FUNDAMENTALS OF MODERN PSYCHOTHERAPY IN THE REHABILITATION OF PATIENTS WITH SCHIZOPHRENIA

Аннотация

Hope for the recovery of patients with schizophrenia is growing, and job opportunities in the market economy are declining. This puts much higher demands on their operation than a few years ago. The increased interest in psychotherapy in patients with schizophrenia is explained today by recent research on the clinical and economic effectiveness of rehabilitation programs, which makes it possible to see the limits of rehabilitation methods, which are already traditional in psychiatric practice. It is argued that one should not create excessive fantasies about existing rehabilitation programs. Keywords: Schizophrenia, psychotherapy, rehabilitation, psychiatry. Introduction. The pathoplastic role of exogenous social factors is also well known. It is impossible to agree with oedegard's thesis that "real psychoses in adulthood are independent of the world around them. The role of social stressors has been confirmed as one of the factors that depend on the manifestation of schizophrenia psychosis. A connection was established between exogenous damage at the onset of the disease and the peculiarities of its subsequent development. Relapses are often noted in cases of exogenism before the onset of the disease. A clear difference in the course and outcome of schizophrenia in patients living in developing and industrialized countries is known due to sociocultural differences in ethnic structures [1-3]. The social component of biopsychosocial processes usually plays a large role at the level of theoretical understanding of the problem. Biological, penetrates into a person's personality and becomes social. Brain pathology can provoke a biologically determined predisposition to the formation of certain psychological characteristics of an individual in the subject, in the structure of his individuality, the implementation of which later depends on the influence of social factors 276 Yanvar, 2025-Yil [4-7]. In this sense, the hypothesis that brain structures suffering from endogenous psychosis appeared in the early stages of the emergence of mankind and are of social origin is interesting. Both the biological (genetic and morphological structures, metabolism) and the social basis of these diseases are closely related to the human characteristics that distinguish it from animals. The hypothesis is interesting because philosophically it can eliminate the fundamental contradiction of the concepts of the origin of endogenous psychoses (somato-or psychogenesis) [8-9]. In any case, without fully explaining the etiology of schizophrenia, psychosocial factors largely determine its course. Cases of mental pathology, in the pathogenesis of which biological factors play a leading role, cannot be considered exclusively diseases of biological origin. The pathogenesis of such diseases already in the early stages inevitably involves factors of social order. The close connection between biological and Social is manifested in schizophrenia, since mental disorders are manifested mainly in the form of a violation of relations with other people. Thus, in all cases, the meaningful side of mental activity, its social aspects suffer [10-13]. The emphasis on the role of both biological and psychosocial in the pathogenesis of schizophrenia, in our opinion, is extremely important. The history of psychiatry knows many specific examples of the monopolistic domination of monocauzality theories of any pathology, which suggests its artificially narrowed interpretation, often with detrimental consequences for therapeutic practice. Thus, it follows from the idea that schizophrenia is caused only by some neurogumoral dyscrasia, which can be treated with appropriate neurotrophic hormones, just as diabetes is treated with insulin (a famous example is the proposal to treat schizophrenia with vitamin megadosis) [14-17]. The thesis that such drugs are both necessary and adequate means of treatment turns the patient into a certain biochemical abstraction, the object of application of pharmacological agents and any psychosocial effect – something insignificant and, at best, useless [18-21]. An example of biological reductionism is the sensational report of the remarkable success of hemodialysis by several somatic healthy patients diagnosed with schizophrenia. The failures of attempts to control this therapy led to the conclusion that the improvement in the condition of patients who had previously been hospitalized for a long time should, on the contrary, be associated with changes in environmental influences associated with the procedure [22-25]. A reverse example of psychological reductionism is the medical history of patients from the well-known psychoanalytic clinic Chestnut-Lodge, whose years of catamnesis have shown that the inadequacy 277 Yanvar, 2025-Yil of unilateral psychotherapeutic treatment and social activation has led to malignant regression that cripples patients [26-29]. In recent years, most experts have come to the conclusion that purely sociog