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"code": "F42",
"name": "Обсессивно-компульсивное расстройство",
"icd_name": "Обсессивно-компульсивное расстройство",
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"age_min": 5,
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3
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"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>",
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"code": "F42",
"name": "Обсессивно-компульсивное расстройство",
"icd_name": "Обсессивно-компульсивное расстройство",
"gender": 0,
"age_min": 5,
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3
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"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>",
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