Treatment of psychological problems. Psychosomatics - psychological causes of diseases: how and why diseases occur

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.

Psychosis (psychotic disorders) refers to the most bright manifestations mental illnesses, in which the patient’s mental activity does not correspond to the surrounding reality, the reflection of the real world in the mind is sharply distorted, which manifests itself in behavioral disorders, the appearance of abnormal 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 of 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 can suffer a transient psychotic state caused by taking certain medications, drugs, or the so-called psychogenic or “reactive” psychosis that occurs as a result of exposure to severe mental trauma (life-threatening stressful situation, loss loved one etc.). Often there are so-called infectious diseases (developing as a result of 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 tremens – “delirium tremens”.

Psychotic disorders are a very common type of pathology. Statistical data in different regions differ from each other, which is associated with different approaches and capabilities for identifying and accounting for these sometimes difficult to diagnose conditions. On average, the frequency of endogenous psychoses is 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). The most common are auditory hallucinations, the so-called “voices,” which 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 his internal organs are damaged and require 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 suffered 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 type (especially with endogenous diseases) is the periodic type of psychosis with acute attacks of the disease occurring from time to time, 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 the start and intensity of active therapy in combination with socio-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 massacres, 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 of aggressive behavior among mentally ill people are less common than among healthy people. The heredity factor in patients with mental illness manifests itself in the same way as in patients oncological diseases or diabetes. 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, it may be useful information about the initial manifestations of psychosis or symptoms of the 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 scared, 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.)

· Protective 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

Almost everyone depressive states thoughts may arise about not wanting to live. 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.

The following signs warn of the possibility of suicide:

· Statements by the patient about his uselessness, sinfulness, and 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 a long period of 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 go to specialized institutions where they can get advice from a qualified psychiatrist, but to 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 distrust psychiatrists, which is associated with the problem of the so-called “Soviet punitive psychiatry” artificially inflated by the media during the years of perestroika. Most people in our country still associate various serious consequences with a consultation with a psychiatrist: registration at a psychoneurological dispensary, loss of rights (limitation of the ability to drive vehicles, travel abroad, carry weapons), the threat of loss of prestige in the eyes of others, social and professional discredit. Fear of this peculiar stigma, or, as they now say, “stigma”, conviction in the purely somatic (for example, neurological) origin of one’s suffering, confidence in the incurability of mental disorders by methods modern medicine and, finally, simply a lack of understanding of the painful nature of their condition forces sick people and their relatives to categorically refuse any contact with psychiatrists and taking 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 a 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 of mental disorder appear, 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 severe 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 appealing to alternative medicine, which does not have the entire arsenal modern science, can lead to irreparable consequences, in particular, to an unjustified delay in delivering the patient to the first consultation with a psychiatrist. As a result, the patient is often brought to the clinic by an ambulance in a state of acute psychosis, or the patient is taken for examination in the advanced stage of mental illness, when time has already been lost and chronic course with the formation of difficult-to-treat negative disorders.

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 reception of citizens referred by doctors of general clinics or who applied independently (diagnosis, treatment, solution of social issues, examination);

· Referral to a psychiatric hospital;

· Emergency 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 until a 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 by psychotropic drugs, to convey to him his conviction 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 inform 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 social rehabilitation programs and, if necessary, with family psychotherapeutic and psychopedagogical work.

Social rehabilitation is a complex of programs for teaching patients with mental disorders ways of rational behavior both in a hospital setting and in everyday life. 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. Assistive 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 a long period of time. prophylactic intake medicines.

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 powerful and effective remedy treatment of psychosis. Such drugs as aminazine, haloperidol, stelazine and a number of others have proven themselves especially well. They docked well psychomotor agitation, eliminated hallucinations and delusions. With their help, a huge number of patients were able to return to life and 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 various 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 characterized high efficiency in various psychotic conditions. However, while Rispolept is more often prescribed by practitioners in the first place, Leponex is justifiably used only in the absence of an effect from previous treatment, which is associated with a number of pharmacological features of this drug, the nature of side effects and specific complications, which, in particular, require regular monitoring general blood test.

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 patient intolerance to typical antipsychotics.

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 international recommendations regarding the duration of outpatient (maintenance, preventive) treatment clearly stipulate its terms. Thus, patients who have experienced 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 a continuous course, the period 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 a structured daily lifestyle that has maximum therapeutic impact and includes regular physical exercise, reasonable rest, 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, tonsillitis, exacerbation of chronic bronchitis, etc.).

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

· Intoxication (food, alcohol, medicinal and other poisoning).

· Changes in climatic conditions during the holiday period.

Advantages of atypical antipsychotics in 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 serious illnesses such as 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 a 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 even more classical drugs, namely those 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 the correct and timely diagnosis psychosis, prescribing early and adequate treatment, using modern gentle methods of psychopharmacotherapy, combined with methods of social rehabilitation and psychocorrection, it is possible not only to quickly relieve acute symptoms, but also to achieve complete restoration of the patient’s social adaptation.

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Every person has their own psychological characteristics, which affect various areas of life, including sexual life. The same events different people can be perceived differently: for some they go unnoticed, for others they leave severe psychological trauma. In men in particular, such injuries can cause sexual dysfunction. All these conditions are manifested by decreased libido.

Psychological erectile dysfunction: causes

Sexual desire originates primarily in the brain and is a response to visual images, memories, or fantasies. The resulting impulses are transmitted along the spinal cord to the nodes and nerves of the genital organ. Thus, penile enlargement is not only the result of tactile stimulation.

Psychological characteristics of personality. The following factors can contribute to the occurrence of psychological erectile dysfunction: congenital low libido, low self-esteem, fantasies of unusual sex, difficulties in determining sexual orientation, psychological trauma in adolescence and adulthood.

Psychosocial reasons. Sexual problems in a man can arise against the background of poor communication skills, homosexual needs, strict anti-sexual education, unstable family relationships during childhood, unhealthy lifestyle, problems with a partner, lack of sexual experience, suppressed sexual desire.

Psychoneurological reasons. As practice shows, the most common reasons This type of disorder is age-related changes in the body, depression, stress, neurosis of expectation of failure, specific sexual incompatibility with a partner or the presence of sexual dysfunction.

Diagnosis of erectile dysfunction

Very often, men find it difficult to admit to themselves and their partners that they have intimate problem, and a trip to the doctor is constantly postponed due to a feeling of shame, fear of a disappointing prognosis, or hope that the illness will go away on its own. In any case, diagnosis and consultation with a specialist is necessary. To begin with, the doctor must collect information about the patient’s sex life; to do this, he can ask the following questions:

• “How did the sexual disorder manifest itself - suddenly or was there a gradual deterioration in the condition?”
• “How often do you have sexual intercourse?”
• “What is the frequency of dysfunction?”
• “Is the ability to have sexual desire and ejaculation preserved?”
• “What is the quality of erection during masturbation, sexual stimulation, during insertion of the penis and subsequent frictions?”
• After all the necessary details have been clarified, the patient is prescribed a certain type of therapy or given recommendations for lifestyle changes.

Psychological impotence (erectile dysfunction): treatment

In some cases, a man can cope with the disease on his own, without the help of a specialist. Before wondering how to treat psychological impotence, you first need to reconsider your daily routine, learn to deal with stress, get more rest and improve your relationship with your partner. If no improvement is observed, then the help of a medical professional will be necessary. As a rule, such patients are prescribed medications and psychotherapy sessions (conversations with a psychotherapist and/or sexologist).

If psychological impotence is associated with the neurosis of “expectation of failure”, a man will need to remember when this fear first arose, what it was associated with, what his thoughts were after this incident, and what his behavior during sexual contacts became. This information helps the specialist understand the essence of the problem and begin to work effectively with it.

If named psychological trauma at a young age, the patient is asked to mentally travel back to his childhood and remember what contributed to the development of the disease. Perhaps it was a parental suggestion (sex is shameful), worries about the size of the penis, an unsuccessful first sexual experience, etc.

Always remember that you need to take care not only of your psychological state, but also the health of your body. To begin, you need to start leading a healthy lifestyle, give up bad habits (smoking, alcohol), eat right, develop an optimal daily routine and have a regular sex life.

Psychological diseases are caused various factors nervous and mental systems body.

The first factor - productive - lies in the usual mental activity person (the appearance of ideas that partially or completely surround a person’s attention; the patient listens and feels what is not really there).

The second factor - negative - lies in general changes leading to a weakening of a person’s nervous activity.

Types of diseases

Types of psychological diseases are divided into two categories:

• exogenous;
• endogenous.

Analyzing in detail the list of human psychological diseases, it is taken into account that exogenous mental disorders include psychoses that arose under the pressure of environmental factors. Examples of psychoses: the effects of various types of infections on the cortex (gray matter) of the body's head organ - the brain - and the brain as a whole, intoxication with chemicals that have penetrated into the internal part of the body, diseases of the internal organs (kidneys, liver and heart muscle), endocrine diseases. In a separate group of diseases - exogenous mental disorders - we can include reactive psychoses, the causes of which are severe mental and emotional trauma and a constant depressing mental influence on a person.

Endogenous mental disorders include causes of hereditary factors. Such factors can go completely unnoticed by a person, but can result in such a serious list of psychological diseases as: schizophrenia (psychosis in which consciousness and intelligence are preserved, but there is a clear deviation in the psyche), MDP (manic-depressive psychosis - passing from one in other periods of joyful and depressed mood), schizophrenic psychosis(is an intermediate stage between MDP and schizophrenia).

Reasons

Often a person’s thinking leads to the question of the psychological causes of illness. These include a huge variety of different factors. They all depend on what exactly the person is sick with. When analyzing the psychological problems of diseases and their causes, we always come to one human organ, which is responsible for our psyche. This is the brain, any disruption of which leads to unstable functioning of our thinking and an unstable mental state.

The psychological causes of illnesses have not been fully studied, but with complete confidence it can be noted that the psychological causes of mental illnesses are influenced by biological, social, and also psychological factors that violate correct work nervous system. They also include situations hereditary factor and deep stress in the body.

Resistance to the above reasons is determined by the physical characteristics of a person as an individual and his general mental development as a whole. All people can react completely differently to the same type of situation. Some can easily survive failure and draw a conclusion and try to move forward again, while others fall into depression and, sitting still, depress an already difficult situation. What will lead to disruption of their nervous system and reveal the psychological prerequisites for the disease?

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Almost all symptoms of psychological illnesses can be detected with the naked eye of a qualified doctor. There can be a huge variety of symptoms. Patients do not give some of them special significance and do not seek qualified help from professionals.

Psychological diseases and their symptoms include receptor disorders:

Treatment of psychological diseases

Treat psychological illnesses a person is quite difficult, but in fully possible and effective. With such treatment, it is very important to determine the names of psychological diseases so that you can know with confidence what and for what to treat the patient.

Basically, all treatment involves a detailed study of the main psychosomatic symptoms. All mental illness and disorders are treated in psychological clinics experienced specialists and safe drugs for patients.

The probability of recovery of patients in our time is very high, but we should not put off the treatment of mental disorders for a long time. If there are psychological prerequisites for illness, immediate contact with a psychiatrist is the best option in this case!