Clinical and socio-psychological factors determining adherence to treatment of patients with somatoform disorders

Currently, somatoform disorders, and especially manifold somatoform symptoms, widespread among employable population, often for a long time remain without proper and adequate diagnosis and treatment, and therefore have a tendency to a chronic course. Despite a significant number of publications, researchers pay insufficient attention to clinical manifestations, social and microsocial factors in the pathogenesis of somatoform disorders. Objective: to study the relationship of clinical and socio-psychological factors that determine compliance and prognosis in the treatment of somatoform disorders. Materials and Methods: 150 patients (53 men and 97 women) were examined based on the Borderline States Department of the Mental Health Research Institute, mean age was 40.4 ± 4.5 years with diagnosed somatoform disorder in accordance with the ICD-10 diagnostic criteria. Patients were subdivided according to age parameter, clinical picture of the course of the disease, and clinical and pathogenetic variant. We used clinical, psychopathological, clinical-dynamic, clinical-follow-up, psychological (Spielberger-Khanin scale, MPIT -multi-profile personality investigation technique, Actual mental state test, Toronto alexithymia scale and E. Hein test (1988) to determine copying-mechanisms modified by I.Ya. Stoyanova), statistical methods. Results: analysis of psycho-traumatic situations revealed that intra-family psycho-injuries (63.3%) were of the greatest significance. Abnormal forms of upbringing occurred in 92.7% of patients. The peculiarities of inner ideas of the disease in patients with somatoform disorders, depending on the predominance of cognitive, behavioral, and affective response patterns, determined the formation and state of the therapeutic alliance and adherence to therapy. The main clinical and pathogenetic variants, social and micro-social factors affecting the process of psychopharmacotherapy and complex psychosocial rehabilitation of patients were considered. Conclusion: psychological, individual and personality traits of patients, the styles of their family upbringing and functioning make a significant contribution to the development of mental maladjustment, have a significant impact on the formation and course of somatoform disorders, prevent the formation of full compliance at all stages of therapy and rehabilitation of patients, determine the prognosis and indications for long-term psychotherapeutic support of patients after discharge from a psychiatric hospital.