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"icd_name": "Психические и поведенческие расстройства, вызванные одновременным употреблением нескольких психоактивных веществ",
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"lead": "Нарушение здоровья, относящееся к группе психические расстройства и расстройства поведения, связанные с употреблением психоактивных веществ",
"description": "Полинаркомания – заболевание, связанное с употреблением двух и более наркотических средств одновременно или в определенной последовательности, при чем ко всем им сформирована зависимость. Сочетанное употребление различных психоактивных веществ изменяет клинику заболевания, влияет на темп формирования основных симптомов и синдромов, приводит к более тяжелым медицинским и социальным последствиям.",
"etiology": "<p>Факторами риска развития полинаркомании являются условия, способствующие повторному применению психоактивных веществ:</p>\r\n<ul>\r\n<li>Социальные – низкий материальный уровень, информационные перегрузки, стрессы, национальные обычаи, окружающая социальная среда, случаи злоупотребления психоактивными веществами в семейном анамнезе и т.д.;</li>\r\n<li>Психологические – низкая социальная адаптированность, психические расстройства (особенно депрессия);</li>\r\n<li>Биологические – наследственная предрасположенность к применению психоактивных веществ, молодой возраст, сопутствующие соматические и неврологические заболевания.</li>\r\n</ul>",
"pathogenesis": "<p>Прием психоактивного вещества вызывает индивидуальные, более или менее выраженные положительные эмоции. Это побуждает к повторному использованию этого вещества (феномен «подкрепления»). Каждый эпизод искусственно вызванного состояния комфорта способствует формированию патологической системы достижения этого состояния. Функция этой системы имеет целью прием очередной (подкрепляющей) порции вещества для достижения психологического и физического комфорта.</p>\r\n<p>Медиаторами патологической системы подкрепления являются дофамин, норадреналин, серотонин, эндогенные опиоиды. Наркотики и другие психоактивные вещества активируют систему подкрепления. Это сопровождается выбросом дополнительных количеств нейромедиаторов из мест их депонирования. Они обеспечивают развитие очередного эпизода эйфории, хорошего настроения, повышения работоспособности. Так формируется устойчивое патологическое влечение к повторному приему психоактивного вещества. Затем, со временем, запасы нейромедиаторов постепенно истощаются в связи с повторным приемом психоактивных веществ, снижается активность системы подкрепления, развивается тягостное чувство психоэмоционального дискомфорта, озлобленности, упадка физических и умственных сил, формируется непреодолимая потребность повторного стимулирования организма приемом психоактивных средств – психической зависимости. Повышается толерантность к психоактивному веществу, в результате для поддержания комфортного состояния пациенту требуется постоянное увеличение дозы вещества. Также происходит адаптация к негативным эффектам психоактивных веществ – нивелируются тошнота, рвота, головная боль и т.д., возникавшие ранее при приеме наркотиков, алкоголя и других веществ.</p>\r\n<p>Развитие стадии физической зависимости связано с накоплением избытка дофамина в ткани мозга в связи с прекращением или существенным снижением содержания психоактивных веществ в организме. Это является ключевым фактором в развитии абстинентного синдрома. В то же время прогрессирует повышение толерантности к психоактивному веществу, больные увеличивают дозу вплоть до токсической.</p>\r\n<p>Финальная стадия наркомании представляет собой комплекс патогенных синдромов:</p>\r\n<ul>\r\n<li>Синдром физической зависимости организма от психоактивного вещества. Представляет собой следствие включения этого вещества и/или его метаболитов в качестве компонентов и регуляторов обмена веществ в нервной ткани и органах;</li>\r\n<li>Синдром сниженной толерантности к психоактивному веществу. Он проявляется тем, что потребление этого вещества становится более редким, но обязательным; доза вещества уменьшается, потребление его уже не сопровождается устранением дискомфорта и развитием эйфории. Оно позволяет лишь избежать абстинентного синдрома или уменьшить тяжесть его течения;</li>\r\n<li>Синдром полиорганной недостаточности;</li>\r\n<li>Синдром деградации личности.</li>\r\n</ul>\r\n<p> </p>\r\n<p> </p>",
"diagnostics": "<p>Постановка диагноза полинаркомании представляет собой непростую задачу, что связано с усложняющейся клинической картиной заболевания, обусловленной сочетанным действием нескольких психоактивных веществ на организм.</p>\r\n<p>Обследование больных полинаркоманией включает в себя осмотр нарколога и психиатра.</p>\r\n<p>По показаниям назначают дополнительные исследования (ЭКГ, ЭхоЭГ, УЗИ внутренних органов и т. д.), консультации терапевта, кардиолога, невролога, гастроэнтеролога и других специалистов.</p>\r\n<p>Для подтверждения приема наркотических или токсических средств при полинаркомании выполняют экспертизу алкогольного опьянения и тест на наркотики. Для оценки регулярности употребления применяют анализ волос на наркотики и определение антител к наркотическим веществам. Важным аргументом в пользу полинаркомании являются особенности абстинентного синдрома, представляющие собой сочетание признаков зависимости от нескольких психоактивных веществ.</p>\r\n<p>Проводятся также:</p>\r\n<ul>\r\n<li>Токсикологическое исследование (в течение 2 дней после употребления большинства препаратов) мочи и крови</li>\r\n<li>Скрининг-тесты психоактивного вещества — неспецифичные, высока вероятность ошибки</li>\r\n<li>Психологическое тестирование. </li>\r\n</ul>",
"treatment": "<p>Лечение полинаркомании осуществляется в стационаре, так как множественная зависимость часто сопровождается грубыми личностными и волевыми нарушениями, отсутствием критики к своему состоянию и повышенной агрессивностью. В ряде случаев больные с полинаркоманией могут представлять опасность для окружающих.</p>\r\n<p>Пациенту, страдающему полинаркоманией, проводят дезинтоксикационную терапию, назначают препараты для восстановления обмена веществ, нормализации психического состояния и улучшения функций различных органов и систем. </p>\r\n<p>Медикаментозное лечение полинаркомании осуществляют на фоне психологической поддержки. С больными полинаркоманией работает психотерапевт, возможны как индивидуальные консультации, так и занятия в группе. Оптимальным вариантом при полинаркомании является длительная реабилитация в специализированном центре с последующим регулярным амбулаторным наблюдением.</p>",
"prevention": "<p>Профилактика включает в себя:</p>\r\n<ul>\r\n<li>Полное воздержание от приёма психоактивного вещества;</li>\r\n<li>Пропаганду здорового образа жизни;</li>\r\n<li>Лечение сопутствующих соматических и психических расстройств с последующей поддерживающей терапией;</li>\r\n<li>Психотерапия. </li>\r\n</ul>",
"clinical_picture": "<p>Наиболее распространены комбинации следующих психоактивных веществ:</p>\r\n<ul>\r\n<li>Алкоголя с седативными средствами, реже с марихуаной и кокаином;</li>\r\n<li>Опиоидов с марихуаной, кокаином, амфетаминами, с алкоголем.</li>\r\n</ul>\r\n<p>Для постановки диагноза зависимости необходимо наличие следующих признаков:</p>\r\n<ul>\r\n<li>Синдром изменённой реактивности организма на действие данного психоактивного вещества (исчезновение защитных реакций, изменение толерантности, формы потребления и формы опьянения);</li>\r\n<li>Синдром психической зависимости (обсессивное (навязчивое) влечение, ощущение психического комфорта при наркотическом опьянении);</li>\r\n<li>Синдром физической зависимости (компульсивное влечение, потеря контроля над дозой, абстинентный синдром, физический комфорт при наркотическом опьянении);</li>\r\n<li>Синдром отмены (абстиненция, абстинентный синдром) — специфический синдром, возникающий в результате прекращения интенсивного употребления психоактивных веществ (характерны толерантность и признаки зависимости). Вещества с более короткой продолжительностью действия вызывают более непродолжительную и более интенсивную абстиненцию, а вещества с более длительным действием вызывают пролонгированную, но менее тяжёлую абстиненцию. </li>\r\n</ul>\r\n<p>В основном заболевание клинически проявляется:</p>\r\n<ul>\r\n<li>обширным поражением внутренних органов и ЦНС;</li>\r\n<li>сильным изменением личности;</li>\r\n<li>агрессивностью и асоциальностью;</li>\r\n<li>психическими расстройствами хронического и затяжного характера;</li>\r\n<li>слабоумием;</li>\r\n<li>снижением интеллектуальных способностей.</li>\r\n</ul>\r\n<p>Также может проявляться индивидуальная симптоматика. Например, галлюцинации, бессонница, головные боли и другие.</p>\r\n<p> </p>",
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"code": "A81",
"name": "Медленные вирусные инфекции центральной нервной системы",
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"pathogenesis": "",
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"image": null,
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"standard_type": 3,
"danger": 1,
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"parent": null,
"block_rubric": 9,
"standards": []
}
]
}
