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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.