Authors

  • Nilufar Ablaizova
  • Xudoyberdi Amirov
  • Otabek Mardiyev

DOI:

https://doi.org/10.71337/inlibrary.uz.science-research.63685

Keywords:

schizophrenia treatment psychotherapy rehabilitation.

Abstract

The growing interest in psychosis psychotherapy all over the world is explained by recent research on the clinical and economic effectiveness of rehabilitation programs, which makes it possible to see the limits of the possibilities of rehabilitation methods, which have already become traditional in psychiatric practice. It is suggested that you should not create excessive fantasies about existing rehabilitation programs, since they do not solve the strategic task – to treat patients. In addition, in relation to some contingents, they do not solve the tactical task – to return to work in production. If the forms and methods used are not radically changed to a higher order, involving psychodynamically oriented psychotherapy methods, the increasing efforts in these directions will also have no effect.

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EFFECTIVENESS OF THE USE OF MODERN METHODS OF PSYCHOTHERAPY IN

SCHIZOPHRENIA AND VARIOUS PSYCHOSES

1

Ablaizova Nilufar Anvar qizi

2

Amirov Xudoyberdi Olimjon o‘g‘li

3

Mardiyev Otabek Asriddinovich

1-2

Student of group 509 of the medical faculty of Samarkand State Medical University,

Samarkand, Republic of Uzbekistan.

3

Assistant of the department of psychiatry, medical psychology and narcology, Samarkand State

Medical University, Samarkand, Republic of Uzbekistan.

https://doi.org/10.5281/zenodo.14749392

Abstract. The growing interest in psychosis psychotherapy all over the world is explained

by recent research on the clinical and economic effectiveness of rehabilitation programs, which

makes it possible to see the limits of the possibilities of rehabilitation methods, which have already

become traditional in psychiatric practice. It is suggested that you should not create excessive

fantasies about existing rehabilitation programs, since they do not solve the strategic task – to

treat patients. In addition, in relation to some contingents, they do not solve the tactical task – to

return to work in production. If the forms and methods used are not radically changed to a higher

order, involving psychodynamically oriented psychotherapy methods, the increasing efforts in

these directions will also have no effect.

Keywords: schizophrenia, treatment, psychotherapy, rehabilitation.

Introduction.

The desire to ensure that the maximum number of mental patients in the

post-hospital period is among the healthy population is growing in parallel with the trend of

increased relapses due to the low level of adaptation of everyday life to psychosocial stressors in

a certain part of patients. Hope for the recovery of patients with schizophrenia is growing, and in

the conditions of a market economy, the possibility of their employment is declining [1]. This

creates much higher demands for their productivity than a few years ago. Economic costs for

stopping relapses in inpatient settings are growing, which exceeds the cost of keeping this group

of patients constant in wards for chronic patients; there is also a large psychological burden of a

healthy environment, which is associated with the presence of pre-morbid mental patients [2-4].

Further increase in the effectiveness and profitability of treatment is possible only on the

basis of psychotherapy, which is an intervention aimed at optimizing the individual components

of rehabilitation programs and, first of all, increasing the social and labor adaptation of patients.


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Therefore, the general statement of the question about the effectiveness of psychotherapy

has now paved the way for the correct formula: what psychotherapy, under what conditions and in

which patients is effective in relation to certain tasks of the expected result, as well as how the

effectiveness of this psychotherapeutic model changes when its individual parameters change [5-

7]. The answer to such a statement of the question provides a systematic analysis of various groups

of factors related to the subsystems of the patient, the characteristics of the doctor and their

interaction, including those determined by the specifics of this model of psychotherapy. This

complex task has not been satisfactorily solved to this day, which is primarily due to the difficulties

of the general theoretical order [8].

The subsystem of psychotherapeutic model factors and the problem of its direct

implementation during treatment remain the least available to this day. The study of the

psychotherapeutic process comes to the fore, leaving aside the traditional comparison of statistical

measures of the individual state of the patient before and after treatment, which allows us to talk

about a new paradigm in the development of psychotherapy. Now a simple link to the name of the

model used is not enough [9-11]. Psychotherapeutic models are presented in general form in

educational manuals, as a result of which the psychotherapist receives his qualifications not mainly

when reading manuals, but in the process of careful study of relevant practical skills for many

years, in which imitation of the individual style of their mentor plays a large role. All this in

practice can make it much longer than the letter of the classic description of the model used [12-

14].

Most of the research on the effectiveness of psychotherapy so far is carried out without

disclosing the specifics of the doctor's behavior, if the course is carried out by a sufficiently

qualified and experienced specialist, it is carried out at all times and in relation to each lege artis

patient. Since this is not always the case, it is very important to objectively control the

psychotherapy process, to verify that the practical behavior of the doctor is consistent with the

theoretical description of the model he uses [15-18].

It is necessary to clarify not only the compatibility of this model, but also the quality of the

interventions used, since their number is not enough for the success of therapy. Vague opinions

are expressed about the possibility of doing this. According to some experts, the technique of

schizophrenia psychotherapy does not have a clear description. "There are several preliminary

actions, some recommendations and many warnings from what can be taught. In practice, they

rely on the intuition of a doctor" [19-22]. It is difficult to agree that a similar point of view is

promising in increasing the objectivity of the level of comparative studies in psychotherapy.


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Other authors complain about the difficulties associated with the uncertainty of the context

of psychotherapeutic interaction: some interventions contribute to success or do not always mean

ineffective. In the process of therapy, other parameters are involved that make the

psychotherapeutic effect effective or ineffective. Single assumptions that individual variants of

subsystems of the psychotherapeutic process are related to each other are intuitive and not

supported by empirical verification [23-26].

In achieving a therapeutic effect, more accurate information is needed about the relative

specific gravity of the individual components of psychotherapeutic models. This is of particular

interest to the differential analysis of the psychotherapeutic model when performed by lege artis.

This allows you to find out in detail what happens not at the level of general statements of

theoretical concept problems, but at a certain level of interaction, which is distinguished from the

various physician behaviors that form the current basis of this model [27-29].

The fact that the principled effectiveness of all basic scientifically based psychotherapeutic

models is confirmed indicates that each of them is relatively ineffective, since it does not contain

the effective components of other models that can have a therapeutic effect on a particular part of

patients at a certain stage. Solving the problem of providing each patient with an optimal complex

of therapeutic parameters from the arsenals of various psychotherapeutic models, taking into

account the individual psychodynamic and psychopathological characteristics of the patient, that

is, the creation of integral transmodel psychotherapy is possible only on the basis of systematic

and differentiated study of the most important parameters of the psychotherapeutic process [30-

33].

This work is aimed at getting acquainted with the theoretical conditions, technical

capabilities and methods of objectifying psychosis psychotherapy – the central aspects of this

therapeutic approach at the current stage of its development. Linking treatment strategies to

concepts of the nature of schizophrenia. Biological and psychosocial approaches [34-37]

The influence of genetic factors on the emergence of schizophrenia has been a long-

established and reliably established fact, which for many decades has led to the limited attitude of

classical psychiatry towards schizophrenia psychotherapy. The genetic conditioning of

schizophrenia is reliable and has been proven to varying degrees. The specific effects of maternal

genetic traits on the fetus are proposed (if the mother has schizophrenia in the family, then children

are 5 times more likely to have schizophrenia than the father), especially since a similar "maternal

effect" is noted in certain types of oligophobia, their genetic origin does not raise any doubts [38-

41].


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Scandinavian studies of children raised in families of mentally healthy sponsored parents

from a young age of schizophrenia, as well as longitudinal studies of adopted children with later

schizophrenia, made it possible to refute only psychological hypotheses of the appearance of

schizophrenia. Among the biological relatives of adopted children with schizophrenia, a

significantly higher percentage of childhood autism and psychopathic personality traits was

reported compared to biological relatives of adopted children who did not have schizophrenia.

However, the thoroughness of these studies ensured the reliability of the conclusion that

genetic predisposition is a necessary but insufficient condition for the appearance of schizophrenia.

Research data show that many factors play a role in the etiology of schizophrenia, and each

of them is responsible for a small part of the disorder. In the features of the pathological process,

there is no strict, clear connection between the genetic material and its subsequent implementation.

Hereditary factors do not determine the specificity of schizophrenia in determining the

main types of Crepelin. They are also not related to the features of the manifestation of the process

and its symptomatic image. The hypothesis that schizophrenia with negative consequences is a

"genetic" form of disorder has also not been confirmed.

Genetic theory does not provide a satisfactory answer to the question of why the disease

does not develop in some cases that can theoretically occur. How to explain that in Twins with the

same structure of the gene material, only 50 percent of compliance for the disease was determined?

Why is the genotype not always implemented in the phenotype; moreover, why are

schizophrenia genes not implemented in most cases?. Morbidity in cohabitation with one parent

with schizophrenia is 17-28%. Morbidity is 11% in children brought up in a child's homes and

who have not come into contact with their mother with schizophrenia in the first 3 days, which is

not much different from the morbidity rate of mentally healthy children raised there (8-9%).

Thus, raising offspring of patients with schizophrenia by adoptive mentally healthy parents

reduces the risk of the disease to the average level of the population as a whole. In the case of a

first-degree relative with schizophrenia, the risk for offspring is considered moderate-the

likelihood of illness for a child does not exceed 10%. In the case of two sick relatives of the first

degree, the risk is considered high, then the recommendation to terminate the pregnancy is

considered justified. Some authors consider that during genetic counseling, it is more appropriate

not to give specific recommendations to clients, but only to provide information about the

likelihood of risk that they will have to make decisions on their own.

The organic nature of schizophrenia finds its support in recent neurophysiological,

biochemical and morphological studies.


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A number of attempts have been made to identify the biological signs of schizophrenia –

pathological interhemispheric activity, asymmetry of electrical conduction of the skin during

social interaction, lateralized brain dysfunction associated with a lack of mental productivity.

However, the value and reliability of these markers, their relationship with important

clinical parameters, has not yet been sufficiently established. Thus, if in some publications there

is a correlation between the expansion of the cerebral ventricles and a decrease in the level of

social activity of patients with schizophrenia, other works show signs such as moderate

ventriculomegaly, uneven compression of cortical tissue structures, signs of brain dysfunction in

EEG and neuropsychological insufficiency., has nothing to do with any of the large number of

patients. psychopathological parameters of patients, degree of workability or therapeutic resistance

[42-44].

The lack of uncertainty in understanding the etiology of schizophrenia makes the

theoretical discussion of the priority of one of two complex – or biological or psychosocial-factors

that take the main responsibility for the emergence of the disease and significantly determine the

content of therapeutic strategies understandable [45].

Psychosocial parameters of the schizophrenic process, of course, have a

psychopathological effect. Thus, the high-quality syndromic manifestation of the clinical picture

is reflected in the level of social perception, in the deadlines for conducting a complex of

rehabilitation measures, subsequently achieved at the level of social adaptation and in the forecast

as a whole [46].

However, psychopathological phenomena do not define everything, nor always, in the

picture of schizophrenia. The proportion and autonomy of factors of psychosocial nature is very

large. There is no direct relationship between the objective level of psychopathological diseases

and the level of their subjective perception, as well as the frequency and quality of actions to

combat the disease. The degree of social inconsistency and the depth of deficit manifestation with

the severity of conflict relations, as well as the strict relationship between the level of self-

awareness and the registers of psychopathological diseases, are not completely related. Antisocial

forms of patient behavior, especially in cases of a low progressive course of schizophrenia, are

associated not only, but often not with the endogenous process, but also with the general

orientation of the patient's personality, his system of relationships and social relations [47-49].

The variety of clinical options depends on the inclusion in them of many different

manifestations of compensation and adaptation, including psychological protective phenomena.

These mechanisms can have a direct pathoplastic effect on psychopathological phenomena.


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Thus, the excessive development of the internal response apparatus by fantasizing negative

emotions contributes to the formation of more pronounced effective symptoms and enriches the

patient's hallucinations and fantasies with additional content. This effect in some cases forces a

different view of the nature of psychopathological phenomena. Thus, for example, some authors

believe that anosognosia should be considered a characteristic feature of thinking, and not a

manifestation of negative symptoms [50-52].

Conclusions.

Individual structures are closely related to highly Cardinal

psychopathological parameters. Thus, there is a relationship between the personal composition of

patients with schizophrenia and the subsequent progrediency of the process. Obviously, the

formation of an attitude to the disease is influenced not only by its direction and severity, but also

by a number of psychological factors, for example, the hierarchical level of motives, their breadth,

the content of leading activities, value orientations, features of behavior regulation. Psychogenic

pathological development of an individual can be observed not only at the stage of remission, as

previously thought, but also in the process of active current schizophrenia.

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