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The thematic plan of lecture employment psychiatry and addiction, rate for 5 medico-profilactical
faculty
Lecture№ 1
Theme: the Subject and purporse of psychiatry, narcology.
Organization of mental health and substance abuse services. Patologi of sensation and perception.
Subject and problems of medical psychology, psychiatry and narcology. History and the basic directions of
development. Structure of mental activity. The basic conditions for mentality formation. The basic methods of
medical psychology, psychiatry and narcology. Principles of the organization of the hospital and extrahospital
psychiatric help. The basic indications for hospitalization. The dynamic account of mental patients. A role of the
general practitioner in psychiatry and narcology. Functions of the general practitioner in a psychiatric hospital, a
clinic. Medical secret and principles.
Physiological bases of sensation and perception. Sensitivity thresholds. Selectivity, integrity. Individual and age
features. A pathology of sensations and perception: hyper- and gipoestesia, anesthesia, illusions, hallucinations
and frustration of touch synthesis. Objective signs of hallucinations and their classification: on sense organs,
hallucination of the general feeling, true and false hallucinations. A pathophysiological basis of illusions and
hallucinations. Infringement of touch synthesis. Features of infringement of perception at various mental
diseases. Supervision and care of patients with perception infringement.
At a statement of a theme of lecture it is necessary to underline especially importance of mental activity in
human lives, constant and close interrelation "mental" and "somatic", a role of the mental factor in development
of some somatic illnesses.
It is necessary to underline also that general practitioners often meet such pathology of sensations as
сенестопатия, combined with a morbid depression. Knowledge of psychiatry will help отдифференцировать a
mental pathology from the somatic.
At an explanation of section of hallucinations, students should acquire that this pathology is a sign of the mental
frustration demanding treatment in stationary conditions. The student should acquire borders between norm and a
pathology of processes of perception, to familiarize with various kinds of infringements and to seize skills of
revealing of the given frustration on their external displays
Thinking. Definition. Concept, judgements, conclusions. Cogitative operations, thinking of the medical worker.
Individual and age features. Methods of psychological research of thinking. Norm and pathology borders.
Infringements of associative process. Pathologically accelerated and slowed down thinking. Ментизм, шперунг.
Разорванность, incoherence, инкогеренция thinking. Персеверации and pathological thoroughness. Аутичное,
, symbolical, paralogical thinking. Features of frustration of associative thinking at various diseases and
psychopathological syndromes.
Crazy ideas, definition, their clinical versions. Brad sensual, figurative, secondary. Brad of interpretation,
primary, systematized, interpretive. Classification of delirium by the maintenance: delirium of the relation,
prosecution, a poisoning, influence, greatness, self-abasement etc.
Crazy syndromes: паранойяльный, paranoid, galljutsinatorno-paranoid, парафренный. A syndrome of mental
automatism – Kandinsky-Klerambo syndrome. Crazy behavior, external signs of presence of crazy frustration.
Features of supervision and construction of mutual relations the nurse – the patient with thinking infringements.
Supervaluable ideas. Definition of concept and clinical value.
Persuasive conditions. Persuasive fears (phobias), the notions of compulsion, actions, representations. Objective
signs of the given infringements in behavior of the patient. Supervision and care of patients with thinking
frustration.
At a statement of materials of lecture it is necessary to inform of students that the abstract thinking is peculiar
only to the person and the more qualitatively it, the the person is more intellectual. Besides, should be told that
much on mechanisms of thinking isn't known to a science yet.
At an explanation of concept of delirium it is necessary to specify argumentativeness of the statement that at
delirium the consciousness isn't broken. Absence of criticality, speaks about нарушенности reality
comprehension, but ability of orientation is kept. It is necessary to note the big difference between sketchy
delirium and systematized, to give дифференциально – diagnostic criteria between delirium and obsessions.
Memory. Attention. The basic properties. Physiological bases of memory. Classification of kinds of memory.
Conditions of optimum storing. Preservation and reproduction of the remembered. Methods of psychological
research of memory and attention. Individual and age features. Communication of memory and attention with
other physiological processes.
Intelligence. Definition. The basic properties. Communication of intelligence with thinking and other
psychological processes. Individual and age features. Norm and pathology borders. Patopsihologichesky methods
of research.The basic quantitative and qualitative infringements of memory – гипомнезия, гипермнезия, an
amnesia (retrograde, антероградная, фиксационная, progressing). The law of Ribo. Paramnesias:
псевдоременесценции, конфабуляции, криптомнезии. Korsakovsky амнестический a syndrome. Walter
Bjuelja's triad. Psychiatry is part of medicine, medical discipline. In turn, it is divided into general psychiatry that
deals with the basic, common to many mental illnesses patterns and manifestations of mental disorder, the
etiology and pathogenesis, the nature of typical psychopathological processes, their causes, the principles of
classification, recovery problems, research methods, and private psychiatry investigating the specific mental
illness. By expanding the field of psychiatry formed its separate branches: child psychiatry, studying mental
illness in children, military psychiatry, exploring the features of mental illness arising in the army, their
prevention and treatment, as well as military and psychiatric examination, forensic psychiatry, which develops
problems forensic psychiatric assessment, psychiatric criteria for insanity and incompetence, the legal status of
psychiatric patients, psychiatric examination of labor, working on disability for mental illness, problems of labor
compensation, resettlement, employment persons with disabilities;
Pathology of sensation and perception. Sensation - a reflection of the individual properties of objects of the
surrounding material world and his own body (color, light, heat, pain, etc.), the result of the impact of objects in
the external world and his own body on the senses .. Perception - to play in the minds of a complete image with
all its properties and qualities. This is an active process. Man perceives only in activities at work that aggravates
and enhances perception. In the process of improvement and differentiation of perceptions happen automatically.
Only children at the beginning of the cognitive functions of perception is a complex process of individual acts of
elementary sensations. Illusion - twisted, wrong perception of real objects or items. Illusions under certain
circumstances may occur in healthy people. This is facilitated by the weakness of sight, hearing, fear. Man,
awesome, can take over in the dark wood figure of an attacker or any other subject. If he will not run away from
fear and will approach closer, you will see that he was wrong and corrects the error of perception. In healthy
people, like the illusion of short duration are different.
The following types of illusions:Verbal - arise in a state of anxious depression, intense fear. They appear in a
false perception of reality of what is happening around talking. In the words of others, not related to the patient,
he hears in his address accusations, threats and accusations.
Pareydolicheskie - arise against the background of incipient stupefaction, different and fantastic imagery.
Patterns on the wallpaper, cracks in the wall, flashing light on the ceiling start to move, take the shape of
animals, humans, monsters.Affective illusions occur against a background of fear, anxiety and depressed mood.
The noise of children playing happily outside the window, is seen as the cry of the tortured sick relatives, the
clatter of dishes - as saber rattling.
Hallucinations - the perception that does not exist or is currently missing object perception without an object.
Under the hallucinations to be understood spontaneously emerging views that are projected outward and thus
acquire the character, not distinguishable from reality. Material substratum of hallucinations are reporting sick,
revived to the extent of real perception, which is localized in the objective space, take on the character of reality.
Last seen in the fact that the patient reacts to the hallucinatory images of both the real-world objects and
phenomena. Hallucinations can occur not only on 5 senses, but in other senses - sense of the body in space,
feeling the pressure sensations from visceral organs.
Visual hallucinations are very diverse. They can be elementary (fotopsii), manifested in the form of light
flashes, light spots, bars, and sophisticated - with the vision of scenes. Panoramic hallucinations are immobile,
the patient "sees" the picture of the landscape. Visual hallucinations may be black and white or color, can be
painted in natural color or monochrome. Visual hallucinations may be total and lacunary. In the first case, the
patient sees the full figure of a man or animal, in the second - their individual parts: nose, ears, head, horns, etc.
A variety of visual hallucinations - ekstrakampinnye under which hallucinatory image is localized outside the
purview of the patient. The patient may describe the size and color of the ulcer, localized in the sky, without the
help
of
a
mirror
image
or
an
imaginary
person
who
is
behind
it.
Visual hallucinations are more common in acute and acutely occurring emerging psychosis associated with CNS
intoxication, infection, accompanied by a dimming of consciousness. They are often seen in the picture of
epileptic psychosis. Auditory hallucinations in the picture of mental illness occupy a large place. Razlichat
acousma (non-verbal hallucinations - the noise, whistling, banging, crashing, banging, etc.) and phoneme (human
speech). Auditory hallucinations are often unpleasant for the patient, threatening, swearing content. It reflects the
affective state of patients. If you are depressed state of different voices threatening and accusing the contents,
then the high spirits of patients is beneficial, benevolent. A variety of auditory hallucinations are command
hallucinations. The patient hears voices commanding him to commit a particular act. Under the influence of
hallucinations, patients may carry dangerous to others and of himself. Analysis of features of manifestation of
auditory hallucinations in each case can be a major tool in the diagnosis of mental illness and determining its
prognosis. Thus, if schizophrenia voice that the patient hears, are turning directly to him, when psychosis
exogenous voices speak about a patient in the third person. In the olfactory hallucinations of the patient has more
disgusting (smell of a corpse, urine, feces, pus, etc.), at least - pleasant smells. When taste hallucinations he feels
alien to the food taste. Hallucinations of smell and taste, occurring less frequently than visual or auditory, is most
often seen in patients with schizophrenia. By tactile hallucination is the perception on the skin or under the skin
of worms, insects or other foreign objects. In all these cases the experience of patients is not accompanied by
their visual perception. A variety of tactile hallucinations are oropharyngeal foreign body when the patient feels
oropharyngeal foreign body (skin, hair, wool, straw, wood lice, leeches, etc.) and produces a motion that mimic
the extraction and removal of them. Tactile hallucinations developed in the administration of tetraethyl lead, the
picture of alcoholic, epileptic, influenza and tuberculosis psychoses. Temperature hallucinations - the feeling of
heat in a particular area of the body. Gigricheskie hallucinations - the feeling of the presence of moisture on the
surface of the body. Visceral hallucinations - the feeling in the body cavities of frogs, snakes, spiders, other
animals or inanimate objects. Pseudohallucinations unlike hallucinations, first of all, do not identify with real
objects, the patients talk about the special voices, visions, and secondly, they are considered sick as a result of
exposure, violence, manifested externally, and thirdly, they are usually not projected outwards, and are located in
subjective space, while the patients see their "inner eye", "The eyes turned inward."
Pseudohallucinations can be localized outside - in cases of olfactory pseudohallucinations when the patient
claims that by the action of external force caused by hideous smells that he feels in real space.
In these cases the main differential diagnostic features are unreal character pseudohallucinations
psevdogallyutsinatornyh images, their subjectivity, feeling madeness, violence, and alienation. By
pseudohallucinations patient consciousness is always receptive, it does not recognize them their property,
because the occurrence of these subjective phenomena never accompanied by the subject's sense of their own
activities. When visual pseudohallucinations patients speak of "made", showing images, pictures.
When patients hear the auditory pseudohallucinations "made", transmitted at a distance voice, localized in the
head, abdomen, stomach, upper and lower extremities. The votes belong to friends or strangers for men, women
or children, often distinguished by swearing, accused, orders, commenting content.
If you feel sick hallucinations Speech Movement's own language, which arise against their will under the
influence from the outside. Often movements are accompanied by pronunciation of words.
Functional hallucinations are one of the first symptoms of acute intoxication and acute psychosis which
developed schizophrenia, occur in the presence of real-life stimulus, and there are up to as long as there is this
real stimulus. In contrast, functional hallucinations, delusions do not merge with a real object, as seen along with
him. For example with the noise of running a car engine together with sick that hears the voices of the noise, the
threat in his address, when the car drives off and stops the engine noise, voices disappear.
Inspired by hallucinations occur in the presence of hallucinatory state of readiness. The most common:
1. Lipman symptom - the patient awake at all ages descended pressure on the eyeball can cause visual
hallucinations;
2. Reichardt symptom - the patient sees on a blank sheet of paper drawings or reading a text that does not exist;
3. Aschaffenburg symptom - the patient is talking on the phone disconnected from the network.
Often patients hide their hallucinatory experiences. In these cases come to the aid objective signs of
hallucinations. Patients listened to the voices, meet them or stop one's ears with cotton wool, paper, clay, covered
with their hands. In the olfactory hallucinations of the patients nose clamped, with visual hallucinations - watch
look for nonexistent objects, peering into something or zazhmurivayut eyes.
Hypersthesia - hypersensitivity to external stimuli. With her diverse stimuli, which in a balanced state of the
human body are not noticed, are becoming unbearable. The light seems unusually bright sound - very loud,
smells - too much to bear, the clothes - the rough. Increased susceptibility of external stimuli, and neutral in the
normal state of the body, often observed in patients with symptoms of astenizirovannyh irritable weakness.
Hypoesthesia - lowering the sensitivity to external stimuli - a disorder, the opposite hypersthesia, and is
manifested in the fact that everything around is perceived unclear remotely. Things look washed out, the sounds
are
heard
from
afar
the
light
of
day
seems
dim.
Senestopatii - various, painful, very unpleasant sensations in the form of contraction, perturbation, bursting,
turning over in his hands, feet, joints throughout the body. They are usually characterized by uncertainty and
ambiguity of feelings, and therefore the patients often to explain his feelings have resorted to comparing. With
this study the relevant authorities of modern methods do not detect any change.
Violations of sensory perception are psychosensory disorder, manifested in the distortion of the external world
and his own body. They are:
1. imperception body schema - a patient feel that his body is lengthened, shortened, expanded, his head swells,
the language does not fit in the mouth, the limbs are lengthened or shortened, the body may feel light or heavy;
2. violation of the perception of objects in space - they are perceived as real, but distorted perception of
their shape and size: the objects increases (makropsiya), decrease (mikropsiya), elongated (porropsiya), distorted
form (dismegalopsiya);
3. violation of the perception of time - the time it runs excruciatingly long, flowing at an incredible pace.
At an explanation of section of hallucinations, students should acquire that this pathology is a sign of the mental
frustration demanding treatment in stationary conditions. The student should acquire borders between norm and a
pathology of processes of perception, to familiarize with various kinds of infringements and to seize skills of
revealing of the given frustration on their external displays
Thinking. Definition. Concept, judgements, conclusions. Cogitative operations, thinking of the medical worker.
Individual and age features. Methods of psychological research of thinking. Norm and pathology borders.
Infringements of associative process. Pathologically accelerated and slowed down thinking. Mentism, Shperung,
incoherence thinking. Perseveration and pathological thoroughness. Autistic, symbolical, paralogical thinking.
Features of frustration of associative thinking at various diseases and psychopathological syndromes.
Crazy ideas, definition, their clinical versions. Brad sensual, figurative, secondary. Brad of interpretation,
primary, systematized, interpretive. Classification of delirium by the maintenance: delirium of the relation,
prosecution, a poisoning, influence, greatness, self-abasement etc.
Crazy syndromes: paranoia, paranoid, galljutsinatorno-paranoid, parafren. A syndrome of mental automatism –
Kandinsky-Klerambo syndrome. Crazy behavior, external signs of presence of crazy frustration. Features of
supervision and construction of mutual relations the nurse – the patient with thinking infringements.
Supervaluable ideas. Definition of concept and clinical value.
Persuasive conditions. Persuasive fears (phobias), the notions of compulsion, actions, representations. Objective
signs of the given infringements in behavior of the patient. Supervision and care of patients with thinking
frustration.
At a statement of materials of lecture it is necessary to inform of students that the abstract thinking is peculiar
only to the person and the more qualitatively it, the the person is more intellectual. Besides, should be told that
much on mechanisms of thinking isn't known to a science yet.
At an explanation of concept of delirium it is necessary to specify argumentativeness of the statement that at
delirium the consciousness isn't broken. Absence of criticality, speaks about нарушенности reality
comprehension, but ability of orientation is kept. It is necessary to note the big difference between sketchy
delirium and systematized, to give дифференциально – diagnostic criteria between delirium and obsessions.
Memory. Attention. The basic properties. Physiological bases of memory. Classification of kinds of memory.
Conditions of optimum storing. Preservation and reproduction of the remembered. Methods of psychological
research of memory and attention. Individual and age features. Communication of memory and attention with
other physiological processes.
Intelligence. Definition. The basic properties. Communication of intelligence with thinking and other
psychological processes. Individual and age features. Norm and pathology borders. Patopsihologichesky methods
of research.
The basic quantitative and qualitative infringements of memory – гипомнезия, гипермнезия, an amnesia
(retrograde, антероградная, фиксационная, progressing). The law of Ribo. Paramnesias:
псевдоременесценции, конфабуляции, криптомнезии. Korsakovsky амнестический a syndrome. Walter
Bjuelja's triad.
OLIGOFRENIA. Expressiveness degrees – moronity, a deficiency of intellect, an idiocy. DEMENSION –
LACUNAR and total. The characteristic деменции depending on a nosology. Objective signs of intellectuallymnesticheskih infringements. Supervision and care of patients from memory and mind pathologies.
At a statement of materials of lecture it is necessary to underline about a special place of memory in mental
activity of the person. Besides, it is expedient to result the comment of academician P.K.Anokhin on article of
the American scientist about possibility of transfer of "knowledge" by introduction of an extract (suspension) of a
brain of one individual to other, live person. This most proves the molecular mechanism of memory.
It is necessary to direct also attention of students to problem urgencies олигофрении. In connection with
application in the past ядохимикатов, the broken ecology the quantity sick of the given pathology has sharply
increased. To it promoted both frequent to pregnancy, and childbirth of local women, related marriages, etc.
social factors. Therefore, for preventive maintenance олигофрении explanatory work of medical workers among
the population is important. For work of the staff nurse knowledge of external displays of the given pathology are
very important, abilities to speak with patients of various intellectual level to have skill on care of patients with
intellectual-mnesticheskimi infringements.