Mental Illness Treatment
A modern approach to the treatment of mental illness involves the integrated use of various methods of biological exposure with psychotherapy and measures for the social and labor rehabilitation of patients. Therapeutic tactics should be clinically sound, i.e. the diagnosis must be correctly made, the psychopathological symptoms, the severity of the condition, the individual characteristics of the patient's personality and his physical condition determined. Therapy should be dynamic - depend on the change in the patient's condition, stage of development of the disease. If in acute psychosis the patient is treated with medication, then when leaving psychosis, measures of psychotherapeutic influence and social readaptation become more and more important. The method of drug administration is also determined by the condition of the patient, its severity and severity. Usually psychotropic drugs are prescribed orally (tablets, dragees, powders, drops, syrup) or as intramuscular injections. In some cases, use the intravenous route of administration (for speed of effect) or intravenous drip. Drugs are prescribed taking into account possible side effects and complications. All indications and contraindications are carefully analyzed.
Treatment can be either outpatient or inpatient. This is determined depending on the condition of the patient, the possible consequences of the disease both for the patient himself and for others, and in some cases - the desire of the patient. With severe mental disorders, treatment usually begins in a hospital, and then, after passing the severity of the condition, continue on an outpatient basis. The task of outpatient treatment in such cases is to stabilize the condition or to further improve it and deepen remission. However, on an outpatient basis, not only supportive therapy is possible, but also a stopping or correcting self-relieving condition. Such stopping treatment is prescribed for patients with erased mental episodes, reactive conditions that do not require hospitalization. Corrective therapy (psychocorrection) is carried out with mental disorders of the border circle (neurosis, psychopathy, neurotic reactions).
Biological therapy refers to the methods of therapeutic effect on the biological processes that underlie mental disorders. It includes the use of psychotropic drugs (psychopharmacotherapy), shock treatment methods (insulinocomatosis and electroconvulsive therapy), as well as other drugs - hormones, vitamins, diets.
Psychopharmacotherapy. For a long time, different drugs have been used that affect the human psyche. The arsenal of such products was limited to certain herbal preparations (opium, valerian, caffeine, ginseng) and minerals (bromine salts). Psychopharmacotherapy began to develop rapidly only from the beginning of the fifties, when chlorpromazine was discovered. A literally new era has begun in the treatment and maintenance of the mentally ill. One after another, new groups of drugs were discovered: tranquilizers, antidepressants, nootropics. Currently, the search for new, more effective drugs with minimal side effects and complications continues.
There are several groups of psychotropic drugs.
Antipsychotics (haloperidol, triftazine, stelazine, tizercin, chlorpromazine, etc.) - eliminate painful perception disorders (hallucinations), thinking (delirium), fear, agitation, aggressiveness.
This is the main tool in the treatment of psychosis. Apply both inside and in injections. For outpatient maintenance therapy, prolonged (long-acting) drugs are used. For example, moditen-depot is administered intramuscularly 1 time every 3-4 weeks, semap is given orally 1-2 times a week. When using antipsychotics, especially large doses, side effects and complications can occur. Of the side effects that are most often observed: tremor of hands, stiffness of movements, maskiness of the face, convulsive reduction of individual muscles (more often chewing, swallowing muscles, muscles of the tongue, lips, eyes), restlessness (feeling of "anxiety" in the legs with the need to constantly move, "do 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. Such antipsychotics, such as eglonil, leponex, do not cause the above side effects and there is no need to prescribe correctors. Antipsychotics are very widely used in psychiatry: for the treatment of any psychotic conditions, including schizophrenia, involutional, alcoholic, reactive psychoses.
Tranquilizers (seduxen, elenium, phenazenam, tazepam, etc.) - have a calming effect, eliminate emotional tension, anxiety, excessive excitement, cause muscle relaxation, contribute to falling asleep. Relieving emotional stress and anxiety, tranquilizers contribute to the normalization of vegetative-vascular manifestations, in particular, lowering blood pressure, heartbeat, relieving various "spasms" and associated respiratory and gastrointestinal disorders. Each tranquilizer has its own preferred spectrum of action. Some drugs have a more soothing effect, others have a soothing relaxing effect, while others have sleeping pills (hypnotic). This fact must be taken into account when prescribing treatment. If the patient suffers from insomnia, drugs such as Rademorm, Eunoktin, Rohypnol, which contribute to falling asleep and deepening night sleep, are recommended. In cases where it is necessary to obtain a calming effect without muscle relaxation and sleeping pills (for example, to relieve increased excitement on the exam, during a responsible meeting, report), the so-called daytime tranquilizers (ore-hotel, stratium, grandaxin, vinexepam) are used, which even have some stimulating effect. Due to the wide spectrum of psychotropic activity, tranquilizers are used not only in psychiatric practice, in particular in the treatment of neurosis, neurotic reactions, patho-characteristic disorders, but also in many somatic diseases.
Antidepressants (amitriptyline, melipramine, herfonal, azafen, ludiomil, pyrazidol, etc.) - increase painfully lowered mood, eliminate the inhibition of mental activity and motor activity. Two groups of antidepressants are distinguished - with a stimulating and sedative (calming) effect. The drugs 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, tryptisol) are used for severe anxiety, anxiety. When treating with antidepressants, side effects can be noted, such as dry mouth, constipation, palpitations, delayed urination or, congestion, salivation, diarrhea, decreased 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 depression of various origins: the depressive phase of manic-depressive psychosis, neurotic depression, depressive states in somatic diseases. Antidepressants, like other psychotropic drugs, are prescribed only by a doctor. It is not recommended to use these drugs on their own in order to avoid side effects and unpleasant complications.
Psychostimulants (sydnocarb, caffeine, cefedrine) - increase mental (thinking) and motor 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 metabolic drugs. This group consists of drugs with different chemical structures and mechanisms of action (nootropil, piracetam, pyriditol, encephabol, gammalon, phenibut), united by the common effect they exert. 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 for many mental disorders, to relieve a hangover and intoxication syndrome in alcoholics, for atherosclerosis of cerebral vessels, for cerebrovascular accidents, for traumatic brain injuries, etc. Preparations of this group practically do not cause side effects. In rare cases, mainly in senile patients, excitability, sexual desire, sleep disturbance increase. It is recommended to use nootropics in the morning, given their activating effect.
Mood stabilizers (lithium salts) - eliminate painful mood swings, normalize excessively high mood. It is used mainly for the prevention of depressive and manic seizures in patients with manic-depressive psychosis (cyclothymia), periodic schizophrenia. Treatment with lithium salts is carried out under the control of its content in the blood serum, for which patients are periodically taken 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 tremors, muscle weakness, fatigue, nausea, which are easily eliminated by reducing the dosage of the drug.
Insulin shock therapy. The basis of this method is a nonspecific stress effect on the body, increasing its defenses. In other words, as a result of shock therapy, adaptive capabilities increase so much that the body itself fights the disease. Treatment consists in the daily administration of increasing doses of insulin until symptoms of hypoglycemia appear first (a decrease in blood sugar) and then a coma (a complete turn off of consciousness). From a coma, they are removed by intravenous administration of glucose, as well as by ingesting sugar syrup. The course of treatment is usually 20-30 com. Before treatment, the patient is carefully examined. Insulinocomatous therapy is carried out only for young, physically healthy individuals. Indications for the use of this method are currently limited. It is used to treat certain forms of schizophrenia.
Electroconvulsive therapy (ECT). The method consists in artificially inducing seizures by exposure to alternating electric current. The mechanism of action of electroconvulsive treatment is still not well understood. The effect of this method is associated with the effect of an 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 as part of manic-depressive psychosis, schizophrenia. The course of treatment is 4-10 shocks. Abroad, this method is used quite often due to the rather quick effect and lower price compared to the medical treatment method. Domestic psychiatrists use ECT quite rarely, only in cases of depression resistant to psychotropic drugs.
All methods of biological therapy are carried out in coordination with the patient or his relatives, if the patient is in acute psychosis and does not give a report on his actions.
Psychotherapy is a complex psychological effect of a doctor on the patient's psyche. The main tool of the doctor is the word. Psychotherapy in a broad sense covers the entire area of communication between the doctor and the patient. A doctor of any profile, communicating with the patient, has a psychological effect on him. Moreover, the ability to talk with a patient in order to penetrate his soul and gain trust is necessary for a psychiatrist.
The goal of psychotherapy is the elimination of painful symptoms, a change in attitude towards oneself, one's condition and environment. The basis of all psychotherapeutic influences is the suggestion and explanation offered in various proportions and sequences.
Rational (explanatory) psychotherapy is a method of influencing a patient through a logically reasoned explanation. It is usually carried out in the form of a dialogue between the doctor and the 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 to correct the patient's misconceptions about his illness. The doctor should have clarity and clarity of thinking in order to use the scientific logically structured argument, accessible to understanding the language, to inspire the patient with hope for recovery, to inspire him, to help overcome the false understanding of the disease and its consequences. Before convincing the patient of something, the doctor must listen to him patiently and carefully, because this is of great importance for establishing emotional contact between the doctor and the patient.
Suggestive therapy is the suggestion of various thoughts, including hostility and aversion (for example, to alcohol). The suggestion is taken by the patient without logical processing and critical reflection. At the time of suggestion, the patient perceives information passively, without reflection. The effect is mainly on the emotional sphere. Suggestion is carried out both in a state of wakefulness and in a state of hypnotic sleep.
Waking suggestion is carried out either individually or collectively. Appropriate conditions are necessary for the suggestion: a darkened room isolated from noise, comfortable chairs (so that the patient relaxes). Of great importance is facial expressions, movements, speech of a doctor, his appearance.
Self-hypnosis is the suggestion to oneself of ideas, thoughts, feelings recommended by a doctor and aimed at eliminating painful phenomena and improving overall well-being. Self-hypnosis is realized through an autogenic training, which the patient learns with the help of a psychotherapist.
Hypnosis is a therapeutic suggestion carried out in a state of hypnotic sleep. Before starting treatment, the patient is explained the essence of the method so that he is not afraid, does not strain during the session. Each session consists of three stages: euthanasia, the actual suggestion, exit from hypnosis. The number of sessions per treatment course is 10-15. You can conduct hypnosis sessions with a group of patients. For this, patients with the same pathology and problems are selected.
Collective and group psychotherapy is a mutual therapeutic effect of patients, carried out under the guidance of a doctor. In other words, this type of treatment involves not only the impact of the doctor on patients, but also group members on each other. It is very important that the group has an atmosphere of mutual understanding and trust, frankness, interest in achieving a common goal.
Family psychotherapy is a therapeutic effect aimed at resolving interpersonal relationships in the patient's family. It is used for the prevention and treatment of neurosis, the rehabilitation of mentally ill patients 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 pathological conditioned reflex connections and developing desirable behaviors. For example, this method has been successfully used in the treatment of various fears (fear of the dark, water, metro). The patient, under the guidance of a doctor, teaches himself through training to overcome 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 electrosleep, acupuncture, spa treatment, occupational therapy.