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Treatment of mental illnesses


The modern approach to the treatment of mental illnesses presupposes the integrated application of various methods of biological influence 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 diagnosed, the psychopathological symptomatology, the severity of the condition, the individual characteristics of the patient's personality and his physical condition are determined. Therapy should be dynamic - depend on the changes in the patient's condition, the stage of the development of the disease. If in acute psychosis the patient undergoes medical treatment, then when psychosis exits, the measures of psychotherapeutic influence and social readaptation become more important. The mode of administration of drugs is also determined by the patient's condition, severity and severity. Usually psychotropic drugs are prescribed inside (tablets, dragees, powders, drops, syrup) or in the form of intramuscular injections. In some cases, use the intravenous route (for speed of effect) or intravenous drip infusion. Preparations are prescribed taking into account possible side effects and complications. All indications and contraindications are carefully analyzed.
Treatment can be both outpatient and inpatient. This is determined depending on the patient's condition, possible consequences of the disease both for the patient himself and for others, and in some cases - the patient's desire. In severe mental disorders, treatment usually begins in the hospital, and then, after passing the severity of the condition, continue in the outpatient setting. The task of outpatient treatment with such cases is stabilization of the condition or its further improvement and deepening of remission. However, in outpatient settings, not only maintenance therapy is possible, but also a stopping or corrective condition. Such a stopping treatment is prescribed for patients with erased psychic episodes, reactive states that do not require hospitalization. Corrective therapy (psychocorrection) is carried out with mental disorders of the borderline (neuroses, psychopathies, neurotic reactions).
Biological therapy refers to the methods of curative influence on the biological processes that underlie mental disorders. It includes the use of psychotropic drugs (psychopharmacotherapy), shock treatment methods (insulin-comatose and electroconvulsive therapy), as well as other drugs - hormones, vitamins, diets.
Psychopharmacotherapy. Since ancient times, various drugs have been used that affect the human psyche. The arsenal of such drugs was limited to some herbal preparations (opium, valerian, caffeine, ginseng) and mineral substances (bromine salts). Psychopharmacotherapy began to develop rapidly only from the beginning of the fifties, when aminazine was discovered. A new era has begun in the treatment and maintenance of mentally ill people. 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, trifazin, stelazin, tizercin, aminazine, etc.) - eliminate painful perception disorders (hallucinations), thinking (delirium), fear, excitement, aggression.
This is the main tool in the treatment of psychosis. Apply both inside and in injections. For outpatient maintenance therapy, long-acting drugs are used. For example, modified-depot is administered intramuscularly once every 3-4 weeks, the semap is given orally 1-2 times a week. When using neuroleptics, especially large doses, there may be side effects and complications. Of the side effects most often observed: tremor of hands, stiffness of movements, maskedness of the face, convulsive reduction of individual muscles (often chewing, swallowing muscles, muscles of the tongue, lips, eyes), restlessness (feeling of "anxiety" in the legs with the need to constantly move, "not Finds its place "). Even mild manifestations of these disorders require the appointment of special correctors (cyclodol, parcupan), the doses of which are selected individually. Neuroleptics such as eglonil, leponex, 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 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 tension and anxiety, tranquilizers contribute to the normalization of vegetative-vascular manifestations, in particular, lowering blood pressure, reducing heart rate, removing various "spasms" and associated respiratory and gastrointestinal disorders. Each tranquilizer has its own preferred spectrum of action. Some drugs have a more pronounced calming effect, in others - along with calming relaxing, in others - sleeping pills (hypnotic). This fact is necessarily taken into account in the appointment of treatment. If the patient suffers from insomnia, such drugs as radedorm, eunotin, and rohypnol are recommended, which help to fall asleep and deepen the night's sleep. In those cases when it is necessary to get a calming effect without muscle relaxation and hypnotic action (for example, to remove the heightened excitement in the exam, during a responsible meeting, the report), the so-called daily tranquilizers (rudotel, stratium, grandaxin, uksepam) Stimulating action. In connection with a wide range of psychotropic activity, tranquilizers find application not only in psychiatric practice, in particular in the treatment of neuroses, neurotic reactions, pathocharacterological disorders, but also in many somatic diseases.
Antidepressants (amitriptyline, melipramine, gerfonal, azafen, ludiomil, pyrazidol, etc.) - increase the morbidly low mood, eliminate the inhibition of mental activity and motor activity. There are two groups of antidepressants - with a stimulating and sedative (calming) effect. Preparations of the first group (melipramine, noredal) are prescribed in those cases when along with a depressed mood there is pronounced motor and speech retardation. Antidepressants of the second group (amitriptyline, triptyzole) are used for severe anxiety and anxiety. In the treatment of antidepressants, side effects such as dry mouth, constipation, heart palpitations, urinary retention, or set-up, salivation, diarrhea, a decrease in heart rate, a decrease in blood pressure may occur. 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, 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 your own to avoid side effects and unpleasant complications.
Psychostimulants (sidnokarb, caffeine, cefedrin) - increase mental (thinking) and motor activity, relieve fatigue, inhibition, lethargy. The use of ah is limited to a certain range of disorders: severe asthenic conditions, apathy. Stimulants are appointed by a psychiatrist. Perhaps addictive.
Nootropics or preparations of metabolic action. This group consists of different drugs (nootropil, pyracetam, pyriditol, encephabol, gamma-lon, phenybut), different in chemical structure and mechanism of action, united by the generality of their effect. Nootropics increase mental efficiency, general tone, improve attention, memory, enhance the protective properties of the body. The range of their application is very wide. Nootropics are used for many mental disorders, for removing hangover and intoxication syndrome in alcoholics, for atherosclerosis of cerebral vessels, for disorders of cerebral circulation, for craniocerebral trauma, and so on. Preparations of this group practically do not cause side effects. In rare cases, mainly in patients of senile age, excitability, sexual desire, sleep is disturbed. It is recommended to apply nootropics in the first half of the day, given their activating effect.
Stabilizers of mood (lithium salts) - eliminate painful mood swings, normalize excessively high mood. They are used mainly to prevent depressive and manic attacks in patients with manic-depressive psychosis (cyclothymia), periodic schizophrenia. Treatment with lithium salts is carried out under the control of its content in blood serum, for which the 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 (kidney, heart and blood vessel diseases, 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.
Insulino-shock therapy. This method is based on a nonspecific stressor effect on the body, which increases its protective forces. In other words, as a result of shock therapy, the adaptive capacity is so high that the body struggles with the disease itself. The treatment consists in the daily administration of increasing doses of insulin until the appearance of symptoms of hypoglycemia (reduction of sugar content in the blood) first, and then - a coma (complete disabling of consciousness). From a coma is deduced by intravenous introduction of a glucose, and also reception of a sugar syrup inside. The course of treatment is usually 20-30 kom. Before the treatment, the patient is carefully examined. Insulin-coma therapy is given only to 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 the artificial triggering convulsive seizures by exposure to alternating electric current. The mechanism of action of electroconvulsive treatment has not been sufficiently clarified to date. The effect of this method is associated with the effect of electric current on subcortical brain centers, as well as on metabolic processes in the central nervous system.
ECT is used in endogenous (psychotic) depression in the context of manic-depressive psychosis, schizophrenia. The course of treatment - 4-10 shocks. Abroad, this method is used quite often because of a fairly rapid effect and a lower price compared with the drug treatment method. Domestic psychiatrists use ECT very rarely, only in cases of drug-resistant depressions.
All methods of biological therapy are carried out in coordination with the patient or his relatives, if the patient in acute psychosis and does not give a report to his actions.
Psychotherapy is the complex psychological impact of a physician on the psyche of a patient. The main tool of the doctor is the word. Psychotherapy in a broad sense covers the whole area of ​​communication between the doctor and the patient. The doctor of any profile, communicating with the patient, has a psychological effect on him. Especially the ability to talk with a sick person, in order to penetrate into his soul and gain trust, is necessary for a psychiatrist.
The goal of psychotherapy is to eliminate painful symptoms, change attitudes towards oneself, one's condition and the environment. The basis of all psychotherapeutic influences is suggestion and explanation, offered in various ratios and sequences.
Rational (explanatory) psychotherapy is a method of influencing a patient by a logically reasoned explanation. It is usually conducted 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 necessity and appropriateness of the prescribed treatment, and correct the patient's misconceptions about his illness. The physician should have clarity and clarity of thinking, so that using scientifically logically constructed argumentation, accessible to understanding the language, inspire the patient with hope of recovery, inspire him, help overcome the false understanding of the disease and its consequences. Before convincing a patient in anything, the doctor should listen patiently and attentively, for this is of great importance for establishing an emotional contact between the doctor and the patient.
Suggestive therapy - suggestion of various thoughts, including dislike and disgust (for example, to alcohol). Suggestion is prone to patients without logical processing and critical thinking. At the moment of suggestion, the patient perceives the information passively, without reflection. The influence is mainly on the emotional sphere. Suggestion is carried out both in a state of wakefulness and in a state of hypnotic sleep.
Suggestion in the waking state is carried out either individually or collectively. To carry out the suggestion, the appropriate conditions are necessary: ​​a darkened room isolated from noise, comfortable armchairs (so that the patient relaxes). Of great importance is facial expressions, movements, speech of the doctor, his appearance.
Self-expression 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 autogenic training, which the patient is trained with the help of a physician-psychotherapist.
Hypnosis is a medical suggestion conducted in a state of hypnotic sleep. Before starting treatment, the patient is explained the essence of the method, so that he is not afraid, not strained during the session. Each session consists of three stages: euthanasia, the actual suggestion, the way out of hypnosis. The number of sessions for the course of treatment 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 - the 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 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, interest in achieving a common goal.
Family therapy is a curative effect aimed at resolving interpersonal relationships in the patient's family. Used for the prevention and treatment of neuroses, the 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 desirable forms of behavior. For example, this method is successfully used in the treatment of various fears (fear of darkness, water, metro). A patient under the guidance of a doctor by training teaches himself to overcome the fear that arises in a psychotraumatic situation.
In addition to the above methods of biological treatment and psychotherapy, various physiotherapeutic methods of influence are widely used, including electrosleep, acupuncture, sanatorium treatment, occupational therapy.