Psychotherapeutic paradigm in the methodology of complex social and therapeutic correction of relationships in families of patients with epilepsy: new possibilities of a systematic approach

Background. The study of intra-family relationships of patients with epilepsy is of interest due to the high prevalence of this disease. The study of the microclimate in the family, the value orientations of its members, the psychiatric literacy of relatives in relation to the disease are of great importance for increasing the level of social adaptation of patients with epilepsy. Objective: to study the actual homeostasis of families of patients with epilepsy with the subsequent development of psychotherapeutic strategies for correcting relationships. Material and Methods. Base and period of the study: Interdisciplinary Center for the Prevention of Paroxysmal Conditions (ICPPS) of the Tomsk National Research Medical Center, 2001-2019. Selection for the research sample was carried out by a non-sampling method. The group of patients (n=1969) included 971 men and 998 women with different forms of epilepsy, disease duration from 0 to 19 years, various severity of mental disorders and without them. The group of family members (relatives) of patients (n=1141) consisted of 675 women and 466 men. Evaluation of intrafamily relations during the visit to the ICPPS was carried out based on the results of a conversation with the patient and his relatives and questionnaire data using a questionnaire developed by us (semi-structured interview method, including the attitude of relatives towards the patient and the medical care system, the impact of the disease on the attitude of the patient himself towards the closest relatives), and according to the results of the FACES-3 personality questionnaire. Results and Discussion. 71.4% of patients with epilepsy demonstrated high psychiatric literacy. They consider head injuries and severe infections (40%), aggravated heredity (20%), and alcoholism (6.7%) to be the main causative factor of the disease. 88.9% associate financial difficulties and conflict relations in the family with the disease. 82.6% agree to be under the supervision of a neurologist or an epileptologist, but not a psychiatrist. 10% of male patients associated with the intake of antiepileptic drugs a decrease in sexual desire and activity. 40% of men considered themselves leaders of the family, but relatives denied their main role. Relatives of the patients were not registered with psychiatrists for mental and behavioral disorders; in isolated cases, there were diseases associated with alcohol abuse. Cohesion and adaptation (actual homeostasis) of the family was assessed by FACES-3: harmonious (40%) and negative (10%) relationships were revealed, high cohesion (50%). 35% of families quickly adapted to the new conditions, 13.5% of families, due to inconsistency and rigidity, were characterized by excessive social flexibility, 10% of families had low adaptive potential. Found types of families: medium balanced (50%), balanced (40%), disharmonious (10%). The degree of subjective satisfaction with family life was revealed: 43.3% - high and medium, 56.7% - low. The programs developed by us for the correction of relations in different family models (the patient is a child, the patient is a spouse, the patient is a parent) have been introduced into the practice of the ICPPS. The use of psychotherapeutic programs in a complex model of personalized therapy for patients with epilepsy made it possible to increase the efficiency of treatment and rehabilitation work up to 84.3%.