Perinatal psychology is a new section of clinical (medical) psychology. Lecture: Perinatal Psychology and Psychiatry Perinatal Pathopsychology

The history of the development of perinatology.
Perinatal psychology.
Perinatal psychiatry. The concept of diathesis.
Diagnosis of neuropsychic disorders at an early age.

G. J. Craig defined perinatology(Greek peri - about, around; Latin natus - birth). as "a branch of medicine that studies the health, diseases and methods of treatment of children in a time perspective, including conception, prenatal period, childbirth and the first months of the postnatal period." The perinatal period lasts from the 28th week of a person's prenatal life to the 7th day of life after birth. Interest in new science is largely due to the need to find ways to stop the growth trend in the number of newborns with neuropsychiatric disorders. There are many reasons for this phenomenon: the success of medicine, leading to a decrease in the mortality rate of children with pathology, in the past years, incompatible with life, and unsatisfactory psycho-preventive work with pregnant women, and errors in obstetrics, and the deterioration of the environment, and the growth of drug addiction. The development of perinatology in Russia and Western countries was significantly different. Widespread in the west psychoanalytically oriented research in perinatology. In the 1920s, psychoanalysis was attacked in Russia and banned as "propaganda of bourgeois ideology." In 1924 the State Psychoanalytic Institute was closed, and in 1940 the director of the Institute, ID Ermakov, was arrested, who later died in the camp. In 1948, the famous psychiatrist Professor A.S. Chistovich was dismissed from the Leningrad Military Medical Academy for a lecture on the analysis of dreams. In the Soviet Union, conception, pregnancy, and childbirth were viewed in the light of the dominant ideas of nervousism as a set of unconditioned and conditioned reflexes that follow one after another, connected with instinctive activity. The psychology of pregnancy was studied only from the standpoint the teachings of I.P. Pavlov... On its basis, I. Z. Velvovsky and his co-workers in 1949 developed and implemented "Psychoprophylactic method of labor pain relief". Maternal-child relations were studied in Soviet child psychology by L. S. Vygotsky and his students, but outside perinatology (mother, as a representative of the human race, as a subject of cognitive activity). The founders of perinatology in our country are deservedly considered N.L. Garmashova and N.N. Konstantinova (1985).

Research activity in this area continues to grow. In St. Petersburg on March 20-22, 1997, a conference was held on the issues of perinatology, at which a decision was made to establish the Association of Perinatal Psychology and Medicine of Russia. Since then, conferences have been held annually in Russia, bringing together obstetricians-gynecologists, neonatologists, neuropathologists, psychiatrists, psychotherapists and psychologists.

Perinatal psychology- This is a field of psychological science that studies the patterns of human mental development due to interaction with the mother at the earliest stages of his ontogenesis from conception to the first months of life after birth. The duration of the postnatal period, included in the sphere of interest of perinatologists, is assessed differently by different authors. However, if we consider the main features of the perinatal period the symbiotic relationship of the mother with the child, the inability of the child to distinguish himself from the world around him, that is, the absence of clear bodily and mental boundaries, the lack of independence of his psyche, then this period can be maximally expanded. before self-awareness, that is approximately up to three years of life... The founder of the theory of transactional analysis wrote about the influence of psychosocial factors on conception, on the formation of mental functions and the development of the personality of the unborn child. E. Bern(1972). He believed that "the situation of a person's conception can strongly influence his fate" - this is "Embryonic attitude", i.e. the birth situation can be the result of chance, passion, love, violence, deception, cunning or indifference - any of these options must be analyzed. E. Bern singled out "Generic scripts". He considered the most common scenarios "origin" and "crippled mother". The first is based on the child's doubts that his parents are real, the second is based on the child's knowledge of how difficult the birth was for the mother. E. Bern attaches great importance to the order of birth, first and last names.

Another, also widespread in Western countries, is the direction of perinatal psychology, in which the mother-child relationship is interpreted as form of imprinting. The way the mother interacted with the newborn child in the first hours of life has a great influence on their subsequent interaction.

Back in 1966 P.G. Svetlov established critical periods of ontogenesis:

· The period of implantation (5-6 days after conception);

· The period of development of the placenta (4-6 weeks of pregnancy);

· 20-24 weeks of pregnancy are also critical, since it is at this time that many systems of the body are rapidly developing, acquiring by the end of this period the character inherent in newborns [PK Anokhin, 1966; Bodyazhina V. I., 1967].

The condition of a pregnant woman in critical periods can significantly affect the characteristics of the emerging mental functions of the unborn child, and therefore, in many respects, determine his life scenario. The uterus represents the first ecological niche in humans. A woman has gestational dominant in the brain. There are physiological and psychological components of the gestational dominant. Physiological and psychological components, respectively, are determined by biological or mental changes occurring in a woman's body, aimed at bearing, giving birth and nursing a child. The psychological component of the gestational dominant is of particular interest to perinatal psychologists. 5 types of PCGD were identified:

1. Optimal type PCGD is noted in women who are responsible, but without undue anxiety, regarding their pregnancy. In these cases, as a rule, family relationships are harmonious, pregnancy is desired by both spouses. The optimal type contributes to the formation of a harmonious type of family education of the child.

2. Hypogestogenic type often occurs in women who have not completed their studies, who are passionate about work. Among them there are both young students and women who will soon turn or have already turned 30 years old. The former do not want to take academic leave, continue to take exams, attend discos, play sports, and go hiking. Their pregnancy is often unplanned. Women of the second subgroup, as a rule, already have a profession, are passionate about work, and often occupy leading positions. They are planning a pregnancy, as they rightly fear that the risk of complications increases with age. Most often, the types of family education are formed: hypoprotection, emotional rejection, underdevelopment of parental feelings.

3. Euphoric type noted in women with hysterical personality traits, as well as in those who have been treated for infertility for a long time. Often, pregnancy becomes a means of manipulation, a way to change relationships with your husband, to achieve mercantile goals. The euphoric type corresponds to the expansion of the sphere of parental feelings towards the child, conniving hyperprotection, preference for children's qualities.

4. Anxious type characterized by a high level of anxiety in pregnant women, which affects her somatic state. Anxiety can be quite justified (the presence of acute or chronic diseases, disharmonious relations in the family, unsatisfactory material and living conditions, etc.). In some cases, a pregnant woman either overestimates the existing problems, or cannot explain what the anxiety is associated with, which is accompanied by hypochondriacia. With this type, the dominant hyperprotection is most often formed in family education, and increased moral responsibility is often noted. The mother's educational uncertainty is expressed.

5. Depressive type manifests itself, first of all, by a sharply reduced mood background in pregnant women. A woman who dreamed of a child may begin to assert that now she does not want him, does not believe in her ability to bear and give birth to a healthy child, is afraid of dying in childbirth. Dysmorphic ideas often arise. The woman believes that pregnancy "disfigured her", she is afraid of being abandoned by her husband. In severe cases, overvalued, and sometimes delusional hypochondriacal ideas, ideas of self-deprecation with suicidal tendencies appear. There are emotional rejection of the child, cruel treatment of him.

Childbirth is the strongest physical and mental trauma for a child, accompanied by a threat to life. This echoes the assertion of K. Nogpeu (1946) that the horror experienced by a newborn and the experience from the first seconds of the existence of a feeling of hostility to the world form "basal anxiety", the level of which predetermines future actions of a person. K. Nogpeu identifies three main types of behavior strategies associated with basal anxiety:

striving for people;
desire from people (independence);
striving against people (aggression).

Glad scientists agree with existence hypothetical dynamic matrices, governing the processes related to the perinatal level of the unconscious, and name them basic perinatal matrices(BPM) by St. Grof.

Biological basis first perinatal matrix is the experience of the initial unity of the fetus and the mother in the period of ideal intrauterine existence.
An empirical pattern second perinatal matrix refers to the very beginning of biological birth, to its first clinical stage. With the full deployment of this stage, the fetus is periodically compressed by uterine spasms, but the cervix is still closed, there is no way out. At the same time, the child experiences a feeling of increasing anxiety associated with an impending mortal danger, aggravated by the fact that it is impossible to determine the source of the danger.
Third perinatal matrix reflects the second clinical stage of biological labor. At this stage, the contractions of the uterus continue, but the cervix is already open. This allows the fetus to constantly move through the birth canal, which is accompanied by severe mechanical compression, suffocation, and often contact with biological materials (blood, urine, mucus, feces). It all happens in context desperate struggle for survival... At the same time, the situation does not seem hopeless.
Fourth Perinatal Matrix associated with the final stage of childbirth, with the immediate birth of a child. believes that the act of birth is liberation and, at the same time, an irrevocable rejection of the past. The joy of liberation is combined with anxiety: after intrauterine darkness, the child first encounters a bright light, the cutting off of the umbilical cord stops the bodily connection with the mother, and the child becomes anatomically independent. The physical and mental trauma received during childbirth, associated with a threat to life, with a sharp change in the conditions of existence, largely determines the further development of the child.

After childbirth, the process of adaptation of the child to new conditions begins. If during childbirth the baby can and usually does receive acute psychological trauma, then with the wrong attitude towards him in the postnatal period, the baby can get into a chronic traumatic situation... As a result of the research, it was found that the relationship between mother and child develops during the first three months of life and determines the quality of their attachment by the end of the year and thereafter.

M. Einsfoort managed to distinguish three types of behavior of children when communicating with their mother:

Type of A. Avoiding attachment - occurs in about 21.5% of cases. It is characterized by the fact that the child does not pay attention to the mother's leaving the room, and then to her return, does not seek contact with her. He does not make contact even when his mother begins to flirt with him.

Type of V. Safe attachment- occurs more often than others (66%). It is characterized by the fact that the child feels comfortable in the presence of the mother. If she leaves, the child begins to worry, stops research activities. When the mother returns, he seeks contact with her and, having established it, quickly calms down, again continues his studies.

Type of WITH. Ambivalent attachment - occurs in about 12.5% of cases. Even in the presence of the mother, the child remains anxious. When she leaves, anxiety increases. When she returns, the baby strives for her, but resists contact. If his mother takes him in her arms, he breaks free.

PERINATAL PSYCHIATRY. For more than 10 years, a new branch of psychotherapy and psychiatry, specializing in serving young children, has emerged in our country and even earlier abroad. Under early age understand

neonatal period (from 0 to 1 month of life),
infant period (from 1 month to 1 year of life)
the period of early childhood itself (from 1 to 3 years of age).

Perinatal psychiatry- a section of child psychiatry devoted to the study of the etiology, pathogenesis, clinical picture and prevalence, as well as the development of methods for the diagnosis, treatment, rehabilitation and prevention of mental disorders in children that arise at the earliest stages of ontogenesis from conception to the first months of life after birth in the context of the child's interaction with the mother and her mental state.

In many ways, the development of micropsychiatry was predetermined by the successes of child psychoanalysis (A. Freud, M. Klein, D. Bowlby, D. Winicotta, R. A. Spitz). The most consistent studies of children at high risk for mental pathology are carried out by the American researcher V. Fish, who began observing children born to parents with schizophrenia (from the day of their birth) in 1952. years of life, were ration, or PDM) and the syndrome of "pathologically calm children".

In Russia, interest in mental disorders in young children has been manifested since about the 50s of the XX century by individual works of such well-known child psychiatrists as G.E.Sukhareva, T.P. Simeon, S.S.Mnukhin, M.Sh. Vrono, G. V. Kozlovskaya, O. V. Bazhenova. In Russian child psychiatry recently, a set of features characterizing a predisposition to mental pathology is designated by the term "Mental diathesis". These can be short-term stops in development, leaps and "pseudo-delays". In these cases, there is dissociation of development. Epidemiological studies (1985-1992) showed that the prevalence of schizotypal diathesis in young children is 1,6 %.

Clinical manifestations of schizotypal diathesis.(The psyche in schizotypal diathesis is based on observation and examination using the GNOM technique of 1 children of schizophrenic parents at the age of infancy and toddlers up to 3 years old). Already at the early stages of ontogenesis in children, mental abnormalities are revealed in the psychobiological systems mother-child, sleep-wakefulness and in food rituals that form the basis of the pre-verbal behavior of the newborn. Developmental disorders are expressed in the form of 4 groups of disorders: 1) disharmony of psychophysical development; 2) dysregular or uneven development; 3) developmental dissociation; 4) deficiency of mental manifestations.

Psychopathology of an early age has the following features: mosaic clinical symptoms in the form of a combination of mental disorders with manifestations of developmental disorders; "Cohesion" of mental disorders with neurological disorders; coexistence of positive and negative symptoms; rudimentary psychopathological phenomena (microsymptomatics), transient clinical phenomena.

In children, there is a disorder in all spheres of the body's life. In the instinctive-vegetative sphere this is expressed by dyssomnias, perverse reactions to hunger and microclimatic stimuli. The absence or decrease of "food dominant" in eating behavior, peak symptom, pathological drives, decrease and perversion of the instinct of self-preservation, with simultaneous reactions of panic, conservatism and rigidity of protective rituals, the phenomenon of identity are noted. As a rule, these disorders develop against the background of various somatovegetative dysfunctions. The described violations can be noted starting from the 2nd month of life. Emotional sphere: From the first 2 months of a child's life, emotional disorders are also noted. They are manifested by the distortion of the maturation of the formula of the revitalization complex, emotional rigidity and the prevalence of the negative pole of mood, the absence or weakness of emotional resonance, the exhaustion of emotional reactions, their inadequacy and paradoxicality. Against the background of such a general characteristic of emotional response in children from infancy, more pronounced dysthymia, dysphoria, less often hypomania, fears, and panic reactions (mainly nocturnal) are noted. Signs of depression are especially frequent: depression with phobias, masked by a somatovegetative component, with persistent weight loss and anorexia, an endogenous mood rhythm. Among a wide variety of depressive reactions, two of their relatively delineated variants were identified - "infantile depression" (after birth distress) and "deprivation depression".

Cognitive disorders most often expressed in the distortion of play activity in the form of stereotypical rigid play manipulations with non-play items. The structure of violations of the cognitive sphere also includes symptoms of distortion of the child's self-awareness and self-awareness. This manifests itself in the form of persistent pathological fantasizing with reincarnation and loss of self-consciousness as a child, as well as violations of gender identification at an older age (3-4 years).

Also characteristic attention disorders observed from the 1st month of a child's life. They are expressed by a frozen "puppet" look or a "nowhere" look, which is usually associated with the phenomenon of "withdrawal" (without disturbances of consciousness) in the form of short "disconnections" from the environment. Among attention disorders, the phenomenon of "hypermetamorphosis" (over-attention) and selectivity of attention are observed. In these cases, concentration of attention is simultaneously fleeting in a forced situation and rigid in spontaneous activity.

Social Behavior Disorders are manifested by a delay and distortion of the skills of neatness and self-care, as well as stereotypes of behavior in the form of meaningless rituals when falling asleep, eating, dressing, and playing. Communication disorders are manifested by a negative attitude towards the mother or an ambivalent symbiotic relationship with her, the phenomenon of protodiacrisis and fear of people (anthropophobia) with a simultaneous indifference to them in general. Quite often, autistic behavior is noted, which, traced from the first months of life, becomes more pronounced by the age of 1 year and older, reaching the degree of "pseudo-blindness" and "pseudo-deafness". In disorders of the function of communication, a large place is occupied by speech disorders: true and pseudo speech delays, as well as elective mutism, echolalia, speech stereotypes, neologisms, "stuttering" and "stuttering" disorders.

Among movement disorders most often, micro-catatonic symptoms and phenomena related to a specific neurological pathology are noted.

Neurological manifestations of schizotypal diathesis. At the 1st year of life, the following phenomena appear quite clearly, disorders of adaptive reactions in the vegetative-instinctive sphere with hypersensitivity to sensory stimuli, violation of orienting reflexes; the formation of diffuse muscle hypotension and a decrease in motor activity in the absence of focal motor symptoms.

From the first year of life, the following are determined neurological disorders: hydrocephalus syndrome; "Gaze ataxia", gaze instability during fixation, lack of friendly movements of the eyeballs, convergence, divergence, oculogyric crises; suprasegmental lesions of the VII, IX, XII pairs of cranial nerves, expressed in a violation in the development of complex complex acts of chewing, swallowing, expressiveness of facial expressions, speech; muscle hypotension in combination with dynamic muscular dystonia; change in general motor activity; violation of the friendliness of the left- and right-sided orientation of movements; hypomimia and orofacial hyperkinesis; hypotonic-hyperkinetic and hypokinetic-rigid disorders; dyspraxic disorders; motor stereotypes; atactic syndromes of the developmental period; violations of the tempo and general expressiveness of speech; dissociation of speech development; cortical dysarthria during the development of speech; tactile and sensory hypo- and hypersensitivity; sleep disorders, night screams; hyperventilation disorders, heart rate arrhythmia; distal hyperhidrosis; transient miosis, anisocoria. A special neurological status is formed that does not fit into the framework of any of the known neurological syndromes. According to EEG data, in children from groups at high risk of developing schizophrenia against the background of varying degrees of severity of immaturity of bioelectrical activity, signs of pathological electrogenesis were revealed in the form of hypersynchrony of physiological waveforms and abnormal “burst” activity.

After 3 years of age, if the schizotypic diathesis remains sufficiently pronounced, it begins to gradually transform into schizoid personality traits from character accentuations (extreme variant of the norm) to severe schizoidia, sometimes with outpost symptoms of endogenous psychosis, but without signs of manifestation of the disease. Transformation of schizotypal diathesis into early childhood autism and schizophrenia is possible, as well as its full compensation until practical recovery. In this sense, the first option is naturally more favorable, although a high degree of its severity does not always mean an unfavorable prognosis.

Dobryakov I.V. (St. Petersburg)

Annotation. The article provides the definition of a new section of clinical (medical) psychology - perinatal psychology, describes its main features and tasks, shows the relevance of the development of perinatal psychology and the implementation of its achievements into practice.

Keywords: clinical (medical) psychology, perinatal, dyad, biopsychosocial approach.

At the beginning of the twentieth century V.M. Bekhterev, who combined the talent of an outstanding clinician-psychiatrist, psychotherapist, neurologist with deep knowledge in the field of morphology, psychology, physiology, developed and introduced into practice a new scientific direction: neuropsychiatry. It meets modern requirements for a comprehensive interdisciplinary study of the nervous system and psyche of a healthy and sick person. Created by V.M. Bekhterev Research Institute, in addition to departments engaged in medical research in the field of neurology, psychiatry, psychology, in 1932 formed a sector of social psychoneurology. Thus, the concept of neuropsychiatry by V.M. Ankylosing spondylitis included biopsychosocial triad... At the institute, which bears his name after the death of the creator, methods of treatment have been developed and continue to improve, combining both biological and sociopsychological effects with a differentiated observation system. They are viewed as a complex dynamic system of interrelated components (medical, psychological, social) aimed at restoring the patient's personal and social status. The ideas of V.M. Bekhterev, despite the changing, often very difficult political situations, was successfully developed by his students and followers (E.S. Averbukh, L.I. Wasserman, R.Ya. Golant, M.M. Kabanov, B.D. F. Lazursky, A.E. Lichko, S.S.Mnukhin, V.N.Myasishchev, Yu.V. Popov, T.Ya. Khvilivitsky and others).

Guided by his ideas, M.M. Kabanov formulated the principles of rehabilitation in neuropsychiatry:

The principle of the unity of biological and psychosocial influences;

The principle of versatility of efforts and impacts in the implementation of a rehabilitation program;

The principle of partnership;

The principle of stepping (transitivity) of the applied efforts, the impacts and measures.

The pioneering works of V.M. Bekhterev and his students made it possible to increase the efficiency of work with patients suffering from nervous and mental diseases. The need to introduce such an approach in all areas of medicine was obvious. An important role in this was played by G. Engel, who developed an approach called "Biopsychosocial"... He argued that the clinician needs to consider not only the biological, but also the psychological and social aspects of the disease. Only then will he be able to correctly understand the cause of the patient's suffering, offer adequate treatment and win the patient's trust. His holistic model has become an alternative to the generally accepted biomedical approach that has reigned supreme in industrial societies since the middle of the 20th century. The speed of spread of Angel's ideas in various fields of medicine was different, which is associated with the specifics of understanding the mutual influences of psychological, biological and social factors, identifying patterns, theoretical justification and testing by practice.

The introduction of a biopsychosocial approach into obstetrics has met and continues to meet with resistance from a number of doctors. Meanwhile, neglect of psychological and social factors has led and is leading to the now recognized non-constructive features of rendering assistance to pregnant women and women in labor. The most famous of them and widely practiced earlier include the categorical prohibition of visits by relatives of women in maternity hospitals, separation of mother and child immediately after childbirth, etc. psychology, which differs from its other sections in the features of its subject, the specificity of the range of phenomena studied.

Medical psychology- one of the main applied branches of psychological science, the purpose of which is to apply a variety of psychological knowledge in the field of medical activity (health protection, disease prevention, diagnosis, treatment, rehabilitation), in medical research. In addition, the area of interest of medical psychology includes relations that arise between all participants in the process of providing medical care. In the Russian Federation, in 2000, the Ministry of Education, by order No. 686, approved the specialty "clinical psychology" (022700). A definition has been adopted according to which clinical psychology is a wide-profile specialty that has an inter-sectoral nature and participates in solving a set of problems in the health care system, public education and social assistance to the population. Medical psychology has especially close ties with psychotherapy and psychiatry.

The section of medical (clinical) psychology is perinatal psychology, since at all stages of the implementation of the reproductive function (conception, pregnancy, childbirth, baby care), a person needs a medical examination, observation, and sometimes treatment. First of all, it is closely related to obstetrics, but no less important is its relationship with psychiatry and psychotherapy... In the process of conception, during pregnancy, in the implementation of feeding and caring for a child, a person experiences the strongest both positive and negative emotions. Pregnancy, regardless of whether it is desired or not, like the birth of a child, is accompanied by heavy loads on all systems of the woman's body, which can affect the state of her health, the development of the child, lead to asthenization, to an increase in anxiety, to the appearance of fears, depressive experiences. Pregnancy and childbirth will certainly entail changes in a woman's attitude towards herself, towards others, in relation to the attitude of others towards her, that is, changes in her personality. There is also a change in the social status of the spouses who become mother and father. Thus, the appearance of a new member in the family inevitably leads to a restructuring of the family system and changes marital relations. All of the above explains why during pregnancy and childbirth the degree of risk of the onset or exacerbation of family problems, somatic and neuropsychiatric disorders in both spouses, but especially in a woman, sharply increases. At conception, the two organisms of the mother and the child begin to live a common life, forming a dyad. The entire body of a woman is radically rebuilt in order to optimally ensure the vital functions of the two. For this, an additional common organ is formed - the placenta. Consecutively arising in connection with reproductive function and replacing each other dominant states in a woman's body, determined by biological (primarily hormonal) changes, psychological and social factors are called maternal dominant... The maternal dominant includes a physiological component and a psychological component. They are, respectively, determined by biological or mental changes occurring with a woman, aimed at carrying, and then giving birth and nursing a child.

Gestational dominant(lat .: gestatio - pregnancy, dominans - dominant) ensures the direction of all body reactions to create optimal conditions for the development of prenate. The psychological component of the gestational dominant is a set of mechanisms of mental self-regulation, which are activated when pregnancy occurs and form behavioral stereotypes in a pregnant woman, aimed at preserving gestation and creating conditions for the development of prenate. The peculiarities of the psychological component of the gestational dominant are manifested in the changes in the woman's relationship system associated with pregnancy. We have identified five options for its formation: optimal, hypogestogenic, euphoric, anxious, depressive. The optimal option is favorable both for the course of pregnancy and childbirth, and for the formation of bonding after childbirth, for the development of the baby. Women who show signs of euphoric, hypogestogenic, anxious, euphoric variants of the psychological component of the gestational dominant need to be monitored, since they may have neuropsychiatric and somatic disorders, or have an increased risk of their occurrence. Variants of the psychological component of the gestational dominant can change during pregnancy, depending on the gestational age, the somatic state of the woman, the situation in the family, the relationship with the doctor, etc. This makes it possible to correct the psychological component of the gestational dominant, sets before specialists the task of conducting a screening psychological examination of pregnant women for the early identification of those in need of medical and psychological assistance, guides the specialist in what it should be expressed.

Thus, pregnancy and childbirth are a critical situation for both parents, which has all its characteristic features. Indeed, for parents, bearing and giving birth to a child are events that can be dated and localized in time, accompanied by strong persistent emotional reactions, requiring large costs and a long time for adaptation. In this regard, professional psycho-preventive work should be carried out with a family expecting the birth of a child. Parents-to-be should have access to psychological, psychotherapeutic, and sometimes psychiatric help. It is advisable that such work be carried out by specialists in health care institutions (in perinatal centers, antenatal clinics, maternity hospitals, children's clinics), and not by midwives and psychologists or simply enthusiasts without special clinical training at home or in hobby groups. This will ensure the professionalism of the assistance provided and the relationship of specialists.

Perinatal psychology can be defined as a section of clinical psychology involved in solving the psychological problems of providing obstetric-gynecological, perinatal care to the population. The very name "perinatal psychology", reflecting its essence, is in conflict with the generally accepted obstetric terminology. The word "perinatal" has a mixed Greek-Latin origin: peri- - around (Greek); natus - birth (lat.). In 1973, at the 7th FIGO World Congress (International Federation of Obstetricians and Gynecologists), the definition of the "perinatal period" was adopted and included in the international classification of the 10th revision (ICD-10), according to which it begins from 22 full weeks (154 days) of pregnancy and ends 7 full days after birth... In obstetrics, the period from the 28th week of a person's intrauterine life to the 7th day of his life after birth is also often considered perinatal. From the point of view of perinatal psychologists, the perinatal period includes the entire prenatal period, the birth itself and the first months after birth. This, in contrast to the understanding of the term by obstetricians, is more consistent with the etymological meaning of the concept, allows us to consider the birth of a child not as a separate event, represented by a point on the time axis, but as a long process, starting from conception and covering the entire prenatal period, the birth itself and the first months after birth. The signs of the perinatal period are:

The presence of a symbiotic relationship between mother and child;

The child's lack of self-awareness, that is, his inability to distinguish himself from the world around him, to build clear bodily boundaries and boundaries of the psyche;

The lack of independence of the child's psyche, its dependence on the characteristics of maternal mental functions.

The activities of a perinatal psychologist are aimed at increasing the mental resources and adaptive capabilities of women and men in the process of implementing reproductive functions, harmonizing family relations, creating optimal conditions for the development of prenate and baby, and protecting the health of women and children.

Object research and psychological impact in perinatal psychology are dynamically developing dyadic systems: matrimonial holon, "pregnant-prenate", "mother-child". That is, a perinatal psychologist works with dyads. The essence of the dyadic approach is that the husband and wife are considered as a dyad - the matrimonial holon, and the pregnant woman and the prenate, mother and baby, as components of one "mother-child" system. Within these systems, their elements interact, develop and acquire a new social status of mother, father, or child. The mother-child dyad is a subsystem of the family, and everything that happens in the family affects it.

The perinatal dyad is a self-developing open structure with complex dynamics regulated by supposedly simple, but as yet unknown algorithms of interactions both within the dyad itself and the dyad as a whole with the environment. The result of these processes is difficult to predict: during the perinatal period, the prenate, and then the baby lives with the mother practically the same life, and the dynamic structure "surrounding world-mother-prenate" is especially sensitive to any fluctuations. The fact that a woman in the perinatal period becomes part of two dyads at the same time (in one - a wife, in the other - a mother) can lead to conflict situations. It is the task of the perinatal psychologist to timely detect the possibility of this and prevent the conflict, help its constructive resolution.

Subject professional activities of a perinatal psychologist can be:

Development of mental processes in the early stages of ontogenesis;

Socio-psychological phenomena that appear in women and men in connection with their reproductive function;

Psychological characteristics of relationships in a family expecting the birth of a child, with a small child;

Psychosomatic disorders associated with reproductive processes.

A perinatal psychologist performs a variety of activities: preventive, didactic, advisory, diagnostic, corrective, expert, rehabilitation, research and others.

In addition to the dyadic nature of the object of research, the features of perinatal psychology include the family nature of the problems that it studies; sequential change of tasks related to the stages of family life, stages of the implementation of the reproductive function; psychoprophylactic focus.

The following sections of perinatal psychology:

Child conception psychology;

Psychology of the pregnancy period (mother-prenate dyads);

Psychology of the early postnatal period (mother-child dyad);

Psychology of the influence of the course of the perinatal period on mental development in general and on personality development in particular;

Crisis perinatal psychologists (in case of a threat to the health, life of the mother and / or child, death).

The main tasks of perinatal psychology can be formulated as follows.

1. Determination of the role of psychological (including family) factors in the processes of conception, pregnancy and childbirth; the formation of the mother-child dyad; development of a child of infancy and early age.

2. Investigation of the influence of various diseases of a woman on her attitude to conception, pregnancy, childbirth; the formation of the mother-child dyad; mental development of the prenate / child.

3. Development of methods of psychological research, adequate for solving the problems of perinatal psychology.

4. Creation of methods of early psychological intervention aimed at optimizing the course of the perinatal period and family functioning at the stages of conception, expectation of the child and in the postpartum period.

5. Development of methods of psychological and psychotherapeutic assistance in situations of perinatal loss and birth of a sick child.

6. Solving psychological problems arising from the use of modern technologies to combat infertility (in vitro fertilization, surrogacy, etc.).

Perinatal psychology is developing, therefore, it has both constant specific signs and transitory signs that are a sign of the present:

The dyadic nature of the object (the "pregnant-fetus" or "mother-child" systems);

The family character of the problems she is intended to solve;

Low level of awareness of patients in need of perinatal psychological and psychotherapeutic assistance about the possibility of receiving it;

The need to actively identify those in need of perinatal psychological and psychotherapeutic assistance, to form their motivation to receive it;

Iatrogenic, psychogenic and didactogenic nature of a number of disorders, which are indications for the use of perinatal psychocorrection and psychotherapy;

Insufficient development of the legal framework for the provision of psychological and psychotherapeutic assistance in the event of perinatal losses;

Sequential change of tasks of perinatal psychocorrection and psychotherapy associated with the stages of family life, stages of the implementation of the reproductive function;

The need for close cooperation of the perinatal psychologist, psychotherapist with other specialists (obstetricians-gynecologists, neonatologists, neurologists, etc.);

Preference for short-term psychocorrectional and psychotherapeutic techniques;

Lack of specific psychological tools and methodological developments in the field of perinatal psychology and psychotherapy;

Insufficient number of competent perinatal psychologists and psychotherapists;

Preventive focus of PP and psychotherapy.

A specialist in the field of perinatal psychology needs special knowledge and mastery of special techniques. This dictates the need to train such specialists at the psychology departments of universities, in the system of postgraduate psychological and medical education. The state institution in which, for the first time in our country, curricula and plans for thematic improvement cycles in the field of perinatal psychology, psychopathology and psychotherapy of psychologists, psychiatrists, psychotherapists, neonatologists were developed was the St.Petersburg Medical Academy of Postgraduate Education (now the North-West State Medical University named after I.I.Mechnikov). The work was carried out and continues at the Department of Child Psychiatry, Psychotherapy and Medical Psychology (Head of the Department - Doctor of Medical Sciences, Prof. EG Eidemiller).

The development and implementation of perinatal psychological counseling and psychotherapy aimed at improving the mental state of pregnant women and women in labor, harmonizing relations in families awaiting the birth of a child and raising a baby, is one of the urgent, priority state tasks. Their solution will reduce the number of complications during pregnancy and childbirth, the number of newborns with neuropsychiatric disorders (including by reducing the use of medications).

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UDC 159.922.7-053.31

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Any pathopsychological experiment includes observation of the patient, behavior, conversation with him, analysis of life history, the course of the disease.

Rossolimo proposed a quantitative method for studying the psyche. Rossolimo's method made it possible to introduce the experiment into the clinic. The experiment began to be actively used in psychiatry. Any pathopsychological experiment should be aimed at elucidating the structure of the pathopsychological syndrome.

Pathopsychological syndrome is a relatively stable, internally related set of individual symptoms.

Symptom- This is a single disorder that manifests itself in various areas: in behavior, emotional response, cognitive activity of the patient.

Pathopsychological syndrome is not directly data. To highlight it, it is necessary to structure and interpret the material obtained in the course of the research.

It is important to remember that the nature of the violations is not specific to a particular disease or the form of its course. He is only typical of them.

These violations should be assessed in conjunction with the data of holistic psychological research. The difficulty lies in judging why the patient does this or that.

The concept of the pathopsychological syndrome allows predicting the appearance of the disorders most typical for this disease. According to the forecast, implement a certain strategy and tactics of the experiment. Those. the style of the experiment is selected, the selection of hypotheses for testing the subject's material. You don't need to be biased.

For the syndromic approach in psychiatry, as in medicine, it is important to determine the essential features of mental disorders, which ensures the completeness of the analysis and the validity of the researcher's conclusions.

Pathopsychological diagnostics.

The pathopsychological syndrome in schizophrenia, epilepsy, and diffuse brain lesions is well developed. In psychopathy, the pathopsychological syndrome has not been identified.

It is necessary to highlight the structure of the pathopsychological syndrome.

The pathopsychological syndrome can change with the course of the disease, depending on such characteristics of the disease as: form, duration, time of onset, quality of remission, degree of the defect. If the disease started earlier, then the disease will affect those areas in which the disease arose. (In adolescence, epilepsy will affect the entire mental sphere, leaving an imprint on the personality).

With schizophrenia: paroxysmal form. There is also a continuously flowing form. With such a disease, mental changes are observed.

What should be analyzed?

Components of the pathopsychological syndrome.

features of affective response, motivation, patient relationship system - this is the motivational component of the activity
an analysis of the attitude to the fact of the survey is carried out
how the subject reacts to the experimenter (flirts, tries to impress)
analysis of attitudes towards individual tasks (memory test), changes in behavior during the experiment.
Analysis of the performance of the task, attitude to the result (may be indifferent). It is necessary to record everything.
Analysis of the attitude towards the experimenter's estimates.

Characteristics of the patient's actions when solving a cognitive task: assessment of purposefulness, controllability of actions, criticality.
Type of operational equipment: features of the generalization process, changes in the selectivity of cognitive activity (synthesis, comparison operations)
Characteristics of the dynamic procedural aspect of activity: that is, how the activity changes over time (the patient is characterized by uneven performance in case of cerebrovascular disease).

A single symptom says nothing.

For differential diagnosis: a psychologist should pay the greatest attention to those symptoms that most reliably allow differentiating the pathopsychological syndromes of various diseases. That is, if a situation has arisen: you need to differentiate schizophrenia or psychopathy. Need to know what are the differences? Psychopathy is less severe than schizophrenia.

For diagnostics, studies of the processes of thinking and the emotionally volitional sphere are used, and it is important to find the difference in the correlation of symptoms. For schizophrenia, a weakening of motivation is more characteristic (they do not want a lot), a depletion of the emotional-volitional sphere, a violation of meaning formation, there is a decrease or inadequacy, a paradox of self-esteem.

All these violations are combined with the operational and dynamic aspects of thinking. In this case, the main thing in the violation of thinking is a change in the motivational component. Error correction not available. Refusal of corrections. They lack motivation to do the task well.

With psychopathy: there is a brightness, instability of the emotional and motivational components of the activity. And sometimes the arising disturbance of thinking is also unstable. There are no persistent violations. At the same time, emotionally determined errors are quickly corrected (to impress the experimenter). It is necessary to clearly understand what methods allow this to be effectively investigated.

For the differential diagnosis of schizophrenia and mental pathology caused by organic disorders in the syndrome, most attention is paid to other symptoms. In addition to the emotional-volitional sphere and thinking, the features of mental performance are analyzed. How quickly does the patient deplete? What is the pace of the task? Organic disorders are characterized by rapid emaciation.

Pathopsychology (from the Greek pathos - suffering, illness) is a branch of clinical psychology that studies the patterns of the decay of mental activity and personality traits in comparison with the patterns of formation and course of mental processes in the norm.

Pathopsychology is one of the intensively and fruitfully developing areas of psychology.

The founder of Russian pathopsychology, Zeigarnik, is a student of Levin, the world famous German psychologist. She developed the theoretical foundations of pathopsychology, described disorders of mental processes, formulated the principles of work of a pathopsychologist. Scientific and practical activities were continued by students and followers: Polyakov, S. Ya. Rubinstein, Sokolova, Spivakovskaya, Nikolaeva, Tkhostov, Bratus, etc.

Clinical psychopathology investigates, identifies, describes and systematizes the manifestations of impaired mental functions, while pathopsychology reveals, using psychological methods, the nature of the course and features of the structure of mental processes leading to the disorders observed in the clinic. Although pathopsychology has received more application in the psychiatric clinic, at present its methodological techniques are used not only in psychiatry. Taking into account shifts in the patient's mental state, changes in his working capacity, his personality characteristics become necessary in therapeutic, surgical clinics and other areas of medicine.

Knowledge of pathopsychology is important for psychologists of any specialization and specialization, since the professional communication of a psychologist with people does not exclude a meeting with a mentally ill person.

In this regard, it should be emphasized that on the border between psychology and pathopsychology lies such an urgent problem for social practice and, in particular, a number of its areas, as the question of the norm, that is, normal mental development. In pathopsychology, in determining the norm and mental health, they usually adhere to the provisions of the World Health Organization, the norm is understood as "... not only the absence of diseases, but the state of physical, social and mental well-being."

In pathopsychology, ideas about pathopsychological syndromes of violations of the cognitive, motivational-volitional and personal spheres in mental illness have been developed (Polyakov, Kudryavtsev, Bleikher, etc.).

According to Korsakova, “clinical and psychological syndrome” is a naturally occurring combination of symptoms of impaired cognitive processes or personality, which is based on the insufficiency of the link that unites them in the systemic and structural structure of the psyche caused by a painful process. The author considers the clinical and psychological syndrome within the framework of two approaches - pathopsychological and neuropsychological. In pathopsychology, the central place is occupied by the search for a common link in the violation of higher mental functions, which underlies the development of individual symptoms during the implementation of such functions. For example, a syndrome-forming radical in schizophrenia may be a violation of motivation, which results in changes (or features) characteristic of this disease in thinking, perception, memory, etc.

As Polyakov writes, the clinical-psychological syndrome does not differ from the clinical-psychopathological one, but it has a different content. "If clinical (psychopathological) studies reveal the patterns of manifestations of disturbed mental processes, then experimental psychological studies should answer the question: how is the course (that is, the structure) of mental processes themselves disturbed."

Of a number of psychopathological syndromes, the following are of greatest importance in the clinic (Bleicher, Kruk):

Schizophrenic, or dissociative symptom complex (F20-F29) - consists of such personality-motivational disorders as a change in the structure of the hierarchy of motives, a violation of the purposefulness of thinking (resonance, diversity, etc.); emotional-volitional disorders (flattening and dissociation of emotions, parabulia, etc.), changes in self-esteem and self-awareness (autism, alienation, etc.);

Psychopathic (personality-abnormal) symptom complex (F60-F69) - consists of emotional and volitional disorders, changes in the structure of the hierarchy of motives, inadequacy of the level of aspirations and self-esteem, disorders of thinking of the catatim type, violations of forecasting and reliance on past experience (in the clinic - accentuated and psychopathic personality and psychogenic reactions caused to a large extent by abnormal soil) (F43);

Organic (exo- and endogenous) (F00-F09) symptom complexes - consist of symptoms of decreased intelligence, disintegration of the system of previous knowledge and experience, impaired memory, attention, and the operational side of thinking; instability of emotions; decrease in critical abilities (in the clinic, this corresponds to exogenous organic lesions of the brain - cerebral atherosclerosis (I67.2); consequences of craniocerebral trauma (F06); substance abuse (F13-F19) and other diseases, as well as "endogenous organic" disorders type of true epilepsy (G40), primary atrophic processes in the brain (G31);

Oligophrenic symptom complex (F70-F79) - consists of an inability to learn, the formation of concepts, abstraction, a lack of general information and knowledge, primitiveness and concreteness of thinking, increased suggestibility and emotional disorders.

It should also indicate the symptom complex of psychogenic disorganization, characteristic of reactive psychoses (F23).

Pathopsychological syndrome plays an essential role as a link in nosological and functional diagnostics.

Pathopsychology is a psychological science, and therefore its problems, prospects and achievements cannot be considered in isolation from the development and state of general psychology, psychological knowledge in general.