Lecture
One of the promising directions in current research is the development of stress-diathesis concepts of mental illness, based on the biopsychosocial paradigm in psychiatry and psychology, which posit that some individuals have an increased vulnerability to specific environmental stressors. Exposure to these stressors sharply increases the likelihood of affective and behavioral disorders in vulnerable individuals. Stress-diathesis concepts have been developed and experimentally confirmed for suicidal behavior, alcohol and drug dependence, depressive disorders, and schizophrenia.
Recent research indicates that with the onset and progression of an illness, patients' vulnerability to specific stressors increases many times over. The experience itself of an acute depressive or suicidal crisis, or of psychoactive substance use, produces a number of changes at the neurobiological and cognitive-emotional levels, which increase the individual's sensitivity to specific environmental influences and make him or her vulnerable to subsequent episodes of the illness.
Thus, the presence in an individual of increased vulnerability to certain types of environmental stressors is a key risk factor for mental disorders. This gives rise to the problem of effectively recognizing signs of this vulnerability for the purpose of early diagnosis and prevention of neuropsychiatric illness.
All current attempts to solve this problem are conducted from the standpoint of the so-called comprehensive approach to predicting the risk of neuropsychiatric disorders. The essence of this approach consists of (1) identifying the physiological, psychological, and socio-psychological characteristics that account for a high risk of developing neuropsychiatric disorders, (2) assessing each of these characteristics using a separate psychological test, and (3) predicting the probability of mental disorders on the basis of a mechanical combination (a «complex») of the results of the individual tests.
Abroad, the stress-diathesis model (J. John Mann, 1998) is popular. This concept arose from research on suicidal behavior, which showed, on the one hand, that traditional psychiatric diagnosis contributes little to the assessment of suicide risk, since suicide risk is not proportional to the severity of the mental pathology, while on the other hand, suicides cannot be explained simply as a reaction to extraordinary stress. The stress-diathesis model combined diathesis, as a predisposition to suicide determined by heredity, upbringing, chronic illness, changes in the metabolism of certain substances (serotonin, cholesterol, prolactin), substance abuse, and dietary restrictions, with the stresses that directly precede a suicide (psychological trauma, acute illness, recent use of alcohol or sedatives, etc.). According to the author, stress-diathesis is the key element distinguishing psychiatric patients with a high risk of suicide from those with a low risk.
An alternative to the comprehensive approach is the so-called system-situational approach in clinical psychodiagnostics. Although the basic principles of this approach were formulated back in the work of L.S. Vygotsky, A.R. Luria, and B.F. Lomov, it has undergone intensive development only in the last decade, thanks to the advent of modern information technologies.
The essence of the system-situational approach consists of (1) conducting a systemic analysis of the features of the regulation of a person's mental activity in specific stress-inducing situations, (2) developing a theoretical model of the regulation of human activity in these situations, and (3) creating, on the basis of this model, computer test tasks that, in their psychological content, model human activity under the influence of specific stressors. The results of performing these tasks make it possible to predict a person's behavior in real stressful situations. If an individual exhibits «breakdowns» of voluntary regulation of activity under the simulated stress-inducing conditions, this means there is an increased likelihood that he or she will display maladaptive behavior in corresponding situations in real life.
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