5.3.6. Медицинская психология

Проблема профессиональной психологической помощи ветеранам боевых действий актуализировалась в связи с масштабами и интенсивностью ведения специальной военной операции. Несмотря на массовую практику и значительный опыт оказания психологической помощи ветеранам боевых действий, научно обоснованной такую работу в настоящий период можно признать лишь отчасти. Однако в процессе накопления опыта, являющегося необходимым этапом выявления и осмысления существующих в этой области проблем, уже возможна научная проблематизация рассматриваемой сферы деятельности. Очевидно, что ряд применяемых подходов и практик требует научной экспертизы, осмысления и пересмотра, знания, накопленные в данной области, нуждаются в анализе, систематизации и целенаправленном пополнении. Научная проблематизация практики профессиональной психологической помощи ветеранам боевых действий будет способствовать мобилизации научного сообщества и координации усилий исследователей в создании надежной и актуальной научной базы для эффективного ведения такой работы. В статье обозначены основные проблемы, пробелы и затруднения, имеющиеся в наличном знании о негативных психологических последствиях, наблюдаемых у ветеранов боевых действий, а также об оказании им профессиональной психологической помощи. К числу основных проблем отнесены: 1) классификация негативных психологических последствий пребывания в зоне боевых действий; 2) дифференциация подходов к работе с комбатантами, переживающими различные неблагоприятные последствия боевых действий; 3) оптимизация вмешательства специалистов по психологическому здоровью в процесс естественной реабилитации и реадаптации ветеранов; 4) трудности вовлечения ветеранов в психотерапевтический процесс; 5) предотвращение реадаптационной психотравматизации ветеранов после возвращения в гражданское общество; 6) сложности конструктивной ресоциализации психически благополучных ветеранов. Перспективой системного решения названных проблем и развития данной области психологической практики может стать их систематизация в рамках отрасли психологических знаний, которая может быть обозначена как “поствоенная психология”.

Rehabilitation robotics aims to promote activity-dependent reorganization of the nervous system. However, people with paralysis cannot generate sufficient activity during robot-assisted rehabilitation and, consequently, do not benefit from these therapies. Here, we developed an implantable spinal cord neuroprosthesis operating in a closed loop to promote robust activity during walking and cycling assisted by robotic devices. This neuroprosthesis is device agnostic and designed for seamless implementation by nonexpert users. Preliminary evaluations in participants with paralysis showed that the neuroprosthesis enabled well-organized patterns of muscle activity during robot-assisted walking and cycling. A proof-of-concept study suggested that robot-assisted rehabilitation augmented by the neuroprosthesis promoted sustained neurological improvements. Moreover, the neuroprosthesis augmented recreational walking and cycling activities outdoors. Future clinical trials will have to confirm these findings in a broader population.

Childbirth is a life-changing event in a mother’s life. While the transition to motherhood has recently been recognized as one of the most neuroplastic periods in adulthood, no study has yet explored whether the hippocampus and amygdala change during the peripartum in relation to childbirth experience and perinatal depression symptoms. In this longitudinal neuroimaging study, we assessed 88 first-time gestational mothers in late pregnancy and early postpartum and 30 nulliparous control women. We used optimized high-resolution MRI scans to quantify volumetric changes in the hippocampus and amygdala, along with their substructures. We found that increases in depression symptoms during the peripartum were positively correlated with changes in the right amygdala. A more challenging birth experience was associated with bilateral increases in hippocampal volume. These findings show that studying the neuroanatomical changes during the transition to motherhood can inform not only about adaptive processes but also about potential vulnerabilities, highlighting the importance of tracking perinatal experiences to enhance women’s health.

Humans lack memories for specific events from the first few years of life. We investigated the mechanistic basis of this infantile amnesia by scanning the brains of awake infants with functional magnetic resonance imaging while they performed a subsequent memory task. Greater activity in the hippocampus during the viewing of previously unseen photographs was related to later memory-based looking behavior beginning around 1 year of age, suggesting that the capacity to encode individual memories comes online during infancy. The availability of encoding mechanisms for episodic memory during a period of human life that is later lost from our autobiographical record implies that postencoding mechanisms, whereby memories from infancy become inaccessible for retrieval, may be more responsible for infantile amnesia.

Repetitive negative thinking processes such as rumination and worry — also referred to as ‘perseverative thinking’ or ‘perseverative cognition’ — have traditionally been conceptualized as distinct processes defined, measured and studied in the clinical literature from a disorder-specific stance (for example, rumination in relation to depression, worry in relation to anxiety). However, rumination and worry are highly correlated, share phenomenological features, load onto a common factor, and predict and maintain multiple psychopathologies. In this Review, we overview the evidence base that conceptualizes repetitive negative thinking as an overarching cognitive process unconstrained by disorder-related content or temporal focus. The related theories and the empirical literature covering measurement, treatment and prevention support repetitive negative thinking as a transdiagnostic process. Adopting a transdiagnostic approach can help advance a more nuanced understanding of the role of repetitive negative thinking in clinical presentations and their treatment.

Close to 50 million children under 18 years of age are currently forcibly displaced from their homes because of armed conflict and other emergencies. Displaced children and adolescents are at increased risk of developing poor mental health. However, knowledge about how best to support their mental health and well-being is limited. In this Review, we consolidate knowledge on the prevalence of mental disorders in settings of forced displacement, discuss individual differences in response to war and displacement, and review existing mental health and psychosocial support approaches. Critical assessment of this literature indicates a substantial mental health burden among displaced children and supports a broad range of risk and resilience mechanisms. Although some specific mental health and psychosocial support interventions have positively influenced forcibly displaced children’s mental health, there is a need for more culturally and contextually relevant, accessible and evidence-based services that also address family and community factors during displacement. We discuss recommendations to ensure that these services are linked to strategies that target adverse conditions and structural barriers and strengthen the socio-ecological resources that contribute to children’s positive development and well-being.

Voluntary, flexible stopping of speech output is an essential aspect of speech motor control, especially during natural conversations. The cognitive and neural mechanisms of speech inhibition are not well understood. Here we have recorded direct high-density cortical activity while participants engaged in continuous speech production and were visually cued to stop speaking. Neural recordings revealed distinct activity in the premotor frontal cortex correlated with stopping speech. This activity was found in largely separate cortical sites from regions encoding vocal tract articulatory movements. Moreover, this activity primarily occurred with abrupt stopping in the middle of an utterance, rather than naturally completing a phrase. Electrocortical stimulation at many premotor sites with inhibitory stop activity caused involuntary speech arrest, which contradicts previous clinical interpretations of this effect as evidence for critical centres of speech production. Together, these results suggest a previously unknown premotor cortical network that supports the inhibitory control of speech, providing implications for understanding both natural and altered speech production.

Death anxiety (DA), apprehension when thinking about death, has long been associated with distress. Studies have suggested that DA may transdiagnostically contribute to mental disorders. We conducted a systematic review and meta-analysis, aiming to estimate the relationship between DA and distress or symptoms of mental disorders. The included studies reported the correlation between DA and distress or symptoms of mental disorders, across general population and clinical samples, using previously validated measures for all outcomes. PsychInfo and the Psychology and Behavioral Sciences Collection (via EBSCO), Embase, and Medline (via PubMed) were systematically searched up to 30 October 2023. Study quality was evaluated with the Study Quality Assessment Tools (National Heart, Lung, and Blood Institute). A total of 129 studies were included, reporting on 158 independent samples, for a total of 34,147 participants. Most studies were rated as poor quality. The findings indicated consistently positive associations between DA and distress outcomes (general anxiety: r = 0.42, P < 0.001; depression: r = 0.41, P < 0.001; distress: r = 0.36, P < 0.001). Heterogeneity was substantial, and prediction intervals crossed zero for all outcomes, except for anxiety and distress. We found no moderation by DA measure, sample type or the proportion of women in the sample. However, the association was stronger (t(35.37) = −2.055, P = 0.047) when medical conditions were present (r = 0.48, P < 0.001) than when they were absent (r = 0.37, P < 0.001). There was evidence of small-study effects, indicating possible publication bias. DA should be investigated in longitudinal studies across diverse samples of patients to clarify its contribution to psychopathology.

Emotion regulation (ER) plays a central role in mental health, but the effect differs across cultures. Here, expanding from extant literature’s focus on Western–Eastern dichotomy or individualism–collectivism, this meta-analysis synthesized evidence on the associations between the two most-studied ER strategies (cognitive reappraisal and expressive suppression) and two mental health outcomes (psychopathology and positive functioning) and investigated the moderating roles of several cultural dimensions: Hofstede’s national cultures dimensions, education, industrialization, richness and democracy (EIRDness), and sample demographics. A comprehensive literature search was conducted using electronic databases (CINAHL, Scopus, Web of Science, PsycINFO and MEDLINE) to identify eligible studies reporting relationships between ER and mental health outcomes (PROSPERO: CRD42021258190, 249 articles, n = 150,474, 861 effect sizes, 37 countries/regions). For Hofstede’s national cultures and EIRDness, multimodel inference revealed that greater reappraisal propensity was more adaptive in more short-term-oriented, uncertainty-tolerant and competition-driven cultures, whereas greater suppression propensity was more maladaptive in more indulgent and competition-driven cultures. For demographics, greater reappraisal propensity was more adaptive for samples with more female (B = −0.19, 95% confidence interval (CI) −0.29 to −0.09) and more racial minority participants (B = −0.32, 95% CI −0.51 to −0.13), whereas greater suppression propensity was more maladaptive in younger samples (B = −0.004, 95% CI −0.005 to −0.002). These findings elucidate how cultures are associated with the function of ER and suggests ways in which future studies can integrate cultural characteristics when examining ER and psychological adjustment.

Autism spectrum disorder (ASD) is clinically heterogeneous, with ongoing debates about phenotypic differences between boys and girls. Understanding these differences, particularly at the age of first symptom onset, is critical for advancing early detection, uncovering aetiological mechanisms and improving interventions. Leveraging the Get SET Early programme, we analysed a cohort of 2,618 toddlers (mean age: ~27 months) through cross-sectional, longitudinal and clustering analyses, performed using statistical and machine learning approaches, to assess sex differences in groups with ASD, developmental delay and typical development across standardized and experimental measures, including eye tracking. The results revealed no significant sex differences in toddlers with ASD across 17 of 18 measures, including symptom severity based on the Autism Diagnostic Observation Schedule, receptive and expressive language based on the Mullen Scales of Early Learning and social attention based on the GeoPref eye-tracking test. In contrast, girls with typical development outperformed boys on several measures. Subtyping analyses stratifying toddlers into low, medium and high clusters similarly showed virtually no sex differences in ASD. Overall, our findings suggest that phenotypic sex differences are minimal or non-existent in those with ASD at the time of first symptom onset.