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"lead": "Нарушение здоровья, относящееся к группе расстройства настроения [аффективные расстройства]",
"description": "Аффективные эмоциональные расстройства включают в себя комплекс психических патологий, характеризующихся преимущественным изменением эмоциональной сферы, а также настроения или в сторону депрессии, или в сторону приподнятости. При этом часто меняется также уровень активности человека.\r\n",
"etiology": "<p>Существует три группы причин аффективных расстройств: </p>\r\n<ol>\r\n<li>Биологические причины, связанные с обменом веществ в головном мозге. </li>\r\n<li>Генетические. О высокой вероятности того, что в основе этой патологии лежат генные мутации, говорит то, что примерно у половины больных биполярным синдромом, хотя бы один родитель страдает расстройством настроения. </li>\r\n<li>Психосоциальные факторы. </li>\r\n</ol>",
"pathogenesis": "<p>Основной гипотезой патогенеза афферентных психозов в настоящее время (в частности ондогенной депрессии) является сератониновая. Согласно серотониновой гипотезе в основе заболевания лежит снижение уровня серотонина в различных отделах мозга, которые функционально связаны с эмоциональностью. При аффективных расстройствах снижается также функциональная активность белков – переносчиков серотонина через мембрану тромбоцита. </p>",
"diagnostics": "<p>Диагностика аффективных расстройств проводится психиатром. Она начинается с тщательного сбора анамнеза. Для углубленного изучения особенностей психической деятельности может быть назначено медико-психологическое обследование. Аффективная симптоматика может наблюдаться на фоне заболеваний: эндокринной системы (адреногенитального синдрома, гипотиреоза, тиреотоксикоза); нервной системы (эпилепсии, рассеянного склероза, опухолей головного мозга); психических расстройств (шизофрении, расстройств личности, деменции).</p>",
"treatment": "<p>При лечении аффективных расстройств используются нормотимики, антипсихотики и антидепрессанты. </p>\r\n<p>Нормотимические препараты обладают антиманиакальными свойствами и способны значительно смягчать выраженность очередной аффективной фазы или предотвращать её наступление. </p>\r\n<p>Антипсихотические препараты используются для купирования маниакальных состояний, состояний с психомоторным возбуждением, а также для лечения маний и депрессий с психотическими признаками (в виде галлюцинаций и бреда). </p>",
"prevention": "<p>Профилактика аффективных расстройств состоит из таких правил: </p>\r\n<ul>\r\n<li>отказ от вредных привычек; </li>\r\n<li>доверительные отношения в семье, особенно между родителями и детьми; </li>\r\n<li>прием лекарств, включающих нейромедиаторы — поможет избежать развития такой проблемы, как сезонное аффективное расстройство, но все медикаменты должны быть выписаны клиницистом; </li>\r\n<li>раннее выявление и комплексное лечение заболеваний, которые могут вызвать коморбидные нарушения; </li>\r\n<li>регулярное прохождение полного профилактического осмотра в медицинском учреждении, в том числе с посещением психиатра — даст возможность на ранних стадиях выявить органическое аффективное расстройство.</li>\r\n</ul>",
"clinical_picture": "<p>Дистимия — хроническое, умеренное нарушение настроения, когда человек жалуется на почти ежедневное плохое настроение на протяжении, по крайней мере, двух лет. Симптомы не такие тяжёлые, как при клинической депрессии, хотя люди с дистимией одновременно подвержены периодическим эпизодам клинической депрессии (иногда называемой «двойной депрессией») </p>\r\n<p>Циклотимия — это более мягкая форма биполярного расстройства, которая проявляется время от времени расстройством настроения и лёгким гипоманиакальным (либо повышенным настроением) периодом, без каких-либо более тяжёлых форм мании или депрессии. Часто характеризуется «симметричным» течением, то есть, правильным либо непрерывным чередованием противоположных эпизодов, либо сдвоенными эпизодами. </p>",
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"code": "F33",
"name": "Рекуррентное депрессивное расстройство",
"icd_name": "Рекуррентное депрессивное расстройство",
"gender": 0,
"age_min": 0,
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3
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"slug": "f33_rekurrentnoe_depressivnoe_rasstroystvo",
"lead": "Нарушение здоровья, относящееся к группе расстройства настроения [аффективные расстройства]",
"description": "Рекуррентное депрессивное расстройство – расстройство, характеризующееся повторными эпизодами депрессий, без анамнестических данных об отдельных эпизодах приподнятого настроения, гиперактивности, которые могли отвечать критериям мании",
"etiology": "<p>К основным факторам, которые могут привести к развитию расстройства, являются генетическая предрасположенность человека, психогенные факторы – депрессии или следствие органических поражений (например, резидуально-органическая неполноценность, перенесенные ранее нейроинфекции, интоксикации, травм головы и т.п.). Первые эпизоды рекуррентного депрессивного расстройства обычно вызваны внешней провокацией (чаще психотравмирующими обстоятельствами), однако в возникновении и развитии повторных фаз преобладают факторы, не связанные с внешними обстоятельствами.</p>",
"pathogenesis": "<p>Причины рекуррентного расстройства лежат в нарушении обмена норадреналина, дофамина, серотонина, посредством которых нервные клетки — нейроны — осуществляют проведение импульсов и передачу информации. Причина этих нарушений не установлена. Получены доказательства генетических причин заболевания, теории повреждений на уровне нейронов с формированием очагов активности по типу эпилепсии, теории нарушения ритмов сна и бодрствования.</p>",
"diagnostics": "<p>Основным методом диагностики депрессии до сих пор остается клинический (психопатологический). Каких-либо достоверных инструментальных методик для диагностики депрессии, обладающих достаточной чувствительностью и специфичностью, в настоящее время не существует. Вспомогательную роль могут играть стандартизированные психометрические шкалы (шкала Гамильтона для оценки депрессий – HDRS, госпитальная шкала депрессий – HADS, шкала Монтгомери-Асберг – MADRS). Однако их применение в основном ограничивается объективизацией и определением степени тяжести состояния в научных исследованиях. Некоторые из шкал вполне пригодны для скрининга на аффективную патологию, но ни в коей мере не могут заменить собой целенаправленный расспрос жалоб и выявление в анамнезе больного эпизодов депрессии, суицидального поведения, хронических соматических заболеваний, стойких нарушений сна, аппетита, длительных болевых синдромов. Заподозрить наличие депрессии зачастую позволяет принадлежность пациента к группе риска по аффективной патологии (отягощенный аффективной патологией и/или суицидами семейный анамнез, сведения о конституциональном складе пациента – расстройства личности аффективного или тревожного круга).</p>",
"treatment": "<p><strong></strong>B лeчeнии дeпpeccии любoгo видa или фopмы вaжнeйшee знaчeниe имeeт пcиxoтepaпeвтичecкoe лeчeниe.</p>\r\n<p>Для лeчeния peкуppeнтнoгo paccтpoйcтвa чaщe вceгo пpимeняют:</p>\r\n<ul>\r\n<li>пoвeдeнчecкую пcиxoтepaпию – c ee пoмoщью бoльнoй учитcя упpaвлять cвoими эмoциями и мыcлями, измeнять cитуaции, cтaвшиe пpичинoй paзвития пpoблeм и учитьcя «пpaвильнoму» пoвeдeнию, пpинocящeму пoлoжитeльныe эмoции и удoвoльcтвиe;</li>\r\n<li>кoгнитивную пcиxoтepaпию – этa мeтoдикa нaпpaвлeнa нa изучeниe мыcлeй и нeгaтивныx уcтaнoвoк, cтaвшиx пpичинoй paзвития пcиxичecкoгo зaбoлeвaния;</li>\r\n<li>ceмeйную пcиxoтepaпию – пoмoгaeт нaлaдить oтнoшeния мeжду члeнaми ceмьи, poдитeлями-дeтьми, cупpугaми и тaк дaлee, тaк кaк дocтaтoчнo чacтo имeннo ceмeйныe пpoблeмы cтaнoвятcя пpичинoй дeпpeccивныx paccтpoйcтв.</li>\r\n</ul>\r\n<p>Taкжe peкуppeнтнoe дeпpeccивнoe paccтpoйcтвo лeчитьcя c пoмoщью дpугиx мeтoдик, пoмoгaющиx пaциeнту избaвлятьcя oт нeгaтивныx эмoций, пoлучaть пoлoжитeльныe и paccлaблятьcя. Пoпуляpнocтью пoльзуютcя apт- и музыкoтepaпия, мeдитaции, йoгa, зaнятия cпopтoм, плaвaньe, пpoгулки, aнимaл-тepaпия.</p>\r\n<p>Пpи cтaциoнapнoм лeчeнии тaкжe иcпoльзуeтcя cвeтoлeчeниe, мeтoд дeпpивaции cнa – кoгдa пaциeнту нe дaют cпaть вcю нoчь или пocтoяннo будят и мeтoд cтимуляции oпpeдeлeнныx нepвныx цeнтpoв.</p>\r\n<p>Meдикaмeнтoзнaя кoppeкция</p>\r\n<p>Пpи cpeднeй и тяжeлoй cтeпeни мeдикaмeнтoзнoe лeчeниe cчитaeтcя oбязaтeльным.</p>\r\n<p>Aнтидeпpeccaнты – пpeпapaты этoй гpуппы пoмoгaют cпpaвитьcя c пpиcтупaми aпaтии, тocки, cнижeниeм нacтpoeния, cуицидaльными мыcлями. Пpинцип дeйcтвия пpeпapaтoв ocнoвaн нa блoкиpoвaнии зaxвaтa нeйpoмeдиaтopo в гoлoвнoм мoзгe, зa cчeт чeгo увeличивaeтcя иx кoнцeнтpaция в кpoви и уcиливaeтcя иx дeйcтвиe нa opгaнизм чeлoвeкa.</p>\r\n<p>Tpaнквилизaтopы и нopмoтимики– oкaзывaют уcпoкoитeльнoe и cтaбилизиpующee нacтpoeниe дeйcтвиe, cнимaют тpeвoгу, paздpaжeниe, aгpeccию. Haчинaют дeйcтвoвaть ужe cпуcтя 1-2 cутoк пocлe пpимeнeния, нo вызывaют пpивыкaниe, coнливocть, зaмeдляют peaкцию и имeют мнoгo пoбoчныx дeйcтвий, пoэтoму дoлжны пpинимaтьcя тoлькo пo нaзнaчeнию вpaчa и тoлькo в peкoмeндуeмыx дoзиpoвкax.</p>\r\n<p>Heйpoлeптики – эти пpeпapaты пpимeняютcя пpи нaличии пcиxoпaтoлoгичecкиx cимптoмoв, тaкиx кaк бpeд или гaллюцинaции или пpи тяжeлoй фopмe дeпpeccии c oткaзoм oт пищи или cуицидaльными пoпыткaми.</p>\r\n<p> </p>",
"prevention": "<p>Специфических методов профилактики рекуррентного депрессивного расстройства не разработано. Важно максимально снизить частоту приступов для этого рекомендуется, регулярно обращаясь к врачу-психиатру, в целях профилактического лечения. Также необходимо уменьшить количество стрессовых ситуаций, которым подвергается больной.</p>",
"clinical_picture": "<p>Основные симптомы</p>\r\n<ul>\r\n<li>депрессивное настроение;</li>\r\n<li>снижение интереса или удовольствия от деятельности, которая ранее была приятна пациенту;</li>\r\n<li>снижение энергии и повышенная утомляемость.</li>\r\n</ul>\r\n<p>Дополнительные симптомы</p>\r\n<ul>\r\n<li>снижение самооценки и чувства уверенности в себе;</li>\r\n<li>беспричинное чувство самоосуждения и чувство вины;</li>\r\n<li>идеи или действия направленные на самоповреждение или суицид;</li>\r\n<li>снижение способности к сосредоточению и вниманию;</li>\r\n<li>мрачное и пессимистическое видение будущего;</li>\r\n<li>нарушение сна;</li>\r\n<li>изменение аппетита.</li>\r\n</ul>",
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