Organization and conduct of medical and rehabilitation ...

Organization of medical and rehabilitative care for patients with anxiety disorders are extremely complicated and are associated with large clinical and organizational difficulties. Past due mainly to functional impairment, defining times imperceptible transition from the normal manifestations of mental health to the pathology that requires a thorough differential diagnosis using a multidisciplinary approach that includes data from various medical specialties (internal medicine, cardiology, gastroenterology, neurology, etc.) and para-clinical disciplines (psychology, physiology, hygiene, etc.). This primarily refers to diseases of the cardiovascular system, gastrointestinal tract, chronic nonspecific respiratory diseases, endocrine disorders, in which the complex interaction of adverse mental and somatic factors lead to the formation of neurotic disorders, disrupting the mechanisms of social and psychological adaptation. Anxiety reaction maladaptation often manifest with chronic somatic diseases. The disease is a comorbid disorder, when the background of somatic pathology appears neurotic and neurosis-like symptoms. Deterioration of mental condition of the patient, contributing to its somatic state, significantly reduces the tolerance to stress. It is noted the so-called "poslestressovaya psychosomatic vulnerability, causing increased sensitivity to any stimuli of the environment after suffering stress. Among this category are a substantial group of patients who have lasts for months and sometimes years of neurosis-like symptomatology and often expressed in "somatizirovanii mental disorder", ie, in this case it is rather about "symptoms, to a large extent mimics these or other somatic disease, "not" neuroticism "this or that body, and on the functional mental disorder. Characteristically, it is this group of patients destined to persistent but fruitless search for the causes of their ailments before they become obvious need for psychiatric assessment and treatment. Intermittent use of tranquilizers "on the advice of friends" does not give the desired effect and forms a belief in the "incurable" diseases. All this leads to untimely and inadequate diagnosis, weighting of the disease, to unjustified expenses on unnecessary in this case study, persistent disability and subsequent social maladjustment. It is important to note that the proposal to consult a psychiatrist, these patients are often treated negatively and reject calls to PND, as well as a sanatorium department of mental hospitals for fear of stigmatization and discrimination. Nevertheless, the emergence of highly specific modern pharmaceuticals, the inclusion in the context of psychiatry of general medical concepts such as risk / benefit, quality of life, individual sensitivity, harmony, and a shift in the relationship between doctor and patient from paternalism to partnership have increased public confidence in the psychiatric service have fostered her contacts with somatic health-care facilities.