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10Д1АГНОСТИЧН1 КРИТЕРН ПСИХ1ЧНИХ РОЗЛАД1В У В1ДДАЛЕНОМУ ПЕР1ОД1 ЧЕРЕПНО-МОЗКОВО1 ТРАВМИ
В. Е. Казаков ДЗ «Луганський державний медичний ушверситет»
Резюме. Пщ спостереженням знаходилися 437 хворих з вщдаленими наслдками черепно-мозково! травми. Хворi дослджувалися клiнiко-психопатологiчним, психодiагностичним, нейропсихологiчним та шструментальними методами. У процесi дослiдження виявилося, що до дiагностичних критерив у вщдаленому перiодi черепно-мозково! травми можна вiднести специфшу клжчно! картини рiзних психопатологiчних варiантiв, стiйкi специфiчнi пору-шення сну, когнiтивнi порушення у виглядi розладiв емоцшно! пам'ятi та когштивного на-вчання.
Kamhobí слова: критери, ЧМТ, психопатолоия, порушення сну, когттивне научшня
УДК 612.821+616.89
EMOTIONAL DISTURBANCES ON PANIC DISORDER PATIENTS
O. I. Kudinova Kharkiv Medical Academy of Postgraduate Education
Summary. The considerable growth of anxiety disorders consists paroxysmal phenomena contemporary happened. The panic disorder (PD) is the main in their structure. The emotional disturbances of 40 PD patients and 20 agorafobia patients. By were investigated with the clinic and pathopsychological methods. The high level of anxiety was shown. By pathopsychologically investigation the high level of personality anxiety and low level of neurotism and depression were indentified. The system of psychotherapy correction was established, with high efficacy in 68% cases.
Key words: Emotional disturbances, panic disorder, psychotherapy correction.
Paroxysmal disturbances are one of the most important problem of modern medicine. This is due to their significant prevalence. According to epidemiological researches up to 80% of the population suffers from paroxysmal and permanent vegetative symptoms that clinically manifested as vegetative dysfunction syndromes [1, 2]. One of the most common form of vegetative dysfunction is the panic disorder (PD), which manifested by paroxysmal disturbances as panic attacks (PA) with vegetative, emotional and ideatoryc components [3].
The modern concept of panic disorder had been formed in the middle of the last century in two areas: medical and psychological. The first detailed clinical description of the disease had been made by American therapist J. M. Da Costa in 1981, although the author assessed the condition as a disorder of heart activity. After this appeared the term «Da Costa's syndrome» [4]. In the psychological medicine panic attacks for the first time had been described by O. Domrich (1849), who believed that they were caused by strong emotional reactions. PD had been acknowledged for the first time as separate diagnostic category «panic disorders» (PD) in the American classification DSM-IV [5]. There had been highlighted the following diagnostic criteria: a clear frequency of anxiety attacks (panic), the appearance of anticipatory anxiety in the «interictal period» and the frequent development of agoraphobia, an increased hereditary genetic risk for PD, marked relationship with depression and alcoholism; frequent presence of mitral valve prolapse; provocation of panic attacks by sodium lactate and carbon dioxide, high effectiveness of antidepressants, inefficiency of the traditional benzodiazepine tranquilizers and psychotherapy.
Under the traditional nosological approach PD most frequently were described in the structure of neurosis as a «vegetative crisis» (often sympathicotonic, less often mixed or vagoinsularly), in the structure of which had been included a state of anxiety and fear. Later, in
Клиническая психиатрия и психофармакотерапия
progredient development, arise phobic disorders such as agoraphobia, cardiophobia, insultofobia. At the same time, doubtless pathogenetic part of PD are emotional disturbances. In the ICD-10 panic disorder stand out as a separate diagnostic unit (F 41.0), in a cluster of neurotic and somatoform disorders [7].
According to statistical research from 1 to 4% of adult population suffers from PA at stated periods of their life (Angst J. Wicki W., 1993). In a special epidemiological research were found that subsyndromal (not attained the diagnostic criteria of ICD-10 and DSM-IV), but defined as syndrome and required therapeutic intervention forms of PA found in 9-19% of the adult population (Angst J. Wicki W., 1994). About 15% of people experience panic attack in their life. PA are more common among younger people (mostly women), appears at the age of 20-30 years, and very rarely under 15 and after 65 years (Wayne A. M., 1998; Smulevich A. B., 2000) [3, 4, 5, 8].
PA usually occurs on the background of psychogenic (highpoint of the conflict, under influence of severe stress) and biological (hormonal changes, onset of sexual activity).
At the same time, in conjoint diagnostic criteria of PD had pointed that PA develops without any connection with current psychological factors.
All of the above was the rationale for the research, the aim of which was: to investigate the state of the emotional sphere of patients with panic disorder.
Contingents and methods. In the main group were examined 40 patients with panic disorder (F 41.0), and 20 patients with agoraphobia (A) (F 40.0), as the control group. All the patients underwent clinical, psychopathological and psycho-diagnostic revision using the Hamilton Depression Rate Scale, the scale of personal anxiety and reactive anxiety by Spielberger, Eysenck questionnaire, questionnaire of personal accentuation by Leonhard.
Results and discussion.
Clinical and psychopathological research of patients with PD showed that the paroxysmal clinical manifestations fit into the pattern of PA symptoms complex.
Paroxysm started on sudden feeling of intense fear, the intensity of symptoms increased critical. The structure of paroxysmal vegetative symptoms include: tachycardia, sweating, dry mouth; vegetative-visceral symptoms: shortness of breath, feeling of choking, discomfort or pain in the chest, nausea or abdominal discomfort, flashes of hot and chill, paresthesia; ideatory-emotional symptoms: dizziness, instability, nausea, weakness, with elements of derealization, depersonalization, fear of madness, loss of self-control or felling of coming loss of consciousness, fear of death.
Permanent manifestations were detected mainly in the control group (A) and were characterized by asthenic, anxious and subdepressive symptoms, that submitted in a variety of syndromes: anxious-phobic - 31%, asthenic-depressive 16%, asthenic-hypochondriacal - 16%, asthenic, anxiety - 21%, asthenic - 14%.
Among patients with PD leading psychopathological syndromes were: asthenia (20% patients), anxiety and depression (33% of patients) and hypochondriac (46.66% of patients).
Materials of pathopsychological research have shown the following. Patients with PD, according to Ayzenk scale in 55% of cases noted high level of neurotism, while patients with agoraphobia in 47% of cases had domination of average level.
The average level of depression according to Hamilton scale in patients with PD was 16 points, which corresponds to moderate depression, and patients with agoraphobia had 20 points, i.e., correspond to high depression.
According to Spielberger scale PD patients the average anxiety level score was 39, and patients with agoraphobia - 42 points. Indicators of reactive anxiety were significantly different: patients with PD average level was 33 points, and patients with agoraphobia - 54 points.
By Leonhard scale were found that patients with PD overcame demonstrativeness - average score 17, torpidity - average score 16.5, exaltation - average score of 20.
Patients with agoraphobia had: hyperthymia - average rate 19, dysthymia - average rate 18, anxiety - average rate 21.
We have developed system of psychological correction of patients with PD. Psychotherapeutic methods used on the background of stabilizing pharmacotherapy and continued after it's termination. The best effectiveness had shown cognitive-behavioral therapy (CBT by A. Beck).
Therapy, developed by Aaron Beck, is a short-term structured therapy that uses active cooperation between the doctor and patient to reach therapeutic aims, and focuses on current problems and their resolution.
The theoretical basis of CBT is the idea that the affective and somatic-vegetative changes are interconnected and required cognitive correction.
The main goals of therapy were: 1) the identification of false conceptions of the patients about their disease; 2) training of alternative methods of response; 3) enactment of new ideas and new cognitive behavioral reactions.
CBT has performed 2-4 times a week, the duration of the course was from 4 to 6 weeks. CBT consisted of three main components: a didactic, cognitive and behavioral.
The didactic component included a rational explanation of false conceptions and erroneous logic to the patient. Held clarification of the association of thinking, behavior affects and logical explanation of the therapeutic process.
The cognitive component consists of four processes: 1) formation of new thinking stereotype, 2) testing of new stereotype, 3) identification of maladaptive provisions underlying the pathological symptoms, 4) changing the stereotype of maladaptive provisions.
The behavioral component been used to modify maladaptive or faulty thinking and behavioral stereotypes. The main methods: creation of optimal activity scheme, retention of new stereotypes, self-esteem training, role-play and distraction techniques.
The scheme has shown its significant effectiveness. Complete reduction of PD symptoms had achieved in 68% of patients, a significant improvement - in 20% of cases, no significant changes had detected in 12% of patients.
References
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2. Михайлов Б. В. Стан i стратепя реформування психотерапп i медично'1 психологи в Украшь //Медицинская психология.Т. 6. № 3 (23)' 2011.- С.44-47.
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4. Напреенко O. K. Депресп та тривога в загальномедичнш практищ (сощальш. доагностичш та лжувально- профтактичш аспекти) // Вюник психiaтрiï та психофармакотерапп, 2002, № 1, с. 7-12.
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6. Вейн А. М., Панические атаки // Международный медицинский журнал. —1997. —№ 3.— С. 75-79.
7.Коркина М.В., Марилов В. В. Психосоматические расстройства//Психиатрия.- М.: Медицина, 1995.- С.501-502.
8. Sartorius N. The classification of mental disorders in the Tenth Revision of The International Classification
of Diseases.- Sfera,- 1997.-104.
9. Manfred E. Beutel, Franz Bleichener, Friedrich von Heymann, Karin Tritt, Jochen Hardt: Anxiety Disorders and Comorbidity in Psychosomatic Inpatients. J Psychother and Psychosom 2010;79 (1):58.
10. Mergl R, Seidscheck I, Allgaier AK, Möller HJ, Hegerl U, Henkel V: Depressive, anxiety and somatoform disorders in primary care: prevalence and recognition. Depress Anxiety 2007;24:185-195.
11. Bisson, J.L., Shepherd, J. P., Joy, D., Probert, R., & Newcombe, R. G. (2004). Early cognitive-behavioral therapy for post-traumatic stress symptoms after physical injury. Randomised controlled trial. British Journal of Psychiatry, 814, 63-69.
12. Hunsley, J., & Lee, C. M. (2007). Research-informed benchmarks for psychological treatments: Efficacy studies, effectiveness studies, and beyond. Professional Psychology: Research and Practice, 38 (1), 21-33.
ЭМОЦИОНАЛЬНЫЕ НАРУШЕНИЯ У БОЛЬНЫХ С ПАНИЧЕСКИМИ РАССТРОЙСТВАМИ
Е. И. Кудинова
Харьковская медицинская академия последипломного образования
Резюме. В настоящее время наблюдается значительный рост тревожных расстройств с пароксизмальными проявлениями. В их структуре значительное место занимают панические расстройства (ПР). Нами было проведено изучение нарушений эмоциональной сферы у 40 больных ПР и 20 больных с агорафобией по данным клинических и психопатологических исследований. Установлен высокий уровень тревожной симптоматики. По данным патопсихологических исследований установлено, что у больных с ПР преобладает высокий уровень личностной тревожности, на фоне относительно низких показателей нейротизма и депрессии. Разработана система психоневротической коррекции, показавшая высокую эффективность в 68% случаев.
Клиническая психиатрия и психофармакотерапия
Ключевые слова: эмоциональная сфера, паническое расстройство, психотерапевтическая коррекция.
ЕМОЦ1ЙН1 ПОРУШЕННЯ У ХВОРИХ 13 ПАН1ЧНИМИ РОЗЛАДАМИ
О. I. Кудшова Харшвська медична академ1я тслядипломно! освiти
Резюме. В тепергшнш час помiчаeться значний зрiст тривожних розладгв з пароксизмаль-ними проявами. В !х структурi значне мiсце займають панiчнi розлади (ПР). Нами було проведено вивчення порушень емоцшно! сфери у 40 хворих з ПР та 20 хворих з агорафобieю по даним клiнiчних и психопатолопчних дослджень. Визначений високий ргвень тривожно! симптоматики. За показниками патопсихолопчних дослiджень визначено, що у хворих з ПР переважае високий ргвень особиспсно! тривожностi, на тлi вщносно низьких показниюв нейротизму та депреси. Розроблена система психоневротично! корекцп, що зазначила висо-ку ефективнiсть в 68% випадюв.
Ключовi слова: емоцшна сфера, панiчний розлад, психотерапевтична корекщя.
УДК 616.895.8-082.4/.6:340.63-039.76
НЕЙРОКОГН1ТИВНИЙ ДЕФ1ЦИТ У ХВОРИХ НА ШИ3ОФРЕН1Ю 3 ПРОДУКТИВНО-ПСИХОТИЧНИМ МЕХАН13МОМ РЕАЛ13АЦН СУСП1ЛЬНО НЕБЕЗПЕЧНИХ Д1ЯНЬ
А. М. Куштр
Державний заклад "Украшська психiатрична лшарня з суворим наглядом МОЗ Укра1ни",
м. Дншропетровськ
Резюме. У статтi наведенi результата анал1зу особливостей нейрокогнiтивного дефщиту у хворих шизофрешею, якi являють собою особливу сусп1льну небезпеку та ско!ли делшти за продуктивно-психотичним механiзмом !х реалзаци. На прикладi вичерпно! популяцп таких хворих в Украiнi видмено та описано характернi риси нейрокогттивних порушень у даного контингенту. Оцшена можливiсть використання вказаних ознак в лшувально-реабЫтацшному процесi, а також у якостi прогностичних щодо ризику повторних правопо-рушень у даного контингенту.
Ключовi слова: шизофрен1я, нейрокогнiтивний дефщит, сусп1льно небезпечнi д1яння про-ти життя особи, мехашзм реал1зацп особливо небезпечних д1янь.
Актуальн1сть теми. Останне десятир1ччя знаменувалося великою шльшстю широкомас-штабних дослщжень, що присвячеш вивченню нейрокогн1тивного дефщиту (НД) у хворих на шизофрешю [ 1-3]. Слщ вщмгтити, що низка 1х автор1в нашть вважають за дощльне вщокремити щ нейрокогн1тивн1 розлади у самостшну групу, поряд з позитивною та негативною симптоматикою [4-6]. Такий шдхщ пов'язаний, по-перше, з1 встановленням суттевих кореляцш м1ж р1внем НД та сощальним дефщитом, порушеннями глобального р1вня функщонування i функщональним виходом захворювання. А по-друге - науковим обГрунтуванням того факту, що НД заважае адаптацп хворих та перешкоджае 1х сощально! реабштацп [7-10].
Тем не менш, в доступнш лiтературi юнують лише поодинош роботи, що присвяченi дослiдженню нейрокогштивного дефiциту у пацiентiв з шизофрешею, що ско!ли сусшльно-небезпечнi д1яння (СНД) [11], а також заходам медико-сощально! реабштацп при них, зокре-ма у хворих, як1 ско!ли СНД за продуктивно-психотичним механiзмом !х реамзацп (П-П МР).
Мета дослщження: встановлення особливостей нейрокогнiтивного дефщиту у хворих на шизофрешю з продуктивно-психотичним механзмом реалзаци особливо суспьльно небезпечних д1янь.
