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.