Demoralization in the Context of Differential Diagnosis of Mental States in Severely Ill Patients with Hazard of Death

Abstract

Background. Timely and accurately conducted introduction of demoralization into the differential diagnostics make it possible to define objective and subjective factors essential to demoralization, which constitute actual psychological state of a patient. It also helps to differentiate these factors from variety of syndrome signs and, therefore, to stabilize individual mental condition by making therapeutic interventions more targeted. Objectives. The aim is to elicit specific features of and to discern criteria for distinction of the notion of demoralization from variety of other concepts frequently used in clinical psychologist’s activity to describe pathological mental states that patients with severe somatic disease may have. Results. Based on the comparison of the demoralization concept and mental distortions frequent in a clinic of severely ill somatic patients, essential and pivotal sings of the phenomenon of demoralization are shown. The epidemiological data on occurrence and intensity rates, as well as demoralization comorbidity to a number of disturbed mental activity symptoms and states amid patients with different somatic nosology are given. Conclusions. As a psychological state, demoralization can be diagnosed among either inpatients or outpatients. It might also present itself singularly or be comorbid to any mental distortion yet maintaining its seminal qualities, such as distress, subjective incompetence experience and preservation of motivation. Discrimination of demoralization state might have both therapeutic and prognostic value.

Keywords

• demoralization
• major depressive disorder
• dysthymic disorder
• adjustment disorder
• acute stress
• posttraumatic stress disorder
• distress
• somatic disease