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PSYCHOTHERAPEUTIC PROBLEMS IN THE PROCESS OF TREATMENT IN
VARIOUS AREAS OF MEDICINE
1
Sultanov Shoxrux Xabibullayevich
2
Turayev Bobir Temirpulotovich
3
Turaqulov Otabek Murodullayevich
3
Xabibjonov Baxriddinjon Bahodirjon o‘g‘li
1
Doctor of Science, SciencesDepartment of Therapeutic direction No.3, Tashkent State Dental
Institute, Tashkent, Uzbekistan
2
Assistant of the department of psychiatry, medical psychology and narcology, Samarkand State
Medical University, Samarkand, Republic of Uzbekistan
3
Student of group 409 of the dentistry faculty of Samarkand State Medical University,
Samarkand, Republic of Uzbekistan
https://doi.org/10.5281/zenodo.14647622
Abstract. Despite the introduction of high-tech treatments into medical practice, the stable
prevalence and development of life-threatening complications in hypertension, diabetes mellitus,
chronic kidney failure, cancer and many other chronic diseases remains high. One of the reasons
for this condition is that patients follow therapy at a low level or adhere poorly to treatment.
Key words: Psychotherapeutic, therapy, treatments, hypertension, diabetes, chronic kidney
failure, cancer.
Introduction.
"Compliance" (Eng. "consent, adaptation, distribution of views") involves
conscious collaboration between the doctor and the patient, as well as his family members. Today,
compliance is recognized as a mandatory condition for any serious therapy, providing therapeutic
effectiveness. It is noted that even under Hippocrates, commitment was a problem, and the patient's
lies about taking medication were relevant. The following terms are also used to adhere to therapy
[1-4].
Components of the complement: the type of behavior, the degree of conformity and the
degree of purposefulness of the patient. In this case, the type of behavior includes taking the drug,
the regularity of visits to the clinic and the correct implementation of other medical
recommendations. Noncomplability indicates that the patient receives the wrong dose of the drug
(too small or too large), does not follow the frequency and duration of taking the medication, or
uses other (not recommended by the doctor) drugs; independently cancels the drug or prematurely
stops taking it.
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Lack of compliance is manifested in distrust of the doctor, double examination of his
actions, the desire to make adjustments to the therapeutic strategy, violation of the restrictive
regime, non-compliance with the diet, arbitrary cancellation of therapy, early activation of the
patient in the postoperative period [5-8].
In modern literature, many studies have been published dedicated to the study of individual
factors affecting conformity. Among them, a group of factors related to the previous experience
of the patient and the subjective perception of his illness stand out; factors related to the features
of the formation of a therapeutic Union; factors related to treatment; factors related to the
microsocial environment of the patient. In general, the system of Organization of health care –
how the patient interacts with it, how the drugs prescribed to the patient are taken into account and
issued, their cost, as well as the peculiarities of the forms and the peculiarities of the system of
relations of patients with medical personnel have a certain effect on the formation of complayens
[9-13].
Some authors argue that the formation and maintenance of the complement largely depends
on the degree of understanding of the patient's own disease, the goals of drug treatment, its benefits
and risks. Factors that negatively affect patient compliance also include insufficient interaction
between the doctor and patient and the appointment of combined drug therapy.
There are many indications that low compliance levels are associated with therapeutic
regimes that must be carried out throughout life and have a preventive nature.
For many patients, overcoming psychological barriers in abandoning behavioral
stereotypes that have been developing over the years is a very serious problem. In most chronic
diseases, complete compliance of the patient's behavior with medical recommendations (a high
level of compliance) is very difficult. The deep basis of Non-complayens were distorted cognitive
conditions and negative patient expectations, supported by the cognitive-af - affective
consequences of a failed treatment experience, such as distrust of success and frustration with
outcomes. In addition, psychological changes that occur in patients affected by the disease can
prevent them from actively participating in therapy [14-17].
Patients ' refusal of drug therapy and unwillingness to change their lifestyle due to illness,
as well as problems with it, are found in various diseases. Thus, in surgery and cardiology, every
seventh patient gives up the full size of the therapy offered to him. There is a higher number of
refusals from treatment in cases that present health risks or are not effective enough. For example,
cancer patients have a 45% abstinence rate, while older and older patients have a 25% abstinence
rate.
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According to cardiology studies, after emergencies, patients are characterized by a gradual
decrease in motivation to follow medical recommendations [18-21].
Hyponosogical reactions associated with low compliance in the Cardiovascular Clinic are
mainly male, their manifestations are more common in adulthood, says the Cardiovascular Clinic.
One of the variants of hypognosia is the syndrome of" excellent apathy", there is a clear
dissociation between the manifestation of hidden somatized anxiety (tachycardia, sweating,
tremors) and a careless attitude to the prognosis and outcome of the disease, which some authors
associate with the pathology of imagination and narcissistic complexes of ideal physical health.
The deliberate rejection of anxiety from the manifestation of the disease comes first, and the direct
symptoms of somatic disease are interpreted as temporary and insignificant. However, behind the
facade of these reactions lies the fear associated with a violation of the functioning of the heart
[26].
For patients with hypertension, a decrease in complacency is characteristic when blood
pressure stabilizes. Different types of adherence to therapy specific to these patients are
highlighted; the author found that complayens correlates with specific personality traits. Thus, for
patients with a scarce type of complement, low intellectual productivity, lack of emotional control,
non-fulfillment, care in relationships are characteristic. When formal, negativistic, unstable,
symbiotic types of complayens predominate, patients are more likely to have personal qualities
such as isolation, affectivity, sensitivity, high suspicion, conservatism. The constructive type of
complement is associated with personal characteristics such as the locus of external control, high
anxiety, hypochondria, sensitivity to the approval of others [5].
A study on the complementary properties of coronary heart disease patients and their
correlation with some of its psychological characteristics found that high levels of coherence of
patients with different clinical forms of CAD are positively correlated with levels of emotional
stability, responsiveness (G), high self-control (Q3), harmonious and disturbing types of attitudes.
disease, with a factor of personalization for good events, I. e. with a desire to take responsibility
for positive events taking place in life; negative attitudes were determined by the degree of
depression and the desire to explain negative phenomena as permanent and uncontrollable [12].
Less than 60% of adults with diabetes and less than 40% of patients with bronchial asthma and
hypertension report complete adherence to the medication regimen [15]. Having studied the
peculiarities of the psychological adaptation of individuals suffering from chronic kidney failure
and being treated with hemodialysis to the disease, data are presented that from 40 to 64% of
patients with hemodialysis do not adhere to the water and drinking regime.
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Among the factors associated with low compliance, the author points out the presence of
low educational level, low social and economic status of patients, lack of family and social support,
depression. In his study, the author proved that life is distinguished by greater meaningfulness,
purposefulness, satisfaction with self-realization and confidence in the ability to control what is
happening than patients who tend to break the therapeutic regime [3].
Noted that only 47% of patients with arthrosis were in full compliance with the treatment
regimen, and 24% reported deliberate discontinuation of medication or dose changes during the
last year of treatment. High rates of noncomplyence in patients with rheumatoid arthritis have been
found by the author in patients with symptoms of uncertainty and inferiority, who tend to assume
guilt and responsibility for a state of high self-control and frustration [18-21].
Psychological factors of forced behavior of dental patients were identified. In particular,
this is the predominance of conformal relations, a tendency to compromise, compliance,
responsibility, business orientation. At the same time, the main reason to see a doctor is acute pain,
and the main reason for not applying in a timely manner is the fear of medical manipulation and a
underestimation of the severity of its condition [22-25].
Claims that the premorbid personality traits of patients are related to conformity. For
example, patients with hysterical characteristics are characterized by an increased risk of
developing addiction to drugs, have a careless and careless attitude to treatment, and can use drugs
to manipulate others. Patients with obsessive characteristics follow the doctor's instructions on
time, and taking medications for them becomes a kind of ritual, which makes it even more difficult
to cancel medications. Neurotic, infantile, anxious individuals are characterized by a tendency to
self-medicate and abuse of psychotropic drugs. The tendency to regularly disrupt the therapy
regimen with hyperthymic individuals due to mild transitions, instability of interests, insufficient
assessment of the severity of the disease [26-30].
There is a lot of information in the literature, according to which the rate of refusal of
treatment among the mentally ill is high. This is due to a change in cognitive processes, a decrease
in personality, criticality, the ability to identify signs of mental illness in mental patients. Between
one-third and half of patients break the regimen of taking medications during their stay in a
psychiatric hospital, and two-thirds reduce the recommended doses without agreeing with doctors,
take them at random or stop the medication altogether. Of all three re-accepted cases, either two
are the result of a complete or partial lack of conformity. Antisocial and suicidal behaviors are
more common in patients who have stopped taking medication.
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The social consequences of complement disorder are the production and family problems
of patients, reducing their quality of life, as well as increasing the amount of material costs for
further treatment [31-35].
Among the most important causes of noncompliance are the side effects of
psychopharmacotherapy, the duration of treatment and the complexity of the medication regimen,
subjective improvement in well-being, non-criticism of their condition, lack of information about
the disease and prescribed treatment. For complayens, it is assumed that not only the objective fact
of the presence of adverse events when taking medications is relevant, but also the subjective
tolerance of these adverse events [36-41].
A negative attitude towards drugs can be formed under the influence of socio-cultural ideas
about the harmfulness of taking medications. If treatment is perceived by patients as a threat of
autonomy, psychological resistance to medical treatment increases. Noncomplayens are more
characteristic of patients with subacute and sluggish course of mental disorders. The situation is
further complicated by the change in the lifestyle and behavior of the patient, which is so necessary
in the treatment of mental disorders. In general, only a third of adult patients strictly adhere to
treatment recommendations, a third adhere to them in part, and the rest refuse this need at all.
An increase in interest in the problem of conformity in psychiatry is due to several reasons.
First, the violation of compliance with the prescribed drug prescribing regimen prescribed by
patients largely determines the high rates of hospital regospitalization of the mentally ill in our
country, an increase in the duration of hospitalization and an increase in primary disability, which
leads to significant financial costs for treatment [42-47].
As a result of the mental state study we conducted, 84 patients in the last phase of chronic
kidney failure who were on the waiting list for a kidney transplant were diagnosed with an increase
in the level of personal anxiety in 73.1% of patients, 57% of patients. Anxiety composition was
dominated by anxious assessment reactions of perspective, asthenic component, social protection
reactions. The response to the disease was characterized by a predominance of anxiety-sensitive
(47,6%), anozognosic (21,4%), hypochondria (8,3%) and dysphoric (7,2%) types. 60,7% of
patients were found to have depressive spectrum symptoms (a minor depressive episode on the
Hamilton Scale). 70% of patients were found to have an increase in the hostility index, 48,8% had
a higher level of negativism, and 62% had a higher level of irritation. All these characteristics of
the mental state of patients with chronic kidney disease can negatively affect therapeutic
motivation, adherence to treatment, the characteristics of the therapeutic Union and interpersonal
relationships in general, reducing the quality of therapy and satisfaction with the social assistance
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provided. Determining the condition of the disease, along with limiting social ties, leads to the
further formation of hypochondriac features and further enhances the social adaptation of the
patient. Anxious experiences with surgery are often the reason for rejection of kidney transplants,
and hypognosia interferes with full awareness and acceptance of disease-related information,
which negatively affects compliance [48-53].
Since the patient's high level of compliance after transplantation plays a very important
role, timely recognition and subsequent elimination of sensory-voluntary field and behavioral
disorders is a priority in the practice of treating patients in need of organ transplantation at the
waiting list stage.
Conclusions.
Thus, the problem of studying complexity remains relevant in various areas
of Medicine. The decrease in the number of negative results in the postoperative period, the
Prevention of the development of complications and the development of chronic diseases are
largely determined by the patient's competent medical behavior. The problem of studying the
complement is important in the context of providing high-tech assistance to patients, in particular,
in the transplant clinic, where the survival of the transplant and the life of the patient as a whole
depend on the competent implementation of medical recommendations. The identification of
psychological factors associated with high and low compatibility in patients with different
nosology allows you to predict the characteristics of the medical behavior of patients, determine
the "goals" of psychological intervention aimed at optimizing compliance at different stages of the
disease.
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