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
9
Tema: MENTAL FRUSTRATION VASCULAR ORIGIN. MENTAL DISEASES IN
INVOLUTION AND SENILE AGE. MENTAL INFRINGEMENTS AT SENILE AGE.
SENILE PSYCHOSES.
(For teachers and students of higher medical educational institutions)
Training manuals
For Higher Medical Nurse Business faculty 3 courses
Tashkent 2011
Department of Psychiatry and Addiction
"Approved"
Vice-rector for academic,
Professor OP Teshaev
«___»________ 2011.
9
Tema: MENTAL FRUSTRATION VASCULAR ORIGIN. MENTAL DISEASES IN
INVOLUTION AND SENILE AGE. MENTAL INFRINGEMENTS AT SENILE AGE.
SENILE PSYCHOSES.
For Higher Medical Nurse Business faculty 3 courses
Higher Medical Nurse Business faculty ММК yes
checked and approved
The report № ______________
«___» ______________ 2011 __
TASHKENT 2011
Tema: MENTAL FRUSTRATION VASCULAR ORIGIN. MENTAL DISEASES IN
INVOLUTION AND SENILE AGE. MENTAL INFRINGEMENTS AT SENILE AGE. SENILE
PSYCHOSES.
Venue lessons, equipment
 Department of Psychiatry at the medical psychology at the base Tashkent Сity Clinical
Psychiatry Hospital
 Tables
 Slides
 Tables, charts, educational development in electronic format, computer
 Demonstrated on patients and volunteers
2. Duration of study topics:
Number of hours – 4,3
3. The purpose of training.
 To form a general idea of the impact of vascular pathology in mental activity;
 Give an idea of presenile and senile psychoses;
 Describe the main methods of diagnosis and treatment of diseases of vascular origin;
Tasks
The student should know:
- The concept of "mental disease of vascular origin," "presenile psychosis," "senile psychosis";
- Classification of diseases of vascular origin in psychiatry, their clinical characteristics;
The student should be able to:
Find an approach to patients suffering from diseases of vascular origin, a mentally ill person in elderly
and senile age and collect complaints, history, or Follow-up data to assess mental status, a preliminary
diagnosis.
4. Motivation.
Relevance of the topic is the increasing incidence of mental illness in elderly and senile age. Senile
psychoses, unlike other mental illnesses have their specific clinical manifestations are not observed in
other age periods
5. Interdisciplinary communication and intersubject.
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
communication with older people is inevitable for any medical specialty that is in contact with
patients.
6. The content of lessons.
6.1 The theoretical part.
Vascular brain disease, hypertension, hypotension, cerebral atherosclerosis is a systemic disease of
cerebral vessels with endocrine disruption, neurohumoral, and biochemical processes of metabolism, is
soaking vessel wall lipids, narrowing the bloodstream and reducing the elasticity of the walls, thereby
disrupted trophic tissue possible thrombosis and tissue necrosis areas developing MS.
Lang developed the etiopathogenesis of hypertension. Long-term stress conditions result in violations
of the regulation of vascular tone and form pockets of stagnant excitation and defeat is in the following
stages:
Stage 1 - functional changes - transient increase in blood pressure, labile blood pressure.
Stage 2 - Functional organic pathological changes in blood vessels, where all signs are stable, blood
pressure increased, but its level may vary.
Stage 3 - organic changes of blood vessels (stroke, necrosis, thrombosis) - pronounced sclerotic
changes,
organic
impairment
(encephalopathy)
in
varying
degrees
of
severity.
SYSTEMATICS mental disorders
IN VASCULAR DISORDERS.
Mental disorders in vascular disorders by type of flow can be: 1) acute, 2) subacute, and 3) chronic.
On the severity: 1) neurotic level, and 2) a psychotic level, and 3) dementia.
The
stages
of
development
of
mental
disorders
are:
Stage I - neurasthenic - manifested in the form of neurosis disorders that have a progressive nature
against the reduction of mental capacity.
Neurosis syndromes develop as a direct consequence of the deterioration of the cerebral blood flow
and lack of compensatory mechanisms. Their dynamics corresponds to the dynamics of vascular
disease. External factors can be used as a plot of experiences, but they do not determine the prevailing
nature of complaints and behavior. Major psychiatric disorders neurosis syndromes:
1. Asthenic syndrome. Asthenic disorders occupy a leading place among the neurotic and neurotic
disorders. This is the most common disorders in vascular diseases in the early stages of their
development, and the later with their wave-like flow. In the preferential localization of pathological
processes in the vessels of the brain asthenic disorders tend to occur against a background of
pulmonary manifestations psychoorganic violations in the form of slow and rigidity of thought
processes, memory loss for the current and recent events. This combination of symptoms led some
authors to call tserebrastenicheskim syndrome.
2. Tserebrastenichesky syndrome. Decreased performance is due not only to increased mental
exhaustion and fatigue after intensive exercise, but with a distinct slowing of mental activity and
memory impairment. Difficulty concentrating difficulty, combined with the play of recent events,
resulting in reduced efficiency of mental work. Patients have to spend much time on various quests to
repeat what has already been done. A critical attitude to the changes appeared more disorganized them.
They try to avoid the rush, to use in physical work and in the process of thinking is firmly fixed
stereotypes.
3. Astenodepressivnyh syndrome. Along with the above manifestations of asthenic and
tserebrastenicheskimi are clearly marked depressive components. Depressed mood with a sense of
hopelessness and futility is largely associated with feelings of deteriorating physical and mental
condition, but to some extent a direct and - somatogenic - a reflection of the general decline in vitality.
For depressed mood often associated irritability, especially in the mornings when it can reach the
degree of dysphoria. Another characteristic component of affective disorders is anxiety that comes
without some external reasons or due to temporary deterioration of general condition.
Stage II - encephalopathy - ie formation stage psychoorganic syndrome with the triad-Valberta Byuela
as a result of chronic insufficiency of the intracranial circulation, hemodynamic disorders. Therefore,
all the symptoms of vascular origin has a characteristic feature - the flicker of symptoms, which is
associated with compensation and decompensation of hemodynamics. Along with a decrease in
intellectual-mental capacity is a violation of adaptation in the usual stereotype of life and workloads,
the patient is coping, but at the slightest deviation, change the stereotype, the emergence of new
requirements - are lost, become distracted, unworkable, increased levels of anxiety and possible
development of vascular and acute psychosis cerebral accident (stroke, crises).
All vascular psychoses, and especially with the confusion, different blinking symptoms and gain in the
evening-night time, the presence of neurological disorders.
The main psychopathological syndromes of vascular psychoses:
1. Mania - is rare, only 4% of 150 surveyed. Less durable and is combined with an organic defect,
which is gradually growing, making more and more atypical mania. There are cases of manic
states after hemorrhage and mikroinfarktov brain.
2. Anxious-depressive syndrome. Anxiety is one of the most common disorders, especially in the
presence of hypertension. The degree of its severity may vary considerably from the abovedescribed neurotic fear of anxiety level to an uncontrollable psychotic episodes of anxiety and
fear, at the height of which may be a narrowing of consciousness. Patients become anxious,
confused, looking for help, but only after beginning to identify depressive symptoms with the
color of despair, sometimes with thoughts of his own guilt, or interpretative delusions, mostly
relations and harassment. Possible violation of individual episodes of perception as illusion or
simple hallucinations, suicide is a danger.
3. Depressive-dysphoric syndrome - characterized by gradual onset, irritability increases, patients
exhibit verbal aggression, hardly soothed. Or become tearful or moody.
4. Depressive-hypochondriac syndrome. Patients are becoming more and more fixated on
violations of various body functions, which may have existed in them before, but now their
value is overestimated, refracted through the assessment of hopelessness depressive state,
which leads to the formation of hypochondriacal delusions.
4. Anxious-delusional syndrome. Usually develop in the long process of the disease, after periods
of neurosis disorders and affective disorders. Develop delusional ideas of reference. Join
delusions of persecution. Some patients have hypochondriacal delusions orientation. The less
anxiety, the more able patients to critical toward their experiences. With increasing anxiety,
unstable equilibrium is disturbed again. Development of delusional beliefs in states of anxiety
and fear begins when a characteristic of these disorders, states in the form of restriction of
active and passive gain attention joins a distinct lack of capacity for analysis, synthesis,
abstraction. The same, apparently, explains the lack of systematic delusions.
Stunning
5. Stunning state of mild to moderate degree, developing subacute and sometimes lasting several
days. They are sometimes underestimated, bearing in asthenic conditions, on the other hand,
paying attention to the slowness and poor quality of the responses to classify them as
manifestations of dementia. Proper assessment indicates acute or subacute ischemic and poses
the problem of differentiation of neoplastic process.
Stage III - dementia - vascular dementia as opposed to progressive paralysis is partial, that is sick for a
long time is critical.
Types of dementia:
 Dismnesticheskaya - gross violations of memory safety of criticism;
 Senilnopodobnaya - coarsening, callousness, the loss of shame, greed, restlessness;
 Psevdoparaliticheskaya - disinhibition, carelessness, loss of moral and ethical criteria;
 Psevdotumoroznaya
load
up
stunned
with
focal
phenomena.
Rarely transition into total dementia.
Differential Diagnosis
Diagnosis is based on the identification of syndromes described, the nature of their origin and
dynamics. In patients with signs of somatonevrologicheskimi disease (atherosclerosis, hypoand hypertension, etc.)
On the vascular genesis should speak only when the emergence and further development of
mental disorders associated with pathogenic mechanisms that are characteristic vascular
pathological process, especially with hypoxia and brain with an organic lesion of him,
considering also the reactions of the individual to cardiovascular disease and disturbance of
cerebral function. Great diagnostic importance is the communication time between their
emergence and stability of the current violation of a vascular process, as well as the appearance
of additional physical disorders obliged cardiovascular disease. Confirmation of vascular
genesis of mental disorders at the stage of development of functional disorders is to identify the
initial symptoms psychoorganic (sharpening of personal characteristics, mnemonic and
affective disorders).
Among the important diagnostic features of vascular origin is the emergence of episodes of
repeated disturbances of consciousness, it is turned off in the acutest period of cerebral blood
flow, clouding in the acute stage of these disorders, and the appearance of confusion after
vascular crises or joining the most minor of exogenous hazard. For the flow of mental disorders
of vascular origin is characterized by acute or gradual and episodic variations, and
exacerbations of the development of certain syndromological structures. All this makes the
symptoms polymorphic. Cutting disorder that can unite the various stages of the disease, a
growth psychoorganic symptoms. Differential diagnosis of protracted psychotic disorder refers
to a complex problem. E. L. Sternberg (1977) considered it possible to dif. diagnosis of
vascular psychoses by endogenous attach importance to:
a simple clinical picture, and sometimes rudimentary psychiatric syndromes;
b) no tendency to complicate the syndrome and, conversely, a tendency to stabilize them or
reduction;
c) the relatively frequent occurrence of acute psychotic episodes of exogenous type.
Treatment.
Needed:
1. improve cerebral blood flow;
2. vasodilators - papaverine, dibasol, spazmolitin, nigeksin;
3. Anticoagulants - Heparin, sinkumar;
4. psychotropic drugs - fenolon, etaperazin, sanopaks, neuleptin;
5. antidepressants - triptizol, amitriptyline, tranquilizers, leponeks, nootropics, anticonvulsants.
In the appointment of treatment should remember the following principles:
1. take into account the stage, a clinic, the pathogenesis of the disease;
2. the complexity of treatment;
3. assignment of treatment after a thorough examination;
4. take into account the tolerance of drugs: soft prescribe antipsychotics, third dose of the slow
picking up individual therapeutic dose.
Schematically,
the
mental
illness
of
old
age
is
divided
into:
1. Mental disorders that are associated with menopause.
2. Involutional or presenile, psychosis (involutional melancholia, presenile paranoid).
3. Senile, senile psychoses (senile dementia, Alzheimer's disease) and sistemnoatroficheskie
brain disease (Pick's disease, etc.).
The latter group includes unequal in etiological and nosological forms of diseases, united by
common similarity: they all inherent gradually and steadily over a progressive disease process
with outcome in glubokle dementia.
Involutional melancholia - most often occurs in women aged 50 and 60 years. So far etialogiya
and pathogenesis of the disease is not fully elucidated. But the significance of endogenous
toxic process in the soil involyutsionnyhsdvigov in the body is not in doubt and he bezyslovno,
is a leading and decisive moment in the development of psychosis. Predisposing factors are a
variety of psychogenic or somatogenno.
Leading syndrome at all protyazheniiinvolyutsionny melancholy - anxious melancholy
depression with frequent addition of delusions samoobveneniya, upichizheniya or
hypochondriacal nature.
Patients are constantly in a state of restlessness, which is expressed in a confused bustle, which
changes from time to time expressed in agitation. They are rushing to Palam, finding a place
for himself, zalamlivayut hands and sometimes graze and scratch themselves, pull out a hair. It
is characterized by the wail of patients with a recurrence of complaints in the same terms.
Restlessness with time can be replaced inhibition, but anxious melancholy intensity is not
reduced. Anxiety is usually worse when the external conditions (transfer to another ward or
department). Disorders of perception often manifested in the form of verbal illusions in the
conversation surrounding the conviction are heard, censure and reproach. Comaticheskie
maloharakterny symptoms. Differs only in weight loss, premature aging. In some cases, the
disease becomes very turbulent and unfavorable course. It is expressed in a continuous agitated
excitement, verging on the degree of fury. The periods of agitation replaced helpless confusion
with the elements of confusion on the type of oneyroidnogo. Patients with catastrophic speed
weakened and depleted. Later motor stimulation can go a stuporous state resembling a
catatonic, with symptoms of negativism.
Flow. Involutional melancholia have a long course. It lasts for many months, sometimes years.
The outcomes of the disease are different. Perhaps a full recovery, but often leaves the
consequences of disease in the form of persistent fatigue with a reduction in overall activity at a
uniformly depressed. Pathological anatomy. In severe involutional melancholia there is a
general degeneration, mainly affecting the glands of internal secretion. Usually indicated
moderate strophic cerebral cortex (forehead - temporal divisions). Pathological pattern reflects
the toxic-anoxic changes in the central nervous system.
Differential diagnosis. In the involutional melancholia, especially early in the disease may have
difficulty in differential diagnosis, as in the elderly depressed state of various origins are often
accompanied by symptoms of anxiety and restlessness. From the manic - depressive psychosis
involutional melancholia offers the following features: absence of circular attacks in the past,
the prevalence of anxiety and fear in the clinical picture. From depression involutional
melancholia of vascular origin by the absence of wavy, shimmering flow and a certain
dependence of the depth of a psychotic state of oscillation of vascular tone.
Treatment. Currently, more useful antipsychotic drugs (chlorpromazine, etc.) in combination
with antidepressant (imipramine, imipramine, etc.)
Involutional (presenile) paranoid - otherwise referred to as involutional paranoia, involutional
paraphrenic, presenile delusion of damage.
The clinical picture. The disease is characterized by the gradual development of persistent
delusions on the background of clear consciousness and outwardly orderly conduct. Very
typical structure of delirium and its plot. In the delusional concept involves the narrow circle of
people (neighbors, acquaintances) who are suspected of intentionally causing all sorts of
trouble. Delusional themes of building usually does not extend beyond the narrow domestic
relations (delusions of "small scale", "everyday relationships"). Initially, patients are taken
around the claim for real everyday squabbles, but over time they gradually emerging clearly
pathological entity. Patients are convinced that the neighbors spoil their stuff, get smuggled
into the room, using the pick and picked up the keys to pour in food debris, cracks in the walls
and doing a room let in natural gas. At first, the neighbors are organized gatherings, come to
some obviously suspicious person. All this is done with the apparent aim of property damage,
injury or survival of the apartment. Often there are disorders of perception in the form of
olfactory hallucinations, auditory illusions, often in the form of verbal illusions. It differs also
delusional interpretation of bodily sensations, sometimes associated with physical disorders
(heart - the result of gas poisoning, etc.). Chronic course of illness. Somatic condition status of
any characteristic features can be identified.
Diagnosis. Differential - diagnostic difficulties always associated with the demarcation of
involutional paranoia of late schizophrenia. The essential criteria for the diagnosis are the
emotional safety of patients, the absence of clinical picture of symptoms of mental automatism.
Treatment. Performed in a hospital and is the application of massive doses of chlorpromazine
(up to 800-1000mt per day) or other antipsychotics. After discharge, patients should take it at
home in smaller doses (called podderzhivaoschaya therapy) .
Senile psychosis (senile dementia) - occurs in old age, usually between 70 and 80 years. At the
core of senile psychosis is a progressive atrophic process steadily brain, mainly affecting the
cerebral cortex. This process is an expression of pathology, rather than a natural physiological
involution of the parenchyma of the brain, occurring in old age ..
Reasons contributing to the development of senile psychosis, has not yet been established. It is
believed by some authors, a definite value in this regard are the hereditary factors.
The clinical picture. Clinic senile psychosis mainly from increasing global phenomena
naturally progressive dementia with memory disorders and subsequent decay of all mental
activity.
Development of the disease is gradual. Initial symptoms are expressed only in distraction and
forgetfulness, as well as a change in character traits that seem to be sharpened and act in an
exaggerated form.
In the future there are qualitatively different changes in the character (psychopathic disorder).
Patients become stubbornness, along with heightened suggestibility and naive credulity. A
critical attitude to existing disorders is completely absent. Dramatically upset the memory, and
the fresher experience, the sooner they are forgotten (Ribot law). Therefore, patients with life
begins to flow to cruise past events. Memories of episodes of long-term period and are the
subject of constant discussion. They always repeat the same thing, always it seems to them the
news. In familiar surroundings sick yet somehow retain orientation, but they are completely
helpless in the new location. Gradually the memory completely decays.
Clinical variants of the disease varied, and therefore stand the various forms of senile
psychosis. For a simple shape characteristic of the above picture of frustration. In some cases,
in addition to dementia, to the fore the affective disorders as a continuous depressed mood from
somber detachment from life.
Against the background of dementia in amnestic symptom often observed delusions of poverty
or a robbery. The patient becomes restless and extremely suspicious, hide their stuff in the
corners, forgetting about it, and all the accused, that they robbed and left penniless. Typical for
them at night worrying. During the day they are sleepy and sluggish, and at night they start to
wander around the apartment, knocking on doors to neighbors, searching for something, while
grumbling curse and resist attempts to put them under the bed.
Konfabulyatornaya form of senile psychosis, or presbiofreniya, previously considered as a
special kind of disease. In such cases, the amnestic syndrome combined with copious
confabulation which involve episodes of old events, simply allegations relating to the
environment
or
the
life
of
a
professional
activity
of
the
former.
Delirious and konfabulyatornuyu form refers to the form of senile dementia specific
localization otrofii or attach vascular and somatic disorders (AV Snezhnevsky).
Alzheimer's Disease - is a form (an early form of) dementia. The disease usually begins in
boleeranem age (between 55 and 65 years and 45-50 years in Dej). Potognomonichno that in
the beginning to the fore not personality changes, and focal disorder sostorony central nervous
system. The first symptoms of memory disorders can be expressed with the accession of spatial
dezirientirovki and confusion at a relative still retain the vitality and iffektivnoy elementv
criticism to his state. Over vremeniravevaetsya ulubokoe dementia with coarse and
aprakticheskimi afektivnymi disorders. In contrast to senile dementia of the disease over a
prolonged (10-15 years). In the final stage of the disease is completely lost derivation activity,
muscle rigidity appears extrapyramidal, grasping, proboscis and other reflexes.
Pathological anatomy. Morphological changes in the brain in senile psychosis are very
common. There is a general atrophy of the cerebral cortex predominantly frontal, temporal and
parietal lobes. Brain weight is much lower than the average age norms. Hard and soft meninges
cloudy, thickened, enlarged cerebral ventricles. Histologically, marked diffuse degeneration of
nerve cells, more pronounced in the third and fourth cortical layers of the frontal and temporal
individual.
Treatment. Senile psychosis persisted bonyh necessary in those cases. when they have suicidal
tendencies. Patients may present a danger to others, since they are often due to forgetfulness
and lack of understanding of his actions leave open gas burner valves, organize arson attacks,
etc.
In the case of excitation (senile delirium) used antipsychotics (chlorpromazine 25-100 mg),
cardiac agents; thoroughly hygienic care.
Pick's disease - occurs more often in predstarchekom age (59-60 years), and in some cases and
in younger (43-45 years), is an independent nosological form, related to the so-called systemic
degenerative processes (E.Ya. Sternberg). At the heart disease is a progressive atrophy of
individual brain regions, which usually covers the frontal and temporo-parietal lobes. The
frontal cortex is always affected more deeply.
The clinical picture. In most cases, early signs of disease are expressed primarily in changes in
personality, appearance of the patient such features in the character and behavior that
previously were not typical of him. At the same time came the thought processes visible with
the loss of critical faculties. Becomes impossible to adequate assessment of environmental
situation, lost the criteria of generally accepted rules of behavior, disappearing sense of
proportion and measure. The patient begins to make absurd acts, gross blunders in the
occupation, without noticing it.
The disease occurs in different ways, depending on the preferential localization of atrophic
process
During atrophy and Pick's slow chronic, progressive pathological process completes a full
collapse of mental activity. The average duration of illness 8-10 years.
Pathological anatomy. Differs sharply pronounced atrophy of the cerebral cortex, especially in
the frontal - temporal divisions. The surface of the atrophic areas takes the characteristic form
of "kernel of a walnut" (depletion of gyri and sulci depression). Atrophy extends to the white
matter and subcortical structures. Senile no crises, there is no degeneration of the fibrils, in
contrast to Alzheimer's.
Used in this lesson, new educational technologies:
Guidelines and technology of the business game "round table".
All students are divided into groups by drawing lots 3 groups of 4 students each. Each group
sits at a separate table, prepare a blank sheet of paper and a pen. In the worksheet, write the
date, group number, department, name Student participants in this subgroup, the name of the
business game. One of the participants in each group takes a question from the envelope.
Difficulty level of tasks for all subgroups of approximately the same. Students re-write on a
piece of his job. Embarks on a circle sheet. Each student writes his answer sheet and passes the
other. To answer every student is given 3 minutes. At the expiration of time shall be a teacher.
All the participants discuss the results, choose the most correct answers, which put a maximum
score. To play 15 minutes of discussion.
Complex issues for the business game "round table" on a practical lesson on the theme "Mental
disorders in involution and old age"
1. Specify the boundaries of involutional age.
2. Which mental disorders are found in the involution of age?
3. Premorbid features of patients with involutional melancholia.
4. Treatment of involutional melancholia.
5. Enter the premorbid features of patients with involutional paranoid.
6. What are features of delirium with paranoid involution.
7. Enter the symptoms of malignant catatonia.
8. What are the symptoms of an initial period of Alzheimer's disease.
9. What are the symptoms characteristic of the middle stage of Alzheimer's disease?
10. Symptoms of end-stage Alzheimer's disease.
11. Prove the symptoms of the initial period of Pick's disease.
12. Differential - diagnostic features of the disease Pick's and Alzheimer's disease.
13. Name the form of senile dementia.
14. What type of amnesia is the lead in senile dementia?
15. Personality changes in senile dementia.
6.3 The practical part.
STEP BY STEP PRACTICAL SKILLS FOR GPs on "HYPERTENSIVE"
Purpose: Supervision of patients with vascular disease, staging of the primary diagnosis,
assessment of severit of disease and basic treatment assignment
Ongoing stages (stage)
№
1
2
3
4
5
6
7
8
stage
event
not
fully
The patient sits in a chair at a distance of 1-1.5m, the doctor sits in front of the 0
test and asks for his mental status.
Of the complaints: headache, ringing in the ears, flies flickering before my 0
eyes, sleep disturbance, fatigue, irritability, anxiety, fears.
From the history of the disease: the beginning of a gradual, against stressful 0
situations
In the general examination: a serious condition, consciousness is clear. 0
Situation actively. Skin normal color, sweating, red dermographism.
Mental status: hypochondria, indecision, irritability, anger, autonomic 0
reactions, and mental disorders such as paroxysmal disorders, absence seizures,
twilight disorders, epipripadki, a person loses mental flexibility, nozofobii,
hallucinatory-paranoid syndrome
Rationale for the clinical diagnosis and exposure to the definition of severity, 0
according to the accepted classification
Possible
complications:
Dementia
0
5 0
Basic treatment:
antihypertensive treatment
sedatives
Tranquilizers
nootropics
satisfied
correctly
Prevention: outpatient observation
Total
10
100
0
0
15
15
10
10
10
15
10
2. STEP BY STEP PRACTICAL SKILLS FOR GPs on "Senile and presenile psychosis".
Purpose: the diagnosis, assessment of disease severity and the appointment of a basic treatment of
patients
with
pathology
of
presenile
and
senile
Ongoing
stages
(stage)
№
1
2
3
4
5
6
7
stage
event
not
fully
The patient is placed on a couch, the doctor is right, asks the passport data; ill 0
elderly
Of the complaints: weakness, fatigue, lethargy, nonvanishing after rest, sleep, 0
indecisiveness, excessive suspiciousness, obsession, melancholy mood.
Mental status: pomrachneno consciousness. Depression and anxiety on every 0
occasion, patients rassteryany, hyperkinesia. It is monotonic, verbegeratsiya,
when changing the seat anxiety increases.
Preliminary
diagnosis
of
presenile
psychoses. 0
Complete blood count: hemoglobin decrease, a slight increase in ESR
Justification and exhibiting clinical diagnosis of certain forms of the disease, 0
according to the accepted classification
Possible complications: suicide attempts at the height of attack, death by 0
misadventure.
Basic treatment:
0
1) The restrictive regime
2) antipsychotics
satisfied
correctly
15
15
10
15
10
15
15
3) ECT (electroconvulsive therapy)
4) ICT (acupuncture)
5) hypnotics
6) sedatives
7) antidepressants
Total
0
100
8. Criteria for evaluating the current control.
№
1.
Progress in
number (%)
96-100
2.
91-95
3.
86-90
4.
81-85
5.
76-80
scoring
Excellent
"5"
Good "4"
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
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
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
6.
71-75
7.
66-70
8.
61-65
9.
56-60
10.
55 and
below
№
1
2
3.
4.
5.
6.
7.
8.
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)
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.
Length in
minutes.
180
225
5
10
50
50
10
15
medical history, clinical
role-playing case studies
Working with the clinical
laboratory instruments
30
40
25
30
Oral questioning, test,
debate, discussion of the
practical work
25
30
Information, questions
for self-study
10
20
10. Quiz Questions
1. Defining the essence of the concept of "brain disease".
2. Etiology and pathogenesis of vascular diseases of the brain.
3. Clinic, the dynamics, the outcome of brain vascular diseases.
4. Features of treatment of patients with cerebral atherosclerosis and hypertension.
5. Selection criteria involutional age - menopause, presenile, senile.
6. Psychiatric disorders in menopause.
7. Mental disorders in senile age.
8. Mental disorders in presenile age.
11. Recommended reading.
1. Zharikov, NM et al. - "Psychiatry". Textbook, 1989.
2. Alimov, HO, Alimov U.H. - "Psychiatry klinikasining mukadimasi."
3. Huzhaeva NI , Shayusupova AU "Psychiatry." Textbook in Uzbek.
4. Guide to Psychiatry, edited by AV Snezhnevsky, Moscow, Volume 1.
11. Recommended reading.
1. Zharikov, NM et al. - "Psychiatry". Textbook, 1989.
2. Alimov, HO, Alimov U.H. - "Psychiatry klinikasining mukadimasi."
3. Huzhaeva NI , Shayusupova AU "Psychiatry." Textbook in Uzbek.
4. Guide to Psychiatry, edited