Download Higher Medical Nurse Business faculty ММК yes

MINISTRY OF HEALTH OF UZBEKISTAN
CENTRE FOR MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
"Approved"
Head of main department of personnel
and institutions of higher education
of Uzbekistan Ministry of Health
prof. _______________Sh.E.Atahanov
«____»________________ 2011 yil
Department: Psychiatry and Addiction
Name of discipline: PSYCHIATRY
4 theme: A PROBLEM OF THE PERSON. PSYCHOPATHY,
PSYCHOPATHY FRUSTRATION. PSYCHOGENIC DISEASES.
NEUROSISES. JET PSYCHOSES
(For teachers and students of the Higher Medical educational institutions)
The uchebno-methodical grant
FOR STUDENTS 3 COURSES OF FACULTY
«HIGHER MEDICAL NURSE BUSINESS»
Tashkent 2011
Department of Psychiatry and Addiction
"Approved"
Vice-rector for academic,
Professor OP Teshaev
«___»________ 2011.
6. theme: A problem of the person. psychopathy, psychopathy frustration.
Psychogenic diseases. Neurosises. Jet psychoses
FOR STUDENTS 3 COURSES OF FACULTY
«HIGHER MEDICAL NURSE BUSINESS»
Higher Medical Nurse Business faculty ММК yes
checked and approved
The report № ______________
«___» ______________ 2011 __
TASHKENT 2011
Topic: «A PROBLEM OF THE PERSON. PSYCHOPATHY,
PSYCHOPATHY
FRUSTRATION.
PSYCHOGENIC
DISEASES.
NEUROSISES. JET PSYCHOSES».
1.Venue lessons, equipment.
Department of Psychiatry and Addiction at the base GKPB Guza Tashkent.Tables and charts in
an electronic format, the computer
2.Duration of study topics:
Number of hours -.
-The purpose of training.
-Give the criteria for determining what is "normal person" and "abnormal personality".
To give a classification of psychopathy with the description of the clinical characteristics of each
species.
Give an idea of the problems addressed by the "small" Psychiatry:
-To form a general idea of psychogenic disorders:
-Give a classification of the neuroses, to list the main methods of treatment; Tasks The student
should know:
-The concept of "personality", "pathological personality development", "psychopathic disorder";
-Classification of psychopathy, the main clinical features of each option;
-Classification of neuroses;
Features of the clinical manifestations of neurosis;
3.The student should be able to:
Find an approach to a patient suffering from neurosis, reactive psychosis, psychopathy and
collect complaints, history, or Follow-up data to assess mental status, a preliminary diagnosis,
determine the level of GPs need treatment on an outpatient basis to a psychiatrist or psychiatric
hospitalization.
4.Motivation.
The doctor of any medical specialty and, of course, a general practitioner encounters every day ¬
Xia and interacts with patients belonging to a variety of human types, including pathological. It
is obvious that it requires the ability to understand them, the ability to properly and consciously
build their inter ¬ relationship with the various personality types for more efficient and
professional diagnosis and treatment available to the patient's disease.
5.Interdisciplinary communication and Inter predmetnye.
Teaching this topic is based on the knowledge bases of students of physiology, psychology and
pharmacology. The knowledge gained will be useful during the passage of all the disciplines of
therapeutic and surgical (cardiology, neurology, gynecology, urology, general surgery, etc.) as
well as interaction with people is unavoidable for any medical specialty that is in contact with
patients.
6. The content of lessons.
1.1 The theoretical part.
1.2 The concept of "small" of psychiatry.
For "small" psychiatry is characterized by mobility, the transformation of one state to another.
The same patient may suffer from psychopathy, neurosis, psychosis, reactive, and can provide
situational reaction. For small Psychiatry are psychopathy and psychopathic states, neuroses
and neurosis-like states, reactive state. The concept of mental rules of a normal character - the
conventional concept.
The structure of personality, normal and abnormal variations. Personality has a structure
consisting of a biologically and socially determined components: temperament, character, focus
and breadth of interests, world view. Temperament - is a quantitative characteristic, which
determines the strength, speed, tempo, rhythm occurring mental processes that balance the
processes of inhibition and excitation (choleric, sanguine, phlegmatic, melancholic - of
Hippocrates). This is a basic, biologically determined characteristics of the individual, does not
change with age and exposure to the social environment, and character - high-quality, socially
and biologically deterministic component, which undergoes changes with age and is influenced
by
the
society.
Normal character - it's integrity, the organic, harmonious, relationship of personality traits,
which follow some of the other and are able to create adequate interpersonal relations, which
contributes to adaptation of the individual in society.
In life we are confronted with various disabilities in the formation of personality - the infantile
personality, accented, psychopathic personality. Accentuation of the individual - not a
diagnosis, this is an extreme limit of normal, disadaptation occurs only with certain situations
of exposure to the weak link in the personality, which has a strong hand, can compensate and
keep the person in the adaptation.
Psychopathy.
Psychopathy - persistent abnormality of personality, characterized by a disharmony of the
emotional-volitional and original, predominantly affective thinking. Psychopathic features
appear in childhood or adolescence and persist without significant change throughout life, they
pervade the entire personality, define its structure and usually interfere with a full adaptation of
the individual to the environment.
To establish the nosological diagnosis of psychopathy as important to have a so-called triad
PBGannushkina: the totality of character disorders, their persistence and change in social
adaptation inverse dynamics and persists throughout life. The study of this disease began not by
psychiatrists, and writers who described certain personality types. They were called "moral
estates" (English), "moral imbeciles," "original cranks" (Grizenger), "ugly personality"
(Kandinsky), "congenital pathological harmful rogues" (Kraepelin), in literature, Leskov, "The
old sociopaths" Chekhov "Psychopaths". The pathology of personality - psychopathy - emerges
from the interaction of two factors: congenital or acquired early in the biological inferiority of
the nervous system and influence the external environment. Constitutional-genetic factor
(autosomal dominant pattern of inheritance) and poor education in early childhood - are leading
factors
etiopathogenetical
psychopathy.
The criteria for diagnosis.
Criteria for diagnosis of OV Kerbikovu:
1.the totality of the pathological character traits;
2.stability or low reversibility in their lifetime;
3.because the first two criteria - disadaptation in society.
The clinical picture of psychopathy. Psychopathic personality (by Kurt Schneider) - this is the
person who is ugly because of his character to cause suffering to others and to suffer
themselves. Psychopath finds himself anywhere. Pathological features accompany him
throughout his life, different types of psychopathy manifest themselves at different stages.
The classification of psychopathy.
A variety of clinical characteristics peculiar to psychopaths, is the cause of the existence of a
large number of classifications. In German-speaking countries, the most popular classification
of K. Schneider (1923), which is considered abnormal personality as a "constitutional options
the norm."
There are the following of psychopathy:
1.
Psychopathy is dominated by changes in thinking:
Asthenics-psychasthenic;
Schizoid
paranoiac.
2.Psychopathy is dominated by emotional disorders:
Excitable,hysterical;Epileptoidy,cycloid.
3.Psychopathy is dominated by volitional disorders: unstable.
4.Psychopathy is a disorder of drives.
5.Psychopathy with behavior problems in society.
6.Mixed forms of psychopathy: a mosaic.
If you imagine the hysterical personality, here there are two poles of character, one that
approaches the excitable, the other - with fantasy, pseudologist, daydreaming, close to the
expansive
schizoid.
Form of psychopathy.
1. Asthenic psychopaths: a child there is increased timidity, indecision, impressionability.
Particularly self-conscious they become the new situation, among strangers, where they have the
feeling of inferiority. Hypersensitivity, "mimoznost" appear in such persons as against mental
stimuli and physical activity. At the same time they felt expressed variations of efficiency,
downs of mood, fatigue, weakness.
2. Psychasthenic psychopaths. The main feature - the alarm mistrust, impressionability,
insecurity, low self-esteem.
3. Hysterical psychopaths. The main feature - the desire by all means to attract the attention of
others., So the behavior of such individuals is characterized by demonstrativeness, theatricality,
it lacks the simplicity and naturalness. They need to be in the spotlight. Characteristic of
hysterical personalities mental immaturity, infantilism is often not given the opportunity to attain
their aspirations through the development of truly available to them abilities. Their feelings are
superficial, unstable, and external appearance of emotional reactions is inadequate about, is
demonstrative theatrical character, depth and subjective importance of the reaction is not great.
Given the clinical features of hysterical psychopaths relationships with others persons can
distinguish two types of personality structure: excitable and braking. For group I belong bright
nature, extravagant, "hungry for recognition", intolerant comments and objections.
For group II is characterized by increased vulnerability, sensitivity, fantasy, fast exhaustion and
neurotic reactions, which are easily fixed. Under adverse conditions, they tend to withdraw into
yourself, go into the world of his fantasies and fictions. Observed behavior of the type of "flight
into
illness".
4. Excitable psychopaths. The leading character traits - irritability, anxiety, coupled with
explosive, vicious, vindictive, prone to mood swings dominated by his angry-sullen background,
vindictiveness, viscosity affective reactions, irritability, a tendency to violent manifestations of
affect response to the often minor reasons that runs through the entire life of individuals.
5. Schizoid psychopaths. These individuals, along with vulnerability, timidity, shyness, some
inertia in life conflicts are marked features such as unsociable, intravertirovannost, the
propensity to internal processing of their experiences, difficulty in contact with officials from the
immediate environment, a tendency to fantasize on topics far from reality, some coldness and
dryness in relation to a close, angularity, stiffness in the behavior. Revealed the lack of a sense of
humor, too much seriousness or sentimentality. They tend to self-reflection. Often these
individuals exhibit a fairly high level of education, good learning ability in low motor skill.
6. Paranoiac psychopath. Lead is a particular manifestation of patoharakterologicheskih tendency
to overvalued entities, combined with low flexibility of the psyche, suspicion and, as a rule, with
high self-esteem. Overvalued ideas expressed and the first typical paranoiac reactions occur in
these individuals usually for 20-25 years. From childhood, they are characterized by the
unilateral interests, combined with stubbornness, bluntness. Reassessment of their abilities,
manifested in the tendency giperstenichnost for leadership, self-affirmation. Inherent selfishness,
uncompromising desire to act in any situation in his own peremptory categorical judgments, as a
rule, interfere to maintain good relations within the family and team.
7. Gipertimiki and gipotimiki - "optimists" and "pessimists", the person with the prevailing
elevated or depressed mood, and perceiving the situation through the prism of the "pink or dark
glasses."
8.Cycloid. The main feature - the tendency to emotional instability, mood swings.
9.Unstable (spineless) psychopaths - weak-willed, suggestible, often conformal identity, without
independence in motivation and behavior. The differential diagnosis should be made with
psihopatizatsii personality (or psychopathic condition), which is always secondary, and is a
syndrome of other underlying disease (schizophrenia, alcoholism, the effects of traumatic brain
injury, etc.). The need for distinguishing psychopaths from neuroses arise mainly in the
psychopathic dynamics. The major. The signs for the differential diagnosis of neurosis are the
subjective feeling of illness, estrangement pathological manifestations of personality, the
presence of vegetative components of neurotic disorders. The development of neurotic states on
the basis of psychotic compound the difficulties of diagnosis, often only after the treatment of
neurosis and improvements can talk about the structure of the psychopathic personality of the
patient.
Treatment. Drug of choice for relieving mild decompensation of psychopathy is a neuroleptic
neuleptil, tranquilizers and antidepressants. The basis of prevention is a complex social and
educational activities, medical and pedagogical correction.
Psychogenic. To include psychogenic illness caused by acute or chronic trauma. When exposed
to severe trauma develop reactive psychoses. Lesser effect, but prolonged exposure causes
psychogenic neuroses. Psychogenic disorders are functional in nature and totally reversible.
However, particularly significant for the individual and the circumstances of chronic traumatic
neurosis and reactive states can acquire a protracted course .. Neuroses, their classification,
clinical features, diagnosis and treatment. Neurosis - is psychogenic, neuro-psychiatric disorder,
results from the breach very important relationship between man and manifests itself in specific
clinical phenomena in the absence of psychotic phenomena. For the disease are of great
importance not only innate typological properties of the nervous system and its state at the time
of the trauma (for example, under the influence of exogenous asthenia hazard), but also set the
individual, defining it to some events of the environment, the ability to critically assess
perceived, the ability to overcome life's difficulties. Mental trauma can lead to changes that
cause autonomic dysfunction, in particular, violations of the internal organs. In recent years,
these disorders often have to speak to the fore, ie, may be the central focus and involve the
patient, while the accompanying common disorders of the nervous activity (irritability, depressed
mood, insomnia, etc.) recede into the background. In this case there may be disturbances in the
cardiovascular, respiratory, digestive, reproductive and other systems. Autonomic dysfunction
may be manifested in the form of vegetative-vascular dystonia and crises. When dystonia
autonomic dysfunction are as sharp sympathicotonia (increased heart rate, increased blood
pressure, dry mouth, sensitivity to cold extremities, white dermographism, etc.) or vagotonia
(slow pulse, lowering of blood pressure, increased salivation, increased peristalsis of the bowel,
skin redness, Red dermographism). Against the background of dystonia (sometimes combined)
can be observed by the sympatho-adrenal (increased heart rate, pain and discomfort in the heart,
increasing blood pressure, numbness, cold extremities, chills) or vago-insular (the sensation of
fading or disruption of the heart, feeling short of breath , choking, discomfort in the epigastric
region, increased peristalsis), or mixed crises.
Classification of neurosis.
Are the following types of neuroses:
1.neurasthenia;
2.obsessive-compulsive disorder;
3.hysterical neurosis.
Neurasthenia.
The etiology and pathogenesis. In describing her neurasthenia associated with the rapid
development of civilization, that nervous system is not able to sustain the growing demands and
pace of life, fatigue occurs. Several authors point to the importance of constitutional factors. The
role of these two factors, social and constitutional continues condemned to date.
Overload, overcoming fatigue and forced insomnia, which deprives the body rest and
recuperation, reduce body reserves and lead to nervous exhaustion. The result is a touchy
weakness.
Neurasthenia - a psychogenic neurotic disorder in the clinical picture which has its principal
place of asthenic syndrome. In practice, you must know that the clinical picture is often found
neurasthenic syndrome, in which along with the genesis of psychogenic factors play a role
somatogenic debilitating effects, and since they both can lead to neurotic symptom, the question
arises whether neurotic symptom of psychogenic distinction etiology of somatogenno
conditioned. GP needs to know that neurasthenia is observed increase in sensitivity with respect
to intero-and proprioceptive stimuli, ie, coming from internal organs and various body parts of
patients.
Differential diagnosis.Needed:
1.distinction:
-Neurotic syndrome, psychogenic from somatogenic;
- Asthenic symptoms of neurasthenia;
2.delimitation:
-Neurosis of schizophrenia;
From surgical diseases;
Treatment. The main thing - the elimination of traumatic factor therapy. Depending on the stage
of neurasthenia - a sedative tranquilizers (for hypersthenic stage) or stimulatory effect (at
hyposthenic stage), vitamin therapy, physiotherapy, etc. The main treatment - a psychiatrist.
Obsessive-compulsive disorder.
The etiology and pathogenesis. From the standpoint of Pavlov's teaching phobias are stagnant
excitation focus is not as strong as in delirium, without the expressed zones of inhibition of
induction, so to obsessive and critical attitude persists. At the heart of compulsive contrasting
desires and inclinations is ultra-phase cells in the cerebral cortex (EA Popov). It is believed that
the continued existence of stagnant focus of excitation occur depletion and the appearance of the
phase state, which clinically is reflected in the increasing complexity of the picture of neurosis.
The basis of obsessive-compulsive disorders are clear induction of relations, ie more complex
disorders of higher nervous activity.
Treatment. In mild - psychotherapy, physiotherapy and restorative treatment. With more severe
manifestations of the disease - psychotherapy, tranquilizers, antipsychotics prescribed if
necessary. The main treatment - a psychiatrist.
Hysterical neurosis.
A variety of hysterical symptoms has led to note that the hysteria - is a "chameleon" who
constantly changes his colors and can simulate almost any other disease.
Sensory disorders (disorders of sensation in the form of hypesthesia, anesthesia) and movement
disorders (in the form of hyperkinesis, paresis, paralysis, events astasia-Abaza) should be
differentiated from organic disease. Movement disorders in the form of hysterical seizures
differentiated from epileptic seizures.
Treatment. In addition to addressing traumatic factor (as with any form of neurosis) are
conducting psychotherapy and prescribe tranquilizers if necessary - antidepressants,
antipsychotics, physiotherapy, vitamin. The main treatment - a psychiatrist.
Diagnosis of neuroses.
In the diagnosis of neurosis important clinical method. Diagnosis should include:
1.demarcation from similar symptoms, pathology;
2. study of the dynamics of the disease should include three criteria:
-The severity and characteristics of clinical manifestations;
-The structure and characteristics of the individual patient;
The diagnosis of the most important clinical-psychopathological method, additional research is
pathopsychological in which a common goal - the establishment of etiopathogenetic links
between the clinical picture of disease, situation and personality. In addition, the task of
psychological research includes:
1.to study the characteristics of the patient's personality and his life relationships;
2.identify areas of traumatic experiences and psychological essence of the neurotic conflict;
3.characteristic of the basic psychological processes (thinking, memory, etc.) and states (anxiety,
depression,
etc.);
Along with the above, if necessary, carry paraclinical methods of investigation to exclude a
somatic, organic and other pathology.
Differential diagnosis. Differential diagnosis is difficult, especially in cases where the disease
takes a protracted nature. We must know that a prolonged neurosis pose with prolonged duration
of the neurosis and in the presence of polymorphism in neurotic disorders. Neurotic
development, unlike the neurotic, has a longer duration of disease (at least 5 years), a significant
burden of psychological trauma, there was no significant improvement within 1-2 years after the
normalization of living conditions, the weakening of emotional disturbances related to the
situation, the emergence of chronic mood disorders which is not defined by trauma, greater
stability of the clinical picture. Neurotic personality development differentiate from
psychopathy, but unlike the latter, with the development of neurotic disorders
patoharakterologicheskie perceived as alien to the individual, painful, not the totality of these
disorders
are
manifested
in
certain
situations
and
unstable.
Neurotic personality development is different from the prolonged neurosis because there are
qualitatively new traits, the same type of response to different situations, depressed mood, there
is little associated with a traumatic situation, the loss of "a form of neurosis," resistance to
"conventional" methods of treating, reducing the level of social adaptation.
Treatment of different types of neurosis elucidated by considering each type of neurosis. You
must know that the treatment of neurosis has its principal place of psychotherapy: individual
interviews, suggestion in the waking state of hypnosis, group, team, family therapy. In the acute
condition - psychotherapy, aimed at reducing the internal tension and anxiety fears and
subsequently - suggestion to restructure the relationship between the individual breaches the
social environment and microsocial environment, overcoming inadequate claims intensification
therapy, which facilitates the re-socialization and integration into working life.
1. elimination of emotional disturbances that are typical for a neurotic level of engagement
(emotional lability, "irritable weakness", fears, anxiety, tension, etc.);
2. treatment of asthenic disorders, overcoming physical and mental exhaustion;
3.regulation of autonomic disorders;
4.identification and elimination of somatic disorders;
5.use in the treatment of drugs, psychotherapy and antidepressant medication if necessary.
Reactive psychoses, their clinical characteristics, diagnosis and treatment. The main reason for
reactive psychosis - traumatic factor. Reactive psychosis - a complex and integrated response of
the brain and body to psychogenic factors. Reactive state of the psychosomatic unity indicates
the whole body, his whole response to the psychic blow. In the etiology is proved not only the
role of psychogenic factors, but also revealed important pathological simptomoobrazuyuschee
soil (various forms of psychopathy, character accentuations, etc.). The development of reactive
psychosis, their clinical picture and dynamics also depend on the constitutional peculiarities of
personality, gender, age, previous diseases, physical condition, they are due to the influence of
super-strong for the individual stimuli. Jaspers triad reflects the main features of reactive
psychosis:
Type reactive state depends on the strength and significance of trauma to the individual and
typological characteristics of the personality. In the immediate threat to life is disorder of the
brain, so that rational behavior is eliminated, and management of human activities (excitement,
stupor). Factor causing disturbance of mental activity is excessive emotion (fear, despair).
Clinical forms are distinguished:
1. Affective-shock reactions.
2. Jet paranoia.
3.Hysterical psychosis.
4. Reactive depression.
Affective-shock reactions (reactions of extreme situations) usually occur in the form of motor
excitation or inhibition, up to a stupor. Hyperkinetic form (motor storm) is characterized by
chaotic, senseless restlessness: a man rushes, makes a lot of unnecessary movements, aimlessly
waving hands, screaming, begging for help, not noticing the real path to salvation.
Length of excitation 15 - 25 minutes.
Hysterical psychosis - heterogeneous clinical presentation of psychotic states (hysterical clouded
state, pseudodementia, puerilism syndrome, delusional fantasies, hysterical stupor). Hysterical
clouded state is different mosaic symptoms and behavior of patients demonstrativeness: laughter,
singing and crying interrupted by seizures, freezing in a mournful posture followed by a brief
excitation
..
Pseudodementia arises because of the constricted consciousness, and is characterized by the
imaginary loss of knowledge of simple, wrong answers (past-speech) and actions (past-actions).
Patients at this staring eyes, smiling foolishly, can not perform simple arithmetic tasks,
operations, when the score was helpless fingers, do not call her name, last name, not enough
focus in the atmosphere, the white is called black. A variation is pseudodementia Ganser
syndrome that develops in individuals who are in prison zaklcheniya. Unlike pseudodementia, it
takes a long time and against the background of deep stupefaction.
Puerilism - children's behavior: the patient starts talking childish voice, asks to let him go to the
"mother" not to offend anyone, to pick him up, give a toy, lisp, playing with dolls, pout,
stomping their feet, running. Jet paranoia - paranoia psychogenic relatively rare form of reactive
psychosis, occurs more frequently in the military environment. In their development play an
important role predisposing factors, physical fatigue, irregular meals, alcohol abuse, long-term
insomnia. The main pathogenetic point is the situation - the situation of the railway
(overcrowded trains, large train stations, countless crowds, vague announcements, rush, the
uncertainty and anxiety).
Used in this lesson, new educational technologies:
Guidelines and technology of the business game "knob in the middle of the table."
The group is divided into 3 subgroups. Each subgroup writes on a piece of group number,
department, name participants, the game's name, date of meeting. Each subgroup is invited to
answer a specific question. Each student writes on a piece of your name and your answer sheet
and sends a neighbor, a knob on the center of the table. The teacher monitors and evaluates the
work of the correctness and completeness of response. Rated on a scale of theoretical training is
included in the rating assessment of the day.
Complex issues for the business game "handle in the middle of the table" on a practical lesson on
the topic: "Problems of identity. Psychopathy "
1.Give a definition of psychopathy.
2.List the types of psychopaths.
3.Specify the criteria for the diagnosis of "psychopathy".
4.The structure of personality.
5. Stages of identity formation.
6.Factors affecting the formation of personality.
7. List the main features of psychopathy psychasthenic circle.
8. List the main features of psychopathy epileptic circle.
9. List the main features of psychopathy excitable circle.
10. List the main features of psychopathy paranoid circle.
11. List the main features of psychopathy unstable range.
12. Enter the difference between psychopaths psychasthenic circle of psychopaths asthenic
circle.
13. Enter the difference between psychotic schizoid psychopaths psychasthenic circle from the
circle.
14. Conduct a differential diagnosis between psychopathy and psychopathic disorders.
15. What personality structure socially determined?
Guidelines and technology of the business game "cat in a bag"
A group of students is divided into 3 subgroups. Each subgroup writes on a sheet date, group
number, department, name participants, the name of the business game. One of the participants
in each group takes the envelope a separate option. After 15 minutes of discussion, and writing
teacher collects the answer sheets. The estimation is made on a scale and in failing to take into
account the current control over the theoretical part, depending on the accuracy, completeness
and responsiveness.
Complex issues for the business game "Cat in the bag" on a practical lesson on "Neuroses,
etiology, clinical features, treatment. Reactive psychoses, classification, clinical outcome "
1. Give a definition of neurosis.
2. The main etiological factor in the development of neurosis.
3. Neurosis - a functional or organic disease?
4. List the clinical forms of neuroses.
5. Leading syndrome psychasthenic neurosis.
6. Leading symptoms of hysterical neurosis.
7. List the symptoms of a neurotic level.
8. Give a differential diagnosis between neurosis and neurotic disorders.
9. Give a definition of a neurotic reaction.
10. Neurotic reaction - is a diagnosis of a condition?
11. Criteria for the diagnosis of "neurosis."
12. Which personality is formed more often "hysterical neurosis"?
13. Which groups of psychotropic medications used in the treatment of neuroses?
14. Enter the neuroleptic used for the treatment of lingering forms psychasthenic neurosis.
15. Outcomes of neuroses.
16. Give a definition of reactive psychosis.
17. Criteria for the diagnosis of "reactive psychosis" according to Jaspers.
6.2 Analytical part.
Situational problems.
1.Patient K., aged 32, came to the clinic to the physician with complaints of palpitations, a sense
of interruption, the constant stabbing pain in the heart, general weakness, irritability, emotional
lability, sometimes anxiety, depressed mood. The disease emerged last month after a prolonged
mental trauma. Last year my mother was seriously ill, the sick cared for her, worried, tired. At
the same time worsened relations with her husband, they divorced. After the divorce, and the
disease appeared. Somatic status: heart rate 72-80 beats / min, rhythmic, labile. Borders of the
heart within the normal range, the tones are clear, no noise. BP 150/90. Neurological status: a
light tremor of the fingers, hyperhidrosis. ECG - normal. Blood test - all the population in the
normal range. Put a preliminary diagnosis, justify the answer.
A: Given the mental state the patient, consisting of asthenia, emotional and vegetative-somatic
disorders, their occurrence after fatigue, trauma, lack of somatic and organic pathology can be
diagnosed neurasthenia.
2. Patient V., age 27. She complained of fear of death, fear of contracting rabies after a dog
grabbed the patient's dress. Last week was bad sleep, he and appetite. Up to 22 years was nearly
healthy and able-bodied. Different precision, pedantic, and some anxiety, suspiciousness. At age
26 while walking cat scratched, but the patient did not pay attention to it. Then, encountering
infectious disease physician, I learned that this can lead to infection with rabies. The doctor
categorically asked her to come to the Pasteur point for vaccination, and added that in case of
absence, he would force her to come over the police. The patient spent in trouble all night, but
could not calm down at the thought that she contracted rabies.
After the vaccinations, when it was ruled a real danger of rabies, the patient's condition had not
improved. Experienced the fear of rabies and anxiety, when I saw dogs, cats and even birds.
Became particularly fastidious, abandoned the work. House required the mother to wash her
hands frequently, "so as not to infection." The very hard going through the condition, but "had
nothing to do with them." In the clinic there is increased hypochondria, morbid fastidiousness, it
is often washed his hands, avoiding contact, kept in isolation, did not take treats from the others,
was afraid of infection. The mood of depressed, anxious, suspicious. Talking about his
experiences as alien, not peculiar to her personality. Sleep surface. Place a clinical diagnosis,
indicate
the
leading
symptoms
of
this
syndrome.
A: The mental state fits into the framework of obsessive-compulsive. Disease evolved from
anxious hypochondriac personality after trauma. Diagnosis - obsessive-compulsive disorder.
This clinical observation is noteworthy that the disease has developed after reporting a physician
about the possibility of rabies, ie two years after the event (the patient scratching cat). The
clinical picture leading place obsession, mainly phobia. Along with these there are affective
disorders (anxiety, depressed mood) and hypochondriacal.
A: paranoid type. diagnosis.
6.3 The practical part.
STEP BY STEP PRACTICAL SKILLS FOR GPs on the "neurosis" Purpose: Supervision of
patients with borderline pathology, staging of the primary diagnosis, assessment of severity of
disease
and
basic
treatment
assignment
Ongoing stages (stage)
№
Stage
event
satisfie
not
d
fully
correctl
y
1
2
3
4
5
6
7
8
9
The patient is placed on a couch, the doctor is right, asks the passport data,
women are sick more often.
Of the complaints: memory loss, depressed thoughts, headaches, insomnia,
obsessive-compulsive, decreased performance and fears.
From the history of the disease: long-term stressful situation
In the general examination: a serious condition, consciousness is clear.
Situation actively. Skin normal color, sweating.
In the general examination: a serious condition, consciousness is clear.
Situation actively. Pale skin, white dermographism. Sweating
Mental status: memory loss, weakening of attention, emotional lability.
Consciousness was clear, obsessive-phobic disorders, the criticism kept,
senestopatii, psychic asthenia
Possible complications: a defect of personality, suicide attempts
Rationale and exhibiting clinical diagnosis of certain forms of the disease,
according to the accepted classification
Possible complications: suicide attempts
0
10
0
10
0
0
10
10
0
10
0
10
0
0
10
10
10
10
for differential diagnosis: psychopathy, neurosis disorders in organic brain
lesions, sluggish schizophrenia.
11 Basic treatment:
1) treatment-conservative mode
2) tranquilizers
3) antidepressants
4) therapy
Total
10
0
100
STEP BY STEP PRACTICAL SKILLS FOR GPs in relieving withdrawal symptoms.
Objective: To provide emergency medical care in relieving withdrawal symptoms. Ongoing
stages
(stage)
№
Stage
event
not
fully
satisfie
d
correctl
y
1
With agitation and aggression: retention, fixation (wide clamps, scrap materials:
sheets, towels) to a bed, stretcher.
Tranquilizers: Diazepam, Rohypnol, phenazepam, nitrazepam
Detoxification 0.9% sodium chloride, 5% glucose solution, gemodez,
reopoligljukin, diuretics, correction of acid base balance: sodium bicarbonate
Nootropics: Piracetam, nootropil
Symptomatic agents: cardiac glycosides, antiarrhythmics, analeptics, hormones:
prednisolone, dexamethasone
Non-narcotic analgesics Analgin, baralgin
Non-specific anti-inflammatory drugs in the presence of joint pain:
phenylbutazone, reopirin, ibuprofen, diclofenac sodium
hydroxybutyrate sodium 20% - 15 - 20 ml / slow
Total
0
15
0
0
15
10
0
0
10
10
0
0
15
10
0
0
10
100
2
3
4
5
6
7
8
8. Criteria for evaluating the current control.
№
1.
Progress in
number (%)
96-100
2.
91-95
scoring
Excellent
"5"
the student's knowledge level rating
sums up and makes decisions
Creative thinking
Independently analyzed
Into practice
Shows high activity, a creative approach to the conduct of
interactive games
Correctly solves the case studies with full justification for the
answer
Understands the subject matter
Knows, says confident
Has a faithful representation
to think creatively
Independently analyzed
Into practice
3.
86-90
4.
81-85
5.
76-80
6.
71-75
7.
66-70
8.
61-65
9.
56-60
10.
55 and
below
№
1
Shows high activity, a creative approach to the conduct of
interactive games
Correctly solves the case studies with full justification for the
answer
Understands the subject matter
Knows, says confident
Has a faithful representation
to independently analyze
Into practice
Shows high activity, a creative approach to the conduct of
interactive games
Correctly solves the case studies with full justification for the
answer
Understands the subject matter
Knows, says confident
Has a faithful representation
Good "4"
into practice
Shows high activity during the interactive games
Correctly solve situational problems, but the rationale for the
answer not full enough
Understands the subject matter
Knows, says confident
Has a faithful representation
are active in conducting interactive games
Correctly solve situational problems, but not a complete
justification of the answer
Understands the subject matter
Knows, says confident
Has a faithful representation
correctly solve situational problems, but not a complete justification
of the answer
Understands the subject matter
Knows, says confident
Has a faithful representation
satisfactorily satisfies
"3"
Understands the subject matter
Correctly solve situational problems, but can not justify a response
Knows, says confident
Has a faithful representation of some issues topic
Admits Error in solving situational problems
Knows, says not sure
Has a faithful representation of some issues topic
Knows says no confidence
Has a partial view
unsatisfactory satisfactorily "2" does not accurately represent
Do not know
9. Chronological map of classes (for klinichekim subjects)
stage of training sessions
Form
An introductory word lecturer (study subjects)
Length in
minutes.
180
225
5
10
2
3.
4.
5.
6.
7.
8.
Discussion topics practical training, use of new
educational technologies (small group
discussions, case studies, "the method of
snowballs," a round table, etc.) as well as
checking the source of knowledge siudentov, the
use of visual aids (slides, audio, video tapes,
models, phantoms, ECG, X-ray, etc.
Summing up the discussion
Giving students tasks to perform the practical
part of training. Cottage explanations and notes
for the task. Self-Supervision
The assimilation of skills a student with a
teacher (Supervision thematic patient)
Analysis of the results of laboratory and
instrumental studies thematic patient, differential
diagnosis, treatment plan and rehabilitation,
prescriptions, etc.
Talk degree goal classes on the basis of
developed theoretical knowledge and practical
experience on the results of the student, and with
this in mind, evaluation of the group.
Conclusion of the teacher on this lesson.
Assessment of the students on a 100 point
system and its publication. Cottage set students
the next class (a set of questions).
The survey, an
explanation.
50
50
10
15
medical history, clinical 30
role-playing case studies
Working with the
25
clinical laboratory
instruments
40
Oral questioning, test,
25
debate, discussion of the
practical work
30
Information, questions
for self-study
20
10
10. Quiz Questions
1. The content of ethyl alcohol in the blood, depending on the degree of intoxication.
2. Pathological intoxication. Factors that contribute to the pathological intoxication
3. Clinical signs of intoxication, depending on the degree.
4. Differences between domestic drinking from the first stage of chronic alcoholism.
5. Differential diagnosis of alcoholic hallucinosis from delirium tremens.
6. The tactics of a general practitioner with acute alcohol intoxication (alcohol coma), in a
residential alcoholism and chronic alcoholism. 1. The causes of psychopathy and its clinical
forms.
7. Course and outcome of psychopathy.
8. Differentiation between psychopathy and psychopathic disorders.
9. External manifestations of the behavioral reactions of psychopaths.
10. Definition of "psychogenic illness", "neurosis", "reactive psychosis."
11. Clinical manifestations of reactive psychosis, diagnostic criteria.
12. Clinical manifestations, course of hysterical neurosis.
13. Treatment and prevention of neuroses.
14. Clinical manifestations of acute reactive psychosis (affective - shock reactions), during,
treatment.
15. Clinical manifestations of hysterical psychosis, during, treatment.
11. Recommended reading.
1. Alimov H.A, Alimov U.H, "Psychiatry klinikasining mukaddimasi" Tashkent 1997.
2. Shoyusupova A.U, Hodjaeva NI, "Psychiatry" Tashkent 1995.
3. M.V Zharikov et al. "Psychiatry," Moscow, 1969.
4. Korkina M.V et al. "Psychiatry" M.1995.
5. Kirpichenko AA, "Psychiatry" Minsk 1989.
30
6. Snezhnevsky AV (Ed.) "Guide to Psychiatry," Vol.1, 2. 1983.
7. Banshchikov V. Korolenko TS.T, Davydov I.V, "General Psychopathology" M.1971.
8. Tashmatov BA, Magzumova Sh.Sh., Bulychev, NS "Psychiatry in the activities of general
practitioners", Tashkent, 2004.