Cognitive coping therapy of alcohol addiction and neurotic disorders in patients with suicidal thoughts

The high prevalence of suicidal phenomena among young patients with addictive and neurotic disorders necessitates the inclusion of suicide prevention components in therapeutic programs. At the same time, among the interventions with proven effectiveness, the leading place is occupied by methods associated with increasing cognitive rationality and adaptability of stress response. The aim of the study: personalization of the method of cognitive coping therapy for suicidal behavior for patients with alcohol addiction and neurotic disorders. Materials and methods: 166 patients (105 with alcohol addiction, 61 with neurotic disorders) of young age (under 35 years of age), with higher and incomplete higher education, were examined. Clinical-psychopathological and psychometric methods were applied. Mathematical data processing was carried out using the SPSS-Statistics V26 program. Results: The presence of suicidal thoughts in history was detected in 33.3% of patients with alcohol addiction and 27.9% of patients with neurotic disorders - in the absence of cases of committing suicide attempts, limiting suicidal behavior to the first two stages of its internal forms, which is typical for a contingent of highly educated youth with these nosologies. Three possible variants of the formation of suicidality (sthenic, hyposthenic and associated with painful loneliness) were identified by the method of factor analysis. Both clinical groups were characterized by the formation of suicidality associated with painful loneliness. An additional option for patients with addiction was the hyposthenic variant (hypothymic symptoms), and for persons with neurotic disorders, the sthenic variant (dysphoric symptoms and aggressiveness). With alcohol addiction among patients with suicidal thoughts, an increased severity of alcoholization was revealed, with neurotic disorders - almost no alcohol consumption. Persons with suicidal thoughts in alcohol addiction were characterized by an increased level of severity of both depression and anxiety, in patients with neurotic disorders, a connection between suicidal thoughts and depression was established, in the absence of a connection between suicidality and anxiety. In the cognitive style of patients with alcohol addiction, suicidal risk was associated with an irrational setting of evaluative dichotomous thinking, in patients with neurotic disorders, with an attitude of obligation towards other people. The coping style associated with suicidal risk in alcohol addiction was characterized by a tendency to unproductive indignation in stressful situations, unwillingness to delegate responsibility and accept support from the environment. In neurotic disorders, suicidal risk was associated with impaired emotional response to stressors (decreased self-control and a tendency to aggressive reactions), as well as an increased willingness to take personal responsibility for the situation (which is generally adaptive for coping "everyday stress", but in this case requires a change of approach to intervention). Conclusion: The identified clinical and psychological characteristics of patients with suicidal risk should be taken into account when implementing suicide prevention as part of psychotherapeutic interventions for alcohol addiction and neurotic disorders.