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"code": "F25",
"name": "Шизоаффективные расстройства",
"icd_name": "Шизоаффективные расстройства",
"gender": 0,
"age_min": 10,
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"slug": "f25_shizoaffektivnye_rasstroystva",
"lead": "Нарушение здоровья, относящееся к группе шизофрения, шизотипические состояния и бредовые расстройства",
"description": " \r\n\r\nШизоаффективное расстройство – это биполярное расстройство психики, которое отличает сочетание двух отклонений, а именно аффективного расстройства и шизофрении. ",
"etiology": "<p>В развитии заболевания имеет значение генетический фактор. У пациентов с данной патологией довольно часто можно обнаружить родственников как с шизофренией, так и с биполярным аффективным расстройством; </p>\r\n<p>Среди больных шизоаффективным расстройством преобладают одинокие люди, чьи близкие живут далеко и не оказывают им поддержку; </p>\r\n<p>Нередко присутствует связь между злоупотреблением спиртными напитками, употреблением психоактивных веществ и развитием шизоидных отклонений, что при этом первично, а что вторично — пока изучается. Также существует мнение о близости данного вида расстройств к эпилепсии. </p>\r\n<p>Довольно часто приступы болезни возникают под действием влияния извне, когда удается установить связь между психотравмирующей ситуацией и обострением болезни. </p>",
"pathogenesis": "<p>У таких больных нарушается обмен веществ в головном мозге, что является причиной нарушений. Между клетками мозга теряется старая «правильная» цепочка передачи информации, и сообщения между нейронами происходит совершенно в хаотичном порядке. Это и вызывает всю последующую симптоматику. Запустить болезнь в действие может плохое и негативное социальное окружение, резкие изменения в жизни человека, стрессы, замкнутость от социума на длительное время или же тяжелые вирусные инфекции, которыми переболел человек. <br class=\"SCXW85501203\" /> </p>",
"diagnostics": "<p>Диагноз шизоаффективное расстройство ставится при условии наличия в одном эпизоде: Не менее двух характерных признаков депрессивного эпизода: </p>\r\n<ul>\r\n<li>сниженная способность к вниманию и сосредоточению; </li>\r\n<li>снижение самооценки и уверенности; </li>\r\n<li>навязчивые идеи уничижения и виновности; </li>\r\n<li>пессимизм и мрачность по отношению к своему будущему; </li>\r\n<li>нарушения сна и аппетита; </li>\r\n<li>самоповреждение и попытки суицида </li>\r\n</ul>\r\n<p>Не менее одного-двух типичных признаков шизофрении: </p>\r\n<ul>\r\n<li>вкладывание или отнятие мыслей, их трансляция или вещание (эхо мыслей); </li>\r\n<li>бред влияния, воздействия, восприятия или пассивности, который относится к действиям, мыслям, телу (в том числе отдельным его частям); </li>\r\n<li>слуховые галлюцинации (комментирующие или осуждающие голоса, обсуждающие или осуждающие его поведение), другие виды галлюцинаций, например, «разговаривающие» части тела; </li>\r\n<li>стойкие бредовые идеи, которые не характерны для данной культуры, религиозной принадлежности и имеют невозможный и неадекватный характер. Отождествление себя с историческими, политическими или религиозными деятелями, наличие сверхспособностей (общение с инопланетянами, управление погодой). </li>\r\n</ul>",
"treatment": "<p>Для лечения шизоаффективного расстройства назначают следующие лекарственные препараты. </p>\r\n<p>Успокоительные средства </p>\r\n<p>Нейролептики назначаются, чтобы подавить психотические симптомы, такие как бред, галлюцинации и паранойя. К нейролептикам относятся такие препараты как клозапин, рисперидон и оланзапин. </p>\r\n<p>Стабилизаторы настроения </p>\r\n<p>Стабилизаторы настроения назначаются при шизоаффективном расстройстве биполярного типа. Они помогают держать под контролем аффективную сторону заболевания, смягчая периоды мании и депрессии, характерные для биполярного расстройства. Наиболее распространёными стабилизаторами настроения являются препараты лития. </p>\r\n<p>Антидепрессанты </p>\r\n<p>При шизоаффективном расстройстве депрессивного типа назначаются антидепрессанты. Они помогают побороть чувство безнадёжности, печали, нормализуют сон и улучшают концентрацию внимания. Наиболее часто назначаются циталопрам, флуоксетин и эсциталопрам. </p>\r\n<p>Из немедикаментозной терапии часто применяются следующие методы </p>\r\n<p>Психотерапия </p>\r\n<p>Выстраивание доверительных отношений с врачом в ходе психотерапии помогает пациенту лучше понять свою болезнь и с большей уверенностью смотреть в будущее. Сеансы психотерапии учат пациента ставить реальные жизненные цели, решать проблемы и выстраивать взаимоотношения. Пациент может быть обучен новым поведенческим стратегиям, которые будут способствовать более эффективному общению дома и на работе. </p>\r\n<p>Семейная или групповая терапия </p>\r\n<p>Лечение может быть более эффективным, если люди, страдающие шизоаффективным расстройством, будут иметь возможность обсудить свою жизнь и проблемы с людьми, страдающими таким же заболеванием. Появление группы поддержки также может уменьшить социальную изоляцию больных и обеспечить постоянный контроль за ними. </p>\r\n<p> </p>",
"prevention": "<p>Специфических методов профилактики нет, так как это заболевание не имеет чёткой этиологии. Снизить риск его развития можно, если вести правильный образ жизни не только в физиологическом, но и психологическом понимании. При первых же проявлениях вышеописанной клинической картины следует обращаться за консультацией к психиатру. </p>",
"clinical_picture": "<p>В большинстве случаев шизоаффективному приступу предшествует психическая травма. </p>\r\n<p>Для общей клинической картины патологии характерно наличие признаков, общих для аффективного расстройства и шизофрении. Эти симптомы включают: </p>\r\n<ul>\r\n<li>повышенную возбудимость, которая на фоне агрессивности приводит к нервному срыву; </li>\r\n<li>нарушения сна - повышенная сонливость или бессонница; </li>\r\n<li>пониженный уровень аппетита; </li>\r\n<li>быструю утомляемость и физическую усталость, даже при незначительных нагрузках; </li>\r\n<li>потерю интереса к происходящему вокруг и к интересовавшим ранее занятиям; </li>\r\n<li>развитие комплекса вины, неполноценности, которые с течением времени переходят в чувство глубокой безнадежности; мысли о смерти; </li>\r\n<li>затуманенность умственной деятельности, интеллекта; </li>\r\n<li>невозможность сконцентрироваться на каком-либо процессе; </li>\r\n<li>стремление к определенному виду деятельности, обычно – сексуального характера; </li>\r\n<li>изменение темпа речи в сторону ускорения при определенных обстоятельствах; </li>\r\n<li>в период обострений – опасное поведение в социуме; </li>\r\n<li>устойчивую тенденцию к снижению мыслительного труда, интеллекта, проявляющуюся по типу классического слабоумия; </li>\r\n<li>бредовые идеи и высказывания; </li>\r\n<li>слуховые галлюцинации, возникновение которых связано с повышенными эмоциональными переживаниями или переутомлением; </li>\r\n<li>периодическое странное, нелогичное, некорректное поведение, сопровождающееся монотонным бредом; </li>\r\n<li>нелогичные эмоции– смех на похоронах. </li>\r\n</ul>",
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},
"code": "J47",
"name": "Бронхоэктазия",
"icd_name": "Бронхоэктазия",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 4,
"slug": "j47_bronhoektaziya",
"lead": "Нарушение здоровья, относящееся к группе хронические болезни нижних дыхательных путей",
"description": "Бронхоэктатическая болезнь – заболевание, характеризующееся необратимыми изменениями (расширением, деформацией) бронхов, сопровождающимися функциональной неполноценностью и развитием хронического гнойно-воспалительного процесса в бронхиальном дереве.",
"etiology": "<p>Причиной первичных бронхоэктазов служат: </p>\r\n<ul>\r\n<li>недоразвитие (дисплазия) бронхиальной стенки, при этом один или несколько слоев стенки развиты недостаточно; </li>\r\n<li>иммунодефициты, способствующие частым инфекционным заболеваниям; </li>\r\n<li>пороки развития бронхолегочной системы; </li>\r\n<li>нарушение баланса в ферментативной системе, функцией которой является адекватная выработка бронхиальной слизи. </li>\r\n</ul>\r\n<p>Заболевания, приводящие к развитию бронхоэктазов, перечислены ниже. </p>\r\n<ul>\r\n<li>Муковисцидоз. При этой патологии секреция желез бронхов нарушена, вследствие чего слизь меняет свои свойства, становясь густой. Она застаивается в бронхах и быстро инфицируется. Генетически неполноценная стенка бронха повреждается, ослабевает и растягивается, образуя бронхоэктазы. </li>\r\n<li>Синдром «неподвижных ресничек». Этот синдром включает в себя целую группу генетически обусловленных заболеваний, при которых нарушается секреция и выведение бронхиальной слизи, что создает предпосылки к развитию бронхоэктатической болезни. </li>\r\n<li>Первичные и вторичные иммунодефициты. </li>\r\n<li>Частые вирусные и бактериальные инфекции дыхательных путей – бронхиты, особенно обструктивные, пневмонии, детские инфекции (коклюш, корь), туберкулез. </li>\r\n<li>Хронические инфекции верхних дыхательных путей – тонзиллиты, синуситы, фарингиты, аденоиды у детей. </li>\r\n<li>Бронхогенный рак, сдавление бронхов увеличенными лимфатическими узлами извне, инородное тело бронхов и другие заболевания, вызывающие закупорку (обтурацию просвета бронха). </li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p>Хроническое воспаление бронхиального дерева вызывает изменения в слизистом и мышечном слоях бронхов, а также в околобронхиальной ткани. Становясь податливыми, пораженные стенки бронхов расширяются. Замещение соединительной тканью легочной ткани после перенесенных бронхитов, пневмоний, туберкулеза или абсцесса легкого приводят сморщиванию легочной ткани и растяжению, деформации бронхиальных стенок. Деструктивные процессы также поражают нервные окончания, артериолы и капилляры, питающие бронхи. </p>\r\n<p>С присоединением инфекции и развитием воспалительного процесса бронхоэктазы заполняются гнойной мокротой, поддерживающей хроническое воспаление в видоизмененных бронхах. Так развивается бронхоэктатическая болезнь. </p>\r\n<p>Поддержанию гнойного воспаления в бронхах способствует бронхиальная обструкция, затруднение самоочищения бронхиального дерева, снижение защитных механизмов бронхолегочной системы, хронические гнойные процессы в носоглотке. </p>",
"diagnostics": "<p>В общем анализе крови в период ремиссии заболевания изменения отсутствуют. В период обострения отмечается небольшой лейкоцитоз (повышение количества лейкоцитов). </p>\r\n<p>При анализе мокроты лаборант определит активность воспалительного процесса, о котором свидетельствуют большое количество мокроты, повышенное содержание лейкоцитов и нейтрофилов, наличие одного или нескольких видов бактерий. </p>\r\n<p>На ЭКГ в случае развития у больного хронического легочного сердца будут присутствовать признаки гипертрофии правого желудочка. </p>\r\n<p>На рентгенограмме органов грудной клетки у части больных определяется ячеистый рисунок в области нижних долей легких, однако в большинстве случаев бронхоэктатической болезни это исследование не информативно. </p>\r\n<p>Компьютерная томография органов грудной клетки имеет гораздо большее значение в диагностике, нежели рентгенография. </p>\r\n<p>Бронхография – это основной метод диагностики данной патологии. Контрастированием в области поражения определяются разнообразной формы расширения бронхов. Обычно эти изменения локализованы на уровне бронхов 4–6-го порядка. Нередко ниже области расширения контраст не распространяется (это явление носит название симптом «обрубленного дерева»). </p>",
"treatment": "<p>Питание пациентов с бронхоэктатической болезнью должно быть полноценным, обогащенным белком и витаминами. В рацион дополнительно включаются мясо, рыба, творог, овощи, соки, фрукты. Вне обострений бронхоэктатической болезни показаны занятия дыхательной гимнастикой, прием отхаркивающих трав, санаторно-курортная реабилитация. </p>\r\n<p>В периоды обострений бронхоэктатической болезни основные лечебные мероприятия направлены на санацию бронхов и подавление гнойно-воспалительного процесса в бронхиальном дереве. </p>\r\n<p>Часто при бронхоэктатической болезни прибегают к проведению бронхоальвеолярного лаважа (промывания бронхов) и отсасыванию гнойного секрета с помощью бронхоскопа. Лечебная бронхоскопия позволяет не только промыть бронхи и удалить гнойный секрет, но и ввести в бронхиальное дерево антибиотики, муколитики, бронхолитики, применить ультразвуковую санацию. </p>\r\n<p>При отсутствии противопоказаний (легочного сердца, двусторонних бронхоэктазов и др.) показано хирургическое лечение бронхоэктатической болезни - удаление измененной доли легкого (лобэктомия). Иногда оперативное лечение бронхоэктатической болезни проводится по жизненным показаниям (в случае тяжелого, непрекращающегося кровотечения). </p>",
"prevention": "<p>Первичная профилактика этой патологии заключается в предотвращении или своевременной полноценной терапии острых заболеваний бронхолегочного дерева – бронхитов, бронхиолитов и пневмоний, а также в предупреждении хронизации этих процессов. </p>\r\n<p>Целью вторичной профилактики является сведение к минимуму частоты обострений бронхоэктатической болезни и снижение риска развития осложнений. Этого удается достичь путем своевременной санации бронхиального дерева и адекватной, комплексной терапии развивающихся обострений до полного исчезновения симптомов воспаления. </p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>В период ремиссии (благополучный период, без проявлений заболевания или с небольшими симптомами) пациента может беспокоить кашель с выделением небольшого количества слизисто-гнойной мокроты, или симптомы полностью отсутствуют. </p>\r\n<p>Обострение: </p>\r\n<ul>\r\n<li>кашель с большим количеством гнойной мокроты с неприятным запахом. Мокрота лучше отходит по утрам и в определенном положении тела – на противоположном нахождению бронхоэктазов (деформация, расширение бронхов) боку; </li>\r\n<li>симптомы интоксикации – повышение температуры тела, слабость, повышенное потоотделение, головная боль, снижение аппетита и работоспособности; </li>\r\n<li>одышка; </li>\r\n<li>возможно кровохарканье (из-за разрыва капилляров легочной сосудистой сети); </li>\r\n<li>боль в грудной клетке. </li>\r\n</ul>\r\n<p>При длительном течении: </p>\r\n<ul>\r\n<li>синюшность пальцев, губ, кончика носа (из-за развития сердечно-легочной недостаточности); </li>\r\n<li>изменение формы пальцев — утолщение вследствие костных разрастаний, выпуклость ногтевой пластины. </li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 104,
"standards": [
4815
]
},
{
"id": 6313,
"symptoms": [
{
"id": 87,
"synonyms": [
{
"name": "деперсонализация"
},
{
"name": "потеря ощущения реальности"
},
{
"name": "потеря связи с реальностью"
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