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"code": "F44",
"name": "Диссоциативные [конверсионные] расстройства",
"icd_name": "Диссоциативные [конверсионные] расстройства",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
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"periodicity": 1,
"slug": "f44_dissociativnye_konversionnye_rasstroystva",
"lead": "Нарушение здоровья, относящееся к группе невротические, связанные со стрессом и соматоформные расстройства",
"description": "Диссоциативные (конверсионные) расстройства – это расстройства, которые выражаются в частичной или полной потере сознательного контроля над памятью и ощущениями, с одной стороны, и над контролированием движений тела с другой. ",
"etiology": "<p>Диссоциативное расстройство формируется у личности на фоне присутствия в прошлом или настоящем нескольких неблагоприятных обстоятельств, в числе которых наиболее весомые: </p>\r\n<ul>\r\n<li>воздействие стрессовых факторов, которые человек оценивает как непереносимые; </li>\r\n<li>травматический опыт в прошлом; </li>\r\n<li>наличие защитного механизма – диссоциации, то есть восприятие события, происходящее лично с индивидом как явления у кого-то постороннего; </li>\r\n<li>способность вытеснять (изолировать) свои воспоминания из сферы сознания. </li>\r\n</ul>\r\n<p>Почва для развития патологии закладывается в детском возрасте: человек не рождается с ощущением цельной идентичности, становление личности проходит в результате многообразных переживаний и разнопланового воздействия. Базой для формирования у личности диссоциативного расстройства является дефицит родительского внимания и заботы в тяжелых для малыша ситуациях, когда он, не владея необходимыми механизмами преодоления проблем, вынужден применять деструктивные формы защиты, вытесняя свои негативные ощущения из сферы сознания. </p>\r\n<p>В качестве главной причины развития аномальных состояний, по мнению многих исследователей, выступает факт физического и психологического насилия, пережитого личностью в детские годы. Также в роли пускового механизма обнаруживаются вытесненные из сознания воспоминания о пережитых стихийных бедствиях, военных конфликтах, смерти близких родственников или затяжной болезни. </p>\r\n<p> </p>",
"pathogenesis": "<p>Механизм возникновения диссоциативного расстройства сложен. Разум человека словно разделяется на составные. Они не забываются, а просто активизируются в определенных обстоятельствах. Доступ становится свободным только к определенным образам, памяти, мыслям, а потом словно оказывается запрещенным при активации других воспоминаний. <br class=\"SCXW253022860\" /> <br class=\"SCXW253022860\" />Все типы диссоциативных расстройств имеют тенденцию к ремиттированию спустя несколько недель или месяцев, особенно, если их возникновение было связано с травматическим жизненным событием. Могут развиваться иногда более постепенно и более хронические расстройства, особенно параличи и анестезии, если начало связано с неразрешимыми проблемами или расстроенными межперсональными взаимосвязями. </p>",
"diagnostics": "<p>Диагноз выставляется на основании беседы с больным, данных объективного осмотра и результатов дополнительных исследований. </p>\r\n<p>Для постановки диагноза необходимы два критерия. </p>\r\n<ol>\r\n<li>подтверждение информации о стрессах или психологических конфликтах, лежащих в основе расстройства. </li>\r\n<li>отсутствие неврологического или соматического заболевания, которое могло бы вызвать выявленные нарушения.</li>\r\n</ol>\r\n<p>Проводятся исследования, исключающие органическое поражение головного мозга: МРТ, КТ. </p>\r\n<p>Кроме того, диагностика включает изучение физиологических параметров: артериального давления, частоты пульса. </p>",
"treatment": "<p>Лечение диссоциативных расстройств должно быть комплексным, включающим психотерапию, фармакотерапию. </p>\r\n<p>Психотерапия направлена на коррекцию когнитивного и поведенческого состояния больного. Специалист проводит при необходимости не только беседы, но и сеансы гипноза, внушения, после которых пациент может вести нормальный образ жизни без тревог и конверсионных нарушений психики. </p>\r\n<p>Фармакотерапия расстройств включает все классы психофармакологических средств — нейролептики, транквилизаторы, антидепрессанты, психостимуляторы, ноотропы, тимолептики. Наиболее широкое применение находят транквилизаторы и антидепрессанты</p>",
"prevention": "<p>Сохранение психического здоровья и предупреждение психических расстройств – гораздо менее понятная задача, чем предупреждение инфекционных болезней, для профилактики которых проводится вакцинация, а для лечения применяются антибиотики; в области психических заболеваний таких мер не существует. <br class=\"SCXW133581643\" /> <br class=\"SCXW133581643\" />Во всем мире наркомания и алкоголизм привели к кризису психического здоровья. В результате формирования зависимости страдает психика десятков миллионов мужчин, женщин и детей. <br class=\"SCXW133581643\" /> <br class=\"SCXW133581643\" />Насилие над детьми – тоже существующий во всем мире феномен. Как фактор возникновения психических заболеваний оно заслуживает намного большего внимания, чем ему сейчас уделяется. В последние годы такое насилие рассматривается как первичная причина синдрома множественной личности. Международные организации, такие, как Всемирная организация здравоохранения, усиленно работают над выявлением и искоренением насилия над детьми, осуществляемого в странах третьего мира под видом детского труда, т.е. постоянного и узаконенного использования детей в промышленности и сельском хозяйстве фактически в качестве рабов. </p>",
"clinical_picture": "<p>К основным признакам заболевания, по которым врач диагностирует расстройство конверсионного типа, относятся: </p>\r\n<ul>\r\n<li>Амнезия — резкая потеря памяти вследствие стресса, травмы, но при этом сохраняется способность усваивать свежую информацию. У больного нормальное сознание и он понимает, что утрачена память. </li>\r\n<li>Фуга. Неожиданный, внезапный уход больного человека из дома, с работы. Страдающий диссоциацией может воспринимать себя другой личностью, откликаться на другое имя, не понимать, что происходит в реальности. </li>\r\n<li>Нарушение идентификации. Человек отождествляет себя с несколькими лицами, которые присутствуют в его сознании. При этом каждое «я» проявляется в свое время и меняет взгляды человека, настроение, отношение к окружающим и к самому себе. Более того, вмещенные в сознание больного личности могут иметь разную половую принадлежность, национальность, имена. Пациенты такого рода не помнят своей истинной природы, а также внутренние «я» не знакомы друг с другом. </li>\r\n<li>Деперсонализация. Происходит отчуждение от собственного тела, человек видит себя как бы во сне, искажается ощущение времени, пространства. Больным кажется несоразмерными руки, ноги, голова или они чувствуют себя роботами, состояние нередко сопровождается тревожностью, депрессией. </li>\r\n<li>Синдром Ганзера. При диссоциации, больной может преднамеренно усиливать свое тяжелое психическое состояние. Чаще всего встречается у мужчин, отбывающих срок заключения — возникает миморечь, то есть неверные ответы, амнезия, нарушение восприятия, дезориентация. </li>\r\n<li>Транс. При конверсионных расстройствах пациент перестает реагировать на внешние факторы. Состояние сопровождает пилотов после длительных перелетов, медиумов, сектантов. Такие признаки наблюдаются у определенных народностей — малайских амоков, эскимосских либлокто. </li>\r\n<li>Кома. При расстройстве возможна потеря сознания, состояние ступора, комы. </li>\r\n</ul>\r\n<p> </p>",
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{
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},
"code": "F42",
"name": "Обсессивно-компульсивное расстройство",
"icd_name": "Обсессивно-компульсивное расстройство",
"gender": 0,
"age_min": 5,
"age_max": 89,
"cause": [
3
],
"periodicity": 1,
"slug": "f42_obsessivno-kompulsivnoe_rasstroystvo",
"lead": "Нарушение здоровья, относящееся к группе невротические, связанные со стрессом и соматоформные расстройства",
"description": " Обсессивно-компульсивное расстройство – это группа психологических заболеваний, характеризующаяся возникновением навязчивых мыслей (обсессий), с которыми человек пытается бороться с помощью таких же навязчивых действий (компульсий). ",
"etiology": "<p>Этиология ОКР не выяснена, на этот счет существует несколько гипотез. Причины могут быть биологическими, психологического или социально-общественного характера. </p>\r\n<p>Биологические причины: </p>\r\n<ul>\r\n<li>родовые травмы; </li>\r\n<li>патологии вегетативной нервной системы; </li>\r\n<li>особенности передачи сигнала в мозг; </li>\r\n<li>нарушение метаболизма с изменением обмена веществ, необходимых для нормальной работы нейронов (снижение уровня серотонина, повышение концентрации дофамина); </li>\r\n<li>черепно-мозговые травмы в анамнезе; </li>\r\n<li>органическое поражение мозга (после менингита); </li>\r\n<li>хронический алкоголизм и наркотическая зависимость; </li>\r\n<li>наследственная предрасположенность; </li>\r\n<li>осложненные инфекционные процессы. </li>\r\n</ul>\r\n<p>Социально-общественные и психологические факторы: </p>\r\n<ul>\r\n<li>детская психологическая травма; </li>\r\n<li>психологическая семейная травма; </li>\r\n<li>строгое религиозное воспитание; </li>\r\n<li>чрезмерная опека родителей; </li>\r\n<li>профессиональная деятельность в условиях стресса; </li>\r\n<li>потрясение, связанное с угрозой для жизни. </li>\r\n</ul>",
"pathogenesis": "<p>На сегодняшний день наиболее распространена и признана нейротрансмиттерная теория. Суть этой теории состоит в том, что имеется связь обсессивно-компульсивного расстройства с нарушениями коммуникации между определенными областями коры головного мозга и базальными ганглиями. </p>\r\n<p>Обозначенные структуры взаимодействуют посредством серотонина. Так, ученые считают, что при ОКР наблюдается недостаточный уровень серотонина ввиду усиленного обратного захвата (нейронами), что препятствует передаче импульса следующему нейрону.[7][8] В целом же необходимо сказать, что патогенез данного расстройства достаточно сложен и до конца не изучен. </p>\r\n<p> </p>",
"diagnostics": "<p>Для точного диагноза, обсессивные симптомы или компульсивные действия, либо и те и другие должны иметь место наибольшее количество дней за период по крайней мере 2 недели подряд и быть источником дистресса и нарушения активности. Обсессивные симптомы должны иметь следующие характеристики: </p>\r\n<ul>\r\n<li>они должны быть расценены как собственные мысли или импульсы больного; </li>\r\n<li>должны быть по крайней мере одна мысль или действие, которым больной безуспешно сопротивляется, даже если наличествуют другие, которым больной более не сопротивляется; </li>\r\n<li>мысль о выполнении действия не должна быть сама по себе приятна (простое уменьшение напряженности или тревоги не считается в этом смысле приятным); </li>\r\n<li>мысли, образы или импульсы должны быть неприятно повторяющимися. </li>\r\n</ul>\r\n<p>Хотя обсессивные мысли и компульсивные действия обычно сосуществуют, целесообразно устанавливать один из этих типов симптоматики в качестве доминирующего у некоторых больных, поскольку они могут реагировать на разные виды терапии. </p>\r\n<p> </p>",
"treatment": "<p>Терапия навязчивых состояний включает медикаментозное лечение и психотерапию в качестве обязательных элементов </p>\r\n<p>Психотерапия </p>\r\n<p>Она предполагает использование таких лечебных методик, как: </p>\r\n<p>Когнитивно-поведенческая коррекция, которую разработал американский психиатр Д. Шварц. Методика дает больному возможность противостоять влиянию расстройства, изменяя порядок ритуальных действия, упрощая их, чтобы постепенно свести к минимуму. В основе метода — осознанное отношение человека к своей психической проблеме и поэтапное сопротивление её признакам. </p>\r\n<p>«4 шага» — другая методика, разработанная тем же специалистом в области психиатрии. Ее действие основано на том, что врач объясняет больному: </p>\r\n<ul>\r\n<li>какие из его опасений оправданы, а какие спровоцированы воздействием ОКР, а потому не имеют смысла; </li>\r\n<li>как, попав в ту или иную ситуацию, действовал бы здоровый человек; </li>\r\n<li>каким образом можно пресекать навязчивые мысли. </li>\r\n</ul>\r\n<p>Экспозиция и предупреждение — одна из самых эффективных форм коррекции поведения у страдающих ОКР. При этом экспозиция заключается в погружение больного в условия, провоцирующие дискомфорт в связи с обсессиями. Врач инструктирует, как оказывать сопротивление позывам выполнить компульсивные действия, формируя предупреждение патологической ответной реакции. По данным статистики подавляющее большинство прошедших такое лечение добиваются стойкого улучшения состояния.Эффект от психотерапии может длиться много месяцев. </p>\r\n<p>В лечении ОКР применяются и другие разновидности психокоррекции: </p>\r\n<ul>\r\n<li>групповая и семейная;</li>\r\n<li>рациональная и аверсивная;</li>\r\n<li>иные виды. </li>\r\n</ul>\r\n<p>Медикаментозная терапия психотропными препаратами </p>\r\n<p>Максимальную эффективность при ОКР показали антидепрессанты. При нарастании тревожности на первых этапах лечения их дополняют транквилизаторами. При хронических случая ОКР, когда антидепрессанты из ряда ингибиторов обратного захвата серотонина оказываются неэффективными, все больше назначают атипичные антипсихотические препараты. </p>\r\n<p> </p>",
"prevention": "<p> Первичная психопрофилактика: </p>\r\n<ul>\r\n<li>Предотвращение психотравмирующих влияний на работе и в быту. </li>\r\n<li>Предотвращение ятрогений и дидактогений (правильное воспитание ребёнка, например, не прививать ему мнения о его неполноценности или превосходстве, не порождать чувство глубокого страха и вины при совершении «грязных» поступков, здоровые отношения между родителями). </li>\r\n<li>Предотвращение семейных конфликтов. </li>\r\n</ul>\r\n<p>Вторичная психопрофилактика (предотвращение рецидивов): </p>\r\n<ul>\r\n<li>Изменение отношения больных к психотравмирующим ситуациям путём бесед (лечение убеждением), самовнушения и внушения; своевременное лечение при их выявлении. Проведение регулярной диспансеризации. </li>\r\n<li>Способствование увеличению яркости в помещении — убрать плотные шторы, использовать яркое освещение, максимально использовать светлое время суток, светолечение. Свет способствует вырабатыванию серотонина. </li>\r\n<li>Общеукрепляющая и витаминотерапия, достаточный сон. </li>\r\n<li>Диетотерапия (полноценное питание, отказ от кофе и алкогольных напитков, включить в меню продукты питания с повышенным содержанием триптофана (аминокислоты, из которой образуется серотонин): финики, бананы, сливы, инжир, томаты, молоко, сою, чёрный шоколад). </li>\r\n<li>Своевременное и адекватное лечение других заболеваний: эндокринных, сердечно-сосудистых, особенно атеросклероза сосудов мозга, злокачественных новообразований, железо- и витамин B12-дефицитной анемии. </li>\r\n<li>Обязательно избегать возникновения пьянства и тем более алкоголизма, наркомании и токсикомании. Употребление алкогольных напитковнерегулярно в малых количествах действует седативно, поэтому не может спровоцировать рецидив. Влияние употребления «лёгких наркотиков» типа марихуаны на рецидив ОКР не исследовалось, поэтому их также лучше избегать. </li>\r\n</ul>\r\n<p>Всё вышесказанное относилось к индивидуальной психопрофилактике. Но необходимо на уровне учреждений и государства в целом проводить социальную психопрофилактику — оздоровление труда и бытовых условий, службы в вооружённых силах. </p>",
"clinical_picture": "<p>Больные ОКР — мнительные люди, склонные к редким максимально-решительным действиям, что сразу заметно на фоне их доминирующего спокойствия. Основными признаками являются тягостные стереотипные, навязчивые (обсессивные) мысли, образы или влечения, воспринимающиеся как бессмысленные, которые в стереотипной форме вновь и вновь приходят на ум больному и вызывают безуспешную попытку сопротивления. К их характерным темам относятся: </p>\r\n<ul>\r\n<li>страх заражения или загрязнения; </li>\r\n<li>страх причинения вреда себе или другим; </li>\r\n<li>сексуально откровенные или жестокие мысли и образы; </li>\r\n<li>религиозные или нравственные идеи; </li>\r\n<li>страх потерять или не иметь какие-то вещи, которые могут понадобиться; </li>\r\n<li>порядок и симметрия: идея, что всё должно быть выстроено «правильно»; </li>\r\n<li>суеверия, чрезмерное внимание к чему-то, что рассматривается как везение или невезение. </li>\r\n</ul>\r\n<p>Компульсивные действия или ритуалы представляют собой повторяющиеся вновь и вновь стереотипные поступки, смысл которых заключается в предотвращении каких-либо объективно маловероятных событий. Обсессии и компульсии чаще переживаются как чужеродные, абсурдные и иррациональные. Пациент страдает от них и им сопротивляется. </p>\r\n<p>Следующие симптомы являются показателями обсессивно-компульсивного расстройства: </p>\r\n<ul>\r\n<li>навязчивые, всё время повторяющиеся мысли; </li>\r\n<li>тревога, следующая этим мыслям; </li>\r\n<li>определённые и, с целью устранения тревоги, часто повторяемые одинаковые действия. </li>\r\n</ul>\r\n<p>Классическим примером этой болезни считается страх загрязнения, при котором у больного каждое соприкосновение с грязными, по его мнению, предметами вызывает дискомфорт и, как следствие, навязчивые мысли. Чтобы избавиться от этих мыслей, он начинает мыть руки. Но даже если ему в какой-то момент кажется, что он достаточно вымыл руки, любое соприкосновение с «грязным» предметом заставляет его начать свой ритуал заново. Эти ритуалы позволяют пациенту достичь временного облегчения состояния. Несмотря на то, что больной осознаёт бессмысленность этих действий, бороться с ними он не в состоянии. </p>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
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}
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