Medical and psychological support for stroke prevention in patients of working age with a history of transient ischemic attack

- Бондаренко, Н.О. (orcid.org/0009-0002-1040-6031) (2025) Medical and psychological support for stroke prevention in patients of working age with a history of transient ischemic attack Masters thesis, Інститут психології імені Г. С. Костюка.

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Abstract

Bondarenko N.O. Medical and psychological support for stroke prevention in patients of working age with a history of transient ischemic attack. – Qualifying scientific work on manuscript rights. Dissertation for obtaining the scientific degree of Doctor of Philosophy in specialty 053 Psychology. H.S. Kostyuk Institute of Psychology, National Academy of Sciences of Ukraine. Kyiv, 2025. The dissertation is devoted to solving the scientific problem of optimizing the methods of action of a family medicine doctor in psychological support of involving patients of working age who have survived TIA in effective compliance with the aim of stroke prevention based on the typology of their personal and behavioral characteristics. Every year in Ukraine more than 140 thousand cases of primary or recurrent stroke are registered. At the same time, according to official statistics, 30–40% of stroke patients die within the first 30 days and up to 50% within a year from the onset of the disease; 20–40% of surviving patients become dependent on outside help (12.5% of primary disability) and only about 10% return to a full-fledged life. This serious and sudden disease is undoubtedly a mental trauma for both the patient and his immediate environment. It is well known that it is accompanied by neurotic, depressive disorders, changes in self-attitude and other psychological problems. This is especially traumatic for people of working age. And although all over the world, especially in developed countries, a lot of effort is being made to prevent and combat this terrible disease, and at the level of common sense it is clear that the psychological consequences of the disease require special attention, so far this spectrum of problems in practice is far from the recommended standards, as is directly indicated in numerous publications and scientific research. But in this burdensome for people and for the state problem there is another important point, which, at first glance, seems to the affected people to be something insignificant, while it can hide terrible consequences. We are talking about a transient ischemic attack (TIA), which is a short episode of neurological dysfunction with clinical manifestations, but the absence of signs of a brain infarction and is not considered a stroke. The main dangerous, specifically psychological, consequence of this condition is that often patients, after learning that they did not have a stroke, continue to behave as if nothing had happened, thereby increasing the risk of a stroke. Due to the complexity of the problem, in particular, the low availability of such patients for examination and the non-mass order of working with them in the post-hospital period, this aspect of the problem remains outside the scope of research attention. It is about providing secondary prevention in patients who, after a short stay in the hospital with a diagnosis of TIA, returned to their usual lifestyle, but, neglecting the recommendations of doctors, after some times were hospitalized again, already with a stroke. Therefore, the relevance of secondary prevention after a transient ischemic attack and, in particular, psychoprophylaxis, is not only unquestionable, but absolutely obvious. The aim of the study is to theoretically and empirically substantiate the model of interaction between family medicine physicians and neurologists with patients of working age with a history of TIA, the purpose of which is to psychologically ensure effective compliance for stroke prevention. The study was conducted on the basis of neurology departments of municipal non-profit enterprises of the executive body of the Kyiv City Council (Kyiv City State Administration): Kyiv City Clinical Hospital No. 3; Kyiv City Clinical Hospital No. 4; “Olexandrivska ( now Sviato-Myrhailivsky) Clinical Hospital”, as well as on the basis of the private medical center DolinSky (Brovary) and the municipal non-profit enterprise “Kyiv City Medical Center” of the executive body of the Kyiv City Council (Kyiv City State Administration). To study the features of clinical and psychological support for secondary stroke prevention in patients of working age after TIA, we studied a cohort of patients (106 people), which included several groups of patients with the appropriate diagnosis (G-45). 62 family medicine doctors and a neurologist were also involved in the study. The first section – “Modern approaches to medical and psychological work with patients of working age after TIA” – highlights the state of development of the research problem in Ukraine and abroad, carries out an empirical study of the psychological aspects of the nosology of TIA, identifies difficulties and problems of family medicine doctors in working with this category of patients, and provides a theoretical and empirical justification of the optimal model of interaction between family medicine doctors and neurologists in the process of working with patients who have suffered a TIA.The biopsychosocial approach is substantiated as a conceptual and methodological basis for the study, which allows for a systematic analysis of the interaction of clinical, individual-personal and psychosocial determinants that influence the patient's choice of a particular strategy of behavior in relation to the disease and to a doctor (psychologist). Based on the results of the analysis of scientific literature, taking into account the essence of the categorical apparatus of the study, which includes such concepts as "transient ischemic attack", "psychoprophylaxis", "stroke prevention", "mental state", "depression", "compliance", "family doctor", "construct", "value of health", "patient somatotype", the general psychological phenomenology accompanying TIA is clarified in detail. Its aggravating consequences are identified: cognitive, motivational, behavioral. The theoretical and methodological approaches of scientists from both Ukraine and leading countries of the world to understanding the essence, in addition to exclusively medical measures, of the psychological attitude towards patients with TIA, the diversity and confusion of manifestations and symptoms of which is a problem for differentiating those patients who are at risk of disability from those who recover without complications, have been studied. And this is despite the fact that one should carefully differentiate the aggravation and truly somatic components of the processes after a transient ischemic attack. A differentiation of two close, but not identical concepts has been carried out, according to which: the concept and term “adherence to treatment” denote an important nuance – a state of readiness, but not yet realized, while “compliance” itself records and reflects the patient’s real efforts and activities in the appropriate direction. The most common affective complication after a transient ischemic attack has been reported to be the development of depressive symptoms. Depression is estimated to affect 29% to 33% of patients with TIA. It is associated with a worse prognosis, poorer functional recovery, greater difficulties with social reintegration, lower quality of life, and an increased risk of stroke recurrence. Over 60% of people report that their TIA has affected them emotionally. People feel vulnerable and lose confidence in the world around them, particularly when leaving the house, and experience a wide range of emotions, mostly negative, which often cause significant distress. Most people worry that they will have another TIA (73%) or stroke (70%) in the future. The differences of transient ischemic attacks in working age compared to other age groups include a number of aspects, including not always clear causes of occurrence (etiology), specific manifestations of the disease, insufficient psychological diagnosis of the patient, and difficulties in secondary prevention. The second section – “Pilot study of personal factors in patients with a history of TIA in view of the prospects for stroke prevention” – describes the stages of empirical research, the implementation of which allowed us to build the actual subject of scientific research. It was found that patients with a higher level of anxiety are more likely to comply with the doctor's recommendations, which can be explained by an increased level of fear of the possible consequences of TIA. It was also noted that compliance correlates with the importance of such values as health and material well-being. That is, patients who attach great importance to their health and do not have financial difficulties are more likely to comply with medical recommendations. Gender differences in the level of compliance were not statistically significant, which indicates that men and women after TIA demonstrate the same adherence to treatment. This may indicate that the level of compliance depends more on the individual characteristics of the patient's personality than on gender differences in the clinical manifestations of stroke. Factor analysis using the principal components method (covering 71.2% of the variance) revealed four factors that influence the behavior of patients after TIA. Anxious-psychotic personality accentuation: patients with high levels of anxiety, a tendency to rigid judgments and impulsive reactions demonstrated a high level of declarative, but not real, compliance (main factor, 21.7% of the variance). Hypochondriac-hysteroid type: patients who focus on their well-being and show emotional lability are prone to declarative adherence to treatment, but may neglect real preventive measures (second partial factor (20.6% of the variance)). The effect of depression on the stability of compliance: patients with subjectively felt depression, even if it is not clearly detected by tests, are more likely to adhere to the doctor's recommendations (third partial factor, 16.7% of the variance). Age-related decline in optimism: older patients tend to have a decrease in optimism about their health, which may affect their adherence to treatment (fourth partial factor, 12.0% of the variance). It is noted that patients with psychotic accentuation, as well as with neurotic accentuation, are prone to declarative cooperation in the direction of preventing an acute vascular episode (stroke). The first (declarative) is due to distrust and a tendency to excitable reactions, the second - to anxiety and the need for sympathy. Patients suffering from depression, even if they hide their low mood, count on cooperation with the doctor and the average medical staff (even with a clinical psychologist) and are really ready to bear responsibility for the conditions and rules of interaction with these specialists, who help and provide measures for secondary prevention of stroke. It is the last category of patients with TIA who are most open and interested in cooperation in the formation of trusting compliance in the post-hospital period.This stage of the study allowed us to conclude that in the future, in order to build a holistic guiding framework for ensuring effective secondary stroke prevention when working with outpatients, socio-demographic variables should be included as those that influence the patient's social situation and, therefore, the system of his attitudes. In accordance with the main goal of the dissertation, in the third section – «Predictors of post-hospital health-preserving behavior of patients after TIA: an empirical study" – the peculiarities of doctors' perception and understanding of the psychological aspects of patients with a history of TIA were described, which allowed to substantiate the optimal model of doctor-patient interaction to ensure compliance at the stage of secondary stroke prevention. For this purpose, based on the data obtained in a two-stage pilot study, an experimental sample of patients was formed according to three-dimensional psychological characteristics that affect readiness for post-hospital treatment: personal, psycho-emotional, value-semantic. The final experimental sample consisted of 82 patients aged 34 to 63 years, of whom 29 were female and 53 were male, after suffering a transient ischemic attack and non-disabling strokes. The average age of the patients was 51 years. Based on the generalized personality profile of the studied patients, it was found that non-declarative adherence to treatment is found in patients with high anxiety and a tendency to hypochondria. Patients prone to psychosomatic disorders and fixed fears also show an increased emotional reaction to the disease. But the latter can be both a positive factor for adherence to treatment (due to a high level of motivation to avoid complications) and a negative one, if the patient seeks to avoid situations that cause him stress, including medical procedures. A special study was conducted on the perception of the problem of compliance with patients after TIA by family doctors. It was found that most doctors, regardless of their medical experience, most often prefer to conduct educational work, but without focusing it on a specific psychotype of the patient, and that better compliance is usually established with female patients than with male patients. Based on the analysis of the difficulties encountered by family medicine doctors and neurologists at the stage of secondary stroke prevention, based on the psychological and behavioral typology of patients, taking into account their somatotype and the indicators of the ABCD test scale (regarding the probability of stroke depending on the current state of the patient in the situation of TIA), a model of interaction between family medicine doctors and neurologists with patients of working age has been proposed, the style and method of implementation of which provides the conditions for solving the problem of stroke prevention at the stage of its secondary prevention both by taking into account the patient's psychotype and by building a stylistic style of the doctor's communicative behavior dependent on this. The scientific novelty of the results obtained is that: For the first time: a practical orientation basis for medical and psychological support of compliance with a family doctor and a neurologist in patients after suffering TIA, in particular by increasing the psychological and communicative competence of doctors, has been developed; At the same time it is established that enough four psychodiagnostic techniques for the classification of patients by three types: psychologically prosperous, psychologically burdened and psychologically disadvantaged; proposed and sound model of interaction of family medicine and neurologist with patients of working age, taking into account their somatotypes, features of the value-semantic sphere and type of behavior to ensure secondary prevention of stroke; it is revealed that gender differences in compliance in patients-women and male patients with TIA are not noted, and the financial barrier and biased attitude to medication is a significant obstacle in making decisions about treatment. Improved: substantiation of the position on the complex biopsychosocial approach as the conceptual and methodological basis of the study; understanding the content and scope of the concept of "compliance" as a realized commitment to preventive treatment and formulated the necessary and sufficient conditions for it in medical practice; established: relationships between psychological characteristics of patients who have suffered TIA and ways of involving them in psychoprophylactic work, as well as the typical difficulties of family doctors and neurologists in communication with patients at the stage of posthospital secondary stroke prevention. Have received further development: issues about factors that contribute to ensuring commitment and compliance to preventive treatment after TIA. The practical significance of the study is to provide family medicine doctors with reliable modern information on the psychological typology of personal and behavioral properties of patients with TIA at the stage of secondary stroke prevention, which has great humanitarian and socio-economic significance. The results obtained can be used in the professional training of students in the specialties "Psychology", "General practice - family medicine", "Medical practice", or doctors undergoing retraining in higher medical institutions of postgraduate education in the specialization "Neurology" and "Family medicine".

Item Type:	Thesis (Masters)
Keywords:	anxiety, cardiovascular diseases, cognitive impairment, communication, communicative competence, compliance, construct, depression, depressive state, family doctor, mental health, mental state, patient's somatotype, post-traumatic stress disorder, psychological competence, psychological defence, psychocorrection, stroke prevention, stress, transient ischemic attack, value of health, working age, PTSD
Subjects:	Science and knowledge. Organization. Computer science. Information. Documentation. Librarianship. Institutions. Publications > 1 Philosophy. Psychology Science and knowledge. Organization. Computer science. Information. Documentation. Librarianship. Institutions. Publications > 6 Applied Sciences. Medicine. Technology > 61 Medical sciences
Divisions:	Institute of Psychology after N.Kostiuk > Synytsya department of education
Depositing User:	Н. О. Бондаренко
Date Deposited:	07 Apr 2025 18:57
Last Modified:	07 Apr 2025 18:57
URI:	https://lib.iitta.gov.ua/id/eprint/745026

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