Formation of suicidality among the young patients with addictive and neurotic disorders: social and psychological risk factors, and psychotherapy
The high prevalence of suicidal phenomena among young patients with addictive and neurotic disorders makes it necessary to include components of suicidal prevention in therapeutic programs. At the same time, among interventions with proven effectiveness, the leading place is taken by methods related to increasing the cognitive rationality and adaptability of the stress response. Aim: to substantiate the methodology for identified groups of suicidal risk and approaches to its prevention among young highly educated patients with addictive and neurotic pathology based on cognitive-coping therapy. Materials and methods: 124 young patients (aged 19-35, 56.5% male, 43.5% female) were examined, 72 of whom were alcohol addicted, 52 had neurotic anxiety and depressive disorders. Clinical and psychopathological, psychometric, and statistical methods were applied. Results: a history of suicidal thoughts was found in 25% of young patients with alcohol addiction and in 41.2% of patients with neurotic disorders. As groups of increased suicidal risk patients with comorbid conditions (both addictive and anxiety-depressive) are identified, as well as patients with manifestations of socio-psychological distress (psychotraumatic situations, inharmonious conditions of bringing-up in childhood, violations of adaptation in preschool and educational instituations, the specifics of prevailing interests during adolescence with concentration in the "virtual world", with underdeveloped hobby reactions and reactions of communication with peers) in both nosological groups. In the formation of suicidality in patients with addictive and neurotic disorders, three main variants (sthenic, hyposthenic, and associated with communicative incompetence) are identified by factor analysis. These variants are manifested both at the level of charactero-logical traits, and at the level of symptoms observed in the clinical picture. The prevailing variant of suicidality formation should be taken into account when personalizing psychotherapeutic interventions. As one of the solutions to the problem of preventing suicidal behavior, the method of cognitive coping therapy can be used, which involves the identification and correction of irrational cognitive attitudes with the formation of an adaptive coping style of patients. The highest value for suicidal risk was found for cognitive distortions associated with external locus of control, low frustration tolerance, and inability to delay hedonism. Maladaptive coping style is primarily associated with a lack of readiness for rational assessment of stressors, inability to interact productively with the environment, and violations of emotional self-regulation. Conclusions: the identification of comorbidity of addictive and neurotic anxiety and depressive disorders, specific manifestations of socio-psychological distress and certain characterological traits in young patients indicates the need to include in the psychotherapeutic complex of measures to prevent suicide risk. The basis for these measures can be cognitive-coping therapy personalized for the leading variant of suicidality formation.