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Section 8. Medical science
In the firstdays after the injury for all patients on a healthy foot measured bone mineral density (BMD) by ultrasonic densitometer “SONOST 3000” (Korea). Further dynamics of BMD at the heel bone were measured at 3, 6 and 12 months, the results of which were compared with each other.
Results and discussion: UZDM — characterizes the state of bone mineral density in terms of the speed of passage of ultrasound (SOS — Speed of sound) and broadband attenuation (BUA — Broadband ultrasound attenuation) and reflects the number, size and spatial orientation of the trabeculars of bone.
After operation, setting rod compression-distraction device with dynamic unloading to the hip joint, UZDM conducted on healthy limb in 1-2 days and after 3 months in the affected limb after removal of the device, in order to avoid distortion of the results, because automatic program summarizes bone density and device, thus giving knowingly false results.
When surgical treatment with the use of dynamic unloading apparatus, we obtained the following results. A normal BMD came from these indicators BMD of healthy limbs. This group consisted of 28 patients. UZDM results in injuries of the acetabulum were: the first day was the norm — in 24 (85.7 %), osteopenia in 3 (10.7 %) and osteoporosis in 1 (3.6 %) patients. After 3 months of normal BMD have not been identified, all patients with acetabular
fractures observed: osteoporosis in 24 (85.7 %), and osteopenia in 4 (14.3 %).
After 6 months of normal BMD were observed: 14 (50.0 %), osteopenia in 8 (28.6 %), osteoporosis-6 (21.4 %) patients. These BMD at 18 months were as follows: normal values of bone mineral density in 22 (78.6 %), osteopenia in 4 (14.3 %) and osteoporosis in 2 (7.1 %) patients.
Changes in osteopenia and osteoporosis in healthy limb dynamics we have not obtained. In the group of patients with fractures of the acetabulum, who used the device of dynamic unloading device recovered of BMD in 22 (78.5 %) patients.
Thus, the dates UZDM shows, that — 22 (78.5 %) from 28 patients recovered with normal BMD, which was imposed author rod compression-distraction apparatus with dynamic unloading device, as a consequence, early static load on the limb was the prevention of osteoporosis.
Conclusions:
1. The use of traditional treatments (plaster cast, skeletal traction) and immobilization 3-4 months, leading to inactivity and loss of bone mineral density, thus reducing the quality of life of patients.
2. Using the author device, allows to make an early activation of the patient on the 2nd day after the operation, which contributed to the recovery of BMD 22 (78.6 %) of the 28 studied.
References:
1. Beletsky A. V, Varanovich A. I., Murzich A. E. Determine indications for surgery and the choice of surgical approaches for complex fractures of the acetabulum.//Journal of Traumatology and Orthopedics N. N. Pirogov. - 2010. - № 4. - P. 30-37.
2. Buachidze O. Sh., Onopriyenko G. A., Voloshin V. P., Zubikov V. S. Surgery of the hip joint. - M.: Medicina, 2002 - 136 p.
3. Landa VA., Bulibina T. I. To diagnosis and treatment of patients with fractures of the acetabulum.//J. Health and Medical Technology. - 2005. - № 8. - P. 22-23.
4. Rakhimzhanova R. I., Abdrakhmanov J. S., Spichak L. V. Radiological diagnosis of aseptic necrosis of the femoral head.//Consilium. - 2010. - № 6. - S. 26-28.
5. Berry D. J., Halasy M. Uncementedacetabular components for arthritis after acetabular fracture.//Clin Orthop Relat Res. -2002. - P. 164-167.
6. Gary J. L., Van Hal M., Gibbons S. D., Reinert C. M., Starr A. J. Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation.//J Orthop Trauma. - 2012. - P. 278-83.
Chembaev Bulat Renatovich, PhD student, Tashkent Institute of Postgraduate Medical Education E-mail: [email protected] Yeshimbetova Saida Zakirovna, Doctor of Medical Sciences, professor, Tashkent Institute of Postgraduate Medical Education
Characteristics of panss’s values and theirs dynamics among individuals with schizophrenia who have committed grave socially dangerous acts
Abstract: The paper attempts to evaluate values of the PANSS scale of positive and negative syndromes of schizophrenia among 157 individuals with schizophrenia who have committed grave socially dangerous acts according to psychopathological mechanisms. The PANSS scale confirmed the specificity and isolation of the identified
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Characteristics of panss’s values and theirs dynamics among individuals with schizophrenia who have committe...
psychopathological mechanisms of commitment of grave socially dangerous acts by schizophrenics, and also revealed the dynamics of psychopathological symptoms, which is important in the working out of differentiated treatment and preventive activities.
Keywords: schizophrenia, socially dangerous acts, psychopathological mechanisms, PANSS scale, forensic psychiatry.
Introduction
In 1996, at the 49th session of the World Health Assembly, the resolution WHA 49.25 was adopted. It declared violence to be the major and ever-growing public health problem all over the world. In the “World report on violence and health", an ecological model of interpretation of violence was used to study relationships between individual and contextual factors, which considered violence as a product of multiple factors that influence person’s behavior [4]. Multiple factors take part in the genesis of grave socially dangerous acts committed by schizophrenics, so it is necessary to develop and improve special methods, taking into consideration both medical and legal aspects, to prevent such acts [5; 6], especially because it is very difficult to predict aggression and violent acts by schizophrenics [1; 2; 3]. The PANSS (Positive and Negative Syndrome Scale) is one of the most important rating instruments for patients with schizophrenia.
Objectives
This study was to evaluate symptoms and signs of schizophrenia in patients who have committed grave socially dangerous acts, by using the PANSS scale of positive and negative syndromes of schizophrenia and to compare these results according to psychopathological mechanisms of socially dangerous acts of mental patients.
Materials and methods
According to the law of the Republic of Uzbekistan, individuals who have committed grave socially dangerous acts because of a mental disorder and who are found not guilty by reason of insanity by the courts, are exculpated and subject to compulsory treatment for an indefinite period of time (in the Tashkent High Security Psychiatric Hospital, the only high-security hospital for mentally-ill offenders in Uzbekistan). Patients of this hospital, who have committed serious assaultive acts (homicide, attempted homicide, grievous bodily harm) and met ICD-10 criteria for schizophrenia were included in the study. The data were collected via face-to-face interviews, and also from the patients’ charts and forensic psychiatric examination statements. To evaluate the mental state and its dynamics we used the PANSS scale. We measured values at the time of commitment of socially dangerous acts and one year later, during the compulsory treatment and then calculated the difference between them. We evaluated the mental condition of 157 patients whose medical documentation contained comprehensive information, so we were able to use all features of the PANSS scale.
The data were analyzed using Statistica v.10. Statistical analysis included the Kruskall-Wallis test was used for ranking the variables. The significance level was set at 0.05.
Results
We used the systematics of psychopathological mechanisms of socially dangerous acts of mental patients (Maltseva M. M., Kotov V. P.) to study the deluded experiences of patients who had committed socially dangerous acts by productive-psychotic mechanism. We found that the content of morbid experiences was miscellaneous and not always included active aggression against the victims. Therefore, depending on the degree of the subject’s participation in realization of the morbid experiences, we identified two separate psychopathological mechanisms in the structure of the productive-psychotic mechanism, which we called “unconditional-psychotic” and “conditional-psychotic" mechanisms.
Unconditional-psychotic mechanism assumes psychopathological symptoms that force the patients (regardless of their mentality) to commit socially dangerous acts. Such symptoms included consciousness disorder, delusion, and perceptual disturbance, when patients experience an imagined imminent threat to themselves or to family members (persecutory delusion with deadly threat, delusion of poisoning), delusion with significant affective component (delusion of littleness, altruistic delusion), automatic behavior, and impulsive actions associated with thought process disorder. The criteria of this mechanism are a lack of self-restraint from committing actions as a result of deep psychotic state (consciousness disorder, significant affective disorder, automatic behavior, though disorganization ruling out any purposeful activity) or the content of deluded experiences, which drive responses based purely on self-preservation instinct, and inconsistence of the aggression with the actual situation that lacks any threat to the patients’ (or their family members’) life or health.
Conditional-psychotic mechanism assumes psychopathological symptoms that do not force the patients to act aggressively. This mechanism prevails in cases where the content of delusion doesn’t include an imminent threat to the life of the patient who decided to respond in a socially unacceptable way (delusion of detriment, delusion of reference, delusion of control), or where imperative hallucinations make the patient to act aggressively. The criteria of this mechanism are conditionality of socially dangerous acts owing to deluded experiences: patients think that someone harms them (physically or morally), or the presence of imperative hallucinations that “order" the patients to commit aggressive acts, and inconsistence of the aggression both with the actual and imagined situation that lacks any threat to the patients’ life or health.
In case of negative-personality mechanism, a socially dangerous act is committed because the patient (owing
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Section 8. Medical science
to defective condition or a combination of acquired personality deformation and social personality characteristics) finds such illegal acts, which are related to the external situation and/or the patient’s impulses, acceptable.
This mechanism doesn’t rule out psychotic symptoms at the moment of commitment of socially dangerous acts in case of an external situation that, though being incongruous with the patient’s psychotic experiences, triggered the aggressive response mechanism specific to this patient. The criteria of
this mechanism are the commitment of socially dangerous acts based on common (for example, domestic) motives and negative psychopathological symptoms.
To evaluate the mental state and its dynamics depending on the identified psychopathological mechanisms, we used the PANSS scale. We measured values at the time of commitment of socially dangerous acts (Table 1) and one year later, during the compulsory treatment (Table 2), and then calculated the difference between them (Table 3).
Table 1. - Distribution of PANSS scale indicators for schizophrenics at the time of commitment of socially dangerous acts depending on the psychopathological mechanism of offence
Psychopathological mechanism
Unconditional-psychotic (n = 41) Conditio chotic 1 rnal-psy-n = 55) Negative- personality (n = 61) Kruska ANOVA l-Wallis ry Ranks Intergroup comparison
Average M Average M Average M H p
Scale of positive syndromes 23.58 5.81 22.49 4.26 18.95 4.97 19.91 < 0.001 1,2 > 3
Scale of negative syndromes 26.55 7.53 20.95 5.39 26.16 7.47 19.21 < 0.001 2 < 1,3
General psychopathological scale 51.40 9.80 44.47 8.76 43.97 9.54 15.86 < 0.001 1 > 2,3
Total points 101.52 19.13 87.91 14.51 89.08 18.53 13.83 < 0.001 1 > 2,3
Bipolar composite index (±) -2.98 7.13 1.55 5.66 -7.03 7.89 17.10 < 0.001 2 > 3
The highest values on all three scales were obtained for schizophrenics whose grave socially dangerous acts were based on unconditional-psychotic mechanism. The lowest values on the scale of positive syndromes, the general psychopathological scale, and composite index were obtained for schizophrenics whose offences were based on negative-personality mechanism.
The lowest values on the scale of negative syndromes were obtained for schizophrenics whose offences were based on conditional-psychotic mechanism; these patients’ results for the other scales were between the ones obtained for schizophrenics whose offences were based on the unconditional-psychotic and negative-personality mechanisms.
Table 2. - Distribution of PANSS scale indicators for schizophrenics one year after the commitment of socially dangerous acts, during compulsory treatment, depending on the psychopathological mechanism of offence
Psychopathological mechanism
Unconditional-psychotic (n = 41) Conditio chotic 1 nal-psy-n = 55) Negative- personality (n = 61) Kruska ANOVA i-Wallis jy Ranks Intergroup comparison
Average M Average M Average M H p
Scale of positive syndromes 12.23 2.81 12.47 3.39 12.82 4.10 0.24 0.89 ns
Scale of negative syndromes 22.25 7.57 20.29 6.20 25.08 5.04 16.97 < 0.001 2 < 3
General psychopathological scale 32.20 7.59 30.16 6.95 34.08 7.74 10.69 0.005 2 < 3
Total points 66.68 15.71 62.93 13.75 71.98 14.31 9.71 0.008 2 < 3
Bipolar composite index (±) -10.03 7.11 -7.82 6.65 -12.24 5.44 14.23 < 0.001 2 > 3
PANSS scale-based re-evaluation of the patients one year after the commitment of socially dangerous acts, during compulsory treatment, had not revealed any significant differences on the scale of positive syndromes between schizophrenics whose offences were based on different psychopathological mechanisms, which could be explained by the administration of antipsychotic drugs that mostly affected productive
psychopathological symptoms. The lowest values on the scale of negative syndromes and the general psychopathological scale, and the lowest values of composite index were obtained for schizophrenics whose offences were based on conditional-psychotic mechanism. The highest values on the scale of negative syndromes were obtained for schizophrenics whose offences were based on negative-personality mechanism.
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Rehabilitation methods of treatment of acetabulum damage
Table 3. - Difference between PANSS scale indicators during the compulsory treatment of schizophrenics (one year after they committed socially dangerous acts) and at the time of committing the offence
Psychopatholog ical mechanism
Unconditional-psychotic (n = 41) Conditio chotic 1 rnal-psy-n = 55) Negative- personality (n = 61) Kruska ANOVA l-Wallis jy Ranks Intergroup comparison
Average M Average M Average M H p
Scale of positive syndromes -11.35 5.86 -10.02 4.56 -6.13 4.99 24.21 < 0.001 1,2 < 3
Scale of negative syndromes -4.30 7.56 -0.65 4.59 -1.08 4.98 6.81 0.033 1 < 2
General psychopathological scale -19.20 11.94 -14.31 9.70 -9.89 8.42 16.43 < 0.001 1,2 < 3
Total points -34.85 21.65 -24.54 15.46 -17.10 14.69 18.07 < 0.001 1 < 3
Bipolar composite index (±) -7.05 7.82 -9.36 5.56 -5.21 6.39 12.03 0.002 2 < 3
Conclusions
By analyzing mental state dynamics, we found the greatest difference between the offence-time and treatmenttime values on all three scales for schizophrenics whose offences were based on unconditional-psychotic mechanism. The smallest difference on the scale of positive syndromes and on the general psychopathological scale was obtained for schizophrenics whose offences were based on negative-personality mechanism. The smallest difference on the scale
of negative syndromes were obtained for schizophrenics whose offences were based on conditional-psychotic mechanism; these patients’ difference for the other scales were between the ones obtained for schizophrenics whose offences were based on the unconditional-psychotic and negative-personality mechanisms. These differences allow one to detect the psychopathological mechanism of socially dangerous acts using the PANSS scale when no follow-up data are available.
References:
1. Monahan J., Steadman H.J., Appelbaum P. S., Robbins P. C., Mulvey E. P., Silver E., Roth L. H., Grisso T. Developing a clinically useful actuarial tool for assessing violence risk.//The British Journal of Psychiatry. - 2000. - vol. 176. - Р. 312-319.
2. Steadman H., Mulvey E., Monahan J., Robbins P., Appelbaum P., Grisso T., Roth L. and Silver E. Violence by people discharged from acute psychiatric impatient facilities and by other in the same neighborhood.//Archives of General Psychiatry. - 1998. - vol. 41. - Р 395-401.
3. Wallace C., Mullen P., Burgess P., Palmer S., Ruschena D. and Browne C. Serious criminal offending and mental disorder. Care linkage study.//British Journal of Psychiatry. - 1998. - vol. 172. - Р. 477-484.
4. World report on violence and health: summary. - Geneva, World Health Organization, 2002.
5. Мальцева М. М., Котов В. П. Опасные действия психически больных. - М., 1995. - 256 с.
6. Шостакович Б. В. Психические расстройства и преступность.//Механизмы человеческой агрессии. - М., 2000. -С. 150-160.
Shorustamov Mukhammad Todjalievich, Branch manager clinic of Tashkent Medical Academy,
Republic Uzbekistan E-mail: [email protected]
Rehabilitation methods of treatment of acetabulum damage
Abstract: The article is devoted to solving improvement of rehabilitation treatment methods in acetabular injuries. Offered algorithm enables to improve rehabilitation treatment methods of acetabular injuries and to introduce its usage widely in traumatology-orthopedics practice.
Keywords: rehabilitation methods, acetabulum damage, innovation algorithm.
Rehabilitation treatment is a main stage of restoration of functioning hip joint in patients with acetabulum damage. How shows our experience, inopportune started or inadequate rehabilitation methods of treatment may threaten even
high qualitatively performed surgical interventions. At present a great number of recommendations are worked out aimed at rehabilitation of this group of patients. But majority of them went out of date and require revision taking into account
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