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{
"name": "Малоумие"
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{
"name": "Олигофрения"
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"slug": "nevrologiya",
"lead": "ЛидОбласть медицины, включающая в себя лечение 1036 заболеваний. В 1140 клиниках России оказывается помощь по этому направлению медицины.",
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{
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{
"id": 69,
"disease_count": null,
"name": "другое",
"code": "B69",
"branch_medicine_code": "069",
"slug": "drugoe",
"lead": "Область медицины, включающая в себя лечение 268 заболеваний. В 3931 клинике России оказывается помощь по этому направлению медицины.",
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},
{
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"disease_count": null,
"name": "клиническая лабораторная диагностика",
"code": "B16",
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"slug": "klinicheskaya_laboratornaya_diagnostika",
"lead": "Область медицины, включающая в себя лечение 2214 заболеваний. В 886 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"name": "психиатрия и судебно психологическая экспертиза",
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"slug": "psihiatriya_i_sudebno_psihologicheskaya_ekspertiza",
"lead": "Область медицины, включающая в себя лечение 486 заболеваний. В 491 клинике России оказывается помощь по этому направлению медицины.",
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}
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},
"code": "F79",
"name": "Умственная отсталость неуточненная",
"icd_name": "Умственная отсталость неуточненная",
"gender": 0,
"age_min": 0,
"age_max": 89,
"cause": [
3
],
"periodicity": 4,
"slug": "f79_umstvennaya_otstalost_neutochnennaya",
"lead": "Нарушение здоровья, относящееся к группе умственная отсталость",
"description": "Умственная отсталость — врождённая или приобретённая в раннем возрасте задержка, либо неполное развитие психики, проявляющаяся нарушением интеллекта, вызванная патологией головного мозга и ведущая к социальной дезадаптации. Проявляется в первую очередь в отношении разума (откуда и название), также в отношении эмоций, воли, речи и моторики. ",
"etiology": "<p>К возможным причинам развития умственной отсталости относят: </p>\r\n<ul>\r\n<li>Генетические (хромосомные аномалии, дисфункция отдельных генов); </li>\r\n<li>Внутриутробное поражение плода нейротоксическими факторами физической (ионизирующее излучение), химической или инфекционной (вирусы герпеса, сифилис, краснуха, и др.) природы; </li>\r\n<li>Значительная недоношенность; </li>\r\n<li>Нарушения в процессе родов (асфиксия, родовая травма); </li>\r\n<li>Травмы головы, гипоксия головного мозга, инфекции с поражением центральной нервной системы; </li>\r\n<li>Педагогическая запущенность в первые годы жизни у детей из неблагополучных семей. </li>\r\n<li>Умственная отсталость неясной этиологии. </li>\r\n</ul>",
"pathogenesis": "<p>Патогенетические механизмы различных форм умственной отсталости значительно отличаются друг от друга. Однако имеются и общие звенья патогенеза, среди которых особенно важная роль принадлежит хроногенному фактору, т.е. периоду онтогенеза (индивидуального развития), в котором происходит поражение развивающегося мозга различные патогенные воздействия, как генетические, так и экзогенные, действуя в один и тот же период, могут вызвать однотипные клинические проявления, в то время как один и тот же этиологический фактор, воздействуя на разных этапах онтогенеза, может приводить к различным последствиям. </p>\r\n<p>Около 75% случаев умственной отсталости обусловлено поражением головного мозга во внутриутробном периоде. Формирование органов и систем чаще всего нарушается во время критических этапов развития. Все внутриутробные аномалии развития подразделяют: </p>\r\n<ul>\r\n<li>на бластопатии, обусловленные поражением зародыша в период бластогенеза (до 4 нед беременности); </li>\r\n<li>на эмбриопатии – поражение плода в период эмбриогенеза, т.е. от 4 нед до 4 мес беременности; </li>\r\n<li>на фетопатии – поражение плода в сроки от 4 мес до конца беременности.</li>\r\n</ul>",
"diagnostics": "<p>При диагностике умственной отсталости нельзя ограничиваться только установлением факта общего психического недоразвития ребенка. При диагностике умственной отсталости целесообразно: </p>\r\n<ul>\r\n<li>изучение семейного анамнеза и пренатального развития, течения родов, периода новорожденности и последующего развития; </li>\r\n<li>клиническое обследование больного (включает диагностическую беседу с пациентом и физикальное обследование). В результате диагностической беседы получают основные данные, характеризующие психический статус больного. При проведении физикального обследования важно оценивать как неврологические симптомы, так и возможные соматические аномалии, пороки развития, стигмы дизэмбриогенеза (малые пороки); </li>\r\n<li>генетические исследования; </li>\r\n<li>пренатальные диагностические процедуры (УЗИ, амниоцентез); </li>\r\n<li>параклинические исследования; </li>\r\n<li>использование психологических и педагогических методик. </li>\r\n</ul>\r\n<p>Инструментальное обследование включает рентгенографию черепа, ЭхоЭГ (УЗИ), КТ, МРТ, ЭЭГ (электроэнцефалография). </p>",
"treatment": "<p>Специфическая терапия проводится при некоторых видах умственной отсталости с установленной причиной (врождённый сифилис, токсоплазмоз и др.); при умственной отсталости, связанной с нарушениями метаболизма (фенилкетонурия и др.), назначают диетотерапию; при умственной отсталости токсоплазмозного происхождения применяют сульфаниламиды с хлоридином; при эндокринопатиях (микседема, кретинизм) — гормональное лечение. Лекарственные средства назначают также для коррекции эмоциональной лабильности и подавления извращённых влечений. </p>\r\n<p>Большое значение для компенсации олигофренического дефекта имеют лечебно-воспитательные мероприятия, трудовое обучение и профессиональное приспособление. В реабилитации и социальной адаптации умственно отсталых пациентов наряду с органами здравоохранения играют роль вспомогательные школы, школы-интернаты, специализированные ПТУ, мастерские для умственно отсталых и др. </p>\r\n<p>Чем раньше начато лечебно-педагогическое воздействие, тем лучше результат коррекции нарушений при дебильности. </p>\r\n<p>В первые годы жизни эффективны повторные курсы рефлексотерапии, в том числе сегментарного и точечного массажа, позволяющие стимулировать кровообращение и обменные процессы в коре головного мозга. </p>\r\n<p>Большое значение имеет правильное питание, игры на свежем воздухе, регулярные занятия лечебной физкультурой, плавание, иппотерапия, музыкотерапия, постоянное общение со здоровыми сверстниками. </p>\r\n<p>Необходимы ежедневные развивающие занятия, периодические консультации дефектолога, психолога и выполнение полученных рекомендаций, посещение детского сада, школьные занятия. </p>\r\n<p>У взрослых, у которых с детства диагностирована умственная отсталость легкой степени, в коррекции на первый план выходит регулярная физическая активность, работа по дому и на производстве, социальная адаптация. </p>",
"prevention": "<p>Профилактика умственной отсталости основана на серьезном подходе к своему здоровью и здоровью будущих поколений. Перед планированием беременности, супругам желательно пройти обследования специалистов для выявления инфекционных и хронических заболеваний, иногда требуется консультация генетика. Беременная женщина должна помнить об ответственности за здоровье своего еще не родившегося ребенка. Необходимо вести правильный образ жизни, избегать влияния вредных факторов, регулярно посещать женскую консультацию и четко следовать рекомендациям гинеколога. После рождения ребенка родителям следует наладить контакт с педиатром, выполнять все назначенные обследования. При появлении подозрения на умственную отсталость у ребенка необходимо своевременно обратиться к специалисту и начать лечение. Некоторые родители находятся во власти предубеждений по отношению к психоневрологам и психиатрам, и стараются избежать посещения этих специалистов даже при наличии серьезных показаний, нанося тем самым непоправимый вред здоровью и будущему своего ребенка. </p>\r\n<p> </p>",
"clinical_picture": "<p>Дети с органическими поражениями коры головного мозга (олигофрены) растут обычно ослабленными, раздражительными. Многие из них страдают энурезом. </p>\r\n<p>При легкой степени умственной отсталости IQ пациентов составляет 50-69. Внешне такие пациенты практически не отличаются от здоровых людей. Обычно они испытывают сложности в обучении из-за сниженной способности к концентрации внимания. При этом память у них достаточно хорошая. Часто пациенты с легкой степенью умственной отсталости имеют нарушения поведения. Они зависимы от родителей или воспитателей, их пугает смена обстановки. Иногда такие пациенты становятся замкнутыми (т.к. плохо распознают эмоции других людей, поэтому испытывают сложности при общении). А иногда наоборот, стараются привлечь к себе внимание различными яркими поступками, обычно нелепыми, а подчас и антисоциальными. Внушаемость пациентов с легкой степенью умственной отсталостью может привлекать к ним представителей криминального мира, тогда они становятся либо жертвой обмана, любо игрушкой в руках преступников. Практически все пациенты этой группы осознают свое отличие от здоровых людей и стремятся скрыть свое заболевание. </p>\r\n<p>Среди больных различают эретичных (возбудимых), вялых апатичных, злобно-упрямых, мстительных и торпидных (заторможенных). Характер их может быть добродушно-ласковым и приветливым, либо агрессивным со злобностью, упрямством и недоверчивостью к окружающим. </p>\r\n<p>Все интересы страдающих дебильностью преимущественно сконцетрированы на удовлетворении инстинктов (пищевого и полового), а также на своей внешности. </p>\r\n<p>У больных отмечается некоторая неуклюжесть, размашистость движений. Иногда встречаются неврологические расстройства и аномалии физического развития, собственно, как и при других формах умственной отсталости. </p>\r\n<full></full>\r\n<p>Дети с умеренной степенью умственной отсталости способны накопить некоторый запас сведений; механическая память у многих достаточно развита. Такие больные овладевают речью, хотя запас слов у них невелик, речь аграмматична, а понимание и использование речи ограничено. При легкой имбецильности сознание своего «Я» более или менее развито. Многие больные эгоцентричны, требуют к себе повышенного внимания, проявляют радость при положительной оценке их действий и обиду, когда их ругают. К самостоятельной жизни эти больные, как правило, не приспособлены и нуждаются в постоянной опеке и в уходе за ними. Уроаень IQ у них колеблется в диапазоне от 45 до 59. </p>\r\n<p>Клиническая картина тяжелой умеренной отсталости сходна с симптоматологией легкой имбецильности. Отмечается низкий уровень социального функционирования, что проявляется практически полной невозможности усвоить элементарные школьные знания, бытовые умения и навыки. Обычно таких детей выводят из системы обучения, в дальнейшем они на протяжении всей жизни нуждаются в опеке и постоянном уходе. В отличие от пациентов с умеренной умственной отсталостью, у этих больных выражены расстройства моторной сферы, что также затрудняет даже их простую социальную адаптацию. Внешне отличаются от обычно развивающихся сверстников (выражение лица менее осмысленное). Умственно отсталый ребенок часто имеют в анамнезе соматические заболевания – нарушения зрения, слуха и работы внутренних органов. Нередко нарушена работа опорно-двигательного аппарата. Походка из-за этого неустойчивая, плохо развита координация движений, особенно, согласованных. Обращенную к ним речь понимают, но чаще ориентируются по интонации и выражению лица. Для усвоения простых навыков необходимо многократное повторение. Плохо ориентируются в пространстве, во времени не ориентируются. Могут повторять элементарные действия, склонны к подражанию. Но внимание крайне неустойчивое. Эмоционально отзывчивые, но скорее, инстинктивно, чем осознанно. Уровень IQ у этих пациентов соответствует диапазону 30-44 ед. </p>\r\n<full></full>\r\n<p>Людям, больным идиотией, недоступна осмысленная деятельность, речь не развита, они могут произносить лишь отдельные нечленораздельные звуки и слова, не понимают речи окружающих, не отличают родственников от посторонних. На окружающую обстановку, людей обычно никак не реагируют, и даже ярким светом или громким звуком не привлечь и не задержать их внимание. С больными идиотией возможны лишь рудиментарные формы невербального общения. Мышление не развивается, реакция на окружающее резко снижена. </p>\r\n<p>Эмоциональная жизнь исчерпывается примитивными реакциями удовольствия и неудовольствия. Больные идиотией не могут смеяться или плакать, не могут радоваться. У одних преобладают вспышки немотивированного гнева, у других — вялость и безразличие ко всему окружающему. </p>\r\n<p>Люди, больные идиотией, не способны к самостоятельной жизни: не владеют простейшими навыками самообслуживания, не могут одеться или раздеться, не могут самостоятельно есть, не отличают съедобное от несъедобного, всё тянут в рот, иногда даже не пережёвывают пищу, не отличают холодное от горячего, неопрятны, не испытывают беспокойства от мокрого белья, нуждаются в постоянном уходе и надзоре. </p>\r\n<p>Чувствительность всех видов, включая болевую, у них понижена. Они могут никак не реагировать на телесные повреждения. У некоторых больных наблюдаются эпизодические проявления агрессии и аутоагрессии, например, удары себя или окружающих, царапанье и укусы. Часто можно встретить расстройство влечений, проявляющееся в поедании нечистот или постоянном онанизме. </p>\r\n<p>Больные, страдающие идиотией, с трудом могут ходить, зачастую у них нарушено строение внутренних органов. Двигательные реакции примитивны, бедны, слабо координированы. Больные идиотией поздно и с трудом учатся ходить, их движения неуклюжи, в некоторых случаях они передвигаются лишь ползком. Характерны стереотипии — однообразные, стереотипные движения, например, переминание с ноги на ногу, движения из стороны в сторону нижней челюстью, раскачивание туловища взад и вперёд, стереотипное кивание головой. Часто идиотия сочетается с параличами, эпилептиформными припадками, эндокринными нарушениями, отставанием телесного развития, а также различными уродствами и дефектами. </p>\r\n<p>У больных идиотией встречается копрофагия (поедание собственных экскрементов). Также характерно непроизвольное мочеиспускание и дефекация. </p>",
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