Treatment with psychology. Psychological treatments

1. WHAT ARE PSYCHOSES

The purpose of this material is to convey in the most accessible form to all interested people (primarily relatives of patients) modern scientific information about the nature, origin, course and treatment of such serious diseases as psychosis.

Psychoses (psychotic disorders) are understood as the most striking manifestations mental illness, at which mental activity the patient does not correspond to the surrounding reality, the reflection of the real world in the consciousness is sharply distorted, which manifests itself in behavioral disorders, the appearance of unusual pathological symptoms and syndromes.

Most often, psychoses develop within the framework of so-called “endogenous diseases” (Greek. endo – inside, genesis– origin). Variant of the occurrence and course of a mental disorder due to the influence of hereditary (genetic) factors, which include: schizophrenia, schizoaffective psychosis, affective diseases (bipolar and recurrent depressive disorder). The psychoses that develop with them are the most severe and protracted forms mental suffering.

The concepts of psychosis and schizophrenia are often equated, which is fundamentally wrong, since psychotic disorders can occur in a number of mental illnesses: Alzheimer's disease, senile dementia, chronic alcoholism, drug addiction, epilepsy, mental retardation, etc.

A person may experience a transient psychotic state caused by taking certain medicines, drugs, or the so-called psychogenic or “reactive” psychosis that occurs as a result of exposure to severe mental trauma (a stressful situation with a danger to life, the loss of a loved one, etc.). Often there are so-called infectious (developing as a result of a severe infectious disease), somatogenic (caused by severe somatic pathology, such as myocardial infarction) and intoxication psychoses. The most striking example of the latter is delirium delirium- “delirium tremens”.

Psychotic disorders are a very common type of pathology. Statistical data in different regions differ from each other, which is due to different approaches and the ability to identify and account for these sometimes difficult to diagnose conditions. On average, frequency endogenous psychoses makes up 3-5% of the population.

Accurate information about the prevalence of exogenous psychoses among the population (Greek. exo– outside, genesis– origin. There is no option for development due to the influence of external causes outside the body, and this is explained by the fact that most of these conditions occur in patients with drug addiction and alcoholism.

The manifestations of psychosis are truly limitless, which reflects the richness of the human psyche. The main manifestations of psychosis are:

• hallucinations(depending on the analyzer, auditory, visual, olfactory, gustatory, and tactile are distinguished). Hallucinations can be simple (bells, noise, calls) or complex (speech, scenes). Most common auditory hallucinations, the so-called “voices” that a person can hear coming from outside or sounding inside the head, and sometimes the body. In most cases, voices are perceived so clearly that the patient does not have the slightest doubt about their reality. Voices can be threatening, accusing, neutral, imperative (commanding). The latter are rightfully considered the most dangerous, since patients often obey the orders of voices and commit acts that are dangerous to themselves or others.

· crazy ideas– judgments, conclusions that do not correspond to reality, completely master the patient’s consciousness, and cannot be corrected by dissuading and explaining. Content crazy ideas can be very diverse, but the most common are: delusions of persecution (patients believe that they are being spied on, they want to kill them, intrigues are woven around them, conspiracies are being organized), delusions of influence (from psychics, aliens, special services with the help of radiation, radiation , “black” energy, witchcraft, damage), delusions of damage (they add poison, steal or spoil things, want to survive from the apartment), hypochondriacal delusions (the patient is convinced that he is suffering from some kind of disease, often terrible and incurable, stubbornly proves that he is affected internal organs, requires surgical intervention). There are also delusions of jealousy, invention, greatness, reformism, other origins, love, litigious, etc.

· movement disorders , manifested in the form of inhibition (stupor) or agitation. When stupor occurs, the patient freezes in one position, becomes inactive, stops answering questions, looks at one point, and refuses to eat. Patients in a state of psychomotor agitation, on the contrary, are constantly on the move, talk incessantly, sometimes grimace, mimic, are foolish, aggressive and impulsive (they commit unexpected, unmotivated actions).

· mood disorders manifested by depressive or manic states. Depression is characterized, first of all, by low mood, melancholy, depression, motor and intellectual retardation, disappearance of desires and motivations, decreased energy, a pessimistic assessment of the past, present and future, ideas of self-blame, and thoughts of suicide. A manic state is manifested by unreasonably elevated mood, accelerated thinking and motor activity, reassessment of the capabilities of one’s own personality with the construction of unrealistic, sometimes fantastic plans and projections, disappearance of the need for sleep, disinhibition of drives (alcohol and drug abuse, promiscuous sexual relations).

All of the above manifestations of psychosis belong to the circle positive disorders, so named because the symptoms that appear during psychosis seem to be added to the pre-morbid state of the patient’s psyche.

Unfortunately, quite often (though not always) a person who has experienced psychosis, despite the complete disappearance of his symptoms, develops so-called negative disorders, which in some cases lead to even more serious social consequences than the psychotic state itself. Negative disorders are so called because patients experience a change in character, personal properties, and a loss of powerful layers from the psyche that were previously inherent in it. Patients become lethargic, lack initiative, and passive. Often there is a decrease in energy tone, the disappearance of desires, motivations, aspirations, an increase in emotional dullness, isolation from others, a reluctance to communicate and enter into any social contacts. Often their previously inherent responsiveness, sincerity, and sense of tact disappear, and irritability, rudeness, quarrelsomeness, and aggressiveness appear. In addition, patients develop thinking disorders that become unfocused, amorphous, rigid, and meaningless. Often these patients lose their previous work skills and abilities so much that they have to register for disability.

2. COURSE AND PROGNOSIS OF PSYCHOSES

The most common (especially with endogenous diseases) is the periodic type of psychosis with occasional episodes of psychosis. acute attacks diseases, both provoked by physical and psychological factors, and spontaneous. It should be noted that there is also a single-attack course, observed more often in adolescence. Patients, having suffered one, sometimes protracted attack, gradually recover from the painful state, restore their ability to work and never come to the attention of a psychiatrist. In some cases, psychoses can become chronic and develop into a continuous course without disappearance of symptoms throughout life.

In uncomplicated and unadvanced cases, inpatient treatment usually lasts one and a half to two months. This is exactly the period doctors need to fully cope with the symptoms of psychosis and select the optimal supportive therapy. In cases where the symptoms of the disease turn out to be resistant to drugs, several courses of therapy are required, which can delay the hospital stay for up to six months or more. The main thing that the patient’s relatives need to remember is that do not rush the doctors, do not insist on an urgent discharge “on receipt”! It takes a certain time to completely stabilize the condition, and by insisting on early discharge, you risk getting an undertreated patient, which is dangerous for both him and you.

One of the most important factors influencing the prognosis of psychotic disorders is the timeliness of initiation and intensity of active therapy in combination with social and rehabilitation measures.

3. WHO ARE THEY – THE MENTALLY ILL?

Over the centuries, a collective image of a mentally ill person has formed in society. Unfortunately, in the minds of many people, he is still an unkempt, unshaven man with a burning gaze and an obvious or secret desire to attack others. They fear the mentally ill because, supposedly, “it is impossible to understand the logic of their actions.” Mental illnesses are considered to be sent down from above, strictly inherited, incurable, contagious, leading to dementia. Many believe that the cause of mental illness is difficult living conditions, prolonged and severe stress, complex family relationships, and lack of sexual contact. Mentally ill people are considered either “weaklings” who simply cannot pull themselves together or, going to the other extreme, sophisticated, dangerous and ruthless maniacs who commit serial and mass murders and sexual violence. It is believed that people suffering from mental disorders do not consider themselves sick and are unable to think about their treatment.

Unfortunately, the relatives of the patient often internalize the views typical in society and begin to treat the unfortunate person in accordance with the prevailing misconceptions in society. Often, families into which a mentally ill person appears try at all costs to hide their misfortune from others and thereby aggravate it even more, dooming themselves and the patient to isolation from society.

Mental disorder is a disease like any other. There is no reason to be ashamed that this disease runs in your family. The disease is of biological origin, i.e. occurs as a result of metabolic disorders of a number of substances in the brain. Suffering from a mental disorder is about the same as having diabetes, peptic ulcers, or other chronic disease. Mental illness is not a sign of moral weakness. Mentally ill people cannot eliminate the symptoms of their illness through willpower, just as it is impossible to improve their vision or hearing through willpower. Mental illnesses are not contagious. The disease is not transmitted by airborne droplets or other means of infection, so it is impossible to get psychosis by closely communicating with the patient. According to statistics, cases aggressive behavior It is less common among mentally ill people than among healthy people. The heredity factor in patients with mental illness manifests itself in the same way as in patients with cancer or diabetes mellitus. If two parents are sick, the child gets sick in about 50% of cases; if one, the risk is 25%. Most people with mental disorders understand that they are ill and seek treatment, although initial stages illness is difficult for a person to accept. A person's ability to make decisions about his or her own treatment is greatly enhanced if family members are involved and approve and support their decisions. And, of course, we should not forget that many brilliant or famous artists, writers, architects, musicians, and thinkers suffered from serious mental disorders. Despite the serious illness, they managed to enrich the treasury of human culture and knowledge, immortalizing their name with the greatest achievements and discoveries.

4. SIGNS OF BEGINNING DISEASE OR EXCERNSATION

For relatives whose loved ones suffer from one or another mental disorder, information about initial manifestations psychosis or symptoms of an advanced stage of the disease. All the more useful may be recommendations on some rules of behavior and communication with a person in a painful condition. IN real life It is often difficult to immediately understand what is happening to your loved one, especially if he is afraid, suspicious, distrustful and does not directly express any complaints. In such cases, only indirect manifestations of mental disorders can be noticed. Psychosis can have a complex structure and combine hallucinatory, delusional and emotional disorders (mood disorders) in various proportions. The following symptoms may appear during the disease, all without exception, or individually.

Manifestations of auditory and visual hallucinations:

· Self-talk that resembles a conversation or remarks in response to someone's questions (excluding comments out loud like “Where did I put my glasses?”).

· Laughter for no apparent reason.

· Sudden silence, as if a person is listening to something.

· Alarmed, preoccupied look; inability to concentrate on the topic of conversation or a specific task.

· The impression that your relative sees or hears something that you cannot perceive.

The appearance of delirium can be recognized by the following signs:

· Changed behavior towards relatives and friends, the appearance of unreasonable hostility or secrecy.

· Direct statements of implausible or dubious content (for example, about persecution, about one’s own greatness, about one’s irredeemable guilt.)

· Defensive actions in the form of curtaining windows, locking doors, obvious manifestations of fear, anxiety, panic.

· Expressing fears for one’s life and well-being, or for the life and health of loved ones without obvious grounds.

· Separate, meaningful statements that are incomprehensible to others, adding mystery and special significance to everyday topics.

· Refusal to eat or carefully checking the contents of food.

· Active litigious activity (for example, letters to the police, various organizations with complaints about neighbors, co-workers, etc.).

How to respond to the behavior of a person suffering from delusions:

· Do not ask questions that clarify the details of delusional statements and statements.

· Do not argue with the patient, do not try to prove to your relative that his beliefs are wrong. Not only does this not work, but it can also worsen existing disorders.

· If the patient is relatively calm, inclined to communicate and help, listen carefully, reassure him and try to persuade him to see a doctor.

Suicide Prevention

In almost all depressive states, thoughts of not wanting to live may arise. But depression accompanied by delusions (for example, guilt, impoverishment, incurable somatic illness) is especially dangerous. At the height of the severity of the condition, these patients almost always have thoughts of suicide and suicidal readiness.

Warning about the possibility of suicide following signs:

· Statements by the patient about his uselessness, sinfulness, guilt.

· Hopelessness and pessimism about the future, reluctance to make any plans.

· The patient’s conviction that he has a fatal, incurable disease.

· Sudden calming of the patient after long period sadness and anxiety. Others may have the false impression that the patient's condition has improved. He puts his affairs in order, for example, writes a will or meets with old friends whom he has not seen for a long time.

Precautionary measures:

· Take any conversation about suicide seriously, even if it seems unlikely to you that the patient might try to commit suicide.

· If you get the impression that the patient is already preparing for suicide, do not hesitate to immediately seek professional help.

· Hide dangerous objects (razors, knives, pills, ropes, weapons), carefully close windows and balcony doors.

5. YOUR RELATIVE GOT ILL

All members of the family where a mentally ill person appears initially experience confusion, fear, and do not believe what happened. Then the search for help begins. Unfortunately, very often the first thing they do is not to specialized institutions, where they can get advice from a qualified psychiatrist, but, best case scenario, to doctors of other specialties, in the worst case – to healers, psychics, specialists in the field of alternative medicine. The reason for this is a number of existing stereotypes and misconceptions. Many people have a mistrust of psychiatrists, which is due to the artificially inflated means mass media during the years of perestroika, the problem of the so-called “Soviet punitive psychiatry" Most people in our country still associate various severe consequences: registration at a psychoneurological dispensary, loss of rights (limitation of the ability to drive vehicles, travel abroad, carry weapons), threat of loss of prestige in the eyes of others, social and professional discredit. Fear of this kind of stigma, or, as they now say, “stigma”, conviction in the purely somatic (for example, neurological) origin of their suffering, confidence in the incurability of mental disorders by the methods of modern medicine and, finally, simply a lack of understanding of the painful nature of their condition force people to people and their relatives categorically refuse any contact with psychiatrists and psychotropic therapy - the only real opportunity to improve their condition. It should be emphasized that after the adoption in 1992 of the new Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision,” most of the above fears are unfounded.

The infamous “registration” was abolished ten years ago, and currently a visit to a psychiatrist does not threaten negative consequences. Nowadays, the concept of “accounting” has been replaced by the concepts of advisory and medical care and dispensary observation. The advisory population includes patients with mild and short-term mental disorders. Help is provided to them if they independently and voluntarily go to the dispensary, at their request and with their consent. Minor patients under the age of 15 are provided with assistance at the request or with the consent of their parents or legal representatives of their rights. The dispensary observation group includes patients suffering from severe, persistent or frequently exacerbating mental disorders. Dispensary observation can be established by the decision of a commission of psychiatrists, regardless of the consent of the person suffering from a mental disorder, and is carried out through regular examinations by doctors of psychoneurological dispensaries (PND). Dispensary observation is terminated upon condition of recovery or significant and persistent improvement in the patient’s condition. As a rule, observation is stopped if there are no exacerbations for five years.

It should be noted that often when the first signs appear mental disorder Concerned relatives assume the worst - schizophrenia. Meanwhile, as already mentioned, psychoses have other causes, so each patient requires a thorough examination. Sometimes delay in seeing a doctor is fraught with the most serious consequences (psychotic conditions that develop as a result of a brain tumor, stroke, etc.). To identify the true cause of psychosis it is necessary advisory assistance a qualified psychiatrist using the most complex high-tech methods. This is also why turning to alternative medicine, which does not have the full arsenal of modern science, can lead to irreparable consequences, in particular, to an unjustified delay in bringing the patient to the first consultation with a psychiatrist. As a result, the patient is often brought to the clinic by ambulance in a state of acute psychosis, or the patient is examined in an advanced stage of mental illness, when time has already been lost and there is a chronic course with the formation of negative disorders that are difficult to treat.

Patients with psychotic disorders may receive specialized assistance in PND at the place of residence, in psychiatric research institutions, in psychiatric and psychotherapeutic care offices at general clinics, in psychiatric offices of departmental clinics.

The functions of the psychoneurological dispensary include:

· Outpatient appointments for citizens referred by doctors general clinics or those who applied independently (diagnosis, treatment, solution social issues, examination);

· Direction to psychiatric hospital;

· Urgent Care at home;

· Advisory and dispensary observation patients.

After examining the patient, the local psychiatrist decides in what conditions to carry out treatment: the patient’s condition requires urgent hospitalization in a hospital or outpatient treatment is sufficient.

Article 29 of the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens during its provision” clearly regulates the grounds for involuntary hospitalization in a psychiatric hospital, namely:

“A person suffering from a mental disorder may be hospitalized in a psychiatric hospital without his consent or without the consent of his legal representative before the judge's decision, if his examination or treatment is possible only in inpatient conditions, and the mental disorder is severe and causes:

a) his immediate danger to himself or others, or

b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or

c) significant harm to his health due to a deterioration in his mental state if the person is left without psychiatric help.”

6. TREATMENT: BASIC METHODS AND APPROACHES.

Despite the fact that psychoses are complex group, which includes conditions of various origins, the principles of treatment for them are the same. Throughout the world, drug therapy is considered the most effective and reliable method of treating psychosis. When it is carried out, an unconventional, strictly individual approach is used to each patient, taking into account age, gender, and the presence of other diseases. One of the main tasks of a specialist is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the “harm” caused psychotropic drugs, convey to him your confidence in the effectiveness of treatment, subject to systematic adherence to the prescribed prescriptions. Otherwise, there may be a violation of medical recommendations regarding doses and medication regimen. The relationship between doctor and patient should be built on mutual trust, which is guaranteed by the specialist’s adherence to the principles of non-disclosure of information, medical confidentiality, and anonymity of treatment. The patient, in turn, should not hide such important information as a fact of use psychoactive substances(drugs) or alcohol, taking medications used in general medicine, driving or operating a car complex mechanisms. A woman should notify her doctor if she is pregnant or breastfeeding. Often, relatives or the patients themselves, having carefully studied the annotations for the medications recommended to them, are perplexed, and sometimes even indignant, that the patient was prescribed a drug for, while he has a completely different diagnosis. The explanation is that almost all drugs used in psychiatry act nonspecifically, i.e. They help with a wide range of painful conditions (neurotic, affective, psychotic) - it’s all about the prescribed dose and the doctor’s skill in selecting optimal treatment regimens.

Undoubtedly, taking medications should be combined with programs social rehabilitation and, if necessary, with family psychotherapeutic and psychopedagogical work.

Social rehabilitation is a complex of programs for teaching patients with mental disorders how to rational behavior both in a hospital setting and at home. Rehabilitation is aimed at teaching social skills for interacting with other people, skills necessary in everyday life, such as accounting for one’s own finances, cleaning the house, shopping, using public transport, etc., vocational training, which includes the actions necessary to obtain and job retention, and training for those patients who want to graduate from high school or college. Auxiliary psychotherapy is also often used to help mentally ill people. Psychotherapy helps mentally ill people feel better about themselves, especially those who experience feelings of inferiority as a result of their illness and those who seek to deny the presence of the illness. Psychotherapy helps the patient master ways to solve everyday problems. An important element of social rehabilitation is participation in peer support groups with other people who understand what it means to be mentally ill. Such groups, led by patients who have undergone hospitalization, allow other patients to experience help in understanding their problems, and also expand their opportunities for participation in recovery activities and community life.

All of these methods, when used wisely, can improve efficiency. drug therapy, but are not able to completely replace drugs. Unfortunately, science still does not know how to cure mental illnesses once and for all; psychoses often have a tendency to recur, which requires long-term preventive medication.

8. NEUROLEPTICS IN THE TREATMENT SYSTEM OF PSYCHOTIC DISORDERS

The main drugs used to treat psychosis are the so-called neuroleptics or antipsychotics.

The first chemical compounds that have the property of stopping psychosis were discovered in the middle of the last century. Then, for the first time, psychiatrists had a powerful and effective treatment for psychosis in their hands. Such drugs as aminazine, haloperidol, stelazine and a number of others have proven themselves especially well. They stopped psychomotor agitation well, eliminated hallucinations and delusions. With their help huge amount patients were able to return to life, to escape from the darkness of psychosis. However, over time, evidence has accumulated that these drugs, later called classical antipsychotics, act only on positive symptoms, often without affecting the negative. In many cases, the patient was discharged from a psychiatric hospital without delusions or hallucinations, but became passive and inactive, and was unable to return to work. In addition, almost all classical antipsychotics cause so-called extrapyramidal side effects (drug-induced parkinsonism). These effects are manifested by muscle stiffness, tremors and convulsive twitching of the limbs, sometimes there is a hard-tolerable feeling of restlessness, which is why patients are in constant motion, unable to stop for a minute. To reduce these unpleasant phenomena, doctors are forced to prescribe a number of additional drugs, which are also called correctors (cyclodol, parkopan, akineton, etc.). The side effects of classical antipsychotics are not limited to extrapyramidal disorders; in some cases, drooling or dry mouth, urination problems, nausea, constipation, palpitations, a tendency to lower blood pressure and fainting, weight gain, decreased libido, erectile dysfunction and ejaculation may be observed. In women, galactorrhea (discharge from the nipples) and amenorrhea (disappearance of menstruation) are common. It should be noted side effects from the central nervous system: drowsiness, deterioration of memory and concentration, increased fatigue, the possibility of developing the so-called neuroleptic depression.

Finally, it should be emphasized that, unfortunately, traditional antipsychotics do not help everyone. There has always been a portion of patients (about 30%) whose psychoses were difficult to treat, despite adequate therapeutic tactics with timely change of drugs of different groups.

All these reasons explain the fact that patients often voluntarily stop taking medications, which in most cases leads to an exacerbation of the disease and re-hospitalization.

A real revolution in the treatment of psychotic disorders was the discovery and implementation of clinical practice in the early 90s, a fundamentally new generation of neuroleptics - atypical antipsychotics. The latter differ from classical neuroleptics in their selectivity of neurochemical action. By acting only on certain nerve receptors, these drugs, on the one hand, turned out to be more effective, and on the other, much better tolerated. They were found to cause virtually no extrapyramidal side effects. Currently, several such drugs are already available on the domestic market - rispolept (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine) and azaleptin (leponex), which was previously introduced into clinical practice. The most widely used are Leponex and Rispolept, which are included in the “List of Vital and Essential Medicines”. Both of these drugs are highly effective in various psychotic conditions. However, while rispolept is more often prescribed practical doctors First of all, Leponex is justifiably used only in the absence of an effect from previous treatment, which is associated with a number of pharmacological features this drug, the nature of side effects and specific complications, which, in particular, require regular monitoring general analysis blood.

What are the advantages of atypical antipsychotics in the treatment of acute phase psychosis?

1. The possibility of achieving a greater therapeutic effect, including in cases of symptom resistance or intolerance to typical neuroleptics by the patient.

2. Significantly greater effectiveness in treating negative disorders than classical antipsychotics.

3. Security, i.e. insignificant severity of both extrapyramidal and other side effects characteristic of classical antipsychotics.

4. No need to take correctors in most cases with the possibility of monotherapy, i.e. treatment with one drug.

5. Admissibility of use in weakened, elderly and somatically burdened patients due to low interaction with somatotropic drugs and low toxicity.

8. SUPPORTIVE AND PREVENTIVE THERAPY

Among psychotic disorders of various origins, psychoses developing as part of endogenous diseases make up the lion's share. The course of endogenous diseases differs in duration and tendency to relapse. That is why in international recommendations Regarding the duration of outpatient (maintenance, preventive) treatment, its terms are clearly specified. Thus, patients who have suffered a first episode of psychosis as preventive therapy It is necessary to take small doses of drugs for one to two years. If a repeated exacerbation occurs, this period increases to 3-5 years. If the disease shows signs of transition to continuous flow, the duration of maintenance therapy is increased indefinitely. That is why among practical psychiatrists there is a justified opinion that in order to treat patients who become ill for the first time (during their first hospitalization, less often outpatient therapy), maximum efforts should be made, and the longest and most complete course of treatment and social rehabilitation should be carried out. All this will pay off handsomely if it is possible to protect the patient from repeated exacerbations and hospitalizations, because after each psychosis negative disorders increase, which are especially difficult to treat.

Preventing relapse of psychosis

Reducing the relapse of mental illness is facilitated by an orderly daily lifestyle that has the maximum therapeutic effect and includes regular exercise, reasonable rest, a stable daily routine, balanced diet, giving up drugs and alcohol and regularly taking medications prescribed by your doctor as maintenance therapy.

Signs of an approaching relapse may include:

· Any significant changes behavior, daily routine or activity of the patient (unstable sleep, loss of appetite, appearance of irritability, anxiety, change in social circle, etc.).

· Features of behavior that were observed on the eve of the previous exacerbation of the disease.

· The appearance of strange or unusual judgments, thoughts, perceptions.

· Difficulty performing ordinary, simple tasks.

· Unauthorized termination of maintenance therapy, refusal to visit a psychiatrist.

If you notice warning signs, take the following measures:

· Notify your doctor and ask him to decide if your therapy needs to be adjusted.

· Eliminate all possible external stressors on the patient.

· Minimize (within reasonable limits) all changes in your daily routine.

· Provide the patient with as calm, safe and predictable an environment as possible.

To avoid exacerbation, the patient should avoid:

· Premature withdrawal of maintenance therapy.

· Violations of the medication regimen in the form of an unauthorized dosage reduction or irregular intake.

· Emotional turmoil (conflicts in the family and at work).

· Physical overload, including both excessive exercise and overwhelming housework.

· Colds (acute respiratory infections, flu, sore throats, exacerbations chronic bronchitis etc.).

· Overheating (solar insolation, prolonged stay in a sauna or steam room).

· Intoxications (food, alcohol, medicinal and other poisonings).

· Changes in climatic conditions during the holiday period.

Benefits of atypical antipsychotics during preventive treatment.

When carrying out maintenance treatment, the advantages of atypical antipsychotics over classical antipsychotics are also revealed. First of all, this is the absence of “behavioral toxicity,” that is, lethargy, drowsiness, inability to engage in any activity for a long time, slurred speech, and unsteady gait. Secondly, a simple and convenient dosing regimen, because Almost all new generation drugs can be taken once a day, say at night. Classical antipsychotics, as a rule, require three doses, which is caused by the peculiarities of their pharmacodynamics. In addition, atypical antipsychotics can be taken without regard to meals, which allows the patient to maintain their usual daily routine.

Of course, it should be noted that atypical antipsychotics are not a panacea, as some advertising publications try to present. Medicines that completely cure such serious illnesses like schizophrenia or bipolar affective disorder, has yet to be opened. Perhaps the main disadvantage of atypical antipsychotics is their cost. All new drugs are imported from abroad, produced in the USA, Belgium, Great Britain and, naturally, have high price. Thus, the approximate costs of treatment when using the drug in average dosages for a month are: Zyprexa - $300, Seroquel - $250, Rispolept - $150. True, recently more and more pharmacoeconomic studies have appeared, convincingly proving that the total costs of patient families for the purchase of 3-5, and sometimes more classical drugs, namely, such complex circuits are used for the treatment and prevention of psychotic disorders, approaching the cost of one atypical antipsychotic (here, as a rule, monotherapy is carried out, or simple combinations with 1-2 more drugs are used). In addition, a drug such as rispolept is already included in the list of drugs provided free of charge in dispensaries, which makes it possible, if not to fully meet the needs of patients, then at least partially to alleviate their financial burden.

It cannot be said that atypical antipsychotics have no side effects at all, because Hippocrates said that “an absolutely harmless medicine is absolutely useless.” When taking them, there may be an increase in body weight, a decrease in potency, and disorders monthly cycle in women, increased levels of hormones and blood sugar. However, it should be noted that almost all of these adverse events depend on the dosage of the drug, occur when the dose is increased above the recommended one and are not observed when using average therapeutic doses.

Extreme caution must be exercised when deciding whether to reduce dosages or discontinue an atypical antipsychotic. This question can only be decided by the attending physician. Untimely or abrupt discontinuation of the drug can lead to sharp deterioration the patient's condition, and, as a result, to urgent hospitalization in a psychiatric hospital.

Thus, from all of the above it follows that psychotic disorders, although they are among the most serious and quickly disabling diseases, do not always fatally lead to severe outcomes. In most cases, provided that psychosis is correctly and timely diagnosed, early and adequate treatment is prescribed, and modern gentle methods of psychopharmacotherapy are used, combined with methods of social rehabilitation and psychocorrection, it is possible not only to quickly stop acute symptoms, but also to achieve complete restoration of the patient’s social adaptation.

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Psychological problems with potency are the most common cause of impotence among men under 60 years of age. However, only advanced forms of erectile dysfunction force the patient to seek help from a specialist due to the delicacy of the disease. What to do if you notice a decrease in potency, how to determine whether it is psychogenic impotence and other useful information in our article.

In the article:

The nature of psychogenic erectile dysfunction

In fact, factors leading to psychogenic impotence can be found in any man who suffers from one or another potency disorder, since failures in bed always entail stress on the psyche - stress.

What should you pay attention to? Firstly, one failure is not a reason to be upset. Diagnosis impotence is set by a doctor on the condition that a man cannot achieve or maintain an erection during intercourse in at least 25% of cases. Individual episodes of unsuccessful sex can occur in each partner; they are provoked, for example, by severe fatigue.

The further development of the disease largely depends on the man’s temperament and attitude towards the problem. If he begins to worry greatly about failure, focusing attention on this, then the ground almost always develops for real psychogenic erectile dysfunction.

A calm attitude and competent analysis of what happened allows you to overcome and forget a minor problem in bed. Unfortunately, the most typical situation is fear and confusion when losing an erection.

Mental impotence has a multifaceted nature, so it is often impossible to cope with the disease on your own.

Causes of psychological problems with potency

Experts prioritize psychological trauma, which most often occurs in childhood. These are conflicts between parents and children, especially when sex is presented as something shameful. Such young men cannot then perceive intimate life as something pleasant and bringing pleasure. During sexual self-identification, boys often begin to show their genitals, this occurs between the ages of 3 and 5 years. This should not become a reason for intimidation or scolding of the child, because this period is normal in the development of one’s psychosexual position. Otherwise, in the future it will be more difficult for the guy to relate to intimate life, as something pleasant and bringing pleasure.

Often, such disorders are combined with personal factors, such as fear of a partner’s pregnancy, venereal disease, causing pain to a partner and much more.

Intimacy is one of the forms of communication between people. If partners do not know each other well enough, they do not trust each other in to the fullest, then this may well provoke a lack of erection in the partner. Individuals with sexual dysfunction have a history of painful sexual experiences, whether physical or psychological trauma.

Methods for treating psychogenic impotence

Psychological impotence should not be a problem of only one partner; a woman should also know how to properly help her man. Treatment measures should be focused on the following principles:

1. Eliminate the reasons that caused the decrease in sexual desire. At this stage, the man visits the following doctors: andrologist, psychiatrist-sexologist, neurologist, endocrinologist and, possibly, a neurosurgeon.
2. It is necessary to minimize and eliminate the psychological factor that provoked the injury.
3. An experienced sex therapist will help overcome the fixation syndrome and the neurosis of expectation of failure, which occurs in the stronger sex after an erection fails.
4. Persons suffering from organic and psychoneurological diseases that are accompanied by asthenic syndrome, vitamin therapy, rehabilitation, and physiotherapy are indicated. Of course, rationality is not in last place. therapeutic nutrition and drug correction.

Treatment of psychological erectile dysfunction should begin with eliminating the factors that led to psycho-social maladjustment. Failures that haunt a man from the moment of his first sexual intercourse indicate a lack of sexual skills; young people simply do not have experience communicating with the opposite sex.

The psychologist, together with the patient, should discuss the portrait of an ideal partner, choose a model of behavior during intimacy, the most comfortable for a man and his woman. Over the course of several meetings with a woman, it is necessary to implement the plan discussed. More often disorders this kind overtake those who have not had regular or prolonged experience of intimate intimacy.

Technique of marital psychotherapy

The technique of marital psychotherapy is used with patients who are prone to conflict situations in family life. The psychologist explains and tries to change the type of communication between spouses. It is important to understand what does not suit partners in a relationship and to find a point of mutual understanding. The doctor’s plans include teaching spouses new effective interactions, which will help not only improve their sex life, but also save the marriage.

Mental impotence at the second stage is subject to correction with stimulants and general tonics. For example, when a complex adaptogen (Cigapan) is prescribed, vitamin complex, metabolic drug (testiscompositum).

At the third stage, for successful treatment, the patient is asked to take a phosphodiesterase inhibitor drug (for example,) and a second drug, Vikair, before sexual intercourse. If their effect is minimal, the doctor may prescribe additional antidepressants. For example, it could be a complex. This step-by-step treatment will allow you to restore an erection in 1-2 months in 90% of patients.

The proposed treatment methods, such as readaptation of couples in intimate life, work with psychoneurologists, can reduce the number of prescribed drugs and their dosage. For the patient, this means not only material savings, but also a minimum of side effects from pharmacotherapy, stability in relationships in the future, and the prevention of serious complications erectile dysfunction. It's no secret that harmonious sex life increases the working capacity and reproduction of the population.

The methods described on how to overcome psychological impotence can be used among different groups population: both among young people and among individuals mature age. Often such dysfunction is combined with ejaculation disorders, for example, or, conversely, with low sensitivity of the genital organs.

So that a man can control this process, he is recommended drugs that correct ejaculation. These also include the one mentioned earlier.

In conclusion, it is worth noting that timely therapy is very important. Successful conservative treatment with early diagnosis is observed in 80% of cases, so there is almost no reason for men to worry. Only in the remaining 20% ​​can the patient have disorders organic type, which require a more in-depth approach.