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TREATMENT AND PREVENTION
The treatment of mental disorders in patients with cancer consists of a psychotherapeutic effect on the patient and his environment, as well as, if necessary, the use of psychotropic drugs or their combinations.
Psychotherapy of children suffering from cancer is justified by the age-related features of experiencing the disease and identifying the main pathogenetic mechanism of psychological response to the critical life situation created by the disease. As such a mechanism, we single out a kind of deprivation *, the meaning of which is two points: 1) a sharp change in the life situation that leads to the loss of habitual social connections, 2) the atmosphere of psychological stress of adults surrounding the child increases the degree of attention to him. In this case, there is a pronounced deficit in the usual, undistorted by communication illness. With an increase in the age of children and the experience of the disease, an awareness of the connection of their disease with the problems of life, death, and the future occurs. Awareness of this connection and an increase in the experience of deprivation increases the likelihood of crisis and psychopathological reactions.
The goal of psychotherapeutic assistance to children with cancer is the prevention and correction of crisis and psychopathological reactions. The immediate goal of psychotherapy is to overcome the effects of deprivation, as well as psychological correction of experiences associated with ideas about life, death, the future in sick children. Based on our experience, the most effective is individual psychotherapy, in which the proportion of personal appeal to a child is much higher than when using group methods. Psychotherapeutic correction begins from the first moment of the examination, which should have a psychotherapeutic focus and be dentologically gentle. Depending on the psychological state, the situation of the leading psychological syndrome, various methods of psychotherapy are used.
Rational, explanatory therapy is carried out in children over 10-11 years old with a loss of their faith in recovery, fears for the future, feelings associated with the limitations caused by the disease. All beliefs are held on concrete examples of literature, cases from practice, and most importantly, it is necessary to draw the attention of the patient to his own successes in difficult situations.
* Deprivation (from the English. Deprivation - deprivation, loss). In medicine: failure to meet any needs of the body.
Waking up is carried out in children aged 5-14 years with anxiety, fears, refusal of examination, resistance to medical and diagnostic procedures. The essence of the suggestion is the need for medical manipulations, the short duration of pain in this situation. An essential role in this is played by the appeal to the courage and fortitude of the patient.
The main goal of family psychotherapy is to support the family in an extreme situation regarding the unfavorable life prognosis of the child’s disease and to teach the family how to communicate best with them. The specific tasks of psychotherapy include: reducing emotional stress, anxiety, confusion; decreased guilt; optimization of family attitudes for the future; indirect effect on a sick child through parents. Depending on the stage of the disease, the experience of the parents and their condition, the following issues are discussed in psychotherapeutic conversations: about the possibilities of modern treatment and its prospects; the redistribution of roles and relationships in the family in connection with the illness of the child; discussing the tactics of parental behavior with the sick and other healthy children in the family; about the role of parents in explaining to the child the reasons, essence and prognosis of the disease; discussion of family plans for the future, taking into account the outcome of the disease.
The experience of psychotherapeutic work with children suffering from cancer, shows the possibility of including a wide range of psychotherapeutic methods used in children's practice, but most importantly, they must necessarily be confidential, equal, “serious” communication with the child, the psychotherapist’s deep confidence in the highest value of mental well-being in every moment of a child’s life, right up to the last minute.
The absence of the effect of psychotherapy in some patients, repeated decompensations, the presence of persistent and clearly defined psychopathological symptoms, including psychotic forms, indicate the need for psychotropic drugs.
In addition, there is evidence of the possibility of some psychotropic drugs to weaken the side effects of antitumor chemotherapy, to reduce the immunosuppressive effect of cytostatics, and in some cases to enhance their therapeutic effect [I. Veksler, 1983]. Works on this topic in pediatric oncology are few and performed on small groups of patients [Pfefferbaum-Levine V.V. et al., 1983; Maisami M., Sohmer B. N., Coyle J. T., 1985]. To stop emotional disorders (except depression), it is advisable to use benzodiazepine tranquilizers (mezapam, diazepam and their analogues) as the most promising ones, since drugs of this class have a wide spectrum of action that extends to the numerous symptoms of non-psychotic conditions, the ability to normalize not only mental, but and vegetative and somatic disorders. In depressive states, depending on their structure, phenazepam or azafen has a good effect. The latter belongs to the class of antidepressants, is effective for depression of various origins, its side effects are minimal. With psycho-organic and severe asthenic syndromes, piracetam (nootropil) gives a good therapeutic effect, a course of treatment lasting 1.5-2 months. In psychotic conditions with stupefaction, the most appropriate, in our opinion, is haloperidol, which has a fairly pronounced general and selective antipsychotic effect with minor and few somatic contraindications. It is advisable to prescribe haloperidol in drops, which allows it to be flexibly dosed. It should be noted that the appointment of psychotropic drugs should be carried out only on the recommendation of a child psychiatrist.
Thus, for the correction of mental disorders in oncological diseases, there are various psychotherapeutic methods and approaches, as well as a fairly wide arsenal of psychotropic drugs. These effects are part of a range of therapeutic measures that helps to improve the quality of life of children with cancer.
The implementation of this treatment complex requires a rational distribution of efforts between the pediatric psychiatrist and oncologists. The specificity of the work of oncologists is associated with extreme mental depreciation, leading to a psychoprotective focus on the somatic aspects of the disease. Therefore, the psychiatrist’s task includes the element of psychological relief of oncologists and the entire staff of the department, and introducing them into the course of the basic medical and psychological problems of children suffering from tumor diseases. But it is impossible to assign the task of treating mental disorders to oncologists only. A child psychiatrist, who has not yet been included in the staff of cancer departments, also cannot satisfy the real needs for psychiatric and medical-psychological assistance. There is an urgent need for the introduction of cancer psychologists into the oncology departments, possessing both diagnostic and correctional skills. Working under the guidance of a psychiatrist and with him, such a group could provide preventive and medical assistance to children, family, and staff of the department. The effects of this help are associated not only with the improvement of the mental state of sick children, but also with the preservation of the mental health of their family members, as well as with a decrease in the psychological “wear and tear” of medical workers in cancer departments.
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TREATMENT AND PREVENTION
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