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Mental illness treatment


The modern approach to the treatment of mental illness involves the complex application of various methods of biological effects with psychotherapy and measures for the social and labor rehabilitation of patients. Therapeutic tactics should be clinically based, i.e. the diagnosis should be correctly made, the psychopathological symptoms, the severity of the condition, the individual characteristics of the patient’s personality and physical condition should be determined. Therapy must be dynamic - depending on the change in the patient's condition, the stage of development of the disease. If in acute psychosis a patient is treated with medication, then when leaving the psychosis, the measures of psychotherapeutic influence and social rehabilitation become more and more important. The method of administration of drugs is also determined by the patient's condition, his severity and severity. Usually, psychotropic drugs are prescribed by mouth (tablets, dragees, powders, drops, syrup) or as intramuscular injections. In some cases, use the intravenous route of administration (for quick effect) or intravenous drip infusion. Preparations are prescribed taking into account possible side effects and complications. Carefully analyzed all indications and contraindications.
Treatment can be both outpatient and inpatient. This is determined depending on the condition of the patient, the possible consequences of the disease both for the patient himself and for those around him, and in some cases, the patient’s desire. In cases of marked mental disorders, treatment is usually started in the hospital, and then, after the severity of the condition has passed, they are continued on an outpatient basis. The task of outpatient treatment in such cases is the stabilization of the condition or its further improvement and the deepening of remission. However, on an outpatient basis, not only supportive therapy is possible, but also a stopping or correcting self-painful condition. Such a cupping treatment is prescribed to patients with erased mental episodes, reactive conditions that do not require hospitalization. Corrective therapy (psycho-correction) is carried out with mental disorders of the border circle (neuroses, psychopathies, neurotic reactions).
Biological therapy refers to methods of therapeutic effects on biological processes that underlie mental disorders. It includes the use of psychotropic drugs (psychopharmacotherapy), shock treatments (insulin comatose and electroconvulsive therapy), as well as other means - hormones, vitamins, diets.
Psychopharmacotherapy. Since ancient times, used various drugs that affect the human psyche. The arsenal of such funds was limited to some herbal preparations (opium, valerian, caffeine, ginseng) and mineral substances (bromine salts). Psychopharmacotherapy began to flourish only from the beginning of the fifties, when aminazine was discovered. A new era began in the treatment and maintenance of the mentally ill. One after another, new groups of drugs were opened: tranquilizers, antidepressants, nootropics. Currently, the search continues for new, more effective drugs with minimal side effects and complications.
There are several groups of psychotropic drugs.
Neuroleptics (haloperidol, triftazin, stelazin, tizertsin, aminazin, etc.) - eliminate painful disorders of perception (hallucinations), thinking (nonsense), fear, agitation, aggressiveness.
This is the main tool in the treatment of psychosis. Apply both internally and injections. For outpatient maintenance therapy using drugs prolonged (long) action. For example, moditen-depot is administered intramuscularly 1 time in 3-4 weeks, semapur is given orally 1-2 times a week. When using neuroleptics, especially large doses, side effects and complications can occur. The most common side effects include: hand tremors, stiffness, mask-like face, jerking of individual muscles (often chewing, swallowing muscles, muscles of the tongue, lips, eyes), restlessness (anxiety in the legs with the need to constantly move, not finds a place "). Even mild manifestations of these disorders require the appointment of special correctors (cyclodol, parkopan), the doses of which are selected individually. Neuroleptics such as eglonil, leponeks do not cause the above described side effects and there is no need to prescribe correctors. Neuroleptics are very widely used in psychiatry: for the treatment of any psychotic states, including schizophrenia, involutional, alcoholic, reactive psychoses.
Tranquilizers (seduxen, Elenium, phenazenam, tazepam, etc.) - have a calming effect, eliminate emotional tension, anxiety, excessive anxiety, cause muscle relaxation, contribute to sleep. Removing emotional stress and anxiety, tranquilizers help to normalize vegetative-vascular manifestations, in particular, lower blood pressure, decrease heart rate, relieve various "spasms" and related respiratory and gastrointestinal disorders. Each tranquilizer has its primary spectrum of action. In some drugs, the sedative effect is more pronounced, in others - along with a calming relaxing effect, in others - hypnotic (hypnotic). This fact is necessarily taken into account when prescribing treatment. If the patient suffers from insomnia, drugs such as Radeorm, Eunookin, Rohypnol are recommended to help sleep and deepen the night's sleep. In cases where it is necessary to get a calming effect without muscle relaxation and hypnotic effects (for example, to relieve increased excitement at the exam, during a responsible meeting, report), apply so-called daytime tranquilizers (orehotel, stratium, grandaxine, uxepam) that even have some stimulating action. In connection with a wide range of psychotropic activity, tranquilizers are used not only in psychiatric practice, in particular in the treatment of neurosis, neurotic reactions, and pathological characteristics, but also in many somatic diseases.
Antidepressants (Amitriptyline, Melipramine, Gerfonal, Azafen, Ludiomil, Pyrazidol, etc.) - increase the painful low mood, eliminate the inhibition of mental activity and motor activity. There are two groups of antidepressants with stimulating and sedative (sedative) effects. Preparations of the first group (Melipramine, Nuredal) are prescribed in cases where, along with a depressed mood, there is a pronounced motor and speech inhibition. Antidepressants of the second group (amitriptyline, triptizol) are used with strong anxiety and anxiety. When treating with antidepressants, there may be side effects, such as dry mouth, constipation, rapid heartbeat, urinary retention, or a little bit, drooling, diarrhea, decrease in heart rate, lowering blood pressure. However, these side effects are not life-threatening and are eliminated with the help of a doctor.
Antidepressants are used in the treatment of depressions of various origins: the depressive phase of manic-depressive psychosis, neurotic depression, depressions in somatic diseases. Antidepressants, like other psychotropic drugs, are prescribed only by a doctor. It is not recommended to use these drugs independently in order to avoid side effects and unpleasant complications.
Psychostimulants (sydnocarb, caffeine, cefedrin) - increase mental (thinking) and physical activity, relieve fatigue, lethargy, lethargy. The use of ah is limited to a certain range of disorders: severe asthenic conditions, apathy. Stimulants are prescribed by a psychiatrist. Perhaps addictive.
Nootropics or drugs of metabolic action. This group consists of drugs of different chemical structure and mechanism of action (nootropil, piracetam, pyriditol, encephabol, gammalon, phenibut), which are united by the common effect they have. Nootropics increase mental performance, overall tone, improve attention, memory, increase the protective properties of the body. The range of their application is very wide. Nootropics are used in many mental disorders, for relieving hangover and intoxication syndrome in alcoholics, in atherosclerosis of cerebral vessels, in disorders of cerebral circulation, in traumatic brain injuries and so on. Drugs in this group practically do not cause side effects. In rare cases, mainly in elderly patients, anxiety, sexual desire increases, sleep is disturbed. It is recommended to use nootropics in the morning, considering their activating effect.
Mood stabilizers (lithium salts) - eliminate painful mood swings, normalize excessively elevated mood. Used mainly for the prevention of depressive and manic attacks in patients with manic-depressive psychosis (cyclotymia), periodic schizophrenia. Treatment with lithium salts is carried out under the control of its content in the blood serum, for which patients periodically take blood for analysis. Side effects and complications usually occur with an overdose of the drug or in the presence of severe somatic diseases (diseases of the kidneys, heart and blood vessels, thyrotoxicosis, metabolic disorders). The most common are small hand tremor, muscle weakness, fatigue, nausea, which are easily eliminated by lowering the dosage of the drug.
Insulin shock therapy. The basis of this method is a non-specific stress effect on the body, increasing its defenses. In other words, as a result of shock therapy, the adaptive capacity increases so much that the body itself is struggling with the disease. Treatment consists of daily administration of increasing doses of insulin until symptoms of hypoglycemia appear first (decrease in blood sugar level) and then a comatose state (complete deactivation of consciousness). From the coma is derived by intravenous glucose, as well as taking the sugar syrup inside. The course of treatment is usually 20-30 com. Before treatment, the patient is carefully examined. Insulin therapy is performed only to young, physically healthy individuals. Indications for use of this method are currently limited. It is used to treat some forms of schizophrenia.
Electroconvulsive therapy (ECT). The method is to artificially induce convulsive seizures by exposure to alternating electric current. The mechanism of action of electroconvulsive treatment has not been clarified to date. The effect of this method is associated with the effect of electric current on the subcortical brain centers, as well as on metabolic processes in the central nervous system.
ECT is used for endogenous (psychotic) depressions in the framework of manic-depressive psychosis and schizophrenia. The course of treatment is 4-10 shocks. Abroad, this method is used quite often due to a fairly quick effect and a lower price compared with the drug treatment method. Domestic psychiatrists use ECT quite rarely, only in cases of depression-related psychotropic drugs.
All methods of biological therapy are carried out in consultation with the patient or his relatives, if the patient is in acute psychosis and does not give an account of his actions.
Psychotherapy - a complex psychological impact of the doctor on the patient's psyche. The main instrument of the doctor is the word. Psychotherapy in a broad sense covers the whole area of ​​communication between a doctor and a patient. A doctor of any profile, communicating with a patient, has a psychological effect on him. Moreover, the ability to talk with the patient, to penetrate into his soul and gain confidence, you need a psychiatrist.
The goal of psychotherapy is to eliminate painful symptoms, change attitudes towards oneself, one’s condition and one’s environment. The basis of all psychotherapeutic influences is constituted by suggestion and explanation, proposed in various ratios and sequences.
Rational (explanatory) psychotherapy is a method of influencing a patient by means of a logically reasoned explanation. It is usually held in the form of a dialogue between a doctor and a patient. The purpose of such an interview is to explain the causes and nature of the disease, its possible outcomes, the need and appropriateness of the prescribed treatment, and the correction of the patient's misconceptions about his illness. The physician must have clarity and clarity of thinking in order to use scientific, logical reasoning, easy-to-understand language to instill in the patient the hope of recovery, to inspire him, to help overcome a false understanding of the disease and its consequences. Before convincing the patient of something, the doctor must listen to him patiently and carefully, because it is of paramount importance for establishing emotional contact between the doctor and the patient.
Suggestive therapy - suggestion of various thoughts, including hostility and disgust (for example, to alcohol). Suggestion is taken by patients without logical processing and critical thinking. At the moment of suggestion, the patient perceives information passively, without thinking. The influence is mainly on the emotional sphere. Suggestion is carried out both in the waking state and in the state of hypnotic sleep.
Implantation in the waking state is carried out either individually or collectively. Appropriate conditions are necessary for carrying out the suggestion: a darkened room isolated from noise, comfortable chairs (for the patient to relax). Of great importance is facial expressions, movements, speech of the doctor, his appearance.
Self-suggestion is the suggestion to oneself of ideas, thoughts, feelings, recommended by the doctor and aimed at eliminating the painful phenomena and improving the general well-being. Self-hypnosis is realized through autogenic training, which the patient learns with the help of a doctor-psychotherapist.
Hypnosis is a therapeutic suggestion conducted in a state of hypnotic sleep. Before starting treatment, the essence of the method is explained to the patient, so that he is not afraid, does not strain during the session. Each session consists of three stages: sleep, proper suggestion, and exit from hypnosis. The number of sessions per course of treatment is 10-15. You can conduct hypnosis sessions with a group of patients. To do this, select patients with the same pathology and problems.
Collective and group psychotherapy - mutual therapeutic effects of patients, carried out under the guidance of a doctor. In other words, this type of treatment provides not only the impact of the doctor on the patients, but also the members of the group on each other. It is very important that the group has an atmosphere of mutual understanding and trust, frankness, and interest in achieving a common goal.
Family psychotherapy is a therapeutic effect aimed at resolving interpersonal relations in the patient's family. Used for the prevention and treatment of neurosis, rehabilitation of the mentally ill after discharge from the hospital in order to create a favorable microclimate in the family.
Behavioral psychotherapy is a complex of psychotherapeutic techniques aimed at breaking the pathological conditioned reflex connections and developing the desired forms of behavior. For example, this method is successfully used in the treatment of various fears (fear of the dark, water, the subway). A patient under the guidance of a doctor by training teaches himself to overcome the fear that arises in a traumatic situation.
In addition to the above methods of biological treatment and psychotherapy, various physiotherapeutic methods of exposure are widely used, including electric, acupuncture, spa treatment, and occupational therapy.