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Acute mental disorders in emergency victims, first aid algorithm. Prevention of neuropsychiatric disorders in extreme situations Psychogenic disorders at various stages of an emergency

In conditions of catastrophes and natural disasters, neuropsychic disorders manifest themselves in a wide range: from a state of maladaptation and neurotic, neurosis-like reactions to reactive psychoses. Their severity depends on many factors: age, gender, level of initial social adaptation; individual characterological characteristics; additional aggravating factors at the time of the disaster (loneliness, caring for children, presence of sick relatives, own helplessness: pregnancy, illness, etc.).

The psychogenic impact of extreme conditions consists not only of a direct, immediate threat to human life, but also an indirect one associated with its anticipation. Mental reactions during a flood, hurricane and other extreme situations do not have any specific character, inherent only in a specific extreme situation. These are rather universal reactions to danger, and their frequency and depth are determined by the suddenness and intensity of the extreme situation (Aleksandrovsky, 1989; Aleksandrovsky et al., 1991).

The traumatic impact of various unfavorable factors that arise in life-threatening conditions on a person’s mental activity is divided into non-pathological psycho-emotional (to a certain extent physiological) reactions and pathological states - psychogenia (reactive states). The former are characterized by psychological clarity of the reaction, its direct dependence on the situation and, as a rule, a short duration. With non-pathological reactions, working capacity is usually preserved (although it is reduced), the ability to communicate with others and critically analyze one’s behavior. Typical for a person who finds himself in a catastrophic situation are feelings of anxiety, fear, depression, concern for the fate of family and friends, and the desire to find out the true extent of the catastrophe (natural disaster). Such reactions are also referred to as a state of stress, mental tension, affective reactions, etc.

In contrast to non-pathological reactions, pathological-psychogenic disorders are painful conditions that incapacitate a person, depriving him of the opportunity for productive communication with other people and the ability to take purposeful actions. In some cases, disorders of consciousness occur and psychopathological manifestations arise, accompanied by a wide range of psychotic disorders.

Psychopathological disorders in extreme situations have much in common with the clinical picture of disorders that develop under normal conditions. However, there are also significant differences. Firstly, due to the multiplicity of sudden psycho-traumatic factors in extreme situations, mental disorders occur simultaneously in a large number of people. Secondly, the clinical picture in these cases is not as individual as in “usual” traumatic circumstances, and is reduced to a small number of fairly typical manifestations. Thirdly, despite the development of psychogenic disorders and the ongoing dangerous situation, the victim is forced to continue to actively fight the consequences of a natural disaster (catastrophe) for the sake of survival and preserving the lives of loved ones and everyone around him.

The most frequently observed psychogenic disorders during and after extreme situations are combined into 4 groups - non-pathological (physiological) reactions, pathological reactions, neurotic states and reactive psychoses (see Table 1.1).

Table 1.1.

Psychogenic disorders observed during and after extreme situations (Alexandrovsky, 2001)

A person’s behavior in a suddenly developed extreme situation is largely determined by the emotion of fear, which to a certain extent can be considered physiologically normal, since it contributes to the emergency mobilization of the physical and mental state necessary for self-preservation. With the loss of a critical attitude towards one’s own fear, the appearance of difficulties in purposeful activities, the decrease and disappearance of the ability to control actions and make logically based decisions, various psychotic disorders (reactive psychoses, affective-shock reactions), as well as states of panic, are formed.

Among reactive psychoses in situations of mass disasters, affective shock reactions and hysterical psychoses are most often observed. Affective-shock reactions occur during a sudden life-threatening shock; they are always short-lived, lasting from 15–20 minutes to several hours or days and are represented by two forms of shock states - hyper- and hypokinetic. The hypokinetic variant is characterized by phenomena of emotional and motor inhibition, general “numbness,” sometimes even to the point of complete immobility and mutism (affectogenic stupor). People freeze in one position, their facial expressions express either indifference or fear. Vasomotor-vegetative disturbances and deep confusion of consciousness are noted. The hyperkinetic variant is characterized by acute psychomotor agitation (motor storm, fugue reaction). People are running somewhere, their movements and statements are chaotic and fragmentary; facial expressions reflect frightening experiences. Sometimes acute speech confusion predominates in the form of an incoherent speech stream. People are disoriented, their consciousness is deeply darkened.

With hysterical disorders, vivid figurative ideas begin to predominate in a person’s experiences, people become extremely suggestible and self-hypnosis. Against this background, disturbances of consciousness often develop. Hysterical twilight stupefaction is characterized not by its complete shutdown, but by narrowing with disorientation and deceptions of perception. A specific psychotraumatic situation is always reflected in people's behavior. The clinical picture shows demonstrative behavior with crying, absurd laughter, and hysteroform seizures. Hysterical psychoses also include hysterical hallucinosis, pseudodementia, and poirilism.

The most typical manifestations of non-psychotic (neurotic) disorders at various stages of the development of the situation are acute reactions to stress, adaptive (adaptive) neurotic reactions, neuroses (anxiety, hysterical, phobic, depressive, hypochondriacal, neurasthenia).

Acute stress reactions are characterized by rapidly passing non-psychotic disorders of any nature that arise as a reaction to extreme physical stress or a psychogenic situation during a natural disaster and usually disappear after a few hours or days. These reactions occur with a predominance of emotional disorders (states of panic, fear, anxiety and depression) or psychomotor disorders (states of motor agitation, retardation).

Adaptive reactions are expressed in mild or transient non-psychotic disorders that last longer than acute reactions to stress. They are observed in people of any age without any obvious preexisting mental disorder. Such disorders are often somewhat limited in clinical manifestations (partial) or identified in specific situations; they are usually reversible. Usually they are closely related in time and content to traumatic situations caused by bereavement.

The most frequently observed adaptive reactions under extreme conditions include:

Short-term depressive reaction (reaction* loss);

Prolonged depressive reaction;

A reaction with a predominant disorder of other emotions (reaction of worry, fear, anxiety, etc.).

The main observed forms of neuroses include:

– anxiety (fear) neurosis, which is characterized by a combination of mental and somatic manifestations of anxiety that do not correspond to real danger and manifest themselves either in the form of attacks or in the form of a stable state. Anxiety is usually diffuse and can increase to a state of panic. Other neurotic manifestations, such as obsessive or hysterical symptoms, may be present, but they do not dominate the clinical picture;

– hysterical neurosis, characterized by neurotic disorders in which disturbances of vegetative, sensory and motor functions predominate (“conversion form”), selective amnesia that occurs according to the type of “conditioned pleasantness and desirability”, suggestion and self-hypnosis against the background of an affectively narrowed consciousness. Pronounced changes in behavior may occur, sometimes taking the form of a hysterical fugue. This behavior may mimic psychosis or, rather, correspond to the patient's idea of psychosis;

– neurotic phobias, for which a neurotic state with a pathologically expressed fear of certain objects or specific situations is typical;

– depressive neurosis – it is defined by neurotic disorders characterized by depression of inadequate strength and clinical content, which is a consequence of traumatic circumstances. It does not include vital components, daily and seasonal fluctuations among its manifestations and is determined by the patient’s concentration on the traumatic situation that preceded the illness. Usually in the experiences of patients there is no projection of longing for the future. Often there is anxiety, as well as a mixed state of anxiety and depression;

– neurasthenia, expressed by autonomic, sensorimotor and affective dysfunctions and occurring as irritable weakness with insomnia, increased fatigue, distractibility, low mood, constant dissatisfaction with oneself and others. Neurasthenia can be a consequence of prolonged emotional stress, overwork, or occur against the background of traumatic injuries and somatic diseases;

– hypochondriacal neurosis – manifests itself mainly by excessive preoccupation with one’s own health, the functioning of an organ, or, less commonly, the state of one’s mental abilities. Usually painful experiences are combined with anxiety and depression.

The study of mental disorders observed in extreme situations, as well as the analysis of a complex of rescue, rescue, social and medical measures, makes it possible to schematically identify three periods of development of the situation in which various psychogenic disorders are observed.

First (acute) period characterized by a sudden threat to one’s own life and the death of loved ones. It lasts from the beginning of exposure to an extreme factor until the organization of rescue operations (minutes, hours). Powerful extreme exposure during this period mainly affects vital instincts (for example, self-preservation) and leads to the development of nonspecific, extrapersonal psychogenic reactions, the basis of which is fear of varying intensity. At this time, psychogenic reactions of psychotic and non-psychotic levels are predominantly observed. In some cases, panic may develop.

Immediately after acute exposure, when signs of danger appear, people become confused and do not understand what is happening. After this short period, with a simple fear reaction, a moderate increase in activity is observed: movements become clear, economical, muscle strength increases, which facilitates movement to a safe place. Speech disturbances are limited to acceleration of its tempo, hesitations, the voice becomes loud, ringing. Mobilization of will and animation of ideational processes are noted. Mnestic disturbances during this period are represented by a decrease in fixation of the environment, unclear memories of what is happening around, but one’s own actions and experiences are fully remembered. Characteristic is a change in the sense of time, the flow of which slows down, so that the duration of the acute period in perception is increased several times. With complex fear reactions, first of all, more pronounced movement disorders are observed in the hyperdynamic or hypodynamic variants described above. Speech production is fragmentary, limited to exclamations, and in some cases there is aphonia. Memories of the event and their behavior among victims during this period are undifferentiated and summary.

Along with mental disorders, nausea, dizziness, frequent urination, chills-like remora, fainting, and, in pregnant women, miscarriages are often observed. The perception of space changes, the distance between objects, their size and shape are distorted. Sometimes the environment seems “unreal”, and this feeling persists for several hours after exposure. Kinesthetic illusions (the feeling of the earth shaking, flying, swimming, etc.) can also be long-lasting.

With simple and complex reactions of fear, consciousness is narrowed, although in most cases accessibility to external influences, selectivity of behavior, and the ability to independently find a way out of a difficult situation are preserved.

In second period, occurring during the deployment of rescue operations, begins, in a figurative expression, “normal life in extreme conditions.” At this time, in the formation of states of maladjustment and mental disorders, a much greater role is played by the personality characteristics of the victims, as well as their awareness of not only the ongoing situation in some cases, but also new stressful influences, such as the loss of relatives, separation of families, loss of home and property. Important elements of prolonged stress during this period are the expectation of repeated impacts, the discrepancy between expectations and the results of rescue operations, and the need to identify dead relatives. The psycho-emotional stress characteristic of the beginning of the second period is replaced by its end, as a rule, by increased fatigue and “demobilization” with asthenic-depressive or apathetic-depressive manifestations.

After the end of the acute period, some victims experience short-term relief, an uplift in mood, a desire to actively participate in rescue operations, verbosity, endless repetition of the story about their experiences, their attitude towards what happened, bravado, and discrediting the danger. This phase of euphoria lasts from a few minutes to several hours. As a rule, it is replaced by lethargy, indifference, ideational inhibition, difficulty in understanding the questions asked, and difficulties in completing even simple tasks. Against this background, episodes of psycho-emotional stress with a predominance of anxiety are observed. In a number of cases, peculiar states develop; the victims give the impression of being detached and self-absorbed. They sigh frequently and deeply, bradyphasia is noted, retrospective analysis shows that in these cases internal experiences are often associated with mystical and religious ideas. Another variant of the development of an anxious state during this period may be characterized by the predominance of “anxiety with activity.” Characteristic features include motor restlessness, fussiness, impatience, verbosity, and the desire for an abundance of contacts with others. Expressive movements can be somewhat demonstrative and exaggerated. Episodes of psycho-emotional stress are quickly replaced by lethargy and apathy.

In the third period, beginning for victims after their evacuation to safe areas, many experience complex emotional and cognitive processing of the situation, reassessment of their own experiences and sensations, and awareness of losses. At the same time, psychogenically traumatic factors associated with a change in life pattern, living in a destroyed area or in a place of evacuation also become relevant. Becoming chronic, these factors contribute to the formation of relatively persistent psychogenic disorders. Along with persistent nonspecific neurotic reactions and conditions, protracted and developing pathocharacterological disorders begin to predominate during this period. Somatogenic mental disorders can be subacute in nature. In these cases, both the “somatization” of many neurotic disorders and, to a certain extent, the opposite of this process, “neurotization” and “psychopathy,” are observed.

In the dynamics of asthenic disorders that developed after an extreme, sudden situation, autochthonous episodes of psycho-emotional stress with a predominance of anxiety and increased vegetosomatic disorders are often observed. Essentially, asthenic disorders are the basis on which various borderline neuropsychiatric disorders are formed. In some cases they become protracted and chronic.

With the development of pronounced and relatively stable affective reactions against the background of asthenia, asthenic disorders themselves seem to be pushed into the background. The victims experience vague anxiety, anxious tension, bad premonitions, and the expectation of some kind of misfortune. “Listening to danger signals” appears, which may be ground shaking from moving mechanisms, unexpected noise, or, conversely, silence. All this causes anxiety, accompanied by muscle tension, trembling in the arms and legs. This contributes to the formation of persistent and long-term phobic disorders. Along with phobias, as a rule, there is uncertainty, difficulty in making even simple decisions, and doubts about the fidelity and correctness of one’s own actions. Often there is a constant discussion of the experienced situation, close to obsession, and memories of a past life with its idealization.

Another type of manifestation of emotional stress is psychogenic depressive disorders. A peculiar awareness of “one’s guilt” before the dead appears, an aversion to life arises, and regret that he survived and did not die with his relatives. The phenomenology of depressive states is supplemented by asthenic manifestations, and in a number of observations – apathy, indifference, and the appearance of a melancholy affect. The inability to cope with problems leads to passivity, disappointment, decreased self-esteem, and a feeling of inadequacy. Often, depressive manifestations are less pronounced, and somatic discomfort (somatic “masks” of depression) comes to the fore: diffuse headache, worsening in the evening, cardialgia, heart rhythm disturbances, anorexia.

In general, depressive disorders do not reach a psychotic level, victims do not experience ideational inhibition, and they, although with difficulty, cope with everyday worries.

Along with these neurotic disorders, people who have experienced an extreme situation quite often experience decompensation of character accentuations and psychopathic personality traits. In this case, both the individually significant psychotraumatic situation and the previous life experience and personal attitudes of each person are of great importance. Personality characteristics leave an imprint on neurotic reactions, playing an important pathoplastic role.

The main group of states of personal decompensation is usually represented by reactions with a predominance of the radical excitability and sensitivity. Such persons, for an insignificant reason, give violent emotional outbursts that are objectively inappropriate to the occasion. At the same time, aggressive actions are not uncommon. Such episodes are most often short-lived, occur with some demonstrativeness, theatricality, and are quickly replaced by an asthenic-depressive state, lethargy and indifference to the environment.

A number of observations indicate dysphoric mood coloring. People in this state are gloomy, gloomy, and constantly dissatisfied. They challenge orders and advice, refuse to complete tasks, quarrel with others, and abandon work they have started. There are also frequent cases of increased paranoid accentuations - those who have survived an acute extreme situation become envious, spy on each other, write complaints to various authorities, believe that they have been deprived, that they have been treated unfairly. In these situations, rental attitudes most often develop.

Along with the noted neurotic and psychopathic reactions at all three stages of the development of the situation, the victims experience autonomic dysfunction and sleep disorders. The latter not only reflect the entire complex of neurotic disorders, but also significantly contribute to their stabilization and further aggravation. Most often, it is difficult to fall asleep; it is hampered by a feeling of emotional tension, anxiety, and hyperesthesia. Night sleep is superficial, accompanied by nightmares, and usually short-lived. The most intense changes in the functional activity of the autonomic nervous system manifest themselves in the form of fluctuations in blood pressure, pulse lability, hyperhidrosis, chills, headaches, vestibular disorders, and gastrointestinal disorders. In some cases, these conditions acquire a paroxysmal character, becoming most pronounced during an attack. Against the background of autonomic dysfunctions, exacerbation of psychosomatic diseases, relatively compensated before the extreme event, and the appearance of persistent psychosomatic disorders are often observed.

During all of these periods, the development and compensation of psychogenic disorders in emergency situations depend on three groups of factors: the specifics of the situation, individual response to what is happening, social and organizational measures. However, the importance of these factors in different periods of development of the situation is not the same. Over time, the nature of the emergency situation and the individual characteristics of the victims lose their immediate significance, and on the contrary, not only medical, but also socio-psychological assistance and organizational factors increase and become fundamental.

The main factors influencing the development and compensation of mental disorders in emergency situations can be classified as follows.

Directly during an event (catastrophe, natural disaster, etc.):

1) Features of the situation:

– emergency intensity;

– duration of emergency;

– suddenness of emergency.

2) Individual reactions:

– somatic condition;

- age;

– emergency preparedness;

– personal characteristics.

– awareness;

- “collective behavior”.

When carrying out rescue operations after the completion of a dangerous event:

1) Features of the situation:

- “secondary psychogenies”.

2) Individual reactions:

– personal characteristics;

– individual assessment and perception of the situation;

- age;

– somatic condition.

3) Social and organizational factors:

– awareness;

– organization of rescue operations;

- “collective behavior”.

During the later stages of an emergency:

1) Social-psychological and medical assistance:

– rehabilitation;

– somatic condition.

2) Social and organizational factors:

– social structure;

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Emergency psychological assistance in dangerous and emergency situations

7.1. Neuropsychic disorders in extreme situations

In conditions of catastrophes and natural disasters, neuropsychic disorders manifest themselves in a wide range: from a state of maladaptation and neurotic, neurosis-like reactions to reactive psychoses. Their severity depends on many factors: age, gender, level of initial social adaptation; individual characterological characteristics; additional aggravating factors at the time of the disaster (loneliness, caring for children, the presence of sick relatives, one’s own helplessness: pregnancy, illness, etc.).

The psychogenic impact of extreme conditions consists not only of a direct, immediate threat to human life, but also of an indirect one associated with its anticipation. Mental reactions during emergencies do not have any specific character, inherent only in a specific extreme situation. These are rather universal reactions to danger.

The traumatic impact of various unfavorable factors that arise in life-threatening conditions on a person’s mental activity is divided into non-pathological psycho-emotional(to a certain extent physiological) reactions and pathological conditions psychogenics (reactive states). The former are characterized by psychological clarity of the reaction, its direct dependence on the situation and, as a rule, a short duration. With non-pathological reactions, working capacity is usually preserved (although it is reduced), the ability to communicate with others and critically analyze one’s behavior. Typical feelings for a person who finds himself in a catastrophic situation are anxiety, fear, depression, concern for the fate of family and friends, and the desire to find out the true scale of the catastrophe (natural disaster). Such reactions are also referred to as a state of stress, mental tension, affective reactions, etc.

Unlike non-pathological reactions, pathological psychogenic disorders are painful conditions that incapacitate a person, depriving him of the opportunity for productive communication with other people and the ability to take purposeful actions. In some cases, disorders of consciousness occur and psychopathological manifestations arise, accompanied by a wide range of psychotic disorders.

Among reactive psychoses in situations of mass disasters, affective shock reactions and hysterical psychoses are most often observed.

Affective-shock reactions

Affective-shock reactions are caused by a sudden strong impact, usually posing a threat to life (fire, earthquake, flood, etc.). Manifest in the form of excitement or lethargy.

Reactions with excitement are expressed by meaningless chaotic motor restlessness against the background of a narrowed consciousness. People are running somewhere, often towards imminent danger, their movements and statements are chaotic and fragmentary; facial expressions reflect frightening experiences. Sometimes acute speech confusion predominates in the form of an incoherent speech stream. People are disoriented, their consciousness is deeply darkened.

Reactions with inhibition are accompanied by partial or complete immobility (stupor). Despite the threatening danger, the person seems to freeze, become numb, unable to make a movement or say a word. Jet stupor lasts from several minutes to several hours. Facial expressions reflect either fear, horror, despair, confusion, or absolute indifference to what is happening. In cases where inhibition does not reach the level of stupor, patients are available for contact, but their speech is slow, monosyllabic, movements are constrained, and there is a feeling of heaviness in the legs. Consciousness may be narrowed with subsequent loss of individual events from memory.

Hysterical psychoses

Hysterical psychoses are manifested by hysterical twilight stupefaction, disorders of movements or sensations.

With hysterical twilight stupefaction, consciousness narrows, victims mechanically perform familiar actions, and in conversations constantly return to the traumatic situation. Symptoms of the disorder have a mixed and usually variable pattern with motor agitation or, less commonly, retardation. In addition to the initial state of stupefaction, anxiety, anger, despair, withdrawal or hyperactivity, and depression may be observed. During this period, hysterical seizures are possible, in which, unlike epileptic seizures, there is no complete loss of consciousness, the victim does not fall backward, there is no amnesia of the seizure, there is no severe bodily injury from a fall, or tongue biting. These conditions are dangerous due to suicide attempts.

In case of disorders, as a result of the stress experienced, movements are difficult or sensations are lost (usually skin sensitivity, less often vision).

As a result of the stress experienced, victims may experience euphoria. Usually the duration of this period does not exceed several hours, and sometimes even minutes. With euphoria, mood is inappropriately elevated. The patient overestimates his strengths and capabilities, neglects the real danger. This prevents him from seeking help from a doctor in a timely manner, which can lead to death. The behavior of people in the affected area should be closely monitored, especially those who, having received injuries, are involved in rescue operations.

Non-psychotic (neurotic) disorders

Adaptive (adaptive) reactions are expressed in mild or transient non-psychotic disorders that last longer than acute reactions to stress. They are observed in people of any age without any obvious preexisting mental disorder.

The most frequently observed adaptive reactions under extreme conditions include:

short-term depressive reaction (loss reaction);
prolonged depressive reaction;
reaction with a predominant disorder of other emotions (reaction of worry, fear, anxiety, etc.).

The main observable forms of neuroses include anxiety (fear) neurosis, which is characterized by a combination of mental and somatic manifestations of anxiety that do not correspond to real danger and manifest themselves either in the form of attacks or in the form of a stable state. Anxiety is usually diffuse and can increase to a state of panic.

Panic (from the Greek panikos sudden, strong (of fear), literally inspired by the god of forests Pan) mental state of a person unaccountable, uncontrollable fear caused by a real or imaginary danger, covering a person or many people; an uncontrollable desire to avoid a dangerous situation.

Panic is a state of horror, accompanied by a sharp weakening of volitional self-control. A person becomes completely weak-willed, unable to control his behavior. The consequence is either stupor or what E. Kretschmer called a “whirlwind of movement,” that is, disorganization of planned actions. Behavior becomes anti-volitional: needs directly or indirectly related to physical self-preservation suppress needs related to personal self-esteem. At the same time, the person’s heart rate increases significantly, breathing becomes deep and frequent, as there is a feeling of lack of air, sweating increases, and the fear of death increases. It is known that 90% of people who escaped from a shipwreck die from hunger and thirst within the first three days, which cannot be explained by physiological reasons, because a person is capable of not eating or drinking for much longer. It turns out that they die not from hunger and thirst, but from panic (i.e., in fact, from the chosen role).

It is known about the Titanic disaster that the first ships approached the site of the disaster just three hours after the death of the ship. These ships found many dead and insane people in the lifeboats.

How to resist panic? How to get yourself out of the weak-willed state of a doll and turn into an active character? Firstly, it’s good to turn your state into any action, and to do this you can ask yourself the question: “What am I doing?” and answer it with any verb: “I’m sitting,” “I’m thinking,” “I’m losing weight,” etc. This way, the role of a passive body is automatically shed and turns into an active personality. Secondly, you can use any of the techniques that social psychologists have developed to calm a panicked crowd. For example, rhythmic music or singing helps relieve panic. This technique has been around since the 1960s. Americans use it by equipping all their embassies in Third World countries with loud music speakers. If an aggressive crowd appears near the embassy, loud music is turned on and the crowd becomes controllable. Humor relieves panic well. As eyewitnesses of the events of 1991 (the State Emergency Committee coup) note, it was Gennady Khazanov’s humorous speech in front of the crowd that psychologically turned the tide of events of the unsuccessful coup.

And the most important tool that specialist psychologists use to prevent group panic is the elbow lock. The feeling of closeness of comrades sharply increases psychological stability.

In emergency situations, other neurotic manifestations may develop, such as obsessive or hysterical symptoms:

hysterical neurosis, characterized by neurotic disorders in which disturbances of autonomic, sensory and motor functions predominate, selective amnesia; Significant changes in behavior may occur. This behavior may mimic psychosis or, rather, correspond to the patient's idea of psychosis;

neurotic phobias, for whom a neurotic state is typical with a pathologically expressed fear of certain objects or specific situations;

depressive neurosis it is characterized by depression of inadequate strength and content, which is a consequence of traumatic circumstances;

neurasthenia, expressed by vegetative, sensorimotor and affective dysfunctions and characterized by weakness, insomnia, increased fatigue, distractibility, low mood, constant dissatisfaction with oneself and others;

hypochondriacal neurosis manifests itself mainly by excessive preoccupation with one’s own health, the functioning of an organ, or, less commonly, the state of one’s mental abilities. Usually painful experiences are combined with anxiety and depression.

Three periods of development of the situation can be distinguished in which various psychogenic disorders are observed.

First (acute) period characterized by a sudden threat to one’s own life and the death of loved ones. It lasts from the beginning of exposure to an extreme factor until the organization of rescue operations (minutes, hours). Powerful extreme exposure during this period mainly affects vital instincts (for example, self-preservation) and leads to the development of nonspecific, psychogenic reactions, the basis of which is fear of varying intensity. In some cases, panic may develop.

Immediately after acute exposure, when signs of danger appear, people become confused and do not understand what is happening. After this short period, with a simple fear reaction, a moderate increase in activity is observed: movements become clear, muscle strength increases, which facilitates movement to a safe place. Speech disturbances are limited to acceleration of its tempo, hesitations, the voice becomes loud, ringing. There is a mobilization of will. Characteristic is a change in the sense of time, the flow of which slows down, so that the duration of the acute period in perception is increased several times. With complex fear reactions, more pronounced movement disorders in the form of anxiety or retardation are first noted. The perception of space changes, the distance between objects, their size and shape are distorted. Kinesthetic illusions (the feeling of the earth shaking, flying, swimming, etc.) can also be long-lasting. Consciousness is narrowed, although in most cases accessibility to external influences, selectivity of behavior, and the ability to independently find a way out of a difficult situation remain.

In the second period, occurring during the deployment of rescue operations, begins, in a figurative expression, “normal life in extreme conditions.” At this time, in the formation of states of maladjustment and mental disorders, a much greater role is played by the personality characteristics of the victims, as well as their awareness of not only the ongoing situation in some cases, but also new stressful influences, such as the loss of relatives, separation of families, loss of home and property. Important elements of prolonged stress during this period are the expectation of repeated impacts, the discrepancy between expectations and the results of rescue operations, and the need to identify dead relatives. The psycho-emotional stress characteristic of the beginning of the second period is replaced by its end, as a rule, by increased fatigue and “demobilization” with asthenic and depressive manifestations.

After the end of the acute period, some victims experience short-term relief, an uplift in mood, a desire to actively participate in rescue operations, verbosity, endless repetition of the story about their experiences, and discrediting the danger. This phase of euphoria lasts from a few minutes to several hours. As a rule, it gives way to lethargy, indifference, lethargy, and difficulty performing even simple tasks. In some cases, the victims give the impression of being detached and self-absorbed. They sigh frequently and deeply, and their inner experiences are often associated with mystical and religious ideas. Another variant of the development of an anxious state during this period may be characterized by the predominance of “anxiety with activity”: motor restlessness, fussiness, impatience, verbosity, the desire for an abundance of contacts with others. Episodes of psycho-emotional stress are quickly replaced by lethargy and apathy.

In the third period, which begins for victims after their evacuation to safe areas, many experience complex emotional and cognitive processing of the situation, reassessment of their own experiences and sensations, and awareness of losses. At the same time, psychogenically traumatic factors associated with a change in life pattern, living in a destroyed area or in a place of evacuation also become relevant. Becoming chronic, these factors contribute to the formation of relatively persistent psychogenic disorders.

Essentially, asthenic disorders are the basis on which various borderline neuropsychiatric disorders are formed. In some cases they become protracted and chronic. The victims experience vague anxiety, anxious tension, bad premonitions, and the expectation of some kind of misfortune. “Listening to danger signals” appears, which may be ground shaking from moving mechanisms, unexpected noise, or, conversely, silence. All this causes anxiety, accompanied by muscle tension, trembling in the arms and legs. This contributes to the formation of persistent and long-term phobic disorders. Along with phobias, as a rule, there is uncertainty, difficulty in making even simple decisions, and doubts about the fidelity and correctness of one’s own actions. Often there is a constant discussion of the experienced situation, close to obsession, and memories of a past life with its idealization.

Another type of manifestation of emotional stress is psychogenic depressive disorders. A peculiar awareness of “one’s guilt” before the dead appears, an aversion to life arises, and regret that he survived and did not die with his relatives. The inability to cope with problems leads to passivity, disappointment, decreased self-esteem, and a feeling of inadequacy.

People who have experienced an extreme situation quite often experience decompensation of character accentuations and psychopathic personality traits. In this case, both the individually significant psychotraumatic situation and the previous life experience and personal attitudes of each person are of great importance.

Along with the noted neurotic and psychopathic reactions at all three stages of the development of the situation, the victims experience autonomic dysfunction and sleep disorders. The latter not only reflect the entire complex of neurotic disorders, but also significantly contribute to their stabilization and further aggravation. Most often, it is difficult to fall asleep; it is hampered by a feeling of emotional tension and anxiety. Night sleep is superficial, accompanied by nightmares, and usually short-lived. The most intense changes in the functional activity of the autonomic nervous system manifest themselves in the form of fluctuations in blood pressure, pulse lability, hyperhidrosis (excessive sweating), chills, headaches, vestibular disorders, and gastrointestinal disorders.

During all of these periods, the development and compensation of psychogenic disorders in emergency situations depend on three groups of factors: the specifics of the situation, individual response to what is happening, social and organizational measures. However, the importance of these factors in different periods of development of the situation is not the same. The main factors influencing the development and compensation of mental disorders in emergency situations can be classified as follows:

directly during an event (catastrophe, natural disaster, etc.):
features of the situation: emergency intensity;

duration of emergency;

suddenness of the emergency;

individual reactions:

somatic condition;

age;

emergency preparedness;

personal characteristics;

awareness;

“collective behavior”;

when carrying out rescue operations after the completion of a dangerous event:
features of the situation: “secondary psychogenies”;
individual reactions:

personal characteristics;

individual assessment and perception of the situation;

age;

somatic condition;

social and organizational factors:

awareness;

organization of rescue operations;

“collective behavior”;

at remote stages of an emergency:
socio-psychological and medical assistance:

rehabilitation;

somatic condition;

social and organizational factors:

social structure;

compensation.

The main content of psychological trauma is the loss of faith that life is organized in accordance with a certain order and can be controlled. Trauma affects the perception of time, and under its influence the vision of the past, present and future changes. In terms of the intensity of the feelings experienced, traumatic stress is commensurate with the entire previous life. Because of this, it seems like the most significant event in life, like a “watershed” between what happened before and after the traumatic event, as well as everything that will happen afterwards.

An important place is occupied by the question of the dynamics of psychogenic disorders that develop in dangerous situations.

There are several classifications of the phases of the dynamics of people’s states after traumatic situations.

Mental reactions during disasters are divided into four phases: heroism, honeymoon, disappointment and recovery.

Heroic phase begins immediately at the moment of the disaster and lasts several hours, it is characterized by altruism, heroic behavior caused by the desire to help people, to escape and survive. False assumptions about the possibility of overcoming what happened arise precisely in this phase.
Honeymoon phase occurs after a disaster and lasts from a week to 36 months. Those who survive feel a strong sense of pride that they have overcome all dangers and survived. In this phase of the disaster, the victims hope and believe that soon all problems and difficulties will be resolved.
Disillusionment Phase usually lasts from 3 months to 12 years. Intense feelings of disappointment, anger, resentment and bitterness arise from the collapse of hopes.
Recovery phase begins when survivors realize that they themselves need to improve their lives and solve problems that arise, and take responsibility for carrying out these tasks.

Another classification of successive phases or stages in the dynamics of people’s condition after psychotraumatic situations is proposed in the work of M. M. Reshetnikov et al. (1989):

« Acute emotional shock" Develops after a state of torpor and lasts from 3 to 5 hours; characterized by general mental stress, extreme mobilization of psychophysiological reserves, heightened perception and increased speed of thought processes, manifestations of reckless courage (especially when saving loved ones) while simultaneously reducing the critical assessment of the situation, but maintaining the ability for purposeful activity.
« Psychophysiological demobilization" Duration up to three days. For the vast majority of those surveyed, the onset of this stage is associated with the first contacts with those who were injured and with the bodies of the dead, with an understanding of the scale of the tragedy. It is characterized by a sharp deterioration in well-being and psycho-emotional state with a predominance of feelings of confusion, panic reactions, a decrease in moral normative behavior, a decrease in the level of efficiency of activity and motivation for it, depressive tendencies, some changes in the functions of attention and memory (as a rule, those examined cannot clearly remember what they did these days). Most of the respondents complain in this phase of nausea, “heaviness” in the head, discomfort in the gastrointestinal tract, and a decrease (even absence) of appetite. The same period also included the first refusals to carry out rescue and “clearance” work (especially related to the removal of bodies of the dead), a significant increase in the number of erroneous actions when driving vehicles and special equipment, up to the creation of emergency situations.
« Resolution stage» 312 days after the natural disaster. According to subjective assessment, mood and well-being are gradually stabilizing. However, according to the results of observations, the vast majority of those examined retain a reduced emotional background, limited contact with others, hypomimia (mask-like appearance of the face), decreased intonation coloring of speech, and slowness of movements. Towards the end of this period, a desire to “speak out” appears, implemented selectively, aimed primarily at persons who were not eyewitnesses of the natural disaster. At the same time, dreams appear that were absent in the two previous phases, including disturbing and nightmare dreams, in various ways reflecting the impressions of tragic events.

Against the background of subjective signs of some improvement in the condition, a further decrease in physiological reserves (by the type of hyperactivation) is objectively noted. The phenomena of overwork are progressively increasing.

« Recovery stage" It begins approximately on the 12th day after the disaster and is most clearly manifested in behavioral reactions: interpersonal communication is activated, the emotional coloring of speech and facial reactions begins to normalize, for the first time after the disaster jokes can be noted that evoke an emotional response from others, normal dreams are restored.

7.2. Features of emergency psychological assistance in extreme situations

In conditions of mass destruction, according to their mental state, victims are usually divided into 4 categories.

First category poses a real danger to himself and others. Such victims are in a state of upset consciousness and have aggressive or suicidal tendencies. This category also includes people with exacerbation of mental illness due to stress.

To the fourth category include victims with the mildest form of disorders. After taking all the necessary measures and remaining at rest for a short time, this category can return to their usual way of life in the shortest possible time.

When providing assistance to victims with various mental disorders that arose as a result of a stressful situation, the main thing is to eliminate cases of affective arousal and aggressive reactions with clouded consciousness. Such people pose a real danger to themselves and others and need medical attention first and foremost. The presence of such victims in a group can significantly complicate rescue efforts, since their behavior may be unpredictable, which can cause significant danger for both the victims and the rescue team. When relieving such conditions, the most effective and fast-acting pharmacological drugs necessary in such situations are used (neuroleptics, antidepressants and tranquilizers, as well as their combinations).

When providing emergency psychological assistance, it is necessary to remember that victims of natural disasters and catastrophes suffer from the following factors caused by an extreme situation:

Suddenness. Few disasters develop gradually, reaching a critical phase by the time potential victims have been warned - for example, a flood or an impending hurricane or storm. Most emergencies occur unexpectedly (earthquake, tsunami, man-made disasters, etc.).
Lack of similar experience. Since disasters and catastrophes, fortunately, occur infrequently, people learn to experience them already at the moment of the event itself.
Duration. This factor varies from case to case. For example, a gradually developing flood may subside just as slowly, while an earthquake lasts a few seconds and causes much more destruction. However, for victims of some long-term extreme situations (for example, hostage situations), the traumatic effects may multiply with each passing day.
Lack of control. No one is able to control events during disasters; It may take a long time before a person is able to control the most ordinary events of daily life. If this loss of control persists for a long time, even competent and independent people may show signs of helplessness.
Grief and loss. Victims of disasters may be separated from loved ones or lose someone close to them; the worst thing is to remain in a state of uncertainty, awaiting news of all possible losses. In addition, the victim may lose his social role and position due to the disaster, and lose hopes of restoring what was lost.
Constant changes. The destruction caused by a disaster may be irreparable: the victim may find himself in completely new conditions.
Waiting for death. Even short life-threatening situations can change a person’s personal structure and cause profound changes at the regulatory level. In a close encounter with death, a severe existential crisis is very likely.
Moral uncertainty. A disaster victim may be faced with life-altering value decisions, such as who to save, how much to risk, who to blame.
Behavior during the event. Everyone would like to look their best in a difficult situation, but few manage to do so. What a person did or did not do during a disaster can haunt him long after other wounds have healed.
The scale of destruction. After a disaster, the survivor is likely to be amazed at what it has done to his environment and social structure. Changes in cultural norms force a person to adapt to them or remain an outsider; in the latter case, emotional damage is combined with social maladjustment.

In these conditions, people need emergency psychological help, the procedure for providing it in extreme situations has its own specifics. In particular, in these conditions, due to time constraints, it is not possible to use standard diagnostic procedures.

Conventional methods of psychological influence are also inapplicable in many extreme situations. It all depends on the goals of psychological influence: in one case, you need to support, help; in another it is necessary to stop, for example, rumors, panic; in the third to negotiate.

The main principles of assistance people in emergency situations are:

urgency;
proximity to the scene of events;
waiting for normalcy to return;
simplicity of psychological influence.

Urgency means that help should be provided to the victim as quickly as possible: the more time passes from the moment of injury, the higher the likelihood of chronic disorders, including post-traumatic stress disorder.

Closeness consists of providing assistance in the most extreme or emergency situation and surrounded by victims and loved ones.

Waiting for normalcy to return is that a person who has suffered a stressful situation should be treated not as a patient, but as a normal person. It is necessary to maintain confidence that normalcy will return soon.

Simplicity of psychological impact It is necessary to take the victim away from the source of injury, provide food, rest, a safe environment and the opportunity to be listened to.

Features of work when providing emergency psychological assistance:

Often we have to work with groups of victims, and these groups are not created artificially, based on the needs of the psychotherapeutic process, they are created by life itself due to the dramatic situation of the disaster.
Patients are often in an acute affective state.
The social and educational status of many victims is often low, and they would never find themselves in a psychologist’s (psychotherapist) office in their life.
Heterogeneity of psychopathologies among victims. Victims often suffer, in addition to traumatic stress, from neuroses, psychoses, character disorders, etc.

The presence of a sense of loss in almost all patients, since victims often lose loved ones, friends, favorite places to live and work, which contributes to the picture of traumatic stress.

Goals and objectives of emergency psychological assistance include the prevention of acute panic reactions, psychogenic neuropsychic disorders; increasing the individual's adaptive capabilities. Emergency psychological assistance to the population should be based on the principle of “infiltration” into the surface layers of consciousness, i.e., on working with symptoms.

Psychotherapy and psychoprophylaxis are carried out in two directions:

The first with a healthy part of the population in the form of prevention:

a) acute panic reactions;

b) delayed, “retarded” neuropsychic disorders.

The second direction is psychotherapy and psychoprophylaxis of persons with developed neuropsychic disorders. The technical difficulties of conducting rescue operations in disaster zones can lead to the fact that victims find themselves in complete isolation from the outside world for quite a long time. In this case, psychotherapeutic assistance in the form of emergency “ information therapy", the purpose of which is the psychological maintenance of the vitality of those who are alive, but are in complete isolation from the outside world (earthquakes, destruction of homes as a result of accidents, explosions, etc.). “Information therapy” is implemented through a sound amplifier system and consists of broadcasting the following recommendations that victims should hear:

information that the world around them is coming to their aid and everything is being done to ensure that help comes to them as quickly as possible;
remain completely calm, as this is one of the main means to their salvation;
the need to provide self-help;
in case of rubble, do not make any physical efforts to self-evacuate, in order to avoid dangerous displacement of the debris;
save your energy as much as possible;
stay with your eyes closed, which will bring you closer to a state of light drowsiness and will help save physical strength;
breathe slowly, shallowly and through the nose, which will save moisture and oxygen in the body and the surrounding air;
mentally repeat the phrase “I am completely calm” 56 times, alternating these self-hypnosis with periods of counting up to 20, which will relieve internal tension and normalize pulse and blood pressure, as well as achieve self-discipline;
maintain courage and patience, since liberation from “captivity” may take longer than desired.

The purpose of "information therapy" It is also a reduction in the feeling of fear among victims, since it is known that in crisis situations more people die from fear than from exposure to a real destructive factor. After the victims are freed from the rubble of buildings, it is necessary to continue psychotherapy in an inpatient setting.

Another group of people who receive psychological assistance in emergency situations are relatives of people under rubble. Psychotherapeutic influences that should be provided by specialists are applicable to them. Psychological assistance in emergency situations and emergencies is also necessary for rescuers who are experiencing psychological stress. A specialist must have the ability to promptly identify symptoms of psychological problems in himself and his colleagues, and have the ability to organize and conduct classes on psychological relief, stress relief, and emotional tension. Possession of the skills of psychological self- and mutual assistance in crisis and extreme situations is of great importance not only for the prevention of mental trauma, but also for increasing resistance to stress and readiness for rapid response in emergency situations.

1. Let the victim know that you are nearby and that rescue measures are already being taken.

The victim should feel that he is not alone in this situation. Approach the victim and say, for example: “I will stay with you until the ambulance arrives.”

2. Try to rid the victim of prying eyes.

Curious glances are very unpleasant for a person in a crisis situation. If onlookers do not leave, give them some instructions, for example, to drive the curious away from the scene.

3. Make skin-to-skin contact carefully.

Light physical contact usually calms victims down. Therefore, take the victim by the hand or pat him on the shoulder. Touching the head or other parts of the body is not recommended. Take a position at the same level as the victim. Even when providing medical assistance, try to be on the same level as the victim.

4. Talk and listen.

Listen carefully, do not interrupt, and be patient while performing your duties. Speak yourself, preferably in a calm tone, even if the victim loses consciousness. Don't be nervous. Avoid reproaches. Ask the victim: “Is there anything I can do for you?” If you feel compassion, don't hesitate to say so.

Emergency psychological assistance techniques

A person in an extreme situation may experience the following symptoms:

rave;
hallucinations;
apathy;
stupor;
motor excitement;
aggression;
fear;
nervous trembling;
cry;
hysterics.

Help in this situation consists, first of all, in creating conditions for nervous “relaxation”.

Delusions and hallucinations. The main signs of delusion include false ideas or conclusions, the fallacy of which cannot be dissuaded by the victim.

Hallucinations are characterized by the fact that the victim experiences a sensation of the presence of imaginary objects that do not currently affect the corresponding sense organs (hears voices, sees people, smells, etc.).

In this situation:

Contact medical workers, call an emergency psychiatric team.
Before specialists arrive, make sure that the victim does not harm himself or others. Remove objects that pose a potential danger from it.
Isolate the victim and do not leave him alone.
Speak to the victim in a calm voice. Agree with him, don't try to convince him. Remember that in such a situation it is impossible to convince the victim.

Apathy can occur after prolonged intense but unsuccessful work; or in a situation where a person suffers a serious failure and ceases to see the meaning of his activities; or when it was not possible to save someone, and a loved one in trouble died. There is a feeling of fatigue such that you don’t want to move or speak; movements and words come with great difficulty. A person can remain in a state of apathy from several hours to several weeks.

The main signs of apathy are:

indifferent attitude towards the environment;
lethargy, lethargy;
Slow speech with long pauses.

In this situation:

Talk to the victim. Ask him a few simple questions: “What is your name?”; "How do you feel?"; “Do you want to eat?”
Take the victim to a place of rest, help him get comfortable (be sure to take off his shoes).
Take the victim's hand or place your hand on his forehead.
Give the victim the opportunity to sleep or just lie down.
If there is no opportunity to rest (an incident on the street, in public transport, waiting for the end of the operation in the hospital), then talk more with the victim, involve him in any joint activity (take a walk, drink tea or coffee, help others who need help).

Stupor is one of the body's most powerful defense reactions. It occurs after severe nervous shocks (explosion, attack, brutal violence), when a person has spent so much energy on survival that he no longer has the strength to contact the outside world.

Stupor can last from several minutes to several hours. Therefore, if assistance is not provided and the victim remains in this state for a long time, this will lead to his physical exhaustion. Since there is no contact with the outside world, the victim will not notice the danger and will not take action to avoid it.

The main signs of stupor are:

a sharp decrease or absence of voluntary movements and speech;
lack of reactions to external stimuli (noise, light, touch, pinching);
“freezing” in a certain position, numbness, a state of complete immobility;
possible tension of individual muscle groups.

In this situation:

Bend the victim's fingers on both hands and press them to the base of the palm. The thumbs should be pointed outwards.
Using the tips of your thumb and forefinger, massage the victim's points located on the forehead, above the eyes, exactly halfway between the growth line
Place the palm of your free hand on the victim's chest. Match your breathing to the rhythm of his breathing.
A person, while in a stupor, can hear and see. Therefore, speak into his ear quietly, slowly and clearly what can evoke strong emotions (preferably negative). It is necessary to achieve a reaction from the victim by any means, to bring him out of his stupor.

Motor excitement. Sometimes the shock from a critical situation (explosions, natural disasters) is so strong that a person simply ceases to understand what is happening around him. A person loses the ability to think logically and make decisions, and becomes like an animal rushing about in a cage.

The main signs of motor excitation are:

sudden movements, often aimless and meaningless actions;
abnormally loud speech or increased speech activity (a person speaks nonstop, sometimes completely meaningless things);
there is often no reaction to others (to comments, requests, orders).

In this situation:

Use the “grab” technique: from behind, insert your hands under the victim’s armpits, press him towards you and slightly tip him over.
Isolate the victim from others.
Massage “positive” points. Speak in a calm voice about the feelings he is experiencing: “Do you want to do something to make this stop? Do you want to run away, hide from what is happening?”
Do not argue with the victim, do not ask questions, and in conversation avoid phrases with the particle “no” that refer to unwanted actions, for example: “Don’t run,” “Don’t wave your arms,” “Don’t shout.”
Remember that the victim may cause harm to himself and others.
Motor excitement usually does not last long and can be replaced by nervous tremors, crying, and aggressive behavior.

Aggression. Aggressive behavior is one of the involuntary ways in which the human body “tries” to reduce high internal tension. The manifestation of anger or aggression can persist for quite a long time and interfere with the victim himself and those around him.

The main signs of aggression are:

irritation, dissatisfaction, anger (for any, even minor reason);
striking others with hands or any objects;
verbal abuse, swearing;
muscle tension;
increased blood pressure.

In this situation:

Minimize the number of people around you.
Give the victim an opportunity to “let off steam” (for example, to talk it out or “beat” a pillow).
Assign him work that involves high physical activity.
Show kindness. Even if you do not agree with the victim, do not blame him, but speak out about his actions. Otherwise, aggressive behavior will be directed at you. You can’t say: “What kind of person are you!” You should say: “You are terribly angry, you want to smash everything to smithereens. Let's try to find a way out of this situation together."
Try to defuse the situation with funny comments or actions.
Aggression can be extinguished by fear of punishment:
if there is no goal to benefit from aggressive behavior;
if the punishment is severe and the likelihood of its implementation is high.
If you do not help an angry person, this will lead to dangerous consequences: due to decreased control over your actions, the person will commit rash acts and may injure himself and others.

Fear. A child wakes up at night because he had a nightmare. He is afraid of the monsters that live under the bed. Once a man gets into a car accident, he can’t get behind the wheel again. A man who survived an earthquake refuses to go to his surviving apartment. And the one who has been subjected to violence has difficulty forcing himself to enter his entrance. The reason for all this is fear.

The main signs of fear include:

muscle tension (especially facial);
strong heartbeat;
rapid shallow breathing;
decreased control over one's own behavior.

Panic fear and horror can prompt flight, cause numbness or, conversely, agitation and aggressive behavior. At the same time, the person has poor self-control and is not aware of what he is doing and what is happening around him.

In this situation:

Place the victim's hand on your wrist so that he can feel your calm pulse. This will be a signal for the patient: “I am here now, you are not alone!”
Breathe deeply and evenly. Encourage the victim to breathe in the same rhythm as you.
If the victim speaks, listen to him, show interest, understanding, sympathy.
Give the victim a light massage of the most tense muscles in the body.

Nervous trembling. After an extreme situation, uncontrollable nervous tremors appear. This is how the body “relieves” tension.

If this reaction is stopped, then the tension will remain inside, in the body, and cause muscle pain, and in the future can lead to the development of such serious diseases as hypertension, ulcers, etc.

trembling begins suddenly immediately after the incident or after some time;
there is a strong trembling of the whole body or its individual parts (a person cannot hold small objects in his hands or light a cigarette);
the reaction lasts quite a long time (up to several hours);
then the person feels very tired and needs rest.

In this situation:

The trembling needs to be increased.
Grab the victim by the shoulders and shake him hard and sharply for 10-15 seconds.
Keep talking to him, otherwise he may perceive your actions as an attack.
After the reaction is completed, the victim must be given the opportunity to rest. It is advisable to put him to bed.
It is forbidden:
hug the victim or hold him close to you;
cover the victim with something warm;
reassure the victim, tell him to pull himself together.

Crying. When a person cries, substances that have a calming effect are released inside him. It's good if there is someone nearby with whom you can share your grief.

The main signs of this condition:

the person is already crying or ready to burst into tears;
lips tremble;
there is a feeling of depression;
Unlike hysterics, there are no signs of excitement.

If a person holds back tears, then there is no emotional release or relief. When the situation drags on, internal tension can harm a person's physical and mental health.

In this situation:

Do not leave the victim alone.
Establish physical contact with the victim (take his hand, put your hand on his shoulder or back, stroke his head). Let him feel that you are nearby.
Use “active listening” techniques (they will help the victim express his grief): periodically say “aha”, “yes”, nod your head, i.e. confirm that you are listening and sympathize; repeat after the victim excerpts of phrases in which he expresses his feelings; talk about your feelings and the feelings of the victim.
Do not try to calm the victim. Give him the opportunity to cry and speak out, to “throw out” his grief, fear, and resentment.
Don't ask questions, don't give advice. Your job is to listen.

Hysterical. A hysterical attack lasts several minutes or several hours.

Main features:

consciousness is preserved;
excessive excitement, lots of movements, theatrical poses;
speech is emotionally rich, fast;
screams, sobs.

In this situation:

Remove spectators, create a calm environment. Stay alone with the victim if it is not dangerous for you.
Unexpectedly perform an action that may greatly surprise you (you can slap him in the face, pour water on him, drop an object with a roar, or sharply shout at the victim).
Speak to the victim in short phrases, in a confident tone (“Drink water,” “Wash yourself”).
After the hysteria comes a breakdown. Put the victim to sleep. Before the specialist arrives, monitor his condition.
Do not indulge the wishes of the victim.

Order writing a unique work

Severe natural disasters and catastrophes, not to mention the possible massive sanitary losses during war, are a difficult experience for many people. A mental reaction to extreme conditions, especially in cases of significant material losses and loss of life, can permanently deprive a person of the ability to act rationally and effectively, despite the “psychological protection” that helps prevent disorganization of mental activity and behavior. Many researchers have concluded that preventive health care is the most effective means of preventing the impact of trauma on a person's mental health. A group of American researchers (Fullerton S., Ursano R. et al., 1997), based on a generalization of their own data, came to the conclusion that preventive medical care in anticipating mental trauma, during an emergency event and during overcoming its consequences can be considered in the following three directions.

I. Primary prevention

Informing you of what to expect.

Training in control and mastery skills.

Limit exposure.

Sleep hygiene.

Filling the psychological need for support and rest.

Informing and training loved ones to enhance “natural support.”

II. Secondary prevention

Restore security and public services.

Primary care training.

Sorting the sick and wounded.

Early diagnosis of the wounded.

Diagnosis of somatization as a possible mental distress.

Training teachers for early decontamination of distress.

Collection of information.

III. Tertiary prevention

Treatment of comorbid disorders.

Increased attention to family distress, loss and demoralization, violence against loved ones or children in the family.

Compensation.

Deactivation of the processes of “withdrawal” and social avoidance.

Psychotherapy and necessary drug treatment.

Practical measures aimed at preventing psychiatric and medical-psychological consequences of emergency situations can be divided into those carried out in the period before the occurrence, during the action of psychotraumatic extreme factors and after the cessation of their influence.

Before an extreme situation occurs, it is necessary to prepare the medical service of the Civil Defense (CD) and rescuers to work in extreme conditions. It should include:

Training of personnel of sanitary posts and squads to provide medical assistance to victims with psychogenic disorders;

Formation and development of high psychological qualities, the ability to behave correctly in extreme situations, the ability to overcome fear, determine priorities and act purposefully; development of organizational skills for psychoprophylactic work with the population;

Informing medical workers and the population about the possibilities of using psychotherapeutic and medications for psychoprophylaxis.

The list of the indicated ways to prevent states of mental maladjustment in extreme conditions, directly addressed primarily to various units of the civil defense medical service, should be supplemented by a wide range of educational and organizational activities aimed at overcoming carelessness and neglect of certain life-threatening effects on a person, both in those cases when “harmfulness” is clearly tangible, so also when it is, until a certain time, hidden from the sight and understanding of ignorant people.

Mental hardening is of great importance, i.e. development by a person of courage, will, composure, endurance and the ability to overcome feelings of fear.

The need for this kind of preventive work follows from the analysis of many emergency situations, including the Chernobyl disaster.

“... From Minsk in my car I (an engineer, a nuclear power plant worker) was driving towards the city of Pripyat... I approached the city somewhere around two hours and thirty minutes at night... I saw a fire above the fourth power unit. A flame-lit ventilation pipe with transverse red stripes was clearly visible. I remember well that the flame was higher than the chimney. That is, it reached a height of about one hundred and seventy meters above the ground. I did not turn home, but decided to drive closer to the fourth power unit in order to get a better look... I stopped about a hundred meters from the end of the emergency unit (in this place, as it will be calculated later, at that time the background radiation reached 800-1500 roentgens per hour mainly from graphite, fuel and flying radioactive cloud scattered by the explosion). I saw in the near light of the fire that the building was dilapidated, there was no central hall, no separator rooms, the separator drums, moved from their places, gleamed reddishly. Such a picture really hurt my heart... I stood there for a minute, there was an oppressive feeling of incomprehensible anxiety, numbness, my eyes absorbed everything and remembered it forever. But anxiety kept creeping into my soul, and involuntary fear appeared. Feeling of an invisible threat nearby. It smelled like after a strong lightning strike, still astringent smoke, it began to burn my eyes and dry my throat. I was coughing. And I lowered the glass to get a better look. It was such a spring night. I turned the car around and drove to my home. When I entered the house, mine were asleep. It was about three o'clock in the morning. They woke up and said they heard explosions but didn't know what they were. Soon an excited neighbor came running, whose husband was already on the block. She informed us about the accident and suggested drinking a bottle of vodka to decontaminate the body...”

“At the time of the explosion, two hundred and forty meters from the fourth block, just opposite the turbine room, two fishermen were sitting on the bank of the supply canal and catching fry. They heard explosions, saw a blinding burst of flame and flying pieces of hot fuel, graphite, reinforced concrete and steel beams like fireworks. Both fishermen continued their fishing, unaware of what had happened. They thought that a barrel of gasoline had probably exploded. Literally before their eyes, fire crews deployed, they felt the heat of the flames, but blithely continued fishing. The fishermen received 400 roentgens each. Closer to the morning, they developed uncontrollable vomiting; according to them, it was as if the chest was burning with heat, like fire, the eyelids were cutting, the head was bad, as if after a wild hangover. Realizing that something was wrong, they barely made it to the medical unit...”

“Resident of Pripyat X., senior engineer of the production and administrative department of the Chernobyl NPP construction department, testifies: “On Saturday, April 26, 1986, everyone was already preparing for the May 1st holiday. Warm fine day. Spring. The gardens are blooming... Among the majority of builders and installers, no one knew anything yet. Then something leaked about an accident and fire at the fourth power unit. But no one really knew what exactly happened. The children went to school, the kids played outside in sandboxes and rode bicycles. By the evening of April 26, all of them already had high activity in their hair and clothes, but we didn’t know it then. Not far from us on the street they were selling delicious donuts. An ordinary day off... A group of neighboring kids rode bicycles to the overpass (bridge), from there the emergency block was clearly visible from the side of the Yanov station. This, as we later learned, was the most radioactive place in the city, because a cloud of nuclear release passed there. But this became clear later, and then, on the morning of April 26, the guys were simply interested in watching the reactor burn. These children later developed severe radiation sickness."

Both in the above and in many similar examples, belief in a miracle, in “maybe”, in the fact that everything can be easily fixed, paralyzes, makes a person’s thinking inflexible, deprives him of the opportunity to objectively and competently analyze what is happening, even in the case when There is the necessary theoretical knowledge and some practical experience. Amazing carelessness! In the case of the Chernobyl accident, it turned out to be criminal.

During the period of exposure to psychotraumatic extreme factors, the most important psychoprophylactic measures are:

Organization of clear work to provide medical care to victims with psychogenic disorders;

Objective information from the population about the medical aspects of a natural disaster (catastrophe);

Assistance to civil society leaders in suppressing panic, statements and actions;

Involving lightly injured people in rescue and emergency recovery operations.

After the end of a life-threatening catastrophic situation57, psychoprophylaxis should include the following measures:

Complete information to the population about the consequences of a natural disaster (catastrophe) and other impacts and their impact on human health;

Maximum use of all opportunities to involve large groups of victims in order to make generalized collective decisions on the organization of rescue operations and medical care;

Prevention of relapses or repeated mental disorders (so-called secondary prevention), as well as the development of psychogenically caused somatic disorders;

Drug prevention of delayed psychogenic reactions;

Involving the easily injured in participation in rescue and emergency recovery operations and in providing medical care to victims.

As experience shows, the main causes of “man-made” tragedies are quite similar in different countries in all kinds of disasters: technical imperfection of machines and mechanisms, violation of technical requirements for their operation. However, behind this there are human flaws - incompetence, superficial knowledge, irresponsibility, cowardice, which prevents the timely detection of detected errors, inability to take into account the capabilities of the body, calculate forces, etc. Such phenomena should be condemned not only by various control bodies, but first of all by the conscience of every person, brought up in the spirit of high morality.

One of the most important socio-psychological preventive tasks is information to the population about the situation, carried out permanently. Information must be complete, objective, truthful, but also, within reasonable limits, reassuring. The clarity and brevity of the information makes it especially effective and understandable. The absence or delay of information necessary for making rational decisions during or after a natural disaster or catastrophe gives rise to unpredictable consequences. For example, untimely and half-truthful information from the population about the radiation situation in the zone of the Chernobyl accident led to many tragic results both directly for the health of the population and for making organizational decisions to eliminate the accident and its consequences.

This contributed to the development of neuroticism in wide circles of the population and the formation of psychogenic mental disorders at the remote stages of the Chernobyl tragedy. In this regard, in the territories where the population lives, to one degree or another affected by the accident (contamination zones, places of residence of displaced persons), Psychological Rehabilitation Centers were created, combining socio-psychological and informational assistance and focused on the prevention of preclinical forms of mental maladaptation .

An important place in the implementation of primary prevention of psychogenic disorders is given to the understanding that a modern person must be able to behave correctly in any, even the most difficult, situations.

Along with cultivating the ability not to get lost in difficult life situations that develop in extreme conditions, competence, professional knowledge and skills, moral qualities of people managing complex mechanisms and technological processes, and the ability to give clear and constructive instructions are of the most important preventive importance.

Particularly terrible consequences are caused by incompetent decisions and the choice of the wrong course of action during the initial stages of an extreme pre-catastrophic situation or during an already developed disaster. Consequently, during the professional selection and training of managers and performers of the most critical areas of work in many areas of economic activity, it is necessary to take into account the psychological characteristics and professional competence of a particular candidate. Anticipation of his behavior in extreme conditions should occupy an important place in the system of general prevention of the development of life-threatening situations and the psychogenic disorders caused by them.

It is not without reason that they believe that uncontrollable fear indicates a lack of confidence in oneself, one’s knowledge, and skills. It can also lead to panic reactions, to prevent which it is necessary to stop the spread of false rumors, be firm with the “leaders” of alarmists, direct people’s energy to rescue work, etc. It is known that the spread of panic is facilitated by many factors caused by a person’s psychological passivity in extreme situations and lack of readiness to fight the elements.

Extreme situation we will call a suddenly arisen situation that threatens or is subjectively perceived by a person as threatening life, health, personal integrity, and well-being.

The main features of extreme situations are the following:

– the usual way of life is destroyed, a person is forced to adapt to new conditions;

– life is divided into “life before the event” and “life after the event.” You can often hear “this was before the accident” (illness, move, etc.);

– a person who finds himself in such a situation is in a special condition and needs psychological help and support;

– Most of the reactions that occur in a person can be characterized as normal reactions to an abnormal situation.

We can say that when faced with an extreme situation, a person is in a special psychological state. This condition in medicine and psychology is usually called an acute reaction to stress.

Acute stress disorder is a short-term disorder that occurs in response to psychological or physiological stress of exceptional magnitude. That is, this is a normal human reaction to an abnormal situation.

Psychological assistance techniques can significantly alleviate a person’s condition and, to a certain extent, prevent the delayed consequences of psychological trauma. Probably everyone has found themselves in a situation where the person next to them feels bad, but we don’t know how to help them. The surest and oldest way to help a person experiencing this condition is participation, compassion, empathy, and the techniques described below may also be useful.

Experts talk about an acute reaction to stress when the following symptoms are observed:

– a person may be in a state of stupor, anxiety, anger, fear, despair, hyperactivity (motor agitation), apathy, etc. may also be observed, but none of the symptoms prevails for a long time;

– symptoms pass quickly (from several hours to several days);

– there is a clear temporal connection (several minutes) between the stressful event and the onset of symptoms.

Techniques for helping with conditions such as fear, anxiety, crying, hysteria, apathy, guilt, anger, anger, uncontrollable trembling, and motor agitation will be discussed.

When providing psychological assistance, it is important to follow the following rules:

You need to take care of your own safety. When experiencing grief, a person often does not understand what he is doing, and therefore can be dangerous. Do not try to help a person if you are not sure of your absolute physical safety (there are examples when, when attempting suicide, a person not only throws himself from the roof, but also pulls along the one who is trying to help him; or, for example, people often attack with their fists on the one who reports the death of a loved one, even if it is a random stranger).

Get medical attention. Make sure the person has no physical injuries or heart problems. If necessary, call a doctor or an ambulance. The only exception is a situation when, for some reason, medical assistance cannot be provided immediately (for example, you have to wait for doctors to arrive, or the victim is isolated, for example, blocked in the rubble of a building collapse, etc.).

In this case, your actions should be as follows:

– inform the victim that help is already on the way;

– tell him how to behave: save energy as much as possible; breathe shallowly, slowly, through the nose - this will save oxygen in the body and the surrounding space;

– prohibit the victim from doing anything for self-evacuation or self-liberation.

When you are near a person who has suffered mental trauma as a result of exposure to extreme factors (terrorist attack, accident, loss of loved ones, tragic news, physical or sexual violence, etc.), do not lose your composure. The victim's behavior should not frighten, irritate or surprise you. His condition, actions, emotions are a normal reaction to abnormal circumstances.

If you feel that you are not ready to help a person, you are scared, it is unpleasant to talk to a person, do not do it. Know that this is a normal reaction and you have the right to it. A person always senses insincerity from his posture, gestures, and intonations, and an attempt to help through force will still be ineffective. Find someone who can do it.

The basic principle of providing assistance in psychology is the same as in medicine: “Do no harm.” It is better to refuse unreasonable, thoughtless actions than to harm a person. Therefore, if you are not sure of the correctness of what you are going to do, it is better to refrain.

Now let’s look at emergency psychological assistance techniques for others in each of the conditions listed above.

Help with fear

Don't leave the person alone. Fear is hard to bear alone.

Talk about what the person is afraid of. There is an opinion that such conversations only increase fear, but scientists have long proven that when a person speaks out his fear, it becomes less strong. Therefore, if a person talks about what he is afraid of, support him, talk about this topic.

Don’t try to distract a person with phrases: “Don’t think about it,” “This is nonsense,” “This is nonsense,” etc.

Invite the person to do some breathing exercises, such as these:

1. Place your hand on your stomach; inhale slowly, feel how first your chest fills with air, then your stomach. Hold your breath for 1-2 seconds. Exhale. First the stomach goes down, then the chest. Repeat this exercise slowly 3-4 times;

2. Take a deep breath. Hold your breath for 1-2 seconds. Start exhaling. Exhale slowly and pause for 1-2 seconds about halfway through the exhalation. Try to exhale as much as possible. Slowly repeat this exercise 3-4 times. If it is difficult for a person to breathe at this rhythm, join him - breathe together. This will help him calm down and feel that you are nearby.

If a child is afraid, talk to him about his fears, after that you can play, draw, sculpt. These activities will help your child express his feelings.

Try to keep the person busy with something. This will distract him from his worries.

Remember - fear can be useful (if it helps you avoid dangerous situations), so you need to fight it when it interferes with living a normal life.

Help with anxiety

It is very important to try to get the person to talk and understand what exactly is bothering him. In this case, perhaps the person will become aware of the source of the anxiety and will be able to calm down.

Often a person becomes anxious when he lacks information about current events. In this case, you can try to make a plan for when, where and what information can be obtained.

Try to keep the person busy with mental work: counting, writing, etc. If he is passionate about this, then the anxiety will subside.

Physical labor and household chores can also be a good way to calm down. If possible, you can do exercises or go for a run.

Help with crying

Crying is a way to let out your feelings, and you shouldn't immediately try to calm someone down if they're crying. But, on the other hand, being next to a crying person and not trying to help him is also wrong. What should the help consist of? It’s good if you can express your support and sympathy to the person. You don't have to do it with words. You can simply sit next to him, hug the person, stroking his head and back, let him feel that you are next to him, that you sympathize and empathize with him. Remember the expressions “cry on your shoulder”, “cry on your vest” - this is exactly what it’s about. You can hold a person's hand. Sometimes an outstretched helping hand means much more than hundreds of spoken words.

Help with hysterics

Unlike tears, hysteria is a condition that you need to try to stop. In this state, a person loses a lot of physical and psychological strength. You can help a person by doing the following:

Remove spectators, create a calm environment. Stay alone with the person if it is not dangerous for you.

Unexpectedly perform an action that may greatly surprise (for example, you can slap the person in the face, pour water on him, drop an object with a crash, or sharply shout at the victim). If you cannot perform such an action, then sit next to the person, hold his hand, stroke his back, but do not engage in conversation with him or, especially, in an argument. Any words you say in this situation will only add fuel to the fire.

After the hysteria has subsided, speak to the victim in short phrases, in a confident but friendly tone (“drink water,” “wash your face”).

After the hysteria comes a breakdown. Give the person a chance to rest.

Help with apathy

In a state of apathy, in addition to a loss of strength, indifference sets in and a feeling of emptiness appears. If a person is left without support and attention, then apathy can develop into depression. In this case, you can do the following:

Talk to the person. Ask him a few simple questions based on whether he is familiar to you or not: “What is your name?”, “How are you feeling?”, “Are you hungry?”

Take the victim to a place of rest, help him get comfortable (you must take off your shoes).

Take the person's hand or place your hand on their forehead.

Give him the opportunity to sleep or just lie down.

If there is no opportunity to rest (an incident on the street, on public transport, waiting for the end of the operation in the hospital), then talk more with the victim, involve him in any joint activity (you can take a walk, go for tea or coffee, help others who need help).

Krzhechkovsky A.Yu. (Stavropol)

Krzhechkovsky Alexander Yurievich

Doctor of Medical Sciences, Professor, Head of the Department of Psychiatry, Narcology and Medical Psychology, State Educational Institution of Higher Professional Education, St. State Medical Academy of the Ministry of Health and Social Development of Russia.

Email: [email protected]

Annotation. The increasingly frequent occurrence of extreme situations in our time and a certain change in attitude towards them require systematization of data on this issue. The report describes the characteristics of mental disorders during natural disasters and catastrophes, during environmental disasters, among refugees and migrants. The issues of the emergence of mental disorders both in military service and in “unusual living conditions”, as factors of extreme influences, are also discussed. The information may be useful to physicians caring for victims in these conditions.

Key words: mental disorders, extreme influences, correction.

INTRODUCTION

In our age of civilization, urbanization and scientific and technological progress, people, as before, are faced with extremely strong influences from the external environment. In some cases, they are on the verge of tolerance and can cause adaptation disorders. The term “extreme conditions” is usually used to refer to these impacts. The latter are understood as extreme natural conditions of existence that put the body on the brink of tolerance. Habitats with such conditions are usually called extreme zones. The latter can be natural - natural (for example: the Arctic, Antarctica, deserts, etc.) and anthropogenic - resulting from human activity (for example: areas of the Chernobyl nuclear power plant, an explosion at the crossing of the Arzamas station, large-scale terrorist attacks, etc.). Extreme zones can form over a long period of time (significant changes in climatic conditions, intense environmental pollution with industrial waste, etc.) and arise suddenly, as is observed during natural disasters or disasters caused by people (catastrophes).

Extreme conditions are a powerful factor influencing the human body as a whole, including its psyche. These conditions can easily lead to stressful conditions and general maladaptation phenomena. The clinical manifestations of the disorders are diverse. However, they have common features and mechanisms of occurrence and development, which to a certain extent depend on the nature and rate of formation of extreme conditions.

This report will discuss mainly acute and prolonged psychogenic mental disorders in various extreme conditions, as well as some clinical manifestations of mental adaptation disorders. It (the message) is intended for persons who have initial training in general and private psychiatry within the scope of the medical university program in this discipline.

MENTAL DISORDERS
IN NATURAL DISASTERS AND DISASTERS

Mental disorders during natural disasters and mass disasters occupy a special place due to the fact that they can simultaneously occur in a large number of people. In these cases, extreme conditions mean situations that are dangerous to the life, health and well-being of large groups of the population, caused by floods, fires, earthquakes, various accidents, and the use of various weapons by the enemy during war. The World Health Organization defines natural disasters as situations characterized by unforeseen, serious and immediate threats to public health. A multifactorial assessment of such situations allows us to distinguish three periods of their development, during which various psychogenic disorders are observed.

The first period is characterized by a sudden threat to one’s own life and the death of loved ones. It continues from the onset of a disaster to the organization of rescue efforts. Powerful extreme exposure during this period mainly affects the instincts of self-preservation and leads to the development of nonspecific psychogenic reactions, the basis of which is fear of varying intensity. At this time, psychogenic reactions of psychotic and non-psychotic levels are predominantly observed; in some cases, panic may develop.

In the second period, which occurs during the deployment of rescue operations, the personality traits of the victims play a large role in the formation of states of maladjustment and mental disorders. It is also important for the victims to realize that in some cases the life-threatening situation continues in combination with new stressful influences, such as the loss of relatives, separation of families, loss of home and property. An important element of prolonged stress during this period is the expectation of repeated impacts, the discrepancy between expectations and the results of rescue operations, and the need to identify dead relatives. At the beginning of this period, psycho-emotional stress is observed, which is usually subsequently replaced by increased fatigue and asthenic-depressive manifestations.

In the third period, which begins for victims after their evacuation to safe areas, many experience complex emotional and cognitive processing of the situation, assessment of their own experiences and sensations, and assessment of losses incurred. During this period, psychotraumatic factors associated with a change in life stereotype (living in a destroyed area or in a place of evacuation, the need for close communication with strangers, etc.) become relevant. Becoming chronic, these factors contribute to the formation of relatively persistent psychogenic disorders.

As studies by Yu.A. Aleksandrovsky and his colleagues, psychopathological disorders in extreme situations have much in common with clinical disorders that develop under normal conditions, but there are also significant differences. Firstly, during natural disasters and catastrophes, mental disorders occur simultaneously in a large number of people. Secondly, the clinical picture in these cases is not strictly individual, as in ordinary psychotraumatic situations, in nature and is reduced to a small number of fairly typical manifestations. Thirdly, despite the development of psychogenic disorders and the ongoing life-threatening situation, the affected person is forced to continue to actively fight the consequences of a natural disaster (catastrophe) for the sake of his survival and the preservation of the lives of loved ones and everyone around him.

Schematically, all psychogenic disorders that arise in life-threatening situations during and after natural disasters and catastrophes can be divided as follows: 1. Non-pathological (physiological) reactions, 2. Psychogenic pathological reactions, 3. Psychogenic neurotic states, 4. Acute reactive psychoses and 5. Protracted reactive psychoses.

Non-pathological (physiological) reactions. They are characterized by a predominance of emotional tension with fear or depressed mood, increased (or decreased) motor activity, and vegetative-vascular lability. Fear arises immediately after the appearance of signs of danger and is combined with confusion and misunderstanding of what is happening. After this short period, with a simple reaction of fear, a slight increase in activity is noted: movements become clear, economical, muscle strength increases, people move to safer places. Speech becomes faster, voice becomes louder; mobilization of will, attention, and thinking is noted. Memory impairments can be represented by a decrease in fixation of the environment, unclear recollection of what is happening around with a full volume of memories of one’s own actions and experiences. Characteristic is a change in the perception of time, the flow of which seems to slow down and the duration of events seems to be increased several times. Often there is a sharpening of characterological characteristics and decompensation of personal accentuations. However, in any case, it is typical to retain the ability to critically assess what is happening and purposeful activities of the victims. Approximately non-pathological psychogenic reactions are observed within several days.

Psychogenic pathological reactions. They are characterized by a deeper level of disorder, assessed as neurotic. They are also based on a fear reaction, in which quite pronounced movement disorders are noted. With their hyperdynamic variant, there is aimless throwing, a lot of inappropriate movements that make it difficult to quickly make the right decisions, and possible panicked flight. The hypodynamic variant is manifested by the fact that a person seems to freeze in place, squat down, and clasp his head in his hands. When assistance is provided, he either passively submits or begins to resist. Subsequently, asthenic, depressive and hysteroid states begin to predominate in the clinical picture. These reactions arise under the influence of circumstances that are specifically significant for a person, and their clinical manifestations largely depend on the personal characteristics of the victims. However, depressive and asthenic-depressive disorders, which have a wide range of severity, are most often observed. The ability to critically assess the situation and purposeful activity is reduced. The course of psychogenic pathological reactions depends on the real ways of development of the emergency situation and the prospects for its resolution for each individual person; their duration is up to 6 months.

Psychogenic neurotic states. In this case, there is a stabilization and complication of existing reactive neurotic disorders, which leads to the formation of various neuroses: neurasthenia (exhaustion neurosis, asthenic neurosis), hysterical neurosis, depressive neurosis, obsessive-compulsive neurosis. In terms of their duration, neurotic conditions can last for 3-5 years. Due to their chronic nature and socially determined circumstances becoming more complex over time, neurotic states are transformed into various variants of pathological personality development. The latter are accompanied not only by sharpening, but also by the appearance of new characterological traits, as well as a complex of psychosomatic disorders. In these cases, the formation of alcoholism, substance abuse, and drug addiction is often observed. The process of pathological personality development usually begins 3-5 years after the onset of neurotic disorders and leads, figuratively speaking, to the formation of socially determined psychopathy.

Acute reactive psychoses. This pathology occurs immediately after a disaster and is characterized primarily by the development of affective-shock reactions in the form of reactive stupor or psychomotor agitation and twilight states of consciousness. Affective-shock reactions develop instantly and occur in the form of either a fugiform reaction or a stuporous form. The fugiform reaction is characterized by a disorder of consciousness with meaningless, erratic movements, and uncontrollable flight, often towards danger. The victim does not recognize those around him, there is no adequate contact, speech production is incoherent, often limited to an inarticulate scream. Hyperpathy is noted, in which an extraneous sound or light touch further intensifies fear; unmotivated aggression is possible. Memories of the experience are partial; Usually the beginning of the event is remembered. In the stuporous form, general immobility, numbness, mutism, and sometimes catatonic-like symptoms are observed. Patients do not react to their surroundings, often assume a fetal position, and there are memory impairments in the form of fixation amnesia. Psychomotor agitation, as a rule, is short-term and lasts up to several hours. Stuporous reactions last longer - up to 15-20 days. Complete recovery is observed in almost all cases. Twilight states of consciousness are characterized by a narrowing of the volume of consciousness, predominantly automated forms of behavior, motor restlessness (less often retardation), and sometimes fragmentary hallucinatory and delusional experiences. Their duration is short and in almost half of patients the psychosis ends within one day. As a rule, all persons who have suffered psychogenic twilight disorders experience a complete restoration of health and adapted activities.

Acute reactive psychoses end with a sharp drop in mental tone, “paralysis of emotions,” states of prostration, severe asthenia and apathy, when a threatening situation does not cause anxiety. Residual effects are most often represented by an asthenic symptom complex.

Protracted reactive psychoses. These psychoses usually form within a few days. The most common depressive form of psychosis with the classic triad of clinical manifestations (decreased mood, motor retardation, slowed thinking). Patients are “immersed” in the current situation, which determines all their experiences. Usually observed is a deterioration in appetite, weight loss, poor sleep, constipation, tachycardia, dry mucous membranes, and cessation of menstruation in women. The duration of psychosis is 2-3 months; the prognosis is relatively favorable. Psychogenic paranoid has a longer course. Delusional ideas of relationship and persecution with it develop against the background of pronounced affective disorders: anxiety, fear, depression. A pseudodementia form of prolonged psychosis is also possible, the duration of which in this case reaches a month or more. The condition of the patients is characterized by gross “impairments” of the intellect (the inability to name age, date, list anamnestic data, names of relatives, or perform basic calculations). The behavior is of the nature of foolishness (inappropriate facial expressions, stretching of lips, lisping speech, etc.).

When diagnosing psychogenic disorders that arise in an extreme situation, it is always necessary to take into account the possibility of the presence of other lesions (including traumatic brain injuries) that aggravate and prolong mental disorders in victims.

Thus, mental disorders during natural disasters and catastrophes are diverse and range from non-pathological forms of reaction to their psychotic variants. A very important role in the genesis of these disorders is played by the personal characteristics of the victims, which (under almost equal conditions of influence) determine the nature and duration of mental maladjustment.

MENTAL DISORDERS
IN ECOLOGICAL DISASTER

Extreme situations that arise as a result of changes in the environment can be called environmental disasters. Environmental disasters can be either natural or man-made and affect both large and small regions. Unlike rapidly developing natural disasters, an environmental catastrophe can be not only sudden, but also the result of slowly developing (tens of years), disastrous in its consequences, ordinary environmental processes (radiation and industrial pollution of the natural environment, contamination of food with toxic substances, cumulation of “genetic harmfulness" of generations in certain regions of the world, etc.). Sudden environmental disasters (the accident at the Chernobyl nuclear power plant, an explosion on an overpass in Bashkiria, etc.) in their pathogenic significance can be equated to natural disasters, and therefore the victims will also experience a corresponding structure of psychogenic disorders (see the previous section). A different picture arises with the slow accumulation of environmental hazards. In this case, they can be divided into three main groups: 1. Direct effects of toxic substances mainly on the central nervous system; 2. Somatic diseases resulting from exposure to toxic substances; 3. Awareness of the possibility of the occurrence of various diseases due to exposure to environmental hazards. As a rule, all these factors act in combination, significantly complicating the picture of the manifestation of mental disorders. However, when carrying out the diagnostic process, it is advisable to take into account the possibility of various pathogenetic mechanisms, since this can determine the tactics of providing medical care.

The direct effects of toxic substances are directly related to toxicology and are covered in sufficient detail in the relevant literature. Depending on the chemical class of the acting agent and its concentration, various mental disorders can occur, from minor neurosis-like disorders to psychotic states with disturbances of consciousness according to the exogenous type of response, as well as in the form of the formation of an organic symptom complex.

Somatic diseases that arise in people living in areas of environmental disasters are often not recognized by them as a consequence of exposure to an unfavorable living environment. In this case, the clinical picture is represented by typical disorders characteristic of somatogenic mental illnesses. The range of observed disorders is quite wide and extends from borderline mental disorders (asthenia, depression, hysterical and obsessive states, hypochondria) to somatically caused psychoorganic pathology (encephalopathic syndrome) and psychoses (affective, exogenous, schizoform).

Psychogenic mental illnesses arise in an environmentally unfavorable environment due to a person’s awareness of a constant threat to his life and health (fears for the life and health of loved ones). The high significance and extreme relevance of these experiences is often provoked and supported by sensations arising as a result of autonomic hyperactivity (for example, a person who, for objective reasons, feels a rapid heartbeat can associate it with the onset of a serious heart disease). The leading manifestation of these conditions is anxiety, which is directly related to the possibility of the onset of a particular disease. Along with this, irritability, difficulty concentrating, hyperesthesia, and general anxiety are noted; Complaints of memory loss are common. The latter should be differentiated from a true decrease in memory in a somatically caused psychoorganic disorder. A depressive disorder is often detected, characterized by low mood, an inability to experience feelings of joy, a pessimistic way of thinking and decreased energy, and a significant deterioration in performance. These conditions are often difficult to distinguish from each other, since anxiety is a typical symptom of depressive disorder syndrome; and vice versa - anxiety syndrome often includes some depressive symptoms. These syndromes can therefore be differentiated by the relative severity of their symptoms and the order in which they occur. Based on anxiety and depressive disorders, a hypochondriacal state is often formed. In this case, we are not talking about a painful conviction of a person that he has a serious somatic illness, but about a reorientation of the victim’s personal attitudes with a primary focus on the state of his health, a significant overestimation of the severity of disorders and a change on this basis in his entire lifestyle, according to the victim’s ideas about the internal picture of his illness. Other forms of mental disorders are possible, but they are not common and rarely reach psychotic levels. This is probably due to the slow increase in situational influence, which, with this type of development, causes predominantly borderline mental disorders. The personal characteristics of the victims are of enormous importance in the occurrence of mental disorders. People with anxious-suspicious, anankastic and paranoid character traits are most susceptible to them (disorders).

MENTAL STATE OF REFUGEES AND MIGRANTS

Migrants are a population that moves from one area to another. The term “migrant” unites people of different cultures, nationalities, religions, and different socio-demographic characteristics. By type, migration is distinguished between planned (students, people changing jobs, migrants from agricultural to industrial areas and vice versa, etc.) and unplanned - spontaneous migration caused by various disasters, war, oppression, violence, etc. In the latter case, migrants are usually called refugees. Based on the direction of movement, internal migration (within the country) and external migration (outside the country) are distinguished. The relevance of the problem of refugees and migrants (including the problem of their mental health) is growing from year to year due to the steady increase in their number. According to statistics, there are about 20 million refugees in the world today and twice as many people forcibly displaced within their own countries. People with unplanned external migration are at greatest risk of developing mental illness. The problems they face upon arrival in a new country are, first of all, a new society, a new language, a new culture. A person’s adaptation to a place of migration is also influenced by nationality and belonging to a particular ethnic group. Stress reactions that arose at various levels before migration and during resettlement intensify as a person adapts to new conditions. In these conditions, migrants especially feel the suppression of their culture in the process of adopting new customs; They realize that many of them will no longer be able to return to their homeland, they experience nostalgia, and feel isolation. In addition, migrants face the following difficulties: certain forms of their behavior and their speech are often not accepted by the new society; people are unable to express themselves due to language barriers, which can cause mental trauma amounting to deafness and dumbness. A particularly significant stress factor for a person is cultural change, since, regardless of other factors, a conflict arises between old and new cultural values. As for refugees, the occurrence of mental disorders in them is associated with the situation of violence in their home country, the process of expulsion, the environment of the move, the impressions of the first refuge, and then with the peculiarities of the new country of culture and the first period of adaptation, during which refugees most acutely feel their uselessness, isolation from their homes, isolation, loss of work, and in some cases, family. Such psychological problems are classified as post-traumatic stress disorders.

The multiplicity of active psychogenic factors complicates the clinical picture of mental disorders and can lead to an incorrect assessment of the patient by the doctor. Without taking into account cultural and national characteristics, as well as without proper knowledge of the language, the patient can be attributed to non-existent confusion, anxiety, delirium, disorientation, etc. In this regard, the diagnosis of mental disorders must be based on very specific and easily identifiable signs. A guide published by the World Health Organization (1996) and translated into Russian in 1998 (Kyiv - Sfera Publishing House) entitled “Mental Health of Refugees” makes the following recommendations for identifying people with various mental disorders:

Symptoms and signs of stress - Mental symptoms: irritability or anger over minor issues; sadness, crying, or feeling helpless; rapid mood changes; poor ability to concentrate, the need for repeated repetitions to learn simple things; obsessive return to the same thoughts. Physical symptoms: fatigue, headaches, muscle tension, irregular heartbeat, feeling short of breath, nausea or abdominal pain, poor appetite, vague pain in the arms, legs or chest, menstrual irregularities in women. Behavioral symptoms: decreased activity, lack of energy; increased activity, "restlessness"; difficulties associated with the need to concentrate on one thing; using alcohol or drugs to reduce tension; sleep disorders; lack of emotionality; disputes and disagreements; too much dependence on others in decision making, the need for constant external support.

Symptoms and signs of depression- all-consuming grief and deep sadness; lack of hope for the best; thoughts of harming yourself; tearfulness; constant anxiety; anxiety, tension; lack of joy in life; lack of energy, fatigue; physical complaints such as persistent headaches; poor sleep; weight loss; lack of interest in sex; problems with concentration and memory; feeling “bad,” worthless, or less respected than other people.

These symptoms must be actively identified, since in an extreme situation, a refugee can assess his condition as the norm corresponding to his status, and therefore will not make complaints.

Symptoms and signs of acute psychosis, occurring with impaired consciousness, do not have any special manifestations compared to ordinary painful conditions. However, one should take into account the fact that in conditions of migration, acute psychotic states can be not only of psychogenic origin, but also caused by other reasons; acute infectious diseases, vitamin deficiency, head injury, sudden cessation of alcohol or drug intake. Differential diagnosis of the causes of psychotic disorders usually does not present any particular difficulties.

The mental health of refugee children poses a rather complex problem. Mass movements of people inevitably lead to cases of family breakdown and separation. The risk is particularly high in unstable refugee camps. There are two general problems that require special attention. First, some children belong to vulnerable and dysfunctional families (single-parent families, large families, families caring for other people's children in addition to their own). Secondly, many children may be neglected due to the loss of family and home. In the latter case, children exhibit relatively similar signs of suffering. The development of such children sometimes stops or even goes backwards.

Young children separated from their families often exhibit the following symptoms: short bursts of intense crying; teacher's rejection; refusal of food; digestive disorders; sleep disorders.

Children aged 4-5 years may have the same reactions and often behave like younger children. At this age, the following disorders may occur: the child sucks his thumb; bed-wetting; Difficulties in controlling impulses (the child easily loses self-control or shows inappropriate emotions); signs characteristic of a younger age appear in speech. Street children aged 4-5 years often have nightmares and night terrors. They may also experience fear of specific objects and phenomena (loud voices, animals, etc.) or imaginary creatures (ghosts, witches, etc.).

School-age children may exhibit the following symptoms: withdrawal towards teachers; depression; irritability; anxiety; inability to concentrate; bad behavior at school; isolation towards children of their own age.

Adolescents separated from their families often experience the following reactions: depression, moodiness, isolation, aggressiveness, frequent headaches, stomach cramps and other functional disorders.

Another problem for doctors working among refugees is the problem of alcoholism and drug addiction. Some refugees turn to alcohol and drugs as a means of distracting them from real life problems. Others have excess time not engaged in any useful activity. A refugee may reason like this: “I don’t care about the future and what happens to me and others...” When family and society cease to control the normal behavior of their members, young people are especially quick to turn to alcohol and drugs. If refugees regularly resort to alcohol or drug use, they quickly lose interest in improving their living conditions, stop thinking about the future, and do not worry about the well-being of their loved ones. Even if just a few people begin to abuse alcohol or drugs, it affects the entire community, undermining discipline and its confidence in the future.

MILITARY SERVICE
AS A FACTOR OF EXTREME IMPACTS

The conscription of young people for active service in the Army can be assessed as a kind of extreme impact, since it significantly changes the usual way of life and places increased demands on the physical and mental capabilities of the individual, especially during the period of adaptation to military service. Special studies have shown that the difficulties of military service, especially against the backdrop of psychological unpreparedness for it, cause depression in a number of people, emotional instability, isolation and isolation, passivity and apathy, self-doubt, and a feeling of hopelessness. This is often accompanied by a deterioration in relationships with others and behavioral deviations - suicidal attempts, demonstrative and blackmailing auto-aggressive actions, unauthorized abandonment of the unit, conflicts with commanders. Behavioral disorders in this case should be considered in terms of the impact on a person of a complex of interrelated and interdependent external pathogenic causes and internal predisposing conditions, which depend on a combination of psychopathological, personal and situational factors. Based on their target orientation and motives, they can be divided into two groups: 1) passive-defensive type, which includes unauthorized abandonment of a unit, auto-aggressive actions and addictive behavior, which are a form of escape from traumatic experiences with refusal to solve personal and social problems; 2) aggressive type, which consists in the dominance of negativistic, hostile, defiant behavior, accompanied by rudeness, outbursts of anger, rage with destructive actions, physical violence, cruelty towards others, caused by motives of hostility, enmity, anger, revenge against the background of insecurity social status, anxiety, feelings of threat, alienation.

In peacetime, in military personnel with psychogenic behavioral disorders that developed during the first half of the year from the moment of conscription into the Army, in the vast majority of cases (84%) character accentuations were identified, among which epileptoid, unstable, asthenoneurotic and hysteroid were more often identified. Poor tolerance of a regulated regime, a poorly developed sense of duty, the need to stay in a closed group, incompatibility in a microsocial environment, a negative attitude towards military service among some people with character accentuations lead to a rapid increase in personality disharmony against the background of emotional tension and the secondary emergence of microsocial conflicts.

In the second half of military service, contrary to what was expected, the number of behavioral violations not only does not decrease, but even increases. The greatest share of behavioral disorders falls during this period on persons with character accentuations of predominantly sensitive, asthenoneurotic, schizoid and psychasthenic types. Their characteristic self-doubt, indecision, vulnerability, emotional lability under conditions of increased physical and psycho-emotional stress contribute to increased asthenic manifestations, sharpening of characterological characteristics with the appearance of increased irritability, rapid mental and physical exhaustion, and decreased resistance to negative situational influences. Against this background, exposure to additional psychological trauma associated with family and legal problems, emotional rejection from colleagues, etc., as a rule, was a trigger point in the development of psychogenic reactions. Their structure during this period is dominated by neurotic reactions, the characteristic feature of which is the high prevalence of behavioral disorders and the weak severity of vegetative and motor symptoms, which is due to age characteristics, as well as limited possibilities for resolving conflict situations in the army environment. The internal orientation of experiences, fixation on traumatic events are accompanied by detachment from the environment, the desire for loneliness, the experience of despair, hopelessness, the insurmountability of the situation, a feeling of dissatisfaction with oneself, as well as outbursts of irritation, which culminated in auto-aggressive actions and unauthorized abandonment of the part. In the second year of service, the number of psychogenic disorders decreases, probably due to the completion of the adaptation process.

Thus, in the conditions of military service, the leading role in the occurrence of psychogenic reactions and associated behavioral disorders belongs to the personal factors formed in the pre-conscription period that determine increased vulnerability to various types of psychotraumatic situations. The sharpening of characterological characteristics, a decrease in moral criteria and moral attitudes during the period of destabilizing socio-political processes affecting the Army, contribute to the development of behavioral disorders of a predominantly passive-defensive type.

The physical and psychological stressors of war, in contrast to peacetime, significantly reduce the role of premorbid soil in the development of psychogenic reactions. In military personnel with psychogenic behavioral disorders developing in the first six months of being in a combat situation, a sharpening of personality characteristics was predominantly observed under conditions of pronounced psycho-emotional stress and in most cases reflected the usual ways of responding within the framework of pathocharacterological reactions. A longer stay in a combat situation contributes not only to the sharpening of inherent characterological traits, but also to the appearance of new, acquired, previously uncharacteristic traits in some individuals against the background of long-term anxious fears and asthenia. It should be noted that the formation of accentuations is accompanied by the development of preferential ways of responding, reflecting the presence of a certain personality structure. In military personnel with epileptoid traits, they manifest themselves in outbursts of passion with a tendency toward aggression; in persons with hysterical traits, the same affective reactions acquire a demonstrative coloring; in the presence of asthenic features, irritable weakness with an auto-aggressive orientation is typical. Becoming more and more differentiated for each type of accentuation, these habitual ways of responding largely determine the specificity of behavioral disorders. The appearance of nonspecific (not characteristic of this type of accentuation) psychogenic behavioral disorders indicates the unfavorable nature of the dynamics of accentuation, reflecting the increase in personal disharmony due to the addition of new traits. Thus, in a combat situation, military personnel with epileptoid accentuation often exhibit increased vulnerability in the sphere of interpersonal relationships, an increased sense of duty and responsibility for the lives of colleagues; in persons with unstable, asthenoneurotic, schizoid and sensitive character accentuations, alertness, suspicion, and hostility appeared, combined with increased irritability and explosiveness.

The impact of powerful psycho-traumatic factors in a combat situation contributes to the formation of psychogenic reactions and associated behavioral disorders in a large number of individuals, regardless of the presence of character accentuations. Survival in war is associated with the development of new ways of responding in the form of constant vigilance, hostile perception of the environment, immediate response (usually aggressive) in relation to the source of the threat. At the same time, growing threat and fear are accompanied by a feeling of helplessness, self-doubt, powerlessness in front of the external environment and lead to a change in the form of affects, actions, and thinking. The affective embrace of experiences determines a one-sided assessment of reality, an exaggeration of its threatening nature, and significantly distorts emotional connections with others. Contributing to survival in a complex and contradictory combat environment, aggressiveness skills take the form of a pathological behavioral stereotype acquired under conditions of chronic stress, leading to persistent socio-psychological disadaptation.

Thus, in contrast to peacetime, in a combat situation the role of environmental stress factors in the development of psychogenic behavioral disorders increases significantly. Adaptation in conditions of constant threat to life, affecting the vital instincts of a person, is accompanied by the development of methods of response necessary for survival in the form of alertness, suspicion, hostile perception of the situation, aggression towards the source of the threat. Existing for a long time, they are constantly strengthened by the personality and increase its disharmony, which is expressed in behavioral disorders, mainly of the aggressive type.

EXTREME IMPACTS
“UNUSUAL CONDITIONS OF EXISTENCE”

A radical break in the habitual, long-established conditions of existence puts the “unusuality of existence” on a par with psychogenics and psychotraumatization. The emergence and actualization of the problem of “unusual conditions of existence” is predetermined by mankind’s intensive exploration of air, sea and outer space in the 20th century, as well as the penetration of civilization into hard-to-reach regions of the earth (long-term autonomous expeditions to the Far North, Antarctica, etc.). The psychophysiological organization of a person sometimes turns out to be unprepared to reflect these conditions either in the process of phylogenesis (development of the genus) or in the process of ontogenesis (individual development), which creates a serious problem: to what extent and how can the psychophysiological organization of a person ensure adequate adaptation and adequate perception of reality? reality in conditions to which it was not adapted in the process of its development.

“Unusual conditions of existence” have features that differ from “usual” conditions, which primarily include the presence of a threat to life, monotony of life (monotony), desynchronosis of sleep and wakefulness rhythms, limitation of information (personal, special and mass), and in certain conditions - a feeling of loneliness. The identified psychological features of “unusual conditions of existence” do not act in isolation, but in combination, ultimately leading to maladaptation of the individual in new conditions. It should be remembered that mental re-adaptation to unusual conditions, disadaptation and readaptation to ordinary living conditions are subject to the natural alternation of stages described by V.I. Lebedev (1989):

1. Preparatory stage - the stage of starting mental stress - the stage of acute mental reactions of “entry”.

2. Mental re-adaptation - unstable mental activity - deep mental changes.

3. Readaptation - the stage of acute mental reactions of “exit” - the stage of final mental stress.

On preparatory stage, regardless of the specifics of unusual conditions, a person collects the necessary information and understands the tasks that he has to solve in these conditions, masters the necessary professional skills and establishes a system of personal relationships with other group members. As we approach the conventional barrier that separates ordinary living conditions from unusual ones (the stage of initial mental stress) and a similar barrier that separates the time spent in unusual conditions from ordinary ones (the stage of final mental stress), mental tension increases, which is expressed in unpleasant experiences, in subjective slowing down the passage of time, sleep disturbances and autonomic disorders. The reasons for the increase in mental stress also include information uncertainty, anticipation of possible emergency situations and mental “playing out” of the corresponding operations to resolve them.

When overcoming the psychological barrier separating ordinary living conditions from unusual (changed) ones, positive emotional experiences arise, states of “emotional resolution”, which are largely associated with the elimination of information uncertainty. Acute mental reactions of “entrance” manifest themselves in the form of spatial illusions, impaired self-awareness (derealization-depersonalization disorders), acute affective reactions and disharmonies in the motor sphere.

Stage mental re-adaptation has a lot in common with the stage readaptation, at which the processes of reflection, the system of reflection and coordination of motor activity are restored to a level adequate for normal living conditions. The longer the period of stay in unusual, changed conditions, the longer and more difficult the readaptation to normal living conditions occurs. During this period, mental re-adaptation may be replaced by a stage of unstable mental activity.

At all of the above stages, one often has to deal with a number of mental phenomena that can be designated as “unusual mental states (pseudopsychopathological). During periods of re-adaptation and readaptation, these include the phenomena of eidetism, exteriorization reactions (the phenomenon of “creating an interlocutor”), as well as psychological openness. At the stage of unstable mental activity - emotional lability, disturbance of the rhythm of sleep and wakefulness. Unusual mental states (pseudopsychopathological) are distinguished from mental pathology by a clear psychologically understandable connection with reality, the motivation of these phenomena, as well as the short duration and preservation of a critical attitude towards them. normal living conditions and doubts about the reality of experienced mental disorders quickly dissipate under the influence of rational explanations from others.

The stage of final mental stress is caused by anticipation of a return to normal life, and, sometimes, by anxious expectations of possible extreme situations during the final period of being in unusual conditions. In this situation, nervousness, painful emotional experiences, a slowdown in the passage of time and other disturbances appear. Among the acute mental “exit” reactions, it is necessary to take into account the possibility of developing pronounced shifts in the emotional state (euphoria, hypomanic states), disturbances in motor automatisms, disorders in the perception of the depth of objects and disturbances in the constancy of their sizes, and a decrease in the sensitivity thresholds of the visual and auditory analyzers. At the long stage of readaptation, in addition to “pseudopsychopathological” conditions, psychopathic, schizoid and hypochondriacal personality disorders are possible. This personal pathology, being a consequence of individual or group isolation in extreme conditions, affects readaptation to the usual social environment, reduces the overall “level of civilization” and sometimes forms an attitude to return to the experienced situation of unusual conditions.

Thus, a person’s personality develops, mastering unusual conditions of existence. The need to form an individual’s relationship to them determines the difficulties of adaptation that arise. The breakdown of relationships towards their inadequacy and self-centeredness leads to the formation of ideas of relation, overvalued and obsessive ideas, manifesting themselves either at the level of pre-pathology or at the level of psychosis. Information insufficiency covers not only the assessment of the external conditions of the situation, but also self-esteem in fundamentally new operating conditions. Psychogenies of unusual living conditions are clinically manifested in both sthenic (with overvalued ideas) and asthenic (with obsessive ideas) variants. At the same time, the asthenic variant, recognized by the individual as a disease, predominantly leads to neurotic dynamics, and the unconscious supervalue leads to psychopathic and psychotic dynamics.

ISSUES OF PROVIDING PSYCHIATRIC CARE
IN EXTREME SITUATIONS

As already noted, the largest share of mental disorders in extreme situations falls on psychogenic disorders of the borderline level. In this regard, when providing medical care to victims, leading importance must be given to psychotherapeutic methods of treatment. Considering that psychotherapeutic influence in these conditions is forced to be provided not only by psychiatrists, but also by doctors of other profiles, it is advisable, within the framework of this manual, to highlight some general issues of psychotherapy.

In all forms of psychotherapy aimed at helping the patient overcome emotional problems, two methodological techniques are combined - listening And statement. In this process, the former is usually more important than the latter, since the main goal of treatment is to help the patient better understand himself. For the patient, part of this process is thinking aloud, which is good for clarifying ideas that have not previously been formulated in verbal form, as well as allowing one to become aware of previously unrecognized connections between certain aspects of feelings and behavior. The next important part of psychotherapy is restoration of morale, since most victims experienced stressful situations, were demoralized and lost confidence that they could help themselves. It should also be remembered that all types of psychotherapy include rationalization, which makes it possible to make the patient's disorders more understandable. A reasonable explanation for the condition can be given either by the victim himself as a result of a conversation with a doctor, or by a doctor. Whatever the method of presenting a reasonable explanation, the problem as a result becomes more understandable, and this gives the patient confidence that it can be resolved. The psychotherapeutic effect also contains an element suggestions however, its effects are short-lived (excluding hypnotherapy) and wear off over time.

Based on the above general provisions, the goal of psychotherapeutic influence on victims in extreme situations is to cause significant positive changes in the patient’s mental state in a short time. In the first stages, immediately after exposure to stress, it is most advisable to use the so-called “discussion therapy”. In its use, the physician primarily plays a passive role, mostly limiting his intervention to comments regarding the emotional significance of the patient's statements. In this case, it is necessary to take into account that not all victims are able to verbally define their feelings. In this regard, in the process of work it is necessary to teach the patient to name his sensations and shades of experiences. Partial “translation” of the patient’s emotional feelings to the level of abstraction contributes to a certain rationalization of his experiences and opens access to further psychotherapeutic work with him. Next, you need to invite the patient to tell the story of his mental trauma (catastrophe), and allow him to talk about it as many times as he wants. During this period, you need to listen to patients with emotional support, occasionally assessing their style of behavior and, if necessary, offering new options. You need to be prepared for the fact that symptoms of emotional disturbances may intensify during the first stories. However, this process is necessary, since the untold story of the disaster, as it were, “keeps the victim in place” and he cannot begin his new story, a new life. In other words, the story of the disaster separates the past from the present and allows us to build the future on the basis of the present. The doctor’s comments during the conversation should emphasize human resilience and virtue, eliminate feelings of guilt, try to reduce suffering from losses, and open perspectives.

Subsequently (or with other types of exposure to extreme conditions on the psyche), it is advisable to use “supportive” psychotherapy. During this procedure, the patient is also encouraged to talk about his problems. Doctor listens his patient with sympathy, gives advice and can use suggestion to help the patient during a period of short-term worsening of symptoms. In case of insoluble problems, the patient is helped to come to terms with the inevitable and, despite everything, lead as normal a life as possible. It is necessary to be able to listen to the patient; this is an important part of maintenance therapy. The patient should feel the doctor's focused attention and interest and see that their concerns are taken seriously. play a big role explanation and advice, but it must be borne in mind that a patient in a state of distress will most likely subsequently be able to remember only a little of what the doctor said. In addition, doctors often give their advice in overly complicated language. The main provisions should be formulated simply and clearly; It is advisable to repeat them more often, and sometimes it is useful to put these points in writing so that the patient can study them outside of a conversation with the doctor. Has great value reassurance However, it should not be premature, as this may destroy confidence in the doctor. This technique can only be used when the patient's problems are fully understood. The reassurance must be truthful, but if the patient asks about the prognosis, then the most optimistic possible outcome should be spoken. If the patient discovers that he has been deceived, he will lose the trust on which the entire treatment depends. Even in the most difficult cases, a positive approach can be maintained, encouraging the patient to rely on the positive qualities he has, albeit few. In supportive care, patients must be encouraged to take responsibility for their actions and solve their problems independently. However, there are times when the doctor needs to use his authority as a specialist to convince the patient to take the necessary first step. Thus, a patient in a state of anxiety can be confidently told that he is able to cope with the social difficulties that frighten him. This type of persuasion is called instilling prestige. It is important to discuss the achieved results in such a way that the patient gets the impression that the problem was solved to a greater extent by himself than by the doctor. During maintenance therapy, the regulation of the relationship between the patient and the doctor is very important. The doctor should behave in such a way as not to make the patient dependent on him. The patient should not rely on the doctor in everything and should always know the boundary between him and himself.

Along with psychotherapy, tranquilizers, antipsychotics and other psychotropic drugs are used when treating victims in extreme situations. Recommendations for their use are given in any prescription reference book. The peculiarity of the use of these drugs in these conditions is that they are prescribed in small doses. This especially applies to tranquilizers, the use of which can quickly lead to addiction. In this regard, there are recommendations in the literature to sharply limit the use of these drugs and prescribe small doses of antipsychotics instead. When treating victims in extreme situations (especially refugees), one should also take into account their need to take large doses of alcohol or drugs. In this regard, work with this contingent should also have a drug treatment focus.

If mental disorders of a psychotic level occur, conventional treatment with antipsychotic drugs is carried out, according to the existing recommendations of psychopharmacotherapy.

CONCLUSION

This report highlighted the most important manifestations of mental disorders in people who find themselves in extreme situations. On the one hand, these disorders are very diverse, but on the other hand, they have much in common. The main point uniting the mental pathology developing in this case is the formation of psychogenies of various levels. Their range is very wide: from acute stress disorders and adaptation reactions to protracted neuroses and psychotic states. This fact also determines the nature of assistance to victims, which, along with psychotropic drugs, must necessarily be psychotherapeutic. An increase in the number of disasters in the world, the introduction of a person into areas that are unusual for him, the imposition of increasingly higher demands on the human psyche as a result of the acceleration of the rhythm of life, urbanization, etc. makes the problem of living in extreme situations relevant not only for psychiatrists, but also for doctors of other profiles. The author hopes that the information presented on this issue will provide some assistance to doctors who are forced to work with a contingent of people who have survived certain extreme situations.

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Krzhechkovsky A.Yu. Mental disorders in extreme conditions and their medical and psychological correction. [Electronic resource] // Medical psychology in Russia: electronic. scientific magazine 2011. N 3..mm.yyyy).

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