Criteria for diagnostics and treatment of somatic patients who use psychoactive substances in the practice of family medicine
Authors: Tabachnikov S. I. , Pinchuk I. Ya. , Kharchenko Ye. M. , Mykhalchuk N. O. , Chepurna A. M. , Zdoryk I. F. 
Published: June 2020

Background. The usage of psychoactive substances (PS) is one of the most urgent among other medical and social problems of nowadays. One of the aspects of menacing nature of this phenomenon is psychological and somatic consequences, so called comorbid conditions, which in the future lead to severe psychosomatic disorders, more significant in young or old age. Contemporary medical reform in Ukraine has reoriented for family doctors general medical care to somatic patients, which, in turn, requires the creation of professional scientific and practical developments to provide them with qualified assistance.

Objective – to develop of the system of diagnostic and medical care for somatic patients who use PS in the practice of family medicine.

Materials and methods. In accordance with the relevant methods (clinical, anamnestic, socio-demographic, psychodiagnostic, clinical-psychopathological and statistical), 220 thematic patients who applied with somatic complaints to the family doctor were examined. All these patients take different kinds of PS.

Results. Characteristic features of the examined patients were such as: prevailing age group was the senior group of people (60%), the youngest was 38%; a large proportion of respondents were educated in dysfunctional families (42%); the families in which the parents use of PS, in the families in which there where systematic conflicts, material and everyday problems, burdened heredity, concomitant somatic diseases (28%), etc. Most of these surveyed began to use PS in the age of teenagers (66%), a significantly smaller number was that one who had begun to use PS in elderly age. The motivation for the usage of surfactant in the younger group was dominated by the negative impact of the micro-environment, at the elder age we diagnostic the subjective deprivation of the patients from difficult social circumstances, improvement of general mental and physical conditions. The complaints of these patients who need a help of family doctors were formed by us in the form of the main profiles of somatic pathology: cardiovascular, pulmonary-respiratory, gastro-intestinal. In the mental plan these patients had depressive, disturbing, asthenic states in different proportions. Most of them who use PS prefer tobacco and alcohol or combined forms (72%), much less patients use PS. The developed system of early diagnostics of comorbid pathology is based on a four-level clinical characteristic of psychosomatic pathology with the appropriate correlation between the type and level of PS which had been used.

Conclusions. The main profiles of somatization in these cases were outlined (48% of patients have the problems with the cardiovascular system, with the digestive tract – 32%, with the pulmonary-respiratory system – 20% of patients), which were combined with mental illnesses. The system of early diagnostics of the usage of psychoactive substances by somatic patients was developed with the help of corresponding AUDIT-tests, a number of parallel psycho-diagnostic methods and laboratory data. On the basis of characteristic features of anamnesis, socio-demographic, clinical psycho-pathological and somatic data, a system of psycho-therapeutic, rehabilitation and psycho-prophylaxis assistance to the patients in the practice of family medicine was developed.