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"etiology": "<p>Диссоциативное расстройство формируется у личности на фоне присутствия в прошлом или настоящем нескольких неблагоприятных обстоятельств, в числе которых наиболее весомые: </p>\r\n<ul>\r\n<li>воздействие стрессовых факторов, которые человек оценивает как непереносимые; </li>\r\n<li>травматический опыт в прошлом; </li>\r\n<li>наличие защитного механизма – диссоциации, то есть восприятие события, происходящее лично с индивидом как явления у кого-то постороннего; </li>\r\n<li>способность вытеснять (изолировать) свои воспоминания из сферы сознания. </li>\r\n</ul>\r\n<p>Почва для развития патологии закладывается в детском возрасте: человек не рождается с ощущением цельной идентичности, становление личности проходит в результате многообразных переживаний и разнопланового воздействия. Базой для формирования у личности диссоциативного расстройства является дефицит родительского внимания и заботы в тяжелых для малыша ситуациях, когда он, не владея необходимыми механизмами преодоления проблем, вынужден применять деструктивные формы защиты, вытесняя свои негативные ощущения из сферы сознания. </p>\r\n<p>В качестве главной причины развития аномальных состояний, по мнению многих исследователей, выступает факт физического и психологического насилия, пережитого личностью в детские годы. Также в роли пускового механизма обнаруживаются вытесненные из сознания воспоминания о пережитых стихийных бедствиях, военных конфликтах, смерти близких родственников или затяжной болезни. </p>\r\n<p> </p>",
"pathogenesis": "<p>Механизм возникновения диссоциативного расстройства сложен. Разум человека словно разделяется на составные. Они не забываются, а просто активизируются в определенных обстоятельствах. Доступ становится свободным только к определенным образам, памяти, мыслям, а потом словно оказывается запрещенным при активации других воспоминаний. <br class=\"SCXW253022860\" /> <br class=\"SCXW253022860\" />Все типы диссоциативных расстройств имеют тенденцию к ремиттированию спустя несколько недель или месяцев, особенно, если их возникновение было связано с травматическим жизненным событием. Могут развиваться иногда более постепенно и более хронические расстройства, особенно параличи и анестезии, если начало связано с неразрешимыми проблемами или расстроенными межперсональными взаимосвязями. </p>",
"diagnostics": "<p>Диагноз выставляется на основании беседы с больным, данных объективного осмотра и результатов дополнительных исследований. </p>\r\n<p>Для постановки диагноза необходимы два критерия. </p>\r\n<ol>\r\n<li>подтверждение информации о стрессах или психологических конфликтах, лежащих в основе расстройства. </li>\r\n<li>отсутствие неврологического или соматического заболевания, которое могло бы вызвать выявленные нарушения.</li>\r\n</ol>\r\n<p>Проводятся исследования, исключающие органическое поражение головного мозга: МРТ, КТ. </p>\r\n<p>Кроме того, диагностика включает изучение физиологических параметров: артериального давления, частоты пульса. </p>",
"treatment": "<p>Лечение диссоциативных расстройств должно быть комплексным, включающим психотерапию, фармакотерапию. </p>\r\n<p>Психотерапия направлена на коррекцию когнитивного и поведенческого состояния больного. Специалист проводит при необходимости не только беседы, но и сеансы гипноза, внушения, после которых пациент может вести нормальный образ жизни без тревог и конверсионных нарушений психики. </p>\r\n<p>Фармакотерапия расстройств включает все классы психофармакологических средств — нейролептики, транквилизаторы, антидепрессанты, психостимуляторы, ноотропы, тимолептики. Наиболее широкое применение находят транквилизаторы и антидепрессанты</p>",
"prevention": "<p>Сохранение психического здоровья и предупреждение психических расстройств – гораздо менее понятная задача, чем предупреждение инфекционных болезней, для профилактики которых проводится вакцинация, а для лечения применяются антибиотики; в области психических заболеваний таких мер не существует. <br class=\"SCXW133581643\" /> <br class=\"SCXW133581643\" />Во всем мире наркомания и алкоголизм привели к кризису психического здоровья. В результате формирования зависимости страдает психика десятков миллионов мужчин, женщин и детей. <br class=\"SCXW133581643\" /> <br class=\"SCXW133581643\" />Насилие над детьми – тоже существующий во всем мире феномен. Как фактор возникновения психических заболеваний оно заслуживает намного большего внимания, чем ему сейчас уделяется. В последние годы такое насилие рассматривается как первичная причина синдрома множественной личности. Международные организации, такие, как Всемирная организация здравоохранения, усиленно работают над выявлением и искоренением насилия над детьми, осуществляемого в странах третьего мира под видом детского труда, т.е. постоянного и узаконенного использования детей в промышленности и сельском хозяйстве фактически в качестве рабов. </p>",
"clinical_picture": "<p>К основным признакам заболевания, по которым врач диагностирует расстройство конверсионного типа, относятся: </p>\r\n<ul>\r\n<li>Амнезия — резкая потеря памяти вследствие стресса, травмы, но при этом сохраняется способность усваивать свежую информацию. У больного нормальное сознание и он понимает, что утрачена память. </li>\r\n<li>Фуга. Неожиданный, внезапный уход больного человека из дома, с работы. Страдающий диссоциацией может воспринимать себя другой личностью, откликаться на другое имя, не понимать, что происходит в реальности. </li>\r\n<li>Нарушение идентификации. Человек отождествляет себя с несколькими лицами, которые присутствуют в его сознании. При этом каждое «я» проявляется в свое время и меняет взгляды человека, настроение, отношение к окружающим и к самому себе. Более того, вмещенные в сознание больного личности могут иметь разную половую принадлежность, национальность, имена. Пациенты такого рода не помнят своей истинной природы, а также внутренние «я» не знакомы друг с другом. </li>\r\n<li>Деперсонализация. Происходит отчуждение от собственного тела, человек видит себя как бы во сне, искажается ощущение времени, пространства. Больным кажется несоразмерными руки, ноги, голова или они чувствуют себя роботами, состояние нередко сопровождается тревожностью, депрессией. </li>\r\n<li>Синдром Ганзера. При диссоциации, больной может преднамеренно усиливать свое тяжелое психическое состояние. Чаще всего встречается у мужчин, отбывающих срок заключения — возникает миморечь, то есть неверные ответы, амнезия, нарушение восприятия, дезориентация. </li>\r\n<li>Транс. При конверсионных расстройствах пациент перестает реагировать на внешние факторы. Состояние сопровождает пилотов после длительных перелетов, медиумов, сектантов. Такие признаки наблюдаются у определенных народностей — малайских амоков, эскимосских либлокто. </li>\r\n<li>Кома. При расстройстве возможна потеря сознания, состояние ступора, комы. </li>\r\n</ul>\r\n<p> </p>",
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"standards": [
5249
]
}
]
}
