RU2168312C1 - Method for revealing clinical specific of boundary neuropsychic disorders - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves showing PARI question table and evaluating the degree, to which a sign is pronounced, in scores. Children-to-parents relations are also evaluated using retrospective analysis data. The question table is filled by adult children in correspondence to views and approaches to education applied by their mothers. Dominating active mode of mother and child interaction being found to take place, cooperation factor is considered to be pointed out. Excessive emotional remoteness of mother and child interaction being revealed, isolation factor is considered to be pointed out. Dominating maternal authority being revealed, subordination factor is considered to be pointed out. High scores of cooperation factor being found, depressive disorders are considered to take place. High scores of isolation factor being revealed, conversion disorders are considered to take place. High scores of subordination factor being revealed, hypochondric disorders are considered to take place. EFFECT: enhanced effectiveness of psychotherapeutic treatment.1 dwg, 4 tbl

Description

 The invention relates to medicine, specifically to psychiatry and psychotherapy, and can be used in the treatment of patients with neurotic, stress-related and somatoform disorders.

 The well-known PARI technique (questionnaire "Measurement of parental attitudes and reactions", parental attitude research instrument, P.K. Bell, ES Schafer), which is designed to study the attitude of parents (primarily mothers) to different aspects of family life (family role), the most common features of parenting. Along with assessing the specifics of family relations, the main subject of analysis in the methodology is parent-child relationships, the assessment of parent-child contact from the point of view of its optimality. This technique, the psychometric adaptation of which for the Russian-language sample was carried out by T.V. Nescheret (The best psychological tests for professional selection and career guidance. - Petrozavodsk: Petrocom, 1992, p. 188-198), T. V. Arkhireeva (Rogov E.I. Handbook of a Practical Psychologist in Education: Textbook. - M.: Vlados , 1996, pp. 334-345), is a multidimensional questionnaire presented to the parent (mother).

 The methodology includes 115 judgments. When performing the methodology for each provision, four possible answers are provided (see the Questionnaire presented at the end of the description).

 23 aspects are analyzed, signs relating to different aspects of the relationship of parents to the child and life in the family. Accordingly, 23 scales are laid down, each of which has five questions. The scheme for converting answers into points is contained in the “key” of the methodology (A - 4 points; a - 3 points; b - 2 points; B - 1 point). The amount of digital significance determines the severity of the sign, consisting of answers to five thematic questions, repeated every 23 points (for example, 1, 24, 47, 70, 93 questions are combined in sign 1 - “encouraging verbalization”). The maximum score is 20 points, the minimum is 5; high marks - 18, 19 and 20 points; low - 8, 7, 6, 5 points.

 The questionnaire combines the following aspects-features.

 1. "Promotion of verbalization."

 2. "Excessive care."

 3. "Dependence on the family."

 4. "Suppression of the will of the child."

 5. "The feeling of self-sacrifice."

 6. "Fear of offending."

 7. "Family Conflicts".

 8. "Excessive rigor."

 9. "Irritating parents."

 10. "The dependence of the child on the mother."

 11. "Parent authority".

 12. "Suppression of aggressiveness of the child."

 13. "Dissatisfaction with the role of the mistress" ("martyrdom" of parents).

 14. "Partnerships."

 15. "Promotion of child activity."

 16. "Avoidance of communication with the child."

 17. "Indifference of the husband."

 18. "Suppression of the sexuality of the child."

 19. "Domination of the mother."

 20. "Extraordinary interference with the world of the child."

 21. "The equation of attitude."

 22. "The desire to accelerate the development of the child."

 23. "Maternal independence" (the need for outside assistance in raising a child).

 This technique has not been used in medicine in the treatment of patients.

 The objective of the invention is to increase the effectiveness of psychotherapeutic treatment.

 The task is achieved by the fact that patients are presented with a PARI questionnaire with a score for the severity of the symptom; an assessment is made of a retrospective analysis of parent-child relationships, while the adult children fill out the questionnaire in accordance with the views and approaches to raising their mother; and according to the prevalence of active interaction between mother and child, the factor of “cooperation” is distinguished, by the excessive emotional distance of the mother and the child, the factor of isolation, the prevalence of mother’s authoritarianism in relations with the child, the factor of submission and the high rates of the factor of cooperation reveal depressive disorders; factor "isolation" - the presence of conversion disorders; factor "submission" - hypochondriacal disorders.

 For a better understanding of the essence of the method, we offer a specific clinical example.

 Patient E-va T., b. 1957

 The first appeal to the NPO with the dispensary on March 24, 1993 about stabbing pains in the heart, palpitations, sweating, headaches, low mood, weakness, tearfulness that bothered the patient for the last six months.

 From the anamnesis it became known that for 7 years the patient has observed transient hypertension, palpitations, redness, with the increase of which she turned to the territorial clinic. The local doctor regarded these conditions as manifestations of vegetative-vascular dystonia. The treatment with vegetative stabilizing drugs (bellataminal) gave an unstable effect. The patient remained worried about his health, especially with the resumption of symptoms.

 The examination (including ECG, ultrasound of the heart) showed no signs of cardiovascular disease. With a syndromic assessment of the observed state of Neurocirculatory Dystonia, the patient was referred for consultation with a psychotherapist.

 During the initial consultation, it was found that the above symptoms appeared in the patient against the background of a traumatic situation, the relevance of which remained: the married man (the patient’s “attachment object”) left his wife for another woman, while the patient expected that he would finally be " darling. "

 Along with a diagnostic assessment of the current mental state, the examination included an analysis of biographical, anamnestic data, the results of an experimental psychological study (according to the proposed method).

 Anamnesis. On the line of the father: the grandmother was distinguished by a strong, strong-willed character (like "Vassa Zheleznova"). During the epidemic, she lost her first husband and two sons, but because of her own illness she did not know where they were buried. Having changed her place of residence with her surviving son in her arms, she entered into a second marriage. Her chosen one was an "avid gambler and smoker", lost the last things, did it secretly from his wife, whom she was very afraid of. Usually silent in the family, even when his wife was wrong. Having become a mother-in-law, the grandmother insisted that the patient's parents live with her. No matter how the young people tried to maintain a "good relationship", she remained a "thunderstorm at home", often bringing her daughter-in-law (the sick mother) to tears. Having taken up the upbringing of the first granddaughter, she categorically forbade "to produce poverty" - to give birth to a second child (patient).

 On the line of the mother. Grandfather was hardworking, worked tirelessly to feed his family (there were 11 children), for which he fell under the "dispossession". He was released after clarifying the situation, but caught a cold during a long walk home and soon died.

 Grandmother is soft, kind, sympathetic, “blinded” after unexpected events - the brutal dispossession process and the death of her husband. However, after treatment at the ophthalmologist, "vision was returned."

 Mother - kind, soft, caring, in her husband's parental home was forced to submit to her mother-in-law, remaining defenseless there, since her husband often left for the session. Attempts to defend themselves ended with her own tears. Suffered from arterial hypertension. Of the whole family, only the mother, according to the patient, loved her, cared for and supported her. People around them said that their characters were the same, and this greatly pleased the patient (“there was no better compliment”).

 Father - restrained, silent, strict, loved and proud of his eldest daughter (she graduated from the institute and held a responsible position in the institution where she worked). He expected a boy from his second pregnancy. Someone in the hospital first mistakenly pleased him that the expectations were met. According to the patient, all her life she felt “that great disappointment” that her father experienced when he saw the girl again; his detachment and coldness to himself. Suffered from arterial hypertension and coronary heart disease.

 The older sister is four years older than the patient. Since childhood, was the favorite of his father and his mother. Was more successful at school. She always made fun of her younger sister, brought her to tears, inspired her that she was “alien”, “step-mother”, taken by her parents to bring up Kazakhs who lived nearby, who did not want to leave her because of their dissimilarity to their people. After graduating from college, she returned to her parents' house, where she continues to live to the present. After the death of her mother, she lived with her father. After his death, she married (at 45) a widower with two children.

 Proband grew anxious, timid, shy. She experienced many fears and often complained of boredom. The only person with whom she could share and from whom she received emotional support was her mother. Often at night after listening to terrible tales and stories of the elder sister, conditions were observed with a sudden fear of death (of their own or those close to them). Cried, asked my mother "never die."

 From childhood, I got used to “being bad,” since everyone was compared to an excellent student, a beautiful sister, cited her as an example and demanded the same behavior. From preschool age myopia was discovered, which interfered with school years: it was poorly seen, then headaches appeared from tension. She was afraid to answer at all, was shy, perceived her studies as torment. She was known as a “lazy girl” both at home and at school. The mood was changeable, it was sad, it became more fun, more active. She loved to dream: at the same time she could imagine herself as a “border guard with a mustache and a dog”, then “an employee of the zoo”, then “a scientist doing some experiments”. In high school, the main theme of fantasies was love, the desire to have many children (boys), similar only to “him” (“so that he, he, he, in repeated repetition” would be around me).

 She constantly analyzed her experiences, she did not perceive herself as “worthy”. She fell in love with beautiful, cheerful, “easy” ones, which she herself was not, and lived for some time with her own feelings, which were quickly replaced by pain and disappointment, as her chosen ones easily “abandoned” her. In such situations, she closed herself in, cried, and was sad until the appearance of a new "object of attachment." She preferred living in her own romantic world of dreams and fantasies. I was burdened by relations with my relatives in the family (there was no longer enough maternal support), so I easily decided to go to Tomsk to study. Despite the nostalgia for home for the first five years, she appreciated “freedom” from moralizing and for the first time felt “good” attitude from new acquaintances, felt “necessary”. After the death of the mother, short visits home returned the feeling of "bad" that was actively (with an abundance of reproaches) created by the father and older sister. Remained to work in Tomsk at one of the factories as a storekeeper. Here for the first time seven years ago I met a man who attracted her attention with a cheerful disposition and external attractiveness. The new hobby turned out to be unrequited: timid attempts to “bring the dream closer” were in vain. The “Object of Affection” was married a second time and did not pay any attention to the patient. I was worried that life did not work out, blamed myself for not being able to build relationships with people. She performed her duties with perseverance and perseverance, and, returning home (to the hostel), she "lived a dream." Then she began to notice heart palpitations, redness of the face, hyperhidrosis, which at first she explained to herself with excessive shyness and excitement, especially if they occurred during meetings with a friend. Somewhat later, stitching pains appeared in the left half of the chest and transient episodes of arterial hypertension. Repeatedly over the course of seven years, she turned in alarm for her heart to the doctors of the general medical network, who, according to the results of the examination, did not detect heart pathology, which was reported to the patient. However, frequently recurring symptoms have provoked concerns about possible heart disease. Short-term courses of vegetative-stabilizing drugs (bellataminal) did not significantly change the condition.

 The patient continued to "dream of living together with her chosen one." When she suddenly found out that he, deciding to leave his second wife, chose not her, but another woman, she experienced "mental pain", devastation and disappointment. The mood decreased, became tearful, there were sensations of interruptions in the work of the heart, headaches, weakness, anxiety, anxiety, insomnia, pain in the heart area became more frequent. Within six months I was on sick leave several times about this condition. The local therapist was diagnosed with autonomic dystonia syndrome. Due to the persistence of symptoms, the patient was referred for consultation at the NCO with the dispensary of the Cardiology Research Institute of the Siberian Branch of the Russian Academy of Medical Sciences, where, after clinical and paraclinical examinations, the cardiologist was offered a consultation with a psychotherapist.

 The current mental state of the patient (here is a description of the state after recoding according to the International Classification of Mental and Behavioral Disorders of the 10th revision introduced on January 1, 1998) at the time of the examination was determined by severe anxiety and depressive symptoms that appeared in connection with the stressful situation about six months ago and persisted connection with her. Along with this, the symptoms of autonomic excitation (redness, hyperhidrosis, palpitations) with cardialgia, transient hypertension, and cephalgia, which have caused concern and concern about the state of the cardiovascular system, persisted and even intensified somewhat over the past seven years. The studies revealed only a few extrasystoles on the ECG.

 In accordance with the diagnostic criteria of ICD-10, the diagnosis is “Mixed anxiety and depressive reaction” (F 43.22) in comorbid combination with “Somatoform autonomic dysfunction” (F 45.3).

 Identified limited ability to make everyday decisions without enhanced advice and encouragement from others; fear of being abandoned by a person with whom there is a close relationship, and to remain left to itself; willingness to subordinate their own needs to the needs of other people on whom they depend, and excessive compliance with their desires; difficulties in presenting even reasonable demands to people who are dependent on are signs of “Dependent Personality Disorder” (F 60.7).

 The results of an experimental psychological study.

 The level of alexithymia (according to TAS) was 67 ("non-alexithymic patient").

 According to Leary’s methodology, the predominant style of interpersonal interaction is “responsibly generous,” as a rule, detected in individuals of an emotionally labile type with a tendency to idealize the harmony of interpersonal relationships, with pronounced emotional involvement and sacrifice. Typical for such individuals is the problem of suppressed (repressed) hostility, somatization of anxiety and vegetative imbalance as a result of blocking behavioral reactions (according to L.N. Sobchik, 1990).

In a retrospective assessment of the style of maternal education (the proposed method) in accordance with the PARI questionnaire, such aspect signs as accented (from 18 to 20 points) were found:
“Promotion of Verbalization" (paragraph 1),
“Dependence on the family” (paragraph 3),
“Dependence of the child on the mother” (paragraph 10),
“Suppression of aggressiveness” (paragraph 12) and
"Mother's Inadequacy" (p. 23).

According to the results of factor analysis, the following values of the identified factors were observed:
factor "cooperation"0.745;
isolation factor 0.277;
factor "submission" 0.231.

 The maximum value of the “cooperation” factor, which, when correlated, found a direct relationship with the conditions of emotional symbiosis in childhood, was confirmed by interviewing and collecting anamnestic, biographical data about the patient’s views on the characteristics of parent-child relationships. The patient, who grew up in conditions of emotional symbiosis with her mother, when establishing close relationships, expected active verbal contact, equality and close interaction as the only possible way to confront the "alien world". In a frustration situation, the patient's retrospective fixation on the relationship of "cooperation" with the mother was manifested through depressed mood, increased fatigue, tearfulness, that is, the presence of depressive disorders, cardialgia and various signs of autonomic dysfunction. The patient was distinguished by unrealistic expectations in established relationships with men with the rapid formation of emotional dependence on the object of attachment.

 Work with the patient included individual and group psychotherapy conducted by one psychotherapist (combined psychotherapy).

 Based on the data obtained in accordance with the “Scale for assessing child-parent relations”, a schematized “Profile of relationships with Significant Others” was compiled (see drawing).

Further psychotherapeutic work with the patient provided for the provision during the individual and group interaction conditions:
for the safe response of negative feelings and attitudes towards the father (“resentment”), the elder sister (“resentment”), the grandmother on the father’s side (“anger”), and the mother (“guilt” of not being able to protect from the grandmother);
to compensate for the patient’s increased affiliate needs;
for adoption of the family situation in the parental home through the expansion of awareness in the variety of styles of interpersonal relationships and the development of a mature social position;
to restore adequate self-esteem through awareness of their own physical, cognitive and social competence;
to recognize their dependence on the "object of attachment" as an unconscious desire to have reliable care and guardianship;
to overcome a sense of comprehensive responsibility for others and to respond to feelings of “shame” for the parental family;
to develop new communication skills;
to expand the patient’s social circle;
to achieve relaxation and learning how to self-regulate.

 The patient’s occupations in an open, long-term, outpatient psychotherapeutic group for two years and subsequent sessions of individual supportive psychotherapy contributed to a significant improvement in the patient’s quality of life. During therapy, a rapid reduction in depressive and anxiety disorders was achieved; normalization of blood pressure and heart rate with the elimination of cardialgia and cephalgia. The restoration of a positive attitude towards the future was facilitated by the awareness of one’s own desire for dependence on stereotypically chosen “unstable objects” (alcohol abusers, married) with the repetition of the scenario of “rejected love”, acceptance of oneself through reflection of the uniqueness of each person and gaining confidence in their own competence and significance.

 A five-year follow-up showed that after the therapy, the patient did not go to the doctors for medical help (except for a few cases of colds). She resumed correspondence with relatives, having restored a warmer relationship with them, and began to feel greater mutual understanding with them; actively helped her sister in finding medicines for her father during his illness. Overcoming previously interfering communication barriers, it became more independent in decision-making. In her personal life, faced with the temptation to become the fourth darling of the former "object of her affection", she decided to try herself in family life (in a civil marriage) with him; maintained an adequate view of the situation subsequent to this event. It was joyfully adopted by the "mother-in-law", which, as it turned out, has long been tormented with her alcoholized son. For several months, the patient lived in the love she had once dreamed of, and in the struggle for the preservation of that idealized image of the “lover,” whose excessive affective richness and significance were diminished during the course of psychotherapy. Remaining kind, gentle, caring, responding to someone else's misfortune, she independently decided to end her relationship with a partner who had disappointed her expectations. The gap was initiated by her and went away without any somatic or mental disorders. The patient gained confidence that she was able to make her own decisions based not only on the emotional attitude to the situation, but on the basis of a balanced, thoughtful choice of her own. During the follow-up period, she continued to maintain relations with some members of the psychotherapeutic group, as well as with the psychotherapist, occasionally seeking psychological support and advice.

 Thus, the study of the retrospective assessment of parent-child relationships in the course of the survey in accordance with the proposed method made it possible to diagnose pathogenic beliefs associated with the early experience of interpersonal relationships in the parental family and their emotional reinforcement associated with the development of neurotic stress-related and somatoform disorders.

 Conducting combined (individual and group psychotherapy with the same psychotherapist) psychotherapy helped to restore the patient’s mental health, reduce functional cardiovascular disorders and increase the level of her personal and social adaptation.

 The proposed method was studied in 97 patients suffering from neurotic, stress-related and somatoform disorders, accompanied by functional cardiovascular disorders.

 97 patients were asked to complete the PARI questionnaire. We analyzed 23 aspects-signs relating to different aspects of the relationship of parents to the child and life in the family. It was necessary for patients to reproduce the attitude of their mothers to the issues of upbringing and family life under consideration.

 Below are the results of the analysis of the dependence of the obtained indicators of a retrospective assessment by patients of the educational style of the mother on the conditions of upbringing (emotional symbiosis and emotional deprivation).

 When analyzing the obtained 23 quantitative parameters (aspect-attributes) using the principal component method, three factors were obtained that characterize the current style of parental education retrospectively assessed by patients (explaining 34.08% of the variance).

 The first and statistically most significant factor was represented by four signs: 1 - “encouraging verbalization”; 14 - “establishing partnerships”; 15 - "the development of the activity of the child" and 21 - "the desire for the equation of relations." Conditionally, this factor is called "cooperation" (explains 13.54% of the distribution). He testified that in the style of maternal education, according to a retrospective assessment of 97 patients, the desire for active interaction with the child prevails.

 The second factor included “family conflicts” (7), “mother irritability” (9), “dissatisfaction with the role of the hostess” (13), “avoiding communication with the child” (16), and “indifference of the husband” (17). He combined the signs that impede the effective interaction of the parent with the child, leading to excessive emotional distance with him. Conditionally, this factor was called "isolation" (explains 11.64% of the distribution).

 The third factor was “the child’s dependence on the mother” (10), “the super-authority of the parents” (11) and “the dominance (power) of the mother” (19). It reflects the degree of mother’s authoritarianism in relations with the child, defined as “submission” (explains 8.9% of the total distribution).

 In the table. 1 (factorial loads obtained by the method of principal components with orthogonal rotation (Varimax normalized) are shown.

 Partly, the obtained results coincided with the identified factors of the original methodology. So, the “cooperation” factor included the same signs as the “optimal emotional contact” scale. The factor "isolation" corresponded to two signs (9 and 16), belonging to the scale "excessive emotional distance with the child." The greatest differences were observed in the third factor (“submission”), which included only one of the eight “excessive concentration on the child” scales (10) and, at the same time, reflecting the degree of encouraged dependence and subordination of the authority and authority of the parents (mother).

 Further analysis revealed the existing relationship of the selected factors with clinical manifestations in the current state of patients. In factor 1, significant differences were found between the group of patients in whose condition severe asthenic disorders, decreased mood were observed, and the group where these symptoms were absent. The indicator turned out to be higher in the first group (by the sign of asthenia - F = 5,309; P = 0.023389; by the sign of low mood - F = 4.889; P = 0.029428). That is, people with a depressed mood and asthenic disorders attached greater importance to "cooperation" in the educational style of the mother. The presence of depressive disorders revealed a direct relationship with high rates of the factor "cooperation".

 Higher values for factor 2 were noted in the group of patients with conversion disorders at the time of the examination compared with the group in which these disorders were absent (F = 7.305, P = 0.008147). Thus, between the presence of conversion disorders in patients and the factor of "isolation" revealed a reliable relationship. A similar relationship was found between the clinical sign "irritability" and the indicator of factor 2. A higher value of the factor was observed in the group of patients with severe irritability (F = 4,906; P = 0,029147).

 Thus, for patients who were characterized by excessive irritability, as well as patients suffering from conversion disorders, fixation on the violations existing in the parental families was characteristic. Their parents could hardly solve their own problems, because of which the child was often "expelled" from communication or used as a target for projecting negative feelings. Hence, it is likely that activation of suppression (repression) mechanisms leads to conversion disorders, in some cases, and as a result of identification with an irritated, conflicting parent, their own irritability, in other cases.

 In factor 3 ("submission"), significant differences were found between groups of patients with and without hypochondria disorders (F = 8.585, P = 0.004244). A higher rate was found in the group of patients suffering from hypochondria disorders. That is, the factor "submission", characterizing the degree of authoritarianism and dominance of the mother by a retrospective assessment of patients, had a direct relationship with the hypochondriacal tendencies diagnosed in them.

 It is noteworthy that factor 3 (“submission”) turned out to be associated with a certain type of dynamics of the observed mental disorders (according to the five-year history). Thus, significant differences in factor 3 were revealed between the group of patients in the dynamics of which there were no significant changes in the state and the group of patients who had a history of varying degrees of positive changes (F = 25.323; P = 0.000002). The absence of changes in the mental state of patients was in feedback with factor 3: its indicators were lower in this group.

 The factors “cooperation” (1) and “submission” (3) had a direct relationship with the conditions of emotional symbiosis with the mother and feedback with the conditions of emotional deprivation in childhood. For the “isolation” factor, the opposite laws were true (Table 2).

 Significant differences were also revealed by factor 1 and factor 2 between groups of patients brought up under conditions of deprivation of the father and with his active participation. So, the factor “cooperation” had lower values in the group of people who grew up in conditions of deprivation of the father. And the factor of “isolation” in this group, on the contrary, was determined by a higher indicator (Table 3).

 Thus, as a result of the factor analysis using orthogonal rotation (Varimax normalized) 23 aspects-signs of a retrospective assessment by patients of the maternal parenting style (according to the proposed method), three reliably interpreted factors were established: “cooperation”, “isolation”, “submission”.

 The first factor (“cooperation”) reflects the quality of the interaction between the mother and the child, and in terms of its importance was higher in the groups of patients with depressive disorders. Since a direct relationship was found between this factor and the presence of emotional symbiosis with the mother in the childhood of these patients, it can be assumed that the retrospective dominant of partnership interaction and understanding as nostalgia for a safe world of childhood is actualized against the background of a depressed state.

 The second factor ("isolation"), linking the negative aspects of the family microclimate and educational approaches, was directly dependent on deprivation in childhood (emotional deprivation and lack of paternal participation in education). The presence of conversion disorders and irritability distinguished patients in the group of which the rates of factor 2 were the highest.

 The third factor ("submission") found a connection with the conditions of emotional symbiosis in childhood and had higher values in the group of patients with hypochondria disorders. At the same time, lower indices were noted in the group of patients (7), in whose condition no changes occurred during the five-year history.

 Based on the latter, the factor of "submission", reflecting the degree of authoritarianism, the dominance of the mother and the recognition of her authority, cannot be unequivocally regarded as a negative factor in education. The patients' retrospective emphasis on “subordinating” to parental authority turned out to be associated with the need to find an analogue of this authority in the person of, for example, a psychotherapist. In this case, the tendency to transfer responsibility for one’s health is structurally included in the structure of the first stage of patient interaction. The need for help and support for a “good mother” developed over the years in conditions of emotional symbiosis in the face of an uncertain situation associated with poor health was sharply updated. Under the conditions created by the psychotherapist for empathic acceptance, patients recouped their symbiotic need. They seemed to relive the symbiosis with their mother, but without its negative sides, due to the psychotherapist’s non-involvement in the conflict. Thus, the willingness to accept authority and obedience in conditions of safe constructive interaction with the doctor contributed to more effective cooperation during individual and group psychotherapy of patients. As a result, there were positive changes in the mental state of patients in the group, which was distinguished by higher rates in factor 3 (“submission”) (Table 4).

 Conducted factorial and correlation analyzes allowed us to conclude the following.

 1. The proposed method can be used with instructions that are offered not to the parent to find out his educational trends (as in the original questionnaire), but to the patient himself ("adult children") for a retrospective assessment of the parental style of education. The information received reflects the introjected image of the mother and relations with her, as well as the features of the intrafamily interaction that have been recorded in past experience.

 2. Mathematical processing using factor analysis of 23 aspects-signs in the proposed method allowed us to identify three factors: "cooperation", "isolation", "submission". They included signs that partially corresponded to the three groups of “parent-child relations” of the original methodology (“optimal emotional contact”, “excessive emotional distance with the child”, “excessive concentration on the child”), as well as a number of signs characterizing other aspects of the family interaction) .

 3. The correlation analysis of the data obtained by the proposed method in a group of patients with functional cardiovascular disorders revealed a direct relationship between the factors "cooperation" and "submission" with the conditions of emotional symbiosis in childhood; factor "isolation" - with the conditions of emotional deprivation. The data clarifies the understanding of the characteristics of parent-child relationships.

 4. Retrospective fixation on the relationship of "cooperation" with mothers in depressed patients who grew up in conditions of emotional symbiosis; "isolation" - in patients with conversion disorders and irritability; "subordination" - in patients with hypochondriacal disorders - reflect the conjugation of individual clinical manifestations in patients with functional disorders of the cardiovascular system and their perception of parental parenting style.

 5. The “subordination” factor turned out to be more associated with positive changes in the condition of patients (according to a five-year follow-up), which allows us to evaluate the positive aspects of maternal dominance used at the initial stage of psychotherapeutic interaction and ensuring its effectiveness.

 The proposed method can be used in psychotherapeutic work with patients suffering from borderline neuropsychiatric disorders. In the process of working with patients, conditions are created for recognizing the pathogenicity of individual settings, judgments and their role in maintaining the observed symptoms and disorders. This method allows, thanks to a modified instruction, to identify a retrospectively reproducible (child's) experience of family interaction, opening up opportunities for patients to reflect and directly respond to hidden emotions.

Claims (1)

 A method for identifying the clinical features of borderline neuropsychiatric disorders, including the presentation of a PARI questionnaire with a point assessment of the severity of the symptom, characterized in that the assessment is made by a retrospective analysis of child-parent relations, while the questionnaire is filled in by adult children in accordance with the views and approaches to raising their mother and according to the prevalence of active interaction between mother and child, the factor of "cooperation" is distinguished, according to the excessive emotional distance of the mother with the child, the factor of "isolation" I ", by the predominance of authoritarian mother's relationship with the child - the factor of" submission "and high performance factor" cooperation "detect the presence of depressive disorders; - factor "isolation" - the presence of conversion disorders; - factor "submission" - hypochondriacal disorders.

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