The global burden of disease ...

The global burden of disease. Cambridge, MA: Harvard University Press, 1996 20.Potts SG, Bass CM Psychological morbidity in patients with chest pain and normal or nearnormal coronary arteries. Psychol. Med.1995, v.25, pp. 339-347 21. Shapiro P. A. Lidagoster L. Glassman A. H. Depression and heart disease. Psychiatr.Ann., 1997, v.27, pp.347-352 22.Sharma R., Markar HR Mortality in affective disorder. J. Affect.Dis., 1994, v.31, pp.91-96 Published with permission from Russian Medical Journal.

Safety wider category ...

Security broader category that overlaps portability. It also includes the absence of a negative effect on metabolic processes, the functions of individual organs and systems, which is particularly significant during prolonged therapy. Following the recommendations of the so-called Compliance, ie agreement, coherence patient and physician important factor for successful therapy. Usually not less than 1 / 3 therapeutic recommendations are not fully implemented, violations of regularity and precision of the prescribed purposes. Alignment is especially important in ambulatory practice, where the function of monitoring therapy largely passed, "delegate" to the patient, of course, necessarily prepared for it. References: 1. Avrutsky GY Neduva A. M. Treatment of Mental Illness: Science, 1984. 2. Report on world health 2001.Psihicheskoe Health: New Understanding, New Hope. WHO, 2001 3. Clinical Manual: Models of diagnosis and treatment of mental and behavioral rasstoroystv Ed red.V.N.Krasnova and IY Gurovich. M.: Application of the journal "Social and Clinical Psychiatry, 1999 4. KornetovN.A.Depressivnye disorder. Systematics, diagnostics, semiotics, therapy. Tomsk.: Siberian Publishing House, 2001 5. Krasnov VN The organizational model of care to those suffering from depression, in terms of territorial polikliniki.Metodicheskie rekomendatsii.M: Ministry of Health Rossii.2000. 6. Krasnov VN Psychiatric disorders in general medical praktike.Russky Medical zhurnal.2001.tom9.N 25.s.1187-1191 7. Mosolov SN Clinical use of modern antidepressants. SPb.: Medical News Agency 1995. 8. Educational Program on Depressive Disorders. Module 1. Overview and Main Aspects, World Psychiatric assotsiatsiya.Per. with angl.M.: Eli Lilly Vostok, 1999. 9. Smulevich AB Kozyrev VN Syrkin AL Depression in the medically ill. Moscow: 1997 10. Smulevich AB Depression in general medicine. M.2001 11. Federal guidelines for physicians on the use of drugs (Formulary System). Release P., 2001 12. Bech P. Pharmacological treatment of depressive disorders: A review. Depressive Disorders. Eds. M. Maj, N. Sartorius. Chichester etc: Wiley.1999, pp.89-127 13.Carney RM, Freedland KE Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosom. Med. 1988, v.50, pp.627-633 14.Glassman AH, Pierse DW Treatment of depression in patients with heart disease. J. Pract. Psychiat.a.Behav.Health., 1998, v.4, pp.140-149 15.Katon W., Sullivan MD Depression and chronic mental illness. J. Clin. Psychiatry, 1990, v.51, pp. 3-11 16.Lesperance F. et al. Major depression before and after miocardial infartion: its nature and consequences. Psychosomatic Medicine, 1996, v. 1958, pp.99-110 17.Lyness J.M. et al. Depressive symptoms, medical illness and functional status in depressed psychiatric inpatients. Am.J. Psychiatry. 1993, v. 150, pp.910-915 18.Moeller HJ (Hrsg) Therapie psychhiatrischer Erkrankungen.Stuttgart: Enke Verlag, 1993 19.Murray Ch.JL, Lopes AD

The simultaneous use of 2 antidepressants ...

The simultaneous use of 2 antidepressants with different chemical structure is justified as an admission of overcoming resistance to therapy, but only after at least 2 full courses of monotherapy with different antidepressants. It should be noted that resistant depression is an indication for inpatient treatment, preferably in specialized institutions. This is due to difficulties in selecting therapy, the need for a higher than acceptable in the outpatient setting, doses of drugs, a higher risk of suicide. The real, clinically adequate duration of therapy (usually estimated by several months) is not determined by the absence of rapid onset of therapeutic outcome (it would normally be expected in 3-6 weeks) and the known laws of return of depression, the removal of the prerequisites of relapse or commit a rudimentary symptoms. Several months' use of antidepressants (already beyond the reach of the apparent improvement) also belongs to the modern principles of treatment of depression: the past, as noted above, the breaking of depression, lack of primary and secondary symptoms of depression within 2 weeks is usually considered a sufficient reason for the rapid decrease in successive doses of an antidepressant to minimum or even to stop taking it. Tolerability and safety of antidepressant drugs are particularly important in modern therapy. Portability involves no significant side effects, as is obvious to the patient (eg, dry mouth, headaches, visual disturbances, which can serve as breeding grounds for subjective intolerance), and are not always obvious changes in heart rate, blood pressure, effects of behavioral toxicity such as breach of fine motor coordination, reduced wakefulness, cognitive disorders (attention span, memory, speed of execution of logical operations, spatial orientation). Cognitive impairment is particularly important for the working person dealing with the constant intellectual component in the performance of professional functions. Modern intellectualization of labor, use of technology, particularly computer, intermediaries activities, and frequent execution of operator actions that require constant change and re-focus, communication all require a modern treatment of benign and supportive (at least not the oppressor), cognitive function properties. Recently, more attention when antidepressant therapy is justified on safety of sexual function, the lack of antidepressant side effects such as weakening of erection, delay ejaculation, repression of orgasm. Please keep in mind that sexual function (libido, especially) are in themselves suffering with depression and logical manner restored when adequate antidepressant therapy.

Need to focus on some ...

It is necessary to highlight some general principles on the use of antidepressants. Monotherapy with the basic requirement for modern treatment of depression: the appointment of a selected product and its use for at least 4 weeks, reaching the maximum tolerated therapeutic dose is desirable to 7-14 day of treatment. In this case, tolerance may allow moderately expressed transient side effects, about which the patient is warned in advance and is willing to suffer for the sake of the main therapeutic outcome, which (and this also needs to know the patient) is usually not expected before the end of the 1 st, and often at the 3 - her week of therapy. In addition to biological intolerance (cholinolytic particular expression or other side effects), it is necessary to consider the possible psychological intolerance of particular sensitivity, nevynoslivost patient to some, even quite mild side effects. Sometimes it is excused in a special (and regular) the patient's attention to the preservation and maintenance of some relevance to the daily activities of functions: the unacceptability of even a light tremor of fingers in musicians, dry mouth for teachers, etc. But often psychological intolerance associated with particular sensitivity to pain, physical discomfort, sensory, as personality traits. Recognizing the important principle of modern single-agent treatment of depression can be considered justified in some types of complementary, concurrent therapy: 1) the so-called Therapy cover, which usually precedes the main purpose of antidepressant, and 2) adjuvant therapy, join the main to enhance or stabilize the main action of antidepressant. Therapy is mainly limited to cover the somatotropic and neurometabolic drugs and is focused on mitigating or preventing the reactions of organic and somatic changes of the soil. It can be antihypertensives (preferred b-blockers), vegetostabiliziruyuschie drugs (benzodiazepines are used mainly symptomatic); cerebroprotective funds (primarily nootropics) are appointed at the expressed cognitive impairment, especially if these phenomena were detected during the previous courses of therapy and impede full remission and re-socialization patient. However, the appointment of adjuvant therapy is preferable to defer to the stage, allowing to evaluate therapeutic options (efficacy and safety) of the main therapeutic agent. In particular as it relates to cognitive impairment and psycho-vegetative manifestations (reflecting somatization of mood disorders), because in most cases, these disorders are closely linked with depression and are reduced with the reduction of its main manifestations of affective (depression, anxiety), motivational and volitional (the inducement to activity) and vital (depression and change drives). To some extent, to the adjuvant drugs can be classified timostabilizatory, in particular, carbamazepine, whose accession to the stage to achieve the effect and end the active antidepressant therapy is justified not only to smooth out the emotional and autonomic instability common to complete the main therapy, but also to the subsequent long antirelapse treatment actually prevent worsening and recurrence of depression and general mood fluctuations in the probability of their occurrence.

Reducing the possibility of ...

Benefits of rehabilitation therapy, as restoration of the old social role and professional abilities of the patient, actually appeared only in the last decade. This is due to the fact that, along with justified itself when expressed, severe depression, tricyclic antidepressants appeared several new pharmacological group of antidepressants. Their advantages and benefits compared with tricyclic compounds are due not so much the power of antidepressant action (here, they often yield tricyclic antidepressants), but significantly less severe side effects, respectively, more robust security. It is side effects, including cardiotoxic, hepatotoxic, neurotoxic, limit the scope of today, such high-tricyclic antidepressants as amitriptyline, imipramine, irreversible MAO inhibitors. Above all, these restrictions apply to general medical practice. However, the modern choice of antidepressants (the major ones are listed in Table. 2) is quite wide. Many of these facilities have no significant side effects and under certain conditions can be successfully applied in the general profile settings and primary care network. Affiliation antidepressant to a particular subgroup is determined by its chemical structure, but does not always correlate with its ultimate pharmacological effect. For example, antidepressants, SSRIs and SSOZS opposite effects on certain receptor systems, are considered to be associated with depression, but they both eventually have antidepressant effects. Many antidepressants are polyvalent in effects on different neurotransmitters - serotonin, norepinephrine, dopamine and related receptor systems. Scattered atypical antidepressants are sometimes referred to various groups or define as modulators of serotonin receptors - such as trazodone [12]. Preference is given to modern treatment of depression drugs with less side effects. In addition, many of today's vehicles may be taken 1-2 times per day, which is important in long-term outpatient treatment. Taken into account when choosing a drug known features of the therapeutic effect of an antidepressant: a balance of tianeptine and maprotiline, mirtazapine, milnacipran, the presence of an activating component of the antidepressant activity of selective serotonin reuptake inhibitors - fluoxetine, sertraline, paroxetine, to a lesser degree of citalopram and fluvoxamine ( the latter can be protivotrevozhnoe and action), a combination of proper antidepressant (timoanalepticheskih), anxiolytic (tranquilizing, calming) vegetostabiliziruyuschih properties of Mianserin. Well use it when expressed anxiety autonomic manifestations of depression, the presence of a soporific effect during persistent insomnia with trazodone, marked effectiveness in apathy and anergy of moclobemide.

The presence of depression in patients with cardiovascular ...

The presence of depression in patients with cardiovascular diseases not only complicates the course and therapy of these disorders, but also reduces the life expectancy of patients. For example, depression, developing immediately after myocardial infarction, 3,5 times increased risk of dying of the disease [14.22]. In modern medicine, there is no other more dramatic and almost simultaneously changing group of disorders, what are the depression and cardiovascular disease. In recent years, they are distinguished by certain tendency to increase the rating burden amongst other forms of pathology. This is clearly confirmed by indicators of medical statistics and predictive models of the prevalence of different forms of pathology. Deserve special attention by WHO and the World Bank, based on predictions of the Harvard School of Public Health [2.19]. According to the criteria DALY (reduction of operational, sotsialnopolnotsennoy life), the most unfavorable dynamics of c early 90s and in the coming decades, characterized by 3 clinical forms: unipolar depression, coronary heart disease, cerebrovascular disease. In 1990, these diseases (or more precisely, the burden of these diseases) held on 4, 5, 6 seats. By 2020, the burden of these diseases will increase, and coronary heart disease becomes the leading cause of reducing the full-fledged human life, unipolar depression will be second place, and cerebrovascular disease will take 4 position (on the third will go traffic injuries). Clinical (and therapeutic) importance of a combination of depression with somatic pathology and more frequent detection of depression in primary care networks require close cooperation between psychiatrists and internists, search for new effective forms of such interaction with the organization of care to patients with depression outside of traditional mental health facilities. Such attempts are taken [4,5,9], but are still limited. However, the general concept of treatment of depression in recent years and is modified to a large extent based on the change of generations of antidepressants, the emergence of various non-drug treatments for depressed patients [1,3,7,8,11,12,18]. New therapeutic agents induce another to assess the opportunities and the organizational forms of treatment of depression, rather than 20-30 years ago. In this context, it seems reasonable shorthand for the stages of formation of the modern strategy of treatment of depression is a strategy, because it is not only and not on specific Zoloft to improve their pharmacological properties and effectiveness as a change of their relations with other methods of therapy in the general system of treatment suffering from depression. Finally, we are talking about and a certain change in the content of the concept of therapy, which today includes not only the methods of biological therapy (primarily drug therapy), but also forms of psychological and psychosocial effects (Table 1) Restorative therapy involves the deployment of Multiprofessional activity in clinical practice, including primary care network, providing maximum availability of assistance for persons with depression.

Intensive treatment with vitamins ...

Intensive treatment with vitamins and nootropics must be at least 23 months. Only in this case it is possible to observe a reduction of memory impairment and other manifestations of psychoorganic syndrome. In some cases, memory disturbances disappear completely, as well as other manifestations of this syndrome. Patients become active enough, there is criticism. However, this result may be achieved infrequently. Most rapidly disappearing manifestations of alcoholic polyneuropathy. In connection with gross violations of memory and the phenomena of dementia in most cases, patients recognize the disabled (disabilities of the second group). After graduating from acute alcoholic psychoses, as well as in protracted and chronic forms, there should be temperance therapy. So, a month after the end of the delirium, hallucinosis, and acute paranoia may tend to holding temperance therapy in full. Its aim to prevent re-occurrence of alcohol psychosis. Published with permission from Russian Medical Journal.

Current approaches to the treatment of depression

Prof. VN Krasnov Institute of Psychiatry, Ministry of Health, Moscow In the current epidemiological situation of depressive disorders attracted attention as a clinical and social phenomenon and as an object of therapeutic research. In a recent publication in breast cancer (№ 25, 2001) [6] we presented some evidence of high prevalence of depression worldwide, and that significant social and economic burden that carries with it a disease. Public health planning for the coming decades can not be done without taking into account the scale of the problems of depression, their relationship not only with psychiatric practice, but with many areas of somatic medicine [2]. To date, there are a number of institutional, social, and proper medical prerequisites for significant changes in helping people suffering from depression and the prevention of severe, chronic, disabling form of depression. Meanwhile, modern therapeutic agents used to treat depression is not enough or not quite adequately, without complying with the established scientific and preferences, and address the adverse effects and drug interactions. Depressive and anxiety disorders often manifest themselves exclusively somatic (somatovegetative) symptoms and are in the same way as somatic, as well as a mental disorder. Along with it there and is becoming increasingly pressing problem of conjugation of various forms of somatic and neurological disorders and depression. This primarily refers to the so-called psychosomatic diseases. Moreover, current projections suggest similar trends in the prevalence of depression and certain systemic diseases. In this case, confirmed particularly close relationship of depression and cardiovascular disease. Comorbidity of depression and hypertension is about 30% [17] and in patients in myocardial infarction depression are found in 16-45% of cases [10,16,21].

Only long antialcoholic ...

Only antialcoholic prolonged treatment, which patients are completely stopped drinking alcohol, may help in some cases, the gradual reduction of verbal hallucinosis and the disappearance of the perception of deception. Acute alcoholic paranoid docked as well as acute alcoholic hallucinosis. To eliminate the fear and the normalization of behavior might slow intravenous injection of 50 mg of chlorpromazine. This leads to the onset of sleep. On waking affect of fear is much less pronounced. Possible and intramuscular 1015 mg haloperidol concurrently with parenteral administration of 2,040 mg of diazepam. Neuroleptic therapy should continue for as long as patients pobredovomu interpret the behavior of others. If, after the abolition of neuroleptics reappears acute sensory delusions of persecution, it is necessary to exclude the presence of endogenous disease. Treatment of patients with alcoholic delusions of jealousy by using drugs with antipsychotic activity. Can be assigned to chlorpromazine 150 mg / day, haloperidol 15 mg per day, etc. Treatment of antipsychotic drugs continues as long as the tensions affect anger, a willingness to aggressive actions. In cases where the delirium of jealousy, combined with low mood, together with neuroleptics appointed antidepressants (amitriptyline). Success of therapy is dezaktualizatsiya delirium, loss of aggressive tendencies. Only upon reaching this result the patient may be discharged from the hospital. Highly desirable to conduct long temperance therapy, as well as the resumption of alcohol abuse rather quickly leads to the actualization of the ideas of jealousy. In some cases, during the delirium tremens becomes protracted. For several weeks in the evenings there are hallucinatory stupor, disorientation, restlessness. It always indicates the presence of alcoholic encephalopathy or associated systemic diseases. Most often cited a combination of alcoholic encephalopathy with serious medical conditions (pneumonia, pulmonary tuberculosis, cirrhosis of the liver). In these cases, treatment with B vitamins and piracetam. To combat insomnia, and excitation used diazepam, oxybutyrate sodium, low doses of haloperidol in combination with diazepam. Treatment of patients with Korsakov's psychosis and alcoholic dementia by taking into account the stage of the disease. In all cases we are talking about alcohol entselofalopatii, the initial phase of which takes place in a delirious stupor. At this stage treatment is the same as in relieving delirium tremens. In the second stage, when the detected gross memory impairment and multiple cognitive disorders, the intensive vitamin therapy. Doses of vitamin B1 can be as high as 300,400 mg per day. At the same time introduce vitamins B6, C, nicotinic acid. Must be appointed nootropics. Of paramount importance was the introduction of sufficiently large doses of piracetam (812 g / day).

Thiamine is introduced at a daily dose of ...

Thiamine is introduced at a daily dosage of 5001000 mg. It was at these doses using thiamine can increase the level of oxidative processes and reduce the severity of cerebral hypoxia. In addition, we introduce vitamins C, B6, PP. The range of prescribed drugs must include ethyl alcohol. Using alcohol to arrest severe delirium tremens is impossible, but ethanol helps stabilize the situation and buy time for intensive care. Sustained hyperthermia eliminated by introducing 2 ml of 50% of metamizol sodium in the great vessels are superimposed bubbles with ice. Extremely helpful is the introduction of a day to 30 g piracetam. Infusion therapy is conducted over 1,236 hours. It stops when the normal physical condition and sleep comes. In the coming days after arresting severe delirium tremens marked drowsiness, severe fatigue with increased exhaustibility. At this stage lasts vitamin, is introduced nootropil to 812 grams per day. It is best to carry out treatment of patients with severe delirium tremens in the intensive care unit, where there are opportunities for long-term infusion therapy under laboratory control. Therapy of patients with acute alcoholic hallucinosis constructed taking into account the fact that this psychosis, there is no significant violations of homeostasis. To eliminate the affect of fear and the normalization of behaviors were successfully used chlorpromazine (50 mg 3 times daily), levomepromazine. It later turned out that it is safer to use drugs such as haloperidol, triftazin, zuklopentiksol. Usually introduced by intramuscular injection 1015 mg and 2040 mg haloperidol diazepam. Sometimes combined with haloperidol hlorprotiksenu (15 mg 3 times a day). Antipsychotic drugs administered to until disappear verbal hallucinations. Seeking to normalize sleep. If, after the abolition of antipsychotics renewed verbal hallucinosis is necessary to exclude the presence of endogenous mental illness. All the patients underwent vitamin. Since 30% of the typical delirium tremens begins with the appearance of abundant auditory illusions of perception, the construction of therapy always take into account neurological disorders. In the presence of generalized tremor, ataxia, a rough, profuse sweating therapy is the same as in case of delirium. If alcoholic hallucinosis takes a protracted course, it is necessary to continue antipsychotic treatment. In some cases it is expedient to attach hypoglycemic insulin. Then in the morning, inject insulin, a second antipsychotic. In some cases prolonged hallucinosis accompanied by a decline in mood and appearance of more or less pronounced depressive symptoms. In these cases, can be attached to antidepressants. Appointment of antipsychotics patients with chronic alcoholic hallucinosis does not lead to the disappearance of verbal hallucinations. Neuroleptics can only eliminate the aggravation of symptoms caused by another alcoholic excesses.

Unfavorable for expressed ...

Unfavorable change over expressed in a typical hyperkinetic delirium, mussitiruyuschim, hyperthermia occurs sopor and coma. Death occurs during the collapse, which may arise during mussitiruyuschego delirium. Case-fatality rate reaches 1,015%. Usually have to deal with two variants tyazheloprotekayuschego delirium. For the first characterized by progressive dehydration and hypovolemia. Having decompensated metabolic acidosis, hypovolemia politsitemicheskaya, the concentration of sodium in blood plasma and decreases its concentration in red blood cells, drops of potassium in plasma and erythrocytes. The second option is accompanied by hyperhydration, increased politsitemicheskoy hypervolemia. There is decompensated metabolic acidosis. Increased potassium content in blood plasma and sodium in erythrocytes decreases the concentration of potassium in erythrocytes and plasma sodium levels. On the severity of the condition can be judged not only by the depth of confusion and progression of neurologic symptoms, but the content of sodium and potassium ions. In a typical delirium tremens sodium content was 2024 umol / L, potassium 6580 micromoles per liter. In severe delirium tremens sodium content (erythrocyte) above 24 micromol / l and potassium 3.5 mmol / liter. With such a violation of hypokalemia and the ratio of potassium and sodium, edema of the brain. When dehydration and hypovolemia skin is dry, hot, facial features, sharp, there is cyanosis of lips, noted wears neck veins, inhibition of reflexes. Arises serchechnososudistaya and respiratory failure. Necessary to conduct rehydration. Introduced more fluid than urine. Treatment is effective if the urine output increased to 400,500 ml. Used 5% glucose, Ringer's solution, isotonic sodium chloride solution, gemodez, reopoliglyukin, dextran. Blood volume filled by the introduction of 14 liters of fluid. Be sure to introduce the ions of potassium, sodium, and tachyarrhythmias, magnesium sulfate, sodium chloride, propranolol, novokainamid. When hyperhydration overcrowding neck veins, peripheral edema, signs of cerebral edema. Used by 1,020% glucose with insulin, 30% solution of potassium chloride, furosemide, mannitol. Woo to the amount of urine on 10% higher than the amount of fluid infused. To combat the metabolic acidosis arising during that and the other variant tyazheloprotekayuschego delirium on the basis of laboratory parameters are introduced 5% sodium bicarbonate, Cocarboxylase, disol, potassium chloride. To increase the level of blood pressure and normalization of vascular permeability using hydrocortisone and prednisolone. With the trend towards lower blood pressure dose of prednisolone is 80 mg, when a kollaptoidnyh states simultaneously introduced no less than 120 mg prednisolone. Of particular importance is the introduction of vitamins complex B. It is believed that in many developed severe delirium tremens, as well as acute encephalopathy GayeVernike due to deficiency of vitamin B1.

The authors managed with the help of this ...

The authors succeeded in using this technique for two years to exclude deaths from delirium tremens. There are other combinations sedatikov, hypnotics and neuroleptics. To maintain serchechnososudistoy kordiamin activity is widely used, if necessary, cardiac glycosides: 0,05% or 0,06% strophanthin Korglikon, which is injected slowly intravenously together with glucose. All patients were administered vitamins B1, C, B6, in conventional or high dosages. From other funds often assigned to carbamazepine, 0.2 mg 3 times a day. To make up for the loss of fluid injected polionnye solutions (up to 10,001,500 ml / day). Very efficient drip 400 ml gemodeza. The basic principle of therapy is the use of any drug or drug combination, depending on the performance of the previous appointment. For example, during hours of sleep made additional sedatives and hypnotics are not entered. If you sleep too short or the administration of drugs does not lead to the onset of sleep, re-use a combination of the previously prescribed medicines. Adverse symptoms are inability to arrest the delirium (remove the excitement and insomnia, delusions of perception) for a day of intensive therapy, as well as the resumption of delirious symptoms after many hours of sleep. In these cases, usually resort to methods, designed to relief tyazheloprotekayuschego delirium. Severe course of alcoholic delirium occurs in about 10% of all cases of delirium tremens. Usually preceded by many years of psychosis, or many months the continuous abuse of spirits. Withdrawal syndrome occurs very hard. Severe delirium tremens, as well as acute encephalopathy GayneVernike often begins with a series of seizures, repeated vomiting, accompanied by pain in the stomach, or a sharp rise in blood pressure. Most often initially appears typical of delirium, but during the first day the state of weights due to the deepening confusion, the appearance of gross neurological symptoms and signs of brain edema. To distinguish between complicated by delirium tremens (accession concomitant somatic diseases) and tyazheloprotekayuschy. Severe delirium tremens is an alcoholic psychosis, accompanied by profound confusion, caused by an abnormality of the brain. The main problem in relieving severe delirium tremens following: detoxification (removal of hypoxia, acidosis, hypovitaminosis); correction vodnoelektrolitnogo exchange and kislotnoosnovnogo state, prevention of cerebral edema and pulmonary edema of the brain control, elimination of hemodynamic and cardiovascular disorders, prevention of collapse, the elimination of excitation and insomnia . In all cases obligatory in infusion therapy. Relief of excitation and the elimination of insomnia is achieved by intravenous injection of thiopental sodium or oxybutyrate. You can then begin infusion therapy. The earlier treatment begins, so it is successful.

For these purposes for decades ...

For these purposes for decades used a variety of hypnotics and sedatives, as well as combinations thereof. Particularly effective was the combination of ethanol with barbiturates. The proposed EA Popov (1935), a mixture of ethyl alcohol and pentobarbital are still being used successfully for relief of alcohol withdrawal syndrome and delirium tremens. The use of ethanol seems to be quite reasonable, because delirium, the modern view, is the most difficult the withdrawal syndrome. Later it became clear that the more effective is the combination of sodium amytal and alcohol. Usually prescribed phenobarbital or 0.4 0,50,6 amytal with 4050 ml of 40 ? ethyl alcohol. Mixture is given repeatedly to achieve the long hours of sleep. With the advent of tranquilizers found that perfect effect can give an introduction to 2,040 mg of diazepam or 200 400 mg of meprobamate. Diazepam (relanium) was the preferred drug, especially intramuscular or intravenous injection. Abroad, and then in our country, is widely used hlormetiazol. Especially effective is the slow drip 500 ml 0.8% solution hlormetiazola. Hlormetiazol used in minor surgery for raushnarkoza. The ability of the drug to cause a deep sleep has been very valuable for the relief of delirium. Of course, the introduction of hlormetiazola requires continuous monitoring of the patient because of possible during anesthesia breathing stops. In domestic Addiction successfully used a slow (drip) the introduction of 3040 ml of 20% solution of sodium oxybutyrate. Typically, first introduced in 2040 mg of diazepam, then oxybutyrate sodium. Oxybutyrate sodium is valuable, which increases the endurance of the brain to hypoxia, occurring during a delirium, and quickly released from the body. For relief of delirium and used some funds for anesthesia. So, delirium were cut by i / m injection of 10 ml of 10% solution of hexenal or 10 ml of 2% or 5% solution of thiopental sodium. Usually for the renewal of these drugs in the enema was administered sodium amytal 0.5. Made also unsuccessfully attempted to use general anesthesia using nitrous oxide. Used and various combinations of drugs that have had a sedative and hypnotic effects. So, effectively a combination of 0.5 amytal with diphenhydramine 50 mg or 50 mg of diphenhydramine 50 mg prometizina. Of the neuroleptics used chlorpromazine, butyrophenone. It turned out that the use of powerful aadrenolitikov best avoided because of the possible fall in blood pressure. However, intramuscular injection of 1015 mg of haloperidol is very often leads to a decrease in excitation onset of sleep. In relieving delirium usually resort to a combination of several drugs. So, has spread the technique proposed VI Sema et al (1985). According to this methodology consistently introduce the following products: a mixture of Popov (40 ? alcohol from 0,4 phenobarbital) 100 150 ml, 48 ml of 0.5% of diazepam intravenously, 4050 mL of 20% solution of sodium oxybutyrate intravenously, 10 ml of 5% solution of Amity intramuscularly , 15 mg of haloperidol intramuscularly.

For most diseases in the ...

For most diseases there are now well-established pattern - treatment standards, which include obtaining well-defined results. To use therapy for somatic and psychosomatic diseases such schemes (patterns), virtually none. The use of psychotherapy in general "can not predict the outcome. Practice shows: psychotherapy in the internist can be effective on the date in the case when using techniques that provide correction and personality, and direct the work of the body concerned. To create such treatment patterns (schemes) knowledge only psychotherapy, or only care enough. Experience of using waste patterns of pharmacological therapy with minimal support, such as bronchial asthma, shows the efficiency is much superior to all existing conventional methods of treatment, especially in the long term. Specific psychotherapy treatment in the reorganization of a particular system or organ, has proved effective in other diseases, it would seem, is not involved directly with psychosomatics (eg, acute myocardial infarction). To generate templates provide psychological care for the majority of known diseases lone effort is not enough. Requires commitment and serious work collectives of like-minded, accepting the postulate of the unity of psychic and somatic development of pathological somatic processes. Email: gleb_y2000@mail.ru

Treatment of patients with alcoholic psychosis

Professor AG Hoffman Institute of Psychiatry, Ministry of Health, Moscow Psychotic states arising in some patients with alcoholism as a result of years of alcohol abuse are quite varied in clinical manifestations, severity and duration. The most difficult the psychoses accompanied by marked confusion (delirium). Second in frequency space occupied by acute alcoholic hallucinosis. The share of these two types of alcoholic psychosis accounted for approximately 90% of all psychotic states caused by alcohol abuse. Much rarer acute alcoholic paranoia, protracted hallucinosis, alcoholic delusions of jealousy. A special group of alcoholic encephalopathy, accompanied by the appearance of psychotic symptoms. Therapy for various types of alcoholic psychoses varies significantly, forcing separately consider the treatment of patients with delirium, hallucinosis, paranoia and alcoholic encephalopathy with psychotic symptoms. Relief of delirium tremens is modified depending on the severity of the condition. In light and medium gravity (typical) delirium tremens is not a material breach of homeostasis and therapeutic activities are focused on the clinical manifestations of psychosis. The main problem in relieving pulmonary and medium gravity delirious states removal of excitation and insomnia, to maintain cardiovascular activity, supplementation of fluid loss.

As another example, the patient suffers from ...

Another example, a patient suffering from idiopathic esophageal spasm, a few years transformed into a functional impairment aholaziyu esophagus with the morphological reconstruction of the esophagus wall and the need for surgical correction. Any "functional" violation would inevitably have a morphological basis, because it is one of the conditions of conservation and transformation of memory in nature. Our research methods in the clinic do not allow us to track those initial, subtle morphological changes in these stages are characterized by somatic implement short-term memory in the form of altered function. Yes, in this and there is no need. The main thing to understand the laws governing the development process. The main thing to understand what all the psycho-emotional processes are necessarily based on a somatic basis and does not exist in isolation from each other. The degree of somatic (from the morphological - not necessarily identical) expression may be different: reversible, partially reversible with the restoration of the most appropriate body for the operation and in cases of irreversible pathology. From this point of view will require a different scale for evaluating the changes: the reaction, the state (for example, bronchial asthma without complications), and finally, a disease where the morphological disturbances prevail to the extent that the psycho-emotional recede into the background ("The Moor has done it, Moor can go "). I want to emphasize that the author has in no way opposed to other described and studied relations - Somatopsychical, complex, combined-offs. Yes, it's simply impossible to do if you understand and accept that the psyche and somatic biologically united and divided only in our minds, because of habit to divide, to make it easier to learn, but, alas, does not understand. There is another problem of judgments, difficult to assess how the development of psychosomatic disorders. This problem is unconscious. In psychology, we mean only that archived in the memory through the mind and the time of the study or the life of consciousness is derived, including different patterns of behavior and response. Completely ignored a broader interpretation (which is epistemologically Bole exact), when under the unconscious means all great controls and directs the activities of the brain, providing vital functions of the body. For psychosomatic medicine is, in contrast to the more narrow task of psychology is understanding fundamentally changes the approach to therapy. Undesirable patterns of regulation may be formed in addition to general consciousness through the senses, where emotions are the only conductor of the corresponding entry in memory. The notion of continuity in the psycho-emotional response to> the emergence of functional disorders of> the development of morphological changes in target organs> psycho-emotional response as a single mechanism with the closely related links at all stages of development can be considered quite different clinical data and traditional somatic diseases.

Everything in his power: and the life and ...

All in his power: and the life and tears and love ", and plans and hopes, and somatic state, whose parameters are in fractions of seconds are monitored constantly. And this raises another interesting problem: the understanding of memory, which is in a situation with psychosomatics is described most often as a property of consciousness, but is only a part (like consciousness itself) took a small percentage of the total activity of the brain. The memory inherent in the brain is much more extensive and integrated directly in connection with the activities and status (including somatic) of all organs and systems. Brain in the chaos of incoming information identifies the order parameters in the form of permanent and temporary management templates, which are described Anokhin and complemented H. Bekhtereva in the form of functional systems and subsystems. Clinician it is important to remember that the degree of influence of these systems in the morphological aspect ranges from minor functional correction to stimulate cellular and total apoptosis, ie, the regulation on the issue of life and death. In other words, it is not only about the "functional" disorders, but also the mandatory morphological changes, which must deal with an internist. Some phenomena occurring in the human body seem curious, but, in fact, eminently practical, and they appear constantly, though not always openly to the researcher. For an understanding of psychosomatic processes, it is especially important. For example, we know that if we impose long-term bandage on the joint imobiliziruyuschuyu, the joint is replaced by bone and connective tissue with a complete turn off the original function. Realized demand effect. In this example, with a negative sign: something that does not need to be liquidated. However, there is always the same phenomenon with a positive sign, regardless of the fact that a phenomenon is helpful or harmful to the organism in terms of our consciousness. The process of adaptation and compensation rarely considered in our consciousness. It suffices to follow the evolution of any disease "functional" origins. Physician therapeutic profile when you first visit establishes a diagnosis of biliary dyskinesia, but the patient internal picture of disease does not reflect the views of a doctor, and psychotherapeutic work with her was conducted. After some time (a year or two - depends on the type of person) in this patient confirmed the diagnosis of chronic acalculous cholecystitis, which she insisted even the first time. After a few more years of a diagnosis of gallstone disease. Who is right? Right and the doctor and patient. Available dyskinesia (undeniably functional disorder) violating the passage of bile led to e thickening and stagnation, created the stage for inflammation of the gallbladder wall. Later, these same conditions contributed to the violation of physical and chemical properties of bile to form stones - full circle - "function" is transformed into the morphological changes, which, in turn, on the basis of feedback deepen functional impairment.

In most cases, taken ...

In most cases, accepted that "this does not die, although die and not so rare! Yes, and the term "functional" was introduced, probably from hopelessness, to somehow understand each other. Centuries of empirical and scientific experience, however, continually put and continues to question the established traditions. The mass of psychological disorders with organ-oriented and psevdoorgannymi masks, which were strongly rejected internists as "not ours" and at the same time, did not fit into a large psychiatry, have been identified as "border states" (or ours - or your "). So in one group were psychological disorders such as anksioznyh states, phobias, obsessions different, neurotic depression, neurasthenia, hysteria, as well as numerous somatic "mask" diseases and disorders of the regulation related to the autonomic nervous system. Masks, these states have been identified so that psychiatrists could not establish any changes in the organs (yes it is a specialty and do not!), And internists do not do - on the principle of "do not sit not in his sleigh." For each disease, in therapy, there are waste treatment regimens, which include obtaining well-defined results. When using psychotherapy with somatic and psychosomatic diseases such schemes (templates) are virtually absent. The use of psychotherapy in general "can not predict the outcome. Existing techniques, at best, are directed to the symptoms of systemic manifestations, not of the essence of the disease. Practice shows: psychotherapy in the internist can be effective on the date in the case when using techniques that provide correction and personality, and violations of the morphology and function of the body concerned directly. To create such treatment patterns (schemes) knowledge only for psychotherapy, or only care enough. Should be their union. Publication of the last time on psychosomatics compromise have combined all the available theories of these disorders, but not brought anything radically new in the understanding of the problem. Remain the "mask" certain vegetative disturbances, psycho-emotional disorders related to them or their cause. The very terminology does not reflect the epistemology of Psychosomatics, since changes soma acts only as somatoform. Forty-year experience of the therapist and the therapist's twenty years of experience in one person suggests that this interpretation is erroneous. I will not dwell on the analysis of general issues of information processing in the human body, because this is a topic for another discussion, though it was she who can understand the meaning and ways of forming irregularities. It is not secret the fact that nothing in the "man" is not done alone or in isolation with all the seeming autonomy of some manifestations. There is no separate psychophysiology, physiology, cardiovascular system, etc. Metaphorically we can say that all organs and systems ultimately are attendants of the brain that gives us the perception of the environment and adapt - its resistance to pressure.

Model of man adopted as the basis ...

Model Rights, adopted as the basis for its study in the 20 century, was in fact a system with the infinite variety of parameters of freedom that could not be observed and described in this model. Replaced the study of somatic must inevitably come to the study of information security man as an integrated single system, as part of nature, laws which are universal and applicable to the understanding of many of its properties, including a man who is still revered as the "king" of nature, separating unconsciously by its laws. The situation in medicine today can be summarized as follows. On the table laid out in a full set of parts and components for television. Around the table sat 90 specialists (in the number of nomenclature of Russian health care professions), each of whom knows the intricacies of detail and considers it paramount. Each of them can be proud of their achievements and scientific work in their field of specialization, but there is no installer, who owns the information on their interactions, enabling a whole of these details with the new quality - the TV. The installer does not necessarily know for certain parts of the device and, more important to know their place and purpose in the processing, management and implementation of information. Such a specialty in medicine today is missing, but can set up without additional effort, if you combine the two most common specialty: therapy and psychotherapy alone, in the face of a doctor. . Disputes within the meaning of the term as well as symptoms do not subside until now. And, despite an increase in interest in the subject in recent decades, new publications continue to one-sidedly interpret the observed phenomena. This is difficult to accuse the authors themselves, since the general trend of fragmentation of medical specialties, this situation is quite logical. All work performed and written by psychiatrists - psychotherapists. Sharing with internists Commonwealth few changes position, because established traditional division between somatic and psychic leaves all the interpretation of the same in accordance with the prevailing mentality. The principle of "to each his own" reliably protects organopatologicheskie approaches from antropopatologicheskogo understanding. Psychiatry, better than other professions mastered clinical research methods, and almost never uses Pathomorphology and somatic medicine, diagnosis based on additional research Assurance direct violation of the morphology (cytological, histological studies) or instrumental data, indirectly confirming these violations remain each in its platform with its does not coincide explanations and concepts. Psychiatric care of authors does not allow them to go deep into organopatologiyu and in all the papers the main emphasis on the psychological, psycho-emotional level phenomena, which from the standpoint internist only "functional" and therefore not the main, are not dangerous, do not deserve special attention.

Keltner N. L., Folks D. G. Psyhcotropic ...

Keltner N. L., Folks D. G. Psyhcotropic drugs. / / Mosby, St. Louis, 1997, 584 p. Published with permission from Russian Medical Journal.

Psychosomatics - need another concept

Yakovlev GI

The present stage of its development is characterized by ...

The current stage of its development is characterized by change of generations in all groups of psychotropic drugs. New medicines have first of all a greater breadth of clinical activities at the selectivity of neurochemical and qualitatively higher tolerance, identified as non-conventional indications for their use, and other, previously unknown positive clinical effects. Much progress has occurred in understanding the biological mechanisms of action of psychotropic drugs, including genetically determined factors that can hope to achieve in the near future, new peaks in the psychopharmacological treatment of mental illness. References: 1. Avrutsky GY, Neduva AA Treatment of the mentally ill. / / Moscow, Medicine, pp. 1988 528. 2. Avrutsky GY Some patterns of drug pathomorphism schizophrenia: Problems of Psychopharmacology, 1976, pp. 517. 3. Avrutsky GY Changing clinics and course of psychosis as a result of mass psychopharmacological and their implications for improving medical care / / J. Neuropathology and Psychiatry. SS Korsakova, 1979, N8, with. 13871394. 4. Zhislin SG On the change in course and symptoms of psychosis in the treatment of modern psychotropic drugs: Problems of Psychopharmacology, M., 1962, pp. 7385. 5. Mosolov SN Chronobiological aspects normotimicheskogo of anticonvulsants and lithium salts. / / Anticonvulsants in psychiatric and neurological practice. / Edited by AM Vein and SN Mosolov, pp. 72253. 6. Mosolov SN Clinical use of modern antidepressants. / / Medical News Agency. SP, 1995, pp. 568. 7. Mosolov SN Fundamentals of pharmacotherapy. / / M., 1996, pp. 288. 8. Mosolov SN Biological Basis of Modern antipsychotic therapy / / Russian Journal of Psychiatry, 1998, N6, s.712. 9. Mosolov SN Psychometric scale assessment of symptoms of schizophrenia and the concept of positive and negative disorders / M., New Color, 2001, 238s. 10. Smulevich AB, Vartanian FE, Zavidovskaya GI Rumyantsev, GM Some problems pamorfoza schizophrenia associated with the use of psychotropic drugs, Vestnik AMN USSR, 1971, N5, s.7985. 11. Smulevich AB, Gindikin VJ, Avedisova AS etc. Application of psychotropic agents in somatic network. / / Journal of Neuropathology and Psychiatry, 1985, (4., Pp. 594 599. 12. Smulevich AB, Panteleyev GP Some actual problems of clinical pharmacotherapy. / / Journal of Neuropathology and Psychiatry., 1983, (9, with. 1345 1351. 13. Tiganov A. Guide to Psychiatry in 2 volumes / Medicine, 1999. 14. Delay J., Deniker P. Methodes chimiotherapeutique en Psychiatrie. / / Paris, Masson, 1961, 496 p. 15. Ginestet D., Kapsambelis V. Therapeutique medicamenteuse des troubbes psychiatriques de L. Adulte. / / Medecine Sciences, Flammarion, Paris, 1996, 402 p. 16. Petrilowitsch N. Psychiatrislhe Krankheitsleitslehre and psychiatrische Pharmakotherapie 2Aufl., Basel, 1968. 17. Shader RI Manual of Psychiatric Therapeutic. / / Little, Brown and Comp. (Inc), 1994, 496 p.

In addition, were found a variety of ...

Also, were found a variety of side effects and complications, especially kidney, sometimes resulting in long-term continuous reception of lithium salts. These circumstances have resulted in the early '80s to a specific revision of the indications for prophylactic use of lithium and stimulated the search for alternative drugs with similar normotimicheskoy activity. In recent years, and timostabiliziruyuschy antimaniakalny effects were found in the new anticonvulsants (lamotrigine, topiramate, gabapentin, Tiagabine, vigabatrin), atypical antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole), calcium channel blockers verapamil, nifedipine and diltiazem. In prophylactic calcium channel blockers are used mainly for failure or intolerance to other drugs normotimicheskih. With regard to tranquilizers or sleeping pills, here the most unpleasant thing, apparently, is the development of addiction and the formation of drug dependence. In this regard, the Conciliation Commission, WHO (1996) does not recommend benzodiazepine drugs continuously for more than 23 weeks. Benzodiazepine derivatives are not deprived of the phenomenon of behavioral toxicity and mnestic violations. Several new drugs with nebenzodiazepinovym mechanism of action seems to be devoid of these properties. Renewed interest in the some of the older tranquilizers, such as antigistaminovomu drug hydroxyzine. Significant progress in the treatment of panic attacks and phobic disorders has made use of powerful new benzodiazepine derivatives alprazolama and clonazepam. Among hypnotics drugs appeared nebenzodiazepinovoy structure of zopiclone and zolpidem, minimally alter the basic neurophysiological characteristics of sleep (Table 3) and more rarely cause addiction phenomenon. In recent years there has been a new surge of interest in the development of tools with nootropic activity (neurometabolic stimulants). Here also is an increase in the clinical differentiation of products (antiastenichesky, nootropic, mnemotropny, vazovegetativny, adaptogenic and other effects). Had the tools with distinct psychoactive (Fenotropil, atsefen, bifemelan) timoanalepticheskoy (Sadenozilmetionin, meklofenoksat, etc.), adaptogenic (synthetic tiroliberiny) or tranquilizing (phenibut, meksidol, dipeptides pirrolidinkarbonovyh acids, etc.) activity. Past without much risk can be used in patients with seizure disorders, with sleep disorders and various anxiety syndromes. Thus, despite the current lack of an ideal of psychotropic drugs, and some pessimistic assessment of the prospects of pharmacotherapy, as well as a number of negative trends (such as an increase in the number of cases of therapeutic resistance, development of the phenomena of habituation and side effects) psychopharmacotherapy today remains the main method of treatment of mental disorders and continues to develop rapidly.