Clinical and psychological analysis of emotional and personality disorders in patients with long-term consequences of craniocerebral trauma complicated and uncomplicated by alcoholism
Background: The importance and relevance of studies of neuropsychiatric disorders in the remote period of craniocerebral trauma (CCT) is determined by high incidence of both head injuries (1-4 per 1000 population per year) and their consequences (up to 70-90%), with their significant diversity and insufficient knowledge about them, often aggravated by chronic alcoholism. The aim of the study:To study the role of a number of clinical, biological and socio-psychological factors in the formation of emotional and personality disorders in patients with distant consequences of CCT, complicated and uncomplicated by alcoholism, with an analysis of cerebral and other pathogenic mechanisms of their development. Materials and methods: 256 patients (203 men, 53 women) at the stage of remote consequences of CCT were examined with the use of clinical and psychopathological and experimental psychological (Rosenzweig test) methods. Traumatic epilepsy was diagnosed in 127 patients (sample 1); in 129 patients paroxysmal epileptic symptoms were absent (sample 2), despite the similarity of other neuropsychic disorders. Each sample consisted of two groups – persons without addiction to alcohol and persons with alcohol addiction. Results: Clinically, emotional and personality disorders were diagnosed in the structure of two main syndromic blocks – neurosis-like and psychopathy-like – with a similar frequency of their detection in patients with traumatic epilepsy without alcohol addiction and a significant predominance of psychopathic block in patients composing three other study groups. The study of the characteristics of the emotional response in frustrating situations with the Rosenzweig test has revealed a significant decrease in frustration tolerance for all diagnostic groups, with the greatest similarity with the unity of etiopathogenetic factors – a combination of head injury with alcoholism or head injury without alcohol addiction. The former were characterized by more pronounced social maladaptation and increased demands on their environment, while the latter were characterized by greater personality weakness and vulnerability. Conclusion: Violations of emotionally-personal functioning in individuals with long-term consequences of CCT both uncomplicated and complicated by alcoholism, have a multifactorial genesis with multilevel and hierarchical pattern involved in the process of mechanisms, each of which corresponds to one of the basic levels – biological, psychological and social. The analysis and consideration of these factors can reveal the most significant “target” for the treatment and rehabilitation impacts and, consequently, to improve their effectiveness.