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"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Агорафобия – это фобия, проявляющаяся в виде боязни открытых пространств, больших скоплений людей, перехода широких улиц и площадей, пребывания в местах, которые невозможно покинуть быстро и незаметно для окружающих и т. д.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Развитие агорафобии обусловлено сочетанием нескольких физических и психологических факторов, значимость которых может существенно различаться. Обычно в основе лежит низкий уровень базовой безопасности (ощущения уровня безопасности мира, которое закладывается в детстве и оказывает влияние на всю последующую жизнь человека). По каким-то причинам в детском возрасте у пациентов сформировался устойчивый образ себя, как уязвимого, беззащитного, беспомощного, неспособного справиться с обстоятельствами, и образ мира, как заведомо опасного, угрожающего пространства, не прощающего слабостей и промахов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наряду с особенностями воспитания имеют значение особенности характера больных. Агорафобия чаще развивается у чувствительных, впечатлительных, тревожных пациентов, склонных скрывать свои переживания, «копить в себе» негативные эмоции. Иногда агорафобия возникает после острых травмирующих событий: тяжелой болезни, физического или сексуального насилия, смерти близкого человека, стихийного бедствия, потери работы или пребывания на территории военных действий.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">По данным исследований, у некоторых больных агорафобией нарушена связь вестибулярного аппарата с проприоцептивной и визуальной системами восприятия. Обычно люди без труда поддерживают равновесие, ориентируясь на три вида сигналов: проприоцептивные, тактильные и визуальные. Если равновесие поддерживается только или преимущественно за счет визуальных и тактильных сигналов, возможна дезориентация при пребывании в движущейся толпе, попадании на наклонные поверхности и большие открытые пространства с минимумом ориентиров.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Отмечается связь агорафобии с наследственно обусловленным изменением уровня некоторых гормонов в головном мозге. У больных с агорафобией часто наблюдается вегето-сосудистая дистония и нейроциркуляторная дистония. Специалисты также отмечают, что при наличии соответствующего преморбидного фона агорафобия может развиться в результате злоупотребления спиртными напитками, стимуляторами (в том числе – кофеином), бензодиазепинами и наркотическими препаратами.</span></p>",
"pathogenesis": "",
"diagnostics": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагноз ставит врач-психиатр, который анализирует все жалобы, оценивает все ситуации, которые описывает пациент. Также дополнительно проводятся тесты на тревожность и уровень депрессии. Если необходимо исключение определенных болезней – проводятся консультации врачей по профилю.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наиболее эффективный способ лечения – когнитивно-поведенческая терапия. Это метод психотерапии, при котором врач с пациентом совместно определяют те убеждения и тревожные мысли, которые возникают при посещении определенных мест. Затем пациента погружают в пугающие его ситуации под контролем врача и затем уже самостоятельно. Формируется постепенная устойчивость к фобическим ситуациям, уровень тревоги снижется. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если выявлена депрессия, панические атака или другие проблемы психики, лечение дополняют медикаменты – транквилизаторы и антидепрессанты. Принимают их строго в подобранной врачом дозе и только по указанной им схеме. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если выявлены психотравмы и конфликты личности, понадобится психотерапия в разных ее формах – психоанализ, гештальт-терапия, психодрама и т.д. Это не избавит от агорафобии полностью, но поменяет отношение к себе, устранит страхи, приступы паники.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возможны методы профилактики, направленные на устранение провоцирующих факторов – стрессов, перегрузок эмоционального и физического плана. Это здоровый образ жизни, максимально разнообразное и натуральное питание, отказ от избытка алкоголя и курения, режим дня.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основным критерием таких расстройств являются интенсивные внезапно возникающие приступы тревожности и острого страха, продолжающиеся около 10-30 минут. Приступ панической атаки начинается исподволь и без видимого повода. Она может включать минимум четыре из следующих симптомов:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">учащенное сердцебиение;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">потливость;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ощущение головокружения и слабости, неустойчивости, легкости в голове или предобморочное состояние;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">болезненные ощущения или дискомфорт в грудной клетке и области сердца;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">озноб, чувство внутренней дрожи, дрожь или покачивание;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ощущение нехватки воздуха, затруднения дыхания, удушья;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">поверхностное дыхание или одышка;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">тошнота или дискомфорт в желудке и кишечнике;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">деперсонализация (необычность, расстройство самовосприятия, смосознания) и дереализация (необычность восприятия окружающего мира, переживание чувства его нереальности и странности, непохожести на то, что он являл обычно);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ощущения онемения или покалывания (парестезии);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">резкое покраснение или побледнение, волны жара и холода; страх смерти;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">страх сойти с ума или сделать нечто неправильное;</span></li>\r\n</ul>\r\n<p> </p>",
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"code": "F39",
"name": "Расстройство настроения [аффективное] неуточненное",
"icd_name": "Расстройство настроения [аффективное] неуточненное",
"gender": 0,
"age_min": 0,
"age_max": 89,
"cause": [
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"periodicity": 1,
"slug": "f39_rasstroystvo_nastroeniya_affektivnoe_neutochnennoe",
"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. ",
"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>\r\n<p> </p>",
"diagnostics": "<p> </p>\r\n<p> </p>\r\n<p>Диагностика аффективных расстройств проводится психиатром. Она начинается с тщательного сбора анамнеза.</p>\r\n<p>Для углубленного изучения особенностей психической деятельности может быть назначено медико-психологическое обследование.</p>\r\n<p>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>Основные симптомы депрессивного синдрома: </p>\r\n<ul>\r\n<li>отсутствие интереса к окружающему миру; </li>\r\n<li>состояние длительной печали или тоски; </li>\r\n<li>пассивность, апатия; </li>\r\n<li>нарушения концентрации внимания; </li>\r\n<li>ощущение собственной никчемности; </li>\r\n<li>нарушения сна;</li>\r\n<li>снижение аппетита; </li>\r\n<li>ухудшение трудоспособности; </li>\r\n<li>периодически возникающие мысли о суициде; </li>\r\n<li>ухудшение общего состояния здоровья, не находящее объяснения при обследовании. </li>\r\n</ul>\r\n<p>Для биполярного расстройства характерны: </p>\r\n<ul>\r\n<li>чередование фаз депрессии и мании; </li>\r\n<li>подавленность настроения во время депрессивной фазы; </li>\r\n<li>во время маниакального периода – безрассудность, раздражительность, агрессия, галлюцинации и (или) бред. </li>\r\n</ul>\r\n<p>Тревожное расстройство имеет следующие проявления: </p>\r\n<ul>\r\n<li>тяжелые, навязчивые мысли; </li>\r\n<li>нарушения сна; </li>\r\n<li>снижение аппетита; </li>\r\n<li>постоянное чувство тревоги или страха; </li>\r\n<li>одышка;</li>\r\n<li>тахикардия; </li>\r\n<li>ухудшение концентрации внимания.</li>\r\n</ul>",
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"name": "Устойчивые расстройства настроения [аффективные расстройства]",
"icd_name": "Устойчивые расстройства настроения [аффективные расстройства]",
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"slug": "f34_ustoychivye_rasstroystva_nastroeniya_affektivnye_rasstroystva",
"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": "F34.1",
"name": "Дистимия",
"icd_name": "Дистимия",
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"lead": "расстройство настроения, в основе которого лежат те же когнитивные и физические проблемы, характерные депрессии, но с менее серьёзными и более длительными симптомами",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дистимическое расстройство нередко возникает в детском или подростковом возрасте и более распространено среди женщин. Точные причины возникновения устойчивых депрессивных расстройств остаются специалистам неизвестны. Есть лишь некоторые предположения:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Считается, что у людей, страдающих дистимией, есть некоторые особенности в строении головного мозга. Этот вопрос не до конца изучен, но исследователи надеются, что работа в данном направлении поможет пролить больше света на причины заболевания и найти новые способы лечения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У людей, страдающих депрессией, нарушена правильная работа нейротрансмиттеров (дефицит серотонина) - веществ, которые передают сигналы в головном мозге человека. В результате повреждаются механизмы, отвечающие за стабилизацию настроения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также, определенную роль играет наследственность. Статистика показывает, что риск хронического депрессивного расстройства повышен у людей, у которых есть родственники с аналогичным заболеванием. Вполне возможно, это обусловлено некоторыми генами, которые еще предстоит открыть;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Провоцируют начало заболевания обычно разные негативные события в жизни пациента, а именно: психотравмирующие события, физические травмы и серьезные заболевания, тяжелые утраты, сильные и хронические стрессы.</span></li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагноз ставится врачом-психотерапевтом после клинико-анамнестического обследования. Оно включает оценку симптомов, порядок их появления, связь с событиями в жизни человека — стрессами, перегрузками, травмами, инфекционными или другими заболеваниями.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для подтверждения диагноза клинический психолог выполняет патопсихологическое исследование. Он дает заключение об особенностях личности пациента и выявляет отклонения когнитивных процессов (мышления, памяти, внимания).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для дифференциальной диагностики проводят инструментальные и лабораторные исследования:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ЭЭГ — с органическим поражением нервной системы;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нейрофизиологическая тест-система и Нейротест с эндогенными заболеваниями (шизофрения, шизотипическое расстройство).</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вначале для улучшения общего тонуса и повышения настроения используются антидепрессанты. Обычно подбираются препараты трициклической группы или ингибиторы обратного захвата серотонина. Эти средства последнего поколения обладают минимальными побочными эффектами и не вызывают привыкания. Важно понимать, что основное действие их начинается спустя 2-3 недели после начала применения. В первые несколько дней состояние пациента может несколько усугубится, и поэтому врач на данный период назначает прикрытие в виде короткого курса транквилизатора. Особо тяжелые формы с нарушением поведения требуют применения нейролептиков.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение дистимии осуществляется преимущественно с помощью следующих видов психотерапии:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">групповая;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">индивидуальная;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">семейная;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">когнитивно-поведенческая;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">интерперсональная.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Посещение группы поддержки позволяет открыто проявлять себя среди таких пациентов, которые хорошо понимают человека с дистимией и депрессией. Излечившиеся от болезни делятся своими историями и поднимают больному уверенность в своих силах. В групповых занятиях появляется возможность восстановления навыков общения. Такая же методика позволяет успешно осуществлять лечение неврастении.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Задача каждого психотерапевта при оказании помощи заключается в формировании у пациента объективного отношения к себе, обучение адекватной реакции в ответ на любые негативные проявления в окружающем мире, и перенаправить негативные мысли в позитивное русло. Если причиной дистимии становятся определенные особенности характера, то специалист помогает изменить их в лучшую сторону. После успешного лечения рекомендуется продолжать совершать действия для повышения самоуважения и самооценки, поменять образ жизни (устранить вредные привычки, отводить достаточное количество времени на полноценный отдых и сон, перейти на здоровое питание).</span></p>",
"prevention": "",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дистимия, симптомы которой схожи с проявлениями рекуррентной депрессии, может начинаться уже в юношеском возрасте. По сравнению с рекуррентным расстройством, ее проявления выражены слабее и растянуты во времени — на два года и более. Если созревание личности происходит под искажающим влиянием дистимии, то такой человек, повзрослев, воспринимает признаки расстройства как часть своей «меланхоличной натуры». И только профессионал может отделить конституционально-личностные особенности человека от симптомов болезни.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ниже приводим основные признаки, которые должны присутствовать не менее, чем два года подряд (в юношеском возрасте — 1 год). Возможны эпизоды улучшения состояния продолжительностью не более нескольких недель.</span></p>\r\n<ul>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">снижение способности концентрировать внимание;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">негативная оценка будущего, настоящего, и прошлого. Как вариант, прошлое может наоборот идеализироваться, и тогда состояние приобретает черты ностальгической депрессии;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">чувство ненужности, безнадежности;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сниженный или, реже, повышенный аппетит;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">бессонница, сонливость днем;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">упадок жизненных сил;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сниженная уверенность в себе, самооценка;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижение полового влечения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">отсутствие удовольствия от того, что раньше доставляло радость.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чем дольше болеет человек, тем хуже становится качество его жизни — присоединяются другие заболевания (зависимость от психоактивных веществ, панические атаки, социофобия), также возможен переход болезни в биполярное аффективное расстройство.</span></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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5158,
5242,
5248
]
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