Pervichko, E.I.

The work presents historiographic and theoretical methodological study of establishment of fundamental theses of L.S. Vygotsky’s cultural-historical concept within the field of clinical psychology.

We prove potency in application of contemporary philosophical concepts, which help distinguish between the types of scientific rationality (classical, nonclassical, and postnonclassical), for scientific reflection over the development of psychology and designation of paradigmatic status of cultural-historic concept suggested by L.S. Vygotsky and Vygotsky-Luria syndrome approach at the contemporary stage of science.

Present study of scientific works of L.S. Vygotsky and his followers demonstrated that fundamentals of cultural-historic conception suggested by L.S. Vygotsky and further developed in methodology of Vygotsky-Luria syndrome approach, these fundamentals presented the origins of not only non-classical, but as well post-nonclassical model of scientific rationality. They are characterized by post-nonclassical understanding of the object and method of psychological study and post-nonclassical mode of thinking of the scientists.

As it was showed, in works of L.S. Vygotsky there formulated general methodological requirements to organization of mental studies, which, on the whole, go in tune with the requirements introduced for study of complex self-developing systems. There were produced arguments to prove that the concept of Vygotsky-Luria syndrome approach describes mental syndromes as dynamic structures, which display the features of self-organization, self-determination and adaptive rationality. Hence, they can be regarded as open self-developing systems.

We assume and verify the hypothesis that the syndrome analysis, due to the features of post-nonclassic modeling of scientific rationality it reveals, may be regarded as theoretically productive methodological approach at the modern stage of science.

The article aims to demonstrate advances in methodological means suggested by Vygotsky’s cultural-historical concept in association with a theoretical model of a Person-centered diagnosis and practical use of the construct for clinical psychology and medicine. This, to a greater extent, arises from the fact that the cultural-historical concept (due to its humanistic nature and epistemological content) is closely related to the person-centered integrative approach. But for all that the concept corresponds to the ideals of postnonclassical model of scientific rationality with a number of ‘key’ features. Above all it manifests its “methodological maturity” to cope with open self-developing systems, which is most essential at the modern stage of scientific knowledge.

The work gives consideration to ‘defining pillars’ of Person-centered approach in modern medicine, to humanistic traditions of the Russian clinical school, and high prospects in diagnostics of such mental constructs as “subjective pattern of disease” and “social situation of personal development in disease” - within the context of person-centered integrative diagnosis.

This article discusses the need for implementation a cross-cultural study of subjective pattern of disease and its correlation with a particular “social situation of personality development under disease conditions”. It aims at development and substantiation of the model of person-centered integrative approach, enhancement of its diagnostic scope and, consequently, improvement of the model of person-centered care in modern psychiatry and medicine.

This article considers the potential for applying contemporary philosophical theories (which distinguish classical, nonclassical, and postnonclassical types of scientific rationality) to the specification of theoretical methodological principles in the study of clinical psychology. We prove that psychological syndrome analysis (developed by the Vygotsky–Luria–Zeigarnik school), taken as a system of principles for organizing research as well as for interpreting its results, conforms to the epistemological complexity of the object of study in clinical psychology, which is understood in the postnonclassical scientific view as a self-developing system. We present an example of the formation of a psychosomatic syndrome in 290 patients with mitral-valve prolapse, applying methods of qualitative and statistical data analysis in a longitudinal clinical-psychological study. We prove that the syndrome is system-defined and has a multilevel character, and that its structure is determined by several factors: the motivational factor (with the domination of the failure-avoidance motive and the unsatisfied self-approval need); the factor of the emotional-regulation disorders, represented by both excessive emotional repression and lack of emotional control; and a psychophysiological factor. We argue that a psychosomatic syndrome can be used as a means for approaching not only diagnostic but also prognostic tasks both in clinical psychology and in medicine. We conclude that the results of our empirical study, conducted within the framework of postnonclassical philosophy and using the methods of psychological syndrome analysis, not only expand the scientific background on the nature of a particular disease (mitral-valve prolapse) but also pose further questions whose investigation will broaden our view of the psychological mechanisms of psychosomatic- syndrome genesis.

The article aims to demonstrate a high efficiency of the methodological means suggested by psychological syndrome analysis approach (Vygotsky-Luria school) for solving theoretical and applied issues in contemporary person-centered medicine. 

This is achieved through an example of empirical study meant to construct a psychosomatic syndrome for 290 patients with mitral valve prolapse (MVP). Analysis of all collected data was based on psychological syndrome analysis concept (Vygotsky–Luria school) and A.R. Luria’s principles for psychological factors (causes) selection, which determine the logic and structure of a neuropsychological syndrome. It demonstrated the association between characteristics of emotional experiences and clinical symptoms manifested in MVP patients. This correlation was statistically verified. The results proved that the most important syndrome-establishment factor (radical) is a specific emotionality and dysfunction of emotion regulation and emotional control in MVP patients (excessive emotional repression with insufficient reflection of emotional experiences). Features of the motivation sphere of MVP patients appear as a second psychological syndrome-establishment factor: these are domination of the motive of failure avoidance and unsatisfied self-approval need. 

We argue that psychological syndrome analysis can be used as a means to approach not only diagnostic but also prognostic tasks both in clinical psychology and medicine, as well as for the development and implementation of the person-centered integrative diagnosis model. 

We maintained that this approach, applied in theoretical and practical fields of clinical psychology and mental health care is highly efficient at the current stage of the science evolution due to prospects revealed by s new methodological context of postnonclassical model of rationality and a comprehensive character of the cultural-historical concept regarding an individual and his mind as a self-developing open systems.

In the study, psychological and physiological features were assessed during an experimentally designed stressful situation in 85 subjects with hypertension (HTN) in the workplace, 85 patients with essential HTN, and 82 healthy individuals.

It was showed, that patients with HTN in the experimental situation were characterized by a complex of physiological and psychological features, which distinguish them from healthy participants. A reliably greater increase In systolic blood pressure (BP) was recorded in these patients in comparison with healthy individuals (on average by 14 and 3 mmHg respectively). The aspiration level (AL) of these patients was characterized by a reliably greater height, inadequacy, and instability; as for nonverbal behavior, it revealed a reliably greater amount of gestures, and frequent changes in voice tone against similar features of healthy individuals.

The group of patients with HTN at work, when compared with essential HTN patients, was characterized by a reliably greater increase of systolic BP (on the average by 16 and 4 mmHg respectively) as a reaction to emotional stress. The systolic BP increase in this group was revealed in combination with an initially reliably lower catecholamines’ level (CA), a gradual decrease of CA level in urine, and renin and angiotensin-1 in blood plasma during the experiment. This combination is an indicator of chronic stress and psychophysiological exhaustion. The patients did not manifest any increase of anxiety during the experiment; they were characterized, however, by a greater frequency of AL inadequacy and instability. The behavior of patients with HTN at work during the experiment was marked by a limited repertory of poses and gestures, but more vigorous facial expressions, and frequent pitch jumps. Obtained results lead us to confirm that the repression of emotions comes as a significant pathogenetic factor in the genesis of psychosomatic syndrome among patients with HTN at work, as opposed to patients with essential HTN.

The main purpose of the present study was to assess the role of motivation in the effective cognitive activity of elderly hypertension (HTN) patients provided with antihypertensive treatment; 25 patients with HTN took part in the study, stage 1-2; their mean age was 67.6±6.1. The psychological examination program embraced a quantitative measurement of intelligence quotient (IQ) with the Wechsler Adult Intelligence Scale, and an investigation into the qualitative features of their cognitive processes, applying a pathopsychological study procedure (Zeigarnik, 1962, 1972) and the principles of psychological syndrome analysis (Vygotsky-Luria-Zeigarnik school). The results showed that within the psychological syndrome structure of cognitive disorders in HTN patients, the leading part is played by two syndrome-generating factors: a neurodynamic factor and a motivational factor. The patients with reduced motivation would achieve poor general test results, if compared with the group of highly motivated participants. A correlation analysis of the data revealed the interconnection between frequency disturbances in motivation and the frequency in occurrence of various signs of cognitive decline, such as low efficiency in memorization and delayed recall, as well as lower IQ test results. The data provide a strong argument to support the hypothesis that motivation is of particular importance as a factor in the generation of cognitive disorders in HTN patients.

The purpose of the study was to investigate the dynamics of the psychological features and clinical symptoms in mitral valve prolapse (MVP) patients receiving long-term integrative psychotherapy for anxiety disorders (AD) and to investigate the psychological factors of their improvement in mental health as a result of psychotherapy. Thirty-two MVP patients with AD attended long-term integrative psychotherapy. Psychological and clinical examinations of the patients were made before and after the therapy courses and in a follow-up study after 2, 5, and 10 years. Data from the study show that 78.1% of the patients who attended psychotherapy sessions demonstrated valid improvements in self-rated psychological well-being and a reduction in their anxiety levels. Analysis of emotion-regulation strategies showed that psychotherapy encouraged the use of strategies effective for solving adaptive tasks. Positive dynamics in the development of personality reflection, the recognition of one’s emotional experiences, improved skills of self-regulation, and growing awareness of actual needs, individual purposes, and personality resources—all were associated with the reduction of MVP clinical symptoms. The psychiatrist who interviewed the patients reported that most of them were in sustained remission.

Background. Parents have a significant impact on the formation of their children’s attitude toward health. A detailed study of this effect will allow us to devise strategies for interaction with children and directions of psychological correction of maladaptive behaviors in health issues.

Objective. To study the relationship between attitude toward healthin primary-school-age children and their parents and styles of childrearing.

Design. The study comprised 69 primary-school-aged children and their parents. The method of “Unfinished Sentences About Health” and the questionnaire “Analysis of Family Relationships” were used.Components of attitude toward healthsuch as health self-esteem, assessment of healthy people, diseases, health promotion actions, health promotion factors (causes), and the value of health were considered. 

Results. [1]The findings showed that the parents’ components of attitude toward healthare interrelated with those in children’s at all levels (from behavioral to semantic and axiological) and are connected with the style of childrearing.

Conclusion. Data analysis showed the impact of the style of childrearing and the interrelation of certain parental attitude toward healthcomponents with attitude toward health in primary-school-age children. This problem requires detailed study due to its theoretical significance and the obvious social challenges it presents.

1. These are not Results, but part of the Design.