Аннотация:
Aim: to create a statistically reliable conceptual structural-dynamic model of alterd states of consciousness (ASC) caused by psychoactive substances (PS), taking into account the clinical and psychopathological features of such conditions and identifying the trigger points of the process.
Methods. Statistical methods based on multidimensional statistical analysis were used to confirm the model of ASC created by the clinical and psychopathological method. Structural equation modeling was carried out, namely, a path analysis that allows analyzing causal relationships [9, 11, 13, 14]. Structural modeling was carried out using the IBM Amos 22.0 Windows program [12].
Results. The result of the analysis was a conceptual structural-dynamic model of ASC initiated by psychoactive substances, including: the stages of development of symptoms in the bodily, affective and ideational spheres; the consistent deepening of the disintegration of the psyche; trigger mechanisms controlling the movement of the pathological process. The model takes into account the mutual influence of 12 variables (stages) on each other, determines the predominance of bodily, affective, ideational and behavioral components at individual levels of mental disintegration, the main clinical characteristics of the condition. The reliability of the created model turned out to be high (at p = 0.019), which indicates that this model can exist with exactly the number of stages and with such a sequence of influences that was proposed. The analysis of regression loads (travel coefficients) showed that the largest contribution to the identified model is made by the “Stage of initial disorders of general feeling” (P1,2=1.69 at p<0.001), “Stage of partial disorder of consciousness” (P6,9=1.8 at p<0.01), “Stage of pronounced manifestations of mixed affect” (P8,10 = 1.73 at p <0.01) and “Behavior directed by the use of psychoactive substances” (P11,12=1.94 at p <0.001). Thus, it was revealed and statistically proved the existence of 4 triggers that make the greatest contribution to this model. In the process of formation of the ASC, 4 levels of disintegration of the psyche are identified. The accumulated influence was calculated for each selected level of disintegration. The accumulated influence at level I is 3.79 (p<0.01), at level II – 4.00 (p<0.01), at level III – 6.72 (p<0.01), at level IV – 7.65 (p<0.01). Thus, as a result of the movement of the pathological process from the I-th to the IV–th level of disintegration, the intensity of negative changes will increase by 2 times (7.65 vs. 3.79).
Causal influence (TCE or Total Causal Effect) was also studied for each selected sphere (bodily, affective and ), which allows us to calculate the degree of influence of individual elements of the system on each other and the system as a whole and, thus, determine the vector of movement of the pathological process. It was revealed that the causal influence of the bodily sphere is 6.84 (p<0.01); for the affective sphere – 11.35 (p<0.01), for the ideational sphere – 12.07 (p<0.01). At the same time, changes occur not only in the vertical plane of the model, accumulating negative influence from the I to IV level of disintegration, but also the accumulation of negative influence can be traced from the corporeal to the ideational sphere, changing in the horizontal plane of the model.
Conclusion. The conducted research has confirmed the expediency and justification of using modern statistical methods based on multidimensional statistical analysis to objectify phenomenologically obtained data on such complexly organized and poorly studied mental phenomena as altered states of consciousness.
Ключевые слова:
altered states of consciousness, levels of disintegration, triggers, path analysis, accumulated influence, causal influence.