Разработана система терапии и профилактики, учитывающая специфику формирования невротических расстройств у женщин. Основой системы является этиопатогенетическая психотерапия, которая реализуется в сочетании с фармакотерапией. Специфика психотерапии состоит в предпочтительном использовании недирективных методов, преобладании групповых форм воздействия над индивидуальными и облигатном включении в комплекс психотерапевтических мероприятий семейной психотерапии. При проведении фармакотерапии учитывается ведущая симптоматика, динамика заболевания и предшествующая терапия.
Оценка эффективности разработанной системы терапии и профилактики свидетельствует о ее преимуществах по сравнению с методами, применяющимися без учета гендерной специфики.
Ключевые слова: невротические расстройства у женщин, этиология, патогенез, гендерный подход, клинико-психопатологические, патопсихологические и социально-психологические особенности диагностика и терапия.
SUMMARY
Bakhteyeva T.D. Neurotic disorders in women (etiology, pathogenesis, clinic, therapy). - Manuscript.
Thesis to quest a scientific degree of Doctor of Medical Sciences on specialty 14.01.16 - Psychiatry. – “Institute of Neurology, Psychiatry and Narcology of the AMS of Ukraine” State Institution, Kharkiv, 2008.
In the thesis on the base of a complex clinical-psychopathological, patho-psychological and socio-psychological examination of 316 women with different forms of neurotic pathology (113 with neurasthenia (F48.0), 94 with anxiety-phobic disorders (F40.9), 109 with somatoform disorders (F45.3)) and 127 men with the same forms of neurotic pathology (46 patients with neurasthenia (F48.0), 38 with anxiety-phobic disorders (F40.9), 43 with somatoform disorders (F45.3)) etiological factors, mechanisms of formation, peculiarities of a clinical picture of neurotic disorders in female patients were investigated.
It was found out that development of neurotic disorders in women is stipulated by an action of factors of psychic dramatization with such main features as conjunctioning, mutual strengthening and localization predominantly on a microsocial level. Psychogenias of a macrosocial direction (socio-economic factors) play a background supportive role in a genesis of neurotic disease in female patients. A character peculiarity of psychopathology in neurotic disorders in women is a predominance of depressive and somatized manifestations. Along with this certain peculiarities were defected in the frames of each of the pathological forms.
It was found out that a generalization of psychogenia and a gender-role conflict played a significant role in mechanisms of formation of neurotic disorders in women.
On the base of a gender approach to the analysis of neurotic disorders a model of a neurosogenesis is worked out taking into account specific features of pathology due to patient’s gender.
The complex approach used in this work allowed us to work out gender-based criteria of diagnosis and principles of therapy of neurotic disorders in women.
Key words: neurotic disorders in women, etiology, pathogenesis, gender approach, clinical-psychopathological, pathopsychological and socio-psychological peculiarities, diagnosis and therapy.