Yanvar, 2025-Yil
276
FUNDAMENTALS OF MODERN PSYCHOTHERAPY IN THE REHABILITATION OF
PATIENTS WITH SCHIZOPHRENIA
1
Anarbayev Sardor Alisherovich
2
Choriyev Ilhomjon Faxriddin 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.14749472
Abstract. Hope for the recovery of patients with schizophrenia is growing, and job
opportunities in the market economy are declining. This puts much higher demands on their
operation than a few years ago. The increased interest in psychotherapy in patients with
schizophrenia is explained today by recent research on the clinical and economic effectiveness of
rehabilitation programs, which makes it possible to see the limits of rehabilitation methods, which
are already traditional in psychiatric practice. It is argued that one should not create excessive
fantasies about existing rehabilitation programs.
Keywords: Schizophrenia, psychotherapy, rehabilitation, psychiatry.
Introduction.
The pathoplastic role of exogenous social factors is also well known. It is
impossible to agree with oedegard's thesis that "real psychoses in adulthood are independent of the
world around them. The role of social stressors has been confirmed as one of the factors that
depend on the manifestation of schizophrenia psychosis. A connection was established between
exogenous damage at the onset of the disease and the peculiarities of its subsequent development.
Relapses are often noted in cases of exogenism before the onset of the disease. A clear
difference in the course and outcome of schizophrenia in patients living in developing and
industrialized countries is known due to sociocultural differences in ethnic structures [1-3].
The social component of biopsychosocial processes usually plays a large role at the level
of theoretical understanding of the problem. Biological, penetrates into a person's personality and
becomes social. Brain pathology can provoke a biologically determined predisposition to the
formation of certain psychological characteristics of an individual in the subject, in the structure
of his individuality, the implementation of which later depends on the influence of social factors
Yanvar, 2025-Yil
277
[4-7]. In this sense, the hypothesis that brain structures suffering from endogenous psychosis
appeared in the early stages of the emergence of mankind and are of social origin is interesting.
Both the biological (genetic and morphological structures, metabolism) and the social basis
of these diseases are closely related to the human characteristics that distinguish it from animals.
The hypothesis is interesting because philosophically it can eliminate the fundamental
contradiction of the concepts of the origin of endogenous psychoses (somato-or psychogenesis)
[8-9].
In any case, without fully explaining the etiology of schizophrenia, psychosocial factors
largely determine its course. Cases of mental pathology, in the pathogenesis of which biological
factors play a leading role, cannot be considered exclusively diseases of biological origin. The
pathogenesis of such diseases already in the early stages inevitably involves factors of social order.
The close connection between biological and Social is manifested in schizophrenia, since
mental disorders are manifested mainly in the form of a violation of relations with other people.
Thus, in all cases, the meaningful side of mental activity, its social aspects suffer [10-13].
The emphasis on the role of both biological and psychosocial in the pathogenesis of
schizophrenia, in our opinion, is extremely important. The history of psychiatry knows many
specific examples of the monopolistic domination of monocauzality theories of any pathology,
which suggests its artificially narrowed interpretation, often with detrimental consequences for
therapeutic practice. Thus, it follows from the idea that schizophrenia is caused only by some
neurogumoral dyscrasia, which can be treated with appropriate neurotrophic hormones, just as
diabetes is treated with insulin (a famous example is the proposal to treat schizophrenia with
vitamin megadosis) [14-17]. The thesis that such drugs are both necessary and adequate means of
treatment turns the patient into a certain biochemical abstraction, the object of application of
pharmacological agents and any psychosocial effect – something insignificant and, at best, useless
[18-21].
An example of biological reductionism is the sensational report of the remarkable success
of hemodialysis by several somatic healthy patients diagnosed with schizophrenia. The failures of
attempts to control this therapy led to the conclusion that the improvement in the condition of
patients who had previously been hospitalized for a long time should, on the contrary, be associated
with changes in environmental influences associated with the procedure [22-25]. A reverse
example of psychological reductionism is the medical history of patients from the well-known
psychoanalytic clinic Chestnut-Lodge, whose years of catamnesis have shown that the inadequacy
Yanvar, 2025-Yil
278
of unilateral psychotherapeutic treatment and social activation has led to malignant regression that
cripples patients [26-29].
In recent years, most experts have come to the conclusion that purely sociogenetic and
purely biological models of mental disorders are imperfect; historical concepts that psychoses are
caused by biological and neuroses – sociopsychological factors are illegally simplified and do not
correspond to the state of modern knowledge. The opposition to personality development of
endogenous conditioned processes, carried out in the past on the example of paranoia, has lost its
importance to some extent [30-34]. The monocausal method of examining endogenous psychoses
has been recognized as outdated in terms of the current state of development of psychiatry.
Therefore, the practical neglect of this thesis often leads to the phenomenon of
humanization of Medicine, which has become more and more troubling in recent times. The
rapidly developing technical and mechanization of Medicine, the deepening of specialists, brings
an impersonal approach to the patient, focusing attention only on individual organs and fragments.
It does not serve to improve the situation in this area, and the excessive interest of many
young doctors with bright achievements of Natural Sciences and technologies leads them to an
imaginary belief that all therapy issues can be solved by the achievements of the pharmaceutical
industry and improving technology [24-28].
Any type of therapy can only be part of a general approach to the treatment of
schizophrenia. Thus, for example, the introduction of adrenaline into the blood is not enough for
the appearance of a subjective feeling of anxiety – external stimuli are also required, which often
turn the sensations of Heartbeat into a Gestalt-anxiety phenomenon. Thus, anxiety therapy with
drugs alone can affect only part of the overall perception of anxiety-physiological symptoms,
which will put aside the psychological content of the problem [42-46].
Therefore, Psychiatry in principle cannot exist without psychotherapy, although "deep
interest in psychotherapy does not mean alienation from the medical colleagues of the psychiatrist.
He should feel like a doctor first, then a specialist in neuropsychiatric diseases, and only
then a person with a special interest in psychotherapy" [18-22].
Modern psychiatric theorists seek to learn from the instructive situation that a number of
previous generations of psychiatrists who worked with Unitarian, monocausal theories of
schizophrenia had little benefit to their patients treated according to these theories. Now the desire
to avoid any reductionism is noticeable – biological, psychological and social. Foss and
Rothenberg propose a new paradigm called the "infomedical model", which treats a person as an
ideal decoder, that is, a cybernetic system, the state of which is the final result of the integral
Yanvar, 2025-Yil
279
Organization of information from different levels – somatic, psychological and social. The most
radical proponents of so-called" new epistemology " reject all traditional methods of research,
considering them to be derived from linear-causal reductionist paradigms, and therefore
incompatible with the modern state of knowledge of systematic processes. However, more
moderate opponents rightfully challenge them, since a systematic approach should include both
new and old methods [24-29].
In order for the treatment to be effective, the doctor must have at his disposal the knowledge
accumulated by the clinical experience of various theoretical schools. However, the theoretical
conceptualization of biopsychosocial integration is significantly different from the level of
practical implementation of therapeutic models that can still be used. Solving today's problems in
psychiatry is possible only when general psychopathology and psychodynamic psychology are
effectively included in the unified foundation of objectively established knowledge about human
activity. The existing pace of research progress, unfortunately, does not allow us to hope for a
quick solution to these problems [35-38.
In general, a new level of theoretical understanding of basic scientific problems is
manifested in the transformation of a monologue of individual theories into a dialogue between
different concepts, the assimilation of constructive ideas developed in different approaches. A new
level of dialogical scientific thinking is characterized by the destruction of their frames while
maintaining the traditions of schools. As a result, the explanatory possibilities inherent in each
theory are updated. "Perhaps it will be most correct to conclude that the opposition of one direction
in psychiatry to another, as well as the unwarranted claims of each of the main clinical directions
in psychiatry – nosological, syndromic and psychodynamic representatives – to the only possible
and correct path to the development of psychiatry should be ended" [38-42].
The most relevant to the modern systematic understanding of schizophrenia is perhaps the
stress-diathesis model, whose concept of weakness – a predisposition to schizophrenia – and sin
with sufficient accuracy, which in some cases makes it difficult to clearly distinguish the indicators
of weakness from the manifestations of the active process. Weakness is manifested by the fact that
the stressor changes the patient's ability to resist it, so the absolute value of the stressor will be
relative. In this sense, some authors believe that the term "weakness" has now replaced the older
psychodynamic concept of "ego weakness" [43-47]. Nevertheless, this concept has been actively
involved to interpret a number of clinical phenomena. In particular, the correlation of patients with
schizophrenia with fertility rates is considered as a result of the genetic predisposition of patients
and the interaction of seasonally activated viral infection.
Yanvar, 2025-Yil
280
In the group of adopted children of patients with schizophrenia, more manifestations of
psychosis were noted in comparison with the control group of adopted children of mentally healthy
parents, but all of them, as it turned out, were brought up in families with a serious violation of
relationships within the family. This supports the hypothesis of the interaction of genetic
vulnerability with the social family environment [48-51].
In its most advanced form, the stress-diathesis model describes its systematic nature and
the "non-dualistic" principle inherent in it, both from the reductionistic linear "stimulus-reaction"
model and from unilateral metapsychological interpretations [52-56].
An individual with signs of initial vulnerability does not adequately respond to the effects
of social stressors (e.g., family conflicts) and thus causes an appropriate environmental reaction,
which in turn enhances the social disruption of the subject. The vicious circle is also formed at the
intrapsychic level: a strong social stress background activates psychopathological arousal, which
reduces the level of psychological protection, which reveals pathogenic effects and other weak
stress factors [57-64]. This step-by-step escalation reaches an important point of psychotic
disorder, which means "a place where there is no return".
Conclusions.
The further course of the disease cannot also be expressed as a linear organic
process, determined mainly by genetic factors. Environmental factors continue to play an
important role by forming biopsychosocial vicious circles with several feedback effects leading to
nonlinear escalation processes. The fate of relapses can be determined by the balance between the
intensity of social stress and the success of problem-solving behaviors. Chronic conditions arise
as a result of initial weakness, psychosocial stress effects, and complex interactions between
protective regulatory methods at the biological, psychological, and social levels.
REFERENCES
1.
Antsiborov S. et al. Association of dopaminergic receptors of peripheral blood lymphocytes
with a risk of developing antipsychotic extrapyramidal diseases //Science and innovation. –
2023. – Т. 2. – №. D11. – С. 29-35.
2.
Asanova R. et al. Features of the treatment of patients with mental disorders and
cardiovascular pathology //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 545-550.
3.
Biktimirova G., Turayev B., Ochilova N. Features of the pathokinesis of adaptation disorders
in men with mild forms of cardiovascular disease //Modern Science and Research. – 2024.
– Т. 3. – №. 1. – С. 602-610.
Yanvar, 2025-Yil
281
4.
Borisova Y. et al. Concomitant mental disorders and social functioning of adults with high-
functioning autism/asperger syndrome //Science and innovation. – 2023. – Т. 2. – №. D11.
– С. 36-41.
5.
Ibragimova M., Turayev B., Shernazarov F. Features of the state of mind of students of
medical and non-medical specialties //Science and innovation. – 2023. – Т. 2. – №. D10. –
С. 179-183.
6.
Konstantinova O. et al. Experience in the use of thiamine (vitamin B1) megadose in the
treatment of korsakov-type alcoholic encephalopathy //Science and innovation. – 2023. – Т.
2. – №. D12. – С. 564-570.
7.
Lomakin S. et al. Socio-demographic, personal and clinical characteristics of relatives of
patients with alcoholism //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 278-283.
8.
Murodullayevich K. R., Holdorovna I. M., Temirpulotovich T. B. The effect of exogenous
factors on the clinical course of paranoid schizophrenia //Journal of healthcare and life-
science research. – 2023. – Т. 2. – №. 10. – С. 28-34.
9.
Nematillayevna S. D. et al. Features of non-psychotic diseases and cognitive disorders in
organic brain damage of vascular genesis in elderly people //Amaliy va tibbiyot fanlari ilmiy
jurnali. – 2024. – Т. 3. – №. 2. – С. 124-130.
10.
Nematillayevna S. D. et al. Prevalence of anxiety and depressive disorders in elderly patients
//Scientific journal of applied and medical sciences. – 2024. – Т. 3. – №. 2. – С. 118-123.
11.
Novikov A. et al. Alcohol dependence and manifestation of autoagressive behavior in
patients of different types //Science and innovation. – 2023. – Т. 2. – №. D11. – С. 413-419.
12.
Ochilov U. et al. The main forms of aggressive manifestations in the clinic of mental
disorders of children and adolescents and factors affecting their occurrence //Science and
innovation. – 2023. – Т. 2. – №. D11. – С. 42-48.
13.
Ochilov U. et al. The question of the features of clinical and immunological parameters in
the diagnosis of juvenile depression with" subpsychotic" symptoms //Science and
innovation. – 2023. – Т. 2. – №. D12. – С. 218-222.
14.
Pachulia Y. et al. Assessment of the effect of psychopathic disorders on the dynamics of
withdrawal syndrome in synthetic cannabinoid addiction //Science and innovation. – 2023.
– Т. 2. – №. D12. – С. 240-244.
15.
Rotanov A. et al. Comparative effectiveness of treatment of somatoform diseases in
psychotherapeutic practice //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 267-
272.
Yanvar, 2025-Yil
282
16.
Rotanov A. et al. Social, socio-cultural and behavioral risk factors for the spread of hiv
infection //Science and innovation. – 2023. – Т. 2. – №. D11. – С. 49-55.
17.
Rotanov A. et al. Suicide and epidemiology and risk factors in oncological diseases //Science
and innovation. – 2023. – Т. 2. – №. D12. – С. 398-403.
18.
Sedenkov V. et al. Clinical and socio-demographic characteristics of elderly patients with
suicide attempts //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 273-277.
19.
Sedenkova M. et al. Features of primary and secondary cognitive functions characteristic of
dementia with delirium //Science and innovation. – 2023. – Т. 2. – №. D11. – С. 56-62.
20.
Sharapova D. et al. Clinical and socio-economic effectiveness of injectable long-term forms
of atypical antipsychotics in schizophrenia //Science and innovation. – 2023. – Т. 2. – №.
D12. – С. 290-295.
21.
Sharapova D., Shernazarov F., Turayev B. Psychological factors for the formation of
aggressive behavior in the youth environment //Science and Innovation. – 2023. – Т. 2. – №.
D12. – С. 404-408.
22.
Shernazarov F., Sharapova D., Turayev B. Features of the development of manic and mixed
episodes in patients with bipolar affective disorder who use cannabioids //Science and
innovation. – 2024. – Т. 3. – №. D3. – С. 123-128.
23.
Solovyova Y. et al. Protective-adaptive complexes with codependency //Science and
innovation. – 2023. – Т. 2. – №. D11. – С. 70-75.
24.
Spirkina M. et al. Integrated approach to correcting neurocognitive defects in schizophrenia
//Science and innovation. – 2023. – Т. 2. – №. D11. – С. 76-81.
25.
Sultanov S. et al. Depression and post-traumatic stress disorder in patients with alcoholism
after the covid-19 pandemic //Science and innovation. – 2023. – Т. 2. – №. D11. – С. 420-
429.
26.
Sultanov S. et al. The impact of the covid-19 pandemic on the mental state of people with
alcohol addiction syndrome //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 296-
301.
27.
Temirpulatovich T. B. et al. Alkogolizm bilan kasallangan bemorlarda covid-19
o’tkazgandan keyin jigardagi klinik va labarator o’zgarishlar //journal of biomedicine and
practice. – 2023. – Т. 8. – №. 1.
28.
Temirpulatovich T. B., Murodullayevich K. R. Characteristic features of postkovid
syndrome in patients with alcoholism, the presence of various liver diseases //Open Access
Repository. – 2023. – Т. 4. – №. 2. – С. 266-277.
Yanvar, 2025-Yil
283
29.
Temirpulatovich T. B., Uzokboyevich T. A. Biochemical Changes in the Liver After Covid-
19 Disease in Alcohol-Dependent Patients and Their Effects on the Course of Alcoholism
//The Peerian Journal. – 2023. – Т. 15. – С. 28-37.
30.
Temirpulotovich T. B. et al. Ways to Develop Speech and Overcome Them in Children With
Cerebral Palsy //European journal of modern medicine and practice. – 2024. – Т. 4. – №. 2.
– С. 355-368.
31.
Temirpulotovich T. B. Somatoform variant post-traumatic stress disorder //Journal of
healthcare and life-science research. – 2023. – Т. 2. – №. 9. – С. 45-52.
32.
Uskov A. et al. Efficacy and tolerance of pharmacotherapy with antidepressants in non-
psychotic depressions in combination with chronic brain ischemia //Science and Innovation.
– 2023. – Т. 2. – №. D12. – С. 409-414.
33.
Uskov A. et al. Evaluation of the effectiveness of supportive therapy in the practice of
outpatient treatment of schizophrenia with long term atypical antipsychotics //Science and
innovation. – 2023. – Т. 2. – №. D12. – С. 316-321.
34.
Usmanovich O. U. et al. Characteristic Features of Affective Disorders in Anxiety-Phobic
Neurosis //European journal of modern medicine and practice. – 2024. – Т. 4. – №. 2. – С.
251-259.
35.
Usmanovich O. U. et al. Clinical and Psychological Characteristics of Affective Disorders
in Children with Autism Disorders //European journal of modern medicine and practice. –
2024. – Т. 4. – №. 2. – С. 260-267.
36.
Usmanovich O. U. et al. Clinical and Psychological Characteristics of Affective Disorders
in Children with Autism Disorders //European journal of modern medicine and practice. –
2024. – Т. 4. – №. 2. – С. 260-267.
37.
Usmonovich O. U., Temirpulatovich T. B. The influence of the presence of mentally ill
children in the family on the psyche of parents //Journal of education, ethics and value. –
2023. – Т. 2. – №. 8. – С. 68-75.
38.
Xushvaktova D., Turayev B., Shernazarov F. Clinical features of mental disorders in
synthetic drug users //Science and innovation. – 2023. – Т. 2. – №. D10. – С. 242-247.
39.
Hamdullo o'g'li J. H., Temirpulotovich T. B. Features of the Clinical Course of Post-
Traumatic Epilepsy, Psychiatric and Neurosurgical Approaches //International Journal of
Cognitive Neuroscience and Psychology. – 2024. – Т. 2. – №. 2. – С. 8-14.
Yanvar, 2025-Yil
284
40.
Hamidullayevna X. D., Temirpulotovich T. B. Features of psycho-emotional changes in
women during pregnancy //Journal of Science in Medicine and Life. –2024. – Т. 2. – №. 3.
– С. 71-77.
41.
Hamidullayevna X. D., Temirpulotovich T. B. Personality and interpersonal relationships of
primary school students with hyperactivity disorder of minimal brain dysfunction and
attention deficit //International Journal of Cognitive Neuroscience and Psychology. – 2024.
– Т. 2. – №. 3. – С. 22-27.
42.
Holdorovna I. M., Temirpulotovich T. B. Analysis of the psychopathological and
neurophysiological profile of children left without parental care //Journal of Science in
Medicine and Life. – 2024. – Т. 2. – №. 3. – С. 63-70.
43.
Holdorovna I. M., Temirpulotovich T. B. Psychopathological features of long-term
endogenous depressions //International Journal of Cognitive Neuroscience and Psychology.
– 2024. – Т. 2. – №. 3. – С. 15-21.
44.
Jalilova S. H., Kibriyev K., Turayev B. Contemporary accounts of schizophrenia //Modern
Science and Research. – 2025. – Т. 4. – №. 1.
45.
Qilicheva Z., Rahimova M., Turayev B. Psychoses observed in infectious diseases and their
peculiarities //Modern Science and Research. – 2025. – Т. 4. – №. 1.
46.
Ravshanova B. G. et al. Features of Conducting Art Therapy in Patients With Psychosis
Without Organic Changes //European journal of modern medicine and practice. – 2024. – Т.
4. – №. 2. – С. 15-21.
47.
Sadullayeva R., Sharafova M., Turayev B. The development of psychoses in infectious
diseases and their clinical features //Modern Science and Research. – 2025. – Т. 4. – №. 1.
– С. 124-129.
48.
Shernazarov F., Sharapova D., Turayev B. Features of the development of manic and mixed
episodes in patients with bipolar affective disorder who use cannabioids //Science and
innovation. – 2024. – Т. 3. – №. D3. – С. 123-128.
49.
Sultanov S. et al. Assessment of dental status in patients with schizophrenia //Modern
Science and Research. – 2025. – Т. 4. – №. 1. – С. 271-278.
50.
Sultanov S. et al. Methods for assessing the psycho-emotional state of patients on an
outpatient basis //Modern Science and Research. – 2025. – Т. 4. – №. 1. – С. 262-270.
51.
Sultanov S. et al. Psychotherapeutic preparation for orthopedic treatment of dental patients
and adaptation to prosthetics //Modern Science and Research. – 2025. – Т. 4. – №. 1. – С.
290-296.
Yanvar, 2025-Yil
285
52.
Sultanov S. et al. Psychotherapeutic problems in the process of treatment in various areas of
medicine //Modern Science and Research. – 2025. – Т. 4. – №. 1. – С. 279-289.
53.
Temirpulatovich T. B. Маиший ичкиликбозлик муаммоси бўлган шахсларга ижтимоий
омилларнинг covid-19 пандемиси даврида таъсири //Journal of biomedicine and practice.
– 2022. – Т. 7. – №. 4.
54.
Temirpulotovich T. B. Behavioral Changes of Individuals Who Abuse Synthetic
Psychostimulants //European journal of modern medicine and practice. – 2024. – Т. 4. – №.
2. – С. 369-376.
55.
Temirpulotovich T. B. Clinical Course of Alcoholic Polyneuropathy and Alcoholic
Myopathy Observed in Alcoholism //Journal of Medical Genetics and Clinical Biology. –
2025. – Т. 2. – №. 3. – С. 34-41.
56.
Temirpulotovich T. B. Clinical Pictures of Cognitive Dysfunctions Observed in Alcoholism
//Journal of Medical Genetics and Clinical Biology. – 2025. – Т. 2. – №. 3. – С. 42-50.
57.
Temirpulotovich T. B. et al. Psychopathological and neuropsychological features of negative
diseases in late schizophrenia. – 2024.
58.
Temirpulotovich T. B., Usmanovich O. U. Modern approaches to the diagnosis and
treatment of acquired mental retardation, epidemiology of dementia, clinical forms
(literature review) //Journal of biomedicine and practice. – 2024. – Т. 9. – №. 1.
59.
Turaev, B., and R. Khayatov. "Suicidal intentions in people with alcohol dependence
syndrome in the presence of depressive disorders." Journal Bulletin of the doctor 1.2 (2022):
115-117.
60.
Tursunboyev M., Yaxyayev M., Turayev B. Clinical psychopathological features of sleep
disorders //Modern Science and Research. – 2025. – Т. 4. – №. 1. – С. 130-139.
61.
Usmanovich O. U., Temirpulotovich T. B. Morphofunctional Foundations of the
Development of Vascular Cognitive and Emotional Disorders //International Journal of
Cognitive Neuroscience and Psychology. – 2024. – Т. 2. – №. 2. – С. 15-21.
62.
Очилов У. У., Тураев Б. Т., Жумагелдиев Н. Н. Особенности формирования и течения
алкоголизма у лиц с акцентуациями характера и личностными расстройствами
//Вестник науки и образования. – 2020. – №. 10-4 (88). – С. 101-103.
63.
Очилов, Улугбек Усманович. "Тураев Бобир Темирпулатович, Алимова Юлдуз
Шамсиддиновна, Алкаров Рустам Бахтиярович."." Клинические особенности
психопатического поведения у подростков с психическими расстройствами" Вестник
науки и образования 23-3 (2020): 101.
Yanvar, 2025-Yil
286
64.
Хаятов Р. Б. и др. Аффективные расстройства у больных алкогольной зависимостью
как фактор риска развития суицидального поведения //Достижения науки и
образования. – 2019. – №. 11 (52). – С. 96-98.
