phase can have positive and negative outputs: the phase of secondary adaptation, the phase of the formation of compensatory mechanisms or suicide. With favorable the end of the phase of surrender, it goes into the sixth phase;
6) the secondary adaptation phase, or second life in a situation disease. In the formation of this phase, the disease nosology is not so important (except for AIDS). It is important to understand how this disease is treated conservatively; whether the disease restricts life in the home or not; Are signs of this disease visible (visible defects, pain); the socio-psychological cause of the disease (for example, is to blame or not, a domestic trauma or not); socially beneficial disease or not; the situation, the environment in which the disease occurs; who will take care of the family (social and household factor); features of personality. The latter factor is the most important, as it affects the rehabilitation potential of the patient.
At the sixth phase, compensatory mechanisms are triggered. However, not all of them are socially acceptable (for example, drunkenness). There are the following variants of the forms of compensatory mechanisms:
a) through the disease. All personal structures (character, temperament, motivation, etc.) are focused on the disease, introvert and extravert variants of the situation development are possible. Human interests narrow, biological needs predominate: egocentrism develops, the rental system is rigidly formed and stabilized, an abstract perspective is formed: "Here I will recover, then I will do ..."). Avoiding frustration goes through a reassessment of the importance of the system "sickness-health" for themselves, the society, the reference group;
b) through the activity - direct and indirect compensation.
Fig. 8. Compensatory mechanism & quot; through activity & quot;
In the & quot; second life & quot; there is realization of oneself through other types of activities that were not realized before the illness and not connected with it: education, work, sex life, family, hobby, antisocial life.
There comes an emotionally acceptable long-term state - motivation, beliefs, goals, direction are replaced.
4. Type of reaction to the disease.
There are three types of response to the disease: stenotic, asthenic, rational.
Stenic type of response to the disease can be called "fight to the end". It has both a positive side - a struggle for one's health and a negative one - a struggle that takes away all forces and replaces all other activities. As a result, after a few years the patient is relatively healthy, with no family, work, hobby, etc.
Asthenic type of response implies the absence of a fight against the disease. This type of response also has two sides: positive - it is easy to form the "second life" (the sixth phase in the situation of the disease) and negative - the medical and biological potential is not fully realized.
Rational form of the response. In this type of reaction to illness, the patient clearly calculates strengths and opportunities, social, psychological and material consequences. They take into account the forecast and the direction is changing in time.
5. Relation to the situation of the disease. By an adequate relation to the situation of the disease is meant the correspondence of the subjective image to the objective state of the patient. The patient is able to correctly reflect the situation and respond to it.
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